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Anwar M, Faisal A, Jawed K, Yousuf A, Shaikh I. Association Between Maternal Literacy and Child Immunization According to the Expanded Program on Immunization Schedule in a Primary Health Care Center of a Squatter Settlement in Karachi. Cureus 2023; 15:e43608. [PMID: 37719540 PMCID: PMC10503871 DOI: 10.7759/cureus.43608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 09/19/2023] Open
Abstract
Background An increase in maternal education may influence vaccine administration to a significant extent, therefore reducing the childhood mortality rate. Hence, this survey aims to establish an association between maternal literacy and childhood immunization in children under five years of age. Methods A questionnaire-based cross-sectional study was conducted in a primary healthcare center of a squatter settlement in Karachi, Pakistan. Mothers of 250 children under the age of five years were interviewed. We used IBM SPSS Statistics for Windows, version 20 (released 2011; IBM Corp., Armonk, New York, United States) for data analysis to assess the relationship between maternal education and childhood immunization. Results The survey revealed that complete vaccination coverage among children under five years of age (n=250) was 71.7%, while 24.6% were partially vaccinated and 2% were unvaccinated. The most common reason for unvaccinated children was the parents' personal choice (80%), while incomplete vaccination was majorly due to a medical condition (30.2%). Conclusion According to the survey, maternal educational qualification did not prove to be directly associated with vaccination coverage in children. However, a multi-centered study with larger sample size and multiple populations as targets would provide more accurate outcomes.
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Affiliation(s)
- Maryum Anwar
- College of Medicine, Ziauddin University, Karachi, PAK
| | | | - Kainat Jawed
- College of Medicine, Ziauddin University, Karachi, PAK
| | - Aamna Yousuf
- College of Medicine, Ziauddin University, Karachi, PAK
| | - Imran Shaikh
- Community Health Sciences, Ziauddin University, Karachi, PAK
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Sultana N, Hossain A, Das H, Pallikadavath S, Koeryaman M, Rahman M, Chowdhury AH, Bhuiya A, Mahmood SS, Hanifi SMA. Is the maternal health voucher scheme associated with increasing routine immunization coverage? Experience from Bangladesh. Front Public Health 2023; 11:963162. [PMID: 36817885 PMCID: PMC9937056 DOI: 10.3389/fpubh.2023.963162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 01/05/2023] [Indexed: 02/05/2023] Open
Abstract
Bangladesh initiated the Maternal Health Voucher Scheme (MHVS) in 2007 to improve maternal and child health practices and bring equity to the mainstream of health systems by reducing financial and institutional barriers. In this study, we investigated whether the MHVS has an association with immunization coverage in a rural area of Bangladesh. Between 30 October 2016 and 15 June 2017, we carried out a cross-sectional survey in two low performing areas in terms of immunization coverage- Chattogram (erstwhile Chittagong division) and Sylhet division of Bangladesh. We calculated the coverage of fully immunized children (FIC) for 1151 children aged 12-23 months of age. We compared the coverage of FIC between children whose mothers enrolled in MHVS and children whose mother did not. We analyzed immunization coverage using crude odds ratio (OR) and adjusted OR (aOR) from binary logistic regression models. The overall coverage of FIC was 86%. Ninety-three percent children whose mothers were MHVS members were fully immunized whereas the percentage was 84% for the children of mothers who were not enrolled in MHVS. Multivariate analysis also shows that FIC coverage was higher for children whose mothers enrolled in MHVS compared to those children whose mothers did not; the aOR was 2.03 (95% confidence interval 1.11-3.71). MHVS provides a window for non-targeted benefits of childhood vaccination. Providing health education to pregnant mothers during prenatal care may motivate them to immunize their children. Programmes targeted for mothers during pregnancy, childbirth and post-natal may further increase utilization of priority health services such as childhood immunization.
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Affiliation(s)
- Nazia Sultana
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh,*Correspondence: Nazia Sultana ✉
| | - Aazia Hossain
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Hemel Das
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Saseendran Pallikadavath
- Portsmouth-Brawijaya Centre for Global Health, Population, and Policy, University of Portsmouth, Portsmouth, United Kingdom
| | - Mira Koeryaman
- Portsmouth-Brawijaya Centre for Global Health, Population, and Policy, University of Portsmouth, Portsmouth, United Kingdom
| | - Mohammad Rahman
- Salford Business School, University of Salford, Salford, United Kingdom
| | | | - Abbas Bhuiya
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Shehrin Shaila Mahmood
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - S. M. A. Hanifi
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
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Trends and determinants of taking tetanus toxoid vaccine among women during last pregnancy in Bangladesh: Country representative survey from 2006 to 2019. PLoS One 2022; 17:e0276417. [PMID: 36264922 PMCID: PMC9584373 DOI: 10.1371/journal.pone.0276417] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022] Open
Abstract
Background Tetanus occurring during pregnancy is still an important cause of maternal and neonatal mortality in developing countries. This study estimated the trend of tetanus toxoid (TT) immunization coverage from 2006 to 2019 in Bangladesh, considering socio-demographic, socio-economic, and geospatial characteristics. Methods The dataset used in this study was extracted from Multiple Indicator Cluster Surveys (2006, 2012–13, and 2019) including 28,734 women aged between 15–49 years. Data analysis was performed using cross-tabulation and logistic regression methods. Further, the spatial distribution of TT immunization coverage was also depicted. Results The trend of TT immunization (81.8% in 2006 to 49.3% in 2019) and that of taking adequate doses of TT (67.1% in 2006 to 49.9% in 2019) has gradually decreased throughout the study period. Among the administrative districts, North and South-West regions had lower coverage, and South and West regions had relatively higher coverage of both TT immunization and that of adequate doses. Antenatal TT immunization (any dosage, inadequate or adequate) was significantly associated with lower age (AOR = 3.13, 1.55–6.34), higher education (AOR = 1.20, 1.03–1.40), living in urban areas (AOR = 1.17, 1.03–1.34), having immunization card (AOR = 5.19, 4.50–5.98), using government facilities for birth (AOR = 1.41, 1.06–1.88), and receiving antenatal care (ANC) (AOR = 1.51, 1.35–1.69). In addition, living in urban areas (AOR = 1.31, 1.10–1.55), having immunization cards (AOR = 1.62, 1.36–1.92), and choosing others’ homes for birth (AOR = 1.37, 1.07–1.74) were significantly associated with adequate TT immunization. However, higher education (AOR = 0.57, 0.44–0.74), having poor wealth index (AOR = 0.65, 0.50–0.83), and receiving ANC (AOR = 0.76, 0.63–0.92) had lower likelihood of taking adequate TT immunization. Conclusions The gradual decline in the TT immunization rate in the present study suggests the presence of variable rates and unequal access to TT immunization, demanding more effective public health programs focusing on high-risk groups to ensure adequate TT immunization.
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Faruk A, Quddus IA. COVID-19 Vaccination: Willingness and practice in Bangladesh. DEVELOPMENT POLICY REVIEW : THE JOURNAL OF THE OVERSEAS DEVELOPMENT INSTITUTE 2022; 41:e12645. [PMID: 35936972 PMCID: PMC9347408 DOI: 10.1111/dpr.12645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 03/28/2022] [Accepted: 05/03/2022] [Indexed: 06/15/2023]
Abstract
Motivation Mass adult immunization for COVID-19, coupled with the urgency, is a challenge for any lower-middle-income country (LMIC) like Bangladesh. Our analysis focuses on demand-side constraints early in the vaccination campaign to help gauge vaccine acceptability and potential contributing factors. Identifying registration and compliance challenges early on will help ensure a seamless immunization programme. Purpose We seek to identify subgroups who may need specific interventions by comparing willingness to be vaccinated and registration behaviour, and to understand how actual registration and take-up decisions compare between rural and urban slum regions. Approach and Methods We use data from three surveys conducted between late January and early September 2021. The article includes a nationally representative survey on vaccine acceptability and a study on vaccination rollout behaviour in rural and urban slums. Findings Willingness was not an issue in Bangladesh, but the weak link was getting individuals to register. Once they did, compliance was very high. When the information gap regarding registration was addressed by campaigning, registration and take-up increased. Confidence in public service delivery influenced favourable responses to mass immunization efforts. Women were falling behind initially in terms of both registration knowledge and completion. Online registration needed to be complemented with alternatives. Social networking was a vital source of information and encouragement. Policy implications Communication strategies are necessary to inform the public at an early stage, which should provide information about registration eligibility and detailed registration instructions. Ensuring and sustaining service quality will also be beneficial. In LMICs like Bangladesh, low-tech intensive registration methods are required. Information campaigns about the registration procedure should specifically target rural communities and women. Community-based mechanisms may reduce transaction costs and increase confidence.
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Affiliation(s)
- Avinno Faruk
- BRAC Institute of Governance and Development (BIGD)BRAC UniversityBangladesh
| | - Ishmam Al Quddus
- BRAC Institute of Governance and Development (BIGD)BRAC UniversityBangladesh
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Hossain MJ, Rahman SMA, Emran TB, Mitra S, Islam MR, Dhama K. Recommendation and Roadmap of Mass Vaccination against Coronavirus Disease 2019 Pandemic in Bangladesh as a Lower-Middle-Income Country. ARCHIVES OF RAZI INSTITUTE 2021; 76:1815-1822. [PMID: 35546989 DOI: 10.22092/ari.2021.356357.1824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 11/10/2021] [Indexed: 10/15/2022]
Abstract
Low-income countries (LICs) and lower-middle-income countries (LMICs) are still deprived of the optimum doses of coronavirus disease 2019 (COVID-19) vaccines for their population, equal access and distribution, as well as mass immunization roadmaps to be implemented for achieving herd immunity and protection from the ongoing pandemic. In this short report, we are interacting with the world public health experts, as well as national and global leaders for warranting the mass vaccination drive to be more progressive against COVID-19 with equitable access of vaccines to LICs or LMICs to save the lives of the poorest country people and refugees. From several scientific databases, such as Google Scholar, PubMed, as well as national and international news websites, the data were collected data by utilizing appropriate keywords regarding the topic. Bangladesh might be exemplified in this brief communication as the representative of LMIC. As of October 14, 2021, 48% of the world's people have received at least one dose of the COVID-19 vaccine. In contrast, only 2.5% of people from LICs have come in under COVID-19 vaccination for at least a single shot. Both LICs and LMICs need far more vision and ambition, including political, administrative, and diplomatic progress along with enhancing the vaccination drive for their population to be immunized through simultaneous mass vaccination progress of other countries with implementing public health safety measures against the COVID-19 pandemic.
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Affiliation(s)
- M J Hossain
- Department of Pharmacy, State University of Bangladesh, 77 Satmasjid Road Dhanmondi, Dhaka-1205, Bangladesh
| | - S M A Rahman
- Department of Clinical Pharmacy and Pharmacology, Faculty of Pharmacy, University of Dhaka, Dhaka-1000, Bangladesh
| | - T B Emran
- Department of Pharmacy, BGC Trust University, Chittagong-4381, Bangladesh
| | - S Mitra
- Department Pharmacy, Faculty of Pharmacy, University of Dhaka, Dhaka-1000, Bangladesh
| | - M R Islam
- Department of Pharmacy, University of Asia Pacific, 74/A, Green Road, Farmgate, Dhaka 1205, Bangladesh
| | - K Dhama
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly-243122, Uttar Pradesh, India
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Hossain MM, Sobhan MA, Rahman A, Flora SS, Irin ZS. Trends and determinants of vaccination among children aged 06-59 months in Bangladesh: country representative survey from 1993 to 2014. BMC Public Health 2021; 21:1578. [PMID: 34419002 PMCID: PMC8379560 DOI: 10.1186/s12889-021-11576-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 07/29/2021] [Indexed: 12/01/2022] Open
Abstract
Background Vaccination has important consequences for childhood development, mortality, and inequalities in health and well-being. This research explores the trend of vaccinations coverage from 1993 to 2014 and determines the significant factors for vaccinations coverage in Bangladesh, considering geospatial, socioeconomic, and demographic characteristics. Methods This study uses a secondary dataset extracted from the Bangladesh Demographic and Health Survey (BDHS) from 1992 to 93 to 2014. The association between selected independent variables and vaccination coverage of children was examined through the Chi-square test. In addition, unadjusted and adjusted logistic regression approaches were applied to determine the effects of covariates on vaccination status by using the BDHS-2014 dataset. Results The results reveal that the trend of the vaccination coverage rate has gradually been increased over the study period. The coverage rate of BCG is observed maximum while the lowest for Measles vaccination among all types of vaccinations. The findings revealed that the significantly lower coverage of all vaccination had been observed in the Sylhet region. Children of higher educated mothers (OR 10.21; CI: 4.10–25.37) and father (OR 8.71; CI: 4.03–18.80), born at health facilities (OR 4.53; CI: 2.4–8.55) and whose mother has media exposure (OR 3.20; CI: 2.22–4.60) have more chance of receiving BCG vaccine. For DPT vaccination coverage, there is a significant difference from children whose mothers have primary (OR 1.7; CI: 1.35–2.15), secondary (OR 3.5; CI: 2.75–4.45), and higher (OR 9.6; CI: 5.28–17.42) educational qualification compared to children of illiterate mothers. Findings demonstrated that children born in wealthier households have a higher likelihood of being immunized against DPT, Polio, and Measles vaccination than children born in the poorest households. Conclusions The findings reveal that to enhance and make sustainable the overall country’s vaccination coverage, we should pay more attention to the mother’s education, socioeconomic condition, children’s age, birth order number, having media exposure, place of residence, and religion. The authors think that this finding would be helpful to accelerate the achievement target of Sustainable Development Goals (SDGs) for children’s health in Bangladesh. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11576-0.
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Affiliation(s)
- Md Moyazzem Hossain
- Department of Statistics, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh. .,School of Mathematics, Statistics & Physics, Newcastle University, Newcastle upon Tyne, UK.
| | - Md Abdus Sobhan
- Chief Economist's Unit, Bangladesh Bank, Head Office, Dhaka, 1000, Bangladesh
| | - Azizur Rahman
- School of Computing, Mathematics and Engineering, Charles Sturt University, Wagga Wagga, NSW, 2678, Australia.
| | | | - Zahida Sultana Irin
- Department of Medicine, University of British Columbia, Vancouver, V5Z 1M9, British Columbia, Canada
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Kitamura T, Bouakhasith V, Phounphenghack K, Pathammavong C, Xeuatvongsa A, Kobayashi A, Norizuki M, Okabayashi H, Miyano S, Mori Y, Takeda M, Sugiyama M, Mizokami M, Machida M, Hachiya M. Vaccine temperature management in Lao People's Democratic Republic: A nationwide cross-sectional study. Heliyon 2021; 7:e07342. [PMID: 34307926 PMCID: PMC8258653 DOI: 10.1016/j.heliyon.2021.e07342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 05/05/2021] [Accepted: 06/14/2021] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE The objective of the study was to evaluate the duration and frequency of vaccine exposure to suboptimal temperatures during transit from the central vaccine storage in the capital to health centers in Lao PDR. METHODS Temperature data loggers traveled from the capital to the health centre storages (146) with the vaccines to monitor the vaccine temperature nationwide. One health centre per district was selected using a simple random sampling method for the first round of temperature monitoring. One health centre was selected from every forty-nine high risk districts monitor the trend of vaccine temperature at the health centre storage and during outreach sessions in several districts. Vaccines and temperature data loggers were transported using the normal vaccination transportation. FINDINGS Overall, the vaccines were exposed to temperatures >8 °C for an average of 1648 min, equivalent to 9.0% of the observational period, and to temperatures <0 °C for an average of 184 min, equivalent to 1.35% of the study period. The proportion of exposure to temperatures >8 °C was the highest during the transit from the capital to the province. The proportion of exposure to temperatures <0 °C was the highest during storage at district level. Examined by region, vaccines in the northern provinces had higher risk of exposure to temperatures >8 °C; however, the risk of exposure to temperatures <0 °C was scattered nationwide. Moreover, some health centers showed fluctuations in storage temperature. CONCLUSIONS Challenges associated with cold chain management, and the resulting deterioration of vaccines, might account for outbreaks of vaccine-preventable diseases. The government should examine and invest in suitable technologies and approaches to ensure consistency in cold chain management.
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Affiliation(s)
- Tomomi Kitamura
- National Center for Global Health and Medicine, 1-21-1 Toyama Shinjuku, Tokyo, 1628655 Japan
| | | | | | | | | | - Akiko Kobayashi
- School of International Health, Graduate School of Medicine, University of Tokyo, Tokyo, 113-8654, Japan
| | - Masataro Norizuki
- National Center for Global Health and Medicine, 1-21-1 Toyama Shinjuku, Tokyo, 1628655 Japan
| | - Hironori Okabayashi
- National Center for Global Health and Medicine, 1-21-1 Toyama Shinjuku, Tokyo, 1628655 Japan
| | - Shinsuke Miyano
- National Center for Global Health and Medicine, 1-21-1 Toyama Shinjuku, Tokyo, 1628655 Japan
| | - Yoshio Mori
- National Institute of Infectious Diseases, Murayama Branch, 4-7-1 Gakuen, Musashimurayama, Tokyo, 208-0011, Japan
| | - Makoto Takeda
- National Institute of Infectious Diseases, Murayama Branch, 4-7-1 Gakuen, Musashimurayama, Tokyo, 208-0011, Japan
| | - Masaya Sugiyama
- Genome Medical Sciences Project, National Center for Global Health and Medicine, 1-7-1 Kohnodai, Ichikawa, Chiba, 272-8516, Japan
| | - Masashi Mizokami
- Genome Medical Sciences Project, National Center for Global Health and Medicine, 1-7-1 Kohnodai, Ichikawa, Chiba, 272-8516, Japan
| | - Munehito Machida
- Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 13-1 Takaramachi, Ishikawa, Kanazawa, 9208640, Japan
| | - Masahiko Hachiya
- National Center for Global Health and Medicine, 1-21-1 Toyama Shinjuku, Tokyo, 1628655 Japan
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Islam MR, Hasan M, Nasreen W, Tushar MI, Bhuiyan MA. The COVID-19 vaccination experience in Bangladesh: Findings from a cross-sectional study. Int J Immunopathol Pharmacol 2021; 35:20587384211065628. [PMID: 34911394 PMCID: PMC8689597 DOI: 10.1177/20587384211065628] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Vaccination rollout against COVID-19 has started in developed countries in early December 2020. Mass immunization for poor or low-income countries is quite challenging before 2023. Being a lower-middle-income country, Bangladesh has begun a nationwide COVID-19 vaccination drive in early February 2021. Here, we aimed to assess the opinions, experiences, and adverse events of the COVID-19 vaccination in Bangladesh. METHODS We conducted this online cross-sectional study from 10 February 2021, to 10 March 2021, in Bangladesh. A self-reported semi-structured survey questionnaire was used using Google forms. We recorded demographics, disease history, medication records, opinions and experiences of vaccination, and associated adverse events symptoms. RESULTS We observed leading comorbid diseases were hypertension (25.9%), diabetes (21.1%), heart diseases (9.3%), and asthma (8.7%). The most frequently reported adverse events were injection site pain (34.3%), fever (32.6%), headache (20.2%), fatigue (16.6%), and cold feeling (15.4%). The chances of having adverse events were significantly higher in males than females (p = 0.039). However, 36.4% of respondents reported no adverse events. Adverse events usually appeared after 12 h and went way within 48 h of vaccination. Besides, 85.5% were happy with the overall vaccination management, while 88.0% of the respondents recommended the COVID-19 vaccine for others for early immunization. CONCLUSION According to the present findings, reported adverse events after the doses of Covishield in Bangladesh were non-serious and temporary. In Bangladesh, the early vaccination against COVID-19 was possible due to its prudent vaccine deal, previous mass vaccination experience, and vaccine diplomacy.
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Affiliation(s)
- Md. Rabiul Islam
- Department of Pharmacy, University of Asia Pacific, Dhaka, Bangladesh
| | - Moynul Hasan
- Department of Pharmacy, Jagannath University, Dhaka, Bangladesh
| | - Waheeda Nasreen
- Department of Pharmacy, University of Asia Pacific, Dhaka, Bangladesh
| | - Md. Ismail Tushar
- Department of Pharmaceutical Sciences, North South University, Dhaka, Bangladesh
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Hossain MM, Abdulla F, Karimuzzaman M, Rahman A. Routine Vaccination Disruption in Low-Income Countries: An Impact of COVID-19 Pandemic. Asia Pac J Public Health 2020; 32:509-510. [PMID: 32917115 DOI: 10.1177/1010539520957808] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Md Moyazzem Hossain
- Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK.,Jahangirnagar University, Dhaka, Bangladesh
| | | | | | - Azizur Rahman
- Charles Sturt University, Wagga Wagga, New South Wales, Australia
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Murshid ME, Haque M. Hits and misses of Bangladesh National Health Policy 2011. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2020; 12:83-93. [PMID: 32742106 PMCID: PMC7373115 DOI: 10.4103/jpbs.jpbs_236_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 11/05/2019] [Accepted: 11/27/2019] [Indexed: 11/04/2022] Open
Abstract
National Health Policy (NHP) is a guiding principle for a country to identify the priority of health-care needs, resource allocations according to prioritization, and to achieve specific health-care goals. In addition, NHP is usually wide-ranging, all-inclusive plan that pursues each and every population to move on the road to better health. NHP targets to achieve universal health coverage and delivering quality health-care services to all at inexpensive cost, through a preemptive, protective, and prophylactic health-care program in all national and international developmental policy and planning. There are quite a few constituents that are valuable in executing health policy. These elements include novelty, technical compendium, communiqué, conglomerates, administration, supervision, and political awareness and promise. Health policies can be implemented at all levels of the government system. It helps in strengthening the overall health-care system of the country by effective public-private coordination and collaboration. In the year 1990, the Government of Bangladesh (GoB) tried to promulgate an NHP. Unfortunately, the attempt failed. The health-care system of the country operated without a policy until 2011. In the year 2011, the country's first health policy was published by the GoB. Though the country has have achieved excellent progress in providing health care, but yet Bangladesh has a few critical challenges that need immediate attention. In this article, we will try to address the pros and cons of the Bangladesh NHP 1990 and the positive aspects and challenges of NHP 2011.
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Affiliation(s)
| | - Mainul Haque
- Unit of Pharmacology, Faculty of Medicine and Defense Health, Universiti Pertahanan Nasional Malaysia (National Defense University of Malaysia), Kuala Lumpur, Malaysia
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Abstract
Maternal education plays a central role in children's health, but there has been little research comparing the role of maternal education across health outcomes. It is important to distinguish child health outcomes from medical care outcomes. Health outcomes such as short-term morbidity and stunting are multifactorial in origin and determined by a range of factors not necessarily under a mother's control. Mother's education, given the necessary structural factors such as medical centres, is likely to lead to increased access to, and uptake of, medical services. Using data from the 2004-05 India Human Development Survey, eight separate logistic regressions were carried out on 11,026 women of reproductive age and their last-born child under five years of age. The results showed that maternal education had the strongest association with medical care, immunization (except polio) and iron supplementation for pregnant mothers, moderate association with underweight and weak association with short-term diseases and stunting. In addition, the study investigated whether maternal education impacts child health and medical care outcomes through the intervening roles of empowerment and human, social and cultural capital. These intervening linkages were found to be missing for short-term diseases and stunting, bolstering the argument that the influence of maternal education is limited for these outcomes.
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Affiliation(s)
- Kriti Vikram
- Department of Sociology, National University of Singapore, Singapore
| | - Reeve Vanneman
- Department of Sociology, University of Maryland, College Park, United States of America
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12
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Jahan Y, Moriyama M, Rahman MM, Shahid ASMSB, Rahman A, Hossain N, Das SK, Hossain MI, Golam Faruque AS, Chisti MJ. Changing trends in measles vaccination status between 2004 and 2014 among children aged 12-23 months in Bangladesh. Trop Med Int Health 2019; 25:475-482. [PMID: 31863611 DOI: 10.1111/tmi.13366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To assess the current measles vaccination status in Bangladesh, explain changing differentials in measles vaccination, and determine contexts that may improve measles vaccination coverage. METHODS Secondary data analysis of datasets (2004-2014) from the nationally representative Bangladesh Demographic and Health Surveys that followed stratified, multi-stage cluster sampling design conducted both in urban and rural contexts. RESULTS 5468 children aged 12-23 months were surveyed, of whom 892 (16%) reported non-compliance to measles vaccine. After simultaneous adjusting for covariates in multivariate logistic regression, children who came from a poor socio-economic background, who had mothers with no formal schooling, who were underweight, of higher birth order (≥4), who had adolescent mothers, who had a history of home delivery and who had no exposure to media were observed to be significantly associated with lack of measles vaccination. Measles vaccination coverage among children of adolescent mothers was consistently low. Despite lack of media exposure, measles vaccination status gradually increased from 26% in 2004 to 33% in 2014. Lack of maternal education was no longer associated with measles vaccination status in 2007, 2011 and 2014. Stunted children continued to be associated with lack of measles immunisation in 2014. Children with higher birth order demonstrated 53% excess risk for not being immunised with measles vaccine. Mothers with no exposure to mass media were two times more likely to have children without measles immunisation as indicated by BDHS 2014 data. CONCLUSIONS Our findings will help policy makers formulate strategies for expanding measles vaccination coverage in order to achieve further reduction in disease burden and mortality in Bangladesh.
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Affiliation(s)
- Yasmin Jahan
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Michiko Moriyama
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Md Moshiur Rahman
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | | | - Atiqur Rahman
- Department of Social and Welfare Studies, Linkoping University, Linkoping, Sweden
| | - Nasif Hossain
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Sumon Kumar Das
- Child Health Division, Menzies School of Health Research, Casuarina, NT, Australia
| | - Md Iqbal Hossain
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Abu Syed Golam Faruque
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Mohammod Jobayer Chisti
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
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Coverage and Determinants of Full Immunization: Vaccination Coverage among Senegalese Children. ACTA ACUST UNITED AC 2019; 55:medicina55080480. [PMID: 31416213 PMCID: PMC6723170 DOI: 10.3390/medicina55080480] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 07/27/2019] [Accepted: 08/09/2019] [Indexed: 11/27/2022]
Abstract
Background and Objectives: In line with the global success of immunization, Senegal achieved impressive progress in childhood immunization program. However, immunization coverage is often below the national and international targets and even not equally distributed across the country. The objective of this study is to estimate the full immunization coverage across the geographic regions and identify the potential factors of full immunization coverage among the Senegalese children. Materials and Methods: Nationally representative dataset extracted from the latest Continuous Senegal Demographic and Health Survey 2017 was used for this analysis. Descriptive statistics such as the frequency with percentage and multivariable logistic regression models were constructed and results were presented in terms of adjusted odds ratio (AOR) with a 95% confidence interval (CI). Results: Overall, 70.96% of Senegalese children aged between 12 to 36 months were fully immunized and the coverage was higher in urban areas (76.51%), west ecological zone (80.0%), and among serer ethnic groups (77.24%). Full immunization coverage rate was almost the same between male and female children, and slightly higher among the children who were born at any health care facility (74.01%). Children who lived in the western zone of Senegal were 1.66 times (CI: 1.25–2.21; p = 0.001) and the children of Serer ethnic groups were 1.43 times (CI: 1.09–1.88; p = 0.011) more likely to be fully immunized than the children living in the southern zone and from the Poular ethnic group. In addition, children who were born at health facilities were more likely to be fully immunized than those who were born at home (AOR = 1.47; CI: 1.20–1.80; p < 0.001), and mothers with recommended antenatal care (ANC) (4 and more) visits during pregnancy were more likely to have their children fully immunized than those mother with no ANC visits (AOR: 2.06 CI: 1.19–3.57; p = 0.010). Conclusions: Immunization coverage was found suboptimal by type of vaccines and across ethnic groups and regions of Senegal. Immunization program should be designed targeting low performing areas and emphasize on promoting equal access to education, decision-making, encouraging institutional deliveries, and scaling up the use of antenatal and postnatal care which may significantly improve the rate full immunization coverage in Senegal.
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Sarker AR, Akram R, Ali N, Sultana M. Coverage and factors associated with full immunisation among children aged 12-59 months in Bangladesh: insights from the nationwide cross-sectional demographic and health survey. BMJ Open 2019; 9:e028020. [PMID: 31289076 PMCID: PMC6629384 DOI: 10.1136/bmjopen-2018-028020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To estimate the coverage and factors associated with full immunisation coverage among children aged 12-59 months in Bangladesh. STUDY DESIGN The study is cross sectional in design. Secondary dataset from Bangladesh Demographic and Health Survey was used for this analysis. Immunisation status was categorised as 'fully immunised' if the children had received all the eight recommended vaccine doses otherwise 'partially/unimmunised'. SETTINGS Bangladesh. PARTICIPANT Children aged 12-59 months were the study participants. Participants were randomly selected through a two-stage stratified sampling design. A total of 6230 children were eligible for the analysis. RESULTS About 86% of the children (5356 out of 6230) were fully immunised. BCG has the highest coverage rate (97.1%) followed by oral polio vaccine 1 (97%) and pentavalent 1 (96.6%), where the coverage rate was the lowest for measles vaccine (88%). Coverage was higher in urban areas (88.5%) when compared with rural ones (85.1%). Full immunisation coverage was significantly higher among children who lived in the Rangpur division (adjusted OR (AOR)=3.46; 95% CI 2.45 to 4.88, p<0.001), were 48-59 months old (AOR=1.32; 95% CI 1.06 to 1.64, p=0.013), lived in a medium size family (AOR=1.56; 95% CI 1.32 to 1.86, p<0.001), had parents with a higher level of education (AOR=1.96; 95% CI 1.21 to 3.17, p=0.006 and AOR=1.55; 95% CI 1.05 to 2.29, p=0.026) and belonged to the richest families (AOR=2.2; 95% CI 1.5 to 3.21, p<0.001). The likelihood of being partially or unimmunised was higher among children who had the father as their sole healthcare decision-maker (AOR=0.69; 95% CI 0.51 to 0.92, p<0.012). CONCLUSIONS There were significant variations of child immunisation coverage across socioeconomic and demographic factors. These findings will inform innovative approaches for immunisation programmes, and the introduction of relevant policies, including regular monitoring and evaluation of immunisation coverage-particularly for low-performing regions, so that the broader benefit of immunisation programmes can be achieved in all strata of the society.
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Affiliation(s)
- Abdur Razzaque Sarker
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
- Bangladesh Institute of Development Studies, Dhaka, Bangladesh
| | - Raisul Akram
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Nausad Ali
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Marufa Sultana
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
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Farzad F, A Reyer J, Yamamoto E, Hamajima N. Socio-economic and demographic determinants of full immunization among children of 12-23 months in Afghanistan. NAGOYA JOURNAL OF MEDICAL SCIENCE 2018. [PMID: 28626253 PMCID: PMC5472543 DOI: 10.18999/nagjms.79.2.179] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Immunization is one of the most cost-effective interventions to reduce vaccine-preventable diseases morbidity and mortality. Vaccination coverage is very low in Afghanistan; National Risk and Vulnerability Assessment (NRVA) Survey 2008 estimated the coverage of fully immunized children to be 37%. The current study was designed to examine the factors influencing full immunization among children aged 12–23 months. Demographic and vaccination data of 2,561 children of 12–23 months was extracted from the Afghanistan Health Survey (AHS) 2012. The data was analyzed by logistic regression to estimate adjusted odds ratios (AOR) and 95% confidence intervals (CI). The study found that 38.8% of the children were fully immunized. The coverage for specific vaccines was 80.9% for BCG, 72.0% for OPV3, 64.8% for measles, and 50.1% for Penta3. Urban residence (AOR = 0.60, 95% CI 0.40–0.90 relative to rural), children of poorer families (AOR = 1.36, 95% CI 1.10–1.67 relative to poorest), some education (AOR = 1.59, 95% CI 1.20–2.11 relative to no education) and antenatal care (AOR = 1.70, 95% CI 1.44–2.01 relative to not received) were found to be significant predicators of full immunization. This study indicated that the full-immunization rate in Afghanistan was quite low compared to the national target of 90% coverage. Therefore, strategies taking into account the identified factors seem to be vital to improve vaccination coverage.
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Affiliation(s)
- Fraidoon Farzad
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Joshua A Reyer
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Eiko Yamamoto
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nobuyuki Hamajima
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Rahman A, Reza AAS, Bhuiyan BA, Alam N, Dasgupta SK, Mostari S, Anwar I. Equity and determinants of routine child immunisation programme among tribal and non-tribal populations in rural Tangail subdistrict, Bangladesh: a cohort study. BMJ Open 2018; 8:e022634. [PMID: 30361402 PMCID: PMC6224713 DOI: 10.1136/bmjopen-2018-022634] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 06/12/2018] [Accepted: 09/14/2018] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES The study estimated valid vaccination coverage of under 5 children in a rural area under Tangail subdistrict and examined their sociodemographic correlates including ethnicity. SETTING The study sites are three primary areas where tribal and non-tribal population resides together in a rural subdistrict of Bangladesh. PARTICIPANTS Routine vaccination information of a cohort of 2802 children, born between 1 January 2011 and 31 December 2012, were retrieved from the Expanded Program on Immunization (EPI) registers maintained by the health assistants. Collected data were entered in an Oracle-based computer program. Univariate, bivariate and multivariate analyses were performed in SPSS V.20 to explore coverage and differentials for full valid vaccination coverage in the study area. RESULTS Valid vaccination coverage was 90.6% among tribal population and 87.3% among non-tribal population(p=0.25). Compared with females, males had higher valid vaccination coverage (89.2% vs 85.9%) and lower invalid (5.4% vs 6.9%) and no-coverage (5.3% vs 7.3%) (p=0.03). Households with mobile phones had higher valid coverage (90.9% vs 86.5%) and lower invalid (4.5% vs 6.7%) and no coverage (4.5% vs 6.9%) compared with those without mobile phones (p=0.01). Coverage of valid vaccination was higher among children of Oronkhola union than in children of the other two unions. CONCLUSION The study documented that valid vaccination coverage was high in this rural area, and there was no significant ethnic variation which was one of the strengths of the national EPI. However, there is significant variation by gender of the child, household ownership of mobile phones and geographical location of households.
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Affiliation(s)
- Aminur Rahman
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ashek Ahmed Shahid Reza
- Expended Program on Immunization Department, Director General of Health Services (DGHS), Government of Bangladesh (GoB), Dhaka, Bangladesh
| | - Badrul Alam Bhuiyan
- Global Consortium for Public Health Research, Liverpool John Moores University, Liverpool, UK
| | - Nurul Alam
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shushil K Dasgupta
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shabnam Mostari
- Community Skilled Birth Attendant Program, Obstetrical and Gynaecological Society of Bangladesh (OGSB), Mohammadpur, Bangladesh
| | - Iqbal Anwar
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Kitamura T, Bouakhasith V, Phounphenghack K, Pathammavong C, Xeuatvongsa A, Norizuki M, Okabayashi H, Mori Y, Machida M, Hachiya M. Assessment of temperatures in the vaccine cold chain in two provinces in Lao People's Democratic Republic: a cross-sectional pilot study. BMC Res Notes 2018; 11:261. [PMID: 29703228 PMCID: PMC5924473 DOI: 10.1186/s13104-018-3362-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 04/18/2018] [Indexed: 11/10/2022] Open
Abstract
Objective All childhood vaccines, except the oral polio vaccine, should be kept at 2–8 °C, since the vaccine potency can be damaged by heat or freezing temperature. A temperature monitoring study conducted in 2008–2009 reported challenges in cold chain management from the provincial level downwards. The present cross-sectional pilot study aimed to assess the current status of the cold chain in two provinces (Saravan and Xayabouly) of Lao People’s Democratic Republic between March–April 2016. Two types of temperature data loggers recorded the temperatures and the proportions of time exposed to < 0 or > 8 °C were calculated. Results The temperature remained within the appropriate range in the central and provincial storages. However, the vaccines were frequently exposed to > 8 °C in Saravan and < 0 °C in Xayabouly in the district storage. Vaccines were exposed to > 8 °C during the transportation in Saravan and to both > 8 and < 0 °C in Xayabouly. Thus, challenges in managing the cold chain in the district storage and during transportation remain, despite improvements at the provincial storage. A detailed up-to-date nationwide analysis of the current situation of the cold chain is warranted to identify the most appropriate intervention to tackle the remaining challenges.
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Affiliation(s)
- Tomomi Kitamura
- Bureau of International Cooperation, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo, 1628655, Japan.
| | - Viraneth Bouakhasith
- National Immunization Program, Ministry of Health, Lao PDR, Simuang Road, Vientiane, Lao People's Democratic Republic
| | - Kongxay Phounphenghack
- National Immunization Program, Ministry of Health, Lao PDR, Simuang Road, Vientiane, Lao People's Democratic Republic
| | - Chansay Pathammavong
- National Immunization Program, Ministry of Health, Lao PDR, Simuang Road, Vientiane, Lao People's Democratic Republic
| | - Anonh Xeuatvongsa
- National Immunization Program, Ministry of Health, Lao PDR, Simuang Road, Vientiane, Lao People's Democratic Republic
| | - Masataro Norizuki
- Bureau of International Cooperation, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo, 1628655, Japan
| | - Hironori Okabayashi
- Bureau of International Cooperation, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo, 1628655, Japan
| | - Yoshio Mori
- Laboratory of Rubella, Department of Virology III, National Institute of Infectious Diseases, Murayama Branch, 4-7-1 Gakuen, Musashimurayama, Tokyo, 208-0011, Japan
| | - Munehito Machida
- Department of Global Health, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 9208640, Japan
| | - Masahiko Hachiya
- Bureau of International Cooperation, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo, 1628655, Japan
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Shawon MSR, Adhikary G, Ali MW, Shamsuzzaman M, Ahmed S, Alam N, Shackelford KA, Woldeab A, Lim SS, Levine A, Gakidou E, Uddin MJ. General service and child immunization-specific readiness assessment of healthcare facilities in two selected divisions in Bangladesh. BMC Health Serv Res 2018; 18:39. [PMID: 29370842 PMCID: PMC5784675 DOI: 10.1186/s12913-018-2858-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 01/18/2018] [Indexed: 11/10/2022] Open
Abstract
Background Service readiness of health facilities is an integral part of providing comprehensive quality healthcare to the community. Comprehensive assessment of general and service-specific (i.e. child immunization) readiness will help to identify the bottlenecks in healthcare service delivery and gaps in equitable service provision. Assessing healthcare facilities readiness also helps in optimal policymaking and resource allocation. Methods A health facility survey was conducted between March 2015 and December 2015 in two purposively selected divisions in Bangladesh; i.e. Rajshahi division (high performing) and Sylhet division (low performing). A total of 123 health facilities were randomly selected from different levels of service, both public and private, with variation in sizes and patient loads from the list of facilities. Data on various aspects of healthcare facility were collected by interviewing key personnel. General service and child immunization specific service readiness were assessed using the Service Availability and Readiness Assessment (SARA) manual developed by World Health Organization (WHO). The analyses were stratified by division and level of healthcare facilities. Results The general service readiness index for pharmacies, community clinics, primary care facilities and higher care facilities were 40.6%, 60.5%, 59.8% and 69.5%, respectively in Rajshahi division and 44.3%, 57.8%, 57.5% and 73.4%, respectively in Sylhet division. Facilities at all levels had the highest scores for basic equipment (ranged between 51.7% and 93.7%) and the lowest scores for diagnostic capacity (ranged between 0.0% and 53.7%). Though facilities with vaccine storage capacity had very high levels of service readiness for child immunization, facilities without vaccine storage capacity lacked availability of many tracer items. Regarding readiness for newly introduced pneumococcal conjugate vaccine (PCV) and inactivated polio vaccine (IPV), most of the surveyed facilities reported lack of sufficient funding and resources (antigen) for training programs. Conclusions Our study suggested that health facilities suffered from lack of readiness in various aspects, most notably in diagnostic capacity. Conversely, with very few challenges, nearly all the health facilities designated to provide immunization services were ready to deliver routine childhood immunization services as well as newly introduced PCV and IPV.
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Affiliation(s)
- Md Shajedur Rahman Shawon
- International Centre for Diarrhoeal Disease Research, (icddr,b), Mohakhali, Dhaka, 1212, Bangladesh. .,Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK.
| | - Gourab Adhikary
- International Centre for Diarrhoeal Disease Research, (icddr,b), Mohakhali, Dhaka, 1212, Bangladesh
| | - Md Wazed Ali
- International Centre for Diarrhoeal Disease Research, (icddr,b), Mohakhali, Dhaka, 1212, Bangladesh
| | - Md Shamsuzzaman
- Expanded Programme on Immunisation, Directorate General of Health Services (DGHS), Mohakhali, Dhaka, 1212, Bangladesh
| | - Shahabuddin Ahmed
- International Centre for Diarrhoeal Disease Research, (icddr,b), Mohakhali, Dhaka, 1212, Bangladesh
| | - Nurul Alam
- International Centre for Diarrhoeal Disease Research, (icddr,b), Mohakhali, Dhaka, 1212, Bangladesh
| | - Katya A Shackelford
- Institute for Health Matrices and Evaluation (IHME), University of Washington, Seattle, USA
| | - Alexander Woldeab
- Institute for Health Matrices and Evaluation (IHME), University of Washington, Seattle, USA
| | - Stephen S Lim
- Institute for Health Matrices and Evaluation (IHME), University of Washington, Seattle, USA
| | - Aubrey Levine
- Institute for Health Matrices and Evaluation (IHME), University of Washington, Seattle, USA
| | - Emmanuela Gakidou
- Institute for Health Matrices and Evaluation (IHME), University of Washington, Seattle, USA
| | - Md Jasim Uddin
- International Centre for Diarrhoeal Disease Research, (icddr,b), Mohakhali, Dhaka, 1212, Bangladesh.
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Shafiq Y, Khowaja AR, Yousafzai MT, Ali SA, Zaidi A, Saleem AF. Knowledge, attitudes and practices related to tetanus toxoid vaccination in women of childbearing age: A cross-sectional study in peri-urban settlements of Karachi, Pakistan. J Infect Prev 2018; 18:232-241. [PMID: 29317900 DOI: 10.1177/1757177416689722] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 12/14/2016] [Indexed: 11/16/2022] Open
Abstract
Backgound A higher incidence of neonatal tetanus implies failure of the vaccination program in Pakistan. Objectives The objective of this study was to assess knowledge, attitudes and practices related to tetanus toxoid (TT) vaccine in women of childbearing age. Methods We performed a cross-sectional survey in peri-urban Karachi, Pakistan, among women of childbearing age, stratified into three mutually exclusive groups as: married pregnant; married non-pregnant; and unmarried. Descriptive and inferential analyses were performed to estimate vaccine coverage and knowledge attributes. Results A total of 450 women participated, of which the largest proportion were married and non-pregnant (n = 185/450, 41%). Over 50% of women (n = 258/450) had not received TT vaccine. Most unmarried women (n = 139, 97%) were unvaccinated. Non-vaccination predictors included: women aged <25 years without any formal education (adjusted odds ratio [OR], 2.1; 95% confidence interval [CI], 1.0-4.4), lack of knowledge about free vaccination (adjusted OR, 4.0; 95% CI, 1.64-10.20), poor knowledge of tetanus disease/vaccination (adjusted OR, 4.6; 95%, 2.2-9.6), living with extended family (adjusted OR, 2.0; 95% CI, 1.04-3.96); family non-supporting vaccination (adjusted OR, 5.7; 95% CI, 2.3-13.9); and husband/other family member deciding upon issues related to women's health (adjusted OR, 2.9; 95% CI, 1.3-6.6). Conclusion Low coverage of TT vaccine is largely influenced by poor knowledge, family structure and family decision-making in the local communities of Pakistan.
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Affiliation(s)
- Yasir Shafiq
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Asif Raza Khowaja
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Syed Asad Ali
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Anita Zaidi
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Ali Faisal Saleem
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
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20
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Mugali RR, Mansoor F, Parwiz S, Ahmad F, Safi N, Higgins-Steele A, Varkey S. Improving immunization in Afghanistan: results from a cross-sectional community-based survey to assess routine immunization coverage. BMC Public Health 2017; 17:290. [PMID: 28376806 PMCID: PMC5379688 DOI: 10.1186/s12889-017-4193-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 03/21/2017] [Indexed: 12/28/2022] Open
Abstract
Background Despite progress in recent years, Afghanistan is lagging behind in realizing the full potential of immunization. The country is still endemic for polio transmission and measles outbreaks continue to occur. In spite of significant reductions over the past decade, the mortality rate of children under 5 years of age continues to remain high at 91 per 1000 live births. Methods The study was a descriptive community-based cross sectional household survey. The survey aimed to estimate the levels of immunization coverage at national and province levels. Specific objectives are to: establish valid baseline information to monitor progress of the immunization program; identify reasons why children are not immunized; and make recommendations to enhance access and quality of immunization services in Afghanistan. The survey was carried out in all 34 provinces of the country, with a sample of 6125 mothers of children aged 12–23 months. Results Nationally, 51% of children participating in the survey received all doses of each antigen irrespective of the recommended date of immunization or recommended interval between doses. About 31% of children were found to be partially vaccinated. Reasons for partial vaccination included: place to vaccinate child too far (23%), not aware of the need of vaccination (17%), no faith in vaccination (16%), mother was too busy (15%), and fear of side effects (11%). Conclusion The innovative mechanism of contracting out delivery of primary health care services in Afghanistan, including immunization, to non-governmental organizations is showing some positive results in quickly increasing coverage of essential interventions, including routine immunization. Much ground still needs to be covered with proper planning and management of resources in order to improve the immunization coverage in Afghanistan and increase survival and health status of its children.
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Affiliation(s)
- Raveesha R Mugali
- United Nations Children's Fund, UNOCA Compound, UNICEF Afghanistan Country Office, Jalalabad Road, Kabul, Afghanistan.
| | - Farooq Mansoor
- The Health Protection and Research Organization (HPRO), Kabul, Afghanistan
| | | | - Fazil Ahmad
- United Nations Children's Fund, UNOCA Compound, UNICEF Afghanistan Country Office, Jalalabad Road, Kabul, Afghanistan
| | | | - Ariel Higgins-Steele
- United Nations Children's Fund, UNOCA Compound, UNICEF Afghanistan Country Office, Jalalabad Road, Kabul, Afghanistan
| | - Sherin Varkey
- United Nations Children's Fund, UNOCA Compound, UNICEF Afghanistan Country Office, Jalalabad Road, Kabul, Afghanistan
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Xeuatvongsa A, Hachiya M, Miyano S, Mizoue T, Kitamura T. Determination of factors affecting the vaccination status of children aged 12-35 months in Lao People's Democratic Republic. Heliyon 2017; 3:e00265. [PMID: 28367510 PMCID: PMC5362045 DOI: 10.1016/j.heliyon.2017.e00265] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 02/26/2017] [Accepted: 03/09/2017] [Indexed: 12/02/2022] Open
Abstract
Vaccines are one of the most important achievements in public health, and a major contributor to this success is the Expanded Programme on Immunization. The utilisation of vaccination services and completion of the recommended schedule are determined by numerous factors. In Lao People’s Democratic Republic (Lao PDR), the overall immunisation coverage has been improving. However, notwithstanding the improvement in immunisation coverage and the supplementary immunisation activities, there have been measles, diphtheria, and polio outbreaks in the country. The recent multicounty study of household health surveys revealed that the within-country economic-related inequality in the delivery of a vaccine was still high in Lao PDR. Our previous work evaluated the factors associated with vaccination status among the children aged 5–9 years old, which was older age group for this type of study. This study evaluated factors that affect vaccination status among children aged between 12 and 35 months. It is a nationwide population-based cross-sectional study that used data obtained through multistage cluster sampling. We found that the proportion of infants who were fully immunised was lower than the national target and that “maternal ethnicity” (odds ratio (OR) 0.34, 95% confidence interval [CI]: 0.20–0.60), “paternal education” (OR 1.87, 95% CI: 1.12–3.10), and “source of information about vaccination date by medical staff” (OR 1.65, 95% CI: 1.01–2.71) were significantly associated with the children’s vaccination status. Numerous factors are associated with the completion of the recommended vaccine schedule, and some factors are location-specific. Identification of these factors should lead to actions for facilitating the optimal use of vaccination services by all the children in Lao PDR.
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Affiliation(s)
- Anonh Xeuatvongsa
- Deputy Director of the Mother and Child Health Center/National Manager of the National Immunization Program, Ministry of Health, Lao People's Democratic Republic: Ban Vutnak, Sisattanak District, Vientiane, Lao People's Democratic Republic
| | - Masahiko Hachiya
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo 162-8655, Japan
| | - Shinsuke Miyano
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo 162-8655, Japan
| | - Tetsuya Mizoue
- Center for Clinical Sciences, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo 162-8655, Japan
| | - Tomomi Kitamura
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo 162-8655, Japan
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Ramakrishnan G, Wright M, Alam M, Naylor C, Kabir M, Zerin A, Ferdous T, Pedersen K, Hennig BJ, Donowitz JR, Wegmuller R, Haque R, Petri WA, Herbein J, Gilchrist CA. Rapid assessment of tetanus vaccine-induced immunity in Bangladesh and the Gambia. Diagn Microbiol Infect Dis 2016; 87:272-274. [PMID: 27916543 DOI: 10.1016/j.diagmicrobio.2016.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 10/28/2016] [Accepted: 11/19/2016] [Indexed: 02/08/2023]
Abstract
We have developed recombinant fragment C based rapid point of care dipstick devices to assess tetanus immunization status using plasma or whole blood. The devices demonstrated specificity of 0.90 and sensitivity of 0.90 (whole blood)/0.94 (plasma) at field sites in Bangladesh and The Gambia when compared to a commercial ELISA with the immune cut-off titer set as ≥0.1IU/mL.
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Affiliation(s)
- Girija Ramakrishnan
- Department of Medicine/Division of Infectious Disease and International Health, University of Virginia, Charlottesville, VA, USA
| | | | - Masud Alam
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh (icddr,b)
| | - Caitlin Naylor
- Nutrition Theme, MRC Unit The Gambia (MRCG), Banjul, The Gambia
| | - Mamun Kabir
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh (icddr,b)
| | - Ayesha Zerin
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh (icddr,b)
| | - Tahsin Ferdous
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh (icddr,b)
| | | | - Branwen J Hennig
- Nutrition Theme, MRC Unit The Gambia (MRCG), Banjul, The Gambia; MRC International Nutrition Group, London, School of Hygiene & Tropical Medicine, London, UK
| | - Jeffrey R Donowitz
- Division of Pediatric Infectious Diseases, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond
| | - Rita Wegmuller
- Nutrition Theme, MRC Unit The Gambia (MRCG), Banjul, The Gambia; MRC International Nutrition Group, London, School of Hygiene & Tropical Medicine, London, UK
| | - Rashidul Haque
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh (icddr,b)
| | - William A Petri
- Department of Medicine/Division of Infectious Disease and International Health, University of Virginia, Charlottesville, VA, USA
| | | | - Carol A Gilchrist
- Department of Medicine/Division of Infectious Disease and International Health, University of Virginia, Charlottesville, VA, USA.
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Hasman A, Noble DJ. Childhood immunisation in South Asia - overcoming the hurdles to progress. Perspect Public Health 2016; 136:273-7. [PMID: 27528641 PMCID: PMC4989267 DOI: 10.1177/1757913916658633] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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Kumar C, Singh PK, Singh L, Rai RK. Socioeconomic disparities in coverage of full immunisation among children of adolescent mothers in India, 1990-2006: a repeated cross-sectional analysis. BMJ Open 2016; 6:e009768. [PMID: 27519918 PMCID: PMC4985793 DOI: 10.1136/bmjopen-2015-009768] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Studies have highlighted that children of adolescent (aged 15-19 years) mothers are likely to receive relatively poor healthcare. With an unacceptably high adolescent birth rate, India houses the highest number of adolescent mothers globally, putting children at risk of inadequate vaccination. This paper assesses trends and extent of socioeconomic disparities in the coverage of full immunisation among children of adolescent mothers in India. DESIGN Repeated cross-sectional analytical study. DATA SOURCES 3 consecutive rounds of the National Family Health Survey (NFHS) conducted during 1992-1993, 1998-1999 and 2005-2006 were used. Besides, the required information is also extracted from the 2011 Indian Census. PARTICIPANTS Children (aged 12-23 months) of adolescent (aged 15-19 years) mothers. Sample inclusion criteria involved the last child of the adolescent eligible to avail full immunisation. SETTING Nationally representative sample. DATA ANALYSIS The Cochran-Armitage test, χ(2) test and binary logistic regression methods were applied to attain the study objective. RESULTS Between 1990 and 2006, a non-significant increase of 4 percentage points in full immunisation of children of adolescent mothers was estimated. During the same period, a large difference between the probability of children of adolescent mothers receiving full immunisation belonging to the least (predicted probability (PP): 0.196 in 1990-1993, and PP: 0.213 in 2003-2006) and the most (PP: 0.589 in 1990-1993, and PP: 0.645 in 2003-2006) socioeconomically privileged group was estimated, and this disparity persisted over the survey period. CONCLUSIONS During 1990-2006, an insufficient improvement in provision of full immunisation to children born to adolescent mothers was recorded. The study underscored the suboptimum immunisation of rural, illiterate and poor children of adolescent women. The programme and policymakers could focus on district-wise concentration of adolescent women, especially those belonging to the underprivileged groups, to design a targeted intervention to elevate the level of immunisation of children of adolescent mothers.
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Affiliation(s)
- Chandan Kumar
- Department of Geography, School of Earth Sciences, Central University of Karnataka, Kalaburagi, Karnataka, India
| | - Prashant Kumar Singh
- Population Health & Nutrition Research Program, Institute for Human Development, New Delhi, Delhi, India
| | - Lucky Singh
- National Institute of Medical Statistics, Indian Council of Medical Research, New Delhi, Delhi, India
| | - Rajesh Kumar Rai
- Society for Health and Demographic Surveillance, Suri, West Bengal, India
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Understanding factors influencing vaccination acceptance during pregnancy globally: A literature review. Vaccine 2015; 33:6420-9. [DOI: 10.1016/j.vaccine.2015.08.046] [Citation(s) in RCA: 198] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 08/06/2015] [Accepted: 08/11/2015] [Indexed: 01/22/2023]
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Hu Y, Luo S, Tang X, Lou L, Chen Y, Guo J, Zhang B. Does introducing an immunization package of services for migrant children improve the coverage, service quality and understanding? An evidence from an intervention study among 1548 migrant children in eastern China. BMC Public Health 2015; 15:664. [PMID: 26173803 PMCID: PMC4501193 DOI: 10.1186/s12889-015-1998-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 06/30/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND An EPI (Expanded Program on Immunization) intervention package was implemented from October 2011 to May 2014 among migrant children in Yiwu, east China. This study aimed to evaluate its impacts on vaccination coverage, maternal understanding of EPI and the local immunization service performance. METHODS A pre- and post-test design was used. The EPI intervention package included: (1) extending the EPI service time and increasing the frequency of vaccination service; (2) training program for vaccinators; (3) developing a screening tool to identify vaccination demands among migrant clinic attendants; (4) Social mobilization for immunization. Data were obtained from random sampling investigations, vaccination service statistics and qualitative interviews with vaccinators and mothers of migrant children. The analysis of quantitative data was based on a "before and after" evaluation and qualitative data were analyzed using content analysis. RESULTS The immunization registration (records kept by immunization clinics) rate increased from 87.4 to 91.9% (P = 0.016) after implementation of the EPI intervention package and the EPI card holding (EPI card kept by caregivers) rate increased from 90.9 to 95.6% (P = 0.003). The coverage of fully immunized increased from 71.5 to 88.6% for migrant children aged 1-4 years (P < 0.001) and increased from 42.2 to 80.5% for migrant children aged 2-4 years (P < 0.001). The correct response rates on valid doses and management of adverse events among vaccinators were over 90% after training. The correct response rates on immunization among mothers of migrant children were 86.8-99.3% after interventions. CONCLUSION Our study showed a substantial improvement in vaccination coverage among migrant children in Yiwu after implementation of the EPI intervention package. Further studies are needed to evaluate the cost-effectiveness of the interventions, to identify individual interventions that make the biggest contribution to coverage, and to examine the sustainability of the interventions within the existing vaccination service delivery system in a larger scale settings or in a longer term.
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Affiliation(s)
- Yu Hu
- Zhejiang Center for Disease Control and Prevention, Institute of Immunization and Prevention, No. 3399 Binsheng Road, Binjiang District, Hangzhou, P. R. China.
| | - Shuying Luo
- Yiwu Center for Disease Control and Prevention, Institute of Immunization and Prevention, Yiwu, China.
| | - Xuewen Tang
- Zhejiang Center for Disease Control and Prevention, Institute of Immunization and Prevention, No. 3399 Binsheng Road, Binjiang District, Hangzhou, P. R. China.
| | - Linqiao Lou
- Yiwu Center for Disease Control and Prevention, Institute of Immunization and Prevention, Yiwu, China.
| | - Yaping Chen
- Zhejiang Center for Disease Control and Prevention, Institute of Immunization and Prevention, No. 3399 Binsheng Road, Binjiang District, Hangzhou, P. R. China.
| | - Jing Guo
- Zhejiang Center for Disease Control and Prevention, Institute of Immunization and Prevention, No. 3399 Binsheng Road, Binjiang District, Hangzhou, P. R. China.
| | - Bing Zhang
- Zhejiang Center for Disease Control and Prevention, Institute of Immunization and Prevention, No. 3399 Binsheng Road, Binjiang District, Hangzhou, P. R. China.
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Costs of routine immunization services in Moldova: Findings of a facility-based costing study. Vaccine 2015; 33 Suppl 1:A60-5. [DOI: 10.1016/j.vaccine.2014.12.034] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 12/05/2014] [Accepted: 12/08/2014] [Indexed: 11/20/2022]
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Dwumoh D, Essuman EE, Afagbedzi SK. Determinant of factors associated with child health outcomes and service utilization in Ghana: multiple indicator cluster survey conducted in 2011. ACTA ACUST UNITED AC 2014; 72:42. [PMID: 25810910 PMCID: PMC4373068 DOI: 10.1186/2049-3258-72-42] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 08/27/2014] [Indexed: 11/10/2022]
Abstract
Background The effects of National Health Insurance Scheme in Ghana and its impact on child health outcome and service utilization cannot be underestimated. Despite the tremendous improvement in child health care in Ghana, there are still some challenges in relation to how National health insurance membership, socioeconomic status and other demographic factors impacts on child health outcomes. The study seeks to determine the association between NHIS membership, socio-economic status, geographic location and other relevant background factors, on child health service utilization and outcomes. Methods Secondary data from the Multiple Indicator Cluster Survey conducted in 2011 was used. Multivariate analysis based on Binary Logistic Regression Models and Multiple linear regression techniques was applied to determine factors associated with child health outcomes and service utilization. Collection of best models was based on Hosmer-Lemeshow Goodness-Of-Fit as one criterion of fit and the Akaike Information Criterion. Results Controlling for confounding effect of socioeconomic status, age of the child, mothers education level and geographic location, the odds of a child developing anemia for children with National Health Insurance Scheme Membership is 65.2% [95% CI: 52.9-80.2] times less than children without National Health Insurance Scheme Membership. The odds of being fully immunized against common childhood illnesses for children with NHIS membership is 2.3[95% CI: 1.4-3.7] times higher than children without National Health Insurance Scheme Membership. There was no association between National Health Insurance Scheme Membership and stunted growth in children. Conclusions National Health Insurance Scheme Membership was found to be related to child health service utilization (full immunization) of children under five a child’s anemia status. Children with NHIS are more likely to be fully immunized against common childhood diseases and are less likely to develop anemia. Stunted growth of children was not associated with National Health Insurance Scheme Membership. Health Education on the registration and the use of the National Health Insurance should be made a national priority to enable the Ministry of Health achieve routine Immunization targets and to reduce to the bearers minimum prevalence of anemia.
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Affiliation(s)
- Duah Dwumoh
- Department of Biostatistics, School of Public Health University of Ghana, Legon, Ghana
| | - Edward Eyipe Essuman
- Department of Biological Environmental and Occupational Health Sciences, School of Public Health, University of Ghana, Legon, Ghana
| | - Seth Kwaku Afagbedzi
- Department of Biostatistics, School of Public Health University of Ghana, Legon, Ghana
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Mohamud AN, Feleke A, Worku W, Kifle M, Sharma HR. Immunization coverage of 12-23 months old children and associated factors in Jigjiga District, Somali National Regional State, Ethiopia. BMC Public Health 2014; 14:865. [PMID: 25146502 PMCID: PMC4158082 DOI: 10.1186/1471-2458-14-865] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 08/18/2014] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Immunization coverage in Ethiopia is less than the herd immunity level desired to prevent the spread of eight target diseases targeted by the World Health Organization's Expanded Program of Immunization. In particular, the Somali region of the country still has by far the lowest level of immunization coverage. The objective of this study was to measure the immunization coverage of 12-23 months old children and associated factors in the urban and rural areas of Jigjiga district. METHODS A community based cross-sectional survey was conducted in 582 households with 12-23 months old children in two urban and four rural wards. The data were collected from mothers or caregivers through interviews based on pre-tested and structured questionnaires and from the review of vaccination cards. Data were processed using SPSS version 16. To identify factors associated with the immunization status of children, bivariate and multiple logistic regression analyses were worked out and the Hoshmer and Lemeshow's goodness-of-fit was used to assess the fitness of multiple logistic regression model. RESULTS Three-fourth (74.6%) of the children surveyed were ever vaccinated, whereas 36.6% were fully vaccinated. The immunization coverage rate from card assessment for Bacillus Calmette-Guérin was 41.8%, while for Oral Polio Vaccine Zero, Oral Polio Vaccine One /Pentavalent1, Oral Polio Vaccine Two /Pentavalent2, Oral Polio Vaccine Three /Pentavalent3, and measles were 10.4%, 41.1%, 33.9%, 27.5%, and 24.9%, respectively. Maternal literacy (AOR = 3.06, 95% CI = 1.64, 5.71), Tetanus Toxoid Vaccine (AOR = 2.43, 95% CI = 1.56, 3.77), place of delivery (AOR = 2.02, 95% CI = 1.24, 3.28), place of residence (AOR = 2.04, 95% CI = 1.33, 3.13), and household visits by health workers (AOR = 1.92, 95% CI = 1.17, 3.16), were found to be factors significantly associated with full immunization in the multivariate logistic regression analysis. CONCLUSIONS The overall immunization coverage was found to be low. Hence, to increase the immunization coverage and reduce the incidences of missed opportunity, delivery in the health institution should be promoted, the outreach activities of the health institutions should be strengthened and greater utilization of health services by mothers should be encouraged.
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Affiliation(s)
- Abdi Nur Mohamud
- />Jigjiga Health Science College, Somali National Regional State, Jigjiga, Ethiopia
| | - Amsalu Feleke
- />Health Service Management and Health Economics Department, College of Medicine and Health Science, University of Gondar, PO Box No. 196, Gondar, Ethiopia
| | - Walelegn Worku
- />Department of Environmental and Occupational Health and Safety, College of Medicine and Health Science, University of Gondar, PO Box No. 196, Gondar, Ethiopia
| | - Manay Kifle
- />Department of Environmental and Occupational Health and Safety, College of Medicine and Health Science, University of Gondar, PO Box No. 196, Gondar, Ethiopia
| | - Hardeep Rai Sharma
- />Institute of Environmental Studies, Kurukshetra University, Kurukshetra, Haryana India
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Hu Y, Chen Y, Guo J, Tang X, Shen L. Completeness and timeliness of vaccination and determinants for low and late uptake among young children in eastern China. Hum Vaccin Immunother 2014; 10:1408-15. [PMID: 24584000 DOI: 10.4161/hv.28054] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND We studied completeness and timeliness of vaccination and determinants for low and delayed uptake in children born between 2008 and 2009 in Zhejiang province in eastern China. METHODS We used data from a cross-sectional cluster survey conducted in 2011, which included 1146 children born from 1 Jan 2008 to 31 Dec 2009. Various vaccination history, social-demographic factors, attitude and satisfaction toward immunization from caregivers were collected by a standard questionnaire. We restricted to the third dose of HepB, PV, and DPT (HepB3, PV3, and DPT3) as outcome variables for completeness of vaccination and restricted to the first dose of HepB, PV, DPT, and MCV(HepB1, PV1, DPT1, and MCV1) as outcome variables for timeliness of vaccination. The χ(2) test and logistic regression analysis were applied to identify the determinants of completeness and timeliness of vaccination. Survival analysis by the Kaplan-Meier method was performed to present the timeliness vaccination. RESULTS Coverage for HepB1, HepB3, PV1, PV3, DPT1, DPT3, and MCV1 was 93.22%, 90.15%, 96.42%, 91.63%, 95.80%, 90.16%, and 92.70%, respectively. Timely vaccination occurred in 501/1146(43.72%) children for HepB1, 520/1146(45.38%) for PV1, 511/1146(44.59%) for DPT1, and 679/1146(59.25%) for MCV1. Completeness of specific vaccines was associated with mother' age, immigration status, birth place of child, maternal education level, maternal occupation status, socio-economic development level of surveyed areas, satisfaction toward immunization service and distance of the house to immunization clinic. Timeliness of vaccination for specific vaccines was associated with mother' age, maternal education level, immigration status, siblings, birth place, and distance of the house to immunization clinic. CONCLUSION Despite reasonably high vaccination coverage, we observed substantial vaccination delays. We found specific factors associated with low and/or delayed vaccine uptake. These findings can help to improve strategies such as Reaching Every District (RED), out-reach vaccination services and health education to reach children who remain inadequately protected.
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Affiliation(s)
- Yu Hu
- Institute of Immunization and Prevention; Zhejiang Center for Disease Control and Prevention; Hangzhou, PR China
| | - Yaping Chen
- Institute of Immunization and Prevention; Zhejiang Center for Disease Control and Prevention; Hangzhou, PR China
| | - Jing Guo
- Institute of Immunization and Prevention; Zhejiang Center for Disease Control and Prevention; Hangzhou, PR China
| | - Xuewen Tang
- Institute of Immunization and Prevention; Zhejiang Center for Disease Control and Prevention; Hangzhou, PR China
| | - Lingzhi Shen
- Institute of Immunization and Prevention; Zhejiang Center for Disease Control and Prevention; Hangzhou, PR China
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Adams AM, Rabbani A, Ahmed S, Mahmood SS, Al-Sabir A, Rashid SF, Evans TG. Explaining equity gains in child survival in Bangladesh: scale, speed, and selectivity in health and development. Lancet 2013; 382:2027-37. [PMID: 24268604 DOI: 10.1016/s0140-6736(13)62060-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
By disaggregating gains in child health in Bangladesh over the past several decades, significant improvements in gender and socioeconomic inequities have been revealed. With the use of a social determinants of health approach, key features of the country's development experience can be identified that help explain its unexpected health trajectory. The systematic equity orientation of health and socioeconomic development in Bangladesh, and the implementation attributes of scale, speed, and selectivity, have been important drivers of health improvement. Despite this impressive pro-equity trajectory, there remain significant residual inequities in survival of girls and lower wealth quintiles as well as a host of new health and development challenges such as urbanisation, chronic disease, and climate change. Further progress in sustaining and enhancing equity-oriented achievements in health hinges on stronger governance and longer-term systems thinking regarding how to effectively promote inclusive and equitable development within and beyond the health system.
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Affiliation(s)
- Alayne M Adams
- Centre for Equity and Health Systems, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
| | - Atonu Rabbani
- Department of Economics, University of Dhaka, Dhaka, Bangladesh
| | | | - Shehrin Shaila Mahmood
- Centre for Equity and Health Systems, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ahmed Al-Sabir
- National Institute of Population Research and Training (NIPORT), Dhaka, Bangladesh
| | - Sabina F Rashid
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
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El Arifeen S, Christou A, Reichenbach L, Osman FA, Azad K, Islam KS, Ahmed F, Perry HB, Peters DH. Community-based approaches and partnerships: innovations in health-service delivery in Bangladesh. Lancet 2013; 382:2012-26. [PMID: 24268607 DOI: 10.1016/s0140-6736(13)62149-2] [Citation(s) in RCA: 130] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In Bangladesh, rapid advancements in coverage of many health interventions have coincided with impressive reductions in fertility and rates of maternal, infant, and childhood mortality. These advances, which have taken place despite such challenges as widespread poverty, political instability, and frequent natural disasters, warrant careful analysis of Bangladesh's approach to health-service delivery in the past four decades. With reference to success stories, we explore strategies in health-service delivery that have maximised reach and improved health outcomes. We identify three distinctive features that have enabled Bangladesh to improve health-service coverage and health outcomes: (1) experimentation with, and widespread application of, large-scale community-based approaches, especially investment in community health workers using a doorstep delivery approach; (2) experimentation with informal and contractual partnership arrangements that capitalise on the ability of non-governmental organisations to generate community trust, reach the most deprived populations, and address service gaps; and (3) rapid adoption of context-specific innovative technologies and policies that identify country-specific systems and mechanisms. Continued development of innovative, community-based strategies of health-service delivery, and adaptation of new technologies, are needed to address neglected and emerging health challenges, such as increasing access to skilled birth attendance, improvement of coverage of antenatal care and of nutritional status, the effects of climate change, and chronic disease. Past experience should guide future efforts to address rising public health concerns for Bangladesh and other underdeveloped countries.
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Affiliation(s)
- Shams El Arifeen
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Aliki Christou
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Laura Reichenbach
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
| | | | - Kishwar Azad
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | | | | | - Henry B Perry
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - David H Peters
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Abstract
Rapid urbanisation in the 20th century has been accompanied by the development of slums. Nearly one-third of the world's population and more than 60% of urban populations in the least developed countries live in slums, including hundreds of millions of children. Slums are areas of broad social and health disadvantage to children and their families due to extreme poverty, overcrowding, poor water and sanitation, substandard housing, limited access to basic health and education services, and other hardships (eg, high unemployment, violence). Despite the magnitude of this problem, very little is known about the potential impact of slum life on the health of children and adolescents. Statistics that show improved mortality and health outcomes in cities are based on aggregated data and may miss important intraurban disparities. Limited but consistent evidence suggests higher infant and under-five years mortality for children residing in slums compared with non-slum areas. Children suffer from higher rates of diarrhoeal and respiratory illness, malnutrition and have lower vaccination rates. Mothers residing in slums are more poorly educated and less likely to receive antenatal care and skilled birth assistance. Adolescents have earlier sexual debut and higher rates of HIV, and adopt risky behaviours influenced by their social environment. We also know little about the consequences of this form of early childhood on long-term health-related behaviour (eg, diet and exercise) and non-communicable disease outcomes, such as obesity, heart disease and mental illness. Further attention to understanding and addressing child health in slum settings is an important priority for paediatricians and those committed to child health worldwide.
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Payne S, Townend J, Jasseh M, Lowe Jallow Y, Kampmann B. Achieving comprehensive childhood immunization: an analysis of obstacles and opportunities in The Gambia. Health Policy Plan 2013; 29:193-203. [PMID: 23426974 PMCID: PMC3944881 DOI: 10.1093/heapol/czt004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction Immunization is a vital component in the drive to decrease global childhood mortality, yet challenges remain in ensuring wide coverage of immunization and full immunization, particularly in low- and middle-income countries. This study assessed immunization coverage and the determinants of immunization in a semi-rural area in The Gambia. Methods Data were drawn from the Farafenni Health and Demographic Surveillance System. Children born within the surveillance area between January 2000 and December 2010 were included. Main outcomes assessed included measles, BCG and DTP vaccination status and full immunization by 12 months of age as reported on child healthcards. Predictor variables were evaluated based on a literature review and included gender, ethnicity, area of residence, household wealth and mother’s age. Results Of the 7363 children included in the study, immunization coverage was 73% (CI 72–74) for measles, 86% (CI 86–87) for BCG, 79% (CI 78–80) for three doses of DTP and 52% (CI 51–53) for full immunization. Coverage was significantly associated with area of residence and ethnicity, with children in urban areas and of Mandinka ethnicity being least likely to be fully immunized. Conclusions Despite high levels of coverage of many individual vaccines, delivery of vaccinations later in the schedule and achieving high coverage of full immunization remain challenges, even in a country with a committed childhood immunization programme, such as The Gambia. Our data indicate areas for targeted interventions by the national Expanded Programme of Immunization.
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Affiliation(s)
- Sarah Payne
- Department of Public Health, University of Oxford, Room 106, Rosemary Rue Building, Old Road Campus, Headington, Oxford OX3 7LG, UK. E-mail:
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Siddiqui NT, Owais A, Agha A, Karim MS, Zaidi AKM. Ethnic Disparities in Routine Immunization Coverage. Asia Pac J Public Health 2013; 26:67-76. [DOI: 10.1177/1010539513475648] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Karachi is the only mega city in the world with persistent poliovirus transmission. We determined routine childhood immunization rates in Karachi and identified predictors of vaccine completion. A population-based cross-sectional survey was conducted in Karachi between August and September 2008. Data on demographics, socioeconomic, and DTP3 vaccination status in children 12 to 23 months old were collected. Logistic regression was used to identify predictors of vaccination completion. Overall, 1401 participants were approached; 1391 consented to participate. Of these, 1038 (75%) were completely vaccinated. Punjabi families had the highest DTP3 coverage (82%), followed by Urdu-speaking families (79%). Pashtun (67%) and Bengali (48%) families had the lowest vaccine coverage. Children of mothers with ≥12 years of schooling (OR = 25.4; 95% CI = 5.7-113.1) were most likely to be vaccinated. A quarter of study participants were unvaccinated. Targeted strategies for boosting DTP3 rates in communities with low immunization coverage are essential for polio eradication in Karachi.
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Jacobs B, Lindelow M, Xayyavong P, Sackett P. Building on community outreach for childhood vaccination to deliver maternal and child health services in Laos: a feasibility assessment. REPRODUCTIVE HEALTH MATTERS 2012; 20:112-21. [DOI: 10.1016/s0968-8080(12)40649-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Kawakatsu Y, Honda S. Individual-, family- and community-level determinants of full vaccination coverage among children aged 12–23 months in western Kenya. Vaccine 2012; 30:7588-93. [DOI: 10.1016/j.vaccine.2012.10.037] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Revised: 10/03/2012] [Accepted: 10/10/2012] [Indexed: 10/27/2022]
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Vikram K, Vanneman R, Desai S. Linkages between maternal education and childhood immunization in India. Soc Sci Med 2012; 75:331-9. [PMID: 22531572 PMCID: PMC3495071 DOI: 10.1016/j.socscimed.2012.02.043] [Citation(s) in RCA: 137] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Revised: 01/15/2012] [Accepted: 02/28/2012] [Indexed: 11/16/2022]
Abstract
While correlations between maternal education and child health have been observed in diverse parts of the world, the causal pathways explaining how maternal education improves child health remain far from clear. Using data from the nationally representative India Human Development Survey of 2004-5, this analysis examines four possible pathways that may mediate the influence of maternal education on childhood immunization: greater human, social, and cultural capitals and more autonomy within the household. Data from 5287 households in India show the familiar positive relationship between maternal education and childhood immunization even after extensive controls for socio-demographic characteristics and village- and neighborhood-fixed effects. Two pathways are important: human capital (health knowledge) is an especially important advantage for mothers with primary education, and cultural capital (communication skills) is important for mothers with some secondary education and beyond.
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Affiliation(s)
- Kriti Vikram
- Department of Sociology, 2112 Art-Sociology Building, University of Maryland, College Park, MD 20742, United States.
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Andrews-Chavez J, Biswas A, Gifford M, Eriksson C, Dalal K. Identifying households with low immunisation completion in Bangladesh. Health (London) 2012. [DOI: 10.4236/health.2012.411166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Kaewkungwal J, Singhasivanon P, Khamsiriwatchara A, Sawang S, Meankaew P, Wechsart A. Application of smart phone in "Better Border Healthcare Program": a module for mother and child care. BMC Med Inform Decis Mak 2010; 10:69. [PMID: 21047412 PMCID: PMC2989931 DOI: 10.1186/1472-6947-10-69] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2010] [Accepted: 11/03/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To assess the application of cell phone integrating into the healthcare system to improve antenatal care (ANC) and expanded programme on immunization (EPI) services for the under-served population in border area. METHODS A module combining web-based and mobile technology was developed to generate ANC/EPI visit schedule dates in which the healthcare personnel can cross-check, identify and update the mother's ANC and child's EPI status at the healthcare facility or at the household location when performing home visit; with additional feature of sending appointment reminder directly to the scheduled mother in the community. RESULTS The module improved ANC/EPI coverage in the study area along the country border including for both Thai and non-Thai mothers and children who were either permanent resident or migrants; numbers of ANC and EPI visit on-time as per schedule significantly increased; there was less delay of antenatal visits and immunizations. CONCLUSIONS The module integrated and functioned successfully as part of the healthcare system; it is proved for its feasibility and the extent to which community healthcare personnel in the low resource setting could efficiently utilize it to perform their duties.
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Affiliation(s)
- Jaranit Kaewkungwal
- Center of Excellence for Biomedical and Public Health Informatics (BIOPHICS) Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Rajavithi Campus, Mahidol University, Bangkok, Thailand
| | - Pratap Singhasivanon
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Rajavithi Campus, Mahidol University, Bangkok, Thailand
| | - Amnat Khamsiriwatchara
- Center of Excellence for Biomedical and Public Health Informatics (BIOPHICS) Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Surasak Sawang
- Center of Excellence for Biomedical and Public Health Informatics (BIOPHICS) Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Rajavithi Campus, Mahidol University, Bangkok, Thailand
| | - Pongthep Meankaew
- Center of Excellence for Biomedical and Public Health Informatics (BIOPHICS) Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Apisit Wechsart
- Tanowsri Health Center, Suan Phung, Ratchaburi Provincial Health Office. Ratchaburi, Thailand
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Kaseje D, Olayo R, Musita C, Oindo C, Wafula C, Muga R. Evidence-based dialogue with communities for district health systems' performance improvement. Glob Public Health 2010; 5:595-610. [DOI: 10.1080/17441690903418969] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Quaiyum MA, Gazi R, Khan AI, Uddin J, Islam M, Ahmed F, Saha NC. Programmatic aspects of dropouts in child vaccination in Bangladesh: findings from a prospective study. Asia Pac J Public Health 2010; 23:141-50. [PMID: 20566520 DOI: 10.1177/1010539509342119] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The present study investigated prospectively programmatic factors relating to dropouts in child vaccination in 6 subdistricts of Bangladesh. A cross-sectional survey (n = 2700) was conducted estimating overall coverage of immunization using cluster sampling. The eligible subsample of children (n = 1064) was followed up prospectively to understand reasons for dropouts. In-depth interviews (n = 73) with mothers/caregivers and service providers were done and EPI (Expanded Programme on Immunization) sessions were observed (n = 131). Irregular EPI sessions were the prime cause of dropouts particularly in low-performing subdistricts. The other programmatic factors linked with dropouts were (a) no reminder about subsequent session/doses, (b) unfriendly behavior or absence of vaccinator, ( c) refusal due to lost card or vaccine exhausted, and (d) short duration of sessions. Providers highlighted constraints such as financial problems for transportation, particularly in the hard-to-reach areas and vacancies of the posts of health assistants. The barriers to completing full schedules of vaccination can be removed to a large extent through programmatic adjustments.
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Affiliation(s)
- Md Abdul Quaiyum
- International Centre for Diarrhoeal Disease Research Bangladesh, Mohakhali, Dhaka, Bangladesh
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Community perceptions of bloody diarrhoea in an urban slum in South Asia: implications for introduction of a Shigella vaccine. Epidemiol Infect 2010; 139:599-605. [PMID: 20546637 DOI: 10.1017/s0950268810001391] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Understanding local perceptions of disease causation could help public health officials improve strategies to prevent bloody diarrhoea. A cross-sectional survey was conducted in Dhaka, Bangladesh to elicit community beliefs about the causes of and prevention strategies for bloody diarrhoea. Between March and June 2003, we interviewed 541 randomly selected respondents. Overall, 507 (93%) respondents perceived that a vaccine could prevent bloody diarrhoea. If a vaccine provided lifetime protection, 445 (83%) respondents stated that they would opt to get the vaccine and would pay a median of $0·05 (range U.S.$0·01-0·15) for it, equivalent to <1% of their median weekly income. There was almost universal perception that an effective vaccine to prevent bloody diarrhoea was highly beneficial and acceptable. While respondents valued a vaccine for prevention of bloody diarrhoea, they were only willing to pay minimally for it. Therefore, achieving a high rate of Shigella vaccine coverage may require subsidy of vaccine purchase.
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Uddin MJ, Koehlmoos TP, Saha NC, Khan IA, Shamsuzzaman. Child immunization coverage in rural hard-to-reach areas of Bangladesh. Vaccine 2010; 28:1221-5. [DOI: 10.1016/j.vaccine.2009.11.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2009] [Revised: 11/08/2009] [Accepted: 11/09/2009] [Indexed: 11/27/2022]
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Usman HR, Kristensen S, Rahbar MH, Vermund SH, Habib F, Chamot E. Determinants of third dose of diphtheria-tetanus-pertussis (DTP) completion among children who received DTP1 at rural immunization centres in Pakistan: a cohort study. Trop Med Int Health 2009; 15:140-7. [PMID: 19930140 DOI: 10.1111/j.1365-3156.2009.02432.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE In Pakistan, a high proportion of children fail to complete third dose of diphtheria-tetanus-pertussis (DTP3) after having received the first dose (DTP1). A cohort study was conducted to identify the factors predicting three doses of diphtheria-tetanus-pertussis (DTP3) completion among children who have received DTP1 at six centres of Expanded Programme on Immunization (EPI) in rural Pakistan. METHOD We analyzed a cohort of mother-child pairs enrolled at DTP1 between November 2005 and May 2006 in the standard care group of a larger randomized controlled trial. Data were collected from mothers on a structured questionnaire at enrollment, and each child was followed up at clinic visits for 90 days to record dates of DTP2 and DTP3. Multivariable log-binomial regression analysis was performed to identify the independent predictors of DTP3 completion. RESULTS Only 39% (149/378) of enrolled children completed DTP3 during the follow-up period. After adjusting for the centre of enrollment in multivariable analysis, DTP3 completion was higher among children who were < or =60 days old at enrolment [adjusted risk ratio (Adj. RR) 1.39, 95% confidence interval (CI): 1.06-1.82], who were living in a household with monthly household income >Rs. 3000 (US$ 50) (Adj. RR 1.76, 95% CI: 1.16-2.65), and who were living < or =10 min away from EPI centre (Adj. RR 1.31, 95% CI: 1.04-1.66). CONCLUSIONS Interventions targeting childhood immunization dropouts should focus on bringing more children to EPI centres on-time for initial immunization. Relocation of existing EPI centres and creation of new EPI centres at appropriate locations may decrease the travel time to the EPI centres and result in fewer immunization dropouts.
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Affiliation(s)
- Hussain R Usman
- Department of Epidemiology, University of Alabama at Birmingham, AL 35294-0022, USA.
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Haddad S, Bicaba A, Feletto M, Taminy E, Kabore M, Ouédraogo B, Contreras G, Larocque R, Fournier P. System-level determinants of immunization coverage disparities among health districts in Burkina Faso: a multiple case study. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2009; 9 Suppl 1:S15. [PMID: 19828059 PMCID: PMC3226234 DOI: 10.1186/1472-698x-9-s1-s15] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Background Despite rapid and tangible progress in vaccine coverage and in premature mortality rates registered in sub-Saharan Africa, inequities to access remain firmly entrenched, large pockets of low vaccination coverage persist, and coverage often varies considerably across regions, districts, and health facilities' areas of responsibility. This paper focuses on system-related factors that can explain disparities in immunization coverage among districts in Burkina Faso. Methods A multiple-case study was conducted of six districts representative of different immunization trends and overall performance. A participative process that involved local experts and key actors led to a focus on key factors that could possibly determine the efficiency and efficacy of district vaccination services: occurrence of disease outbreaks and immunization days, overall district management performance, resources available for vaccination services, and institutional elements. The methodology, geared toward reconstructing the evolution of vaccine services performance from 2000 to 2006, is based on data from documents and from individual and group interviews in each of the six health districts. The process of interpreting results brought together the field personnel and the research team. Results The districts that perform best are those that assemble a set of favourable conditions. However, the leadership of the district medical officer (DMO) appears to be the main conduit and the rallying point for these conditions. Typically, strong leadership that is recognized by the field teams ensures smooth operation of the vaccination services, promotes the emergence of new initiatives and offers some protection against risks related to outbreaks of epidemics or supplementary activities that can hinder routine functioning. The same is true for the ability of nurse managers and their teams to cope with new situations (epidemics, shortages of certain stocks). Conclusion The discourse on factors that determine the performance or breakdown of local health care systems in lower and middle income countries remains largely concentrated on technocratic and financial considerations, targeting institutional reforms, availability of resources, or accessibility of health services. The leadership role of those responsible for the district, and more broadly, of those we label "the human factor", in the performance of local health care systems is mentioned only marginally. This study shows that strong and committed leadership promotes an effective mobilization of teams and creates the conditions for good performance in districts, even when they have only limited access to supports provided by external partners. Abstract in French See the full article online for a translation of this abstract in French.
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Affiliation(s)
- Slim Haddad
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Canada.
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Which factors explain the decline in infant and child mortality in Matlab, Bangladesh? JOURNAL OF POPULATION RESEARCH 2009. [DOI: 10.1007/s12546-008-9003-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Uddin MJ, Larson CP, Oliveras E, Khan AI, Quaiyum MAMA, Chandra Saha N. Child Immunization Coverage in Rural Hard-to-Reach Haor Areas of Bangladesh: Possible Alternative Strategies. Asia Pac J Public Health 2008; 21:8-18. [DOI: 10.1177/1010539508327030] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article assessed the status of childhood vaccination coverage and the possibility of using selected alternative vaccination strategies in rural hard-to-reach haor (low lying) areas of Bangladesh. Data were collected through survey, in-depth interviews, group discussion, and observations of vaccination sessions. Complete immunization coverage among 12- to 23-month-old children was found to be significantly lower in study areas when compared with the national coverage levels. The study identified reasons for low complete immunization coverage in hard-to-reach areas, including irregular/cancelled extended program on immunization (EPI) sessions, less time spent in EPI spots by field staff, and absence of any alternative strategy for remote areas. The findings indicated that the existing service delivery strategy is not sufficient to improve immunization coverage in hard-to-reach areas. However, most of the strategies assessed are considered possible to implement by health care providers in hard-to-reach areas. The study suggested that before implementing alternative strategies in hard-to-reach areas, feasibility and effectiveness of the possible strategies need to be tested to identify evidence-based strategies.
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Affiliation(s)
- Md. Jasim Uddin
- Health Systems and Infectious Diseases Division, ICDDR,B,
Mohakhali, Dhaka, Bangladesh,
| | - Charles P. Larson
- Health Systems and Infectious Diseases Division, ICDDR,B,
Mohakhali, Dhaka, Bangladesh
| | - Elizabeth Oliveras
- Health Systems and Infectious Diseases Division, ICDDR,B,
Mohakhali, Dhaka, Bangladesh
| | - Azharul Islam Khan
- Health Systems and Infectious Diseases Division, ICDDR,B,
Mohakhali, Dhaka, Bangladesh
| | | | - Nirod Chandra Saha
- Health Systems and Infectious Diseases Division, ICDDR,B,
Mohakhali, Dhaka, Bangladesh
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Bondy JN, Thind A, Koval JJ, Speechley KN. Identifying the determinants of childhood immunization in the Philippines. Vaccine 2008; 27:169-75. [PMID: 18789997 DOI: 10.1016/j.vaccine.2008.08.042] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2008] [Revised: 08/22/2008] [Accepted: 08/22/2008] [Indexed: 11/26/2022]
Abstract
A key method of reducing morbidity and mortality is childhood immunization, yet in 2003 only 69% of Filipino children received all suggested vaccinations. Data from the 2003 Philippines Demographic Health Survey were used to identify risk factors for non- and partial-immunization. Results of the multinomial logistic regression analyses indicate that mothers who have less education, and who have not attended the minimally-recommended four antenatal visits are less likely to have fully immunized children. To increase immunization coverage in the Philippines, knowledge transfer to mothers must improve.
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Affiliation(s)
- Jennifer N Bondy
- Department of Epidemiology & Biostatistics, The University of Western Ontario, London, ON, Canada.
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Baqui AH, Rosecrans AM, Williams EK, Agrawal PK, Ahmed S, Darmstadt GL, Kumar V, Kiran U, Panwar D, Ahuja RC, Srivastava VK, Black RE, Santosham M. NGO facilitation of a government community-based maternal and neonatal health programme in rural India: improvements in equity. Health Policy Plan 2008; 23:234-43. [DOI: 10.1093/heapol/czn012] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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