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Saxenian H, Alkenbrack S, Freitas Attaran M, Barcarolo J, Brenzel L, Brooks A, Ekeman E, Griffiths UK, Rozario S, Vande Maele N, Ranson MK. Sustainable financing for Immunization Agenda 2030. Vaccine 2022:S0264-410X(22)01450-5. [PMID: 36464542 DOI: 10.1016/j.vaccine.2022.11.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/02/2022] [Accepted: 11/17/2022] [Indexed: 12/05/2022]
Abstract
Sustainable financing for immunization refers to the sufficient and predictable allocation and use of resources to support the achievement of immunization goals within the framework of overall health financing. The Immunization Agenda 2030 (IA2030) agenda spells out four important focus areas needed for sustainable financing: (1) ensuring sufficient and predictable resources, (2) making optimal use of resources, (3) aligning partnerships, and (4) supporting sustainable transitions from external assistance. This paper summarizes the evidence and proposes interventions under each area. While immunization is one of the best investments and justifies public financing, the COVID-19 pandemic has led to the worst economic recession since the Great Depression and threatens countries' ability to mobilize funding to ensure continuity and access to essential services, including immunization. Strategies for ensuring adequate resources differ by income group but include raising more revenues, reprioritizing the budget towards health, and ensuring that health resources favor Primary Health Care (PHC) and immunization. In low- and lower-middle income countries, support from Gavi, the Vaccine Alliance, which channels the largest amount of external financing, will remain important, but some lower-middle income countries will need to prepare for transition. Countries benefitting from the Global Polio Eradication Initiative (GPEI) are also experiencing a transition from GPEI financing to domestic and other external financing. This paper outlines ways in which countries can improve the use of domestic and external resources to better incentivize high-quality PHC and immunization services and align immunization programs with health sector reforms. While governments must lead, collective action from development partners, the private sector, and civil society is needed to promote health system financing systems that ensure that the world is better prepared for future outbreaks and pandemics, while reinforcing the IA2030 vision and making progress towards universal health coverage and the Sustainable Development Goals.
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Affiliation(s)
| | - S Alkenbrack
- World Bank Group, Health, Nutrition and Population Global Practice, Washington, D.C., United States
| | | | - J Barcarolo
- Gavi, The Vaccine Alliance, Geneva, Switzerland(1)
| | - L Brenzel
- Bill & Melinda Gates Foundation, Seattle, WA, United States
| | - A Brooks
- Bridges to Development, Geneva, Switzerland
| | - E Ekeman
- World Health Organization, Geneva, Switzerland
| | - U K Griffiths
- UNICEF Programme Division, New York City, NY, United States
| | - S Rozario
- UNICEF Programme Division, New York City, NY, United States
| | | | - M K Ranson
- World Bank Group, Health, Nutrition and Population Global Practice, Geneva, Switzerland
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Individual- and Neighborhood-Level Factors of Measles Vaccination Coverage in Niamey, Niger: A Multilevel Analysis. Vaccines (Basel) 2022; 10:vaccines10091513. [PMID: 36146591 PMCID: PMC9505597 DOI: 10.3390/vaccines10091513] [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: 07/30/2022] [Revised: 09/02/2022] [Accepted: 09/07/2022] [Indexed: 11/16/2022] Open
Abstract
Vaccination is a proven equitable intervention if people take advantage of the opportunity to get vaccinated. Niger is a low-income country in West Africa, with a 76% measles 1 vaccination coverage rate in 2016. This study was conducted to identify individual- and neighborhood-level factors that could improve measles 1 vaccination coverage in Niamey, the capital. In October 2016, 460 mothers with children aged 12-23 months were surveyed. The outcome was to determine whether the mother's child had been vaccinated against measles 1 or not. For individual-level variables of measles 1 vaccination status, the following were included: mother's age group, mother tongue, maternal education level, husband's job, where the mother gave birth (at home or at a health center) and whether the mother discussed vaccination with friends. Neighborhood-level factors were access time to the health center, household access to electricity, and a grand-mean-centered wealth score. Multilevel logistic regression analysis was performed. At the individual-level, primary and secondary-educated mothers were more likely to vaccinate their children against measles 1 (aOR 1.97, 95% CI 1.11-3.51). At the neighborhood-level, no factors were identified. Therefore, a strengthened focus on equity-based, individual factors is recommended, including individual motivation, prompts and ability to access vaccination services.
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Bianchi FP, Stefanizzi P, Trerotoli P, Tafuri S. Sex and age as determinants of the seroprevalence of anti-measles IgG among European healthcare workers: A systematic review and meta-analysis. Vaccine 2022; 40:3127-3141. [PMID: 35491343 DOI: 10.1016/j.vaccine.2022.04.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 03/14/2022] [Accepted: 04/04/2022] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The international literature shows good evidence of a significant rate of measles susceptibility among healthcare workers (HCWs). As such, they are an important public health issue. METHODS We conducted a systematic review and meta-analysis to estimate the prevalence of susceptible HCWs in EU/EEA countries and in the UK and to explore the characteristics (sex and age differences) and management of those found to be susceptible. RESULTS Nineteen studies were included in the meta-analysis. The prevalence of measles-susceptible HCWs was 13.3% (95 %CI: 10.0-17.0%). In a comparison of serosusceptible female vs. male HCWs, the RR was 0.92 (95 %CI = 0.83-1.03), and in a comparison of age classes (born after vs. before 1980) the RR was 2.78 (95 %CI = 2.20-3.50). The most recent studies proposed the mandatory vaccination of HCWs. DISCUSSION According to our meta-analysis, the prevalence of serosusceptible European HCWs is 13%; HCWs born in the post-vaccination era seem to be at higher risk. Healthcare professionals susceptible to measles are a serious epidemiological concern. Greater efforts should therefore be made to identify those who have yet to be vaccinated and actively encourage their vaccination.
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Affiliation(s)
| | - Pasquale Stefanizzi
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Italy
| | - Paolo Trerotoli
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Italy
| | - Silvio Tafuri
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Italy.
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Yemeke TT, Mitgang E, Wedlock PT, Higgins C, Chen HH, Pallas SW, Abimbola T, Wallace A, Bartsch SM, Lee BY, Ozawa S. Promoting, seeking, and reaching vaccination services: A systematic review of costs to immunization programs, beneficiaries, and caregivers. Vaccine 2021; 39:4437-4449. [PMID: 34218959 PMCID: PMC10711749 DOI: 10.1016/j.vaccine.2021.05.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 05/19/2021] [Accepted: 05/20/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Understanding the costs to increase vaccination demand among under-vaccinated populations, as well as costs incurred by beneficiaries and caregivers for reaching vaccination sites, is essential to improving vaccination coverage. However, there have not been systematic analyses documenting such costs for beneficiaries and caregivers seeking vaccination. METHODS We searched PubMed, Scopus, and the Immunization Delivery Cost Catalogue (IDCC) in 2019 for the costs for beneficiaries and caregivers to 1) seek and know how to access vaccination (i.e., costs to immunization programs for social mobilization and interventions to increase vaccination demand), 2) take time off from work, chores, or school for vaccination (i.e., productivity costs), and 3) travel to vaccination sites. We assessed if these costs were specific to populations that faced other non-cost barriers, based on a framework for defining hard-to-reach and hard-to-vaccinate populations for vaccination. RESULTS We found 57 studies describing information, education, and communication (IEC) costs, social mobilization costs, and the costs of interventions to increase vaccination demand, with mean costs per dose at $0.41 (standard deviation (SD) $0.83), $18.86 (SD $50.65) and $28.23 (SD $76.09) in low-, middle-, and high-income countries, respectively. Five studies described productivity losses incurred by beneficiaries and caregivers seeking vaccination ($38.33 per person; SD $14.72; n = 3). We identified six studies on travel costs incurred by beneficiaries and caregivers attending vaccination sites ($11.25 per person; SD $9.54; n = 4). Two studies reported social mobilization costs per dose specific to hard-to-reach populations, which were 2-3.5 times higher than costs for the general population. Eight studies described barriers to vaccination among hard-to-reach populations. CONCLUSION Social mobilization/IEC costs are well-characterized, but evidence is limited on costs incurred by beneficiaries and caregivers getting to vaccination sites. Understanding the potential incremental costs for populations facing barriers to reach vaccination sites is essential to improving vaccine program financing and planning.
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Affiliation(s)
- Tatenda T Yemeke
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Elizabeth Mitgang
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, NY 10027, USA
| | - Patrick T Wedlock
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, NY 10027, USA
| | - Colleen Higgins
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Hui-Han Chen
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Sarah W Pallas
- Global Immunization Division, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Taiwo Abimbola
- Global Immunization Division, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Aaron Wallace
- Global Immunization Division, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Sarah M Bartsch
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, NY 10027, USA
| | - Bruce Y Lee
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, NY 10027, USA
| | - Sachiko Ozawa
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA; Department of Maternal and Child Health, UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
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A systems map of the economic considerations for vaccination: Application to hard-to-reach populations. Vaccine 2021; 39:6796-6804. [PMID: 34045101 DOI: 10.1016/j.vaccine.2021.05.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 05/06/2021] [Accepted: 05/11/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Understanding the economics of vaccination is essential to developing immunization strategies that can be employed successfully with limited resources, especially when vaccinating populations that are hard-to-reach. METHODS Based on the input from interviews with 24 global experts on immunization economics, we developed a systems map of the mechanisms (i.e., necessary steps or components) involved in vaccination, and associated costs and benefits, focused at the service delivery level. We used this to identify the mechanisms that may be different for hard-to-reach populations. RESULTS The systems map shows different mechanisms that determine whether a person may or may not get vaccinated and the potential health and economic impacts of doing so. The map is divided into two parts: 1) the costs of vaccination, representing each of the mechanisms involved in getting vaccinated (n = 23 vaccination mechanisms), their associated direct vaccination costs (n = 18 vaccination costs), and opportunity costs (n = 5 opportunity costs), 2) the impact of vaccination, representing mechanisms after vaccine delivery (n = 13 impact mechanisms), their associated health effects (n = 10 health effects for beneficiary and others), and economic benefits (n = 13 immediate and secondary economic benefits and costs). Mechanisms that, when interrupted or delayed, can result in populations becoming hard-to-reach include getting vaccines and key stakeholders (e.g., beneficiaries/caregivers, vaccinators) to a vaccination site, as well as vaccine administration at the site. CONCLUSION Decision-makers can use this systems map to understand where steps in the vaccination process may be interrupted or weak and identify where gaps exist in the understanding of the economics of vaccination. With improved understanding of system-wide effects, this map can help decision-makers inform targeted interventions and policies to increase vaccination coverage in hard-to-reach populations.
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Byberg S, Aaby P, Rodrigues A, Stabell Benn C, Fisker AB. The mortality effects of disregarding the strategy to save doses of measles vaccine: a cluster-randomised trial in Guinea-Bissau. BMJ Glob Health 2021; 6:e004328. [PMID: 33941513 PMCID: PMC8098964 DOI: 10.1136/bmjgh-2020-004328] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 03/31/2021] [Accepted: 04/16/2021] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Measles vaccine (MV) may improve health beyond measles protection. To avoid wastage from multi-dose vials, children in Guinea-Bissau are only measles vaccinated when aged 9-11 months and when six or more children are present. We assessed health impacts of providing MV to all measles-unvaccinated children 9-35 months. METHODS We cluster-randomised 182 village clusters under demographic surveillance in rural Guinea-Bissau to an 'MV-for-all-policy' arm where we offered MV regardless of age and number of children present at our bi-annual village visits, or a 'Restrictive-MV-policy' arm where we followed national policy. Measles-unvaccinated children aged 9-35 months were eligible for enrolment and followed to 5 years of age. In intention-to-treat analyses, we compared mortality using Cox regression analyses with age as underlying timescale. The primary analysis was for children aged 12-35 months at eligibility assessment. Interactions with several background factors were explored. RESULTS Between 2011 and 2016, we followed 2778 children in the primary analysis. MV coverage by 3 years was 97% among children eligible for enrolment under the MV-for-all-policy, and 48% under the Restrictive-MV-policy. Mortality was 59% lower than anticipated and did not differ by trial arm (MV-for-all-policy: 45/1405: Restrictive-MV-policy: 44/1373; HR: 0.95 (95% CI 0.64 to 1.43)). The effect of MV-for-all changed over time: The HR was 0.53 (95% CI 0.27 to 1.07) during the first 1½ years of enrolment but 1.47 (95% CI 0.87 to 2.50) later (p=0.02, test of interaction). Explorative analyses indicated that the temporal change may be related to interactions with other childhood interventions. CONCLUSION The MV-for-all-policy increased MV coverage but had no overall effect on overall mortality. TRIAL REGISTRATION NUMBER NCT01306006.
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Affiliation(s)
- Stine Byberg
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Bandim Health Project, OPEN, University of Southern Denmark, Copenhagen, Denmark
- Research Center for Vitamins and Vaccines, Statens Serum Institut, Copenhagen, Denmark
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Peter Aaby
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Bandim Health Project, OPEN, University of Southern Denmark, Copenhagen, Denmark
- Research Center for Vitamins and Vaccines, Statens Serum Institut, Copenhagen, Denmark
| | | | - Christine Stabell Benn
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Bandim Health Project, OPEN, University of Southern Denmark, Copenhagen, Denmark
- Research Center for Vitamins and Vaccines, Statens Serum Institut, Copenhagen, Denmark
- Danish Institute for Advanced Study, University of Southern Denmark, Odense, Denmark
| | - Ane Baerent Fisker
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Bandim Health Project, OPEN, University of Southern Denmark, Copenhagen, Denmark
- Research Center for Vitamins and Vaccines, Statens Serum Institut, Copenhagen, Denmark
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Li AJ, Tabu C, Shendale S, Okoth PO, Sergon K, Maree E, Mugoya IK, Machekanyanga Z, Onuekwusi IU, Ogbuanu IU. Qualitative insights into reasons for missed opportunities for vaccination in Kenyan health facilities. PLoS One 2020; 15:e0230783. [PMID: 32226039 PMCID: PMC7105087 DOI: 10.1371/journal.pone.0230783] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 03/08/2020] [Indexed: 12/04/2022] Open
Abstract
Background In 2016, Kenya conducted a study of missed opportunities for vaccination (MOV)—when eligible children have contact with the health system but are not fully vaccinated—to explore some of the reasons for persistent low vaccination coverage. This paper details the qualitative findings from that assessment. Methods Using the World Health Organization MOV methodology, teams conducted focus group discussions among caregivers and health workers and in-depth interviews of key informants in 10 counties in Kenya. Caregivers of children <24 months of age visiting the selected health facilities on the day of the assessment were requested to participate in focus group discussions. Health workers were purposively sampled to capture a broad range of perspectives. Key informants were selected based on their perceived insight on immunization services at the county, sub-county, or health facility level. Results Six focus group discussions with caregivers, eight focus group discussions with health workers, and 35 in-depth interviews with key informants were completed. In general, caregivers had positive attitudes toward healthcare and vaccination services, but expressed a desire for increased education surrounding vaccination. In order to standardize vaccination checks at all health facility visits, health workers and key informants emphasized the need for additional trainings for all staff members on immunization. Health workers and key informants also highlighted the negative impact of significant understaffing in health facilities, and the persistent challenge of stock-outs of vaccines and vaccination-related supplies. Conclusions Identified factors that could contribute to MOV include a lack of knowledge surrounding vaccination among caregivers and health workers, inadequate number of health workers, and stock-outs of vaccines or vaccination-related materials. In addition, vaccination checks outside of vaccination visits lacked consistency, leading to MOV in non-vaccinating departments. Qualitative assessments could provide a starting point for understanding and developing interventions to address MOV in other countries.
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Affiliation(s)
- Anyie J. Li
- ASPPH/CDC Allan Rosenfield Global Health Fellowship and PHI/CDC Global Health Fellowship, Atlanta, GA, United States of America
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
- * E-mail:
| | - Collins Tabu
- National Vaccines and Immunization Program, Ministry of Health Kenya, Nairobi, Kenya
| | - Stephanie Shendale
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Headquarters, Geneva, Switzerland
| | | | - Kibet Sergon
- World Health Organization Kenya Country Office, Nairobi, Kenya
| | - Ephantus Maree
- National Vaccines and Immunization Program, Ministry of Health Kenya, Nairobi, Kenya
| | | | - Zorodzai Machekanyanga
- Inter-Country Support Team (IST)–East and Southern Africa, World Health Organization, Harare, Zimbabwe
| | | | - Ikechukwu Udo Ogbuanu
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Headquarters, Geneva, Switzerland
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Nkwenkeu SF, Jalloh MF, Walldorf JA, Zoma RL, Tarbangdo F, Fall S, Hien S, Combassere R, Ky C, Kambou L, Diallo AO, Krishnaswamy A, Aké FH, Hatcher C, Patel JC, Medah I, Novak RT, Hyde TB, Soeters HM, Mirza I. Health workers' perceptions and challenges in implementing meningococcal serogroup a conjugate vaccine in the routine childhood immunization schedule in Burkina Faso. BMC Public Health 2020; 20:254. [PMID: 32075630 PMCID: PMC7031928 DOI: 10.1186/s12889-020-8347-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 02/12/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Meningococcal serogroup A conjugate vaccine (MACV) was introduced in 2017 into the routine childhood immunization schedule (at 15-18 months of age) in Burkina Faso to help reduce meningococcal meningitis burden. MACV was scheduled to be co-administered with the second dose of measles-containing vaccine (MCV2), a vaccine already in the national schedule. One year following the introduction of MACV, an assessment was conducted to qualitatively examine health workers' perceptions of MACV introduction, identify barriers to uptake, and explore opportunities to improve coverage. METHODS Twelve in-depth interviews were conducted with different cadres of health workers in four purposively selected districts in Burkina Faso. Districts were selected to include urban and rural areas as well as high and low MCV2 coverage areas. Respondents included health workers at the following levels: regional health managers (n = 4), district health managers (n = 4), and frontline healthcare providers (n = 4). All interviews were recorded, transcribed, and thematically analyzed using qualitative content analysis. RESULTS Four themes emerged around supply and health systems barriers, demand-related barriers, specific challenges related to MACV and MCV2 co-administration, and motivations and efforts to improve vaccination coverage. Supply and health systems barriers included aging cold chain equipment, staff shortages, overworked and poorly trained staff, insufficient supplies and financial resources, and challenges with implementing community outreach activities. Health workers largely viewed MACV introduction as a source of motivation for caregivers to bring their children for the 15- to 18-month visit. However, they also pointed to demand barriers, including cultural practices that sometimes discourage vaccination, misconceptions about vaccines, and religious beliefs. Challenges in co-administering MACV and MCV2 were mainly related to reluctance among health workers to open multi-dose vials unless enough children were present to avoid wastage. CONCLUSIONS To improve effective administration of vaccines in the second-year of life, adequate operational and programmatic planning, training, communication, and monitoring are necessary. Moreover, clear policy communication is needed to help ensure that health workers do not refrain from opening multi-dose vials for small numbers of children.
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Affiliation(s)
| | - Mohamed F. Jalloh
- U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329 USA
| | - Jenny A. Walldorf
- U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329 USA
| | - Robert L. Zoma
- Institut National de Statistique et Démographie, Ouagadougou, Burkina Faso
| | | | - Soukeynatou Fall
- UNICEF Ouagadougou, 01 PO Box 3420, Ouagadougou 01, Burkina Faso
| | - Sansan Hien
- UNICEF Ouagadougou, 01 PO Box 3420, Ouagadougou 01, Burkina Faso
| | | | - Cesaire Ky
- Ministère de la Santé, Ouagadougou, Burkina Faso
| | | | | | | | | | - Cynthia Hatcher
- U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329 USA
| | - Jaymin C. Patel
- U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329 USA
| | - Isaïe Medah
- Ministère de la Santé, Ouagadougou, Burkina Faso
| | - Ryan T. Novak
- U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329 USA
| | - Terri B. Hyde
- U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329 USA
| | - Heidi M. Soeters
- U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329 USA
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Thysen SM, Byberg S, Martins JSD, Kallestrup P, Griffiths UK, Fisker AB. Household costs of seeking BCG vaccination in rural Guinea-Bissau. Vaccine 2019; 37:5505-5508. [PMID: 31405635 DOI: 10.1016/j.vaccine.2019.08.004] [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] [Received: 02/01/2019] [Revised: 07/26/2019] [Accepted: 08/02/2019] [Indexed: 10/26/2022]
Abstract
In Guinea-Bissau, a vial of BCG vaccine is often not opened unless 10 infants are present for vaccination, with the aim of reducing vaccine wastage. This causes delays in vaccination, as previously demonstrated in Guinea-Bissau and other low-income countries. Reducing wastage of BCG vaccine to save money may deprive infants of important health benefits and transfer costs from the vaccination programme to mothers. Using the Bandim Health Project's rural Health and Demographic Surveillance System, we interviewed mothers of infants aged 1-11 months about household costs of seeking BCG vaccination. On average mothers took their infant for BCG vaccination 1.26 times before obtaining the vaccine. For mothers who had sought BCG vaccine for their infants the average cost was 1.89 USD for each BCG-vaccinated infant. Among BCG-unvaccinated infants at the time of interview, 42% had brought their infant for BCG vaccination in vain at an average cost of 2.83 USD.
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Affiliation(s)
- Sanne M Thysen
- OPEN, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark; Bandim Health Project, Bissau, Guinea-Bissau; Research Centre for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark; Center for Global Health (GloHAU), Aarhus University, Aarhus, Denmark.
| | - Stine Byberg
- Bandim Health Project, Bissau, Guinea-Bissau; Research Centre for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
| | | | - Per Kallestrup
- Center for Global Health (GloHAU), Aarhus University, Aarhus, Denmark
| | - Ulla K Griffiths
- UNICEF, Health Section, Programme Division, New York, United States
| | - Ane B Fisker
- OPEN, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark; Bandim Health Project, Bissau, Guinea-Bissau; Research Centre for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
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Thysen SM, Fernandes M, Benn CS, Aaby P, Fisker AB. Cohort profile : Bandim Health Project's (BHP) rural Health and Demographic Surveillance System (HDSS)-a nationally representative HDSS in Guinea-Bissau. BMJ Open 2019; 9:e028775. [PMID: 31189684 PMCID: PMC6575866 DOI: 10.1136/bmjopen-2018-028775] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 03/25/2019] [Accepted: 05/15/2019] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Bandim Health Project (BHP) monitors health and survival of women and children in a nationally representative rural Health and Demographic Surveillance System (HDSS) in Guinea-Bissau. The HDSS was set up in 1989-1990 to collect data on health interventions and child mortality. PARTICIPANTS The HDSS covers 182 randomly selected clusters across the whole country. The cohort is open, and women and children enter the cohort, when they move into the selected clusters, and leave the cohort, when they move out or die, or when children reach 5 years of age. Data are collected through biannual or more frequent household visits. At all village visits, information on pregnancies, vital status, vaccination status, arm circumference, use of bed nets and other basic information is collected for women and children. Today, more than 25 000 women and 23 000 children below the age of 5 years are under surveillance. FINDINGS TO DATE Research from the BHP has given rise to the hypothesis that vaccines, in addition to their targeted effects, have important non-specific effects altering the susceptibility to other infections. Initially, it was observed that mortality among children vaccinated with the live BCG or measles vaccines was much lower than the mortality among unvaccinated children, a difference, which could not be explained by prevention of tuberculosis and measles infections. In contrast, mortality tended to be higher for children who had received the non-live Diphtheria-Tetanus-Pertussis vaccine compared with children who had not received this vaccine. Since the effect differed for the different vaccines, no bias explained the contrasting findings. FUTURE PLANS New health interventions are introduced with little assessment of real-life effects. Through the HDSS, we can describe both the implementation of interventions (eg, the vaccination programme) and their effects. Furthermore, the intensive follow-up allows the implementation of randomised trials testing potential better vaccination programmes.
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Affiliation(s)
- Sanne Marie Thysen
- OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Research Center for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
- Center for Global Health, Aarhus University, Aarhus, Denmark
| | | | - Christine Stabell Benn
- OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Research Center for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
| | - Peter Aaby
- OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
| | - Ane Bærent Fisker
- OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Research Center for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
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11
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Byberg S, Fisker AB, Thysen SM, Rodrigues A, Enemark U, Aaby P, Benn CS, Griffiths UK. Cost-effectiveness of providing measles vaccination to all children in Guinea-Bissau. Glob Health Action 2018; 10:1329968. [PMID: 28580855 PMCID: PMC5496167 DOI: 10.1080/16549716.2017.1329968] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background: Measles vaccination is associated with major reductions in child mortality and morbidity. In Guinea-Bissau, to limit vaccine wastage, children are only measles-vaccinated if at least six children aged 9–11 months are present at a vaccination session. Objective: To estimate the incremental cost-effectiveness of providing measles vaccine (MV) to all children regardless of age and number of children present. Methods: We estimated MV coverage among children living in villages cluster-randomized to MV for all children and among children cluster-randomized to the current restrictive MV policy (status quo). Prices of MV and injection equipment were obtained from the United Nations Children’s Fund (UNICEF). Cost savings of hospital admissions averted were collected from a sample of health facilities. The non-specific mortality effects of MV were estimated and presented as deaths averted and life years gained (LYG) from providing MV-for-all. Results: MV coverage at 36 months was 97% in MV-for-all clusters and 84% in restrictive MV policy clusters. Conservatively assuming 90% wastage of MV under the MV-for-all policy and 40% under the restrictive MV policy, cost per child vaccinated was USD 3.08 and USD 1.19, respectively. The incremental costs per LYG and death averted of the MV-for-all policy were USD 5.61 and USD 148, respectively. The MV-for-all policy became cost-saving at 88% wastage. Conclusions: Taking the low cost of MV and the beneficial non-specific effects of MV into consideration, a 10-dose MV vial should be reclassified as a ‘1+ dose vial’. The vial should be opened for a single child, irrespective of age, but can vaccinate up to 10 children.
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Affiliation(s)
- Stine Byberg
- a Bandim Health Project , Indepth Network , Bissau Codex , Guinea-Bissau.,b Research Center for Vitamins and Vaccines (CVIVA) , Statens Serum Institut , Copenhagen S , Denmark.,c OPEN, Odense Patient data Explorative Network , Odense University Hospital/Institute of Clinical Research, University of Southern Denmark , Odense , Denmark
| | - Ane Bærent Fisker
- a Bandim Health Project , Indepth Network , Bissau Codex , Guinea-Bissau.,b Research Center for Vitamins and Vaccines (CVIVA) , Statens Serum Institut , Copenhagen S , Denmark.,c OPEN, Odense Patient data Explorative Network , Odense University Hospital/Institute of Clinical Research, University of Southern Denmark , Odense , Denmark
| | - Sanne Marie Thysen
- a Bandim Health Project , Indepth Network , Bissau Codex , Guinea-Bissau.,b Research Center for Vitamins and Vaccines (CVIVA) , Statens Serum Institut , Copenhagen S , Denmark.,d Department of Public Health, Centre for Global Health , Aarhus University , Aarhus , Denmark
| | - Amabelia Rodrigues
- a Bandim Health Project , Indepth Network , Bissau Codex , Guinea-Bissau
| | - Ulrika Enemark
- d Department of Public Health, Centre for Global Health , Aarhus University , Aarhus , Denmark
| | - Peter Aaby
- a Bandim Health Project , Indepth Network , Bissau Codex , Guinea-Bissau.,b Research Center for Vitamins and Vaccines (CVIVA) , Statens Serum Institut , Copenhagen S , Denmark
| | - Christine Stabell Benn
- a Bandim Health Project , Indepth Network , Bissau Codex , Guinea-Bissau.,b Research Center for Vitamins and Vaccines (CVIVA) , Statens Serum Institut , Copenhagen S , Denmark.,c OPEN, Odense Patient data Explorative Network , Odense University Hospital/Institute of Clinical Research, University of Southern Denmark , Odense , Denmark
| | - Ulla Kou Griffiths
- e Department of Global Health and Development , London School of Hygiene and Tropical Medicine , London , UK
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12
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Enhancing immunization during second year of life by reducing missed opportunities for vaccinations in 46 countries. Vaccine 2018; 36:3260-3268. [PMID: 29731113 DOI: 10.1016/j.vaccine.2018.04.070] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 04/22/2018] [Accepted: 04/23/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Delivering vaccination services during the second year of life (2YL)1 provides countries with an opportunity to achieve greater coverage, to provide booster doses and vaccines missed during the first year of life, as well as contribute towards disease control and elimination goals. METHODS Using data from demographic health surveys (DHSs) conducted during 2010 to 2016, this paper explores the proportion of missed opportunities for vaccinations generally provided during routine immunization among children in their 2YL. RESULTS DHS data in 46 countries surveyed 478,737 children, from which 169,259 children were 12-23 months old and had vaccination/health cards viewed by surveyors. From this group, 69,489 children aged 12-23 months had contact with health services in their 2YL. Three scenarios for a missed opportunity for vaccinations were analysed: (1) a child received one vaccine in the immunization schedule and was eligible for another vaccine, but did not receive any further vaccination, (2) a child received a vitamin A supplementation (VAS) and was due for a vaccine, but did not receive vaccines that were due, and (3) a child was taken to a health facility for a sick visit and was due (and eligible) for a vaccine, but did not receive the vaccine. A total of 16,409 (24%) children had one or more missed opportunities for vaccinations. CONCLUSION This analysis highlights the magnitude of the problem of missed opportunities in the 2YL. The global community needs to provide better streamlined guidance, policies and strategies to promote vaccination screenings at well-child and sick child visits in the 2YL. Where they do not exist, well-child visits in the 2YL should be established and strengthened.
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13
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Olorunsaiye CZ, Langhamer MS, Wallace AS, Watkins ML. Missed opportunities and barriers for vaccination: a descriptive analysis of private and public health facilities in four African countries. Pan Afr Med J 2017; 27:6. [PMID: 29296141 PMCID: PMC5745949 DOI: 10.11604/pamj.supp.2017.27.3.12083] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 04/25/2017] [Indexed: 11/11/2022] Open
Abstract
Introduction Missed opportunities and barriers to vaccination limit progress toward achieving high immunization coverage and other global immunization goals. Little is known about vaccination practices contributing to missed opportunities and barriers among private healthcare providers in Africa. Methods Service Provision Assessments (SPA) of representative samples of health facilities in four African countries (Kenya, Tanzania, Senegal, Malawi) in 2010-2015 were used to describe missed opportunities and barriers for vaccination in public, private for-profit, private not-for-profit and faith-based facilities. Data included vaccination practices, observations during sick child and antenatal visits, and exit interviews following sick child visits. Results Data from 3,219 health facilities, 11,613 sick child visits and 8,698 antenatal visits were included. A smaller proportion of for-profit facilities offered child vaccination services (country range, 25-37%) than did public facilities (range, 90-96%). The proportion of facilities offering pentavalent vaccine (diphtheria, pertussis, tetanus, hepatitis B and Haemophilus influenza type b antigens) daily ranged 0-77% across countries and facility types. Less than 33% of for-profit facilities in any country offered measles vaccination daily. A minority of public or private providers assessed the child's vaccination status during a sick child visit (range by country and facility type, 14-44%), or offered tetanus toxoid during antenatal visits (range, 19-51%). Very few providers discussed the importance of newborn vaccination. Conclusion Substantial missed opportunities for, and barriers to, vaccination were identified across this representative sample of health facilities in four African countries. Strategies are needed to ensure that private and public providers implement practices to minimize barriers and missed opportunities for vaccination.
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Affiliation(s)
| | - Margaret Shaw Langhamer
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta 30329, GA, USA.,Emory University, Atlanta, GA, USA
| | - Aaron Stuart Wallace
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta 30329, GA, USA
| | - Margaret Lyons Watkins
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta 30329, GA, USA
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Kagoné M, Yé M, Nébié E, Sie A, Schoeps A, Becher H, Muller O, Fisker AB. Vaccination coverage and factors associated with adherence to the vaccination schedule in young children of a rural area in Burkina Faso. Glob Health Action 2017; 10:1399749. [PMID: 29185899 PMCID: PMC5800485 DOI: 10.1080/16549716.2017.1399749] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 10/30/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Vaccination is an important tool for reducing infectious disease morbidity and mortality. In the past, less than 80% of children 12-23 months of age were fully immunized in Burkina Faso. OBJECTIVES To describe coverage and assess factors associated with adherence to the vaccination schedule in rural area Burkina Faso. METHODS The study population was extracted from the Nouna Health and Demographic surveillance system cohort. Data from four rounds of interviews conducted between November 2012 and June 2014 were considered. This study included 4016 children aged 12-23 months. We assessed the effects of several background factors, including sex, factors reflecting access to health care (residence, place of birth), and maternal factors (age, education, marital status), on being fully immunized defined as having received Bacillus Calmette-Guérin (BCG), three doses of diphtheria-tetanus-pertussis and oral polio vaccine, and measles vaccine by 12 months of age. The associations were studied using binomial regression to derive prevalence ratios (PRs) in univariate and multivariate regression models. RESULTS The full vaccination coverage increased significantly over time (72% in 2012, 79% in 2013, and 81% in 2014, p = 0.003), and the coverage was significantly lower in urban than in rural areas (PR 0.84; 0.80-0.89). Vaccination coverage was neither influenced by sex nor influenced by place of birth or by maternal factors. CONCLUSION The study documented a further improvement in full vaccination coverage in Burkina Faso in recent years and better vaccination coverage in rural than in urban areas. The organization of healthcare systems with systematic outreach activities in the rural areas may explain the difference between rural and urban areas.
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Affiliation(s)
- Moubassira Kagoné
- Ministry of Health, Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
- Institute of Public Health, Medical School, Ruprecht-Karls-University, Heidelberg, Germany
| | - Maurice Yé
- Ministry of Health, Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | - Eric Nébié
- Ministry of Health, Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | - Ali Sie
- Ministry of Health, Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | - Anja Schoeps
- Institute of Public Health, Medical School, Ruprecht-Karls-University, Heidelberg, Germany
| | - Heiko Becher
- Institut für medizinische Biometrie und Epidemiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Olaf Muller
- Institute of Public Health, Medical School, Ruprecht-Karls-University, Heidelberg, Germany
| | - Ane Baerent Fisker
- Research Centre for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
- Bandim Health Project, Bissau, Guinea-Bissau
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