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Yemeke TT, McMillan S, Marciniak MW, Ozawa S. A systematic review of the role of pharmacists in vaccination services in low-and middle-income countries. Res Social Adm Pharm 2020; 17:300-306. [PMID: 32295736 DOI: 10.1016/j.sapharm.2020.03.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pharmacists' role in vaccination has expanded in some countries with pharmacists having greater authority to perform various immunization activities, from vaccine storage, vaccine adverse event reporting, vaccination education and advocacy, to vaccine administration. However, pharmacists' present involvement in vaccination services is poorly understood across low- and middle-income countries (LMICs). OBJECTIVE To identify and synthesize evidence on pharmacists' roles in offering vaccination services in LMICs. METHODS We searched three databases (PubMed, Embase, Scopus) and the gray literature to identify articles which described pharmacist involvement in vaccination services in LMICs. We abstracted data on reported roles of pharmacists in vaccination, as well as relevant country, vaccines, and populations served. RESULTS From the initial 612 records we identified, twenty-five (n = 25) studies representing 25 LMICs met our inclusion criteria. The most commonly reported role of pharmacists in vaccination across identified LMICs was vaccine advocacy and education (n = 15 countries). Pharmacist administered vaccination and storage of vaccines at pharmacies was reported in 8 countries. An additional 6 countries reported allowing vaccination at community pharmacies by other healthcare professionals. Immunization related training for pharmacists was reported or required in 8 countries. Fewer studies reported that pharmacists have access to patient immunization records in their respective LMICs (n = 6 countries) or had reported pharmacist involvement in vaccine adverse event reporting (n = 4 countries). CONCLUSIONS Pharmacists have the potential to play an important role in increasing access to vaccines and improving coverage, yet evidence of their role in vaccinations remains limited across LMICs. Greater documentation of pharmacists' involvement in vaccination services in LMICs is needed to demonstrate the value of successful integration of pharmacists in immunization programs.
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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 at Chapel Hill, Chapel Hill, NC, USA
| | - Stephen McMillan
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Macary Weck Marciniak
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sachiko Ozawa
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Maternal and Child Health, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Nandi A, Deolalikar AB, Bloom DE, Laxminarayan R. Haemophilus influenzae type b vaccination and anthropometric, cognitive, and schooling outcomes among Indian children. Ann N Y Acad Sci 2019; 1449:70-82. [PMID: 31180594 PMCID: PMC6852042 DOI: 10.1111/nyas.14127] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 04/25/2019] [Accepted: 05/03/2019] [Indexed: 11/29/2022]
Abstract
Haemophilus influenzae type b (Hib) affects 337,000 Indian children every year. A vaccine against Hib was introduced in 2011 as part of the pentavalent vaccine and scaled up nationwide. This study investigated the associations between Hib vaccination and child anthropometry, cognition, and schooling outcomes in India. We used longitudinal survey data and employed propensity score matching to control for observed systematic differences between children who reported receipt or nonreceipt of Hib vaccine before age 6 years (n = 1824). Z-scores of height-for-age (HAZ) and BMI-for-age (BMIZ), percentage scores of English, mathematics, reading, and Peabody Picture Vocabulary tests, and attained schooling grade of children were examined. Hib-vaccinated children had 0.25 higher HAZ, scored 4.09 percentage points (pp) higher on the English test and 4.78 pp higher on the mathematics test, and attained 0.16 more schooling grades than Hib-unvaccinated children at age 11-12 years. At age 14-15 years, they had 0.18 higher HAZ, scored 3.63 pp higher on the reading test and 3.22 pp higher on the mathematics test, and attained 0.15 more schooling grades than Hib-unvaccinated children. The findings indicate potential long-term health, cognitive, and schooling benefits of the Hib vaccine, subject to the effect of unobserved confounding factors.
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Affiliation(s)
- Arindam Nandi
- Center for Disease Dynamics, Economics and Policy, Washington, DC
| | - Anil B Deolalikar
- School of Public Policy and Department of Economics, University of California, Riverside, California
| | - David E Bloom
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Ramanan Laxminarayan
- Center for Disease Dynamics, Economics and Policy, New Delhi, India.,Princeton Environmental Institute, Princeton University, Princeton, New Jersey
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Prinja S, Bahuguna P, Duseja A, Kaur M, Chawla YK. Cost of Intensive Care Treatment for Liver Disorders at Tertiary Care Level in India. PHARMACOECONOMICS - OPEN 2018; 2:179-190. [PMID: 29623618 PMCID: PMC5972113 DOI: 10.1007/s41669-017-0041-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
BACKGROUND Liver diseases contribute significantly to the health and economic burden globally. We undertook this study to assess the health system costs, out-of-pocket (OOP) expenditure and extent of financial risk protection associated with treatment of liver disorders in a tertiary care public sector hospital in India. METHODOLOGY The present study was undertaken in an intensive care unit (ICU) of a tertiary care hospital in North India. It comprised an ICU and an HDU (high dependency unit). Bottom-up micro-costing was undertaken to assess the health system costs. Data on OOP expenditure and indirect costs were collected for 150 liver disorder patients admitted to the ICU or HDU from December 2013 to October 2014. Per-patient and per-bed-day costs of treatment were estimated from both health system and patient perspectives. Financial risk protection was assessed by computing prevalence of catastrophic health expenditure as a result of OOP expenditure. RESULTS In 2013-2014, health system costs per patient treated in the ICU and HDU were US$2728 [Indian National Rupee (INR) 1,63,664] and US$1966 (INR 1,17,985), respectively. The mean OOP expenditures for treatment in the ICU and HDU were US$2372 (INR 1,42,297) and US$1752 (INR 1,05,093), respectively. Indirect costs of hospitalization in ICU and HDU patients were US$166 (INR 9952) and US$182 (INR 10,903), respectively. CONCLUSION Treatment of chronic liver disorders poses an economic challenge for both the health system and patients. There is a need to focus on prevention of liver disorders, and finding ways to treat patients without exposing their households to the catastrophic effect of OOP expenditure.
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Affiliation(s)
- Shankar Prinja
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| | - Pankaj Bahuguna
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Ajay Duseja
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manmeet Kaur
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Yogesh Kumar Chawla
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Arya BK, Bhattacharya SD, Sutcliffe CG, Saha MK, Bhattacharyya S, Niyogi SK, Moss WJ, Panda S, Das RS, Mallick M, Mandal S. Immunogenicity and safety of two doses of catch-up immunization with Haemophilus influenzae type b conjugate vaccine in Indian children living with HIV. Vaccine 2016; 34:2267-74. [PMID: 26988256 DOI: 10.1016/j.vaccine.2016.03.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 02/01/2016] [Accepted: 03/04/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Children living with HIV are at increased risk of disease from Haemophilus influenzae type b (Hib). Data are limited on the immunogenicity of a two-dose, catch-up schedule for Hib conjugate vaccine (HibCV) among HIV-infected children accessing antiretroviral therapy (ART) late. OBJECTIVES The objectives of the study were to: (1) evaluate baseline immunity to Hib and the immunogenicity and safety of two doses of HibCV among HIV-infected Indian children; and (2) document the threshold antibody level required to prevent Hib colonization among HIV-infected children following immunization. METHODS We conducted a prospective cohort study among HIV-infected children 2-15 years of age and HIV-uninfected children 2-5 years of age. HIV-infected children received two doses of HibCV and uninfected children received one. Serum anti-Hib PRP IgG antibodies were measured at baseline and two months after immunization in the HIV-infected children. Nasopharyngeal (NP) swabs were collected at baseline and follow-up. RESULTS 125 HIV-infected and 44 uninfected children participated. 40% of HIV-infected children were receiving ART and 26% had a viral load >100,000 copies/mL. The geometric mean concentration of serum anti-Hib PRP antibody increased from 0.25 μg/mL at baseline to 2.65 μg/mL after two doses of HibCV, representing a 10.6-fold increase (p<0.0001). 76% percent of HIV-infected children mounted an immune response. Moderate or severe immune suppression, trimethoprim/sulfamethoxazole prophylaxis, and lower baseline antibody levels were associated with lower post-vaccine serum anti-Hib PRP IgG antibodies. A serum anti-Hib PRP IgG antibody level ≥ 3.3 μg/mL was protective against Hib NP colonization. There were no differences in adverse events between HIV-infected and uninfected children. CONCLUSION Including a catch-up immunization schedule for older HIV infected children in countries introducing Hib vaccines is important. Older HIV-infected children with delayed access to ART and without suppressed viral loads mounted an adequate immune response following two doses of HibCV.
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Affiliation(s)
- Bikas K Arya
- School of Medical Science and Technology, Indian Institute of Technology (IIT) - Kharagpur, India
| | | | - Catherine G Sutcliffe
- International Vaccine Access Center and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Malay K Saha
- National HIV Reference Laboratory/Division of Virology, National Institute of Cholera and Enteric Diseases (NICED)/Indian Council of Medical Research (ICMR)-Kolkata, India
| | | | - Swapan Kumar Niyogi
- Division of Bacteriology, National Institute of Cholera and Enteric Diseases (NICED)/Indian Council of Medical Research (ICMR)-Kolkata, India
| | - William J Moss
- International Vaccine Access Center and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Samiran Panda
- Division of Epidemiology, National Institute of Cholera and Enteric Diseases (NICED)/Indian Council of Medical Research (ICMR)-Kolkata, India
| | - Ranjan Saurav Das
- School of Medical Science and Technology, Indian Institute of Technology (IIT) - Kharagpur, India
| | - Mausom Mallick
- National HIV Reference Laboratory/Division of Virology, National Institute of Cholera and Enteric Diseases (NICED)/Indian Council of Medical Research (ICMR)-Kolkata, India
| | - Sutapa Mandal
- Division of Bacteriology, National Institute of Cholera and Enteric Diseases (NICED)/Indian Council of Medical Research (ICMR)-Kolkata, India
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Sharma A, Kaplan WA, Chokshi M, Zodpey SP. Role of the private sector in vaccination service delivery in India: evidence from private-sector vaccine sales data, 2009-12. Health Policy Plan 2016; 31:884-96. [PMID: 26976803 DOI: 10.1093/heapol/czw008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND India's Universal Immunization Programme (UIP) provides basic vaccines free-of-cost in the public sector, yet national vaccination coverage is poor. The Government of India has urged an expanded role for the private sector to help achieve universal immunization coverage. We conducted a state-by-state analysis of the role of the private sector in vaccinating Indian children against each of the six primary childhood diseases covered under India's UIP. METHODS We analyzed IMS Health data on Indian private-sector vaccine sales, 2011 Indian Census data and national household surveys (DHS/NFHS 2005-06 and UNICEF CES 2009) to estimate the percentage of vaccinated children among the 2009-12 birth cohort who received a given vaccine in the private sector in 16 Indian states. We also analyzed the estimated private-sector vaccine shares as function of state-specific socio-economic status. RESULTS Overall in 16 states, the private sector contributed 4.7% towards tuberculosis (Bacillus Calmette-Guérin (BCG)), 3.5% towards measles, 2.3% towards diphtheria-pertussis-tetanus (DPT3) and 7.6% towards polio (OPV3) overall (both public and private sectors) vaccination coverage. Certain low income states (Uttar Pradesh, Rajasthan, Madhya Pradesh, Orissa, Assam and Bihar) have low private as well as public sector vaccination coverage. The private sector's role has been limited primarily to the high income states as opposed to these low income states where the majority of Indian children live. Urban areas with good access to the private sector and the ability to pay increases the Indian population's willingness to access private-sector vaccination services. CONCLUSION In India, the public sector offers vaccination services to the majority of the population but the private sector should not be neglected as it could potentially improve overall vaccination coverage. The government could train and incentivize a wider range of private-sector health professionals to help deliver the vaccines, especially in the low income states with the largest birth cohorts. We recommend future studies to identify strengths and limitations of the public and private health sectors in each Indian state.
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Affiliation(s)
- Abhishek Sharma
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA Center for Global Health and Development, Boston University School of Public Health, Boston, MA, USA Precision for Value, Boston, MA, USA
| | - Warren A Kaplan
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA Center for Global Health and Development, Boston University School of Public Health, Boston, MA, USA
| | - Maulik Chokshi
- Indian Institute of Public Health, Public Health Foundation of India, New Delhi, India
| | - Sanjay P Zodpey
- Indian Institute of Public Health, Public Health Foundation of India, New Delhi, India
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