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Michael F, Mirambo MM, Lyimo D, Salehe A, Kyesi F, Msanga DR, Mahamba D, Nyawale H, Kwiyolecha E, Okamo B, Mwanyika PJ, Maghina V, Bendera E, Salehe M, Hokororo A, Mwipopo E, Khamis AC, Nyaki H, Magodi R, Mujuni D, Konje ET, Katembo B, Wilillo R, Mshana SE. Rotavirus genotype diversity in Tanzania during Rotavirus vaccine implementation between 2013 and 2018. Sci Rep 2023; 13:21795. [PMID: 38066194 PMCID: PMC10709589 DOI: 10.1038/s41598-023-49350-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 12/07/2023] [Indexed: 12/18/2023] Open
Abstract
The study aims to determine Rotavirus genotypes between 2013 and 2018 during implementation of ROTARIX vaccine in Tanzania. The analysis of surveillance data obtained between 2013 and 2018 was done to determine circulating genotypes after introduction of Rotarix vaccine. From 2013 to 2018, a total of 10,557 samples were collected and screened for Rotavirus using an enzyme immunoassay. A significant decrease in Rotavirus positivity (29.3% to 17.8%) from 2013 to 2018 (OR 0.830, 95% CI 0.803-0.857, P < 0.001) was observed. A total of 766 randomly selected Rotavirus positive samples were genotyped. Between 2013 and 2018, a total of 18 Rotavirus genotypes were detected with G1P [8] being the most prevalent. The G1P [8] strain was found to decrease from 72.3% in 2015 to 13.5% in 2018 while the G9P [4] strain increased from 1 to 67.7% in the same years. G2P [4] was found to decrease from 59.7% in 2013 to 6.8% in 2018 while G3P [6] decreased from 11.2% in 2014 to 4.1% in 2018. The data has clearly demonstrated that ROTARIX vaccine has provided protection to varieties of the wild-type Rotavirus strains. Continuous surveillance is needed to monitor the circulation of Rotavirus strains during this era of vaccine implementation.
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Affiliation(s)
- Fausta Michael
- Ministry of Health, Immunization and Vaccine Development Program, Dodoma, Tanzania
| | - Mariam M Mirambo
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania.
| | - Dafrossa Lyimo
- Ministry of Health, Immunization and Vaccine Development Program, Dodoma, Tanzania
| | - Abdul Salehe
- Ministry of Health, Immunization and Vaccine Development Program, Zanzibar, Tanzania
| | - Furaha Kyesi
- Ministry of Health, Immunization and Vaccine Development Program, Dodoma, Tanzania
| | - Delfina R Msanga
- Department of Paediatrics and Child Health, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Dina Mahamba
- Department of Pediatrics and Child Health, College of Health Sciences, University of Dodoma, P.O. Box 395, Dodoma, Tanzania
| | - Helmut Nyawale
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Elizabeth Kwiyolecha
- Department of Paediatrics and Child Health, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Bernard Okamo
- Department of Biochemistry and Molecular Biology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Paul J Mwanyika
- Department of Pediatrics and Child Health, Mbeya Zonal Referral Hospital, P.O. Box 419, Mbeya, Tanzania
| | - Victoria Maghina
- Department of Pediatrics and Child Health, Mbeya Zonal Referral Hospital, P.O. Box 419, Mbeya, Tanzania
| | - Elice Bendera
- Department of Pediatrics and Child Health, Muheza Designated District Hospital, Tanga, Tanzania
| | - Mohammed Salehe
- Department of Pediatrics and Child Health, Bombo Regional Referral Hospital, Tanga, Tanzania
| | - Adolfine Hokororo
- Department of Paediatrics and Child Health, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Ernestina Mwipopo
- Department of Pediatrics and Child Health, Mwananyamala Regional Referral Hospital, Dar es Salaam, Tanzania
| | - Asha C Khamis
- Department of Pediatrics and Child Health, Temeke Regional Referral Hospital, Dar es Salaam, Tanzania
| | - Honest Nyaki
- Ministry of Health, Immunization and Vaccine Development Program, Dodoma, Tanzania
| | - Richard Magodi
- Ministry of Health, Immunization and Vaccine Development Program, Dodoma, Tanzania
| | - Delphius Mujuni
- Ministry of Health, Immunization and Vaccine Development Program, Dodoma, Tanzania
| | - Eveline T Konje
- Department of Epidemiology and Biostatistics, School of Public Health, Catholic University of Health and Allied Sciences, P.O. Box 1464, Mwanza, Tanzania
| | - Betina Katembo
- National Public Health Laboratory, Dar es Salaam, Tanzania
| | - Ritha Wilillo
- World Health Organization, Country Office, Dar es Salaam, Tanzania
| | - Stephen E Mshana
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
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Michael F, Mirambo MM, Lyimo D, Kyesi F, Msanga DR, Joachim G, Nyaki H, Magodi R, Mujuni D, Tinuga F, Bulula N, Nestory B, Mongi D, Makuwani A, Katembo B, Mwengee W, Mphuru A, Mohamed N, Kayabu D, Nyawale H, Konje ET, Mshana SE. Reduction in Rubella Virus Active Cases among Children and Adolescents after Rubella Vaccine Implementation in Tanzania: A Call for Sustained High Vaccination Coverage. Vaccines (Basel) 2022; 10:vaccines10081188. [PMID: 35893837 PMCID: PMC9332844 DOI: 10.3390/vaccines10081188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/15/2022] [Accepted: 07/22/2022] [Indexed: 02/04/2023] Open
Abstract
Rubella virus (RV) infection in susceptible women during the first trimester of pregnancy is associated with congenital Rubella syndrome (CRS). In countries where a vaccination program is implemented, active case surveillance is emphasized. This report documents the magnitude of active cases before and after vaccine implementation in Tanzania. A total of 8750 children and adolescents with signs and symptoms of RV infection were tested for Rubella IgM antibodies between 2013 and 2019 using enzyme immunoassay followed by descriptive analysis. The median age of participants was 3.8 (IQR: 2−6.4) years. About half (4867; 55.6%) of the participants were aged 1−5 years. The prevalence of RV active cases was 534 (32.6%, 95% CI: 30.2−34.9) and 219 (3.2%, 95% CI: 2.7−3.6) before and after vaccine implementation, respectively. Before vaccination, the highest prevalence was recorded in Pemba (78.6%) and the lowest was reported in Geita (15.6%), whereas, after vaccination, the prevalence ranged between 0.5% in Iringa and 6.5% in Pemba. Overall, >50% of the regions had a >90% reduction in active cases. The significant reduction in active cases after vaccine implementation in Tanzania underscores the need to sustain high vaccination coverage to prevent active infections and eventually eliminate CRS, which is the main goal of Rubella vaccine implementation.
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Affiliation(s)
- Fausta Michael
- Ministry of Health, Immunization and Vaccine Development Program, Dodoma P.O. Box 743, Tanzania; (F.M.); (D.L.); (F.K.); (G.J.); (H.N.); (R.M.); (D.M.); (F.T.); (N.B.); (B.N.); (D.M.); (A.M.)
| | - Mariam M. Mirambo
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania; (H.N.); (S.E.M.)
- Correspondence:
| | - Dafrossa Lyimo
- Ministry of Health, Immunization and Vaccine Development Program, Dodoma P.O. Box 743, Tanzania; (F.M.); (D.L.); (F.K.); (G.J.); (H.N.); (R.M.); (D.M.); (F.T.); (N.B.); (B.N.); (D.M.); (A.M.)
| | - Furaha Kyesi
- Ministry of Health, Immunization and Vaccine Development Program, Dodoma P.O. Box 743, Tanzania; (F.M.); (D.L.); (F.K.); (G.J.); (H.N.); (R.M.); (D.M.); (F.T.); (N.B.); (B.N.); (D.M.); (A.M.)
| | - Delfina R. Msanga
- Department of Pediatrics and Child Health, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania;
| | - Georgina Joachim
- Ministry of Health, Immunization and Vaccine Development Program, Dodoma P.O. Box 743, Tanzania; (F.M.); (D.L.); (F.K.); (G.J.); (H.N.); (R.M.); (D.M.); (F.T.); (N.B.); (B.N.); (D.M.); (A.M.)
| | - Honest Nyaki
- Ministry of Health, Immunization and Vaccine Development Program, Dodoma P.O. Box 743, Tanzania; (F.M.); (D.L.); (F.K.); (G.J.); (H.N.); (R.M.); (D.M.); (F.T.); (N.B.); (B.N.); (D.M.); (A.M.)
| | - Richard Magodi
- Ministry of Health, Immunization and Vaccine Development Program, Dodoma P.O. Box 743, Tanzania; (F.M.); (D.L.); (F.K.); (G.J.); (H.N.); (R.M.); (D.M.); (F.T.); (N.B.); (B.N.); (D.M.); (A.M.)
| | - Delphius Mujuni
- Ministry of Health, Immunization and Vaccine Development Program, Dodoma P.O. Box 743, Tanzania; (F.M.); (D.L.); (F.K.); (G.J.); (H.N.); (R.M.); (D.M.); (F.T.); (N.B.); (B.N.); (D.M.); (A.M.)
| | - Florian Tinuga
- Ministry of Health, Immunization and Vaccine Development Program, Dodoma P.O. Box 743, Tanzania; (F.M.); (D.L.); (F.K.); (G.J.); (H.N.); (R.M.); (D.M.); (F.T.); (N.B.); (B.N.); (D.M.); (A.M.)
| | - Ngwegwe Bulula
- Ministry of Health, Immunization and Vaccine Development Program, Dodoma P.O. Box 743, Tanzania; (F.M.); (D.L.); (F.K.); (G.J.); (H.N.); (R.M.); (D.M.); (F.T.); (N.B.); (B.N.); (D.M.); (A.M.)
| | - Bonaventura Nestory
- Ministry of Health, Immunization and Vaccine Development Program, Dodoma P.O. Box 743, Tanzania; (F.M.); (D.L.); (F.K.); (G.J.); (H.N.); (R.M.); (D.M.); (F.T.); (N.B.); (B.N.); (D.M.); (A.M.)
| | - Dhamira Mongi
- Ministry of Health, Immunization and Vaccine Development Program, Dodoma P.O. Box 743, Tanzania; (F.M.); (D.L.); (F.K.); (G.J.); (H.N.); (R.M.); (D.M.); (F.T.); (N.B.); (B.N.); (D.M.); (A.M.)
| | - Ahmed Makuwani
- Ministry of Health, Immunization and Vaccine Development Program, Dodoma P.O. Box 743, Tanzania; (F.M.); (D.L.); (F.K.); (G.J.); (H.N.); (R.M.); (D.M.); (F.T.); (N.B.); (B.N.); (D.M.); (A.M.)
| | - Betina Katembo
- National Public Health Laboratory, Dar es Salaam P.O. Box 9083, Tanzania;
| | - William Mwengee
- World Health Organization, Country Office, Dar es Salaam P.O. Box 9292, Tanzania;
| | - Alex Mphuru
- United Nations Children’s Fund (UNICEF), Country Office, Dar es Salaam P.O. Box 4076, Tanzania;
| | - Nassor Mohamed
- Immunization Center, John Snow Inc. (JSI), 2733 Crystal Dr 4th Floor, Arlington, VA 22202, USA;
| | - David Kayabu
- Management and Development for Health (MDH), Dar es Salaam P.O Box 79810, Tanzania;
| | - Helmut Nyawale
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania; (H.N.); (S.E.M.)
| | - Eveline T. Konje
- Department of Epidemiology and Biostatistics, School of Public Health, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania;
| | - Stephen E. Mshana
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania; (H.N.); (S.E.M.)
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Mkopi A, Mtenga S, Festo C, Mhalu G, Shabani J, Tillya R, Masemo A, Kheir K, Nassor M, Mwengee W, Lyimo D, Masanja H. Factors affecting non-coverage of measles-rubella vaccination among children aged 9-59 months in Tanzania. Vaccine 2021; 39:6041-6049. [PMID: 34531077 DOI: 10.1016/j.vaccine.2021.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/21/2021] [Accepted: 09/03/2021] [Indexed: 11/17/2022]
Abstract
Globally, measles remains a major cause of child mortality, and rubella is the leading cause of birth defects among all infectious diseases. In 2012, the World Health Assembly endorsed the Global Vaccine Action Plan that set a target to eliminate Measles-Rubella (MR) in five of the six World Health Organization (WHO) regions by 2020. This was cross-sectional study employed both quantitative and qualitative research methods. The sample size was calculated to provide overall, age- and sex-specific coverage estimates for MR vaccine among children aged between 9 and 59 months at the national level. Using desired precision of ±5% with an expected coverage of 95%, a total of 15,235 households were required. The age of children, a child who had received the MR vaccine before the campaign, household wealth quintile, the age of caregivers, and their marital status were associated with non-coverage of MR vaccination among children aged 9-59 months in Tanzania. Nationally, an estimated 88.2% (95% CI: 87.3-89%) of children aged 9-59 months received the MR campaign dose, as assessed by caregivers' recall. These estimates revealed slightly higher coverage in Zanzibar 89.6% (95% CI: 84.7-93%) compared to Mainland Tanzania 88.1% (95% CI 87.2-88.9%). These associated factors revealed causes of unvaccinated children and may be some of the reasons for Tanzania's failure to meet the MR campaign target of 95 percent vaccination coverage. Thus, vaccine development must increase programmatic oversight in order to improve immunization activities and communication strategies in Tanzanian areas with low MR coverage.
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Affiliation(s)
| | - Sally Mtenga
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | | | - Grace Mhalu
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | | | | | - Ame Masemo
- Zanzibar Health Research Institute, Zanzibar, Tanzania
| | - Khamis Kheir
- Zanzibar Health Research Institute, Zanzibar, Tanzania
| | - Mohamed Nassor
- World Health Organization, Tanzania Country Office, Dar es Salaam, Tanzania
| | - William Mwengee
- World Health Organization, Tanzania Country Office, Dar es Salaam, Tanzania
| | - Dafrossa Lyimo
- Ministry of Health, Community Development, Gender, Elderly, and Children, Dar es Salaam, Tanzania
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Li AJ, Manzi F, Kyesi F, Makame Y, Mwengee W, Fleming M, Mkopi A, Mmbaga S, Lyimo D, Loharikar A. Tanzania's human papillomavirus (HPV) vaccination program: Community awareness, feasibility, and acceptability of a national HPV vaccination program, 2019. Vaccine 2021; 40 Suppl 1:A38-A48. [PMID: 34229889 PMCID: PMC9601816 DOI: 10.1016/j.vaccine.2021.06.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 03/31/2021] [Accepted: 06/19/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND In April 2018, Tanzania introduced the human papillomavirus (HPV) vaccine nationally to 14-year-old girls, utilizing routine delivery strategies (i.e. vaccinating girls at health facilities and community outreach, including schools). We sought to assess awareness, feasibility, and acceptability of the HPV vaccination program among health workers and community-level stakeholders. METHODS We conducted cross-sectional in-person surveys among health workers, school personnel, community leaders, and council leaders in 18 council areas across six regions of Tanzania in October-November 2019. Regions were purposively selected to provide demographic, geographic, and vaccination coverage variability; sub-regional levels used random or stratified random sampling. Surveys included questions on HPV vaccine training and knowledge, delivery strategy, target population, and vaccine and program acceptability. Descriptive analysis was completed for all variables stratified by respondent groups. RESULTS Across the 18 councils, there were 461 respondents, including health workers (165), school personnel (135), community leaders (143), and council leaders (18). Over half of each respondent group (50-78%) attended a training or orientation on HPV vaccine. Almost 75% of the health workers and school personnel respondent groups, and less than half (45%) of community leaders correctly identified the target age group for HPV vaccine. Most (80%) of the health workers indicated HPV vaccination was available at health facilities and schools; most (79%) indicated that the majority of girls receive HPV vaccine in school. Approximately half (52%) of all respondents reported hearing misinformation about HPV vaccine, but 97% of all respondents indicated that HPV vaccine was either "very accepted" or "somewhat accepted" in their community. CONCLUSION The HPV vaccination program in Tanzania was well accepted by community stakeholders in 18 councils; adequate knowledge of HPV vaccine and the HPV vaccination program was demonstrated by health workers and school personnel. However, continued technical support for integration of HPV vaccination as a routine immunization activity and reinforcement of basic knowledge about HPV vaccine in specific community groups is needed. The Tanzania experience provides an example of how this vaccine can be integrated into routine immunization delivery strategies and can be a useful resource for countries planning to introduce HPV vaccine as well as informing global partners on how to best support to countries in operationalizing their HPV vaccine introduction plans.
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Affiliation(s)
- Anyie J Li
- CDC Foundation, Atlanta, GA, USA; Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Fatuma Manzi
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Furaha Kyesi
- Ministry of Health, Community Development, Gender, Elderly, and Children, Dar es Salaam, Tanzania
| | | | - William Mwengee
- World Health Organization, Tanzania Country Office, Dar es Salaam, Tanzania
| | - Monica Fleming
- Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Dafrossa Lyimo
- Ministry of Health, Community Development, Gender, Elderly, and Children, Dar es Salaam, Tanzania
| | - Anagha Loharikar
- Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
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Mphuru A, Li AJ, Kyesi F, Mwengee W, Mazige F, Nshunju R, Shayo B, Giattas MR, Loharikar A, Lyimo D. National introduction of human papillomavirus (HPV) vaccine in Tanzania: Programmatic decision-making and implementation. Vaccine 2021; 40 Suppl 1:A2-A9. [PMID: 33962839 PMCID: PMC9601814 DOI: 10.1016/j.vaccine.2021.04.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 03/13/2021] [Accepted: 04/14/2021] [Indexed: 12/18/2022]
Abstract
Background: Cervical cancer is the leading cause of cancer among women in Tanzania, with approximately 10,000 new cases and 7,000 deaths annually. In April 2018, the Government of Tanzania introduced 2 doses of human papillomavirus (HPV) vaccine nationally to adolescent girls to prevent cervical cancer, following a successful 2-year pilot introduction of the vaccine in the Kilimanjaro Region. Methods: We interviewed key informants at the national level in Tanzania from February to November 2019, using a semi-structured tool to better understand national decision-making and program implementation. We conducted a comprehensive desk review of HPV vaccine introduction materials and reviewed administrative coverage data. Results: Ten key informants were interviewed from the Ministry of Health, Community Development, Gender, Elderly, and Children, the World Health Organization, and other partners, and HPV vaccine planning documents and administrative coverage data were reviewed during the desk review. Tanzania introduced HPV vaccine to a single-age cohort of 14-year-old girls, with the decision-making process involving the Tanzania Immunization Technical Advisory Group and the national Interagency Coordination Committee. HPV vaccine was integrated into the routine immunization delivery strategy, available at health facilities and through outreach services at community sites, community mobile sites (>10 km from the health facility), and primary and secondary schools. Pre-introduction activities included trainings and microplanning workshops for health workers and school personnel at the national, regional, council, and health facility levels. Over 6,000 health workers and 22,000 school personnel were trained nationwide. Stakeholder and primary health care committee meetings were also conducted at the national level and in each of the regions as part of the advocacy and communication strategy. Administrative coverage of the first dose of HPV vaccine at the end of 2019 was 78%, and second dose coverage was 49%. No adverse events following HPV vaccination were reported to the national level. Discussion: Tanzania successfully introduced HPV vaccine nationally targeting 14-year-old girls, using routine delivery strategies. Continued monitoring of vaccination coverage will be important to ensure full 2-dose vaccination of eligible girls. Tanzania can consider periodic intensified vaccination and targeted social mobilization efforts, as needed.
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Affiliation(s)
- Alex Mphuru
- UNICEF, Tanzania Country Office, Dar es Salaam, Tanzania
| | - Anyie J Li
- CDC Foundation, Atlanta, GA, USA; Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Furaha Kyesi
- Ministry of Health, Community Development, Gender, Elderly, and Children, Dar es Salaam, Tanzania
| | - William Mwengee
- World Health Organization, Tanzania Country Office, Dar es Salaam, Tanzania
| | - Fikiri Mazige
- UNICEF, Tanzania Country Office, Dar es Salaam, Tanzania
| | | | | | | | - Anagha Loharikar
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Dafrossa Lyimo
- World Health Organization, Tanzania Country Office, Dar es Salaam, Tanzania
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Li AJ, Kyesi F, Mwengee W, Mphuru A, Giattas MR, Shayo B, Nshunju R, Lyimo D, Loharikar A. Impact of the human papillomavirus (HPV) vaccine supply shortage on Tanzania's national HPV vaccine introduction. Vaccine 2021; 40 Suppl 1:A26-A29. [PMID: 33509696 PMCID: PMC9614714 DOI: 10.1016/j.vaccine.2021.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/01/2020] [Accepted: 01/14/2021] [Indexed: 11/22/2022]
Affiliation(s)
- Anyie J Li
- CDC Foundation, Atlanta, GA, USA; Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Furaha Kyesi
- Ministry of Health, Community Development, Gender, Elderly, and Children, Dar es Salaam, Tanzania
| | - William Mwengee
- World Health Organization, Tanzania Country Office, Dar es Salaam, Tanzania
| | - Alex Mphuru
- UNICEF, Tanzania Country Office, Dar es Salaam, Tanzania
| | | | | | | | - Dafrossa Lyimo
- Ministry of Health, Community Development, Gender, Elderly, and Children, Dar es Salaam, Tanzania
| | - Anagha Loharikar
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Vaughan K, Clarke-Deelder E, Tani K, Lyimo D, Mphuru A, Manzi F, Schütte C, Ozaltin A. Immunization costs, from evidence to policy: Findings from a nationally representative costing study and policy translation effort in Tanzania. Vaccine 2020; 38:7659-7667. [PMID: 33077300 PMCID: PMC7604567 DOI: 10.1016/j.vaccine.2020.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 09/29/2020] [Accepted: 10/01/2020] [Indexed: 12/02/2022]
Abstract
Delivery costs represent 33% of total immunization program costs in Tanzania. Costs are higher for outreach than for facility-based delivery. We used calibration methods to estimate unit and total costs. This work will inform domestic resource advocacy and planning.
Introduction Information on the costs of routine immunization programs is needed for budgeting, planning, and domestic resource mobilization. This information is particularly important for countries such as Tanzania that are preparing to transition out of support from Gavi, the Vaccine Alliance. This study aimed to estimate the total and unit costs for of child immunization in Tanzania from July 2016 to June 2017 and make this evidence available to key stakeholders. Methods We used an ingredients-based approach to collect routine immunization cost data from the facility, district, regional, and national levels. We collected data on the cost of vaccines as well as non-vaccine delivery costs. We estimated total and unit costs from a provider perspective for each level and overall, and examined how costs varied by delivery strategy, geographic area, and facility-level service delivery volume. An evidence-to-policy plan identified key opportunities and stakeholders to target to facilitate the use of results. Results The total annual economic cost of the immunization program, inclusive of vaccines, was estimated to be US$138 million (95% CI: 133, 144), or $4.32 ($3.72, $4.98) per dose. The delivery costs made up $45 million (38, 52), or $1.38 (1.06, 1.70) per dose. The costs of facility-based delivery were similar in urban and rural areas, but the costs of outreach delivery were higher in rural areas than in urban areas. The facility-level delivery cost per dose decreased with the facility service delivery volume. Discussion We estimated the costs of the routine immunization program in Tanzania, where no immunization costing study had been conducted for five years. These estimates can inform the program’s budgeting and planning as Tanzania prepares to transition out of Gavi support. Next steps for evidence-to-policy translation have been identified, including technical support requirements for policy advocacy and planning.
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Affiliation(s)
| | - Emma Clarke-Deelder
- Harvard T.H. Chan School of Public Health, Department of Global Health and Population, Boston, MA, USA.
| | - Kassimu Tani
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Dafrossa Lyimo
- Immunization and Vaccines Development (IVD), Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
| | - Alex Mphuru
- Immunization and Vaccines Development (IVD), Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
| | - Fatuma Manzi
- Ifakara Health Institute, Dar es Salaam, Tanzania
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Carnahan E, Ferriss E, Beylerian E, Mwansa FD, Bulula N, Lyimo D, Kalbarczyk A, Labrique AB, Werner L, Shearer JC. Determinants of Facility-Level Use of Electronic Immunization Registries in Tanzania and Zambia: An Observational Analysis. Glob Health Sci Pract 2020; 8:488-504. [PMID: 33008860 PMCID: PMC7541123 DOI: 10.9745/ghsp-d-20-00134] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 07/07/2020] [Indexed: 11/18/2022]
Abstract
We provide a framework to quantify the use of electronic immunization registry systems at the facility level and results show the importance of behavioral and organizational factors in explaining their sustained use in Tanzania and Zambia. Background: As more countries transition from paper-based to electronic immunization registries (EIRs) to collect and track individual immunization data, guidance is needed for successful adoption and use of these systems. Little research is available on the determinants of EIR use soon after introduction. This observational study assesses the determinants of facility health care workers’ use of new EIRs in Tanzania and Zambia, implemented during 2016 to 2018. Methods: We used EIR data entered between 2016 and 2018 from 3 regions in Tanzania and 1 province in Zambia to measure weekly EIR system use for a total of 50,639 facility-weeks. We joined secondary data on facility characteristics and applied the Performance of Routine Information System Management framework to categorize characteristics as organizational, technical, or behavioral. We used a generalized estimating equations logistic regression model to assess facility characteristics as potential determinants of system use. Results: In both countries, the estimated odds of weekly EIR use declined weekly after EIR introduction. In Tanzania, health centers and hospitals had increased odds of system use compared to dispensaries. For each additional health care worker trained in a facility during the EIR introduction, the estimated odds of weekly EIR use increased. Tanzanian facilities that had transitioned entirely to paperless reporting had higher odds of sustained use compared to those maintaining parallel electronic and paper-based reporting systems. In Zambia, distance from the district health office was significantly associated with decreasing odds of system use. There were significant differences in EIR use by district in both countries. Discussion: The results highlight the importance of organizational and behavioral factors in explaining sustained EIR use. As EIRs are introduced in new settings, we recommend indicators of engagement and use be built directly into the system so they can be routinely monitored, and course corrections can be implemented as needed.
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Affiliation(s)
| | - Ellen Ferriss
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Francis Dien Mwansa
- National Expanded Programme on Immunisation, Ministry of Health, Lusaka, Zambia
| | - Ngwegwe Bulula
- Immunisation and Vaccines Development Program, Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
| | - Dafrossa Lyimo
- Immunisation and Vaccines Development Program, Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
| | - Anna Kalbarczyk
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alain B Labrique
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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9
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Chopra M, Bhutta Z, Chang Blanc D, Checchi F, Gupta A, Lemango ET, Levine OS, Lyimo D, Nandy R, O'Brien KL, Okwo-Bele JM, Rees H, Soepardi J, Tolhurst R, Victora CG. Addressing the persistent inequities in immunization coverage. Bull World Health Organ 2019; 98:146-148. [PMID: 32015586 PMCID: PMC6986232 DOI: 10.2471/blt.19.241620] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 12/01/2019] [Accepted: 12/02/2019] [Indexed: 12/02/2022] Open
Affiliation(s)
- Mickey Chopra
- World Bank, 1776 G St NW, Washington, DC, 20006, United States of America (USA)
| | | | - Diana Chang Blanc
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Francesco Checchi
- Epidemiology and International Health, London School of Hygiene and Tropical Medicine, London, England
| | | | - Ephrem T Lemango
- International Institute for Primary Health Care, Ministry of Health, Addis Ababa, Ethiopia
| | | | - Dafrossa Lyimo
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, United Republic of Tanzania
| | - Robin Nandy
- Health Section, United Nations Children's Fund, New York, USA
| | - Katherine L O'Brien
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | | | - Helen Rees
- Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Rachel Tolhurst
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, England
| | - Cesar G Victora
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
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10
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Lyimo D, Kamugisha C, Yohana E, Eshetu M, Wallace A, Ward K, Mantel C, Hennessey K. Improving the efficiency and standards of a National Immunization Program Review: lessons learnt from United Republic of Tanzania. Pan Afr Med J 2017; 28:209. [PMID: 29610647 PMCID: PMC5878854 DOI: 10.11604/pamj.2017.28.209.10466] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 02/13/2017] [Indexed: 11/24/2022] Open
Abstract
A National Immunization Program Review (NIP Review) is a comprehensive external assessment of the performance of a country’s immunization programme. The number of recommended special-topic NIP assessments, such as those for vaccine introduction or vaccine management, has increased. These assessments often have substantial overlap with NIP reviews, raising concern about duplication. Innovative technical and management approaches, including integrating several assessments into one, were applied in the United Republic of Tanzania’s 2015 NIP Review. These approaches and processes were documented and a post-Review survey and group discussion. The Tanzania Review found that integrating assessments so they can be conducted at one time was feasible and efficient. There are concrete approaches for successfully managing a Review that can be shared and practiced including having a well-planned desk review and nominating topic-leads. The use of tablets for data entry has the potential to improve Review data quality and timely analysis; however, careful team training is needed. A key area to improve was to better coordinate and link findings from the national-level and field teams.
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Affiliation(s)
- Dafrossa Lyimo
- Ministry of Health & Social Welfare, Dar Es Salaam, Tanzania
| | | | - Emmanuel Yohana
- Ministry of Health & Social Welfare, Dar Es Salaam, Tanzania
| | - Messeret Eshetu
- World Health Organization, Intercountry Support Office for Eastern and Southern Africa, Harare, Zimbabwe
| | - Aaron Wallace
- US Centers for Disease Control & Prevention, Atlanta, GA, USA
| | - Kirsten Ward
- US Centers for Disease Control & Prevention, Atlanta, GA, USA
| | - Carsten Mantel
- World Health Organization, Headquarters, Geneva, Switzerland
| | - Karen Hennessey
- World Health Organization, Headquarters, Geneva, Switzerland
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11
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Mwingira UJ, Means AR, Chikawe M, Kilembe B, Lyimo D, Crowley K, Rusibamayila N, Nshala A, Mphuru A. Integrating Neglected Tropical Disease and Immunization Programs: The Experiences of the Tanzanian Ministry of Health. Am J Trop Med Hyg 2016; 95:505-507. [PMID: 27246449 PMCID: PMC5014249 DOI: 10.4269/ajtmh.15-0724] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 04/09/2016] [Indexed: 12/03/2022] Open
Abstract
Global health practitioners are increasingly advocating for the integration of community-based health-care platforms as a strategy for increasing the coverage of programs, encouraging program efficiency, and promoting universal health-care goals. To leverage the strengths of compatible programs and avoid geographic and temporal duplications in efforts, the Tanzanian Ministry of Health and Social Welfare coordinated immunization and neglected tropical disease programs for the first time in 2014. Specifically, a measles and rubella supplementary vaccine campaign, mass drug administration (MDA) of ivermectin and albendazole, and Vitamin A were provisionally integrated into a shared community-based delivery platform. Over 21 million people were targeted by the integrated campaign, with the immunization program and MDA program reaching 97% and 93% of targeted individuals, respectively. The purpose of this short report is to share the Tanzanian experience of launching and managing this integrated campaign with key stakeholders.
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Affiliation(s)
- Upendo John Mwingira
- Neglected Tropical Disease Control Programme, Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
| | | | - Maria Chikawe
- Neglected Tropical Disease Control Programme, Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
| | - Bernard Kilembe
- Neglected Tropical Disease Control Programme, Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
| | - Dafrossa Lyimo
- Immunization and Vaccine Development, Ministry of Health and Social Welfare, Dar es Salaam, Tanzania
| | | | - Neema Rusibamayila
- Preventive Services, Ministry of Health and Social Welfare, Dar es Salaam, Tanzania
| | - Andreas Nshala
- ENVISION, IMA WorldHealth, Dar es Salaam, Tanzania.,Neglected Tropical Disease Control Programme, Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
| | - Alex Mphuru
- Immunization and Vaccine Development, Ministry of Health and Social Welfare, Dar es Salaam, Tanzania
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