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Miguel Bambo

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Mvundura M, Ng J, Reynolds K, Theng Ng Y, Bawa J, Bambo M, Bonsu G, Payne J, Chua J, Guerette J, Odei Antwi-Agyei K, Ribe S, Chinavane D, Arhin-Wiredu K, Shah A, Sitoe J, Yunus S, Powelson J, Amponsa-Achiano K, Eshioramhe Kojak K, Fredick Dadzie J, Asghar N, Caetano Correa G, Robertson J. Vaccine wastage in Ghana, Mozambique, and Pakistan: An assessment of wastage rates for four vaccines and the context, causes, drivers, and knowledge, attitudes and practices for vaccine wastage. Vaccine 2023:S0264-410X(23)00582-0. [PMID: 37270365 DOI: 10.1016/j.vaccine.2023.05.033] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 05/12/2023] [Accepted: 05/13/2023] [Indexed: 06/05/2023]

Abstract

Vaccine procurement costs comprise a significant share of immunization program costs in low- and middle-income countries, yet not all procured vaccines are administered. Vaccine wastage occurs due to vial breakage, excessive heat or freezing, expiration, or when not all doses in a multidose vial are used. Better estimates of vaccine wastage rates and their causes could support improved management of vaccine stocks and reduce procurement costs. This study examined aspects of wastage for four vaccines at service delivery points in Ghana (n = 48), Mozambique (n = 36), and Pakistan (n = 46). We used prospective data from daily and monthly vaccine usage data entry forms, along with cross-sectional surveys, and in-depth interviews. The analysis found that estimated monthly proportional open-vial wastage rates for vaccines in single-dose vials (SDV) or in multi-dose vials (MDV) that can be kept refrigerated up to four weeks after opening ranged from 0.08 % to 3 %. For MDV where remaining doses are discarded within six hours after opening, the mean wastage rates ranged from 5 % to 33 %, with rates being highest for measles containing vaccine. Despite national-level guidance to open a vaccine vial even when only one child is present, vaccines in MDV that are discarded within six hours of opening are sometimes offered less frequently than vaccines in SDV or in MDV where remaining doses can be used for up to 4 weeks. This practice can lead to missed opportunities for vaccination. While closed-vial wastage at service delivery points (SDPs) was relatively rare, individual instances can result in large losses, suggesting that monitoring closed-vial wastage should not be neglected. Health workers reported insufficient knowledge of vaccine wastage tracking and reporting methods. Improving reporting forms would facilitate more accurate reporting of all causes of wastage, as would additional training and supportive supervision. Globally, decreasing doses per vial could reduce open-vial wastage.

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Cossa-Moiane I, Cossa H, Bauhofer AFL, Chilaúle J, Guimarães EL, Bero DM, Cassocera M, Bambo M, Anapakala E, Chissaque A, Sambo J, Langa JS, Manhique-Coutinho LV, Fantinatti M, Lopes-Oliveira LA, Da-Cruz AM, de Deus N. High Frequency of Cryptosporidium hominis Infecting Infants Points to A Potential Anthroponotic Transmission in Maputo, Mozambique. Pathogens 2021;10:pathogens10030293. [PMID: 33806380 PMCID: PMC8002024 DOI: 10.3390/pathogens10030293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 01/26/2021] [Revised: 02/12/2021] [Accepted: 02/13/2021] [Indexed: 11/16/2022] Open

Affiliation(s)

Idalécia Cossa-Moiane Instituto Nacional de Saúde (INS), EN1, Bairro da Vila–Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique; (A.F.L.B.); (J.C.); (E.L.G.); (D.M.B.); (M.C.); (M.B.); (E.A.); (A.C.); (J.S.); (J.S.L.); (L.V.M.-C.); (N.d.D.) Institute of Tropical Medicine, 2000 Antwerp, Belgium Correspondence: ; Tel.: +258-84-327-3270
Hermínio Cossa Centro de Investigação em Saúde de Manhiça (CISM), Unidade de Pesquisa Social, Manhiça Foundation (Fundação Manhiça, FM), Manhiça 1929, Mozambique;
Adilson Fernando Loforte Bauhofer Instituto Nacional de Saúde (INS), EN1, Bairro da Vila–Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique; (A.F.L.B.); (J.C.); (E.L.G.); (D.M.B.); (M.C.); (M.B.); (E.A.); (A.C.); (J.S.); (J.S.L.); (L.V.M.-C.); (N.d.D.) Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, 1349-008 Lisboa, Portugal
Jorfélia Chilaúle Instituto Nacional de Saúde (INS), EN1, Bairro da Vila–Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique; (A.F.L.B.); (J.C.); (E.L.G.); (D.M.B.); (M.C.); (M.B.); (E.A.); (A.C.); (J.S.); (J.S.L.); (L.V.M.-C.); (N.d.D.)
Esperança Lourenço Guimarães Instituto Nacional de Saúde (INS), EN1, Bairro da Vila–Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique; (A.F.L.B.); (J.C.); (E.L.G.); (D.M.B.); (M.C.); (M.B.); (E.A.); (A.C.); (J.S.); (J.S.L.); (L.V.M.-C.); (N.d.D.) Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, 1349-008 Lisboa, Portugal
Diocreciano Matias Bero Instituto Nacional de Saúde (INS), EN1, Bairro da Vila–Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique; (A.F.L.B.); (J.C.); (E.L.G.); (D.M.B.); (M.C.); (M.B.); (E.A.); (A.C.); (J.S.); (J.S.L.); (L.V.M.-C.); (N.d.D.)
Marta Cassocera Instituto Nacional de Saúde (INS), EN1, Bairro da Vila–Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique; (A.F.L.B.); (J.C.); (E.L.G.); (D.M.B.); (M.C.); (M.B.); (E.A.); (A.C.); (J.S.); (J.S.L.); (L.V.M.-C.); (N.d.D.) Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, 1349-008 Lisboa, Portugal
Miguel Bambo Instituto Nacional de Saúde (INS), EN1, Bairro da Vila–Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique; (A.F.L.B.); (J.C.); (E.L.G.); (D.M.B.); (M.C.); (M.B.); (E.A.); (A.C.); (J.S.); (J.S.L.); (L.V.M.-C.); (N.d.D.)
Elda Anapakala Instituto Nacional de Saúde (INS), EN1, Bairro da Vila–Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique; (A.F.L.B.); (J.C.); (E.L.G.); (D.M.B.); (M.C.); (M.B.); (E.A.); (A.C.); (J.S.); (J.S.L.); (L.V.M.-C.); (N.d.D.)
Assucênio Chissaque Instituto Nacional de Saúde (INS), EN1, Bairro da Vila–Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique; (A.F.L.B.); (J.C.); (E.L.G.); (D.M.B.); (M.C.); (M.B.); (E.A.); (A.C.); (J.S.); (J.S.L.); (L.V.M.-C.); (N.d.D.) Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, 1349-008 Lisboa, Portugal
Júlia Sambo Instituto Nacional de Saúde (INS), EN1, Bairro da Vila–Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique; (A.F.L.B.); (J.C.); (E.L.G.); (D.M.B.); (M.C.); (M.B.); (E.A.); (A.C.); (J.S.); (J.S.L.); (L.V.M.-C.); (N.d.D.) Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, 1349-008 Lisboa, Portugal
Jerónimo Souzinho Langa Instituto Nacional de Saúde (INS), EN1, Bairro da Vila–Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique; (A.F.L.B.); (J.C.); (E.L.G.); (D.M.B.); (M.C.); (M.B.); (E.A.); (A.C.); (J.S.); (J.S.L.); (L.V.M.-C.); (N.d.D.)
Lena Vânia Manhique-Coutinho Instituto Nacional de Saúde (INS), EN1, Bairro da Vila–Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique; (A.F.L.B.); (J.C.); (E.L.G.); (D.M.B.); (M.C.); (M.B.); (E.A.); (A.C.); (J.S.); (J.S.L.); (L.V.M.-C.); (N.d.D.)
Maria Fantinatti Laboratório Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz-FIOCRUZ, Rio de Janeiro 22040-360, Brazil; (M.F.); (L.A.L.-O.); (A.M.D.-C.)
Luis António Lopes-Oliveira Laboratório Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz-FIOCRUZ, Rio de Janeiro 22040-360, Brazil; (M.F.); (L.A.L.-O.); (A.M.D.-C.)
Alda Maria Da-Cruz Laboratório Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz-FIOCRUZ, Rio de Janeiro 22040-360, Brazil; (M.F.); (L.A.L.-O.); (A.M.D.-C.) Disciplina de Parasitologia, Faculdade de Ciências Médicas, UERJ/RH, Rio de Janeiro 21040-900, Brazil
Nilsa de Deus Instituto Nacional de Saúde (INS), EN1, Bairro da Vila–Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique; (A.F.L.B.); (J.C.); (E.L.G.); (D.M.B.); (M.C.); (M.B.); (E.A.); (A.C.); (J.S.); (J.S.L.); (L.V.M.-C.); (N.d.D.) Departamento de Ciências Biológicas, Universidade Eduardo Mondlane, Maputo 3453, Mozambique

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de Deus N, Chilaúle JJ, Cassocera M, Bambo M, Langa JS, Sitoe E, Chissaque A, Anapakala E, Sambo J, Guimarães EL, Bero DM, João ED, Cossa-Moiane I, Mwenda JM, Weldegebriel GG, Parashar UD, Tate JE. Early impact of rotavirus vaccination in children less than five years of age in Mozambique. Vaccine 2017;36:7205-7209. [PMID: 29128381 DOI: 10.1016/j.vaccine.2017.10.060] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 05/28/2017] [Revised: 09/04/2017] [Accepted: 10/17/2017] [Indexed: 11/18/2022]

Abstract

BACKGROUND

Mozambique introduced rotavirus vaccine (Rotarix, GSK Biologicals) in the National Immunization Program in September 2015 with the objective of reducing the burden of total diarrheal disease and specifically severe rotavirus disease. This study aimed to evaluate the early impact of rotavirus vaccine in reducing all-cause diarrhea and rotavirus-specific hospitalizations.

METHODS

We analysed stool specimens collected from children under five years old, between January 2014 and June 2017 within the National Surveillance for Acute Diarrhea. We compared annual changes in rotavirus positivity, median age of children hospitalized for rotavirus and the number of all-cause for diarrheal hospitalizations. Rotavirus detection was performed using enzyme immunoassay.

RESULTS

During this period, 1296 samples were collected and analyzed. Rotavirus positivity before vaccine introduction was 40.2% (39/97) in 2014 and 38.3% (225/588) in 2015, then after vaccine introduction reduced to 12.2% and 13.5% in 2016 and 2017, respectively. The median age of children hospitalized for rotavirus was 9 and 11 months in 2014 and 2015 and 10 months in 2016 and 2017. Rotavirus hospitalizations exhibited a seasonal peak prior to vaccine introduction, between June and September in 2014 and 2015, coinciding with winter period in Mozambique. After vaccine introduction, the peak was delayed until August to December in 2016 and was substantially diminished. There was a reduction in all-cause acute diarrhea hospitalizations in children aged 0-11 months after vaccine introduction.

CONCLUSION

We observed a reduction in rotavirus positivity and in the number of all-cause diarrhea hospitalizations after vaccine introduction. The data suggest rotavirus vaccine is having a positive impact on the control of rotavirus diarrheal disease in Mozambique.

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