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Wariri O, Utazi CE, Okomo U, Sowe A, Sogur M, Fofanna S, Ezeani E, Saidy L, Sarwar G, Dondeh BL, Murray KA, Grundy C, Kampmann B. Impact of the COVID-19 pandemic on the coverage and timeliness of routine childhood vaccinations in the Gambia, 2015-2021. BMJ Glob Health 2023; 8:e014225. [PMID: 38148110 PMCID: PMC10753753 DOI: 10.1136/bmjgh-2023-014225] [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: 10/11/2023] [Accepted: 12/10/2023] [Indexed: 12/28/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic caused widespread morbidity and mortality and resulted in the biggest setback in routine vaccinations in three decades. Data on the impact of the pandemic on immunisation in Africa are limited, in part, due to low-quality routine or administrative data. This study examined coverage and timeliness of routine childhood immunisation during the pandemic in The Gambia, a country with an immunisation system considered robust. METHODS We obtained prospective birth cohort data of 57 286 children in over 300 communities in two health and demographic surveillance system sites, including data from the pre-pandemic period (January 2015-February 2020) and the three waves of the pandemic period (March 2020-December 2021). We determined monthly coverage and timeliness (early and delayed) of the birth dose of hepatitis B vaccine (HepB0) and the first dose of pentavalent vaccine (Penta1) during the different waves of the pandemic relative to the pre-pandemic period. We implemented a binomial interrupted time-series regression model. RESULT We observed no significant change in the coverage of HepB0 and Penta1 vaccinations from the pre-pandemic period up until the periods before the peaks of the first and second waves of the pandemic in 2020. However, there was an increase in HepB0 coverage before as well as after the peak of the third wave in 2021 compared with the pre-pandemic period (pre-third wave peak OR = 1.83, 95% CI 1.06 to 3.14; post-third wave period OR=2.20, 95% CI 1.23 to 3.92). There was some evidence that vaccination timeliness changed during specific periods of the pandemic. Early Penta1 vaccination decreased by 70% (OR=0.30, 95% CI 0.12 to 0.78) in the period before the second wave, and delayed HepB0 vaccination decreased by 47% (OR=0.53, 95% CI 0.29 to 0.97) after the peak of the third wave in 2021. CONCLUSION Despite the challenges of the COVID-19 pandemic, The Gambia's routine vaccination programme has defied the setbacks witnessed in other settings and remained resilient, with coverage increasing and timeliness improving during the second and third waves. These findings highlight the importance of having adequate surveillance systems to monitor the impact of large shocks to vaccination coverage and timeliness.
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Affiliation(s)
- Oghenebrume Wariri
- Vaccines and Immunity Theme, MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Vaccine Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Chigozie Edson Utazi
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, UK
- Southampton Statistical Sciences Research Institute, , University of Southampton, Southampton, UK
| | - Uduak Okomo
- Vaccines and Immunity Theme, MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia
- MARCH Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Alieu Sowe
- Expanded Programme on Immunization, Ministry of Health and Social Welfare, Banjul, The Gambia
| | - Malick Sogur
- Expanded Programme on Immunization, Ministry of Health and Social Welfare, Banjul, The Gambia
| | - Sidat Fofanna
- Expanded Programme on Immunization, Ministry of Health and Social Welfare, Banjul, The Gambia
| | - Esu Ezeani
- Health and Demographic Surveillance System (HDSS), MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Lamin Saidy
- Data Management & Architecture, MRC Unit The Gambia a London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Golam Sarwar
- Health and Demographic Surveillance System (HDSS), MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Bai-Lamin Dondeh
- Data Management & Architecture, MRC Unit The Gambia a London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Kris A Murray
- Centre on Climate Change and Planetary Health, MRC Unit The Gambia at The London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Chris Grundy
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Beate Kampmann
- Vaccines and Immunity Theme, MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia
- Vaccine Centre, London School of Hygiene and Tropical Medicine, London, UK
- Centre for Global Health, Charité Universitatsmedizin Berlin, Berlin, Germany
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Adeniji YR, Jalo I, Okonkwo I, Poksireni MR, Manga M, Wariri O, Alhassan HA, Warnow EI. Diagnostic value of rapid test for malaria among febrile neonates in a tertiary hospital in North-East Nigeria: a prospective cross-sectional study. Arch Dis Child 2023; 109:11-15. [PMID: 37879855 PMCID: PMC10803997 DOI: 10.1136/archdischild-2023-325906] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 08/30/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVE The WHO recommends testing using microscopy or rapid diagnostic test (RDT) before treatment for malaria. However, the use of RDT to diagnose neonatal malaria has not been widely validated with most studies limited to the first week of life. Thus, we conducted this study to determine the utility of RDT in the diagnosis of congenital and acquired malaria in febrile neonates in Nigeria. DESIGN This prospective cross-sectional descriptive study consecutively recruited 131 febrile neonates at the Special Care Baby Unit (SCBU) of the Federal Teaching Hospital Gombe, Nigeria. All study participants concurrently had RDT (HRP2, LDH) and malaria microscopy. The performance of both methods was then compared. RESULT Seventy-eight of 131 neonates tested for malaria by blood smear microscopy demonstrated malaria parasites; a prevalence of 59.5%. Parasite count ranged from 16 to 520 /μL and the median parasite count was 81.0 /μL with IQR (40.0-134.5). The majority of patients (93.5%) had low-density parasitaemia (≤2+). All species identified were Plasmodium falciparum. None of the 131 neonates tested positive on RDT. The sensitivity and positive predictive value of RDT for neonatal malaria was zero. Congenital malaria was the most common form of neonatal malaria, accounting for 75.6%, while acquired and transfusion-related malaria were estimated at 12.8% and 11.6%, respectively. CONCLUSION The RDT used in this study was not sensitive in the diagnosis of congenital or acquired neonatal malaria; therefore, microscopy remains the preferred method of diagnosis of neonatal malaria.
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Affiliation(s)
| | - Iliya Jalo
- Department of Paediatrics, Federal Teaching Hospital Gombe, Gombe, Nigeria
| | - Ikechukwu Okonkwo
- Department of Child Health, University of Benin Teaching Hospital, Benin City, Nigeria
| | | | - Mohammed Manga
- Medical Microbiology, Federal Teaching Hospital Gombe, Gombe, Nigeria
| | - Oghenebrume Wariri
- Vaccines and Immunity Theme, MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | | | - Elon Isaac Warnow
- Department of Paediatrics, Federal Teaching Hospital Gombe, Gombe, Nigeria
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Wariri O, Afolabi MO, Mukandavire C, Saidu Y, Balogun OD, Ndiaye S, Okpo EA, Nomhwange T, Uthman OA, Kampmann B. COVID-19 vaccination implementation in 52 African countries: trajectory and implications for future pandemic preparedness. BMJ Glob Health 2023; 8:e013073. [PMID: 38084478 PMCID: PMC10711863 DOI: 10.1136/bmjgh-2023-013073] [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: 06/08/2023] [Accepted: 11/15/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION To end the COVID-19 pandemic, the WHO set a goal in 2021 to fully vaccinate 70% of the global population by mid-2022. We projected the COVID-19 vaccination trajectory in 52 African countries and compared the projected to the 'actual' or 'observed' coverage as of December 2022. We also estimated the required vaccination speed needed to have attained the WHO 70% coverage target by December 2022. METHODS We obtained publicly available, country-reported daily COVID-19 vaccination data, covering the initial 9 months following the deployment of vaccines. We used a deterministic compartmental Susceptible-Exposed-Infectious-Recovered-type model and fit the model to the number of COVID-19 cases and vaccination coverage in each African country using a Markov chain Monte Carlo approach within a Bayesian framework. FINDINGS Only nine of the 52 African countries (Tunisia, Cabo Verde, Lesotho, Mozambique, Rwanda, Seychelles, Morocco, Botswana and Mauritius) were on track to achieve full COVID-19 vaccination coverage rates ranging from 72% to 97% by the end of December 2022, based on their progress after 9 months of vaccine deployment. Of the 52 countries, 26 (50%) achieved 'actual' or 'observed' vaccination coverage rates within ±10 percentage points of their projected vaccination coverage. Among the countries projected to achieve <30% by December 2022, nine of them (Chad, Niger, Nigeria, South Sudan, Tanzania, Somalia, Zambia, Sierra Leone and Côte d'Ivoire) achieved a higher observed coverage than the projected coverage, ranging from 12.3 percentage points in South Sudan to 35.7 percentage points above the projected coverage in Tanzania. Among the 52 countries, 83% (43 out of 52) needed to at least double their vaccination trajectory after 9 months of deployment to reach the 70% target by December 2022. CONCLUSION Our findings can guide countries in planning strategies for future global health emergencies and learning from each other, especially those that exceeded expectations and made significant progress towards the WHO's 2022 COVID-19 vaccination target despite projected poor coverage rates.
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Affiliation(s)
- Oghenebrume Wariri
- Vaccines and Immunity Theme, MRC Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
- Vaccine Centre, London School of Hygiene and Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Muhammed Olanrewaju Afolabi
- Vaccine Centre, London School of Hygiene and Tropical Medicine, London, UK
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Christinah Mukandavire
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Yauba Saidu
- Clinton Health Access Initiative, Yaounde, Cameroon
| | | | - Sidy Ndiaye
- WHO Regional Office for Africa, Brazzaville, Republic of Congo
| | | | - Terna Nomhwange
- Immunization, WHO Country Office for Nigeria, Abuja, Nigeria
| | - Olalekan A Uthman
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Warwick Centre for Global Health, Division of Health Sciences, University of Warwick Medical School, Coventry, UK
| | - Beate Kampmann
- Vaccines and Immunity Theme, MRC Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
- Vaccine Centre, London School of Hygiene and Tropical Medicine, London, UK
- Centre for Global Health, Charité Universitatsmedizin, Berlin, Germany
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Wariri O, Utazi CE, Okomo U, Metcalf CJE, Sogur M, Fofana S, Murray KA, Grundy C, Kampmann B. Mapping the timeliness of routine childhood vaccination in The Gambia: A spatial modelling study. Vaccine 2023; 41:5696-5705. [PMID: 37563051 DOI: 10.1016/j.vaccine.2023.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/29/2023] [Accepted: 08/01/2023] [Indexed: 08/12/2023]
Abstract
INTRODUCTION Timeliness of routine vaccination shapes childhood infection risk and thus is an important public health metric. Estimates of indicators of the timeliness of vaccination are usually produced at the national or regional level, which may conceal epidemiologically relevant local heterogeneities and makeitdifficultto identify pockets of vulnerabilities that could benefit from targeted interventions. Here, we demonstrate the utility of geospatial modelling techniques in generating high-resolution maps of the prevalence of delayed childhood vaccination in The Gambia. To guide local immunisation policy and prioritize key interventions, we also identified the districts with a combination of high estimated prevalence and a significant population of affected infants. METHODS We used the birth dose of the hepatitis-B vaccine (HepB0), third-dose of the pentavalent vaccine (PENTA3), and the first dose of measles-containing vaccine (MCV1) as examples to map delayed vaccination nationally at a resolution of 1 × 1-km2 pixel. We utilized cluster-level childhood vaccination data from The Gambia 2019-20 Demographic and Health Survey. We adopted a fully Bayesian geostatistical model incorporating publicly available geospatial covariates to aid predictive accuracy. The model was implemented using the integrated nested Laplace approximation-stochastic partial differential equation (INLA-SPDE) approach. RESULTS We found significant subnational heterogeneity in delayed HepB0, PENTA3 and MCV1 vaccinations. Specificdistricts in the central and eastern regions of The Gambia consistentlyexhibited the highest prevalence of delayed vaccination, while the coastal districts showed alower prevalence forallthree vaccines. We also found that districts in the eastern, central, as well as in coastal parts of The Gambia had a combination of high estimated prevalence of delayed HepB0, PENTA3 and MCV1 and a significant population of affected infants. CONCLUSIONS Our approach provides decision-makers with a valuable tool to better understand local patterns of untimely childhood vaccination and identify districts where strengthening vaccine delivery systems could have the greatest impact.
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Affiliation(s)
- Oghenebrume Wariri
- Vaccines and Immunity Theme, MRC Unit The Gambia a London School of Hygiene and Tropical Medicine, Fajara, Gambia; Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom; Vaccine Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Chigozie Edson Utazi
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, United Kingdom; Southampton Statistical Sciences Research Institute, University of Southampton, Southampton, United Kingdom
| | - Uduak Okomo
- Vaccines and Immunity Theme, MRC Unit The Gambia a London School of Hygiene and Tropical Medicine, Fajara, Gambia; MARCH Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - C Jessica E Metcalf
- Department of Ecology & Evolutionary Biology, Princeton University, Princeton, NJ, USA
| | - Malick Sogur
- Expanded Programme on Immunization, Ministry of Health and Social Welfare, The Gambia, Banjul, Gambia
| | - Sidat Fofana
- Expanded Programme on Immunization, Ministry of Health and Social Welfare, The Gambia, Banjul, Gambia
| | - Kris A Murray
- Centre on Climate Change and Planetary Health, MRC Unit The Gambia at The London School of Hygiene and Tropical Medicine, Fajara, Gambia
| | - Chris Grundy
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Beate Kampmann
- Vaccines and Immunity Theme, MRC Unit The Gambia a London School of Hygiene and Tropical Medicine, Fajara, Gambia; Vaccine Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom; Centre for Global Health, Charité Universitatsmedizin, Berlin, Germany
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Wariri O, Utazi CE, Okomo U, Sogur M, Murray KA, Grundy C, Fofanna S, Kampmann B. Timeliness of routine childhood vaccination among 12-35 months old children in The Gambia: Analysis of national immunisation survey data, 2019-2020. PLoS One 2023; 18:e0288741. [PMID: 37478124 PMCID: PMC10361478 DOI: 10.1371/journal.pone.0288741] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 07/03/2023] [Indexed: 07/23/2023] Open
Abstract
The Gambia's routine childhood vaccination programme is highly successful, however, many vaccinations are delayed, with potential implications for disease outbreaks. We adopted a multi-dimensional approach to determine the timeliness of vaccination (i.e., timely, early, delayed, and untimely interval vaccination). We utilised data for 3,248 children from The Gambia 2019-2020 Demographic and Health Survey. Nine tracer vaccines administered at birth and at two, three, four, and nine months of life were included. Timeliness was defined according to the recommended national vaccination windows and reported as both categorical and continuous variables. Routine coverage was high (above 90%), but also a high rate of untimely vaccination. First-dose pentavalent vaccine (PENTA1) and oral polio vaccine (OPV1) had the highest timely coverage that ranged from 71.8% (95% CI = 68.7-74.8%) to 74.4% (95% CI = 71.7-77.1%). Delayed vaccination was the commonest dimension of untimely vaccination and ranged from 17.5% (95% CI = 14.5-20.4%) to 91.1% (95% CI = 88.9-93.4%), with median delays ranging from 11 days (IQR = 5, 19.5 days) to 28 days (IQR = 11, 57 days) across all vaccines. The birth-dose of Hepatitis B vaccine had the highest delay and this was more common in the 24-35 months age group (91.1% [95% CI = 88.9-93.4%], median delays = 17 days [IQR = 10, 28 days]) compared to the 12-23 months age-group (84.9% [95% CI = 81.9-87.9%], median delays = 16 days [IQR = 9, 26 days]). Early vaccination was the least common and ranged from 4.9% (95% CI = 3.2-6.7%) to 10.7% (95% CI = 8.3-13.1%) for all vaccines. The Gambia's childhood immunization system requires urgent implementation of effective strategies to reduce untimely vaccination in order to optimize its quality, even though it already has impressive coverage rates.
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Affiliation(s)
- Oghenebrume Wariri
- Vaccines and Immunity Theme, MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Vaccine Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Chigozie Edson Utazi
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, United Kingdom
- Southampton Statistical Sciences Research Institute, University of Southampton, Southampton, United Kingdom
| | - Uduak Okomo
- Vaccines and Immunity Theme, MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
- MARCH Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Malick Sogur
- Expanded Programme on Immunization, Ministry of Health and Social Welfare, Banjul, The Gambia
| | - Kris A. Murray
- Centre on Climate Change and Planetary Health, MRC Unit The Gambia at The London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Chris Grundy
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sidat Fofanna
- Expanded Programme on Immunization, Ministry of Health and Social Welfare, Banjul, The Gambia
| | - Beate Kampmann
- Vaccines and Immunity Theme, MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
- Centre for Global Health, Charite Universitatsmedizin Berlin, Berlin, Germany
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Haidara FC, Umesi A, Sow SO, Ochoge M, Diallo F, Imam A, Traore Y, Affleck L, Doumbia MF, Daffeh B, Kodio M, Wariri O, Traoré A, Jallow E, Kampmann B, Kapse D, Kulkarni PS, Mallya A, Goel S, Sharma P, Sarma AD, Avalaskar N, LaForce FM, Alderson MR, Naficy A, Lamola S, Tang Y, Martellet L, Hosken N, Simeonidis E, Welsch JA, Tapia MD, Clarke E. Meningococcal ACWYX Conjugate Vaccine in 2-to-29-Year-Olds in Mali and Gambia. N Engl J Med 2023; 388:1942-1955. [PMID: 37224196 PMCID: PMC10627475 DOI: 10.1056/nejmoa2214924] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND An effective, affordable, multivalent meningococcal conjugate vaccine is needed to prevent epidemic meningitis in the African meningitis belt. Data on the safety and immunogenicity of NmCV-5, a pentavalent vaccine targeting the A, C, W, Y, and X serogroups, have been limited. METHODS We conducted a phase 3, noninferiority trial involving healthy 2-to-29-year-olds in Mali and Gambia. Participants were randomly assigned in a 2:1 ratio to receive a single intramuscular dose of NmCV-5 or the quadrivalent vaccine MenACWY-D. Immunogenicity was assessed at day 28. The noninferiority of NmCV-5 to MenACWY-D was assessed on the basis of the difference in the percentage of participants with a seroresponse (defined as prespecified changes in titer; margin, lower limit of the 96% confidence interval [CI] above -10 percentage points) or geometric mean titer (GMT) ratios (margin, lower limit of the 98.98% CI >0.5). Serogroup X responses in the NmCV-5 group were compared with the lowest response among the MenACWY-D serogroups. Safety was also assessed. RESULTS A total of 1800 participants received NmCV-5 or MenACWY-D. In the NmCV-5 group, the percentage of participants with a seroresponse ranged from 70.5% (95% CI, 67.8 to 73.2) for serogroup A to 98.5% (95% CI, 97.6 to 99.2) for serogroup W; the percentage with a serogroup X response was 97.2% (95% CI, 96.0 to 98.1). The overall difference between the two vaccines in seroresponse for the four shared serogroups ranged from 1.2 percentage points (96% CI, -0.3 to 3.1) for serogroup W to 20.5 percentage points (96% CI, 15.4 to 25.6) for serogroup A. The overall GMT ratios for the four shared serogroups ranged from 1.7 (98.98% CI, 1.5 to 1.9) for serogroup A to 2.8 (98.98% CI, 2.3 to 3.5) for serogroup C. The serogroup X component of the NmCV-5 vaccine generated seroresponses and GMTs that met the prespecified noninferiority criteria. The incidence of systemic adverse events was similar in the two groups (11.1% in the NmCV-5 group and 9.2% in the MenACWY-D group). CONCLUSIONS For all four serotypes in common with the MenACWY-D vaccine, the NmCV-5 vaccine elicited immune responses that were noninferior to those elicited by the MenACWY-D vaccine. NmCV-5 also elicited immune responses to serogroup X. No safety concerns were evident. (Funded by the U.K. Foreign, Commonwealth, and Development Office and others; ClinicalTrials.gov number, NCT03964012.).
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Affiliation(s)
- Fadima C Haidara
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Ama Umesi
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Samba O Sow
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Magnus Ochoge
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Fatoumata Diallo
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Abdulazeez Imam
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Youssouf Traore
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Lucy Affleck
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Moussa F Doumbia
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Bubacarr Daffeh
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Mamoudou Kodio
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Oghenebrume Wariri
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Awa Traoré
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Edrissa Jallow
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Beate Kampmann
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Dhananjay Kapse
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Prasad S Kulkarni
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Asha Mallya
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Sunil Goel
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Pankaj Sharma
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Annamraju D Sarma
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Nikhil Avalaskar
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - F Marc LaForce
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Mark R Alderson
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Abdi Naficy
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Steve Lamola
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Yuxiao Tang
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Lionel Martellet
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Nancy Hosken
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Evangelos Simeonidis
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Jo Anne Welsch
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Milagritos D Tapia
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Ed Clarke
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
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Toyin-Thomas P, Ikhurionan P, Omoyibo EE, Iwegim C, Ukueku AO, Okpere J, Nnawuihe UC, Atat J, Otakhoigbogie U, Orikpete EV, Erhiawarie F, Gbejewoh EO, Odogu U, Akhirevbulu ICG, Kwarshak YK, Wariri O. Drivers of health workers' migration, intention to migrate and non-migration from low/middle-income countries, 1970-2022: a systematic review. BMJ Glob Health 2023; 8:bmjgh-2023-012338. [PMID: 37156560 PMCID: PMC10174016 DOI: 10.1136/bmjgh-2023-012338] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 03/17/2023] [Accepted: 04/25/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND The migration of healthcare workers (HWs) from low/middle-income countries (LMICs) is a pressing global health issue with implications for population-level health outcomes. We aimed to synthesise the drivers of HWs' out-migration, intention to migrate and non-migration from LMICs. METHODS We searched Ovid MEDLINE, EMBASE, CINAHL, Global Health and Web of Science, as well as the reference lists of retrieved articles. We included studies (quantitative, qualitative or mixed-methods) on HWs' migration or intention to migrate, published in either English or French between 1 January 1970 and 31 August 2022. The retrieved titles were deduplicated in EndNote before being exported to Rayyan for independent screening by three reviewers. RESULTS We screened 21 593 unique records and included 107 studies. Of the included studies, 82 were single-country studies focusing on 26 countries, while the remaining 25 included data from multiple LMICs. Most of the articles focused on either doctors 64.5% (69 of 107) and/or nurses 54.2% (58 of 107). The UK (44.9% (48 of 107)) and the USA (42% (45 of 107)) were the top destination countries. The LMICs with the highest number of studies were South Africa (15.9% (17 of 107)), India (12.1% (13 of 107)) and the Philippines (6.5% (7 of 107)). The major drivers of migration were macro-level and meso-level factors. Remuneration (83.2%) and security problems (58.9%) were the key macro-level factors driving HWs' migration/intention to migrate. In comparison, career prospects (81.3%), good working environment (63.6%) and job satisfaction (57.9%) were the major meso-level drivers. These key drivers have remained relatively constant over the last five decades and did not differ among HWs who have migrated and those with intention to migrate or across geographical regions. CONCLUSION Growing evidence suggests that the key drivers of HWs' migration or intention to migrate are similar across geographical regions in LMICs. Opportunities exist to build collaborations to develop and implement strategies to halt this pressing global health problem.
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Affiliation(s)
- Patience Toyin-Thomas
- Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, USA
| | - Paul Ikhurionan
- Department of Child Health, University of Benin Teaching Hospital, Benin City, Nigeria
| | - Efe E Omoyibo
- Department of Paediatrics, Federal Medical Centre, Asaba, Nigeria
| | - Chinelo Iwegim
- Fraser Health Authority, Surrey, British Columbia, Canada
| | - Avwebo O Ukueku
- Department of Obstetrics and Gynaecology, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Jermaine Okpere
- Department of Clinical Research, Alpha Research Clinic, Edmonton, Alberta, Canada
| | - Ukachi C Nnawuihe
- Department of Clinical Services, Intercountry Centre for Oral Health for Africa, Jos, Nigeria
| | - Josephine Atat
- Department of Restorative Dentistry, University of Benin Teaching Hospital, Benin City, Nigeria
| | - Uwaila Otakhoigbogie
- Department of Oral Pathology and Oral Medicine, University of Nigeria, Enugu, Nigeria
| | | | - Franca Erhiawarie
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | | | - Uyoyo Odogu
- Department of Preventive Dentistry, Lagos University Teaching Hospital, Lagos, Nigeria
| | | | | | - Oghenebrume Wariri
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, Gambia
- Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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8
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Ikhurionan P, Kwarshak YK, Agho ET, Akhirevbulu ICG, Atat J, Erhiawarie F, Gbejewoh EO, Iwegim C, Nnawuihe U, Odogu U, Okpere J, Omoyibo EE, Orikpete EV, Otakhoigbogie U, Ukueku A, Ugwi P, Wariri O. Understanding the trends, and drivers of emigration, migration intention and non-migration of health workers from low-income and middle-income countries: protocol for a systematic review. BMJ Open 2022; 12:e068522. [PMID: 36600347 PMCID: PMC9730369 DOI: 10.1136/bmjopen-2022-068522] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION The WHO estimates a shortage of 18 million health workers (HWs) by 2030, primarily in low-income and middle-income countries (LMICs). The perennial out-migration of HWs from LMICs, often to higher-income countries, further exacerbates the shortage. We propose a systematic review to understand the determinants of HWs out-migration, intention to migrate and non-migration from LMICs. METHODS AND ANALYSIS This protocol was designed in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols guideline for the development and reporting of systematic review protocols. We will include English and French language primary studies (quantitative or qualitative) focused on any category of HWs; from any LMICs; assessed migration or intention to migrate; and reported any determinant of migration. A three-step search strategy that involves a search of one electronic database to refine the preliminary strategy, a full search of all included databases and reference list search of included full-text papers for additional articles will be employed. We will search Ovid MEDLINE, EMBASE, CINAHL, Global Health and Web of Science from inception to August 2022. The retrieved titles will be imported to EndNote and deduplicated. Two reviewers will independently screen all titles and abstract for eligibility using Rayyan. Risk of bias of the individual studies will be determined using the National Institute of Health study quality assessment tools for quantitative studies and the 10-item Critical Appraisal Skills Programme checklists for qualitative studies. The results will be presented in the form of narrative synthesis using a descriptive approach ETHICS AND DISSEMINATION: We will not seek ethical approval from an institutional review board, as this is a systematic review. At completion, we will submit the report of this review to a peer-reviewed journal for publication. Key findings will be presented at local and international conferences. PROSPERO REGISTRATION NUMBER CRD42022334283.
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Affiliation(s)
- Paul Ikhurionan
- Department of Paediatrics, University of Benin Teaching Hospital, Benin City, Nigeria
| | | | - Ekhosuehi T Agho
- Department of Oral Medicine, Ahmadu Bello University, Zaria, Nigeria
| | - Itua C G Akhirevbulu
- Orthopaedics and Trauma Division, Department of Surgery, Edo Specialist Hospital, Benin City, Nigeria
| | - Josephine Atat
- Department of Restorative Dentistry, University of Benin Teaching Hospital, Benin City, Nigeria
| | - Franca Erhiawarie
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | | | - Chinelo Iwegim
- Fraser Health Authority, Surrey, British Columbia, Canada
| | - Ukachi Nnawuihe
- Intercountry Centre for Oral Health for Africa, Jos, Nigeria
| | - Uyoyo Odogu
- Department of Preventive Dentistry, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Jermaine Okpere
- Department of Clinical Research, Alpha Research Clinic Inc, Edmonton, Alberta, Canada
| | - Efe E Omoyibo
- Department of Paediatrics, Federal Medical Centre, Asaba, Nigeria
| | - Efetobo Victor Orikpete
- Department of Oral Pathology and Oral Biology, University of Port Harcourt, Port Harcourt, Nigeria
| | - Uwaila Otakhoigbogie
- Department of Oral Pathology and Oral Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Avwebo Ukueku
- Department of Obstetrics and Gynaecology, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Patience Ugwi
- Lawton Community Health Center, Lawton, Oklahoma, USA
| | - Oghenebrume Wariri
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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9
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Afolabi MO, Adebiyi A, Cano J, Sartorius B, Greenwood B, Johnson O, Wariri O. Prevalence and distribution pattern of malaria and soil-transmitted helminth co-endemicity in sub-Saharan Africa, 2000-2018: A geospatial analysis. PLoS Negl Trop Dis 2022; 16:e0010321. [PMID: 36178964 PMCID: PMC9555675 DOI: 10.1371/journal.pntd.0010321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 10/12/2022] [Accepted: 09/16/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Limited understanding exists about the interactions between malaria and soil-transmitted helminths (STH), their potential geographical overlap and the factors driving it. This study characterised the geographical and co-clustered distribution patterns of malaria and STH infections among vulnerable populations in sub-Saharan Africa (SSA). METHODOLOGY/PRINCIPAL FINDINGS We obtained continuous estimates of malaria prevalence from the Malaria Atlas Project (MAP) and STH prevalence surveys from the WHO-driven Expanded Special Project for the Elimination of NTDs (ESPEN) from Jan 1, 2000, to Dec 31, 2018. Although, MAP provides datasets on the estimated prevalence of Plasmodium falciparum at 5km x 5km fine-scale resolution, we calculated the population-weighted prevalence of malaria for each implementation unit to ensure that both malaria and STH datasets were on the same spatial resolution. We incorporated survey data from 5,935 implementation units for STH prevalence and conducted the prevalence point estimates before and after 2003. We used the bivariate local indicator of spatial association (LISA analysis) to explore potential co-clustering of both diseases at the implementation unit levels among children aged 2-10 years for P. falciparum and 5-14 years for STH, living in SSA. Our analysis shows that prior to 2003, a greater number of SSA countries had a high prevalence of co-endemicity with P.falciparium and any STH species than during the period from 2003-2018. Similar prevalence and distribution patterns were observed for the co-endemicity involving P.falciparum-hookworm, P.falciparum-Ascaris lumbricoides and P.falciparum-Trichuris trichiura, before and after 2003. We also observed spatial variations in the estimates of the prevalence of P. falciparum-STH co-endemicity and identified hotspots across many countries in SSA with inter-and intra-country variations. High P. falciparum and high hookworm co-endemicity was more prevalent in West and Central Africa, whereas high P. falciparum with high A. lumbricoides and high P. falciparum with high T. trichiura co-endemicity were more predominant in Central Africa, compared to other sub-regions in SSA. CONCLUSIONS/SIGNIFICANCE Wide spatial heterogeneity exists in the prevalence of malaria and STH co-endemicity within the regions and within countries in SSA. The geographical overlap and spatial co-existence of malaria and STH could be exploited to achieve effective control and elimination agendas through the integration of the vertical control programmes designed for malaria and STH into a more comprehensive and sustainable community-based paradigm.
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Affiliation(s)
- Muhammed O. Afolabi
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Adekola Adebiyi
- College of Agriculture, Engineering and Environmental Design, Legacy University, Banjul, The Gambia
| | - Jorge Cano
- Expanded Special Project for Elimination of NTDs, World Health Organization Regional Office for Africa, Brazzaville, Republic of the Congo
| | - Benn Sartorius
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- Department of Health Metric Sciences, University of Washington, Seattle, Washington, United States of America
| | - Brian Greenwood
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Olatunji Johnson
- Department of Mathematics, University of Manchester, Manchester, United Kingdom
| | - Oghenebrume Wariri
- Department of Infectious Diseases Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
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10
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Nomhwange T, Wariri O, Nkereuwem E, Olanrewaju S, Nwosu N, Adamu U, Danjuma E, Onuaguluchi N, Enegela J, Nomhwange E, Jean Baptiste AE, Mulombo WK. COVID-19 vaccine hesitancy amongst healthcare workers: An assessment of its magnitude and determinants during the initial phase of national vaccine deployment in Nigeria. EClinicalMedicine 2022; 50:101499. [PMID: 35770256 PMCID: PMC9233171 DOI: 10.1016/j.eclinm.2022.101499] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 05/19/2022] [Accepted: 05/20/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND While vaccination plays a critical role in the global response to the COVID-19 pandemic, vaccine rollout remains suboptimal in Nigeria and other Low- and Middle-income countries (LMICs). This study documents the level of hesitancy among health workers (HWs) during the initial COVID-19 vaccine deployment phase in Nigeria and assesses the magnitude and determinants of hesitancy across Nigeria. METHODS A cross sectional study across all States in Nigeria was conducted with over 10,000 HWs interviewed between March and April 2021. Data were cleaned and analyzed with proportions and confidence intervals of hesitancy documented and stratification by HW category. We compared the level of confidence/acceptance to be vaccinated across Nigeria and documented the sources of negative information amongst HWs who refused the vaccine. FINDINGS Among the 10 184 HWs interviewed, 9 369 [92% (95% CI= 91, 92)] were confident of the COVID-19 vaccines and were already vaccinated at the time of this survey. Compared to HWs who were less than 20 years old, those aged 50 - 59 years were significantly more confident of the COVID-19 vaccines and had been vaccinated (OR=3.8, 95% CI=2.3 - 6.4, p<0.001). Only 858 (8%) of the HWs interviewed reported being hesitant with 57% (479/858) having received negative information, with the commonest source of information from social media (43.4%.). INTERPRETATION A vast majority of HWs who were offered COVID-19 vaccines as part of the first phase of national vaccine roll out were vaccinated and reported being confident of the COVID-19 vaccines. The reported hesitancy was due mainly to safety issues, and negative information about vaccines from social media. The issues identified remain a significant risk to the success of subsequent phases of the vaccine rollout in Nigeria. FUNDING None.
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Affiliation(s)
- Terna Nomhwange
- World Health Organization Country office, Abuja, Nigeria
- Corresponding author at: Terna Nomhwange, World Health Organization Country office, Abuja, Nigeria.
| | - Oghenebrume Wariri
- MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Esin Nkereuwem
- MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | | | - Ngozi Nwosu
- National Primary Health Care Development Agency (NPHCDA) Abuja, Nigeria
| | - Usman Adamu
- National Primary Health Care Development Agency (NPHCDA) Abuja, Nigeria
| | - Ezekiel Danjuma
- World Health Organization East and Southern Africa Inter country support team (IST), Harare, Zimbabwe
| | - Nneka Onuaguluchi
- Africa Disease prevention and research development Initiative (ADRAP), Abuja, Nigeria
| | - Joseph Enegela
- Africa Disease prevention and research development Initiative (ADRAP), Abuja, Nigeria
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11
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Wariri O, Okomo U, Kwarshak YK, Utazi CE, Murray K, Grundy C, Kampmann B. Timeliness of routine childhood vaccination in 103 low-and middle-income countries, 1978-2021: A scoping review to map measurement and methodological gaps. PLOS Glob Public Health 2022; 2:e0000325. [PMID: 36962319 PMCID: PMC10021799 DOI: 10.1371/journal.pgph.0000325] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 06/14/2022] [Indexed: 11/19/2022]
Abstract
Empiric studies exploring the timeliness of routine vaccination in low-and middle-income countries (LMICs) have gained momentum in the last decade. Nevertheless, there is emerging evidence suggesting that these studies have key measurement and methodological gaps that limit their comparability and utility. Hence, there is a need to identify, and document these gaps which could inform the design, conduct, and reporting of future research on the timeliness of vaccination. We synthesised the literature to determine the methodological and measurement gaps in the assessment of vaccination timeliness in LMICs. We searched five electronic databases for peer-reviewed articles in English and French that evaluated vaccination timeliness in LMICs, and were published between 01 January 1978, and 01 July 2021. Two reviewers independently screened titles and abstracts and reviewed full texts of relevant articles, following the guidance framework for scoping reviews by the Joanna Briggs Institute. From the 4263 titles identified, we included 224 articles from 103 countries. China (40), India (27), and Kenya (23) had the highest number of publications respectively. Of the three domains of timeliness, the most studied domain was 'delayed vaccination' [99.5% (223/224)], followed by 'early vaccination' [21.9% (49/224)], and 'untimely interval vaccination' [9% (20/224)]. Definitions for early (seven different definitions), untimely interval (four different definitions), and delayed vaccination (19 different definitions) varied across the studies. Most studies [72.3% (166/224)] operationalised vaccination timeliness as a categorical variable, compared to only 9.8% (22/224) of studies that operationalised timeliness as continuous variables. A large proportion of studies [47.8% (107/224)] excluded the data of children with no written vaccination records irrespective of caregivers' recall of their vaccination status. Our findings show that studies on vaccination timeliness in LMICs has measurement and methodological gaps. We recommend the development and implement of guidelines for measuring and reporting vaccination timeliness to bridge these gaps.
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Affiliation(s)
- Oghenebrume Wariri
- Vaccines and Immunity Theme, MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Vaccine Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Uduak Okomo
- Vaccines and Immunity Theme, MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | | | - Chigozie Edson Utazi
- WorldPop, School of geography and Environmental Science, University of Southampton, Southampton, United Kingdom
- Southampton Statistical Sciences Research Institute, University of Southampton, Southampton, United Kingdom
| | - Kris Murray
- MRC Unit The Gambia at The London School of Hygiene and Tropical Medicine, Fajara, The Gambia
- MRC Centre for Global Infectious Disease Analysis, Imperial College School of Public Health, Imperial College London, London, United Kingdom
| | - Chris Grundy
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Beate Kampmann
- Vaccines and Immunity Theme, MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
- Vaccine Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
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12
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Afolabi MO, Wariri O, Saidu Y, Otu A, Omoleke SA, Ebenso B, Adebiyi A, Ooko M, Ahinkorah BO, Ameyaw EK, Seidu AA, Agogo E, Nomhwange T, Salami K, Mohammed NI, Yaya S. Tracking the uptake and trajectory of COVID-19 vaccination coverage in 15 West African countries: an interim analysis. BMJ Glob Health 2021; 6:bmjgh-2021-007518. [PMID: 34906987 PMCID: PMC8718349 DOI: 10.1136/bmjgh-2021-007518] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 09/23/2021] [Accepted: 10/28/2021] [Indexed: 11/04/2022] Open
Abstract
The African Union Bureau of Heads of State and Government endorsed the COVID-19 Vaccine Development and Access Strategy to vaccinate at least 60% of each country's population with a safe and efficacious vaccine by 2022, to achieve the population-level immunity needed to bring the pandemic under control. Using publicly available, country-level population estimates and COVID-19 vaccination data, we provide unique insights into the uptake trends of COVID-19 vaccinations in the 15 countries that comprise the Economic Community of West Africa States (ECOWAS). Based on the vaccination rates in the ECOWAS region after three months of commencing COVID-19 vaccinations, we provide a projection of the trajectory and speed of vaccination needed to achieve a COVID-19 vaccination coverage rate of at least 60% of the total ECOWAS population. After three months of the deployment of COVID-19 vaccines across the ECOWAS countries, only 0.27% of the region's total population had been fully vaccinated. If ECOWAS countries follow this trajectory, the sub-region will have less than 1.6% of the total population fully vaccinated after 18 months of vaccine deployment. Our projection shows that to achieve a COVID-19 vaccination coverage of at least 60% of the total population in the ECOWAS sub-region after 9, 12 and 18 months of vaccine deployment; the speed of vaccination must be increased to 10, 7 and 4 times the current trajectory, respectively. West African governments must deploy contextually relevant and culturally acceptable strategies for COVID-19 vaccine procurements, distributions and implementations in order to achieve reasonable coverage and save lives, sooner rather than later.
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Affiliation(s)
| | - Oghenebrume Wariri
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.,Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Yauba Saidu
- Clinton Health Access Initiative, Yaounde, Cameroon.,Institute for Global Health, University of Siena, Siena, Italy
| | - Akaninyene Otu
- Department of Infection and Travel Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Department of Internal Medicine, College of Medical Sciences, Faculty of Clinical Sciences, University of Calabar, Calabar, Cross River State, Nigeria
| | | | - Bassey Ebenso
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
| | - Adekola Adebiyi
- College of Agriculture, Engineering and Environmental Design, Legacy University, Banjul, Gambia
| | - Michael Ooko
- Statistics & Bioinformatics, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Liverpool, New South Wales, Australia
| | - Edward Kwabena Ameyaw
- School of Public Health, Faculty of Health, University of Technology Sydney, Liverpool, New South Wales, Australia
| | - Abdul-Aziz Seidu
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.,Department of Estate Management, Takoradi Technical University, Takoradi, Ghana
| | - Emmanuel Agogo
- Resolve to Save Lives, (Vital Strategies), Regus 4th Floor, Tower C, Churchgate Plaza, 473 Constitution Avenue, Central Business District, Abuja, Nigeria
| | | | | | - Nuredin Ibrahim Mohammed
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.,Statistics & Bioinformatics, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada.,The George Institute for Global Health, Imperial College London, London, UK
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Wariri O, Alhassan JAK, Mark G, Adesiyan O, Hanson L. Trends in obesity by socioeconomic status among non-pregnant women aged 15-49 y: a cross-sectional, multi-dimensional equity analysis of demographic and health surveys in 11 sub-Saharan Africa countries, 1994-2015. Int Health 2021; 13:436-445. [PMID: 33205197 PMCID: PMC8417076 DOI: 10.1093/inthealth/ihaa093] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/30/2020] [Accepted: 10/22/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Global obesity estimates show a steadily increasing pattern across socioeconomic and geographical divides, especially among women. Our analysis tracked and described obesity trends across multiple equity dimensions among women of reproductive age (15-49 y) in 11 sub-Saharan African (SSA) countries during 1994-2015. METHODS This study consisted of a cross-sectional series analysis using nationally representative demographic and health surveys (DHS) data. The countries included were Cameroon, Comoros, Congo, Cote d'Ivoire, Ghana, Kenya, Lesotho, Nigeria, Senegal, Zambia and Zimbabwe. The data reported are from a reanalysis conducted using the WHO Health Equity Assessment Toolkit that assesses inter- and intra-country health inequalities across socioeconomic and geographical dimensions. We generated equiplots to display intra- and inter-country equity gaps. RESULTS There was an increasing trend in obesity among women of reproductive age across all 11 SSA countries. Obesity increased unequally across wealth categories, place of residence and educational measures of inequality. The wealthiest, most educated and urban dwellers in most countries had a higher prevalence of obesity. However, in Comoros, obesity did not increase consistently with increasing wealth or education compared with other countries. The most educated and wealthiest women in Comoros had lower obesity rates compared with their less wealthy and less well-educated counterparts. CONCLUSION A window of opportunity is presented to governments to act structurally and at policy level to reduce obesity generally and prevent a greater burden on disadvantaged subpopulation groups in sub-Saharan Africa.
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Affiliation(s)
- Oghenebrume Wariri
- Medical Research Council (MRC) Unit The Gambia, at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Jacob Albin Korem Alhassan
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Canada
| | - Godwin Mark
- Department of Internal Medicine, Federal Teaching Hospital, Gombe, Nigeria
| | | | - Lori Hanson
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Canada
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14
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Edem B, Nkereuwem E, Wariri O. Voices in the wilderness: how exclusionist article processing charge policies of academic journals underscore what is wrong with global health. Lancet Glob Health 2021; 9:e1205-e1207. [PMID: 34416204 DOI: 10.1016/s2214-109x(21)00262-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 05/25/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Bassey Edem
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia.
| | - Esin Nkereuwem
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Oghenebrume Wariri
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
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15
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Imam A, Wariri O, Dibbasey T, Camara A, Mendy A, Sanyang AN, Ceesay M, Jallow S, Jallow AE, Bah K, Johnson N, Trawally E, Sowe D, Darboe A, Kampmann B, Idoko OT. Conducting clinical research in a resource-constrained setting: lessons from a longitudinal cohort study in The Gambia. BMJ Glob Health 2021; 6:e006419. [PMID: 34400549 PMCID: PMC8370547 DOI: 10.1136/bmjgh-2021-006419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/27/2021] [Accepted: 07/30/2021] [Indexed: 11/17/2022] Open
Abstract
Clinical research conducted to Good Clinical Practice (GCP) standards is increasingly being undertaken in resource-constrained low-income and middle-income countries (LMICs) settings. This presents unique challenges that differ from those faced in high-income country (HIC) contexts, due to a dearth of infrastructure and unique socio-cultural contexts. Field experiences by research teams working in these LMIC contexts are thus critical to advancing knowledge on successful research conduct in these settings. The Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine has operated in The Gambia, a resource-constrained LMIC for over 70 years and has developed numerous research support platforms and systems. The unit was the lead clinical collaborator in a recently completed Expanded Program on Immunization Consortium (EPIC) study, involving a multicountry collaboration across five countries including the USA, Canada, Belgium, Papua New Guinea and The Gambia. The EPIC study recruited and completed follow-up of 720 newborn infants over 2 years. In this paper, we provide in-depth field experience covering challenges faced by the Gambian EPIC team in the conduct of this study. We also detail some reflections on these challenges. Our findings are relevant to the international research community as they highlight practical day-to-day challenges in conducting GCP standard clinical research in resource-constrained LMIC contexts. They also provide insights on how study processes can be adapted early during research planning to mitigate challenges.
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Affiliation(s)
- Abdulazeez Imam
- Vaccines and Immunity, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Oghenebrume Wariri
- Vaccines and Immunity, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Tida Dibbasey
- Vaccines and Immunity, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Abdoulie Camara
- Vaccines and Immunity, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Anthony Mendy
- Vaccines and Immunity, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Assan N Sanyang
- Vaccines and Immunity, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Masaneh Ceesay
- Vaccines and Immunity, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Samba Jallow
- Vaccines and Immunity, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Abdoulie E Jallow
- Vaccines and Immunity, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Kaddijatou Bah
- Vaccines and Immunity, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Njilan Johnson
- Vaccines and Immunity, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Ebrima Trawally
- Vaccines and Immunity, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Dawda Sowe
- Department of Expanded Programme on Immunisation, Ministry of Health and Social Welfare, The Gambia, Banjul, Gambia
| | - Alansana Darboe
- Vaccines and Immunity, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Beate Kampmann
- Vaccines and Immunity, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Olubukola T Idoko
- Vaccines and Immunity, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
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Abatan B, Agboghoroma O, Akemoke F, Antonio M, Awokola B, Bittaye M, Bojang A, Bojang K, Brotherton H, Cerami C, Clarke E, D'Alessandro U, de Silva T, Drammeh M, Forrest K, Hofmann N, Jagne S, Jah H, Jarju S, Jaye A, Jobe M, Kampmann B, Manjang B, Martinez-Alvarez M, Mohammed N, Nadjm B, Ndiath MO, Nkereuwem E, Nwakanma D, Oko F, Okoh E, Okomo U, Olatunji Y, Oriero E, Prentice AM, Roberts C, Roca A, Sabally B, Sambou S, Samateh A, Secka O, Sesay AK, Singhateh Y, Susso B, Usuf E, Vilane A, Wariri O. Intense and Mild First Epidemic Wave of Coronavirus Disease, The Gambia. Emerg Infect Dis 2021; 27:2064-2072. [PMID: 34286683 PMCID: PMC8314844 DOI: 10.3201/eid2708.204954] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic is evolving differently in Africa than in other regions. Africa has lower SARS-CoV-2 transmission rates and milder clinical manifestations. Detailed SARS-CoV-2 epidemiologic data are needed in Africa. We used publicly available data to calculate SARS-CoV-2 infections per 1,000 persons in The Gambia. We evaluated transmission rates among 1,366 employees of the Medical Research Council Unit The Gambia (MRCG), where systematic surveillance of symptomatic cases and contact tracing were implemented. By September 30, 2020, The Gambia had identified 3,579 SARS-CoV-2 cases, including 115 deaths; 67% of cases were identified in August. Among infections, MRCG staff accounted for 191 cases; all were asymptomatic or mild. The cumulative incidence rate among nonclinical MRCG staff was 124 infections/1,000 persons, which is >80-fold higher than estimates of diagnosed cases among the population. Systematic surveillance and seroepidemiologic surveys are needed to clarify the extent of SARS-CoV-2 transmission in Africa.
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17
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Edem B, Onwuchekwa C, Wariri O, Nkereuwem E, Nkereuwem OO, Williams V. Trends in clinical trial registration in sub-Saharan Africa between 2010 and 2020: a cross-sectional review of three clinical trial registries. Trials 2021; 22:472. [PMID: 34289892 PMCID: PMC8293494 DOI: 10.1186/s13063-021-05423-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 02/18/2021] [Accepted: 07/05/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Prospective registration of clinical trials is an ethical, scientific, and legal requirement that serves several functions, including minimising research wastage and publication bias. Sub-Saharan Africa (SSA) is increasingly hosting clinical trials over the past few years, and there is limited literature on trends in clinical trial registration and reporting in SSA. Therefore, we set out to determine the trends in clinical trials registered in SSA countries between 2010 and July 2020. METHODS A cross-sectional study design was used to describe the type of clinical trials that are conducted in SSA from 1 January 2010 to 31 July 2020. The registries searched were ClinicalTrials.gov (CTG), the Pan African Clinical Trials Register (PACTR), and the International Standard Randomized Controlled Trial Number (ISRCTN). Data were extracted into Excel and imported into STATA for descriptive analysis. RESULTS CTG had the highest number of registered trials at 2622, followed by PACTR with 1501 and ISRCTN with 507 trials. Trials were observed to increase gradually from 2010 and peaked at 2018-2019. Randomised trials were the commonest type, accounting for at least 80% across the three registries. Phase three trials investigating drugs targeted at infections/infestations were the majority. Few completed trials had their results posted: 58% in ISRCTN and 16.5% in CTG, thus suggesting reporting bias. CONCLUSION Despite the gradual increase in clinical trials registered during the period, recent trends suggest a drop in the number of trials registered across the region. Strengthening national and regional regulatory capacity will improve clinical trial registration and minimise reporting bias in completed clinical trials.
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Affiliation(s)
- Bassey Edem
- Department of Vaccines and Immunity, Medical Research Council (MRC) Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia.
| | - Chukwuemeka Onwuchekwa
- Department of Vaccines and Immunity, Medical Research Council (MRC) Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Oghenebrume Wariri
- Department of Vaccines and Immunity, Medical Research Council (MRC) Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Esin Nkereuwem
- Department of Vaccines and Immunity, Medical Research Council (MRC) Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Oluwatosin O Nkereuwem
- Department of Vaccines and Immunity, Medical Research Council (MRC) Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Victor Williams
- Unit of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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18
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Sanyang B, Kanteh A, Usuf E, Nadjm B, Jarju S, Bah A, Bojang A, Grey-Johnson M, Jones JC, Gai A, Sarr C, Sillah F, Wariri O, Oko F, Cerami C, Forrest K, Sey AP, Jallow H, Nwakanma D, Sesay AK, D'Alessandro U, Roca A. COVID-19 reinfections in The Gambia by phylogenetically distinct SARS-CoV-2 variants-first two confirmed events in west Africa. Lancet Glob Health 2021; 9:e905-e907. [PMID: 34090610 PMCID: PMC8175042 DOI: 10.1016/s2214-109x(21)00213-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/09/2021] [Accepted: 04/19/2021] [Indexed: 12/15/2022]
Affiliation(s)
- Bakary Sanyang
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara 273, The Gambia
| | - Abdoulie Kanteh
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara 273, The Gambia
| | - Effua Usuf
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara 273, The Gambia
| | - Behzad Nadjm
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara 273, The Gambia
| | - Sheikh Jarju
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara 273, The Gambia
| | - Alasana Bah
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara 273, The Gambia
| | - Abdoulie Bojang
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara 273, The Gambia
| | - Mary Grey-Johnson
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara 273, The Gambia
| | - Joquina Chiquita Jones
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara 273, The Gambia
| | - Abdou Gai
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara 273, The Gambia
| | - Catherine Sarr
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara 273, The Gambia
| | - Fatoumata Sillah
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara 273, The Gambia
| | - Oghenebrume Wariri
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara 273, The Gambia
| | - Francis Oko
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara 273, The Gambia
| | - Carla Cerami
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara 273, The Gambia
| | - Karen Forrest
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara 273, The Gambia
| | | | - Haruna Jallow
- National Public Health Laboratories, Kotu, The Gambia
| | - Davis Nwakanma
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara 273, The Gambia
| | - Abdul Karim Sesay
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara 273, The Gambia
| | - Umberto D'Alessandro
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara 273, The Gambia
| | - Anna Roca
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara 273, The Gambia.
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19
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Wariri O, Okomo U, Kwarshak YK, Murray KA, Grundy C, Kampmann B. Timeliness of routine childhood vaccination in low- and middle-income countries, 1978-2021: Protocol for a scoping review to map methodologic gaps and determinants. PLoS One 2021; 16:e0253423. [PMID: 34138965 PMCID: PMC8211249 DOI: 10.1371/journal.pone.0253423] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/04/2021] [Indexed: 11/18/2022] Open
Abstract
The literature on the timeliness of childhood vaccination (i.e. vaccination at the earliest appropriate age) in low-and middle-income countries has important measurement and methodological issues that may limit their usefulness and cross comparison. We aim to conduct a comprehensive scoping review to map the existing literature with a key focus on how the literature on vaccination timeliness has evolved, how it has been defined or measured, and what determinants have been explored in the period spanning the last four decades. This scoping review protocol was developed based on the guidance for scoping reviews from the Joanna Briggs Institute. We will include English and French language peer-reviewed publications and grey literature on the timeliness of routine childhood vaccination in low-and middle-income countries published between January 1978 through to 2021. A three-step search strategy that involves an initial search of two databases to refine the keywords, a full search of all included electronic databases, and screening of references of previous studies for relevant articles missing from our full search will be employed. The search will be conducted in five electronic databases: MEDLINE, EMBASE, Global Health, CINAHL and Web of Science. Google search will also be conducted to identify relevant grey literature on vaccination timeliness. All retrieved titles from the search will be imported into Endnote X9.3.3 (Clarivate Analytics) and deduplicated. Two reviewers will screen the titles, abstracts and full texts of publications for eligibility using Rayyan-the web based application for screening articles for systematic reviews. Using a tailored data extraction template, we will extract relevant information from eligible studies. The study team will analyse the extracted data using descriptive statistical methods and thematic analysis. The results will be presented using tables, while charts and maps will be used to aid the visualisation of the key findings and themes. The proposed review will generate evidence on key methodological gaps in the literature on timeliness of childhood vaccination. Such evidence would shape the direction of future research, and assist immunisation programme managers and country-level stakeholders to address the needs of their national immunisation system.
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Affiliation(s)
- Oghenebrume Wariri
- Vaccines and Immunity Theme, MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Uduak Okomo
- Vaccines and Immunity Theme, MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | | | - Kris A. Murray
- MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
- MRC Centre for Global Infectious Disease Analysis, Imperial College School of Public Health, Imperial College London, London, United Kingdom
| | - Chris Grundy
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Beate Kampmann
- Vaccines and Immunity Theme, MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
- The Vaccine Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
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20
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Wariri O, Okomo U, Cerami C, Okoh E, Oko F, Jah H, Bojang K, Susso B, Olatunji Y, Nkereuwem E, Akemokwe FM, Jobe M, Agboghoroma OF, Kebbeh B, Sowe G, Gilleh T, Jobe N, Usuf E, Clarke E, Brotherton H, Forrest K. Establishing and operating a 'virtual ward' system to provide care for patients with COVID-19 at home: experience from The Gambia. BMJ Glob Health 2021; 6:e005883. [PMID: 34140303 PMCID: PMC8212157 DOI: 10.1136/bmjgh-2021-005883] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 05/22/2021] [Indexed: 12/20/2022] Open
Abstract
Health systems in sub-Saharan Africa have remained overstretched from dealing with endemic diseases, which limit their capacity to absorb additional stress from new and emerging infectious diseases. Against this backdrop, the rapidly evolving COVID-19 pandemic presented an additional challenge of insufficient hospital beds and human resource for health needed to deliver hospital-based COVID-19 care. Emerging evidence from high-income countries suggests that a 'virtual ward' (VW) system can provide adequate home-based care for selected patients with COVID-19, thereby reducing the need for admissions and mitigate additional stress on hospital beds. We established a VW at the Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine, a biomedical research institution located in The Gambia, a low-income west African country, to care for members of staff and their families infected with COVID-19. In this practice paper, we share our experience focusing on the key components of the system, how it was set up and successfully operated to support patients with COVID-19 in non-hospital settings. We describe the composition of the multidisciplinary team operating the VW, how we developed clinical standard operating procedures, how clinical oversight is provided and the use of teleconsultation and data capture systems to successfully drive the process. We demonstrate that using a VW to provide an additional level of support for patients with COVID-19 at home is feasible in a low-income country in sub-Saharan Africa. We believe that other low-income or resource-constrained settings can adopt and contextualise the processes described in this practice paper to provide additional support for patients with COVID-19 in non-hospital settings.
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Affiliation(s)
- Oghenebrume Wariri
- Vaccines and Immunity Theme, Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Uduak Okomo
- Vaccines and Immunity Theme, Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Carla Cerami
- Nutrition Theme, Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Emmanuel Okoh
- Disease Control and Elimination, Medical Research Council Unit The Gambia, at London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Francis Oko
- Vaccines and Immunity Theme, Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Hawanatu Jah
- Disease Control and Elimination, Medical Research Council Unit The Gambia, at London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Kalifa Bojang
- Disease Control and Elimination, Medical Research Council Unit The Gambia, at London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Bubacarr Susso
- Clinical Services Department, Medical Research Council Unit The Gambia, at London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Yekini Olatunji
- Disease Control and Elimination, Medical Research Council Unit The Gambia, at London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Esin Nkereuwem
- Vaccines and Immunity Theme, Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Fatai Momodou Akemokwe
- Clinical Services Department, Medical Research Council Unit The Gambia, at London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Modou Jobe
- Nutrition Theme, Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Orighomisan Freda Agboghoroma
- Clinical Services Department, Medical Research Council Unit The Gambia, at London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Bunja Kebbeh
- Clinical Services Department, Medical Research Council Unit The Gambia, at London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Ghata Sowe
- Vaccines and Immunity Theme, Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Thomas Gilleh
- Data Management and Archives, Medical Research Council Unit The Gambia, at London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Naffie Jobe
- Directorate, Medical Research Council Unit The Gambia, at London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Effua Usuf
- Disease Control and Elimination, Medical Research Council Unit The Gambia, at London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Ed Clarke
- Vaccines and Immunity Theme, Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Helen Brotherton
- Disease Control and Elimination, Medical Research Council Unit The Gambia, at London School of Hygiene and Tropical Medicine, Banjul, Gambia
- Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Karen Forrest
- Clinical Services Department, Medical Research Council Unit The Gambia, at London School of Hygiene and Tropical Medicine, Banjul, Gambia
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21
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Wariri O, Nkereuwem E, Erondu NA, Edem B, Nkereuwem OO, Idoko OT, Agogo E, Enegela JE, Sesay T, Conde IS, Kaucley L, Awuah AAA, Abdullahi S, Luce RR, Banda R, Nomhwange T, Kampmann B. A scorecard of progress towards measles elimination in 15 west African countries, 2001-19: a retrospective, multicountry analysis of national immunisation coverage and surveillance data. Lancet Glob Health 2021; 9:e280-e290. [PMID: 33607028 PMCID: PMC7900524 DOI: 10.1016/s2214-109x(20)30481-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 10/16/2020] [Accepted: 10/28/2020] [Indexed: 01/08/2023]
Abstract
Background The WHO Regional Office for the Africa Regional Immunization Technical Advisory Group, in 2011, adopted the measles control and elimination goals for all countries of the African region to achieve in 2015 and 2020 respectively. Our aim was to track the current status of progress towards measles control and elimination milestones across 15 west African countries between 2001 and 2019. Methods We did a retrospective multicountry series analysis of national immunisation coverage and case surveillance data from Jan 1, 2001, to Dec 31, 2019. Our analysis focused on the 15 west African countries that constitute the Economic Community of West African States. We tracked progress in the coverage of measles-containing vaccines (MCVs), measles supplementary immunisation activities, and measles incidence rates. We developed a country-level measles summary scorecard using eight indicators to track progress towards measles elimination as of the end of 2019. The summary indicators were tracked against measles control and elimination milestones. Findings The weighted average regional first-dose MCV coverage in 2019 was 66% compared with 45% in 2001. 73% (11 of 15) of the west African countries had introduced second-dose MCV as of December, 2019. An estimated 4 588 040 children (aged 12–23 months) did not receive first-dose MCV in 2019, the majority (71%) of whom lived in Nigeria. Based on the scorecard, 12 (80%) countries are off-track to achieving measles elimination milestones; however, Cape Verde, The Gambia, and Ghana have made substantial progress. Interpretation Measles will continue to be endemic in west Africa after 2020. The regional measles incidence rate in 2019 was 33 times the 2020 elimination target of less than 1 case per million population. However, some hope exists as countries can look at the efforts made by Cape Verde, The Gambia, and Ghana and learn from them. Funding None.
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Affiliation(s)
- Oghenebrume Wariri
- Vaccines and Immunity Theme, MRC Unit the Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia.
| | - Esin Nkereuwem
- Vaccines and Immunity Theme, MRC Unit the Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | | | - Bassey Edem
- Vaccines and Immunity Theme, MRC Unit the Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Oluwatosin O Nkereuwem
- Vaccines and Immunity Theme, MRC Unit the Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Olubukola T Idoko
- Sanofi Pasteur, Lyon, France; The Vaccine Centre, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Joseph E Enegela
- Africa Diseases Prevention and Research Development Initiative, Abuja, Nigeria
| | - Tom Sesay
- Expanded Programme on Immunization, Freetown, Sierra Leone
| | | | | | | | | | - Richard Ray Luce
- WHO, West African Regional Support Team, Ouagadougou, Burkina Faso
| | | | | | - Beate Kampmann
- Vaccines and Immunity Theme, MRC Unit the Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia; The Vaccine Centre, London School of Hygiene and Tropical Medicine, London, UK
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22
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Nkereuwem OO, Kochhar S, Wariri O, Johm P, Ceesay A, Kinteh M, Kampmann B. The use of a speaking book® to enhance vaccine knowledge among caregivers in The Gambia: A study using qualitative and quantitative methods. BMJ Open 2021; 11:e040507. [PMID: 34006021 PMCID: PMC7942236 DOI: 10.1136/bmjopen-2020-040507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To measure the usefulness of a Speaking Book (SB) as an educational tool for enhancing knowledge, understanding and recall of key vaccine-related information among caregivers in The Gambia, as well as its acceptability and relevance as a health promotion tool for caregivers and healthcare workers. DESIGN AND SETTING We developed a multimedia educational tool, the vaccine Speaking Book, which contained prerecorded information about vaccines provided in The Gambia's Expanded Programme on Immunization. Using qualitative and quantitative methods, we then conducted a sequential study assessing the use of this tool among caregivers andhealthcare workers in The Gambia.Participants200 caregivers attending primary healthcare centres in The Gambia for routine immunisation services for their infants, and 15 healthcare workers employed to provide immunisation services at these clinics. OUTCOME MEASURES We calculated the median knowledge scores on vaccine-related information obtained at baseline, 1-month and 3-month follow-up visits. Wilcoxon's matched-pairs signed-rank test was used to compare the difference in the median knowledge scores between baseline and 1-month, and between baseline and 3-month follow-up visits. RESULTS Of the 113 caregivers who participated, 104 (92%) completed all three study visits, 108 (95.6%) completed the baseline and 1-month follow-up visits, and 107 (94.7%) completed the baseline and 3-month follow-up visits. The median knowledge score increased from 6.0 (IQR 5.0-7.0) at baseline to 11.0 (IQR 8.0-14.0) at 1-month visit (p<0.001), and 15.0 (IQR 10.0-20.0) at 3-month visit (p<0.001). Qualitative results showed high acceptability and enthusiasm for the Speaking Book among both caregivers and healthcare workers. The Speaking Book was widely shared in the community and this facilitated communication with healthcare workers at the primary healthcare centres. CONCLUSIONS Context-specific and subject-specific Speaking Books are a useful communication and educational tool to increase caregiver vaccine knowledge in low/middle-income countries.
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Affiliation(s)
- Oluwatosin O Nkereuwem
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Sonali Kochhar
- Global Health, Global Healthcare Consulting, New Delhi, India
- Global Health, University of Washington Department of Global Health, Seattle, Washington, USA
| | - Oghenebrume Wariri
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Penda Johm
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Amie Ceesay
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Mamanding Kinteh
- Expanded Programme on Immunization, Ministry of Health and Social Welfare, The Gambia, Banjul, The Gambia
| | - Beate Kampmann
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia
- The Vaccine Centre, London School of Hygiene and Tropical Medicine, London, UK
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Wariri O, Onuwabuchi E, Alhassan JAK, Dase E, Jalo I, Laima CH, Farouk HU, El-Nafaty AU, Okomo U, Dotse-Gborgbortsi W. The influence of travel time to health facilities on stillbirths: A geospatial case-control analysis of facility-based data in Gombe, Nigeria. PLoS One 2021; 16:e0245297. [PMID: 33411850 PMCID: PMC7790442 DOI: 10.1371/journal.pone.0245297] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/24/2020] [Indexed: 12/14/2022] Open
Abstract
Access to quality emergency obstetric and newborn care (EmONC); having a skilled attendant at birth (SBA); adequate antenatal care; and efficient referral systems are considered the most effective interventions in preventing stillbirths. We determined the influence of travel time from mother's area of residence to a tertiary health facility where women sought care on the likelihood of delivering a stillbirth. We carried out a prospective matched case-control study between 1st January 2019 and 31st December 2019 at the Federal Teaching Hospital Gombe (FTHG), Nigeria. All women who experienced a stillbirth after hospital admission during the study period were included as cases while controls were consecutive age-matched (ratio 1:1) women who experienced a live birth. We modelled travel time to health facilities. To determine how travel time to the nearest health facility and the FTHG were predictive of the likelihood of stillbirths, we fitted a conditional logistic regression model. A total of 318 women, including 159 who had stillborn babies (cases) and 159 age-matched women who had live births (controls) were included. We did not observe any significant difference in the mean travel time to the nearest government health facility for women who had experienced a stillbirth compared to those who had a live birth [9.3 mins (SD 7.3, 11.2) vs 6.9 mins (SD 5.1, 8.7) respectively, p = 0.077]. However, women who experienced a stillbirth had twice the mean travel time of women who had a live birth (26.3 vs 14.5 mins) when measured from their area of residence to the FTHG where deliveries occurred. Women who lived farther than 60 minutes were 12 times more likely of having a stillborn [OR = 12 (1.8, 24.3), p = 0.011] compared to those who lived within 15 minutes travel time to the FTHG. We have shown for the first time, the influence of travel time to a major tertiary referral health facility on the occurrence of stillbirths in an urban city in, northeast Nigeria.
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Affiliation(s)
- Oghenebrume Wariri
- Vaccines and Immunity Theme, MRC Unit The Gambia at the London School of
Hygiene and Tropical Medicine, Fajara, The Gambia
- African Population and Health Policy Initiative, Gombe, Gombe State,
Nigeria
| | - Egwu Onuwabuchi
- African Population and Health Policy Initiative, Gombe, Gombe State,
Nigeria
- Department of Obstetrics and Gynaecology, Federal Teaching Hospital
Gombe, Gombe, Nigeria
| | - Jacob Albin Korem Alhassan
- African Population and Health Policy Initiative, Gombe, Gombe State,
Nigeria
- Department of Community Health and Epidemiology, College of Medicine,
University of Saskatchewan, Saskatoon, Canada
| | - Eseoghene Dase
- African Population and Health Policy Initiative, Gombe, Gombe State,
Nigeria
- Department of Obstetrics and Gynaecology, Cedarcrest Hospital, Abuja,
Nigeria
| | - Iliya Jalo
- Department of Paediatrics, Federal Teaching Hospital Gombe, Gombe,
Nigeria
| | | | - Halima Usman Farouk
- Department of Obstetrics and Gynaecology, Federal Teaching Hospital
Gombe, Gombe, Nigeria
| | - Aliyu U. El-Nafaty
- Department of Obstetrics and Gynaecology, Federal Teaching Hospital
Gombe, Gombe, Nigeria
| | - Uduak Okomo
- Vaccines and Immunity Theme, MRC Unit The Gambia at the London School of
Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Winfred Dotse-Gborgbortsi
- School of Geography and Environmental Science, University of Southampton,
Southampton, United Kingdom
- WorldPop Research Group, School of Geography and Environmental Science,
University of Southampton, Southampton, United Kingdom
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Wariri O, Akhimienho KI, Alhassan JAK, Jalo I, Oloyede IP, Nyong EE, Bode-Thomas F. Population and Individual-Level Double Burden of Malnutrition Among Adolescents in Two Emerging Cities in Northern and Southern Nigeria: A Comparative Cross-Sectional Study. Ann Glob Health 2020; 86:153. [PMID: 33362989 PMCID: PMC7747759 DOI: 10.5334/aogh.3093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background Over the past three decades, double burden of malnutrition (DBM), a situation where high levels of undernutrition (stunting, thinness, or micronutrient deficiency) coexist with overnutrition (overweight and obesity), continues to rise in sub-Saharan Africa. Compared to other countries in the region, the evidence on DBM is limited in Nigeria. Objective This paper aimed to determine the comparative prevalence of population-level and individual-level DBM among adolescents in two emerging cities in northern and southern Nigeria. Methods This was a comparative cross-sectional study among apparently healthy secondary school adolescents aged 10-18 years in Gombe (northern Nigeria) and Uyo (southern Nigeria) between January 2015 and June 2017. A multistage random sampling technique was implemented to recruit adolescents from 24 secondary schools in both cities. Measures of general obesity (body mass index) and stature (height-for-age) were classified and Z-scores generated using the WHO AnthroPlus software, which is based on the WHO 2006 growth reference. Population-level DBM was defined as the occurrence of thinness and overweight/obesity within the population. Individual-level DBM was defined as the proportion of individuals who were concurrently stunted and had truncal obesity or stunted and were overweight/obese. Findings Overall, at the population-level in both settings, 6.8% of adolescents had thinness, while 12.4% were overweight/obese signifying a high burden of population-level DBM. Comparatively, the population-level DBM was higher in Gombe compared to Uyo (thinness: 11.98% vs 5.3% and overweight/obesity: 16.08% vs 11.27% in Gombe vs Uyo respectively). Overall, at the individual level, 6.42% of stunted adolescents had coexisting truncal obesity, while 8.02% were stunted and had coexisting general overweight/obesity. Like the trend with population-level DBM, individual-level DBM was higher in Gombe (northern Nigeria) compared to Uyo (southern Nigeria). Conclusion High levels of population-level and individual-level DBM exist in Gombe and Uyo. However, the level of DBM (under- and over-nutrition) is higher in Gombe located in northern Nigeria compared to Uyo in southern Nigeria.
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Affiliation(s)
- Oghenebrume Wariri
- MRC Unit the Gambia at the London School of Hygiene and Tropical Medicine, Fajara, GM
- African Population and Health Policy Initiative, Gombe, NG
- Aberdeen Centre for Health Data Science (ACHDS), Institute of Applied Health Sciences, University of Aberdeen, UK
| | | | - Jacob Albin Korem Alhassan
- African Population and Health Policy Initiative, Gombe, NG
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, CA
| | - Iliya Jalo
- Department of Paediatrics, Federal Teaching Hospital Gombe, NG
- Department of Paediatrics, College of Medical Sciences, Gombe State University, Gombe, NG
| | - Iso Precious Oloyede
- Department of Paediatrics, University of Uyo Teaching Hospital, Akwa-Ibom State, NG
| | - Eno Etim Nyong
- Department of Paediatrics, University of Uyo Teaching Hospital, Akwa-Ibom State, NG
| | - Fidelia Bode-Thomas
- Paediatric Cardiology Unit, Department of Paediatrics, Jos University Teaching Hospital (JUTH), Jos, NG
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Dase E, Wariri O, Onuwabuchi E, Alhassan JAK, Jalo I, Muhajarine N, Okomo U, ElNafaty AU. Applying the WHO ICD-PM classification system to stillbirths in a major referral Centre in Northeast Nigeria: a retrospective analysis from 2010-2018. BMC Pregnancy Childbirth 2020; 20:383. [PMID: 32611330 PMCID: PMC7329521 DOI: 10.1186/s12884-020-03059-8] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 06/16/2020] [Indexed: 11/16/2022] Open
Abstract
Background Lack of a unified and comparable classification system to unravel the underlying causes of stillbirth hampers the development and implementation of targeted interventions to reduce the unacceptably high stillbirth rates (SBR) in sub-Saharan Africa. Our aim was to track the SBR and the predominant maternal and fetal causes of stillbirths using the WHO ICD-PM Classification system. Methods This was a retrospective observational study in a major referral centre in northeast Nigeria between 2010 and 2018. Specialist Obstetricians and Gynaecologists assigned causes of stillbirths after an extensive audit of available stillbirths’ records. Cause of death was assigned via consensus using the ICD-PM classification system. Results There were 21,462 births between 1 January 2010 and 31 December 2018 in our study setting; of these, 1177 culminated in stillbirths with a total hospital SBR of 55 per 1000 births (95% CI: 52, 58). There were two peaks of stillbirths in 2012 [62 per 1000 births (95% CI: 53, 71)], and 2015 [65 per 1000 births (95% CI, 55, 76)]. Antepartum and intrapartum stillbirths were almost equally prevalent (48% vs 52%). Maternal medical and surgical conditions (M4) were the commonest (69.3%) cause of antepartum stillbirths while complications of placenta, cord and membranes (M3) accounted for the majority (45.8%) of intrapartum stillbirths and the trends were similar between 2010 and 2018. Antepartum and intrapartum fetal causes of stillbirths were mainly due to prematurity which is a disorder of fetal growth (A5 and I6). Conclusions Most causes of stillbirths in our setting are due to preventable causes and the trends have remained unabated between 2010 and 2018. Progress toward global SBR targets are off-track, requiring more interventions to halt and reduce the high SBR.
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Affiliation(s)
- Eseoghene Dase
- Department of Obstetrics and Gynaecology, Federal Teaching Hospital Gombe, Gombe, Nigeria.,African Population and Health Policy Initiative, Gombe, Gombe State, Nigeria
| | - Oghenebrume Wariri
- African Population and Health Policy Initiative, Gombe, Gombe State, Nigeria. .,Vaccines and Immunity Theme, Medical Research Council (MRC) Unit The Gambia at The London School of Hygiene and Tropical Medicine, Banjul, The Gambia. .,Aberdeen Centre for Health Data Science (ACHDS), Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
| | - Egwu Onuwabuchi
- Department of Obstetrics and Gynaecology, Federal Teaching Hospital Gombe, Gombe, Nigeria.,African Population and Health Policy Initiative, Gombe, Gombe State, Nigeria
| | - Jacob A K Alhassan
- African Population and Health Policy Initiative, Gombe, Gombe State, Nigeria.,Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Iliya Jalo
- Department of Paediatrics, Federal Teaching Hospital Gombe, Gombe, Nigeria.,Department of Paediatrics, College of Medical Sciences, Gombe State University, Gombe, Nigeria
| | - Nazeem Muhajarine
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Uduak Okomo
- Vaccines and Immunity Theme, Medical Research Council (MRC) Unit The Gambia at The London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Aliyu U ElNafaty
- Department of Obstetrics and Gynaecology, Federal Teaching Hospital Gombe, Gombe, Nigeria.,Department of Obstetrics and Gynaecology, College of Medical Sciences, Gombe State University, Gombe, Nigeria
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Alhassan JAK, Wariri O, Onuwabuchi E, Mark G, Kwarshak Y, Dase E. Access to skilled attendant at birth and the coverage of the third dose of diphtheria-tetanus-pertussis vaccine across 14 West African countries - an equity analysis. Int J Equity Health 2020; 19:78. [PMID: 32487158 PMCID: PMC7268225 DOI: 10.1186/s12939-020-01204-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 05/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Universal Health Coverage (UHC) remains a critical public health goal that continues to elude many countries of the global south. As countries strive for its attainment, it is important to track progress in various subregions of the world to understand current levels and mechanisms of progress for shared learning. Our aim was to compare multidimensional equity gaps in access to skilled attendant at birth (SAB) and coverage of the third dose of Diphtheria-Tetanus-Pertussis (DTP3) across 14 West African countries. METHODS The study was a cross sectional comparative analysis that used publicly available, nationally representative health surveys. We extracted data from Demographic and Health Surveys, and Multiple Indicator Cluster Surveys conducted between 2010 and 2017 in Benin, Burkina Faso, Cote d' Ivoire, The Gambia, Ghana, Guinea, Guinea Bissau, Liberia, Mali, Niger, Nigeria, Senegal, Sierra Leone and Togo. The World Health Organization's Health Equity Assessment Toolkit (HEAT Plus) software was used to evaluate current levels of intra-country equity in access to SAB and DTP3 coverage across four equity dimensions (maternal education, location of residence, region within a country and family wealth status). RESULTS There was a general trend of higher levels of coverage for DTP3 compared to access to SAB in the subregion. Across the various dimensions of equity, more gaps appear to have been closed in the subregion for DTP3 compared to SAB. The analysis revealed that countries such as Sierra Leone, Liberia and Ghana have made substantial progress towards equitable access for the two outcomes compared to others such as Nigeria, Niger and Guinea. CONCLUSION In the race towards UHC, equity should remain a priority and comparative progress should be consistently tracked to enable the sharing of lessons. The West African subregion requires adequate government financing and continued commitment to move toward UHC and close health equity gaps.
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Affiliation(s)
- Jacob Albin Korem Alhassan
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Canada
- African Population and Health Policy Initiative, Gombe, Nigeria
| | - Oghenebrume Wariri
- African Population and Health Policy Initiative, Gombe, Nigeria
- Medical Research Council (MRC) Unit The Gambia, London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Egwu Onuwabuchi
- African Population and Health Policy Initiative, Gombe, Nigeria
- Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Gombe, Nigeria
| | - Godwin Mark
- Department of One Health, The University of Edinburgh, Royal (Dick) School of Veterinary Studies, Edinburgh, Scotland UK
| | - Yakubu Kwarshak
- Department of Global Health and Management, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland UK
| | - Eseoghene Dase
- African Population and Health Policy Initiative, Gombe, Nigeria
- Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Gombe, Nigeria
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Wariri O, Ajani A, Raymond MP, Iliya A, Lukman O, Okpo E, Isaac E. "What will my child think of me if he hears I gave him HIV?": a sequential, explanatory, mixed-methods approach on the predictors and experience of caregivers on disclosure of HIV status to infected children in Gombe, Northeast Nigeria. BMC Public Health 2020; 20:373. [PMID: 32197648 PMCID: PMC7085175 DOI: 10.1186/s12889-020-08506-x] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 03/11/2020] [Indexed: 11/16/2022] Open
Abstract
Background With increasing access to effective Anti-Retroviral Therapy (ART), the proportion of children who survive into later childhood with HIV has increased. Consequently, caregivers are constantly being confronted with the dilemma of ‘if’, ‘when’, and ‘how’ to tell their children living with HIV their status. We aimed to determine the prevalence and predictors of disclosure and explore the barriers caregivers face in disclosing HIV status to children living with HIV in Gombe, northeast Nigeria. Methods We conducted a sequential, explanatory, mixed-methods study at the specialist Paediatric HIV clinic of the Federal Teaching Hospital Gombe, northeast Nigeria. The quantitative component was a cross sectional, questionnaire-based study that consecutively recruited 120 eligible primary caregivers of children (6–17 years) living with HIV. The qualitative component adopted an in-depth one-on-one interview approach with 17 primary caregivers. Primary caregivers were purposively selected to include views of those who had made disclosure and those who have not done so to gain an enhanced understanding of the quantitative findings. We examined the predictors of HIV status disclosure to infected children using binary logistic regression. The qualitative data was analysed using a combined deductive and inductive thematic analysis approach. Results The mean age of the index child living with HIV was 12.2 ± 3.2 years. The prevalence of disclosure to children living with HIV was 35.8%. Children living with HIV were 10 times more likely to have been told their status if their caregivers believed that disclosure had benefits [AOR = 9.9 (95% CI = 3.2–15.1)], while HIV-negative compared to HIV-positive caregivers were twice more likely to make disclosures [AOR = 1.8 (95%CI = 0.7–4.9)]. Girls were 1.45 times more likely than boys to have been disclosed their HIV positive status even after adjusting for other variables [AOR = 1.45 (95% CI = 0.6–3.5)]. Caregivers expressed deep-seated feeling of guilt and self-blame, HIV-related stigma, cultural sensitivity around HIV, and fears that the child might not cope as barriers to non-disclosure. These feeling were more prominent among HIV-positive caregivers. Conclusion The process of disclosure is a complex one and caregivers of HIV positive children should be supported emotionally and psychologically to facilitate disclosure of HIV status to their children. This study further emphasises the need to address HIV-related stigma in resource constrained settings.
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Affiliation(s)
- Oghenebrume Wariri
- Vaccines and Immunity Theme, Medical Research Council (MRC) Unit, The Gambia at The London School of Hygiene and Tropical Medicine, Fajara, The Gambia. .,Aberdeen Centre for Health Data Science (ACHDS), Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK.
| | - Ayomikun Ajani
- Department of Paediatrics, Federal Teaching Hospital (FTH), Gombe, Nigeria
| | | | - Asabe Iliya
- Department of Paediatrics, Federal Teaching Hospital (FTH), Gombe, Nigeria
| | - Olatoke Lukman
- Department of Paediatrics, Federal Teaching Hospital (FTH), Gombe, Nigeria
| | - Emmanuel Okpo
- Aberdeen Centre for Health Data Science (ACHDS), Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK.,Department of Public Health Medicine, NHS Grampian, Aberdeen, UK
| | - Elon Isaac
- Department of Paediatrics, Federal Teaching Hospital (FTH), Gombe, Nigeria.,Department of Paediatrics, College of Medical Sciences, Gombe State University, Gombe, Nigeria
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Idoko OT, Smolen KK, Wariri O, Imam A, Shannon CP, Dibassey T, Diray-Arce J, Darboe A, Strandmark J, Ben-Othman R, Odumade OA, McEnaney K, Amenyogbe N, Pomat WS, van Haren S, Sanchez-Schmitz G, Brinkman RR, Steen H, Hancock REW, Tebbutt SJ, Richmond PC, van den Biggelaar AHJ, Kollmann TR, Levy O, Ozonoff A, Kampmann B. Corrigendum: Clinical Protocol for a Longitudinal Cohort Study Employing Systems Biology to Identify Markers of Vaccine Immunogenicity in Newborn Infants in The Gambia and Papua New Guinea. Front Pediatr 2020; 8:610461. [PMID: 33313031 PMCID: PMC7707081 DOI: 10.3389/fped.2020.610461] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 09/28/2020] [Indexed: 11/13/2022] Open
Abstract
[This corrects the article DOI: 10.3389/fped.2020.00197.].
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Affiliation(s)
- Olubukola T Idoko
- Vaccines and Immunity Theme, Medical Research Council Unit the Gambia at London School of Hygiene and Tropical Medicine, Fajara, Gambia.,Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital, Boston, MA, United States.,CIH LMU Center for International Health, Medical Center of the University of Munich (LMU), Munich, Germany.,The Vaccine Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kinga K Smolen
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Oghenebrume Wariri
- Vaccines and Immunity Theme, Medical Research Council Unit the Gambia at London School of Hygiene and Tropical Medicine, Fajara, Gambia
| | - Abdulazeez Imam
- Vaccines and Immunity Theme, Medical Research Council Unit the Gambia at London School of Hygiene and Tropical Medicine, Fajara, Gambia
| | | | - Tida Dibassey
- Vaccines and Immunity Theme, Medical Research Council Unit the Gambia at London School of Hygiene and Tropical Medicine, Fajara, Gambia
| | - Joann Diray-Arce
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Alansana Darboe
- Vaccines and Immunity Theme, Medical Research Council Unit the Gambia at London School of Hygiene and Tropical Medicine, Fajara, Gambia
| | - Julia Strandmark
- Vaccines and Immunity Theme, Medical Research Council Unit the Gambia at London School of Hygiene and Tropical Medicine, Fajara, Gambia
| | - Rym Ben-Othman
- Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Oludare A Odumade
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital, Boston, MA, United States.,The Vaccine Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Division of Medicine Critical Care, Harvard Medical School, Boston Children's Hospital, Boston, MA, United States
| | - Kerry McEnaney
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital, Boston, MA, United States.,Department of Cardiology, Boston Children's Hospital, Boston, MA, United States
| | - Nelly Amenyogbe
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, WA, Australia
| | - William S Pomat
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Simon van Haren
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Guzmán Sanchez-Schmitz
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Ryan R Brinkman
- BC Cancer Agency, Vancouver, BC, Canada.,Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Hanno Steen
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States.,Department of Pathology, Boston Children's Hospital, Boston, MA, United States
| | - Robert E W Hancock
- Department of Microbiology & Immunology, University of British Columbia, Vancouver, BC, Canada
| | - Scott J Tebbutt
- PROOF Centre of Excellence, Vancouver, BC, Canada.,Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada.,Division of Respiratory Medicine, Department of Medicine, UBC, Vancouver, BC, Canada
| | - Peter C Richmond
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, WA, Australia.,Division of Pediatrics, School of Medicine, Perth Children's Hospital, University of Western Australia, Nedlands, WA, Australia
| | - Anita H J van den Biggelaar
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, WA, Australia
| | - Tobias R Kollmann
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, WA, Australia
| | - Ofer Levy
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States.,Broad Institute of MIT & Harvard, Cambridge, MA, United States
| | - Al Ozonoff
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Beate Kampmann
- Vaccines and Immunity Theme, Medical Research Council Unit the Gambia at London School of Hygiene and Tropical Medicine, Fajara, Gambia.,The Vaccine Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Idoko OT, Smolen KK, Wariri O, Imam A, Shannon CP, Dibassey T, Diray-Arce J, Darboe A, Strandmark J, Ben-Othman R, Odumade OA, McEnaney K, Amenyogbe N, Pomat WS, van Haren S, Sanchez-Schmitz G, Brinkman RR, Steen H, Hancock REW, Tebbutt SJ, Richmond PC, van den Biggelaar AHJ, Kollmann TR, Levy O, Ozonoff A, Kampmann B. Clinical Protocol for a Longitudinal Cohort Study Employing Systems Biology to Identify Markers of Vaccine Immunogenicity in Newborn Infants in The Gambia and Papua New Guinea. Front Pediatr 2020; 8:197. [PMID: 32426309 PMCID: PMC7205022 DOI: 10.3389/fped.2020.00197] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 04/01/2020] [Indexed: 01/30/2023] Open
Abstract
Background: Infection contributes to significant morbidity and mortality particularly in the very young and in low- and middle-income countries. While vaccines are a highly cost-effective tool against infectious disease little is known regarding the cellular and molecular pathways by which vaccines induce protection at an early age. Immunity is distinct in early life and greater precision is required in our understanding of mechanisms of early life protection to inform development of new pediatric vaccines. Methods and Analysis: We will apply transcriptomic, proteomic, metabolomic, multiplex cytokine/chemokine, adenosine deaminase, and flow cytometry immune cell phenotyping to delineate early cellular and molecular signatures that correspond to vaccine immunogenicity. This approach will be applied to a neonatal cohort in The Gambia (N ~ 720) receiving at birth: (1) Hepatitis B (HepB) vaccine alone, (2) Bacille Calmette Guerin (BCG) vaccine alone, or (3) HepB and BCG vaccines, (4) HepB and BCG vaccines delayed till day 10 at the latest. Each study participant will have a baseline peripheral blood sample drawn at DOL0 and a second blood sample at DOL1,-3, or-7 as well as late timepoints to assess HepB vaccine immunogenicity. Blood will be fractionated via a "small sample big data" standard operating procedure that enables multiple downstream systems biology assays. We will apply both univariate and multivariate frameworks and multi-OMIC data integration to identify features associated with anti-Hepatitis B (anti-HB) titer, an established correlate of protection. Cord blood sample collection from a subset of participants will enable human in vitro modeling to test mechanistic hypotheses identified in silico regarding vaccine action. Maternal anti-HB titer and the infant microbiome will also be correlated with our findings which will be validated in a smaller cohort in Papua New Guinea (N ~ 80). Ethics and Dissemination: The study has been approved by The Gambia Government/MRCG Joint Ethics Committee and The Boston Children's Hospital Institutional Review Board. Ethics review is ongoing with the Papua New Guinea Medical Research Advisory Committee. All de-identified data will be uploaded to public repositories following submission of study output for publication. Feedback meetings will be organized to disseminate output to the study communities. Clinical Trial Registration: Clinicaltrials.gov Registration Number: NCT03246230.
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Affiliation(s)
- Olubukola T Idoko
- Vaccines and Immunity Theme, Medical Research Council Unit the Gambia at London School of Hygiene and Tropical Medicine, Fajara, Gambia.,Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital, Boston, MA, United States.,CIH LMU Center for International Health, Medical Center of the University of Munich (LMU), Munich, Germany.,The Vaccine Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kinga K Smolen
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Oghenebrume Wariri
- Vaccines and Immunity Theme, Medical Research Council Unit the Gambia at London School of Hygiene and Tropical Medicine, Fajara, Gambia
| | - Abdulazeez Imam
- Vaccines and Immunity Theme, Medical Research Council Unit the Gambia at London School of Hygiene and Tropical Medicine, Fajara, Gambia
| | | | - Tida Dibassey
- Vaccines and Immunity Theme, Medical Research Council Unit the Gambia at London School of Hygiene and Tropical Medicine, Fajara, Gambia
| | - Joann Diray-Arce
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Alansana Darboe
- Vaccines and Immunity Theme, Medical Research Council Unit the Gambia at London School of Hygiene and Tropical Medicine, Fajara, Gambia
| | - Julia Strandmark
- Vaccines and Immunity Theme, Medical Research Council Unit the Gambia at London School of Hygiene and Tropical Medicine, Fajara, Gambia
| | - Rym Ben-Othman
- Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Oludare A Odumade
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital, Boston, MA, United States.,The Vaccine Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Division of Medicine Critical Care, Harvard Medical School, Boston Children's Hospital, Boston, MA, United States
| | - Kerry McEnaney
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital, Boston, MA, United States.,Department of Cardiology, Boston Children's Hospital, Boston, MA, United States
| | - Nelly Amenyogbe
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, WA, Australia
| | - William S Pomat
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Simon van Haren
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Guzmán Sanchez-Schmitz
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Ryan R Brinkman
- BC Cancer Agency, Vancouver, BC, Canada.,Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Hanno Steen
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States.,Department of Pathology, Boston Children's Hospital, Boston, MA, United States
| | - Robert E W Hancock
- Department of Microbiology & Immunology, University of British Columbia, Vancouver, BC, Canada
| | - Scott J Tebbutt
- PROOF Centre of Excellence, Vancouver, BC, Canada.,Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada.,Division of Respiratory Medicine, Department of Medicine, UBC, Vancouver, BC, Canada
| | - Peter C Richmond
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, WA, Australia.,Division of Pediatrics, School of Medicine, Perth Children's Hospital, University of Western Australia, Nedlands, WA, Australia
| | - Anita H J van den Biggelaar
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, WA, Australia
| | - Tobias R Kollmann
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, WA, Australia
| | - Ofer Levy
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States.,Broad Institute of MIT & Harvard, Cambridge, MA, United States
| | - Al Ozonoff
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Beate Kampmann
- Vaccines and Immunity Theme, Medical Research Council Unit the Gambia at London School of Hygiene and Tropical Medicine, Fajara, Gambia.,The Vaccine Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Wariri O, Edem B, Nkereuwem E, Nkereuwem OO, Umeh G, Clark E, Idoko OT, Nomhwange T, Kampmann B. Tracking coverage, dropout and multidimensional equity gaps in immunisation systems in West Africa, 2000-2017. BMJ Glob Health 2019; 4:e001713. [PMID: 31565416 PMCID: PMC6747924 DOI: 10.1136/bmjgh-2019-001713] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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: 05/14/2019] [Revised: 07/03/2019] [Accepted: 07/23/2019] [Indexed: 11/18/2022] Open
Abstract
Background Several West African countries are unlikely to achieve the recommended Global Vaccine Action Plan (GVAP) immunisation coverage and dropout targets in a landscape beset with entrenched intra-country equity gaps in immunisation. Our aim was to assess and compare the immunisation coverage, dropout and equity gaps across 15 West African countries between 2000 and 2017. Methods We compared Bacille Calmette Guerin (BCG) and the third dose of diphtheria–tetanus–pertussis (DTP3) containing vaccine coverage between 2000 and 2017 using the WHO and Unicef Estimates of National Immunisation Coverage for 15 West African countries. Estimated subregional median and weighted average coverages, and dropout (DTP1–DTP3) were tracked against the GVAP targets of ≥90% coverage (BCG and DTP3), and ≤10% dropouts. Equity gaps in immunisation were assessed using the latest disaggregated national health survey immunisation data. Results The weighted average subregional BCG coverage was 60.7% in 2000, peaked at 83.2% in 2009 and was 65.7% in 2017. The weighted average DTP3 coverage was 42.3% in 2000, peaked at 70.3% in 2009 and was 61.5% in 2017. As of 2017, 46.7% of countries (7/15) had met the GVAP targets on DTP3 coverage. Average weighted subregional immunisation dropouts consistently reduced from 16.4% in 2000 to 7.4% in 2017, meeting the GVAP target in 2008. In most countries, inequalities in BCG, and DTP3 coverage and dropouts were mainly related to equity gaps of more than 20% points between the wealthiest and the poorest, high coverage regions and low coverage regions, and between children of mothers with at least secondary education and those with no formal education. A child’s sex and place of residence (urban or rural) minimally determined equity gaps. Conclusions The West African subregion made progress between 2000 and 2017 in ensuring that its children utilised immunisation services, however, wide equity gaps persist.
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Affiliation(s)
- Oghenebrume Wariri
- Vaccines and Immunity Theme, MRC Unit the Gambia at the London School of Hygiene and Tropical Medicine, Fajara, Gambia
| | - Bassey Edem
- Vaccines and Immunity Theme, MRC Unit the Gambia at the London School of Hygiene and Tropical Medicine, Fajara, Gambia
| | - Esin Nkereuwem
- Vaccines and Immunity Theme, MRC Unit the Gambia at the London School of Hygiene and Tropical Medicine, Fajara, Gambia
| | - Oluwatosin O Nkereuwem
- Vaccines and Immunity Theme, MRC Unit the Gambia at the London School of Hygiene and Tropical Medicine, Fajara, Gambia
| | - Gregory Umeh
- World Health Organization Country Office for Nigeria, Abuja, Nigeria
| | - Ed Clark
- Vaccines and Immunity Theme, MRC Unit the Gambia at the London School of Hygiene and Tropical Medicine, Fajara, Gambia
| | - Olubukola T Idoko
- Vaccines and Immunity Theme, MRC Unit the Gambia at the London School of Hygiene and Tropical Medicine, Fajara, Gambia.,Centre for International Health, Medical Centre, University of Munich, Munchen, Germany
| | - Terna Nomhwange
- World Health Organization Country Office for Nigeria, Abuja, Nigeria
| | - Beate Kampmann
- Vaccines and Immunity Theme, MRC Unit the Gambia at the London School of Hygiene and Tropical Medicine, Fajara, Gambia.,The Vaccine Centre, London School of Hygiene and Tropical Medicine, London, UK
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D’Ambruoso L, van der Merwe M, Wariri O, Byass P, Goosen G, Kahn K, Masinga S, Mokoena V, Spies B, Tollman S, Witter S, Twine R. Rethinking collaboration: developing a learning platform to address under-five mortality in Mpumalanga province, South Africa. Health Policy Plan 2019; 34:418-429. [PMID: 31243457 PMCID: PMC6736195 DOI: 10.1093/heapol/czz047] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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] [Accepted: 05/11/2019] [Indexed: 01/08/2023] Open
Abstract
Following 50 years of apartheid, South Africa introduced visionary health policy committing to the right to health as part of a primary health care (PHC) approach. Implementation is seriously challenged, however, in an often-dysfunctional health system with scarce resources and a complex burden of avoidable mortality persists. Our aim was to develop a process generating evidence of practical relevance on implementation processes among people excluded from access to health systems. Informed by health policy and systems research, we developed a collaborative learning platform in which we worked as co-researchers with health authorities in a rural province. This article reports on the process and insights brought by health systems stakeholders. Evidence gaps on under-five mortality were identified with a provincial Directorate after which we collected quantitative and qualitative data. We applied verbal autopsy to quantify levels, causes and circumstances of deaths and participatory action research to gain community perspectives on the problem and priorities for action. We then re-convened health systems stakeholders to analyse and interpret these data through which several systems issues were identified as contributory to under-five deaths: staff availability and performance; service organization and infrastructure; multiple parallel initiatives; and capacity to address social determinants. Recommendations were developed ranging from immediate low- and no-cost re-organization of services to those where responses from higher levels of the system or outside were required. The process was viewed as acceptable and relevant for an overburdened system operating 'in the dark' in the absence of local data. Institutional infrastructure for evidence-based decision-making does not exist in many health systems. We developed a process connecting research evidence on rural health priorities with the means for action and enabled new partnerships between communities, authorities and researchers. Further development is planned to understand potential in deliberative processes for rural PHC.
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Affiliation(s)
- Lucia D’Ambruoso
- Centre for Global Development and Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
- Department of Public Health and Clinical Medicine, Umeå Centre for Global Health Research, Epidemiology and Global Health, Umeå University, Umeå, Sweden
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, Johannesburg, South Africa
| | - Maria van der Merwe
- Centre for Global Development and Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Oghenebrume Wariri
- Centre for Global Development and Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
- Medical Research Council (MRC) Unit, The Gambia at London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Peter Byass
- Centre for Global Development and Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
- Department of Public Health and Clinical Medicine, Umeå Centre for Global Health Research, Epidemiology and Global Health, Umeå University, Umeå, Sweden
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, Johannesburg, South Africa
| | - Gerhard Goosen
- Mpumalanga Department of Health, Nelspruit, South Africa
| | - Kathleen Kahn
- Department of Public Health and Clinical Medicine, Umeå Centre for Global Health Research, Epidemiology and Global Health, Umeå University, Umeå, Sweden
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
| | | | | | - Barry Spies
- Mpumalanga Department of Health, Nelspruit, South Africa
| | - Stephen Tollman
- Department of Public Health and Clinical Medicine, Umeå Centre for Global Health Research, Epidemiology and Global Health, Umeå University, Umeå, Sweden
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
| | - Sophie Witter
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
| | - Rhian Twine
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, Johannesburg, South Africa
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Wariri O, Jalo I, Bode-Thomas F. Discriminative ability of adiposity measures for elevated blood pressure among adolescents in a resource-constrained setting in northeast Nigeria: a cross-sectional analysis. BMC Obes 2018; 5:35. [PMID: 30524740 PMCID: PMC6276203 DOI: 10.1186/s40608-018-0211-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 08/28/2018] [Indexed: 11/30/2022]
Abstract
Background Several studies examining the association and discriminative ability of adiposity measures for prehypertension and hypertension among adolescents have reported varying outcomes. We aimed to determine the discriminative ability of the Body Mass index (BMI), Waist Circumference (WC), and Waist-to-Height Ratio (WHtR) adiposity measures for elevated blood pressure (prehypertension and hypertension combined) among adolescents in Gombe, northeast Nigeria. Methods This cross-sectional study used a multi-stage sampling technique and involved 367 secondary school adolescent (10–18 years) boys and girls in Gombe Local Government Area, Gombe State, northeast Nigeria from January to September 2015. We examined and compared the associations and discriminative ability of the BMI, WC and the WHtR for elevated blood pressure using multiple logistic regression and receiver operating characteristics (ROC) curves. Area under the curves (AUC), odds ratio (OR) and 95% confidence intervals (CI) are reported. Results All three measures of adiposity were strongly and positively associated with elevated blood pressure. The BMI obesity showed the strongest association with elevated blood pressure with odds that was double the odds of WC and triple that of WHtR [adjusted OR for BMI 15.3, 95% CI (4.8–27.9)]. The discriminative ability of adiposity measures for elevated blood pressure using AUC was comparable (0.786 for BMI, vs 0.780 for WC, vs 0.761 for WHtR). Conclusion We provide evidence, here on the BMI, WC and WHtR to support the use of simple indirect measures of adiposity in evaluating adiposity-related risk including prehypertension and hypertension among Nigerian adolescents. Electronic supplementary material The online version of this article (10.1186/s40608-018-0211-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Oghenebrume Wariri
- Vaccines and Immunity Theme, MRC Unit, The Gambia at The London School of Hygience and Tropical Medicine, Fajara, The Gambia
| | - Iliya Jalo
- Department of Paediatrics, Federal Teaching Hospital (FTH), Gombe, Nigeria.,3Department of Paediatrics, College of Medical Sciences, Gombe State University, Gombe, Nigeria
| | - Fidelia Bode-Thomas
- 4Paediatric Cardiology Unit, Department of Paediatrics, Jos University Teaching Hospital (JUTH), Jos, Nigeria
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Wariri O, D’Ambruoso L, Twine R, Ngobeni S, van der Merwe M, Spies B, Kahn K, Tollman S, Wagner RG, Byass P. Initiating a participatory action research process in the Agincourt health and socio-demographic surveillance site. J Glob Health 2017; 7:010413. [PMID: 28685035 PMCID: PMC5475314 DOI: 10.7189/jogh.07.010413] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Despite progressive health policy, disease burdens in South Africa remain patterned by deeply entrenched social inequalities. Accounting for the relationships between context, health and risk can provide important information for equitable service delivery. The aims of the research were to initiate a participatory research process with communities in a low income setting and produce evidence of practical relevance. METHODS We initiated a participatory action research (PAR) process in the Agincourt health and socio-demographic surveillance site (HDSS) in rural north-east South Africa. Three village-based discussion groups were convened and consulted about conditions to examine, one of which was under-5 mortality. A series of discussions followed in which routine HDSS data were presented and participants' subjective perspectives were elicited and systematized into collective forms of knowledge using ranking, diagramming and participatory photography. The process concluded with a priority setting exercise. Visual and narrative data were thematically analyzed to complement the participants' analysis. RESULTS A range of social and structural root causes of under-5 mortality were identified: poverty, unemployment, inadequate housing, unsafe environments and shortages of clean water. Despite these constraints, single mothers were often viewed as negligent. A series of mid-level contributory factors in clinics were also identified: overcrowding, poor staffing, delays in treatment and shortages of medications. In a similar sense, pronounced blame and negativity were directed toward clinic nurses in spite of the systems constraints identified. Actions to address these issues were prioritized as: expanding clinics, improving accountability and responsiveness of health workers, improving employment, providing clean water, and expanding community engagement for health promotion. CONCLUSIONS We initiated a PAR process to gain local knowledge and prioritize actions. The process was acceptable to those involved, and there was willingness and commitment to continue. The study provided a basis from which to gain support to develop fuller forms of participatory research in this setting. The next steps are to build deeper involvement of participants in the process, expand to include the perspectives of those most marginalized, and engage in the health system at different levels to move toward an ongoing process of action and learning from action.
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Affiliation(s)
- Oghenebrume Wariri
- Centre for Global Development and Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK
- Department of Paediatrics, Federal Teaching Hospital Gombe, Gombe, Nigeria
| | - Lucia D’Ambruoso
- Centre for Global Development and Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK
- Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Rhian Twine
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH, Accra, Ghana
| | - Sizzy Ngobeni
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH, Accra, Ghana
| | - Maria van der Merwe
- Directorate for Maternal, Child, Women and Youth Health and Nutrition, Mpumalanga Department of Health, South Africa
| | - Barry Spies
- Directorate for Maternal, Child, Women and Youth Health and Nutrition, Mpumalanga Department of Health, South Africa
| | - Kathleen Kahn
- Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH, Accra, Ghana
| | - Stephen Tollman
- Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH, Accra, Ghana
| | - Ryan G Wagner
- Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH, Accra, Ghana
| | - Peter Byass
- Centre for Global Development and Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK
- Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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