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Tayler-Gray J, Patel M, Wigley A, McCall B, Gossage J. 1296 DEMOGRAPHIC AND MORTALITY EVALUATION OF URGENT COMMUNITY RESPONSE REFERRALS THAT ARE MANAGED IN COMMUNITY VS THOSE HOSPITALISED. Age Ageing 2023. [DOI: 10.1093/ageing/afac322.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Abstract
Introduction
Demographic evaluation of urgent community response teams [UCR] is important to ensure equity of access and clinical outcomes for patients from all socio-demographic groups using such services. This retrospective descriptive study aimed to evaluate demographic and mortality differences between patients referred to UCR in terms of those managed in the community [Group1] versus those subsequently hospitalised [Group2].
Methods
Data was obtained over a 12-month period [2021-2022] for all new patients referred to a 7-day consultant-led UCR that serves a multi-ethnic, inner-city population. Data included demographic details, source of referral, urgency of referral and mortality within 60 days.
Results
Of 995 patients, 75.6%[n=752] were in Group 1; 24.4%[243] were in Group 2. The two groups were comparable in terms of age [mean(SD): 80.1(12.6) vs 80.0(11.4), p=ns] and gender [males:39.4% vs 42.4%,p=ns]. There were similar proportion of Black and minority ethnic patients within the two groups [21.0% (158) vs 24.7% (60), p=ns]. Source of referral were comparable between the two groups[p=ns]; overall, 67.7%[674] were from GP practices, 5.6%[56] Community Practitioners, 4.7%[47] NHS111, 2.7%[27] Ambulance, 32%[32] Palliative care, 5.9%[59] Emergency department, 10.1%[100] post-hospitalisation. Compared to Group 1 [46.9% (353)], significantly more patients in Group 2 were referred for urgent assessment within 2 hours [65.4% (159), p<0.001]. More patients died in Group2 within 60 days [22.2% (54) vs 11.3% (85), p<0.001].
Discussion
This large survey has described age, gender and ethnic similarities between the two groups, demonstrating equity of provision irrespective of protected characteristics. As might be clinically expected, patients referred for hospitalisation were assessed more urgently and had higher mortality rates compared to those managed in the community. This study provides valuable information for clinicians and researchers of similar UCR services in future.
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Affiliation(s)
- J Tayler-Gray
- Lewisham and Greenwich NHS Trust Department of Elderly Medicine, , Lewisham, London SE13 6LH
| | - M Patel
- Lewisham and Greenwich NHS Trust Department of Elderly Medicine, , Lewisham, London SE13 6LH
| | - A Wigley
- Lewisham and Greenwich NHS Trust Department of Elderly Medicine, , Lewisham, London SE13 6LH
| | - B McCall
- Lewisham and Greenwich NHS Trust Department of Elderly Medicine, , Lewisham, London SE13 6LH
| | - J Gossage
- Lewisham and Greenwich NHS Trust Department of Elderly Medicine, , Lewisham, London SE13 6LH
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Utazi CE, Aheto JMK, Wigley A, Tejedor-Garavito N, Bonnie A, Nnanatu CC, Wagai J, Williams C, Setayesh H, Tatem AJ, Cutts FT. Mapping the distribution of zero-dose children to assess the performance of vaccine delivery strategies and their relationships with measles incidence in Nigeria. Vaccine 2023; 41:170-181. [PMID: 36414476 DOI: 10.1016/j.vaccine.2022.11.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 07/02/2022] [Revised: 10/19/2022] [Accepted: 11/14/2022] [Indexed: 11/21/2022]
Abstract
Geographically precise identification and targeting of populations at risk of vaccine-preventable diseases has gained renewed attention within the global health community over the last few years. District level estimates of vaccination coverage and corresponding zero-dose prevalence constitute a potentially useful evidence base to evaluate the performance of vaccination strategies. These estimates are also valuable for identifying missed communities, hence enabling targeted interventions and better resource allocation. Here, we fit Bayesian geostatistical models to map the routine coverage of the first doses of diphtheria-tetanus-pertussis vaccine (DTP1) and measles-containing vaccine (MCV1) and corresponding zero-dose estimates in Nigeria at 1x1 km resolution and the district level using geospatial data sets. We also map MCV1 coverage before and after the 2019 measles vaccination campaign in the northern states to further explore variations in routine vaccine coverage and to evaluate the effectiveness of both routine immunization (RI) and campaigns in reaching zero-dose children. Additionally, we map the spatial distributions of reported measles cases during 2018 to 2020 and explore their relationships with MCV zero-dose prevalence to highlight the public health implications of varying performance of vaccination strategies across the country. Our analysis revealed strong similarities between the spatial distributions of DTP and MCV zero dose prevalence, with districts with the highest prevalence concentrated mostly in the northwest and the northeast, but also in other areas such as Lagos state and the Federal Capital Territory. Although the 2019 campaign reduced MCV zero-dose prevalence substantially in the north, pockets of vulnerabilities remained in areas that had among the highest prevalence prior to the campaign. Importantly, we found strong correlations between measles case counts and MCV RI zero-dose estimates, which provides a strong indication that measles incidence in the country is mostly affected by RI coverage. Our analyses reveal an urgent and highly significant need to strengthen the country's RI program as a longer-term measure for disease control, whilst ensuring effective campaigns in the short term.
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Affiliation(s)
- C Edson Utazi
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton SO17 1BJ, UK; Southampton Statistical Sciences Research Institute, University of Southampton, Southampton SO17 1BJ, UK; Department of Statistics, Nnamdi Azikiwe University, Awka PMB 5025, Nigeria.
| | - Justice M K Aheto
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton SO17 1BJ, UK; Department of Biostatistics, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Adelle Wigley
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton SO17 1BJ, UK
| | - Natalia Tejedor-Garavito
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton SO17 1BJ, UK
| | - Amy Bonnie
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton SO17 1BJ, UK
| | - Christopher C Nnanatu
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton SO17 1BJ, UK; Department of Statistics, Nnamdi Azikiwe University, Awka PMB 5025, Nigeria
| | - John Wagai
- World Health Organization Consultant, Abuja, Nigeria
| | - Cheryl Williams
- U.S. Centers for Disease Control and Prevention, Nigeria Country Office, Abuja, Nigeria
| | | | - Andrew J Tatem
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton SO17 1BJ, UK
| | - Felicity T Cutts
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
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Wigley A, Lorin J, Hogan D, Utazi CE, Hagedorn B, Dansereau E, Tatem AJ, Tejedor-Garavito N. Estimates of the number and distribution of zero-dose and under-immunised children across remote-rural, urban, and conflict-affected settings in low and middle-income countries. PLOS Glob Public Health 2022; 2:e0001126. [PMID: 36962682 PMCID: PMC10021885 DOI: 10.1371/journal.pgph.0001126] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 10/05/2022] [Indexed: 02/11/2023]
Abstract
While there has been great success in increasing the coverage of new childhood vaccines globally, expanding routine immunization to reliably reach all children and communities has proven more challenging in many low- and middle-income countries. Achieving this requires vaccination strategies and interventions that identify and target those unvaccinated, guided by the most current and detailed data regarding their size and spatial distribution. Through the integration and harmonisation of a range of geospatial data sets, including population, vaccination coverage, travel-time, settlement type, and conflict locations. We estimated the numbers of children un- or under-vaccinated for measles and diphtheria-tetanus-pertussis, within remote-rural, urban, and conflict-affected locations. We explored how these numbers vary both nationally and sub-nationally, and assessed what proportions of children these categories captured, for 99 lower- and middle-income countries, for which data was available. We found that substantial heterogeneities exist both between and within countries. Of the total 14,030,486 children unvaccinated for DTP1, over 11% (1,656,757) of un- or under-vaccinated children were in remote-rural areas, more than 28% (2,849,671 and 1,129,915) in urban and peri-urban areas, and up to 60% in other settings, with nearly 40% found to be within 1-hour of the nearest town or city (though outside of urban/peri-urban areas). Of the total number of those unvaccinated, we estimated between 6% and 15% (826,976 to 2,068,785) to be in conflict-affected locations, based on either broad or narrow definitions of conflict. Our estimates provide insights into the inequalities in vaccination coverage, with the distributions of those unvaccinated varying significantly by country, region, and district. We demonstrate the need for further inquiry and characterisation of those unvaccinated, the thresholds used to define these, and for more country-specific and targeted approaches to defining such populations in the strategies and interventions used to reach them.
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Affiliation(s)
- Adelle Wigley
- WorldPop, Geography and Environmental Science, University of Southampton, Highfield Campus, Southampton, United Kingdom
| | - Josh Lorin
- Gavi, The Vaccine Alliance, Geneva, Switzerland
| | - Dan Hogan
- Gavi, The Vaccine Alliance, Geneva, Switzerland
| | - C. Edson Utazi
- WorldPop, Geography and Environmental Science, University of Southampton, Highfield Campus, Southampton, United Kingdom
| | - Brittany Hagedorn
- Institute for Disease Modelling, Bill & Melinda Gates Foundation, Seattle, Washington, WA, United States of America
| | - Emily Dansereau
- Institute for Disease Modelling, Bill & Melinda Gates Foundation, Seattle, Washington, WA, United States of America
| | - Andrew J. Tatem
- WorldPop, Geography and Environmental Science, University of Southampton, Highfield Campus, Southampton, United Kingdom
| | - Natalia Tejedor-Garavito
- WorldPop, Geography and Environmental Science, University of Southampton, Highfield Campus, Southampton, United Kingdom
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Utazi CE, Pannell O, Aheto JMK, Wigley A, Tejedor-Garavito N, Wunderlich J, Hagedorn B, Hogan D, Tatem AJ. Assessing the characteristics of un- and under-vaccinated children in low- and middle-income countries: A multi-level cross-sectional study. PLOS Glob Public Health 2022; 2:e0000244. [PMID: 36962232 PMCID: PMC10021434 DOI: 10.1371/journal.pgph.0000244] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 02/03/2022] [Indexed: 11/18/2022]
Abstract
Achieving equity in vaccination coverage has been a critical priority within the global health community. Despite increased efforts recently, certain populations still have a high proportion of un- and under-vaccinated children in many low- and middle-income countries (LMICs). These populations are often assumed to reside in remote-rural areas, urban slums and conflict-affected areas. Here, we investigate the effects of these key community-level factors, alongside a wide range of other individual, household and community level factors, on vaccination coverage. Using geospatial datasets, including cross-sectional data from the most recent Demographic and Health Surveys conducted between 2008 and 2018 in nine LMICs, we fitted Bayesian multi-level binary logistic regression models to determine key community-level and other factors significantly associated with non- and under-vaccination. We analyzed the odds of receipt of the first doses of diphtheria-tetanus-pertussis (DTP1) vaccine and measles-containing vaccine (MCV1), and receipt of all three recommended DTP doses (DTP3) independently, in children aged 12-23 months. In bivariate analyses, we found that remoteness increased the odds of non- and under-vaccination in nearly all the study countries. We also found evidence that living in conflict and urban slum areas reduced the odds of vaccination, but not in most cases as expected. However, the odds of vaccination were more likely to be lower in urban slums than formal urban areas. Our multivariate analyses revealed that the key community variables-remoteness, conflict and urban slum-were sometimes associated with non- and under-vaccination, but they were not frequently predictors of these outcomes after controlling for other factors. Individual and household factors such as maternal utilization of health services, maternal education and ethnicity, were more common predictors of vaccination. Reaching the Immunisation Agenda 2030 target of reducing the number of zero-dose children by 50% by 2030 will require country tailored analyses and strategies to identify and reach missed communities with reliable immunisation services.
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Affiliation(s)
- C Edson Utazi
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, United Kingdom
| | - Oliver Pannell
- Flowminder Foundation and WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, United Kingdom
| | - Justice M K Aheto
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, United Kingdom
| | - Adelle Wigley
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, United Kingdom
| | - Natalia Tejedor-Garavito
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, United Kingdom
| | | | - Brittany Hagedorn
- Institute for Disease Modeling, Bill & Melinda Gates Foundation, Seattle, Washington, WA, United States of America
| | - Dan Hogan
- Gavi, The Vaccine Alliance, Geneva, Switzerland
| | - Andrew J Tatem
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, United Kingdom
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Gore-Langton GR, Cano J, Simpson H, Tatem A, Tejedor-Garavito N, Wigley A, Carioli A, Gething P, Weiss DJ, Chandramohan D, Walker PGT, Cairns ME, Chico RM. Global estimates of pregnancies at risk of Plasmodium falciparum and Plasmodium vivax infection in 2020 and changes in risk patterns since 2000. PLOS Glob Public Health 2022; 2:e0001061. [PMID: 36962612 PMCID: PMC10022219 DOI: 10.1371/journal.pgph.0001061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 10/03/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Women are at risk of severe adverse pregnancy outcomes attributable to Plasmodium spp. infection in malaria-endemic areas. Malaria control efforts since 2000 have aimed to reduce this burden of disease. METHODS We used data from the Malaria Atlas Project and WorldPop to calculate global pregnancies at-risk of Plasmodium spp. infection. We categorised pregnancies as occurring in areas of stable and unstable P. falciparum and P. vivax transmission. We further stratified stable endemicity as hypo-endemic, meso-endemic, hyper-endemic, or holo-endemic, and estimated pregnancies at risk in 2000, 2005, 2010, 2015, 2017, and 2020. FINDINGS In 2020, globally 120.4M pregnancies were at risk of P. falciparum, two-thirds (81.0M, 67.3%) were in areas of stable transmission; 85 2M pregnancies were at risk of P. vivax, 93.9% (80.0M) were in areas of stable transmission. An estimated 64.6M pregnancies were in areas with both P. falciparum and P. vivax transmission. The number of pregnancies at risk of each of P. falciparum and P. vivax worldwide decreased between 2000 and 2020, with the exception of sub-Saharan Africa, where the total number of pregnancies at risk of P. falciparum increased from 37 3M in 2000 to 52 4M in 2020. INTERPRETATION Historic investments in malaria control have reduced the number of women at risk of malaria in pregnancy in all endemic regions except sub-Saharan Africa. Population growth in Africa has outpaced reductions in malaria prevalence. Interventions that reduce the risk of malaria in pregnancy are needed as much today as ever.
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Affiliation(s)
- Georgia R Gore-Langton
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Jorge Cano
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Expanded Special Project for Elimination of Neglected Tropical Diseases, WHO Regional Office for Africa, Brazzaville, Democratic Republic of the Congo
| | - Hope Simpson
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Andrew Tatem
- WorldPop, Geography and Environmental Science, University of Southampton, Southampton, United Kingdom
| | - Natalia Tejedor-Garavito
- WorldPop, Geography and Environmental Science, University of Southampton, Southampton, United Kingdom
| | - Adelle Wigley
- WorldPop, Geography and Environmental Science, University of Southampton, Southampton, United Kingdom
| | - Alessandra Carioli
- WorldPop, Geography and Environmental Science, University of Southampton, Southampton, United Kingdom
| | - Peter Gething
- Malaria Atlas Project, Telethon Kids Institute, Perth Children's Hospital, Nedlands, Australia
- Faculty of Health Sciences, Curtin University, Bentley, Australia
| | - Daniel J Weiss
- Malaria Atlas Project, Telethon Kids Institute, Perth Children's Hospital, Nedlands, Australia
- Faculty of Health Sciences, Curtin University, Bentley, Australia
| | - Daniel Chandramohan
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Patrick G T Walker
- Faculty of Medicine, School of Public Health, Imperial College London, London, United Kingdom
| | - Matthew E Cairns
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - R Matthew Chico
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Danby S, Wan H, Chittock J, Brown K, Wigley A, Cork M. 129 Characterisation of the skin barrier defect in atopic dermatitis using in vivo ATR-FTIR spectroscopy. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.06.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Chittock J, Cooke A, Lavender T, Brown K, Wigley A, Victor S, Cork MJ, Danby SG. Development of stratum corneum chymotrypsin-like protease activity and natural moisturizing factors from birth to 4 weeks of age compared with adults. Br J Dermatol 2016; 175:713-20. [PMID: 26994359 DOI: 10.1111/bjd.14568] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND From birth, the functional properties of the neonatal epidermal barrier mature whereby the stratum corneum (SC) hydrates and the skin surface acidifies. The identification of a thinner infant SC compared with adults suggests underdeveloped mechanisms underlying differentiation and desquamation. OBJECTIVES To assess the functional properties of the neonatal SC from birth, in conjunction with the quantification of superficial chymotrypsin-like protease activity [kallikrein-7 (KLK-7)] and filaggrin-derived natural moisturizing factors (NMF). METHODS A total of 115 neonates recruited to the Oil in Baby SkincaRE (OBSeRvE) randomized controlled trial underwent a full evaluation of the SC at birth (< 72 h old) and at 4 weeks of age (n = 39, no oil control group) using minimally invasive instrumentation and methodology. A cohort of 20 unrelated adults was recruited for comparison. RESULTS At birth NMF levels correlated with SC hydration (r = 0·50) and skin-surface pH (r = -0·54). From birth to 4 weeks, transepidermal water loss (TEWL), superficial KLK-7 activity and filaggrin-derived NMF significantly elevated. Impaired epidermal barrier function at birth (> 75th percentile TEWL) was accompanied by significantly elevated chymotrypsin-like protease activity and reduced levels of NMF. CONCLUSIONS The biophysical, biological and functional properties of the developing neonatal SC are transitional from birth to 4 weeks of age and differ significantly from adults. The presence of impaired barrier function with elevated protease activity and reduced NMF at birth suggests why certain infants are predisposed to epidermal barrier breakdown and the development of atopic dermatitis.
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Affiliation(s)
- J Chittock
- The Academic Unit of Dermatology Research, Department of Infection and Immunity, Faculty of Medicine, Dentistry and Health, The University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, U.K..
| | - A Cooke
- School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, U.K
| | - T Lavender
- School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, U.K
| | - K Brown
- The Academic Unit of Dermatology Research, Department of Infection and Immunity, Faculty of Medicine, Dentistry and Health, The University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, U.K
| | - A Wigley
- The Academic Unit of Dermatology Research, Department of Infection and Immunity, Faculty of Medicine, Dentistry and Health, The University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, U.K
| | - S Victor
- Institute of Human Development, The University of Manchester, Manchester, U.K.,Sidra Neonatology Center of Excellence, Sidra Medical and Research Center, Doha, Qatar
| | - M J Cork
- The Academic Unit of Dermatology Research, Department of Infection and Immunity, Faculty of Medicine, Dentistry and Health, The University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, U.K.,The Pediatric Dermatology Clinic, Sheffield Children's Hospital, Sheffield, U.K
| | - S G Danby
- The Academic Unit of Dermatology Research, Department of Infection and Immunity, Faculty of Medicine, Dentistry and Health, The University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, U.K
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