1
|
Dias-Karunaratne N, Whop L, Ward J, Vujovich-Dunn C, Amin J, Dakiniewich A, Dyda A. Representation of marginalised populations in digital surveillance for notifiable conditions in Australia: a systematic review. Perspect Public Health 2024; 144:162-173. [PMID: 38509693 PMCID: PMC11103913 DOI: 10.1177/17579139241237101] [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] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
AIM This study aims to establish whether digital surveillance methods for notifiable diseases in Australia collect and report data in relation to marginalised populations. METHODS The literature was systematically reviewed to identify primary research studies published between January 2005 and July 2023. Studies were included if they described an Australian digital surveillance system for notifiable conditions. The results were synthesised with a focus on evaluating the collection and reporting of data in relation to marginalised populations. RESULTS A total of 13 articles reporting on seven surveillance systems were identified. Influenza and adverse events following immunisation were the two most common notifiable conditions monitored. A total of six surveillance systems encompassing 16 articles reported information on sub-populations. Of these, three surveillance systems (nine articles) included data on marginalised populations. CONCLUSION The data collected or reported in relation to sub-groups that characterise diversity in terms of health care needs, access, and marginalised populations are minimal. It is recommended that a set of equity and reporting principles is established for the future creation and use of any digital surveillance system.
Collapse
Affiliation(s)
- N Dias-Karunaratne
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - L Whop
- National Centre for Aboriginal and Torres Strait Islander Wellbeing Research, Australian National University, Canberra, ACT, Australia
| | - J Ward
- Poche Centre for Indigenous Health, The University of Queensland, Brisbane, QLD, Australia
| | - C Vujovich-Dunn
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - J Amin
- Department of Health Science, Macquarie University, Sydney, NSW, Australia
| | - A Dakiniewich
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - A Dyda
- School of Public Health, The University of Queensland, 288 Herston Road, Herston, Brisbane, QLD 4072, Australia
| |
Collapse
|
2
|
Wand H, Vujovich-Dunn C, Derrick K, Moodley J, Reddy T, Naidoo S. Geospatial variations in socioeconomic conditions and health outcomes in COVID-19 era: insights from South Africa (2020-2022). GeoJournal 2023; 88:1-17. [PMID: 38625344 PMCID: PMC9988606 DOI: 10.1007/s10708-023-10851-4] [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] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 04/17/2024]
Abstract
South Africa also has the highest burden of coronavirus disease 2019 (COVID-19) related comorbidities in Africa. We aimed to quantify the temporal and geospatial changes in unemployment, food insecurity, and their combined impact on depressive symptoms among South Africans who participated into several rounds of national surveys. We estimated the population-attributable risk percent (P A R % ) for the combinations of the risk factors after accounting for their correlation structure in multifactorial setting. Our study provided compelling evidence for immediate and severe effect of the pandemic where 60% of South Africans reported household food insecurity or household hunger, shortly after the pandemic emerged in 2020. Despite the grants provided by the government, these factors were also identified as the most influential risk factors (adjusted odds ratios (aORs) ranged from 2.06 to 3.10, p < 0.001) for depressive symptoms and collectively associated with 62% and 53% of the mental health symptoms in men and women, respectively. Similar pattern was observed among pregnant women and 41% of the depressive symptoms were exclusively associated with those who reported household hunger. However, aORs associated with the concerns around pandemic and vaccine were mostly not significant and ranged from 1.12 to 1.26 which resulted substantially lower impacts on depressive symptoms (PAR%:7%-and-14%). Our findings suggest that South Africa still has unacceptably high rates of hunger which is accelerated during the pandemic. These results may have significant clinical and epidemiological implications and may also bring partial explanation for the low vaccine coverage in the country, as priorities and concerns are skewed towards economic concerns and food insecurity.
Collapse
Affiliation(s)
- Handan Wand
- Biostatistics and Databases Program ,Kirby Institute, University of New South Wales, Level 6, Wallace Wurth Building, Kensington, NSW 2052 Australia
| | - Cassandra Vujovich-Dunn
- Biostatistics and Databases Program ,Kirby Institute, University of New South Wales, Level 6, Wallace Wurth Building, Kensington, NSW 2052 Australia
| | - Kate Derrick
- Emergency Department, Royal Prince Alfred Hospital, Sydney, Australia
| | | | - Tarylee Reddy
- Biostatistics Unit, South African Medical Research Council, Durban, Kwazulu-Natal South Africa
| | | |
Collapse
|
3
|
Wand H, Vujovich-Dunn C, Moodley J, Reddy T, Naidoo S. Population-level impact of beliefs and attitudes on vaccine decision-making in South Africa: results from the COVID-19 Vaccine Survey (2021/2022). Public Health 2023; 216:58-65. [PMID: 36801593 PMCID: PMC9829597 DOI: 10.1016/j.puhe.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 12/11/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023]
Abstract
OBJECTIVES In addition to being home to more than seven million HIV-infected individuals, South Africa also has a high burden of COVID-19 and related comorbidities worldwide. We aimed to identify the most influential "beliefs" and "attitudes" on vaccine decision-making behavior. STUDY DESIGN This study used panel data from cross-sectional surveys. METHODS We used the data from Black South Africans who participated in the "COVID-19 Vaccine Surveys" (November 2021 and February/March 2022) in South Africa. Besides standard risk factor analysis, such as multivariable logistic regression models, we also used the modified version of population attributable risk percent and estimated the population-level impacts of beliefs and attitudes on vaccine decision-making behavior using the methodology in multifactorial setting. RESULTS A total of 1399 people (57% men and 43% women) who participated in both surveys were analyzed. Of these, 336 (24%) reported being vaccinated in survey 2. Overall low perceived risk, concerns around efficacy, and safety were identified as the most influential factors and associated with 52%-72% (<40 years) and 34%-55% (40+ years) of the unvaccinated individuals. CONCLUSION Our findings highlighted the most influential beliefs and attitudes on vaccine decision-making and their population-level impacts, which are likely to have significant public health implications exclusively for this population.
Collapse
Affiliation(s)
- H Wand
- Kirby Institute, University of New South Wales, Kensington, 2052, New South Wales, Australia. http://kirby.unsw.edu.au
| | - C Vujovich-Dunn
- Kirby Institute, University of New South Wales, Kensington, 2052, New South Wales, Australia.
| | - J Moodley
- The Aurum Institute, Johannesburg, South Africa.
| | - T Reddy
- Biostatistics Unit, South African Medical Research Council, Durban, Kwazulu-Natal, South Africa.
| | - S Naidoo
- Numolux Group, Pretoria, South Africa.
| |
Collapse
|
4
|
Wand H, Vujovich-Dunn C, Moodley J, Reddy T, Naidoo S. Developing and Validating Risk Algorithm for Hypertension in South Africa: Results from a Nationally Representative Cohort (2008-2017). High Blood Press Cardiovasc Prev 2022; 29:451-461. [PMID: 35917033 PMCID: PMC9537209 DOI: 10.1007/s40292-022-00534-5] [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: 04/12/2022] [Accepted: 07/04/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction There is compelling evidence of significant country-level disparities where African countries, particularly South Africa, have the highest hypertension rates in the world. Aim To develop and validate a simple risk scoring algorithm for hypertension in a large cohort (80,270) of South African men and women. Methods Multivariable logistic regression models were used to build our hypertension risk scoring algorithm and validated externally and internally using the standard statistical techniques. We also compared our risk scores with the results from the Framingham risk prediction model for hypertension. Results Six factors were identified as the significant correlates of hypertension: age, education, obesity, smoking, alcohol intake and exercise. A score of ≥ 25 (out of 57) for men and ≥ 35 (out of 75) for women were selected as the optimum cut-points with 82% (43%) and 83% (49%) sensitivity (specificity) for males and females, respectively in the development datasets. We estimated probabilities of developing hypertension using the Framingham risk prediction model, which were higher among those with higher scores for hypertension. Conclusions Identifying, targeting and prioritising individuals at highest risk of hypertension will have significant impact on preventing severe cardiometabolic diseases by scaling up healthy diet and life-style factors. Our six-item risk scoring algorithm may be included as part of hypertension prevention and treatment programs by targeting older individuals with high body fat measurements who are at highest risk of developing hypertension. Supplementary Information The online version contains supplementary material available at 10.1007/s40292-022-00534-5.
Collapse
Affiliation(s)
- Handan Wand
- Biostatistics and Databases Program, Kirby Institute, University of New South Wales (UNSW Sydney), Level 6, Wallace Wurth Building, Kensington, Sydney, NSW 2052 Australia
| | - Cassandra Vujovich-Dunn
- Biostatistics and Databases Program, Kirby Institute, University of New South Wales (UNSW Sydney), Level 6, Wallace Wurth Building, Kensington, Sydney, NSW 2052 Australia
| | | | - Tarylee Reddy
- Biostatistics Unit, South African Medical Research Council, Durban, Kwazulu-Natal South Africa
| | | |
Collapse
|
5
|
Vujovich-Dunn C, Wand H, Brotherton JML, Gidding H, Sisnowski J, Lorch R, Veitch M, Sheppeard V, Effler P, Skinner SR, Venn A, Davies C, Hocking J, Whop L, Leask J, Canfell K, Sanci L, Smith M, Kang M, Temple-Smith M, Kidd M, Burns S, Selvey L, Meijer D, Ennis S, Thomson C, Lane N, Kaldor J, Guy R. Measuring school level attributable risk to support school-based HPV vaccination programs. BMC Public Health 2022; 22:822. [PMID: 35468743 PMCID: PMC9036743 DOI: 10.1186/s12889-022-13088-x] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 03/24/2022] [Indexed: 12/27/2022] Open
Abstract
Background In Australia in 2017, 89% of 15-year-old females and 86% of 15-year-old males had received at least one dose of the HPV vaccine. However, considerable variation in HPV vaccination initiation (dose one) across schools remains. It is important to understand the school-level characteristics most strongly associated with low initiation and their contribution to the overall between-school variation. Methods A population-based ecological analysis was conducted using school-level data for 2016 on all adolescent students eligible for HPV vaccination in three Australian jurisdictions. We conducted logistic regression to determine school-level factors associated with lower HPV vaccination initiation (< 75% dose 1 uptake) and estimated the population attributable risk (PAR) and the proportion of schools with the factor (school-level prevalence). Results The factors most strongly associated with lower initiation, and their prevalence were; small schools (OR = 9.3, 95%CI = 6.1–14.1; 33% of schools), special education schools (OR = 5.6,95%CI = 3.7–8.5; 8% of schools), higher Indigenous enrolments (OR = 2.7,95% CI:1.9–3.7; 31% of schools), lower attendance rates (OR = 2.6,95%CI = 1.7–3.7; 35% of schools), remote location (OR = 2.6,95%CI = 1.6–4.3; 6% of schools,) and lower socioeconomic area (OR = 1.8,95% CI = 1.3–2.5; 33% of schools). The highest PARs were small schools (PAR = 79%, 95%CI:76–82), higher Indigenous enrolments (PAR = 38%, 95%CI: 31–44) and lower attendance rate (PAR = 37%, 95%CI: 29–46). Conclusion This analysis suggests that initiatives to support schools that are smaller, with a higher proportion of Indigenous adolescents and lower attendance rates may contribute most to reducing the variation of HPV vaccination uptake observed at a school-level in these jurisdictions. Estimating population-level coverage at the school-level is useful to guide policy and prioritise resourcing to support school-based vaccination programs. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13088-x.
Collapse
Affiliation(s)
- C Vujovich-Dunn
- University of New South Wales, Kirby Institute, Kensington, Australia.
| | - H Wand
- University of New South Wales, Kirby Institute, Kensington, Australia
| | - J M L Brotherton
- Australian Centre for the Prevention of Cervical Cancer, Population Health, East Melbourne, Victoria, Australia.,University of Melbourne, Melbourne School of Population and Global Health, Carlton, VIC, Australia
| | - H Gidding
- University of Sydney, Northern Clinical School, Sydney, Australia.,Women and Babies Research, Kolling Institute, Northern Sydney Local Health District, Sydney, Australia.,School of Population Health, University of New South Wales, Kensington, Australia.,National Centre for Immunisation Research and Surveillance, Sydney, Australia
| | - J Sisnowski
- University of New South Wales, Kirby Institute, Kensington, Australia.,Australian National University, National Centre for Epidemiology & Population Health, Canberra, Australia
| | - R Lorch
- University of New South Wales, Kirby Institute, Kensington, Australia
| | - M Veitch
- Department of Health and Human Services, Tasmanian Government, Hobart, Australia
| | - V Sheppeard
- Communicable Diseases Branch, NSW Health, St Leonards, New South Wales, Australia.,University of Sydney, Sydney School of Public Health, Camperdown, NSW, Australia
| | - P Effler
- Communicable Disease Control Directorate, Department of Health, Western Australia, East Perth, Australia
| | - S R Skinner
- University of Sydney, Specialty of Child and Adolescent Health, Faculty of Medicine and Health, Sydney, Australia.,Children's Hospital Westmead, Sydney Children's Hospitals Network, Westmead, Australia
| | - A Venn
- Menzies Institute for Medical Research, University of Tasmania, Tasmanian, Australia
| | - C Davies
- University of Sydney, Specialty of Child and Adolescent Health, Faculty of Medicine and Health, Sydney, Australia.,Children's Hospital Westmead, Sydney Children's Hospitals Network, Westmead, Australia
| | - J Hocking
- University of Melbourne, Melbourne School of Population and Global Health, Carlton, VIC, Australia
| | - L Whop
- Australian National University, National Centre for Epidemiology & Population Health, Canberra, Australia.,Menzies School of Health Research, Charles Darwin University, Cairns, QLD, Australia
| | - J Leask
- National Centre for Immunisation Research and Surveillance, Sydney, Australia.,University of Sydney, Sydney Nursing School, Faculty of Medicine and Health, Camperdown, NSW, Australia
| | - K Canfell
- The Daffodil Centre, University of Sydney, A Joint Venture With Cancer Council NSW, Sydney, Australia
| | - L Sanci
- University of Melbourne, Medicine, Dentistry and Health Sciences, Carlton, VIC, Australia
| | - M Smith
- The Daffodil Centre, University of Sydney, A Joint Venture With Cancer Council NSW, Sydney, Australia.,School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - M Kang
- University of Sydney, Westmead Clinical School, Sydney, New South Wales, Australia
| | - M Temple-Smith
- University of Melbourne, Medicine, Dentistry and Health Sciences, Carlton, VIC, Australia
| | - M Kidd
- Flinders University, Southgate Institute for Health, Society and Equity, Bedford Park, South Australia, Australia
| | - S Burns
- Curtin University, School of Population Health, Bentley, WA, Australia
| | - L Selvey
- University of Queensland, School of Public Health, St Lucia, QLD, Australia
| | - D Meijer
- Immunisation Unit, Health Protection NSW, St Leonard's, New South Wales, Australia
| | - S Ennis
- Immunisation Unit, Health Protection NSW, St Leonard's, New South Wales, Australia
| | - C Thomson
- Communicable Disease Control Directorate, Department of Health, Western Australia, East Perth, Australia
| | - N Lane
- Department of Health and Human Services, Tasmanian Government, Hobart, Australia
| | - J Kaldor
- University of New South Wales, Kirby Institute, Kensington, Australia
| | - R Guy
- University of New South Wales, Kirby Institute, Kensington, Australia
| |
Collapse
|
6
|
Vujovich-Dunn C, Skinner SR, Brotherton J, Wand H, Sisnowski J, Lorch R, Veitch M, Sheppeard V, Effler P, Gidding H, Venn A, Davies C, Hocking J, Whop LJ, Leask J, Canfell K, Sanci L, Smith M, Kang M, Temple-Smith M, Kidd M, Burns S, Selvey L, Meijer D, Ennis S, Thomson CA, Lane N, Kaldor J, Guy R. School-Level Variation in Coverage of Co-Administered dTpa and HPV Dose 1 in Three Australian States. Vaccines (Basel) 2021; 9:vaccines9101202. [PMID: 34696310 PMCID: PMC8537995 DOI: 10.3390/vaccines9101202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 09/14/2021] [Accepted: 10/08/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Australian adolescents are routinely offered HPV and dTpa (diphtheria, tetanus, pertussis) vaccines simultaneously in the secondary school vaccination program. We identified schools where HPV initiation was lower than dTpa coverage and associated school-level factors across three states. METHODS HPV vaccination initiation rates and dTpa vaccination coverage in 2016 were calculated using vaccine databases and school enrolment data. A multivariate analysis assessed sociodemographic and school-level factors associated with HPV initiation being >5% absolute lower than dTpa coverage. RESULTS Of 1280 schools included, the median school-level HPV initiation rate was 85% (interquartile range (IQR):75-90%) and the median dTpa coverage was 86% (IQR:75-92%). Nearly a quarter (24%) of all schools had HPV vaccination initiation >5% lower than dTpa coverage and 11 % had >10% difference. School-level factors independently associated with >5% difference were remote schools (aOR:3.5, 95% CI = 1.7-7.2) and schools in major cities (aOR:1.8, 95% CI = 1.0-3.0), small schools (aOR:3.3, 95% CI = 2.3-5.7), higher socioeconomic advantage (aOR:1.7, 95% CI = 1.1-2.6), and lower proportions of Language-background-other-than-English (aOR:1.9, 95% CI = 1.2-3.0). CONCLUSION The results identified a quarter of schools had lower HPV than dTpa initiation coverage, which may indicate HPV vaccine hesitancy, and the difference was more likely in socioeconomically advantaged schools. As hesitancy is context specific, it is important to understand the potential drivers of hesitancy and future research needs to understand the reasons driving differential uptake.
Collapse
Affiliation(s)
- Cassandra Vujovich-Dunn
- The Kirby Institute, University of New South Wales, Kensington, Sydney 2052, Australia; (H.W.); (J.S.); (R.L.); (J.K.); (R.G.)
- Correspondence: ; Tel.: +61-2-9348-0033
| | - Susan Rachel Skinner
- Children’s Hospital Westmead, Sydney Children’s Hospitals Network, Sydney 2145, Australia; (S.R.S.); (C.D.)
- Faculty of Medicine and Health, University of Sydney, Specialty of Child and Adolescent Health, Sydney 2006, Australia
| | - Julia Brotherton
- Population Health, VCS Foundation Ltd., East Melbourne, Melbourne 3053, Australia;
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Melbourne 3010, Australia;
| | - Handan Wand
- The Kirby Institute, University of New South Wales, Kensington, Sydney 2052, Australia; (H.W.); (J.S.); (R.L.); (J.K.); (R.G.)
| | - Jana Sisnowski
- The Kirby Institute, University of New South Wales, Kensington, Sydney 2052, Australia; (H.W.); (J.S.); (R.L.); (J.K.); (R.G.)
- National Centre for Epidemiology & Population Health, Australian National University, Canberra 0200, Australia;
| | - Rebecca Lorch
- The Kirby Institute, University of New South Wales, Kensington, Sydney 2052, Australia; (H.W.); (J.S.); (R.L.); (J.K.); (R.G.)
| | - Mark Veitch
- Department of Health and Human Services, Tasmanian Government, Hobart 7001, Australia; (M.V.); (N.L.)
| | - Vicky Sheppeard
- Communicable Diseases Branch, Health Protection NSW, St Leonards, Sydney 2065, Australia;
- School of Public Health, University of Sydney, Camperdown, Sydney 2006, Australia;
| | - Paul Effler
- Department of Health, Communicable Disease Control Directorate, East Perth 6000, Australia; (P.E.); (C.A.T.)
| | - Heather Gidding
- School of Population Health, University of New Souh Wales, Sydney 2052, Australia;
- Norther Clinical School of Sydney, University of Sydney, Camperdown, Sydney 2006, Australia
- Women and Babies Research, Kollin Intstitye, Northern Sydney Local Health District, St Leaonards, Sydney 2064, Australia
- National Centre for Immunisation Research and Surveillance, Westmead, Sydney 2145, Australia
| | - Alison Venn
- Menzies Institute for Medical Research, University of Tasmania, Tasmanian 7000, Australia;
| | - Cristyn Davies
- Children’s Hospital Westmead, Sydney Children’s Hospitals Network, Sydney 2145, Australia; (S.R.S.); (C.D.)
- Faculty of Medicine and Health, University of Sydney, Specialty of Child and Adolescent Health, Sydney 2006, Australia
| | - Jane Hocking
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Melbourne 3010, Australia;
| | - Lisa J. Whop
- National Centre for Epidemiology & Population Health, Australian National University, Canberra 0200, Australia;
- Menzies School of Health Research, Charles Darwin University, Brisbane 4000, Australia
| | - Julie Leask
- Faculty of Medicine and Health, Sydney Nursing School, University of Sydney, Camperdown, Sydney 2006, Australia;
| | - Karen Canfell
- Cancer Research Division, Cancer Council, Brisbane 2011, Australia;
| | - Lena Sanci
- Medicine, Dentistry and Health Sciences, University of Melbourne, Carlton, Melbourne 3010, Australia; (L.S.); (M.T.-S.)
| | - Megan Smith
- School of Public Health, University of Sydney, Camperdown, Sydney 2006, Australia;
- Cancer Research Division, Cancer Council, Brisbane 2011, Australia;
| | - Melissa Kang
- Westmead Clinical School, University of Sydney, Sydney 2006, Australia;
| | - Meredith Temple-Smith
- Medicine, Dentistry and Health Sciences, University of Melbourne, Carlton, Melbourne 3010, Australia; (L.S.); (M.T.-S.)
| | - Michael Kidd
- Southgate Institute for Health, Flinders University, Adelaide 5042, Australia;
| | - Sharyn Burns
- School of Population Health, Curtin University, Perth 6102, Australia;
| | - Linda Selvey
- School of Public Health, University of Queensland, Brisbane 4072, Australia;
| | - Dennis Meijer
- Immunisation Unit, Health Protection NSW, St Leonards, Sydney 2065, Australia; (D.M.); (S.E.)
| | - Sonya Ennis
- Immunisation Unit, Health Protection NSW, St Leonards, Sydney 2065, Australia; (D.M.); (S.E.)
| | - Chloe A. Thomson
- Department of Health, Communicable Disease Control Directorate, East Perth 6000, Australia; (P.E.); (C.A.T.)
| | - Nikole Lane
- Department of Health and Human Services, Tasmanian Government, Hobart 7001, Australia; (M.V.); (N.L.)
| | - John Kaldor
- The Kirby Institute, University of New South Wales, Kensington, Sydney 2052, Australia; (H.W.); (J.S.); (R.L.); (J.K.); (R.G.)
| | - Rebecca Guy
- The Kirby Institute, University of New South Wales, Kensington, Sydney 2052, Australia; (H.W.); (J.S.); (R.L.); (J.K.); (R.G.)
| |
Collapse
|
7
|
Sisnowski J, Vujovich-Dunn C, Gidding H, Brotherton J, Wand H, Lorch R, Veitch M, Sheppeard V, Effler P, Skinner SR, Venn A, Davies C, Hocking J, Whop L, Leask J, Canfell K, Sanci L, Smith M, Kang M, Temple-Smith M, Kidd M, Burns S, Selvey L, Meijer D, Ennis S, Thomson C, Lane N, Kaldor J, Guy R. Differences in school factors associated with adolescent HPV vaccination initiation and completion coverage in three Australian states. Vaccine 2021; 39:6117-6126. [PMID: 34493408 DOI: 10.1016/j.vaccine.2021.08.076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 08/19/2021] [Accepted: 08/20/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Schools are the primary setting for the delivery of adolescent HPV vaccination in Australia. Although this strategy has achieved generally high vaccination coverage, gaps persist for reasons that are mostly unknown. This study sought to identify school-level correlates of low vaccination course initiation and completion in New South Wales, Tasmania, and Western Australia to inform initiatives to increase uptake. METHODS Initiation was defined as the number of first doses given in a school in 2016 divided by vaccine-eligible student enrolments. Completion was the number of third doses given in a school in 2015-2016 divided by the number of first doses. Low initiation and completion were defined as coverage ≤ 25thpercentile of all reporting schools. We investigated correlations between covariates using Spearman's rank correlation coefficients. Due to multicollinearity, we used univariable logistic regression to investigate associations between school characteristics and low coverage. RESULTS Median initiation was 84.7% (IQR: 75.0%-90.4%) across 1,286 schools and median completion was 93.8% (IQR: 86.0%-97.3%) across 1,295 schools. There were strong correlations between a number of school characteristics, particularly higher Indigenous student enrolments and lower attendance, increasing remoteness, higher postcode socioeconomic disadvantage, and smaller school size. Characteristics most strongly associated with low initiation in univariate analyses were small school size, location in Tasmania, and schools catering for special educational needs. Low completion was most strongly associated with schools in Tasmania and Western Australia, remote location, small size, high proportion of Indigenous student enrolments, and low attendance rates. CONCLUSION This study provides indicative evidence that characteristics of schools and school populations are associated with the likelihood of low initiation and completion of the HPV vaccination course. The findings will guide further research and help target initiatives to improve vaccination uptake in schools with profiles associated with lower coverage.
Collapse
Affiliation(s)
- J Sisnowski
- The Kirby Institute, Faculty of Medicine, University of New South Wales, Wallace Wurth Building, High St., Kensington, New South Wales, Australia; Australian National University, National Centre for Epidemiology & Population Health, Canberra, Australia.
| | - C Vujovich-Dunn
- The Kirby Institute, Faculty of Medicine, University of New South Wales, Wallace Wurth Building, High St., Kensington, New South Wales, Australia.
| | - H Gidding
- University of New South Wales, School of Public Health and Community Medicine, Kensington, Australia; National Centre for Immunisation Research and Surveillance, Westmead, Australia; The University of Sydney Northern Clinical School, St Leonards, Australia.
| | - J Brotherton
- Population Health, VCS Foundation, East Melbourne, Victoria, Australia; University of Melbourne, Melbourne School of Population and Global Health, Carlton, Victoria, Australia.
| | - H Wand
- The Kirby Institute, Faculty of Medicine, University of New South Wales, Wallace Wurth Building, High St., Kensington, New South Wales, Australia.
| | - R Lorch
- The Kirby Institute, Faculty of Medicine, University of New South Wales, Wallace Wurth Building, High St., Kensington, New South Wales, Australia.
| | - M Veitch
- Tasmanian Government, Department of Health and Human Services, Hobart, Australia.
| | - V Sheppeard
- Communicable Diseases Branch, Health Protection NSW, St Leonards, New South Wales, Australia; University of Sydney, Sydney School of Public Health, Camperdown, New South Wales, Australia.
| | - P Effler
- Communicable Disease Control Directorate, Department of Health, Western Australia, East Perth, Australia.
| | - S R Skinner
- Children's Hospital Westmead, Sydney Children's Hospitals Network, Westmead, Australia; University of Sydney, Specialty of Child and Adolescent Health, Faculty of Medicine and Health, Camperdown, New South Wales, Australia.
| | - A Venn
- Menzies Institute for Medical Research, University of Tasmania, Tasmanian, Australia.
| | - C Davies
- Children's Hospital Westmead, Sydney Children's Hospitals Network, Westmead, Australia; University of Sydney, Specialty of Child and Adolescent Health, Faculty of Medicine and Health, Camperdown, New South Wales, Australia.
| | - J Hocking
- University of Melbourne, Melbourne School of Population and Global Health, Carlton, Victoria, Australia.
| | - L Whop
- Australian National University, National Centre for Epidemiology & Population Health, Canberra, Australia; Menzies School of Health Research, Charles Darwin University, Cairns, Queensland, Australia.
| | - J Leask
- National Centre for Immunisation Research and Surveillance, Westmead, Australia; University of Sydney, Sydney Nursing School, Faculty of Medicine and Health, Camperdown, New South Wales, Australia.
| | - K Canfell
- Cancer Research Division, Cancer Council, New South Wales, Australia.
| | - L Sanci
- University of Melbourne, Medicine, Dentistry and Health Sciences, Carlton, Victoria, Australia.
| | - M Smith
- Communicable Disease Control Directorate, Department of Health, Western Australia, East Perth, Australia; Cancer Research Division, Cancer Council, New South Wales, Australia.
| | - M Kang
- University of Sydney, Westmead Clinical School, New South Wales, Australia.
| | - M Temple-Smith
- University of Melbourne, Medicine, Dentistry and Health Sciences, Carlton, Victoria, Australia.
| | - M Kidd
- Flinders University, Southgate Institute for Health, Society and Equity, South Australia, Australia.
| | - S Burns
- Curtin University, School of Population Health, Western Australia, Australia.
| | - L Selvey
- University of Queensland, School of Public Health, Queensland, Australia.
| | - D Meijer
- Immunisation Unit, Health Protection NSW, St Leonards, New South Wales, Australia.
| | - S Ennis
- Immunisation Unit, Health Protection NSW, St Leonards, New South Wales, Australia.
| | - C Thomson
- Communicable Disease Control Directorate, Department of Health, Western Australia, East Perth, Australia.
| | - N Lane
- Tasmanian Government, Department of Health and Human Services, Hobart, Australia.
| | - J Kaldor
- The Kirby Institute, Faculty of Medicine, University of New South Wales, Wallace Wurth Building, High St., Kensington, New South Wales, Australia.
| | - R Guy
- The Kirby Institute, Faculty of Medicine, University of New South Wales, Wallace Wurth Building, High St., Kensington, New South Wales, Australia.
| |
Collapse
|
8
|
Vujovich-Dunn C, Kaufman J, King C, Skinner SR, Wand H, Guy R, Leask J. A systematic review and meta-analysis of effectiveness of decision aids for vaccination decision-making. Vaccine 2021; 39:3655-3665. [PMID: 34052064 DOI: 10.1016/j.vaccine.2021.05.021] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND This systematic review and meta-analysis aimed to assess the effectiveness of vaccination decision aids compared with usual care on vaccine uptake, vaccine attitudes, decisional conflict, intent to vaccinate and timeliness. METHODS Searches were conducted in OVID Medline, OVID Embase, CINAHL, PsycINFO, the Cochrane Library and SCOPUS. Randomised controlled trials were included if they evaluated the impact of decision aids as defined by the International Patient Decision Aids Standards Collaboration. Where possible, meta-analysis was undertaken. Where meta-analysis was not possible, we conducted a narrative synthesis. Risk of bias in included trials was assessed using the Cochrane Collaboration's risk of bias tool. Data were analysed using STATA. RESULTS Five RCTs were identified that evaluated the effectiveness of decision aids in the context of vaccination decision making. Meta-analysis of four studies showed that decision aids may have slightly increased vaccination uptake, but this was reduced to no effect once studies with higher risk of bias were excluded. Meta-analysis of three studies showed that decision aids moderately increased intention to vaccinate. Narrative synthesis of two studies suggested that decision aids reduced decisional conflict. One study reported that decision aids decreased perceived risk of vaccination. Content, format and delivery method of the decision aids varied across the studies. It was not clear from the information reported whether these variations affected the effectiveness of the decision aids. CONCLUSION Decision aids can assist in vaccine decision making. Future studies of decision aids could provide greater detail of the decision aids themselves, which would enable comparison of the effectiveness of different elements and formats. Standardising decision aids would also allow for easier comparison between decision aids.
Collapse
Affiliation(s)
- Cassandra Vujovich-Dunn
- The Kirby Institute, Faculty of Medicine, University of New South Wales, Wallace Wurth Building, High St., Kensington, NSW 2052, Australia.
| | - Jessica Kaufman
- Murdoch Children's Research Institute, The Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria 3052, Australia; Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Victoria 3086 Australia.
| | - Catherine King
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Locked Bag 4001, 2145 Westmead, NSW, Australia; The Children's Hospital at Westmead Clinical School, the Faculty of Medicine and Health, The University of Sydney, Locked Bag 4001, 2145 Westmead, NSW, Australia.
| | - S Rachel Skinner
- The Children's Hospital at Westmead Clinical School, the Faculty of Medicine and Health, The University of Sydney, Locked Bag 4001, 2145 Westmead, NSW, Australia; University of Sydney, Specialty of Child and Adolescent Health, Faculty of Medicine and Health, Camperdown, NSW 2006, Australia.
| | - Handan Wand
- The Kirby Institute, Faculty of Medicine, University of New South Wales, Wallace Wurth Building, High St., Kensington, NSW 2052, Australia.
| | - Rebecca Guy
- The Kirby Institute, Faculty of Medicine, University of New South Wales, Wallace Wurth Building, High St., Kensington, NSW 2052, Australia.
| | - Julie Leask
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Locked Bag 4001, 2145 Westmead, NSW, Australia; University of Sydney, Susan Wakil School of Nursing and Midwifery, Camperdown, NSW 2006, Australia.
| |
Collapse
|
9
|
Martiniuk A, Jagilli R, Natuzzi E, Ilopitu JW, Oipata M, Christie AM, Korini J, Vujovich-Dunn C, Yu W. Cancer in the Solomon Islands. Cancer Epidemiol 2018; 50:176-183. [PMID: 29120823 DOI: 10.1016/j.canep.2017.04.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 04/26/2017] [Accepted: 04/29/2017] [Indexed: 01/04/2023]
Abstract
INTRODUCTION The Solomon Islands, with a population of 550,000, has significant challenges in addressing non-communicable diseases, including cancer, in the face of significant economic, cultural, general awareness and health system challenges. OBJECTIVES To summarise the existing knowledge regarding cancer in the Solomon Islands, to gather new data and make recommendations. METHODS A literature review was undertaken and cancer data from the National Referral Hospital, Honiara were analysed and are presented. Key stakeholders were interviewed for their perspectives including areas to target for ongoing, incremental improvements. Last, a health services audit for cancer using the WHO SARA tool was undertaken. RESULTS Breast and cervical cancer remain the first and second most commonly identified cancers in the Solomon Islands. The Solomons cancer registry is hospital based and suffers from incomplete data collection due to its passive nature, lack of resources for data entry and processing resulting in weak data which is rarely used for decision-making. The health system audit revealed system and individual reasons for delayed diagnosis or lack of cancer treatment or palliation in the Solomon Islands. Reasons included lack of patient knowledge regarding symptoms, late referrals to the National Referral Hospital and inability of health care workers to detect cancers either due to lack of skills to do so, or lack of diagnostic capabilities, and an overall lack of access to any health care, due to geographical barriers and overall national economic fragility. CONCLUSION The Solomon Islands is challenged in preventing, diagnosing, treating and palliating cancer. Stakeholders recommend establishing specialty expertise (in the form of a cancer unit), improved registry processes and increased collaboration between the sole tertiary hospital nationwide and other Solomon health services as important targets for incremental improvement.
Collapse
Affiliation(s)
- Alexandra Martiniuk
- University of Sydney, Australia; University of Toronto, Australia; George Institute for Global Health, Edward Ford Building, 2000, Australia.
| | - Rooney Jagilli
- General Surgeon and Medical Superintendent National Referral Hospital, Honiara, Solomon Islands.
| | - Eileen Natuzzi
- San Diego State University, School of Public Health, USA.
| | | | - Meltus Oipata
- National Referral Hospital, Honiara, Solomon Islands
| | | | | | | | - William Yu
- Hunter New England Health, Newcastle, 2305, Australia.
| |
Collapse
|