scholarly journals Impact of health system strengthening on delivery strategies to improve child immunization coverage and inequalities in rural Madagascar

2021 ◽  
Author(s):  
Elinambinina Rajaonarifara ◽  
Matthew H. Bond ◽  
Ann C Miller ◽  
Felana Angella Ihantamalala ◽  
Laura F Cordier ◽  
...  
Keyword(s):  
Health System ◽  
Vaccination Coverage ◽  
Odds Ratio ◽  
Immunization Coverage ◽  
Population Level ◽  
Health System Strengthening ◽  
Routine Immunization ◽  
Immunization Rates ◽  
Vaccination Campaigns ◽  
The Impact

Background: To reach global immunization goals, national programs need to balance routine immunization at health facilities with vaccination campaigns and other outreach activities (e.g. vaccination weeks), which boost coverage at particular times and help reduce geographic inequalities. However, where routine immunization is weak, an overreliance on vaccination campaigns may lead to heterogeneous coverage. Here, we assessed the impact of a health system strengthening (HSS) intervention on the relative contribution of routine immunization and outreach activities to reach immunization goals in rural Madagascar. Methods: We obtained data from health centers in Ifanadiana district on the monthly number of recommended vaccines (BCG, measles, DTP and Polio) delivered to children, during 2014-2018. We also analyzed data from a district-representative cohort carried out every two years in over 1500 households in 2014-2018. We compared changes inside and outside the HSS catchment in the delivery of recommended vaccines, population-level vaccination coverage, geographic and economic inequalities in coverage, and timeliness of vaccination. The impact of HSS was quantified via mixed-effects logistic regressions. Results: The HSS intervention was associated with a significant increase in immunization rates (Odds Ratio between 1.22 for measles and 1.49 for DTP), which diminished over time. Outreach activities were associated with a doubling in immunization rates, but their effect was smaller in the HSS catchment. Analysis of cohort data revealed that HSS was associated with higher vaccination coverage (Odds Ratio between 1.18 per year of HSS for measles and 1.43 for BCG), a reduction in economic inequality, and a higher proportion of timely vaccinations. Yet, the lower contribution of outreach activities in the HSS catchment was associated with persistent inequalities in geographic coverage, which prevented achieving international coverage targets. Conclusion: Investment in stronger primary care systems can improve vaccination coverage, reduce inequalities and improve the timeliness of vaccination via increases in routine immunizations.

scholarly journals Impact of health system strengthening on delivery strategies to improve child immunisation coverage and inequalities in rural Madagascar

2022 ◽  
Vol 7 (1) ◽  
pp. e006824
Author(s):  
Elinambinina Rajaonarifara ◽  
Matthew H Bonds ◽  
Ann C Miller ◽  
Felana Angella Ihantamalala ◽  
Laura Cordier ◽  
...  
Keyword(s):  
Health System ◽  
Vaccination Coverage ◽  
Population Level ◽  
Health System Strengthening ◽  
Routine Immunisation ◽  
Relative Contribution ◽  
Geographical Inequalities ◽  
Care Systems ◽  
Vaccination Campaigns ◽  
The Impact

BackgroundTo reach global immunisation goals, national programmes need to balance routine immunisation at health facilities with vaccination campaigns and other outreach activities (eg, vaccination weeks), which boost coverage at particular times and help reduce geographical inequalities. However, where routine immunisation is weak, an over-reliance on vaccination campaigns may lead to heterogeneous coverage. Here, we assessed the impact of a health system strengthening (HSS) intervention on the relative contribution of routine immunisation and outreach activities to reach immunisation goals in rural Madagascar.MethodsWe obtained data from health centres in Ifanadiana district on the monthly number of recommended vaccines (BCG, measles, diphtheria, tetanus and pertussis (DTP) and polio) delivered to children, during 2014–2018. We also analysed data from a district-representative cohort carried out every 2 years in over 1500 households in 2014–2018. We compared changes inside and outside the HSS catchment in the delivery of recommended vaccines, population-level vaccination coverage, geographical and economic inequalities in coverage, and timeliness of vaccination. The impact of HSS was quantified via mixed-effects logistic regressions.ResultsThe HSS intervention was associated with a significant increase in immunisation rates (OR between 1.22 for measles and 1.49 for DTP), which diminished over time. Outreach activities were associated with a doubling in immunisation rates, but their effect was smaller in the HSS catchment. Analysis of cohort data revealed that HSS was associated with higher vaccination coverage (OR between 1.18 per year of HSS for measles and 1.43 for BCG), a reduction in economic inequality, and a higher proportion of timely vaccinations. Yet, the lower contribution of outreach activities in the HSS catchment was associated with persistent inequalities in geographical coverage, which prevented achieving international coverage targets.ConclusionInvestment in stronger primary care systems can improve vaccination coverage, reduce inequalities and improve the timeliness of vaccination via increases in routine immunisations.

scholarly journals Achieving a “step change” in the tuberculosis epidemic through comprehensive community-wide intervention: a model-based analysis

BMC Medicine ◽  
2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Sourya Shrestha ◽  
Emily A. Kendall ◽  
Rebekah Chang ◽  
Roy Joseph ◽  
Parastu Kasaie ◽  
...  
Keyword(s):  
Health System ◽  
Adult Population ◽  
Preventive Therapy ◽  
Step Change ◽  
Health System Strengthening ◽  
World Health ◽  
Unsuccessful Treatment ◽  
Incidence And Mortality ◽  
Epidemiological Impact ◽  
The Impact

Abstract Background Global progress towards reducing tuberculosis (TB) incidence and mortality has consistently lagged behind the World Health Organization targets leading to a perception that large reductions in TB burden cannot be achieved. However, several recent and historical trials suggest that intervention efforts that are comprehensive and intensive can have a substantial epidemiological impact. We aimed to quantify the potential epidemiological impact of an intensive but realistic, community-wide campaign utilizing existing tools and designed to achieve a “step change” in the TB burden. Methods We developed a compartmental model that resembled TB transmission and epidemiology of a mid-sized city in India, the country with the greatest absolute TB burden worldwide. We modeled the impact of a one-time, community-wide screening campaign, with treatment for TB disease and preventive therapy for latent TB infection (LTBI). This one-time intervention was followed by the strengthening of the tuberculosis-related health system, potentially facilitated by leveraging the one-time campaign. We estimated the tuberculosis cases and deaths that could be averted over 10 years using this comprehensive approach and assessed the contributions of individual components of the intervention. Results A campaign that successfully screened 70% of the adult population for active and latent tuberculosis and subsequently reduced diagnostic and treatment delays and unsuccessful treatment outcomes by 50% was projected to avert 7800 (95% range 5450–10,200) cases and 1710 (1290–2180) tuberculosis-related deaths per 1 million population over 10 years. Of the total averted deaths, 33.5% (28.2–38.3) were attributable to the inclusion of preventive therapy and 52.9% (48.4–56.9) to health system strengthening. Conclusions A one-time, community-wide mass campaign, comprehensively designed to detect, treat, and prevent tuberculosis with currently existing tools can have a meaningful and long-lasting epidemiological impact. Successful treatment of LTBI is critical to achieving this result. Health system strengthening is essential to any effort to transform the TB response.

scholarly journals Increasing Full Child Immunization Rates by Government Using an Innovative Computerized Immunization Due List in Rural India

2018 ◽  
Vol 55 ◽  
pp. 004695801775129
Author(s):  
Enakshi Ganguly ◽  
Rahul Gupta ◽  
Alik Widge ◽  
R. Purushotham Reddy ◽  
K. Balasubramanian ◽  
...  
Keyword(s):  
Vaccination Coverage ◽  
Andhra Pradesh ◽  
Health Workers ◽  
Immunization Coverage ◽  
Rural India ◽  
Great Promise ◽  
Immunization Rates ◽  
Comprehensive Health ◽  
Charitable Trust ◽  
Novel Strategy

Increasing child vaccination coverage to 85% or more in rural India from the current level of 50% holds great promise for reducing infant and child mortality and improving health of children. We have tested a novel strategy called Rural Effective Affordable Comprehensive Health Care (REACH) in a rural population of more than 300 000 in Rajasthan and succeeded in achieving full immunization coverage of 88.7% among children aged 12 to 23 months in a short span of less than 2 years. The REACH strategy was first developed and successfully implemented in a demonstration project by SHARE INDIA in Medchal region of Andhra Pradesh, and was then replicated in Rajgarh block of Rajasthan in cooperation with Bhoruka Charitable Trust (private partners of Integrated Child Development Services and National Rural Health Mission health workers in Rajgarh). The success of the REACH strategy in both Andhra Pradesh and Rajasthan suggests that it could be successfully adopted as a model to enhance vaccination coverage dramatically in other areas of rural India.

Grounding evaluation design in the socio-ecological model of health: a logic framework for the assessment of a national routine immunization communication initiative in Kyrgyzstan

2020 ◽  
Vol 27 (4) ◽  
pp. 59-68
Author(s):  
Renata Schiavo ◽  
Upal Basu Roy ◽  
Latisha Faroul ◽  
Galina Solodunova
Keyword(s):  
Public Health ◽  
International Development ◽  
Media Coverage ◽  
Ecological Model ◽  
Public Health Intervention ◽  
Immunization Coverage ◽  
Evaluation Framework ◽  
Routine Immunization ◽  
Attitudes And Practices ◽  
Immunization Rates

Childhood routine immunization (RI) is a highly effective public health intervention for the prevention of infectious diseases. Despite high immunization rates, a 2018 Knowledge, Attitudes, and Practices (KAP) study by the United Nations Children’s Fund (UNICEF) noted a growing practice of vaccine refusal among parents and primary caregivers as well as clusters of significantly lower immunization coverage in some provinces. Moreover, a 2018 Joint Appraisal report by GAVI (Global Vaccine Alliance) has highlighted a decrease in immunization rates among children under 1 year of age from 96.1% to 92% for some vaccines. As a result, UNICEF is spearheading a national communication initiative to increase the rates of RI in Kyrgyzstan. This initiative includes strengthening interpersonal communication skills of local healthcare workers, improving the quality and accuracy of media coverage via a tailored outreach to the Kyrgyz media, as well as fostering community engagement to give voice to local champions and engage hesitant parents and vaccine refuters. UNICEF has also partnered with a research team for the design phase of a suitable evaluation framework. Grounded in the socio-ecological model (SEM) of health, the framework recognizes the interconnection of behavioral, social, and policy change, and includes not only activity-specific indicators (process indicators) but also progress, outcome, and impact indicators to document results among key groups and stakeholders at different levels of the SEM, and, ultimately, on immunization rates in Kyrgyzstan. The framework reflects the importance of an integrated and multilevel approach to intervention and communication design, and integrates the SEM with a logic model that connects different components of the initiative. This paper introduces this evaluation framework, including implications for the evaluation of child health programs, and other public health, communication, and international development interventions.

scholarly journals The importance of sustained compliance with physical distancing during COVID-19 vaccination rollout

2021 ◽  
Author(s):  
Alexandra Teslya ◽  
Ganna Rozhnova ◽  
Thi Mui Pham ◽  
Daphne van Wees ◽  
Hendrik Nunner ◽  
...  
Keyword(s):  
Vaccination Coverage ◽  
Vaccine Coverage ◽  
Transmission Model ◽  
Cumulative Number ◽  
Vaccination Rates ◽  
Contact Rates ◽  
Health Authorities ◽  
Public Health Authorities ◽  
Vaccination Campaigns ◽  
The Impact

Abstract Mass vaccination campaigns against SARS-CoV-2 are under way in many countries with the hope that increasing vaccination coverage will enable reducing current physical distancing measures. Compliance with these measures is waning, while more transmissible virus variants such as B.1.1.7 have emerged. Using SARS-CoV-2 transmission model we investigated the impact of the feedback between compliance, the incidence of infection, and vaccination coverage on the success of a vaccination programme in the population where waning of compliance depends on vaccine coverage. Our results suggest that the combination of fast waning compliance, slow vaccination rates, and more transmissible variants may result in a higher cumulative number of infections than in a situation without vaccination. These adverse effects can be alleviated if vaccinated individuals do not revert to pre-pandemic contact rates, and if non-vaccinated individuals remain compliant with physical distancing measures. Both require convincing, clear and appropriately targeted communication strategies by public health authorities.

scholarly journals Impact of COVID-19 pandemic on routine childhood immunisation services post lockdown in a tertiary care centre in Meerut district of western U.P.

2021 ◽  
Vol 8 (2) ◽  
pp. 219
Author(s):  
Archana D. Agrawal ◽  
Gaurav Gupta ◽  
Ashu Bhasin ◽  
Abhishek Singh ◽  
Alpa Rathi
Keyword(s):  
Public Health ◽  
Tertiary Care ◽  
Immunization Coverage ◽  
Routine Immunization ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Vaccine Preventable Diseases ◽  
Number Of Children ◽  
Birth Dose ◽  
The Impact

Background: The severe acute respiratory syndrome corona virus-2 (SARS CoV-2) disease pandemic has been a threat to public health and health care system world-wide including routine immunization which has been greatly disrupted putting children at risk for vaccine-preventable diseases (VPDs). A study with an aim to analyse the impact of COVID-19 pandemic on routine immunization coverage post lockdown at a tertiary care centre of western UP.Methods: A retrospective analytical study was conducted at LLRM Medical College, Meerut comparing 3 periods of year 2020, each of 4 weeks viz: 1-28th of February, 1-28 of August and 1-28 of December.Results: Total number of vaccine beneficiaries decreased significantly post lockdown from 646 in February to 275 and 419 in August and December respectively. The percent reduction was maximally seen in booster vaccines while birth dose group was least affected. There was 76.2% and 39.3% reduction in number of children receiving primary doses of combination vaccines in August and December period respectively as compared to February 2020. We found 68.42% and 54.39 % reduction in MR-1 beneficiaries in August and December respectively as compared to February 2020.Conclusions: Significant reduction is found in total number of children receiving immunization during un-lockdown period, compared to pre-COVID level. This difference was more significant in booster doses compared to birth doses. We did not find any significant catch up in vaccine beneficiaries by December 2020 despite 7 months of un-lockdown raising significant concern for public health.

scholarly journals Mathematical modeling of endemic cholera transmission

2021 ◽  
Author(s):  
Dennis L Chao
Keyword(s):  
Mathematical Modeling ◽  
Herd Immunity ◽  
Population Level ◽  
Additional Benefit ◽  
Mass Vaccination ◽  
The Cost ◽  
Vaccination Campaigns ◽  
The Impact ◽  
Indirect Protection ◽  
Endemic Cholera

Abstract Mathematical modeling can be used to project the impact of mass vaccination on cholera transmission. Here, we discuss two examples for which indirect protection from mass vaccination needs to be considered. In the first, we show that non-vaccinees can be protected by mass vaccination campaigns. This additional benefit of indirect protection improves the cost-effectiveness of mass vaccination. In the second, we model the use of mass vaccination to eliminate cholera. In this case, a high population level of immunity, including contributions from infection and vaccination, is required to reach the “herd immunity” threshold needed to stop transmission and achieve elimination.

scholarly journals The Impact of War in Yemen on Immunization Coverage of Children Under One Year of Age: Descriptive Study

10.2196/14461 ◽  
2019 ◽  
Vol 5 (4) ◽  
pp. e14461
Author(s):  
Amr Torbosh ◽  
Mohammed Abdulla Al Amad ◽  
Abdulwahed Al Serouri ◽  
Yousef Khader
Keyword(s):  
Vaccination Coverage ◽  
Negative Impact ◽  
Vaccine Coverage ◽  
National Health System ◽  
Immunization Coverage ◽  
Measles Vaccine ◽  
One Year ◽  
Expanded Program On Immunization ◽  
The Impact ◽  
Marked Drop

Background After 2 years of war that crippled the capacity of the Yemeni National Health System and left only 45% of health facilities functioning, Yemen faced increasing vaccine-preventable disease (VPD) outbreaks and may be at high risk of polio importation. Objective The aim of this study was to determine the impact of the 2015 war on the immunization coverage of children under 1 year. Methods Data on vaccination coverage for 2012-2015 were obtained from the national Expanded Program on Immunization (EPI). The vaccination coverage was calculated at the national and governorate levels by dividing the number of actually vaccinated children by the estimated population of children under 1 year. Results Although there was an increase from 2012 to 2014 in the national coverage for penta-3 vaccine (82% in 2012 vs 88% in 2014) and measles vaccine (70% in 2012 vs 75% in 2014), the coverage was still below the national target (≥95%). Furthermore, the year 2015 witnessed a marked drop in the national coverage compared with 2014 for the measles vaccine (66% in 2015 vs 75% in 2014), but a slight drop in penta-3 vaccine coverage (84% in 2015 vs 88% in 2014). Bacillus Calmette–Guérin vaccine also showed a marked drop from 73% in 2014 to 49% in 2015. These reductions were more marked in governorates that witnessed armed confrontations (eg, Taiz, Lahj, and Sa’dah governorates). On the other hand, governorates that did not witness armed confrontations showed an increase in coverage (eg, Raymah and Ibb), owing to an increase in their population because of displacement from less secure and confrontation-prone governorates. Conclusions This analysis demonstrated the marked negative impact of the 2015 war on immunization coverage, especially in the governorates that witnessed armed confrontations. This could put Yemen at more risk of VPD outbreaks and polio importation. Besides the ongoing efforts to stop the Yemeni war, strategies for more innovative vaccine delivery or provision and fulfilling the increasing demands are needed, especially in governorates with confrontations. Enhancing EPI performance through supportable investments in infrastructure that was destroyed by the war and providing decentralized funds are a prerequisite.

scholarly journals Impact of vaccination and non-pharmaceutical interventions on SARS-CoV-2 dynamics in Switzerland

2021 ◽  
Author(s):  
Andrew J. Shattock ◽  
Epke A. Le Rutte ◽  
Robert P Duenner ◽  
Swapnoleena Sen ◽  
Sherrie L Kelly ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Vaccination Coverage ◽  
Vaccination Campaign ◽  
Population Level ◽  
Morbidity And Mortality ◽  
Transmission Model ◽  
Third Wave ◽  
The Impact ◽  
Pharmaceutical Interventions

As vaccination coverage against SARS-CoV-2 increases amidst the emergence and spread of more infectious and potentially more deadly viral variants, decisions on timing and extent of relaxing effective, but unsustainable, non-pharmaceutical interventions (NPIs) need to be made. An individual-based transmission model of SARS-CoV-2 dynamics, OpenCOVID, was developed to compare the impact of various vaccination and NPI strategies on the COVID-19 epidemic in Switzerland. We estimate that any relaxation of NPIs in March 2021 will lead to increasing cases, hospitalisations, and deaths resulting in a "third wave" in spring and into summer 2021. However, we find a cautious phased relaxation can substantially reduce population-level morbidity and mortality. We find that faster vaccination campaign can offset the size of such a wave, allowing more flexibility for NPI to be relaxed sooner. Our sensitivity analysis revealed that model results are particularly sensitive to the infectiousness of variant B.1.1.7.

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