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 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 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 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 The Impact of Technology-Enabled Care Coordination in a Complex Mental Health System: A Local System Dynamics Model (Preprint)

2020 ◽  
Author(s):  
Frank Iorfino ◽  
Jo-An Occhipinti ◽  
Adam Skinner ◽  
Tracey Davenport ◽  
Shelley Rowe ◽  
...  
Keyword(s):  
Mental Health ◽  
Growth Rate ◽  
Psychological Distress ◽  
Health System ◽  
Care Coordination ◽  
Mental Health System ◽  
Service Capacity ◽  
Health Related ◽  
Care Systems ◽  
The Impact

BACKGROUND Prior to the COVID-19 pandemic, major shortcomings in the way mental health care systems were organized were impairing the delivery of effective care. The mental health impacts of the pandemic, the recession, and the resulting social dislocation will depend on the extent to which care systems will become overwhelmed and on the strategic investments made across the system to effectively respond. OBJECTIVE This study aimed to explore the impact of strengthening the mental health system through technology-enabled care coordination on mental health and suicide outcomes. METHODS A system dynamics model for the regional population catchment of North Coast New South Wales, Australia, was developed that incorporated defined pathways from social determinants of mental health to psychological distress, mental health care, and suicidal behavior. The model reproduced historic time series data across a range of outcomes and was used to evaluate the relative impact of a set of scenarios on attempted suicide (ie, self-harm hospitalizations), suicide deaths, mental health–related emergency department (ED) presentations, and psychological distress over the period from 2021 to 2030. These scenarios include (1) business as usual, (2) increase in service capacity growth rate by 20%, (3) standard telehealth, and (4) technology-enabled care coordination. Each scenario was tested using both pre– and post–COVID-19 social and economic conditions. RESULTS Technology-enabled care coordination was forecast to deliver a reduction in self-harm hospitalizations and suicide deaths by 6.71% (95% interval 5.63%-7.87%), mental health–related ED presentations by 10.33% (95% interval 8.58%-12.19%), and the prevalence of high psychological distress by 1.76 percentage points (95% interval 1.35-2.32 percentage points). Scenario testing demonstrated that increasing service capacity growth rate by 20% or standard telehealth had substantially lower impacts. This pattern of results was replicated under post–COVID-19 conditions with technology-enabled care coordination being the only tested scenario, which was forecast to reduce the negative impact of the pandemic on mental health and suicide. CONCLUSIONS The use of technology-enabled care coordination is likely to improve mental health and suicide outcomes. The substantially lower effectiveness of targeting individual components of the mental health system (ie, increasing service capacity growth rate by 20% or standard telehealth) reiterates that strengthening the whole system has the greatest impact on patient outcomes. Investments into more of the same types of programs and services alone will not be enough to improve outcomes; instead, new models of care and the digital infrastructure to support them and their integration are needed.

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 Exogenous re-infection and the dynamics of tuberculosis epidemics: local effects in a network model of transmission

2006 ◽  
Vol 4 (14) ◽  
pp. 523-531 ◽  
Author(s):  
Ted Cohen ◽  
Caroline Colijn ◽  
Bryson Finklea ◽  
Megan Murray
Keyword(s):  
Network Model ◽  
Disease Transmission ◽  
Control Strategies ◽  
Disease Incidence ◽  
Infected Individual ◽  
Population Level ◽  
Recent Infection ◽  
Tb Control ◽  
Relative Contribution ◽  
The Impact

Infection with Mycobacterium tuberculosis leads to tuberculosis (TB) disease by one of the three possible routes: primary progression after a recent infection; re-activation of a latent infection; or exogenous re-infection of a previously infected individual. Recent studies show that optimal TB control strategies may vary depending on the predominant route to disease in a specific population. It is therefore important for public health policy makers to understand the relative frequency of each type of TB within specific epidemiological scenarios. Although molecular epidemiologic tools have been used to estimate the relative contribution of recent transmission and re-activation to the burden of TB disease, it is not possible to use these techniques to distinguish between primary disease and re-infection on a population level. Current estimates of the contribution of re-infection therefore rely on mathematical models which identify the parameters most consistent with epidemiological data; these studies find that exogenous re-infection is important only when TB incidence is high. A basic assumption of these models is that people in a population are all equally likely to come into contact with an infectious case. However, theoretical studies demonstrate that the social and spatial structure can strongly influence the dynamics of infectious disease transmission. Here, we use a network model of TB transmission to evaluate the impact of non-homogeneous mixing on the relative contribution of re-infection over realistic epidemic trajectories. In contrast to the findings of previous models, our results suggest that re-infection may be important in communities where the average disease incidence is moderate or low as the force of infection can be unevenly distributed in the population. These results have important implications for the development of TB control strategies.

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.

scholarly journals Whole-genome sequencing of SARS-CoV-2 in the Republic of Ireland during waves 1 and 2 of the pandemic

2021 ◽  
Author(s):  
P.W.G. Mallon ◽  
F. Crispie ◽  
G. Gonzalez ◽  
W. Tinago ◽  
A.A. Garcia Leon ◽  
...  
Keyword(s):  
Genetic Diversity ◽  
Phylogenetic Analysis ◽  
Whole Genome Sequencing ◽  
Disease Severity ◽  
Genome Sequencing ◽  
Population Level ◽  
Whole Genome ◽  
Multiple Introductions ◽  
Relative Contribution ◽  
The Impact

AbstractBackgroundWhole-genome sequencing (WGS) of SARS-CoV-2 laboratory-confirmed cases can provide insights into viral transmission and genetic diversity at a population level. However, less is known about the impact of non-pharmaceutical interventions (NPIs), including ‘lockdowns’, on circulating SARS-CoV-2 lineages and variants of concern, the relative contribution of travel to re-emergence of pandemic waves within communities or how different lineages and variants contribute to disease severity.MethodsWe have conducted an analysis within a prospective, multicentre observational study of individuals attending four hospitals in the South-East of Ireland with COVID-19. Samples underwent WGS from which lineages and variants were assigned, lineage frequency was plotted over time and phylogenetic analysis was employed to determine the origin of variants detected post-lockdown. Univariate and multivariate analyses assessed relationships between viral lineage/variant and COVID-19 disease severity.ResultsWe analysed 225 genome sequences across two SARS-CoV-2 waves, 134 (59.6%) from wave 1 (March to June) and 91 (40.4%) from wave 2 (July to December), representing 15.2% of COVID-19 admissions to these hospitals during the sampling periods. Four variants (B.1.1.162, B1.1.70, B.1.1.267 and B.1.1) comprised 68% of variants detected during wave 1. Of these variants, only a single B.1.1.70 sequence was detected in wave 2, while the B.1.177 lineage emerged and contributed to 82.3% of lineages detected. Phylogenetic analysis suggested multiple introductions of wave 2 variants from outside Ireland. We found no consistent association between SARS-CoV-2 lineages and disease severity.ConclusionsThese data suggest elimination of common SARS-CoV-2 lineages from hospitalised cases associated with effective NPIs and that importation of new viral variants through travel was a significant contributor to the re-emergence of the pandemic in the second wave in Ireland. Our findings highlight the importance of genomic surveillance in identifying circulating viral genetic diversity and variants of concern and, also, modelling the disease burden of SARS-CoV-2.

scholarly journals The Impact of Conflict on Immunisation Coverage in 16 Countries

2018 ◽  
Vol 8 (4) ◽  
pp. 211-221 ◽  
Author(s):  
John Grundy ◽  
Beverley-Ann Biggs
Keyword(s):  
Health System ◽  
Disease Incidence ◽  
National Policy ◽  
Disease Outbreaks ◽  
Health System Strengthening ◽  
World Health ◽  
Immunisation Coverage ◽  
Global Alliance ◽  
Middle Income ◽  
The Impact

Background: Military conflict has been an ongoing determinant of inequitable immunisation coverage in many low- and middle-income countries, yet the impact of conflict on the attainment of global health goals has not been fully addressed. This review will describe and analyse the association between conflict, immunisation coverage and vaccine-preventable disease (VPD) outbreaks, along with country specific strategies to mitigate the impact in 16 countries. Methods: We cross-matched immunisation coverage and VPD data in 2014 for displaced and refugee populations. Data on refugee or displaced persons was sourced from the United Nations High Commissioner for Refugees (UNHCR) database, and immunisation coverage and disease incidence data from World Health Organization (WHO) databases. Demographic and Health Survey (DHS) databases provided additional data on national and sub-national coverage. The 16 countries were selected because they had the largest numbers of registered UNHCR "persons of interest" and received new vaccine support from Global Alliance for Vaccine and Immunisation (GAVI), the Vaccine Alliance. We used national planning and reporting documentation including immunisation multiyear plans, health system strengthening strategies and GAVI annual progress reports (APRs) to assess the impact of conflict on immunisation access and coverage rates, and reviewed strategies developed to address immunisation program shortfalls in conflict settings. We also searched the peer-reviewed literature for evidence that linked immunisation coverage and VPD outbreaks with evidence of conflict. Results: We found that these 16 countries, representing just 12% of the global population, were responsible for 67% of global polio cases and 39% of global measles cases between 2010 and 2015. Fourteen out of the 16 countries were below the global average of 85% coverage for diphtheria, pertussis, and tetanus (DPT3) in 2014. We present data from countries where the onset of conflict has been associated with sudden drops in national and sub-national immunisation coverage. Tense security conditions, along with damaged health infrastructure and depleted human resources have contributed to infrequent outreach services, and delays in new vaccine introductions and immunisation campaigns. These factors have in turn contributed to pockets of low coverage and disease outbreaks in sub-national areas affected by conflict. Despite these impacts, there was limited reference to the health needs of conflict affected populations in immunisation planning and reporting documents in all 16 countries. Development partner investments were heavily skewed towards vaccine provision and working with partner governments, with comparatively low levels of health systems support or civil partnerships. Conclusion: Global and national policy and planning focus is required on the service delivery needs of conflict affected populations, with increased investment in health system support and civil partnerships, if persistent immunisation inequities in conflict affected areas are to be addressed.

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