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

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.

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Legitimising a ‘Zombie idea’: childhood vaccines and autism

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.807 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

M Rizzi ◽

K Attwell ◽

V Casigliani ◽

J Taylor ◽

F Quattrone ◽

...

Keyword(s):

Public Health ◽

Decision Making ◽

Media Coverage ◽

Economic Benefits ◽

Lessons Learned ◽

Strategic Decision ◽

Childhood Vaccination ◽

Vaccine Hesitancy ◽

Scientific Authority ◽

Immunization Rates

Abstract Background In June 2017 the Italian government made childhood vaccination mandatory following a drop in immunization rates. In the years preceding, two court judgments affirmed a causal link between vaccines and autism. Studies have linked these decisions to internet searches about vaccine-autism, the popularity of 'no-vax' theories, and drops in immunization rates. This paper provides an in-depth case study of both decisions and their impact. Methods We use a synthetic research design reliant on: (i) a systematic collection of primary sources (publicly available and obtained via official access to information requests); (ii) interviews with key actors prominently involved in the two cases or privy to the Italian vaccine-injury compensation regime (iii) a systematic analysis of media coverage. Results Circumstantial and systemic flaws enabled these decisions. Poor trial strategies, insufficient resources and laborious communication practices between arms of government were facilitators. Lack of awareness of the social sensitivity of vaccine issues, underestimation of the phenomenon of vaccine hesitancy, and a tendency to 'think in silos' informed the lack of attention dedicated to the cases. The decisions created false expectations of economic benefits and vindication for families with autistic children, resulting in increased litigation. Systemic flaws exist in the process of appointment of expert consultants acting for the court leading to judicial reliance on false data. Conclusions Lessons learned include greater levels of attention to vaccine cases by the administration and a matured attitude of adjudicating bodies. Two issues remain: (i) the inability of government lawyers to disseminate positive results to counteract unfounded narratives; (ii) flaws in the process of appointing expert consultants advising courts, which remains focused on the fiduciary nature of the relationship, rather than scientific authority. Key messages The Milan and Rimini decisions that directly affected vaccine governance stemmed from a combination of circumstantial decision-making and systemic flaws that still lurk in public health governance. Strategic decision-making that overlooks lower levels of the adjudicative system can lead to significant public health consequences as courts of law and courts of public opinion obey different logics.

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

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20210073 ◽

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.

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

10.1101/2021.07.19.21260640 ◽

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.

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‘It was a ravage!’: lived experiences of epidemic cholera in rural Haiti

BMJ Global Health ◽

10.1136/bmjgh-2019-001834 ◽

2019 ◽

Vol 4 (6) ◽

pp. e001834 ◽

Cited By ~ 1

Author(s):

Yodeline Guillaume ◽

Gregory J Jerome ◽

Ralph Ternier ◽

Louise C Ivers ◽

Max Raymond

Keyword(s):

Public Health ◽

Focus Groups ◽

Quantitative Research ◽

Public Health Intervention ◽

Public Health Education ◽

Healthcare Services ◽

Cross Sectional ◽

Attitudes And Practices ◽

Prevention Messages ◽

Increased Risk

IntroductionA cholera epidemic began in Haiti over 8 years ago, prompting numerous, largely quantitative research studies. Assessments of local ‘knowledge, attitudes and practices’ relevant for cholera control have relied primarily on cross-sectional surveys. The voices of affected Haitians have rarely been elevated in the scientific literature on the topic.MethodsWe undertook focus groups with stakeholders in the Artibonite region of Haiti in 2011, as part of planning for a public health intervention to control cholera at the height of the epidemic. In this study, we coded and analysed themes from 55 community members in five focus groups, focusing on local experiences of cholera and responses to the prevention messages.ResultsThe majority of participants had a personal experience with cholera and described its spread in militaristic terms, as a disease that ‘attacked’ individuals, ‘ravaged’ communities and induced fear. Pre-existing structural deficiencies were identified as increasing the risk of illness and death. Knowledge of public health messages coincided with some improvements in water treatment and handwashing, but not changes in open defecation in their community, and was sometimes associated with self-blame or shame. Most participants cited constrained resources, and a minority listed individual neglect, for inconsistent or unimproved practices.ConclusionThe experience of epidemic cholera in a rural Haitian community at the beginning of a major outbreak included a high burden and was exacerbated by poverty, which increased risk while hindering practice of known prevention messages. To interrupt cholera transmission, public health education must be paired with investments in structural improvements that expand access to prevention and healthcare services.

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Evaluation of factors, associated with defaulting routine immunization in children

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20200063 ◽

2020 ◽

Vol 7 (2) ◽

pp. 263

Author(s):

Gayathri Devi Chinnappa ◽

Chikkanarasa P. S. Reddy ◽

Sarala Sabapathy ◽

Deepthy Alice Varghese

Keyword(s):

Public Health Intervention ◽

Immunization Coverage ◽

Cost Effective ◽

Routine Immunization ◽

World Health ◽

Age Group ◽

Immunization Program ◽

Main Determinant ◽

Factors Associated ◽

Maximum Coverage

Background: India was one of the first countries to adopt the World Health Organization’s Expanded Programme of Immunization (EPI). The program started globally in 1974 and was initiated in India in 1978. Immunization is considered to be one of the most important cost-effective and a powerful public health intervention. Achieving maximum coverage, however, has been a challenge due to many reasons, including high rates of defaulters from the program. The term ªdefaulterº is used to refer a child who misses the scheduled vaccinations for any reason. The objective of this study was to explore the reasons behind defaulting from the routine immunization program.Methods: A study was conducted in Bowring and Lady Curzon Hospital, Bangalore between January 2012 and December 2012. A total of sixty six children’s’ details were gathered from mothers of defaulted children. Children below 5 years attending OPD were included in the study. Children above 5 years and inpatients were excluded. Observations and review of relevant documents was done.Results: Of the 66 children, in our study, males were more than females. Children in the age group of 2 years to 5 years were 17(25%) as compared to those between 1 to 2 years. Mothers were more literate than fathers. Muslim children had the best immunization coverage. The main determinant of defaulting was lack of knowledge and awareness regarding immunization by the mothers (21/31%) followed by sickness in children (11/16%), causing them to default immunization schedulesConclusions: The main reason for defaulting from the immunization program was lack of awareness, regarding immunization by mothers in the community.

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The Affective Politics of Karma among Buddhist Cancer Charities in Vietnam

Journal of Vietnamese Studies ◽

10.1525/vs.2020.15.4.33 ◽

2020 ◽

Vol 15 (4) ◽

pp. 33-62

Author(s):

Sara Swenson

Keyword(s):

Public Health ◽

Global Existence ◽

Food Production ◽

Public Health Intervention ◽

Health Intervention ◽

Moral Failure ◽

Cancer Rates ◽

Charity Work

In this article, I explore how Buddhist charity workers in Vietnam interpret rising cancer rates through understandings of karma. Rather than framing cancer as a primarily physical or medical phenomenon, volunteers state that cancer is a product of collective moral failure. Corruption in public food production is both caused by and perpetuates bad karma, which negatively impacts global existence. Conversely, charity work creates merit, which can improve collective karma and benefit all living beings. I argue that through such interpretations of karma, Buddhist volunteers understand their charity at cancer hospitals as an affective and ethical form of public health intervention.

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What Drives Resistance to Public Health Measures in Canada's COVID-19 Pandemic? A Rapid Assessment of Knowledge, Attitudes, and Practices

SSRN Electronic Journal ◽

10.2139/ssrn.3605193 ◽

2020 ◽

Author(s):

Jack G. Underschultz ◽

Paul Barber ◽

Daniel Richard ◽

Tracey Hillier

Keyword(s):

Public Health ◽

Rapid Assessment ◽

Attitudes And Practices ◽

Health Measures ◽

Knowledge Attitudes And Practices

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Bullying, School Violence, and Climate in Evolving Contexts

10.1093/oso/9780190663049.001.0001 ◽

2018 ◽

Cited By ~ 4

Author(s):

Ron Avi Astor ◽

Rami Benbenisthty

Keyword(s):

School Violence ◽

School Safety ◽

Media Coverage ◽

Large Scale ◽

Ecological Model ◽

Empirical Studies ◽

Practical Applications ◽

Teacher Student ◽

Area Of Interest ◽

New Research

Since 2005, the bullying, school violence, and school safety literatures have expanded dramatically in content, disciplines, and empirical studies. However, with this massive expansion of research, there is also a surprising lack of theoretical and empirical direction to guide efforts on how to advance our basic science and practical applications of this growing scientific area of interest. Parallel to this surge in interest, cultural norms, media coverage, and policies to address school safety and bullying have evolved at a remarkably quick pace over the past 13 years. For example, behaviors and populations that just a decade ago were not included in the school violence, bullying, and school safety discourse are now accepted areas of inquiry. These include, for instance, cyberbullying, sexting, social media shaming, teacher–student and student–teacher bullying, sexual harassment and assault, homicide, and suicide. Populations in schools not previously explored, such as lesbian, gay, bisexual, transgender, and queer students and educators and military- and veteran-connected students, become the foci of new research, policies, and programs. As a result, all US states and most industrialized countries now have a complex quilt of new school safety and bullying legislation and policies. Large-scale research and intervention funding programs are often linked to these policies. This book suggests an empirically driven unifying model that brings together these previously distinct literatures. This book presents an ecological model of school violence, bullying, and safety in evolving contexts that integrates all we have learned in the 13 years, and suggests ways to move forward.

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