Measles in conflict-affected northern Syria: results from an ongoing outbreak surveillance program

Abstract Background The Syrian conflict has dramatically changed the public health landscape of Syria since its onset in March of 2011. Depleted resources, fractured health systems, and increased security risks have disrupted many routine services, including vaccinations, across several regions in Syria. Improving our understanding of infectious disease transmission in conflict-affected communities is imperative, particularly in the Syrian conflict. We utilize surveillance data from the Early Warning Alert and Response Network (EWARN) database managed by the Assistance Coordination Unit (ACU) to explore trends in the incidence of measles in conflict-affected northern Syria and analyze two consecutive epidemics in 2017 and 2018. Methods We conducted a retrospective time-series analysis of the incidence of clinically suspected cases of measles using EWARN data between January 2015 and June 2019. We compared regional and temporal trends to assess differences between geographic areas and across time. Results Between January 2015 and June 2019, there were 30,241 clinically suspected cases of measles reported, compared to 3193 cases reported across the whole country in the decade leading up to the conflict. There were 960 regional events that met the measles outbreak threshold and significant differences in the medians of measles incidence across all years (p-value < 0.001) and in each pairwise comparison of years as well as across all geographic regions (p-value < 0.001). Although most governorates faced an elevated burden of cases in every year of the study, the measles epidemics of 2017 and 2018 in the governorates of Ar-Raqqa, Deir-Ez-Zor, and Idlib accounted for over 71% of the total suspected cases over the entire study period. Conclusions The 2017 and 2018 measles epidemics were the largest since Syria eliminated the disease in 1999. The regions most affected by these outbreaks were areas of intense conflict and displacement between 2014 and 2018, including districts in Ar-Raqqa, Deir-Ez-Zor, and Idlib. The spread of measles in northern Syria serves as an indicator of low immunization coverage and limited access to care and highlights the Syrian peoples’ vulnerability to infectious diseases and vaccine preventable diseases in the setting of the current conflict.

Download Full-text

An epidemiological investigation of the 2019 suspected pertussis outbreak in northwestern Nigeria

SAGE Open Medicine ◽

10.1177/20503121211008344 ◽

2021 ◽

Vol 9 ◽

pp. 205031212110083

Author(s):

Omoleke Semeeh ◽

Biniam Getachew ◽

Yusuf Taofik ◽

Lukman Surajudeen ◽

Assad Hassan ◽

...

Keyword(s):

Confidence Interval ◽

Disease Transmission ◽

Attack Rate ◽

Odds Ratio ◽

Case Fatality Rate ◽

Adjusted Odds Ratio ◽

Case Fatality ◽

Immunization Coverage ◽

Fatality Rate ◽

Vaccine Preventable Diseases

Introduction: In 2019, we investigated the profile of the cases and controls and the determinants of pertussis transmission in Kebbi State, Northwestern Nigeria, to inform better immunization and surveillance strategies. Methods: Community-based unmatched case–control study and review of the 2019 pertussis routine surveillance data in the affected settlements in the state were conducted. A total of 52 suspected cases of pertussis and 107 control from two local government areas in Kebbi State were recruited. Data were analyzed using descriptive and inferential statistics. Results: The highest attack rate was observed among between 1- and 4-year age group followed by children less than 1-year old, and the least attack rate was among those above 15 years. The overall attack rate and the case fatality rate were 2.10% and 0.10%, respectively. A higher attack rate was observed among women, whereas the case fatality rate was more among males. From the community survey, we observed that the cases were less likely to have pertussis vaccination history (adjusted odds ratio = 0.28, 95% confidence interval = 0.11–0.74) compared with the controls. Knowing pertussis prevention methods were found protective for pertussis transmission (adjusted odds ratio = 0.14, 95% confidence interval = 0.04–0.45). Conclusion: This study showed the vulnerability of children under 5 years, especially under 1 year, to vaccine-preventable diseases in rural populations, where “real” immunization coverage is sub-optimal, and the dominant socio-demographic factors are supportive of disease transmission. We found immunization and knowledge of the preventive measures to be protective against pertussis outbreaks. Therefore, routine immunization services must be intensified to improve coverage and prevent future pertussis outbreak(s).

Download Full-text

Determinants of low immunization coverage among children aged 12-23 months in narok south narok county kenya

Journal of Pediatrics & Neonatal Care ◽

10.15406/jpnc.2020.10.00413 ◽

2020 ◽

Vol 10 (2) ◽

pp. 52-66

Author(s):

Richard Kipkemoi Lang’at ◽

Samwel Odiwour ◽

Maxwell Philip Omondi

Keyword(s):

Public Health ◽

Health Care ◽

Health Facility ◽

Vaccination Coverage ◽

Maternal Education ◽

Immunization Coverage ◽

World Health ◽

P Value ◽

Place Of Delivery ◽

Vaccine Preventable Diseases

Childhood immunization remains one the primary health care core component and the most effective public health interventions for controlling and eliminating life-threatening vaccine preventable diseases in the world. According to 2014 Kenya National Demographic and Health Survey (KDHS), a few children of ages 12 to 23 months in Kenya presented below average in terms of vaccination coverage of children who are fully immunized. Delayed vaccinations would increase the risk for vaccine preventable diseases in the community, therefore the information obtained from this study is to help policy makers come up with sound strategies to increase immunization coverage from 57%- 90% as recommended by World Health Organization. The broad objective of the study was to determine reasons influencing low vaccination coverage between children of ages 12 to 23 months in Narok South sub-county, Narok County in Kenya. This is to contribute to the reduction of morbidity and mortality caused by infectious diseases of public health importance related to vaccine preventable disease. Methods: This was a cross-sectional descriptive study. The study used mixed methods, both quantitative and qualitative. A structured questionnaire was used to collect data on social demographic and social cultural factors, maternal health care utilization and knowledge. Key informative Interviews and Focus Group Discussions were used to collect qualitative data on 454 mothers/caretakers with children aged between 12-23 months reached in Narok South sub county. Results: The total number of mothers/caregivers who were interviewed were 454, with a response of 100%. Results of immunization coverage; BCG 73%, OPV1 59%, OPV2 51%, OPV3 49%, Penta1 58%, Penta2 51%, Penta3 50%, Measles 54% and Fully Immunized Children 47%. Further, 47% of the children in the sub-county were fully immunized and 53% were unimmunized. The SD mean for mothers/caregivers and children 31.4 and 17.0 respectively and over 70% of the mothers/caregivers had no formal education. There were significant association predictors with immunization coverage included maternal education (X2 =11.75, df=4 p value=0.02), distance to health facility (X2 =62.30, df=2 p value=0.00), also, there was strong significant association with childbirth ranking (OR=1.218, p value=0.04). Bivariate analysis, there was an association with mothers/caregivers’ who had more than one visits with fully immunized children (χ2=13.54, df =2 and p value =0.001), source of the immunization information OR=0.75 and p value=0.02 and, ultimately, there was association between mother’s/caregiver place of delivery with non-fully immunized children (X2=74.40,df=1 p value=0.01). Predictors of non-fully immunized children in the study population were; place of delivery, family size, education level, source of income, none attendance of Antenatal clinics, distance to the health facility, source of the vaccination information was associated with incomplete fully immunized children. Conclusion: The immunization coverage for the fully immunized child in the sub county was very low 47%, compared to national 77%. Key players in the immunization sector should identify children who are at risk, deploy reach every child strategy, encourage pregnant mothers to attend ANC, expand outreach services, increase funds allocation to health sector and build more health facilities to improve immunization coverage.

Download Full-text

Determinants of vaccination dropout among children 12-23 months age in north Gondar zone, northwest Ethiopia, 2019

PLoS ONE ◽

10.1371/journal.pone.0246018 ◽

2021 ◽

Vol 16 (2) ◽

pp. e0246018

Author(s):

Muluken Genetu Chanie ◽

Gojjam Eshetie Ewunetie ◽

Asnakew Molla ◽

Amare Muche

Keyword(s):

Risk Factors ◽

Side Effects ◽

Tetanus Toxoid ◽

Health Workers ◽

Immunization Coverage ◽

Northwest Ethiopia ◽

P Value ◽

North West ◽

Vaccine Preventable Diseases ◽

North West Ethiopia

Background Vaccination is a proven tool in preventing and eradicating childhood infectious diseases. Each year, vaccination averts an estimated 2–3 million deaths from vaccine preventable diseases. Even though immunization coverage is increasing globally, many children in developing countries still dropout vaccination. The objective of this study was to identify determinants of vaccination dropout among children age 12–23 months in North Gondar, North west Ethiopia. Methods Community based unmatched case-control study was conducted in north Gondar from March 1–27, 2019 among 366 children age 12–23 months (92 cases and 274 controls). Multistage sampling was used for reaching to the community. Data were collected from mothers who had 12–23 months age children using a pretested structured face to face interview. Data were entered using Epi info v. 7 and exported to SPSS v. 20 for analysis. On multivariable logistic regression variables with P-value <0.05 at 95% CI were considered statistically significant. Result Counseling for mothers about vaccination (AOR = 7.2, 95% CI: (2.93–17.5)); fear of vaccine side effects (AOR = 3.5, 95% CI: (1.56–8.12)); PNC attended (AOR = 3.6, 95% CI: (1.52–8.39)) and mothers not received tetanus toxoid vaccination (AOR = 2.4, 95% CI: (1.03–5.35)) were found risk factors of vaccination dropout. Conclusion Counseling on vaccination, fear of vaccine side effects, PNC attended and mothers’ tetanus toxoid vaccination status during ANC visit were found risk factors. Management bodies and health workers need to consider “reaching every community” approach, Counsel every mother at any opportunity, and provide TT vaccination for all pregnant mothers helps to reduce vaccination dropout among children.

Download Full-text

Temporal trends in utilization of transcatheter aortic valve implantation and patient characteristics – a nationwide cohort study

European Heart Journal ◽

10.1093/ehjci/ehaa946.2618 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

J.E Strange ◽

C Sindet-Pedersen ◽

G Gislason ◽

C Torp-Pedersen ◽

E.L Fosboel ◽

...

Keyword(s):

Aortic Valve ◽

Transcatheter Aortic Valve Implantation ◽

Temporal Trends ◽

Patient Characteristics ◽

P Value ◽

Transcatheter Aortic Valve ◽

History Of ◽

Aortic Valve Implantation ◽

Valve Implantation ◽

First Time

Abstract Introduction In recent years, there has been a surge in the utilization of transcatheter aortic valve implantation (TAVI) for the treatment of severe symptomatic aortic stenosis. Randomized controlled trials have compared TAVI to surgical aortic valve replacement (SAVR) in patients at high-, intermediate-, and low perioperative risk. As TAVI continues to be utilized in patients with lower risk profiles, it is important to investigate the temporal trends in “real-world” patients undergoing TAVI. Purpose To investigate temporal trends in the utilization of TAVI and examine changes in patient characteristics of patients undergoing first-time TAVI. Methods Using complete Danish nationwide registries, we included all patients undergoing first-time TAVI between 2008 and 2017. To compare patient characteristics, the study population was stratified according to calendar year in the following groups: 2008–2009, 2010–2011, 2012–2013, 2014–2015, and 2016–2017. Results We identified 3,534 patients undergoing first-time TAVI. In 2008–2009, 180 patients underwent first-time TAVI compared with 1,417 patients in 2016–2017, resulting in a 687% increase in TAVI procedures performed. During the study period, the median age remained stable (2008–2009: Median age 82 year [25th–75th percentile: 78–85] vs. 2016–2017: Median age 81 years [25th–75th percentile: 76–85]; P-value: 0.06). The proportion of men undergoing first-time TAVI increased over the years (2008–2009: 49.4% vs 2016–2017: 54.9%; P-value for trend: <0.05), also the proportion with diabetes increased (2008–2009: 12.2% vs. 2016–2017: 19.3%; P-value for trend: <0.05). The proportion of patients with a history of stroke decreased over the years (2008–2009: 13.9% vs. 2016–2017: 12.1%; P-value for trend: <0.05). The same trend was seen in patients with a history of myocardial infarction (2008–2009: 24.4% vs. 2016–2017: 11.9%; P-value for trend: <0.05), ischaemic heart disease (2008–2009: 71.7% vs. 2016–2017: 29.4%; P-value for trend: <0.05), and heart failure (2008–2009: 45.6% vs. 2016–2017: 29.4%; P-value for trend: <0.05). Conclusions In this nationwide study, there was a marked increase in the utilization of TAVI in the years 2008–2017. Patients undergoing first-time TAVI had a decreasing comorbidity burden, while the age of the patients at first-time TAVI remained stable. Funding Acknowledgement Type of funding source: None

Download Full-text

Integrated TB and HIV care for Mozambican children: temporal trends, site-level determinants of performance, and recommendations for improved TB preventive treatment

AIDS Research and Therapy ◽

10.1186/s12981-020-00325-9 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

W. Chris Buck ◽

Hanh Nguyen ◽

Mariana Siapka ◽

Lopa Basu ◽

Jessica Greenberg Cowan ◽

...

Keyword(s):

Temporal Trends ◽

Scale Up ◽

Preventive Treatment ◽

Preventive Therapy ◽

Pediatric Hiv ◽

Hiv Care ◽

Pediatric Care ◽

P Value ◽

Missed Opportunities ◽

Art Initiation

Abstract Background Pediatric tuberculosis (TB), human immunodeficiency virus (HIV), and TB-HIV co-infection are health problems with evidence-based diagnostic and treatment algorithms that can reduce morbidity and mortality. Implementation and operational barriers affect adherence to guidelines in many resource-constrained settings, negatively affecting patient outcomes. This study aimed to assess performance in the pediatric HIV and TB care cascades in Mozambique. Methods A retrospective analysis of routine PEPFAR site-level HIV and TB data from 2012 to 2016 was performed. Patients 0–14 years of age were included. Descriptive statistics were used to report trends in TB and HIV indicators. Linear regression was done to assess associations of site-level variables with performance in the pediatric TB and HIV care cascades using 2016 data. Results Routine HIV testing and cotrimoxazole initiation for co-infected children in the TB program were nearly optimal at 99% and 96% in 2016, respectively. Antiretroviral therapy (ART) initiation was lower at 87%, but steadily improved from 2012 to 2016. From the HIV program, TB screening at the last consultation rose steadily over the study period, reaching 82% in 2016. The percentage of newly enrolled children who received either TB treatment or isoniazid preventive treatment (IPT) also steadily improved in all provinces, but in 2016 was only at 42% nationally. Larger volume sites were significantly more likely to complete the pediatric HIV and TB care cascades in 2016 (p value range 0.05 to < 0.001). Conclusions Mozambique has made significant strides in improving the pediatric care cascades for children with TB and HIV, but there were missed opportunities for TB diagnosis and prevention, with IPT utilization being particularly problematic. Strengthened TB/HIV programming that continues to focus on pediatric ART scale-up while improving delivery of TB preventive therapy, either with IPT or newer rifapentine-based regimens for age-eligible children, is needed.

Download Full-text

Athletes Drive Distinctive Trends of COVID-19 Infection in a College Campus Environment

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18147689 ◽

2021 ◽

Vol 18 (14) ◽

pp. 7689

Author(s):

Austin T. Hertel ◽

Madison M. Heeter ◽

Olivia M. Wirfel ◽

Mara J. Bestram ◽

Steven A. Mauro

Keyword(s):

Risk Group ◽

Temporal Trends ◽

Rapid Identification ◽

College Campus ◽

Surveillance Program ◽

Institutions Of Higher Education ◽

Rt Pcr ◽

Campus Environment ◽

Incidence Risk ◽

Academic Year

The COVID-19 pandemic forced most institutions of higher education to offer instruction and activities offsite, impacting millions of people. As universities consider resuming normal operations on campus, evidence-based guidance is needed to enhance safety protocols to reduce the spread of infectious disease in their campus environments. During the 2020/2021 academic year, Gannon University in Erie, PA, USA, was able to maintain most of its operations on campus. Part of Gannon’s disease mitigation strategy involved the development of a novel in-house, real-time RT-PCR-based surveillance program, which tested 23,227 samples to monitor the presence of COVID-19 on campus. Temporal trends of COVID-19 infection at Gannon were distinct from statewide data. A significant portion of this variance involved student athletes and associated staff, which identified as a higher incidence risk group compared with non-athletes. Rapid identification of athlete driven outbreaks allowed for swift action to limit the spread of COVID-19 among teammates and to the rest of the campus community. This allowed for successful completion of instruction and a modified season for all sports at Gannon. Our findings provide insights that could prove useful to the thousands of institutions seeking to resume a more traditional presence on campus.

Download Full-text

Colorectal Cancer in Lebanon: Incidence, Temporal Trends, and Comparison to Regional and Western Countries

Cancer Control ◽

10.1177/1073274821996869 ◽

2021 ◽

Vol 28 ◽

pp. 107327482199686

Author(s):

Najla A. Lakkis ◽

Ola El-Kibbi ◽

Mona H. Osman

Keyword(s):

Colorectal Cancer ◽

Cancer Incidence ◽

Temporal Trends ◽

Incidence Rates ◽

Steady Increase ◽

P Value ◽

Western Countries ◽

Incidence And Mortality ◽

Colorectal Cancer Incidence ◽

Males And Females

Global trends in the incidence and mortality rates of colorectal cancer show a steady increase with significant predilection to western developed countries, possibly linking it to westernized lifestyles among other risk factors. This study aims to investigate the incidence and trends of colorectal cancer in Lebanon, a country in the Middle East and North Africa region, and to compare these rates to those in regional and western countries. Colorectal cancer incidence data were extracted from the Lebanese National Cancer Registry for the currently available years 2005 to 2016. The calculated age-standardized incidence rates and age-specific rates were expressed as per 100,000 population. The age-standardized incidence rates of colorectal cancer in Lebanon increased from 16.3 and 13.0 per 100,000 in 2005 to 23.2 and 20.2 per 100,000 in 2016, among males and females, respectively. The incidences were higher for males, and they increased with age. The annual percent change was +4.36% and +4.45%, in males and females respectively (p-value < 0.05). There was a non-statistically significant trend of decrease in recent years (since 2012 in males and since 2011 in females). The age-standardized incidence rates in Lebanon were higher than those in the majority of the regional countries, but lower than the rates in developed western countries. There were high age-specific incidence rates at age groups 40-44 and 45-49 years in Lebanon in both males and females (with significant rising temporal trend) compared to other countries, including the ones reported to have the highest colorectal cancer age-standardized incidence rate worldwide. Therefore, the burden of colorectal cancer is significant in Lebanon. This raises the necessity to develop national strategies tailored to reduce colorectal cancer incidence through promoting healthy lifestyles, raising awareness, and early detection as of 40 years of age.

Download Full-text

Trends in urban storm water quality in Tallinn and influences from stormflow and baseflow

Journal of Water Security ◽

10.15544/jws.2016.001 ◽

2016 ◽

Vol 2 (1) ◽

Cited By ~ 1

Author(s):

Bharat Maharjan ◽

Karin Pachel ◽

Enn Loigu

Keyword(s):

Temporal Trends ◽

Oxygen Demand ◽

Road Dust ◽

Kendall Test ◽

P Value ◽

Upward Trend ◽

Monotonic Trend ◽

Acidic Rain ◽

Interpretation Of Change

Temporal trends provide a good interpretation of change in stormwater quality over time. This study aimed to analyse trends and influences due to stormflow and baseflow. Grab samples of 18-19 years from 1995 to 2014 recorded at outlets of 7 Tallinn watersheds were analysed for monotonic trend through seasonal Mann Kendall test for long-term, short-term, baseflow and stormflow. Statistically significant downward trends (P-value (p) < 0.05) were found for 6 – hydrocarbon (HC), 1 – suspended solids (SS), 3 – biological oxygen demand (BOD), 4 – total nitrogen (TN) and 2 – total phosphorus (TP) out of 7 sampling outlets over the last 10 years. Less significant decreasing trends (p > 0.05 and < 0.2) for 3 – SS, 1 – BOD, 1 – TN and 1 – TP were identified. Statistically significant long-term upward trends of pH were re-vealed in 5 basins, which reduced to 2 with 5 less significant upward trends over the 10 year period, indicating improve-ments in pH reduction. Härjapea has the highest pH without trend but it includes an upward trend of TN at p = 0.051. The highly possible causes for downward trends are street sweeping, sewer network improvement, decline in sub-urban agri-cultural areas, etc. The upward trend results of pH are related to increased alkalinisation due to acidic rain, weathering of carbonate rocks, sewage discharge and alkaline road dust. In most of the basins, stormflow has more influence on trends than baseflow.

Download Full-text

Determinants of COVID-19 Vaccine Acceptance in Ghana

International Journal of Health Sciences and Research ◽

10.52403/ijhsr.20220124 ◽

2022 ◽

Vol 12 (1) ◽

pp. 175-187

Author(s):

Sumani Abdul-Manan ◽

Alhassan Iddrisu Abdullai ◽

Buhari Gunu Yussif

Keyword(s):

Rural Areas ◽

Sampling Technique ◽

P Value ◽

Snowball Sampling ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Vaccine Acceptance ◽

Vaccine Preventable Diseases ◽

Negative Effect ◽

Social Media Platforms

Background: A proven strategy for saving lives from vaccine-preventable diseases is the timely vaccination of the people. In Ghana, there is considerable hesitation about the Covid-19 vaccines due to anxieties and uncertainties about their safety. With varying perceptions and believes being developed about Covid-19 vaccines, there is a likely negative effect on vaccine acceptance or otherwise. This study aims to ascertain the levels of acceptance of potential Covid-19 vaccine among Ghanaian adults, to identify predictors of vaccine acceptance or hesitance. Methodology: A web based cross-sectional survey conducted among Ghanaians above 18 years, conducted between the month of February and March, 2021. Data were collected by administering online google forms (Questionnaire). The questionnaire was shared through social media platforms. A snowball sampling technique was used where researchers shared google forms to close friends and family. Analyses were conducted at p-value <0.05 using descriptive statistics, cross-tabulations and logistic regression. Results: A total of 350 responses were achieved by end of data collection. Out of these, only 348 were considered for analysis based on the inclusion and exclusion criteria. Majority of the respondents (65.2%) were male, a third (30%) of them live in rural areas and about 57.5% were married. Factors such as age, educational level, prior vaccine acceptance history, personal vulnerability and self-feeling of health were significantly associated with covid-19 vaccine acceptance. Conclusion: The results depict low acceptance rate for potential covid-19 vaccine among Ghanaians. Government and MoH should engage the media on its role in combating misinformation with regards the Covid-19 vaccine. Key words: coronavirus disease 2019 (Covid-19), vaccine, hesitance, acceptance.

Download Full-text

Do the dynamics of vaccine programs improve the full immunization of children under the age of five in Cameroon?

10.21203/rs.3.rs-19140/v2 ◽

2020 ◽

Author(s):

Rodrigue NDA'CHI DEFFO ◽

Benjamin FOMBA KAMGA

Keyword(s):

Infant Mortality ◽

Birth Order ◽

Immunization Coverage ◽

Developed Countries ◽

Demographic And Health Surveys ◽

Least Developed Countries ◽

Vaccine Preventable Diseases ◽

Development Goals ◽

Mother’S Age ◽

The Impact

Abstract Background: Among the eight Millennium Development Goals (MDGs), three were devoted to health. Two amongst which MDG4 in relation to the reduction of infant mortality has not been achieved in Least Developed Countries (LDC). In Africa, a significant part of infant mortality is due to vaccine-preventable diseases administered free of charge by the Extended Program on Immunization (EPI). As such, in the "social equity" pillar of Sustainable Development Goals (SDG), the MDGs related to health have yet been taken into account. The achievement of these objectives requires an understanding of the immunization behavior of children under five years of age through an analysis of immunization dynamics between 1991 and 2011.Methods: We use data from Demographic and Health Surveys (DHS) of 1991, 1998, 2004 and 2011 carried out by the National Institute of Statistics (NIS). The module concerning EPI vaccines was administered to 3350, 2317, 8125 and 25524 under 5 in 1991, 1998, 2004 and 2011 respectively. The Immunization analysis was made from the logistic model for complete immunization and the Oaxaca's decomposition to assess the contribution of the unexplained part, which is that of the strategies/programs implemented between 1991 and 2011 by the EPI to improve immunization.Results: In general, children with vaccination card are more than 7 times likely to be fully immunized than their counterparts who do not have any. This result was higher in 1991 (approximately 57) and lowest in 2011 (5). In addition, the child's birth order reduces his/her probability of being fully immunized and the impact increases with the latter's birth order. On the other hand, the mother's age as well as her level of education increase the child's likelihood of receiving all basic vaccines. Moreover, the contributions of EPI partners in terms of immunization support as well as strategies to promote immunization through communication for development are of a particular importance in increasing immunization coverage. They significantly explain 67.62% of the 0.105 gain recorded within the 2011-2004 period and 72.46% of the 0.069 gain recorded within the 2004-1998 period.Conclusion: The contribution of EPI partner organizations is fundamental for the achievement of EPI objectives. Since they contribute to increase the likelihood of fully immunized children. The link with child immunization is done through the specific characteristics to the mother.

Download Full-text