The correlation and determinants of cost-benefit analysis of measles vaccines among the medical centers providing Expanded Program on Immunization (EPI)

Introduction: Measles is a highly contagious viral infection, vaccine-preventable diseases claim the lives of nearly 30 million people each year around the world, including 17% of children under the age of 5. Methodology: This was a descriptive and cross-sectional investigation. Retrospective data collection was used. We looked at medical centers that provided EPI administrations. Results: Around 8% of the youngsters in the study were found to have measles, according to the health center's records. There are an undetermined number of measles-infected children. Only 12% of those surveyed had received the measles vaccine, and the vast majority (88%) had never received the shot. According to statistical analysis, the study's r square value is r=0.35, which is considered to be an intermediate direct relationship (Wastage of vaccine and total cost). It illustrates that if there is no system of checks and balances on vaccine waste, it could have an impact on the overall cost of the vaccination. Vaccines wastage shows a positive association with Dose wastage x2= 438.8 (p-value 0.002). the breakage of vaccine vial x2 = 369.6 (p-value 0.015), expiration of vaccines x2 = 1068 (p-value 0.006), cold chain maintenance x2 = 79.99 (p-value 0.014) & inventory missing was x2 646.9 (p-value 0.004) showed statistical significance. Conclusion: The elimination of any disease would be contributed by the parallel factors one of that includes also financial state. In less time and cost we can vaccinate the number of children and can achieve universal coverage of immunization.

Thailand effective coverage of diabetes and hypertension: challenges and solutions

BackgroundIncreased Disability Adjusted Life Year (DALY) of diabetes and hypertension draws policy attention to improve effective coverage. This study assesses effective coverage of the two conditions in Thailand between 2016 and 2019.MethodWe estimated total diabetes and hypertension cases using age and sex specific prevalence rates for respective populations. Individual data from public insurance databases (2016-2019) were retrieved to estimate three indicators: detected need (diagnosed/total estimated cases), crude coverage (received health services/total estimated cases) and effective coverage (controlled/total estimated cases). Controlled diabetes was defined as Haemoglobin A1C (HbA1C) below 7% and controlled hypertension as blood pressure below 140/90 mmHg. In-depth interview of 85 multi-stakeholder key informants was conducted to identify challenges to better effective coverage.FindingsIn 2016-2019, among Universal Coverage Scheme members residing outside Bangkok, estimated cases were around 3.1-3.2 million for diabetes and 8.7-9.2 million for hypertension. For diabetes services, all three indicators have shown slow increase over the four years (67.4%, 69.9%, 71.9%, and 74.7% for detected need; 38.7%, 43.1%, 45.1%, 49.8% for crude coverage; and 8.1%, 10.5%, 11.8%, 11.7% for effective coverage). For hypertension services, the performance was poorer for detection (48.9%, 50.3%, 51.8%, 53.3%) and crude coverage (22.3%, 24.7%, 26.5%, 29.2%) but was better for effective coverage (11.3%, 13.2%, 15.1%, 15.7%) than diabetes service. For both diseases, the estimates were higher for the females and older age groups than their counterparts. Complex interplays between supply and demand side barriers were a key challenge. Database challenges remain which hamper regular assessment of effective coverage.RecommendationsGiven the increased diabetes and hypertension prevalence, strategic recommendations cover long term actions for primary prevention of known risk factors as unhealthy diet and sedentary behaviour. Short term actions aim to improve effective coverage through the application of Chronic Care Model, increase attention to non-pharmacological intervention and patient empowerment.

Health actor approaches to financing universal coverage strategies for pneumococcal and rotavirus immunisation programmes in low-income and middle-income countries: a scoping review protocol

IntroductionSustainable financing of immunisation programmes is an important step towards universal coverage of life-saving vaccines. Yet, financing mechanisms for health programmes could have consequences on the design of universal approaches to immunisation coverage. Effective implementation of immunisation interventions necessitates investigating the roles of institutions and power on interventions. This review aims to understand how sustainable financing and equitable immunisation are conceptualised by health actors like Gavi, and government-related entities across low-income and middle-income countries (LMICs) and how financing mechanisms can affect universal coverage of vaccines.Methods and analysisThis study protocol outline a scoping review of the peer-reviewed and the grey literature, using established methodological framework for scoping review. Literature will be identified through a comprehensive search of multiple databases and grey literature. All peer-reviewed implementation research studies from the year 2002 addressing financing and universal coverage of immunisation programmes for the pneumococcal conjugated vaccine and rotavirus vaccines immunisation interventions will be included and grey literature published in/after the year 2015. For the study scope, population, concept and context are defined: Population as international and national health stakeholders financing immunisation programmes; Concept as implementation research on pneumococcal conjugate and rotavirus vaccination interventions; and Context as LMICs. Findings will be quantitatively summarised to provide an overview and narratively synthesised and analysed. Studies that do not use implementation research approaches, frameworks or models will be excluded.Ethics and disseminationEthics approval is not required for this scoping review. Findings and recommendations will be presented to implementation researchers and health stakeholders.

Institutionalizing Leadership Management and Governance for Health System Strengthening in Emerging Economies: Evidence from the Partnership for Health System Strengthening in Africa (PHSSA)Programme

Health systems in an emerging economy, specifically Sub-Saharan Africa (SSA) are characterized as fragile with low implementation of Universal Health Coverage. While acknowledging that the cause of the inadequacy in emerging economies is multi-factorial, other arguments are that the root cause is inadequate political and technical leadership. Evidence reveals that visionary, imaginative, decisive, responsible, and responsive leadership is insufficient to persuade all stakeholders in low-income nations in Sub-Saharan Africa to work together to attain the constructive goal of universal coverage. On the contrary, other academics suggest that successful leadership would establish a clear national vision for universal coverage and a commitment to achieving that objective over time. These contrasting observations motivated an interrogation of the link between health system governance and Universal Health Coverage in an emerging economy taking evidence from the PHSSA programme. Through a meta-analysis of the existing literature as well as analysis of the findings from the programme, the paper explores experiences, critical success factors and recommendations for improvement of UHC through institutionalizing health system governance in an emerging economy. The research provides evidence that the governance linkages in health systems and the outcomes they produce are contingent rather than assured, due to the variety and complexity inherent in the health system governance paradigm. The situation-specific setting of a country's health system determines what can be accomplished through health governance strategy design and implementation efforts. The paper recommends a need to create a conducive environment for adoption of health systems programmes by contextualizing health governance with regard to the larger set of governance institutions that surround it. A competency framework should also be adopted in recruitment of competent health managers. The study also recommends a need for the countries in seeking to institutionalize health system governance to develop and support an organizational structure and context that sustains leadership practices through advocacy, create an enabling environment for health systems leadership, management and governance through the development of ethics and other competences specific to universal health care situations as well as provide proper financial support system so that institutionalization of leadership, management and governance can have maximum impact on the effectiveness and efficiency of health systems. There is also a need to institutionalize short courses, seminars and conferences in health leadership, management, and governance so as to entrench participatory leadership in health systems.

The First GLP Compliant Study in Africa for the Evaluation of LLIN’s; Efficacy of SafeNet® and SafeNet NF®

Background: To attain and sustain the universal Long-Lasting Insecticidal Nets (LLINs) coverage, cheap nets that provides equivalent or better protection than the standard LLINs, are required. While it is essential to follow the World Health Organization (WHO) guidelines for the evaluation of LLINs, adherence to the Good Laboratory Practice (GLP) is necessary to generate reliable and reproducible data that will facilitate efficient LLINs to be speedy registered. Adherence to GLP obviate the need to duplicate the assessment and ensures substandard LLINs are not reaching the market. This study aimed to evaluate efficacy of SafeNet NF® and SafeNet® LLIN in accordance to the WHO Pest Evaluation Scheme (WHOPES) and the GLP guidelines. Both candidate LLINs were manufactured with less fabrics to cut down manufacturing costs, motivated by the need for cheaper LLINs to achieve universal coverage. Materials & Methods: SafeNet NF® and SafeNet® LLIN, were assessed in experimental huts against wild, pyrethroid-resistant Anopheles arabiensis mosquitoes. Efficacy in terms of mosquito blood-feeding inhibition and mortality, was compared with Interceptor® LLIN and an untreated net. All nets were washed and artificially holed to simulate a used torn net. The GLP guidelines were followed throughout this study.Results: The mortality of mosquitoes exposed to SafeNet NF® and SafeNet® LLIN were equivalent to that of the reference net. Blood-feeding inhibition was only evident in Interceptor® LLIN. Adherence to GLP was observed throughout the study.Conclusions: Step-wise procedures to conduct LLIN evaluation in compliance to both WHOPES and GLP guidelines are elaborated in this study. SafeNet NF® and SafeNet® LLIN offers equivalent protection as Interceptor® LLIN and can facilitate universal LLIN coverage due to its low manufacturing cost. However, further research is needed to understand durability, acceptability and residual efficacy of these nets in field environments.

Universal Health Coverage

As part of the Sustainable Development Goals the right to health is captured under the rubric of universal health coverage (UHC). That is that all people should have access to the high quality care they need without suffering financial hardship. This chapter explores this seminal topic reviewing the theory of universal coverage and definitions that shape the current conversation about UHC. This chapter also highlights some important steps taken by countries to expand access to quality health care but challenges the rhetoric that financing care through insurance schemes, a common approach to UHC) is sufficient when the inputs into the health systems do not match the disease burden. Finally, the chapter investigates the theory and practice behind a morbidity-based approach to strengthening health systems and achieving UHC.

Does Use of Acupuncture Reduce the Risk of Type 2 Diabetes Mellitus in Patients With Rheumatoid Arthritis? Evidence From a Universal Coverage Health Care System

Objectives: Although acupuncture is often advocated for patients with rheumatoid arthritis (RA), its efficacy for type 2 diabetes mellitus (T2DM), a common metabolic disease among RA cohorts, has not yet been established. This retrospective cohort study aimed to determine the association between acupuncture use and the development of T2DM among them.Methods: Data were collected from 1999 through 2008 for individuals aged 20–70 years in the nationwide insurance database of Taiwan. From them, we extracted 4,941 subjects within newly diagnosed RA and being T2DM free at baseline. A total of 2,237 patients had ever received acupuncture, and 2,704 patients without receiving acupuncture were designated as a control group. All of them were followed to the end of 2013 to identify T2DM incidence. The Cox proportional hazards regression model was utilized to obtain the adjusted hazard ratio (HR) for acupuncture use.Results: Compared with the RA subjects without use of acupuncture, the incidence of T2DM was lower for those who received acupuncture, with the incidence rates of 24.50 and 18.00 per 1,000 person-years (PYs), respectively. After adjusting for potential confounders, use of acupuncture was significantly related to the lower T2DM risk, with the adjusted HR of 0.73 [95% confidence interval (CI) 0.65–0.86]. Those who used acupuncture for more than five sessions had the greatest benefit in lowering the susceptibility to T2DM.Conclusion: Adding acupuncture into conventional treatment for RA was found to be related to lower risk of T2DM among RA patients. Further clinical and mechanistic studies are warranted.

Intensive surveillance, rapid response and border collaboration for malaria elimination: China Yunnan’s ‘‘3 + 1’’strategy

Background Eliminating malaria and preventing re-establishment of malaria transmission in border areas requires universal coverage of malaria surveillance and a rapid response to any threats (i.e. malaria cues) of re-establishing transmission. Main text Strategy 1: Intensive interventions within 2.5 km-wide perimeter along the border to prevent border-spill malaria. The area within 2.5 km along the international border is the travel radius of anopheline mosquitoes. Comprehensive interventions should include: (1) proactive and passive case detection, (2) intensive vector surveillance, (3) evidence-based vector control, and (4) evidence-based preventative treatment with anti-malarial drugs. Strategy 2: Community-based malaria detection and screening of migrants and travellers in frontier townships. Un-permitted travellers cross borders frequently and present in frontier townships. Maintenance of intensified malaria surveillance should include: (1) passive malaria detection in the township hospitals, (2) seek assistance from villager leaders and health workers to monitor cross border travellers, and refer febrile patients to the township hospitals and (3) the county’s Centre for Disease Control and Prevention maintain regular proactive case detection. Strategy 3: Universal coverage of malaria surveillance to detect malaria cues. Passive detection should be consolidated into the normal health service. Health services personnel should remain vigilant to ensure universal coverage of malaria detection and react promptly to any malaria cues. Strategy + 1: Strong collaborative support with neighbouring countries. Based on the agreement between the two countries, integrated control strategies should be carried out to reduce malaria burden for both countries. There should be a clear focus on the border areas between neighbouring countries. Conclusion The 3 + 1 strategy is an experience summary of border malaria control and elimination, and then contributed to malaria elimination in Yunnan’s border areas, China. Nevertheless, Yunnan still has remaining challenges of re-establishment of malaria transmission in the border areas, and the 3 + 1 strategy should still be carried out.

What Is Out There and What Can We Learn? International Evidence on Funding and Delivery of Long-Term Care

This article describes the social care funding and delivery arrangements of a varied selection of developed countries, focusing on long-term care of older people. International evidence and latest reforms can inform the debate as countries struggle economically. Some have opted for mandatory social insurance that provides universal coverage. A premium is paid and if the insured individual or relatives require support, they are entitled to it. Others opted for a similar universal system but with earmarked taxation, while others fund their social care entirely from general taxation. Many chose a safety-net system in which benefits are means-tested leaving wealthier individuals to secure private arrangements of care. Within the UK, the level of support varies as Scotland provides personal care free of charge, being more generous than England, Wales and Northern Ireland. There is no “one solution”, but understanding different options can help in the discussion of current and future reforms.

Quality of Life in Patients With Systemic Lupus Erythematosus Ramathibodi Hospital

Background: Systemic Lupus Erythematosus (SLE) is an autoimmune disease. It is a chronic disease and exhibits symptoms in many organs and patients will be offered a variety of immunosuppressants, which may cause many side effects and worsen the quality of life. Objective: To study the quality of life in SLE patients receiving treatment in Ramathibodi Hospital. Methods: A cross-sectional study of all SLE patients were collected during February 2017 to February 2018, by using questionnaires to measure the quality of life. Results: Total of 510 SLE patients, 96.7% were female. The mean (SD) age was 40.9 (13.0) years, and the disease duration was 10.5 (8.2) years. Most of them got a bachelor’s degree or higher (54.1%). Universal coverage scheme was the most treatment welfare of the patients. Despite the disease limitation for pregnancy, 7.2% of the SLE patients had 3 children while only 17.0% had miscarriages while pregnant. The general quality of life (SF-36) was in a good level, and disease-specific quality of life (SLEQoL) was at a moderate level. The older patients and a longer disease duration were inversely related to quality of life including physical health, overall health. Conclusions: SLE patients who received the treatment at Ramathibodi Hospital had a relatively good quality of life. Factors related to quality of life were age and duration of the disease.