Improving immunization data quality in Peru and Mexico: Two case studies highlighting challenges and lessons learned.

INTRODUCTION: The Global Vaccine Action Plan and the Regional Immunization Action Plan of the Americas call for countries to improve immunization data quality. Immunization information systems, particularly electronic immunization registries (EIRs), can help to facilitate program management and increase coverage. However, little is known about efforts to develop and implement such systems in low- and middle-income countries. We present the experiences of Mexico and Peru in implementing EIRs. METHODS: We conducted case studies of an EIR in Mexico and of a population registry in Peru. Information was gathered from technical documents, stakeholder focus groups, site visits, and semi-structured interviews of national stakeholders. We organized findings into narratives that emphasized challenges and lessons learned. RESULTS: Mexico built one of the world's first EIRs, incorporating novel features such as local-level tracking of patients; however, insufficient resources and poor data registration practices led to the system's discontinuation. Peru created an information system to improve affiliation to social programs, including the immunization program and quality of demographic data. Mexico's experience highlights lessons in failed sustainability of an EIR and a laudable effort to reform a country's information system. Peru's demonstrates that attempts to improve health and other data may strengthen health systems, including immunization data. Major challenges in information system implementation and sustainability in Peru and Mexico related to funding, clear governance structures, and resistance among health workers. DISCUSSION: These case studies reinforce the need for countries to ensure adequate funding, plans for sustainability, and health worker capacity-building activities before implementing EIRs. They also suggest new approaches to implementation, including economic incentives for sub-national administrative levels and opportunities to link efforts to improve immunization data with other health and political priorities. More information on best practices is needed to ensure the successful adoption and sustainability of immunization registries in low- and middle-income countries.

Administration of an inhibitor of estrogen biosynthesis facilitates working memory acquisition in male rats.

Estradiol is known to improve performance of some working memory tasks in female animals and post-menopausal women. In females the main source of estradiol is the ovary. In addition, in both males and females estradiol is synthesized in extragonadal tissues. The role of non-ovarian estradiol synthesis on cognitive abilities has not been adequately explored. In the sent study we have assessed the effect of an inhibitor of aromatase, the enzyme that produces estradiol from testosterone, on egocentric working memory in male rats. Sprague-Dawley adult male rats received the intra-esophageal administration of the aromatase inhibitor letrozole (2.5 mg/kg), or vehicle. Rats treated with the aromatase inhibitor committed less errors than untreated animals or animals treated with vehicle, when tested in a cross-arms maze. Retention and retrieval stages were unaffected by aromatase inhibition. This finding indicates that aromatase activity is involved in egocentric working memory performance. The effect of the aromatase inhibitor on working memory may be due to the increase in testosterone levels resulting from aromatase inhibition or to modifications in the availability of estradiol in the brain.

Spine-type densities of hippocampal CA1 neurons vary in proestrus and estrus rats.

Spines-mediated synaptic activity has been associated to learning ability. Dendritic spines from hippocampal CA1 pyramidal neurons of proestrus rats have been reported to be more numerous than in estrus animals, but some behavioral studies have reported a better performance during the estrus stage of the estrous cycle. Because spine shape has been shown to be strongly related to the post-synaptic processing of information, a quantitative morphological study related to the proportional density of each type of spine, was conducted in Golgi material of hippocampal CA1 pyramidal cells of proestrus and estrus rats. After three regular estrous cycles had been asserted, seven Sprague-Dawley female adult rats in proestrus and eight in estrus, were used. Mushroom-shaped spines from hippocampal pyramidal cells predominated in proestrous rats, being 15.1% more numerous in this stage than in estrus; while thin spines were the predominant type of spine in estrous animals, being 15.5% more abundant in estrus than in proestrus. The predominance of the mushroom-shaped or thin spines in the hippocampal CA1 pyramidal neurons during the respective stages of the rat estrous cycle, could be related to the organization of the hippocampal activity-dependent mnemonic information.