Leveraging Resource Centers for Strengthening Immunization Supply Chain.

The efficacy of immunization programs is critically dependent on robust supply chain management, a complex challenge exacerbated by expanding program scopes and evolving vaccine technologies. This comprehensive review underscores the pivotal role of Resource Centers in fortifying the immunization supply chain, presenting a paradigm shift toward enhanced national and global health outcomes. Through a detailed examination of their key activities, the article elucidates how these centers catalyze improvements across various facets of supply chain management - from the integration of suitable technology technologies and specialized training programs to the development of sustainable models and advocacy for policy prioritization. This further explores the multifaceted challenges these centers confront, including funding constraints, capacity building, and infrastructural gaps, alongside the burgeoning opportunities presented by new vaccine introductions, donor interest in health system strengthening, and the potential for broadened scope beyond immunization. By weaving together examples of existing centers worldwide, the review highlights their contributions towards optimizing vaccine logistics, enhancing data management, and ultimately achieving Sustainable Development Goal 3. The insights provided offer valuable guidance for planning and sustaining resource centers, positioning them as indispensable allies in the global pursuit of universal immunization coverage.

Aerosol drug therapy in critically ill patients (Aero-in-ICU study): A multicentre prospective observational cohort study.

BACKGROUND: In recent years, a significant understanding of delivering optimal aerosol therapy and the availability of various drugs and devices have led to an increase in its use in clinical practice. There are only a few studies available regarding their use in critically ill patients from a few parts of the world. We aimed to study the practice pattern of aerosol therapy in critically ill patients from Indian intensive care units (ICUs). METHODS: After ethical approval, this multi-centric prospective observational study was performed over a study period of four weeks. Newly admitted adult patients considered who had an artificial airway and/or ventilation (including non-invasive). Patients were followed up for the next 14 days or until ICU discharge/death (whichever came first) for details of each aerosol therapy, including ongoing respiratory support, drug type, and aerosol-generating device. RESULTS: From the nine participating centers across India, 218 patients were enrolled. Of 218 enrolled patients, 72.48% received 4884 aerosols with 30.91 ± 27.15 (95%CI: 26.6-35.1) aerosols per patient over 1108 patient days. Approximately 62.7% during IMV, 30.2% during NIV, 2.3% in spontaneously breathing patients with an artificial airway during weaning, and 4.7% were given without an artificial airway after weaning or decannulation. In 59%, a single drug was used, and bronchodilators were the most frequent. The jet nebulizer was the most common, followed by the ultrasonic and vibrating mesh aerosol generator. The ventilator setting was changed in only 6.6% of the aerosol sessions with IMV and none with NIV. CONCLUSION: Aerosol therapy is frequently used with a wide variation in practices; bronchodilators are the most commonly used drugs, and jet nebulizers are the most widely used.

Progress and challenges in achieving tuberculosis elimination in India by 2025: A systematic review and meta-analysis.

BACKGROUND: Tuberculosis (TB) continues to pose a significant public health challenge in India, which is home to one of the highest TB burdens worldwide. This systematic review and meta-analysis will aim to synthesize the anticipated progress and potential challenges in achieving TB elimination in India by 2025. METHODS: A comprehensive search will be conducted across multiple databases, including PubMed, Scopus, and Web of Science, to identify relevant studies. The eligibility criteria will encompass individuals diagnosed with TB in India, interventions targeting TB treatment, prevention, or control, and various comparator groups. Outcomes of interest will include incidence reduction, mortality rate, treatment success rate, barriers to TB care, and more. Both quantitative and qualitative data will be synthesized, and the risk of bias will be assessed using established tools. OUTCOMES: The review is expected to provide a holistic understanding of the TB landscape in India, highlighting the effective interventions and potential challenges in the journey towards TB elimination. CONCLUSIONS: While it is anticipated that significant progress will be made in the fight against TB in India, challenges are likely to persist. This review will offer a comprehensive roadmap for researchers, policymakers, and healthcare professionals, emphasizing the importance of continued efforts, innovative strategies, and a multi-pronged approach in achieving the goal of TB elimination in India by 2025.

Advancing Solar Energy for Primary Healthcare in Developing Nations: Addressing Current Challenges and Enabling Progress Through UNICEF and Collaborative Partnerships.

This comprehensive document explores the intersection of Sustainable Development Goals (SDGs) and the global transition to renewable energy, with a particular focus on solar energy. The text emphasizes the critical role of reliable and sustainable energy, especially solar power, in achieving health-related SDGs, particularly in low- and middle-income countries (LMICs). It discusses the challenges faced by healthcare facilities in these regions, emphasizing the importance of uninterrupted electricity for critical medical equipment and services. The document highlights the increasing significance of solar energy globally and its potential to address challenges in the healthcare sector. The International Energy Agency's (IEA) estimation that solar photovoltaic (PV) energy has become the cheapest source of electricity is discussed, along with the World Bank's active role in supporting solar energy projects in developing countries. The document presents the current status of solarization, emphasizing the exponential growth of solar capacity and generation. It also discusses global initiatives such as Mission Innovation and the contribution of various international aid organizations, including Sustainable Energy for All (SEforALL), Power Africa, Lighting Global, SolarAid, UNDP - Solar for Health (S4H), and the World Bank. A significant portion of the document focuses on the role of solar energy in healthcare, detailing successful solarization projects in India, sub-Saharan Africa, and other regions. It addresses the challenges of implementing solar PV projects in healthcare facilities, emphasizing the importance of maintenance and proper management. The document also provides insights into the contributions of United Nations Children's Fund (UNICEF) in advancing solar-powered health systems, emphasizing its support to over 80 countries in solarization and off-grid energy solutions for healthcare. In conclusion, this article emphasizes the need for collaboration among international aid organizations, governments, and development partners to ensure universal access to reliable and sustainable electricity, particularly in healthcare facilities. It underscores the importance of long-term planning, sustainability, innovative business models, and awareness campaigns to achieve scalable and impactful results in the intersection of solar energy and healthcare delivery.

Navigating the Pandemic: An Exploration of Medical Practitioners' Preparedness, Concerns, Adaptations, and Practices During the COVID-19 Epidemic in India.

Introduction The coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, has had profound health and societal impacts, and healthcare providers from diverse backgrounds had to continuously adapt and update to manage patient care, prevent morbidity-mortality, and minimize transmission of the infection. Methodology A cross-sectional survey was conducted among 218 doctors in western India. A structured questionnaire was used to gather data on demographic characteristics, patient consultations, infection prevention practices, COVID-19 diagnosis, management, vaccination attitudes, and healthcare program disruptions. Multistage probability sampling was undertaken to select 161 (64%) private and 57 (26%) public sector doctors from the list of clinics and hospitals reporting COVID-19 cases in the urban municipal corporation area of South Gujarat. Private sector doctors were contacted through the network of public administrative staff and caregivers of their area. They were provided the choice of date, time, and mode (telephonically, face to face, or online) of interview. Descriptive measures of central tendency and variation were calculated. Inferential statistics was applied to test the significance of the difference between sub-groups. For ratio and interval variables, t-test (for two groups) and ANOVA (for more than two groups) were applied while for nominal and ordinal variables, chi-square and appropriate tests were applied. Results The mean age of the 218 doctors included in the study was 43.6 ± 11.1 years while the mean duration of practice was 16.9 ±10.8 years. During the pandemic, patients' consultation frequencies decreased at the clinics while telephonic and residential consultancies increased, which was statistically significant (P=0.000). Social distancing (n= 187; 85%), isolation (n=157; 72%), and consultation reduction (n=65; 30%) were adopted by doctors. Both public and private doctors preferred government-recognized COVID-19 centers for testing (n=167; 76.7%) and reverse transcriptase-polymerase chain reaction (RT-PCR) as the standard diagnostic test (n=196; 90%). A combination of antipyretics, favipiravir, and antibiotics was used to manage symptomatic cases. Concerns and emotional stress for personal and family safety were prominent among this group of frontline medical doctors (94%). Delivery of healthcare programs for chronic conditions like hypertension and tuberculosis was negatively affected (n=102; 47%). Despite these challenges, doctors managed cases and advised vaccination to control the pandemic. Conclusion This study among over 200 qualified medical practitioners during the pandemic attempts to fill gaps in COVID-19 management, prevention, and safety measures. To the best of our knowledge, this is one of the few studies providing genuine insights into the practice of private doctors with a large sample size. Findings show the established treatment, prophylaxis, and vaccination protocols among private and public practitioners. It highlights the need for adaptable healthcare strategies and collaboration between public and private sectors for managing future global health emergencies.

'Vaccinate my village' strategy in Malawi: an effort to boost COVID-19 vaccination.

OBJECTIVES: To boost COVID-19 vaccine uptake, an innovative 'vaccinate my village' (VMV) strategy using door-to-door vaccination by Health Surveillance Assistants (HSA) was adopted. In this study, we assessed the impact of the 'vaccinate my village' strategy on COVID-19 vaccine uptake. METHODS: This was a cross-sectional review of the data on COVID-19 vaccination obtained from the Ministry of Health, Malawi, from 11 March 2021 to September 2022. RESULTS: From March 2021-4 September 2022,091,551 COVID-19 vaccine doses were administered, out of which 2,253,546 were administered over just six months as a part of VMV as compared to 1,838,005 doses were administered over 13 months as a part of other strategies. The proportion of Malawi's population receiving at least one dose of the COVID-19 vaccine increased substantially from 4.66 to 15.4 with the implementation of the VMV strategy (p = 0.0001). District-wise coverage of the COVID-19 vaccine also increased significantly after its implementation (p = 0.0001). CONCLUSIONS: Door-to-door vaccination involving HSAs benefitted the COVID-19 vaccination program in Malawi by ensuring accessibility, availability, and acceptability.

Infodemics during era of COVID-19 pandemic: A review of literature.

The coronavirus disease 2019 (COVID-19) pandemic, caused by the new coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread across the globe and has affected the health of millions of people. During the pandemic, social media was the major source of information for isolated and anxious people. Infodemics is defined as "an overburden of information - some accurate and some not - that makes it hard for people to find trustworthy source and reliable guidance when they need it." Misinformation raised out of infodemics during COVID-19 created many serious issues regarding the prevention and treatment of COVID-19. With the help of available literature, we aimed to review the role of infodemic in relation to worsening of COVID-19 spread and vaccine utilization with possible preventable measures to control infodemic. Various social media platforms were a major source of infodemic. The active role of world agencies, narrative guidelines by the local authority, use of artificial intelligence (AI) by social media platforms and active participation of community and health care professionals can control infodemics effectively.

Key lessons learned from the immunization supply chain of Malawi, an African country using EVM2.0.

Objectives: A country's immunization system's effectiveness depends on its supply chain's efficacy. To assess the challenges of maintaining an efficient vaccine supply chain, Malawi conducted its assessment using The EVM2.0 tool (Effective Vaccine Management). Methods: It is a cross-sectional study in which all EVM requirements were assessed between September and October 2021. Data were collected from eighty-two randomly selected sites using the site selection tool of the EVM. Data were entered into the EVM assessment tool 2.0 version 1.12 for analysis. This tool generates performance indicators and criteria scores for assessed sites, compared with a WHO minimum score of 80%. Results: Overall criteria scores across all levels of the immunization supply chain showed a statistically significant mean difference of 5.92 (t = 2.58, P = 0.02). Comparative overall mean criteria scores across different levels of the immunization supply chain showed no statistically significant difference for primary (p = 0.76), sub-national (p = 0.69), and lowest distribution stores (p = 0.12). However, a substantial gap was found in the overall mean scores of the health facility's service point (SP) (t = 4.12, P = 0.001). The overall category scores across all immunization supply chain levels did not show a statistically significant difference. However, among individual category scores, Infrastructure (76 %), Equipment (67 %), Policies and procedures (62 %), Financial (47 %), and Resources (64 %) were found to be below the WHO minimum score. Conclusion: Though the 2021 Malawi EVM assessment findings are promising, they still identified the gaps to be improved to ensure the vaccine availability in the right amount, at the right time, and at the right cost.

COVID-19 vaccine express strategy in Malawi: An effort to reach the un-reach.

OBJECTIVES: To establish the impact of "Covid-19 Vaccination express" (CVE) on vaccine uptake in Malawi. DESIGN: Retrospective cross-sectional study to compare the daily vaccine administration rate in CVE and routine covid vaccination (RCV). RCV data was collected from March 2021 to October 2021. The data regarding CVE was collected from 5 November 2021 to 31 December 2021. Data was collected regarding (1) the total number and type of vaccine doses administered and (2) Demographic details like age, gender, occupation, presence of comorbidities, the first dose, or the second dose of the people who received a vaccine. RESULTS: From March-December 2021, a total of 1,866,623 COVID-19 vaccine doses were administered, out of which 1,290,145 doses were administered at a mean daily vaccination rate of 1854 (95 % CI: 1292-2415) doses as a part of RCV, and 576,478 doses were administered at a mean daily vaccination rate of 3312 (95 % CI: 2377-4248) doses as a part of CVE. Comparing the mean daily doses (Astra Zeneca, AZ doses 1 & 2) administered in the CVE and RCV showed that the mean daily doses of AZ vaccine administered were significantly higher in the CVE (p < 0.05). CONCLUSION: CVE successfully increased the uptake of the Covid-19 vaccine.

Management of Ludwig's Angina at a Tertiary Care Hospital in Western Region of India.

Introduction Ludwig's angina is cellulitis of submandibular space, submental space, and sublingual space. The main causative factors include dental infections (dental caries with atypical periodontitis, pericoronitis, and dental procedures). Other predisposing conditions include poor dental hygiene, dental caries, malnutrition, diabetes mellitus, AIDS, and various other immunocompromised states. It presents as an acute onset and spreads very rapidly causing bilateral diffuse neck swelling, edema of floor of mouth, pain, fever, trismus, foul-smelling pus discharge, difficulty in swallowing, airway edema, and tongue displacement creating a compromised airway with stridor. So it requires early diagnosis and aggressive management. Material and methods Clinical data of all patients with clinical diagnosis of Ludwig's angina managed at the Department of Otorhinolaryngology-Head and Neck Surgery, Sir Takhatsinhji (T) General Hospital and Government Medical College, Bhavnagar, India, from 2015 to 2019 were analyzed retrospectively in this study. Result Over the review period, 30 cases were diagnosed as Ludwig's angina, out of which 12 (40%) were males and 18 (60%) were females; male to female ratio was 1:1.5. The age of the patients ranged from six months to 64 years, with a mean age of 38.86 years. Fever, neck swelling, and neck pain were present in all patients. In 16 patients, incision and drainage were done under general anesthesia while the rest five patients required only local anesthesia. In six patients (20%), for maintenance of airway, tracheostomy was required. The most common complication was necrotizing fasciitis and death followed by septicemia. Mortality was observed in three patients (10%) in this study. Conclusion Despite improved outcomes compare to pre-antibiotic era, Ludwig's angina still remains a potentially life-threatening disease in ENT at present. Dental caries, uncontrolled diabetes mellitus, and malnutrition are commonly associated conditions. With early diagnosis, close airway observation, aggressive intravenous antibiotic treatment, and timely surgical intervention, morbidity, and mortality can be reduced.

Study of Clinical Outcome and Healthcare Modalities of COVID-19 Patients Treated With Remdesivir at a Tertiary Care Teaching Hospital.

Background Effective treatment for COVID-19 infection is still under evaluation. Remdesivir is an approved drug for COVID-19 treatment and major countries have released guidelines on the use of remdesivir. Still, many factors are under evaluation which can determine the future use of remdesivir. Aim To study the clinical outcome and healthcare modalities of COVID-19 patients treated with remdesivir. Materials and methods A retrospective study was conducted through the clinical records of patients admitted to the tertiary care hospital between August 2020 and December 2020. All the patients who were administered remdesivir intravenously as per standard protocol were included in the study. Data were analyzed for statistical association between health care modalities and patient characteristics. Results Among 166 patients included, the mean age of patient who received remdesivir was 57.51 ± 12.98 years (95% confidence interval (CI), 30-84). The mean duration of stay and duration of oxygen requirement were 12.80 ± 5.99 (95% CI, 5-30) and 9.41 ± 7.47 (95% CI, 0-39) days, respectively. A total of 12 (7.23%) required assisted ventilation and the cure rate was 89.76% (149/166). Out of 166 patients, 105 (63.25%) had comorbidities, among which hypertension and diabetes were the most common. Significantly >60 year age group had a higher duration of oxygen requirement (u=2,639.5, p=0.01), while ≤60 year age group had a higher cure rate (X2=4.23, p=0.03) and a higher requirement for assisted ventilation (X2=4.77, p=0.02). Differences and associations in the above-mentioned health care modalities were not statistically significant for gender and comorbidity except that non-comorbid had a higher cure rate (X2=3.97, p=0.04). The odds ratio of comorbidity and cure rate was 1.07, while the association of the number of comorbidities with the duration of stay (p=0.62) and duration of oxygen requirement (p=0.35) was not statistically significant. Conclusion In remdesivir-treated patients, age affects utilization of health care modalities. Female, non-comorbid, and younger patients have better clinical outcomes.

A Simple, Objective, and Mathematical Grading Scale for the Assessment of Facial Nerve Palsy.

OBJECTIVES: It is imperative to acquire a simple, objective, and mathematical method for the assessment of facial nerve palsy which can be universally accepted and implemented. A grading scale which is convenient, continuous and economical was attempted for the first time for global and region-specific assessment of facial nerve palsy. STUDY DESIGN: Hospital-based observational study. SETTING: Medical college hospital. PATIENTS: Ten normal subjects and 51 patients with facial paralysis. INTERVENTIONS: Patients with facial nerve palsy were graded according to the revised version of House-Brackmann grading system (HBGS-2) and a newly proposed grading system. MAIN OUTCOME MEASURES: The results of the present study were compared with the HBGS-2. Data were analyzed using SPSS-17 (IBM Corporation, New York) for descriptive statistics, normality test, Wilcoxon signed-rank test, and Mann-Whitney U test. RESULTS: The mean time spent on recording measurements was 288 seconds. For the new method and HBGS-2, the modes were graded 3 and 4, corresponding to incomplete facial paralysis. The Kolmogorov-Smirnov normality and Wilcoxon signed rank tests were found significant. In Mann-Whitney U test, probability value indicated that grades of new scale were similar to grades of HBGS-2. CONCLUSION: The proposed simple, objective and mathematical (SOM) method of grading facial nerve palsy is convenient and provides global and regional continuous percentage that can monitor the progress and classify the patients with facial paralysis into six-point grades based on severity. This system was having substantial compatibility with HBGS-2 grading. For further validity, multi-center study with a larger sample of patients would be required.