RESUMEN
BACKGROUND: COVID-19 vaccines have proven effective against severe outcomes in many settings, yet vaccine effectiveness (VE) estimates remain lacking for Kosovo. We aimed to estimate VE against COVID-19 infections, hospitalisations, and deaths for one and two vaccine doses during the fourth pandemic wave in July-September 2021, the period when vaccination initially became widely available. METHODS: We analysed routine surveillance data to define cases and vaccination status as partially (one dose) or completely (two doses) vaccinated. We used the screening method to calculate the proportion of cases with the outcomes vaccinated (PCV). The proportion of the population vaccinated (PPV) was based on numbers vaccinated and the Kosovo population estimate on 30/09/2021. RESULTS: Between July-September 2021, 51,804 COVID-19 cases were reported in Kosovo with 9.3% of cases partially and 3.4% completely vaccinated. Estimated vaccine effectiveness for one dose was 93.1% (95%CI:92.9-93.2%) for infections, 90.3% (95%CI:88.8-91.7%) for hospitalisations, and 90.3% (95%CI:88.4-92.1%) for deaths. Estimated vaccine effectiveness for two doses was 97.8% (95%CI:97.6-97.9%) for infections, 94.5% (95%CI:93.3-95.6%) for hospitalisations, and 94.2% (95%CI: 93.7-96.5%) for deaths. CONCLUSIONS: This study provides real-world evidence for COVID-19 vaccine effectiveness in Kosovo using routine administrative data sources and the screening method. COVID-19 vaccine effectiveness against infections and severe outcomes in Kosovo was higher with two vaccine doses than one dose, which is in accordance with findings from other study designs and settings. Using the screening method in our study reflects an important initial methodology for estimating vaccine effectiveness with routine surveillance that may be particularly important for low- and middle-income settings with less robust surveillance systems or fewer opportunities to conduct more robust vaccine effectiveness study designs.
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Vacunas contra la COVID-19 , COVID-19 , SARS-CoV-2 , Eficacia de las Vacunas , Humanos , COVID-19/prevención & control , COVID-19/epidemiología , COVID-19/inmunología , Kosovo/epidemiología , Vacunas contra la COVID-19/inmunología , Vacunas contra la COVID-19/administración & dosificación , SARS-CoV-2/inmunología , Femenino , Adulto , Persona de Mediana Edad , Masculino , Vacunación , Hospitalización/estadística & datos numéricos , Anciano , Adolescente , Niño , Adulto Joven , PreescolarRESUMEN
The under-5 mortality rate has declined from 93 deaths per 1000 live births in 1990 to 39 per 1000 live births in 2018. This improvement in child survival warrants an examination of age-specific trends and causes of death over time and across regions and an extension of the survival focus to older children and adolescents. We examine patterns and trends in mortality for neonates, postneonatal infants, young children, older children, young adolescents and older adolescents from 2000 to 2016. Levels and trends in causes of death for children and adolescents under 20 years of age are based on United Nations Inter-agency Group for Child Mortality Estimation for all-cause mortality, the Maternal and Child Epidemiology Estimation group for cause of death among children under-5 and WHO Global Health Estimates for 5-19 year-olds. From 2000 to 2016, the proportion of deaths in young children aged 1-4 years declined in most regions while neonatal deaths became over 25% of all deaths under 20 years in all regions and over 50% of all under-5 deaths in all regions except for sub-Saharan Africa which remains the region with the highest under-5 mortality in the world. Although these estimates have great variability at the country level, the overall regional patterns show that mortality in children under the age of 5 is increasingly concentrated in the neonatal period and in some regions, in older adolescents. The leading causes of disease for children under-5 remain preterm birth and infectious diseases, pneumonia, diarrhoea and malaria. For older children and adolescents, injuries become important causes of death as do interpersonal violence and self-harm. Causes of death vary by region.
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Malaria , Nacimiento Prematuro , Adolescente , Causas de Muerte , Niño , Salud Infantil , Preescolar , Femenino , Salud Global , Humanos , Lactante , Recién Nacido , EmbarazoRESUMEN
INTRODUCTION: Non-fatal health loss makes a substantial contribution to the total disease burden among children and adolescents. An analysis of these morbidity patterns is essential to plan interventions that improve the health and well-being of children and adolescents. Our objective was to describe current levels and trends in the non-fatal disease burden from 2000 to 2016 among children and adolescents aged 0-19 years. METHODS: We used years lost due to disability (YLD) estimates in WHO's Global Health Estimates to describe the non-fatal disease burden from 2000 to 2016 for the age groups 0-27 days, 28 days-11 months, 1-4 years, 5-9 years, 10-14 years and 15-19 years globally and by modified WHO region. To describe causes of YLDs, we used 18 broad cause groups and 54 specific cause categories. RESULTS: In 2016, the total number of YLDs globally among those aged 0-19 years was about 130 million, or 51 per 1000 population, ranging from 30 among neonates aged 0-27 days to 67 among older adolescents aged 15-19 years. Global progress since 2000 in reducing the non-fatal disease burden has been limited (53 per 1000 in 2000 for children and adolescents aged 0-19 years). The most important causes of YLDs included iron-deficiency anaemia and skin diseases for both sexes, across age groups and regions. For young children under 5 years of age, congenital anomalies, protein-energy malnutrition and diarrhoeal diseases were important causes of YLDs, while childhood behavioural disorders, asthma, anxiety disorders and depressive disorders were important causes for older children and adolescents. We found important variations between sexes and between regions, particularly among adolescents, that need to be addressed context-specifically. CONCLUSION: The disappointingly slow progress in reducing the global non-fatal disease burden among children and adolescents contrasts starkly with the major reductions in mortality over the first 17 years of this century. More effective action is needed to reduce the non-fatal disease burden among children and adolescents, with interventions tailored for each age group, sex and world region.
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Personas con Discapacidad , Carga Global de Enfermedades , Adolescente , Niño , Preescolar , Femenino , Salud Global , Humanos , Lactante , Recién Nacido , Masculino , Morbilidad , PrevalenciaRESUMEN
BACKGROUND: The leading causes of mortality globally in children younger than five years of age (under-fives), and particularly in the regions of sub-Saharan Africa (SSA) and Southern Asia, in 2018 were infectious diseases, including pneumonia (15%), diarrhoea (8%), malaria (5%) and newborn sepsis (7%) (UNICEF 2019). Nutrition-related factors contributed to 45% of under-five deaths (UNICEF 2019). World Health Organization (WHO) and United Nations Children's Fund (UNICEF), in collaboration with other development partners, have developed an approach - now known as integrated community case management (iCCM) - to bring treatment services for children 'closer to home'. The iCCM approach provides integrated case management services for two or more illnesses - including diarrhoea, pneumonia, malaria, severe acute malnutrition or neonatal sepsis - among under-fives at community level (i.e. outside of healthcare facilities) by lay health workers where there is limited access to health facility-based case management services (WHO/UNICEF 2012). OBJECTIVES: To assess the effects of the integrated community case management (iCCM) strategy on coverage of appropriate treatment for childhood illness by an appropriate provider, quality of care, case load or severity of illness at health facilities, mortality, adverse events and coverage of careseeking for children younger than five years of age in low- and middle-income countries. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase and CINAHL on 7 November 2019, Virtual Health Library on 8 November 2019, and Popline on 5 December 2018, three other databases on 22 March 2019 and two trial registers on 8 November 2019. We performed reference checking, and citation searching, and contacted study authors to identify additional studies. SELECTION CRITERIA: Randomized controlled trials (RCTs), cluster-RCTs, controlled before-after studies (CBAs), interrupted time series (ITS) studies and repeated measures studies comparing generic WHO/UNICEF iCCM (or local adaptation thereof) for at least two iCCM diseases with usual facility services (facility treatment services) with or without single disease community case management (CCM). We included studies reporting on coverage of appropriate treatment for childhood illness by an appropriate provider, quality of care, case load or severity of illness at health facilities, mortality, adverse events and coverage of careseeking for under-fives in low- and middle-income countries. DATA COLLECTION AND ANALYSIS: At least two review authors independently screened abstracts, screened full texts and extracted data using a standardised data collection form adapted from the EPOC Good Practice Data Collection Form. We resolved any disagreements through discussion or, if required, we consulted a third review author not involved in the original screening. We contacted study authors for clarification or additional details when necessary. We reported risk ratios (RR) for dichotomous outcomes and hazard ratios (HR) for time to event outcomes, with 95% confidence intervals (CI), adjusted for clustering, where possible. We used estimates of effect from the primary analysis reported by the investigators, where possible. We analysed the effects of randomized trials and other study types separately. We used the GRADE approach to assess the certainty of evidence. MAIN RESULTS: We included seven studies, of which three were cluster RCTs and four were CBAs. Six of the seven studies were in SSA and one study was in Southern Asia. The iCCM components and inputs were fairly consistent across the seven studies with notable variation for the training and deployment component (e.g. on payment of iCCM providers) and the system component (e.g. on improving information systems). When compared to usual facility services, we are uncertain of the effect of iCCM on coverage of appropriate treatment from an appropriate provider for any iCCM illness (RR 0.96, 95% CI 0.77 to 1.19; 2 CBA studies, 5898 children; very low-certainty evidence). iCCM may have little to no effect on neonatal mortality (HR 1.01, 95% 0.73 to 1.28; 2 trials, 65,209 children; low-certainty evidence). We are uncertain of the effect of iCCM on infant mortality (HR 1.02, 95% CI 0.83 to 1.26; 2 trials, 60,480 children; very low-certainty evidence) and under-five mortality (HR 1.18, 95% CI 1.01 to 1.37; 1 trial, 4729 children; very low-certainty evidence). iCCM probably increases coverage of careseeking to an appropriate provider for any iCCM illness by 68% (RR 1.68, 95% CI 1.24 to 2.27; 2 trials, 9853 children; moderate-certainty evidence). None of the studies reported quality of care, severity of illness or adverse events for this comparison. When compared to usual facility services plus CCM for malaria, we are uncertain of the effect of iCCM on coverage of appropriate treatment from an appropriate provider for any iCCM illness (very low-certainty evidence) and iCCM may have little or no effect on careseeking to an appropriate provider for any iCCM illness (RR 1.06, 95% CI 0.97 to 1.17; 1 trial, 811 children; low-certainty evidence). None of the studies reported quality of care, case load or severity of illness at health facilities, mortality or adverse events for this comparison. AUTHORS' CONCLUSIONS: iCCM probably increases coverage of careseeking to an appropriate provider for any iCCM illness. However, the evidence presented here underscores the importance of moving beyond training and deployment to valuing iCCM providers, strengthening health systems and engaging community systems.
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Manejo de Caso/organización & administración , Servicios de Salud del Niño/organización & administración , Agentes Comunitarios de Salud , Países en Desarrollo , África del Sur del Sahara , Asia , Sesgo , Preescolar , Agentes Comunitarios de Salud/economía , Agentes Comunitarios de Salud/educación , Agentes Comunitarios de Salud/organización & administración , Estudios Controlados Antes y Después , Diarrea/terapia , Fiebre/terapia , Humanos , Lactante , Mortalidad Infantil , Trastornos de la Nutrición del Lactante/terapia , Recién Nacido , Malaria/terapia , Sepsis Neonatal/terapia , Neumonía/terapia , Ensayos Clínicos Controlados Aleatorios como Asunto , Salarios y Beneficios , Naciones UnidasRESUMEN
BACKGROUND: Prompt treatment of pediatric pneumonia symptoms is a cornerstone of child survival programs but remains a challenge in Nigeria. Psychosocial influences, or ideations, directly influence pathways to care but have not been previously measured or examined for pediatric pneumonia. METHODS: A two-stage cluster-sample cross-sectional population-based survey was conducted in Kebbi, Sokoto, and Zamfara States in September 2019. Across 108 enumeration areas, all households were enumerated to census pregnant women and randomly sample women with children under 2 years ("under-twos") for inclusion. Respondents were asked about pediatric pneumonia and other health-related behaviors and ideations developed using the Ideation Model of Strategic Communication and Behavior Change. Prevalence ratios for predictors of care-seeking from formal medical sources and antibiotic treatment for pneumonia symptoms among under-twos were calculated using mixed-effects Poisson regression models with robust error variance. RESULTS: Among 350 under-twos with pneumonia symptoms, 33.8% were taken to formal medical care and 38.0% used antibiotics. Women who positively viewed treatment efficacy and those who positively viewed health services quality had 1.35 (95% CI: 1.00-1.82; P = .050) and 2.13 (95% CI: 1.35-3.35; P = .001) times higher likelihood of attending formal medical sources, while women viewing peers as mostly attending drug shops had 29% lower likelihood. Perceived treatment efficacy and illness susceptibility were also significant predictors for antibiotic use. CONCLUSIONS: Program interventions focusing on increasing pneumonia knowledge alone may not be sufficient to improve care-seeking and treatment rates and should expand to address perceived and actual poor-quality health services and maternal beliefs about treatment efficacy, social norms, illness severity, and susceptibility.