Rotavirus vaccine product switch in Ghana: An assessment of service delivery costs, switching costs, and cost-effectiveness.

Ghana introduced rotavirus vaccine (ROTARIX 1-dose presentation) into the routine national immunization program in 2012 and switched to a different product (ROTAVAC 5-dose presentation) in 2020. ROTAVAC has a lower price per dose (US$0.85 versus US$2.15 for ROTARIX) and smaller cold chain footprint but requires more doses per regimen (three versus two). This study estimates the supply chain and service delivery costs associated with each product, the costs involved in switching products, and compares the cost-effectiveness of both products over the next ten years. We estimated the supply chain and service delivery costs associated with ROTARIX and ROTAVAC (evaluating both the 5-dose and 10-dose presentations) using primary data collected from health facilities in six of the 14 regions in the country. We estimated the costs of switching from ROTARIX to ROTAVAC using information collected from key informant interviews and financial records provided by the government. All costs were reported in 2020 US$. We used the UNIVAC decision-support model to evaluate the cost-effectiveness (US$ per disability-adjusted life-year (DALY) averted from government and societal perspectives) of ROTARIX and ROTAVAC (5-dose or 10-dose presentations) compared to no vaccination, and to each other, over a ten-year period (2020 to 2029). We ran probabilistic sensitivity analyses and other threshold analyses. The supply chain and service delivery economic cost per dose was $2.40 for ROTARIX, $1.81 for ROTAVAC 5-dose, and $1.76 for ROTAVAC 10-dose. The financial and economic cost of switching from ROTARIX to ROTAVAC 5-dose was $453,070 and $883,626, respectively. Compared to no vaccination, the cost per DALY averted was $360 for ROTARIX, $298 for ROTAVAC 5-dose, and $273 for ROTAVAC 10-dose. ROTAVAC 10-dose was the most cost-effective option and would be cost-effective at willingness-to-pay thresholds exceeding 0.12 times the national GDP per capita ($2,206 in the year 2020). The switch from ROTARIX to ROTAVAC 5-dose in 2020 was cost-saving. Rotavirus vaccination is highly cost-effective in Ghana. A switch from ROTAVAC 5-dose to ROTAVAC 10-dose would be cost-saving and should be considered.

Prevalence and factors associated with undernutrition among children under the age of five years in Benin.

BACKGROUND: Benin ranks as one of the countries in the world with an alarmingly high prevalence of stunting, wasting, and underweight in children under five years. However, limited studies have examined the factors associated with the prevalence of these undernutrition indicators among children under five years in the country. This study aimed to fill this research gap by examining the prevalence rates and factors associated with stunting, wasting, and underweight among this specific population of interest. METHODS: This quantitative study utilised data from the most recent Benin Demographic and Health Survey (BDHS) conducted in 2017-18. The survey employed a nationally representative cross-sectional design and utilised a two-stage stratified cluster sampling technique to select participants. The study included a sample of 13,589 children under the age of five years. The main analytical approach employed was binary logistic regression, which was used to explore the associations between undernutrition (the combined outcome variable representing stunting, wasting, and underweight) and various socio-demographic factors. RESULTS: The combined prevalence of stunting, wasting, and underweight among children under five years in Benin during the 2017-18 survey period was 14.95%. Several factors were significantly associated with these indicators of undernutrition, including female gender (AOR = 0.71, 95% CI = 0.59-0.85), birth weight of 4.1 kg and over (AOR = 0.26, 95% CI = 0.14-0.48), multiple births (AOR = 3.22, 95% CI = 2.11-4.91), and a child's experience of diarrhoea (AOR = 1.76, 95% CI = 1.40-2.20). Furthermore, the prevalence of these undernutrition indicators was higher among children whose mothers had lower levels of education (AOR = 0.82, 95% CI = 0.01-0.42) and were unmarried (AOR = 0.67, 95% CI = 0.49-0.93). CONCLUSIONS: This present study confirms that undernutrition rates are elevated in Benin and are closely linked to perinatal factors such as birth weights and multiple births, postnatal health conditions including diarrheal episodes, and socio-demographic determinants such as a child's gender, maternal education level, and marital status. Therefore, there is the need to consider specific modifiable factors, such as low birth weight, episodes of child diarrhoea, and maternal education as priority targets for child nutrition interventions in Benin.

Duration of immunity following full vaccination against SARS-CoV-2: a systematic review.

BACKGROUND: As vaccine roll-out continues across the globe as part of the efforts to protect humanity against SARS-CoV-2, concerns are increasingly shifting to the duration of vaccine-induced immunity. Responses to these concerns are critical in determining if, when, and who will need booster doses following full vaccination against SARS-CoV-2. However, synthesised studies about the durability of vaccine-induced immunity against SARS-CoV-2 are scarce. This systematic review synthesised available global evidence on the duration of immunity following full vaccination against SARS-CoV-2. METHODS: We searched through Psych Info, Web of Science, Scopus, Google Scholar, PubMed, and WHO COVID-19 databases for relevant studies published before December 2021. Five eligibility criteria were used in scrutinising studies for inclusion. The quality of the included studies was assessed based on Joana Briggs Institute's (JBI) Critical Appraisal tool and Cochrane's Risk of Bias tool-version 2 (RoB 2), while the reporting of the results was guided by the Synthesis Without Meta-analysis (SWiM) guidelines. RESULTS: Twenty-seven out of the 666 identified studies met the inclusion criteria. The findings showed that vaccine-induced protection against SARS-CoV-2 infections builds rapidly after the first dose of vaccines and peaks within 4 to 42 days after the second dose, before waning begins in subsequent months, typically from 3 to 24 weeks. Vaccine-induced antibody response levels varied across different demographic and population characteristics and were higher in people who reported no underlying health conditions compared to those with immunosuppressed conditions. CONCLUSIONS: Waning of immunity against SARS-CoV-2 begins as early as the first month after full vaccination and this decline continues till the sixth month when the level of immunity may not be able to provide adequate protection against SARS-CoV-2. While the evidence synthesised in this review could effectively inform and shape vaccine policies regarding the administration of booster doses, more evidence, especially clinical trials, are still needed to ascertain, with greater precision, the exact duration of immunity offered by different vaccine types, across diverse population characteristics, and in different vulnerability parameters. REGISTRATION: The protocol for this review was pre-registered with the International Prospective Register of Systematic Reviews [PROSPERO] (Registration ID: CRD420212818).

Estimating the cost of COVID-19 vaccine deployment and introduction in Ghana using the CVIC tool.

BACKGROUND: This study estimated cost of COVID-19 vaccine introduction and deployment in Ghana. METHODS: Using the WHO-UNICEF COVID-19 Vaccine Introduction and deployment Costing (CVIC) tool Ghana's Ministry of Health Technical Working Group for Health Technology Assessment (TWG-HTA) in collaboration with School of Public Health, University of Ghana, organized an initial two-day workshop that brought together partners to deliberate and agree on input parameters to populate the CVIC tool. A further 2-3 days validation with the Expanded Program of Immunization (EPI) and other partners to finalize the analysis was done. Three scenarios, with different combinations of vaccine products and delivery modalities, as well as time period were analyzed. The scenarios included AstraZeneca (40%), Johnson & Johnson (J&J) (30%), Moderna, Pfizer, and Sputnik V at 10% each; with primary schedule completed by second half of 2021 (Scenario 1); AstraZeneca (30%), J&J (40%), Moderna, Pfizer, and Sputnik V at 10% each with primary schedule completed by first half of 2022 (Scenario 2); and equal distribution (20%) among AstraZeneca, J&J, Moderna, Pfizer, and Sputnik V with primary schedule completed by second half of 2022 (Scenario 3). RESULTS: The estimated total cost of COVID-19 vaccination ranges between $348.7 and $436.1 million for the target population of 17.5 million. These translate into per person completed primary schedule cost of $20.9-$26.2 and per dose (including vaccine cost) of $10.5-$13.1. Again, per person completed primary schedule excluding vaccine cost was $4.5 and $4.6, thus per dose excluding vaccine also ranged from $2.2 - $2.3. The main cost driver was vaccine doses, including shipping, which accounts for between 78% and 83% of total cost. Further, an estimated 8,437-10,247 vaccinators (non-FTEs) would be required during 2021-2022 to vaccinate using a mix of delivery strategies, accounting for 8-10% of total cost. CONCLUSION: These findings provide the estimates to inform resource mobilization efforts by government and other partners.