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1.
Pan Afr Med J ; 33: 294, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692797

RESUMO

The number of children who survive to adolescence is increasing in Nigeria, significantly due to the success of child survival programs, with immunization as a major theme. However, the national immunization schedule in Nigeria is presently restricted to early childhood with no attention paid to immunization in adolescence. Presently, the vaccines that are readily available for adolescents include tetanus toxoid which is normally administered to pregnant women, so necessarily includes adolescent mothers; and a few research programs which offers hepatitis B vaccines. Also, there are few Nigerian adolescents who access immunization as a requirement for travelling outside the country or as a result of parental effort. Knowledge and awareness about adolescent immunization is generally poor. Nigerian adolescents have been shown to be poorly protected from tetanus, rubella and hepatitis B which are vaccine preventable. Neonatal, childhood and adult tetanus, congenital rubella syndrome, cervical cancer and hepatocellular carcinoma are just few of the diseases whose incidence can be reduced with an effective adolescent immunization program. This will also ensure that the gains of childhood immunization is concretized and socio-economic losses as a result of vaccine preventable diseases are eliminated to create a healthy and vibrant workforce. There is an urgent need to build a viable adolescent immunization program in Nigeria as adolescents represent a window of opportunity to prevent diseases which affect both the younger and older age group. This can be extended to other developing countries as well.


Assuntos
Programas de Imunização/organização & administração , Esquemas de Imunização , Imunização/métodos , Vacinas/administração & dosagem , Adolescente , Fatores Etários , Conhecimentos, Atitudes e Prática em Saúde , Acesso aos Serviços de Saúde , Humanos , Nigéria
2.
Can Bull Med Hist ; 36(2): 444-468, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31518178

RESUMO

During the early 1950s, Canada's efforts to prevent polio became heavily influenced by developments in the United States. America's foremost polio charity, the National Foundation for Infantile Paralysis, sponsored University of Pittsburgh researcher Dr. William McD. Hammon to evaluate the efficacy of a human blood fraction, gamma globulin (GG), to prevent paralytic polio. When the resulting clinical trial data appeared to show that the blood fraction offered some protection against the disease, Canadians embraced the concept for reasons of historical trust, parental demand, and public health pragmatism. They established Canada's first national immunization program to fight polio before the vaccine, as well as developed a plan to produce, evaluate, and distribute GG to epidemic areas. Despite being an expensive enterprise for a geographically vast and sparsely populated nation, Canada's GG program was extended to citizens and it became an important response to polio before a safe and effective vaccine was licensed. Although the blood fraction was not as effective at preventing polio paralysis as researchers had anticipated, its systematic use reveals how Canadian health leaders drew on transnational relationships to reduce the incidence of disease.


Assuntos
Programas de Imunização/história , Poliomielite/história , Poliomielite/prevenção & controle , gama-Globulinas/uso terapêutico , Canadá , História do Século XX , Programas de Imunização/organização & administração
3.
BMC Public Health ; 19(1): 1263, 2019 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-31510967

RESUMO

BACKGROUND: Although hepatitis B vaccinations have been integrated in the Universal Immunization Program (UIP) in India over a decade, only half of the children are immunized against hepatitis B. The national average in hepatitis B vaccination conceals large variations across states, districts and socio-economic groups. In this context, the aim of this paper is to examine the spatial heterogeneity and contextual determinants of hepatitis B vaccination across the districts of India. METHODS: Using data of 199,899 children aged 12-59 months from the National Family Health Survey-4 (NFHS-4), 2015-16 we have examined the district level spatial distribution and clustering of hepatitis B vaccination with the help of Moran's I and Local Indicator of Spatial Autocorrelation (LISA) measures. We investigated the low coverage of HBV vaccination using spatial autoregressive models (SAR) at the meso scale. And we applied multivariate binary logistic regression analysis to understand the micro-level predictors of hepatitis B vaccination. RESULTS: In 2015-16, 45% of the children aged 12-59 months were not vaccinated against hepatitis B in India. The coverage of hepatitis B vaccine across the districts of India showed a highly significant spatial dependence (Moran's I = 0.580). Bivariate Moran's I confirmed the spatial clustering of hepatitis B vaccination with mother's education, full antenatal care (ANC) utilization, post natal care (PNC) utilization, institutional births and registration of births at the district level. Districts with a very low coverage of HBV vaccine are clustered in the western, north-eastern regions and in some parts of central India. At the unit (child) level, children's hepatitis B immunization status is mostly determined by the socio-economic and demographic characteristics like their mother's educational status, caste, religion, household's wealth condition, birth order, year of birth and the region they belong to. CONCLUSIONS: District level variation in hepatitis B vaccination is spatially heterogeneous and clustered in India with a strong neighbourhood effect. Uptake of hepatitis B vaccine among Indian children is predominantly dependent upon their socio-economic and demographic characteristics.


Assuntos
Vacinas contra Hepatite B/administração & dosagem , Hepatite B/prevenção & controle , Cobertura Vacinal/estatística & dados numéricos , Pré-Escolar , Feminino , Humanos , Programas de Imunização/organização & administração , Índia , Lactente , Masculino , Características de Residência/estatística & dados numéricos , Fatores Socioeconômicos , Análise Espacial
4.
Pan Afr Med J ; 33(Suppl 2): 5, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31402965

RESUMO

Introduction: The Ebola virus disease (EVD) outbreak in Liberia from 2014-2015 setback the already fragile health system which was recovering from the effects of civil unrest. This led to significant decline in immunization coverage and key polio free certification indicators. The Liberia investment plan was developed to restore immunization service delivery and overall health system. Methods: We conducted a desk review to summarize performance of immunization coverage, polio eradication, measles control, new vaccines and technologies. Data sources include program reports, scientific and grey literature, District Health Information System (DHIS2), Integrated Diseases Surveillance and Response (IDSR) database, auto visual AFP detection and reporting (AVADAR) and ONA Servers. Data analysis was done using Microsoft excel spreadsheets, ONA software and Arc GIS. Results: There was a 36% increase in national coverage for Penta 3 in 2017 compared to 2014 from WUENIC data. Penta 3 dropout rate reduced by 2.5 fold from 15.3% in 2016 to 6.4% in 2017; while MCV1 coverage improved by 23% from 64% in 2015 to 87% in 2017. There was a rebound of non-polio AFP rate (NPAFP) rate from 1.2 in 2015 to 4.3 in 2017. Furthermore, there was a 2-fold increase in the number of AFP cases receiving 3 or more doses of OPV from 36% in 2015 to 61% in 2017. Conclusion: Liberia demonstrated strong rebound of immunization services following the largest and most devastating EVD outbreak in West Africa in 2014 - 2015. Immunization coverage improved and dropout rates reduced. However, there are still opportunities for improvement in the immunization program both at national and sub-national levels.


Assuntos
Surtos de Doenças/prevenção & controle , Programas de Imunização/organização & administração , Cobertura Vacinal , Vacinação/métodos , Doença pelo Vírus Ebola/epidemiologia , Humanos , Libéria/epidemiologia , Poliomielite/epidemiologia , Poliomielite/prevenção & controle , Vigilância em Saúde Pública/métodos , Vacinas/administração & dosagem
5.
Pan Afr Med J ; 33(Suppl 2): 7, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31402966

RESUMO

Introduction: Measles is an acute viral disease that remains endemic in much of sub-Sahara Africa, including Liberia. The 2014 Ebola epidemic disrupted an already fragile health system contributing to low uptake of immunization services, population immunity remained low thus facilitating recurrent outbreaks of measles in Liberia. We describe lessons learnt from detecting and responding to recurrent outbreaks of measles two years post the 2014 Ebola epidemic in Liberia. Methods: We conducted a descriptive study using the findings from Integrated Diseases Surveillance and Response (IDSR) 15 counties, National Public Health Institute of Liberia (NPHIL), National Public Health Reference Laboratory (NPHRL) and District Health Information Software (DIHS2) data conducted from October to December, 2017. We perused the outbreaks line lists and other key documents submitted by the counties to the national level from January 2016 to December 2017. Results: From January 2016 to December 2017, 2,954 suspected cases of measles were reported through IDSR. Four hundred sixty-seven (467) were laboratory confirmed (IgM-positive), 776 epidemiologically linked, 574 clinically confirmed, and 1,137 discarded (IgM-negative). Nine deaths out of 1817 cases were reported, a case fatality rate of 0.5%; 49% were children below the age of 5 years. Twenty-two percent (405/1817) of the confirmed cases were vaccinated while the vaccination status of 55% (994/1817) was unknown. Conclusion: Revitalization of IDSR contributed to increased detection and reporting of suspected cases of measles thus facilitating early identification and response to outbreaks. Priority needs to be given to increasing the uptake of routine immunization services, introducing a second dose of measles vaccine in the routine immunization program and conducting a high-quality supplementary measles immunization campaign for age group 1 to 10 years to provide protection for a huge cohort of susceptible.


Assuntos
Surtos de Doenças , Programas de Imunização/organização & administração , Vacina contra Sarampo/administração & dosagem , Sarampo/epidemiologia , Criança , Pré-Escolar , Feminino , Doença pelo Vírus Ebola/epidemiologia , Humanos , Imunização/métodos , Lactente , Libéria/epidemiologia , Masculino , Sarampo/prevenção & controle , Vigilância em Saúde Pública , Recidiva
7.
BMC Public Health ; 19(1): 1166, 2019 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-31455314

RESUMO

BACKGROUND: Vaccine safety surveillance is an essential requirement in vaccination programmes. It supports signal identification, hypothesis generation, and the identification and rectification of gaps in vaccine pharmacovigilance systems. The objectives of this study were to determine the characteristics and trends of adverse events following immunisation (AEFI) and to assess the performance of the Zimbabwe Expanded Immunisation Programme safety surveillance system. METHODS: We carried out a descriptive study of passively collected vaccine-related Individual Case Safety Report (ICSR) data submitted to the World Health Organization global adverse drug reaction database (VigiBase®) from Zimbabwe during the period 1997 to 2017. We extracted AEFI/ICSR data using VigiLyze® for analysis with respect to the demographic distribution, AEFI characteristics, reporting trends over time, ICSR timeliness and case completeness. RESULTS: A total of 272 vaccine-related ICSRs were included in the analyses with a median completeness score of 0.90 interquartile range, IQR (0.63; 0.90). The overall annual reporting rate was 0.58 per 100,000 vaccine doses and the AEFI reporting ratio ranged between 0 and 30.2 AEFI reports per 100,000 surviving infants. The majority of ICSRs were male (55.3%; p value = 0.641) and the median age was 12 (0-168) months. The majority of ICSRs were reported in children who had received measles (n = 133; 48.9%) and OPV/DTP-Hib-HepB (n = 107; 39.3%) vaccines. Of the 387 observed AEFIs, 301 (77.8%) were systemic events and 86 (22.2%) were local reactions. Systemic events were more frequently reported with doses containing the measles antigen (n = 190; 49.1%) while local events were associated with the multiple antigen OPV/DTP-Hib-HepB (n = 62; 16.0%). The multiple antigen OPV/DTP-Hib-HepB was associated with higher rates for injection site abscess (n = 57), pyrexia (n = 27), diarrhea (n = 15), vomiting (n = 12), and seizures (n = 6). The measles antigen was associated with higher rates for rash (n = 44), ocular disorders (n = 26), pyrexia (n = 26), urticaria (n = 22), diarrhea (n = 8), and vomiting (n = 12). CONCLUSIONS: Most of the ICSRs were associated with measles and OPV/DTP-Hib-HepB vaccines. Zimbabwe's vaccine safety surveillance system is still developing and is not yet fully functional. However, the current system provides a reference point for the monitoring of the ongoing AEFI reporting trends and characteristics.


Assuntos
Sistemas de Notificação de Reações Adversas a Medicamentos/estatística & dados numéricos , Imunização/efeitos adversos , Vigilância da População , Vacinas/efeitos adversos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Programas de Imunização/organização & administração , Lactente , Recém-Nascido , Masculino , Farmacovigilância , Zimbábue/epidemiologia
8.
S D Med ; 72(4): 164-167, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31436929

RESUMO

BACKGROUND: The Sioux Falls Family Medicine Residency serves a large non-English speaking and low socioeconomic status population. We designed a quality initiative to increase influenza and pneumonia vaccination rates in our elderly patients. METHODS: The main components of the project included improved clinic workflow, physician and staff education, and heightened patient awareness of vaccination importance. For the latter, we employed posters with key points about why patients should receive the vaccines, and personalized handouts with a photo of their provider discussing the importance of receiving these vaccines. The handouts were translated into the four most common non-English languages served by our clinics. RESULTS: Following implementation of the initiative, influenza vaccination rates increased from 35 to 53 percent, PPSV23 vaccination rates increased from 62.5 to 64 percent, and most impressively, PCV13 vaccination rates increased from 40 to 60 percent. CONCLUSION: This quality improvement project demonstrated meaningful change with minimal financial and logistical investment and should be sustainable in the long-term.


Assuntos
Programas de Imunização/organização & administração , Vacinas contra Influenza , Influenza Humana/prevenção & controle , Pneumonia/prevenção & controle , Idoso , Medicina de Família e Comunidade , Humanos , Vacinas contra Influenza/administração & dosagem , South Dakota , Vacinação
10.
Sante Publique ; Vol. 31(1): 177-186, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31210512

RESUMO

OBJECTIVE: The objective of this study is to analyze the effect of a technical support aiming to improve vaccine program performance in the 10 health districts (HDs) of Côte d'Ivoire, in which the largest numbers of children not vaccinated against measles were registered. METHOD: These HDs benefited between June 2016 and May 2017, from four quarterly supportive supervisions along with technical support in health logistics and data management and quality. We had followed the evolution of the key indicators in each targeted HD and compared them to the other HDs. RESULTS: The measles containing vaccine coverage (MCVC) had increased and exceeded 80% in 8 out of 10 the targeted HDs. The increase of this MCVC was higher in the targeted HDs (12 points versus 3 points). The number of children not vaccinated against measles had been reduced by 66% and in 8 out of 10 HDs. The global drop-out rate decreased by 13 points in the targeted HDs, whereas it increased by 1 point in the other HDs.The timeliness increased and was more than 80% in 9 of the 10 targeted HDs. The increase of this timeliness was better in the targeted HDs (35 points versus 25 points). The overall quality index was higher in the targeted HDs (90% versus 82%) and the score per component for targeted HDs was better. CONCLUSION: This technical support has have an positive effect on the vaccine performance of targeted HDs. The current challenge is to scale up this type of intervention to all districts in the country.


Assuntos
Programas de Imunização/organização & administração , Vacinação em Massa/organização & administração , Vacina contra Sarampo/administração & dosagem , Sarampo/prevenção & controle , Criança , Costa do Marfim/epidemiologia , Humanos , Programas de Imunização/métodos , Vacinação em Massa/métodos , Vacinação em Massa/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde
11.
Future Microbiol ; 14: 55-58, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31242761

RESUMO

Influenza vaccination rates of healthcare personnel (HCP) have been largely unsatisfactory in Greece. In September 2016, the Ministry of Health established a Steering Committee in order to raise influenza vaccine uptake by HCP. Hereby, we present the results of the actions undertaken by the Steering Committee during the first 2 years of operation. From the 2015-2016 through the 2017-2018 influenza season, influenza vaccination rates among HCP rose from 10.9 to 24.9% in hospitals, and from 24.3 to 40.2% in primary healthcare centers (increases of 128 and 65%, respectively). Rewards were consistently associated with higher vaccine uptake rates among HCP. The following strategies were also significantly associated with increased vaccination rates: vaccination on-site, vaccination of the heads of the departments and promotion of a culture of safety and ethical duty in the workplace.


Assuntos
Pessoal de Saúde/estatística & dados numéricos , Influenza Humana/prevenção & controle , Vacinação/estatística & dados numéricos , Grécia/epidemiologia , Instalações de Saúde , Promoção da Saúde/organização & administração , Promoção da Saúde/estatística & dados numéricos , Humanos , Programas de Imunização/organização & administração , Programas de Imunização/estatística & dados numéricos , Vacinas contra Influenza/administração & dosagem , Influenza Humana/epidemiologia
12.
Artigo em Inglês | MEDLINE | ID: mdl-31233170

RESUMO

INTRODUCTION: Human papillomavirus (HPV) vaccination was included in the national vaccination program in Slovenia in the 2009/2010 school year. It is recommended for girls attending the sixth grade of primary school only and is fully state funded. Based on the initiative of school medicine specialists, Idrija and Cerkno were the first two municipalities to offer municipally sponsored HPV vaccination to boys in the 2014/2015 school year, showing promising results. METHODS: Our aim was to evaluate HPV vaccination coverage among boys attending the sixth grade who received the municipally sponsored HPV vaccine. Data were collected from corresponding physicians from different municipalities. Boys who received less than two doses of HPV vaccine or were HPV vaccinated against payment were excluded from this analysis. RESULTS: The number of municipalities that offer sponsored HPV vaccination of boys increased from two in 2014/2015 to 10 in the 2017/2018 school year. Although the proportion of vaccinated boys was initially relatively low, most municipalities attained at least 50% vaccination coverage rates, which is similar to the current HPV vaccination coverage of girls in Slovenia. CONCLUSIONS: Our data show that the outstanding local initiative by several pediatricians and school medicine specialists can result in HPV vaccine coverage rates of boys that are comparable to or even higher than those in the national vaccination program for girls. Because acceptance of HPV vaccination among boys in Slovenia is adequate, we believe that the inclusion of boys in the national vaccination program, predicted to occur in the 2020/2021 school year, will yield significant results.


Assuntos
Programas de Imunização/organização & administração , Infecções por Papillomavirus/prevenção & controle , Vacinas contra Papillomavirus/administração & dosagem , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Vacinação/estatística & dados numéricos , Adolescente , Humanos , Masculino , Eslovênia
13.
Indian J Public Health ; 63(2): 139-142, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31219063

RESUMO

Temperature excursion and exposure to sub-zero temperatures may reduce the potency of the freeze-sensitive vaccines. This study assessed temperature during vaccine transfers at various levels under the Universal Immunization Program. This cross-sectional study undertaken in 21 districts of three states of India - Bihar (n = 8), Kerala (n = 8), and Gujarat (n = 5). We documented temperature inside the cold boxes and vaccine carriers using LogTag-Trix8 data loggers. In total, 110 vaccine transportation episodes were observed; 55 inter-facility transfers and 55 outreach sessions. Sizable proportions of inter-facility (9% to 35%) and outreach vaccine transfers (18%) were exposed to sub-zero temperature. The proportions of exposure to temperature to >8°C were in the range of 0.8%-11.3% for inter-facility transfers and 2.3% for outreach sessions. The vaccines were exposed to freezing temperatures for significant durations during transportation across the cold chain. Rigorous monitoring of temperature integrity is essential to ensure the delivery of potent vaccines and to avoid vaccine failure.


Assuntos
Programas de Imunização , Potência de Vacina , Vacinas , Estudos Transversais , Armazenamento de Medicamentos , Humanos , Programas de Imunização/métodos , Programas de Imunização/organização & administração , Índia , Refrigeração , Temperatura Ambiente , Transportes
14.
MMWR Morb Mortal Wkly Rep ; 68(24): 539-543, 2019 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-31220058

RESUMO

Before the introduction of rotavirus vaccine in the United States in 2006, rotavirus infection was the leading cause of severe gastroenteritis among U.S. children (1). To evaluate the long-term impact of rotavirus vaccination on disease prevalence and seasonality in the United States, CDC analyzed national laboratory testing data for rotavirus from laboratories participating in CDC's National Respiratory and Enteric Viruses Surveillance System (NREVSS) during the prevaccine (2000-2006) and postvaccine (2007-2018) periods. Nationally, the median annual percentage of tests positive for rotavirus declined from 25.6% (range = 25.2-29.4) in the prevaccine period to 6.1% (range = 2.6-11.1) in the postvaccine period. When compared with the prevaccine period, the postvaccine period saw declines in the annual peak in rotavirus positivity from a median of 43.1% (range = 43.8-56.3) to a median of 14.0% (range = 4.8-27.3) and in the season duration from a median of 26 weeks (range = 23-27) to a median of 9 weeks (range = 0-18). In the postvaccine period, a biennial pattern emerged, with alternating years of low and high rotavirus activity. Implementation of the rotavirus vaccination program has substantially reduced prevalence of the disease and altered seasonal patterns of rotavirus in the United States; these changes have been sustained over 11 seasons after vaccine introduction. Ongoing efforts to improve coverage and on-time vaccination (2) can help maximize the public health impact of rotavirus vaccination.


Assuntos
Programas de Imunização/organização & administração , Laboratórios/tendências , Vigilância da População , Infecções por Rotavirus/diagnóstico , Infecções por Rotavirus/prevenção & controle , Vacinas contra Rotavirus/administração & dosagem , Rotavirus/isolamento & purificação , Criança , Humanos , Lactente , Avaliação de Programas e Projetos de Saúde , Infecções por Rotavirus/epidemiologia , Estações do Ano , Estados Unidos/epidemiologia
15.
Pediatrics ; 144(1)2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31209158

RESUMO

BACKGROUND: High-quality evidence indicates that intervening with health care providers improves human papillomavirus (HPV) vaccine delivery. However, scaling up evidence-based strategies in real-world clinical practice remains challenging. We sought to improve the reach and impact of strategies for HPV vaccination quality improvement (QI) through local adaptation and implementation in a large, not-for-profit health care system. METHODS: We conducted an HPV vaccination QI program using existing materials to support physician training coupled with assessment and feedback. Local physicians with high HPV vaccination rates facilitated training, which included didactic instruction and video vignettes modeling effective communication. We randomly assigned 25 clinics with 77 physicians to the QI arm or the wait-list control arm. We used hierarchical linear models to assess HPV vaccination coverage (≥1 dose) over 6 months among patients aged 12 to 14. RESULTS: Of 45 physicians in the QI arm, the program reached 43 (95%) with training plus assessment and feedback. In the overall sample, HPV vaccination coverage increased in both the QI and control arms (8.6 vs 6.4 percentage points, respectively), although the 2.2-percentage point difference did not reach statistical significance. Sensitivity analyses that excluded physicians with poor data quality indicated a statistically significant advantage of 3.3 percentage points for QI versus control (b = 0.034; SE = 0.015; P < .05). CONCLUSIONS: Our locally adapted QI program achieved excellent reach, with small improvements in HPV vaccination coverage. Future implementation research is needed to bolster program impact and support health systems in leveraging local resources to conduct these programs efficiently.


Assuntos
Serviços de Saúde da Criança/organização & administração , Assistência à Saúde/normas , Programas de Imunização/organização & administração , Infecções por Papillomavirus/prevenção & controle , Vacinas contra Papillomavirus , Adolescente , Criança , Serviços de Saúde da Criança/normas , Prática Clínica Baseada em Evidências , Humanos , Programas de Imunização/normas , Avaliação de Programas e Projetos de Saúde , Melhoria de Qualidade , Texas , Cobertura Vacinal
16.
Pan Afr Med J ; 32: 123, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31223412

RESUMO

Introduction: the government of Uganda aims at reducing childhood morbidity through provision of immunization services. We compared the proportion of children 12-33 months reached using either static or outreach immunization strategies and factors affecting utilization of routine vaccination services in order to inform policy updates. Methods: we adopted the 2015 vaccination coverage cluster survey technique. The sample selection was based on a stratified three-stage sample design. Using the Fleiss formula, a sample of 50 enumeration areas was sufficient to generate immunization coverages at each region. A total of 200 enumeration areas were selected for the survey. Thirty households were selected per enumeration area. Epi-Info software was used to calculate weighted coverage estimates. facility. Results: among the 2231 vaccinated children aged 12-23 months who participated in the survey, 68.1% received immunization services from a health unit and 10.6% from outreaches. The factors that affected utilization of routine vaccination services were; accessibility, where 78.2% resided within 5km from a health. 29.7% missed vaccination due to lack of vaccines at the health facility. Other reasons were lack of supplies at 39.2% and because the caretaker had other things to do, 26.4%. The survey showed 1.8% (40/2271) respondents had not vaccinated their children. Among these, 70% said they had not vaccinated their child because they were busy doing other things and 27.5% had not done so because of lack of motivation. Conclusion: almost 7 in 10 children aged 12-23 months access vaccination at health facilities. There is evidence of parental apathy as well as misconceptions about vaccination.


Assuntos
Programas de Imunização/organização & administração , Imunização/métodos , Vacinação/métodos , Vacinas/administração & dosagem , Apatia , Feminino , Política de Saúde , Acesso aos Serviços de Saúde , Humanos , Lactente , Masculino , Pais/psicologia , Inquéritos e Questionários , Uganda , Cobertura Vacinal
19.
Int J Health Policy Manag ; 8(4): 211-221, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-31050966

RESUMO

BACKGROUND: Military conflict has been an ongoing determinant of inequitable immunisation coverage in many low- and middle-income countries, yet the impact of conflict on the attainment of global health goals has not been fully addressed. This review will describe and analyse the association between conflict, immunisation coverage and vaccine-preventable disease (VPD) outbreaks, along with country specific strategies to mitigate the impact in 16 countries. METHODS: We cross-matched immunisation coverage and VPD data in 2014 for displaced and refugee populations. Data on refugee or displaced persons was sourced from the United Nations High Commissioner for Refugees (UNHCR) database, and immunisation coverage and disease incidence data from World Health Organization (WHO) databases. Demographic and Health Survey (DHS) databases provided additional data on national and sub-national coverage. The 16 countries were selected because they had the largest numbers of registered UNHCR "persons of interest" and received new vaccine support from Global Alliance for Vaccine and Immunisation (GAVI), the Vaccine Alliance. We used national planning and reporting documentation including immunisation multiyear plans, health system strengthening strategies and GAVI annual progress reports (APRs) to assess the impact of conflict on immunisation access and coverage rates, and reviewed strategies developed to address immunisation program shortfalls in conflict settings. We also searched the peer-reviewed literature for evidence that linked immunisation coverage and VPD outbreaks with evidence of conflict. RESULTS: We found that these 16 countries, representing just 12% of the global population, were responsible for 67% of global polio cases and 39% of global measles cases between 2010 and 2015. Fourteen out of the 16 countries were below the global average of 85% coverage for diphtheria, pertussis, and tetanus (DPT3) in 2014. We present data from countries where the onset of conflict has been associated with sudden drops in national and sub-national immunisation coverage. Tense security conditions, along with damaged health infrastructure and depleted human resources have contributed to infrequent outreach services, and delays in new vaccine introductions and immunisation campaigns. These factors have in turn contributed to pockets of low coverage and disease outbreaks in sub-national areas affected by conflict. Despite these impacts, there was limited reference to the health needs of conflict affected populations in immunisation planning and reporting documents in all 16 countries. Development partner investments were heavily skewed towards vaccine provision and working with partner governments, with comparatively low levels of health systems support or civil partnerships. CONCLUSION: Global and national policy and planning focus is required on the service delivery needs of conflict affected populations, with increased investment in health system support and civil partnerships, if persistent immunisation inequities in conflict affected areas are to be addressed.


Assuntos
Conflitos Armados , Controle de Doenças Transmissíveis/organização & administração , Disparidades em Assistência à Saúde/organização & administração , Programas de Imunização/organização & administração , Cobertura Vacinal/organização & administração , Humanos , Esquemas de Imunização , Fatores Socioeconômicos
20.
Health Policy Plan ; 34(4): 271-281, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31074778

RESUMO

The Global Vaccine Action Plan proposes that every country establish or have access to a National Immunization Technical Advisory Group (NITAG) by 2020. The NITAG role is to produce evidence-informed recommendations that incorporate local context, to guide national immunization policies and practice. This study aimed to explore the value and effectiveness of NITAGs in low- and middle-income countries (LMICs), identifying areas in which NITAGs may require further support to improve their functionality and potential barriers to global investment. A multi-methods study design was used, comprising 134 semi-structured interviews and 82 literature review sources that included 38 countries. Interviews were conducted with 53 global/regional and 81 country-level participants able to provide insight into NITAG effectiveness, including NITAG members, national immunization programme staff, and global agency representatives (e.g. the World Health Organisation, the Bill and Melinda Gates Foundation, Gavi the Vaccine Alliance). The review, including published and unpublished sources on NITAGs in LMICs, was conducted to supplement and corroborate interview findings. Data were analysed thematically. NITAGs were described as valuable in promoting evidence-informed vaccination decision-making, with NITAG involvement enhancing national immunization programme strength and sustainability. Challenges to NITAG effectiveness included: (1) unreliable funding; (2) insufficient diversity of member expertise; (3) inadequate conflicts of interest management procedures; (4) insufficient capacity to access and use evidence; (5) lack of transparency; and (6) limited integration with national decision-making processes that reduced the recognition and incorporation of NITAG recommendations. LMIC NITAGs have developed significantly in the past decade. Well-functioning NITAGs were trusted national resources that enhanced country ownership of immunization provision. However, many LMIC NITAGs require additional technical and funding support to strengthen quality and effectiveness, while maintaining impartiality and ensuring sufficient integration with national decision-making processes. Barriers to sustainable global support need to be addressed for LMIC NITAGs to both continue and develop further.


Assuntos
Comitês Consultivos/organização & administração , Programas de Imunização/organização & administração , Tomada de Decisões Gerenciais , Países em Desenvolvimento , Prática Clínica Baseada em Evidências , Política de Saúde , Humanos , Programas de Imunização/economia , Programas de Imunização/normas , Avaliação de Programas e Projetos de Saúde , Pesquisa Qualitativa , Vacinação/legislação & jurisprudência
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