RESUMO
During 2013, the 11 countries of the World Health Organization (WHO) South-East Asia Region* (SEAR) adopted the goals of measles elimination and rubella and congenital rubella syndrome (CRS) control by 2020. During 2019, SEAR countries declared a broader goal for eliminating both measles and rubella§ by 2023 (1). Before 2013, only five SEAR countries had introduced rubella-containing vaccine (RCV). This report updates a previous report and describes progress toward rubella elimination in SEAR during 2013-2021 (2). During 2013-2021, six SEAR countries introduced RCV; all countries in the Region now use RCV in routine immunization. Routine immunization coverage with the first dose of a rubella-containing vaccine (RCV1) increased >600%, from 12% during 2013 to 86% during 2021, and an estimated 515 million persons were vaccinated via RCV supplementary immunization activities (SIAs)¶ during 2013-2021. During this time, annual reported rubella incidence declined by 80%, from 5.5 to 1.1 cases per million population. Maldives and Sri Lanka are verified as having achieved rubella elimination; Bhutan, North Korea, and Timor-Leste have halted endemic transmission of rubella virus for >36 months. SEAR has made substantial progress toward rubella elimination; however, intensified measures are needed to achieve elimination.
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Síndrome da Rubéola Congênita , Vacina contra Rubéola , Rubéola (Sarampo Alemão) , Humanos , Ásia Oriental , Erradicação de Doenças , Programas de Imunização , Vigilância da População , Rubéola (Sarampo Alemão)/epidemiologia , Rubéola (Sarampo Alemão)/prevenção & controle , Síndrome da Rubéola Congênita/epidemiologia , Síndrome da Rubéola Congênita/prevenção & controle , Vacina contra Rubéola/administração & dosagem , Organização Mundial da SaúdeRESUMO
In 2019, Indonesia and the other countries in the World Health Organization South-East Asia Region adopted the goal of measles and rubella elimination by 2023. This report describes Indonesia's progress toward measles and rubella elimination during 2013-2022. During this period, coverage with a first dose of measles-containing vaccine (MCV) decreased from 87% to 84%, and coverage with a second MCV dose decreased from 76% to 67%. After rubella vaccine was introduced in 2017, coverage with the first dose of rubella-containing vaccine increased approximately fivefold, from 15% in 2017 to 84% in 2022. During 2013-2021, annual reported measles incidence decreased by 95%, from 33.2 to 1.4 cases per million population; reported rubella incidence decreased 89%, from 9.3 to 1.0 cases per million population. However, a large surge in measles and rubella cases occurred in 2022, with a reported measles incidence of 29 cases per million and a reported rubella incidence of 3 per million, primarily related to disruption in immunization services caused by the COVID-19 pandemic. In 2022, approximately 26 million children (an estimated 73% of the target population) received a combined measles- and rubella-containing vaccine during supplementary immunization activities completed in 32 provinces. Progress toward measles and rubella elimination in Indonesia has been made; however, continued and urgent efforts are needed to restore routine immunization services that were adversely affected by the COVID-19 pandemic and close immunity gaps to accelerate progress toward measles and rubella elimination.
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Erradicação de Doenças , Vacina contra Sarampo , Sarampo , Vacina contra Rubéola , Rubéola (Sarampo Alemão) , Criança , Humanos , Lactente , COVID-19/epidemiologia , Erradicação de Doenças/tendências , Programas de Imunização , Incidência , Indonésia/epidemiologia , Sarampo/epidemiologia , Sarampo/prevenção & controle , Vacina contra Sarampo/administração & dosagem , Pandemias , Vigilância da População , Rubéola (Sarampo Alemão)/epidemiologia , Rubéola (Sarampo Alemão)/prevenção & controle , Vacina contra Rubéola/administração & dosagemRESUMO
In 2013, member states of the World Health Organization (WHO) South-East Asia Region* (SEAR) adopted the goal of measles elimination and rubella and congenital rubella syndrome control by 2020 (1). In 2014, to provide impetus toward achieving this goal, the Regional Director declared measles elimination and rubella control one of the Regional Flagship Priorities. In 2019, SEAR member states declared a revised goal of eliminating both measles and rubella§ by 2023 (2). The recommended strategies to achieve elimination include 1) achieving and maintaining ≥95% coverage with 2 doses of measles- and rubella-containing vaccine in every district through routine or supplementary immunization activities¶ (SIAs); 2) developing and sustaining a sensitive and timely case-based surveillance system that meets recommended performance indicators**; 3) developing and maintaining an accredited laboratory network; 4) achieving timely identification, investigation, and response to measles outbreaks; and 5) collaborating with other public health initiatives to achieve the preceding four strategies. This report updates a previous report and describes progress toward measles elimination in SEAR during 2003-2020 (3). In 2002, coverage with the first dose of a measles-containing vaccine in routine immunization (MCV1) was 70%, and only three countries in SEAR had added a second routine dose of measles-containing vaccine in routine immunization (MCV2). During 2003-2020, all countries introduced MCV2, and estimated coverage with MCV1 increased 35%, from 65% to 88%, and coverage with MCV2 increased 1,233% from 6% to 80%. Approximately 938 million persons were vaccinated in SIAs. Annual reported measles incidence declined by 92%, from 57.0 to 4.8 cases per 1 million population, and estimated deaths decreased by 97%; an estimated 9.3 million deaths were averted by measles vaccination. By 2020, five countries were verified as having achieved measles elimination. To achieve measles elimination in the region by 2023, additional efforts are urgently needed to strengthen routine immunization services and improve measles-containing vaccine (MCV) coverage, conduct periodic high-quality SIAs, and strengthen measles case-based surveillance and laboratory capacity.
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Sarampo , Rubéola (Sarampo Alemão) , Erradicação de Doenças , Ásia Oriental/epidemiologia , Humanos , Programas de Imunização , Esquemas de Imunização , Incidência , Lactente , Sarampo/epidemiologia , Sarampo/prevenção & controle , Vacina contra Sarampo , Vigilância da População , Vacina contra RubéolaRESUMO
In 2019, India, along with other countries in the World Health Organization (WHO) South-East Asia Region,* adopted the goal of measles and rubella elimination by 2023, a revision of the previous goal of measles elimination and control of rubella and congenital rubella syndrome (CRS) by 2020§ (1-3). During 2017-2021, India adopted a national strategic plan for measles and rubella elimination (4), introduced rubella-containing vaccine (RCV) into the routine immunization program, launched a nationwide measles-rubella supplementary immunization activity (SIA) catch-up campaign, transitioned from outbreak-based surveillance to case-based acute fever and rash surveillance, and more than doubled the number of laboratories in the measles-rubella network, from 13 to 27. Strategies included 1) achieving and maintaining high population immunity with at least 95% vaccination coverage by providing 2 doses of measles- and rubella-containing vaccines; 2) ensuring a sensitive and timely case-based measles, rubella and CRS surveillance system; 3) maintaining an accredited measles and rubella laboratory network; 4) ensuring adequate outbreak preparedness and rapid response to measles and rubella outbreaks; and 5) strengthening support and linkages to achieve these strategies, including planning and progress monitoring, advocacy, social mobilization and communication, identification and utilization of synergistic linkages of integrated program efforts, research, and development. This report describes India's progress toward the elimination of measles and rubella during 2005-2021, with a focus on the years 2017-2021.¶ During 2005-2021, coverage with the first dose of a measles-containing vaccine (MCV) administered through routine immunization increased 31%, from 68% to 89%. During 2011-2021, coverage with a second MCV dose (MCV2) increased by 204%, from 27% to 82%. During 2017-2021, coverage with a first dose of RCV (RCV1) increased almost 14-fold, from 6% to 89%. More than 324 million children received a measles- and rubella-containing vaccine (MRCV) during measles-rubella SIAs completed in 34 (94%) of 36 states and union territories (states) during 2017-2019. During 2017-2021, annual measles incidence decreased 62%, from 10.4 to 4.0 cases per 1 million population, and rubella incidence decreased 48%, from 2.3 to 1.2 cases per 1 million population. India has made substantial progress toward measles and rubella elimination; however, urgent and intensified efforts are required to achieve measles and rubella elimination by 2023.
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Sarampo , Síndrome da Rubéola Congênita , Rubéola (Sarampo Alemão) , Criança , Humanos , Lactente , Erradicação de Doenças , Esquemas de Imunização , Vigilância da População , Sarampo/epidemiologia , Sarampo/prevenção & controle , Vacina contra Sarampo , Rubéola (Sarampo Alemão)/epidemiologia , Rubéola (Sarampo Alemão)/prevenção & controle , Programas de Imunização , Vacina contra Rubéola , Síndrome da Rubéola Congênita/epidemiologia , Síndrome da Rubéola Congênita/prevenção & controleRESUMO
In 2013, the 66th session of the Regional Committee of the World Health Organization (WHO) South-East Asia Region (SEAR)* adopted the goal of elimination of measles and control of rubella and congenital rubella syndrome (CRS) by 2020 (1). Rubella is the leading vaccine-preventable cause of birth defects. Although rubella typically causes a mild fever and rash in children and adults, rubella virus infection during pregnancy, especially during the first trimester, can result in miscarriage, fetal death, or a constellation of congenital malformations known as CRS, commonly including visual, auditory, and/or cardiac defects, and developmental delay (2). Rubella and CRS control capitalizes on the momentum created by pursuing measles elimination because the efforts are programmatically linked. Rubella-containing vaccine (RCV) is administered as a combined measles and rubella vaccine, and rubella cases are detected through case-based surveillance for measles or fever and rash illness (3). This report summarizes progress toward rubella and CRS control in SEAR during 2000-2016. Estimated coverage with a first RCV dose (RCV1) increased from 3% of the birth cohort in 2000 to 15% in 2016 because of RCV introduction in six countries. RCV1 coverage is expected to increase rapidly with the phased introduction of RCV in India and Indonesia beginning in 2017; these countries are home to 83% of the SEAR birth cohort. During 2000-2016, approximately 83 million persons were vaccinated through 13 supplemental immunization activities (SIAs) conducted in eight countries. During 2010-2016, reported rubella incidence decreased by 37%, from 8.6 to 5.4 cases per 1 million population, and four countries (Bangladesh, Maldives, Sri Lanka, and Thailand) reported a decrease in incidence of ≥95% since 2010. To achieve rubella and CRS control in SEAR, sustained investment to increase routine RCV coverage, periodic high-quality SIAs to close immunity gaps, and strengthened rubella and CRS surveillance are needed.
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Surtos de Doenças/prevenção & controle , Vigilância da População , Síndrome da Rubéola Congênita/prevenção & controle , Vacina contra Rubéola/administração & dosagem , Vírus da Rubéola/isolamento & purificação , Rubéola (Sarampo Alemão)/prevenção & controle , Adolescente , Adulto , Sudeste Asiático/epidemiologia , Criança , Pré-Escolar , Surtos de Doenças/estatística & dados numéricos , Feminino , Genótipo , Humanos , Esquemas de Imunização , Incidência , Lactente , Masculino , Rubéola (Sarampo Alemão)/epidemiologia , Síndrome da Rubéola Congênita/epidemiologia , Vírus da Rubéola/genética , Cobertura Vacinal/estatística & dados numéricos , Adulto JovemRESUMO
In 2013, during the 66th session of the Regional Committee of the World Health Organization (WHO) South-East Asia Region (SEAR), the 11 SEAR countries* adopted goals to eliminate measles and control rubella and congenital rubella syndrome by 2020 (1). To accelerate progress in India (2,3), a phased§ nationwide supplementary immunization activity (SIA)¶ using measles-rubella vaccine and targeting approximately 410 million children aged 9 months-14 years commenced in 2017 and will be completed by first quarter of 2019. To ensure a high-quality SIA, planning and preparation were monitored using a readiness assessment tool adapted from the WHO global field guide** (4) by the India Ministry of Health and Family Welfare. This report describes the results and experience gained from conducting SIA readiness assessments in 24 districts of three Indian states (Andhra Pradesh, Kerala, and Telangana) during the second phase of the SIA. In each selected area, assessments were conducted 4-6 weeks and 1-2 weeks before the scheduled SIA. At the first assessment, none of the states and districts were on track with preparations for the SIA. However, at the second assessment, two (67%) states and 21 (88%) districts were on track. The SIA readiness assessment identified several preparedness gaps; early assessment results were immediately communicated to authorities and led to necessary corrective actions to ensure high-quality SIA implementation.
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Programas de Imunização/organização & administração , Vacina contra Sarampo/administração & dosagem , Sarampo/prevenção & controle , Vacina contra Rubéola/administração & dosagem , Rubéola (Sarampo Alemão)/prevenção & controle , Adolescente , Criança , Pré-Escolar , Humanos , Índia , Lactente , Avaliação de Programas e Projetos de SaúdeRESUMO
In 2013, at the 66th session of the Regional Committee of the World Health Organization (WHO) South-East Asia Region (SEAR), a regional goal was established to eliminate measles and control rubella and congenital rubella syndrome* by 2020 (1). WHO-recommended measles elimination strategies in SEAR countries include 1) achieving and maintaining ≥95% coverage with 2 doses of measles-containing vaccine (MCV) in every district, delivered through the routine immunization program or through supplementary immunization activities (SIAs); 2) developing and sustaining a sensitive and timely measles case-based surveillance system that meets targets for recommended performance indicators; and 3) developing and maintaining an accredited measles laboratory network (2). In 2014, Bangladesh, one of 11 countries in SEAR, adopted a national goal for measles elimination by 2018 (2,3). This report describes progress and challenges toward measles elimination in Bangladesh during 2000-2016. Estimated coverage with the first MCV dose (MCV1) increased from 74% in 2000 to 94% in 2016. The second MCV dose (MCV2) was introduced in 2012, and MCV2 coverage increased from 35% in 2013 to 93% in 2016. During 2000-2016, approximately 108.9 million children received MCV during three nationwide SIAs conducted in phases. During 2000-2016, reported confirmed measles incidence decreased 82%, from 34.2 to 6.1 per million population. However, in 2016, 56% of districts did not meet the surveillance performance target of ≥2 discarded nonmeasles, nonrubella cases§ per 100,000 population. Additional measures that include increasing MCV1 and MCV2 coverage to ≥95% in all districts with additional strategies for hard-to-reach populations, increasing sensitivity of measles case-based surveillance, and ensuring timely transport of specimens to the national laboratory will help achieve measles elimination.
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Erradicação de Doenças , Sarampo/epidemiologia , Sarampo/prevenção & controle , Vigilância da População , Adolescente , Bangladesh/epidemiologia , Criança , Pré-Escolar , Humanos , Programas de Imunização , Incidência , Lactente , Vacina contra Sarampo/administração & dosagem , Vírus do Sarampo/genética , Vírus do Sarampo/isolamento & purificação , Vacinação/estatística & dados numéricosRESUMO
In 2012, the Global Vaccine Action Plan* established a goal to achieve measles and rubella elimination in five of the six World Health Organization (WHO) regions (194 countries) by 2020 (1). Measles elimination strategies aim to achieve ≥95% coverage with 2 routine doses of measles-containing vaccine (2), and implement supplementary immunization activities (SIAs) in settings where routine coverage is low or where there are subpopulations at high risk. To ensure SIA quality and to achieve ≥95% SIA coverage nationally, rapid convenience monitoring (RCM) is used during or immediately after SIAs (3,4). The objective of RCM is to find unvaccinated children and to identify reasons for nonvaccination in areas with persons at high risk, to enable immediate implementation of corrective actions (e.g., reassigning teams to poorly vaccinated areas, modifying the timing of vaccination, or conducting mop-up vaccination activities). This report describes pilot testing of RCM using mobile phones (RCM-MP) during the second phase of an SIA in Nepal in 2016. Use of RCM-MP resulted in 87% timeliness and 94% completeness of data reporting and found that, although 95% of children were vaccinated, 42% of areas required corrective vaccination activities. RCM-MP challenges included connecting to mobile networks, small phone screen size, and capturing Global Positioning System (GPS) coordinates. Nonetheless, use of RCM-MP led to faster data transmission, analysis, and decision-making and to increased accountability among levels of the health system.
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Telefone Celular , Programas de Imunização , Vacina contra Sarampo/administração & dosagem , Vigilância da População/métodos , Vacina contra Rubéola/administração & dosagem , Vacinação/estatística & dados numéricos , Pré-Escolar , Erradicação de Doenças , Humanos , Lactente , Sarampo/prevenção & controle , Nepal , Avaliação de Programas e Projetos de Saúde , Rubéola (Sarampo Alemão)/prevenção & controleRESUMO
In 2013, the 66th session of the Regional Committee of the World Health Organization (WHO) South-East Asia Region (SEAR) established a goal to eliminate measles and to control rubella and congenital rubella syndrome (CRS) in SEAR by 2020. Current recommended measles elimination strategies in the region include 1) achieving and maintaining ≥95% coverage with 2 doses of measles-containing vaccine (MCV) in every district, delivered through the routine immunization program or through supplementary immunization activities (SIAs); 2) developing and sustaining a sensitive and timely measles case-based surveillance system that meets minimum recommended performance indicators; 3) developing and maintaining an accredited measles laboratory network; and 4) achieving timely identification, investigation, and response to measles outbreaks. In 2013, Nepal, one of the 11 SEAR member states, adopted a goal for national measles elimination by 2019. This report updates a previous report and summarizes progress toward measles elimination in Nepal during 2007-2014. During 2007-2014, estimated coverage with the first MCV dose (MCV1) increased from 81% to 88%. Approximately 3.9 and 9.7 million children were vaccinated in SIAs conducted in 2008 and 2014, respectively. Reported suspected measles incidence declined by 13% during 2007-2014, from 54 to 47 cases per 1 million population. However, in 2014, 81% of districts did not meet the measles case-based surveillance performance indicator target of ≥2 discarded non-measles cases per 100,000 population per year. To achieve and maintain measles elimination, additional measures are needed to strengthen routine immunization services to increase coverage with MCV1 and a recently introduced second dose of MCV (MCV2) to ≥95% in all districts, and to enhance sensitivity of measles case-based surveillance by adopting a more sensitive case definition, expanding case-based surveillance sites nationwide, and ensuring timely transport of specimens to the accredited national laboratory.
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Erradicação de Doenças , Sarampo/epidemiologia , Sarampo/prevenção & controle , Vigilância da População , Humanos , Programas de Imunização , Esquemas de Imunização , Incidência , Lactente , Vacina contra Sarampo/administração & dosagem , Vírus do Sarampo/isolamento & purificação , Nepal/epidemiologia , Vacinação/estatística & dados numéricosRESUMO
In 2013, the 66th session of the Regional Committee of the World Health Organization (WHO) South-East Asia Region adopted the goal of measles elimination and rubella and congenital rubella syndrome control by 2020 after rigorous prior consultations. The recommended strategies include 1) achieving and maintaining ≥95% coverage with 2 doses of measles- and rubella-containing vaccine in every district through routine or supplementary immunization activities (SIAs); 2) developing and sustaining a sensitive and timely case-based measles surveillance system that meets recommended performance indicators; 3) developing and maintaining an accredited measles laboratory network; and 4) achieving timely identification, investigation, and response to measles outbreaks. This report updates previous reports and summarizes progress toward measles elimination in the South-East Asia Region during 2003-2013. Within the region, coverage with the first dose of a measles-containing vaccine (MCV1) increased from 67% to 78%; an estimated 286 million children (95% of the target population) were vaccinated in SIAs; measles incidence decreased 73%, from 59 to 16 cases per million population; and estimated measles deaths decreased 63%. To achieve measles elimination in the region, additional efforts are needed in countries with <95% 2-dose routine MCV coverage, particularly in India and Indonesia, to strengthen routine immunization services, conduct periodic high-quality SIAs, and strengthen measles case-based surveillance and laboratory diagnosis of measles.
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Erradicação de Doenças , Sarampo/epidemiologia , Sarampo/prevenção & controle , Vigilância da População , Sudeste Asiático/epidemiologia , Criança , Pré-Escolar , Genótipo , Humanos , Programas de Imunização , Incidência , Lactente , Vacina contra Sarampo/administração & dosagem , Vírus do Sarampo/genética , Vírus do Sarampo/isolamento & purificaçãoRESUMO
BACKGROUND: An estimated 2.8 million neonatal deaths occur annually worldwide. The vulnerability of newborns makes the timeliness of seeking and receiving care critical for neonatal survival and prevention of long-term sequelae. To better understand the role active referrals by community health workers play in neonatal careseeking, we synthesize data on referral completion rates for neonates with danger signs predictive of mortality or major morbidity in low- and middle-income countries. METHODS: A systematic review was conducted in May 2014 of the following databases: Medline-PubMed, Embase, and WHO databases. We also searched grey literature. In addition, an investigator group was established to identify unpublished data on newborn referral and completion rates. Inquiries were made to the network of research groups supported by Save the Children's Saving Newborn Lives project and other relevant research groups. RESULTS: Three Sub-Saharan African and five South Asian studies reported data on community-to-facility referral completion rates. The studies varied on factors such as referral rates, the assessed danger signs, frequency of home visits in the neonatal period, and what was done to facilitate referrals. Neonatal referral completion rates ranged from 34 to 97 %, with the median rate of 74 %. Four studies reported data on the early neonatal period; early neonatal completion rates ranged from 46 to 97 %, with a median of 70 %. The definition of referral completion differed by studies, in aspects such as where the newborns were referred to and what was considered timely completion. CONCLUSIONS: Existing literature reports a wide range of neonatal referral completion rates in Sub-Saharan Africa and South Asia following active illness surveillance. Interpreting these referral completion rates is challenging due to the great variation in study design and context. Often, what qualifies as referral and/or referral completion is poorly defined, which makes it difficult to aggregate existing data to draw appropriate conclusions that can inform programs. Further research is necessary to continue highlighting ways for programs, governments, and policymakers to best aid families in low-resource settings in protecting their newborns from major health consequences.
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Agentes Comunitários de Saúde , Instalações de Saúde , Visita Domiciliar , Morbidade , Morte Perinatal/prevenção & controle , Encaminhamento e Consulta , Características de Residência , África Subsaariana , Ásia , Serviços de Saúde Comunitária , Humanos , Recém-Nascido , Encaminhamento e Consulta/estatística & dados numéricosRESUMO
The Government of India, in collaboration with the World Health Organization (WHO), established the National Polio Surveillance Project (NPSP) in 1997 and initiated acute flaccid paralysis (AFP) surveillance to achieve the goal of polio eradication. The WHO South-East Asia Region, comprising of 11 countries, including India, was certified as polio-free in March 2014. India was also validated to have eliminated maternal and neonatal tetanus in May 2015. Over the years, the surveillance of other vaccine-preventable diseases (VPDs) was integrated with AFP surveillance in the country. Outbreak-based measles-rubella (MR) surveillance was initiated in 2005 using AFP surveillance as a platform, case-based fever-rash (FR) surveillance started in 2021 as one of the strategies to achieve measles and rubella elimination in the country. The surveillance of diphtheria, pertussis, and neonatal tetanus was integrated with AFP surveillance in a phased manner during 2015-2022. The surveillance system for VPDs in India, supported by a laboratory network of 10 polio laboratories, 28 measles-rubella laboratories, and 20 diphtheria-pertussis laboratories, has enhanced the national health capacity and security. The setting up and expansion of the surveillance system in the country involved the important component of capacity building of personnel on various components of surveillance, including case identification, case investigation, sample collection and shipment, data analysis and public health response. These capacities have been used effectively during other emergencies, such as the recent COVID-19 pandemic, as well as during outbreaks of other diseases and natural calamities.
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Since the World Health Assembly (WHA) in 2012 endorsed the Global Vaccine Action Plan (GVAP), which included regional measles and rubella elimination goals by 2020, global progress towards verification of measles and rubella elimination has been incremental. Even though the 2020 elimination goals were not achieved, commitment towards achieving measles and rubella elimination has been firmly established in the Immunization Agenda 2030 (IA2030) and the Measles and Rubella Strategic Framework (MRSF) 2021-2030. In 2023, the six Regional Verification Commissions for measles and rubella elimination (RVCs) reviewed data as of 31 December 2022 and confirmed that 82 (42%) Member States have been verified for measles elimination, and 98 (51%) Member States have been verified for rubella elimination. The six RVCs are composed of independent public health and immunization experts who are well-placed to support accelerating measles and rubella elimination. RVCs should be leveraged not only to review elimination documents but also to advocate for and champion public health programming that supports measles and rubella activities. The verification of elimination process is one of many tools that should be deployed to reinforce and accelerate efforts towards achieving a world free of measles and rubella.
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The South-East Asia Region (SEAR) adopted the goal of "measles and rubella elimination by 2023". The goal was revised in 2019 to 'measles and rubella elimination by 2023' The strategies adopted to reach the goal included achieving ≥95% coverage with 2 doses of measles- and rubella-containing vaccine (MCV2; RCV2); establishing effective case-based surveillance supported by an accredited laboratory network; and implementing rapid response measures to control measles outbreaks. Of the 11 countries in the Region, to date five countries have eliminated measles and rubella and two more have controlled rubella. An estimated 242 million cases and 4.7 million deaths due to measles were averted between 2014 and 2022. The high-level political commitment, programmatic infrastructure and partnerships developed for the elimination of polio and maternal and neonatal tetanus played a critical role in this achievement. WHO, supported by key partners, provided technical support and strategic guidance for programmatic improvements, generated evidence to guide policy and strategic shifts, strengthened capacity of health workforce and conducted periodic programmatic reviews. However, unexpected occurrence of COVID-19 pandemic impacted vaccine coverage and quality of surveillance, thereby delaying achievement of the goal, and necessitating a revision of the target date of elimination.
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Country-owned, as opposed to donor-driven, is a principle within the development sector that recognizes the centrality of countries' leadership, systems, and resources in executing programs and achieving sustainable development. In alignment with this notion, the Immunization Agenda 2030 was developed with country ownership as one of four core principles of the ambitious ten-year plan. This means that the success of immunization programs, including those with eradication and elimination goals such as polio, measles, and rubella, and those with broader equity goals to "leave no one behind" on immunization, would be largely driven by country systems. In this paper we deconstruct country ownership into five operational principles: commitment, coordination, capacity, community participation, and accountability. Through this lens, we illustrate how two countries, Nepal and Nigeria, have exemplified country ownership in their measles and rubella elimination programs and we infer the ways in which country ownership drives system performance and sustains program efforts.
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The mortality rates of infants and children aged less than five years are declining globally and in Nepal but less among neonates. Most deliveries occur at home without skilled attendants, and most neonates may not receive appropriate care through the existing medical systems. So, a community-based pilot programme-Morang Innovative Neonatal Intervention (MINI) programme-was implemented in Morang district of Nepal to see the feasibility of bringing the management of sick neonates closer to home. The objective of this model was to answer the question: "Can a team of female community health volunteers and paid facility-based community health workers (collectively called CHWs) within the existing heath system correctly follow a set of guidelines to identify possible severe bacterial infection in neonates and young infants and successfully deliver their treatment?" In the MINI model, the CHWs followed an algorithm to classify sick young infants with possible severe bacterial infection (PSBI). Female Community Health Volunteers (FCHVS) were trained to visit homes soon after delivery, record the birth, counsel mothers on essential newborn care, and assess the newborns for danger-signs. Infants classified as having PSBI, during this or subsequent contacts, were treated with co-trimoxazole and referred to facility-based CHWs for seven-day treatment with injection gentamicin. Additional supervisory support was provided for quality of care and intensified monitoring. Of 11,457 livebirths recorded during May 2005-April 2007, 1,526 (13.3%) episodes of PSBI were identified in young infants. Assessment of signs by the FCHVs matched that of more highly-trained facility-based CHWs in over 90% of episodes. Treatment was initiated in 90% of the PSBI episodes; 93% completed a full course of gentamicin. Case fatality in those who received treatment with gentamicin was 1.5% [95% confidence interval (CI) 1.0-2.3] compared to 5.3% (95% CI 2.6-9.7) in episodes that did not receive any treatment. Within the existing government health infrastructure, the CHWs can assess and identify possible infections in neonates and young infants and deliver appropriate treatment with antibiotics. This will result in improvement in the likelihood of survival and address one of the main causes of neonatal mortality.
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Infecções Bacterianas/diagnóstico , Serviços de Saúde Comunitária/métodos , Promoção da Saúde/métodos , Serviços de Assistência Domiciliar , Serviços de Saúde Rural , Algoritmos , Antibacterianos/uso terapêutico , Anti-Infecciosos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/epidemiologia , Centros Comunitários de Saúde/estatística & dados numéricos , Feminino , Gentamicinas/uso terapêutico , Humanos , Lactente , Recém-Nascido , Masculino , Modelos Organizacionais , Nepal/epidemiologia , Projetos Piloto , Encaminhamento e Consulta , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Voluntários/educaçãoRESUMO
INTRODUCTION: Neonatal sepsis causes high morbidity and mortality of newborns. The study aims to study the predictors and clinical, haematological and bacteriological factors of neonatal sepsis. METHODS: A descriptive cross sectional study was conducted in a Neonatal Intensive Care Unit (NICU) of Paropakar Maternity and Women's Hospital in Kathmandu between October and December 2011. Demographic, obstetrics, clinical and microbiological data were studied for 300 neonates. RESULTS: The NICU prevalence rate of sepsis was 37.12%. Early onset neonatal sepsis was common (91.39%) (P=0.000). Cesarean section (OR 1.95, 95% CI 1.15-3.31), apgar score<4 at 1 min (P=0.00) and <7 at 5 min of birth (P=0.00) predicted sepsis. Neonates with sepsis were more likely to present with hypothermia (OR 1.180, 95% CI 0.080-17.214), pustules (OR 2.188, 95% CI 0.110-43.465), dehydration (OR 3.040, 95% CI 0.170-54.361), diminished movement (OR 3.082, 95% CI 0.433-21.950) and bulging fontanels (OR 16.464, 95% CI 0.007-41495.430). Coagulase negative Staphylococcus spp. (CoNS) (21, 41.17%) was most common pathogen of neonatal sepsis. Variable antibiotic resistance patterns of isolates with emergence of meropenem resistance in Pseudomonas spp. and methicillin resistance in CoNS and S. aurues were noted. Mortality due to sepsis was highest (15, 8.06%) among total mortalities (21, 11.29%). CONCLUSIONS: Delivery via cesarian section, apgar score<4 at 1 min, and <7 at 5 min predicted sepsis. Morbidity and mortality of neonatal sepsis was common in this setting and early maternal and neonatal interventions are required to address this issue.
Assuntos
Sepse/mortalidade , Índice de Apgar , Cesárea , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Doenças do Recém-Nascido/mortalidade , Masculino , Testes de Sensibilidade Microbiana , Nepal , Fatores de Risco , Sepse/diagnóstico , Sepse/microbiologia , Centros de Atenção TerciáriaRESUMO
The mortality rates of infants and children aged less than five years are declining globally and in Nepal but less among neonates. Most deliveries occur at home without skilled attendants, and most neonates may not receive appropriate care through the existing medical systems. So, a community-based pilot programme— Morang Innovative Neonatal Intervention (MINI) programme—was implemented in Morang district of Nepal to see the feasibility of bringing the management of sick neonates closer to home. The objective of this model was to answer the question: “Can a team of female community health volunteers and paid facility-based community health workers (collectively called CHWs) within the existing heath system correctly follow a set of guidelines to identify possible severe bacterial infection in neonates and young infants and successfully deliver their treatment?” In the MINI model, the CHWs followed an algorithm to classify sick young infants with possible severe bacterial infection (PSBI). Female Community Health Volunteers (FCHVS) were trained to visit homes soon after delivery, record the birth, counsel mothers on essential newborn care, and assess the newborns for danger-signs. Infants classified as having PSBI, during this or subsequent contacts, were treated with co-trimoxazole and referred to facility-based CHWs for seven-day treatment with injection gentamicin. Additional supervisory support was provided for quality of care and intensified monitoring. Of 11,457 livebirths recorded during May 2005–April 2007, 1,526 (13.3%) episodes of PSBI were identified in young infants. Assessment of signs by the FCHVs matched that of more highly-trained facility-based CHWs in over 90% of episodes. Treatment was initiated in 90% of the PSBI episodes; 93% completed a full course of gentamicin. Case fatality in those who received treatment with gentamicin was 1.5% [95% confidence interval (CI) 1.0-2.3] compared to 5.3% (95% CI 2.6-9.7) in episodes that did not receive any treatment. Within the existing government health infrastructure, the CHWs can assess and identify possible infections in neonates and young infants and deliver appropriate treatment with antibiotics. This will result in improvement in the likelihood of survival and address one of the main causes of neonatal mortality.