USE OF DATA SYSTEMS IN ADDRESSING SOCIAL DETERMINANTS OF HEALTH
| Friday, 26th of August 2011 |
 |
 |
- USE OF DATA SYSTEMS IN ADDRESSING SOCIAL DETERMINANTS OF HEALTH
Cross posted, with thanks, from www.paho.org
Public Health Reports Volume 126 Supplement 3: 2011
Available online at: http://bit.ly/qyxHXD
This supplement brings attention to the increasing burden and inequities in some health outcomes, as well as the use of data to expand the knowledge base on SDH.
In his special commentary, "The Ultimate Measures of Health," Assistant Secretary for Health Dr. Howard K. Koh discusses the need for a broad "health in all policies" approach to public health for the 21st century. Similarly, in their guest editorial, Drs. Kathleen McDavid Harrison and Hazel D. Dean of the United States Centers for Disease Control and Prevention describe the need for a holistic approach to disease prevention that involves addressing not only individual, social, structural, and environmental determinants, but also working with a wide array of government and private sector organizations, including health, education, justice, environment, and labor. In turn, this holistic approach requires using diverse kinds of data such as surveillance, legal, land use, marketing, workforce, education, and financial.
Several articles within the supplement describe novel ways to use surveillance data from both national and state-level data collection systems, while others demonstrate innovative ways of linking labor, housing, and policy data with public health data to assess health outcomes. Additionally, experts provide specific viewpoints on gender equity as a social determinant, the use of public health law research to address SDH, and psychosocial factors affecting health.”
|
|
||
|
|
|
|
|
Use of Data Systems to Address Social Determinants of Health: A Need to Do More |
|
|
|
Kathleen McDavid Harrison , / Hazel D. Dean , | Deputy Director | National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention | Centers for Disease Control and Prevention |
|
|
|
|
|
|
|
Ritu Sadana , / Sam Harper , |
|
|
|
|
|
|
|
Howard K. Koh , |
|
|
|
|
|
|
|
Susan P. Phillips , |
|
|
|
|
|
|
|
Scott Burris , |
|
|
|
|
|
|
|
Paula A. Braveman , |
|
|
|
|
|
|
|
Johnnie (Chip) Allen , / Robert Jennings , / Robyn S. Taylor / Michele Shipp , |
|
|
|
|
|
|
|
Sha Juan J. Colbert , / Kathleen McDavid Harrison , |
|
|
|
|
|
|
|
Victoria M. Beltran / Kathleen McDavid Harrison , / H. Irene Hall , Hazel D. Dean , |
|
|
|
|
|
|
|
Karen Frederickson Comer , / Shaun Grannis , / Brian E. Dixon , / David J. Bodenhamer , Sarah E. Wiehe , |
|
|
|
|
|
|
|
Laura M. Gaydos , Rajiv Bhatia / Alvaro Morales , / Pam Tau Lee , / Shaw San Liu , Charlotte Chang , / Alicia L. Salvatore , / Niklas Krause / Meredith Minkler |
|
|
|
|
|
|
|
Ruiguang Song , H. Irene Hall , / Kathleen McDavid Harrison / Tanya Telfair Sharpe / Lillian S. Lin , / Hazel D. Dean , |
|
|
|
|
|
|
|
Kristen Soto / Susan Petit , / James L. Hadler , |
|
|
|
|
|
|
|
James Walkup , Ayse Akincigil , Donald R. Hoover , Michele J. Siegel , Shahla Amin Stephen Crystal , |
|
|
|
|
|
|
|
Dara D. Mendez , / Vijaya Hogan Jennifer F. Culhane , |
|
|
|
|
|
|
|
Ana Lòpez-De Fede , John E. Stewart , / James W. Hardin , / Kathy Mayfield-Smith / Dawn Sudduth , Med |
|
|
|
|
|
|
|
Jody Heymann , Amy Raub / Alison Earle , |
|
|
Twitter http://twitter.com/eqpaho
Published: 5 August 2011
Abstract (provisional)
To our knowledge, the present study provides a first time assessment of the contributions of socioeconomic determinants of immunization coverage in India using the recent National Family Health Survey data. Measurement of socioeconomic inequalities in health and health care, and understanding the determinants of such inequalities in terms of their contributions, are critical for health intervention strategies and for achieving equity in health care. A decomposition approach is applied to quantify the contributions from socio-demographic factors to inequality in immunization coverage. The results reveal that poor household economic status, mother's illiteracy, per capita state domestic product and proportion of illiterate at the state level is systematically related to 97% of predictable socioeconomic inequalities in full immunization coverage at the national level. These patterns of evidence suggest the need for immunization strategies targeted at different states and towards certain socioeconomic determinants as pointed out above in order to reduce socioeconomic inequalities in immunization coverage. JEL Classification: I10, I12
WHAT’S NEW THIS WEEKEND ON WWW.CHILDSURVIVAL.NET: MALE CIRCUMCISION, ORAL CHOLERA VACCINES
- HPV IN YOUNG SOUTH AFRICAN MALES, CIRCUMCISED AND UNCIRCUMCISED
|
J Infect Dis. Author manuscript; available in PMC 2010 February 15. Published in final edited form as: J Infect Dis. 2009 January; 199(1): 14–19. Best viewed at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2821597/?tool=pubmed |
Effect of male circumcision on the prevalence of high-risk human papillomavirus in young men: results of a randomized controlled trial conducted in Orange Farm, South Africa
Bertran Auvert,1* Joelle Sobngwi-Tambekou,2 Ewalde Cutler,3 Marthi Nieuwoudt,3 Pascale Lissouba,2 Adrian Puren,3 and Dirk Taljaard4
1Hôpital Ambroise Paré AP-HP, Hôpital Ambroise Paré, Boulogne-Billancourt, F-92100,FR
2Santé publique et épidémiologie des déterminants professionnels et sociaux de la santé INSERM : U687, IFR69, Université Paris Sud - Paris XI, Université de Versailles-Saint Quentin en Yvelines, Hôpital Paul Brousse 16, av Paul Vaillant Couturier 94807 VILLEJUIF,FR
3National Institute for Communicable Disease National Institute for Communicable Disease, Johannesburg,ZA
4Progressus Progressus, Johannesburg,ZA
* Correspondence should be adressed to: Bertran Auvert ; Email: bertran.auvert@uvsq.fr
The publisher's final edited version of this article is available free at J Infect Dis
See other articles in PMC that cite the published article.
Abstract
Introduction
A causal association links high-risk human papillomavirus (HR-HPV) and cervical cancer, which is a major public health problem. The objective of this study was to investigate the association between male circumcision (MC) and HR-HPV prevalence among young men.
Methods
We used data from a male circumcision trial conducted in Orange Farm (South Africa) among men aged 18 to 24. Urethral swabs were collected during a period of 262 consecutive days among participants from the intervention (circumcised) and control (uncircumcised) groups who were reporting for a scheduled follow-up visit. Swabs were analyzed using PCR. HR-HPV prevalence rate ratios (PRRs) were assessed using univariate and multivariate log-Poisson regression.
Results
In an intention-to-treat analysis, HR-HPV prevalences among intervention and control groups were 14.8% (94/637) and 22.3% (140/627), respectively, with a PRR of 0.66 (0.51–0.86) P=0.002. Controlling for propensity score and confounders (ethnic group, age, education, sexual behavior including condom use, marital status, and HIV status) had no effect on the results.
Conclusions
This is the first randomized controlled trial that shows a reduction in urethral HR-HPV infection following male circumcision. This finding explains why women with circumcised partners are less at risk of cervical cancer than other women.
Keywords: Adolescent, Circumcision, Male, statistics & numerical data, Gonorrhea, epidemiology, HIV Infections, epidemiology, Humans, Male, Neisseria gonorrhoeae, isolation & purification, Papillomavirus Infections, epidemiology, Prevalence, Risk Assessment, Risk Factors, Sexual Behavior, physiology, South Africa, epidemiology, Urethra, virology, Young Adult
- MALE CIRCUMCISION IN SUB-SAHARAN AFRICA
Male circumcision continues to move into traditionally non-circumcising societies. Notably, the king of Swaziland has publicly endorsed MC. President Jacob Zuma declares that he has been circumcised. Kenya has had almost 300,000 circumcisions, mostly among traditionally non-circumcising groups, in the last three years.
Good reading.
BD
|
Full text is at http://www.malecircumcision.org/publications/male_circumcision_news.html#news74 |
|
- ORAL CHOLERA VACCINES: THE W.H.O. VIEW
Until the 1990s, only parenterally administered cholera vaccines were available for the prevention of cholera. They were of low efficacy and short duration of protection, and afforded little or no protection against the carrier state. From 1973, WHO removed these vaccines from those listed on the WHO International Vaccination Certificate.
The present century has seen the commercialization of oral cholera vaccines with more satisfactory protection of adults and, especially, children. There is one prequalified cholera vaccine, of Swedish manufacture, listed on the WHO homepage, at http://www.who.int/immunization_standards/vaccine_quality/117_cholera/en/index.html
The package insert (English, French, and Spanish) is at http://www.who.int/immunization_standards/vaccine_quality/117_cholera.pdf
WHO re-issued its position paper on cholera vaccination in 2010, taking into account recent research in the field. The complete text of the position paper, in French and English, is at
http://www.who.int/wer/2010/wer8513.pdf
The following excerpt from the WHO position paper, ‘control of cholera outbreaks, ’ is of special interest to those dealing with epidemics or potential epidemics.
‘The mainstay of control measures to be implemented during ongoing epidemics should remain (i) providing appropriate treatment to people with cholera, (ii) implementing interventions to improve water and sanitation and (iii) mobilizing communities.
‘Pre-emptive vaccination should be considered by local health authorities to help prevent potential outbreaks or the spread of current outbreaks to new areas. Finalizing of predictive risk-assessment tools to help countries determine when pre-emptive cholera vaccination might be used is needed urgently; these tools should be made available and field-tested as soon as possible.
‘Given the recent large and prolonged outbreaks of cholera (for example, in Angola and Zimbabwe), reactive vaccination could be considered by local health authorities as an additional control measure, depending on the local infrastructure and following a thorough investigation of the current and historical epidemiological situation, and clear identification of geographical areas to be targeted.
‘The 3-step decision-making tool developed for crisis situations should guide health authorities in their decisions on whether to use cholera vaccine during complex emergencies. Considering the lack of experience with implementing reactive vaccination against cholera, the feasibility and impact of vaccination in halting ongoing outbreaks should be documented and widely disseminated.
‘Pre-emptive or reactive vaccination should cover as many people as possible who are eligible to receive the vaccine (for example, children aged ≥1 years or ≥2 years, depending on the vaccine), and should be conducted as quickly as possible.’
- UPDATED COCHRANE REVIEW, ORAL CHOLERA VACCINES
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2011 Issue 8, Copyright © 2011 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
Also at http://www2.cochrane.org/reviews/en/ab008603.html
This record should be cited as: Sinclair D, Abba K, Zaman K, Qadri F, Graves PM. Oral vaccines for preventing cholera. Cochrane Database of Systematic Reviews 2011, Issue 3. Art. No.: CD008603. DOI: 10.1002/14651858.CD008603.pub2
Editorial Group: Infectious Diseases Group
This version first published online: March 16. 2011
Last assessed as up-to-date: February 9. 2011
Abstract
Background
Cholera is a cause of acute watery diarrhoea which can cause dehydration and death if not adequately treated. It usually occurs in epidemics, and is associated with poverty and poor sanitation. Effective, cheap, and easy to administer vaccines could help prevent epidemics.
Objectives
To assess the effectiveness and safety of oral cholera vaccines in preventing cases of cholera and deaths from cholera.
Search strategy
In October 2010, we searched the Cochrane Infectious Disease Group Specialized Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; EMBASE; LILACS; the metaRegister of Controlled Trials (mRCT), and the WHO International Clinical Trials Registry Platform (ICTRP) for relevant published and ongoing trials.
Selection criteria
Randomized or quasi-randomized controlled trials of oral cholera vaccines in healthy adults and children.
Data collection and analysis
Each trial was assessed for eligibility and risk of bias by two authors working independently. Data was extracted by two independent reviewers and analysed using the Review Manager 5 software. Outcomes are reported as vaccine protective efficacy (VE) with 95% confidence intervals (CIs).
Main results
Seven large efficacy trials, four small artificial challenge studies, and twenty-nine safety trials contributed data to this review.
Five variations of a killed whole cell vaccine have been evaluated in large scale efficacy trials (four trials, 249935 participants). The overall vaccine efficacy during the first year was 52% (95% CI 35% to 65%), and during the second year was 62% (95% CI 51% to 62%). Protective efficacy was lower in children aged less than 5 years; 38% (95% CI 20% to 53%) compared to older children and adults; 66% (95% CI 57% to 73%).
One trial of a killed whole cell vaccine amongst military recruits demonstrated 86% protective efficacy (95% CI 37% to 97%) in a small epidemic occurring within 4 weeks of the 2-dose schedule (one trial, 1426 participants). Efficacy data is not available beyond two years for the currently available vaccine formulations, but based on data from older trials is unlikely to last beyond three years.
The safety data available on killed whole cell vaccines have not demonstrated any clinically significant increase in adverse events compared to placebo.
Only one live attenuated vaccine has reached Phase III clinical evaluation and was not effective (one trial, 67508 participants). Two new candidate live attenuated vaccines have demonstrated clinical effectiveness in small artificial challenge studies, but are still in development.
Authors' conclusions
The currently available oral killed whole cell vaccines can prevent 50 to 60% of cholera episodes during the first two years after the primary vaccination schedule. The impact and cost-effectiveness of adopting oral cholera vaccines into the routine vaccination schedule of endemic countries will depend on the prevalence of cholera, the frequency of epidemics, and access to basic services providing rapid rehydration therapy.
|
||||
|
Rosa M López-Gigosos1, Elena Plaza2, Rosa M Díez-Díaz2, Maria J Calvo3 Best viewed at http://www.jgid.org/text.asp?2011/3/1/56/77297
|
||||
Cholera is a substantial health burden in many countries in Africa and Asia, where it is endemic. It is as well responsible for ongoing epidemics in sub-Saharan Africa which are becoming greater in terms of frequency, extension, and duration. Given the availability of two oral cholera vaccines and the new data on their efficacy, field effectiveness, feasibility, and acceptance in cholera-affected populations and in travelers, these vaccines should be used in endemic areas, in travelers for these areas and should be considered in areas at risk for outbreaks. The two vaccines currently available in worldwide are: (1) The killed oral vaccine (Dukoral, licensed by SBL-Sweden to Crucell-Holland) is recommended since 1999 by WHO and consists of a mixture of four preparations of heat or formalin killed whole cell Vibrio cholera O1 (Inaba and Ogaba serotypes, and classical and El Tor biotypes) that are then added with purified recombinant cholera toxin (CT) B subunit. Because CT cross-reacts with Escherichia coli LT the vaccine also provides short-term protection against ETEC (enterotoxigenic E. coli) which is of added benefit for travelers. It is available in more than 60 countries. (2) A bivalent O1 and O139 whole cell oral vaccine without CT B subunit (Shanchol) has been lately developed in Vietnam (licensed by VaBiotech-Viet Nam to Shantha Biotechnics-India. It is available in India and Indonesia. A structured search of papers in PubMed and reports on cholera vaccines by WHO and CDC, as well as critical reading and synthesis of the information was accomplished. Inclusion criteria were defined according to reports quality and relevance. Keywords: Cholera vaccines, Travelers, Vaccine-delivery strategies
Public Library of Science, Open Access Research Article A Randomized, Placebo-Controlled Trial of the Bivalent Killed, Whole-Cell, Oral Cholera Vaccine in Adults and Children in a Cholera Endemic Area in Kolkata, India Also at http://www.ncbi.nlm.nih.gov/pubmed/18523643
An effective vaccine against cholera has been used for public health purposes in Vietnam since the 1990s. This vaccine was reformulated to meet WHO requirements. We assessed the safety and immunogenicity of the reformulated bivalent (Vibrio cholerae 01 and 0139) killed whole cell oral vaccine in a cholera endemic area in Kolkata, India. Double-blind, randomized, placebo controlled trial The trial was conducted in the clinical trial ward of the Infectious Diseases Hospital in Kolkata, India The participants were 101 healthy adults (males and non-pregnant females) aged 18–40 years and 100 healthy children (males and non-pregnant females) aged 1–17 years. Participants were randomized to receive either the bivalent killed whole cell oral cholera vaccine or placebo (killed oral Escherichia coli K12) For safety: proportion of subjects with adverse events during the duration of study participation. For immunogenicity: Proportion of subjects who had a ≥4-fold rise in serum vibriocidal antibody titers 14 days after the second dose of vaccine or placebo. Adverse reactions were observed with similar frequency among vaccine and placebo recipients in both age groups. Among adults 4% of vaccine and 8% of placebo recipients and among children 4% of vaccine and 2% of placebo recipients had at least one adverse event within 28 days of the first dose of the vaccine. Following immunization, 53% of adult and 80% of children vaccinees showed a ≥4 fold rise in serum V. cholerae O1 vibriocidal antibody titers. A less pronounced response to V. cholerae O139 vibriocidal antibody titers post-immunization was noted among vaccinees. We found the vaccine to be safe and immunogenic in a cholera-endemic area in India. ClinicalTrials.gov NCT00119197 Dilip Mahalanabis1, Anna Lena Lopez2*, Dipika Sur3, Jacqueline Deen2, Byomkesh Manna3, Suman Kanungo3, Lorenz von Seidlein2, Rodney Carbis2, Seung Hyun Han2,6, Seong Hye Shin2, Stephen Attridge5, Raman Rao4, Jan Holmgren5, John Clemens2, Sujit K. Bhattacharya3 1 Society for Applied Studies, Kolkata, India, 2 International Vaccine Institute, Seoul, Korea, 3 National Institute of Cholera and Enteric Diseases, Kolkata, India, 4 Shantha Biotechnics, Hyderabad, India, 5 University of Gothenburg, Gothenburg, Sweden, 6 Seoul National University, Seoul, Korea Objectives An effective vaccine against cholera has been used for public health purposes in Vietnam since the 1990s. This vaccine was reformulated to meet WHO requirements. We assessed the safety and immunogenicity of the reformulated bivalent (Vibrio cholerae 01 and 0139) killed whole cell oral vaccine in a cholera endemic area in Kolkata, India. Design Double-blind, randomized, placebo controlled trial Setting The trial was conducted in the clinical trial ward of the Infectious Diseases Hospital in Kolkata, India Participants The participants were 101 healthy adults (males and non-pregnant females) aged 18–40 years and 100 healthy children (males and non-pregnant females) aged 1–17 years. Interventions Participants were randomized to receive either the bivalent killed whole cell oral cholera vaccine or placebo (killed oral Escherichia coli K12) Outcome Measures For safety: proportion of subjects with adverse events during the duration of study participation. For immunogenicity: Proportion of subjects who had a ≥4-fold rise in serum vibriocidal antibody titers 14 days after the second dose of vaccine or placebo. Results Adverse reactions were observed with similar frequency among vaccine and placebo recipients in both age groups. Among adults 4% of vaccine and 8% of placebo recipients and among children 4% of vaccine and 2% of placebo recipients had at least one adverse event within 28 days of the first dose of the vaccine. Following immunization, 53% of adult and 80% of children vaccinees showed a ≥4 fold rise in serum V. cholerae O1 vibriocidal antibody titers. A less pronounced response to V. cholerae O139 vibriocidal antibody titers post-immunization was noted among vaccinees. Conclusions We found the vaccine to be safe and immunogenic in a cholera-endemic area in India. Trial Registration ClinicalTrials.gov NCT00119197 Citation: Mahalanabis D, Lopez AL, Sur D, Deen J, Manna B, et al. (2008) A Randomized, Placebo-Controlled Trial of the Bivalent Killed, Whole-Cell, Oral Cholera Vaccine in Adults and Children in a Cholera Endemic Area in Kolkata, India. PLoS ONE 3(6): e2323. doi:10.1371/journal.pone.0002323 Editor: Willliam F. Wade, Dartmouth Medical School, United States of America Received: September 1, 2007; Accepted: April 4, 2008; Published: June 4, 2008 Copyright: © 2008 Mahalanabis et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Funding: This work was supported by the Bill and Melinda Gates Foundation through the Diseases of Most Impoverished Program (grant C-8) administered by the International Vaccine Institute; and the Swedish International Development Cooperation Agency. The sponsors had no role in the design and conduct of the study, or in the analysis, interpretation of data and preparation, review or approval of the manuscript. Competing interests: The authors have declared that no competing interests exist. * E-mail: anlopez@ivi.int
|
WHAT’S NEW THIS WEEK ON WWW.CHILDSURVIVAL.NET
- SALEABILITY OF ANTIMALARIALS IN PRIVATE DRUG SHOPS IN MUHEZA, TANZANIA
There's many a slip 'twixt the cup and the lip. Those who take comfort in the issuance of national policies on malaria drug treatment may take discomfort from this article from Tanzania, available in full at
http://www.malariajournal.com/content/pdf/1475-2875-10-238.pdf
My first experience with private sector marketing of antimalarials was my 1976 purchase, in a private pharmacy in Bangkok, of imported chloroquine. The package insert, from the British manufacturer, informed the reader, in Thai and English, that the chloroquine was ‘effective against all forms of malaria.’ This was five years after the WHO/Thailand studies on chloroquine resistant falciparum malaria, with MoH switchover to from chloroquine to
S-P as the first line treatment for confirmed falciparum malaria.
The more things change, the more they remain the same.
Good reading.
BD
Malaria Journal 2011, 10:238 doi:10.1186/1475-2875-10-238
Published: 15 August 2011
Abstract (provisional)
Background
Artemether-lumefantrine (ALu) replaced sulphadoxine-pymimethamine (SP) as the official first-line anti-malarial in Tanzania in November 2006. So far, artemisinin combination therapy (ACT) is contra-indicated during pregnancy by the national malaria treatment guidelines, and pregnant women depend on SP for Intermittent Preventive Treatment (IPTp) during pregnancy. SP is still being dispensed by private drug stores, but it is unknown to which extent. If significant, it may undermine its official use for IPTp through induction of resistance. The main study objective was to perform a baseline study of the private market for anti-malarials in Muheza town, an area with widespread anti-malarial drug resistance, prior to the implementation of a provider training and accreditation programme that will allow accredited drug shops to sell subsidized ALu.
Methods
All drug shops selling prescription-only anti-malarials, in Muheza town, Tanga Region voluntarily participated from July to December 2009. Qualitative in-depth interviews were conducted with owners or shopkeepers on saleability of anti-malarials, and structured questionnaires provided quantitative data on drugs sales volume.
Results
All surveyed drug shops illicitly sold SP and quinine (QN), and legally amodiaquine (AQ). Calculated monthly sale was 4,041 doses, in a town with a population of 15,000 people. Local brands of SP accounted for 74% of sales volume, compared to AQ (13%), QN (11%) and ACT (2%).
Conclusions
In community practice, the saleability of ACT was negligible. SP was best-selling, and use was not reserved for IPTp, as stipulated in the national anti-malarial policy. It is a major reason for concern that such drug-pressure in the community equals de facto intermittent presumptive treatment. In an area where SP drug resistance remains high, unregulated SP dispensing to people other than pregnant women runs the risk of eventually jeopardizing the effectiveness of the IPTp strategy. Further studies are recommended to find out barriers for ACT utilization and preference for self-medication and to train private drug dispensers.
- GLOBAL USE OF INSECTICIDES FOR VECTOR BORNE DISEASE CONTROL
The first of these two WHO reports is a multiyear review of the use of insecticides – primarily through the use of IRS (indoor residual spraying) and of LLINs – in vector control, especially against malaria and leishmaniasis.
There is a widespread perception that the use of IRS is on the wane. Readers of the first report will note that annual use of DDT in Africa averages >800 tons, a fact not yet widely known. DDT and the more expensive malathion are, respectively, the first and second most commonly used insecticides for indoor residual spraying.
The use of synthetic pyrethroids for LLINs, seen in many countries as universal coverage of all sleeping spaces becomes the norm, requires careful entomological monitoring. The cheers went up in the late ‘50s after the initial successes of household spraying against malaria. Then insecticide resistance began in many successful Asian programmes in the ‘60s and ‘70s. Shall we see the same patterns of rapid development of insecticide resistance in the present decade?
Good reading.
BD
Dear colleagues,
This is to inform you of the publication of the following WHOPES documents. These have been published on the web only:
1. Global use of insecticides for vector-borne disease control – A 10-year assessment (available at http://whqlibdoc.who.int/publications/2011/9789241502153_eng.pdf); and
2. Report of the 14th WHOPES Working group Meeting - Review of Spinosad® EC, Lifenet® LN, MagNetTM LN, Royal Sentry® LN, Yahe® LN, 11—15 April 2011, Geneva, World Health Organization (http://whqlibdoc.who.int/publications/2011/9789241502160_eng.pdf).
With kind regards,
Rajpal Yadav
Dr Rajpal S. Yadav, Scientist, WHO Pesticide Evaluation Scheme, Vector Ecology and Management
Department of Control of Neglected Tropical Diseases, World Health Organization, 20 Avenue Appia, CH-1211 Geneva 27 Switzerland
Email: yadavraj@who.int
Web: http://www.who.int/whopes
- POPULATION, POVERTY AND SUSTAINABLE DEVELOPMENT: A REVIEW OF THE EVIDENCE
This World Bank study looks at the evidence on the relationships between high fertility and poverty.
Thanks to The PanAmerican Health Organization for posting this on their webpage. Readers with interests in health equity may wish to consult http://new.paho.org/equity/index.php?option=com_content&task=view&id=24&Itemid=122
Good reading, BD
Population, poverty, and sustainable development: a review of the evidence
Monica Das Gupta, John Bongaarts, John Cleland
The World Bank - June 2011
Development Research Group -Human Development and Public Services Team
Available online PDF [30p.] at: http://bit.ly/nWjbvd
“………There is a very large but scattered literature debating the economic implications of high fertility. This paper reviews the literature on three themes:
(a) Does high fertility affect low-income countries’ prospects for economic growth and poverty reduction?
(b) Does population growth exacerbate pressure on natural resources? and
(c) Are family planning programs effective at lowering fertility, and should they be publicly funded?
The literature shows broad consensus that while policy and institutional settings are key in shaping the prospects of economic growth and poverty reduction, the rate of population growth also matters. Recent studies find that low dependency ratios (as fertility declines) create an opportunity for increasing productivity, savings and investment in future growth. They find that lower fertility is associated with better child health and schooling, and better health and greater labor-force participation for women. They also indicate that rapid population growth can constrain economic growth, especially in low-income countries with poor policy environments.
Population growth also exacerbates pressure on environmental common property resources. Studies highlight the deep challenges to aligning divergent interests for managing these resources. However, part of the pressure on these resources can be mitigated by reducing the rate of population growth.
Although family planning programs are only one policy lever to help reduce fertility, studies find them effective. Such programs might help especially in the Sub-Saharan African region, where high fertility and institutional constraints on economic growth combine to slow rises in living standards. ……..”
Twitter http://twitter.com/eqpaho
Email: yadavraj@who.int
Web: http://www.who.int/whopes
- BROAD-SPECTRUM ANTIVIRAL THERAPEUTICS
This open access research article from PLOS is best viewed at
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0022572
Broad-Spectrum Antiviral Therapeutics
Currently there are relatively few antiviral therapeutics, and most which do exist are highly pathogen-specific or have other disadvantages. We have developed a new broad-spectrum antiviral approach, dubbed Double-stranded RNA (dsRNA) Activated Caspase Oligomerizer (DRACO) that selectively induces apoptosis in cells containing viral dsRNA, rapidly killing infected cells without harming uninfected cells. We have created DRACOs and shown that they are nontoxic in 11 mammalian cell types and effective against 15 different viruses, including dengue flavivirus, Amapari and Tacaribe arenaviruses, Guama bunyavirus, and H1N1 influenza. We have also demonstrated that DRACOs can rescue mice challenged with H1N1 influenza. DRACOs have the potential to be effective therapeutics or prophylactics for numerous clinical and priority viruses, due to the broad-spectrum sensitivity of the dsRNA detection domain, the potent activity of the apoptosis induction domain, and the novel direct linkage between the two which viruses have never encountered.
WHAT’S NEW THIS WEEKEND ON WWW.CHILDSURVIVAL.NET: POLIO, POLIO, POLIO
For readers not familiar with it, the webpage of the Global Polio Eradication Initiative, www.polioeradication.org, is a delight. The databases, updated weekly, provide wild poliovirus case counts from the four endemic countries (Nigeria,Afghanistan, Pakistan and India) and the polio reintroduction countries. The webpage also gives, for most countries doing polio campaigns, the independent monitoring data gathered during those campaigns, which give an idea of the proportion of <5 children not having finger markings after the most recent polio campaigns. Soon: caregivers‘ sources of information on the campaigns, an invaluable database for those planning social mobilization/behavior change internventions.
Since 2011, the webpage has also carried reports in English (soon, in French) of the Independent Monitoring Board recently created to give the partners advice on how best to accelerate the move towards global eradication.
At its most recent meeting, the IMB asked the question why joint use of OPV and IPV is still ‘floating in the ether‘ after decades of discussion.
This weekend, one RFP for proposals on social science research on polio eradication and several items on combined used of OPV and IPV in developing countries.
1) REQUEST FOR PROPOSALS, SOCIAL SCIENCE RESEARCH ON POLIO ERADICATION
Greetings,
UNICEF, in collaboration with the Global Polio Eradication Partnerships (GPEI), invites interested institutions, teams or individuals to submit proposals to conduct social research focusing on health communication to support polio eradication in Angola, Chad, DRC, Nigeria or Pakistan. Successful proposals will demonstrate the capacity of the bidder to complete the research, along with a clear research thesis, methodologies appropriate for the research, an outline of in-country partnerships and time lines that will produce results applicable to improving communication efforts for polio eradication in the next 18 to 24 months. Proposals that link polio communication research to broader issues in child health are encouraged. Proposals should adhere to the standards outlined in the proposal submission guidelines available at : (http://www.polioeradication.org/Research/Grantsandcollaboration.aspx), and be submitted by 1 September 2011.
Categories for potential research include:
Health provider / client interactions: research that examines the dynamics and quality of individual or community relationships with health workers and health services.
Social and community health issues: research that explores mechanisms for community participation; that helps to identify, document, describe or understand the social determinants of underserved or marginalized groups, or outlines methods to remove social barriers to access as well as increasing individual and community demand for polio vaccine, including social network analysis.
Risk perceptions: research that helps understand individual and/or community perceptions of the risk of polio and other vaccine preventable diseases, and how that compares to perceptions of other risks faced in the context of their social, political and economic realities. Such research could help identify possible triggers or motivations for taking action on immunization.
Gender: research to better understand the gender dimensions of identified high risk communities for polio, to describe how gender roles influence household decision-making around immunization and other protective health behaviours. Of particular interest will be how gender roles influence and construct decision making within the home and within community networks to better inform the design of communication interventions.
New technology: research in the areas of innovative use of new media, such as social networking, or innovative applications of other technologies such as SMS or GPS to promote polio immunization.
Integration: research that highlights opportunities, challenges or strategies to link polio eradication communication to other areas of child survival and development, such as routine immunization or sanitation, for the mutual benefit of all concerned programmes.
Media / messaging: research that focuses on more traditional forms of public health promotion, including formative studies that link community sentiment / knowledge to media messaging and use.
Efficacy studies: research that helps demonstrate what communication strategies or activities work in increasing demand for immunization, community ownership and participation in health services through active health seeking behaviors.
Lessons learned: any research that documents and demonstrate best practices, including capturing aspects of successful micro initiatives or through more comprehensive meta-analyses.
Additional research proposals that do not fit into the above categories are welcome, but should be focused on social aspects of health promotion for polio eradication.
Please pass this announcement along to any individuals or institutions you feel would be interested in this research opportunity.
COMBINED USE OF OPV AND IPV IN DEVELOPING COUNTRIES
During a recent visit to South Africa, I learned that the national immunization program had already incorporated IPV (in a five antigen combination vaccine) into its infant vaccination schedule, while retaining OPV for mass campaigns, the birth dose and at six weeks of age.
In its July 2011 report, the Independent Monitoring Board of GPEI said
- Selective use of combined IPV/OPV is being talked about; why not take a serious look at it?
‘We hear murmurings about the idea of giving IPV and OPV in combination. Proponents highlight the particular value of this idea in areas where access to children is severely limited by conflict. In such settings, each opportunity to access a child is valuable. Repeated vaccination forays cannot be made so the value of each must be captured by using the most effective intervention that there is. Some evidence suggests that a combined approach reduces the risk of vaccine failure compared to giving either IPV or OPV alone. (figure 7). Others are opposed to the idea, believing that it adds unnecessary complexity and cost, and could be dangerous. We do not take a particular view on the answer to this question. But we observe that the question is floating in the ether rather than being grasped. This does have the potential to be a useful innovation, so the debate needs to be properly aired. We make a recommendation to stimulate this.’ (see full report at www.polioeradication.org).
After consulting the IMB report, I checked the WHO homepage and found that 83 countries and territories are currently using IPV, either as part of the regular schedule or, in some countries, for special groups. This included 18 developing countries of the Americas (plus the US and Canada), one African country, and 13 Asian countries. From Andorra to Uruguay, I don’t see a single country using IPV or combined IPV/OPV schedules with recent WPV, VAPP, or cVDPV cases. That is quite an accomplishment.
This 83 is not a majority of the 193 countries of the world, but it is quite a record for a vaccine which lacks several advantages of OPV: it cannot be administered by lay personnel in mass campaigns, it does not provoke gut immunity like that produced by OPV, and it is more expensive than OPV, both alone and, especially in combination vaccines. IPV has two overwhelming advantages as we move towards the polio endgame: it does not provoke the VAPP and the cVDPV associated with the oral vaccine.
Some people believe that IPV should be used in the post-eradication era to prevent the reappearance of polio, others, that it should be used now, to speed the process of eradication.
Here are a few of the published articles on OPV/IPV combinations in developing areas. Note in particular the discussion from Gaza and Israel, a rare case of public health policy from a developing area influencing that in a developed country.
Good reading.
BD
SEQUENTIAL USE OF IPV AND OPV IN THE GAMBIA, OMAN, AND THAILAND
Best viewed at http://www.ncbi.nlm.nih.gov/pubmed/9203722
COMBINED IMMUNIZATION OF INFANTS WITH ORAL AND INACTIVATED POLIOVIRUS VACCINES: RESULTS OF A RANDOMIZED TRIAL IN THE GAMBIA, OMAN, AND THAILAND
WHO Collaborative Study Group on Oral and Inactivated Poliovirus Vaccines*
World Health Organization, Geneva, Switzerland
To assess an immunization schedule combining oral (OPV) and inactivated poliovirus vaccines
(lPV), a clinical trial was conducted in The Gambia, Oman, and Thailand. Children were randomized to receive OPV at birth and at 6, 10, and 14 weeks of age; OPV at birth followed by both OPV and IPV at 6, 10, and 14 weeks of age; or placebo at birth followed by IPV at 6, 10, and 14 weeks of age. Serum specimens were available at 24 weeks for 1291 (77%) of 1685 enrolled infants. In the combined-schedule group, the proportion of children seropositive at 24 weeks was 95%-99% for type 1,99%-100% for type 2, and 97%-100% for type 3. In The Gambia and Oman, the combinedschedule performed significantly better than OPV for type 1 (95%-97% vs. 88%-90%) and type 3 (97%-99% vs. 72%-73%). Across the study sites, IPV given at 6, 10, and 14 weeks of age provided inadequate protection against poliovirus. The combined schedule provided the highest levels of serum antibody response, with mucosal immunity equivalent to that produced by OPV alone.
Abstract above; full text and figures at http://jid.oxfordjournals.org/content/175/Supplement_1/S215.long
In 1988, the World Health Assembly established the target of global eradication of poliomyelitis by the year 2000 [1]. Since then, remarkable progress has occurred in freeing many countries from poliomyelitis [2, 3]. Extensive use of trivalent oral poliovirus vaccine (OPV) has been associated with the interruption of wild poliovirus circulation in the Americas, where the last case of paralytic disease associated with wild poliovirus isolation occurred in August 1991 [4].
Current poliomyelitis eradication strategies recommended by the World Health Organization (WHO) focus on the early and intensive use ofOPV with routine delivery of doses at birth and 6, 10, and 14 weeks of age. Also recommended for countries in which polio is endemic are supplemental OPV delivery strategies, including national immunization days and house-to-house immunization in high-risk areas, strategies that were successful in the elimination effort in the Americas and are being adopted in other parts of the world.
Nonetheless, in developing countries there is wide variation in the serologic response ofchildren to OPV, with overall levels of seroresponse below those seen in industrialized countries. A review of 32 studies in developing countries found that after three doses of OPV, the mean proportion of infants with detectable levels of serum neutralizing antibody was only 73% (range, 36%-99%) for type 1,90% (range, 71%-100%) for type 2, and 70% (range, 40%-99%) for type 3 [5]. A recent large-scale randomized trial in Brazil and The Gambia has confirmed these findings [6]. Even after eight OPV doses delivered in mass campaigns, gaps in immunity, as defined by serum antibody levels, persist in some countries, especially for type 3 [7]. There is also evidence that OPV may not always succeed in preventing transmission of wild poliovirus, even when vaccine coverage is excellent. Outbreaks of poliomyelitis have occurred in some countries where coverage with three or more doses of OPV has been high, notably in Brazil [8], Bulgaria [9], The Gambia [10], Jordan [11], Israel [12], Malaysia [13, 14], Namibia [15], Oman [16, 17], and Saudi Arabia [18]. In these settings, vaccine efficacy has appeared to correlate with seroconversion rates, and some children with well-documented immunization histories have contracted paralytic disease.
Some industrialized countries have become polio-free using inactivated poliovirus vaccine (IPV), but this vaccine has not been recommended by WHO for polio eradication in developing countries. When given to children in developing countries at intervals of 2 months, starting at 8 weeks of age, IPV has evoked excellent serologic response, but it is not known how long this protection lasts [19]. Because IPV does not produce the high levels of intestinal mucosal immunity seen with OPV, a person who is protected from paralytic disease by serum antibody may still excrete and transmit poliovirus to others. Moreover, unlike OPV, IPV is a killed vaccine, and it cannot, spread secondarily to contacts.
A few countries or areas have become polio-free using a combination of OPV and IPV, notably Denmark [20] and the Palestine Self-Rule Areas of Gaza and West Bank [21]. However,these countries or areas use relatively complex schedules that are not completed until the first birthday or older (table 1). In 1988, the World Health Assembly requested research to develop additional polio immunization strategies that could speed the success of polio eradication [1]. Subsequently, the Global Advisory Group of the WHO Expanded Programme on Immunization specifically requested the assessment of a combined polio immunization schedule that would be practical to implement in developing countries, because it was anticipated that such a schedule could provide infants with the beneficial effects of both poliovirus vaccines at an early age [22].
In response to these recommendations, the WHO Collaborative Study Group on Oral and Inactivated Poliovirus Vaccines was formed. Here we report the results of a randomized clinical trial of a combined polio immunization schedule in The Gambia, Oman, and Thailand. To provide findings broadly applicable to future policy recommendations, the combined schedule was studied in different regions of the world. The study group thought it was important to study a simple schedule with simultaneous delivery of OPV and IPV at ages routinely recommended by WHO for immunization in developing countries, with polio immunization completed before 4 months of age (table 1). The trial assessed both the serum immune response and the mucosal immune response (as judged by protection on challenge with monovalent type 1 OPV at 6 months of age).
PROFESSOR NATAN GOLDBLUM AND THE COMBINED VACCINATION
PROGRAM IN GAZA
American Journal of Public Health | May 2011, Vol 101, No. 5
Blum et al. in November 2010 described the pioneering work of Natan Goldblum, a great Israeli virologist and innovator in polio immunization.1 Another important facet of his work was as a key contributor to development of the combined or sequential oral polio vaccine (OPV) and inactivated polio vaccine (IPV) programs used in the West Bank and Gaza since the late 1970s.
Goldblum and Joseph Melnick from Baylor University were asked to consult in 1978 with the Israel Ministry of Health and the Gaza and West Bank public health services. During this time, I was the Coordinator for Health in the West Bank and Gaza for the Israeli Ministry of Health (from 1978-1994), with oversight responsibility for health in the West Bank and Gaza including immunization policy and other aspects of health services and training of Palestinian health providers.
At that time, we faced continuing polio epidemics, mostly in Gaza where sanitary conditions were poor, despite high levels of OPV coverage. As an outcome of the discussions with Goldblum and Melnick, a new approach they recommended was jointly agreed to by the Israeli and Palestinian health officials.
This accord expanded the routine immunization program from four doses of OPV by adding three doses of IPV given in a mixed sequence during the first year of life. This method was later dubbed the Gaza system.Coverage was soon greater than 85%, and catch-up campaigns were conducted for persons aged up to 18 years. Polio disappeared during the next two years and was effectively eradicated from these previously endemic areas.2
During the 1980s, Israel maintained an OPV-only policy, but with a trial IPV program in 2 districts of the country. In 1988, an outbreak of paralytic poliomyelitis occurred mainly among adolescents and young adults in one of these trial districts where the IPV-only policy was in effect (15 cases and one death). As a result of this episode, Israel adopted the Gaza system, and total eradication of polio was rapidly achieved.3,4
After eradication of polio in Gaza, the West Bank, and subsequently in Israel, the Gaza system was adopted and continues in other parts of the Middle East. A combined or sequential OPV and IPV program is an important policy option for polio control.5,6 In light of challenges in countries in which the virus is still endemic (Nigeria, India, Afghanistan, and Pakistan), with recent spread to other countries, the combination of OPV and IPV should again be considered for the endstage of polio eradication in remaining high risk areas.7,8
Ted Tulchinsky, MD, MPH
About the Author
Ted Tulchinsky is with the Braun School of Public Health, Hebrew University-Hadassah, Hadassah, Ein Karem, Jerusalem, Israel.
Correspondence may be sent to T.H. Tulchinsky, MD, MPH, Braun School of Public Health, Hebrew University-Hadassah, Ein Karem, Jerusalem, Israel 91120 (e-mail: tedt@hadassah.org.il). Reprints can be ordered at http://www.ajph.org by clicking the ‘‘Reprints/Eprints’’ link.
This letter was accepted December 19, 2010.
References
1. Blum N, Katz E, Fee E. Professor Natan Goldblum: the pioneer producer of the inactivated poliomyelitis vaccine in Israel. Am J Public Health. 2010;100(11):2074–2075.
1. Tulchinsky T, Abed Y, Shaheen S, et al. A ten-year experience in control of poliomyelitis through a combination of live and killed vaccines in two developing areas. Am J Public Health. 1989;79(12):1648–1652.
1. . Slater PE, Orenstein WA, Morag A, et al. Poliomyelitis outbreak in Israel in 1988: a report with two commentaries. Lancet. 1990;335(8699):1192– 1195. discussion 1196–8.
1. Goldblum N, Gerichter CB, Tulchinsky TH, Melnick JL. Poliomyelitis control in Israel, 1948-1993: changing strategies with the goal of eradication in an endemic area. Bull World Health Organ. 1994;72(5):783–796.
1. Parent du Chaˆtelet I, Merchant AT, Fisher-Hoch S, et al. Serological response and poliovirus excretion following different combined oral and inactivated poliovirus vaccines immunization schedules. Vaccine. 2003; 21(15):1710–1718.
1. Asturias EJ, Dueger EL, Omer SB, et al. Randomized trial of inactivated and live polio vaccine schedules in Guatemalan infants. J Infect Dis. 2007;196(5):692–698.
1. Centers for Disease Control and Prevention. Outbreaks following wild poliovirus importations—Europe, Africa, and Asia, January 2009-September 2010. MMWR Morb Mort Wkly Rep. 2009;59(43):1393–1399.
- WHAT’S NEW THIS WEEK ON WWW.CHILDSURVIVAL.NET: CALCULATING MEASLES MORTALITY, RESPIRATORY ADMINISTRATION OF MEASLES VACCINE,DELIGHT AND UNEASE OVER LAW ON VACCINATION OF STUDENTS AGAINST MENINGITIS, KEVIN DE COCK INTERVIEWED ON NEW DEVELOPMENTS IN HIV/AIDS
- CDC MALARIA POSITIONS, FRENCH SPEAKING AFRICA
The Centers for Disease Control and Prevention (CDC)’s Division of Parasitic Diseases and Malaria announces three career opportunities for Medical Officers and Epidemiologists (GS-14 level, Commissioned Corps 0-5) to serve as CDC Resident Advisor for the President’s Malaria Initiative (PMI) in the Democratic Republic of Congo, Guinea (Conakry) and Mali. The Advisors will help design, implement and evaluate key malaria prevention and control activities in close coordination with the host government and national and international partners, including the non-governmental and private sectors. This is a chance to contribute to one of PMI’s most successful country programs (Mali), or to PMI’s newest countries (DRC and Guinea). All provide excellent opportunities for direct collaboration with National Malaria Control Programs, numerous international and non-governmental organizations, and local malaria and entomology research institutions. More information on PMI, as well as copies of the FY 2011 Malaria Operational Plans for DR Congo and Mali, are available at www.pmi.gov.
Qualified candidates should have a strong background and interest in field epidemiology, monitoring and evaluation, surveillance, public health program implementation, demonstrated effective diplomatic and communications skills, and at least 1-2 years’ public health experience in an international, developing country setting. French language proficiency is required.
For US Citizens: Internal candidates at the GS-14 level interested in a lateral reassignment or Commissioned Corps Officers may contact David Gittelman directly at dmg1@cdc.gov for more information. Please include your CV. Other internal and external candidates should apply via www.USAJobs.gov using the announcement numbers below (hyperlinked). Please remember to indicate your interest in infectious diseases and your country(ies) of interest (the Democratic Republic of Congo, Guinea, and/or Mali), and apply at the GS-14 level.
External Candidates:
Epidemiologist-601-13/14/15 (OVERSEAS)
Job Announcement Number: HHS-CDC-OD-11-432469
Medical Officer, GS-0602-13/14/15 (Direct - Hire) (OVERSEAS)
Job Announcement Number: HHS-CDC-OD-11-430961
Internal Candidates:
Epidemiologist-601-13/14/15 (OVERSEAS)
Job Announcement Number: HHS-CDC-OM-11-432468
Medical Officer, GS-0602-13/14/15 (Direct - Hire) (OVERSEAS)
Job Announcement Number: HHS-CDC-OM-11-432458
For non-US Citizens: Please send your CV and a cover letter directly to David Gittelman at dmg1@cdc.gov.
This is an open continuous announcement; however, due to the urgency of the assignment, we are setting a deadline for applications and inquiries for close of business Monday 22 August 2011.
David M. Gittelman, MPH
Deputy Lead, CDC/President's Malaria Initiative
Malaria Branch, Division of Parasitic Diseases and Malaria
Centers for Disease Control and Prevention
1600 Clifton Road, Mailstop A06
Atlanta, Georgia USA 30333
tel. 404-718-4756
BB: 678-469-9748
cell 404-408-9780
Fax 404-718-4815
e-mail: dgittelman@cdc.gov
- TWO METHODS FOR CALCULATING MEASLES MORTALITY
Comparison of LiST measles mortality model and WHO/IVB measles model
Wei-Ju Chen
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
author email corresponding author email
BMC Public Health 2011, 11(Suppl 3):S33doi:10.1186/1471-2458-11-S3-S33
The electronic version of this article is the complete one and can be found online at: http://www.biomedcentral.com/1471-2458/11/S3/S33
|
Published: |
13 April 2011 |
© 2011 Chen; licensee BioMed Central Ltd.
This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background
The Lives Saved Tool (LiST) has been developed to estimate the impact of health interventions and can consider multiple interventions simultaneously. Given its increasing usage by donor organizations and national program planner, we compare the LiST measles model to the widely used World Health Organization's Department of Immunization, Vaccines and Biologicals (WHO/IVB) measles model which is used to produce estimates serving as a major indicator of monitoring country measles epidemics and the progress of measles control.
Methods
We analyzed the WHO/IVB models and the LiST measles model and identified components and assumptions held in each model. We contrasted the important components, and compared results from the two models by applying historical measles containing vaccine (MCV) coverages and the default values of all parameters set in the models. We also conducted analyses following a hypothetical scenario to understand how both models performed when the proportion of population protected by MCV declined to zero percent in short time period.
Results
The WHO/IVB measles model and the LiST measles model structures differ: the former is a mixed model which applies surveillance data adjusted for reporting completeness for countries with good disease surveillance system and applies a natural history model for countries with poorer disease control program and surveillance system, and the latter is a cohort model incorporating country-specific cause-of-death (CoD) profiles among children under-five. The trends of estimates of the two models are similar, but the estimates of the first year are different in most of the countries included in the analysis. The two models are comparable if we adjust the measles CoD in the LiST to produce the same baseline estimates. In addition, we used the models to estimate the potential impact of stopping using measles vaccine over a 7-year period. The WHO/IVB model produced similar estimates to the LiST model with adjusted CoD. But the LiST model produced low estimates for countries with very low or eliminated measles infection that may be inappropriate.
Conclusions
The study presents methodological and quantitative comparisons between the WHO/IVB and the LiST measles models that highlights differences in model structures and may help users to better interpret and contrast estimates of the measles death from the two models. The major differences are resulted from the usage of case-fatality rate (CFR) in the WHO/IVB model and the CoD profile in the LiST. Both models have their own advantages and limitations. Users should be aware of the issue and apply as update country parameters as possible. Advanced models are expected to validate the policy-planning tools in the future.
- RESPIRATORY ADMINISTRATION OF MEASLES VACCINE
An evaluation of respiratory administration of measles vaccine for prevention of acute lower respiratory infections in children
Daisy Higginson1* , Evropi Theodoratou1* , Harish Nair1,2* , Tanvir Huda3 , Lina Zgaga1 , Suresh S Jadhav4 , Saad B Omer5 , Igor Rudan1,6* and Harry Campbell1*
1 Centre for Population Health Sciences, Global Health Academy, The University of Edinburgh, UK
2 Public Health Foundation of India, New Delhi, India
3 International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh
4 Serum Institute of India Limited, Pune, India
5 Emory University, Rollins School of Public Health, Atlanta, GA, USA
6 Croatian Centre for Global Health, University of Split Medical School, Croatia
author email corresponding author email* Contributed equally
BMC Public Health 2011, 11(Suppl 3):S31doi:10.1186/1471-2458-11-S3-S31
The electronic version of this article is the complete one and can be found online at: http://www.biomedcentral.com/1471-2458/11/S3/S31
|
Published: |
13 April 2011 |
© 2011 Higginson et al; licensee BioMed Central Ltd.
This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background
Measles was responsible for an estimated 100,000 deaths worldwide in 2008. Despite being a vaccine-preventable disease, measles remains a major cause of morbidity and mortality in young children. Although a safe and effective injectable measles vaccine has been available for over 50 years it has not been possible to achieve the uniformly high levels of coverage (required to achieve measles eradication) in most parts of the developing world. Aerosolised measles vaccines are now under development with the hope of challenging the delivery factors currently limiting the coverage of the existing vaccine.
Methods
We used a modified CHNRI methodology for setting priorities in health research investments to assess the strengths and weaknesses of this emerging intervention to decrease the burden of childhood pneumonia. This was done in two stages. In Stage I, we systematically reviewed the literature related to emerging aerosol vaccines against measles relevant to several criteria of interest. Although there are a number of different aerosol vaccine approaches under development, for the purpose of this exercise, all were considered as one intervention. The criteria of interest were: answerability; cost of development, production and implementation; efficacy and effectiveness; deliverability, affordability and sustainability; maximum potential impact on disease burden reduction; acceptability to the end users and health workers; and effect on equity. In Stage II, we conducted an expert opinion exercise by inviting 20 experts (leading basic scientists, international public health researchers, international policy makers and representatives of pharmaceutical companies). The policy makers and industry representatives accepted our invitation on the condition of anonymity, due to the sensitive nature of their involvement in such exercises. They answered questions from the CHNRI framework and their “collective optimism” towards each criterion was documented on a scale from 0 to 100%.
Results
The panel of experts expressed mixed feelings about an aerosol measles vaccine. The group expressed low levels of optimism regarding the criteria of likelihood of efficacy and low cost of development (scores around 50%); moderate levels of optimism regarding answerability, low cost of production, low cost of implementation and affordability (score around 60%); and high levels of optimism regarding deliverability, impact on equity and acceptability to health workers and end-users (scores over 80%). Finally, the experts felt that this intervention will have a modest but nevertheless important impact on reduction of burden of disease due to childhood pneumonia (median: 5%, interquartile range 1-15%, minimum 0%, maximum 45%).
Conclusion
Aerosol measles vaccine is at an advanced stage of development, with evidence of good immunogenicity. This new intervention will be presented as a feasible candidate strategy in the campaign for global elimination of measles. It also presents an unique opportunity to decrease the overall burden of disease due to severe pneumonia in young children.
- DELIGHT AND UNEASE OVER LAW ON STUDENT VACCINATIONS FOR MENINGITIS
By REEVE HAMILTON
New York Times, August 11, 2011
Among the things 22-year old Jamie Schanbaum could not have anticipated three years ago was standing two inches taller, winning a national Paralympic gold medal in cycling and reveling in the Texas Legislature’s passage of two bills in her honor. Those gains, however, came after significant losses — most noticeably of both legs below the knee and much of each finger, the result of a bout with meningococcal septicemia in her sophomore year at the University of Texas.
Commonly known as bacterial meningitis, meningococcal disease is a potentially fatal bacterial infection that saddles about one-fifth of its survivors with lifelong effects. Texas had 336 cases in 2009, according to the Department of State Health Services, 34 of them in people ages 15 to 29.
Ms. Schanbaum underwent numerous operations during months in the hospital, where the onset of a flesh-eating bacteria ultimately necessitated the amputations.
“It could have been worse,” Ms. Schanbaum said. “I could have been blind. I could have been deaf. I could have had brain damage. I could have died. I wouldn’t say I feel unlucky at all. I would say I consider this significant.”
So does Texas, which — after Gov. Rick Perry signed the second bill named for Ms. Schanbaum into law in May — became the first state to require every college student to be vaccinated against bacterial meningitis. (The Jamie Schanbaum Act of 2009 already required students living in campus dorms to be vaccinated.)
The new law, which will take effect at the start of 2012, expands that provision to apply to any new student under 30 taking on-campus classes even if they live off campus. While the tweak sounds deceptively simple, it has colleges and universities scrambling to raise awareness of such a broad policy and to figure out how to put it into effect.
Some critics, like Representative David Simpson, Republican of Longview, argue that the new laws amount to government intrusion, though students can opt out for medical or religious reasons.
The most recent bill, introduced in the Senate by Wendy Davis, Democrat of Fort Worth, was also named for Nicolis Williams, a Texas A&M University student who died in February after contracting bacterial meningitis. Mr. Williams, 20, lived off campus.
“I think it brings meaning to Nicolis’s death,” Ms. Davis said of her bill. “From this day forward, we’ll never know, of course, whose life was saved as a consequence, but no doubt there will be people whose lives are saved.”
Nevertheless, Mr. Simpson and 17 other House members opposed the bill. “I’m for freedom,” he said. “I’m not for the government dictating to us what we must do with our bodies.”
Mr. Simpson said it was comparable to what he considers invasive actions by federal airport security officers, which he has publicly challenged, and to a proposed ban on texting while driving that Mr. Perry vetoed — in Mr. Simpson’s view, correctly — for allowing government too much say in the personal lives of drivers.
Mr. Simpson also noted with particular frustration a February ruling in which the Supreme Court ruled that vaccine makers are protected from lawsuits by parents who believe shots harmed their children.
Mr. Williams’s father, Greg, an administrator at Texas Southern University who championed the bill, said, “I knew at the time of his death that there was probably a bigger plan in place in than I even thought of, because too many things happened that, in my mind, were more than a coincidence.”
Among those things was an empathetic state representative, Charlie F. Howard, Republican of Sugar Land, who had also lost a son. Mr. Howard sponsored the bill in the House.
Most important, the Advisory Committee on Immunization Practices at the federal Centers for Disease Control and Prevention had just updated its recommendations for the bacterial meningitis vaccine to include all college students. The update came after it was found that the vaccination given to preteenagers was wearing off, leaving all young adults ages 17 to 21 vulnerable, not just those living in crowded dorms.
“There was more distress than I’ve ever seen during my tenure about making that recommendation solely on the basis of cost,” said Dr. Carol Baker, a professor at Baylor College of Medicine in Houston and the chairwoman of the advisory committee.
The dispute centered on whether it was worth doubling the price tag of the vaccination program for such a rare disease. The new recommendation passed by a single vote.
Though Dr. Baker said potential side effects of the vaccine were unlikely to be anything more than a sore arm, other people are not convinced.
Dawn Richardson, president of Parents Requesting Open Vaccine Education, opposed the Davis bill because of fear of more serious side effects and of what she sees as a false sense of security the inoculation brings. Ultimately, Ms. Richardson said, she was satisfied by a requirement that universities give students detailed information about the vaccine and the ability to opt out of it. “I consider that a big win,” she said.
Preparing informational materials is one of many tasks facing universities as a result of the law. The Texas Higher Education Coordinating Board, which oversees the carrying out of new legislation, plans to invite public comments to address, among other questions, what to do about continuing-education students who might be on campus for only one or two classes.
There is also the issue of cost. The bill was not expected to create any costs for the state since the vaccine, which can exceed $100 a dose, is to be paid for by students or be covered by insurance. But Wanda Mercer, associate vice chancellor for student affairs for the University of Texas System, sees complications ahead.
“The administrative record-keeping and follow-up by people that is going to be required for those students who don’t comply — and there will be students who don’t comply — is very expensive,” Ms. Mercer said.
Scott McDonald, assistant vice president for academic services at Texas A&M, said he and his colleagues had yet to determine exactly how to prevent students from attending class if they had not been vaccinated or submitted the necessary forms to opt out.
And what about the woman who started it all? Ms. Schanbaum plans to finish her degree at U.T. and hopes for an invitation to compete with the American cycling team at the 2012 Paralympic Games in London. She and her family also promise to continue advocating for the meningitis vaccine and promoting similar laws in other states.
“We have a good friend in Florida whose son died of the disease,” said Ms. Schanbaum’s mother, Patsy. “So we think we’ll go there next.”
- KEVIN DE COCK INTERVIEWED ON NEW DEVELOPMENTS IN HIV/AIDS
From Windy City Times, July 2011
Belgium-born infectious disease specialist Dr. Kevin De Cock is the director of the World Health Organization ( WHO ) Department of HIV/AIDS—a position he has held since 2006. Prior to signing on at WHO, Dr. De Dock spent six years as the director at the U.S. Centers for Disease Control and Prevention ( CDC ) in Kenya and as director of the CDC Division of HIV/AIDS Prevention, Surveillance and Epidemiology in Atlanta.
Windy City Times had the opportunity in July to speak with De Cock in Atlanta.
Windy City Times: Two new studies were released with findings of a significant decrease in HIV/AIDS transmission by using PrEP and the drug Truvada. Can you explain to us why these new findings are so important?
Dr. Kevin De Cock: Sure. In the past couple of years there's been a tremendous sort of resurgence of interest in HIV prevention and important scientific findings concerning new interventions. At the international AIDS conference held in Vienna in 2010, a study was presented showing efficacy of a vaginal microbicide containing Tenofovir. The study showed that it offered partial protection for women in regards to becoming infected with HIV. The important thing about that study in 2010 was that it, firstly, showed that it was possible to develop a vaginal product that women could use, that was under the woman's control and that this could be efficacious. But of course the product contained an anti-retroviral drug so it was … proof of concept also of pre-exposure prophylaxis; in other words taking a drug before an exposure to prevent the establishment of infection. It's just in this case the drug was delivered topically rather than taken by mouth.
So that was the first study last year and then, as you know, about eight months ago there was another study in gay men that showed that taking the pills by mouth also prevented the establishment of infection in uninfected men. And now we have two studies in heterosexuals showing protection in men and women. An additional reason that so much attention is going to these two studies is that a few months ago there was yet another study called a FEM-PrEP study which actually was stopped early because it wasn't showing any benefit. So in a way these additional studies that have just come out are sort of supporting the study in gay men and suggesting that that negative study in women, the FEM-PrEP study, was probably negative, you know, failed to give a positive result, for other reasons.
In addition to all of that, there have been other very important data showing that treatment of infected people reduces their likelihood of transmitting the infection to an HIV-negative person. So all of this, what all of this shows, literally in the space of about a year, is just a tremendous amount of new information highlighting the very important role that anti-retroviral drugs play … or can play … in HIV prevention.
WCT: How important is mass education in the wake of preventing and possibly finding a cure for HIV/AIDS?
KDC: Well I think AIDS is the kind of problem for which we'll never have a single magic bullet because, you know, it's fundamentally a disease … or it's an infection … that is transmitted through behaviors, through very common and human behaviors relating to sexual behavior, drug-using behavior and reproductive behavior, you know, having children. We have pretty much completely closed down the transmission of HIV through blood transfusion; certainly in high-income countries and to a considerably large extent in low and middle-income countries as well. So transmission of HIV through blood as a blood product is not a huge issue anymore the way it was at the beginning of the epidemic. But, you know, human behavior will remain a constant issue as we try to control HIV-AIDS and then there's, of course, also a very important behavioral aspect related to healthcare seeking behavior, adherence to drugs, adherence to interventions, you know, and so on. So there's much more to it…to HIV/AIDS than just commodities and biomedical intervention.
WCT: From your experience to someone reading this interview having just been diagnosed with HIV/AIDS, what are the major differences say, today, as opposed to being diagnosed 30 years ago?
KDC: Oh it's a night and day difference. At the beginning of the epidemic…it's difficult to describe what it was like. I don't know how old you are. Were you around?
WCT: I'm 28, so I was not around. Almost, but—
KDC: Well that's amazing actually. I mean it's…it's difficult to describe what it was like. It was…I mean the fact that this disease apparently came out of nowhere…that wasn't understood, the virus hadn't been discovered, and there wasn't a blood test. What you saw was initially gay men and then drug users and then the recipients of blood transfusions and transfusion products…particularly young hemophiliacs. You saw these people presented with terrible infectious diseases that basically were incurable. And these people were young, by and large, and they rapidly went on to die.
WCT: Right.
KDC: And then the numbers started increasing and the spectrum of the disease broadened, in other words, other things started to be noticed like men would lose weight and develop swollen lymph nodes, and that was a pretty sure sign that down the line they were going to get the full-blown disease. So there were just so many things to work out. Then we saw women getting it…becoming ill. Clue by clue was pieced together and…for example, the first cases in women were very puzzling but then it was found that, well, yes, but their husband had had male-to-male sexual contact when he traveled away from home, and one saw these sorts of observations. And then, you know, the recognition that this wasn't just in the United States, but in other industrialized countries cases were seen, and then in Europe black Africans were showing up coming for treatment from Africa. And then, I mean, it just went on and on and on and just more and more information, and it was just…it was extraordinary. It was really a steep change from before.
But today, we are familiar with AIDS, we understand the infection, the natural history of the disease, there are very good blood tests and other tests, and most importantly, of course, we have very effective therapy. Having said all of that, this is not a disease that anybody wants. This remains a…you know, it's not a good disease to have. It's difficult taking medicines for the rest of your life, because the drugs do have tough side effects. And we don't really know yet, because we haven't been doing this long enough, you know, whether people with HIV who go off to therapy, whether in fact they will live a normal lifestyle or not. It wouldn't be surprising. It's what we see with most other diseases that in fact, you know, life is shortened. But we don't really know that, because the therapies are very effective and we haven't been following people for long enough. But, so in other words, it's a completely different situation today, but we still need a lot of attention to it. People still need support. There still is stigma and discrimination. People still need prevention support to make sure they don't transmit the infection to others. They need to adhere to their drugs, etc., etc. So it's not…simple, but it is completely different.
WCT: Are there specific areas in the world where we see a pattern of an increase or decrease in the number of newly infected individuals?
KDC: No, I think…there's reason to be optimistic, but there's also reason to be concerned. I think that globally we're seeing a reduction in the numbers of new HIV infections, and that's continuing to occur. The peak in new infections was probably about 10 years ago, and the number of new infections has continued to decline and is still doing so, so that's encouraging. Nonetheless, it still means we're having well over 2 million new infections globally every year…about 2.5 - 2.7 million new HIV infections or something like that. That's still a lot of new infections and it's just adding to the total burden of people living with HIV. With our better understanding of prevention and these new modalities, I think we have remarkable opportunities to do even better and to really have a substantial impact on the epidemic, particularly through expanding HIV treatment based on some of the new science that has come in.
Having said all of that, and I think of interest to your readers, because of your area of focus, I am very concerned about the epidemic amongst gay men…men who have sex with men. Firstly, we are not seeing a reduction in new HIV infections in gay men in the United States. The number of new infections has been quite stable for quite some time at over 50,000 new infections; about 56,000 is our estimate in this country, and that hasn't really changed. And one has to ask; the way trends are...can we accept this? Is it just…do we have to sort of just think that it is just inevitable that in the life of a gay man, there is a very high…probability that he will become infected with HIV before the end of his life? I mean that's a terrible thing to accept, but you know the cumulative risk for gay men remains very high.
The other point to emphasize, the second point, is that we now recognize that, of course, there are gay men all over the world, men who have sex with men, all over the world, including in countries where we didn't think or where very little attention went to this issue.
- DO IMPROVEMENTS IN OUTREACH, CLINICAL, AND FAMILY AND COMMUNITY-BASED SERVICES PREDICT IMPROVEMENTS IN CHILD SURVIVAL? AN ANALYSIS OF SERIAL CROSS-SECTIONAL NATIONAL SURVEYS
Nancy Binkin1 , Mickey Chopra1 , Aline Simen-Kapeu2 and Dirk Westhof3
The electronic version of this article is the complete one and can be found online at: http://www.biomedcentral.com/1471-2458/11/456
Abstract
Background
There are three main service delivery channels: clinical services, outreach, and family and community. To determine which delivery channels are associated with the greatest reductions in under-5 mortality rates (U5MR), we used data from sequential population-based surveys to examine the correlation between changes in coverage of clinical, outreach, and family and community services and in U5MR for 27 high-burden countries.
Methods
Household survey data were abstracted from serial surveys in 27 countries. Average annual changes (AAC) between the most recent and penultimate survey were calculated for under-five mortality rates and for 22 variables in the domains of clinical, outreach, and family- and community-based services. For all 27 countries and a subset of 19 African countries, we conducted principal component analysis to reduce the variables into a few components in each domain and applied linear regression to assess the correlation between changes in the principal components and changes in under-five mortality rates after controlling for multiple potential confounding factors.
Results
AAC in under 5-mortality varied from 6.6% in Nepal to -0.9% in Kenya, with six of the 19 African countries all experiencing less than a 1% decline in mortality. The strongest correlation with reductions in U5MR was observed for access to clinical services (all countries: p = 0.02, r2 = 0.58; 19 African countries p < 0.001, r2 = 0.67). For outreach activities, AAC U5MR was significantly correlated with antenatal care and family planning services, while AAC in immunization services showed no association. In the family- and community services domain, improvements in breastfeeding were associated with significant changes in mortality in the 30 countries but not in the African subset; while in the African countries, nutritional status improvements were associated with a significant decline in mortality.
Conclusions
Our findings support the importance of increasing access to clinical services, certain outreach services and breastfeeding and, in Africa, of improving nutritional status. Integrated programs that emphasize these services may lead to substantial mortality declines.
- SIMPLIFIED ART DELIVERY MODELS ARE NEEDED FOR THE NEXT PHASE OF SCALE UP
Also at http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001060
Nathan Ford and Edward Mills discuss broader issues in HIV care delivery raised by research carried out by Lawrence Long and colleagues into down-shifting HIV care to primary health facilities.
Nathan Ford1,2*, Edward J. Mills3
1 Médecins Sans Frontières, Geneva, Switzerland, 2 Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa, 3 Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
Citation: Ford N, Mills EJ (2011) Simplified ART Delivery Models Are Needed for the Next Phase of Scale Up. PLoS Med 8(7): e1001060. doi:10.1371/journal.pmed.1001060
Published: July 19, 2011
Copyright: © 2011 Ford, Mills. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
* E-mail: nathan.ford@joburg.msf.org
This Perspective discusses the following new study published in PLoS Medicine:
Long L, Brennan A, Fox MP, Ndibongo B, Jaffray I, et al. (2011) Treatment Outcomes and Cost-Effectiveness of Shifting Management of Stable ART Patients to Nurses in South Africa: An Observational Cohort. PLoS Med 7(7): e1001055. doi:10.1371/journal.pmed. 1001055
Lawrence Long and colleagues report that “down-referring” stable HIV patients from a doctor-managed, hospital-based ART clinic to a nurse-managed primary health facility provides good health outcomes and cost-effective treatment for patients.
Decentralized ART Provision a Necessity
Efforts to scale up antiretroviral therapy (ART) for people living with HIV/AIDS in resource-limited settings began with a clear recognition of the need to adapt the model of care from individualized care to a public health approach [1]. Ten years ago, the main model for ART delivery was the Western model: specialized and individualized, with patients receiving careful clinical monitoring and drug regimens that were frequently altered according to tolerability, emergence of resistance, and patient preference. Such a level of care was clearly beyond the capacity of hospital services in sub-Saharan Africa 10 years ago, and which remain for the most part poorly funded, poorly equipped, understaffed, and overwhelmed.
Acknowledging the urgency of scaling up treatment for millions of patients in clinical need, innovative approaches to simplified ART delivery were implemented in parallel with (not subsequent to) formal epidemiological assessments. So, the first randomized trial comparing doctors and nurses in the delivery of ART [2] was published 3 years after such “task shifting” was promoted by the World Health Organization [3]. Whilst trial data were important to validate the task shifting approach, the lack of sufficient numbers of doctors in high-burden countries meant that by the time the evidence was published, hundreds of thousands of patients were already dependent on nurses and other mid-level health workers for their HIV care.
New evidence is welcomed. A study published this week in PLoS Medicine by Lawrence Long and colleagues [4] reports the feasibility and benefits of “down-referring” ART patients from hospitals to health centers in South Africa, and shows that ART provision at the health centers was beneficial for both patients (better survival and retention in case) and providers (reduced costs). This type of study is important to stimulate donors and program managers to go further in supporting ART provision beyond centralized, hospital-based facilities. That this type of care is urgently needed is supported by a recent survey by Médecins Sans Frontières revealing that less than one-fifth of public health facilities in the Central African Republic, Guinea, Kenya, Mozambique, and Uganda provided ART [5].
In common with task shifting, which out of necessity was implemented before formal evidence of efficacy was reported, the decentralized provision of ART beyond the hospital level has been happening for several years in many resource-limited settings, where hospitals are few and distant from patients, out of necessity. In Malawi, patients have received ART at health centers since 2006, with outcomes better than those obtained in the hospital [6]. Reports from South Africa [7] and Lesotho [8] show similarly reassuring outcomes for decentralized care.
- CAN LAY HEALTH WORKERS INCREASE IMMUNIZATION COVERAGE?
‘Lay health workers could make an important contribution to achieving the Millennium Development Goal for child health. However, more high-quality studies are needed, particularly from LMICs. More studies are also needed to assess the effects of using LHWs to vaccinate children themselves.’
Full text, with figures, is at http://onlinelibrary.wiley.com/doi/10.1111/j.1365-3156.2011.02813.x/full
Can lay health workers increase the uptake of childhood immunisation? Systematic review and typology
Claire Glenton1, Inger B. Scheel1, Simon Lewin2, George H. Swingler3
Tropical Medicine & International Health
Volume 16, Issue 9, pages 1044–1053, September 2011
Glenton, C., Scheel, I. B., Lewin, S. and Swingler, G. H. (2011), Can lay health workers increase the uptake of childhood immunisation? Systematic review and typology. Tropical Medicine & International Health, 16: 1044–1053. doi: 10.1111/j.1365-3156.2011.02813.x
Objectives Lay health workers (LHWs) are used in many settings to increase immunisation uptake among children. However, little is known about the effectiveness of these interventions. The objective of this review was to assess the effects of LHW interventions on childhood immunisation uptake.
Methods We searched Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, British Nursing Index and Archive, AMED, POPLINE and WHOLIS, reference lists of included papers and relevant reviews, and contacted the authors of relevant papers. We selected randomised and non-randomised controlled trials, controlled before–after studies, and interrupted time series of any intervention delivered by LHWs and designed to increase childhood immunisation uptake. Two authors independently extracted data using a standard form and assessed risk of bias and evidence quality.
Findings We identified twelve studies, ten of which were randomised controlled trials. Seven studies were conducted among economically disadvantaged populations in high-income countries. Five studies were from low- and middle-income countries. In ten studies, LHWs promoted childhood immunisation. In two studies, LHWs vaccinated children themselves. In most of the studies, the control group populations received no intervention or standard care. Most of the studies showed that LHWs increased immunisation coverage. However, study settings were diverse, allowing us to carry out only one meta-analysis including four studies.
Conclusion LHWs could make an important contribution to achieving the Millennium Development Goal for child health. However, more high-quality studies are needed, particularly from LMICs. More studies are also needed to assess the effects of using LHWs to vaccinate children themselves.
| Are three drugs for malaria better than two?
Friday, 24th of April 2020 |
| Public health Interventions and epidemic intensity during the 1918 influenza pandemic
Thursday, 16th of April 2020 |
| Chloroquine and hydroxychloroquine as available weapons to fight COVID-19
Tuesday, 17th of March 2020 |
| Using models to shape measles control and elimination strategies in low- and middle-income countries: A review of recent applications
Monday, 17th of February 2020 |
| Immunization Agenda 2030
Tuesday, 11th of February 2020 |
 |
41137673 |
| www.measlesinitiative.org www.technet21.org www.polioeradication.org www.globalhealthlearning.org www.who.int/bulletin allianceformalariaprevention.com www.malariaworld.org http://www.panafrican-med-journal.com/ |