Decomposing the gap in missed opportunities for vaccination between poor and non-poor in sub-Saharan Africa : a multicountry analyses

Understanding the gaps in MOV between poor and non-poor in sub-Saharan Africa (SSA) would enable an understanding of factors associated with interventions for improving immunization coverage to achieving universal childhood immunization. We aimed to conduct a multicountry analyses to decompose the gap in MOV between poor and non-poor in SSA. We used cross-sectional data from 35 Demographic and Health Surveys in SSA conducted between 2007 and 2016. Descriptive statistics were used to understand the gap in MOV between the urban poor and non-poor, and across the selected covariates. Out of the 35 countries included in this analysis, 19 countries showed pro-poor inequality, five showed pro-non-poor inequality and remaining 11 countries showed no statistically significant inequality. Among the countries with statistically significant pro-illiterate inequality, the risk difference ranged from 4.2% in Congo DR to 20.1% in Kenya. The important factors responsible for the inequality varied across the countries. In Madagascar, the largest contributions to the inequality in MOV was media access followed by number of under-five children and maternal education. However, Liberia media access narrowed the inequality in MOV between poor and non-poor households.The findings indicate that in most SSA countries, children belonging to poor households are most likely to have MOV and that socio-economic inequality in missed opportunities for vaccination is determined not only by health system functions, but also by factors beyond the scope of health authorities and care delivery system. Suggesting the the importance of addressing the social determinants of health, particularly education

Mainstreaming implementation science into immunization systems in the decade of vaccines: A programmatic imperative for the African Region.

Several innovations that can improve immunization systems already exist. Some interventions target service consumers within communities to raise awareness, build trust, improve understanding, remind caregivers, reward service users, and improve communication. Other interventions target health facilities to improve access and quality of vaccination services among others. Despite available empirical evidence, there is a delay in translating innovations into routine practice by immunization programmes. Drawing on an existing implementation science framework, we propose an interactive, and multi-perspective model to improve uptake and utilization of available immunization-related innovations in the African region. It is important to stress that our framework is by no means prescriptive. The key intention is to advocate for the entire immunization system to be viewed as an interconnected system of stakeholders, so as to foster better interaction, and proactive transfer of evidence-based innovation into policy and practice

COVID-19 and routine childhood immunization in Africa : leveraging systems thinking and implementation science to improve immunization system performance

CITATION: Adamu, A. A. et al. 2020. COVID-19 and routine childhood immunization in Africa: Leveraging systems thinking and implementation science to improve immunization system performance. International journal of infectious diseases, 98:161–165. doi:10.1016/j.ijid.2020.06.072The original publication is available at https://www.journals.elsevier.com/international-journal-of-infectious-diseasesOne of the routine health services that is being disrupted by coronavirus disease 2019 (COVID-19) in Africa is childhood immunization. This is because the immunization system relies on functioning health facilities and stable communities to be effective. Its disruption increases the risk of epidemics of vaccine-preventable diseases, which could increase child mortality. Therefore, policymakers must quickly identify robust and context-specific strategies to rapidly scale-up routine immunization in order to mitigate the impact of COVID-19 on their national immunization performance. To achieve this, we propose a paradigm shift towards systems thinking and use of implementation science in immunization decision-making. Systems thinking can inform a more nuanced and holistic understanding of the interrelationship between COVID-19, its control strategies, and childhood immunization. Tools like causal loop diagrams can be used to explicitly illustrate the systems structure by identifying feedback loops. Once mapped and leverage points for interventions have been identified, implementation science can be used to guide the rapid uptake and utilization of multifaceted evidence-based innovations in complex practice settings. As Africa re-strategizes for the post-2020 era, these emerging fields could contribute significantly in accelerating progress towards universal access to vaccines for all children on the continent despite COVID-19.https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S1201971220305075?returnurl=https:%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS1201971220305075%3Fshowall%3Dtrue&referrer=Publishers versio

Early Impact of SARS-CoV-2 Pandemic on Immunization Services in Nigeria

Background: By 11 March 2022, there were 450,229,635 coronavirus disease (COVID-19) cases and 6,019,085 deaths globally, with Nigeria reporting 254,637 cases and 3142 deaths. One of the essential healthcare services that have been impacted by the pandemic is routine childhood immunization. According to the 2018 National Demographic and Health Survey, only 31% of children aged 12–23 months were fully vaccinated in Nigeria, and 19% of eligible children in the country had not received any vaccination. A further decline in coverage due to the pandemic can significantly increase the risk of vaccine-preventable-disease outbreaks among children in Nigeria. To mitigate such an occurrence, it is imperative to urgently identify how the pandemic and the response strategies have affected vaccination services, hence, the goal of the study. Methods: The research method was qualitative, including in-depth interviews of healthcare workers and focus group discussions (FGDs) with caregivers of children aged 0–23 months. We selected one state from each of the three zones of Nigeria: northern, central, and southern. Within each state, 10 local government areas and 20 healthcare facilities were purposively selected. In each facility, 10 healthcare workers were invited for interviews. Overall, 517 healthcare workers were interviewed. For the focus group discussion, 30 communities were selected. Within each selected community, six consenting caregivers were included. Overall, 180 caregivers participated. The data were analyzed using thematic inductive content analysis. Results: Three significant impacts that were observed are: difficulties in accessibility to immunization services, declining immunization demand and uptake among caregivers due to varying factors, and erosion of vaccine confidence among both caregivers and healthcare workers. Movement restriction and lockdown had numerous major impacts, such as decreased general healthcare service delivery, increased transportation costs, fewer engagements that promote vaccine uptake, and cessation of mobile vaccination campaigns that target hard-to-reach communities. Moreover, misinformation, conspiracy beliefs about the pandemic and COVID-19 vaccines, and risk perception negatively influenced general vaccine confidence. Conclusion: The results of this early impact study show that immunization was directly affected by the pandemic and provide insights into areas where interventions are needed for recovery

Rural-urban disparities in missed opportunities for vaccination in sub-Saharan Africa : a multi-country decomposition analyses

Background In this study, we aimed to explore the rural-urban disparities in the magnitude and determinants of missed opportunities for vaccination (MOV) in sub-Saharan Africa. Methods This was a cross-sectional study using nationally representative household surveys conducted between 2007 and 2017 in 35 countries across sub-Saharan Africa. The risk difference in MOV between rural or urban dwellers were calculated. Logistic regression method was used to investigate the urban-rural disparities in multivariable analyses. Then Blinder-Oaxaca method was used to decompose differences in MOV between rural and urban dwellers. Results The median number of children aged 12 to 23 months was 2113 (Min: 370, Max: 5896). There was wide variation in the the magnitude of MOV among children in rural and urban areas across the 35 countries. The magnitude of MOV in rural areas varied from 18.0% (95% CI 14.7 to 21.4) in the Gambia to 85.2% (81.2 to 88.9) in Gabon. Out of the 35 countries included in this analysis, pro-rural inequality was observed in 16 countries (i.e. MOV is prevalent among children living in rural areas) and pro-urban inequality in five countries (i.e. MOV is prevalent among children living in urban areas). The contributions of the compositional ‘explained’ and structural ‘unexplained’ components varied across the countries. However, household wealth index was the most frequently identified factor. Conclusions Variation exists in the level of missed opportunities for vaccination between rural and urban areas, with widespread pro-rural inequalities across Africa. Although several factors account for these rural-urban disparities in various countries, household wealth was the most common

SPARC 2018 Internationalisation and collaboration : Salford postgraduate annual research conference book of abstracts

Welcome to the Book of Abstracts for the 2018 SPARC conference. This year we not only celebrate the work of our PGRs but also the launch of our Doctoral School, which makes this year’s conference extra special. Once again we have received a tremendous contribution from our postgraduate research community; with over 100 presenters, the conference truly showcases a vibrant PGR community at Salford. These abstracts provide a taster of the research strengths of their works, and provide delegates with a reference point for networking and initiating critical debate. With such wide-ranging topics being showcased, we encourage you to take up this great opportunity to engage with researchers working in different subject areas from your own. To meet global challenges, high impact research inevitably requires interdisciplinary collaboration. This is recognised by all major research funders. Therefore engaging with the work of others and forging collaborations across subject areas is an essential skill for the next generation of researchers

Global, regional, and national burden of meningitis, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016

Background Acute meningitis has a high case-fatality rate and survivors can have severe lifelong disability. We aimed to provide a comprehensive assessment of the levels and trends of global meningitis burden that could help to guide introduction, continuation, and ongoing development of vaccines and treatment programmes.AA received funding from Department of Science and Technology, Government of India, New Delhi, through INSPIRE Faculty Award Scheme. HB was financially supported by Mazandaran University of Medical Sciences, Sari, Iran. AB received support for research from the Project of Ministry of Education, Science and Technology of the Republic of Serbia (No. III45005). TWB was supported by the Alexander von Humboldt Foundation through the Alexander von Humboldt Professor award, funded by the Federal Ministry of Education and Research. FC reports European Union (FEDER funds POCI/01/0145/FEDER/007728 and POCI/01/0145/ FEDER/007265) and National Funds (FCT/MEC, Fundação para a Ciência e a Tecnologia and Ministério da Educação e Ciência) under the Partnership Agreements PT2020 UID/MULTI/04378/2013 and PT2020 UID/QUI/50006/2013. HF was financially supported by Urmia University of Medical sciences, Urmia, Iran. EF reports European Union (FEDER funds POCI/01/0145/FEDER/007728 and POCI/01/0145/FEDER/007265) and National Funds (FCT/MEC, Fundação para a Ciência e a Tecnologia and Ministério da Educação e Ciência) under the Partnership Agreements PT2020 UID/MULTI/04378/2013 and PT2020 UID/QUI/50006/2013. JK has received research funding from Merck Pharmaceuticals. AM acknowledges that Imperial College London is grateful for support from the NW London National Institute of Health and Research Collaboration for Leadership in Applied Health Research and Care. UOM acknowledges funding from the German National Cohort Study Federal Ministry of Education and Research Grant #01ER1511/D. AMS was supported by a fellowship from the Egyptian Fulbright Mission Program. MSM acknowledges the support from the Ministry of Education, Science and Technological Development, Republic of Serbia (Contract No. 175087). KBT acknowledges funding supports from the Maurice Wilkins Centre for Biodiscovery, Cancer Society of New Zealand, Health Research Council, Gut Cancer Foundation, and the University of Auckland. CSW’s work is funded by the South African Medical Research Council and the National Research Foundation of South Africa (Grant Numbers: 106035 and 108571)

Assessing readiness to implement routine immunization among patent and proprietary medicine vendors in Kano, Nigeria : a theory-informed cross-sectional study

Background: Patent and proprietary medicine vendors (PPMVs) are widespread in communities and can potentially be used to expand access to routine immunization especially in underserved areas. In this study, we aimed to assess their readiness to implement routine immunization in Kano, Nigeria and identify factors associated with it. Methods: We conducted a cross-sectional survey of PPMVs aged 18 years and above in Kano metropolis, Nigeria, using cluster sampling technique. A 10-item Likert scale-based measure was used to estimate readiness score. The relationship between selected factors and readiness score was examined using multilevel linear modeling technique. Results: A total of 455 PPMVs with median age of 36 years participated in the study. The median raw score for readiness was 4.7 (IQR: 4.3 – 4-8) (maximum obtainable was 5). The mean readiness score (obtained through factor analysis) was 5.28 (SD: 0.58). Readiness score was associated with factors such as knowledge of immunization and task demand, engagement by other public health programs among others. Conclusion: This study demonstrated the feasibility of measuring the level of readiness for implementing routine immunization among PPMVs. Given the high level of readiness, policy makers should consider the possibility of expanding access to immunization through PPMVs

Undergraduate students' perception towards ward rounds as a clinical teaching strategy and perceived impact on academic performance in Zaria

Background: The primary aim of this study is to assess the undergraduate students’ perception on ward-round and clinical teaching activities and its perceived impact on their academic performance in Ahmadu Bello University Teaching Hospital, Shika-Zaria. A descriptive survey design was employed as a methodology for the study. The study population includes undergraduate students of Bachelor of Nursing Sciences (BNSc) in 400 & 500L, Bachelor of Pharmaceutical Sciences (B.Pharm) in 500L and Bachelor of Medicine; Bachelor of Surgery (MBBS) in 400 & 500 Levels with a total number of 910.Materials and Methods: A cross sectional descriptive survey was employed as a study design. Structured questionnaire was used as instrument for data collection which was divided into five sections according to the objectives of the study. Results: The study population comprises of undergraduate students of Bachelor of Nursing Sciences (BNSc) in 400 & 500L, Bachelor of Pharmaceutical Sciences (B.Pharm) in 500L and Bachelor of Medicine; Bachelor of Surgery (MBBS) in 400 & 500 Levels. A sample size of 276 was used. Thef indings of the study revealed that, BNSc and MBBS students demonstrated good perception toward the concept of ward-round as clinical teaching strategy; B.Pharm students had good perception toward ward round but their clinical role was not clearly defined because of limited period of posting. Most of the students enjoyed participating in ward-round and they always participate. Among the BNSc students, “Team work” was rated most as an impact of ward-round that strongly influence their performance, while among the MBBS students “Work-based teaching” got the highest rating and B. Pharm students rated “Improved motivation” as an impact of ward-round that strongly influence their performance. Conclusion: It was concluded that undergraduate students demonstrated good perception of the concept of ward-round and they enjoy participating in all activities during clinical teaching. Interventions such as supervision and guidance of students’ activities while in the clinical area by the clinical instructors, increasing the number of postings of B. pharm students to the ward are needed for effective integration of learning

High burden of chronic kidney disease of unknown cause among patients receiving renal replacement therapy in Northeast Nigeria: A cross-sectional survey of haemodialysis units

BACKGROUND: Chronic kidney disease (CKD) is emerging as a significant public health concern in northeastern Nigeria, particularly in states such as Yobe and Borno. Despite its increasing impact, there is a lack of data characterizing this public health issue. This study aims to explore the prevalence, spatial distribution, and risk factors for CKD among patients receiving haemodialysis (HD) in the region. METHODOLOGY: A cross-sectional survey of HD centres in Yobe, Borno, and Jigawa States of Nigeria was conducted. Questionnaire responses were obtained on demographic, social, and clinical data. Spatial analyses were conducted to determine the geographic distribution of the cases. RESULTS: We identified 376 patients receiving HD services across 4 centres. Of these, 207 (55.1%) were male and the mean age was 46.56 ± 16.4. Most patients reside in urban areas (67.6%). The main pre-dialysis occupations included civil service (100 [26.6%]), agriculture (65 [17.3%]), and trading (58 [15.4%]). 'Hypertension' (195 [51.9%]) was the most common self-reported primary renal disease, followed by unknown causes (70 [18.6%]) and Diabetic Kidney Disease (30 [8%]). Regional analysis demonstrated a particularly high burden of disease in Bade and Jakusko Local Government Areas. CONCLUSION: Spatial analysis suggests the existence of a CKD hotspot geographically associated with communities along the River Yobe, raising the possibility of an important environmental cause of disease. This study also highlights the lack of access to adequate diagnosis and geographical clustering of CKD burden in this region. These findings further reinforce the need for population-representative studies to characterize the burden of CKD alongside strategic healthcare interventions and collaboration among stakeholders aimed at improving access to care.xs