An Analysis of Risk Factors for Incomplete Immunization for Children in Côte d’Ivoire: Examination of 1998-1999 and 2011-2012 Demographic and Health Survey Data

Background: Immunization is said to be the most effective public health intervention to prevent morbidity, complications, and mortality due to infectious disease among children. Due to the importance of vaccination in terms of infectious disease prevention, in terms of high cost-effectiveness ratio, international organizations, governments, and donors have intensified efforts to increase immunization coverage globally. Despite the efforts, thousands of children remain unimmunized or not fully vaccinated worldwide. Objective: To identify factors associated with incomplete immunization among children in Côte d’Ivoire. Method:The 1998-1999 and 2011-2012 Côte d’Ivoire Demography and Health Survey (DHS) data were used in this study. The included 3878 children aged 12 to 59 months with 1326 children from 1998-1999 DHS, and 2552 children from 2011-2012 DHS. Descriptive analysis was performed. Spearman’s correlation coefficient was computed to examine the relationship between variables. Univariate analysis was performed to examine the association between the dependent variable (incomplete immunization) and each independent variable using logistic regression. Variables with a p-value less than .05 in the univariate analysis were included in the multivariate analysis. Multivariate analysis was performed to determine predictors of immunization status using logistic regression (stepwise method). Results: About 42.7% and 50.1% of Côte d’Ivoire were not fully immunized in 1998-1999 and 2011-2012, respectively. Child birth place, mothers’ access to media, mothers’ literacy, place of residence, and religion were the best predictors of incomplete immunization. Conclusion:Health authorities in Côte d’Ivoire should take into account these immunization status predictors in order to address the issue of incomplete immunization

Challenges related to resources mobilization for measles outbreak response: Madagascar experience during the 2018-2019 measles outbreak

Introduction: on October 4th, 2018, a measles outbreak was declared in Madagascar. This study describes challenges related to resources mobilization for the outbreak response. Methods: data were collected using minutes of coordination committee meetings, activities reports, operational action plans and situation reports. Results: the total cost of the outbreak response was estimated to US$ 11,281,381. Operational cost was the leading cost driver (42.45%) followed by vaccine cost (33.74%). Cases management, epidemiological surveillance, communication and social mobilization and routine immunization strengthening represented 23.81% of the total cost. The main funder of the outbreak response was the measles and rubella initiative. Conclusion: good coordination, open dialogue, good use of financial resources and accountability of government and partners have enabled to gain the confidence of national and international donors

Processus de prévalidation de l’élimination du tétanos maternel et néonatal en Côte-d’Ivoire en 2012: Prevalidation process of elimination of maternal and neonatal tetanus in Côte-d’Ivoire in 2012

Context and objective. The Côte-d'Ivoire joined the global initiative for maternal and neonatal tetanus elimination. In order to reach that goal, tetanus vaccine for pregnant women has been introduced in the routine immunization, and supplementary immunization activities have been conducted. In addition, clean deliveries have been promoted, and tetanus surveillance has been conducted. Currently, the country expresses the need to formalize the validation of maternal and neonatal tetanus elimination. The objective of the present study was to ascertain whether the Côte -d'Ivoire could be considered free of maternal and neonatal tetanus. Methods.We conducted a cross-sectional study between 2009 and 2011, in the four health district at high risk of maternal and neonatal tetanus in Côte-dÍvoire. In each district, two health facilities with the poorest performance have been selected. In the catchment area of each health facility, two neighborhoods have been randomly selected. In each neighborhood 20 women of childbearing age and 10 other women with a child aged less than 2 years have been randomly selected through a household survey. Parameters of interest were the following: maternal and neonatal tetanus surveillance, prenatal visits and clean deliveries, and tetanus vaccination. Results. Data have been collected from four (4) health district management teams, eight (8) health facility managers, sixteen (16) village chiefs, four hundred (400) women of childbearing age, and two hundred (200) women with a child aged less than 2 years. The proportion of deliveries in public hospital varied from 16% to 80%. Substances were systematically applied on the umbilical cord after delivery. TT2+ coverage was greater than 80% in 3 districts. The proportion of infants who received all the vaccines for their age ranged from 24% to 70%. No case of maternal and neonatal tetanus has been notified from 2009 to 2011. Conclusion. The Côte-d'Ivoire is on the right way to eliminate maternal and neonatal tetanus. Contexte et objectif. La Côte-d’Ivoire a adhéré à l’initiative mondiale d’élimination du tétanos maternel et néonatal (TMN). Pour y parvenir, il a introduit la vaccination antitétanique pour les femmes enceintes dans la vaccination de routine et organisé des activités de vaccination supplémentaires (AVS). Il a aussi fait la promotion de l’accouchement propre et conduit une surveillance du tétanos néonatal (TNN). Ensuite, Le pays a exprimé le besoin de formaliser la validation de l’élimination du TMN. L’objectif était de vérifier que la Côte-d’Ivoire pouvait être considérée comme un pays ayant éliminé le TMN. Méthodes. Nous avons réalisé une étude transversale, dans les quatre districts sanitaires les plus à risque de TMN en Côte-d’Ivoire, entre janvier 2009 et décembre 2011. Dans chaque district, les deux aires de santé les moins performantes ont été retenues. Dans chacune d’elles, deux localités ont été tirées au sort. Dans chaque localité, l’enquête de ménages sélectionnés de façon aléatoire avait permis d’interviewer 20 femmes en âge de procréer et 10 autres femmes ayant un enfant de moins de 2 ans sélectionné par tirage au sort. Les domaines d’intérêt étaient la surveillance du TMN, les consultations prénatales et accouchements Résultats. L’enquête avait permis de recueillir des données auprès de quatre (4) équipes cadres de district, huit (8) responsables d’aire de santé, seize (16) responsables de villages, quatre cent (400) femmes en âge de procréer et deux cent (200) femmes ayant un enfant de moins de 2 ans. Les proportions d’accouchements dans les structures publiques de soins variaient de 16% à 80%. Des substances étaient systématiquement appliquées sur la plaie du cordon ombilical. La couverture vaccinale pour la deuxième dose du vaccin antitétanique (VAT 2+) était supérieure à 80% dans 3 districts. La proportion d’enfants à jour de leurs vaccins variait de 24% à 70%. Aucun cas de TMN n’a été notifié de 2009 à 2011.Conclusion. La Côte-d’Ivoire est en bonne voie pour l’élimination du TMN

Pancreatic surgery outcomes: multicentre prospective snapshot study in 67 countries

Background: Pancreatic surgery remains associated with high morbidity rates. Although postoperative mortality appears to have improved with specialization, the outcomes reported in the literature reflect the activity of highly specialized centres. The aim of this study was to evaluate the outcomes following pancreatic surgery worldwide.Methods: This was an international, prospective, multicentre, cross-sectional snapshot study of consecutive patients undergoing pancreatic operations worldwide in a 3-month interval in 2021. The primary outcome was postoperative mortality within 90 days of surgery. Multivariable logistic regression was used to explore relationships with Human Development Index (HDI) and other parameters.Results: A total of 4223 patients from 67 countries were analysed. A complication of any severity was detected in 68.7 percent of patients (2901 of 4223). Major complication rates (Clavien-Dindo grade at least IIIa) were 24, 18, and 27 percent, and mortality rates were 10, 5, and 5 per cent in low-to-middle-, high-, and very high-HDI countries respectively. The 90-day postoperative mortality rate was 5.4 per cent (229 of 4223) overall, but was significantly higher in the low-to-middle-HDI group (adjusted OR 2.88, 95 per cent c.i. 1.80 to 4.48). The overall failure-to-rescue rate was 21 percent; however, it was 41 per cent in low-to-middle-compared with 19 per cent in very high-HDI countries.Conclusion: Excess mortality in low-to-middle-HDI countries could be attributable to failure to rescue of patients from severe complications. The authors call for a collaborative response from international and regional associations of pancreatic surgeons to address management related to death from postoperative complications to tackle the global disparities in the outcomes of pancreatic surgery (NCT04652271; ISRCTN95140761)