Global Delivery of Human Papillomavirus Vaccines

Worldwide, cervical cancer is the fourth most common cancer among women, with over half a million women diagnosed with cervical cancer in 2012. Human papillomavirus (HPV) vaccination, if broadly implemented, has the potential to significantly reduce global rates of morbidity and mortality associated with cervical and other HPV-related cancers. Over 100 countries around the world have licensed HPV vaccines. As of February, 2015, there were an estimated 80 national HPV immunization programs and 37 pilot programs, including many implemented in low- and middle-income countries. In this article, global implementation of HPV vaccination programs is discussed, including successes and ongoing challenges. Issues such as vaccine financing and different approaches to HPV vaccine delivery are presented

Drivers of stunting reduction in Peru: A country case study

Background: Peru reduced its under-5 child stunting prevalence notably from 31.3% in 2000 to 13.1% in 2016.Objectives: We aimed to study factors and key enablers of child stunting reduction in Peru from 2000-2016.Methods: Demographic and Health Surveys were used to conduct descriptive analyses [height-for-age z scores (HAZ) means and distributions, equity analysis, predicted child growth curves through polynomial regressions] and advanced regression analyses. An ecological (at department level) multilevel regression analysis was conducted to identify the major predictors of stunting decline from 2000 to 2016, and Oaxaca-Blinder decomposition was conducted to identify the relative contribution of each factor to child HAZ change. A systematic literature review, policy and program analysis, and interviews with relevant stakeholders were conducted to understand key drivers of stunting decline in Peru.Results: The distribution of HAZ scores showed a slight rightward shift from 2000 to 2007/2008, and a greater shift from 2007/2008 to 2016. Stunting reduction was higher in the lowest wealth quintile, in rural areas, and among children with the least educated mothers. Decomposing predicted changes showed that the most important factors were increased maternal BMI and maternal height, improved maternal and newborn health care, increased parental education, migration to urban areas, and reduced fertility. Key drivers included the advocacy role of civil society and political leadership around poverty and stunting reduction since the early 2000s. Key enablers included the economic growth and the consolidation of democracy since the early 2000s, and the acknowledgement that stunting reduction needs much more than food supplementation.Conclusions: Peru reduced child stunting owing to improved socioeconomic determinants, sustained implementation of out-of-health-sector and within-health-sector changes, and implementation of health interventions. These efforts were driven through a multisectoral approach, strong civil society advocacy, and keen political leadership. Peru\u27s experience offers useful lessons on how to tackle the problem of stunting under differing scenarios, with the participation of multiple sectors

Human papillomavirus (HPV) vaccine – identifying and overcoming the challenges to reaching those who need it most

Women in low and middle-income countries experience the greatest burden of cervical cancer in the world, with more than 88% of the 275,000 deaths annually taking place in these areas. The human papillomavirus (HPV) is the most common sexually transmitted infection globally and is the major cause of cervical cancer. Two preventive vaccines were licensed in 2006 and boast great potential for reducing the burden of cervical cancer. Despite the fact that the vaccine has proven to be safe and effective against HPV, there has been a significant lag to delivering it in low and middle income countries (LMICs). Using both a literature review and interviewing experts working in the HPV vaccine field we investigated the current challenges to introducing the HPV vaccine

Global Delivery of Human Papillomavirus Vaccines

Worldwide, cervical cancer is the fourth most common cancer among women, with over half a million women diagnosed with cervical cancer in 2012. Human papillomavirus (HPV) vaccination, if broadly implemented, has the potential to significantly reduce global rates of morbidity and mortality associated with cervical and other HPV-related cancers. Over 100 countries around the world have licensed HPV vaccines. As of February, 2015, there were an estimated 80 national HPV immunization programs and 37 pilot programs, including many implemented in low- and middle-income countries. In this article, global implementation of HPV vaccination programs is discussed, including successes and ongoing challenges. Issues such as vaccine financing and different approaches to HPV vaccine delivery are presented

Youth participation in sexual and reproductive health : policy, practice, and progress in Malawi

Despite recent progress in involving young people in sexual and reproductive health (SRH) policymaking, gaps remain in policy and practice. Recognizing and integrating young people in all stages of SRH policymaking is critical to catalyzing social and political changes necessary to ensure their reproductive health and well-being. This paper describes the policy context in Malawi, and analyzes underlying factors that influence youth participation in sexual and reproductive health policymaking

Perceived reciprocal value of health professionals’ participation in global child health-related work

Abstract Background Leading children’s hospitals in high-income settings have become heavily engaged in international child health research and educational activities. These programs aim to provide benefit to the institutions, children and families in the overseas locations where they are implemented. Few studies have measured the actual reciprocal value of this work for the home institutions and for individual staff who participate in these overseas activities. Our objective was to estimate the perceived reciprocal value of health professionals’ participation in global child health-related work. Benefits were measured in the form of skills, knowledge and attitude strengthening as estimated by an adapted Global Health Competency Model. Methods A survey questionnaire was developed following a comprehensive review of literature and key competency models. It was distributed to all health professionals at the Hospital for Sick Children with prior international work experience (n = 478). Results One hundred fifty six health professionals completed the survey (34%). A score of 0 represented negligible value gained and a score of 100 indicated significant capacity improvement. The mean respondent improvement score was 57 (95% CI 53–62) suggesting improved overall competency resulting from their international experiences. Mean scores were >50% in 8 of 10 domains. Overall scores suggest that international work brought value to the hospital and over half responded that their international experience would influence their decision to stay on at the hospital. Conclusions The findings offer tangible examples of how global child health work conducted outside of one’s home institution impacts staff and health systems locally

Additional file 3: of Perceived reciprocal value of health professionals’ participation in global child health-related work

Summary of participant responses to open-ended survey questions. This file contains a summary of all participant responses to open-ended survey questions. (DOCX 128 kb

Physicians’ perspectives on COVID-19 vaccinations for children: a qualitative exploration in Ontario, Canada

Objectives Parents’ decisions to vaccinate their children against COVID-19 are complex and often informed by discussions with primary care physicians. However, little is known about physicians’ perspectives on COVID-19 vaccinations for children or their experiences counselling parents in their decision-making. We explored physicians’ experiences providing COVID-19 vaccination recommendations to parents and their reflections on the contextual factors that shaped these experiences.Design We conducted an interpretive qualitative study using in-depth interviews. We analyzed the data using reflexive thematic analysis and a socioecological framework.Setting This study involved primary care practices associated with The Applied Research Group for Kids (TARGet Kids!) primary care research network in the Greater Toronto Area, Ontario, Canada.Participants Participants were 10 primary care physicians, including family physicians, paediatricians and paediatric subspecialists.Results Participants discussed elements at the individual level (their identity, role, and knowledge), the interpersonal level (their relationships with families, responsiveness to parents’ concerns, and efforts to build trust) and structural level (contextual factors related to the evolving COVID-19 climate, health system pandemic response, and constraints on care delivery) that influenced their experiences providing recommendations to parents. Our findings illustrated that physicians’ interactions with families were shaped by a confluence of their own perspectives, their responses to parents’ perspectives, and the evolving landscape of the broader pandemic.Conclusions Our study underscores the social and relational nature of vaccination decision-making and highlights the multiple influences on primary care physicians’ experiences providing COVID-19 vaccination recommendations to parents. Our findings offer suggestions for future COVID-19 vaccination programmes for children. Delivery of new COVID-19 vaccinations for children may be well suited within primary care offices, where trusting relationships are established, but physicians need support in staying knowledgeable about emerging information, communicating available evidence to parents to inform their decision-making and dedicating time for vaccination counselling

Drivers of stunting reduction in Senegal: A country case study

Background: Senegal has been an exemplar country in the West African region, reducing child stunting prevalence by 17.9% from 1992 to 2017.Objectives: In this study, we aimed to conduct a systematic in-depth assessment of factors at the national, community, household, and individual levels to determine the key enablers of Senegal\u27s success in reducing stunting in children \u3c5 y old between 1992/93 and 2017.Methods: A mixed methods approach was implemented, comprising quantitative data analysis, a systematic literature review, creation of a timeline of nutrition-related programs, and qualitative interviews with national and regional stakeholders and mothers in communities. Demographic and Health Surveys and Multiple Indicator Cluster Surveys were used to explore stunting inequalities and factors related to the change in height-for-age z-score (HAZ) using difference-in-difference linear regression and the Oaxaca-Blinder decomposition method.Results: Population-wide gains in average child HAZ and stunting prevalence have occurred from 1992/93 to 2017. Stunting prevalence reduction varied by geographical region and prevalence gaps were reduced slightly between wealth quintiles, maternal education groups, and urban compared with rural residence. Statistical determinants of change included improvements in maternal and newborn health (27.8%), economic improvement (19.5%), increases in parental education (14.9%), and better piped water access (8.1%). Key effective nutrition programs used a community-based approach, including the Community Nutrition Program and the Nutrition Enhancement Program. Stakeholders felt sustained political will and multisectoral collaboration along with improvements in poverty, women\u27s education, hygiene practices, and accessibility to health services at the community level reduced the burden of stunting.Conclusions: Senegal\u27s success in the stunting decline is largely attributed to the country\u27s political stability, the government\u27s prioritization of nutrition and execution of nutrition efforts using a multisectoral approach, improvements in the availability of health services and maternal education, access to piped water and sanitation facilities, and poverty reduction. Further efforts in the health, water and sanitation, and agriculture sectors will support continued success

Drivers of stunting reduction in the Kyrgyz Republic: A country case study

Background: Chronic malnutrition among infants and children continues to represent a global public health concern. The Kyrgyz Republic has achieved rapid declines in stunting over the last 20 y, despite modest increases in gross domestic product per capita.Objective: This study aimed to conduct a systematic, in-depth assessment of national, community, household, and individual drivers of nutrition change and stunting reduction, as well as nutrition-specific and -sensitive policies and programs, in the Kyrgyz Republic.Methods: This mixed methods study employed 4 inquiry methods, including: 1) a systematic scoping literature review; 2) retrospective quantitative data analyses, including linear regression multivariable hierarchical modeling, difference-in-difference analysis, and Oaxaca-Blinder decomposition; 3) qualitative data collection and analysis; and 4) analysis of key nutrition-specific and -sensitive policies and programs.Results: Stunting prevalence has decreased in the Kyrgyz Republic, however, subnational variations and inequities persist. Child growth Victora curves show improvements in height-for-age z-scores (HAZ) for children in the Kyrgyz Republic between 1997 and 2014, indicating increased intrauterine growth and population health improvements. The decomposition analysis explained 88.9% (0.637 SD increase) of the predicted change in HAZ for children under 3 y (1997-2012). Key factors included poverty (61%), maternal nutrition (14%), paternal education (6%), fertility (6%), maternal age (3%), and wealth accumulation (2%). Qualitative analysis revealed poverty reduction, increased migration and remittances, food security, and maternal nutrition as key drivers of stunting decline. Systematic scoping literature review findings supported quantitative and qualitative results, and indicated that land reforms and improved food security represented important factors. Key nutrition-specific and -sensitive policies and programs implemented involved breastfeeding promotion, social protection schemes, and land and health sector reforms.Conclusions: Improvements in stunting were achieved amidst political and economic changes. Multilevel enablers, including poverty reduction, improved food security, and introduction of land and health reforms have contributed to improvements in health, nutrition, and stunting among children in the Kyrgyz Republic