28 research outputs found
Eff ect of pentavalent rotavirus vaccine introduction on hospital admissions for diarrhoea and rotavirus in children in Rwanda: a time-series analysis
Background In May, 2012, Rwanda became the fi rst low-income African country to introduce pentavalent rotavirus
vaccine into its routine national immunisation programme. Although the potential health benefi ts of rotavirus
vaccination are huge in low-income African countries that account for more than half the global deaths from
rotavirus, concerns remain about the performance of oral rotavirus vaccines in these challenging settings.
Methods We conducted a time-series analysis to examine trends in admissions to hospital for non-bloody diarrhoea in
children younger than 5 years in Rwanda between Jan 1, 2009, and Dec 31, 2014, using monthly discharge data from
the Health Management Information System. Additionally, we reviewed the registries in the paediatric wards at six
hospitals from 2009 to 2014 and abstracted the number of total admissions and admissions for diarrhoea in children
younger than 5 years by admission month and age group. We studied trends in admissions specifi c to rotavirus at one
hospital that had undertaken active rotavirus surveillance from 2011 to 2014. We assessed changes in rotavirus
epidemiology by use of data from eight active surveillance hospitals.
Findings Compared with the 2009â11 prevaccine baseline, hospital admissions for non-bloody diarrhoea captured by
the Health Management Information System fell by 17â29% from a pre-vaccine median of 4051 to 2881 in 2013 and
3371 in 2014, admissions for acute gastroenteritis captured in paediatric ward registries decreased by 48â49%, and
admissions specifi c to rotavirus captured by active surveillance fell by 61â70%. The greatest eff ect was recorded in
children age-eligible to be vaccinated, but we noted a decrease in the proportion of children with diarrhoea testing
positive for rotavirus in almost every age group.
Interpretation The number of admissions to hospital for diarrhoea and rotavirus in Rwanda fell substantially after
rotavirus vaccine implementation, including among older children age-ineligible for vaccination, suggesting indirect
protection through reduced transmission of rotavirus. These data highlight the benefi ts of routine vaccination against rotavirus in low-income settings
The Economic Burden Attributable to a Childâs Inpatient Admission for Diarrheal Disease in Rwanda
Background: Diarrhea is one of the leading causes of childhood morbidity and mortality. Hospitalization for diarrhea can pose a significant burden to health systems and households. The objective of this study was to estimate the economic burden attributable to hospitalization for diarrhea among children less than five years old in Rwanda. These data can be used by decision-makers to assess the impact of interventions that reduce diarrhea morbidity, including rotavirus vaccine introduction. Methods: This was a prospective costing study where medical records and hospital bills for children admitted with diarrhea at three hospitals were collected to estimate resource use and costs. Hospital length of stay was calculated from medical records. Costs incurred during the hospitalization were abstracted from the hospital bills. Interviews with the childâs caregivers provided data to estimate household costs which included transport costs and lost income. The portion of medical costs borne by insurance and household were reported separately. Annual economic burden before and after rotavirus vaccine introduction was estimated by multiplying the reported number of diarrhea hospitalizations in public health centers and district hospitals by the estimated economic burden per hospitalization. All costs are presented in 2014 US44.22 Âą 101, of which 65% was borne by the household. For households in the lowest income quintile, the household costs were 110% of their monthly income. The annual economic burden to Rwanda attributable to diarrhea hospitalizations ranged from 1.7 million before rotavirus vaccine introduction. Conclusion: Households often bear the largest share of the economic burden attributable to diarrhea hospitalization and the burden can be substantial, especially for households in the lowest income quintile
Track D Social Science, Human Rights and Political Science
Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138414/1/jia218442.pd
Validation of the âEPICESâ social deprivation score in a population of women who have just given birth: a French cross-sectional study
International audienc
Effectiveness of Pentavalent Rotavirus Vaccine under Conditions of Routine Use in Rwanda
Background. Rotavirus vaccine efficacy is lower in low-income countries than in high-income countries. Rwanda was one of the first low-income countries in sub-Saharan Africa to introduce rotavirus vaccine into its national immunization program. We sought to evaluate rotavirus vaccine effectiveness (VE) in this setting. Methods. VE was assessed using a case-control design. Cases and test-negative controls were children who presented with a diarrheal illness to 1 of 8 sentinel district hospitals and 10 associated health centers and had a stool specimen that tested positive (cases) or negative (controls) for rotavirus by enzyme immunoassay. Due to high vaccine coverage almost immediately after vaccine introduction, the analysis was restricted to children 7-18 weeks of age at time of rotavirus vaccine introduction. VE was calculated as (1 - odds ratio) Ă 100, where the odds ratio was the adjusted odds ratio for the rotavirus vaccination rate among case-patients compared with controls. Results. Forty-eight rotavirus-positive and 152 rotavirus-negative children were enrolled. Rotavirus-positive children were significantly less likely to have received rotavirus vaccine (33/44 [73%] unvaccinated) compared with rotavirus-negative children (81/136 [59%] unvaccinated) (P =. 002). A full 3-dose series was 75% (95% confidence interval [CI], 31%-91%) effective against rotavirus gastroenteritis requiring hospitalization or a health center visit and was 65% (95% CI, -80% to 93%) in children 6-11 months of age and 81% (95% CI, 25%-95%) in children âĽ12 months of age. Conclusions. Rotavirus vaccine is effective in preventing rotavirus disease in Rwandan children who began their rotavirus vaccine series from 7 to 18 weeks of age. Protection from vaccination was sustained after the first year of life.SCOPUS: ar.jinfo:eu-repo/semantics/publishe
Can routinely collected national data on childhood morbidity and mortality from diarrhea be used to monitor health impact of rotavirus vaccination in Africa? Examination of pre-vaccine baseline data from Rwanda.
BACKGROUND: As rotavirus vaccine is introduced into routine childhood immunization programs in Africa, understanding its impact on diarrheal disease burden is important. The objective of this analysis was to determine whether routinely collected health information on national diarrhea hospitalizations, in-hospital deaths and outpatient visits would be useful to monitor rotavirus vaccine impact. METHODS: We analyzed data for all-cause, nonbloody diarrheal disease among children <5 years of age from the routine health management information system (HMIS) in Rwanda from January 2008 through December 2011. We described trends in absolute numbers of inpatient admissions, in-hospital deaths and outpatient visits by year, age and setting. RESULTS: All-cause, nonbloody diarrheal hospitalizations and outpatient visits among children <5 years of age in Rwanda from 2008 to 2011 peaked during the June to August dry season, coinciding with the rotavirus season. The bulk of the diarrheal disease burden occurred in children <1 year of age. Health centers provided many care to children with diarrhea including 60-72% of hospitalizations and 97-99% of outpatient visits. Many in-hospital diarrheal deaths (84%) occurred in district hospitals. DISCUSSION: Given the stable and consistent trends and the prominent seasonality consistent with that of rotavirus, HMIS data should provide a useful baseline to monitor rotavirus vaccine impact on the overall diarrheal disease burden in Rwanda. Active, sentinel surveillance for rotavirus diarrhea will help interpret changes in diarrheal disease trends following vaccine introduction. Other countries planning rotavirus vaccine introduction should explore the availability and quality of their HMIS data. Š 2013 Lippincott Williams and Wilkins.SCOPUS: ar.jinfo:eu-repo/semantics/publishe
Can routinely collected national data on childhood morbidity and mortality from diarrhea be used to monitor health impact of rotavirus vaccination in Africa? Examination of pre-vaccine baseline data from Rwanda.
info:eu-repo/semantics/publishe