Implementation of the Meningitis Vaccine Project in Africa: lessons for vaccine implementation programs.

Background The Meningitis Vaccine Project (MVP) was an international partnership that began in 2010 and focused on the development, testing, licensure, and widespread introduction of a conjugate vaccine with the promise of protecting millions of lives from group A meningococcal meningitis. To bridge gaps upstream of vaccine administration and in understanding the project’s planning, delivery and outcomes, the primary objective of this study was to delineate the barriers to and facilitators of sustainable implementation in an upstream context of the delivery of the MenAfriVac vaccine and to draw critical lessons for other vaccination programs. Methods We conducted a qualitative study with key project partners and leaders who worked on the MVP project. The interviewees were initially identified through a literature review and a search of publications and evaluations of the project. Eighteen key stakeholders were interviewed. The interviewees included individuals in the roles of implementation oversight, champion, partner, funder, and frontline implementer. The Consolidated Framework for Implementation Research (CFIR) informed the identification of a priori codes for the directed content analysis. Results There were multiple barriers and facilitators to implementing the vaccine under all five domains of the CFIR framework, including intervention characteristics, outer setting, inner setting, characteristics of individuals, and process. The most common domains mentioned by stakeholders that facilitated the success of the MVP were inner setting and process; specifically, three constructs were most representative—Tension for Change, Formally Appointed Implementation Leaders, and External Change Agents. Conclusions The tension for change—that is, the degree to which stakeholders perceive the current situation as intolerable or needing change— advocated by African leaders served as a crucial foundation for solid leadership for the MPV. The leadership came in the form of the project director and other formally appointed leaders, who could plan, engage and execute the project’s goals effectively. This leadership translated into consistent messaging, information sharing, and multiple levels of engagement with external change agents (including technical experts), which promoted a shared sense of readiness contributing to significant change investments in implementing MVP

Silicon carbide-based capillary membranes for gas separation and water treatment

Membrana cerámica no óxido a base de SiC se sintetizaron a partir de precursores disponibles comercialmente molecular y polvo de SiC. Cinco de Si / B / C polímeros precerámicos diferentes fueron sintetizados por reacción de hidroboración de precursor de carburo de silicio con borano. Análisis FTIR del polímero de Si / B / C sintetizado muestra que la intensidad del pico que indica la presencia de un doble enlace disminuye través de la reacción de hidroboración. En el segundo método, un soporte macroporoso capilar y carburo de silicio plana se sintetizaron a partir comercialmente disponible de SiC-SiC-500 y 800 junto con aditivos. Cinco composiciones diferentes se prepararon y la porosidad se controlan desde ~ 46-51% cambiando atmósfera de sinterización, la temperatura y la composición. Atmósfera de sinterización afecta a la porosidad y tamaño de poro más de la temperatura y agente formador de poros

What are the barriers and facilitators to polio vaccination and eradication programs? A systematic review.

Global efforts to eradicate polio by the Global Polio Eradication Initiative agency partners and country-level stakeholders have led to the implementation of global polio vaccination programs. This study presents the findings of existing studies regarding the barriers and facilitators that countries face when implementing polio interventions. A comprehensive search was conducted in OVID Medline, OVID Embase, EBSCO CINAHL Plus, and Web of Science. Eligible studies underwent quality assessment. A qualitative evidence synthesis approach was conducted and aligned to the Consolidated Framework for Implementation Research (CFIR). The search identified 4147 citations, and following the removal of duplicates and screening according to our inclusion/exclusion criteria, 20 articles were eligible for inclusion in the review. Twelve countries were represented in this review, with India, Nigeria, Pakistan, Ethiopia, and Afghanistan having the most representation of available studies. We identified 36 barriers and 16 facilitators. Seven themes emerged from these barriers and facilitators: fear, community trust, infrastructure, beliefs about the intervention, influential opinions, intervention design, and geo-politics. The most frequently cited CFIR constructs for the facilitators and barriers were knowledge and beliefs about the intervention, followed by available resources. This study identified a wide range of barriers and facilitators to polio vaccination implementation across the globe, adding to the scarce body of literature on these barriers and facilitators from an implementation perspective and using a determinant framework. The diversity of factors among different groups of people or countries highlights the relevance of contexts. Implementers should be conversant with the contexts within which polio eradication programs boost intervention coverage and capacity. This study provides policymakers, practitioners, and researchers with a tool for planning and designing polio immunization programs. Trial registration: A protocol for this systematic review was developed and uploaded onto the PROSPERO international prospective register of systematic reviews database (Registration number: CRD42020222115)

Barriers to the uptake of community-based curative child health services in Ethiopia

Background Uptake of services to treat newborns and children has been persistently low in Ethiopia, despite being provided free-of-charge by Health Extension Workers (HEWs). In order to increase the uptake of these services, the Optimizing the Health Extension Project was designed to be implemented in four regions in Ethiopia. This study was carried out to identify barriers to the uptake of these services and potential solutions to inform the project. Methods Qualitative data were collected in October and November 2015 in 15 purposely selected districts in four regions. We conducted 90 focus group discussions and 60 in-depth interviews reaching a total of 664 participants. Thematic analysis was used to identify key barriers and potential solutions. Results Five demand-side barriers to utilization of health services were identified. Misconceptions about illness causation, compounded with preference for traditional healers has affected service uptake. Limited awareness of the availability of free curative services for children at health posts; along with the prevailing perception that HEWs were providing preventive services only had constrained uptake. Geographic challenge that made access to the health post difficult was the other barrier. Four supply-side barriers were identified. Health post closure and drug stock-out led to inconsistent availability of services. Limited confidence and skill among HEWs and under-resourced physical facilities affected the service delivery. Study participants suggested demand creation solutions such as increasing community awareness on curative service availability and educating them on childhood illness causation. Maintaining consistent supplies and ensuring service availability; along with regular support to build HEWs’ confidence were the suggested supply-side solutions. Creating community feedback mechanisms was suggested as a way of addressing community concerns on the health services. Conclusion This study explored nine demand- and supply-side barriers that decreased the uptake of community-based services. It indicated the importance of increasing awareness of new services and addressing prevailing barriers that deprioritize health services. At the same time, supply-side barriers would have to be tackled by strengthening the health system to uphold newly introduced services and harness sustainable impact

Antenatal care utilization and nutrition counseling are strongly associated with infant and young child feeding knowledge among rural/semi-urban women in Harari region, Eastern Ethiopia

There is a gap in evidence linking antenatal care (ANC) utilization, nutrition counseling, and knowledge of pregnant women about infant and young child feeding (IYCF), particularly in low-income settings. Therefore, this study aimed to identify the association between ANC follow-up and nutrition counseling with IYCF knowledge. A cross-sectional study was conducted among 390 pregnant women in the rural kebeles of the Harari region from January to June 2019. Data were collected using face-to-face interviews on tablet computers. Bivariate and multivariate logistic regression were employed. An adjusted odds ratio (with 95% CI) was used to determine the strength of association between IYCF knowledge with ANC follow-up and nutrition counseling by adjusting for educational status, occupation, gravida, and distance to the nearest health center. Overall, 54.4% [95% CI 49.2, 59.2] of currently pregnant women were knowledgeable about IYCF of which only 20% started ANC follow-up and 24.4% received nutrition counseling. Out of 288 multigravida women, only 51.4% had ANC follow-up during their last pregnancy. In the adjusted model, ANC follow-up during the current pregnancy (AOR 1.85, 95% CI 1.07–3.22), those who received nutrition counseling (AOR 1.92, 95% CI 1.09–3.38), literate in education (AOR 1.71, 95% CI 1.07–2.73), multigravida (AOR 1.96, 95% CI 1.12–3.43), and far from the nearest health center (AOR 0.95, 95% CI 0.93–0.97) were significantly associated with the mothers IYCF knowledge. Thus, health care providers should encourage mothers to attend ANC during pregnancy and provide nutrition counseling about the IYCF

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Study of Solar Cooling Alternatives for Residential Houses in Bahir dar city :

The energy consumption rate of non-OECD countries rises about 2.3 percent per year as compared to the energy consumption rate of OECD countries which is 0.6 percent. If developing countries use energy efficient technology and integrate renewable energy systems in the new building their carbon dioxide emission rate reduces by 25 to 44 percent.  However, even now, renewable energy integrated buildings are hardly considered while constructing them.   This thesis work focuses on the study of solar cooling system options for residential house in Bahir Dar city. To meet the demand of housing in the city, different type of apartments and villa houses are under construction.  Case study was made focusing on two types of residential houses (condominium apartment and Impact Real-estate Villa house) to determine the cooling load and to select cooling system.   Simulation results of IDA ICE software show that the average operative temperatures and cooling loads for condominium apartment and Real-estate Vila are 31.8oC and 30.7oC, 5.53 kW and 5.73 kW respectively. Most of the residences are not satisfied at this operating temperature.   There are different types of solar cooling systems.  Solar Sorption cooling systems are commonly used which can also be classified in to absorption, adsorption and desiccant cooling systems.  Solar adsorption cooling systems are easy to manufacture locally as compared to solar absorption cooling systems. They do not have moving parts. Some of the working medium pairs used in adsorption cooling system are: Activated Carbon/Ammonia, Silica gel/ water, Zeolite/water. Adsorption chillier with Silica gel/ water as a working pair was selected since it can operate at regeneration/desorption temperature as low as 45oC coming from flat plate collectors.  At 75oC regeneration temperature, the system delivers 9oC chilled water temperature.   The selected solar adsorption chiller has been compared with kerosene based adsorption cooling system using HOMER software.  In this project, the optimization was limited on cost comparison between the two energy sources.  The solar based cooling system has lower working cost.   From cooling load simulation result direct solar irradiation is the highest source of cooling load for both houses. This gives an opportunity for passive solar cooling technology