Using the COMMVAC taxonomy to map vaccination communication interventions in Mozambique

Improved communication about childhood vaccination is fundamental to increasing vaccine uptake in low-income countries. Mozambique, with 64% of children fully vaccinated, uses a range of communication interventions to promote uptake of childhood immunisation.; Using a taxonomy developed by the 'Communicate to Vaccinate' (COMMVAC) project, the study aims to identify and classify the existing communication interventions for vaccination in Mozambique and to find the gaps.; We used a qualitative research approach to identify the range of communication interventions used in Mozambique. In-depth semi-structured interviews were carried out with key purposively selected personnel at national level and relevant documents were collected and analysed. These data were complemented with observations of communication during routine vaccination and campaigns in Nampula province. We used the COMMVAC taxonomy, which organises vaccination communication intervention according to its intended purpose and the population targeted, to map both routine and campaign interventions.; We identified interventions used in campaign and routine vaccination, or in both, fitting five of the seven taxonomy purposes, with informing or educating community members predominating. We did not identify any interventions that aimed to provide support or facilitate decision-making. There were interventions for all main target groups, although fewer for health providers. Overlap occurred: for example, interventions often targeted both parents and community members.; We consider that the predominant focus on informing and educating community members is appropriate in the Mozambican context, where there is a high level of illiteracy and poor knowledge of the reasons for vaccination. We recommend increasing interventions for health providers, in particular training them in better communication for vaccination. The taxonomy was useful for identifying gaps, but needs to be more user-friendly if it is to be employed as a tool by health service managers

Perceptions and experiences of childhood vaccination communication strategies among caregivers and health workers in Nigeria: a qualitative study

Effective vaccination communication with parents is critical in efforts to overcome barriers to childhood vaccination, tackle vaccine hesitancy and improve vaccination coverage. Health workers should be able to provide information to parents and other caregivers and support them in reaching decisions about vaccinating their children. Limited information exists regarding the perceptions of caregivers and health workers on the vaccination communication strategies employed in Nigeria. This study, which forms part of the 'Communicate to vaccinate' (COMMVAC) project, aims to explore the perceptions and experiences of caregivers and health workers in Nigeria on vaccination communication strategies implemented in their settings.; We conducted the study in two States: Bauchi in Northern Nigeria and Cross River in the south. We carried out observations (n = 40), in-depth interviews (n = 14) and focus group discussions (FGDs) (n = 12) amongst 14 purposively selected health workers, two community leaders and 84 caregivers in the two states. We transcribed data verbatim and analysed the data using a framework analysis approach.; Caregivers were informed about vaccination activities through three main sources: health facilities (during health education sessions conducted at antenatal or immunization clinics); media outlets; and announcements (in churches/mosques, communities and markets). Caregivers reported that the information received was very useful. Their preferred sources of information included phone text messages, town announcers, media and church/mosque announcements. Some caregivers perceived the clinic environment, long waiting times and health worker attitudes as barriers to receiving vaccination information.When delivering communication interventions, health workers described issues tied to poor communication skills; poor motivation; and attitudes of community members, including vaccine resistance.; Communication about vaccination involves more than the message but is also influenced by the environment and the attitudes of the deliverer and receiver. It is pertinent for health policy makers and programme managers to understand these factors so as to effectively implement communication approaches

Dating and Digging Stratified Archaeology in Circumpolar North America : A View from Nunalleq, Southwestern Alaska

The results presented in this paper were funded by a NERC Radiocarbon Facility grant (NRCF 1917.0415), while the wider project is funded by the Arts and Humanities Research Council (AH/K006029/1). The authors wish to thank all the members of the excavation crew from the 2014 field season for their hard work in the challenging weather conditions of southwest Alaska – without their attention to detail this study would not have been possible. Additional thanks are also due to Qanirtuuq Incorporated for logistical support and warm hospitality in Quinhagak. We also wish to thank Kevin Edwards and Kate Britton, who read an earlier draft of this paper, and three anonymous reviewers for highly constructive criticism that helped us to improve the final manuscript.Peer reviewedPublisher PD

Identification of preliminary core outcome domains for communication about childhood vaccination : an online Delphi survey

Communication interventions for childhood vaccination are promising strategies to address vaccine hesitancy, but current research is limited by the outcomes measured. Most studies measure only vaccination-related outcomes, with minimal consideration of vaccine hesitancy-relevant intermediate outcomes. This impedes understanding of which interventions or elements are effective. It is also unknown which outcomes are important to the range of stakeholders affected by vaccine hesitancy. Outcome selection shapes the evidence base, informing future interventions and trials, and should reflect stakeholder priorities. Therefore, our aim was to identify which outcome domains (i.e. broad outcome categories) are most important to different stakeholders, identifying preliminary core outcome domains to inform evaluation of three common vaccination communication types: (i) communication to inform or educate, (ii) remind or recall, and (iii) enhance community ownership.; We conducted a two-stage online Delphi survey, involving four stakeholder groups: parents or community members, healthcare providers, researchers, and government or non-governmental organisation representatives. Participants rated the importance of eight outcome domains for each of the three communication types. They also rated specific outcomes within one domain ("attitudes or beliefs") and provided feedback about the survey.; Collectively, stakeholder groups prioritised outcome domains differently when considering the effects of different communication types. For communication that aims to (i) inform or educate, the most important outcome domain is "knowledge or understanding"; for (ii) reminder communication, "vaccination status and behaviours"; and for (iii) community engagement communication, "community participation". All stakeholder groups rated most outcome domains as very important or critical. The highest rated specific outcome within the "attitudes or beliefs" domain was "trust".; This Delphi survey expands the field of core outcomes research and identifies preliminary core outcome domains for measuring the effects of communication about childhood vaccination. The findings support the argument that vaccination communication is not a single homogenous intervention - it has a range of purposes, and vaccination communication evaluators should select outcomes accordingly

Hansen’s disease deformities in a high risk area in Mozambique: A case study

Abstract INTRODUCTION: Hansen’s disease is no longer a public health problem in Mozambique, since 2008 (incidence under 1 / 10,000 inhabitants). The country is one of the most affected in the world and Nampula province’s Murrupula district (incidence 1.7 / 10,000) has a high deformity rate (22% in 2010). This study aimed to identify high deformity rate associated determinants and proposals for better health program results. METHODS: This study involved a descriptive quantitative survey, systematic observation of patients and health professionals, and a survey of community volunteers. Data were analyzed using Epi Info 7.2. Pearson's chi-square and Fisher’s exact test were used to assess statistical association with deformity, with a significance level of 5% and 95% confidence interval. Ethical procedures followed the Helsinki declaration (2013). RESULTS: Among 238 subjects, 175 were patients and 63 leprosy health staff. Most patients relied on subsistence agriculture facing social exclusion (43, 25%). The waiting time from first symptoms to diagnosis was over one year for 63%. Deformity affected 116 subjects (68%), particularly those who considered the disease as God’s desire (p = 0.01), and practiced traditional treatments (p = 0.001). Among leprosy health staff, 35 (52%) were not trained on diagnosis and management. CONCLUSIONS: High deformity rate is associated with low economic status, the belief that the disease is God’s desire, the use of traditional healers, late diagnosis, and poor disease management. A health education program targeting professionals and population, with infection screening and self-care groups can prevent deformities

Communication strategies to promote the uptake of childhood vaccination in Nigeria: a systematic map

BACKGROUND: Effective communication is a critical component in ensuring that children are fully vaccinated. Although numerous communication interventions have been proposed and implemented in various parts of Nigeria, the range of communication strategies used has not yet been mapped systematically. This study forms part of the 'Communicate to vaccinate' (COMMVAC) project, an initiative aimed at building research evidence for improving communication with parents and communities about childhood vaccinations in low- and middle-income countries. OBJECTIVE: This study aims to: 1) identify the communication strategies used in two states in Nigeria; 2) map these strategies against the existing COMMVAC taxonomy, a global taxonomy of vaccination communication interventions; 3) create a specific Nigerian country map of interventions organised by purpose and target; and 4) analyse gaps between the COMMVAC taxonomy and the Nigerian map. DESIGN: We conducted the study in two Nigerian states: Bauchi State in Northern Nigeria and Cross River State in Southern Nigeria. We identified vaccination communication interventions through interviews carried out among purposively selected stakeholders in the health services and relevant agencies involved in vaccination information delivery; through observations and through relevant documents. We used the COMMVAC taxonomy to organise the interventions we identified based on the intended purpose of the communication and the group to which the intervention was targeted. RESULTS: The Nigerian map revealed that most of the communication strategies identified aimed to inform and educate and remind or recall. Few aimed to teach skills, enhance community ownership, and enable communication. We did not identify any intervention that aimed to provide support or facilitate decision-making. Many interventions had more than one purpose. The main targets for most interventions were caregivers and community members, with few interventions directed at health workers. Most interventions identified were used in the context of campaigns rather than routine immunisation programmes. CONCLUSIONS: The identification and development of the Nigerian vaccination communication interventions map could assist programme managers to identify gaps in vaccination communication. The map may be a useful tool as part of efforts to address vaccine hesitancy and improve vaccination coverage in Nigeria and similar settings

Impacto de la vacunación sobre la incidencia del sarampión en Mozambique durante el período de 2000-2011

Submitted by Regiane Silva ([email protected]) on 2018-10-01T18:06:38Z No. of bitstreams: 1 Impact of vaccination on the incidence of measles in Mozambique in the period 2000 to 2011.pdf: 1433956 bytes, checksum: 0dfdb0f9bf763a2901523ec72a40e9f3 (MD5)Approved for entry into archive by Regiane Silva ([email protected]) on 2018-10-09T13:40:19Z (GMT) No. of bitstreams: 1 Impact of vaccination on the incidence of measles in Mozambique in the period 2000 to 2011.pdf: 1433956 bytes, checksum: 0dfdb0f9bf763a2901523ec72a40e9f3 (MD5)Made available in DSpace on 2018-10-09T13:40:19Z (GMT). No. of bitstreams: 1 Impact of vaccination on the incidence of measles in Mozambique in the period 2000 to 2011.pdf: 1433956 bytes, checksum: 0dfdb0f9bf763a2901523ec72a40e9f3 (MD5) Previous issue date: 2013Ministério da Saúde, Maputo, Moçambique.Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Rio de Janeiro, RJ, Brasil.Ministério da Saúde, Maputo, Moçambique.O objetivo deste estudo foi analisar as ações de eliminação do sarampo em Moçambique, considerando o impacto do programa de vacinação ao longo do período de 2000-2011. Foram revisados os dados de vacinação e os casos de sarampo disponíveis no Ministério da Saúde. Análise de séries temporais e técnicas estatísticas de análise espacial foram aplicadas. As coberturas variaram entre 82% e 99%. Nas províncias, a cidade de Maputo teve as coberturas abaixo de 70%, e a província de Niassa teve as coberturas acima de 100%. As coberturas apresentaram um padrão espacial que se modificou com o tempo. A taxa de incidência de sarampo no país foi de 1,58 (0,00-40,08 distritos) por 100 mil habitantes. Os distritos que fazem fronteiras com os países vizinhos tiveram as elevadas taxas de incidência. As coberturas de rotina são insuficientes, e a circulação de sarampo continua em Moçambique. O país necessita alcançar coberturas homogêneas e maiores que 95% em crianças menores de um ano, manter as campanhas de vacinação e melhorar a vigilância e o tratamento de casos.The aim of this study was to contribute to the better planning of measles elimination actions in Mozambique, by considering the impact of vaccination actions over the period 2000 to 2011. Descriptive and ecological studies and case records made available by the Ministry of Health were used to analyze measles vaccination coverage. Statistical analysis was performed using time series and spatial analysis. Vaccine coverage rates ranged from 82% to 99%. Coverage rates in Maputo city were under 70% and in Niassa province they were over 100%. Coverage showed a clustered pattern in the districts. The measles incidence rate was 1.58 per 100,000 inhabitants (0.00-40.08 per 100,000 inhabitants); districts bordering neighboring countries presented high incidence rates. Although measles morbidity and mortality has decreased in Mozambique, vaccine coverage has been insufficient to interrupt measles transmission. Enhanced surveillance, including investigation of cases and outbreaks, and improvements in measles vaccination are recommended in order to achieve a homogenous coverage rate of ≥ 95% for both routine and mass vaccination campaigns.El objetivo de este artículo fue analizar las acciones de eliminación del sarampión en Mozambique, considerando el impacto del programa de vacunación a lo largo del período de 2000-2011. Se revisaron los datos de vacunación y casos de sarampión, disponibles en el Ministerio de Salud. Se aplicaron análisis de series temporales y técnicas estadísticas de análisis espacial. Las coberturas variaron entre un 82% y un 99% por nivel. En las provincias, la Ciudad de Maputo tuvo coberturas por debajo de un 70%, mientras que la provincia de Niassa tuvo coberturas por encima de un 100%. Las coberturas presentaron un patrón espacial que se modificó con el tiempo. La tasa de incidencia de sarampión en el país fue de un 1,58 (0,00-40,08 distritos) por 100 mil habitantes. Los distritos que tienen fronteras con países vecinos tuvieron una elevadas tasas de incidencia. Las coberturas de rutina son insuficientes y la propagación del sarampión continúa en Mozambique. El país necesita alcanzar coberturas > 95% en niños menores de un año y que sean homogéneas, mantener las campañas de vacunación, mejorar la vigilancia y el tratamiento de casos

Impact of vaccination on the incidence of measles in Mozambique in the period 2000 to 2011 Impacto de la vacunación sobre la incidencia del sarampión en Mozambique durante el período de 2000-2011 Impacto da vacinação sobre a incidência de sarampo em Moçambique no período de 2000-2011

The aim of this study was to contribute to the better planning of measles elimination actions in Mozambique, by considering the impact of vaccination actions over the period 2000 to 2011. Descriptive and ecological studies and case records made available by the Ministry of Health were used to analyze measles vaccination coverage. Statistical analysis was performed using time series and spatial analysis. Vaccine coverage rates ranged from 82% to 99%. Coverage rates in Maputo city were under 70% and in Niassa province they were over 100%. Coverage showed a clustered pattern in the districts. The measles incidence rate was 1.58 per 100,000 inhabitants (0.00-40.08 per 100,000 inhabitants); districts bordering neighboring countries presented high incidence rates. Although measles morbidity and mortality has decreased in Mozambique, vaccine coverage has been insufficient to interrupt measles transmission. Enhanced surveillance, including investigation of cases and outbreaks, and improvements in measles vaccination are recommended in order to achieve a homogenous coverage rate of ≥ 95% for both routine and mass vaccination campaigns.El objetivo de este artículo fue analizar las acciones de eliminación del sarampión en Mozambique, considerando el impacto del programa de vacunación a lo largo del período de 2000-2011. Se revisaron los datos de vacunación y casos de sarampión, disponibles en el Ministerio de Salud. Se aplicaron análisis de series temporales y técnicas estadísticas de análisis espacial. Las coberturas variaron entre un 82% y un 99% por nivel. En las provincias, la Ciudad de Maputo tuvo coberturas por debajo de un 70%, mientras que la provincia de Niassa tuvo coberturas por encima de un 100%. Las coberturas presentaron un patrón espacial que se modificó con el tiempo. La tasa de incidencia de sarampión en el país fue de un 1,58 (0,00-40,08 distritos) por 100 mil habitantes. Los distritos que tienen fronteras con países vecinos tuvieron una elevadas tasas de incidencia. Las coberturas de rutina son insuficientes y la propagación del sarampión continúa en Mozambique. El país necesita alcanzar coberturas > 95% en niños menores de un año y que sean homogéneas, mantener las campañas de vacunación, mejorar la vigilancia y el tratamiento de casos.O objetivo deste estudo foi analisar as ações de eliminação do sarampo em Moçambique, considerando o impacto do programa de vacinação ao longo do período de 2000-2011. Foram revisados os dados de vacinação e os casos de sarampo disponíveis no Ministério da Saúde. Análise de séries temporais e técnicas estatísticas de análise espacial foram aplicadas. As coberturas variaram entre 82% e 99%. Nas províncias, a cidade de Maputo teve as coberturas abaixo de 70%, e a província de Niassa teve as coberturas acima de 100%. As coberturas apresentaram um padrão espacial que se modificou com o tempo. A taxa de incidência de sarampo no país foi de 1,58 (0,00-40,08 distritos) por 100 mil habitantes. Os distritos que fazem fronteiras com os países vizinhos tiveram as elevadas taxas de incidência. As coberturas de rotina são insuficientes, e a circulação de sarampo continua em Moçambique. O país necessita alcançar coberturas homogêneas e maiores que 95% em crianças menores de um ano, manter as campanhas de vacinação e melhorar a vigilância e o tratamento de casos

Outcomes mapping study for childhood vaccination communication : too few concepts were measured in too many ways

The objectives of this article are to (1) comprehensively catalog outcomes measured in trials of childhood vaccination communication interventions and (2) analyze patterns and trends in outcome selection. To achieve these objectives, we developed a Trial Outcomes Map for vaccination communication.; We searched the Cochrane Central Register of Controlled Trials for trials of childhood vaccination communication interventions, extracting verbatim all outcome information from included trials. Through thematic grouping, we categorized outcomes based on conceptual similarities, forming a Trial Outcomes Map.; We identified 112 relevant trials containing 209 outcomes. Thematic analysis revealed three overarching Outcome Categories: consumer-, vaccination-, and health system-related outcomes. These categories contain 21 Outcome Types (eg, "knowledge," "cost"), measured using 66 different Outcome Variables. Vaccination outcomes were measured most frequently and health system-related outcomes least frequently. Consumer outcomes are increasingly measured in more recent trials.; The number of measures used for the same outcomes complicates data synthesis and interpretation. Despite recent trends toward including consumer outcomes, intermediate outcome measurement is lacking, hampering understanding of how and why vaccination communication interventions do or do not work. This Map may improve outcome consistency in future trials and will contribute to a forthcoming core outcome set

Leprosy indicators and diagnosis delay in Mogovolas, Meconta and Murrupula district of Nampula Province, Mozambique: A baseline survey

Objectives Leprosy is a chronic infectious disease caused by Mycobacterium leprae. The PEP4LEP project will compare two integrated skin-screening interventions combined with the distribution of a single dose of rifampicin as post exposure prophylaxis (SDR-PEP) for contacts of leprosy patients. To implement the study in Mozambique, it was necessary to assess recent epidemiological indicators of leprosy and to estimate case detection delay as a main outcome indicator at baseline. Methods This was a descriptive study to establish the trend of epidemiological indicators of leprosy in the Nampula province districts Murrupula, Meconta and Mogovolas in Mozambique, between 2015 and 2019; and to calculate the average delay to diagnose leprosy cases in these districts. The National Leprosy Control Programme was also described. For the estimation of the case detection delay, 81 recently diagnosed patients were interviewed. Results There were 939 new leprosy cases detected in the three districts from 2015 to 2019, with a high proportion of disability (17.0%). The mean diagnosis delay was 26.6 months (95% CI: 18.4–34.7), while the median was 17.0 months. Multibacillary cases had an average delay of 27.9 months (95% CI: 18.6–37.1), while those with grade 2 disability had an average delay of 47.8 months (95% CI: 15.4–80.2). Conclusion The long case detection delay and high grade 2 disability rates indicate that there is a need for active case finding and chemoprophylaxis with SDR-PEP to help interrupt the chain of Mycobacterium leprae transmission in Nampula province