Immunization programs to support primary health care and achieve universal health coverage

Gains in immunization coverage and delivery of primary health care service have stagnated in recent years. Remaining gaps in service coverage reflect multiple underlying reasons that may be amenable to improved health system design. Immunization systems and other primary health care services can be mutually supportive, for improved service delivery and for strengthening of Universal Health Coverage. Improvements require that dynamic and multi-faceted barriers and risks be addressed. These include workforce availability, quality data systems and use, leadership and management that is innovative, flexible, data driven and responsive to local needs. Concurrently, improvements in procurement, supply chain, logistics and delivery systems, and integrated monitoring of vaccine coverage and epidemiological disease surveillance with laboratory systems, and vaccine safety will be needed to support community engagement and drive prioritized actions and communication. Finally, political will and sustained resource commitment with transparent accountability mechanisms are required. The experience of the impact of COVID-19 pandemic on essential PHC services and the challenges of vaccine roll-out affords an opportunity to apply lessons learned in order to enhance vaccine services integrated with strong primary health care services and universal health coverage across the life course

Should outbreak response immunization be recommended for measles outbreaks in middle- and low-income countries? An update.

Measles caused mortality in >164,000 children in 2008, with most deaths occurring during outbreaks. Nonetheless, the impact and desirability of conducting measles outbreak response immunization (ORI) in middle- and low-income countries has been controversial. World Health Organization guidelines published in 1999 recommended against ORI in such settings, although recently these guidelines have been reversed for countries with measles mortality reduction goals

Too little but not too late: Results of a literature review to improve routine immunization programs in developing countries

<p>Abstract</p> <p>Background</p> <p>Globally, immunization services have been the center of renewed interest with increased funding to improve services, acceleration of the introduction of new vaccines, and the development of a health systems approach to improve vaccine delivery. Much of the credit for the increased attention is due to the work of the GAVI Alliance and to new funding streams. If routine immunization programs are to take full advantage of the newly available resources, managers need to understand the range of proven strategies and approaches to deliver vaccines to reduce the incidence of diseases. In this paper, we present strategies that may be used at the sub-national level to improve routine immunization programs.</p> <p>Methods</p> <p>We conducted a systematic review of studies and projects reported in the published and gray literature. Each paper that met our inclusion criteria was rated based on methodological rigor and data were systematically abstracted. Routine-immunization – specific papers with a methodological rigor rating of greater than 60% and with conclusive results were reported.</p> <p>Results</p> <p>Greater than 11,000 papers were identified, of which 60 met our inclusion criteria and 25 papers were reported. Papers were grouped into four strategy approaches: bringing immunizations closer to communities (n = 11), using information dissemination to increase demand for vaccination (n = 3), changing practices in fixed sites (n = 4), and using innovative management practices (n = 7).</p> <p>Conclusion</p> <p>Immunization programs are at a historical crossroads in terms of developing new funding streams, introducing new vaccines, and responding to the global interest in the health systems approach to improving immunization delivery. However, to complement this, actual service delivery needs to be strengthened and program managers must be aware of proven strategies. Much was learned from the 25 papers, such as the use of non-health workers to provide numerous services at the community level. However it was startling to see how few papers were identified and in particular how few were of strong scientific quality. Further well-designed and well-conducted scientific research is warranted. Proposed areas of additional research include integration of additional services with immunization delivery, collaboration of immunization programs with new partners, best approaches to new vaccine introduction, and how to improve service delivery.</p

Diet, Iq'mik Smokeless Tobacco Use and Cardiometabolic Risk among Yup'ik Alaska Native People living in Southwest Alaska

Thesis (Ph.D.)--University of Washington, 2015Yup'ik Alaska Native people live in rural communities in Southwest Alaska. Many Yup'ik people retain aspects of their traditional lifestyle, including a subsistence diet and use of iq'mik smokeless tobacco. We aimed to characterize associations between these aspects of Yup'ik lifestyle and biomarkers of cardiometabolic (CM) status (e.g., lipids, blood pressure, glucose, adiposity). We conducted three analyses using Center for Alaska Native Health Research adult study participants. First, we tested the reproducibility and reliability of previously identified dietary patterns: "processed foods"; "fruits and vegetables"; and "subsistence foods". We used confirmatory factor analysis to measure reproducibility and composite reliability (n=267) and intraclass correlation coefficients for test-retest reliability (n=113). Next, we characterized associations between dietary pattern quartiles and biomarkers of CM status using regression adjusted for confounders (n=637). Finally, we characterized the association between current iq'mik use and biomarkers of CM status using regression models adjusting for measures of Yup'ik lifestyle or adjusting for a propensity score (n=874). The results confirmed the dietary patterns based on acceptably correlated factor loadings for 17 of the 18 foods used in the analysis and model fit criteria were all above the 0.90 threshold. Composite and test-retest reliability were respectively 0.73 and 0.66 for "processed foods", 0.72 and 0.54 for "fruits and vegetables", and 0.56 and 0.34 for "subsistence foods". Comparing participants in the fourth to first quartile for each dietary pattern, we identified significant associations between "processed foods" and log triglycerides (β=0.11); "fruits and vegetables" and diastolic blood pressure (DBP) (β=2.87) and HbA1c (β=-0.08); and "subsistence foods" and log triglycerides (β=-0.10) and DBP (β=-3.99). Current iq'mik use was significantly associated with log high-density lipoprotein cholesterol (β=0.05), log triglycerides (β=-0.07), HbA1c (β=-0.05), log fasting blood glucose (β=-0.02), log waist circumference (β=-0.04), and log body mass index (β=-0.04), using either adjustment method. Therefore, we confirmed the reproducibility and reliability of the dietary patterns, and found evidence that both diet and iq'mik use were associated with CM risk. The dietary associations align with results from previous studies, and can be used for future research and development of health interventions. However, the iq'mik findings are novel requiring further study

Timing of hepatitis B vaccination and impact of non-simultaneous vaccination with DTP vaccine following introduction of a hepatitis B birth dose in the Philippines

Timely administration of hepatitis B vaccine beginning at birth prevents up to 95 per cent of perinatally acquired hepatitis B virus infections in infants of infected mothers. The Philippines changed its national HepB schedule in 2007 to include a dose at birth. We evaluated vaccination schedule change by reviewing infant records at selected health facilities to measure completeness and timeliness of HepB administration and frequency of recommended, simultaneous vaccination with diphtheria-tetanus-pertussis (DTP) vaccine. Of 1431 sampled infants, 1106 (77 per cent) completed the HepB series and 10 per cent followed the national schedule. The proportion with timely vaccination declined with successive doses: HepB1 (71 per cent), HepB2 (47 per cent), and HepB3 (26 per cent). Twenty-six per cent received HepB2 simultaneously with DTP1 and 34 per cent received HepB3 simultaneously with DTP3. If HepB and DTP vaccination were given simultaneously, 10 per cent more infants could have received all HepB doses. Program implementers should monitor vaccination timeliness and increase simultaneous administration to improve vaccination coverage and decrease disease incidence