22 research outputs found
Adding interventions to mass measles vaccinations in India.
OBJECTIVE: To quantify the impact on mortality of offering a hypothetical set of technically feasible, high-impact interventions for maternal and child survival during India's 2010-2013 measles supplementary immunization activity. METHODS: We developed Lives Saved Tool models for 12 Indian states participating in the supplementary immunization, based on state- and sex-specific data on mortality from India's Million Deaths Study and on health services coverage from Indian household surveys. Potential add-on interventions were identified through a literature review and expert consultations. We quantified the number of lives saved for a campaign offering measles vaccine alone versus a campaign offering measles vaccine with six add-on interventions (nutritional screening and complementary feeding for children, vitamin A and zinc supplementation for children, multiple micronutrient and calcium supplementation in pregnancy, and free distribution of insecticide-treated bednets). FINDINGS: The measles vaccination campaign saved an estimated 19 016 lives of children younger than 5 years. A hypothetical campaign including measles vaccine with add-on interventions was projected to save around 73 900 lives (range: 70 200-79 300), preventing 73 700 child deaths (range: 70 000-79 000) and 300 maternal deaths (range: 200-400). The most effective interventions in the whole package were insecticide-treated bednets, measles vaccine and preventive zinc supplementation. Girls accounted for 66% of expected lives saved (12 712/19 346) for the measles vaccine campaign, and 62% of lives saved (45 721/74 367) for the hypothetical campaign including add-on interventions. CONCLUSION: In India, a measles vaccination campaign including feasible, high-impact interventions could substantially increase the number of lives saved and mitigate gender-related inequities in child mortality
Strategies to increase the demand for childhood vaccination in lowand middle-income countries : a systematic review and meta-analysis
Objective To investigate which strategies to increase demand for vaccination are effective in increasing child vaccine coverage in low- and
middle-income countries.
Methods We searched MEDLINE, EMBASE, Cochrane library, POPLINE, ECONLIT, CINAHL, LILACS, BDSP, Web of Science and Scopus databases
for relevant studies, published in English, French, German, Hindi, Portuguese and Spanish up to 25 March 2014. We included studies of
interventions intended to increase demand for routine childhood vaccination. Studies were eligible if conducted in low- and middle-income
countries and employing a randomized controlled trial, non-randomized controlled trial, controlled before-and-after or interrupted time
series design. We estimated risk of bias using Cochrane collaboration guidelines and performed random-effects meta-analysis.
Findings We identified 11 studies comprising four randomized controlled trials, six cluster randomized controlled trials and one controlled
before-and-after study published in English between 1996 and 2013. Participants were generally parents of young children exposed to an
eligible intervention. Six studies demonstrated low risk of bias and five studies had moderate to high risk of bias. We conducted a pooled
analysis considering all 11 studies, with data from 11 512 participants. Demand-side interventions were associated with significantly higher
receipt of vaccines, relative risk (RR): 1.30, (95% confidence interval, CI: 1.17–1.44). Subgroup analyses also demonstrated significant effects
of seven education and knowledge translation studies, RR: 1.40 (95% CI: 1.20–1.63) and of four studies which used incentives, RR: 1.28
(95% CI: 1.12–1.45).
Conclusion Demand-side interventions lead to significant gains in child vaccination coverage in low- and middle-income countries.
Educational approaches and use of incentives were both effective strategies
Use of measles supplemental immunization activities (SIAs) as a delivery platform for other maternal and child health interventions: opportunities and challenges.
Measles supplementary immunization activities (SIAs) offer children in countries with weaker immunization delivery systems like India a second opportunity for measles vaccination. They could also provide a platform to deliver additional interventions, but the feasibility and acceptability of including add-ons is uncertain. We surveyed Indian programme officers involved in the current (2010-2012) measles SIAs concerning opportunities and challenges of using SIAs as a delivery platform for other maternal and child health interventions. Respondents felt that an expanded SIA strategy including add-ons could be of great value in improving access and efficiency. They viewed management challenges, logistics, and safety as the most important potential barriers. They proposed that additional interventions be selected using several criteria, of which importance of the health problem, safety, and contribution to health equity figured most prominently. For children, they recommended inclusion of basic interventions to address nutritional deficiencies, diarrhoea and parasites over vaccines. For mothers, micronutrient interventions were highest ranked
Estrategias para incrementar la demanda de vacunación infantil en paÃses de ingresos bajos y medios: una revisión sistemática y un metanálisis / Strategies to increase the demand for childhood vaccination in low- and middle-income countries: a systematic review and meta-analysis
Resumen
Objetivo: investigar qué estrategias para aumentar la demanda de vacunación son efectivas a la hora de incrementar la cobertura de vacunación infantil en paÃses de ingresos bajos y medios. MetodologÃa: se realizaron búsquedas en las bases de datos de MEDLINE, EMBASE, Cochrane Library, POPLINE, ECONLIT, CINAHL, LILACS, BDSP, Web of Science y Scopus para encontrar estudios pertinentes, publicados en alemán, español, francés, hindi, inglés y portugués hasta el 25 de marzo de 2014. Se incluyeron estudios de intervenciones que tenÃan como objetivo incrementar la demanda de vacunación infantil de rutina. Los estudios fueron considerados elegibles si se realizaron en paÃses de ingresos bajos y medios y utilizaron un diseño de ensayo controlado aleatorizado, ensayo controlado no aleatorizado, estudio controlado antes y después o de series temporales interrumpidas. Se estimó un riesgo de sesgo mediante las directrices de colaboración de Cochrane y se realizaron metaanálisis de efectos aleatorios. Resultados: se identificaron 11 estudios que abarcan cuatro ensayos controlados aleatorizados, seis ensayos controlados aleatorizados por conglomerados y un estudio controlado antes y después, publicados en inglés entre 1996 y 2013. En general, los participantes fueron padres de niños pequeños expuestos a una intervención elegible. Seis
estudios demostraron un bajo riesgo de sesgo y cinco estudios
presentaron un riesgo de sesgo entre moderado y elevado.
Se realizó un análisis agrupado teniendo en cuenta los 11
estudios, con datos de 11.512 participantes. Las intervenciones
enfocadas en la demanda se relacionaron con una recepción
de las vacunas significativamente superior, riesgo relativo
(RR): 1,30, (intervalo de confianza, IC, del 95%: 1,17–1,44).
Los análisis de los subgrupos también demostraron efectos
importantes de siete estudios de educación y traslación de
conocimientos, RR: 1,40 (IC del 95%: 1,20–1,63) y de cuatro
estudios que utilizaron incentivos, RR: 1,28 (IC del 95%:
1,12–1,45). Conclusión: las intervenciones enfocadas en la
demanda conducen a mejoras significativas en la cobertura
de vacunación infantil en paÃses de ingresos bajos y medios.
Asimismo, los enfoques educativos y el uso de incentivos
fueron estrategias efectivas.
/
Abstract
Objective: To investigate which strategies to increase demand
for vaccination are effective in increasing child vaccine
coverage in low- and middle-income countries. Methodology:
We searched MEDLINE, EMBASE, Cochrane library,
POPLINE, ECONLIT, CINAHL, LILACS, BDSP, Web of
Science and Scopus databases for relevant studies, published in
English, French, German, Hindi, Portuguese and Spanish up to
25 March 2014. We included studies of interventions intended
to increase demand for routine childhood vaccination. Studies
were eligible if conducted in low- and middle-income countries
and employing a randomized controlled trial, non-randomized
controlled trial, controlled before-and-after or interrupted
time series design. We estimated risk of bias using Cochrane
collaboration guidelines and performed random-effects metaanalysis.
Results: it was identified 11 studies comprising four
randomized controlled trials, six cluster randomized controlled
trials and one controlled before-and-after study published in
English between 1996 and 2013. Participants were generally
parents of young children exposed to an eligible intervention.
Six studies demonstrated low risk of bias and five studies had
moderate to high risk of bias. We conducted a pooled analysis
considering all 11 studies, with data from 11 512 participants.
Demand-side interventions were associated with significantly
higher receipt of vaccines, relative risk (RR): 1.30, (95%
confidence interval, CI: 1.17–1.44). Subgroup analyses also
demonstrated significant effects of seven education and
knowledge translation studies, RR: 1.40 (95% CI: 1.20–1.63)
and of four studies which used incentives, RR: 1.28 (95% CI:
1.12–1.45). Conclusion: Demand-side interventions lead to
significant gains in child vaccination coverage in low- and
middle-income countries. Educational approaches and use of
incentives were both effective strategies
Estrategias para incrementar la demanda de vacunación infantil en paÃses de ingresos bajos y medios: una revisión sistemática y un metanálisis
Objetivo: investigar qué estrategias para aumentar la demanda de vacunación son efectivas a la hora de incrementar la cobertura de vacunación infantil en paÃses de ingresos bajos y medios. MetodologÃa: se realizaron búsquedas en las bases de datos de MEDLINE, EMBASE, Cochrane Library, POPLINE, ECONLIT, CINAHL, LILACS, BDSP, Web of Science y Scopus para encontrar estudios pertinentes, publicados en alemán, español, francés, hindi, inglés y portugués hasta el 25 de marzo de 2014. Se incluyeron estudios de intervenciones que tenÃan como objetivo incrementar la demanda de vacunación infantil de rutina. Los estudios fueron considerados elegibles si se realizaron en paÃses de ingresos bajos y medios y utilizaron un diseño de ensayo controlado aleatorizado, ensayo controlado no aleatorizado, estudio controlado antes y después o de series temporales interrumpidas. Se estimó un riesgo de sesgo mediante las directrices de colaboración de Cochrane y se realizaron metaanálisis de efectos aleatorios. Resultados: se identificaron 11 estudios que abarcan cuatro ensayos controlados aleatorizados, seis ensayos controlados aleatorizados por conglomerados y un estudio controlado antes y después, publicados en inglés entre 1996 y 2013. En general, los participantes fueron padres de niños pequeños expuestos a una intervención elegible. Seisestudios demostraron un bajo riesgo de sesgo y cinco estudiospresentaron un riesgo de sesgo entre moderado y elevado.Se realizó un análisis agrupado teniendo en cuenta los 11estudios, con datos de 11.512 participantes. Las intervencionesenfocadas en la demanda se relacionaron con una recepciónde las vacunas significativamente superior, riesgo relativo(RR): 1,30, (intervalo de confianza, IC, del 95%: 1,17–1,44).Los análisis de los subgrupos también demostraron efectosimportantes de siete estudios de educación y traslación deconocimientos, RR: 1,40 (IC del 95%: 1,20–1,63) y de cuatroestudios que utilizaron incentivos, RR: 1,28 (IC del 95%:1,12–1,45). Conclusión: las intervenciones enfocadas en lademanda conducen a mejoras significativas en la coberturade vacunación infantil en paÃses de ingresos bajos y medios.Asimismo, los enfoques educativos y el uso de incentivosfueron estrategias efectivas
Strategies to increase the demand for childhood vaccination in low- and middle-income countries: a systematic review and meta-analysis
OBJECTIVE: To investigate which strategies to increase demand for vaccination are effective in increasing child vaccine coverage in low- and middle-income countries. METHODS: We searched MEDLINE, EMBASE, Cochrane library, POPLINE, ECONLIT, CINAHL, LILACS, BDSP, Web of Science and Scopus databases for relevant studies, published in English, French, German, Hindi, Portuguese and Spanish up to 25 March 2014. We included studies of interventions intended to increase demand for routine childhood vaccination. Studies were eligible if conducted in low- and middle-income countries and employing a randomized controlled trial, non-randomized controlled trial, controlled before-and-after or interrupted time series design. We estimated risk of bias using Cochrane collaboration guidelines and performed random-effects meta-analysis. FINDINGS: We identified 11 studies comprising four randomized controlled trials, six cluster randomized controlled trials and one controlled before-and-after study published in English between 1996 and 2013. Participants were generally parents of young children exposed to an eligible intervention. Six studies demonstrated low risk of bias and five studies had moderate to high risk of bias. We conducted a pooled analysis considering all 11 studies, with data from 11 512 participants. Demand-side interventions were associated with significantly higher receipt of vaccines, relative risk (RR): 1.30, (95% confidence interval, CI: 1.17–1.44). Subgroup analyses also demonstrated significant effects of seven education and knowledge translation studies, RR: 1.40 (95% CI: 1.20–1.63) and of four studies which used incentives, RR: 1.28 (95% CI: 1.12–1.45). CONCLUSION: Demand-side interventions lead to significant gains in child vaccination coverage in low- and middle-income countries. Educational approaches and use of incentives were both effective strategies
Benzimidazoles: Novel Mycobacterial Gyrase Inhibitors from Scaffold Morphing
Type II topoisomerases are well conserved
across the bacterial
species, and inhibition of DNA gyrase by fluoroquinolones has provided
an attractive option for treatment of tuberculosis (TB). However,
the emergence of fluoroquinolone-resistant strains of <i>Mycobacterium
tuberculosis</i> (<i>Mtb</i>) poses a threat for its
sustainability. A scaffold hopping approach using the binding mode
of novel bacterial topoisomerase inhibitors (NBTIs) led to the identification
of a novel class of benzimidazoles as DNA gyrase inhibitors with potent
anti-TB activity. Docking of benzimidazoles to a NBTI bound crystal
structure suggested that this class of compound makes key contacts
in the enzyme active site similar to the reported NBTIs. This observation
was further confirmed through the measurement of DNA gyrase inhibition,
and activity against <i>Mtb</i> strains harboring mutations
that confer resistance to aminopiperidines based NBTIs and <i>Mtb</i> strains resistant to moxifloxacin. Structure–activity
relationship modification at the C-7 position of the left-hand side
ring provided further avenue to improve hERG selectivity for this
chemical series that has been the major challenges for NBTIs