Vaccines have made a major contribution to public health, including the eradication of one deadly disease, small pox, and the near eradication of another, poliomyelitis.Through the introduction of new vaccines, such as those against rotavirus and pneumococcal diseases, and with further improvements in coverage, vaccination can significantly contribute to the achievement of the health-related United Nations Millennium Development Goals.The Global Immunization Vision and Strategy (GIVS) was developed by WHO and UNICEF as a framework for strengthening national immunization programmes and protect as many people as possible against more diseases by expanding the reach of immunization, including new vaccines, to every eligible person.This paper briefly reviews global progress and challenges with respect to public vaccination programmes.

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Global immunization: status, progress, challenges and future

Microbial biofilms in seafood: A food-hygiene challenge

Immunization remains one of the most important public health interventions and cost effective strategies to reduce child mortality and morbidity associated with infectious diseases. It is estimated to avert between 2 and 3 million deaths each year worldwide. The objective of this study was to assess complete immunization coverage and its associated factors among children aged 12 to 23 months in Sinana district, Bale Zone, Southeast Ethiopia. A cross-sectional community based survey was conducted in Sinana district from December 2012 to January 2013. A modified World Health Organization-Expanded Program on Immunization cluster sampling methods were used for household selection. A total 591 children aged 12 to 23 months and their mothers or caregivers were included in the study. Data were collected by using a pre-tested, interviewer administered questionnaire. Bivariate analysis was employed to identify factors associated with full immunization coverage and multiple logistic regression analysis was performed for those factors that showed statistically significant association in bivariate analysis and investigate independent predictors by controlling for possible confounders and significances of all tests were decided at p-value of 0.05. More than three fourth (76.8%) of the children aged 12 to 23 months were fully vaccinated by card plus history. Factors significantly associated with full immunization were antenatal care follow up (AOR = 3.7; 95% CI: 2.3, 5.9), being a farmer (AOR = 1.9; 95% CI: 1.1, 3.1), being father with secondary and above educational level (AOR = 3.1; 95% CI: 1.3, 7.4), having household family income greater than 1000 ETB or 52 USD (AOR = 3.2; 95% CI: 1.4, 7.4), those whose average walking time from home to health facilities is less than an hour (AOR = 3.1; 95% CI: 1.5, 6.3), those who had ever discussed about immunization with health extension workers (AOR = 2.4, 95% CI: 1.3, 4.2) and mothers’ with sufficient knowledge on immunization (AOR = 2.5; 95% CI: 1.5, 4.2). Even though, immunization coverage of children in Sinana district gets improvement over national coverage, yet it is below governmental plan to increase the coverage i.e. 90%. Maternal health care utilization and knowledge of mother about vaccine and vaccine preventable diseases are the main factors associated with complete immunization coverage. It is vital that local programmatic intervention should be strengthened to upgrade awareness of the community on the importance of immunization, antenatal care and working on advancing economic status of community is the way to optimize children’s immunization coverage.

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An assessment of child immunization coverage and its determinants in Sinana District, Southeast Ethiopia

Immunization coverage in Ethiopia is less than the herd immunity level desired to prevent the spread of eight target diseases targeted by the World Health Organization’s Expanded Program of Immunization. In particular, the Somali region of the country still has by far the lowest level of immunization coverage. The objective of this study was to measure the immunization coverage of 12–23 months old children and associated factors in the urban and rural areas of Jigjiga district. A community based cross-sectional survey was conducted in 582 households with 12–23 months old children in two urban and four rural wards. The data were collected from mothers or caregivers through interviews based on pre-tested and structured questionnaires and from the review of vaccination cards. Data were processed using SPSS version 16. To identify factors associated with the immunization status of children, bivariate and multiple logistic regression analyses were worked out and the Hoshmer and Lemeshow’s goodness-of-fit was used to assess the fitness of multiple logistic regression model. Three–fourth (74.6%) of the children surveyed were ever vaccinated, whereas 36.6% were fully vaccinated. The immunization coverage rate from card assessment for Bacillus Calmette-Guerin was 41.8%, while for Oral Polio Vaccine Zero, Oral Polio Vaccine One /Pentavalent1, Oral Polio Vaccine Two /Pentavalent2, Oral Polio Vaccine Three /Pentavalent3, and measles were 10.4%, 41.1%, 33.9%, 27.5%, and 24.9%, respectively. Maternal literacy (AOR = 3.06, 95% CI = 1.64, 5.71), Tetanus Toxoid Vaccine (AOR = 2.43, 95% CI = 1.56, 3.77), place of delivery (AOR = 2.02, 95% CI = 1.24, 3.28), place of residence (AOR = 2.04, 95% CI = 1.33, 3.13), and household visits by health workers (AOR = 1.92, 95% CI = 1.17, 3.16), were found to be factors significantly associated with full immunization in the multivariate logistic regression analysis. The overall immunization coverage was found to be low. Hence, to increase the immunization coverage and reduce the incidences of missed opportunity, delivery in the health institution should be promoted, the outreach activities of the health institutions should be strengthened and greater utilization of health services by mothers should be encouraged.

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Immunization coverage of 12–23 months old children and associated factors in Jigjiga District, Somali National Regional State, Ethiopia

There is an increasing recognition that non communicable diseases impose large economic costs on households, societies and nations. However, not much is known about the magnitude of diabetes expenditure in African countries and to the best of our knowledge no systematic assessment of the literature on diabetes costs in Africa has been conducted. The aim of this paper is to capture the evidence on the cost of diabetes in Africa, review the methods used to calculate costs and identify areas for future research. A desk search was conducted in Pubmed, Medline, Embase, and Science direct as well as through other databases, namely Google Scholar. The following eligibility criteria were used: peer reviewed English articles published between 2006 and 2016, articles that reported original research findings on the cost of illness in diabetes, and studies that covered at least one African country. Information was extracted using two data extraction sheets and results organized in tables. Costs presented in the studies under review are converted to 2015 international dollars prices (I$). Twenty six articles are included in this review. Annual national direct costs of diabetes differed between countries and ranged from I$3.5 billion to I$4.5 billion per annum. Indirect costs per patient were generally higher than the direct costs per patient of diabetes. Outpatient costs varied by study design, data source, perspective and healthcare cost categories included in the total costs calculation. The most commonly included healthcare items were drug costs, followed by diagnostic costs, medical supply or disposable costs and consultation costs. In studies that reported both drug costs and total costs, drug costs took a significant portion of the total costs per patient. The highest burden due to the costs associated with diabetes was reported in individuals within the low income group. Estimation of the costs associated with diabetes is crucial to make progress towards meeting the targets laid out in Sustainable Development Goal 3 set for 2030. The studies included in this review show that the presence of diabetes leads to elevated costs of treatment which further increase in the presence of complications. The cost of drugs generally contributed the most to total direct costs of treatment. Various methods are used in the estimation of diabetes healthcare costs and the costs estimated between countries differ significantly. There is room to improve transparency and make the methodologies used standard in order to allow for cost comparisons across studies.

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Cost of diabetes mellitus in Africa: a systematic review of existing literature

Background
In 1986, the Government of Mali launched its Expanded Program on Immunization (EPI) with the goal of vaccinating, within five years, 80% of all children under the age of five against six target diseases: diphtheria, tetanus, pertussis, poliomyelitis, tuberculosis, and measles. The Demographic and Health Survey carried out in 2001 revealed that, in Kita Circle, in the Kayes region, only 13% of children aged 12 to 23 months had received all the EPI vaccinations. A priority program was implemented in 2003 by the Regional Health Department in Kayes to improve EPI immunization coverage in this area.

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Karim Diakité

Papers

Evaluation of immunization coverage within the Expanded Program on Immunization in Kita Circle, Mali : a cross-sectional survey