Mass measles vaccination in urban Burkina Faso, 1998
01 Jan 2001-Bulletin of The World Health Organization (World Health Organization)-Vol. 79, Iss: 4, pp 296-300
TL;DR: The mass campaign enabled a substantial increase in measles vaccine coverage to be made because it reached a high proportion of children who were difficult to reach through routine methods.
Abstract: OBJECTIVE: To assess the impact of the National Immunization Days (NIDs) on measles vaccine coverage in Burkina Faso in 1998. METHODS: During the week after the campaign, in which measles vaccine was offered to children aged 9-59 months in six cities regardless of vaccination history, a cluster survey was conducted in Ouagadougou and Bobo Dioulasso, the country’s two largest cities. Interviewers visited the parents of 1267 children aged up to 59 months and examined vaccination cards. We analysed the data using cluster sample methodology for the 1041 children who were aged 9-59 months. FINDINGS: A total of 604 (57%) children had received routine measles vaccination prior to the campaign, and 823 (79%) were vaccinated during the NIDs. Among those who had previously had a routine vaccination, 484 (81%) were revaccinated during the NIDs. Among those not previously vaccinated, 339 (78%) received one dose during the NIDs. After the campaign, 943 (91%) children had received at least one dose of measles vaccine. Better socioeconomic status was associated with a higher chance of having been vaccinated routinely, but it was not associated with NID coverage. CONCLUSION: The mass campaign enabled a substantial increase in measles vaccine coverage to be made because it reached a high proportion of children who were difficult to reach through routine methods.
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TL;DR: Poor-rich inequalities in professional delivery care are much larger than those in the other forms of care, and a concerted effort of equity-oriented policy and research is needed to address these inequalities.
Abstract: OBJECTIVE: Progress towards the Millennium Development Goals for maternal health has been slow, and accelerated progress in scaling up professional delivery care is needed. This paper describes poor-rich inequalities in the use of maternity care and seeks to understand these inequalities through comparisons with other types of health care. METHODS: Demographic and Health Survey (DHS) data from 45 developing countries were used to describe poor-rich inequalities by wealth quintiles in maternity care (professional delivery care and antenatal care), full childhood immunization coverage and medical treatment for diarrhoea and acute respiratory infections (ARI). FINDINGS: Poor-rich inequalities in maternity care in general, and professional delivery care in particular, are much greater than those in immunization coverage or treatment for childhood illnesses. Public-sector inequalities make up a major part of the poor-rich inequalities in professional delivery attendance. Even delivery care provided by nurses and midwives favours the rich in most countries. Although poor-rich inequalities within both rural and urban areas are large, most births without professional delivery care occur among the rural poor. CONCLUSION: Poor-rich inequalities in professional delivery care are much larger than those in the other forms of care. Reducing poor-rich inequalities in professional delivery care is essential to achieving the MDGs for maternal health. The greatest improvements in professional delivery care can be made by increasing coverage among the rural poor. Problems with availability, accessibility and affordability, as well as the nature of the services and demand factors, appear to contribute to the larger poor-rich inequalities in delivery care. A concerted effort of equity-oriented policy and research is needed to address the huge poor-rich inequalities in maternity care.
344 citations
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01 Jan 2004
TL;DR: The evidence for twelve key practices identified by UNICEF and WHO to be of key importance in providing good home-care for the child concerning the prevention or treatment of the IMCI conditions in order to ensure survival reduce morbidity and promote healthy growth and development is presented.
Abstract: Every year nearly 11 million children die before reaching their fifth birthday and most of them during their first year of life. Most of these deaths (98% in 2002) are in developing countries; more than half are due to acute respiratory infections diarrhoea measles malaria and HIV/AIDS. In addition malnutrition underlies 54% of all child deaths. Projections based on the 1996 analysis The Global Burden of Disease indicate that these conditions will continue to be major contributors to child deaths in 2020 unless significant efforts are made to control them. In response to this challenge the United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO) developed the Integrated Management of Childhood Illness (IMCI) strategy which focuses on these five conditions and which includes three main components: Improvements in the case management skills of health workers through the provision of locally adapted guidelines on IMCI and through activities to promote their use. Improvements in the health system that are required for the effective management of childhood illness. Improvements in family and community practices. This paper addresses improvements in family and community practices. More specifically it presents the evidence for twelve key practices (see below) identified by UNICEF and WHO to be of key importance in providing good home-care for the child concerning the prevention or treatment of the IMCI conditions in order to ensure survival reduce morbidity and promote healthy growth and development. It does not include the four additional practices added following a meeting of UNICEF the WHO Regional Office for Africa and nongovernmental organizations(NGO) which took place in Durban South Africa in June 2000 as these practices will need additional work to reach a specificity whose impact can be measured. (excerpt)
140 citations
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TL;DR: Specific factors associated with immunization status in Nouna health district are identified in order to advance improved intervention strategies in this district and in those with similar environmental and social contexts.
Abstract: Background
The Expanded Program on Immunization (EPI) is still in need of improvement. In Burkina Faso in 2003, for example, the Nouna health district had an immunization coverage rate of 31.5%, compared to the national rate of 52%. This study identifies specific factors associated with immunization status in Nouna health district in order to advance improved intervention strategies in this district and in those with similar environmental and social contexts.
123 citations
Journal Article•
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TL;DR: It is shown how HIV vaccine models can be used to evaluate the epidemic-level impact of vaccine efficacy, waning in vaccine-induced immunity, vaccination coverage level, and changes (increases or decreases in risky behavior).
Abstract: Mathematical models can be used as health policy tools and predictive tools. Here we review how mathematical models have been used both to predict the consequences of specific epidemic control strategies and to design epidemic control strategies. We review how models have been used to evaluate the potential impact on HIV epidemics of (i) combination antiretroviral therapies (ART) and (ii) imperfect vaccines. In particular, we discuss how models have been used to predict the potential effect of ART on incidence rates, and to predict the evolution of an epidemic of drug-resistant HIV. We also discuss, in detail, how mathematical models have been used to evaluate the potential impact of prophylactic, live-attenuated and therapeutic HIV vaccines. We show how HIV vaccine models can be used to evaluate the epidemic-level impact of vaccine efficacy, waning in vaccine-induced immunity, vaccination coverage level, and changes (increases or decreases) in risky behavior. We also discuss how mathematical models can be used to determine the levels of cross-immunity that vaccines will need to attain if they are to be used to control HIV epidemics in countries where more than one subtype is being transmitted.
73 citations
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TL;DR: Full vaccination rates for children aged less than 1 year and less than 5 years were higher in the Umraniye Health District than in Istanbul, however, the EPI aims for any of the vaccines were not met, and differences were observed in vaccination coverage rates between different socio-economic groups.
Abstract: Summary Objectives The primary objective of this study was to determine the coverage of the Expanded Programme of Immunization (EPI) of the Ministry of Health and the coverage of private vaccines in the Umraniye Health District in order to establish approaches for improving vaccination services. Other objectives were to define the areas that present higher risks for non-vaccination and to determine the factors that influence vaccination coverage. Methods A ‘30×7’ cluster sampling design was adopted as the sampling method. Thirty streets were selected at random from each healthcare region. Sociodemographic and socio-economic characteristics of the population, utilization of vaccination services and vaccination status of children under the age of 5 years were determined by face-to-face interviews. Odds ratios for the sociodemographic and socio-economic characteristics, health centre region and inner country immigration were assessed as possible related factors with the vaccination coverage rates for children under 5 years and under 1 year using the backward elimination method in logistic regression. Results Vaccination coverage was as follows: hepatitis B third dose, 84.6%; Bacille Calmette-Guerin, 94.8%; diphtheria, tetanus, pertussis (DPT) third dose, 90.1%; oral polio virus (OPV) third dose, 90.0%; measles, 88.7%; DPT booster dose, 79.1%; OPV booster dose, 79.0%; measles, mumps, rubella (MMR), 13.3%; haemophilus influenza type b (Hib), 9.3%; and Varicella vaccine, 3.3%. The full vaccination rates for children under 5 years and under 1 year were 68.3 and 79.5%, respectively. Higher socio-economic status was associated with a higher rate of full vaccination and private vaccination for children under 5 years of age. Conclusions Full vaccination rates for children aged less than 1 year and less than 5 years were higher in our district than in Istanbul. However, we did not meet the EPI aims for any of the vaccines, and differences were observed in vaccination coverage rates between different socio-economic groups in the district. Therefore, an intervention programme should be considered to achieve the EPI's goals, particularly in socio-economically disadvantaged groups. Also, the coverage of private vaccination (MMR, Hib, Varicella) is low and more children from higher socio-economic groups receive these vaccines.
63 citations
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TL;DR: The precision of this method, as estimated from the results of both actual and simulated surveys, is considered satisfactory for the requirements of the EPI.
Abstract: The Expanded Program on Immunization (EPI) is using a simplified cluster sampling method based on the random selection of 210 children in 30 clusters of 7 children each to estimate immunization coverage levels. This article analyzes the results of this method in actual and computer simulated surveys. Results from 60 actual surveys conducted in 25 countries were available for analysis for a total of 446 sample estimations of immunization coverage. 83% of the sample results had 95% confidence limits within + or - 10% and none of the surveys had 95% confidence limits exceeding + or - 13%. In addition 12 hypothetical population strata with immunization coverage rates ranging from 10%-99% were established for the purposes of computer simulation and 10 hypothetical communities were established by allocating to them various proportions of each of the strata. These simulated surveys also supported the validity of the EPI method: over 95% of the results were less than + or - 10% from the actual population mean. The precision of this method as estimated from the results of both actual and simulated surveys is considered satisfactory for the requirements of the EPI. Among the actual surveys the proportion of results whose confidence limits exceeded + or - 10% was greatest (50%) when immunization coverage in the sample was 45%-54%.
599 citations
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TL;DR: The theoretical results indicate that the advantages and disadvantages of a pulse strategy should be seriously examined in Israel and in countries with similar patterns of measles virus transmission.
Abstract: Although vaccines against measles have been routinely applied over a quarter of a century, measles is still persistent in Israel, with major epidemics roughly every 5 years. Recent serological analyses have shown that only 85% of Israelis aged 18 years have anti-measles IgG antibodies. Considering the high transmissibility of the virus and the high level of herd immunity required for disease eradication, the Israeli vaccination policy against measles is now being reevaluated. Motivated by theoretical studies of populations in perturbed environments, we examined the possibility of replacing the conventional cohort vaccination strategy by a pulse strategy--i.e., periodic vaccination of several age cohorts at the same time. Numerical studies of a deterministic age-structured model suggest that vaccination, which renders immunity to no more than 85% of the susceptible children aged 1-7 years, once every 5 years will suffice to prevent epidemics in Israel, where infection rate is highest amongst schoolchildren. The model suggests that by using such a strategy the density of susceptible individuals is always kept below the threshold above which recurrent epidemics will be maintained. Analysis of simpler, non-age-structured, models serves to clarify the basic properties of the proposed strategy. Our theoretical results indicate that the advantages and disadvantages of a pulse strategy should be seriously examined in Israel and in countries with similar patterns of measles virus transmission.
312 citations
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TL;DR: The strategy currently used to control measles in most countries has been to immunize each successive birth cohort through the routine health services delivery system, while measles vaccine coverage has increased markedly, significant measles outbreaks have continued to recur.
Abstract: The strategy currently used to control measles in most countries has been to immunize each successive birth cohort through the routine health services delivery system. While measles vaccine coverage has increased markedly, significant measles outbreaks have continued to recur. During the past 5 years, experience in the Americas suggests that measles transmission has been interrupted in a number of countries (Cuba, Chile, and countries in the English-speaking Caribbean and successfully controlled in all remaining countries. Since 1991 these countries have implemented one-time "catch-up" vaccination campaigns (conducted during a short period, usually 1 week to 1 month, and targeting all children 9 months through 14 years of age, regardless of previous vaccination status or measles disease history). These campaigns have been followed by improvements in routine vaccination services and in surveillance systems, so that the progress of the measles elimination efforts can be sustained and monitored. Follow-up mass vaccination campaigns for children younger than 5 years are planned to take place every 3 to 5 years. ( JAMA . 1996;275:224-229)
247 citations