Assessment of missed opportunities for vaccination (MOV) in Burkina Faso using the World Health Organization’s revised MOV strategy: Findings and strategic considerations to improve routine childhood immunization coverage

BackgroundDespite the remarkable achievements of the Expanded Programme on Immunization (EPI) in Burkina Faso, numerous challenges remain, including missed opportunities for vaccination (MOV) which occur when people visit a health facility with at least one vaccine due according to the national immunization schedule, are free of contraindications, and leave without receiving all due vaccine doses. In 2016, we used the revised World Health Organization’s (WHO) MOV strategy to assess the extent of and reasons for MOV in Burkina Faso.MethodsWe purposively selected 27 primary health facilities (PHFs) from the eight health districts with the highest absolute numbers of children who missed the first dose of measles-rubella (MR1) in 2015. We conducted exit interviews with caregivers of children aged 0–23 months, and requested health workers to complete a self-administered knowledge, attitudes and practices (KAP) questionnaire.ResultsA total of 489 caregivers were interviewed, of which 411 were eligible for inclusion in our analysis. Medical consultation (35%) and vaccination (24.5%) were the most frequent reasons for visiting PHFs. Among the 73% of children eligible for vaccination, 76% of vaccination opportunities were missed. Among eligible children, the percentage with MOV was significantly higher in those aged ≥12 months and also in those attending for a reason other than vaccination. A total of 248 health workers completed the KAP questionnaire. Of these, 70% (n = 168/239) considered their knowledge on immunization to be insufficient or outdated; 83% failed to correctly identify valid contraindications to vaccination.ConclusionAddressing MOV offers the potential for substantial increases in vaccine coverage and equity, and ultimately reducing the burden of vaccine-preventable diseases (VPDs). This will require the implementation of a series of interventions aimed at improving community knowledge and practices, raising health workers’ awareness, and fostering the integration of immunization with other health services.     

Uptake of the World Health Organization’s trauma care guidelines: a systematic review

ObjectiveTo understand the degree to which the trauma care guidelines released by the World Health Organization (WHO) between 2004 and 2009 have been used, and to identify priorities for the future implementation and dissemination of such guidelines.MethodsWe conducted a systematic review, across 19 databases, in which the titles of the three sets of guidelines – Guidelines for essential trauma care, Prehospital trauma care systems and Guidelines for trauma quality improvement programmes – were used as the search terms. Results were validated via citation analysis and expert consultation. Two authors independently reviewed each record of the guidelines’ implementation.FindingsWe identified 578 records that provided evidence of dissemination of WHO trauma care guidelines and 101 information sources that together described 140 implementation events. Implementation evidence could be found for 51 countries – 14 (40%) of the 35 low-income countries, 15 (32%) of the 47 lower-middle income, 15 (28%) of the 53 upper-middle-income and 7 (12%) of the 59 high-income. Of the 140 implementations, 63 (45%) could be categorized as needs assessments, 38 (27%) as endorsements by stakeholders, 20 (14%) as incorporations into policy and 19 (14%) as educational interventions.ConclusionAlthough WHO’s trauma care guidelines have been widely implemented, no evidence was identified of their implementation in 143 countries. More serial needs assessments for the ongoing monitoring of capacity for trauma care in health systems and more incorporation of the guidelines into both the formal education of health-care providers and health policy are needed.     

Quality of life among an Iranian general population sample using the World Health Organization’s quality of life instrument (WHOQOL-BREF)

Objectives  

To assess subjective quality of life of an Iranian general population sample.     

At the Roots of The World Health Organization’s Challenges: Politics and Regionalization

The World Health Organization’s (WHO’s) leadership challenges can be traced to its first decades of existence. Central to its governance and practice is regionalization: the division of its member countries into regions, each representing 1 geographical or cultural area.The particular composition of each region has varied over time—reflecting political divisions and especially decolonization. Currently, the 194 member countries belong to 6 regions: the Americas (35 countries), Europe (53 countries), the Eastern Mediterranean (21 countries), South-East Asia (11 countries), the Western Pacific (27 countries), and Africa (47 countries). The regions have considerable autonomy with their own leadership, budget, and priorities. This regional organization has been controversial since its beginnings in the first days of WHO, when representatives of the European countries believed that each country should have a direct relationship with the headquarters in Geneva, Switzerland, whereas others (especially the United States) argued in favor of the regionalization plan.Over time, regional directors have inevitably challenged the WHO directors-general over their degree of autonomy, responsibilities and duties, budgets, and national composition; similar tensions have occurred within regions. This article traces the historical roots of these challenges.Created in 1948, the World Health Organization (WHO) faced a number of challenges in its early years. The agency had to come to terms with the escalating Cold War and the consolidation of a bipolar world, and also needed to deal with the anxieties of British, French, Dutch, Belgian, and Portuguese governments trying to hold on to, or rebuild, their colonial empires as these began to crumble. Like other United Nations (UN) agencies, the WHO quietly abandoned its dreams of a collaborative community of nations and instead began to come to terms with new international political realities. The agency moved closer to US foreign policy and became partially captive to US resources and priorities. It pursued a pragmatic course of limited objectives, settled upon an institutional structure of regionalization—incorporating compromises over decolonization—and initiated several disease control programs.     

The Case for the World Health Organization’s Commission on the Social Determinants of Health to Address Sexual Orientation

The World Health Organization''s (WHO''s) social determinants of health discussion underscores the need for health equity and social justice. Yet sexual orientation was not addressed within the WHO Commission on the Social Determinants of Health final report Closing the Gap in a Generation.This omission of sexual orientation as a social determinant of health stands in stark contrast with a body of evidence that demonstrates that sexual minorities are disproportionately affected by health problems associated with stigma and discrimination, such as mental health disorders.I propose strategies to integrate sexual orientation into the WHO’s social determinants of health dialogue. Recognizing sexual orientation as a social determinant of health is an important first step toward health equity for sexual minorities.Health equity and social justice are central to the World Health Organization’s (WHO’s) discussion of the social determinants of health.1 The WHO’s Commission on the Social Determinants of Health (CSDH) 2008 final report, Closing the Gap in a Generation, defined social determinants of health as living conditions shaped by sociopolitical factors that contribute to the health of individuals and populations.1 The social determinants of health were operationalized in nine themes: early childhood development, globalization, health systems, employment conditions, priority public health conditions, measurement and evidence, women and gender equality, urbanization, and social exclusion.The CSDH social determinants of health conceptual framework posits that factors associated with the distribution of health and well-being include social position, education, occupation, income, gender, and ethnicity/race.1 Sexual orientation was not included within CSDH’s social determinants of health conceptual framework nor mentioned anywhere in this report.1 Yet sexual minorities experience significant and pervasive health disparities. (I use the terms “sexual minority” and “lesbian, gay, bisexual” [LGB] interchangeably to convey nonheterosexual sexualities and identities claimed by persons across diverse cultures and contexts.) For example, systematic reviews and population-based studies report increased risks for depression,2–7 suicidal ideation,2,3,7–9 anxiety,2,3,5–7 and substance dependence2,4,6 among sexual minorities compared with heterosexuals.Open in a separate windowA woman prays next to the coffin of Erick Alex Martinez, a journalist and gay rights campaigner, who was murdered in Honduras along with at least 20 other media workers over the last 3 years. Martinez''s body was found by the roadside in the village of Guasculile, north of the capital, Tegucigalpa. He worked for an association defending lesbian, gay, bisexual, and transgender (LGBT) rights. Martinez had also been chosen last year as a candidate for a coalition of parties that emerged after the ousting of President Manuel Zelaya in 2009. Photograph by Orlando Sierra. Printed with permission of Getty Images.Omission of sexual orientation as a social determinant of health in Closing the Gap in a Generation stands in stark contrast with a large body of evidence that demonstrates that sexual minorities are disproportionately affected by health problems associated with stigma and discrimination.2,5,10 Homosexuality is criminalized in 76 countries and punishable by death in five,11 underscoring the impact of powerful sociopolitical factors on the lives of sexual minorities. Sexual minorities are a demographic that account for a significant proportion of the global disease burden, which is strongly impacted by sociopolitical factors; therefore, they should be included in health equity discussions. My objective is to demonstrate the importance of explicitly recognizing stigma and discrimination targeting sexual minorities as a social determinant of health to promote health equity.     

The Case for the World Health Organization’s Commission on Social Determinants of Health to Address Gender Identity

We analyzed the case of the World Health Organization’s Commission on Social Determinants of Health, which did not address gender identity in their final report.We argue that gender identity is increasingly being recognized as an important social determinant of health (SDH) that results in health inequities. We identify right to health mechanisms, such as established human rights instruments, as suitable policy tools for addressing gender identity as an SDH to improve health equity.We urge the World Health Organization to add gender identity as an SDH in its conceptual framework for action on the SDHs and to develop and implement specific recommendations for addressing gender identity as an SDH.Gender identity is frequently overlooked when social determinants of health (SDHs) are being discussed. We analyzed the case of the World Health Organization’s (WHO’s) Commission on Social Determinants of Health as an initial driver of the SDH movement, which did not address gender identity in their final report published in 2008.1 Subsequent international initiatives focused on the SDHs, such as the Rio Political Declaration on the Social Determinants of Health2 adopted in 2011 and the WHO European Review of the Social Determinants of Health and the Health Divide3 published in 2012, have also omitted gender identity. We argue that gender identity is increasingly being recognized as an important SDH that results in health inequities and should be addressed to improve health equity, including through the application of human rights instruments.     

Conceptualizing disability in US national surveys: application of the World Health Organization’s (WHO) International Classification of Functioning,Disability, and Health (ICF) framework

Purpose

Disability data inform resource allocation and utilization, characterize functioning and changes over time, and provide a mechanism to monitor progress toward promoting and protecting the rights of individuals with disability. Data collection efforts, however, define and measure disability in varied ways. Our objective was to see how the content of disability measures differed in five US national surveys and over time.

Methods

Using the WHO ICF as a conceptual framework for measuring disability, we assessed the National Health Interview Survey (NHIS), Current Population Survey (CPS), Survey of Income and Program Participation (SIPP), National Survey of SSI Children and Families (NSCF), and American Community Survey (ACS) for their content coverage of disability relative to each of the four ICF components (i.e., body functions, body structures, activities and participation, and environment). We used second-level ICF three-digit codes to classify question content into categories within each ICF component and computed the proportion of categories within each ICF component that was represented in the questions selected from these five surveys.

Results

The disability measures varied across surveys and years. The NHIS captured a greater proportion of the ICF body functions and body structures components than did other surveys. The SIPP captured the most content of the ICF activities and participation component, and the NSCF contained the most content of the ICF environmental factors component.

Conclusions

This research successfully illustrated demonstrated the utility of the ICF in examining the content of disability measures in five national surveys and over time.     

Textual analysis of sugar industry influence on the World Health Organization’s 2015 sugars intake guideline

ObjectiveTo determine whether sugar industry-related organizations influenced textual changes between the draft and final versions of the World Health Organization’s (WHO’s) 2015 guideline Sugars intake for adults and children.MethodsStakeholder consultation submissions on the draft guideline from seven sugar industry-related and 10 public health organizations were assessed using the Wordscores program. Document scores were rescaled using the Martin–Vanberg transformation to improve comparability. Draft and final guidelines were compared to identify changes influenced by the sugar industry and public health organizations.FindingsThere was a small shift in transformed Wordscores score between the draft and final guidelines, from 0.25 to 0.24, towards the industry position. The change was linked to increased use of the word “low” to describe the quality of the evidence, consistent with industry arguments. There was also a shift from use of the word “consumption” to “intake”, irrespective of policy position. Scores for World Sugar Research Organisation and Sugar Nutrition UK submissions ( 0.11 and 0.18, respectively) represented strong pro-industry positions and scores for European Public Health Alliance and Wemos submissions (1.00 and 0.88, respectively) represented the strongest public health positions. Industry tactics included challenging the quality of the evidence, distinguishing between different types of sugar and advocating harm reduction.ConclusionThere was little change between draft and final versions of the WHO sugars intake guideline 2015, following industry consultation. The main change was linked to emphasizing the low quality of the evidence on sugar’s adverse effects. Guideline development appeared relatively resistant to industry influence at the stakeholder consultation stage.     

Implementing patient-reported outcome measures in clinical practice: a companion guide to the ISOQOL user’s guide

Quality of Life Research - The use of patient-reported outcome (PRO) measures in clinical practice is increasing. Following the creation of a ‘User’s Guide to Implementing PRO...     

Public Health Agenda Setting in a Global Context: The International Labor Organization’s Decent Work Agenda

We drew on two agenda-setting theories usually applied at the state or national level to assess their utility at the global level: Kingdon’s multiple streams theory and Baumgartner and Jones’s punctuated equilibrium theory. We illustrate our analysis with findings from a qualitative study of the International Labor Organization’s Decent Work Agenda.We found that both theories help explain the agenda-setting mechanisms that operate in the global context, including how windows of opportunity open and what role institutions play as policy entrepreneurs.Future application of these theories could help characterize power struggles between global actors, whose voices are heard or silenced, and their impact on global policy agenda setting.Victor Hugo’s assertion that no one can resist “an idea whose time has come” still resonates today, but what factors contribute to making an idea timely?1^(p1) Many public health issues, including tackling climate change and improving healthy working conditions, hold the potential to garner political and public attention, to mobilize organizational interests, and to surface on policy agendas. Yet these and other health issues continuously compete for legitimacy and resources in the policy process. Agenda setting has inspired much research generally but somewhat less in the public health field.2Research has examined how such issues emerge to be considered as policies, how agendas are set and produced through the political interactions of social actors, and how attention is maintained and resources are allocated to these problems.2 If agenda setting is about shifting us toward what to think by indicating what to think about,3 what are the real-world factors, who are the relevant actors, and which factors and actors really matter? To these questions we add: what may be different about agenda-setting processes in the global context?Theories help scholars explain this contextual complexity to elucidate how and why issues get and stay on policy agendas, and theories help scholars identify the processes that drive these dynamics.4 We assessed the utility of Kingdon’s multiple streams theory and Baumgartner and Jones’s punctuated equilibrium theory for the study of global agenda setting,1,5 with illustrative findings from a qualitative study about the International Labor Organization’s (ILO’s) Decent Work Agenda (DWA). We analyzed selected attributes of these theories in terms of their applicability to the global policy agenda-setting context.     

Maternal near miss and maternal death in the World Health Organization��s 2005 global survey on maternal and perinatal health

Objective

To develop an indicator of maternal near miss as a proxy for maternal death and to study its association with maternal factors and perinatal outcomes.

Methods

In a multicenter cross-sectional study, we collected maternal and perinatal data from the hospital records of a sample of women admitted for delivery over a period of two to three months in 120 hospitals located in eight Latin American countries. We followed a stratified multistage cluster random design. We assessed the intra-hospital occurrence of severe maternal morbidity and the latter’s association with maternal characteristics and perinatal outcomes.

Findings

Of the 97 095 women studied, 2964 (34 per 1000) were at higher risk of dying in association with one or more of the following: being admitted to the intensive care unit (ICU), undergoing a hysterectomy, receiving a blood transfusion, suffering a cardiac or renal complication, or having eclampsia. Being older than 35 years, not having a partner, being a primipara or para > 3, and having had a Caesarean section in the previous pregnancy were factors independently associated with the occurrence of severe maternal morbidity. They were also positively associated with an increased occurrence of low and very low birth weight, stillbirth, early neonatal death, admission to the neonatal ICU, a prolonged maternal postpartum hospital stay and Caesarean section.

Conclusion

Women who survive the serious conditions described could be pragmatically considered cases of maternal near miss. Interventions to reduce maternal and perinatal mortality should target women in these high-risk categories.     

Report from the World Health Organization’s third Product Development for Vaccines Advisory Committee (PDVAC) meeting,Geneva, 8–10th June 2016

The third meeting of WHO’s Product Development for Vaccines Advisory Committee (PDVAC) was held in June 2016, with a remit to revisit the pathogen areas for which significant progress has occurred since recommendations from the 2015 meeting, as well as to consider new advances in the development of vaccines against other pathogens. Since the previous meeting, significant progress has been made with regulatory approvals of the first malaria and dengue vaccines, and the first phase III trials of a respiratory syncytial virus (RSV) vaccine candidate has started in the elderly and pregnant women. In addition, PDVAC has also supported vaccine development efforts against important emerging pathogens, including Middle Eastern Coronavirus (MERS CoV) and Zika virus. Trials of HIV and tuberculosis vaccine candidates are steadily progressing towards pivotal data points, and the leading norovirus vaccine candidate has entered a phase IIb efficacy study. WHO’s Immunization, Vaccine and Biologicals (IVB) department is actively working in several pathogen areas on the recommendation of PDVAC, as well as continuing horizon scanning for advances in the development of vaccines that may benefit low and middle income countries (LMICs), such as the recent licensure of the enterovirus 71 (EV71) vaccine in China. Following on from discussions with WHO’s Strategic Advisory Group of Experts (SAGE) on Immunization, PDVAC will also look beyond licensure and consider data needs for vaccine recommendation and implementation to reduce the delay between vaccine approval and vaccine impact.     

Fatal Incidents in Australia’s Older Farmers (2001–2015)

Objectives: This study assesses nonintentional injury deaths of older farmers and the causal agents associated with these fatalities in Australia (2001–2015). It also explores approaches based on the hierarchy of risk controls to reduce fatalities and injuries in this cohort. Methods: Data on farm-related incidents were sourced from the National Coroners Information System (NCIS) for the study period and coded. Rates were calculated and regression analyses completed to assess trends over time. Results: Those in the 50+ years category (n = 610) accounted for 49.8% of all on-farm nonintentional injury deaths, with males (n = 566) dominating the cases. The annual mean was 40.66 cases (SD = 8.08) and the average rate 36/100,000. Trend analysis revealed a nonstatistically significant (P < 0.05) increase in cases over the period. Farm vehicles and machinery were responsible for almost two thirds of the fatal cases. Conclusion: Nonintentional fatality rates for older farmers have remained relatively unchanged for a significant period in Australia. There is a need to examine additional approaches that not only maintain the benefits of work activity for older farmers but also balance this against a safety perspective.     

Healthcare Providers’ Satisfaction with a State Children’s Health Insurance Program (SCHIP)

Purpose This study’s purpose was to understand how experiences with and perceptions of the health care plan characteristics influence provider satisfaction with a State Children’s Health Insurance Program (SCHIP). Methods Physicians and other health care providers participating in one program (ALL Kids) were mailed a survey (n = 500). Pediatricians were the most likely to return the survey. We used frequencies, chi-square and logistic regression analysis to explore relationships. Results The odds of being less satisfied with the program among providers who perceived that reimbursement in the ALL Kids program was less compared to private insurance were almost 7 times (OR = 6.81; 95% CI = (1.88–24.73)) greater than for those who perceived that reimbursement was more or the same in ALL Kids. Likewise, respondents who perceived that All Kids families were less likely than families with private insurance to return for follow-up visits were less satisfied with ALL Kids (OR = 17.42; 95% CI = (1.85–164.70)). Conclusions The stigma of SCHIP may be less than that often associated with Medicaid; however, this investigation should be considered with others that have identified barriers for provider’s participation. This study indicates that provider satisfaction is related to their perceptions of SCHIP policies and families, though it does not tell us what factors might contribute to this perception, such as, previous experience with public insurance (Medicaid) and publicly insured patients. Increasing reimbursement rates may not address perceptions that affect provider views of publicly-supported health plans and the participating families.     

Addressing a Growing Community’s Health Needs: Project SAHNA (South Asian Health Needs Assessment)

Limited data and research is available on the health issues faced by the South Asian population, especially for those living in the Washington, DC metropolitan area. Online and in-person surveys were administered to a convenience sample (n = 709) of South Asians living in the metropolitan Washington DC region. The survey gathered information on socio-demographics and acculturation; health care access and utilization; sources of health information; perceptions of community health; physical activity and smoking. While over 70 % of participants had a routine physical exam in the last 12 months, foreign born and less acculturated adults were less likely to have had a routine visit in the last 12 months. Internet (76.9 %) and physicians (76.1 %) are key sources of health information for South Asians. Only 29 % of South Asians are engaging in the recommended amount of physical activity per week. The results of this study provide guidance for future work in addressing the health and well-being of South Asian communities in the United States.     

Population immunity to measles in Canada using Canadian Health Measures survey data – A Canadian Immunization Research Network (CIRN) study

We aimed to determine population immunity to measles in Canada, and to assess the risk of future outbreaks. We tested 11,176 sera from Cycles 2 (2009–2011) and 3 (2011–2013) cohorts from the biobank of Statistics Canada’s Canadian Health Measures Survey (CHMS) using the BioPlex 2220 MMRV IgG assay. We then tested all BioPlex negative and equivocal samples using a more sensitive Plaque Reduction Neutralization Test (PRNT). We determined the weighted proportion of positive, equivocal, and negative samples by age, sex, region and whether individuals were born in Canada. We found that 90.0% (95% confidence interval (CI): 88.2, 91.9) of samples were positive, 4.5% (95% CI: 3.4, 5.5) were equivocal and 5.5% (95% CI: 4.3, 6.7) were negative. Individuals in the 12–19 year age band had the lowest proportion positive at 78.7% (95% CI: 74.2, 83.2) and the highest proportion of positive samples was found in those 60–79 years (99.6%, 95% CI: 99.3, 99.9). Seropositivity was consistently <90% across a broad range of pediatric and adult age bands (6–39 years). We found that a slightly higher proportion of females were positive (91.9%, 95% CI: 90.1, 93.6) compared to males (88.3%, 95% CI: 85.8, 90.7). When taking into account interaction between age and born in Canada status, we found individuals born in Canada aged 19 and under were less susceptible (OR = 0.6 (95% CI: 0.4, 0.95)) compared to those born outside Canada whereas, those aged 20 and over were more susceptible (OR = 1.7 (95% CI: 1.1, 2.8)). Our findings indicate that measles immunity in Canada is below the 95% immunity threshold required to sustain measles elimination, underscoring the importance of maintaining high vaccine coverage to prevent future measles outbreaks and sustain Canada’s elimination status.