Timely completion of childhood vaccination and its predictors in Burkina Faso

BackgroundDespite important progress in global vaccination coverage, many countries are still facing preventable disease outbreaks. Timely vaccination is important in getting adequate protection against disease. In light of the paucity of relevant literature, this study investigated the timely completion of childhood routine immunization and identified factors associated with timely vaccination in Burkina Faso.MethodsWe extracted data on child vaccination and other child characteristics from a household survey conducted across 24 districts in 2017. We extracted data on health system characteristics from a parallel facility survey. We applied a Kaplan-Meier time-to-event analysis to estimate timely vaccination coverage defined as the proportion of children that received a given vaccine in the period between three days before and 28 days after the recommended age. We used a Cox proportional hazard model with mixed effects to identify factors associated with timely vaccination.ResultsIn total, 3,138 children aged between 16 and 36 months who could present an immunization booklet were included in the study.The main finding is the existence of an important gap showing that timely vaccination coverage was lower than vaccination coverage. More specifically,this gap ranged from 16% for BCG to 43% for Penta 3. In addition, region and distance between the household and the nearest health facility were the main factors associated with timely full vaccination coverage and specifically for Penta3, MCV1 and MCV2.ConclusionsThis study highlights that timely vaccination coverage remains substantially lower than vaccination coverage. Timeliness of vaccination should therefore be considered as a metric to assess the status of immunization in a country. Geographical accessibility continues to represent a major barrier to timely vaccination, calling for specific interventions on both supply-side (e.g. outreach activities) and demand-side (e.g. vouchers or community-based interventions for vaccination) to counteract its negative effect.     

Non-specific effects of BCG and DTP vaccination on infant mortality: An analysis of birth cohorts in Ghana and Tanzania

BackgroundVaccines may induce non-specific effects on survival and health outcomes, in addition to protection against targeted pathogens or disease. Observational evidence suggests that infant Baccillus Calmette-Guérin (BCG) vaccination may provide non-specific survival benefits, while diphtheria-tetanus-pertussis (DTP) vaccination may increase the risk of mortality. Non-specific vaccine effects have been hypothesized to modify the effect of neonatal vitamin A supplementation (NVAS) on mortality.Methods22,955 newborns in Ghana and 31,999 newborns in Tanzania were enrolled in two parallel, randomized, double-blind, placebo-controlled trials of neonatal vitamin A supplementation from 2010 to 2014 and followed until 1-year of age. Cox proportional hazard models were used to estimate associations of BCG and DTP vaccination with infant survival.ResultsBCG vaccination was associated with a decreased risk of infant mortality after controlling for confounders in both countries (Ghana adjusted hazard ratio (aHR): 0.51, 95% CI: 0.38–0.68; Tanzania aHR: 0.08, 95% CI: 0.07–0.10). Receiving a DTP vaccination was associated with a decreased risk of death (Ghana aHR: 0.39, 95% CI: 0.26–0.59; Tanzania aHR: 0.19, 95% CI: 0.16–0.22). There was no evidence of interaction between BCG or DTP vaccination status and infant sex or NVAS.ConclusionWe demonstrated that BCG and DTP vaccination were associated with decreased risk of infant mortality in Ghana and Tanzania with no evidence of interaction between DTP or BCG vaccination, NVAS, and infant sex. Our study supports global recommendations on BCG and DTP vaccination and programmatic efforts to ensure all children have access to timely vaccination.Clinical trials registration: Ghana (Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12610000582055) and Tanzania (ANZCTR: ACTRN12610000636055)     

Effect of administration of diethylcarbamazine with and without fluconazole on experimental fungal infections in mice

Other researchers have found that diethylcarbamazine (DEC) is effective treatment for filariasis despite a lack of demonstrated in vitro antifilarial activity. The results of our previous investigations using feline and murine leukemia virus models encouraged us to investigate the use of DEC with other infections. In our current experiments, DEC treatment was associated with lower brain fungal burden in fluconazole-treated mice following intravenous injection of Aspergillus fumigatus or increasing numbers of Cryptococcus neoformans organisms, and lower brain and kidney levels of Candida albicans following intravenous injection of increasing numbers of C. albicans. Further investigation of combined DEC and fluconazole treatment of fungal infections is warranted.     

Development of a school-based nutrition intervention for high school students: Gimme 5

PURPOSE: To describe a 4-year intervention targeting fruit/vegetable consumption by high school students. DESIGN: This is a cohort study involving six pairs of schools (n = 12) matched on gender, race, enrollment, and location with schools randomly assigned within pairs to intervention or control conditions. SETTING: Twelve Archdiocese of New Orleans high schools. SUBJECTS: Cohort was defined as students (n = 2339) who were ninth-graders in the 1993-94 school year who provided baseline data. INTERVENTION: Four components of the intervention are: (1) school-wide media-marketing campaign, (2) school-wide meal and snack modification, (3) classroom workshops and supplementary subject matter activities, and (4) parental involvement. MEASURES: Focus groups were conducted for target population input and program development. Process evaluation included student feedback on media-marketing intervention materials and activities reported here. Process measures also included school meal participation, student characteristics, and verification of intervention activities. RESULTS: Focus groups identified barriers to increased consumption of fruit and vegetables as lack of availability, variety, and inconsistency in taste. Student attitudes were favorable regarding a school program to improve diet and parental involvement. Low consumption of fruits/vegetables was reported. After a 2-month school-wide program introduction utilizing various media-marketing materials and activities, 93% of students were aware of the program and 96% could identify the healthy eating message. CONCLUSIONS: Program development can be guided and enriched by student input via focus groups. Media-marketing activities effectively delivered health messages and attracted students' attention. Materials and activities used were acceptable channels for increasing awareness, positive attitudes, and knowledge about fruits/vegetables.     

Supervisors matter more than you think: components of a mission-centered organizational climate

A study was conducted in a medical center among a diverse sample of employees to examine whether components of organizational climate related to workers' knowledge of the organization's mission and mission-centered values. Findings supported a mediated relationship between supervisor behaviors, mission knowledge, and customer service orientation (the organization's key mission value). Employee perceptions of coworker and organizational support and knowledge of their own performance expectations also related positively to customer service orientation. Results suggest that supervisors are in an ideal position to disseminate a mission-centered climate. Practical applications of these findings for management wishing to develop mission-centered climates in health care organizations are discussed.     

Ethics instruction at schools of public health in the United States. Association of Schools of Public Health Education Committee

OBJECTIVES: A survey of US schools of public health was undertaken in 1996 and 1997 to obtain a general picture of public health ethics curricula. METHODS: An explanatory letter with a list of questions for discussion was sent to the deans of the accredited US schools of public health. The deans were asked that at least 1 individual at their school who "is most knowledgeable about ethics curricula" review the list of questions and complete an ethics survey contact form. RESULTS: Ethics instruction was required for all students at only 1 (4%) of the 24 schools surveyed, while 7 schools required ethics instruction for some students. Two of the schools had no ethics courses. Ethics instruction was required for all MPH students at 9 (38%) of the schools and for all doctoral students at 4 (17%) of the schools. Most of the schools (19 of 24, or 79%) offered short courses, seminar series, or invited lectures on ethical topics, and 23 (96%) included lectures on ethics topics in other courses such as health law. CONCLUSIONS: Training programs at US schools of public health vary greatly in how much attention is given to ethics instruction. Model curricula in public health ethics should be developed to help fill this gap.     

Inequalities in low birth weight: parental social class, area deprivation, and "lone mother" status.

OBJECTIVE: To describe the extent of socioeconomic inequalities in low birth weight. To assess the relative benefits of measuring socioeconomic status by individual occupation, socioeconomic deprivation status of area of residence, or both, for describing inequalities and targeting resources. DESIGN: Analysis of birth registrations by registration status: joint compared with sole registrants ("lone mothers"), routinely recorded parental occupation (father's for joint registrants), and census derived enumeration district (ED) deprivation. SETTING: England and Wales, 1986-92. SUBJECTS: 471,411 births with coded parental occupation (random 10% sample) and birth weight. MAIN OUTCOME MEASURES: Proportion of low birth weight (< 2500 g) RESULTS: 34% of births to joint registrants in social classes IV and V, and 45% of births to sole registrants, were in the quintile of most deprived EDs. It was found that 6.8% of births were of low birth weight. Sole registrants were at higher risk (9.3% overall) than joint registrants, across all deprivation quintiles. For joint registrants, the socioeconomic risk gradient was similar by social class or area deprivation, but a greater gradient from 4.7% to 8.7% was found with combined classification. CONCLUSIONS: Up to 30% of low birth weight can be seen as being associated with levels of socioeconomic deprivation below that of the most affluent group, as measured in this study. Caution is needed when targeting interventions to high risk groups when using single indicators. For example, the majority of births to lone mothers and to joint registrants in social classes IV and V would be missed by targeting the most deprived quintile. There is a high degree of inequality in low birth weight according to social class, area deprivation and lone mother status. When using routinely recorded birth and census data, all three factors are important to show the true extent of inequalities.     

Assessment of primary health care access status: an analytic technique for decision making

Access to health care is an issue that has caught the attention of health care providers, policy formulators, and policy analysts, with particular emphasis on access to primary care, which affords all people a viable portal into the health care system.This paper proposes an analytical approach to the assessment of relative primary care access status, measured as the capability to deliver basic primary care services within specific geographic civil areas, or parishes, within the state of Louisiana. An additive multiattribute utility method is employed to develop a scoring system to rank parishes according to a primary care access, or health system capability, numerical score. Routinely collected parameters are used to measure each parish's current capability to provide primary care services. These parameters include demographic, mortality, morbidity, and resource data.A group of experts was used to give weight to each parish's parameter values, resulting in a relative score for each. Thus, parishes (or other geographic areas) can be ranked according to their primary care access status. This information can then be used to allocate resources, to distribute funds for health care services, and to guide policy formulation and implementation.