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Tracking Demographic Movements and Immunization Status to Improve Children’s Access to Immunization: Field-Based Randomized Controlled Trial

BackgroundCountries’ Expanded Program on Immunization (EPI) contribute to the reduction of mortality and morbidity, but access to these vaccines remains limited in most low-income countries.ObjectiveWe aim to assess whether involving community volunteers (CVs) to track children’s vaccination status and demographic movements and using recorded data to plan catch-up immunization sessions can improve children’s vaccination timeliness, completeness, and coverage.MethodsThis was a field-based randomized controlled trial and communities of the Foumban health district in West Cameroon were allocated to intervention or control groups. In the intervention group, a CV per community was trained to visit households monthly for a year to assess and record in a register, details of EPI-targeted children, their demographic movements and immunization status. The scanned recorded pages were sent to the health center immunization team through WhatsApp and used to organize monthly community catch-up immunization sessions. In the control group, EPI vaccination sessions were routinely conducted. Surveys were conducted at 6 and 12 months from the beginning of the intervention in both study groups to assess and compare immunization timeliness, coverage, and completeness.ResultsOverall, 30 buildings per cluster were surveyed at midline and endline. Of the 633 and 729 visited households in the intervention group at midline and endline, 630 (99.5%) and 718 (98.4%), respectively, consented to participate. In the control group, 507 and 651 households were visited and 505 (99.6%) and 636 (97.7%), respectively, consented to participate. At 12 months intervention, the month one timeliness of bacille Calmette–Guerin (BCG) vaccine did not increase in the intervention group compared with the control group for the age groups 0-11 months (adjusted odds ratio [aOR] 1.1, 95% CI 0.7-1.8) and 0-59 months (aOR 1.1, 95% CI 0.9-1.4), and significantly increased for the first-year BCG vaccine administration for the age group 0-23 months (aOR 1.5, 95% CI 1.1-2.2). The coverage of diphtheria-pertussis-tetanus and hepatitis B+Hemophilus influenzae type B (DPT-Hi +Hb) dose 3 (aOR 2.0, 95% CI 1.5-2.7) and of DPT-Hi+Hb dose 1 (aOR 1.8, 95% CI 1.4-2.4) vaccines increased significantly in the intervention group compared with the control group in the age groups 12-59 months and 12-23 months, respectively. Specific (DPT-Hi+Hb dose 1 to DPT-Hi+Hb dose 3: aOR 1.9, 95% CI 1.4-2.6) and general (BCG to measles: aOR 1.5, 95% CI 1.1-2.1) vaccine completeness increased significantly in the intervention group compared with the control group.ConclusionsFindings support that involving CVs to track children’s vaccination status and demographic movements and using recorded data to plan catch-up immunization sessions improve children’s vaccination timeliness, completeness, and coverage. This strategy should be adopted to improve access to vaccination for EPI target populations and the consistency verified in other contexts.Trial RegistrationPan African Clinical Trials Registry PACTR201808527428720; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=3548     

Women's perceptions of caesarean birth: a Roy international study

The purpose of this Roy adaptation model-based multi-site international mixed method study was to examine the relations of type of caesarean birth (unplanned/planned), number of caesarean births (primary/repeat), and preparation for caesarean birth to women's perceptions of and responses to caesarean birth. The sample included 488 women from the United States (n = 253), Finland (n = 213), and Australia (n = 22). Path analysis revealed direct effects for type of and preparation for caesarean birth on responses to caesarean birth, and an indirect effect for preparation on responses to caesarean birth through perception of birth the experience.     

Adaptation to cesarean birth: implementation of an international multisite study

The purpose of this column is to describe the implementation of an international multisite Roy adaptation model-based study of women's perceptions of and responses to cesarean birth. The need for the study arose from the concern that women's childbearing needs may not be met to their full satisfaction, especially if the infant is born by cesarean. Serendipity and networking played a part in the selection of four study sites in the United States (Boston, Milwaukee, Norfolk, Oklahoma City) and two in other countries (Finland, Australia). Data were collected by nursing students and staff nurses. Post-hoc consideration of the diversity of study sites revealed opportunities for examination of the influence of the contextual stimuli of culture and geographic region on the women's adaptation to cesarean birth. Strategies used to foster integration of teaching, practice, and research are discussed.     

Highly economical and direct amination of sp3 carbon using low-cost nickel pincer catalyst

Developing more efficient routes to achieve C–N bond coupling is of great importance to industries ranging from products in pharmaceuticals and fertilizers to biomedical technologies and next-generation electroactive materials. Over the past decade, improvements in catalyst design have moved synthesis away from expensive metals to newer inexpensive C–N cross-coupling approaches via direct amine alkylation. For the first time, we report the use of an amide-based nickel pincer catalyst (1) for direct alkylation of amines via activation of sp³ C–H bonds. The reaction was accomplished using a 0.2 mol% catalyst and no additional activating agents other than the base. Upon optimization, it was determined that the ideal reaction conditions involved solvent dimethyl sulfoxide at 110 °C for 3 h. The catalyst demonstrated excellent reactivity in the formation of various imines, intramolecularly cyclized amines, and substituted amines with a turnover number (TON) as high as 183. Depending on the base used for the reaction and the starting amines, the catalyst demonstrated high selectivity towards the product formation. The exploration into the mechanism and kinetics of the reaction pathway suggested the C–H activation as the rate-limiting step, with the reaction second-order overall, holding first-order behavior towards the catalyst and toluene substrate.

Developing more efficient routes to achieve efficient C–N bond coupling is of great importance to industries ranging from products in pharmaceuticals and fertilizers to biomedical technologies and next-generation electroactive materials.     

Developmental changes in conjunctiva-associated lymphoid tissue of the rabbit

PURPOSE: Organized conjunctiva-associated lymphoid tissue (O-CALT) is constantly exposed to environmental antigens and plays a central role in the common mucosal immune system. This study was undertaken to investigate whether O-CALT in rabbit lymphoid tissue, as in other lymphoid tissue in other mammals, changes with age. METHODS: Fluorescence stereomicroscopy was used to measure the number and size of conjunctival follicles stained with propidium iodide in rabbits ranging in age from 2 days to 57 months. To assess the function of M cells, an antigen-sampling cell type found in the follicle-associated epithelium, transcytosis of fluorescent latex beads was evaluated with confocal microscopy. RESULTS: O-CALT was not present in rabbits at birth, but appeared less than 24 hours after eyes opened at approximately day 11. The number of follicles increased with age until adolescence (2-4 months), when the number stabilized through early adulthood (17-20 months). In aged rabbits (47-57 months), there was a dramatic decline in the number of follicles. This disappearance was most pronounced in the superior conjunctiva. Average follicle diameter increased with age, except in the superior conjunctiva of aged rabbits, where the few remaining follicles were generally smaller. The uptake of latex beads showed that M-cell function was similar in all age groups. CONCLUSIONS: Age-related changes in rabbit O-CALT are similar to those that have been reported for the human conjunctiva. Preferential uptake of latex beads by follicle-associated epithelium indicates that the presence and function of M cells are not affected by aging. The lower level of O-CALT in young and elderly animals, however, would be expected to decrease their ocular mucosal immune responses.