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Mokhtari AM, Barouni M, Moghadami M, Negahdaripour M, Mirahmadizadeh A. Estimating costs of hepatitis B vaccination in infants: experimental evidence of the expanded program on immunization in Southern Iran. J Public Health (Oxf) 2021; 44:558-564. [PMID: 33866375 DOI: 10.1093/pubmed/fdab118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 02/24/2021] [Accepted: 03/23/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Health costs have increased significantly around the world, and cost assessments have become important. This study aimed to collect cost of the resources used in the national hepatitis B immunization program in Southern Iran. METHODS Costs were calculated by investigating the available documents as well as consulting with knowledgeable personnel. These costs were collected using the data from Shiraz University of Medical Sciences. According to the health payer's perspective, the indirect costs of the people were not taken into account. All current and capital costs in year 2017 were calculated and converted to US dollars (USDs). RESULTS In 2017, 33 204 children received hepatitis B vaccine. The total cost of the national hepatitis B vaccination program in Shiraz and the cost of vaccination per child were 473 506 and 14.26 USD, respectively. However, the cost of inoculation of hepatitis B vaccine per dose was estimated at 3.20 USD. Personnel costs constituted the highest proportion (53.84%) of total costs. CONCLUSIONS The cost of hepatitis B vaccination in Iran was lower than other countries. Considering that personnel costs had the largest proportion, it is recommended that proper measures be taken to monitor and modify these costs if necessary.
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Affiliation(s)
- Ali Mohammad Mokhtari
- Department of Epidemiology and Biostatistics, School of Health, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Mohsen Barouni
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohsen Moghadami
- Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Manica Negahdaripour
- Department of Pharmaceutical Biotechnology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Mirahmadizadeh
- Non-communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Donadel M, Panero MS, Ametewee L, Shefer AM. National decision-making for the introduction of new vaccines: A systematic review, 2010-2020. Vaccine 2021; 39:1897-1909. [PMID: 33750592 PMCID: PMC10370349 DOI: 10.1016/j.vaccine.2021.02.059] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Competing priorities make using a transparent and evidence-based approach important when deciding to recommend new vaccines. We conducted a literature review to document the processes and frameworks for national decision-making on new vaccine introductions and explored which key features have evolved since 2010. METHODS We searched literature published on policymaking related to vaccine introduction from March 2010 to August 2020 in six databases. We screened articles for eligibility with the following exclusion criteria: non-human or hypothetical vaccines, the sole focus on economic evaluation or decision to adopt rather than policy decision-making. We employed nine broad categories of criteria from the 2012 review for categorization and abstracted data on the country, income level, vaccine, and other relevant criteria. RESULTS Of the 3808 unique references screened, 116 met eligibility criteria and were classified as: a) framework of vaccine adoption decision-making (27), b) studies that analyse empirical data on or examples of vaccine adoption decision-making (45), c) theoretical and empirical articles that provide insights into the vaccine policymaking process (44 + 17 already included in the previous categories). Commonly reported criteria for decision-making were the burden of disease; vaccine efficacy/effectiveness, safety; impact on health and non-health outcomes; economic evaluation and cost-effectiveness of alternative interventions. Programmatic and acceptability aspects were not as often considered. Most (50; 82%) of the 61 articles describing the process of vaccine introduction policymaking highlighted the role of country, regional, or global evidence-informed recommendations and a robust national governance as enabling factors for vaccine adoption. CONCLUSIONS The literature on vaccine adoption decision-making has expanded since 2010. We found that policymakers and expert advisory committee members (e.g., National Immunization Technical Advisory Group [NITAG]) increasingly value the interventions based on economic evaluations. The results of this review could guide discussions on evidence-informed immunization decision-making among country, sub-regional, and regional stakeholders.
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Affiliation(s)
- Morgane Donadel
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Maria Susana Panero
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lynnette Ametewee
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA; Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Abigail M Shefer
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Carcelen AC, Hayford K, Moss WJ, Book C, Thuma PE, Mwansa FD, Patenaude B. How much does it cost to measure immunity? A costing analysis of a measles and rubella serosurvey in southern Zambia. PLoS One 2020; 15:e0240734. [PMID: 33057405 PMCID: PMC7561102 DOI: 10.1371/journal.pone.0240734] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 10/01/2020] [Indexed: 12/03/2022] Open
Abstract
Background Serosurveys are a valuable surveillance tool because they provide a more direct measure of population immunity to infectious diseases, such as measles and rubella, than vaccination coverage estimates. However, there is concern that serological surveys are costly. We adapted a framework to capture the costs associated with conducting a serosurvey in Zambia. Methods We costed a nested serosurvey in Southern Province, Zambia that collected dried blood spots from household residents in a post-campaign vaccine coverage survey. The financial costs were estimated using an ingredients-based costing approach. Inputs included personnel, transportation, field consumable items, social mobilization, laboratory supplies, and capital items, and were classified by serosurvey function (survey preparation, data collection, biospecimen collection, laboratory testing, and coordination). Inputs were stratified by whether they were applicable to surveys in general or attributable specifically to serosurveys. Finally, we calculated the average cost per cluster and participant. Results We estimated the total nested serosurvey cost was US $68,558 to collect dried blood spots from 658 participants in one province in Zambia. A breakdown of the cost by serosurvey phase showed data collection accounted for almost one third of the total serosurvey cost (32%), followed by survey preparation (25%) and biospecimen collection (20%). Analysis by input categories indicated personnel costs were the largest contributing input to overall serosurvey costs (51%), transportation was second (23%), and field consumables were third (9%). By combining the serosurvey with a vaccination coverage survey, there was a savings of $43,957. We estimated it cost $4,285 per average cluster and $104 per average participant sampled. Conclusions Adding serological specimen collection to a planned vaccination coverage survey provided a more direct measurement of population immunity among a wide age group but increased the cost by approximately one-third. Future serosurveys could consider ways to leverage existing surveys conducted for other purposes to minimize costs.
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Affiliation(s)
- Andrea C. Carcelen
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail:
| | - Kyla Hayford
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - William J. Moss
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | | | | | - Bryan Patenaude
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Sloan ML, Gleason BL, Squire JS, Koroma FF, Sogbeh SA, Park MJ. Cost Analysis of Health Facility Electronic Integrated Disease Surveillance and Response in One District in Sierra Leone. Health Secur 2020; 18:S64-S71. [PMID: 32004122 DOI: 10.1089/hs.2019.0082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Global health security depends on effective surveillance systems to prevent, detect, and respond to disease threats. Real-time surveillance initiatives aim to develop electronic systems to improve reporting and analysis of disease data. Sierra Leone, with the support of Global Health Security Agenda partners, developed an electronic Integrated Disease Surveillance and Response (eIDSR) system capable of mobile reporting from health facilities. We estimated the economic costs associated with rollout of health facility eIDSR in the Western Area Rural district in Sierra Leone and projected annual direct operational costs. Cost scenarios with increased transport costs, decreased use of partner personnel, and altered cellular data costs were modeled. Cost data associated with activities were retrospectively collected and were assessed across rollout phases. Costs were organized into cost categories: personnel, office operating, transport, and capital. We estimated costs by category and phase and calculated per health facility and per capita costs. The total economic cost to roll out eIDSR to the Western Area Rural district over the 14-week period was US$64,342, a per health facility cost of $1,021. Equipment for eIDSR was the primary cost driver (45.5%), followed by personnel (35.2%). Direct rollout costs were $38,059, or 59.2% of total economic costs. The projected annual direct operational costs were $14,091, or $224 per health facility. Although eIDSR equipment costs are a large portion of total costs, annual direct operational costs are projected to be minimal once the system is implemented. Our findings can be used to make decisions about establishing and maintaining electronic, real-time surveillance in Sierra Leone and other low-resource settings.
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Affiliation(s)
- Michelle L Sloan
- Michelle L. Sloan, MA, and Michael J. Park, PhD, are Health Scientists, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA. Brigette L. Gleason, MD, is Surveillance and Program Lead, and Fanny F. Koroma, MSc, is a Public Health Surveillance Specialist; both at the CDC Sierra Leone Country Office, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Freetown, Sierra Leone. James S. Squire, MIPH, is Program Manager, and Solomon Aiah Sogbeh is Senior Public Health Superintendent; both at the National Disease Surveillance Program, Ministry of Health and Sanitation, Freetown, Sierra Leone. The views expressed are the authors' own and do not necessarily represent the views of the Ministry of Health and Sanitation or the US Centers for Disease Control and Prevention
| | - Brigette L Gleason
- Michelle L. Sloan, MA, and Michael J. Park, PhD, are Health Scientists, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA. Brigette L. Gleason, MD, is Surveillance and Program Lead, and Fanny F. Koroma, MSc, is a Public Health Surveillance Specialist; both at the CDC Sierra Leone Country Office, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Freetown, Sierra Leone. James S. Squire, MIPH, is Program Manager, and Solomon Aiah Sogbeh is Senior Public Health Superintendent; both at the National Disease Surveillance Program, Ministry of Health and Sanitation, Freetown, Sierra Leone. The views expressed are the authors' own and do not necessarily represent the views of the Ministry of Health and Sanitation or the US Centers for Disease Control and Prevention
| | - James S Squire
- Michelle L. Sloan, MA, and Michael J. Park, PhD, are Health Scientists, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA. Brigette L. Gleason, MD, is Surveillance and Program Lead, and Fanny F. Koroma, MSc, is a Public Health Surveillance Specialist; both at the CDC Sierra Leone Country Office, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Freetown, Sierra Leone. James S. Squire, MIPH, is Program Manager, and Solomon Aiah Sogbeh is Senior Public Health Superintendent; both at the National Disease Surveillance Program, Ministry of Health and Sanitation, Freetown, Sierra Leone. The views expressed are the authors' own and do not necessarily represent the views of the Ministry of Health and Sanitation or the US Centers for Disease Control and Prevention
| | - Fanny F Koroma
- Michelle L. Sloan, MA, and Michael J. Park, PhD, are Health Scientists, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA. Brigette L. Gleason, MD, is Surveillance and Program Lead, and Fanny F. Koroma, MSc, is a Public Health Surveillance Specialist; both at the CDC Sierra Leone Country Office, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Freetown, Sierra Leone. James S. Squire, MIPH, is Program Manager, and Solomon Aiah Sogbeh is Senior Public Health Superintendent; both at the National Disease Surveillance Program, Ministry of Health and Sanitation, Freetown, Sierra Leone. The views expressed are the authors' own and do not necessarily represent the views of the Ministry of Health and Sanitation or the US Centers for Disease Control and Prevention
| | - Solomon Aiah Sogbeh
- Michelle L. Sloan, MA, and Michael J. Park, PhD, are Health Scientists, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA. Brigette L. Gleason, MD, is Surveillance and Program Lead, and Fanny F. Koroma, MSc, is a Public Health Surveillance Specialist; both at the CDC Sierra Leone Country Office, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Freetown, Sierra Leone. James S. Squire, MIPH, is Program Manager, and Solomon Aiah Sogbeh is Senior Public Health Superintendent; both at the National Disease Surveillance Program, Ministry of Health and Sanitation, Freetown, Sierra Leone. The views expressed are the authors' own and do not necessarily represent the views of the Ministry of Health and Sanitation or the US Centers for Disease Control and Prevention
| | - Michael J Park
- Michelle L. Sloan, MA, and Michael J. Park, PhD, are Health Scientists, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA. Brigette L. Gleason, MD, is Surveillance and Program Lead, and Fanny F. Koroma, MSc, is a Public Health Surveillance Specialist; both at the CDC Sierra Leone Country Office, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Freetown, Sierra Leone. James S. Squire, MIPH, is Program Manager, and Solomon Aiah Sogbeh is Senior Public Health Superintendent; both at the National Disease Surveillance Program, Ministry of Health and Sanitation, Freetown, Sierra Leone. The views expressed are the authors' own and do not necessarily represent the views of the Ministry of Health and Sanitation or the US Centers for Disease Control and Prevention
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Erondu NA, Ferland L, Haile BH, Abimbola T. A systematic review of vaccine preventable disease surveillance cost studies. Vaccine 2019; 37:2311-2321. [PMID: 30902482 DOI: 10.1016/j.vaccine.2019.02.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 01/29/2019] [Accepted: 02/06/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Planning and monitoring vaccine introduction and effectiveness relies on strong vaccine-preventable disease (VPD) surveillance. In low and middle-income countries (LMICs) especially, cost is a commonly reported barrier to VPD surveillance system maintenance and performance; however, it is rarely calculated or assessed. This review describes and compares studies on the availability of cost information for VPD surveillance systems in LMICs to facilitate the design of future cost studies of VPD surveillance. METHODS PubMed, Web of Science, and EconLit were used to identify peer-reviewed articles and Google was searched for relevant grey literature. Studies selected described characteristics and results of VPD surveillance systems cost studies performed in LMICs. Studies were categorized according to the type of VPD surveillance system, study aim, the annual cost of the system, and per capita costs. RESULTS Eleven studies were identified that assessed the cost of VPD surveillance systems. The studies assessed systems from six low-income countries, two low-middle-income countries, and three middle-income countries. The majority of the studies (n = 7) were conducted in sub-Saharan Africa and fifteen distinct VPD surveillance systems were assessed across the studies. Most studies aimed to estimate incremental costs of additional surveillance components and presented VPD surveillance system costs as mean annual costs per resource category, health structure level, and by VPD surveillance activity. Staff time/personnel cost represents the largest cost driver, ranging from 21% to 61% of total VPD surveillance system costs across nine studies identifying a cost driver. CONCLUSIONS This review provides a starting point to guide LMICs to invest and advocate for more robust VPD surveillance systems. Critical gaps were identified including limited information on the cost of laboratory surveillance, challenges with costing shared resources, and missing data on capital costs. Appropriate guidance is needed to guide LMICs conducting studies on VPD surveillance system costs.
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Affiliation(s)
- Ngozi Adaeze Erondu
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom; The Global Bridge Group, LLC, Pleasanton, CA, USA.
| | - Lisa Ferland
- The Global Bridge Group, LLC, Pleasanton, CA, USA
| | | | - Taiwo Abimbola
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Hossain A, Politi C, Mandalia N, Cohen AL. Expenditures on vaccine-preventable disease surveillance: Analysis and evaluation of comprehensive multi-year plans (cMYPs) for immunization. Vaccine 2018; 36:6850-6857. [PMID: 30236633 PMCID: PMC7530543 DOI: 10.1016/j.vaccine.2018.07.068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 07/25/2018] [Accepted: 07/26/2018] [Indexed: 11/25/2022]
Abstract
Despite the importance of vaccine-preventable disease (VPD) surveillance, little is known about the costs of monitoring disease. We used Comprehensive Multi-Year Plans for Immunization (cMYPs) - developed by countries following guidelines from the World Health Organization and United Nations Children's Fund - to estimate expenditures on VPD surveillance at the country level in 2015 US Dollars (USD) in 63 low- and middle-income countries. To evaluate the reliability of cMYP estimates, we also compared cMYP data with findings from previous research studies and assessed whether countries explicitly budgeted for major categories of surveillance activities in their plans for immunization. According to our analysis of cMYPs, countries spent an annual median of $406,108 on VPD surveillance ($0.04 per capita and $1.47 per infant), with reported expenditures ranging from $1,098 (Kiribati) to $21,644,770 (Nigeria). However, the majority of countries failed to explicitly mention several key categories of surveillance activities in their plans, especially laboratory-related surveillance activities. Our results show a large amount of variation in surveillance expenditures (total, per capita, and per infant) between countries and provide insights to improve costing guidelines and practices.
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Affiliation(s)
- Azfar Hossain
- Expanded Programme on Immunization (EPI), Department of Immunizations, Vaccines, and Biologicals (IVB), World Health Organization (WHO), Avenue Appia 20, 1211 Genève 27, Switzerland.
| | - Claudio Politi
- Expanded Programme on Immunization (EPI), Department of Immunizations, Vaccines, and Biologicals (IVB), World Health Organization (WHO), Avenue Appia 20, 1211 Genève 27, Switzerland.
| | - Nikhil Mandalia
- Expanded Programme on Immunization (EPI), Department of Immunizations, Vaccines, and Biologicals (IVB), World Health Organization (WHO), Avenue Appia 20, 1211 Genève 27, Switzerland.
| | - Adam L Cohen
- Expanded Programme on Immunization (EPI), Department of Immunizations, Vaccines, and Biologicals (IVB), World Health Organization (WHO), Avenue Appia 20, 1211 Genève 27, Switzerland.
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7
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Gibson DG, Pereira A, Farrenkopf BA, Labrique AB, Pariyo GW, Hyder AA. Mobile Phone Surveys for Collecting Population-Level Estimates in Low- and Middle-Income Countries: A Literature Review. J Med Internet Res 2017; 19:e139. [PMID: 28476725 PMCID: PMC5438460 DOI: 10.2196/jmir.7428] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 03/11/2017] [Accepted: 03/11/2017] [Indexed: 11/29/2022] Open
Abstract
Background National and subnational level surveys are important for monitoring disease burden, prioritizing resource allocation, and evaluating public health policies. As mobile phone access and ownership become more common globally, mobile phone surveys (MPSs) offer an opportunity to supplement traditional public health household surveys. Objective The objective of this study was to systematically review the current landscape of MPSs to collect population-level estimates in low- and middle-income countries (LMICs). Methods Primary and gray literature from 7 online databases were systematically searched for studies that deployed MPSs to collect population-level estimates. Titles and abstracts were screened on primary inclusion and exclusion criteria by two research assistants. Articles that met primary screening requirements were read in full and screened for secondary eligibility criteria. Articles included in review were grouped into the following three categories by their survey modality: (1) interactive voice response (IVR), (2) short message service (SMS), and (3) human operator or computer-assisted telephone interviews (CATI). Data were abstracted by two research assistants. The conduct and reporting of the review conformed to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results A total of 6625 articles were identified through the literature review. Overall, 11 articles were identified that contained 19 MPS (CATI, IVR, or SMS) surveys to collect population-level estimates across a range of topics. MPSs were used in Latin America (n=8), the Middle East (n=1), South Asia (n=2), and sub-Saharan Africa (n=8). Nine articles presented results for 10 CATI surveys (10/19, 53%). Two articles discussed the findings of 6 IVR surveys (6/19, 32%). Three SMS surveys were identified from 2 articles (3/19, 16%). Approximately 63% (12/19) of MPS were delivered to mobile phone numbers collected from previously administered household surveys. The majority of MPS (11/19, 58%) were panel surveys where a cohort of participants, who often were provided a mobile phone upon a face-to-face enrollment, were surveyed multiple times. Conclusions Very few reports of population-level MPS were identified. Of the MPS that were identified, the majority of surveys were conducted using CATI. Due to the limited number of identified IVR and SMS surveys, the relative advantages and disadvantages among the three survey modalities cannot be adequately assessed. The majority of MPS were sent to mobile phone numbers that were collected from a previously administered household survey. There is limited evidence on whether a random digit dialing (RDD) approach or a simple random sample of mobile network provided list of numbers can produce a population representative survey.
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Affiliation(s)
- Dustin G Gibson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Amanda Pereira
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Brooke A Farrenkopf
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Alain B Labrique
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - George W Pariyo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Adnan A Hyder
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.,Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, United States
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Drews SJ. The Role of Clinical Virology Laboratory and the Clinical Virology Laboratorian in Ensuring Effective Surveillance for Influenza and Other Respiratory Viruses: Points to Consider and Pitfalls to Avoid. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2016; 8:165-176. [PMID: 32226325 PMCID: PMC7100664 DOI: 10.1007/s40506-016-0081-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Influenza and respiratory viruses have a global impact on public health. Clinical virology laboratories and laboratorians play an important role in not only the diagnosis but also the surveillance of these pathogens. Surveillance for influenza and other respiratory pathogens is important, as it informs public health decision making in terms of influenza vaccine and antiviral effectiveness, informs clinicians and public health practitioners about the pathogenicity of specific viral strains, guides clinical practice, and supports laboratory panning activities. Key background issues include the following: the fact that the laboratory is only one of several data providers to a surveillance system, the biologic nature of influenza and respiratory viruses and the laboratory needs to keep up to date on the diagnosis of these agents, the need for laboratorians to be involved in case definition development, the impact of push and pull data flow models on laboratory resources, and the fact that laboratories may be asked to provide more than just test results to surveillance programs. This review also identifies some key issues or questions that arise during the pre-analytic, analytic, and post-analytic phases that could impact on the ability of the laboratory to link to surveillance programs. Finally, issues surrounding virus characterization programs and how they link to surveillance programs are identified and discussed.
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Affiliation(s)
- Steven J. Drews
- Provincial Laboratory for Public Health (ProvLab), 2B1.03 WMC, University of Alberta Hospital, Edmonton, Alberta T6G 2J2 Canada
- Department of Pathology and Laboratory Medicine, University of Alberta, Edmonton, Alberta Canada
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Irurzun-Lopez M, Erondu NA, Djibo A, Griffiths U, Stuart JM, Fernandez K, Ronveaux O, Le Gargasson JB, Gessner BD, Colombini A. The actual and potential costs of meningitis surveillance in the African meningitis belt: Results from Chad and Niger. Vaccine 2015; 34:1133-8. [PMID: 26603955 DOI: 10.1016/j.vaccine.2015.10.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 10/08/2015] [Accepted: 10/09/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND The introduction of serogroup A meningococcal conjugate vaccine in the African meningitis belt required strengthened surveillance to assess long-term vaccine impact. The costs of implementing this strengthening had not been assessed. METHODOLOGY The ingredients approach was used to retrospectively determine bacterial meningitis surveillance costs in Chad and Niger in 2012. Resource use and unit cost data were collected through interviews with staff at health facilities, laboratories, government offices and international partners, and by reviewing financial reports. Sample costs were extrapolated to national level and costs of upgrading to desired standards were estimated. RESULTS Case-based surveillance had been implemented in all 12 surveyed hospitals and 29 of 33 surveyed clinics in Niger, compared to six out of 21 clinics surveyed in Chad. Lumbar punctures were performed in 100% of hospitals and clinics in Niger, compared to 52% of the clinics in Chad. The total costs of meningitis surveillance were US$ 1,951,562 in Niger and US$ 338,056 in Chad, with costs per capita of US$ 0.12 and US$ 0.03, respectively. Laboratory investigation was the largest cost component per surveillance functions, comprising 51% of the total costs in Niger and 40% in Chad. Personnel resources comprised the biggest expense type: 37% of total costs in Niger and 26% in Chad. The estimated annual, incremental costs of upgrading current systems to desired standards were US$ 183,299 in Niger and US$ 605,912 in Chad, which are 9% and 143% of present costs, respectively. CONCLUSIONS Niger's more robust meningitis surveillance system costs four times more per capita than the system in Chad. Since Chad spends less per capita, fewer activities are performed, which weakens detection and analysis of cases. Countries in the meningitis belt are diverse, and can use these results to assess local costs for adapting surveillance systems to monitor vaccine impact.
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Affiliation(s)
- Maite Irurzun-Lopez
- Agence de Médecine Préventive, Bât. JB Say, 4e étage, aile A, 13 chemin du Levant, 01210 Ferney-Voltaire, France(1).
| | - Ngozi A Erondu
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom(2)
| | - Ali Djibo
- Faculté de Médecine Université de Niamey, Niger(3)
| | - Ulla Griffiths
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom(2)
| | - James M Stuart
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom(2); World Health Organization, Avenue Appia 20, 1202 Geneva, Switzerland(4)
| | - Katya Fernandez
- World Health Organization, Avenue Appia 20, 1202 Geneva, Switzerland(4)
| | - Olivier Ronveaux
- World Health Organization, Avenue Appia 20, 1202 Geneva, Switzerland(4)
| | - Jean-Bernard Le Gargasson
- Agence de Médecine Préventive, Bât. JB Say, 4e étage, aile A, 13 chemin du Levant, 01210 Ferney-Voltaire, France(1)
| | - Bradford D Gessner
- Agence de Médecine Préventive, Bât. JB Say, 4e étage, aile A, 13 chemin du Levant, 01210 Ferney-Voltaire, France(1)
| | - Anaïs Colombini
- Agence de Médecine Préventive, Bât. JB Say, 4e étage, aile A, 13 chemin du Levant, 01210 Ferney-Voltaire, France(1)
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10
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Saronga HP, Dalaba MA, Dong H, Leshabari M, Sauerborn R, Sukums F, Blank A, Kaltschmidt J, Loukanova S. Cost of installing and operating an electronic clinical decision support system for maternal health care: case of Tanzania rural primary health centres. BMC Health Serv Res 2015; 15:132. [PMID: 25888762 PMCID: PMC4391308 DOI: 10.1186/s12913-015-0780-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 03/09/2015] [Indexed: 11/30/2022] Open
Abstract
Background Poor quality of care is among the causes of high maternal and newborn disease burden in Tanzania. Potential reason for poor quality of care is the existence of a “know-do gap” where by health workers do not perform to the best of their knowledge. An electronic clinical decision support system (CDSS) for maternal health care was piloted in six rural primary health centers of Tanzania to improve performance of health workers by facilitating adherence to World Health Organization (WHO) guidelines and ultimately improve quality of maternal health care. This study aimed at assessing the cost of installing and operating the system in the health centers. Methods This retrospective study was conducted in Lindi, Tanzania. Costs incurred by the project were analyzed using Ingredients approach. These costs broadly included vehicle, computers, furniture, facility, CDSS software, transport, personnel, training, supplies and communication. These were grouped into installation and operation cost; recurrent and capital cost; and fixed and variable cost. We assessed the CDSS in terms of its financial and economic cost implications. We also conducted a sensitivity analysis on the estimations. Results Total financial cost of CDSS intervention amounted to 185,927.78 USD. 77% of these costs were incurred in the installation phase and included all the activities in preparation for the actual operation of the system for client care. Generally, training made the largest share of costs (33% of total cost and more than half of the recurrent cost) followed by CDSS software- 32% of total cost. There was a difference of 31.4% between the economic and financial costs. 92.5% of economic costs were fixed costs consisting of inputs whose costs do not vary with the volume of activity within a given range. Economic cost per CDSS contact was 52.7 USD but sensitive to discount rate, asset useful life and input cost variations. Conclusions Our study presents financial and economic cost estimates of installing and operating an electronic CDSS for maternal health care in six rural health centres. From these findings one can understand exactly what goes into a similar investment and thus determine sorts of input modification needed to fit their context. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-0780-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Happiness Pius Saronga
- Behavioural Sciences Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania. .,Institute of Public Health, University of Heidelberg, Heidelberg, Germany.
| | - Maxwell Ayindenaba Dalaba
- Navrongo Health Research Centre, Navrongo, Ghana. .,Institute of Public Health, University of Heidelberg, Heidelberg, Germany.
| | - Hengjin Dong
- Centre for Health Policy Studies, Zhejiang University, Hangzhou, China.
| | - Melkizedeck Leshabari
- Behavioural Sciences Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | - Rainer Sauerborn
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany.
| | - Felix Sukums
- Behavioural Sciences Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania. .,Institute of Public Health, University of Heidelberg, Heidelberg, Germany.
| | - Antje Blank
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany.
| | - Jens Kaltschmidt
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany.
| | - Svetla Loukanova
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany.
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Hyde TB, Andrus JK, Dietz VJ, Andrus JK, Hyde TB, Lee CE, Widdowson MA, Verani JR, Friedman C, Azziz-Baumgartner E, Lopez AS, Jumaan A, Dietz VJ. Critical issues in implementing a national integrated all-vaccine preventable disease surveillance system. Vaccine 2013; 31 Suppl 3:C94-8. [PMID: 23777699 DOI: 10.1016/j.vaccine.2013.05.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Revised: 04/29/2013] [Accepted: 05/08/2013] [Indexed: 11/18/2022]
Abstract
In 2007, the World Health Organization published the Global Framework for Immunization Monitoring and Surveillance (GFIMS) outlining measures to enhance national surveillance for vaccine preventable diseases (VPDs). The GFIMS emphasized that VPD surveillance should be integrated and placed in a 'unified framework' building upon the strengths of existing surveillance systems to prevent duplication of activities common to all surveillance systems and to minimize human resource and supply expenditures. Unfortunately, there was little experience in actually developing integrated VPD surveillance. We describe the process of developing operational guidance for ministries of health to implement such an integrated surveillance system for multiple VPDs.
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Affiliation(s)
- Terri B Hyde
- Global Immunization Division, US Centers for Disease Control and Prevention (CDC), 1600 Clifton Road NE, Atlanta, GA 30333, USA.
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Andrus JK, Walker DG. Evidence base for new vaccine introduction in Latin America and the Caribbean. Vaccine 2013; 31 Suppl 3:C2-3. [DOI: 10.1016/j.vaccine.2013.05.074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 05/20/2013] [Accepted: 05/21/2013] [Indexed: 10/26/2022]
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