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Arhin RE, Donkor ES, Slotved HC, Kotey FCN, Dayie NTKD. Etiologic Profile of the Pneumococcus in Ghana: A Systematic Review. BIOMED RESEARCH INTERNATIONAL 2024; 2024:8368996. [PMID: 39229361 PMCID: PMC11371446 DOI: 10.1155/2024/8368996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 04/04/2024] [Accepted: 08/06/2024] [Indexed: 09/05/2024]
Abstract
Objective: To describe the profile of Streptococcus pneumoniae, identify research gaps, and provide in-depth insights into various aspects related to the pathogen. Methods: Google Scholar, PubMed, and ScienceDirect were searched for all studies on the pneumococcus in Ghana that reported on specimen collected, population and sample size, carriage prevalence, incidence of pneumococcal diseases, age of the study population, types of test performed, serotypes identified, antimicrobial susceptibilities, or molecular analysis on the pneumococci for data extraction. Results: Overall, a total of 7954 results were obtained from the three-database search, and of this, 24 articles were selected after screening. A total of 924 isolates were accounted for by serotyping/serogrouping. The prevalence of pneumococcal carriage in Ghana ranges from 11.0% to 51.4% in the population depending on the age (≤ 24-80 years), sickle cell disease (SCD), human immunodeficiency virus (HIV) status, or health of the study population, and penicillin (Pen)-nonsusceptible isolates ranged from 17% to 63%. The prevalence of pneumococci found as the etiologic agent of diseases among Ghanaians ranges from 3.4% for otitis media to 77.7% for meningitis. Overall, the 13-valent pneumococcal conjugate vaccine (PCV) (PCV-13) carriage serotypes accounted for 28.4% of the reported pneumococcal isolates. PCV-13 invasive serotypes accounted for 22.4% of the reported isolates. The non-PCV-13 carriage serotypes accounted for most (43.9%) of the reported isolates. In the pre-PCV-13 era, the nontypeable (NT) (5.5%) and other nonvaccine types (NVTs) (6.4%) were reported as being predominant. The non-PCV-13 serotypes accounted for 4.4% of the reported isolates in invasive pneumococcal disease (IPD) cases. Multidrug resistance (MDR) ranged from 7.8% to 100%. Conclusion: Predicting the invasiveness of pneumococci using molecular typing is the way to go in the future as this will provide answers to the extent to which capsular switching is contributing to the pneumococcal disease burden in Ghana almost a decade after introducing PCV-13. Continuous monitoring of antibiotic resistance patterns at both phenotypic and genotypic levels, along with serotyping and molecular typing, should be a standard practice in the surveillance of pneumococcal disease burden in Ghana.
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Affiliation(s)
- Reuben E. Arhin
- Department of Medical MicrobiologyUniversity of Ghana Medical School, Korle Bu, Ghana
- Department of Science Laboratory TechnologyAccra Technical University, Accra, Ghana
| | - Eric S. Donkor
- Department of Medical MicrobiologyUniversity of Ghana Medical School, Korle Bu, Ghana
| | | | - Fleischer C. N. Kotey
- Department of Medical MicrobiologyUniversity of Ghana Medical School, Korle Bu, Ghana
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Ibrahim AM, Owusu R, Nonvignon J. Sustainability of pneumococcal conjugate vaccination in Ghana: a cost-effectiveness analysis in the context of donor transition. Front Public Health 2024; 12:1383668. [PMID: 39148654 PMCID: PMC11324427 DOI: 10.3389/fpubh.2024.1383668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 07/16/2024] [Indexed: 08/17/2024] Open
Abstract
Background Streptococcus pneumonia is responsible for 18% of infant deaths in Ghana. With co-financing from Gavi in 2012, Ghana introduced the PCV13 into the childhood immunization programme to reduce the burden of Streptococcus pneumonia. However, Ghana will graduate to the Gavi fully self-financing phase in 2026, when the nation assumes full responsibility of paying for the PCV13. This research aims to evaluate the health impact and cost-effectiveness of PCV13 immunization in Ghana since its implementation and after the cessation of support from Gavi. Methods We used the UNIVAC tool to evaluate two main scenarios of cost-effectiveness, from vaccine introduction (2012-2025) and after Gavi transition (2026-2031) in comparison with no vaccination. The sources of data include national data, international estimates and expert opinion. Cost was considered from both the government and societal perspectives. We discounted health outcomes at 3%. Currency values were stated in US Dollars. We tested the robustness of the base case results by performing scenario and sensitivity analyses. Results PCV13 will reduce the pneumococcal disease burden by 48% from 2012 to 2031. The vaccination programme costs are USD 130 million and USD 275 million in 2012-2025 and 2026-2031 respectively. It also has a budget impact of USD 280 million for the 2026-2031 period from the perspective of government. The incremental cost-effectiveness ratios are USD 89 and USD 73 respectively from the perspectives of government and society in 2012-2025. The incremental cost-effectiveness ratios are USD 530 and USD 510 respectively from the perspectives of government and society in 2026-2031. Conclusion The PCV13 vaccination programme in Ghana is cost-effective at 50% GDP per capita threshold even when Gavi withdraws co-financing support from 2026 onwards.
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Affiliation(s)
| | - Richmond Owusu
- Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
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Guertin JR, Gilbert-Ouimet M, Dugas M, Carnovale V, Jalbert L, Svyntozelska O, Demers J, Matteau L, Bergeron F, LeBlanc A. Methods used to account for caregivers' sex and gender within studies examining the financial burden of caregivers of children and adolescents : Results from a scoping review. CLINICOECONOMICS AND OUTCOMES RESEARCH 2024; 16:35-53. [PMID: 38298908 PMCID: PMC10829241 DOI: 10.2147/ceor.s443077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/11/2024] [Indexed: 02/02/2024] Open
Abstract
Background Interest in the financial burden of informal caregivers has been growing. Unfortunately, it remains unclear which method(s) should be used when quantifying this burden. Purpose We conducted a scoping review aimed at identifying which methods have been used to conduct such work and quantified their performance. We were also interested in examining how sex and gender considerations were considered within selected studies. Data Sources Using a standardized approach, we identified studies published between 2012 and 2022 that aimed to document the financial burden of caregivers to child and adolescent patients. Our search strategy was applied to the MEDLINE, Embase, CINHAL, and Academic Search Premier databases. Study Selection Manuscript selection was performed by pairs of reviewers. Data Extraction Data extraction was performed by one reviewer with a second reviewer performing quality control. Results were reported using a narrative approach. Data Synthesis We identified 9801 unique citations, of which 200 were included in our review. Selected studies covered various disease area (eg, infection/parasitic diseases [n = 31, 16%]) and included quantitative (n = 180, 90%), qualitative (n = 4, 2%) and mixed study designs (n = 16, 8%). Most studies (n = 182, 91%) used questionnaires/surveys, either alone or in combination with other methods, to assess caregivers' financial burden. Less than half (n = 93, 47%) of studies reported on caregivers' sex and none reported on their gender. Conclusion We conducted an unrestricted review of published studies examining caregiver's financial burden which allowed us to identify general methodological trends observed in this literature. We believe this work may help improve future studies focusing on this important issue.
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Affiliation(s)
- Jason Robert Guertin
- Centre de recherche du Centre de recherche du CHU de Québec-Université Laval, Quebec City, Quebec, Canada
- Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
- Centre de recherche en organogénèse expérimentale de l’Université Laval/LOEX, Quebec City, Quebec, Canada
| | - Mahée Gilbert-Ouimet
- Centre de recherche du Centre de recherche du CHU de Québec-Université Laval, Quebec City, Quebec, Canada
- Department of Health Sciences, Université du Québec À Rimouski, Levis, Quebec, Canada
| | - Michèle Dugas
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada
| | - Valérie Carnovale
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada
| | - Laura Jalbert
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada
| | - Olha Svyntozelska
- Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada
| | - Juliette Demers
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada
| | - Léonie Matteau
- Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
- Department of Health Sciences, Université du Québec À Rimouski, Levis, Quebec, Canada
| | - Frédéric Bergeron
- Bibliothèque-Direction des services-conseils, Université Laval, Quebec City, Quebec, Canada
| | - Annie LeBlanc
- Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada
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Bilgin GM, Munira SL, Lokuge K, Glass K. Cost-effectiveness analysis of a maternal pneumococcal vaccine in low-income, high-burden settings such as Sierra Leone. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000915. [PMID: 37619237 PMCID: PMC10449127 DOI: 10.1371/journal.pgph.0000915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 07/01/2023] [Indexed: 08/26/2023]
Abstract
Maternal pneumococcal vaccines have been proposed as a method of protecting infants in the first few months of life. In this paper, we use results from a dynamic transmission model to assess the cost-effectiveness of a maternal pneumococcal polysaccharide vaccine from both healthcare and societal perspectives. We estimate the costs of delivering a maternal pneumococcal polysaccharide vaccine, the healthcare costs averted, and productivity losses avoided through the prevention of severe pneumococcal outcomes such as pneumonia and meningitis. Our model estimates that a maternal pneumococcal program would cost $606 (2020 USD, 95% prediction interval 437 to 779) from a healthcare perspective and $132 (95% prediction interval -1 to 265) from a societal perspective per DALY averted for one year of vaccine delivery. Hence, a maternal pneumococcal vaccine would be cost-effective from a societal perspective but not cost-effective from a healthcare perspective using Sierra Leone's GDP per capita of $527 as a cost-effectiveness threshold. Sensitivity analysis demonstrates how the choice to discount ongoing health benefits determines whether the maternal pneumococcal vaccine was deemed cost-effective from a healthcare perspective. Without discounting, the cost per DALY averted would be $292 (55% of Sierra Leone's GDP per capita) from a healthcare perspective. Further, the cost per DALY averted would be $142 (27% GDP per capita) from a healthcare perspective if PPV could be procured at the same cost relative to PCV in Sierra Leone as on the PAHO reference price list. Overall, our paper demonstrates that maternal pneumococcal vaccines have the potential to be cost-effective in low-income settings; however, the likelihood of low-income countries self-financing this intervention will depend on negotiations with vaccine providers on vaccine price. Vaccine price is the largest program cost driving the cost-effectiveness of a future maternal pneumococcal vaccine.
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Affiliation(s)
- Gizem M. Bilgin
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
| | - Syarifah Liza Munira
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
| | - Kamalini Lokuge
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
| | - Kathryn Glass
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
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Kremer P, Haruna F, Tuffour Sarpong R, Agamah D, Billy J, Osei-Kwakye K, Aidoo P, Dodoo D, Okoh-Owusu M. An impact assessment of the use of aerial logistics to improve access to vaccines in the Western-North Region of Ghana. Vaccine 2023; 41:5245-5252. [PMID: 37344263 DOI: 10.1016/j.vaccine.2023.06.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 06/08/2023] [Accepted: 06/08/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Prevention of infectious diseases among children is crucial to improve child health and survival. However, many countries in Sub-Saharan Africa struggle to achieve vaccination targets due to supply chain challenges, which lead to vaccine shortages, stockouts, and increased costs. We evaluated the effects of aerial logistics (centralized storage and delivery by drones) on vaccine stock, stockouts, vaccination coverage and vaccine preventable outcomes in the Western North Region of Ghana. METHODS The study combined retrospective quasi-experimental and cross-sectional designs to evaluate supply chain, programmatic, and clinical outcomes. Surveys to health providers were used to collect information from a random sample of 156 facilities, and secondary data on vaccination coverage and clinical outcomes was analyzed at the district level for the years 2017-2021. RESULTS Facilities served by aerial logistics reported significant reductions in the duration of vaccine stockouts (30 %, p-value < 0.05), as well as in the frequency of missed opportunities for vaccination (44 %, p-value < 0.05). Being served by aerial logistics was associated with increased satisfaction with access to vaccines. Significant differences in vaccination coverage were found for most vaccines, in a range between 13.1 and 37.5 percentage points in vaccination coverage for served districts. Infectious diarrhea cases in children between 5 and 9 years old were reduced by 41.6 % (p-value < 0.05). CONCLUSION End-to-end aerial logistics appears as an effective tool to improve the performance of the supply chain for vaccines. The strategy potentially increases the resilience of the health system and contributes to increased vaccination coverage and higher levels of satisfaction among providers in the Western North Region of Ghana.
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Affiliation(s)
- Pedro Kremer
- Zipline, Global Health Impact and Fulfillment Operations, Nii Akuboye Street, Dzornaman (GD-166-7058), P.O. Box CT 9109, Accra, Ghana.
| | - Florence Haruna
- Zipline, Global Health Impact and Fulfillment Operations, Nii Akuboye Street, Dzornaman (GD-166-7058), P.O. Box CT 9109, Accra, Ghana.
| | - Rejoice Tuffour Sarpong
- Zipline, Global Health Impact and Fulfillment Operations, Nii Akuboye Street, Dzornaman (GD-166-7058), P.O. Box CT 9109, Accra, Ghana.
| | - Dennis Agamah
- Zipline, Global Health Impact and Fulfillment Operations, Nii Akuboye Street, Dzornaman (GD-166-7058), P.O. Box CT 9109, Accra, Ghana.
| | - Joshua Billy
- Ghana Health Service, Western North Regional Health Directorate, 5FQX+93, Anhweam, Ghana.
| | - Kingsley Osei-Kwakye
- Ghana Health Service, Western North Regional Health Directorate, 5FQX+93, Anhweam, Ghana.
| | - Princess Aidoo
- Zipline, Global Health Impact and Fulfillment Operations, Nii Akuboye Street, Dzornaman (GD-166-7058), P.O. Box CT 9109, Accra, Ghana.
| | - Deborah Dodoo
- Zipline, Global Health Impact and Fulfillment Operations, Nii Akuboye Street, Dzornaman (GD-166-7058), P.O. Box CT 9109, Accra, Ghana.
| | - Marion Okoh-Owusu
- Ghana Health Service, Western North Regional Health Directorate, 5FQX+93, Anhweam, Ghana.
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Bal A, Saz EU, Arslan SY, Atik S, Bayturan S, Yurtseven A, Gazi H, Cicek C, Kurugol Z, Bal ZS. The Evaluation of the Diagnostic Performance of the BioFire FilmArray Meningitis/Encephalitis Panel in Children: A Retrospective Multicenter Study. J PEDIAT INF DIS-GER 2022. [DOI: 10.1055/s-0042-1756711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Abstract
Objective Acute bacterial meningitis (ABM) declined after implementing conjugate Haemophilus influenzae type B and the pneumococcal vaccines worldwide. However, it still contributes to significant morbidity and mortality. The Biofire FilmArray Meningitis Encephalitis (FAME) panel can rapidly diagnose common bacterial and viral pathogens. Several studies suggested that the use of FAME may accelerate diagnosis and decrease the time to pathogen-specific therapy. However, the clinical utility is still controversial due to scarce data and relatively high costs. Therefore, we aimed to evaluate the diagnostic performance of FAME in children.
Methods A retrospective multicenter cross-sectional study was conducted to evaluate FAME in diagnosing ABM in children with a suspected central nervous system infection between January 2017 and May 2021.
Results This study consisted of 179 children diagnosed with central nervous system infection who had parallel testing done using FAME and traditional microbiological diagnostic methods. Twenty-two FAME results were positive; 8 (36.3%) were bacterial pathogens and 14 (53.7%) were viral pathogens. The most common viral pathogen was human herpesvirus 6 (n = 6; 27.2%), followed by herpes simplex virus 1 (n = 4; 18.1%), Enterovirus spp. (n = 2; 9%), Parechovirus (n = 2; 9%), and Cytomegalovirus (n = 1; 4.5%). Bacterial pathogens included S. pneumoniae (n = 3; 13.6%), H. influenzae (n = 3; 13.6%), Neisseria meningitidis (n = 1; 4.5%), and Streptococcus agalactiae (n = 1; 4.5%). Bacterial culture confirmed S. pneumoniae infection in only 1 of 8 (12.5%) patients, while 7 of 8 bacterial meningitis were only detected by FAME.
Conclusion FAME may also help with diagnosis and pathogen identification in patients who have already had antibiotics before cerebrospinal fluid collection. The use of FAME to detect infections quickly may minimize the improper use of medications, treatment duration, and the cost of hospitalization.
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Affiliation(s)
- Alkan Bal
- Department of Pediatric Emergency, Medical School of Manisa Celal Bayar University, Manisa, Turkey
| | - Eylem Ulas Saz
- Division of Emergency Medicine, Department of Pediatrics, Medical School of Ege University, Izmir, Turkey
| | - Sema Yildirim Arslan
- Division of Infectious Disease, Department of Pediatrics, Medical School of Ege University, Izmir, Turkey
| | - Sinem Atik
- Department of Pediatrics, Medical School of Manisa Celal Bayar University, Manisa, Turkey
| | - Semra Bayturan
- Division of Infectious Disease, Department of Pediatrics, Medical School of Manisa Celal Bayar University, Manisa, Turkey
| | - Ali Yurtseven
- Division of Emergency Medicine, Department of Pediatrics, Medical School of Ege University, Izmir, Turkey
| | - Hörü Gazi
- Department of Microbiology, Medical School of Manisa Celal Bayar University, Manisa, Turkey
| | - Candan Cicek
- Department of Microbiology, Medical School of Ege University, Izmir, Turkey
| | - Zafer Kurugol
- Division of Infectious Disease, Department of Pediatrics, Medical School of Ege University, Izmir, Turkey
| | - Zumrut Sahbudak Bal
- Division of Infectious Disease, Department of Pediatrics, Medical School of Ege University, Izmir, Turkey
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