1
|
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.
Collapse
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.
| |
Collapse
|
2
|
Nogareda F, Gharpure R, Contreras M, Velandia M, Lucia Pacis C, Elena Chevez A, Azziz-Baumgartner E, Salas D. Seasonal influenza vaccination in the Americas: Progress and challenges during the COVID-19 pandemic. Vaccine 2023:S0264-410X(23)00689-8. [PMID: 37328348 PMCID: PMC10247885 DOI: 10.1016/j.vaccine.2023.06.024] [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: 02/23/2023] [Revised: 06/06/2023] [Accepted: 06/06/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Vaccination is one of the most effective measures to prevent influenza illness and its complications; influenza vaccination remained important during the COVID-19 pandemic to prevent additional burden on health systems strained by COVID-19 demand. OBJECTIVES We describe policies, coverage, and progress of seasonal influenza vaccination programs in the Americas during 2019-2021 and discuss challenges in monitoring and maintaining influenza vaccination coverage among target groups during the COVID-19 pandemic. METHODS We used data on influenza vaccination policies and vaccination coverage reported by countries/territories via the electronic Joint Reporting Form on Immunization (eJRF) for 2019-2021. We also summarized country vaccination strategies shared with PAHO. RESULTS As of 2021, 39 (89 %) out of 44 reporting countries/territories in the Americas had policies for seasonal influenza vaccination. Countries/territories adapted health services and immunization delivery strategies using innovative approaches, such as new vaccination sites and expanded schedules, to ensure continuation of influenza vaccination during the COVID-19 pandemic. However, among countries/territories that reported data to eJRF in both 2019 and 2021, median coverage decreased; the percentage point decrease was 21 % (IQR = 0-38 %; n = 13) for healthcare workers, 10 % (IQR = -1.5-38 %; n = 12) for older adults, 21 % (IQR = 5-31 %; n = 13) for pregnant women, 13 % (IQR = 4.8-20.8 %; n = 8) for persons with chronic diseases, and 9 % (IQR = 3-27 %; n = 15) for children. CONCLUSIONS Countries/territories in the Americas successfully adapted influenza vaccination delivery to continue vaccination services during the COVID-19 pandemic; however, reported influenza vaccination coverage decreased from 2019 to 2021. Reversing declines in vaccination will necessitate strategic approaches that prioritize sustainable vaccination programs across the life course. Efforts should be made to improve the completeness and quality of administrative coverage data. Lessons learned from COVID-19 vaccination, such as the rapid development of electronic vaccination registries and digital certificates, might facilitate advances in coverage estimation.
Collapse
Affiliation(s)
- Francisco Nogareda
- Pan American Health Organization, Special Program Comprehensive Immunization, Washington, DC, USA.
| | - Radhika Gharpure
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Marcela Contreras
- Pan American Health Organization, Special Program Comprehensive Immunization, Washington, DC, USA
| | - Martha Velandia
- Pan American Health Organization, Special Program Comprehensive Immunization, Washington, DC, USA
| | - Carmelita Lucia Pacis
- Pan American Health Organization, Special Program Comprehensive Immunization, Washington, DC, USA
| | - Ana Elena Chevez
- Pan American Health Organization, Revolving Fund, Washington, DC, USA
| | | | - Daniel Salas
- Pan American Health Organization, Special Program Comprehensive Immunization, Washington, DC, USA
| |
Collapse
|
3
|
Dhungana M, Hoben M, O’Brien C, MacDonald SE. Immunization status of children at kindergarten entry in Alberta, Canada. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2022; 114:82-92. [PMID: 35864307 PMCID: PMC9849539 DOI: 10.17269/s41997-022-00663-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 06/14/2022] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Little is known about immunization coverage among kindergarten-aged children in jurisdictions that do not require children's immunization records to be provided at school entry. Thus, we assessed immunization coverage and associated characteristics of a 2008 birth cohort of Alberta children at kindergarten entry as compared with at the end of grade one. METHODS This retrospective cohort study used population-based administrative health data for childhood vaccines in Alberta, Canada. We categorized and compared immunization status of children as follows: (a) complete at kindergarten entry; (b) incomplete at kindergarten entry but complete at the end of grade one; and (c) still incomplete at the end of grade one. To assess factors associated with immunization status, we used multinomial logistic regression. RESULTS Immunization coverage for the complete vaccine series for children (N = 41,515) at kindergarten entry was suboptimal (44.5%, 95% CI 44.0-45.0) and substantially lower than for children at the end of grade one (74.8%, 95% CI 74.3-75.2). Young maternal age, not living with a partner, and having > 1 child in a household were associated with incomplete immunization status at kindergarten entry. Midwife-assisted hospital and home delivery was strongly associated with incomplete immunization status at the end of grade one. CONCLUSION Immunization coverage at kindergarten entry was strikingly low. Risk factors for incomplete immunization status were identified that require particular attention when addressing immunization coverage. The school-based catch-up immunization program in grade one seems to have substantially improved coverage among children, suggesting a potential benefit of shifting the catch-up program from grade one to kindergarten entry.
Collapse
Affiliation(s)
- Manisha Dhungana
- Faculty of Nursing, Edmonton Clinic Health Academy, University of Alberta, 11405-87 Ave NW, Edmonton, Alberta T6G 1C9 Canada
| | - Matthias Hoben
- Faculty of Nursing, Edmonton Clinic Health Academy, University of Alberta, 11405-87 Ave NW, Edmonton, Alberta T6G 1C9 Canada
| | - Celine O’Brien
- Immunization & Communicable Disease Control, Alberta Health, Edmonton, Alberta Canada
| | - Shannon E. MacDonald
- Faculty of Nursing, Edmonton Clinic Health Academy, University of Alberta, 11405-87 Ave NW, Edmonton, Alberta T6G 1C9 Canada
| |
Collapse
|
4
|
Mwinnyaa G, Hazel E, Maïga A, Amouzou A. Estimating population-based coverage of reproductive, maternal, newborn, and child health (RMNCH) interventions from health management information systems: a comprehensive review. BMC Health Serv Res 2021; 21:1083. [PMID: 34689787 PMCID: PMC8542459 DOI: 10.1186/s12913-021-06995-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 09/07/2021] [Indexed: 11/15/2022] Open
Abstract
Background Routinely collected health facility data usually captured and stored in Health Management Information Systems (HMIS) are potential sources of data for frequent and local disaggregated estimation of the coverage of reproductive, maternal, newborn, and child health interventions (RMNCH), but have been under-utilized due to concerns over data quality. We reviewed methods for estimation of national or subnational coverage of RMNCH interventions using HMIS data exclusively or in conjunction with survey data from low- and middle-income countries (LMICs). Methods We conducted a comprehensive review of studies indexed in PubMed and Scopus to identify potential papers based on predefined search terms. Two reviewers screened the papers using defined inclusion and exclusion criteria. Following sequences of title, abstract and full paper reviews, we retained 18 relevant papers. Results 12 papers used only HMIS data and 6 used both HMIS and survey data. There is enormous lack of standards in the existing methods for estimating RMNCH intervention coverage; all appearing to be highly author dependent. The denominators for coverage measures were estimated using census, non-census and combined projection-based methods. No satisfactory methods were found for treatment-based coverage indicators for which the estimation of target population requires the population prevalence of underlying conditions. The estimates of numerators for the coverage measures were obtained from the count of users or visits and in some cases correction for completeness of reporting in the HMIS following an assessment of data quality. Conclusions Standard methods for correcting numerators from HMIS data for accurate estimation of coverage of RMNCH interventions are needed to expand the use of these data. More research and investments are required to improve denominators for health facility-derived statistics. Improvement in routine data quality and analytical methods would allow for timely estimation of RMNCH intervention coverage at the national and subnational levels.
Collapse
Affiliation(s)
- George Mwinnyaa
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, MD, 21205, Baltimore, USA
| | - Elizabeth Hazel
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, MD, 21205, Baltimore, USA
| | - Abdoulaye Maïga
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, MD, 21205, Baltimore, USA
| | - Agbessi Amouzou
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, MD, 21205, Baltimore, USA.
| |
Collapse
|
5
|
|