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Suwantika AA, Zakiyah N, Abdulah R, Diantini A. Assessment of childhood immunization services at private healthcare facilities in Indonesia: a case study in a highly-populated city. Front Public Health 2023; 11:1093387. [PMID: 37575096 PMCID: PMC10415032 DOI: 10.3389/fpubh.2023.1093387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 07/07/2023] [Indexed: 08/15/2023] Open
Abstract
Introduction The need to enhance the utilization of the private sector for immunization programs in Indonesia while maintaining the high quality of services provided is evident. This study aimed to rapidly assess immunization services at private healthcare facilities in Indonesia by using Bandung, the most densely populated city, as the reference case. Methods Initially, a situation analysis was conducted by collecting data from selected healthcare facilities (n = 9). Furthermore, a qualitative study was taken into account by developing framework approaches and conducting interviews with different layers, such as mid-level managers at healthcare facilities (n = 9), professional organizations (n = 4), and public stakeholders (n = 7). Results The situation analysis showed that private healthcare facilities had provided sufficient time for essential childhood immunization services with adequate staff. Nevertheless, the number of limited staff the Ministry of Health (MoH) has trained remains a programmatic problem. Furthermore, private healthcare facilities have used the MoH guidelines and additional internal guidelines for immunization services as the primary reference, including in the efforts to provide complete and reliable equipment. Vaccine availability at private healthcare facilities is manageable with an acceptable out-of-stock level. The results of our interviews highlighted three key findings: the lack of coordination across public and private sectors, the need for immunization service delivery improvement at private healthcare facilities, and the urgency to strengthen institutional capacity for advocacy and immunization systems support. Conclusion Even though private healthcare facilities have been shown to make a modest contribution to childhood immunization services in Indonesia, efforts should be made to expand the role of private healthcare facilities in improving the performance of routine immunization programs.
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Affiliation(s)
- Auliya A. Suwantika
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
- Center of Excellence for Pharmaceutical Care Innovation (PHARCI), Universitas Padjadjaran, Bandung, Indonesia
- Center for Health Technology Assessment, Universitas Padjadjaran, Bandung, Indonesia
| | - Neily Zakiyah
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
- Center of Excellence for Pharmaceutical Care Innovation (PHARCI), Universitas Padjadjaran, Bandung, Indonesia
| | - Rizky Abdulah
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
- Center of Excellence for Pharmaceutical Care Innovation (PHARCI), Universitas Padjadjaran, Bandung, Indonesia
| | - Ajeng Diantini
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
- Center of Excellence for Pharmaceutical Care Innovation (PHARCI), Universitas Padjadjaran, Bandung, Indonesia
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Zucker JR, Rosen JB, Iwamoto M, Arciuolo RJ, Langdon-Embry M, Vora NM, Rakeman JL, Isaac BM, Jean A, Asfaw M, Hawkins SC, Merrill TG, Kennelly MO, Maldin Morgenthau B, Daskalakis DC, Barbot O. Consequences of Undervaccination - Measles Outbreak, New York City, 2018-2019. N Engl J Med 2020; 382:1009-1017. [PMID: 32160662 DOI: 10.1056/nejmoa1912514] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Measles was declared eliminated in the United States in 2000, but the risk of outbreaks owing to international importations remains. An outbreak of measles in New York City began when one unvaccinated child returned home from Israel with measles; onset of rash occurred on September 30, 2018, 9 days after the child returned home. METHODS We investigated suspected cases of measles by conducting interviews, reviewing medical and immunization records, identifying exposed persons, and performing diagnostic testing. Measles-mumps-rubella (MMR) vaccine (given as either MMR or measles-mumps-rubella-varicella vaccine and collectively referred to as MMR vaccine) uptake was monitored with the use of the Citywide Immunization Registry. The total direct cost to the New York City Department of Health and Mental Hygiene was calculated. RESULTS A total of 649 cases of measles were confirmed, with onsets of rash occurring between September 30, 2018, and July 15, 2019. A majority of the patients (93.4%) were part of the Orthodox Jewish community, and 473 of the patients (72.9%) resided in the Williamsburg area of Brooklyn, New York. The median age was 3 years; 81.2% of the patients were 18 years of age or younger, and 85.8% of the patients with a known vaccination history were unvaccinated. Serious complications included pneumonia (in 37 patients [5.7%]) and hospitalization (in 49 patients [7.6%]); among the patients who were hospitalized, 20 (40.8%) were admitted to an intensive care unit. As a result of efforts to promote vaccination, the percentage of children in Williamsburg who received at least one dose of MMR vaccine increased from 79.5% to 91.1% among children 12 to 59 months of age. As of September 9, 2019, a total of 559 staff members at the Department of Health and Mental Hygiene (7% of the agency) had been involved in the measles response. The cost of the Department of Health and Mental Hygiene response was $8.4 million. CONCLUSIONS Importation of measles and vaccination delays among young children led to an outbreak of measles in New York City. The outbreak response was resource intensive and caused serious illness, particularly among unvaccinated children.
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Affiliation(s)
- Jane R Zucker
- From the New York City Department of Health and Mental Hygiene, New York (J.R.Z., J.B.R., M.I., R.J.A., M.L.-E., N.M.V., J.L.R., B.M.I., A.J., M.A., S.C.H., T.G.M., M.O.K., B.M.M., D.C.D., O.B.), and the Centers for Disease Control and Prevention, Atlanta (J.R.Z., N.M.V.)
| | - Jennifer B Rosen
- From the New York City Department of Health and Mental Hygiene, New York (J.R.Z., J.B.R., M.I., R.J.A., M.L.-E., N.M.V., J.L.R., B.M.I., A.J., M.A., S.C.H., T.G.M., M.O.K., B.M.M., D.C.D., O.B.), and the Centers for Disease Control and Prevention, Atlanta (J.R.Z., N.M.V.)
| | - Martha Iwamoto
- From the New York City Department of Health and Mental Hygiene, New York (J.R.Z., J.B.R., M.I., R.J.A., M.L.-E., N.M.V., J.L.R., B.M.I., A.J., M.A., S.C.H., T.G.M., M.O.K., B.M.M., D.C.D., O.B.), and the Centers for Disease Control and Prevention, Atlanta (J.R.Z., N.M.V.)
| | - Robert J Arciuolo
- From the New York City Department of Health and Mental Hygiene, New York (J.R.Z., J.B.R., M.I., R.J.A., M.L.-E., N.M.V., J.L.R., B.M.I., A.J., M.A., S.C.H., T.G.M., M.O.K., B.M.M., D.C.D., O.B.), and the Centers for Disease Control and Prevention, Atlanta (J.R.Z., N.M.V.)
| | - Marisa Langdon-Embry
- From the New York City Department of Health and Mental Hygiene, New York (J.R.Z., J.B.R., M.I., R.J.A., M.L.-E., N.M.V., J.L.R., B.M.I., A.J., M.A., S.C.H., T.G.M., M.O.K., B.M.M., D.C.D., O.B.), and the Centers for Disease Control and Prevention, Atlanta (J.R.Z., N.M.V.)
| | - Neil M Vora
- From the New York City Department of Health and Mental Hygiene, New York (J.R.Z., J.B.R., M.I., R.J.A., M.L.-E., N.M.V., J.L.R., B.M.I., A.J., M.A., S.C.H., T.G.M., M.O.K., B.M.M., D.C.D., O.B.), and the Centers for Disease Control and Prevention, Atlanta (J.R.Z., N.M.V.)
| | - Jennifer L Rakeman
- From the New York City Department of Health and Mental Hygiene, New York (J.R.Z., J.B.R., M.I., R.J.A., M.L.-E., N.M.V., J.L.R., B.M.I., A.J., M.A., S.C.H., T.G.M., M.O.K., B.M.M., D.C.D., O.B.), and the Centers for Disease Control and Prevention, Atlanta (J.R.Z., N.M.V.)
| | - Beth M Isaac
- From the New York City Department of Health and Mental Hygiene, New York (J.R.Z., J.B.R., M.I., R.J.A., M.L.-E., N.M.V., J.L.R., B.M.I., A.J., M.A., S.C.H., T.G.M., M.O.K., B.M.M., D.C.D., O.B.), and the Centers for Disease Control and Prevention, Atlanta (J.R.Z., N.M.V.)
| | - Antonine Jean
- From the New York City Department of Health and Mental Hygiene, New York (J.R.Z., J.B.R., M.I., R.J.A., M.L.-E., N.M.V., J.L.R., B.M.I., A.J., M.A., S.C.H., T.G.M., M.O.K., B.M.M., D.C.D., O.B.), and the Centers for Disease Control and Prevention, Atlanta (J.R.Z., N.M.V.)
| | - Mekete Asfaw
- From the New York City Department of Health and Mental Hygiene, New York (J.R.Z., J.B.R., M.I., R.J.A., M.L.-E., N.M.V., J.L.R., B.M.I., A.J., M.A., S.C.H., T.G.M., M.O.K., B.M.M., D.C.D., O.B.), and the Centers for Disease Control and Prevention, Atlanta (J.R.Z., N.M.V.)
| | - Simone C Hawkins
- From the New York City Department of Health and Mental Hygiene, New York (J.R.Z., J.B.R., M.I., R.J.A., M.L.-E., N.M.V., J.L.R., B.M.I., A.J., M.A., S.C.H., T.G.M., M.O.K., B.M.M., D.C.D., O.B.), and the Centers for Disease Control and Prevention, Atlanta (J.R.Z., N.M.V.)
| | - Thomas G Merrill
- From the New York City Department of Health and Mental Hygiene, New York (J.R.Z., J.B.R., M.I., R.J.A., M.L.-E., N.M.V., J.L.R., B.M.I., A.J., M.A., S.C.H., T.G.M., M.O.K., B.M.M., D.C.D., O.B.), and the Centers for Disease Control and Prevention, Atlanta (J.R.Z., N.M.V.)
| | - Maura O Kennelly
- From the New York City Department of Health and Mental Hygiene, New York (J.R.Z., J.B.R., M.I., R.J.A., M.L.-E., N.M.V., J.L.R., B.M.I., A.J., M.A., S.C.H., T.G.M., M.O.K., B.M.M., D.C.D., O.B.), and the Centers for Disease Control and Prevention, Atlanta (J.R.Z., N.M.V.)
| | - Beth Maldin Morgenthau
- From the New York City Department of Health and Mental Hygiene, New York (J.R.Z., J.B.R., M.I., R.J.A., M.L.-E., N.M.V., J.L.R., B.M.I., A.J., M.A., S.C.H., T.G.M., M.O.K., B.M.M., D.C.D., O.B.), and the Centers for Disease Control and Prevention, Atlanta (J.R.Z., N.M.V.)
| | - Demetre C Daskalakis
- From the New York City Department of Health and Mental Hygiene, New York (J.R.Z., J.B.R., M.I., R.J.A., M.L.-E., N.M.V., J.L.R., B.M.I., A.J., M.A., S.C.H., T.G.M., M.O.K., B.M.M., D.C.D., O.B.), and the Centers for Disease Control and Prevention, Atlanta (J.R.Z., N.M.V.)
| | - Oxiris Barbot
- From the New York City Department of Health and Mental Hygiene, New York (J.R.Z., J.B.R., M.I., R.J.A., M.L.-E., N.M.V., J.L.R., B.M.I., A.J., M.A., S.C.H., T.G.M., M.O.K., B.M.M., D.C.D., O.B.), and the Centers for Disease Control and Prevention, Atlanta (J.R.Z., N.M.V.)
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Yacoob Z, Cook C, Kotovicz F, Kram JJ, Klumph M, Stanley M, Hunter P, Baumgardner DJ. Enhancing Immunization Rates in Two Urban Academic Primary Care Clinics: A Before and After Assessment. J Patient Cent Res Rev 2020; 7:47-56. [PMID: 32002447 PMCID: PMC6988711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
PURPOSE Immunization rates in many cities in the United States remain suboptimal compared to Healthy People 2020 Goals and are lower than national averages. This study aimed to determine whether a lecture-based educational intervention targeted at nurses and medical assistants would improve vaccination rates. METHODS We conducted a quality improvement study in two urban academic family medicine clinics serving a predominantly Medicaid patient population as well as a sizable proportion of refugees. The intervention consisted of 3 lectures that were delivered to clinic nurses and medical assistants. Vaccinations in 1689 patients - 872 in the 3-month preintervention period, 817 in the 3-month postintervention period - were analyzed. RESULTS Following the educational intervention, a statistically significant increase was seen only in human papillomavirus vaccine immunization rates for 13-18-year-olds (from 90.7% [n=54] to 100% [n=45]; P=0.036). When the results were stratified by clinic, only 1 site showed statistically significant increases in: pneumococcal polysaccharide vaccine (23-valent) for high-risk 19-to-64-year-olds (from 36.4% [n=154] to 47.8% [n=136]; P=0.049); Haemophilus influenzae type B vaccine for 2-month-to-5-year-olds (from 91.1% [n=112] to 97.3% [n=111]; P=0.048); and meningococcal conjugate vaccine (quadrivalent) for 13-18-year olds (from 85.2% [n=27] to 100% [n=26]; P=0.042). No increases were seen for our study's refugee patient population (n=171), and a significant decrease of the second-dose measles, mumps, and rubella vaccine (P=0.036) occurred in this subcohort. CONCLUSIONS Ultimately, this quality improvement study demonstrated that educational interventions alone have a limited impact on increasing immunization rates.
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Affiliation(s)
- Zeeshan Yacoob
- University of Wisconsin School of Medicine and Public Health, Madison, WI
- Department of Family Medicine, Aurora UW Medical Group, Aurora Health Care, Milwaukee, WI
| | - Christopher Cook
- Department of Family Medicine, Aurora UW Medical Group, Aurora Health Care, Milwaukee, WI
| | - Fabiana Kotovicz
- University of Wisconsin School of Medicine and Public Health, Madison, WI
- Department of Family Medicine, Aurora UW Medical Group, Aurora Health Care, Milwaukee, WI
| | - Jessica J.F. Kram
- University of Wisconsin School of Medicine and Public Health, Madison, WI
- Department of Family Medicine, Aurora UW Medical Group, Aurora Health Care, Milwaukee, WI
- Center for Urban Population Health, Milwaukee, WI
| | - Marianne Klumph
- Department of Family Medicine, Aurora UW Medical Group, Aurora Health Care, Milwaukee, WI
- Center for Urban Population Health, Milwaukee, WI
| | - Marisa Stanley
- Eau Claire City-County Health Department, Eau Claire, WI
| | - Paul Hunter
- University of Wisconsin School of Medicine and Public Health, Madison, WI
- City of Milwaukee Health Department, Milwaukee, WI
| | - Dennis J. Baumgardner
- University of Wisconsin School of Medicine and Public Health, Madison, WI
- Department of Family Medicine, Aurora UW Medical Group, Aurora Health Care, Milwaukee, WI
- Center for Urban Population Health, Milwaukee, WI
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