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Dang Y, Yang Y, Cao S, Zhang J, Wang X, Lu J, Liang Q, Hu X. Exploring the factors influencing the use of health services by people with diabetes in Northwest China: an example from Gansu Province. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2023; 42:64. [PMID: 37420259 DOI: 10.1186/s41043-023-00402-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 06/18/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND Diabetes is associated with high morbidity, mortality and quality-of-life impairment in patients. In China, the number of people suffering from diabetes ranks first in the world. Gansu Province is located in northwest China and is an economically underdeveloped region of China. By analyzing the level of health service utilization of people with diabetes in Gansu Province, the degree of equity in health service utilization and its influencing factors were studied to provide scientific data to support the promotion of health equity for people with diabetes and the introduction of relevant policies by relevant authorities. METHODS A sample of 282 people with diabetes who were 15 years old and above was chosen by multi-stage stratified sampling method. A structured questionnaire survey was conducted via face-to-face interviews. Random forest and logistic regression analysis were used to demonstrate the effects of the explanatory variables on health seeking behaviors from predisposing, enabling and need variables. The concentration index was used to indicate the equity of health service utilization across households of different economic levels. RESULTS The outpatient rate for the diabetic population surveyed was 92.91%, with 99.87% of urban patients, higher than the 90.39% of rural patients. The average number of hospital days per person was 3.18 days, with 5.03 days per person in urban areas, which was higher than the 2.51 days per person in rural areas. The study showed that the factors most likely to influence patients to seek outpatient services were frequency of taking diabetic medication, whether or not they were contracted to a household doctor, and living environment; the top three factors most likely to influence patients with diabetes to seek inpatient services were number of non-communicable chronic disease, self-assessment of health status, medical insurance. The concentration index for outpatient service utilization and inpatient service utilization were - 0.241 and 0.107, respectively, indicating that outpatient services were concentrated on patients at lower income levels and patients at higher income levels tended to favor inpatient services. CONCLUSION This study found that the low level of health care resources available to people with diabetes, whose health status is suboptimal, makes it difficult to meet their health needs. Patients' health conditions, comorbidities of people with diabetes, and the level of protection were still important factors that hindered the use of health services. It is necessary to promote the rational use of health services by diabetic patients and further improve the corresponding policies to achieve the goal of chronic disease prevention and control in "Health China 2030".
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Affiliation(s)
- Ying Dang
- Department of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Yinan Yang
- Department of Pediatric Cardiology, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Shuting Cao
- Department of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Jia Zhang
- Department of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Xiao Wang
- Department of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Jie Lu
- Health Statistics Information Center of Gansu Province, Lanzhou, Gansu Province, China
| | - Qijun Liang
- Gansu Medical Insurance Service Centre, Lanzhou, Gansu Province, China.
| | - Xiaobin Hu
- Department of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, China.
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Mahachi K, Kessels J, Boateng K, Jean Baptiste Achoribo AE, Mitula P, Ekeman E, Nic Lochlainn L, Rosewell A, Sodha SV, Abela-Ridder B, Gabrielli AF. Zero- or missed-dose children in Nigeria: Contributing factors and interventions to overcome immunization service delivery challenges. Vaccine 2022; 40:5433-5444. [PMID: 35973864 PMCID: PMC9485449 DOI: 10.1016/j.vaccine.2022.07.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 06/11/2022] [Accepted: 07/24/2022] [Indexed: 11/28/2022]
Abstract
Comprehensive review of recent literature on zero- or missed-dose children in Nigeria. Risk factors are well-known and widely studied. Literature on interventions was scattered, and focussed on campaigns and polio. Gaps exist in investigating how to deliver sustainable immunization programs. Further work is needed to operationalise findings of this review.
'Zero-dose' refers to a person who does not receive a single dose of any vaccine in the routine national immunization schedule, while ‘missed dose’ refers to a person who does not complete the schedule. These people remain vulnerable to vaccine-preventable diseases, and are often already disadvantaged due to poverty, conflict, and lack of access to basic health services. Globally, more 22.7 million children are estimated to be zero- or missed-dose, of which an estimated 3.1 million (∼14 %) reside in Nigeria. We conducted a scoping review to synthesize recent literature on risk factors and interventions for zero- and missed-dose children in Nigeria. Our search identified 127 papers, including research into risk factors only (n = 66); interventions only (n = 34); both risk factors and interventions (n = 18); and publications that made recommendations only (n = 9). The most frequently reported factors influencing childhood vaccine uptake were maternal factors (n = 77), particularly maternal education (n = 22) and access to ante- and perinatal care (n = 19); heterogeneity between different types of communities – including location, region, wealth, religion, population composition, and other challenges (n = 50); access to vaccination, i.e., proximity of facilities with vaccines and vaccinators (n = 37); and awareness about immunization – including safety, efficacy, importance, and schedules (n = 18). Literature assessing implementation of interventions was more scattered, and heavily skewed towards vaccination campaigns and polio eradication efforts. Major evidence gaps exist in how to deliver effective and sustainable routine childhood immunization. Overall, further work is needed to operationalise the learnings from these studies, e.g. through applying findings to Nigeria’s next review of vaccination plans, and using this summary as a basis for further investigation and specific recommendations on effective interventions.
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Affiliation(s)
- Kurayi Mahachi
- College of Public Health, University of Iowa, Iowa City, Iowa, United States
| | | | - Kofi Boateng
- Nigeria Country Office, World Health Organization, Abuja, Nigeria
| | | | - Pamela Mitula
- Inter-Country Support Team, Regional Office for Africa, World Health Organization, Ouagadougou, Burkina Faso
| | - Ebru Ekeman
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
| | - Laura Nic Lochlainn
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
| | - Alexander Rosewell
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
| | - Samir V Sodha
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
| | - Bernadette Abela-Ridder
- Department of Control of Neglected Tropical Diseases (NTD), World Health Organization, Geneva, Switzerland
| | - Albis Francesco Gabrielli
- Department of Control of Neglected Tropical Diseases (NTD), World Health Organization, Geneva, Switzerland.
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Hsu YH, Chen CW, Lin YJ, Li CY. Urban-Rural Disparity in the Incidence of Diagnosed Autism Spectrum Disorder in Taiwan: A 10-Year National Birth Cohort Follow-up Study. J Autism Dev Disord 2022; 53:2127-2137. [PMID: 35132529 DOI: 10.1007/s10803-022-05453-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2022] [Indexed: 12/15/2022]
Abstract
Autism spectrum disorder (ASD) is reportedly more prevalent in urban areas partly because of better accessibility and affordability to healthcare. With universal health insurance coverage in Taiwan, a previous study has shown no urban-rural disparity in the utilization rate of a child's preventive healthcare. Under this circumstance, we followed a birth cohort of 176,273 live births from 2006 to 2015 to detect the differences in ASD incidence between urbanicities. After adjusting for socioeconomic factors, children were 1.28 (95% confidence interval (CI): 1.13-1.44) and 1.54 (95% CI: 1.36-1.75) more likely to acquire ASD in satellite and urban areas compared with those in rural areas, respectively. A gradient association between parental educational attainment and ASD incidence was also noted. Greater ASD incidences in more urbanized areas and more advanced educated parents' children were detected under a circumstance with low barriers to healthcare.
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Affiliation(s)
- Yuu-Hueih Hsu
- Department of Public Health, National Cheng Kung University, No. 138, Shengli Rd., North Dist., Tainan, 704302, Taiwan
| | - Chi-Wen Chen
- College of Nursing, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St., Taipei, 112, Taiwan
| | - Yuh-Jyh Lin
- Department of Pediatrics, National Cheng Kung University Hospital, No. 138, Shengli Rd., North Dist., Tainan, 704302, Taiwan
| | - Chung-Yi Li
- Department of Public Health, National Cheng Kung University, No. 138, Shengli Rd., North Dist., Tainan, 704302, Taiwan. .,Department of Public Health, College of Public Health, China Medical University, No. 91, Hsueh-Shih Rd., Taichung, 40402, Taiwan. .,Department of Healthcare Administration, College of Medical and Health Science, Asia University, No. 500, Lioufeng Rd., Wufeng, Taichung, 41354, Taiwan.
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Srivastava S, Muhammad T, Rashmi R, Kumar P. Socioeconomic inequalities in non- coverage of full vaccination among children in Bangladesh: a comparative study of Demographic and Health Surveys, 2007 and 2017-18. BMC Public Health 2022; 22:183. [PMID: 35086495 PMCID: PMC8793237 DOI: 10.1186/s12889-022-12555-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 01/11/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Vaccination is considered as a powerful and cost-effective weapon against many communicable diseases. An increase in full vaccination among the most vulnerable populations in Bangladesh was observed in the last decade. This study aimed to capture the socioeconomic inequalities in non-coverage of full vaccination among children aged 12-23 months using the nationally representative data from the Bangladesh Demographic and Health Surveys (BDHS). METHODS Data for this study have been drawn from the 2007 and 2017-18 BDHS, which covered 10,996 and 20,127 ever-married women aged 15-49 years in 2007 and 2017-18, respectively. Binary logistic regression analysis was performed to find the factors associated with children who did not receive full vaccination. Further, the concentration index was used to observe the socioeconomic inequality for the outcome variable. RESULTS The proportion of children who did not get fully vaccinated decreased by more than 6 points (18.2 percent to 11.8 percent) between the years 2007 and 2017-18. In 2017-18, the odds of children who were not fully vaccinated were 58 percent and 53 percent less among mothers who had primary education in 2007 [adjusted odds ratio (AOR): 0.42; confidence interval (CI): 0.24-0.73] and 2017-18 [AOR: 0.47; CI: 0.23-0.94] respectively, compared to mothers with no education. The inequality for children who were not fully vaccinated had declined between two survey periods [concentration index (CCI) value of - 0.13 in 2007 and -0.08 in 2017-18]. The concentration of inequality in children with higher parity who did not receive full vaccination had increased from 5 percent in 2007 to 16.9 percent in 2017-18. There was a drastic increase in the socioeconomic inequality contributed by place of delivery from 2.9 percent (2007) to 60.5 percent (2017-18) among children who did not receive full vaccination. CONCLUSIONS The present study provide eminent evidence that non-coverage of full vaccination is more prevalent among children from poor households in Bangladesh, which is mainly associated with factors like mother's education, father's education and working status and household wealth index across the two rounds. These factors suggest multifaceted pro-poor interventions that will protect them from hardship and reduce their socioeconomic inequalities in coverage of full vaccination.
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Affiliation(s)
- Shobhit Srivastava
- International Institute for Population Sciences, Maharashtra 400088 Mumbai, India
| | - T. Muhammad
- International Institute for Population Sciences, Maharashtra 400088 Mumbai, India
| | - Rashmi Rashmi
- International Institute for Population Sciences, Maharashtra 400088 Mumbai, India
| | - Pradeep Kumar
- International Institute for Population Sciences, Maharashtra 400088 Mumbai, India
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Oamen TE, Osemene KP, Ihekoronye RM. Assessing the Application of Pharmacoeconomic Evaluations in Medicines Management by Hospital Pharmacists in Nigeria: A Cross-Sectional Survey. Hosp Top 2021; 101:165-174. [PMID: 34821536 DOI: 10.1080/00185868.2021.2001400] [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] [Indexed: 10/19/2022]
Abstract
Application of pharmacoeconomic data for decision making in medicines management is still nascent in most developing countries. Yet, escalating medication costs amidst rising budgetary constraints call for widespread application of economic evidence to maximize available healthcare resources. This study was a descriptive cross-sectional survey of randomly-selected hospital pharmacists from secondary and tertiary healthcare facilities in Ogun State, Southwestern Nigeria, conducted between June and August 2019. A semi-structured questionnaire was used for primary data collection. Appropriate descriptive and inferential statistics were used for data analysis at p < 0.05. Knowledge of pharmacoeconomic concepts was found to be still evolving (mean weighted average, MWA 2.07) among respondents while their ages and ranks had significant associations (P < 0.05) with their knowledge and attitudes. They had a fairly positive attitude toward pharmacoeconomic evaluations (MWA 2.997). Practice of pharmacoeconomic evaluations was inadequate (MWA 2.36). Appropriate policy action and targeted training are strongly recommended.
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Affiliation(s)
- Theophilus Ehidiamen Oamen
- Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Kanayo Patrick Osemene
- Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Romanus Maduabuchi Ihekoronye
- Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, Obafemi Awolowo University, Ile-Ife, Nigeria
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Kadota JL, Katamba A, Musinguzi A, Welishe F, Nabunje J, Ssemata JL, Berger CA, Kamya MR, Namusobya J, Semitala FC, Cattamanchi A, Dowdy DW. Willingness to accept reimbursement for visits to an HIV clinic for tuberculosis preventive therapy. Int J Tuberc Lung Dis 2021; 24:729-731. [PMID: 32718409 DOI: 10.5588/ijtld.20.0010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- J L Kadota
- Division of Pulmonary and Critical Care Medicine and Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA
| | - A Katamba
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda, Department of Medicine, Makerere University, Kampala, Uganda
| | - A Musinguzi
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - F Welishe
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - J Nabunje
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - J L Ssemata
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - C A Berger
- Division of Pulmonary and Critical Care Medicine and Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA
| | - M R Kamya
- Department of Medicine, Makerere University, Kampala, Uganda, Infectious Diseases Research Collaboration, Kampala, Uganda
| | - J Namusobya
- University Research Company, Center for Human Services, Department of Defense HIV/AIDS Prevention Program (URC-DHAPP), Kampala, Uganda
| | - F C Semitala
- Department of Medicine, Makerere University, Kampala, Uganda, Infectious Diseases Research Collaboration, Kampala, Uganda, Makerere University Joint AIDS Program, Kampala, Uganda
| | - A Cattamanchi
- Division of Pulmonary and Critical Care Medicine and Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA, Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
| | - D W Dowdy
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, ,
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Kadota JL, Nabwire S, Nalugwa T, White JS, Cattamanchi A, Katamba A, Shete PB. Patient Perspectives and Willingness to Accept Incentives for Tuberculosis Diagnostic Evaluation in Uganda. Value Health Reg Issues 2021; 25:48-56. [PMID: 33773327 DOI: 10.1016/j.vhri.2020.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 12/02/2020] [Accepted: 12/10/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVES We assessed attitudes and perceptions and willingness to accept (WTA) varying incentive structures for completing tuberculosis (TB) diagnostic evaluation among patients in Uganda. METHODS We surveyed 177 adult patients undergoing TB evaluation at 10 health centers between September 2018 and March 2019. We collected household sociodemographic information and assessed attitudes and perceptions of incentives. We surveyed patients regarding their willingness to complete TB diagnostic evaluation in exchange for incentives ranging in value from 500 Ugandan shillings (USh) to 25 000USh (~$0.15-$6.75). We compared associations between WTA and patient characteristics using ordered logistic regression. RESULTS Participant willingness to return to the health center to complete TB diagnostic evaluation increased proportionally with incentive amount. The median participant accepted between 2000 and 5000 USh. Cash (52%) and transportation vouchers (34%) were the most popular incentive types. Half of respondents preferred unconditional incentives; for a multiday evaluation, 84% preferred conditioning incentive receipt upon returning to the health center. In multivariate models, we found the pairwise difference between the third and lowest income quartile (aOR = 2.38, 95% CI: 1.20-4.69; P = .01), younger age, and difficulty returning to the health center to be significantly associated with WTA higher incentive thresholds. CONCLUSIONS In Uganda, incentives such as cash transfers or transportation vouchers are an acceptable intervention for facilitating adherence to TB diagnostic evaluation. Household income is associated with preferred incentive structure and amount, especially for those at the cusp of the poverty threshold who are more likely to prefer unconditional and higher valued incentives. Targeted and context-specific socioeconomic supports for at-risk patients are needed to optimize outcomes.
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Affiliation(s)
- Jillian L Kadota
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco, San Francisco, CA USA.
| | - Sarah Nabwire
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
| | - Talemwa Nalugwa
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
| | - Justin S White
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA
| | - Adithya Cattamanchi
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco, San Francisco, CA USA; Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
| | - Achilles Katamba
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda; Clinical Epidemiology & Biostatistics Unit, Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Priya B Shete
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco, San Francisco, CA USA; Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
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Dougherty L, Abdulkarim M, Ahmed A, Cherima Y, Ladan A, Abdu S, Kilgori B, Olayinka F, Garr S, Gilroy KE. Engaging traditional barbers to identify and refer newborns for routine immunization services in Sokoto, Nigeria: a mixed methods evaluation. Int J Public Health 2020; 65:1785-1795. [PMID: 33140237 PMCID: PMC7716909 DOI: 10.1007/s00038-020-01518-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES This study evaluates the effectiveness of an intervention that engaged traditional barbers to inform parents about the importance of vaccination and then refer newborns for vaccination services. METHODS We conducted a pre-post quasi-experimental study (n = 2639) to evaluate changes in the coverage of three birth antigens among children aged 0-5 months in response to the intervention. We also conducted in-depth interviews and focus group discussions to assess the enabling factors and challenges associated with implementation. RESULTS We found mothers who received a yellow referral card from a traditional barber were two to three times more likely to vaccinate their children with the three birth antigens. Qualitative findings indicated that the intervention influenced parent's decision to vaccinate their newborn because the barbers were considered a trusted community advisor. Challenges stemmed from the low levels of literacy among community leaders and barbers that resulted in the need for continuous training, low-literacy training materials and supervision. CONCLUSIONS Efforts to increase vaccine coverage rates in northern Nigeria should consider expanding the role of traditional barbers to encourage parents to accept vaccines.
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Affiliation(s)
- Leanne Dougherty
- Maternal and Child Survival Program (MCSP), John Snow, Inc. (JSI), 2733 Crystal Dr 4th Floor, Arlington, VA, 22202, USA.
| | - Masduk Abdulkarim
- Maternal and Child Survival Program (MCSP), John Snow, Inc. (JSI), 2733 Crystal Dr 4th Floor, Arlington, VA, 22202, USA
| | - Aliyu Ahmed
- Maternal and Child Survival Program (MCSP), John Snow, Inc. (JSI), 2733 Crystal Dr 4th Floor, Arlington, VA, 22202, USA
| | - Yakubu Cherima
- Maternal and Child Survival Program (MCSP), John Snow, Inc. (JSI), 2733 Crystal Dr 4th Floor, Arlington, VA, 22202, USA
| | - Aliyu Ladan
- Maternal and Child Survival Program (MCSP), John Snow, Inc. (JSI), 2733 Crystal Dr 4th Floor, Arlington, VA, 22202, USA
| | - Sale Abdu
- Maternal and Child Survival Program (MCSP), John Snow, Inc. (JSI), 2733 Crystal Dr 4th Floor, Arlington, VA, 22202, USA
| | - Bello Kilgori
- Maternal and Child Survival Program (MCSP), John Snow, Inc. (JSI), 2733 Crystal Dr 4th Floor, Arlington, VA, 22202, USA
| | - Folake Olayinka
- Maternal and Child Survival Program (MCSP), John Snow, Inc. (JSI), 2733 Crystal Dr 4th Floor, Arlington, VA, 22202, USA
| | - Sani Garr
- Data Research and Mapping Consult Ltd, Lagos, Nigeria
| | - Kate E Gilroy
- Maternal and Child Survival Program (MCSP), John Snow, Inc. (JSI), 2733 Crystal Dr 4th Floor, Arlington, VA, 22202, USA
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Anderson JD, Pecenka CJ, Bagamian KH, Rheingans RD. Effects of geographic and economic heterogeneity on the burden of rotavirus diarrhea and the impact and cost-effectiveness of vaccination in Nigeria. PLoS One 2020; 15:e0232941. [PMID: 32469927 PMCID: PMC7259699 DOI: 10.1371/journal.pone.0232941] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 04/25/2020] [Indexed: 12/29/2022] Open
Abstract
Child mortality from rotavirus gastroenteritis remains high in Nigeria, representing 14% of all rotavirus deaths worldwide. Here, we examine the potential impact and cost-effectiveness of national rotavirus vaccine introduction in geographic and economic subpopulations of Nigeria. We projected the health and economic outcomes of rotavirus vaccination in children over the first five years of life using a spreadsheet-based model. We modeled child populations using national survey data on rotavirus mortality risk factors and vaccination coverage to predict burden and impact across regional and wealth quintile subpopulations within Nigeria. Our base case considered introduction of a general rotavirus vaccine, modeled to encompass characteristics of existing vaccines, versus no vaccine. Base case costs were estimated from the government perspective, assuming Gavi subsidies, over the first five years. We also present estimates from the cost of vaccination from the perspective of Gavi. We explored uncertainty in model parameters through probabilistic uncertainty, one-way sensitivity, and scenario analyses. According to our estimates, rotavirus enteritis was responsible for 47,898 [95% Uncertainty Limits: 35,361; 63,703] child deaths per year, with approximately 80% of the national burden concentrated in the three northern regions of Nigeria. Rotavirus vaccination was estimated to prevent 6,454 [3,960; 9,721] deaths, 13% [9%; 18%] of the national annual RV burden. National ICERs for rotavirus vaccination from the Nigerian government and Gavi perspectives were US$47 [$18; $105] and $62 [$29; $130] per DALY averted, respectively. General rotavirus vaccination was projected to reduce rotavirus mortality by only 6% [4%; 9%] in the North West region compared to 35% [24%; 47%] in the South East region. Base case ICERs ranged from US$25 [10; 56] per DALY averted in North West to US$64 [18; 157] per DALY averted in South South. Gavi perspective ICERs ranged from US$33 [$15; $68] in North West to US$88 [35; 191] per DALY averted in South South. According to one-way sensitivity analyses, ICERs were most sensitive to vaccine efficacy, followed by estimated administrative costs and rotavirus mortality. Disparities in mortality reduction were largely driven by inequality in vaccination coverage across regions and between socioeconomic subpopulations. Due to high, persistent, and inequitable burden of rotavirus in Nigeria, routine vaccination with any of these rotavirus vaccines would be an high impact and cost-effective strategy in reducing child mortality.
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Affiliation(s)
- John D. Anderson
- Goodnight Family Department of Sustainable Development, Appalachian State University, Boone, NC, United States of America
- * E-mail:
| | - Clinton J. Pecenka
- Center for Vaccine Innovation and Access, PATH, Seattle, WA, United States of America
| | - Karoun H. Bagamian
- Bagamian Scientific Consulting, Gainesville, FL, United States of America
- Department of Environmental and Global Health, University of Florida, Gainesville, FL, United States of America
| | - Richard D. Rheingans
- Goodnight Family Department of Sustainable Development, Appalachian State University, Boone, NC, United States of America
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Sato R, Belel A. The effect of performance-based financing on child vaccinations in northern Nigeria. Vaccine 2020; 38:2209-2215. [PMID: 31983583 DOI: 10.1016/j.vaccine.2020.01.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/08/2019] [Accepted: 01/09/2020] [Indexed: 11/26/2022]
Abstract
Vaccination is known to be one of the most cost-effective ways to avert child deaths. However, in Nigeria, the vaccination completion rate among children is extremely low and the child mortality rate is one of the highest in the world. National immunization coverage survey shows that the low vaccination rate in Nigeria is partly attributed to service delivery issues. This paper evaluates the effect of Performance-Based Financing (PBF), an incentive scheme where health facilities are funded based on their performance, on the quantity of vaccinations carried out in Adamawa state. Under the Nigeria State Health Investment Project (NSHIP), half of the Local Government Areas (LGAs) in Adamawa State were randomly assigned to receive PBF intervention between 2015 and 2018. The Difference-in-Differences (DiD) technique as well as ANCOVA analysis are used to evaluate the effect of PBF on vaccination service delivery indicators. We find that the PBF intervention significantly increased the quantity of full vaccination cases as compared to the comparison group, although the effect size was small. On the other hand, if health facilities receive intensified PEI (Polio Eradication Initiative) concurrently, the effectiveness of PBF in increasing the number of full vaccination cases do not differ significantly from health facilities that are not under PBF. Rather than providing conditional financial incentives such as PBF to health facilities, simply providing unconditional financial and technical assistance to strengthen routine immunization programs might be sufficient to increase the quantity of vaccination service provision. The positive effect of PBF on vaccination provision was not sustainable, either. Future work should explore how we can strengthen the health system in a cost-effective and sustainable way.
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Affiliation(s)
- Ryoko Sato
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA.
| | - Abdullahi Belel
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
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Yugbaré Belemsaga D, Goujon A, Degomme O, Nassa T, Duysburgh E, Kouanda S, Temmerman M. Assessing changes in costs of maternal postpartum services between 2013 and 2014 in Burkina Faso. Int J Equity Health 2019; 18:154. [PMID: 31615526 PMCID: PMC6794858 DOI: 10.1186/s12939-019-1064-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 09/30/2019] [Indexed: 11/23/2022] Open
Abstract
Introduction In Africa, a majority of women bring their infant to health services for immunization, but few are checked in the postpartum (PP) period. The Missed opportunities for maternal and infant health (MOMI) EU-funded project has implemented a package of interventions at community and facility levels to uptake maternal and infant postpartum care (PPC). One of these interventions is the integration of maternal PPC in child clinics and infant immunization services, which proved to be successful for improving maternal and infant PPC. Aim Taking stock of the progress achieved in terms of PPC with the implementation of the interventions, this paper assesses the economic cost of maternal PPC services, for health services and households, before and after the project start in Kaya health district (Burkina Faso). Methods PPC costs to health services are estimated using secondary data on personnel and infrastructure and primary data on time allocation. Data from two household surveys collected before and after one year intervention among mothers within one year PP are used to estimate the household cost of maternal PPC visits. We also compare PPC costs for households and health services with or without integration. We focus on the costs of the PPC intervention at days 6–10 that was most successful. Results The average unit cost of health services for days 6–10 maternal PPC decreased from 4.6 USD before the intervention in 2013 (Jan-June) to 3.5 USD after the intervention implementation in 2014. Maternal PPC utilization increased with the implementation of the interventions but so did days 6–10 household mean costs. Similarly, the household costs increased with the integration of maternal PPC to BCG immunization. Conclusion In the context of growing reproductive health expenditures from many funding sources in Burkina Faso, the uptake of maternal PPC led to a cost reduction, as shown for days 6–10, at health services level. Further research should determine whether the increase in costs for households would be deterrent to the use of integrated maternal and infant PPC.
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Affiliation(s)
- Danielle Yugbaré Belemsaga
- Biomedical and Public Health Department, Institut de Recherche en Sciences de la Santé, 03 B. P 7192, Ouagadougou, 03, Burkina Faso. .,Wittgenstein Centre for Demography and Global Human Capital (IIASA, VID/OAW, WU), Vienna, Austria.
| | - Anne Goujon
- Wittgenstein Centre for Demography and Global Human Capital (IIASA, VID/OAW, WU), Vienna, Austria
| | - Olivier Degomme
- International Centre for Reproductive Health, Faculty of Medicine and Health Sciences, Department of public health and primary care, Ghent University, Ghent, Belgium
| | - Tchichihouenichidah Nassa
- Direction générale des études et des statistiques sectorielles (DGESS), Ministère de la santé, Ouagadougou, Burkina Faso
| | - Els Duysburgh
- International Centre for Reproductive Health, Faculty of Medicine and Health Sciences, Department of public health and primary care, Ghent University, Ghent, Belgium
| | - Seni Kouanda
- Biomedical and Public Health Department, Institut de Recherche en Sciences de la Santé, 03 B. P 7192, Ouagadougou, 03, Burkina Faso.,African Institute of Public Health, Ouagadougou, Burkina Faso
| | - Marleen Temmerman
- International Centre for Reproductive Health, Faculty of Medicine and Health Sciences, Department of public health and primary care, Ghent University, Ghent, Belgium.,Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
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Sibeudu FT, Uzochukwu BS, Onwujekwe OE. Rural-urban comparison of routine immunization utilization and its determinants in communities in Anambra States, Nigeria. SAGE Open Med 2019; 7:2050312118823893. [PMID: 30719291 PMCID: PMC6348577 DOI: 10.1177/2050312118823893] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 12/17/2018] [Indexed: 11/17/2022] Open
Abstract
Objectives: The study determined the levels of geographic differences in the utilization of routine immunization between households in an urban and a rural community. It also identified and compared the determinants of utilization of routine immunization in the two geographic areas. Method: The study was undertaken in two randomly selected communities (one rural and one urban) in Anambra State, Nigeria. Interviewer-administered questionnaires were used to collect information on utilization of immunization services from households. Data were analyzed using descriptive and multiple logistic regression analyses. Result: Households in the urban community had a higher level of utilization of routine immunization (95.5%) than those in the rural community (75.3%) and the difference was statistically significant (p < 0.05). It was also found that more rural dwellers (83.3%) received immunization services from public health facilities compared to the urban dwellers (42%; p < 0.05). Health facilities were nearer to households in the urban community than the rural community (p < 0.05). Mean cost of service per visit was higher in the urban community (p < 0.05), but the difference in the mean cost of transportation per visit was not significant (p = 0.125). Regression analysis shows that place of residence was highly significant for utilization of routine immunization services (p < 0.05). Conclusion: Urban–rural differences exist in utilization of routine immunization services. Health facilities are more proximal to consumers in the urban community than the rural community, with higher travel costs among rural dwellers. Ensuring that there is a functional primary healthcare center in every ward and provision of routine immunization services in market places on local market days can help to increase utilization and reduce rural–urban differences in utilization of immunization services.
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Affiliation(s)
- Florence Tochukwu Sibeudu
- Department of Nursing Science, College of Health Sciences, Nnamdi Azikiwe University, Nnewi, Nigeria.,Department of Health Administration and Management, College of Medicine, University of Nigeria, Enugu, Nigeria
| | - Benjamin Sc Uzochukwu
- Department of Health Administration and Management, College of Medicine, University of Nigeria, Enugu, Nigeria.,Department of Community Medicine, College of Medicine, University of Nigeria, Enugu, Nigeria
| | - Obinna E Onwujekwe
- Department of Health Administration and Management, College of Medicine, University of Nigeria, Enugu, Nigeria.,Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria, Enugu, Nigeria
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Yu W, Lu M, Wang H, Rodewald L, Ji S, Ma C, Li Y, Zheng J, Song Y, Wang M, Wang Y, Wu D, Cao L, Fan C, Zhang X, Liu Y. Routine immunization services costs and financing in China, 2015. Vaccine 2018; 36:3041-3047. [PMID: 29685593 DOI: 10.1016/j.vaccine.2018.04.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 03/21/2018] [Accepted: 04/03/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To estimate the costs of routine immunization (RI) services in China in 2015, to provide objective data relevant to investment in the Expanded Program on Immunization, and to contribute to global data on costing and financing of RI. METHODS The study was conducted between January and March 2016. We selected 276 villages, 138 townships, 46 counties, and 40 prefectures from 15 provinces as investigation sites at random, stratified by eastern, middle, and western regions. Direct cost items included vaccines, personnel, cold chain, surveillance, communication, training, and supervision at the national, provincial, prefecture, county, township, and village levels. We obtained financial data from governmental and external sources. Indirect costs of RI included parents' transportation costs and productivity lost due to taking their children for vaccination. RESULTS Total direct costs were $92.42 for each child fully immunized ($4.20/dose), which equates to $1529.55 million per birth cohort. RI costs were higher in the eastern region than in the western region, and higher than that of the central region. Vaccination coverage was positively associated with direct routine immunization costs. The cost of the recommended vaccines was $19.08/child and vaccine only accounted for 20.64% of total costs. Operational cost, including surveillance, communication, training and supervision, was $217.31/child, accounting for 14.21% of total cost. The indirect cost per child was $72.86; the total indirect cost was $1205.83 million for the birth cohort. Government investment in RI accounted for about 70% of total costs. Revenue from sales of private-sector vaccine supported the remaining 30% of RI costs. CONCLUSIONS While government financing has increased, some operating costs continue to be provided from revenue generated by sales of Category 2 (private-sector) vaccines to families. China could benefit from bringing new and underutilized vaccines into the EPI system based on evidence that includes routine immunization vaccine and operations costs.
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Affiliation(s)
- Wenzhou Yu
- National Immunization Program, Chinese Center for Disease Control and Prevention, No. 27, Nanwei Road, Xicheng District, Beijing, China
| | - Ming Lu
- National Health and Family Planning Commission of the People's Republic of China, No. 1, Xizhimenwai Street, Xicheng District, Beijing, China
| | - Huaqing Wang
- National Immunization Program, Chinese Center for Disease Control and Prevention, No. 27, Nanwei Road, Xicheng District, Beijing, China
| | - Lance Rodewald
- World Health Organization Office in China, 401, Dongwai Diplomatic Office Building, No. 23, Dong zhi men wai Street, Beijing, China
| | - Saisai Ji
- National Immunization Program, Chinese Center for Disease Control and Prevention, No. 27, Nanwei Road, Xicheng District, Beijing, China
| | - Chao Ma
- National Immunization Program, Chinese Center for Disease Control and Prevention, No. 27, Nanwei Road, Xicheng District, Beijing, China
| | - Yixing Li
- National Immunization Program, Chinese Center for Disease Control and Prevention, No. 27, Nanwei Road, Xicheng District, Beijing, China
| | - Jingshan Zheng
- National Immunization Program, Chinese Center for Disease Control and Prevention, No. 27, Nanwei Road, Xicheng District, Beijing, China
| | - Yifan Song
- National Immunization Program, Chinese Center for Disease Control and Prevention, No. 27, Nanwei Road, Xicheng District, Beijing, China
| | - Miao Wang
- National Immunization Program, Chinese Center for Disease Control and Prevention, No. 27, Nanwei Road, Xicheng District, Beijing, China
| | - Yamin Wang
- National Immunization Program, Chinese Center for Disease Control and Prevention, No. 27, Nanwei Road, Xicheng District, Beijing, China
| | - Dan Wu
- National Immunization Program, Chinese Center for Disease Control and Prevention, No. 27, Nanwei Road, Xicheng District, Beijing, China
| | - Lei Cao
- National Immunization Program, Chinese Center for Disease Control and Prevention, No. 27, Nanwei Road, Xicheng District, Beijing, China
| | - Chunxiang Fan
- National Immunization Program, Chinese Center for Disease Control and Prevention, No. 27, Nanwei Road, Xicheng District, Beijing, China
| | - Xuan Zhang
- National Immunization Program, Chinese Center for Disease Control and Prevention, No. 27, Nanwei Road, Xicheng District, Beijing, China
| | - Yanmin Liu
- National Immunization Program, Chinese Center for Disease Control and Prevention, No. 27, Nanwei Road, Xicheng District, Beijing, China.
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