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Hester KA, Sakas Z, Ellis AS, Bose AS, Darwar R, Gautam J, Jaishwal C, James H, Keskinocak P, Nazzal D, Awino Ogutu E, Rodriguez K, Castillo Zunino F, Dixit S, Bednarczyk RA, Freeman MC. Critical success factors for high routine immunization performance: A case study of Nepal. Vaccine X 2022; 12:100214. [PMID: 36148265 PMCID: PMC9486040 DOI: 10.1016/j.jvacx.2022.100214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 07/14/2022] [Accepted: 08/31/2022] [Indexed: 12/04/2022] Open
Abstract
Nepal reported high and sustained immunization coverage compared to peers. National and multi-national partnerships supported information sharing, division of labor, and mutual capacity building. Pro-vaccine messaging through various mediums, including Female Community Health Volunteers, which was tailored to local needs, generated public awareness. Cultural values fostered collective responsibility and community ownership of vaccine coverage.
Introduction The essential components of a vaccine delivery system are well-documented, but robust evidence on how and why the related processes and implementation strategies drive catalytic improvements in vaccination coverage are not well established. To address this gap, we identified critical success factors that may have led to substantial improvements in routine childhood immunization coverage in Nepal from 2000 through 2019. Methods We identified Nepal as an exemplar in the delivery of early childhood immunization through analysis of DTP1 and DTP3 coverage data. Through interviews and focus group discussions at the national, regional, district, health post, and community level, we investigated factors that contributed to high and sustained vaccine coverage. We conducted a thematic analysis through application of implementation science frameworks to determine critical success factors. We triangulated these findings with quantitative analyses using publicly available data. Results The following success factors emerged: 1) Codification of health as a human right, - along with other vaccine-specific legislation - ensured the stability of vaccination programming; 2) National and multi-national partnerships supported information sharing, division of labor, and mutual capacity building; 3) Pro-vaccine messaging through various mediums, which was tailored to local needs, generated public awareness; 4) Female Community Health Volunteers educated community members as trusted and compassionate neighbors; and 5) Cultural values fostered collective responsibility and community ownership of vaccine coverage. Conclusion This case study of Nepal suggests that the success of its national immunization program relied on the engagement and understanding of the beneficiaries. The immunization program was supported by consistent and reliable commitment, collaboration, awareness, and collective responsibility between the government, community, and partners. These networks are strengthened through a collective dedication to vaccination programming and a universal belief in health as a human right.
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Affiliation(s)
- Kyra A. Hester
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Zoe Sakas
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Anna S. Ellis
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Anindya S. Bose
- World Health Organization, Nepal-Immunization Prevention Division, Nepal
| | - Roopa Darwar
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jhalak Gautam
- Family Welfare Division, Department of Health Services, Ministry of Health and Population, Nepal
| | - Chandni Jaishwal
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Hanleigh James
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Pinar Keskinocak
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Dima Nazzal
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | | | - Katie Rodriguez
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Francisco Castillo Zunino
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | | | | | - Matthew C. Freeman
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Corresponding author at: 1518 Clifton Road NE, Atlanta, GA 30322, USA.
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Minta AA, Ferrari M, Antoni S, Portnoy A, Sbarra A, Lambert B, Hauryski S, Hatcher C, Nedelec Y, Datta D, Ho LL, Steulet C, Gacic-Dobo M, Rota PA, Mulders MN, Bose AS, Perea WA, O’Connor P. Progress Toward Regional Measles Elimination - Worldwide, 2000-2021. MMWR Morb Mortal Wkly Rep 2022; 71:1489-1495. [PMID: 36417303 PMCID: PMC9707362 DOI: 10.15585/mmwr.mm7147a1] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
All six World Health Organization (WHO) regions have committed to eliminating measles.* The Immunization Agenda 2021-2030 (IA2030)† aims to achieve the regional targets as a core indicator of impact and positions measles as the tracer of a health system's ability to deliver essential childhood vaccines. IA2030 highlights the importance of ensuring rigorous measles surveillance systems to document immunity gaps and achieve 95% coverage with 2 timely doses of measles-containing vaccine (MCV) among children. This report describes progress toward measles elimination during 2000-2021 and updates a previous report (1). During 2000-2021, estimated global coverage with a first MCV dose (MCV1) increased from 72% to a peak of 86% in 2019, but decreased during the COVID-19 pandemic to 83% in 2020 and to 81% in 2021, the lowest MCV1 coverage recorded since 2008. All countries conducted measles surveillance, but only 47 (35%) of 135 countries reporting discarded cases§ achieved the sensitivity indicator target of two or more discarded cases per 100,000 population in 2021, indicating surveillance system underperformance in certain countries. Annual reported measles incidence decreased 88% during 2000-2016, from 145 to 18 cases per 1 million population, then rebounded to 120 in 2019 during a global resurgence (2), before declining to 21 in 2020 and to 17 in 2021. Large and disruptive outbreaks were reported in 22 countries. During 2000-2021, the annual number of estimated measles deaths decreased 83%, from 761,000 to 128,000; an estimated 56 million measles deaths were averted by vaccination. To regain progress and achieve regional measles elimination targets during and after the COVID-19 pandemic, accelerating targeted efforts is necessary to reach all children with 2 MCV doses while implementing robust surveillance and identifying and closing immunity gaps to prevent cases and outbreaks.
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Dixon MG, Ferrari M, Antoni S, Li X, Portnoy A, Lambert B, Hauryski S, Hatcher C, Nedelec Y, Patel M, Alexander JP, Steulet C, Gacic-Dobo M, Rota PA, Mulders MN, Bose AS, Rosewell A, Kretsinger K, Crowcroft NS. Progress Toward Regional Measles Elimination - Worldwide, 2000-2020. MMWR Morb Mortal Wkly Rep 2021; 70:1563-1569. [PMID: 34758014 PMCID: PMC8580203 DOI: 10.15585/mmwr.mm7045a1] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Cavallaro KF, Sandhu HS, Hyde TB, Johnson BW, Fischer M, Mayer LW, Clark TA, Pallansch MA, Yin Z, Zuo S, Hadler SC, Diorditsa S, Hasan ASMM, Bose AS, Dietz V. Expansion of syndromic vaccine preventable disease surveillance to include bacterial meningitis and Japanese encephalitis: evaluation of adapting polio and measles laboratory networks in Bangladesh, China and India, 2007-2008. Vaccine 2015; 33:1168-75. [PMID: 25597940 PMCID: PMC4830482 DOI: 10.1016/j.vaccine.2015.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 12/30/2014] [Accepted: 01/05/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Surveillance for acute flaccid paralysis with laboratory confirmation has been a key strategy in the global polio eradication initiative, and the laboratory platform established for polio testing has been expanded in many countries to include surveillance for cases of febrile rash illness to identify measles and rubella cases. Vaccine-preventable disease surveillance is essential to detect outbreaks, define disease burden, guide vaccination strategies and assess immunization impact. Vaccines now exist to prevent Japanese encephalitis (JE) and some etiologies of bacterial meningitis. METHODS We evaluated the feasibility of expanding polio-measles surveillance and laboratory networks to detect bacterial meningitis and JE, using surveillance for acute meningitis-encephalitis syndrome in Bangladesh and China and acute encephalitis syndrome in India. We developed nine syndromic surveillance performance indicators based on international surveillance guidelines and calculated scores using supervisory visit reports, annual reports, and case-based surveillance data. RESULTS Scores, variable by country and targeted disease, were highest for the presence of national guidelines, sustainability, training, availability of JE laboratory resources, and effectiveness of using polio-measles networks for JE surveillance. Scores for effectiveness of building on polio-measles networks for bacterial meningitis surveillance and specimen referral were the lowest, because of differences in specimens and techniques. CONCLUSIONS Polio-measles surveillance and laboratory networks provided useful infrastructure for establishing syndromic surveillance and building capacity for JE diagnosis, but were less applicable for bacterial meningitis. Laboratory-supported surveillance for vaccine-preventable bacterial diseases will require substantial technical and financial support to enhance local diagnostic capacity.
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Affiliation(s)
- Kathleen F Cavallaro
- Global Immunization Division, United States Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Hardeep S Sandhu
- Global Immunization Division, United States Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Terri B Hyde
- Global Immunization Division, United States Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Barbara W Johnson
- Division of Vector-Borne Diseases, United States Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Marc Fischer
- Division of Vector-Borne Diseases, United States Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Leonard W Mayer
- Division of Bacterial Diseases, United States Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Thomas A Clark
- Division of Bacterial Diseases, United States Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mark A Pallansch
- Division of Viral Diseases, United States Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Zundong Yin
- National Immunization Programme, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Shuyan Zuo
- World Health Organization, Beijing, People's Republic of China
| | | | | | | | - Anindya S Bose
- National Polio Surveillance Project, World Health Organization, New Delhi, India
| | - Vance Dietz
- Global Immunization Division, United States Centers for Disease Control and Prevention, Atlanta, GA, USA
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Murhekar MV, Ahmad M, Shukla H, Abhishek K, Perry RT, Bose AS, Shimpi R, Kumar A, Kaliaperumal K, Sethi R, Selvaraj V, Kamaraj P, Routray S, Das VN, Menabde N, Bahl S. Measles case fatality rate in Bihar, India, 2011-12. PLoS One 2014; 9:e96668. [PMID: 24824641 PMCID: PMC4019661 DOI: 10.1371/journal.pone.0096668] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 04/10/2014] [Indexed: 11/22/2022] Open
Abstract
Background Updated estimates of measles case fatality rates (CFR) are critical for monitoring progress towards measles elimination goals. India accounted for 36% of total measles deaths occurred globally in 2011. We conducted a retrospective cohort study to estimate measles CFR and identify the risk factors for measles death in Bihar–one of the north Indian states historically known for its low vaccination coverage. Methods We systematically selected 16 of the 31 laboratory-confirmed measles outbreaks occurring in Bihar during 1 October 2011 to 30 April 2012. All households of the villages/urban localities affected by these outbreaks were visited to identify measles cases and deaths. We calculated CFR and used multivariate analysis to identify risk factors for measles death. Results The survey found 3670 measles cases and 28 deaths (CFR: 0.78, 95% confidence interval: 0.47–1.30). CFR was higher among under-five children (1.22%) and children belonging to scheduled castes/tribes (SC/ST, 1.72%). On multivariate analysis, independent risk factors associated with measles death were age <5 years, SC/ST status and non-administration of vitamin A during illness. Outbreaks with longer interval between the occurrence of first case and notification of the outbreak also had a higher rate of deaths. Conclusions Measles CFR in Bihar was low. To further reduce case fatality, health authorities need to ensure that SC/ST are targeted by the immunization programme and that outbreak investigations target for vitamin A treatment of cases in high risk groups such as SC/ST and young children and ensure regular visits by health-workers in affected villages to administer vitamin A to new cases.
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Affiliation(s)
| | - Mohammad Ahmad
- World Health Organization- Country Office for India, National Polio Surveillance Project, New Delhi, India
| | - Hemant Shukla
- World Health Organization- Country Office for India, National Polio Surveillance Project, New Delhi, India; World Health Organization, Geneva, Switzerland
| | - Kunwar Abhishek
- World Health Organization- Country Office for India, National Polio Surveillance Project, New Delhi, India
| | | | - Anindya S Bose
- World Health Organization- Country Office for India, National Polio Surveillance Project, New Delhi, India; Bill and Melinda Gates Foundation, New Delhi, India
| | - Rahul Shimpi
- World Health Organization- Country Office for India, National Polio Surveillance Project, New Delhi, India
| | - Arun Kumar
- World Health Organization- Country Office for India, National Polio Surveillance Project, New Delhi, India
| | | | - Raman Sethi
- World Health Organization- Country Office for India, National Polio Surveillance Project, New Delhi, India
| | | | | | - Satyabrata Routray
- World Health Organization- Country Office for India, National Polio Surveillance Project, New Delhi, India
| | - Vidya Nand Das
- Rajendra Memorial Research Institute for Medical Sciences, Patna, Bihar
| | - Nata Menabde
- World Health Organization- Country Office for India, National Polio Surveillance Project, New Delhi, India
| | - Sunil Bahl
- World Health Organization- Country Office for India, National Polio Surveillance Project, New Delhi, India
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Bose AS, Jayawickramarajah PT. A computer-based epidemiological skills module for medical undergraduates in Nepal. Educ Health (Abingdon) 2000; 13:201-211. [PMID: 14742080 DOI: 10.1080/13576280050074462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To ascertain whether undergraduate medical students could acquire the basic competence needed to design, analyze and use a computer-compatible database in an epidemiologically meaningful way. SETTING Since 1998 the Manipal College of Medical Sciences (MCOMS) of Kathmandu University (KU), Nepal has included in its undergraduate medical curriculum a training module that incorporates knowledge and skills in doing computer-assisted data analyses of epidemiological questions. The present study was designed around the implementation of this module. SUBJECTS All 96 students of the seventh semester (first six months of the fourth year) of the MBBS course at the MCOMS. METHODS The teaching-learning activities for the module were carried out mainly in six 2-hour sessions, for groups of 16 students at a time. The software used was EPI-INFO. MAIN OUTCOME MEASURES Knowledge and skills of computer-assisted data analyses were assessed. In addition, feedback was obtained from the students and scored on seven dimensions. FINDINGS The pre-test/post-test questionnaire score difference, which evaluated the knowledge component, was highly significant (t = 51.3, p < 0.001). In the skills assessment session, 83% were successful. The students gave high average scores on the satisfaction, small group learning environment, curricular relevance and evaluation dimensions; but the scores were relatively low on the time, other resources and confidence dimensions. CONCLUSION The module was successful in achieving its objectives and can be implemented even under tight resource constraints. Our plans for improving upon this first run of the module are outlined in the paper.
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Affiliation(s)
- A S Bose
- Department of Community Health, Manipal College of Medical Sciences, Pokhara, Nepal.
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Bose AS. Maternal behaviour and feeding practices as determinants of childhood diarrhoea: some observations among rural Begalee mothers. Indian J Public Health 1994; 38:120. [PMID: 7797310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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Bose AS, Krishna OR, Kalyanam M. Removal of a needle from a dog's stomach. Mod Vet Pract 1981; 62:882. [PMID: 7335067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Bose AS, Ramakrishna O, Krishnamurthy NT. Surgical repair of a rectal fibroma in a bull. Vet Med Small Anim Clin 1981; 76:1349-50. [PMID: 6916560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Ramakrishna O, Bose AS, Chandrababu P. Traumatic reticulitis in a calf. J Am Vet Med Assoc 1981; 178:1068. [PMID: 7275743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Ramakrishna O, Rao NV, Bose AS, Subba Reddy KV. Tracheal anastomosis in a heifer. J Am Vet Med Assoc 1980; 177:547-8. [PMID: 7002891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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