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Ogutu EA, Ellis AS, Hester KA, Rodriguez K, Sakas Z, Jaishwal C, Yang C, Dixit S, Bose AS, Sarr M, Kilembe W, Bednarczyk R, Freeman MC. Success in vaccination programming through community health workers: a qualitative analysis of interviews and focus group discussions from Nepal, Senegal and Zambia. BMJ Open 2024; 14:e079358. [PMID: 38569679 DOI: 10.1136/bmjopen-2023-079358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVES Community health workers are essential to front-line health outreach throughout low-income and middle-income countries, including programming for early childhood immunisation. Understanding how community health workers are engaged for successful early childhood vaccination among countries who showed success in immunisation coverage would support evidence-based policy guidance across contexts. DESIGN We employed a multiple case study design using qualitative research methods. SETTING We conducted research in Nepal, Senegal and Zambia. PARTICIPANTS We conducted 207 interviews and 71 focus group discussions with 678 participants at the national, regional, district, health facility and community levels of the health systems of Nepal, Senegal and Zambia, from October 2019 to April 2021. We used thematic analysis to investigate contributing factors of community health worker programming that supported early childhood immunisation within each country and across contexts. RESULTS Implementation of vaccination programming relied principally on the (1) organisation, (2) motivation and (3) trust of community health workers. Organisation was accomplished by expanding cadres of community health workers to carry out their roles and responsibilities related to vaccination. Motivation was supported by intrinsic and extrinsic incentives. Trust was expressed by communities due to community health worker respect and value placed on their work. CONCLUSION Improvements in immunisation coverage was facilitated by community health worker organisation, motivation and trust. With the continued projection of health worker shortages, especially in low-income countries, community health workers bridged the equity gap in access to vaccination services by enabling wider reach to underserved populations. Although improvements in vaccination programming were seen in all three countries-including government commitment to addressing human resource deficits, training and remuneration; workload, inconsistency in compensation, training duration and scope, and supervision remain major challenges to immunisation programming. Health decision-makers should consider organisation, motivation and trust of community health workers to improve the implementation of immunisation programming.
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Affiliation(s)
- Emily A Ogutu
- Department of Environmental Health, Emory University, Atlanta, Georgia, USA
| | - Anna S Ellis
- Department of Environmental Health, Emory University, Atlanta, Georgia, USA
| | - Kyra A Hester
- Department of Environmental Health, Emory University, Atlanta, Georgia, USA
| | - Katie Rodriguez
- Department of Environmental Health, Emory University, Atlanta, Georgia, USA
| | - Zoe Sakas
- Department of Environmental Health, Emory University, Atlanta, Georgia, USA
| | - Chandni Jaishwal
- Department of Environmental Health, Emory University, Atlanta, Georgia, USA
| | - Chenmua Yang
- Department of Environmental Health, Emory University, Atlanta, Georgia, USA
| | | | | | - Moussa Sarr
- Institut de Recherche en Santé, de Surveillance Epidemiologique et de Formations, Dakar, Senegal
| | | | - Robert Bednarczyk
- Hubert Department of Global Health, Emory University, Atlanta, Georgia, USA
| | - Matthew C Freeman
- Department of Environmental Health, Emory University, Atlanta, Georgia, USA
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Thakkar N, Abubakar AHA, Shube M, Jama MA, Derow M, Lambach P, Ashmony H, Farid M, Sim SY, O’Connor P, Minta A, Bose AS, Musanhu P, Hasan Q, Bar-Zeev N, Malik SMMR. Estimating the Impact of Vaccination Campaigns on Measles Transmission in Somalia. Vaccines (Basel) 2024; 12:314. [PMID: 38543948 PMCID: PMC10974214 DOI: 10.3390/vaccines12030314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 04/21/2024] Open
Abstract
Somalia is a complex and fragile setting with a demonstrated potential for disruptive, high-burden measles outbreaks. In response, since 2018, Somalian authorities have partnered with UNICEF and the WHO to implement measles vaccination campaigns across the country. In this paper, we create a Somalia-specific model of measles transmission based on a comprehensive epidemiological dataset including case-based surveillance, vaccine registries, and serological surveys. We use this model to assess the impact of these campaign interventions on Somalian's measles susceptibility, showing, for example, that across the roughly 10 million doses delivered, 1 of every 5 immunized a susceptible child. Finally, we use the model to explore a counter-factual epidemiology without the 2019-2020 campaigns, and we estimate that those interventions prevented over 10,000 deaths.
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Affiliation(s)
- Niket Thakkar
- Institute for Disease Modeling, Bill & Melinda Gates Foundation, Seattle, WA 98109, USA
| | | | - Mukhtar Shube
- Federal Ministry of Health, Mogadishu P.O. Box 22, Somalia
| | | | - Mohamed Derow
- Federal Ministry of Health, Mogadishu P.O. Box 22, Somalia
| | | | | | | | - So Yoon Sim
- World Health Organization, 1202 Geneva, Switzerland
| | | | - Anna Minta
- World Health Organization, 1202 Geneva, Switzerland
| | | | | | - Quamrul Hasan
- World Health Organization, Regional Office for the Eastern Mediterranean, Cairo 11371, Egypt
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Paudel KP, Samuel R, Jha R, Pandey BD, Edirisuriya C, Shrestha NL, Gyawali P, Pokhrel A, Shrestha L, Mahato RK, Hossain SS, Arunkumar G, Bose AS, Dhimal M, Gautam D, Neupane S, Thakur N, Shrestha S, Bhusal N, Jha P, Gupta BP, Rayamajhi RB, Subedi KC, Kandel S, Poudel M, Thapa LB, Sharma GN, Gocotano AE, Sunny AK, Gautam R, Bhatta DR, Awale BK, Roka B, Ojha HC, Baral P, Adhikari MD, Lohani GR, Shrestha M, Singh DR, Aryal L, Pandav RS, Pokhrel R. Seroprevalence of SARS-CoV-2 infection in the general population of Nepal during the first and second generalized waves of the COVID-19 pandemic-2020-2021. Influenza Other Respir Viruses 2023; 17:e13234. [PMID: 38149926 PMCID: PMC10752246 DOI: 10.1111/irv.13234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 07/11/2023] [Revised: 11/07/2023] [Accepted: 11/20/2023] [Indexed: 12/28/2023] Open
Abstract
Few seroprevalence studies have been conducted on coronavirus disease (COVID-19) in Nepal. Here, we aimed to estimate seroprevalence and assess risk factors for infection in the general population of Nepal by conducting two rounds of sampling. The first round was in October 2020, at the peak of the first generalized wave of COVID-19, and the second round in July-August 2021, following the peak of the wave caused by the delta variant of SARS-CoV-2. We used cross-sectional probability-to-size (PPS)-based multistage cluster sampling to estimate the seroprevalence in the general population of Nepal at the national and provincial levels. We tested for anti-SARS-CoV-2 total antibody using the WANTAI SARS-CoV-2 Ab ELISA kit. In Round 1, the overall national seroprevalence was 14.4%, with provincial estimates ranging from 5.3% in Sudurpaschim to 27.3% in Madhesh Province. In Round 2, the estimated national seroprevalence was 70.7%, with the highest in the Madhesh Province (84.8%) and the lowest in the Gandaki Province (62.9%). Seroprevalence was comparable between males and females (Round 1, 15.8% vs. 12.2% and Round 2, 72.3% vs. 68.7%). The seroprevalence in the ecozones-Terai, hills, and mountains-was 76.3%, 65.3%, and 60.5% in Round 2 and 17.7%, 11.7%, and 4.6% in Round 1, respectively. In Nepal, COVID-19 vaccination was introduced in January 2021. At the peak of the first generalized wave of COVID-19, most of the population of Nepal remained unexposed to SARS-CoV-2. Towards the end of the second generalized wave in April 2021, two thirds of the population was exposed.
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Affiliation(s)
- Krishna Prasad Paudel
- Epidemiology and Disease Control Division, Department of Health ServicesMinistry of Health and PopulationKathmanduNepal
| | | | - Runa Jha
- National Public Health LaboratoryMinistry of Health and PopulationKathmanduNepal
| | - Basu Dev Pandey
- Epidemiology and Disease Control Division, Department of Health ServicesMinistry of Health and PopulationKathmanduNepal
- DEJIMA Infectious Disease Research Alliance (DIDA)Nagasaki UniversityNagasakiJapan
| | | | | | | | - Amrit Pokhrel
- Epidemiology and Disease Control Division, Department of Health ServicesMinistry of Health and PopulationKathmanduNepal
| | - Lilee Shrestha
- National Public Health LaboratoryMinistry of Health and PopulationKathmanduNepal
| | - Ram Kumar Mahato
- Epidemiology and Disease Control Division, Department of Health ServicesMinistry of Health and PopulationKathmanduNepal
| | | | | | | | | | | | | | - Nishant Thakur
- Epidemiology and Disease Control Division, Department of Health ServicesMinistry of Health and PopulationKathmanduNepal
| | | | | | - Priya Jha
- WHO Country Office for NepalKathmanduNepal
| | | | | | - Koshal Chandra Subedi
- Epidemiology and Disease Control Division, Department of Health ServicesMinistry of Health and PopulationKathmanduNepal
| | - Shashi Kandel
- Epidemiology and Disease Control Division, Department of Health ServicesMinistry of Health and PopulationKathmanduNepal
| | - Mukesh Poudel
- Epidemiology and Disease Control Division, Department of Health ServicesMinistry of Health and PopulationKathmanduNepal
| | - Lila Bikram Thapa
- Epidemiology and Disease Control Division, Department of Health ServicesMinistry of Health and PopulationKathmanduNepal
| | | | | | | | | | | | - Bal Krishna Awale
- National Public Health LaboratoryMinistry of Health and PopulationKathmanduNepal
| | - Bhola Roka
- Epidemiology and Disease Control Division, Department of Health ServicesMinistry of Health and PopulationKathmanduNepal
| | - Hemant Chandra Ojha
- Epidemiology and Disease Control Division, Department of Health ServicesMinistry of Health and PopulationKathmanduNepal
| | - Phanindra Baral
- Epidemiology and Disease Control Division, Department of Health ServicesMinistry of Health and PopulationKathmanduNepal
| | - Mahendra Dhose Adhikari
- Epidemiology and Disease Control Division, Department of Health ServicesMinistry of Health and PopulationKathmanduNepal
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Minta AA, Ferrari M, Antoni S, Portnoy A, Sbarra A, Lambert B, Hatcher C, Hsu CH, Ho LL, Steulet C, Gacic-Dobo M, Rota PA, Mulders MN, Bose AS, Caro WP, O’Connor P, Crowcroft NS. Progress Toward Measles Elimination - Worldwide, 2000-2022. MMWR Morb Mortal Wkly Rep 2023; 72:1262-1268. [PMID: 37971951 PMCID: PMC10684353 DOI: 10.15585/mmwr.mm7246a3] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Measles is a highly contagious, vaccine-preventable disease that requires high population immunity for transmission to be interrupted. All six World Health Organization regions have committed to eliminating measles; however, no region has achieved and sustained measles elimination. This report describes measles elimination progress during 2000-2022. During 2000-2019, estimated coverage worldwide with the first dose of measles-containing vaccine (MCV) increased from 72% to 86%, then declined to 81% in 2021 during the COVID-19 pandemic, representing the lowest coverage since 2008. In 2022, first-dose MCV coverage increased to 83%. Only one half (72) of 144 countries reporting measles cases achieved the measles surveillance indicator target of two or more discarded cases per 100,000 population in 2022. During 2021-2022, estimated measles cases increased 18%, from 7,802,000 to 9,232,300, and the number of countries experiencing large or disruptive outbreaks increased from 22 to 37. Estimated measles deaths increased 43% during 2021-2022, from 95,000 to 136,200. Nonetheless, an estimated 57 million measles deaths were averted by vaccination during 2000-2022. In 2022, measles vaccination coverage and global surveillance showed some recovery from the COVID-19 pandemic setbacks; however, coverage declined in low-income countries, and globally, years of suboptimal immunization coverage left millions of children unprotected. Urgent reversal of coverage setbacks experienced during the COVID-19 pandemic can be accomplished by renewing efforts to vaccinate all children with 2 MCV doses and strengthening surveillance, thereby preventing outbreaks and accelerating progress toward measles elimination.
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Wonodi C, Crowcroft N, Bose AS, Oteri J, Momoh J, Hughes G, Shet A, Pradhan R, Gautam JS, Jean Baptiste AE, Khanal S, Masresha B, Linstrand A. Country ownership as a guiding principle for IA2030: A case study of the measles and rubella elimination programs in Nepal and Nigeria. Vaccine 2023:S0264-410X(23)01131-3. [PMID: 37838480 DOI: 10.1016/j.vaccine.2023.09.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 08/25/2023] [Accepted: 09/22/2023] [Indexed: 10/16/2023]
Abstract
Country-owned, as opposed to donor-driven, is a principle within the development sector that recognizes the centrality of countries' leadership, systems, and resources in executing programs and achieving sustainable development. In alignment with this notion, the Immunization Agenda 2030 was developed with country ownership as one of four core principles of the ambitious ten-year plan. This means that the success of immunization programs, including those with eradication and elimination goals such as polio, measles, and rubella, and those with broader equity goals to "leave no one behind" on immunization, would be largely driven by country systems. In this paper we deconstruct country ownership into five operational principles: commitment, coordination, capacity, community participation, and accountability. Through this lens, we illustrate how two countries, Nepal and Nigeria, have exemplified country ownership in their measles and rubella elimination programs and we infer the ways in which country ownership drives system performance and sustains program efforts.
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Affiliation(s)
- Chizoba Wonodi
- International Vaccine Access Center, Bloomberg School of Public Health, Johns Hopkins University, United States.
| | - Natasha Crowcroft
- Department of Immunization Vaccines & Biologicals, World Health Organization, Geneva, Switzerland
| | - Anindya Sekhar Bose
- Department of Immunization Vaccines & Biologicals, World Health Organization, Geneva, Switzerland
| | - Joseph Oteri
- National Primary Health Care Development Agency, Abuja, Nigeria
| | - Jenny Momoh
- World Health Organization, FCT office, Abuja, Nigeria
| | | | - Anita Shet
- International Vaccine Access Center, Bloomberg School of Public Health, Johns Hopkins University, United States
| | - Rahul Pradhan
- World Health Organization, Immunization Preventable Disease Program, Nepal
| | | | | | - Sudhir Khanal
- World Health Organization, Regional Office for South-East Asia, India
| | - Balcha Masresha
- World Health Organization, Regional Office for Africa, Congo-Brazzaville
| | - Ann Linstrand
- Department of Immunization Vaccines & Biologicals, World Health Organization, Geneva, Switzerland
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6
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Shrestha S, Gurung M, Amatya P, Bijukchhe S, Bose AS, Carter MJ, Gautam MC, Gurung S, Hinds J, Kandasamy R, Kelly S, Khadka B, Maskey P, Mujadidi YF, O’Reilly PJ, Pokhrel B, Pradhan R, Shah GP, Shrestha S, Wahl B, O’Brien KL, Knoll MD, Murdoch DR, Kelly DF, Thorson S, Voysey M, Pollard AJ, Acharya K, Acharya B, Ansari I, Basi R, Bista S, Bista S, Budha AK, Budhathoki S, Deshar R, Dhungel S, Felle S, Gautam K, Gorham K, Gurung TY, Gurung P, Jha R, K.C M, Karnikar SR, Kattel A, Lama L, Magar TKP, Maharjan M, Mallik A, Michel A, Nepal D, Nepal J, Park KM, Prajapati KG, Pudasaini R, Shrestha S, Smedley M, Weeks R, Yadav JK, Yadav SK. Effect of the of 10-valent pneumococcal conjugate vaccine in Nepal 4 years after introduction: an observational cohort study. Lancet Glob Health 2022; 10:e1494-e1504. [DOI: 10.1016/s2214-109x(22)00281-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 05/27/2022] [Accepted: 05/30/2022] [Indexed: 10/14/2022]
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7
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Khanal S, Kassem AM, Bahl S, Jayantha L, Sangal L, Sharfuzzaman M, Bose AS, Antoni S, Datta D, Alexander JP. Progress Toward Measles Elimination — South-East Asia Region, 2003–2020. MMWR Morb Mortal Wkly Rep 2022; 71:1042-1046. [PMID: 35980874 PMCID: PMC9400531 DOI: 10.15585/mmwr.mm7133a2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Danovaro-Holliday MC, Rhoda DA, Lacoul M, Prier ML, Gautam JS, Pokhrel TN, Dixit SM, Rajbhandari RM, Bose AS. Who gets vaccinated in a measles-rubella campaign in Nepal?: results from a post-campaign coverage survey. BMC Public Health 2022; 22:221. [PMID: 35114969 PMCID: PMC8812357 DOI: 10.1186/s12889-021-12475-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 12/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Following the 2015 earthquake, a measles-rubella (MR) supplementary immunization activity (SIA), in four phases, was implemented in Nepal in 2015-2016. A post-campaign coverage survey (PCCS) was then conducted in 2017 to assess SIA performance and explore factors that were associated with vaccine uptake. METHODS A household survey using stratified multi-stage probability sampling was conducted to assess coverage for a MR dose in the 2015-2016 SIA in Nepal. Logistic regression was then used to identify factors related to vaccine uptake. RESULTS Eleven thousand two hundred fifty-three households, with 4870 eligible children provided information on vaccination during the 2015-2016 MR SIA. Overall coverage of measles-rubella vaccine was 84.7% (95% CI: 82.0-87.0), but varied between 77.5% (95% CI: 72.0, 82.2) in phase-3, of 21 districts vaccinated in Feb-Mar 2016, to 97.7% (CI: 95.4, 98.9) in phase-4, of the last seven mountainous districts vaccinated in Mar-Apr 2016. Coverage in rural areas was higher at 85.6% (CI: 81.9, 88.8) than in urban areas at 79.0% (CI: 75.5, 82.1). Of the 4223 children whose caregivers knew about the SIA, 96.5% received the MR dose and of the 647 children whose caregivers had not heard about the campaign, only 1.8% received the MR dose. CONCLUSIONS The coverage in the 2015-2016 MR SIA in Nepal varied by geographical region with rural areas achieving higher coverage than urban areas. The single most important predictor of vaccination was the caregiver being informed in advance about the vaccination campaign. Enhanced efforts on social mobilization for vaccination have been used in Nepal since this survey, notably for the most recent 2020 MR campaign.
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Affiliation(s)
- M Carolina Danovaro-Holliday
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization (WHO), 20, Ave Appia, 1211, Geneva, Switzerland.
| | | | | | | | - Jhalak Sharma Gautam
- Family Welfare Division, Department of Health Services, Government of Nepal, Kathmandu, Nepal
| | - Tara Nath Pokhrel
- Family Welfare Division, Department of Health Services, Government of Nepal, Kathmandu, Nepal
| | | | | | - Anindya Sekhar Bose
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization (WHO), 20, Ave Appia, 1211, Geneva, Switzerland.,Country Office Nepal, WHO, Kathmandu, Nepal
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Bose AS, Rai P, Gupta BP, Pradhan R, Lacoul M, Shakya S, Shrestha D, Gautam A, Bhandari B, Shrestha B, Tinkari BS, Jha R, Khanal B, Shrestha P, Bhusal S, Gautam JS. Nepal Measles outbreak response immunization during COVID-19: a risk-based intervention strategy. Vaccine 2022; 40:2884-2893. [PMID: 35300872 PMCID: PMC8882431 DOI: 10.1016/j.vaccine.2022.02.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 02/12/2022] [Accepted: 02/14/2022] [Indexed: 11/16/2022]
Abstract
In 2020, National Immunization Programme (NIP) of Nepal implemented a measles outbreak response immunization (ORI) campaign, which was additional to an ongoing preventive measles-rubella SIA campaign. Both campaigns were implemented during ongoing COVID-19 transmission. By April, 220 measles cases and two deaths were confirmed from eight districts of Nepal. The NIP triangulated information from surveillance (measles and COVID-19), measles immunization performance and immunity profile, programme capacities and community engagement and applied a logical decision-making framework to the collated data to inform ‘Go/No-Go’ decisions for ORI interventions. This was reviewed by the National Immunization Advisory Committee (NIAC) for endorsement. Outbreak response with non-selective immunization (ORI), vitamin-A administration and case management were implemented in affected municipalities of four districts, while in the remaining districts outbreak response without ORI were undertaken. The structure and iterative application of this logical framework has been described. ORI was implemented without interrupting the ongoing measles-rubella vaccination campaign which had targeted children from 9 to 59 months of age. The age group for ORI was same as SIA in one sub-district area, while for the other three sub-district areas it was from 6 months to 15 years of age. More than 32,000 persons (97% coverage) were vaccinated in ORI response. Overall measles incidence decreased by 98% after ORI. The daily incidence rate of measles was 94 times higher (95% confidence interval: 36.11 – 347.62) before the ORI compared to two weeks after ORI until year end. Close attention to surveillance and other data to inform actions and seamless collaboration between NIP and core immunization partners (WHO, UNICEF), with guidance from NIAC were key elements in successful implementation. This was an example of feasible application of the global framework for implementation of a mass vaccination campaign during COVID-19 through application of a simple decision-making logical framework.
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Affiliation(s)
- Anindya Sekhar Bose
- World Health Organization (WHO), Department of Immunization Vaccines and Biologicals (IVB), Geneva, Switzerland.
| | - Pasang Rai
- WHO Immunization Preventable Disease (IPD) Programme, Nepal.
| | | | | | | | | | | | | | - Bharat Bhandari
- Family Welfare Division (FWD), Dept of Health Services (DOHS), Nepal.
| | | | | | - Runa Jha
- National Public Health Laboratory (NPHL), Ministry of Health and Population, Nepal.
| | - Basudha Khanal
- BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal.
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Huang XX, Bose AS, Gupta BP, Rai P, Joshi S, Gautam JS, Tinkari BS, Vandelaer J, Cohen AL, Patel MK. Vaccine preventable diseases surveillance in Nepal: How much does it cost? Vaccine 2021; 39:5982-5990. [PMID: 34419305 PMCID: PMC8494117 DOI: 10.1016/j.vaccine.2021.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 11/03/2022]
Abstract
Assessing the cost of vaccine preventable diseases (VPD) surveillance is becoming more important in the context of the Global Polio Eradication Initiative (GPEI) funding transition, since GPEI support to polio surveillance helped the incremental building of VPD surveillance systems in many countries, including low income countries such as Nepal. However, there is limited knowledge on the cost of conducting VPD surveillance, especially the national cost for surveillance of multiple vaccine-preventable diseases. The current study sought to calculate the economic and financial costs of Nepal's comprehensive VPD surveillance systems from July 2016 to July 2017. At thecentral level, all surveillance units were included in the sample. At sub-national level, a purposive sampling strategy was used to select a representative sample from locations involved in conducting surveillance. The sub-national sample costs were extrapolated to the nationwide VPD surveillance system. Nepal's total annual economic cost of VPD surveillance was USD 4.81 million or USD 0.18 per capita, while the total financial cost was USD 4.38 million or USD 0.16 per capita. Government expenditures accounted for 56% of the total economic cost, and World Health Organization accounting for 44%. The biggest cost driver was personnel accounting for 51% of the total economic cost. WHO supported trained surveillance personnel through donor funding, mainly from Global Polio Eradication Initiative. As a polio transition priority country, Nepal will need to make strategic choices to fully self-finance or seek full donor support or a mixed-financing model as polio program funding diminishes.
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Affiliation(s)
- Xiao Xian Huang
- Immunization, Vaccines, and Biologicals, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland.
| | - Anindya Sekhar Bose
- World Health Organization Country Office for Nepal, United Nations House, Pulchowk, Lalitpur, Nepal.
| | - Binod Prasad Gupta
- World Health Organization Country Office for Nepal, United Nations House, Pulchowk, Lalitpur, Nepal
| | - Pasang Rai
- World Health Organization Country Office for Nepal, United Nations House, Pulchowk, Lalitpur, Nepal.
| | - Sudhir Joshi
- World Health Organization Regional Office for South-East Asia, World Health House, Indraprastha Estate, Mahatma Gandhi Marg, New Delhi 110 002, India.
| | | | - Bhim Singh Tinkari
- Family Welfare Division, Department of Health Services, Govt. of Nepal, Nepal
| | - Jos Vandelaer
- World Health Organization Regional Office for South-East Asia, World Health House, Indraprastha Estate, Mahatma Gandhi Marg, New Delhi 110 002, India.
| | - Adam L Cohen
- Immunization, Vaccines, and Biologicals, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland.
| | - Minal K Patel
- Immunization, Vaccines, and Biologicals, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland.
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Pradhan R, Sharma Gautam J, Tinkari BS, Adhikari N, Bose AS. Vaccine safety surveillance informs public health policy beyond immunization: A case-series on bleeding following vaccination, Nepal, 2016-2018. Vaccine 2020; 38:6320-6326. [PMID: 32788134 PMCID: PMC7482439 DOI: 10.1016/j.vaccine.2020.07.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 07/15/2020] [Accepted: 07/17/2020] [Indexed: 10/27/2022]
Abstract
BACKGROUND Surveillance for adverse events following immunization (AEFI) is important to monitor vaccine safety and should lead to appropriate responses to improve health and immunization program. Bleeding following vaccination is not recognized as an important AEFI. Without policy of vitamin K (VK) prophylaxis at birth, vitamin K deficiency bleeding (VKDB) could be an important cause of bleeding in young infants and may manifest as AEFI. METHODS We retrospectively analysed all serious AEFI cases that presented with external or internal bleeding reported to Nepal's AEFI surveillance system during 2016-2018. The cases were classified as VKDB, suspected VKDB or non-VKDB. RESULTS During the period, 16 serious AEFI with symptom or sign of bleeding were reported representing 21.3% of all serious AEFI reported. Cases were between 40 and 94 days of age. The National AEFI Investigation Committee classified all cases as coincidental. Fourteen cases (87.5%) had bleeding from injection site. Median time from vaccination to injection site bleeding was 4.3 h (interquartile range: 2.1-11.6 h). Six cases (37.5%) had intra-cranial haemorrhage. Only one case had confirmed history of receiving VK at birth. Ten cases (62.5%) received appropriate treatment (VK injection; blood transfusion if needed). Based on limited laboratory investigations available, three cases (18.75%) could be classified as late onset VKDB and 11 cases (68.75%) as suspected late onset VKDB. CONCLUSION VKDB should be suspected in young infants presenting with bleeding including following vaccination, and prompt treatment should be initiated. Bleeding following vaccination should be recognized as an important AEFI as even a small amount of blood loss in young infants can be catastrophic. We posit that this series is a small subset of VKDB cases in Nepal detected through AEFI surveillance system. In countries without policy of VK prophylaxis at birth including Nepal, the policy should be introduced.
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Affiliation(s)
| | - Jhalak Sharma Gautam
- Family Welfare Division, Department of Health Services, Ministry of Health and Population, Nepal
| | - Bhim Singh Tinkari
- Family Welfare Division, Department of Health Services, Ministry of Health and Population, Nepal
| | - Neelam Adhikari
- National AEFI Investigation Committee, C/O Family Welfare Division, Department of Health Services, Ministry of Health and Population, Nepal
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Abstract
A large-scale campaign to promote measles vaccinations has substantially reduced the number of children dying from the disease in India.
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Affiliation(s)
- Anindya Sekhar Bose
- Immunization Preventable Diseases ProgrammeWorld Health OrganizationKathmanduNepal
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Gupta SK, Sosler S, Haldar P, van den Hombergh H, Bose AS. Introduction strategy of a second dose measles containing vaccine in India. Indian Pediatr 2011; 48:379-82. [DOI: 10.1007/s13312-011-0066-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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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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