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Jean Baptiste AE, Wagai J, Hahné S, Adeniran A, Koko RI, de Vos S, Shibeshi M, Sanders EAM, Masresha B, Hak E. High-resolution geospatial mapping of zero-dose and under-immunized children following Nigeria's 2021 multiple indicator cluster survey/national immunization coverage survey (MICS/NICS). J Infect Dis 2023:jiad476. [PMID: 37930309 DOI: 10.1093/infdis/jiad476] [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: 07/30/2023] [Revised: 10/06/2023] [Accepted: 10/23/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND The "zero-dose" children are those without any routine vaccination or lacking the first dose of the diphtheria-tetanus-pertussis-containing vaccine. As per 2022 WHO/UNICEF estimates, globally, Nigeria has the highest number of zero-dose with over 2.3 million unvaccinated. METHODS We used data from the 2021 Nigeria Multiple Indicator Cluster Survey - National Immunisation Coverage Survey to identify zero-dose and under-immunized children. Geospatial modelling techniques were employed to determine the prevalence of zero-dose children and predict risk areas with under-immunized at a high resolution of 1x1 km. RESULTS Both zero-dose and under-immunized children are more prevalent in socially deprived groups. Univariate and multivariate Bayesian analyses showed positive correlations between the prevalence of zero-dose and under-immunized children with factors like stunting, contraceptive prevalence, and literacy. The prevalence of zero-dose and under-immunized children varies significantly by region and ethnicity, with higher rates observed in the country's northern parts. Significant heterogeneity in the distribution of under-vaccinated children was observed. CONCLUSIONS Nigeria needs to enhance its immunization system and coverage. Geospatial modelling can help deliver vaccines effectively to underserved communities. By adopting this approach, countries can ensure equitable vaccine access and contribute to global vaccination objectives.
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Affiliation(s)
| | - John Wagai
- World Health Organization, Country Office, Abuja, Nigeria
| | - Susan Hahné
- National Institute for Public Health and The Environment, Bilthoven, Netherlands
| | | | | | - Stijn de Vos
- Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Messeret Shibeshi
- World Health Organization, African Regional Office, Brazzaville, Congo
| | - E A M Sanders
- Institute of Public Health and The Environment, Bilthoven, Netherlands
- Department of Paediatric Immunology and Infectious Diseases, University Medical Centre Utrecht, The Netherlands
| | - Balcha Masresha
- World Health Organization, African Regional Office, Brazzaville, Congo
| | - Eelko Hak
- Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
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Johns NE, Hosseinpoor AR, Chisema M, Danovaro-Holliday MC, Kirkby K, Schlotheuber A, Shibeshi M, Sodha SV, Zimba B. Association between childhood immunisation coverage and proximity to health facilities in rural settings: a cross-sectional analysis of Service Provision Assessment 2013-2014 facility data and Demographic and Health Survey 2015-2016 individual data in Malawi. BMJ Open 2022; 12:e061346. [PMID: 35879002 PMCID: PMC9328092 DOI: 10.1136/bmjopen-2022-061346] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Despite significant progress in childhood vaccination coverage globally, substantial inequality remains. Remote rural populations are recognised as a priority group for immunisation service equity. We aimed to link facility and individual data to examine the relationship between distance to services and immunisation coverage empirically, specifically using a rural population. DESIGN AND SETTING Retrospective cross-sectional analysis of facility data from the 2013-2014 Malawi Service Provision Assessment and individual data from the 2015-2016 Malawi Demographic and Health Survey, linking children to facilities within a 5 km radius. We examined associations between proximity to health facilities and vaccination receipt via bivariate comparisons and logistic regression models. PARTICIPANTS 2740 children aged 12-23 months living in rural areas. OUTCOME MEASURES Immunisation coverage for the six vaccines included in the Malawi Expanded Programme on Immunization schedule for children under 1 year at time of study, as well as two composite vaccination indicators (receipt of basic vaccines and receipt of all recommended vaccines), zero-dose pentavalent coverage, and pentavalent dropout. FINDINGS 72% (706/977) of facilities offered childhood vaccination services. Among children in rural areas, 61% were proximal to (within 5 km of) a vaccine-providing facility. Proximity to a vaccine-providing health facility was associated with increased likelihood of having received the rotavirus vaccine (93% vs 88%, p=0.004) and measles vaccine (93% vs 89%, p=0.01) in bivariate tests. In adjusted comparisons, how close a child was to a health facility remained meaningfully associated with how likely they were to have received rotavirus vaccine (adjusted OR (AOR) 1.63, 95% CI 1.13 to 2.33) and measles vaccine (AOR 1.62, 95% CI 1.11 to 2.37). CONCLUSION Proximity to health facilities was significantly associated with likelihood of receipt for some, but not all, vaccines. Our findings reiterate the vulnerability of children residing far from static vaccination services; efforts that specifically target remote rural populations living far from health facilities are warranted to ensure equitable vaccination coverage.
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Affiliation(s)
- Nicole E Johns
- Department of Data and Analytics, World Health Organization, Geneve, Switzerland
| | | | - Mike Chisema
- Preventive Health Services and Expanded Program on Immunization, Malawi Ministry of Health, Lilongwe, Malawi
| | | | - Katherine Kirkby
- Department of Data and Analytics, World Health Organization, Geneve, Switzerland
| | - Anne Schlotheuber
- Department of Data and Analytics, World Health Organization, Geneve, Switzerland
| | - Messeret Shibeshi
- Inter-Country Support Team for East and Southern Africa, World Health Organization, Harare, Zimbabwe
| | - Samir V Sodha
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneve, Switzerland
| | - Boston Zimba
- Malawi Country Office, World Health Organization, Lilongwe, Malawi
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Smith S, Harmanci H, Hutin Y, Hess S, Bulterys M, Peck R, Rewari B, Mozalevskis A, Shibeshi M, Mumba M, Le LV, Ishikawa N, Nolna D, Sereno L, Gore C, Goldberg DJ, Hutchinson S. Global progress on the elimination of viral hepatitis as a major public health threat: An analysis of WHO Member State responses 2017. JHEP Rep 2019; 1:81-89. [PMID: 32039355 PMCID: PMC7001559 DOI: 10.1016/j.jhepr.2019.04.002] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/08/2019] [Accepted: 04/09/2019] [Indexed: 12/11/2022] Open
Abstract
In 2016, the World Health Assembly passed a resolution to eliminate viral hepatitis as a public health threat by 2030. We aimed to examine the status of the global viral hepatitis response. Methods In 2017, the World Health Organization (WHO) asked the Ministries of Health in all 194 Member States to complete a Country Profile on Viral Hepatitis policy uptake indicators, covering national plans/funding, engagement of civil society, testing guidance, access to treatment, and strategic information. Results Of 194 Member States, 135 (70%) responded, accounting for 87% of the global population infected with hepatitis B virus (HBV) and/or C virus (HCV). Of those responding, 84 (62%) had developed a national plan, of which, 49 (58%) had dedicated funding, and 62 (46%) had engaged with civil society; those engaged with civil society were more likely to have a funded plan than others (52% vs. 23%, p = 0.001). Guidance on testing pregnant women (for HBV) and people who inject drugs (for HCV) was available in 70% and 46% of Member States, respectively; 59% and 38% of Member States reported universal access to optimal therapies for HBV and HCV, respectively. Conclusions Most people living with hepatitis B and C reside in a country with a national hepatitis strategy. Governments who engaged with civil society were more advanced in their response. Member States need to finance these national strategies and ensure that those affected have access to hepatitis services as part of efforts to achieve universal health coverage. Lay summary The World Health Organization's goal to eliminate viral hepatitis as a public health threat by 2030 requires global action. Our results indicate that progress is being made by countries to scale-up national planning efforts; however, our results also highlight important gaps in current policies.
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Affiliation(s)
- Shanley Smith
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.,Health Protection Scotland, Glasgow, UK
| | | | - Yvan Hutin
- Department of HIV and Global Hepatitis Programme, World Health Organization, Geneva, Switzerland
| | - Sarah Hess
- Department of HIV and Global Hepatitis Programme, World Health Organization, Geneva, Switzerland
| | - Marc Bulterys
- Department of HIV and Global Hepatitis Programme, World Health Organization, Geneva, Switzerland
| | | | - Bharat Rewari
- World Health Organization, Regional Office for South-East Asia, New Delhi, India
| | - Antons Mozalevskis
- World Health Organization, Regional Office for Europe, Copenhagen, Denmark
| | - Messeret Shibeshi
- World Health Organization, Inter country support team, East and Southern Africa, Zimbabwe
| | - Mutale Mumba
- World Health Organization, Inter country support team, East and Southern Africa, Zimbabwe
| | - Linh-Vi Le
- World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
| | - Naoko Ishikawa
- World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
| | - Désiré Nolna
- World Health Organization AFRO-IST Central, Libreville, Gabon
| | - Leandro Sereno
- World Health Organization, Regional Office for the Americas, Washington, DC, USA
| | | | - David J Goldberg
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.,Health Protection Scotland, Glasgow, UK
| | - Sharon Hutchinson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.,Health Protection Scotland, Glasgow, UK
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Masresha B, Luce R, Shibeshi M, Katsande R, Fall A, Okeibunor J, Weldegebriel G, Mihigo R. Status of Measles Elimination in Eleven Countries with High Routine Immunisation Coverage in The WHO African Region. ACTA ACUST UNITED AC 2018. [DOI: 10.29245/2578-3009/2018/si.1121] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Masresha B, Katsande R, Luce R, Fall A, Shibeshi M, Weldegebriel G, Mihigo R. Performance of National Measles Case-Based Surveillance Systems in The WHO African Region. 2012 - 2016. J Immunol Sci 2018; Suppl:130-134. [PMID: 30957101 PMCID: PMC6446992] [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] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Case based surveillance for measles is implemented in the African Region integrated with Acute Flaccid Paralysis (AFP) surveillance. In 2011, the Region adopted a measles elimination goal to be achieved by 2020, which included coverage, incidence and surveillance performance targets. We reviewed measles case-based surveillance data and surveillance performance from countries in the African Region for the years 2012 - 2016. During this period, a total of 359,019 cases of suspected measles were reported from the 44 of 47 (94%) countries using the case based surveillance system. Of these, 202,126 (56%) had specimens collected for laboratory testing. A total of 39,806 measles cases and 25,679 rubella cases were confirmed by IgM serology. Twelve countries met the two principal surveillance performance indicators for each year during the period and four countries met neither indicator over the period. At the Regional level, both surveillance targets were met in 3 of the 5 years in the period of study; however performance varies widely by country. Surveillance performance did not improve across the Region during the 5 years period. High quality surveillance performance is critical to support the achievement of the regional measles elimination goal. Better integrating implementation with AFP surveillance, securing predictable long-term funding sources, and conducting detailed evaluations at country level to identify and address the root cause of performance gaps is recommended.
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Affiliation(s)
- Balcha Masresha
- WHO Regional Office for Africa, Brazzaville, Congo,Correspondence: Dr. Balcha Masresha, WHO Regional Office for Africa, Brazzaville, Congo;
| | | | - Richard Luce
- WHO Inter-country Support Team for Central Africa, Libreville, Gabon
| | - Amadou Fall
- WHO Inter-country Support Team for Western Africa, Ouagadougou, Burkina Faso
| | - Messeret Shibeshi
- WHO Inter-country Support Team for East and Southern Africa, Harare, Zimbabwe
| | - Goitom Weldegebriel
- WHO Inter-country Support Team for East and Southern Africa, Harare, Zimbabwe
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Masresha B, Shibeshi M, Kaiser R, Luce R, Katsande R, Mihigo R. Congenital Rubella Syndrome in The African Region - Data from Sentinel Surveillance. J Immunol Sci 2018; Suppl:146-150. [PMID: 30957103 PMCID: PMC6446990] [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] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Rubella is a mild febrile rash illness caused by the rubella virus. The most serious consequence of rubella is congenital rubella syndrome (CRS), which occurs if the primary rubella infection occurs during early pregnancy, with subsequent infection of the placenta and the developing fetus. METHODS WHO supported countries to set up sentinel surveillance for CRS using standard case definitions, protocols, and case classification scheme. This descriptive analysis summarises the data from 5 countries which have been regularly reporting. RESULTS A total of 383 suspected cases of CRS were notified from the 5 countries as of December 2016, of which 52 cases were laboratory confirmed and 67 were confirmed on clinical grounds.The majority (43%) of confirmed CRS cases were in the age group 6 - 11 months. The most common major clinical manifestation (Group A) among the confirmed cases is congenital heart disease (72%) followed by cataracts (32%) and glaucoma (10%). DISCUSSION AND CONCLUSIONS The number of years of reporting from these sentinel sites is too short to describe trends in CRS occurrence across the years. However, the limited surveillance data has yielded comparable information with other developing countries prior to introduction of rubella vaccine. As more countries introduce rubella vaccine into their immunisation programs, there is a need to ensure that all rubella outbreaks are thoroughly investigated and documented, to expand sentinel surveillance for CRS in more countries in the Region, and to complement this with retrospective record reviews for CRS cases in selected countries.
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Affiliation(s)
- Balcha Masresha
- WHO Regional Office for Africa. Brazzaville, Congo,Correspondence: Dr. Balcha G Masresha, WHO Regional Office for Africa, Brazzaville, Congo; Telephone No: +263 77 503 5369;
| | - Messeret Shibeshi
- WHO Inter-country Support Team for East and Southern Africa. Harare, Zimbabwe
| | - Reinhard Kaiser
- Formerly with the WHO Inter-country Support Team for East and Southern Africa. Harare, Zimbabwe
| | - Richard Luce
- WHO Inter-country Support Team for Central Africa. Libreville, Gabon
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Masresha B, Luce R, Shibeshi M, Katsande R, Fall A, Okeibunor J, Weldegebriel G, Mihigo R. Status of Measles Elimination in Eleven Countries with High Routine Immunisation Coverage in The WHO African Region. J Immunol Sci 2018; Suppl:140-144. [PMID: 30766973 PMCID: PMC6372061] [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] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Measles elimination is defined as the absence of endemic measles virus transmission in a defined geographic area for at least 12 months in the presence of a well-performing surveillance system. The WHO framework for verification of measles elimination indicates that the achievement of measles and/or rubella elimination should be verified for individual countries. OBJECTIVE We identified 11 high performing countries based on their first dose measles vaccination coverage, and looked at their performance across the various programmatic parameters, to see if they are ready to undertake the verification of measles elimination. METHODS We identified 11 countries with >90% measles first dose coverage for the most recent 5 years according to the WHO UNICEF estimates of national immunisation coverage. We analysed vaccination coverage and surveillance performance in these countries. RESULTS Algeria, Botswana, Gambia, Mauritius, Rwanda, Seychelles have maintained measles first dose (MCV1) coverage of 95% or more since 2011. In 2015, only Algeria, Cape Verde and Seychelles had coverage of 95% or more for the second dose of measles vaccine (MCV2). Of the 22 supplemental immunisation activities (SIAs) among the 11 countries, only 6 had administrative coverage of less than 95%. Only Rwanda and Lesotho attained the case-based surveillance performance targets in all the five years. CONCLUSION Despite their high routine first dose measles immunisation coverage, all of the 11 countries have some program gaps indicating that they do not meet all the criteria to undergo verification of elimination at this point. It is recommended for these countries to set up national verification committees as per the WHO framework for verification of measles elimination, in order to initiate the documentation and monitoring of progress, and to address programmatic gaps in the coming years.
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Affiliation(s)
- Balcha Masresha
- WHO Regional Office for Africa, Brazzaville, Congo,Correspondence: Dr. Balcha G Masresha, WHO Regional Office for Africa, Brazzaville, Congo; Telephone No: +263 77 503 5369;
| | - Richard Luce
- WHO Inter-country Support Team for Central Africa, Libreville, Gabon
| | - Messeret Shibeshi
- WHO Inter-country Support Team for East and Southern Africa, Harare, Zimbabwe
| | | | - Amadou Fall
- WHO Inter-country Support Team for Western Africa, Ouagadougou, Burkina Faso
| | | | - Goitom Weldegebriel
- WHO Inter-country Support Team for East and Southern Africa, Harare, Zimbabwe
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Ismail S, H/Giorgis F, Legesse D, Alemu E, Regassa K, Abdella M, Shibeshi M. Knowledge, attitude and practice on high risk factors pertaining to HIV/AIDS in a rural community. Ethiop Med J 1995; 33:1-6. [PMID: 7895741] [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] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A cross-sectional study on knowledge, attitude and practice on high risk factors for human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) was carried out among rural males of Dembia district, north Gonder Administrative Zone in January 1993. A random sample of 89(92.8%) males were interviewed by six senior medical students. A total of 66(74.2%) people reported to have heard something about AIDS. Eighty (89.9%) males did not know anything about condoms. The most common sources of information on AIDS were close friends, health workers, school teachers and the radio. Favourable attitude was observed. Fifty-four (60.7%) were afraid of getting AIDS; 7.5% had practised extramarital sex in the past three months. Higher knowledge was not associated with high risk behaviour (p > 0.05). Higher knowledge and favourable attitude were strongly correlated, (r = 0.83, 95% CI = 0.76-0.89). Strengthening risk perception, condom promotion and larger or detailed studies were recommended.
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Affiliation(s)
- S Ismail
- Department of Community Health, Gonder College of Medical Sciences
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