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Nkwain J, Zambou VM, Nchinjoh SC, Agbor VN, Adidja A, Mbanga C, Edwidge NN, Ndoula ST, Andreas AN, Diack D, Di Mattei P, Wiwa O, Diaby O, Saidu Y. Deployment of vaccine cold chain equipment in resource-limited settings: lessons from the Gavi Cold Chain Optimization Platform in Cameroon. Int Health 2024:ihae010. [PMID: 38333954 DOI: 10.1093/inthealth/ihae010] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 12/11/2023] [Accepted: 01/13/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Lack of or use of suboptimal cold chain equipment (CCE) is a major barrier to optimal immunization coverage and equity. Gavi established the CCE optimization platform (CCEOP) in 2015 to help eligible countries modernize their cold chain systems. However, there are limited data on CCE deployment at country level. We present lessons learnt from deploying CCE from the Gavi CCEOP in Cameroon. METHODS This cross-sectional study collected data on the number of days items of CCE spent at each point on their trajectory from the entry port to 62 randomly selected health facilities in Cameroon. RESULTS Once equipment arrived at the entry port, it took 10 d for customs clearance, 2 d from customs clearance to warehousing and 257 d (>9 mo) from the warehouse to facilities. Upon arrival at the facilities, it took a median of 53 (range 0-395) d from installation to final commissioning: most of the days (median=210) were spent between installation and final commissioning. The major causes of delays included insufficient coordination and communication across all levels, poor documentation and final commissioning. CONCLUSION Early engagement on customs clearance, strengthening coordination and communication, ensuring proper documentation, as well as eliminating final commissioning, could significantly improve implementation of the program.
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Affiliation(s)
- Jude Nkwain
- Gavi, the Vaccine Alliance, Chem. du Pommier 40, 1218 Le Grand-Saconnex, Geneva, Switzerland
| | - Vouking Marius Zambou
- United Nations Children's Fund (UNICEF), Country Office, Yaoundé, 335 Rue 1810, Cameroon
| | | | - Valirie Ndip Agbor
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK
| | - Amani Adidja
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, P.O. Box 1364, Cameroon
| | - Clarence Mbanga
- Clinton Health Access Initiative Inc., Yaoundé, P.O. Box 2664, Cameroon
| | | | - Shalom Tchokfe Ndoula
- School of Global Health and Bioethics, Euclid University, Bangui, P.O. Box 157, Central African Republic
| | - Ateke Njoh Andreas
- School of Global Health and Bioethics, Euclid University, Bangui, P.O. Box 157, Central African Republic
| | - Demba Diack
- Gavi, the Vaccine Alliance, Chem. du Pommier 40, 1218 Le Grand-Saconnex, Geneva, Switzerland
| | - Pietro Di Mattei
- Gavi, the Vaccine Alliance, Chem. du Pommier 40, 1218 Le Grand-Saconnex, Geneva, Switzerland
| | - Owens Wiwa
- Clinton Health Access Initiative Inc., Yaoundé, P.O. Box 2664, Cameroon
| | - Ousmane Diaby
- Department of Studies and Projects, Ministry of Public Health, Yaoundé, P.O. Box 1937, Cameroon
| | - Yauba Saidu
- Clinton Health Access Initiative Inc., Yaoundé, P.O. Box 2664, Cameroon
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2
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Woldeghebriel M, Aso E, Berlin E, Fashanu C, Kirumira SN, Lam F, Mugerwa R, Nakiganda J, Olaleye T, Opigo J, Osinupebi F, Priestley N, Stringham R, Uhomoibhi P, Visser T, Ward A, Wiwa O, Woolsey A. Assessing availability, prices, and market share of quality-assured malaria ACT and RDT in the private retail sector in Nigeria and Uganda. Malar J 2024; 23:41. [PMID: 38321459 PMCID: PMC10848491 DOI: 10.1186/s12936-024-04863-9] [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: 08/04/2023] [Accepted: 01/25/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND An estimated 50% of suspected malaria cases in sub-Saharan Africa first seek care in the private sector, especially in private medicine retail outlets. Quality of care in these outlets is generally unknown but considered poor with many patients not receiving a confirmatory diagnosis or the recommended first-line artemisinin-based combination therapy (ACT). In 2010, a subsidy pilot scheme, the Affordable Medicines Facility malaria, was introduced to crowd out the use of monotherapies in favour of WHO-pre-qualified artemisinin-based combinations (WHO-PQ-ACTs) in the private health sector. The scheme improved the availability, market share, and cost of WHO-PQ-ACTs in countries like Nigeria and Uganda, but in 2018, the subsidies were halted in Nigeria and significantly reduced in Uganda. This paper presents findings from six retail audit surveys conducted from 2014 to 2021 in Nigeria and Uganda to assess whether the impact of subsidies on the price, availability, and market share of artemisinin-based combinations has been sustained after the subsidies were reduced or discontinued. METHODS Six independent retail audits were conducted in private medicine retail outlets, including pharmacies, drug shops, and clinics in Nigeria (2016, 2018, 2021), and Uganda (2014, 2019, 2020) to assess the availability, price, and market share of anti-malarials, including WHO-PQ-ACTs and non-WHO-PQ-ACTs, and malaria rapid diagnostic tests (RDTs). RESULTS Between 2016 and 2021, there was a 57% decrease in WHO-PQ-ACT availability in Nigeria and a 9% decrease in Uganda. During the same period, non-WHO-PQ-ACT availability increased in Nigeria by 41% and by 34% in Uganda. The price of WHO-PQ-ACTs increased by 42% in Nigeria to $0.68 and increased in Uganda by 24% to $0.95. The price of non-WHO-PQ-ACTs decreased in Nigeria by 26% to $1.08 and decreased in Uganda by 64% to $1.23. There was a 76% decrease in the market share of WHO-PQ-ACTs in Nigeria and a 17% decrease in Uganda. Malaria RDT availability remained low throughout. CONCLUSION With the reduction or termination of subsidies for WHO-PQ-ACTs in Uganda and Nigeria, retail prices have increased, and retail prices of non-WHO-PQ-ACTs decreased, likely contributing to a shift of higher availability and increased use of non-WHO-PQ-ACTs.
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Affiliation(s)
| | - Ezinne Aso
- Clinton Health Access Initiative, Abuja, Nigeria
| | - Erica Berlin
- Clinton Health Access Initiative, Boston, Massachusetts, USA
| | | | | | - Felix Lam
- Clinton Health Access Initiative, Boston, Massachusetts, USA
| | - Robert Mugerwa
- National Malaria Control Division, Ministry of Health, Kampala, Uganda
| | | | - Tayo Olaleye
- Clinton Health Access Initiative, Abuja, Nigeria
| | - Jimmy Opigo
- National Malaria Control Division, Ministry of Health, Kampala, Uganda
| | | | | | | | | | - Theodoor Visser
- Clinton Health Access Initiative, Boston, Massachusetts, USA
| | - Abigail Ward
- Clinton Health Access Initiative, Boston, Massachusetts, USA
| | - Owens Wiwa
- Clinton Health Access Initiative, Abuja, Nigeria
| | - Aaron Woolsey
- Clinton Health Access Initiative, Boston, Massachusetts, USA
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3
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Saidu Y, Agbor VN, Di Mattei P, Nchinjoh SC, Edwidge NN, Njoh AA, Muteh NJ, Prescott M, Wiwa O, Diack D, Flegere J, Montomoli E, Costa Clemens SA, Clemens R. Development of a composite scoring system to rank communities at high risk of zero-dose children in Cameroon: A geospatial analysis. J Glob Health 2023; 13:04136. [PMID: 37971948 PMCID: PMC10653342 DOI: 10.7189/jogh.13.04136] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
Background Despite growing efforts to improve access to vaccination, millions of children, especially in developing countries, have not received a single dose of diphtheria, tetanus, and pertussis (DTP) vaccine. Consequently, they are often called zero-dose children (ZDC). With limited health resources, prioritising communities for rapid and mass zero-dose catch-up vaccination in missed communities to avert epidemic outbreaks is complicated by unreliable denominators used to compute vaccination coverages. Incorporating other indicators of access and utilisation of vaccination services can help with identifying and ranking missed communities based on the likelihood of finding ZDC. We described the process of generating a scoring method to rank health areas in Cameroon based on their likelihood of containing ZDC. Methods We used geospatial analysis to compute and aggregate health area characteristics, including hard-to-reach (HTR) areas (defined as areas of settlement above a one- (for urban areas) or 15-kilometre radius (for rural areas) beyond a vaccinating health facility), amount of area covered by slums and new area settlement, and percentage of children unvaccinated for DTP-1. We attributed a weight based on the ability to limit accessibility or utilisation of vaccination services to each characteristic and computed the score as a weighted average of health area characteristics. The health area score ranged from 0 to 1, with higher scores representing a higher likelihood of containing ZDC. We stratified the analysis by rural and urban health areas. Results We observed substantial district and regional variations in health area scores, with hotspots health areas (administrative level 4) observed in the Far North (0.83), North (0.81), Adamawa (0.80), East (0.75), and South West (0.67) regions. The Adamawa region had the highest percentage of health areas with the highest score (78%), followed by the East (50%), West (48%), and North (46%) regions. For most regions (Far North, South, South West, Littoral, West, and North West), DTP-1 contributed the most to the score. However, HTR settlement areas within a health area contributed substantially to the overall score in the East, North, and Adamawa regions. Conclusions We found substantial variations in health area scores with hotspots in the Far North, North, Adamawa, East, and South West regions. Although DTP-1 could be used as an indicator to identify health areas with ZDC for most communities, HTR settlement area was a valuable indicator in ranking priority health areas in the East, North, and Adamawa regions, further emphasising the need to consider other indicators before prioritisation.
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Affiliation(s)
- Yauba Saidu
- Clinton Health Access Initiative Inc., Yaoundé, Cameroon
- Institute for Global Health, Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Valirie N Agbor
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | | | | | - Andreas A Njoh
- Expanded Program on Immunization, Cameroon Ministry of Public Health, Yaoundé, Cameroon
- School of Global Health and Bioethics, Euclid University, Bangui, Central African Republic
| | | | - Marta Prescott
- Global Analytics and Implementation Research Team, Clinton Health Access Initiative Inc., Boston, USA
| | - Owens Wiwa
- Clinton Health Access Initiative Inc., Yaoundé, Cameroon
| | - Demba Diack
- Gavi, the Vaccine Alliance, Geneva, Switzerland
| | | | - Emanuele Montomoli
- Institute for Global Health, Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
- VisMederi srl, Siena, Italy
| | - Sue A Costa Clemens
- Institute for Global Health, Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
- Department of Pediatrics, University of Oxford, Oxford, UK
| | - Ralf Clemens
- Institute for Global Health, Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
- International Vaccine Institute, IVI, Seoul, Republic of Korea
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Saidu Y, Gu J, Ngenge BM, Nchinjoh SC, Adidja A, Nnang NE, Muteh NJ, Zambou VM, Mbanga CM, Agbor VN, Ousmane D, Njoh AA, Flegere J, Diack D, Wiwa O, Montomoli E, Clemens SAC, Clemens R. The faces behind vaccination: unpacking the attitudes, knowledge, and practices of staff of Cameroon's Expanded program on Immunization. Hum Resour Health 2023; 21:88. [PMID: 37957695 PMCID: PMC10644616 DOI: 10.1186/s12960-023-00869-7] [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] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/03/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Immunization is regarded as one of the most cost-effective public health interventions in global health. However, its cost-effectiveness depends greatly on the knowledge and skills of vaccinators. With the growing complexity of immunization programs, the need for a well-trained vaccination workforce cannot be overemphasized. In this study, we assessed the knowledge, attitudes, and practices among vaccination staff in Cameroon. METHODS Through a descriptive cross-sectional design, we used structured questionnaires and observation guides to collect data from vaccination staff in health facilities that were selected by a multistage sampling method. Data were analyzed using STATA 13 software. RESULTS Overall, we collected data from Expanded Program on Immunization focal staff in 265 health facilities across 68 health districts. Over half (53%) of the surveyed facilities were found in rural areas. Nearly two-thirds of health facilities had immunization focal staff with knowledge gaps for each of the four basic immunization indicators assessed. In other words, only 37% of staff knew how to estimate coverages, 36% knew how to inteprete the EPI monitoring curve, 35% knew how to prepare vaccine orders, and 37% knew how to estimate vaccine wastage. In terms of practices, staff waited for more than ten children to be present before opening a 20-dose vaccine vial in 63% of health facilities, and more than five children to be present before opening a 10-dose vaccine vial in 80% of surveyed facilities. Provision of vaccine-specific information (informing caregiver about vaccine received, explanation of benefits and potential side effects) during immunization sessions was suboptimal for the most part. CONCLUSION This study suggests marked deficits in immunization knowledge among vaccination staff and exposes common attitudes and practices that could contribute to missed opportunities for vaccination and hinder vaccination coverage and equity in Cameroon. Our findings highlight the urgent need to invest in comprehensive capacity building of vaccination staff in Cameroon, especially now that the immunization program is becoming increasingly complex.
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Affiliation(s)
- Yauba Saidu
- Clinton Health Access Initiative Inc., PO Box 2664, Yaounde, Cameroon.
- Institute for Global Health, University of Siena, 53100, Siena, Italy.
| | - Jessica Gu
- Global Vaccine Delivery, Clinton Health Access Initiative Inc, Boston, MA, 02127, United States of America
| | | | | | - Amani Adidja
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | | | | | | | | | - Valirie Ndip Agbor
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Diaby Ousmane
- Department of Projects, Ministry of Public Health, Yaounde, Cameroon
| | - Andreas Ateke Njoh
- Expanded Program on Immunization, Cameroon Ministry of Public Health, PO Box 2084, Yaoundé, Cameroon
- School of Global Health and Bioethics, Euclid University, PO Box 157, Bangui, Central African Republic
| | - Junie Flegere
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Demba Diack
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Owens Wiwa
- Clinton Health Access Iniative Inc., Abuja, Nigeria
| | - Emanuele Montomoli
- Institute for Global Health, University of Siena, 53100, Siena, Italy
- Department Molecular Medicine, University of Siena, Via Aldo Moro 3, 53100, Siena, Italy
- VisMederi Srl, Via Ferrini 53, 53035, Siena, Italy
| | - Sue Ann Costa Clemens
- Institute for Global Health, University of Siena, 53100, Siena, Italy
- Department of Pediatrics, University of Oxford, Oxford, United Kingdom
| | - Ralf Clemens
- Institute for Global Health, University of Siena, 53100, Siena, Italy
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5
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Saidu Y, Gu J, Ngenge BM, Nchinjoh SC, Adidja A, Nnang NE, Muteh NJ, Zambou VM, Mbanga C, Agbor VN, Ousmane D, Njoh AA, Flegere J, Diack D, Wiwa O, Montomoli E, Clemens SAC, Clemens R. Assessment of immunization data management practices in Cameroon: unveiling potential barriers to immunization data quality. BMC Health Serv Res 2023; 23:1033. [PMID: 37759205 PMCID: PMC10537541 DOI: 10.1186/s12913-023-09965-9] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 08/25/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND One crucial obstacle to attaining universal immunization coverage in Sub-Saharan Africa is the paucity of timely and high-quality data. This challenge, in part, stems from the fact that many frontline immunization staff in this part of the world are commonly overburdened with multiple data-related responsibilities that often compete with their clinical tasks, which in turn could affect their data collection practices. This study assessed the data management practices of immunization staff and unveiled potential barriers impacting immunization data quality in Cameroon. METHODS A descriptive cross-sectional study was conducted, involving health districts and health facilities in all 10 regions in Cameroon selected by a multi-stage sampling scheme. Structured questionnaires and observation checklists were used to collect data from Expanded Program of Immunization (EPI) staff, and data were analyzed using STATA VERSION 13.0 (StataCorp LP. 2015. College Station, TX). RESULTS A total of 265 facilities in 68 health districts were assessed. There was limited availability of some data recording tools like vaccination cards (43%), maintenance registers (8%), and stock cards (57%) in most health facilities. Core data collection tools were incompletely filled in a significant proportion of facilities (37% for registers and 81% for tally sheets). Almost every health facility (89%) did not adhere to the recommendation of filling tally sheets during vaccination; the filling was instead done either before (51% of facilities) or after (25% of facilities) vaccinating several children. Moreso, about 8% of facilities did not collect data on vaccine administration. About a third of facilities did not collect data on stock levels (35%), vaccine storage temperatures (21%), and vaccine wastage (39%). CONCLUSION Our findings unveil important gaps in data collection practices at the facility level that could adversely affect Cameroon's immunization data quality. It highlights the urgent need for systematic capacity building of frontline immunization staff on data management capacity, standardizing data management processes, and building systems that ensure constant availability of data recording tools at the facility level.
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Affiliation(s)
- Yauba Saidu
- Clinton Health Access Initiative Inc, PO Box 2664, Yaounde, Cameroon.
- Institute for Global Health, University of Siena, Siena, 53100, Italy.
| | - Jessica Gu
- Global Vaccine Team, Clinton Health Access Initiative Inc, Boston, MA, 02127, USA
| | | | | | - Amani Adidja
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | | | | | | | - Clarence Mbanga
- Clinton Health Access Initiative Inc, PO Box 2664, Yaounde, Cameroon
| | - Valirie Ndip Agbor
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Diaby Ousmane
- Department of Projects, Ministry of Public Health, Yaounde, Cameroon
| | - Andreas Ateke Njoh
- Expanded Program on Immunization, Ministry of Public Health, PO Box 2084, Yaoundé, Cameroon
- School of Global Health and Bioethics, Euclid University, PO Box 157, Bangui, Central African Republic
| | - Junie Flegere
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Demba Diack
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Owens Wiwa
- Clinton Health Access Initiative Inc, PO Box 2664, Yaounde, Cameroon
| | - Emmanuele Montomoli
- Institute for Global Health, University of Siena, Siena, 53100, Italy
- Department Molecular Medicine, University of Siena, Via Aldo Moro 3, 53100, Siena, Italy
- , VisMederi srl, Via Ferrini 53, 53035, Siena, Italy
| | - Sue Ann Costa Clemens
- Institute for Global Health, University of Siena, Siena, 53100, Italy
- Department of Pediatrics, University of Oxford, Oxford, UK
| | - Ralf Clemens
- Institute for Global Health, University of Siena, Siena, 53100, Italy
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Lawson O, Ameyan L, Tukur Z, Dunu S, Kerry M, Okuyemi OO, Yusuf Z, Fasawe O, Wiwa O, Hebert KS, Joseph JT, Nwokwu UE, Okpako O, Chime CI. Cervical cancer screening outcomes in public health facilities in three states in Nigeria. BMC Public Health 2023; 23:1688. [PMID: 37658293 PMCID: PMC10472661 DOI: 10.1186/s12889-023-16539-1] [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: 03/07/2023] [Accepted: 08/16/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Cervical cancer continues to generate a significant burden of disease and death in low- and middle-income countries (LMICs). Lack of awareness and poor access to early screening and pre-cancer treatment contribute to the high mortality. We describe here cervical cancer screening outcomes in public health facilities in three states in Nigeria. METHODS We conducted an observational study in 177 government health facilities in Lagos, Kaduna, and Rivers State, Nigeria from January to December 2021, in which we reviewed programmatic data collected through the newly introduced Cervical Cancer Prevention Program. Women who received screening and provided consent were enrolled into the study. Data were extracted from registers in the health facilities using SurveyCTO and descriptive statistical analysis was conducted using StataSE 15 (StataCorp, College Station, TX, USA). RESULTS Eighty-three thousand, five hundred ninety-three women were included in the analysis including 6,043 (7%) WLHIV. 67,371 (81%) received VIA as their primary screening while 16,173 (19%) received HPV DNA testing, with 49 (< 1%) receiving both at the same time. VIA positivity was 7% for WLHIV and 3% for general population, while HPV prevalence was 16% for WLHIV and 8% for general population. Following a positive HPV result, 21% of women referred, completed triage examination. 96% of women identified with precancerous lesions, received treatment. 44% of women with suspected cancer were successfully referred to an oncology center for advanced treatment. Following treatment with thermal ablation, seven adverse events were reported. CONCLUSIONS The Program has successfully increased women's access to screening and treatment of precancerous lesions. Almost all women who were eligible for pre-cancerous lesion treatment received it, often on the same day when screened using VIA. However, for women referred for a triage exam or due to suspected cancer, many did not complete their referral visits. More effort is required to ensure HPV positive women and women with suspected cancer are adequately linked to care to further reduce morbidity and mortality associated with cervical cancer in Nigeria. Implementation studies should be conducted to provide insights to improve the utilization of the existing centralized and point of care (POC) platforms to facilitate same day results, and to improve triage and treatment rates.
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Affiliation(s)
| | - Lola Ameyan
- Clinton Health Access Initiative, Abuja, Nigeria
| | - Zainab Tukur
- Clinton Health Access Initiative, Abuja, Nigeria
| | - Sophia Dunu
- Clinton Health Access Initiative, Abuja, Nigeria
| | | | | | - Zainab Yusuf
- Clinton Health Access Initiative, Abuja, Nigeria
| | | | - Owens Wiwa
- Clinton Health Access Initiative, Abuja, Nigeria
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7
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Saidu Y, Di Mattei P, Nchinjoh SC, Edwige NN, Nsah B, Muteh NJ, Ndoula ST, Abdullahi R, Zamir CS, Njoh AA, Adidja A, Ndiaye S, Wiwa O, Montomoli E, Clemens SAC. The Hidden Impact of the COVID-19 Pandemic on Routine Childhood Immunization Coverage in Cameroon. Vaccines (Basel) 2023; 11:645. [PMID: 36992229 PMCID: PMC10058217 DOI: 10.3390/vaccines11030645] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 02/16/2023] [Accepted: 02/27/2023] [Indexed: 03/15/2023] Open
Abstract
Background: The third round of the global pulse survey demonstrated that the abrupt and rapid progression of the COVID-19 pandemic significantly disrupted childhood immunization in many countries. Although Cameroon has reported over 120,000 COVID-19 cases, the reported national childhood vaccination coverage during the pandemic seems to have increased compared to that during the pre-COVID-19 period. Indeed, the first dose of the diphtheria, tetanus, and pertussis-containing vaccine (DTP-1) coverage increased from 85.4% in 2019 to 87.7% in 2020, and DTP-3 coverage increased from 79.5% in 2019 to 81.2% in 2020. The paucity of literature on the impact of COVID-19 on childhood vaccination in COVID-19 hotspot regions poses a challenge in developing a context-specific immunization recovery plan, hence the need to conduct this study. Methodology: We conducted a cross-sectional study using 2019 (pre-pandemic period) and 2020 (pandemic period) district childhood immunization data from the DHIS-2 database, weighted using completeness for each data entry against regional data completeness in 2020. Based on COVID-19 incidence, two hotspot regions were selected, with all districts (56/56) included in the final analysis. The Chi-square test was used to compare DTP-1 and DTP-3 coverage during the pre-pandemic and pandemic periods. Results: In the two hotspot regions, 8247 children missed DTP-1, and 12,896 children did not receive DTP-3 vaccines in the pandemic period compared to the results from the pre-pandemic period. Indeed, there was a significant drop in DTP-1 and DTP-3 coverage of 0.8% (p = 0.0002) and 3.1% (p = 0.0003), respectively, in the Littoral Region. Moreover, the Centre Region reported a 5.7% (p < 0.0001) and 7.6% (p < 0.0001) drop in DTP-1 and DTP-3 coverage, respectively. Most districts in the hotspot regions reported a decline in childhood immunization access (62.5%) and utilization (71.4%). Indeed, in the Littoral Region, 46% (11/24) and 58% (14/24) of districts experienced decreased vaccination access and utilization, respectively. Meanwhile, 75% (24/32) and 81% (26/32) of districts in the Centre Region experienced a drop in vaccination access and utilization, respectively. Conclusion: This study reported a situation where the national immunization indicators mask the impact of COVID-19 on childhood immunization in heavily hit regions. Therefore, this study presents valuable information for ensuring continuous vaccination service delivery during public health emergencies. The findings could also contribute to developing an immunization recovery plan and informing policy on future pandemic preparedness and response.
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Affiliation(s)
- Yauba Saidu
- Clinton Health Access Initiative Inc., Yaounde P.O. Box 2664, Cameroon
- Institute for Global Health, University of Siena, 53100 Siena, Italy
| | | | - Sangwe Clovis Nchinjoh
- Clinton Health Access Initiative Inc., Yaounde P.O. Box 2664, Cameroon
- Faculty of Medicine, The Hebrew University-Hadassah Braun School of Public Health and Community Medicine, Jerusalem 91120, Israel
| | | | - Bernard Nsah
- Clinton Health Access Initiative Inc., Yaounde P.O. Box 2664, Cameroon
| | | | - Shalom Tchokfe Ndoula
- Expanded Program on Immunization, Cameroon Ministry of Public Health, Yaounde P.O. Box 2084, Cameroon
| | - Rakiya Abdullahi
- Global Vaccine Team, Clinton Health Access Initiative Inc., Boston, MA 02127, USA
| | - Chen Stein Zamir
- Faculty of Medicine, The Hebrew University-Hadassah Braun School of Public Health and Community Medicine, Jerusalem 91120, Israel
| | - Andreas Ateke Njoh
- Expanded Program on Immunization, Cameroon Ministry of Public Health, Yaounde P.O. Box 2084, Cameroon
- School of Global Health and Bioethics, Euclid University, Bangui BP 157, Central African Republic
| | - Amani Adidja
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaounde B.P. 337, Cameroon
| | - Sidy Ndiaye
- Regional Office for Africa, World Health Organization, Brazzaville P.O. Box 06, Congo
| | - Owens Wiwa
- Clinton Health Access Initiative Inc., Yaounde P.O. Box 2664, Cameroon
| | - Emanuele Montomoli
- Institute for Global Health, University of Siena, 53100 Siena, Italy
- Department Molecular Medicine, University of Siena, Via Aldo Moro 3, 53100 Siena, Italy
- VisMederi srl, Via Ferrini 53, 53035 Siena, Italy
| | - Sue Ann Costa Clemens
- Institute for Global Health, University of Siena, 53100 Siena, Italy
- Department of Pediatrics, University of Oxford, Oxford OX1 2JD, UK
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Joseph J, Demke O, Ameyan L, Bitilinyu-Bango J, Bourgoin B, Diop M, Guèye B, Kama J, Lubega M, Madzima B, Maparo T, Mhizha T, Musoke A, Nabadda S, Phiri T, Tchereni T, Wiwa O, Hariharan K, Peter T, Khan S. Human papillomavirus testing using existing nucleic acid testing platforms to screen women for cervical cancer: implementation studies from five sub-Saharan African countries. BMJ Open 2023; 13:e065074. [PMID: 36609331 PMCID: PMC9827237 DOI: 10.1136/bmjopen-2022-065074] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 12/02/2022] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES To demonstrate acceptability and operational feasibility of introducing human papillomavirus (HPV) testing as a principal cervical cancer screening method in public health programmes in sub-Saharan Africa. SETTING 45 primary and secondary health clinics in Malawi, Nigeria, Senegal, Uganda and Zimbabwe. PARTICIPANTS 15 766 women aged 25-54 years presenting at outpatient departments (Senegal only, general population) or at antiretroviral therapy clinics (all other countries, HIV-positive women only). Eligibility criteria followed national guidelines for cervical cancer screening. INTERVENTIONS HPV testing was offered to eligible women as a primary screening for cervical cancer, and HPV-positive women were referred for visual inspection with acetic acid (VIA), and if lesions identified, received treatment or referral. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcomes were the proportion of HPV-positive women who received results and linked to VIA and the proportion of HPV-positive and VIA-positive women who received treatment. RESULTS A total of 15 766 women were screened and tested for HPV, among whom 14 564 (92%) had valid results and 4710/14 564 (32%) were HPV positive. 13 837 (95%) of valid results were returned to the clinic and 3376 (72%) of HPV-positive women received results. Of women receiving VIA (n=2735), 715 (26%) were VIA-positive and 622 (87%) received treatment, 75% on the same day as VIA. CONCLUSIONS HPV testing was found to be feasible across the five study countries in a public health setting, although attrition was seen at several key points in the cascade of care, namely results return to women and linkage to VIA. Once women received VIA, if eligible, the availability of on-site cryotherapy and thermal ablation allowed for same-day treatment. With sufficient resources and supportive infrastructure to ensure linkage to treatment, use of HPV testing for cervical cancer screening as recommended by WHO is a promising model in low-income and middle-income countries.
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Affiliation(s)
- Jessica Joseph
- Global Health Sciences, Clinton Health Access Initiative, Boston, Massachusetts, USA
| | - Owen Demke
- Global Diagnostics Team, Clinton Health Access Initiative, Boston, Massachusetts, USA
| | - Lola Ameyan
- Cervical Cancer, Clinton Health Access Initiative, Abuja, Nigeria
| | | | | | - Mamadou Diop
- Cancer Institute of Cheikh Anta Diop University, Aristide Le Dantec Hospital, Dakar, Senegal
| | - Babacar Guèye
- Disease Control, Ministère de la Santé et de l'Action Sociale, Dakar, Senegal
| | - Jibrin Kama
- Laboratory Access Program, Clinton Health Access Initiative, Abuja, Nigeria
| | - Marvin Lubega
- Laboratory Access Program, Clinton Health Access Initiative, Kampala, Uganda
| | - Bernard Madzima
- Family Health, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Tatenda Maparo
- Laboratory Access Program, Clinton Health Access Initiative, Harare, Zimbabwe
| | - Tasimba Mhizha
- Laboratory Access Program, Clinton Health Access Initiative, Harare, Zimbabwe
| | | | - Susan Nabadda
- National Health Laboratory and Diagnostic Services, Ministry of Health, Kampala, Uganda
| | | | - Timothy Tchereni
- Sexual, Reproductive, Maternal and Newborn Health, Clinton Health Access Initiative, Lilongwe, Malawi
| | - Owens Wiwa
- Clinton Health Access Initiative, Abuja, Nigeria
| | - Karen Hariharan
- Global Cervical Cancer and Nutrition, Clinton Health Access Initiative, Boston, Massachusetts, USA
| | - Trevor Peter
- Global Diagnostics Team, Clinton Health Access Initiative, Boston, Massachusetts, USA
| | - Shaukat Khan
- Global Diagnostics Team, Clinton Health Access Initiative, Boston, Massachusetts, USA
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9
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Abudiore O, Amamilo I, Campbell J, Eigege W, Harwell J, Conroy J, Jiboye J, Lufadeju F, Amole C, Wiwa O, Anweh D, Agbaji OO, Akanmu AS. High acceptability and viral suppression rate for first-Line patients on a dolutegravir-based regimen: An early adopter study in Nigeria. PLoS One 2023; 18:e0284767. [PMID: 37196012 DOI: 10.1371/journal.pone.0284767] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 04/06/2023] [Indexed: 05/19/2023] Open
Abstract
Nigeria adopted dolutegravir (DTG) as part of first line (1L) antiretroviral therapy (ART) in 2017. However, there is limited documented experience using DTG in sub-Saharan Africa. Our study assessed DTG acceptability from the patient's perspective as well as treatment outcomes at 3 high-volume facilities in Nigeria. This is a mixed method prospective cohort study with 12 months of follow-up between July 2017 and January 2019. Patients who had intolerance or contraindications to non-nucleoside reverse-transcriptase inhibitors were included. Patient acceptability was assessed through one-on-one interviews at 2, 6, and 12 months following DTG initiation. ART-experienced participants were asked about side effects and regimen preference compared to their previous regimen. Viral load (VL) and CD4+ cell count tests were assessed according to the national schedule. Data were analysed in MS Excel and SAS 9.4. A total of 271 participants were enrolled on the study, the median age of participants was 45 years, 62% were female. 229 (206 ART-experienced, 23 ART-naive) of enrolled participants were interviewed at 12 months. 99.5% of ART-experienced study participants preferred DTG to their previous regimen. 32% of particpants reported at least one side effect. "Increase in appetite" was most frequently reported (15%), followed by insomnia (10%) and bad dreams (10%). Average adherence as measured by drug pick-up was 99% and 3% reported a missed dose in the 3 days preceding their interview. Among participants with VL results (n = 199), 99% were virally suppressed (<1000 copies/ml), and 94% had VL <50 copies/ml at 12 months. This study is among the first to document self-reported patient experiences with DTG in sub-Saharan Africa and demonstrated high acceptability of DTG-based regimens among patients. The viral suppression rate was higher than the national average of 82%. Our findings support the recommendation of DTG-based regimen as the preferred 1L ART.
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Affiliation(s)
| | | | | | | | | | - James Conroy
- Clinton Health Access Initiative, Abuja, Nigeria
| | | | | | | | - Owens Wiwa
- Clinton Health Access Initiative, Abuja, Nigeria
| | - Damien Anweh
- Department of Family Medicine, Federal Medical Centre Makurdi, Makurdi, Benue state, Nigeria
| | - Oche Ochai Agbaji
- Department of Medicine, Jos University Teaching Hospital, Katon Rikkos, Plateau state, Nigeria
| | - Alani Sulaimon Akanmu
- Department of Haematology and Blood transfusion, Lagos University Teaching Hospital, Lagos, Lagos State, Nigeria
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10
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Woolsey AM, Simmons RA, Woldeghebriel M, Zhou Y, Ogunsola O, Laing S, Olaleye T, Kipkoech J, Rojas BM, Saran I, Odhiambo M, Malinga J, Ambani G, Kimachas E, Fashanu C, Wiwa O, Menya D, Laktabai J, Visser T, Turner EL, O’Meara WP. Correction: Incentivizing appropriate malaria case management in the private sector: a study protocol for two linked cluster randomized controlled trials to evaluate provider- and client-focused interventions in western Kenya and Lagos, Nigeria. Implement Sci 2022; 17:61. [PMID: 36109753 PMCID: PMC9476591 DOI: 10.1186/s13012-022-01233-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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11
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Saidu Y, Ben Bachire H, Frambo A, Talongwa R, Mbanga C, Nassiuma RZ, Wiwa O. Health policy making process in Cameroon: a case for the utilization of the Target Policy Profile. Gates Open Res 2022. [DOI: 10.12688/gatesopenres.13580.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Translating research findings into health policy often encounters numerous challenges in many African countries, including Cameroon. One of these challenges is the lack of standard tools and procedures to connect researchers to policy makers. A tool such as the Target Policy Profile (TPoP) can help to close this gap, since it is designed to optimize dialogue around the evidence needed to effect a change in policy. In this paper, we assessed the policy making process in Cameroon and suggest how the process can be optimized using the TPoP. Methods: This study reports on qualitative data obtained from in-depth interviews of purposively selected individuals, and quantitative data extracted from strategic plans and reports of 17 vertical health programs in Cameroon. Results: The majority (10/17) of our respondents were males and had an average of 6.5 years’ experience in policy making in Cameroon. A relatively small number of interventions/policies (19) were introduced by the assessed programs between 2015-2020. An even smaller number (9) are planned for introduction in the upcoming years. Four major gaps were identified in the policy making process, including lack of standardized methods and tools, limited use of evidence, limited ownership of the process by the state, and limited evaluation of newly introduced policies/interventions. Our respondents considered the TPoP to be a useful tool, which can help improve policy development, implementation, and evaluation across their different programs. Conclusion: The TPoP can help address gaps identified in the health policy making process in Cameroon. Continued advocacy to help stakeholders understand its value proposition as well as training them on its use cases, may facilitate its adoption and use in Cameroon.
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12
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Dickerson JC, Ibeka P, Inoyo I, Oke OO, Adewuyi SA, Barry D, Bello A, Fasawe O, Garrity P, Habeebu M, Huang FW, Mulema V, Nwankwo KC, Remen D, Wiwa O, Bhatt AS, Roy M. Implementing Patient-Directed Cancer Education Materials Across Nigeria. JCO Glob Oncol 2021; 7:1610-1619. [PMID: 34860566 PMCID: PMC8654433 DOI: 10.1200/go.21.00233] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
As access to cancer care expands in low-income countries, developing tools to educate patients is paramount. We took a picture booklet, which was initially developed by the nonprofit Global Oncology for Malawi and Rwanda, and adapted it for use in Nigeria. The primary goal was to assess acceptability and provide education. The secondary goals were (1) to describe the collaboration, (2) to assess knowledge gained from the intervention, (3) to assess patient understanding of their therapy intent, and (4) to explore patient's experiences via qualitative analysis. In this cross-continent collaboration supported by @StanfordCIGH, low literacy-friendly cancer education booklets developed by @GlobalOnc increased awareness and knowledge about cancer treatment in 4 diverse sites in Nigeria.![]()
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Affiliation(s)
- James C Dickerson
- Department of Medicine (Hematology and Oncology), Stanford University, Stanford, CA
| | - Paulette Ibeka
- Clinton Health Access Initiative, Inc, Abuja, Federal Capital Territory, Nigeria
| | - Itoro Inoyo
- Clinton Health Access Initiative, Inc, Abuja, Federal Capital Territory, Nigeria
| | | | - Sunday A Adewuyi
- Oncology, Ahmadu Bello University Teaching Hospital Zaria, Nigeria
| | | | - Abubakar Bello
- Radiotherapy, Lagos University Teaching Hospital, Idi Araba Lagos, Nigeria
| | - Olufunke Fasawe
- Clinton Health Access Initiative, Inc, Abuja, Federal Capital Territory, Nigeria
| | | | | | | | - Vivienne Mulema
- Clinton Health Access Initiative, Inc, Abuja, Federal Capital Territory, Nigeria
| | | | | | - Owens Wiwa
- Clinton Health Access Initiative, Inc, Abuja, Federal Capital Territory, Nigeria
| | - Ami S Bhatt
- Global Oncology Inc, Oakland, CA.,Department of Medicine (Hematology, Blood and Marrow Transplantation) and of Genetics, Stanford Center for Innovation in Global Health, Stanford University, Stanford, CA.,Global Oncology, Oakland, CA
| | - Mohana Roy
- Department of Medicine, Oncology, Stanford University, Stanford, CA
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13
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Terna Richard M, Taiwo L, Jean Baptiste AE, Bawa S, Dieng B, Wiwa O, Lambo K, Braka F, Shuaib F, Oteri J. Planning for supplemental immunization activities using the readiness assessment dashboard: Experience from 2017/2018 Measles vaccination campaign, Nigeria. Vaccine 2021; 39 Suppl 3:C21-C28. [PMID: 34247903 DOI: 10.1016/j.vaccine.2021.06.070] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 05/09/2021] [Accepted: 06/23/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Globally, supplemental immunization activities (SIAs) are known to be a major strategy for attainment of the global measles elimination goal of less than one measles case per million population within a geographic area by the year 2020. Adequate planning is critical to the success of a vaccination campaign. To achieve a quality SIA implementation for effective interruption of measles transmission, the World Health Organization introduced the SIA Readiness Assessment Tool, which includes the readiness dashboard. It is a strategic planning tool used to ensure critical activities are completed before SIAs. Nigeria implemented a phased measles SIA in 2017/2018 and used the readiness assessment tool in the planning for the campaign. In this article, we report the use of the readiness assessment dashboard in the 2017/2018 measles SIA, we also reviewed its contributions to the outcome of the campaign looking at the post campaign coverage survey results for the states. METHODS We conducted a retrospective review of the readiness assessment dashboard used during the 2017/2018 measles vaccination campaign in Nigeria. The readiness dashboard tool was designed using Microsoft Excel 2016. We reported results in frequencies and proportions using charts and tables. RESULTS The states with 100% readiness a week prior to the campaign scored a post campaign coverage survey result of 84.6 - 96.5% with just one out of the eight states in this category getting a score below 90%. In the same vein, of the eight states that their readiness score at one week to the campaign was below 85%, six had post campaign coverage survey score of less than 90% with the highest score in this category being 92.3%. Some states with good readiness scores also had poor post campaign coverage survey which has been attributed to other factors other than readiness. CONCLUSION The readiness assessment dashboard for the measles vaccination campaign provided a platform for tracking states readiness. It is our view that a link between readiness assessment and coverage should be examined in future studies.
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Affiliation(s)
| | - Lydia Taiwo
- Nigeria Field Epidemiology & Laboratory Training Program (NFELTP), Abuja, Nigeria
| | | | - Samuel Bawa
- World Health Organization, Country Office, Abuja, Nigeria
| | - Boubacar Dieng
- Technical Assistance Consultant, Global Alliance for Vaccines and Immunizations, Nigeria
| | - Owens Wiwa
- Clinton Health Access Initiative (CHAI), Abuja, Nigeria
| | | | - Fiona Braka
- World Health Organization, Country Office, Abuja, Nigeria
| | - Faisal Shuaib
- National Primary Health Care Development Agency, Abuja, Nigeria
| | - Joseph Oteri
- National Primary Health Care Development Agency, Abuja, Nigeria
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14
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Braimoh T, Danat I, Abubakar M, Ajeroh O, Stanley M, Wiwa O, Prescott MR, Lam F. Private health care market shaping and changes in inequities in childhood diarrhoea treatment coverage: evidence from the analysis of baseline and endline surveys of an ORS and zinc scale-up program in Nigeria. Int J Equity Health 2021; 20:88. [PMID: 33789694 PMCID: PMC8011378 DOI: 10.1186/s12939-021-01425-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 03/16/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Nearly 90,000 under-five children die from diarrhoea annually in Nigeria. Over 90% of the deaths can be prevented with oral rehydration salt (ORS) and zinc treatment but coverage nationally was less than 34% for ORS and 3% for zinc with wide inequities. A program was implemented in eight states to address critical barriers to the optimal functioning of the health care market to deliver these treatments. In this study, we examine changes in the inequities of coverage of ORS and zinc over the intervention period. METHODS Baseline and endline household surveys were used to measure ORS and zinc coverage and household assets. Principal component analysis was used to construct wealth quintiles. We used multi-level logistic regression models to estimate predictive coverage of ORS and zinc by wealth and urbanicity at each survey period. Simple measures of disparity and concentration indices and curves were used to evaluate changes in ORS and zinc coverage inequities. RESULTS At baseline, 28% (95% CI: 22-35%) of children with diarrhoea from the poorest wealth quintile received ORS compared to 50% (95% CI: 52-58%) from the richest. This inequality reduced at endline as ORS coverage increased by 21%-points (P < 0.001) for the poorest and 17%-points (P < 0.001) for the richest. Zinc coverage increased significantly for both quintiles at endline from an equally low baseline coverage level. Consistent with the findings of the pairwise comparison of the poorest and the richest, the summary measure of disparity across all wealth quintiles showed a narrowing of inequities from baseline to endline. Concentration curves shifted towards equality for both treatments, concentration indices declined from 0.1012 to 0.0480 for ORS and from 0.2640 to 0.0567 for zinc. Disparities in ORS and zinc coverage between rural and urban at both time points was insignificant except that the use of zinc in the rural at endline was significantly higher at 38% (95%CI: 35-41%) compared to 29% (95%CI, 25-33%) in the urban. CONCLUSION The results show a pro-rural improvement in coverage and a reduction in coverage inequities across wealth quintiles from baseline to endline. This gives an indication that initiatives focused on shaping healthcare market systems may be effective in reducing health coverage gaps without detracting from equity as a health policy objective.
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Affiliation(s)
- Tiwadayo Braimoh
- Clinton Health Access Initiative, No. 62, KG5 Avenue, Kacyiru, Kigali, Rwanda.
| | - Isaac Danat
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, UK
| | | | | | | | - Owens Wiwa
- Clinton Health Access Initiative, Abuja, Nigeria
| | | | - Felix Lam
- Clinton Health Access Initiative, Boston, MA, USA
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15
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Woolsey AM, Simmons RA, Woldeghebriel M, Zhou Y, Ogunsola O, Laing S, Olaleye T, Kipkoech J, Rojas BM, Saran I, Odhiambo M, Malinga J, Ambani G, Kimachas E, Fashanu C, Wiwa O, Menya D, Laktabai J, Visser T, Turner EL, O'Meara WP. Correction to: Incentivizing appropriate malaria case management in the private sector: a study protocol for two linked cluster randomized controlled trials to evaluate provider- and client-focused interventions in western Kenya and Lagos, Nigeria. Implement Sci 2021; 16:27. [PMID: 33726771 PMCID: PMC7962375 DOI: 10.1186/s13012-021-01093-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
An amendment to this paper has been published and can be accessed via the original article.
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Affiliation(s)
| | - Ryan A Simmons
- Duke Global Health Institute, Duke University, Durham, NC, USA.,Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | | | - Yunji Zhou
- Duke Global Health Institute, Duke University, Durham, NC, USA.,Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | | | - Sarah Laing
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Tayo Olaleye
- Clinton Health Access Initiative, Lagos, Nigeria
| | - Joseph Kipkoech
- Academic Model Providing Access to Healthcare, Moi University, Eldoret, Kenya
| | | | - Indrani Saran
- School of Social Work, Boston College, Boston, MA, USA
| | | | | | - George Ambani
- Academic Model Providing Access to Healthcare, Moi University, Eldoret, Kenya
| | - Emmah Kimachas
- Academic Model Providing Access to Healthcare, Moi University, Eldoret, Kenya
| | | | - Owens Wiwa
- Clinton Health Access Initiative, Abuja, Nigeria
| | - Diana Menya
- College of Health Sciences, Moi University School of Public Health, Eldoret, Kenya
| | - Jeremiah Laktabai
- Academic Model Providing Access to Healthcare, Moi University, Eldoret, Kenya.,College of Health Sciences, Moi University School of Medicine, Eldoret, Kenya
| | | | - Elizabeth L Turner
- Duke Global Health Institute, Duke University, Durham, NC, USA.,Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Wendy Prudhomme O'Meara
- Duke Global Health Institute, Duke University, Durham, NC, USA. .,College of Health Sciences, Moi University School of Public Health, Eldoret, Kenya. .,Department of Medicine, Duke University, Durham, NC, USA.
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16
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Woolsey AM, Simmons RA, Woldeghebriel M, Zhou Y, Ogunsola O, Laing S, Olaleye T, Kipkoech J, Rojas BM, Saran I, Odhiambo M, Malinga J, Ambani G, Kimachas E, Fashanu C, Wiwa O, Menya D, Laktabai J, Visser T, Turner EL, O'Meara WP. Incentivizing appropriate malaria case management in the private sector: a study protocol for two linked cluster randomized controlled trials to evaluate provider- and client-focused interventions in western Kenya and Lagos, Nigeria. Implement Sci 2021; 16:14. [PMID: 33472650 PMCID: PMC7816435 DOI: 10.1186/s13012-020-01077-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 11/26/2020] [Accepted: 12/15/2020] [Indexed: 01/02/2023] Open
Abstract
Background A large proportion of artemisinin-combination therapy (ACT) anti-malarial medicines is consumed by individuals that do not have malaria. The over-consumption of ACTs is largely driven by retail sales in high malaria-endemic countries to clients who have not received a confirmatory diagnosis. This study aims to target ACT sales to clients receiving a confirmatory diagnosis using malaria rapid diagnostic tests (mRDTs) at retail outlets in Kenya and Nigeria. Methods This study comprises two linked four-arm 2 × 2 factorial cluster randomized controlled trials focused on malaria diagnostic testing and conditional ACT subsidies with the goal to evaluate provider-directed and client-directed interventions. The linked trials will be conducted at two contrasting study sites: a rural region around Webuye in western Kenya and the urban center of Lagos, Nigeria. Clusters are 41 and 48 participating retail outlets in Kenya and Nigeria, respectively. Clients seeking care at participating outlets across all arms will be given the option of paying for a mRDT—at a study-recommended price—to be conducted at the outlet. In the provider-directed intervention arm, the outlet owner receives a small monetary incentive to perform the mRDT. In the client-directed intervention arm, the client receives a free ACT if they purchase an mRDT and receive a positive test result. Finally, the fourth study arm combines both the provider- and client-directed interventions. The diagnosis and treatment choices made during each transaction will be captured using a mobile phone app. Study outcomes will be collected through exit interviews with clients, who sought care for febrile illness, at each of the enrolled retail outlets. Results The primary outcome measure is the proportion of all ACTs that are sold to malaria test-positive clients in each study arm. For all secondary outcomes, we will evaluate the degree to which the interventions affect purchasing behavior among people seeking care for a febrile illness at the retail outlet. Conclusions If our study demonstrates that malaria case management can be improved in the retail sector, it could reduce overconsumption of ACTs and enhance targeting of publicly funded treatment reimbursements, lowering the economic barrier to appropriate diagnosis and treatment for patients with malaria. Trial registration ClinicalTrials.govNCT04428307, registered June 9, 2020, and NCT04428385, registered June 9, 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s13012-020-01077-w.
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Affiliation(s)
| | - Ryan A Simmons
- Duke Global Health Institute, Duke University, Durham, NC, USA.,Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | | | - Yunji Zhou
- Duke Global Health Institute, Duke University, Durham, NC, USA.,Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | | | - Sarah Laing
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Tayo Olaleye
- Clinton Health Access Initiative, Lagos, Nigeria
| | - Joseph Kipkoech
- Academic Model Providing Access to Healthcare, Moi University, Eldoret, Kenya
| | | | - Indrani Saran
- School of Social Work, Boston College, Boston, MA, USA
| | | | | | - George Ambani
- Academic Model Providing Access to Healthcare, Moi University, Eldoret, Kenya
| | - Emmah Kimachas
- Academic Model Providing Access to Healthcare, Moi University, Eldoret, Kenya
| | | | - Owens Wiwa
- Clinton Health Access Initiative, Abuja, Nigeria
| | - Diana Menya
- College of Health Sciences, Moi University School of Public Health, Eldoret, Kenya
| | - Jeremiah Laktabai
- Academic Model Providing Access to Healthcare, Moi University, Eldoret, Kenya.,College of Health Sciences, Moi University School of Medicine, Eldoret, Kenya
| | | | - Elizabeth L Turner
- Duke Global Health Institute, Duke University, Durham, NC, USA.,Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Wendy Prudhomme O'Meara
- Duke Global Health Institute, Duke University, Durham, NC, USA. .,College of Health Sciences, Moi University School of Public Health, Eldoret, Kenya. .,Department of Medicine, Duke University, Durham, NC, USA.
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17
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Mogekwu FI, Oteri JA, Nsubuga P, Ezebilo O, Maxwell N, Wiwa O, Braka F, Shuaib F. Using data to improve outcomes of supplemental immunisation activities: 2017/2018 Nigeria measles vaccination campaign. Vaccine 2021; 39 Suppl 3:C38-C45. [PMID: 33461831 DOI: 10.1016/j.vaccine.2020.12.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 03/27/2020] [Revised: 11/26/2020] [Accepted: 12/21/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Despite the enormous resources committed to the implementation of supplemental immunisation activities in Nigeria, achieving the required coverage (post-campaign survey) to halt the transmission of vaccine-preventable diseases has continued to seem like an impossibility. A vast volume of data is generated and transmitted during mass vaccination campaigns, but this administrative data does not always culminate into improved coverage. The absence of data-informed guidance from stakeholders with long years of experience in planning and implementing mass vaccination campaigns has impeded achieving 95% coverage in measles campaigns in Nigeria. This study reviews the use of data to guide the implementation of the 2017/2018 measles vaccination campaign in Nigeria. METHODS A central coordinating body was formed at the national level with the same replicated in every state. Tools were developed to measure the performance of the different phases and activities required for the implementation of a mass vaccination campaign as recommended in the international guidelines. Stakeholders were engaged to help ensure that feedback provided by the national measles technical coordinating committee was implemented at the lower level. RESULTS Monitoring and analysis of daily data submission caused a proper spread of senior supervisors, vaccination posts location during the campaign and helped identify areas targeted for mop-up. Although the verification of states' microplan increased the operational target population by 11.2%, the process aided the distribution of resources as appropriate. Maps showing the likely areas that needed additional effort to achieve required coverage with recommendation on the necessary approach to be deployed were transmitted to the states implementing the campaign. CONCLUSION The improvement in the use of data to guide implementation of the Nigeria 2017/2018 measles vaccination campaign caused an increase in the number of states that achieved higher coverage in the post-campaign coverage survey.
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Affiliation(s)
| | - Joseph A Oteri
- National Primary Health Care Development Agency, Abuja, Nigeria
| | - Peter Nsubuga
- Global Public Health Solutions, Atlanta, United States
| | - Obiora Ezebilo
- United Nations Children's Fund, Country Office, Abuja, Nigeria
| | - Nikki Maxwell
- United States Centres for Disease Prevention and Control, Atlanta, United States
| | - Owens Wiwa
- Clinton Health Access Initiative, Abuja, Nigeria
| | - Fiona Braka
- World Health Organization, Country Office, Abuja, Nigeria
| | - Faisal Shuaib
- National Primary Health Care Development Agency, Abuja, Nigeria
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Fasawe O, Adekeye O, Carmone AE, Dahunsi O, Kalaris K, Storey A, Ubani O, Wiwa O. Applying a Client-centered Approach to Maternal and Neonatal Networks of Care: Case Studies from Urban and Rural Nigeria. Health Syst Reform 2020; 6:e1841450. [PMID: 33270477 DOI: 10.1080/23288604.2020.1841450] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
In Nigeria, two maternal and neonatal health Networks of Care (NOC) focus on extending the reach and quality of routine and emergency maternal and neonatal health services tailored to the different contexts. This paper uses the four domains of the NOC framework-Agreements and Enabling Environment, Operational Standards, Quality, Efficiency and Responsibility, and Learning and Adaptation-to describe the NOC, highlighting how each developed to address specific local needs. In Northern Nigeria, the NOC were established in collaboration among Clinton Health Access Initiative and the government to reduce maternal and neonatal morbidity and mortality. Health centers and communities in the network were supported to be better prepared to provide maternal and neonatal care, while birth attendants at all levels were empowered and equipped to stabilize and treat complications. The approach brought services closer to the community and facilitated rapid referrals. The NOC in Lagos State extended the reach of routine and emergency maternal and neonatal health services through organically developed linkages among registered traditional birth attendant clinics, private and public sector facilities, the Primary Healthcare Board, and the Traditional Medicine Board. Traditional birth attendants are registered, trained, and monitored by Apex Community Health Officers, whose responsibilities include collection and review of data and ensuring linkages to postpartum services, such as family planning and immunizations. While differing in their approaches, both NOC provide locally appropriate, pragmatic approaches to supporting women birthing in the community and encouraging institutional delivery to ensure that women and their babies have access to timely, appropriate, and safe services.
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Affiliation(s)
| | | | - Andy E Carmone
- Clinton Health Access Initiative , Boston, Massachusetts, USA
| | | | | | - Andrew Storey
- Clinton Health Access Initiative , Boston, Massachusetts, USA
| | - Osy Ubani
- Lagos Mainland Local Government Area (LGA), Lagos State Ministry of Health , Lagos, Nigeria
| | - Owens Wiwa
- Clinton Health Access Initiative , Abuja, Nigeria
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Graham H, Bakare AA, Fashanu C, Wiwa O, Duke T, Falade AG. Oxygen therapy for children: A key tool in reducing deaths from pneumonia. Pediatr Pulmonol 2020; 55 Suppl 1:S61-S64. [PMID: 31962010 PMCID: PMC7317213 DOI: 10.1002/ppul.24656] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 01/09/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Hamish Graham
- Centre for International Child Health, Royal Children's Hospital, MCRI, University of Melbourne, Parkville, Australia.,Department of Paediatrics, University College Hospital, Ibadan, Nigeria
| | - Ayobami A Bakare
- Department of Community Medicine, University College Hospital, Ibadan, Nigeria
| | | | - Owens Wiwa
- Clinton Health Access Initiative, Abuja, Nigeria
| | - Trevor Duke
- Centre for International Child Health, Royal Children's Hospital, MCRI, University of Melbourne, Parkville, Australia
| | - Adegoke G Falade
- Department of Paediatrics, University College Hospital, Ibadan, Nigeria.,Department of Paediatrics, University of Ibadan, Ibadan, Nigeria
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Fashanu C, Mekonnen T, Amedu J, Onwundiwe N, Adebiyi A, Omokere O, Olaleye T, Gartley M, Gansallo S, Lewu F, Okita A, Musa M, Abubakar A, Ojo T, Ja'afar A, Ekundayo AA, Abubakar ML, Schroder K, Battu A, Wiwa O, Houdek J, Lam F. Improved oxygen systems at hospitals in three Nigerian states: An implementation research study. Pediatr Pulmonol 2020; 55 Suppl 1:S65-S77. [PMID: 32130796 DOI: 10.1002/ppul.24694] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 01/30/2020] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Hypoxemia is a life-threatening condition and is commonly seen in children with severe pneumonia. A government-led, NGO-supported, multifaceted oxygen improvement program was implemented to increase access to oxygen therapy in 29 hospitals in Kaduna, Kano, and Niger states. The program installed pulse oximeters and oxygen concentrators, trained health care workers, and biomedical engineers (BMEs), and provided regular feedback to health care staff through quality improvement teams. OBJECTIVE The aim of this study is to evaluate whether the program increased screening for hypoxemia with pulse oximetry and prescription of oxygen for patients with hypoxemia. METHODOLOGY The study is an uncontrolled before-after interventional study implemented at the hospital level. Medical charts of patients under 5 admitted for pneumonia between January 2017 and August 2018 were reviewed and information on patient care was extracted using a standardized form. The preintervention period of this study was defined as 1 January to 31 October 2017 and the postintervention period as 1 February to 31 August 2018. The primary outcomes of the study were whether blood-oxygen saturation measurements (SpO2 ) were documented and whether children with hypoxemia were prescribed oxygen. RESULTS A total of 3418 patient charts were reviewed (1601 during the preintervention period and 1817 during the postintervention period). There was a significant increase in the proportion of patients with SpO2 measurements after the interventions were conducted (adjusted odds ratio [aOR] 5.0; 4.3-5.7, P < .001). Before the interventions, only 13.7% (95% confidence interval [CI]: 12.2-15.3) of patients had SpO2 measurements and after the interventions, 82.4% (95% CI: 80.7-84.1) had SpO2 measurements. Oxygen administration for patients with clinical signs of hypoxemia also increased significantly (aOR 5.0; 4.2-5.9, P < .001)-from 22.8% (95% CI: 18.8-27.2) to 77.9% (95% CI: 73.9-81.5). CONCLUSION Increasing pulse oximetry and oxygen therapy access and utilization in a low-resourced environment is achievable through a multifaceted program focused on strengthening government-owned systems.
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Affiliation(s)
| | | | - Joseph Amedu
- Department of Hospital Services, Federal Ministry of Health, Abuja, Nigeria.,Department of Family Health, Federal Ministry of Health, Abuja, Nigeria
| | - Ngozi Onwundiwe
- Department of Hospital Services, Federal Ministry of Health, Abuja, Nigeria.,Department of Family Health, Federal Ministry of Health, Abuja, Nigeria
| | - Adebimpe Adebiyi
- Department of Hospital Services, Federal Ministry of Health, Abuja, Nigeria.,Department of Family Health, Federal Ministry of Health, Abuja, Nigeria
| | - Oluseyi Omokere
- Department of Hospital Services, Federal Ministry of Health, Abuja, Nigeria.,Department of Family Health, Federal Ministry of Health, Abuja, Nigeria
| | - Tayo Olaleye
- Clinton Health Access Initiative, Abuja, Nigeria
| | | | | | - Funsho Lewu
- Clinton Health Access Initiative, Abuja, Nigeria
| | | | - Mahmud Musa
- Clinton Health Access Initiative, Abuja, Nigeria
| | | | - Tolulope Ojo
- Clinton Health Access Initiative, Abuja, Nigeria
| | | | | | | | - Kate Schroder
- Clinton Health Access Initiative, Boston, Massachusetts
| | - Audrey Battu
- Clinton Health Access Initiative, Boston, Massachusetts
| | - Owens Wiwa
- Clinton Health Access Initiative, Abuja, Nigeria
| | - Jason Houdek
- Clinton Health Access Initiative, Boston, Massachusetts
| | - Felix Lam
- Clinton Health Access Initiative, Boston, Massachusetts
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Schroder K, Battu A, Wentworth L, Houdek J, Fashanu C, Wiwa O, Kihoto R, Macharia G, Trikha N, Bahuguna P, Dabas H, Kirchoffer D, Muhirwe L, Mucheri P, Musoke A, Lam F. Increasing coverage of pediatric diarrhea treatment in high-burden countries. J Glob Health 2019; 9:0010503. [PMID: 31131105 PMCID: PMC6513503 DOI: 10.7189/jogh.09.010503] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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] [Indexed: 11/16/2022] Open
Abstract
Background Diarrhea is the second leading cause of infectious deaths in children under-five globally. Oral rehydration salts (ORS) and zinc could avert an estimated 93% of deaths, but progress to increase coverage of these interventions has been largely stagnant over the past several decades. The Clinton Health Access Initiative (CHAI), along with donors and country governments in India, Kenya, Nigeria, and Uganda, implemented programs to scale-up ORS and zinc coverage from 2012 to 2016. The programs sought to demonstrate that increases in pediatric diarrhea treatment rates are possible at scale in high-burden settings through a holistic approach addressing both supply and demand barriers. We describe the overall program model and the activities undertaken in each country. The overall goal of the paper is to share the program results and lessons learned to inform other countries aiming to scale-up ORS and zinc. Methods We used a triangulation approach, using population-based household surveys, public facility audits, and private outlet surveys, to evaluate the program model. We used pre- and post-program population-based household survey data to estimate the changes in coverage of ORS and zinc for treatment of diarrhea cases in children under-five in program areas. We also conducted secondary analysis of Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) surveys in surrounding regions and compared annual coverage changes in the CHAI-supported program geographies to the surrounding regions. Results Across CHAI-supported focal geographies, the average ORS coverage across the program areas increased from 35% to 48% and combined ORS and zinc coverage increased from 1% to 24%. ORS coverage increases were statistically significant in the program states in India, from 22% (95% confidence interval CI = 21–23%) to 48% (95% CI = 47–50%) and program states in Nigeria, from 38% (95% CI = 32–40%) to 55% (95% CI = 51–58%). For combined ORS and zinc, coverage increases were statistically significant in all program geographies. Compared to surrounding regions, the estimated annual changes in combined ORS and zinc coverage were greater in program geographies. Using the Lives Saved Tool and based on the coverage changes during the program period, we estimated 76 090 diarrheal deaths were averted in the program geographies. Conclusions Increasing ORS and zinc coverage at scale in high-burden countries and states is possible through a comprehensive approach that targets both demand and supply barriers, including pricing, optimal product qualities, provider dispensing practices, stocking rates, and consumer demand.
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Affiliation(s)
- Kate Schroder
- Clinton Health Access Initiative, Boston, Massachusetts, USA
| | - Audrey Battu
- Clinton Health Access Initiative, Boston, Massachusetts, USA
| | | | - Jason Houdek
- Clinton Health Access Initiative, Boston, Massachusetts, USA
| | | | - Owens Wiwa
- Clinton Health Access Initiative, Abuja, Nigeria
| | | | | | | | | | | | | | | | | | | | - Felix Lam
- Clinton Health Access Initiative, Boston, Massachusetts, USA
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Lam F, Abdulwahab A, Houdek J, Adekeye O, Abubakar M, Akinjeji A, Braimoh T, Ajeroh O, Stanley M, Goh N, Schroder K, Wiwa O, Ihebuzor N, Prescott MR. Program evaluation of an ORS and zinc scale-up program in 8 Nigerian states. J Glob Health 2019; 9:010502. [PMID: 31073399 PMCID: PMC6505637 DOI: 10.7189/jogh.09.010502] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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] [Indexed: 12/02/2022] Open
Abstract
Background In Nigeria, diarrhea is the second leading killer of children under five. Between 2012-2017, the Clinton Health Access Initiative, Inc. (CHAI) and the Government of Nigeria implemented a comprehensive program in eight states aimed at increasing the percentage of children under five with diarrhea who were treated with zinc and oral rehydration solution (ORS). The program addressed demand, supply, and policy barriers to ORS and zinc uptake through interventions in both public and private sectors. The interventions included: (1) policy revision and partner coordination; (2) market shaping to improve availability of affordable, high-quality ORS and zinc; (3) provider training and mentoring; and (4) caregiver demand generation. Methods We conducted cross–sectional household surveys in program states at baseline, midline, and endline and constructed logistic regression models with generalized estimating equations to assess changes in ORS and zinc treatment during the program period. Results In descriptive analysis, we found 38% (95% CI = 34%-42%) received ORS at baseline and 4% (95% CI = 3%-5%) received both ORS and zinc. At endline, we found 55% (95% CI = 51%-58%) received ORS and 30% (95% CI = 27%-33%) received both ORS and zinc. Adjusting for other covariates, the odds of diarrhea being treated with ORS were 1.88 (95% CI = 1.46, 2.43) times greater at endline. The odds of diarrhea being treated with ORS and zinc combined were 15.14 (95% CI = 9.82, 23.34) times greater at endline. When we include the interaction term to investigate whether the odds ratios between the endline and baseline survey were modified by source of care, we found statistically significant results among diarrhea episodes that sought care in the public and private sector. Among cases that sought care in the public sector, the predictive probability of treatment with ORS increased from 57% (95% CI = 50%-65%) to 83% (95% CI = 79%-87%). Among cases that sought care in the private sector, the predictive probability increased from 41% (95% CI = 34%-48%) to 58% (95% CI = 54%-63%). Conclusions Use of ORS and combined ORS and zinc for treatment of diarrhea significantly increased in program states during the program period.
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Affiliation(s)
- Felix Lam
- Clinton Health Access Initiative, Boston, Massachusetts, USA
| | | | - Jason Houdek
- Clinton Health Access Initiative, Abuja, Nigeria
| | | | | | | | | | | | - Melinda Stanley
- Clinton Health Access Initiative, Boston, Massachusetts, USA
| | - Nancy Goh
- Clinton Health Access Initiative, Boston, Massachusetts, USA
| | - Kate Schroder
- Clinton Health Access Initiative, Boston, Massachusetts, USA
| | - Owens Wiwa
- Clinton Health Access Initiative, Abuja, Nigeria
| | - Nnenna Ihebuzor
- National Primary Health Care Development Agency, Abuja, Nigeria.,This paper is dedicated to Dr Nnenna Ihebuzor who passed away on March 24, 2018. The study and the program described would not have been possible without her tireless efforts
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Sloan NL, Storey A, Fasawe O, Yakubu J, McCrystal K, Wiwa O, Lothe LJ, Grepstad M. Advancing Survival in Nigeria: A Pre-post Evaluation of an Integrated Maternal and Neonatal Health Program. Matern Child Health J 2019; 22:986-997. [PMID: 29427018 PMCID: PMC5976701 DOI: 10.1007/s10995-018-2476-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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] [Indexed: 11/27/2022]
Abstract
Introduction Nigeria contributes more obstetric, postpartum and neonatal deaths and stillbirths globally than any other country. The Clinton Health Access Initiative in partnership with the Nigerian Federal Ministry of Health and the state Governments of Kano, Katsina, and Kaduna implemented an integrated Maternal and Neonatal Health program from July 2014. Up to 90% women deliver at home in Northern Nigeria, where maternal mortality ratio and neonatal mortality rates (MMR and NMR) are high and severe challenges to improving survival exist. Methods Community-based leaders (“key informants”) reported monthly vital events. Pre-post comparisons of later (months 16–18) with conservative baseline (months 7–9) rates were used to assess change in MMR, NMR, perinatal mortality (PMR) and stillbirth. Two-tailed cross-tabulations and unadjusted and adjusted logistic regression analyses were conducted. Results Data on 147,455 births (144,641 livebirths and 4275 stillbirths) were analyzed. At endline (months 16–18), MMR declined 37% (OR 0.629, 95% CI 0.490–0.806, p ≤ 0.0003) vs. baseline 440/100,000 births (months 7–9). NMR declined 43% (OR 0.574, 95% CI 0.503–0.655, p < 0.0001 vs. baseline 15.2/1000 livebirths. Stillbirth rates declined 15% (OR 0.850, 95% CI 0.768–0.941, p = 0.0018) vs. baseline 21.1/1000 births. PMR declined 27% (OR 0.733, 95% CI 0.676–0.795, p < 0.0001) vs. baseline 36.0/1000 births. Adjusted results were similar. Discussion The findings are similar to the Cochrane Review effects of community-based interventions and indicate large survival improvements compared to much slower global and flat national trends. Key informant data have limitations, however, their limitations would have little effect on the results magnitude or significance.
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Affiliation(s)
| | - Andrew Storey
- Clinton Health Access Initiative, 383 Dorcester Avenue, Suite 400, Boston, MA, 02127, USA
| | - Olufunke Fasawe
- Clinton Health Access Initiative, 7B Ganges St. Maitama, Abuja, Nigeria
| | - Jamila Yakubu
- Clinton Health Access Initiative, 7B Ganges St. Maitama, Abuja, Nigeria
| | - Kelly McCrystal
- Clinton Health Access Initiative, 383 Dorcester Avenue, Suite 400, Boston, MA, 02127, USA
| | - Owens Wiwa
- Clinton Health Access Initiative, 7B Ganges St. Maitama, Abuja, Nigeria
| | - Lene Jeanette Lothe
- Norwegian Agency for Development Cooperation, Bygdøy Allé 2, 0257, Oslo, Norway
| | - Mari Grepstad
- Norwegian Agency for Development Cooperation, Bygdøy Allé 2, 0257, Oslo, Norway
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Sarley D, Mahmud M, Idris J, Osunkiyesi M, Dibosa-Osadolor O, Okebukola P, Wiwa O. Transforming vaccines supply chains in Nigeria. Vaccine 2017; 35:2167-2174. [DOI: 10.1016/j.vaccine.2016.11.068] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 10/30/2016] [Accepted: 11/08/2016] [Indexed: 10/19/2022]
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Abstract
There are about 1 million small arms in Nigeria, which contribute to a large number of politically motivated killings. These are mainly sectarian (Christian and Muslim) and ethnic, over land and water rights and the relationship between the activities of companies and the environment. In the Ogoni region of the Niger Delta, with a population of half a million in an area of just over 400 square miles, there are 100 oil wells; the local community is attempting non-violently to clean up their environment. From July 1993 to April 1994 there were about 3,000 cases of gun violence, compared with only two in the previous five years. There were 250 deaths and about 100 amputations. Other forms of violence, including rape, also increased. Routine procedures in the hospitals that remained open were disrupted, there were serious effects on the mental health of the community and many became refugees. It appears that the guns used in this episode were imported by a multinational company for use by the Nigerian police.
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Affiliation(s)
- Owens Wiwa
- Culture, Community and Health Studies, Center for Addiction and Mental Health, Toronto, Canada.
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