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Nguyen KH, Chen S, Bao Y, Lu Y, Bednarczyk RA, Vasudevan L. COVID-19 Diagnosis, Severity, and Long COVID Among U.S. Adolescents, National Health Interview Survey, 2022. Am J Health Promot 2024; 38:534-539. [PMID: 38311899 DOI: 10.1177/08901171241231642] [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] [Indexed: 02/06/2024]
Abstract
PURPOSE Understanding disparities in COVID-19 outcomes, overall and stratified by vaccination status, is important for developing targeted strategies to increase vaccination coverage and protect adolescents from COVID-19. DESIGN The 2022 National Health Interview Survey (NHIS) is a cross-sectional nationally representative household survey of U.S. adults. SETTING A probability sample of households in the U.S. SAMPLE One child aged 12-17 years is randomly selected from each family in the household. A knowledgeable adult (eg, parent or guardian), responds on behalf of the child through an in-person interview (response rate = 49.9%). MEASURES Input measures-sociodemographic characteristics and COVID-19 vaccination status; output measures-ever had COVID-19, moderate/severe COVID-19, long COVID. ANALYSIS Prevalence of COVID-19 outcomes was assessed for adolescents aged 12-17 years. Factors associated with each COVID-19 outcome were assessed with multivariable logistic regression analyses. RESULTS Among 2758 adolescents aged 12-17 years in 2022, 60.5% had received ≥1 dose of COVID-19 vaccine, 30.2% had ever been diagnosed by a doctor that they had COVID-19, 29.5% had moderate/severe COVID-19, and 6.2% had long COVID. Adolescents who were vaccinated with ≥1 dose were less likely to be diagnosed with COVID-19 (aOR = .79) and less likely to have long COVID (aOR = .30). CONCLUSION Targeted messaging to highlight the importance of early treatment, the harms of long COVID-19, and the benefits of vaccination in protecting against long-term effects may be necessary to ensure that all adolescents and their families are adequately protected.
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Affiliation(s)
- Kimberly H Nguyen
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, USA
- Department of Epidemiology, George Washington University School of Public Health and Health Sciences, Washington, DC, USA
| | - Siyu Chen
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Yingjun Bao
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Yang Lu
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Robert A Bednarczyk
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, USA
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
- Emory Vaccine Center, Emory University, Atlanta, GA, USA
| | - Lavanya Vasudevan
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, USA
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Stureborg R, Nichols J, Dhingra B, Yang J, Orenstein W, Bednarczyk RA, Vasudevan L. Development and validation of VaxConcerns: A taxonomy of vaccine concerns and misinformation with Crowdsource-Viability. Vaccine 2024; 42:2672-2679. [PMID: 38521676 DOI: 10.1016/j.vaccine.2024.02.081] [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: 06/26/2023] [Revised: 02/24/2024] [Accepted: 02/26/2024] [Indexed: 03/25/2024]
Abstract
We present VaxConcerns, a taxonomy for vaccine concerns and misinformation. VaxConcerns is an easy-to-teach taxonomy of concerns and misinformation commonly found among online anti-vaccination media and is evaluated to produce high-quality data annotations among crowdsource workers, opening the potential adoption of the framework far beyond just academic or medical communities. The taxonomy shows high agreement among experts and outperforms existing taxonomies for vaccine concerns and misinformation when presented to non-expert users. Our proof-of-concept study on the changes in anti-vaccination content during the COVID-19 pandemic indicate impactful future use cases, such as longitudinal studies of the shift in vaccine concerns over time.
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Affiliation(s)
| | | | - Bhuwan Dhingra
- Department of Computer Science, Duke University, Durham, NC, USA
| | - Jun Yang
- Department of Computer Science, Duke University, Durham, NC, USA
| | - Walter Orenstein
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Robert A Bednarczyk
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Lavanya Vasudevan
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Duke Global Health Institute, Durham, NC, USA
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Nguyen KH, McChesney C, Rodriguez C, Vasudevan L, Bednarczyk RA, Corlin L. Child and adolescent COVID-19 vaccination coverage by educational setting, United States. Public Health 2024; 229:126-134. [PMID: 38430658 PMCID: PMC10961195 DOI: 10.1016/j.puhe.2024.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 01/20/2024] [Accepted: 01/27/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVES The COVID-19 pandemic changed the setting of education for many children in the U.S. Understanding COVID-19 vaccination coverage by educational setting is important for developing targeted messages, increasing parents' confidence in COVID-19 vaccines, and protecting all children from severe effects of COVID-19 infection. STUDY DESIGN/METHODS Using data from the Household Pulse Survey (n = 25,173) collected from December 9-19, 2022, January 4-16, 2023, and February 1-13, 2023, this study assessed factors associated with COVID-19 vaccination and reasons for non-vaccination among school-aged children 5-11 and adolescents 12-17 by educational setting. RESULTS Among children 5-11 years, COVID-19 vaccination coverage was higher among those who received in-person instruction (53.7%) compared to those who were homeschooled (32.5%). Furthermore, among adolescents 12-17 years, COVID-19 vaccination coverage was higher among those who received in-person instruction (73.5%) or virtual/online instruction (70.1%) compared to those who were homeschooled (51.0%). Children and adolescents were more likely to be vaccinated if the parental respondent had been vaccinated compared to those who had not. Among children and adolescents who were homeschooled, main reasons for non-vaccination were concern about side effects (45.4-51.6%), lack of trust in COVID-19 vaccines (45.0-50.9%), and lack of trust in the government (32.7-39.2%). CONCLUSIONS Children and adolescents who were home-schooled during the pandemic had lower vaccination coverage than those who attended school in person, and adolescents who were home-schooled had lower vaccination coverage than those who received virtual instruction. Based on the reasons for non-vaccination identified in this study, increasing parental confidence in vaccines, and reducing barriers to access are important for supporting COVID-19 vaccination for school-age children.
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Affiliation(s)
- K H Nguyen
- Department of Epidemiology, George Washington University School of Public Health, Washington, DC, 20037, USA; Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, USA.
| | - C McChesney
- Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - C Rodriguez
- Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - L Vasudevan
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - R A Bednarczyk
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, USA; Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA; Emory Vaccine Center, Emory University, Atlanta, GA, USA
| | - L Corlin
- Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, MA, USA; Department of Civil and Environmental Engineering, Tufts University School of Engineering, Medford, MA, USA
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Nguyen KH, Chen S, Zhao R, Vasudevan L, Beninger P, Bednarczyk RA. Vaccination patterns and up-to-date status of children 19-35 months, 2011-2021. Vaccine 2024; 42:1617-1629. [PMID: 38341291 DOI: 10.1016/j.vaccine.2024.01.096] [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: 10/05/2023] [Revised: 01/27/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024]
Abstract
INTRODUCTION Being up-to-date with all recommended vaccines is needed to protect children from vaccine preventable diseases. Understanding vaccination patterns is needed to develop messaging and strategies to increase vaccination uptake and confidence. METHODS Data from the 2011 to 2021 National Immunization Surveys was used to assess trends and disparities in vaccination patterns, zero vaccination status, and up-to-date status of U.S. children by 19-35 months. RESULTS From 2011 to 2021, adherence to the recommended schedule using the stringent definition increased from 35.7 % to 52.2 % (p < 0.01), adherence to the alternate schedule decreased from 28.2 % to 15.1 % (p < 0.01), and proportion of children who were not up-to-date decreased from 49.0 % to 33.3 % (p < 0.01). However, the proportion of children who had zero vaccinations did not change from 2011 (0.9 %) to 2021 (0.9 %; p = 0.08). In 2021, children 19-23 months were less likely to follow the recommended schedule than children 24-29 months (49.2 % compared to 56.4 %, p < 0.01). Adherence to the recommended schedule among children 19-23 months decreased in 2021 compared to 2020 overall and for some subpopulations (e.g. those with non-Hispanic (NH) Black parents (33.2 % compared to 44.9 %, p < 0.01). Furthermore, it was lowest among children of NH Black parents living at or below the federal poverty level (31.2 %) compared to their respective NH White counterparts (43.6 %, p < 0.01). CONCLUSIONS While there were overall increases in adherence to the recommended schedule from 2011 to 2021, a sustained catch-up program is needed to prevent missed vaccinations and achieve equitable vaccination coverage for all children.
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Affiliation(s)
- Kimberly H Nguyen
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA 30322, USA; Department of Epidemiology, George Washington University School of Public Health, Washington, DC 20037, USA.
| | - Siyu Chen
- Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Ruitong Zhao
- Tufts Medical Center, Institute for Clinical Research and Health Policy Studies, Boston, MA, USA
| | - Lavanya Vasudevan
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA 30322, USA
| | - Paul Beninger
- Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Robert A Bednarczyk
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA 30322, USA; Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA; Emory Vaccine Center, Emory University, Atlanta, GA, USA
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Haji Said A, Winskell K, Bednarczyk RA, Reardon EE, Vasudevan L. Interactive Narrative-Based Digital Health Interventions for Vaccine Communication: Protocol for a Scoping Review. JMIR Res Protoc 2024; 13:e51137. [PMID: 38335024 PMCID: PMC10891492 DOI: 10.2196/51137] [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: 07/22/2023] [Revised: 12/29/2023] [Accepted: 01/02/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Interactive narrative-based digital health interventions hold promise for effectively addressing the complex determinants of vaccine hesitancy and promoting effective communication across a wide range of settings and vaccine types. Synthesizing evidence related to the implementation and evaluation of these interventions could offer valuable perspectives for shaping future strategies in vaccine communication. Prior systematic and scoping reviews have examined narrative-based vaccine communication interventions but not the inclusion of interactivity in such interventions. OBJECTIVE The overall objective of the scoping review is to summarize the evidence on the use of interactive narrative-based digital health interventions for vaccine communication. Specific research questions focus on describing the use of interactive narrative-based digital health interventions (RQ1), describing evaluations of the impact of interactive narrative-based digital health interventions on promoting vaccine uptake (RQ2), and factors associated with their implementation (RQ3). METHODS A detailed search string will be used to search the following databases for records that are relevant to the review questions: PubMed, Embase, Scopus, Web of Science, CINAHL, and PsycINFO. Two reviewers will independently screen the titles and abstracts of identified records against the predefined eligibility criteria. Subsequently, eligible records will undergo comprehensive full-text screening by 2 independent reviewers to assess their relevance to review questions. A data charting tool will be developed and used to extract relevant information from the included articles. The extracted information will be analyzed following the review questions and presented as a narrative summary. Tabular or graphical representations will be used to display review findings, as relevant. RESULTS Public health informationists were consulted to develop the detailed search strategy. The final search string comprised terms related to narrative communication, digital health, and vaccines. The search string was customized to each proposed publication database and implemented on April 18, 2023. A total of 4474 unique records were identified using the search strategy and imported into the Covidence (Veritas Health Innovation Ltd) review management software for title and abstract screening. Title and abstract screening of identified records are ongoing as of December 29, 2023. CONCLUSIONS To our knowledge, this will be the first scoping review to investigate the features of interactive narrative-based digital health interventions and their role in vaccine communication. The goal of this study is to provide a comprehensive overview of the current research landscape and identify prevailing gaps in knowledge. The findings will provide insights for future research and development of novel applications of interactive narrative-based digital health vaccine communication interventions. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/51137.
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Affiliation(s)
- Ahmed Haji Said
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Kate Winskell
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Robert A Bednarczyk
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Erin E Reardon
- Woodruff Health Sciences Center Library, Emory University, Atlanta, GA, United States
| | - Lavanya Vasudevan
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
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Vasudevan L, Ostermann J, Thielman N, Baumgartner JN, Solomon D, Mosses A, Hobbie A, Hair NL, Liang C, van Zwetselaar M, Mfinanga S, Ngadaya E. Leveraging Community Health Workers and a Responsive Digital Health System to Improve Vaccination Coverage and Timeliness in Resource-Limited Settings: Protocol for a Cluster Randomized Type 1 Effectiveness-Implementation Hybrid Study. JMIR Res Protoc 2024; 13:e52523. [PMID: 38214956 PMCID: PMC10818232 DOI: 10.2196/52523] [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: 09/12/2023] [Accepted: 10/26/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Tanzania is 1 of 20 countries where the majority of unvaccinated and undervaccinated children reside. Prior research identified substantial rural-urban disparities in the coverage and timeliness of childhood vaccinations in Tanzania, with children in rural settings being more likely to receive delayed or no vaccinations. Further research is necessary to identify effective and scalable interventions that can bridge rural-urban gaps in childhood vaccination while accounting for multifaceted barriers to vaccination. OBJECTIVE This protocol describes a type 1 effectiveness-implementation hybrid study to evaluate Chanjo Kwa Wakati (timely vaccination in Kiswahili), a community-based digital health intervention to improve vaccination timeliness. The intervention combines human resources (community health workers), low-cost digital strategies (electronic communication, digital case management, and task automation), a vaccination knowledge intervention, and insights from behavioral economics (reminders and incentives) to promote timely childhood vaccinations. METHODS The study will be conducted in 2 predominantly rural regions in Tanzania with large numbers of unvaccinated or undervaccinated children: Shinyanga and Mwanza. Forty rural health facilities and their catchment areas (clusters) will be randomized to an early or delayed onset study arm. From each cluster, 3 cohorts of mother-child dyads (1 retrospective cohort and 2 prospective cohorts) will be enrolled in the study. The timeliness and coverage of all vaccinations recommended during the first year of life will be observed for 1200 children (n=600, 50% intervention group children and n=600, 50% nonintervention group children). The primary effectiveness outcome will be the timeliness of the third dose of the pentavalent vaccine (Penta3). Quantitative surveys, vaccination records, study logs, fidelity checklists, and qualitative interviews with mothers and key informants will inform the 5 constructs of the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework. The results will be used to develop an implementation blueprint to guide future adaptations and scale-up of Chanjo Kwa Wakati. RESULTS The study was funded in August 2022. Data collection is expected to last from February 2024 to July 2027. CONCLUSIONS This study will address the lack of rigorous evidence on the effectiveness of community-based digital health interventions for promoting vaccination coverage and timeliness among children from sub-Saharan Africa and identify potential implementation strategies to facilitate the deployment of vaccination promotion interventions in low- and middle-income countries. TRIAL REGISTRATION ClinicalTrials.gov NCT06024317; https://www.clinicaltrials.gov/study/NCT06024317. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/52523.
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Affiliation(s)
- Lavanya Vasudevan
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Jan Ostermann
- Duke Global Health Institute, Duke University, Durham, NC, United States
- Department of Health Services Policy & Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Nathan Thielman
- Duke Global Health Institute, Duke University, Durham, NC, United States
- Department of Medicine, Duke University, Durham, NC, United States
| | - Joy Noel Baumgartner
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - David Solomon
- National Institute for Medical Research, Muhimbili Research Centre, Dar es Salaam, United Republic of Tanzania
| | - Anna Mosses
- National Institute for Medical Research, Muhimbili Research Centre, Dar es Salaam, United Republic of Tanzania
| | - Amy Hobbie
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Nicole L Hair
- Department of Health Services Policy & Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Chen Liang
- Department of Health Services Policy & Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | | | - Sayoki Mfinanga
- National Institute for Medical Research, Muhimbili Research Centre, Dar es Salaam, United Republic of Tanzania
| | - Esther Ngadaya
- National Institute for Medical Research, Muhimbili Research Centre, Dar es Salaam, United Republic of Tanzania
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Nguyen KH, Zhao R, Chen S, Vaish AK, Bednarczyk RA, Vasudevan L. Population Attributable Fraction of Nonvaccination of COVID-19 Due to Vaccine Hesitancy, United States, 2021. Am J Epidemiol 2024; 193:121-133. [PMID: 37552958 DOI: 10.1093/aje/kwad167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 06/07/2023] [Accepted: 08/03/2023] [Indexed: 08/10/2023] Open
Abstract
Understanding the extent of coronavirus disease 2019 (COVID-19) nonvaccination attributable to vaccine hesitancy versus other barriers can help prioritize approaches for increasing vaccination uptake. Using data from the Centers for Disease Control and Prevention's Research and Development Survey, a nationally representative survey fielded from May 1 to June 30, 2021 (n = 5,458), we examined the adjusted population attribution fraction (PAF) of COVID-19 vaccine hesitancy attributed to nonvaccination according to sociodemographic characteristics and health-related variables. Overall, the adjusted PAF of nonvaccination attributed to vaccine hesitancy was 76.1%. The PAF was highest among adults who were ≥50 years of age (87.9%), were non-Hispanic White (83.7%), had a bachelor's degree or higher (82.7%), had an annual household income of at least $75,000 (85.5%), were insured (82.4%), and had a usual place for health care (80.7%). The PAF was lower for those who were current smokers (65.3%) compared with never smokers (77.9%), those who had anxiety or depression (65.2%) compared with those who did not (80.1%), and those who had a disability (64.5%) compared with those who did not (79.2%). Disparities in PAF suggest areas for prioritization of efforts for intervention and development of messaging campaigns that address all barriers to uptake, including hesitancy and access, to advance health equity and protect individuals from COVID-19.
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Nguyen KH, Levisohn A, McChesney C, Vasudevan L, Bednarczyk RA, Corlin L. Disparities in child and adolescent COVID-19 vaccination coverage and parental intent toward vaccinations for their children and adolescents. Ann Med 2023; 55:2232818. [PMID: 37449878 PMCID: PMC10351440 DOI: 10.1080/07853890.2023.2232818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 06/22/2023] [Accepted: 06/29/2023] [Indexed: 07/18/2023] Open
Abstract
INTRODUCTION Despite recommendations for COVID-19 primary series completion and booster doses for children and adolescents, coverage has been less than optimal, particularly in some subpopulations. This study explored disparities in childhood/adolescent COVID-19 vaccination, parental intent to vaccinate their children and adolescents, and reasons for non-vaccination in the US. METHODS Using the U.S. Census Bureau's Household Pulse Survey (HPS), we analyzed households with children aged <18 years using data collected from September 14 to November 14, 2022 (n = 44,929). Child and adolescent COVID-19 vaccination coverage (≥1 dose, completed primary series, and booster vaccination) and parental intentions toward vaccination were assessed by sociodemographic characteristics. Factors associated with child and adolescent vaccination coverage were examined using multivariable regression models. Reasons for non-vaccination were assessed overall, by the child's age group and respondent's age group. RESULTS Overall, approximately half (50.1%) of children aged < 18 years were vaccinated against COVID-19 (≥1 dose). Completed primary series vaccination was 44.2% among all children aged <18 years. By age group, completed primary series was 13.2% among children <5 years, 43.9% among children 5-11 years, and 63.3% among adolescents 12-17 years. Booster vaccination among those who completed the primary series was 39.1% among children 5-11 years and 55.3% among adolescents 12-17 years. Vaccination coverage differed by race/ethnicity, educational attainment, household income, region, parental COVID-19 vaccination status, prior COVID-19 diagnosis, child's age group, and parental age group. Parental reluctance was highest for children aged <5 years (46.8%). Main reasons for non-vaccination among reluctant parents were concerns about side effects (53.3%), lack of trust in COVID-19 vaccines (48.7%), and the belief that children do not need a COVID-19 vaccine (38.8%). CONCLUSION Disparities in COVID-19 vaccination coverage among children and adolescents continue to exist. Further efforts are needed to increase COVID-19 primary series and booster vaccination and parental confidence in vaccines.
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Affiliation(s)
- Kimberly H. Nguyen
- Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Ariella Levisohn
- Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Cheyenne McChesney
- Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Lavanya Vasudevan
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Robert A. Bednarczyk
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, USA
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
- Emory Vaccine Center, Emory University, Atlanta, GA, USA
| | - Laura Corlin
- Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, MA, USA
- Department of Civil and Environmental Engineering, Tufts University School of Engineering, Medford, MA, USA
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Nelson KN, Shah NS, Cranmer LM, Vasudevan L, Bednarczyk RA. An effective vaccine is only the first step: the need to create and sustain demand for TB vaccines. Int J Tuberc Lung Dis 2023; 27:718-720. [PMID: 37749838 PMCID: PMC10519388 DOI: 10.5588/ijtld.23.0365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 08/07/2023] [Indexed: 09/27/2023] Open
Affiliation(s)
- K N Nelson
- Department of Epidemiology, Emory University Rollins School of Public Health
| | - N S Shah
- Department of Epidemiology, Emory University Rollins School of Public Health, Department of Global Health, Emory University Rollins School of Public Health, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - L M Cranmer
- Department of Epidemiology, Emory University Rollins School of Public Health, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - L Vasudevan
- Department of Global Health, Emory University Rollins School of Public Health
| | - R A Bednarczyk
- Department of Epidemiology, Emory University Rollins School of Public Health, Department of Global Health, Emory University Rollins School of Public Health
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Yelverton V, Hair NL, Ghosh SH, Mfinanga SG, Ngadaya E, Baumgartner JN, Ostermann J, Vasudevan L. Corrigendum to "Beyond coverage: Rural-urban disparities in the timeliness of childhood vaccinations in Tanzania" [Vaccine 40(37) (2022) 5483-5493]. Vaccine 2023; 41:2425. [PMID: 36889993 DOI: 10.1016/j.vaccine.2023.02.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Affiliation(s)
- Valerie Yelverton
- Department of Health Services Policy & Management, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA
| | - Nicole L Hair
- Department of Health Services Policy & Management, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA
| | - Suvomita Happy Ghosh
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC 27710, USA
| | - Sayoki Godfrey Mfinanga
- Muhimbili Research Centre, National Institute for Medical Research, P.O. Box 65001, Dar-es-Salaam, Tanzania; Muhimbili University of Health and Allied Sciences, United Nations Rd, Dar es Salaam, Tanzania; The Nelson Mandela African Institution of Science and Technology (NM-AIST), Nelson Mandela Rd, Arusha, Tanzania; Alliance for Africa Research and Innovation (A4A), Dar es Salaam, Tanzania
| | - Esther Ngadaya
- Muhimbili Research Centre, National Institute for Medical Research, P.O. Box 65001, Dar-es-Salaam, Tanzania
| | - Joy Noel Baumgartner
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC 27710, USA; School of Social Work, University of North Carolina at Chapel Hill, Tate-Turner-Kuralt Building, 325 Pittsboro St, CB #3550, Chapel Hill, NC 27599, USA
| | - Jan Ostermann
- Department of Health Services Policy & Management, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA; Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC 27710, USA; South Carolina SmartState Center for Healthcare Quality, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA
| | - Lavanya Vasudevan
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC 27710, USA; Department of Family Medicine and Community Health, 2200 W. Main Street, Suite 600, School of Medicine, Duke University, Durham, NC 27710, USA.
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Ostermann J, Hair NL, Moses S, Ngadaya E, Godfrey Mfinanga S, Brown DS, Noel Baumgartner J, Vasudevan L. Is the intention to vaccinate enough? Systematic variation in the value of timely vaccinations and preferences for monetary vs non-monetary incentives among pregnant women in southern Tanzania. Vaccine X 2023; 13:100266. [PMID: 36814594 PMCID: PMC9939728 DOI: 10.1016/j.jvacx.2023.100266] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 03/03/2022] [Accepted: 01/20/2023] [Indexed: 01/24/2023] Open
Abstract
Background Globally, approximately 19.7 million children remain under-vaccinated; many more receive delayed vaccinations. Sustained progress towards global vaccination targets requires overcoming, or compensating for, incrementally greater barriers to vaccinating hard-to-reach and hard-to-vaccinate children. We prospectively assessed pregnant women's valuations of routine childhood vaccinations and preferences for alternative incentives to inform interventions aiming to increase vaccination coverage and timeliness in southern Tanzania. Methods Between August and December 2017, 406 women in their last trimester of pregnancy were enrolled from health facilities and communities in the Mtwara region of Tanzania and asked contingent valuation questions about their willingness to vaccinate their child if they were (a) given an incentive, or (b) facing a cost for each vaccination. Interval censored regressions assessed correlates of women's willingness to pay (WTP) for timely vaccinations. Participants were asked to rank monetary and non-monetary incentive options for the timely vaccination of their children. Findings All women expected to get their children vaccinated according to the recommended schedule, even without incentives. Nearly all women (393; 96.8 %) were willing to pay for vaccinations. The average WTP was Tanzania Shilling (Tsh) 3,066 (95 % confidence interval Tsh 2,523-3,610; 1 USD ∼ Tsh 2,200) for each vaccination. Women's valuations of timely vaccinations varied significantly with vaccine-related knowledge and attitudes, economic status, and rural vs urban residence. Women tended to prefer non-monetary over monetary incentives for the timely vaccination of their children. Interpretation Women placed a high value on timely childhood vaccinations, suggesting that unexpected system-level barriers rather than individual-level demand factors are likely to be the primary drivers of missed vaccinations. Systematic variation in the value of vaccinations across women reflects variation in perceived benefits and opportunity costs. In this setting, nonmonetary incentives and other interventions to increase demand and compensate for system-level barriers hold significant potential for improving vaccination coverage and timeliness. ClinicalTrialsgov Protocol NCT03252288.
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Affiliation(s)
- Jan Ostermann
- Department of Health Services Policy & Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- South Carolina Smart State Center for Healthcare Quality, University of South Carolina, Columbia, SC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Corresponding author at: Arnold School of Public Health, 915 Greene St. #351, Columbia, SC 29208, USA.
| | - Nicole L. Hair
- Department of Health Services Policy & Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Sara Moses
- Muhimbili Research Centre, National Institute for Medical Research, Dar-es-Salaam, United Republic of Tanzania
| | - Esther Ngadaya
- Muhimbili Research Centre, National Institute for Medical Research, Dar-es-Salaam, United Republic of Tanzania
| | - Sayoki Godfrey Mfinanga
- Muhimbili Research Centre, National Institute for Medical Research, Dar-es-Salaam, United Republic of Tanzania
- Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, United Republic of Tanzania
- School of Life Sciences and Bioengineering, Nelson Mandela African Institution of Science and Technology, Arusha, United Republic of Tanzania
| | - Derek S. Brown
- Brown School of Social Work, Washington University in Saint Louis, St. Louis, MO, USA
| | - Joy Noel Baumgartner
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lavanya Vasudevan
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Vasudevan L, Stinnett SS, Hart L, Gomez Altamirano P, Gonzalez A, Weaver K, Gray B, Bartlett J. Pregnant individuals' information needs and intention to vaccinate their children with routine and COVID-19 vaccines: Findings from a cross-sectional survey. Int J Gynaecol Obstet 2022:10.1002/ijgo.14571. [PMID: 36353745 PMCID: PMC9877590 DOI: 10.1002/ijgo.14571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 10/26/2022] [Accepted: 11/09/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The current study assessed pregnant individuals' intention to accept routine and COVID-19 vaccines for their baby after birth, and to identify key demographic (e.g., age) and nondemographic characteristics (e.g., prior birth) associated with vaccination intention. METHODS The authors conducted a cross-sectional survey with pregnant individuals attending prenatal practices affiliated with a large academic medical center and two rural county health departments in the southeastern United States. The survey included 11 questions and was self-administered by pregnant individuals in clinic settings. The final analysis included responses from 443 pregnant individuals. RESULTS Only 67% of pregnant individuals planned to vaccinate their baby with all recommended routine vaccines; an additional 22% reported having questions about recommendations. Only 35% of pregnant individuals said they would vaccinate their baby as soon as possible with a COVID-19 vaccine. Younger pregnant individuals and those identifying as Black or African American had lower routine and COVID-19 vaccination intention. Routine vaccination, but not COVID-19 vaccination intention, was associated with familiarity with routine vaccination schedule, trimester of pregnancy, Hispanic ethnicity, history of prior birth, and having access to a computer. CONCLUSION Study findings support differential tailoring of future interventions targeting pregnant individuals to promote routine and COVID-19 vaccines for children.
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Affiliation(s)
- Lavanya Vasudevan
- Department of Family Medicine and Community HealthDuke University School of MedicineDurhamNorth CarolinaUSA,Duke Global Health InstituteDurhamNorth CarolinaUSA,Hubert Department of Global HealthRollins School of Public Health, Emory UniversityAtlantaGeorgiaUSA
| | - Sandra S. Stinnett
- Department of Biostatistics and BioinformaticsDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Lauren Hart
- Department of Family Medicine and Community HealthDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Pedro Gomez Altamirano
- Department of Family Medicine and Community HealthDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Angel Gonzalez
- Department of Family Medicine and Community HealthDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Kristin Weaver
- Department of Obstetrics and GynecologyDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Beverly Gray
- Department of Obstetrics and GynecologyDuke University School of MedicineDurhamNorth CarolinaUSA
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Fish LJ, Harrison SE, McDonald JA, Yelverton V, Williams C, Walter EB, Vasudevan L. Key stakeholder perspectives on challenges and opportunities for rural HPV vaccination in North and South Carolina. Hum Vaccin Immunother 2022; 18:2058264. [PMID: 35439108 PMCID: PMC9248957 DOI: 10.1080/21645515.2022.2058264] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/16/2022] [Indexed: 11/08/2022] Open
Abstract
The objective of this study was to identify factors at the individual, provider, and systems levels that serve as challenges or opportunities for increasing adolescent vaccination-including Human Papillomavirus (HPV) vaccination-in rural communities in the southern United States (US). As part of a broader study to increase HPV vaccine uptake in the southern US, we conducted in-depth interviews with vaccination stakeholders representing public health and education agencies in North Carolina (NC) and South Carolina (SC). Fourteen key stakeholders were recruited using purposive sampling to obtain insights into challenges and solutions to rural-urban disparities in HPV vaccination coverage. Stakeholders were also queried about their experiences and attitudes toward school-based vaccination promotion programs and campaigns. We used a rapid qualitative approach to analyze the data. Stakeholders identified factors at the individual, provider, and systems levels that serve as challenges to vaccination in rural communities. Similar to previous studies, stakeholders mentioned challenges with healthcare access and vaccine-related misconceptions that pose barriers to HPV vaccination for rural residents. Systems-level challenges identified included limited access to high-speed internet in rural areas that may impact providers' ability to interface with state-level digital systems such as the vaccination registry. Stakeholders identified a number of opportunities to increase HPV vaccination coverage, including through school-based health promotion programs. Stakeholders strongly supported school-based programs and approaches to strengthen confidence and demand for HPV vaccination and to help address persistent social determinants and system level factors that pose challenges to HPV vaccination coverage in many rural areas.
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Affiliation(s)
- Laura J. Fish
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, USA
- Duke Cancer Institute, Durham, NC, USA
| | - Sayward E Harrison
- Department of Psychology, Barnwell College, University of South Carolina, Columbia, SC, USA
- South Carolina Smart State Center for Healthcare Quality, University of South Carolina, Columbia, SC, USA
| | | | - Valerie Yelverton
- Department of Health Services Policy & Management, University of South Carolina, Columbia, SC, USA
| | - Charnetta Williams
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Emmanuel B. Walter
- Duke Human Vaccine Institute, Durham, NC, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
- Duke Global Health Institute, Durham, NC, USA
| | - Lavanya Vasudevan
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, USA
- Duke Human Vaccine Institute, Durham, NC, USA
- Duke Global Health Institute, Durham, NC, USA
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Baumgartner JN, Nyambe N, Vasudevan L, Kasonde P, Welsh M. Prevalence of self-reported diabetes risk factors and integration of diabetes screening and referral at two urban HIV care and treatment clinics in Zambia. PLoS One 2022; 17:e0275203. [PMID: 36155991 PMCID: PMC9512175 DOI: 10.1371/journal.pone.0275203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 09/12/2022] [Indexed: 11/30/2022] Open
Abstract
People living with HIV (PLWH) on antiretroviral therapy (ART) are living longer and are at risk of HIV co-morbidities including non-communicable diseases (NCDs), particularly in low-resource settings. However, the evidence base for effectively integrating HIV and NCD care is limited. The Chronic Health Care (CHC) checklist, designed to screen for multiple NCDs including a 6-item diabetes self-report screener, was implemented at two PEPFAR-supported HIV clinics in Kabwe and Kitwe, Zambia. Study objectives were to describe the HIV care and treatment population and their self-reported diabetes-related symptoms, and to evaluate provider-initiated screening and referral post-training on the CHC checklist. This cross-sectional study enrolled 435 adults receiving combination ART services. Clinic exit interviews revealed 46% self-reported at least one potential symptom, and 6% self-reported three or more symptoms to the study team, indicating risk for diabetes and need for further diagnostic testing. In comparison, only 8% of all participants reported being appropriately screened for diabetes by their health provider, with less than 1% referred for further testing. This missed opportunity for screening and referral indicates that HIV-NCD integration efforts need more fully resourced and multi-pronged approaches in order to ensure that PLWH who are already accessing ART receive the comprehensive, holistic care they need.
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Affiliation(s)
| | | | - Lavanya Vasudevan
- Family Medicine & Community Health, and Duke Global Health Institute, Duke University, NC, United States of America
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Yelverton V, Hair NL, Ghosh SH, Mfinanga SG, Ngadaya E, Baumgartner JN, Ostermann J, Vasudevan L. Beyond coverage: Rural-urban disparities in the timeliness of childhood vaccinations in Tanzania. Vaccine 2022; 40:5483-5493. [PMID: 35961796 PMCID: PMC9954535 DOI: 10.1016/j.vaccine.2022.07.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 02/26/2021] [Revised: 05/16/2022] [Accepted: 07/19/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Timely vaccination maximizes efficacy for preventing infectious diseases. In the absence of national vaccination registries, representative sample survey data hold vital information on vaccination coverage and timeliness. This study characterizes vaccination coverage and timeliness in Tanzania and provides an analytic template to inform contextually relevant interventions and evaluate immunization programs. METHODS Cross-sectional data on 6,092 children under age 3 from the 2015-16 Tanzania Demographic and Health Survey were used to examine coverage and timeliness for 14 vaccine doses recommended in the first year of life. The Kaplan-Meier method was used to model time to vaccination. Cox proportional hazard models were used to examine factors associated with timely vaccination. RESULTS Substantial rural-urban disparities in vaccination coverage and timeliness were observed for all vaccines. Across 14 recommended doses, documented coverage ranged from 52 % to 79 %. Median vaccination delays lasted up to 35 days; gaps were larger among rural than urban children and for later doses in vaccine series. Among rural children, median delays exceeded 35 days for the 3rd doses of the polio, pentavalent, and pneumococcal vaccines. Median delays among urban children were < 21 days for all doses. Among rural and urban children, lower maternal education and delivery at home were associated with increased risk of delayed vaccination. In rural settings, less household wealth and greater distance to a health facility were also associated with increased risk of delayed vaccination. DISCUSSION This study highlights persistent gaps in uptake and timeliness of childhood vaccinations in Tanzania and substantial rural-urban disparities. While the results provide an informative situation assessment and outline strategies for identifying unvaccinated children, a national electronic registry is critical for comprehensive assessments of the performance of vaccination programs. The timeliness measure employed in this study-the amount of time children are un- or undervaccinated-may serve as a sensitive performance metric for these programs.
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Affiliation(s)
- Valerie Yelverton
- Department of Health Services Policy & Management, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA
| | - Nicole L Hair
- Department of Health Services Policy & Management, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA
| | - Suvomita Happy Ghosh
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC 27710, USA
| | - Sayoki Godfrey Mfinanga
- Muhimbili Research Centre, National Institute for Medical Research, P.O. Box 65001, Dar-es-Salaam, Tanzania; Muhimbili University of Health and Allied Sciences, United Nations Rd, Dar es Salaam, Tanzania; The Nelson Mandela African Institution of Science and Technology (NM-AIST), Nelson Mandela Rd, Arusha, Tanzania; Alliance for Africa Research and Innovation (A4A), Dar es Salaam, Tanzania
| | - Esther Ngadaya
- Muhimbili Research Centre, National Institute for Medical Research, P.O. Box 65001, Dar-es-Salaam, Tanzania
| | - Joy Noel Baumgartner
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC 27710, USA; School of Social Work, University of North Carolina at Chapel Hill, Tate-Turner-Kuralt Building, 325 Pittsboro St, CB #3550, Chapel Hill, NC 27599, USA
| | - Jan Ostermann
- Department of Health Services Policy & Management, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA; Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC 27710, USA; South Carolina SmartState Center for Healthcare Quality, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA
| | - Lavanya Vasudevan
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC 27710, USA; Department of Family Medicine and Community Health, 2200 W. Main Street, Suite 600, School of Medicine, Duke University, Durham, NC 27710, USA.
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16
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Vasudevan L, Bruening R, Hung A, Woolson S, Brown A, Hastings SN, Linton T, Embree G, Hostler CJ, Mahanna E, Okeke NL, Bosworth H, Sperber NR. COVID-19 vaccination intention and activation among health care system employees: A mixed methods study. Vaccine 2022; 40:5141-5152. [PMID: 35902277 PMCID: PMC9276645 DOI: 10.1016/j.vaccine.2022.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Achieving high COVID-19 vaccination rates among employees is necessary to prevent outbreaks in health care settings. The goal of the study was to produce actionable and timely evidence about factors underlying the intention and decisions to obtain the COVID-19 vaccine by employees. METHODS The study was conducted from December 2020 - May 2021 with employees from a VA health care system in Southeastern US. The study used a convergent mixed methods design comprising two main activities: a cross-sectional survey conducted prior to COVID-19 vaccine distribution, and semi-structured interviews conducted 4-6 months after vaccine distribution. Data were collected about participant characteristics, vaccination intention prior to distribution, vaccination decision post-distribution, determinants of vaccination intention and decision, activating factors, sources of information and intervention needs. Data from the survey and interviews were analyzed separately and integrated narratively in the discussion. RESULTS Prior to vaccine distribution, 77% of employees wanted to be vaccinated. Post vaccine distribution, we identified 5 distinct decision-making groups: 1) vaccine believers who actively sought vaccination and included those sometimes described as "immunization advocates", 2) go along to get along (GATGA) individuals who got vaccinated but did not actively seek it, 3) cautious acceptors who got the COVID-19 vaccine after some delay, 4) fence sitters who remained uncertain about getting vaccinated, and 5) vaccine refusers who actively rejected the COVID-19 vaccine. Participants identifying with Black or multiple races were more likely to express hesitancy in their vaccination intention. CONCLUSION The findings of our study highlight distinct decision-making profiles associated with COVID-19 vaccination among employees of a VA health care system, and provide tailored recommendations to reduce vaccine hesitancy in this population.
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Affiliation(s)
- Lavanya Vasudevan
- Department of Family Medicine and Community Health, Duke University, Durham, NC, USA; Duke Global Health Institute, Durham, NC, USA; Duke Human Vaccine Institute, Durham, NC, USA.
| | - Rebecca Bruening
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, NC, USA
| | - Anna Hung
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, NC, USA; Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Sandra Woolson
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, NC, USA
| | - Adrian Brown
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, NC, USA
| | - Susan N Hastings
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, NC, USA; Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA; Department of Medicine, Duke University School of Medicine, Durham, NC, USA; Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC, USA; Geriatrics Research, Education and Clinical Center, Durham VA Health Care System, Durham, NC, USA
| | - Tammy Linton
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, NC, USA; Office of Public Health and Epidemiology, Durham VA Health Care System, Durham, NC, USA
| | - Genevieve Embree
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA; Office of Public Health and Epidemiology, Durham VA Health Care System, Durham, NC, USA
| | - Christopher J Hostler
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA; Office of Public Health and Epidemiology, Durham VA Health Care System, Durham, NC, USA
| | - Elizabeth Mahanna
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, NC, USA
| | - Nwora Lance Okeke
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA; Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Hayden Bosworth
- Department of Family Medicine and Community Health, Duke University, Durham, NC, USA; Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, NC, USA; Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA; Department of Medicine, Duke University School of Medicine, Durham, NC, USA; Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC, USA
| | - Nina R Sperber
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, NC, USA; Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA; Duke-Margolis Center for Health Policy, Durham, NC, USA
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Vasudevan L, Ostermann J, Wang Y, Harrison SE, Yelverton V, Fish LJ, Williams C, Walter EB. Association of caregiver attitudes with adolescent HPV vaccination in 13 southern US states. Vaccine X 2022; 11:100181. [PMID: 35789674 PMCID: PMC9250032 DOI: 10.1016/j.jvacx.2022.100181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 05/20/2022] [Accepted: 05/23/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Lavanya Vasudevan
- Department of Family Medicine and Community Health, Duke University School of Medicine, 2200 W. Main Street, Suite 600, Durham, NC 27705, USA
- Duke Global Health Institute, 310 Trent Drive, Durham, NC 27710, USA
- Duke Human Vaccine Institute, 27 Alexandria Way, Durham, NC 27703, USA
- Corresponding author at: 2200 W. Main Street, Suite 600, Durham, NC 27710, USA.
| | - Jan Ostermann
- Duke Global Health Institute, 310 Trent Drive, Durham, NC 27710, USA
- Department of Health Services Policy & Management, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA
- South Carolina Smart State Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA
| | - Yunfei Wang
- Duke Human Vaccine Institute, 27 Alexandria Way, Durham, NC 27703, USA
| | - Sayward E. Harrison
- South Carolina Smart State Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA
- Department of Psychology, University of South Carolina, 1512 Pendleton Street, Barnwell College, Suite #220, Columbia, SC 29208, USA
| | - Valerie Yelverton
- Department of Health Services Policy & Management, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA
| | - Laura J. Fish
- Department of Family Medicine and Community Health, Duke University School of Medicine, 2200 W. Main Street, Suite 600, Durham, NC 27705, USA
- Duke Cancer Institute, 2424 Erwin Rd, Suite 602, Durham, NC 27710, USA
| | - Charnetta Williams
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, Atlanta, GA 30329, USA
| | - Emmanuel B. Walter
- Duke Global Health Institute, 310 Trent Drive, Durham, NC 27710, USA
- Duke Human Vaccine Institute, 27 Alexandria Way, Durham, NC 27703, USA
- Department of Pediatrics, Duke University School of Medicine, Box 3675, DUMC, Durham, NC 27710, USA
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Reid HW, Proeschold-Bell RJ, Makarushka C, Melgar Vega KD, Huchko M, Jeronimo J, Vasudevan L. Using the Consolidated Framework for Implementation Research to Inform the Design of the Mobile Inspección Visual con Ácido Acético System: Mixed Methods Case Study. JMIR Form Res 2022; 6:e32577. [PMID: 35737455 PMCID: PMC9264128 DOI: 10.2196/32577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 03/03/2022] [Accepted: 05/02/2022] [Indexed: 12/03/2022] Open
Abstract
Background There is growing evidence supporting the use of mobile health (mHealth) interventions in low- and middle-income countries to address resource limitations in the delivery of health information and services to vulnerable populations. In parallel, there is an increasing emphasis on the use of implementation science tools and frameworks for the early identification of implementation barriers and to improve the acceptability, appropriateness, and adoption of mHealth interventions in resource-limited settings. However, there are limited examples of the application of implementation science tools and frameworks to the formative phase of mHealth design for resource-limited settings despite the potential benefits of this work for enhancing subsequent implementation, scale-up, and sustainability. Objective We presented a case study on the use of an implementation science framework in mHealth design. In particular, we illustrated the usability of the Consolidated Framework for Implementation Research (CFIR) for organizing and interpreting formative research findings during the design of the mobile Inspección Visual con Ácido Acético (mIVAA) system in Lima, Peru. Methods We collected formative data from prospective users of the mIVAA intervention using multiple research methodologies, including structured observations, surveys, group and individual interviews, and discussions with local stakeholders at the partnering organization in Peru. These activities enabled the documentation of clinical workflows, perceived barriers to and facilitators of mIVAA, overarching barriers to cervical cancer screening in community-based settings, and related local policies and guidelines in health care. Using a convergent mixed methods analytic approach and the CFIR as an organizing framework, we mapped formative research findings to identify key implementation barriers and inform iterations of the mIVAA system design. Results In the setting of our case study, most implementation barriers were identified in the CFIR domains of intervention characteristics and inner setting. All but one barrier were addressed before mIVAA deployment by modifying the system design and adding supportive resources. Solutions involved improvements to infrastructure, including cellular data plans to avoid disruption from internet failure; improved process and flow, including an updated software interface; and better user role definition for image capture to be consistent with local health care laws. Conclusions The CFIR can serve as a comprehensive framework for organizing formative research data and identifying key implementation barriers during mHealth intervention design. In our case study of the mIVAA system in Peru, formative research contributing to the CFIR domains of intervention characteristics and inner setting elicited the most key barriers to implementation. The early identification of barriers enabled design iterations before system deployment. Future efforts to develop mHealth interventions for low- and middle-income countries may benefit from using the approach presented in this case study as well as prioritizing the CFIR domains of intervention characteristics and inner setting.
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Affiliation(s)
| | - Rae Jean Proeschold-Bell
- Duke Global Health Institute, Durham, NC, United States
- Center for Health Policy and Inequalities Research, Duke University, Durham, NC, United States
| | - Christina Makarushka
- Department of Family Medicine and Community Health, Duke University, Durham, NC, United States
| | | | - Megan Huchko
- Duke University School of Medicine, Durham, NC, United States
- Duke Global Health Institute, Durham, NC, United States
- Department of Obstetrics and Gynecology, Duke University, Durham, NC, United States
| | | | - Lavanya Vasudevan
- Duke University School of Medicine, Durham, NC, United States
- Duke Global Health Institute, Durham, NC, United States
- Center for Health Policy and Inequalities Research, Duke University, Durham, NC, United States
- Department of Family Medicine and Community Health, Duke University, Durham, NC, United States
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Kansal N, Weaver K, Vasudevan L, Hughes B. Evaluating Influenza and COVID-19 Vaccine Hesitancy Among Pregnant Women Using the Health Belief Model. Am J Obstet Gynecol 2022. [PMCID: PMC8789408 DOI: 10.1016/j.ajog.2021.11.1319] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Vasudevan L, Ostermann J, Wang Y, Harrison SE, Yelverton V, McDonald JA, Fish LJ, Williams C, Walter EB. Predictors of HPV vaccination in the southern US: A survey of caregivers from 13 states. Vaccine 2021; 39:7485-7493. [PMID: 34742592 PMCID: PMC8685535 DOI: 10.1016/j.vaccine.2021.10.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 05/06/2021] [Revised: 10/01/2021] [Accepted: 10/17/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Despite a high burden of human papillomavirus (HPV)-attributable cancers, the southern US lags other regions in HPV vaccination coverage. This study sought to characterize and contextualize predictors of HPV vaccination in the southern US. METHODS From December 2019 - January 2020, parents of adolescents (ages 9-17 years) living in thirteen southern US states were recruited from a nationally-representative online survey panel and completed a cross-sectional survey. The primary study outcome was initiation of HPV vaccination. RESULTS Of 1105 parents who responded to the survey, most were ≥35 years of age and of female gender. HPV vaccination initiation was reported only among 37.3% of adolescents and was highest at age 12. Cumulative HPV vaccination coverage was highest at age 15 (60%) but lower than coverage for tetanus-diphtheria-acellular pertussis (Tdap, 79.3%) and Meningococcal vaccines (MenACWY, 67.3%). Provider recommendation was strongly associated with higher odds of HPV vaccination (aOR: 49.9, 95 %CI: 23.1-107.5). In alternative predictive models, home/online (vs. public) schooling and parents' working status were associated with lower odds of vaccination; health care visits in the past 12 months and shorter travel times to adolescents' usual health care provider were associated with greater odds of vaccination. CONCLUSIONS Our findings suggest missed opportunities for HPV vaccination in the southern US and support strengthening provider recommendation for on-time initiation of HPV vaccination among adolescents. Other strategies to increase HPV vaccinations may include encouraging co-administration with other adolescent vaccines, increasing vaccine access, and promoting vaccinations for home/online-school students.
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Affiliation(s)
- Lavanya Vasudevan
- Department of Family Medicine and Community Health, Duke University School of Medicine, 2200 W. Main Street, Suite 600, Durham, NC 27705, USA; Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA.
| | - Jan Ostermann
- Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA; Department of Health Services Policy & Management, 915 Greene Street, University of South Carolina, Columbia, SC 29208, USA; South Carolina Smart State Center for Healthcare Quality, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA
| | - Yunfei Wang
- Duke Vaccine and Trials Unit, Duke Human Vaccine Institute, 2608 Erwin Road, Suite 210, Durham, NC 27705, USA
| | - Sayward E Harrison
- South Carolina Smart State Center for Healthcare Quality, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA; Department of Psychology, University of South Carolina, 1512 Pendleton Street, Barnwell College, Suite #220, Columbia, SC 29208, USA
| | - Valerie Yelverton
- Department of Health Services Policy & Management, 915 Greene Street, University of South Carolina, Columbia, SC 29208, USA
| | - Jodi-Ann McDonald
- Duke Vaccine and Trials Unit, Duke Human Vaccine Institute, 2608 Erwin Road, Suite 210, Durham, NC 27705, USA
| | - Laura J Fish
- Department of Family Medicine and Community Health, Duke University School of Medicine, 2200 W. Main Street, Suite 600, Durham, NC 27705, USA; Duke Cancer Institute, 2424 Erwin Rd, Suite 602, Durham, NC 27710, USA
| | - Charnetta Williams
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, Atlanta, GA 30329, USA
| | - Emmanuel B Walter
- Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA; Duke Vaccine and Trials Unit, Duke Human Vaccine Institute, 2608 Erwin Road, Suite 210, Durham, NC 27705, USA; Department of Pediatrics, Duke University School of Medicine, Box 3675, DUMC, Durham, NC 27710, USA
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22
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Schroeder K, Maiarana J, Gisiri M, Joo E, Muiruri C, Zullig L, Masalu N, Vasudevan L. Caregiver Acceptability of Mobile Phone Use for Pediatric Cancer Care in Tanzania: Cross-sectional Questionnaire Study. JMIR Pediatr Parent 2021; 4:e27988. [PMID: 34889763 PMCID: PMC8701707 DOI: 10.2196/27988] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/06/2021] [Accepted: 05/06/2021] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND There is a 60% survival gap between children diagnosed with cancer in low- and middle-income countries (LMICs) and those in high-income countries. Low caregiver knowledge about childhood cancer and its treatment results in presentation delays and subsequent treatment abandonment in LMICs. However, in-person education to improve caregiver knowledge can be challenging due to health worker shortages and inadequate training. Due to the rapid expansion of mobile phone use worldwide, mobile health (mHealth) technologies offer an alternative to delivering in-person education. OBJECTIVE The aim of this study is to assess patterns of mobile phone ownership and use among Tanzanian caregivers of children diagnosed with cancer as well as their acceptability of an mHealth intervention for cancer education, patient communication, and care coordination. METHODS In July 2017, caregivers of children <18 years diagnosed with cancer and receiving treatment at Bugando Medical Centre (BMC) were surveyed to determine mobile phone ownership, use patterns, technology literacy, and acceptability of mobile phone use for cancer education, patient communication, and care coordination. Descriptive statistics were generated from the survey data by using mean and SD values for continuous variables and percentages for binary or categorical variables. RESULTS All eligible caregivers consented to participate and completed the survey. Of the 40 caregivers who enrolled in the study, most used a mobile phone (n=34, 85%) and expressed high acceptability in using these devices to communicate with a health care provider regarding treatment support (n=39, 98%), receiving laboratory results (n=37, 93%), receiving reminders for upcoming appointments (n=38, 95%), and receiving educational information on cancer (n=35, 88%). Although only 9% (3/34) of mobile phone owners owned phones with smartphone capabilities, about 74% (25/34) self-reported they could view and read SMS text messages. CONCLUSIONS To our knowledge, this is the first study to assess patterns of mobile phone ownership and use among caregivers of children with cancer in Tanzania. The high rate of mobile phone ownership and caregiver acceptability for a mobile phone-based education and communication strategy suggests that a mobile phone-based intervention, particularly one that utilizes SMS technology, could be feasible in this setting.
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Affiliation(s)
- Kristin Schroeder
- Department of Pediatric Oncology, Duke University Medical Center, Durham, NC, United States.,Department of Oncology, Bugando Medical Centre, Mwanza, United Republic of Tanzania.,Duke Global Health Institute, Durham, NC, United States
| | - James Maiarana
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Mwitasrobert Gisiri
- Department of Oncology, Bugando Medical Centre, Mwanza, United Republic of Tanzania
| | - Emma Joo
- Duke Global Health Institute, Durham, NC, United States
| | - Charles Muiruri
- Duke Global Health Institute, Durham, NC, United States.,Department of Population Health Sciences, Duke University, Durham, NC, United States
| | - Leah Zullig
- Department of Population Health Sciences, Duke University, Durham, NC, United States.,Durham Veterans Affairs Center of Innovation to Accelerate and Practice Transformation, Durham, NC, United States
| | - Nestory Masalu
- Department of Oncology, Bugando Medical Centre, Mwanza, United Republic of Tanzania
| | - Lavanya Vasudevan
- Duke Global Health Institute, Durham, NC, United States.,Department of Family Medicine and Community Health, Duke University, Durham, NC, United States
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Vasudevan L, V J, M S, Ts C. Mucosa-adherent Pediococcus Pentosaceus I44 isolated from healthy human and effect of oleic acid on its probiotic properties. Curr Res Microb Sci 2021; 2:100058. [PMID: 34841348 PMCID: PMC8610357 DOI: 10.1016/j.crmicr.2021.100058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 08/07/2021] [Accepted: 08/12/2021] [Indexed: 11/04/2022] Open
Abstract
A Gram-positive, catalase-negative cocci identified as Pediococcus pentosaceus I44 was isolated from the ileal tissue of a healthy Indian. This isolate exhibited good tolerance to gastrointestinal conditions and bile stress. Oleic acid and oleic acid containing compounds (tween-80, olive oil and sesame oil) were found to have a significant effect on the stress tolerance ability and surface properties of this isolate invitro. Pediococcus pentosaceus I44 represents the autochthonous gut bacterial community and understanding such isolates provide useful insights into their role in human metabolism and health.
With the aim of selectively isolating and understanding the cultivable lactic acid bacteria that are autochthonous to human gut, biopsy samples were collected from the terminal ileum and caecum of healthy volunteers who underwent routine colonoscopy procedure. The use of tissue samples (over stool samples) provides for a better expression of the autochthonous bacterial population of the human gut. The strains that were stable after many rounds of sub-culture were identified and studied further. One such ileal isolate, a Gram-positive, catalase-negative cocci was identified to be Pediococcus pentosaceus I44. It was studied for its gastric tolerance, bile tolerance and surface properties, and reported here. The effect of tween-80, oleic acid, extra virgin olive oil and sesame oil on the aforementioned properties of P. pentosaceus I44 was also analysed. The isolate was able to survive well in simulated gastric fluid of pH 3.0 followed by treatment in simulated intestinal fluid with a survival percentage of around 70%. It was, however, unable to withstand pH 2.0 even in the presence of supplements. It showed good tolerance to bile stress (1% w/v), and its cell surface was found to be hydrophilic. P. pentosaceus I44 showed good aggregation of 87% after 24 h, with oleic acid having a significant effect on the isolate's aggregation potential. P. pentosaceus I44 is one of the few mucosa-bound cultivable bacteria that are adapted for survival in human colon. Studying and analysing such isolates might provide useful insights into their role in metabolism and health.
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Affiliation(s)
- Lavanya Vasudevan
- Department of Biotechnology, Bhupat and Jyoti Mehta School of Biosciences, Indian Institute of Technology Madras, Chennai, Tamil Nadu 600036, India
| | - Jayanthi V
- Gleneagles Global Health City, Cheran Nagar, Perumbakkam, Chennai, Tamil Nadu 600100, India
| | - Srinivas M
- Gleneagles Global Health City, Cheran Nagar, Perumbakkam, Chennai, Tamil Nadu 600100, India
| | - Chandra Ts
- Department of Biotechnology, Bhupat and Jyoti Mehta School of Biosciences, Indian Institute of Technology Madras, Chennai, Tamil Nadu 600036, India
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24
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Goel K, Vasudevan L. Disparities in healthcare access and utilization and human papillomavirus (HPV) vaccine initiation in the United States. Hum Vaccin Immunother 2021; 17:5390-5396. [PMID: 34736353 DOI: 10.1080/21645515.2021.1989919] [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] [Indexed: 10/19/2022] Open
Abstract
Currently in the United States, Human Papillomavirus (HPV) vaccination coverage among eligible individuals is lower compared to coverage goals of 80% set by the HealthyPeople 2030 initiative. In this study, we used the National Health and Nutrition Examination Survey (NHANES) 2015-2016 and 2017-2018 datasets to determine the association between HPV vaccine initiation among individuals of ages 9 to 26 years and their patterns of healthcare access and utilization. In particular, we examined the following healthcare characteristics: 1) having a routine place of healthcare, 2) having health insurance coverage, 3) frequency of healthcare visits per year, and 4) type of routine place of healthcare (outpatient primary care vs. ED, etc.). We fit independent multivariable logistic regression models for each NHANES dataset and controlled for sociodemographic characteristics and interactions with healthcare access and utilization characteristics. Our findings suggest that HPV vaccine initiation is positively associated with having a routine place of healthcare (2015-2016: aOR 1.92, 95% CI 1.25-2.95; 2017-2018: aOR 1.99, 95% CI 1.07-3.68). Relatedly, HPV vaccine initiation is negatively associated with never having received healthcare in the past year (2015-2016: aOR 0.61, 95% CI 0.41-0.90; 2017-2018: aOR 0.45, 95% CI 0.27-0.75). The results of this study suggest that interventions to promote HPV vaccination should include strategies that promote access to and utilization of routine health care services. Our findings are particularly salient in light of the drop in HPV vaccine initiation and healthcare access and utilization among adolescents during the COVID-19 pandemic.
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Affiliation(s)
- Kunal Goel
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Lavanya Vasudevan
- Department of Family Medicine and Community Health, Duke University, Durham, North Carolina, USA
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25
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Harrison SE, Yelverton V, Wang Y, Ostermann J, Fish LJ, Williams CL, Vasudevan L, Walter EB. Examining Associations between Knowledge and Vaccine Uptake Using the Human Papillomavirus Knowledge Questionnaire (HPV-KQ). Am J Health Behav 2021; 45:810-827. [PMID: 34702429 PMCID: PMC8900988 DOI: 10.5993/ajhb.45.5.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Indexed: 11/12/2022]
Abstract
Objectives: Understanding the relationship between human papillomavirus (HPV) knowledge and vaccination behavior is important to inform public health interventions, yet few validated HPV knowledge scales exist. This study describes development of the Human Papillomavirus Knowledge Questionnaire (HPV-KQ) and its validation with parents residing in the southern United States (US). Methods: Drawing on previously published measures, we developed the 13-item HPV-KQ and administered the scale via Web-based survey to parents (N=1105) of adolescents ages 9 to 17 years. Dimensionality, internal consistency, model fit, and predictive validity were assessed. Results: The scale was bidimensional. One factor captured general HPV knowledge, and the second factor captured perceptions of gender differences in HPV infection and vaccine recommendations. The 13-item scale and 2-factor solution displayed strong internal consistency and good model fit. Parents of vaccinated adolescents scored higher on the 13-item HPV-KQ (Mean = 8.56) than parents of unvaccinated adolescents (Mean = 6.43) (p < .001). In regression models, controlling for key covariates, parents' performance on the HPV-KQ predicted adolescent HPV vaccination (p < .001). Conclusions: Evaluation indicates the HPV-KQ is a reliable and valid tool for measuring knowledge of HPV and the HPV vaccine among parents residing in the southern US. We recommend further efforts to validate the scale with other populations.
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Affiliation(s)
- Sayward E Harrison
- Sayward E Harrison, Department of Psychology, University of South Carolina, Columbia, SC, and South Carolina Smart State Center for Healthcare Quality, University of South Carolina, Columbia, SC, United States;,
| | - Valerie Yelverton
- Valerie Yelverton, Department of Health Services Policy & Management, University of South Carolina, Columbia, SC, United States
| | - Yunfei Wang
- Yunfei Wang, Duke Vaccine and Trials Unit, Duke Human Vaccine Institute, Durham, NC, United States
| | - Jan Ostermann
- Jan Ostermann, Department of Health Services Policy & Management, University of South Carolina, Columbia, SC, United States
| | - Laura J Fish
- Laura J Fish, Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, and Duke Cancer Institute, Durham, NC, United States
| | - Charnetta L Williams
- Charnetta L Williams, Immunization Services Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Lavanya Vasudevan
- Lavanya Vasudevan, Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, and Duke Global Health Institute, Durham, NC, United States
| | - Emmanuel B Walter
- Emmanuel B Walter, Duke Vaccine and Trials Unit, Duke Human Vaccine Institute, Durham, NC, Duke Global Health Institute, Durham, NC, and Department of Pediatrics, Duke University School of Medicine, Durham, NC, United States
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26
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Pieters MM, Proeschold-Bell RJ, Coffey E, Huchko MJ, Vasudevan L. Knowledge, attitudes, and practices regarding cervical cancer screening among women in metropolitan Lima, Peru: a cross-sectional study. BMC Womens Health 2021; 21:304. [PMID: 34407799 PMCID: PMC8371792 DOI: 10.1186/s12905-021-01431-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 07/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cervical cancer is a leading cause of cancer deaths among women of reproductive age in Peru. Screening and early identification of pre-cancerous lesions are a cornerstone of the cervical cancer prevention strategy. Yet, there is limited literature on barriers to screening among Peruvian women. In this cross-sectional study, we aimed to examine Peruvian women's knowledge, attitudes, and practices regarding cervical cancer screening and identify possible reasons for the gap between knowledge and screening. METHODS The study was conducted in metropolitan Lima from June-August 2019. We purposefully recruited 12 women who had previously been screened, and 12 who had never been screened for cervical cancer. The women completed a 40-question knowledge and attitude survey and an in-depth interview about barriers to screening. Descriptive analysis was used to calculate a knowledge and attitude score and qualitative analysis was guided by the Health Belief Model constructs. RESULTS Previously screened participants had greater knowledge of cervical cancer symptoms, risk factors, and prevention (mean score = 28.08, S.D. = 4.18) compared to participants who had never been screened (mean score = 21.25, S.D. = 6.35). Both groups described lack of priority and embarrassment as barriers to cervical cancer screening. For participants who had never been screened before, major barriers included the fear of a cancer diagnosis and lack of information about screening services. Pregnancy, unusual gynecological symptoms and encouragement from friends and family were cues to action for participants seeking screening. Most participants in both groups recognized the benefits of getting screened for cervical cancer. Being previously screened increased participants' self-efficacy for engaging in screening behaviors again. Misconceptions regarding screening procedures and cervical cancer were also noted as barriers for participants accessing screening services. CONCLUSIONS Improving knowledge and awareness about cervical cancer and screening programs may improve screening behaviors among women. Targeting women who have never been screened before and addressing their fears and concerns around embarrassment may be other areas for intervention. Misconceptions that deter women from screening services are an important issue that should be addressed in order to increase the number of women who get timely screenings.
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Affiliation(s)
| | - Rae Jean Proeschold-Bell
- Duke Global Health Institute, Durham, NC, USA
- Center for Health Policy and Inequalities Research, Duke University, Durham, NC, USA
| | | | - Megan J Huchko
- Duke Global Health Institute, Durham, NC, USA
- Department of Obstetrics and Gynecology, Duke School of Medicine, Durham, NC, USA
| | - Lavanya Vasudevan
- Duke Global Health Institute, Durham, NC, USA.
- Center for Health Policy and Inequalities Research, Duke University, Durham, NC, USA.
- Department of Family Medicine and Community Health, Duke School of Medicine, Durham, NC, USA.
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27
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Vasudevan L, Glenton C, Henschke N, Maayan N, Eyers J, Fønhus MS, Tamrat T, Mehl GL, Lewin S. Birth and death notification via mobile devices: a mixed methods systematic review. Cochrane Database Syst Rev 2021; 7:CD012909. [PMID: 34271590 PMCID: PMC8785898 DOI: 10.1002/14651858.cd012909.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Ministries of health, donors, and other decision-makers are exploring how they can use mobile technologies to acquire accurate and timely statistics on births and deaths. These stakeholders have called for evidence-based guidance on this topic. This review was carried out to support World Health Organization (WHO) recommendations on digital interventions for health system strengthening. OBJECTIVES Primary objective: To assess the effects of birth notification and death notification via a mobile device, compared to standard practice. Secondary objectives: To describe the range of strategies used to implement birth and death notification via mobile devices and identify factors influencing the implementation of birth and death notification via mobile devices. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, the Global Health Library, and POPLINE (August 2, 2019). We searched two trial registries (August 2, 2019). We also searched Epistemonikos for related systematic reviews and potentially eligible primary studies (August 27, 2019). We conducted a grey literature search using mHealthevidence.org (August 15, 2017) and issued a call for papers through popular digital health communities of practice. Finally, we conducted citation searches of included studies in Web of Science and Google Scholar (May 15, 2020). We searched for studies published after 2000 in any language. SELECTION CRITERIA: For the primary objective, we included individual and cluster-randomised trials; cross-over and stepped-wedge study designs; controlled before-after studies, provided they have at least two intervention sites and two control sites; and interrupted time series studies. For the secondary objectives, we included any study design, either quantitative, qualitative, or descriptive, that aimed to describe current strategies for birth and death notification via mobile devices; or to explore factors that influence the implementation of these strategies, including studies of acceptability or feasibility. For the primary objective, we included studies that compared birth and death notification via mobile devices with standard practice. For the secondary objectives, we included studies of birth and death notification via mobile device as long as we could extract data relevant to our secondary objectives. We included studies of all cadres of healthcare providers, including lay health workers; administrative, managerial, and supervisory staff; focal individuals at the village or community level; children whose births were being notified and their parents/caregivers; and individuals whose deaths were being notified and their relatives/caregivers. DATA COLLECTION AND ANALYSIS For the primary objective, two authors independently screened all records, extracted data from the included studies and assessed risk of bias. For the analyses of the primary objective, we reported means and proportions, where appropriate. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess the certainty of the evidence and we prepared a 'Summary of Findings' table. For the secondary objectives, two authors screened all records, one author extracted data from the included studies and assessed methodological limitations using the WEIRD tool and a second author checked the data and assessments. We carried out a framework analysis using the Supporting the Use of Research Evidence (SURE) framework to identify themes in the data. We used the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach to assess our confidence in the evidence and we prepared a 'Summary of Qualitative Findings' table. MAIN RESULTS For the primary objective, we included one study, which used a controlled before-after study design. The study was conducted in Lao People's Democratic Republic and assessed the effect of using mobile devices for birth notification on outcomes related to coverage and timeliness of Hepatitis B vaccination. However, we are uncertain of the effect of this approach on these outcomes because the certainty of this evidence was assessed as very low. The included study did not assess resource use or unintended consequences. For the primary objective, we did not identify any studies using mobile devices for death notification. For the secondary objective, we included 21 studies. All studies were conducted in low- or middle-income settings. They focussed on identification of births and deaths in rural, remote, or marginalised populations who are typically under-represented in civil registration processes or traditionally seen as having poor access to health services. The review identified several factors that could influence the implementation of birth-death notification via mobile device. These factors were tied to the health system, the person responsible for notifying, the community and families; and include: - Geographic barriers that could prevent people's access to birth-death notification and post-notification services - Access to health workers and other notifiers with enough training, supervision, support, and incentives - Monitoring systems that ensure the quality and timeliness of the birth and death data - Legal frameworks that allow births and deaths to be notified by mobile device and by different types of notifiers - Community awareness of the need to register births and deaths - Socio-cultural norms around birth and death - Government commitment - Cost to the system, to health workers and to families - Access to electricity and network connectivity, and compatibility with existing systems - Systems that protect data confidentiality We have low to moderate confidence in these findings. This was mainly because of concerns about methodological limitations and data adequacy. AUTHORS' CONCLUSIONS We need more, well-designed studies of the effect of birth and death notification via mobile devices and on factors that may influence its implementation.
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Affiliation(s)
- Lavanya Vasudevan
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Durham, North Carolina, USA
- Department of Family Medicine and Community Health, Duke University, Durham, North Carolina, USA
| | | | | | | | | | | | - Tigest Tamrat
- Department of Sexual and Reproductive Health, World Health Organization, Geneva, Switzerland
| | - Garrett L Mehl
- Department of Sexual and Reproductive Health, World Health Organization, Geneva, Switzerland
| | - Simon Lewin
- Norwegian Institute of Public Health, Oslo, Norway
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
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Rossman AH, Reid HW, Pieters MM, Mizelle C, von Isenburg M, Ramanujam N, Huchko MJ, Vasudevan L. Digital Health Strategies for Cervical Cancer Control in Low- and Middle-Income Countries: Systematic Review of Current Implementations and Gaps in Research. J Med Internet Res 2021; 23:e23350. [PMID: 34042592 PMCID: PMC8193495 DOI: 10.2196/23350] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 01/01/2021] [Accepted: 01/13/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Nearly 90% of deaths due to cervical cancer occur in low- and middle-income countries (LMICs). In recent years, many digital health strategies have been implemented in LMICs to ameliorate patient-, provider-, and health system-level challenges in cervical cancer control. However, there are limited efforts to systematically review the effectiveness and current landscape of digital health strategies for cervical cancer control in LMICs. OBJECTIVE We aim to conduct a systematic review of digital health strategies for cervical cancer control in LMICs to assess their effectiveness, describe the range of strategies used, and summarize challenges in their implementation. METHODS A systematic search was conducted to identify publications describing digital health strategies for cervical cancer control in LMICs from 5 academic databases and Google Scholar. The review excluded digital strategies associated with improving vaccination coverage against human papillomavirus. Titles and abstracts were screened, and full texts were reviewed for eligibility. A structured data extraction template was used to summarize the information from the included studies. The risk of bias and data reporting guidelines for mobile health were assessed for each study. A meta-analysis of effectiveness was planned along with a narrative review of digital health strategies, implementation challenges, and opportunities for future research. RESULTS In the 27 included studies, interventions for cervical cancer control focused on secondary prevention (ie, screening and treatment of precancerous lesions) and digital health strategies to facilitate patient education, digital cervicography, health worker training, and data quality. Most of the included studies were conducted in sub-Saharan Africa, with fewer studies in other LMIC settings in Asia or South America. A low risk of bias was found in 2 studies, and a moderate risk of bias was found in 4 studies, while the remaining 21 studies had a high risk of bias. A meta-analysis of effectiveness was not conducted because of insufficient studies with robust study designs and matched outcomes or interventions. CONCLUSIONS Current evidence on the effectiveness of digital health strategies for cervical cancer control is limited and, in most cases, is associated with a high risk of bias. Further studies are recommended to expand the investigation of digital health strategies for cervical cancer using robust study designs, explore other LMIC settings with a high burden of cervical cancer (eg, South America), and test a greater diversity of digital strategies.
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Affiliation(s)
- Andrea H Rossman
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC, United States
| | | | | | | | | | - Nimmi Ramanujam
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC, United States
- Duke Global Health Institute, Durham, NC, United States
| | - Megan J Huchko
- Duke Global Health Institute, Durham, NC, United States
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC, United States
| | - Lavanya Vasudevan
- Duke Global Health Institute, Durham, NC, United States
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, United States
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Vasudevan L, Walter E, Swamy G. Vaccine Hesitancy in North Carolina: The Elephant in the Room? N C Med J 2021; 82:130-137. [PMID: 33649131 DOI: 10.18043/ncm.82.2.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Lavanya Vasudevan
- Assistant professor, Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, North Carolina; assistant research professor, Duke Global Health Institute, Durham, North Carolina; member, Duke Human Vaccine Institute, Durham, North Carolina; advisor, The Duke Program on Medical Misinformation, Durham, North Carolina.
| | - Emmanuel Walter
- Chief medical officer, Duke Human Vaccine Institute, Durham, North Carolina; professor, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina; affiliate, Duke Global Health Institute, Durham, North Carolina
| | - Geeta Swamy
- Associate professor, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina; member, Duke Human Vaccine Institute, Durham, North Carolina
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Mackness J, Gallis JA, Owusu RK, Ali M, Abubakr-Bibilazu S, Adam H, Aborigo R, Awoonor-Williams JK, Lillie M, McEwan E, Hembling J, Vasudevan L, Baumgartner JN. Prevalence and correlates of maternal early stimulation behaviors during pregnancy in northern Ghana: a cross-sectional survey. BMC Pregnancy Childbirth 2021; 21:4. [PMID: 33397319 PMCID: PMC7784360 DOI: 10.1186/s12884-020-03476-9] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 12/03/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Per UNICEF's Nurturing Care Framework, early childhood development (ECD) begins during pregnancy and many lower-resource settings need data to inform their programs for optimal child development. The maternal-fetal relationship can be partly examined via a series of bonding activities called early stimulation behaviors (ESB). This study describes early stimulation behaviors and the associated correlates among pregnant women in Ghana. METHODS This cross-sectional study used data from a cluster-randomized trial in two districts of Northern Ghana. A total of 374 pregnant women were enrolled at baseline and administered a pre-intervention survey. Communication-related early stimulation behaviors was the primary outcome which was evaluated using three maternal-fetal bonding activities; did the woman self-report touching and/or talking, singing, and/or talking about family to her belly. A generalized estimating equation modified Poisson model was used for the bivariate and multivariable analysis. RESULTS About half of the participants reported performing communication-related ESB during pregnancy frequently or sometimes. Bivariate analysis revealed that negative life experiences including higher rates of emotional, physical and sexual intimate partner violence (IPV) and having moderate to severe depressive symptoms were associated with women performing early stimulation behaviors more often. In the multivariable model, physical intimate partner violence remained significantly associated with early stimulation behaviors. CONCLUSION Research on early stimulation behaviors is still in a nascent phase. It is unclear why our results revealed an association between intimate partner violence and early stimulation behaviors; this could reflect a coping mechanism for the expectant mother. Further research is needed to better understand this association and explore potential long-term impacts of early stimulation behaviors during pregnancy on child development. TRIAL REGISTRATION Clinical Trials # NCT03665246 , August 29, 2018.
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Affiliation(s)
| | - John A Gallis
- Department of Biostatistics & Bioinformatics, Duke University, Durham, NC, USA
| | | | - Mohammed Ali
- Catholic Relief Services Country Office, Tamale, Ghana
| | | | - Haliq Adam
- Catholic Relief Services Country Office, Tamale, Ghana
| | | | | | - Margaret Lillie
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Elena McEwan
- Catholic Relief Services Head Quarters, Baltimore, MD, USA
| | - John Hembling
- Catholic Relief Services Head Quarters, Baltimore, MD, USA
| | - Lavanya Vasudevan
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Family Medicine & Community Health, Duke University, Durham, North Carolina, USA
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Vasudevan L, Stinnett S, Mizelle C, Melgar K, Makarushka C, Pieters M, Sanchez LER, Jeronimo J, Huchko MJ, Proeschold-Bell RJ. Barriers to the uptake of cervical cancer services and attitudes towards adopting new interventions in Peru. Prev Med Rep 2020; 20:101212. [PMID: 33224718 PMCID: PMC7666342 DOI: 10.1016/j.pmedr.2020.101212] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/20/2020] [Accepted: 09/17/2020] [Indexed: 11/24/2022] Open
Abstract
Cervical cancer is the leading cause of mortality in women of reproductive age in Peru. Increasing knowledge and awareness may promote cervical cancer screening uptake. Mitigating financial barriers may increase treatment rates among diagnosed women. Participants reported high willingness to adopt new cervical cancer interventions.
Cervical cancer mortality is high among Peruvian women of reproductive age. Understanding barriers and facilitators of cervical cancer screening and treatment could facilitate development of contextually-relevant interventions to reduce cervical cancer incidence and mortality. From April to October 2019, we conducted a cross-sectional survey with 22 medical personnel and administrative staff from Liga Contra el Cancer, in Lima, Peru. The survey included structured and open-ended questions about participants’ roles in cervical cancer prevention and treatment, perceptions of women’s barriers and facilitators for getting screened and/or treated for cervical cancer, as well as attitudes towards adopting new cervical cancer interventions. For structured questions, the frequency of responses for each question was calculated. For responses to open-ended questions, content analysis was used to summarize common themes. Our data suggest that the relative importance and nature of barriers that Peruvian women face are different for cervical cancer screening compared to treatment. In particular, participants mentioned financial concerns as the primary barrier to treatment and a lack of knowledge or awareness of human papillomavirus and/or cervical cancer as the primary barrier to screening uptake among women. Participants reported high willingness to adopt new interventions or strategies related to cervical cancer. Building greater awareness about benefits of cervical cancer screening among women, and reducing financial and geographic barriers to treatment may help improve screening rates, decrease late-stage diagnosis and reduce mortality in women who have a pre-cancer diagnosis, respectively. Further studies are needed to generalize study findings to settings other than Lima, Peru.
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Affiliation(s)
- Lavanya Vasudevan
- Department of Family Medicine and Community Health, Duke University, Durham, NC, USA.,Duke Global Health Institute, Durham, NC, USA.,Center for Health Policy and Inequalities Research, Duke University, Durham, NC, USA
| | - Sandra Stinnett
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | | | | | - Christina Makarushka
- Department of Family Medicine and Community Health, Duke University, Durham, NC, USA
| | | | | | | | - Megan J Huchko
- Duke Global Health Institute, Durham, NC, USA.,Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA
| | - Rae Jean Proeschold-Bell
- Duke Global Health Institute, Durham, NC, USA.,Center for Health Policy and Inequalities Research, Duke University, Durham, NC, USA
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Vasudevan L, Baumgartner JN, Moses S, Ngadaya E, Mfinanga SG, Ostermann J. Parental concerns and uptake of childhood vaccines in rural Tanzania - a mixed methods study. BMC Public Health 2020; 20:1573. [PMID: 33081744 PMCID: PMC7573867 DOI: 10.1186/s12889-020-09598-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 09/22/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Vaccine hesitancy has been recognized as an important barrier to timely vaccinations around the world, including in sub-Saharan Africa. In Tanzania, 1 in 4 children is not fully vaccinated. The objective of this mixed methods study was to describe and contextualize parental concerns towards vaccines in Tanzania. METHODS Between 2016 and 2017, we conducted a cross-sectional survey (n = 134) and four focus group discussions (FGDs, n = 38) with mothers of children under 2 years of age residing in Mtwara region in Southern Tanzania. The survey and FGDs assessed vaccination knowledge and concerns and barriers to timely vaccinations. Vaccination information was obtained from government-issued vaccination cards. RESULTS In the cross-sectional survey, 72% of mothers reported missed or delayed receipt of vaccines for their child. Although vaccine coverage was high, timeliness of vaccinations was lower and varied by vaccine. Rural mothers reported more vaccine-related concerns compared to urban mothers; literacy and access to information were identified as key drivers of the difference. Mothers participating in FGDs indicated high perceived risk of vaccine-preventable illnesses, but expressed concerns related to poor geographic accessibility, unreliability of services, and missed opportunities for vaccinations resulting from provider efforts to minimize vaccine wastage. CONCLUSIONS Findings from our cross-sectional survey indicate the presence of vaccination delays and maternal concerns related to childhood vaccines in Tanzania. In FGDs, mothers raised issues related to convenience more often than issues related to vaccine confidence or complacency. Further research is necessary to understand how these issues may contribute to the emergence and persistence of vaccine hesitancy and to identify effective mitigation strategies.
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Affiliation(s)
- Lavanya Vasudevan
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, North Carolina, USA.,Center for Health Policy and Inequalities Research, Duke University, Durham, North Carolina, USA.,Duke Global Health Institute, Durham, North Carolina, USA
| | | | - Sara Moses
- Muhimbili Research Centre, National Institute for Medical Research, Dar-es-Salaam, United Republic of Tanzania
| | - Esther Ngadaya
- Muhimbili Research Centre, National Institute for Medical Research, Dar-es-Salaam, United Republic of Tanzania
| | - Sayoki Godfrey Mfinanga
- Muhimbili Research Centre, National Institute for Medical Research, Dar-es-Salaam, United Republic of Tanzania.,Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, United Republic of Tanzania.,School of Life Sciences and Bioengineering, Nelson Mandela African Institution of Science and Technology, Arusha, United Republic of Tanzania
| | - Jan Ostermann
- Center for Health Policy and Inequalities Research, Duke University, Durham, North Carolina, USA. .,Duke Global Health Institute, Durham, North Carolina, USA. .,Department of Health Services Policy & Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA. .,South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, SC, USA.
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Bhardwaj A, Subba P, Rai S, Bhat C, Ghimire R, Jordans MJD, Green E, Vasudevan L, Kohrt BA. Lessons learned through piloting a community-based SMS referral system for common mental health disorders used by female community health volunteers in rural Nepal. BMC Res Notes 2020; 13:309. [PMID: 32611435 PMCID: PMC7328268 DOI: 10.1186/s13104-020-05148-5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 06/19/2020] [Indexed: 11/10/2022] Open
Abstract
Objective The Community Informant Detection Tool (CIDT) is a paper-based proactive case detection strategy with evidence for improving help-seeking behavior for mental healthcare. Key implementation barriers for the paper-based CIDT include delayed reporting of cases and lack of active follow up. We used mobile phones and structured text messages to improve timeliness of case reporting, encouraging follow up, and case record keeping. 36 female community health volunteers piloted this mobile phone CIDT (mCIDT) for three months in 2017 in rural Nepal. Results Only 8 cases were identified by health volunteers using mCIDT, and only two of these cases engaged with health services post-referral. Accuracy with the mCIDT was considerably lower than paper-based CIDT, especially among older health volunteers, those with lower education, and those having difficulties sending text messages. Qualitative findings revealed implementation challenges including cases not following through on referrals due to perceived lack of staff at health facilities, assumptions among health volunteers that all earthquake-related mental health needs had been met, and lack of financial incentives for use of mCIDT. Based on study findings, we provide 5 recommendations—in particular attitudinal and system preparedness changes—to effectively introduce new mental healthcare technology in low resource health systems.
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Affiliation(s)
- Anvita Bhardwaj
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Prasansa Subba
- Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, Nepal. .,United Mission to Nepal, Kathmandu, Nepal.
| | - Sauharda Rai
- Duke Global Health Institute, Duke University, Durham, NC, USA.,Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, Nepal.,Henry M Jackson School of International Studies and Department of Global Health, University of Washington, Seattle, WA, USA
| | - Chaya Bhat
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Renasha Ghimire
- Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, Nepal
| | - Mark J D Jordans
- Center for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Eric Green
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Lavanya Vasudevan
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Durham, NC, USA.,Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, USA
| | - Brandon A Kohrt
- Duke Global Health Institute, Duke University, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC, USA
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Schroeder K, Raveendran Y, Goel K, Makarushka C, Gisiri M, Daniels J, Zullig L, Masalu N, Vasudevan L. Development of mNavigator: Digital Health Application to Facilitate Compliance With Standardized Pediatric Cancer Treatment Protocols in Tanzania. JCO Glob Oncol 2020. [DOI: 10.1200/go.20.39000] [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] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Use of standardized treatment protocols has been demonstrated to improve outcomes for pediatric patients with cancer. Yet it is challenging to implement standardized treatment protocols in low- and middle-income countries as a result of infrastructure and resource constraints, as well as poor health provider compliance with treatment protocols. At Bugando Medical Centre (BMC) in Tanzania, health provider compliance with standardized paper-based treatment protocols is low at 22%. One-year overall survival rates among pediatric patients with cancer at BMC are 40% and almost one third of patients abandon treatment. We posit that improving protocol compliance in this setting may decrease treatment abandonment and improve survival rates. Use of digital case management systems has been shown to improve compliance with treatment protocols because of the ability to incorporate such features as decision-support algorithms, prompts and alerts, and checklists. The digital health application mNavigator was designed to facilitate health provider compliance with standardized pediatric cancer treatment protocols in Tanzania. METHODS mNavigator was developed by adapting an open-source digital case management platform called CommCare. The three stages of mNavigator development were as follows: workflow mapping and form development; form programming in CommCare; and quality assurance using mock and deidentified patient records to identify errors in information flow or outputs, assess preliminary usability, and determine areas for improvement. Standardized treatment protocols for Burkitt lymphoma and retinoblastoma were initially incorporated into mNavigator. The mNavigator prototype underwent usability testing at BMC before implementation in routine clinical practice. RESULTS Preliminary system usability, acceptance, and satisfaction evaluation demonstrated high usability response scores (> 80%). Perceived benefits of the mNavigator system included a user-friendly interface, improved record keeping, and assistance with patient tracking using standardized treatment protocols. Suggestions for improvement centered on the incorporation of other standardized treatment protocols (eg, Wilms tumor), improving interoperability with existing electronic recordkeeping systems, and making similar systems available for other clinical departments. CONCLUSION To our knowledge, mNavigator is the first digital health case management system specifically developed to improve health provider compliance with pediatric cancer treatment protocols in a low-resource setting. With high usability and acceptability, mNavigator has been implemented in routine clinical practice. Implementation and patient outcomes evaluations are ongoing and will inform the scale-up for use in other low- and middle-income countries.
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Affiliation(s)
- Kristin Schroeder
- Duke Global Health Institute, Durham, NC
- Duke University School of Medicine, Durham, NC
- Department of Pediatrics, Duke University, Durham, NC
- Bugando Medical Centre, Mwanza, Tanzania
| | | | - Kunal Goel
- Duke University School of Medicine, Durham, NC
| | | | | | | | - Leah Zullig
- Department of Population Health Sciences, Duke University, Durham, NC
| | | | - Lavanya Vasudevan
- Department of Population Health Sciences, Duke University, Durham, NC
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Ni Z, Atluri N, Shaw RJ, Tan J, Khan K, Merk H, Ge Y, Shrestha S, Shrestha A, Vasudevan L, Karmacharya B, Yan LL. Correction: Evaluating the Feasibility and Acceptability of a Mobile Health–Based Female Community Health Volunteer Program for Hypertension Control in Rural Nepal: Cross-Sectional Study. JMIR Mhealth Uhealth 2020; 8:e19048. [PMID: 32525811 PMCID: PMC7317624 DOI: 10.2196/19048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/01/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Zhao Ni
- Duke UniversityDurham, NCUnited States
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Vasudevan L, Ostermann J, Moses SM, Ngadaya E, Mfinanga SG. Patterns of Mobile Phone Ownership and Use Among Pregnant Women in Southern Tanzania: Cross-Sectional Survey. JMIR Mhealth Uhealth 2020; 8:e17122. [PMID: 32267240 PMCID: PMC7177426 DOI: 10.2196/17122] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 11/19/2019] [Revised: 02/04/2020] [Accepted: 02/05/2020] [Indexed: 11/30/2022] Open
Abstract
Background There is a paucity of subnational data on patterns of mobile phone ownership and use in Tanzania to inform the development of digital health interventions. Objective The aim of this study is to assess patterns of mobile phone ownership and use in pregnant women to inform the feasibility and design of digital health interventions for promoting timely uptake of childhood vaccines in southern Tanzania. Methods Between August and November 2017, pregnant women in their third trimester were enrolled at health facilities and from surrounding communities, and asked about their patterns of mobile phone ownership and use in an interviewer administered survey. Results Of 406 women, only 3 had never used a phone. Most women (>98%) could make and receive phone calls. Compared to urban women, rural women reported higher mobile phone use rates but were less likely to be sole owners of phones, and less likely to send or receive SMS, transact money, browse the internet, or use social media via mobile phones. Conclusions The findings suggest high feasibility for digital health interventions delivered via mobile phones to pregnant women in southern Tanzania. The feasibility of smartphone-based interventions or strategies relying on the use of social media or the internet is limited.
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Affiliation(s)
- Lavanya Vasudevan
- Department of Family Medicine and Community Health, School of Medicine, Duke University, Durham, NC, United States.,Duke Global Health Institute, Duke University, Durham, NC, United States.,Center for Health Policy and Inequalities Research, Duke University, Durham, NC, United States
| | - Jan Ostermann
- Duke Global Health Institute, Duke University, Durham, NC, United States.,Center for Health Policy and Inequalities Research, Duke University, Durham, NC, United States.,Department of Health Services, Policy & Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.,South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, SC, United States
| | - Sara Marwerwe Moses
- Muhimbili Research Centre, National Institute for Medical Research, Dar-es-Salaam, United Republic of Tanzania
| | - Esther Ngadaya
- Muhimbili Research Centre, National Institute for Medical Research, Dar-es-Salaam, United Republic of Tanzania
| | - Sayoki Godfrey Mfinanga
- Muhimbili Research Centre, National Institute for Medical Research, Dar-es-Salaam, United Republic of Tanzania.,Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, United Republic of Tanzania.,School of Life Sciences and Bioengineering, Nelson Mandela African Institution of Science and Technology, Arusha, United Republic of Tanzania
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Vasudevan L, Schroeder K, Raveendran Y, Goel K, Makarushka C, Masalu N, Zullig LL. Using digital health to facilitate compliance with standardized pediatric cancer treatment guidelines in Tanzania: protocol for an early-stage effectiveness-implementation hybrid study. BMC Cancer 2020; 20:254. [PMID: 32223740 PMCID: PMC7104518 DOI: 10.1186/s12885-020-6611-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 11/07/2019] [Accepted: 02/07/2020] [Indexed: 11/10/2022] Open
Abstract
Background In high-income countries (HICs), increased rates of survival among pediatric cancer patients are achieved through the use of protocol-driven treatment. Compared to HICs, differences in infrastructure, supportive care, and human resources, make compliance with protocol-driven treatment challenging in low- and middle-income countries (LMICs). For successful implementation of protocol-driven treatment, treatment protocols must be resource-adapted for the LMIC context, and additional supportive tools must be developed to promote protocol compliance. In Tanzania, an LMIC where resource-adapted treatment protocols are available, digital health applications could promote protocol compliance through incorporation of systematic decision support algorithms, reminders and alerts related to patient visits, and up-to-date data for care coordination. However, evidence on the use of digital health applications in improving compliance with protocol-driven treatment for pediatric cancer is limited. This study protocol describes the development and evaluation of a digital health application, called mNavigator, to facilitate compliance with protocol-driven treatment for pediatric cancer in Tanzania. Methods mNavigator is a digital case management system that incorporates nationally-approved and resource-adapted treatment protocols for two pediatric cancers in Tanzania, Burkitt lymphoma and retinoblastoma. mNavigator is developed from an open-source digital health platform, called CommCare, and guided by the Consolidated Framework for Implementation Research. From July 2019–July 2020 at Bugando Medical Centre in Mwanza, Tanzania, all new pediatric cancer patients will be registered and managed using mNavigator as the new standard of care for patient intake and outcome assessment. Pediatric cancer patients with a clinical diagnosis of Burkitt lymphoma or retinoblastoma will be approached for participation in the study evaluating mNavigator. mNavigator users will document pre-treatment and treatment details for study participants using digital forms and checklists that facilitate compliance with protocol-driven treatment. Compliance with treatment protocols using mNavigator will be compared to historical compliance rates as the primary outcome. Throughout the implementation period, we will document factors that facilitate or inhibit mNavigator implementation. Discussion Study findings will inform implementation and scale up of mNavigator in tertiary pediatric cancer facilities in Tanzania, with the goal of facilitating protocol-driven treatment. Trial registration The study protocol was registered in ClinicalTrials.gov (NCT03677128) on September 19, 2018.
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Affiliation(s)
- Lavanya Vasudevan
- Department of Family Medicine and Community Health, Duke School of Medicine, 2200 W. Main Street, Durham, NC, 27710, USA. .,Duke Global Health Institute, 310 Trent Drive, Durham, NC, 27710, USA.
| | - Kristin Schroeder
- Duke Global Health Institute, 310 Trent Drive, Durham, NC, 27710, USA.,Department of Pediatrics, Division of Hematology/Oncology, Duke University Medical Center, 2301 Erwin Rd, Durham, NC, 27710, USA.,Bugando Medical Centre, Wurtzburg Road, Mwanza, Tanzania
| | | | - Kunal Goel
- Duke School of Medicine, 8 Searle Center Drive, Durham, NC, 27710, USA
| | - Christina Makarushka
- Department of Family Medicine and Community Health, Duke School of Medicine, 2200 W. Main Street, Durham, NC, 27710, USA
| | - Nestory Masalu
- Bugando Medical Centre, Wurtzburg Road, Mwanza, Tanzania
| | - Leah L Zullig
- Department of Population Health Sciences, 215 Morris St, Durham, NC, 27701, USA.,Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, 508 Fulton St, Durham, NC, 27705, USA
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Ni Z, Atluri N, Shaw RJ, Tan J, Khan K, Merk H, Ge Y, Shrestha S, Shrestha A, Vasudevan L, Karmacharya B, Yan LL. Evaluating the Feasibility and Acceptability of a Mobile Health-Based Female Community Health Volunteer Program for Hypertension Control in Rural Nepal: Cross-Sectional Study. JMIR Mhealth Uhealth 2020; 8:e15419. [PMID: 32149712 PMCID: PMC7091025 DOI: 10.2196/15419] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 10/29/2019] [Accepted: 12/17/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Hypertension is a major modifiable risk factor for cardiovascular disease, the world's leading cause of death. The prevalence of hypertension is disproportionately higher in South Asian countries than in other regions of the world. Screening for hypertension in primary care settings remains a challenge in many South Asian countries, including Nepal. Nepal is located in the Himalayan Mountains region, posing significant geographical challenges for its rural citizens to access primary health care and service delivery. This barrier increases the costs and inconvenience for rural Nepalis to access hypertension screening and treatment. As a result, the prevalence of hypertension in Nepal tripled in the last 25 years to 22.4%-38.6%. Nepal's Ministry of Health and Population relies on female community health volunteers to link health centers and communities to provide basic health services. Over 50,000 of these volunteers in Nepal have received basic health care training and are assigned to take care of maternal and child health. Due to limited health care resources, adopting new methods to control hypertension is an urgent need in Nepal. Several recent studies in Nepal have recommended extending the role of female community health volunteers to include hypertension management through blood pressure monitoring and home-based education. OBJECTIVE The goal of this study was to assess if a mobile health-based female community health volunteer approach of combining the traditional community health volunteer program with digital technologies would be feasible and acceptable in rural Nepal. METHODS In this study, we recruited 17 female community health volunteers and extended their role from maternal and child health to hypertension management through screening blood pressures. RESULTS All 17 female community health volunteers successfully measured 1113 rural Nepalis' blood pressures, identified 169 hypertensive patients, and collected health behaviors data of the 169 hypertensive patients. Among the 169 patients, 70% of them had a mobile phone, and 92% were interested in receiving health-related information via a mobile phone. Among those who were interested in receiving information via a mobile phone, 84% preferred voice calls, and 7% and 1% preferred texting and apps, respectively. CONCLUSIONS Results from this study indicate that a digital health intervention that leverages feature-phones combined with female community health volunteers may be an acceptable and pragmatic way to implement an evidence-based program to reduce hypertension in rural Nepal.
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Affiliation(s)
- Zhao Ni
- Duke University, Durham, NC, United States
| | | | | | | | - Kinza Khan
- Duke University, Durham, NC, United States
| | | | - Yunfan Ge
- Duke Kunshan University, Kunshan, China
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Ostermann J, Vasudevan L, Baumgartner JN, Ngadaya E, Mfinanga SG. Do mobile phone-based reminders and conditional financial transfers improve the timeliness of childhood vaccinations in Tanzania? Study protocol for a quasi-randomized controlled trial. Trials 2019; 20:397. [PMID: 31272487 PMCID: PMC6611039 DOI: 10.1186/s13063-019-3430-4] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 05/13/2019] [Indexed: 11/10/2022] Open
Abstract
Background Vaccination is a cost-effective strategy for reducing morbidity and mortality among children under 5 years old. To be fully protected from diseases such as tuberculosis, diphtheria, pertussis, and polio, children must receive all recommended vaccinations in a timely manner. In many countries, including Tanzania, high overall vaccination rates mask substantial regional variation in vaccination coverage and low rates of vaccination timeliness. This study evaluates the efficacy of mobile phone-based (mHealth) reminders and incentives for improving vaccination timeliness in the first year of life. Methods The study, conducted in Mtwara Region in Tanzania, includes 400 late-stage pregnant women enrolled from rural and urban health facilities and surrounding communities. The primary outcome is timeliness of vaccinations among their children at 6, 10, and 14 weeks after birth. Timeliness is defined as vaccination receipt within 28 days after the vaccination due date. The quasi-randomized controlled trial includes three arms: (1) standard of care (no reminders or incentives), (2) mobile phone-based reminders, and (3) mobile phone-based reminders and incentives in the form of conditional financial transfers. Assignment into study arms is based on scheduled vaccination dates. Reminder messages are sent to arms 2 and 3 participants via mobile phones 1 week and 1 day prior to each scheduled vaccination. For arm 3 participants, reminder messages offer an incentive that is provided in the form of a mobile phone airtime recharge voucher code for each timely vaccination. Vaccination dates are recorded via participant contact with an mHealth system, phone calls with mothers, and a review of government-issued vaccination cards during an end-line survey. Random effects logistic regression models will be used to estimate the effects of reminders and incentives on the timeliness of vaccinations. Discussion The results will inform implementation science research on the effectiveness of reminders and incentives as a means of improving vaccination timeliness. Trial registration ClinicalTrials.gov, NCT03252288. Registered on 17 August 2017 (retrospectively registered). Electronic supplementary material The online version of this article (10.1186/s13063-019-3430-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jan Ostermann
- Department of Health Services Policy & Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA.,Duke Global Health Institute, Durham, NC, 27708, USA
| | - Lavanya Vasudevan
- Duke Global Health Institute, Durham, NC, 27708, USA. .,Department of Family Medicine and Community Health, School of Medicine, Duke University, Durham, NC, 27705, USA.
| | | | - Esther Ngadaya
- Muhimbili Research Centre, National Institute for Medical Research, Dar-es-Salaam, Tanzania
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Vasudevan L, Wouters E, Cannaert A, Meyrath M, Szpakowska M, Chevigné A, Saini DK, Stove C. Bioassays to study biased signalling of novel synthetic opioids. Toxicologie Analytique et Clinique 2019. [DOI: 10.1016/j.toxac.2019.03.100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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41
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Labrique A, Vasudevan L, Weiss W, Wilson K. Establishing Standards to Evaluate the Impact of Integrating Digital Health into Health Systems. Glob Health Sci Pract 2018; 6:S5-S17. [PMID: 30305335 PMCID: PMC6203412 DOI: 10.9745/ghsp-d-18-00230] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 08/16/2018] [Indexed: 01/19/2023]
Abstract
The key milestones in the rise of digital health illustrate efforts to bridge gaps in the evidence base, a shifting focus to scale-up and sustainability, growing attention to the precise costing of these strategies, and an emergent implementation science agenda that better characterizes the ecosystem—the social, political, economic, legal, and ethical context that supports digital health implementation—necessary to take digital health approaches to scale.
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Affiliation(s)
- Alain Labrique
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lavanya Vasudevan
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Community and Family Medicine, Duke University School of Medicine, Durham, NC, USA.,Center for Health Policy and Inequalities Research, Duke Global Health Institute, Durham, NC, USA
| | - William Weiss
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kate Wilson
- Digital Impact Alliance, Washington, DC, USA
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Abstract
Digital strategies have been formally recognized as a critical health systems strengthening strategy to help meet the Sustainable Development Goals and universal health coverage targets. This landscaping collection reviews multiple possible approaches across health system pillars, from digital referrals to decision support systems, identifying key knowledge gaps across these domains and recognizing the growth needed in the field to realize its full potential.
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Affiliation(s)
- Alain Labrique
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Lavanya Vasudevan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Community and Family Medicine, Duke University School of Medicine, Durham, NC, USA.,Center for Health Policy and Inequalities Research, Duke Global Health Institute, Durham, NC, USA
| | - Garrett Mehl
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Ellen Rosskam
- Office of the Assistant Director-General, Health Metrics and Measurement, World Health Organization, Geneva, Switzerland
| | - Adnan A Hyder
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Orton M, Agarwal S, Muhoza P, Vasudevan L, Vu A. Strengthening Delivery of Health Services Using Digital Devices. Glob Health Sci Pract 2018; 6:S61-S71. [PMID: 30305340 PMCID: PMC6203413 DOI: 10.9745/ghsp-d-18-00229] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 08/29/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Delivery of high-quality efficient health services is a cornerstone of the global agenda to achieve universal health coverage. According to the World Health Organization, health service delivery is considered good when equitable access to a comprehensive range of high-quality health services is ensured within an integrated and person-centered continuum of care. However, good health service delivery can be challenging in low-resource settings. In this review, we summarize and discuss key advances in health service delivery, particularly in the context of using digital health strategies for mitigating human resource constraints. METHODS The review updates the foundational systematic review conducted by Agarwal et al. in 2015. We used PubMed, EMBASE, and CINAHL to find relevant English-language peer-reviewed articles published 2018. Our search strategy for MEDLINE was based on MeSH (medical subject headings) terms and text words of key articles that we identified a priori. Our search identified 92 articles. After screening, we selected 24 articles for abstract review, of which only 6 met the eligibility criteria and were ultimately included in this review. RESULTS Despite encouraging advances in the evidence base on digital strategies for health service delivery, the current body of evidence is still quite limited in 3 main areas: the effectiveness of interventions on health outcomes, improvement in health system efficiencies for service delivery, and the human capacity required to implement and support digital health strategies at scale. Two particular areas, digital health-enhanced referral coordination and mobile clinical decision support systems, demonstrate considerable potential to improve the quality and comprehensiveness of care received by patients, but they require a greater level of standardization and an expanded scope of health worker engagement across the health system in order to scale them up effectively. CONCLUSIONS Additional research is urgently needed to inform the effectiveness of interventions on health outcomes, improvement in health system efficiencies, and cost-effectiveness of service delivery. In particular, more documentation and research on ways to standardize and engage health workers in digital referral and clinical decision support systems can provide the foundation needed to scale these promising approaches in low- and middle-income settings.
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Affiliation(s)
- Maeghan Orton
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Smisha Agarwal
- Johns Hopkins Global Digital Health Initiative, Baltimore, MD, USA
| | - Pierre Muhoza
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lavanya Vasudevan
- Department of Community and Family Medicine, Duke University School of Medicine, Durham, NC, USA. .,Center for Health Policy and Inequalities Research, Duke Global Health Institute, Durham, NC, USA
| | - Alexander Vu
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Johns Hopkins School of Medicine, Baltimore, MD, USA.,School of Medicine, American University of Beirut, Beirut, Lebanon
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Rivenbark J, Martyn L, Whetten K, Vasudevan L. A survey of healthcare-seeking practices and related stigma among community- and street-based children in Cambodia. Int Health 2018; 10:211-213. [PMID: 29506218 PMCID: PMC10615134 DOI: 10.1093/inthealth/ihy008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 09/18/2017] [Revised: 12/19/2017] [Accepted: 01/18/2018] [Indexed: 11/13/2022] Open
Abstract
Background Globally, street children comprise a growing population of vulnerable children. Understanding how they interact with healthcare systems is fundamental to efforts to improve their health and well-being. Methods We surveyed 75 street- and community-based children in Battambang, Cambodia regarding their healthcare-seeking practices and related stigma. Results For demographically similar street and community children, hospitals and pharmacies were preferred healthcare institutions, with this choice being motivated by the caretaker's decision or cost. Street children reported increased fear of being refused treatment. Conclusions Street children and demographically similar community children have similar healthcare-seeking practices and preferences, although street children face increased stigmatization.
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Affiliation(s)
| | | | - Kathryn Whetten
- Sanford School of Public Policy
- Duke Global Health Institute
- Center for Health Policy and Inequalities Research, Duke University, Durham, NC, USA
| | - Lavanya Vasudevan
- Duke Global Health Institute
- Center for Health Policy and Inequalities Research, Duke University, Durham, NC, USA
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Maiarana J, Zullig L, Vasudevan L, Masalu N, Schroeder K. Feasibility of Using a Digital Case Management Application to Expand the Patient Navigator System at Bugando Medical Centre. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.80000] [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] [Indexed: 11/20/2022] Open
Abstract
Abstract 36 Purpose Each year, more than 200,000 children globally are diagnosed with cancer, more than 80% of which occurs in low- to middle-income countries. Pediatric cancer survival rates in low- to middle-income countries are 5% to 25% compared with 80% in high-income countries, with treatment abandonment accounting for one third of the survival gap. A mobile case management system can improve patient communication and reduce treatment abandonment. The current proposal evaluated the feasibility and acceptability of a mobile phone–based case management system at Bugando Medical Centre (BMC) in Mwanza, Tanzania. Methods We surveyed 40 families of children with cancer who attended BMC and 10 pediatric oncology providers at BMC to assess mobile phone ownership, use patterns, communication preferences (eg, voice v text messaging), and the advantages and disadvantages of a mobile case management system. Results In all, 85% of families owned a mobile phone and 100% of providers owned smart phones. Of families, 98% wanted to communicate with a health care provider regarding treatment support using a mobile phone, 92% wanted to receive laboratory results via mobile phone, 95% wanted to receive reminders of upcoming appointments, and 88% wanted to receive educational information on cancer via mobile phone. Of providers, 100% thought that it would be useful to use a mobile phone to communicate with patients, share laboratory results, and view standardized pediatric treatment protocols and checklists. Conclusion Most families of pediatric patients with cancer at BMC use mobile phones, with high interest in using mobile technology to communicate with providers. This increases the likelihood of success for a mobile case management platform that is aimed at reducing the abandonment of care among pediatric patients with cancer. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the authors.
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Affiliation(s)
- Jimmy Maiarana
- Jimmy Maiarana, Brown University, Providence, RI; Leah Zullig, Lavanya Vasudevan, and Kristin Schroeder, Duke University, Durham, NC; and Nestory Masalu, Bugando Medical Centre, Oncology, Mwanza, Tanzania
| | - Leah Zullig
- Jimmy Maiarana, Brown University, Providence, RI; Leah Zullig, Lavanya Vasudevan, and Kristin Schroeder, Duke University, Durham, NC; and Nestory Masalu, Bugando Medical Centre, Oncology, Mwanza, Tanzania
| | - Lavanya Vasudevan
- Jimmy Maiarana, Brown University, Providence, RI; Leah Zullig, Lavanya Vasudevan, and Kristin Schroeder, Duke University, Durham, NC; and Nestory Masalu, Bugando Medical Centre, Oncology, Mwanza, Tanzania
| | - Nestory Masalu
- Jimmy Maiarana, Brown University, Providence, RI; Leah Zullig, Lavanya Vasudevan, and Kristin Schroeder, Duke University, Durham, NC; and Nestory Masalu, Bugando Medical Centre, Oncology, Mwanza, Tanzania
| | - Kristin Schroeder
- Jimmy Maiarana, Brown University, Providence, RI; Leah Zullig, Lavanya Vasudevan, and Kristin Schroeder, Duke University, Durham, NC; and Nestory Masalu, Bugando Medical Centre, Oncology, Mwanza, Tanzania
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Agarwal S, Vasudevan L, Tamrat T, Glenton C, Lewin S, Bergman H, Henschke N, Mehl GL, Fønhus MS. Digital tracking, provider decision support systems, and targeted client communication via mobile devices to improve primary health care. Cochrane Database of Systematic Reviews 2018. [DOI: 10.1002/14651858.cd012925] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Smisha Agarwal
- World Health Organization; Department of Reproductive Health and Research; Chapel Hill NC USA
| | - Lavanya Vasudevan
- Duke Global Health Institute; Center for Health Policy and Inequalities Research; Durham North Carolina USA
| | - Tigest Tamrat
- World Health Organization; Department of Reproductive Health and Research; 20 Avenue Appia Geneva Switzerland CH-1211
| | - Claire Glenton
- Norwegian Institute of Public Health; PO Box 7004 St Olavs plass Oslo Norway N-0130
| | - Simon Lewin
- Norwegian Institute of Public Health; PO Box 7004 St Olavs plass Oslo Norway N-0130
- South African Medical Research Council; Health Systems Research Unit; PO Box 19070 Tygerberg South Africa 7505
| | - Hanna Bergman
- Cochrane; Cochrane Response; St Albans House 57-59 Haymarket London UK SW1Y 4QX
| | - Nicholas Henschke
- Cochrane; Cochrane Response; St Albans House 57-59 Haymarket London UK SW1Y 4QX
| | - Garrett L Mehl
- World Health Organization; Department of Reproductive Health and Research; 20 Avenue Appia Geneva Switzerland CH-1211
| | - Marita S Fønhus
- Norwegian Institute of Public Health; PO Box 7004 St Olavs plass Oslo Norway N-0130
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Vasudevan L, Henschke N, Glenton C, Lewin S, Maayan N, Eyers J, Fønhus MS, Tamrat T, Mehl GL. Birth and death notification via mobile devices. Cochrane Database of Systematic Reviews 2018. [DOI: 10.1002/14651858.cd012909] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Lavanya Vasudevan
- Duke Global Health Institute; Center for Health Policy and Inequalities Research; Durham North Carolina USA
| | | | - Claire Glenton
- Norwegian Institute of Public Health; PO Box 7004 St Olavs plass Oslo Norway N-0130
| | - Simon Lewin
- Norwegian Institute of Public Health; PO Box 7004 St Olavs plass Oslo Norway N-0130
- South African Medical Research Council; Health Systems Research Unit; PO Box 19070 Tygerberg South Africa 7505
| | | | - John Eyers
- Constable House 3 Greenway North Curry Somerset UK TA3 6NQ
| | - Marita S Fønhus
- Norwegian Institute of Public Health; PO Box 7004 St Olavs plass Oslo Norway N-0130
| | - Tigest Tamrat
- World Health Organization; Department of Reproductive Health and Research; 20 Avenue Appia Geneva Switzerland CH-1211
| | - Garrett L Mehl
- World Health Organization; Department of Reproductive Health and Research; 20 Avenue Appia Geneva Switzerland CH-1211
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49
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Devanathan V, Vasudevan L. EP 140. Vestibular evoked myogenic potentials: A retrospective analysis. Clin Neurophysiol 2016. [DOI: 10.1016/j.clinph.2016.05.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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50
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Vasudevan L, Labrique AB, Mehra S, Wu L, Levine O, Feikin D, Klemm R, Christian P, West KP. Maternal determinants of timely vaccination coverage among infants in rural Bangladesh. Vaccine 2014; 32:5514-9. [PMID: 25132336 DOI: 10.1016/j.vaccine.2014.06.092] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [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: 06/01/2013] [Revised: 05/16/2014] [Accepted: 06/26/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Timely vaccination, i.e., the receipt of all scheduled vaccinations in an age-appropriate fashion, is critical for the prevention of deadly diseases in infants and achievement of the UN Millennium Development Goal to reduce infant mortality. Infants, especially in rural or underprivileged settings often receive delayed vaccinations leaving them susceptible to vaccine-preventable illnesses early in the first year of life. In this study, we examined rates of timely vaccination among 24,435 infants born in Gaibandha and Rangpur rural districts of Bangladesh from 2001 to 2007. METHODS Vaccinations due by 14 weeks of age and administered through routine government immunization services were assessed using interviews with enrolled mothers between 11 and 18 weeks postpartum. We created a Timely Vaccination (TV) score to classify infants as vaccinated fully and on schedule (TV=1) or not (TV=0), and used multivariable logistic regression to identify maternal characteristics associated with infant's timely vaccination status. RESULTS Our results suggest that only 19% of infants in this cohort received scheduled vaccinations on time by 11-18 weeks postpartum. Mothers' engagement in paid employment [OR=1.13, 95% CI: 1.03-1.23], receipt of tetanus toxoid vaccination [OR=1.24, 95% CI: 1.11-1.38], history of antenatal care [OR=1.22, 95% CI: 1.12-1.32], or higher socioeconomic status [OR=1.07, 95% CI: 1.03-1.11] were positively associated with timely vaccination of their infants. Mother's perception of small infant size at birth was negatively associated with timely vaccination [OR=0.89, 95% CI: 0.82-0.97]. CONCLUSION Timely vaccination coverage of infants in rural Gaibandha and Rangpur districts is extremely low. This analysis identifies important shortcomings associated with the 1-year vaccination benchmark of routine immunization performance and suggests the need for specific interventions based on potential maternal determinants as well as known system and programmatic barriers of timely vaccination among infants in rural Bangladesh.
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Affiliation(s)
- Lavanya Vasudevan
- Duke Global Health Institute, Durham, NC, United States; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Alain B Labrique
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
| | - Sucheta Mehra
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Lee Wu
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Orin Levine
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Bill and Melinda Gates Foundation, Seattle, WA, United States
| | - Danny Feikin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Rolf Klemm
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Parul Christian
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Keith P West
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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