Dataset Information

The Impact of War in Yemen on Immunization Coverage of Children Under One Year of Age: Descriptive Study.

ABSTRACT: BACKGROUND:After 2 years of war that crippled the capacity of the Yemeni National Health System and left only 45% of health facilities functioning, Yemen faced increasing vaccine-preventable disease (VPD) outbreaks and may be at high risk of polio importation. OBJECTIVE:The aim of this study was to determine the impact of the 2015 war on the immunization coverage of children under 1 year. METHODS:Data on vaccination coverage for 2012-2015 were obtained from the national Expanded Program on Immunization (EPI). The vaccination coverage was calculated at the national and governorate levels by dividing the number of actually vaccinated children by the estimated population of children under 1 year. RESULTS:Although there was an increase from 2012 to 2014 in the national coverage for penta-3 vaccine (82% in 2012 vs 88% in 2014) and measles vaccine (70% in 2012 vs 75% in 2014), the coverage was still below the national target (?95%). Furthermore, the year 2015 witnessed a marked drop in the national coverage compared with 2014 for the measles vaccine (66% in 2015 vs 75% in 2014), but a slight drop in penta-3 vaccine coverage (84% in 2015 vs 88% in 2014). Bacillus Calmette-Guérin vaccine also showed a marked drop from 73% in 2014 to 49% in 2015. These reductions were more marked in governorates that witnessed armed confrontations (eg, Taiz, Lahj, and Sa'dah governorates). On the other hand, governorates that did not witness armed confrontations showed an increase in coverage (eg, Raymah and Ibb), owing to an increase in their population because of displacement from less secure and confrontation-prone governorates. CONCLUSIONS:This analysis demonstrated the marked negative impact of the 2015 war on immunization coverage, especially in the governorates that witnessed armed confrontations. This could put Yemen at more risk of VPD outbreaks and polio importation. Besides the ongoing efforts to stop the Yemeni war, strategies for more innovative vaccine delivery or provision and fulfilling the increasing demands are needed, especially in governorates with confrontations. Enhancing EPI performance through supportable investments in infrastructure that was destroyed by the war and providing decentralized funds are a prerequisite.

SUBMITTER: Torbosh A

PROVIDER: S-EPMC6913770 | biostudies-literature | 2019 Oct

REPOSITORIES: biostudies-literature

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The Impact of War in Yemen on Immunization Coverage of Children Under One Year of Age: Descriptive Study.

Torbosh Amr A Al Amad Mohammed Abdulla MA Al Serouri Abdulwahed A Khader Yousef Y

JMIR public health and surveillance 20191023 4

<h4>Background</h4>After 2 years of war that crippled the capacity of the Yemeni National Health System and left only 45% of health facilities functioning, Yemen faced increasing vaccine-preventable disease (VPD) outbreaks and may be at high risk of polio importation.<h4>Objective</h4>The aim of this study was to determine the impact of the 2015 war on the immunization coverage of children under 1 year.<h4>Methods</h4>Data on vaccination coverage for 2012-2015 were obtained from the national Exp ...[more]

PMID: 31647465

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Project description:The Vietnam National Expanded Program on Immunization (NEPI) has been successfully implementing a nationwide immunization system since 1985. From the start, the program has increased the immunization coverage rate; however, data on immunization coverage in Vietnam are gathered and aggregated from commune health centers in routine, paper-based reports, which have shortcomings. Also, calculations of coverage are inconsistent at subnational levels, which lead to uncertainty about the size of the target population used as the denominator in coverage calculations. The growth of mobile networks in Vietnam provides an opportunity to apply mHealth to improve the immunization program. In 2012, PATH and the Vietnam NEPI developed and piloted a digital immunization registry, ImmReg, to overcome the challenges of the paper system. A final evaluation was conducted in 2015 to assess the impact of ImmReg, including its use of SMS reminders, on improving the immunization program.The study population comprised all children born in Ben Tre province in September and October of 2013, 2014, and 2015, representing pre-intervention, post-intervention, and one year post-intervention, respectively. Data exported from ImmReg were used to compare the immunization rate, dropout rate, and timeliness of vaccination before and after the intervention. Additionally, a rapid survey was conducted to understand the willingness of parents with children due for vaccination to pay for SMS reminder messages on the immunization schedule.Timely administration of oral polio vaccine, Quinvaxem, and measles 1 vaccine significantly increased over time from baseline to post-intervention to one year post-intervention. In particular, the timeliness of vaccination with the third dose of Quinvaxem increased from 53.6% to 65.8% to 77.2%. For measles 1 vaccine, the rate increased from 70.4% to 76.2% to 92.3%. In addition, the dropout rate from Quinvaxem 1 to Quinvaxem 3 declined from 4.2% in 2013 to 0% in 2015, and the dropout rate from Bacillus Calmette-Guérin (BCG) to measles 1 fell from 12.8% in 2013 to 0% in 2015. Full immunization coverage of children under one year old increased significantly from 75.4% in 2013 to 81.7% in 2014 to 99.2% in 2015. Also, survey results indicated that 93.3% of interviewees were willing to pay for SMS reminders for immunization.A digital immunization registry that includes SMS reminders can improve immunization coverage and timeliness of vaccination, thereby strengthening the quality and effectiveness of immunization programs. Integrating this system into the national health information system and leveraging it for other health programs, such as maternal and child health and nutrition as well as infectious disease control, can bring more benefits to the health care system in Vietnam.

Project description:BACKGROUND:Malnutrition continues to be a major public health challenge in Zambia. To effectively address this, health systems must be well strengthened to deliver an effective continuum of care. This paper examines health systems issues and services in relation to nutritional support to children under five years, in order to identify gaps and propose interventions towards universal coverage of essential nutrition services. METHODS:This analysis utilized data from a cross sectional mixed-methods study on factors associated with Severe Acute Malnutrition (SAM) in under-five children to assess health facility nutrition services on offer at select level-one hospitals in five out of ten provinces in Zambia. Stata version 13 was used for analysis. We conducted univariate analysis to assess nutrition services offered, functionality of equipment and tools, availability of human resource and human resource development, and availability of drugs used for assessment and management of nutrition-related health outcomes. RESULTS:We found large variations in the level of nutrition services on offer across districts and provinces. Eighty-eight percent of all the hospitals sampled provided group nutrition counseling and 92% of the hospitals in our sample offered individual nutrition counseling to their clients. Overall, the existence of referral and counter-referral systems between the Community Based Volunteers and hospitals were the lowest among all services assessed at 48% and 58% respectively. We also found inadequate numbers of human resource across all cadres with an exception of nutritionists as recommended by the Ministry of Health. CONCLUSIONS:This study has revealed a number of gaps in the health system and health service delivery that requires to be addressed; most notably, a lack of tools, policies and guidelines, drugs and health specialists to help care for malnourished infants and children. Our findings also reveal inadequate referral systems between the community and health facilities in the management of severe acute malnutrition. Achieving universal coverage for nutrition services in Zambia will require a lot more attention to the health systems issues found in this study.

Project description:BackgroundA variety of studies have considered the affects of India's son preference on gender differences in child mortality, sex ratio at birth, and access to health services. Less research has focused on the affects of son preference on gender inequities in immunization coverage and how this may have varied with time, and across regions and with sibling compositions. We present a systematic examination of trends in immunization coverage in India, with a focus on inequities in coverage by gender, birth order, year of birth, and state.MethodsWe analyzed data from three consecutive rounds of the Indian National Family Health Survey undertaken between 1992 and 2006. All children below five years of age with complete immunization histories were included in the analysis. Age-appropriate immunization coverage was determined for the following antigens: bacille Calmette-Guérin (BCG), oral polio (OPV), diphtheria, pertussis (whooping cough) and tetanus (DPT), and measles.ResultsImmunization coverage in India has increased since the early 1990s, but complete, age-appropriate coverage is still under 50% nationally. Girls were found to have significantly lower immunization coverage (p<0.001) than boys for BCG, DPT, and measles across all three surveys. By contrast, improved coverage of OPV suggests a narrowing of the gender differences in recent years. Girls with a surviving older sister were less likely to be immunized compared to boys, and a large proportion of all children were found to be immunized considerably later than recommended.ConclusionsGender inequities in immunization coverage are prevalent in India. The low immunization coverage, the late immunization trends and the gender differences in coverage identified in our study suggest that risks of child mortality, especially for girls at higher birth orders, need to be addressed both socially and programmatically. ABSTRACT IN HINDI : See the full article online for a translation of this abstract in Hindi.

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The Impact of War in Yemen on Immunization Coverage of Children Under One Year of Age: Descriptive Study.

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The Impact of War in Yemen on Immunization Coverage of Children Under One Year of Age: Descriptive Study.

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