Administrative Coverage Research Articles

Building evidence for improving vaccine adoption and uptake of childhood vaccinations in low- and middle-income countries: a systematic review

Vaccine coverage for children is an important indicator of the performance of national health and immunization systems. Most of the existing literature has targeted mothers’ low educational level, living in underserved districts and/or remote rural areas and economic poverty that are correlated with low immunization coverage but the supply- and demand-side constraints to immunization in low- and middle- income countries (LMICs) are not well understood. The reliability of claimed administrative immunization coverage in these contexts is questionable. To address these barriers within the present Expanded Programme on Immunization (EPI), the difficulties related to inadequate vaccination uptake must be addressed in more depth. Building on already produced literature, this study aims to determine the extent of immunization coverage among children in LMICs, as well as to fill in the gaps in awareness about system-level obstacles that currently hinder the effective delivery and uptake of immunization services through EPI. By two reviewers, a literature search using PubMed and Google Scholar along with targeted grey literature was conducted on the 2nd of June 2021 by following PRISMA guidelines. The search techniques for electronic databases used both Medical Subject Headings (Mesh) and free-text words were tailored to each database's specific needs using a controlled vocabulary that was limited to the English language from 2000 and 2020. Of the 689 records, eleven articles were included in this review meeting the inclusion criteria. In total, five articles related to vaccination coverage, four studies on components of the routine immunization system, one article on the implementation of new and under-utilized vaccines and one were on vaccines financing. We evaluated the quality of the included studies and extracted into tables created by one investigator and double-checked by another. Review findings suggest that specific strategies to reduce inequality may be required. Vaccine procurement and pricing strategies, as well as vaccine customization to meet the needs of LMICs, are all critical components in strengthening immunization systems. Our findings could be used to establish practical strategies for countries and development partners to address coverage gaps and improve vaccination system effectiveness.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40267-021-00890-7.

Determinants of credit risk: A multiple linear regression analysis of Peruvian municipal savings banks

In order to identify the determinants that influence the credit risk of Peruvian municipal savings banks, this quantitative research uses a nonexperimental design and a longitudinal sample to analyze monthly data corresponding to macroeconomic variables and microfinance institutions’ internal variables from 2011 to 2020. Using multiple linear regression, the results show that the interest rate, unemployment rate, and liquidity ratio positively influence the credit risk of Peruvian municipal savings banks; the study also shows that gross domestic product, efficiency of administrative expenses, solvency, and coverage of provisions exert a negative influence on credit risk. It is concluded that seven of the eight independent variables studied influence the credit risk of Peruvian municipal savings banks; only the inflation variable does not significantly influence credit risk.

Coverage evaluation surveys following soil-transmitted helminthiasis and schistosomiasis mass drug administration in Wolaita Zone of Ethiopia-The Geshiyaro project.

The Geshiyaro project aims to break transmission of soil-transmitted helminths and schistosomiasis in the Wolaita Zone of Ethiopia through a combination of two interventions: behavior change communication (BCC) for increased water, sanitation and hygiene (WaSH) infrastructure use alongside preventive chemotherapy (PC) using albendazole (ALB) and praziquantel (PZQ), targeted to reach 90% treatment coverage. Coverage evaluation surveys (CES) were conducted post-treatment, and the resultant survey coverage was compared to reported administrative coverage. This provided a secondary confirmation of the Geshiyaro project coverages, and is used to monitor the success of each Mass Drug Administration (MDA) round. A community-based cross-sectional study was conducted in 13 woredas (districts) of the Wolaita Zone. All eligible individuals from the selected households were invited for an interview. The study design, sample size, analysis and report writing were conducted according to the World Health Organization (WHO) CES guidelines for PC. The study interviewed a total of 3,568 households and 18,875 individuals across 13 woredas in the Wolaita Zone. Overall, the survey coverage across all studied woredas was 81.5% (95% CI; 80.9-82.0%) for both ALB and PZQ. Reported administrative coverage across all studied woredas was higher than survey coverage, 92.7% and 91.2% for ALB and PZQ, respectively. A significant portion of individuals (17.6%) were not offered PC. The predominant reason for not achieving the target coverage of 90% was beneficiary absenteeism during MDA (6.6% ALB, 6.8% PZQ), followed by drug distributors failing to reach all households (4.7% ALB, 4.8% PZQ), and beneficiaries not informed of the program (1.3% ALB, 1.7% PZQ). Programmatic actions will need to be taken during the next MDA campaign to achieve the targeted Geshiyaro project coverage threshold across data collection and program engagement. Adequate training and supervision on recording and reporting administrative coverage should be provided, alongside improved social mobilization of treated communities to increase participation, and strengthened institutional partnerships and communication.

The „Niemands“ – Heimatlose Ausländer in Mannheim

Abstract Heimatloser Ausländer (homeless foreigner) was a status granted to Displaced Persons, who were mostly slave or foreign workers during the Third Reich. How did local authorities and the population in Mannheim – an industrial ‘migration-city’– deal with these first ‘Ausländer’ of the Federal Republic of Germany? This article outlines how local authorities managed housing for dp s and later homeless foreigners and how their concerns were treated with at the Ausländerbehörde (foreigners office). It also looks into the reactions and attitudes of the population mirrored in local/regional administrative files and press coverage. The self-denomination as Niemands (nobodies), originating from sociologist and Mannheim based son of dp s, Stanislaus Stepień, expresses the history of a group of migrants who have been mostly forgotten after serving as projection surfaces and transmission objects for racial knowledge about the ‘migrant Other’ and ‘the German’.

A study of the clean water supply system in Pemalang regency water supply company

The Regional Public Company for drinking water in Pemalang Regency is an official agency given the authority to provide and serve water needs in the Pemalang Regency area. Based on the 2020 BPKP, service coverage is still low. Namely, administrative service coverage of 12.74% and technical service coverage of 18.50%, so the service coverage still does not meet the target and achievement of access to decent drinking water. Based on the BPKP 2020-2024, it is necessary to evaluate the management of the clean water supply system, which aims to improve clean water services in the Pemalang City area. Data analysis was done descriptively. The analysis results will describe the clean water supply system management and evaluation based on appropriate standards, regulations, and literature studies. In addition, analysis using the EPANET program is used for SPAM improvement plans. The same is done for the study of raw water availability and water demand until 2030. The evaluation results found that the existing condition of Pemalang City SPAM is still able to supply clean water needs in the Pemalang City area until 2022, and Perumda must have started looking for supplements or additional discharge to meet drinking water needs up to 2030.

Open Government Data: Usage trends and metadata quality

Open Government Data (OGD) have the potential to support social and economic progress. However, this potential can be frustrated if these data remain unused. Although the literature suggests that OGD data sets’ metadata quality is one of the main factors affecting their use, to the best of our knowledge, no quantitative study provided evidence of this relationship. Considering about 400,000 data sets of 28 national, municipal and international OGD portals, we have programmatically analysed their usage, their metadata quality and the relationship between the two. Our analysis has highlighted three main findings. First, regardless of their size, the software platform adopted, and their administrative and territorial coverage, most OGD data sets are underutilised. Second, OGD portals pay varying attention to the quality of their data sets’ metadata. Third, we did not find clear evidence that data sets’ usage is positively correlated to better metadata publishing practices. Finally, we have considered other factors, such as data sets’ category, and some demographic characteristics of the OGD portals, and analysed their relationship with data sets’ usage, obtaining partially affirmative answers.

Improving routine immunization data quality using daily short message system reporting platform: An experience from Nasarawa state, Nigeria.

Routine immunization (RI) delivery was declared a public health concern in Nigeria in 2017 because of persistently low immunization coverage rates reported in independent surveys. However, administrative coverage rates remain high, suggesting serious data quality issues. We posit that a shorter timespan between service provision and data reporting can improve the monitoring of RI data, and developed a short message system (SMS) text reporting strategy to generate daily RI data points from health facilities (HFs). The goal was to assess whether daily data collection produces complete, reliable and internally consistent data points. The SMS reporting platform was piloted between December 2017 and April 2018 in two Local Government Areas (LGAs, equivalent to districts) of Nasarawa state, Nigeria. The 145 healthcare workers from 55 HFs received one mobile phone and pre-configured SIM card, and were trained to send data through predefined codes. Healthcare workers compiled the data after each vaccination session and transmitted them via SMS. We analyzed completeness, number of weekly sessions, and supportive supervision conducted. During the pilot phase, we received data from 85% (n = 47) of the 55 HFs. We expected 66 fixed-post sessions and 30 outreach sessions per week, but received data for 33 fixed-post and 8 outreach weekly session on average. More HFs reported on Tuesdays compared to other days of the week. When assessing internal consistency, we observed that the reported number of children vaccinated was sometimes higher than the number of doses available from opening a given number of vaccine vials. When found, this discrepancy was noted for all antigens during fixed-post and outreach vaccination sessions. Despite these initial discrepancies, transmitting RI data sessions via texting is feasible and can provide real-time updates to the performance of the RI services at the HF level.

Measles epidemiology and vaccination coverage in Oromia Region, Ethiopia: Evidence from surveillance, 2011–2018

Despite a reported high coverage of measles-containing vaccine (MCV), low-income countries including, Ethiopia, have sustained high measles transmission with frequent outbreaks. We investigated the distribution of measles infection and vaccination in Oromia Regional State, Ethiopia. According to the World Health Organization (WHO) and the Ethiopian measles case classification guidelines, measles cases were classified as laboratory-confirmed, clinically compatible, and epidemiologically linked. We derived measles vaccination coverage estimates using reported measles vaccine efficacy and, the proportion of measles cases vaccinated with measles vaccine at least once from the surveillance data. We calculated measles effective reproduction number (Re) in the region. Almost twenty-five thousand measles cases were reported through the surveillance system, with more than 50% of the suspected and confirmed measles cases reported in 2015. Measles had sustained and high transmission rate with uneven distribution among the zones. Children between 1 and 4 years of age and MCV unvaccinated individuals were the most affected groups. In all the zones, the average surveillance-estimated MCV coverage among both infants and under-five children was significantly lower than the WHO recommended minimum 90% threshold herd-immunity. With this level of vaccination coverage, an infected case can transmit to more than four individuals. Nevertheless, the administrative coverage reports for the concurrent period were consistently above 90%. The estimated MCV coverage across the Oromia region was well below the recommended herd-immunity threshold. It partly explains the apparent mismatch of sustained measles transmission and outbreaks despite the very high administrative coverage estimates. Oromia regional health bureau, in collaboration with key stakeholders, should make a concerted effort to increase the effective-coverage of MCV to at least 90%. Additionally, multiple-dose MCV has to be scaled-up and accompanied with appropriate geographic and age targeting using evidence from surveillance data. Immediate programmatic action is needed to improve the quality of measles surveillance.

National introduction of human papillomavirus (HPV) vaccine in Tanzania: Programmatic decision-making and implementation

BackgroundCervical cancer is the leading cause of cancer among women in Tanzania, with approximately 10,000 new cases and 7,000 deaths annually. In April 2018, the Government of Tanzania introduced 2 doses of human papillomavirus (HPV) vaccine nationally to adolescent girls to prevent cervical cancer, following a successful 2-year pilot introduction of the vaccine in the Kilimanjaro Region. MethodsWe interviewed key informants at the national level in Tanzania from February to November 2019, using a semi-structured tool to better understand national decision-making and program implementation. We conducted a comprehensive desk review of HPV vaccine introduction materials and reviewed administrative coverage data. ResultsTen key informants were interviewed from the Ministry of Health, Community Development, Gender, Elderly, and Children, the World Health Organization, and other partners, and HPV vaccine planning documents and administrative coverage data were reviewed during the desk review. Tanzania introduced HPV vaccine to a single-age cohort of 14-year-old girls, with the decision-making process involving the Tanzania Immunization Technical Advisory Group and the national Interagency Coordination Committee. HPV vaccine was integrated into the routine immunization delivery strategy, available at health facilities and through outreach services at community sites, community mobile sites (>10 km from the health facility), and primary and secondary schools. Pre-introduction activities included trainings and microplanning workshops for health workers and school personnel at the national, regional, council, and health facility levels. Over 6,000 health workers and 22,000 school personnel were trained nationwide. Stakeholder and primary health care committee meetings were also conducted at the national level and in each of the regions as part of the advocacy and communication strategy. Administrative coverage of the first dose of HPV vaccine at the end of 2019 was 78%, and second dose coverage was 49%. No adverse events following HPV vaccination were reported to the national level. DiscussionTanzania successfully introduced HPV vaccine nationally targeting 14-year-old girls, using routine delivery strategies. Continued monitoring of vaccination coverage will be important to ensure full 2-dose vaccination of eligible girls. Tanzania can consider periodic intensified vaccination and targeted social mobilization efforts, as needed.

Efforts Towards Polio Eradication in Madagascar: 1997 to 2017.

BackgroundIn 1988, the World Health Assembly launched the Global Polio Eradication Initiative. WHO AFRO is close to achieve this goal with the last wild poliovirus detected in 2014 in Borno States in Nigeria. The certification of the WHO African Region requires that all the 47 member states meet the critical indicators for a polio free status. Madagascar started implementing polio eradication activities in 1996 and was declared polio free in June 2018 in Abuja. This study describes the progress achieved towards polio eradication activities in Madagascar from 1977-2017 and highlights the remaining challenges to be addressed.MethodsData were collected from the national routine immunization services, Country Acute Flaccid surveillance databases and national reports of SIAS and Mop Up campaign. Country complete polio and immunization related documentation provided detailed historical information’s.ResultsFrom 1997 to 2017, Madagascar reported one wild poliovirus (WPV) outbreak and four circulating Vaccine Derived Polio Virus (cVDPV) oubreaks with a total of 21 polioviruses (1 WPV and 21 cVDPV). The last WPV and cVDPV were notified in 1997 in Antananarivo and 2015 in Sakaraha health districts respectively. Madagascar met the main polio surveillance indicators over the last ten years and made significant progress following the last cVDPV2 outbreak in 2014 -2015. In addition, the country successfully implemented the switch from trivalent Oral Polio Vaccine (tOPV) to bivalent Oral Polio vaccine (bOPV) and containment activities. Environmental Surveillance established since 2015 did not reveal any poliovirus. The administrative coverage of the 3rd dose of oral polio vaccine (OPV3) varied across the years from 55% in 1991 to a maximum of 95% in 2007 before a progressive decrease to 86% in 2017. The percentage of AFP cases with more than 3 doses of oral polio vaccines increased from 56% in 2014 to 88% in 2017. A total of 19 supplementary immunization activities (SIA) were conducted in Madagascar from 1997 to 2017, among which 3 were subnational immunization days (sNID) and 16 were national immunization days (NIDs). Poor routine coverage contributed to the occurrence of cVDPC outbreaks in the country; addressing this should remain a key priority for the country to maintain the polio free status.From 2015 to June 2017, Madagascar achieved the required criteria leading to the acceptance of the country’s polio-free documentation in June 2018 by ARCC. However, continuous efforts will be needed to maintain a highly sensitive polio surveillance system with emphasis on security compromised areas. Finally strengthening the health system and governance at all levels will be necessary if these achievements are to be sustained.ConclusionsHigh national political commitment and support of the Global Polio Eradication Partnership were critical for Madagascar to achieve polio free status. Socio-political instability, weakness of the health system, sub-optimal routine immunization performance, insufficient SIA quality and existing security compromised areas remain critical program challenges to address in order to maintaining the polio free status. Continuous high-level advocacy should be kept in order to ensure that new government authorities maintain polio eradication among the top priorities of the country.

Epidemiological, clinical, and public health response characteristics of a large outbreak of diphtheria among the Rohingya population in Cox's Bazar, Bangladesh, 2017 to 2019: A retrospective study.

BackgroundUnrest in Myanmar in August 2017 resulted in the movement of over 700,000 Rohingya refugees to overcrowded camps in Cox’s Bazar, Bangladesh. A large outbreak of diphtheria subsequently began in this population.Methods and findingsData were collected during mass vaccination campaigns (MVCs), contact tracing activities, and from 9 Diphtheria Treatment Centers (DTCs) operated by national and international organizations. These data were used to describe the epidemiological and clinical features and the control measures to prevent transmission, during the first 2 years of the outbreak. Between November 10, 2017 and November 9, 2019, 7,064 cases were reported: 285 (4.0%) laboratory-confirmed, 3,610 (51.1%) probable, and 3,169 (44.9%) suspected cases. The crude attack rate was 51.5 cases per 10,000 person-years, and epidemic doubling time was 4.4 days (95% confidence interval [CI] 4.2–4.7) during the exponential growth phase. The median age was 10 years (range 0–85), and 3,126 (44.3%) were male. The typical symptoms were sore throat (93.5%), fever (86.0%), pseudomembrane (34.7%), and gross cervical lymphadenopathy (GCL; 30.6%). Diphtheria antitoxin (DAT) was administered to 1,062 (89.0%) out of 1,193 eligible patients, with adverse reactions following among 229 (21.6%). There were 45 deaths (case fatality ratio [CFR] 0.6%). Household contacts for 5,702 (80.7%) of 7,064 cases were successfully traced. A total of 41,452 contacts were identified, of whom 40,364 (97.4%) consented to begin chemoprophylaxis; adherence was 55.0% (N = 22,218) at 3-day follow-up. Unvaccinated household contacts were vaccinated with 3 doses (with 4-week interval), while a booster dose was administered if the primary vaccination schedule had been completed. The proportion of contacts vaccinated was 64.7% overall. Three MVC rounds were conducted, with administrative coverage varying between 88.5% and 110.4%. Pentavalent vaccine was administered to those aged 6 weeks to 6 years, while tetanus and diphtheria (Td) vaccine was administered to those aged 7 years and older. Lack of adequate diagnostic capacity to confirm cases was the main limitation, with a majority of cases unconfirmed and the proportion of true diphtheria cases unknown.ConclusionsTo our knowledge, this is the largest reported diphtheria outbreak in refugee settings. We observed that high population density, poor living conditions, and fast growth rate were associated with explosive expansion of the outbreak during the initial exponential growth phase. Three rounds of mass vaccinations targeting those aged 6 weeks to 14 years were associated with only modestly reduced transmission, and additional public health measures were necessary to end the outbreak. This outbreak has a long-lasting tail, with Rt oscillating at around 1 for an extended period. An adequate global DAT stockpile needs to be maintained. All populations must have access to health services and routine vaccination, and this access must be maintained during humanitarian crises.

Tetanus vaccine coverage in recommended and more than recommended doses among mothers in a West Cameroon health district: a cross sectional study

Background: Vaccination is the best way to protect newborns and mothers against tetanus. The number of doses of Td vaccine recommended by the Expanded Program of Immunization is based on documented protective immune response. During this decade, the Foumban Health District (FHD) was the seat of an epidemic despite the satisfactory administrative immunization coverage. This study was conducted in 2019 in the FHD to assess tetanus vaccine coverage among mothers for their last pregnancy and the cumulative number of vaccine doses administered to the mothers. Method: This was a descriptive cross-sectional study conducted in the FHD in 2019. Mothers living in the district with at least one child younger than five years were included and were selected by random stratified cluster sampling. Trained surveyors used a face-to-face questionnaire, data extraction grid and data-tracking grid to review and collect data from antenatal care booklets, vaccination cards and the women’s own reports of immunization. The immunization coverage per vaccine dose and vaccination completeness rate were estimated. Results: From 621 women visited, 602 (96.9%) responded. A total of 176/511 women (34.4%) had evidence of vaccination. For the last pregnancy, the two-dose immunization proportion was 21.7% (111/511) for documented coverage and 47.6% (243/511) for undocumented coverage. 306/570 women (53.7%) had received more than the recommended five doses necessary for lifetime protection. The recruitment, two and five doses completeness rates were 99.9% (569/570), 95.8% (546/570) and 65.3% (372/570), respectively. Conclusion: More than half of mothers received more doses of tetanus toxoid vaccine than necessary in FHD. This increased the resources needed and the cost of vaccination. Health personnel should be trained and supervised to assess pregnant women’s vaccination status before planning the number of vaccine doses to be administered during pregnancy.

Implementation of integrated supportive supervision in the context of coronavirus 19 pandemic: its effects on routine immunization and vaccine preventable surveillance diseases indicators in the East and Southern African countries.

Introductionthe coronavirus disease (COVID-19) global pandemic has caused serious disruption to almost all aspect of human endeavor forcing countries to implement unprecedented public health measures aimed at mitigating its effects, such as total lockdown (inter and intra), travel bans, quarantine, social distancing in an effort to contain the spread of the virus. Supportive supervision is a functional component of the immunization systems that allows identification of existing gaps, provides an opportunity for onsite training, and document real-time findings for improvement of the program. The control measures of COVID-19 pandemic have also resulted in limitation of operations of the immunization system including supportive supervision. This has limited many aspects of supportive supervision for surveillance and routine immunization monitoring system in the East and Southern African countries. The aim of this study is to identify the effects of COVID-19 on Integrated Supportive Supervision visits for expanded programme on immunization (EPI) and how it influences the immunization and vaccine preventable disease (VPD) surveillance indicators, and its short-term effect towards notification of increase or decrease morbidity and mortality.Methodswe reviewed the integrated supportive supervision (ISS) data and the routine administrative coverage from 19 countries in the East and Southern Africa (ESA) for the period January to August 2019 to analyze the trends in the number of visits, vaccine-preventable diseases (VPD), and routine immunization (RI) indicators using t-test, and compare with the period January to August 2020 during the months of the COVID-19 pandemic.Resultsthirteen countries out of the 19 considered, had shown a decline in the number of integrated supportive supervision (ISS) visits, with 10 (77%) having more than 59% decrease during the January-August 2020 as compared to the same period 2019. Eleven (57%) of the countries have shown a decrease (p-value < 0.05). Ethiopia and Kenya had the highest drop (p-value < 0.000). Six (32%) had an increase in the number of visits, with Madagascar, Zambia, and Zimbabwe having >100% increase in the number of visits. Sixty-seven percent (67%) of the countries that have decreased in the number of ISS visits have equally witnessed a drop in DPT3 administrative coverage. Countries with a low proportion of outreach sessions conducted in the period of January - August 2020, have all had sessions interruption, with more than 40% of the reasons associated with the lockdown.Conclusioncountries have experienced a decrease in the number of supportive supervision visits conducted, during the period of the COVID-19 pandemic and, this has influenced the routine immunization and vaccine-preventable diseases surveillance (VPD) process indicators monitored through the conduct of the visits. Continuous decrease in these performance indicators pose a great threat to the performance sustained and the functionality of the surveillance and immunization system, and consequently on increased surveillance sensitivity to promptly detect outbreaks and aiming to reducing morbidity and mortality in the sub-region.

Reimagining Section 94.1: The Offshore Investment Fund Property Rule

In this article, the author contemplates how section 94.1 of the Income Tax Act (Canada), the offshore investment fund property (OIFP) rule, might be reimagined considering its inefficacy in the face of unique non-resident investment funds. By tracing the anti-avoidance origins of the rule, the author shows that the source of this inadequacy is an expectation overload rather than legislative failure. While the OIFP rule was introduced as a stop-gap designed only to tackle a certain kind of basic intermediation strategy, it is now tasked with the much grander objective of creating a level playing field with respect to the tax treatment of domestic and offshore investment funds. The author shows how this mismatch of aspiration and reality has created the opportunity for savvy investors to manipulate the "motive" test within the rule, and avoid its application, simply by proving themselves to have a sufficiently credible and pervasive alternative reason for investing in an offshore fund (for example, the unique expertise of its manager). The author postulates that this flaw is likely to become more frequently tested as funds specializing in novel asset classes (such as cryptocurrency funds) proliferate and grow. The article closes with the proposition that if the test at the centre of the rule is recast as a purely objective analysis, and certain other changes are made, section 94.1 can be transformed to apply a transaction-cost model that will deter undesirable intermediation attempts and ensure that Canada's revenue authorities get a cut of any profits from superreturn investment opportunities. The author draws on key elements of the ultimately abandoned foreign investment entity rules and certain anti-avoidance provisions from elsewhere in the Act to provide a conceptual foundation for the proposed amendments. He also seeks to demonstrate how revising the OIFP rule in this way will achieve a greater degree of capital export neutrality—a policy thread that runs through the Canadian approach to international taxation—by creating a more (though not wholly) level tax playing field, but without the crippling administrative burden and incomplete tax coverage that may accompany a more capital export neutrality-driven approach.

Methodologies to measure the coverage of vitamin A supplementation: a systematic review.

Countries are increasingly transitioning from event-based vitamin A supplementation (VAS) distribution to delivery through routine health system contacts, shifting also to administrative, electronic-based monitoring tools, a process that brings certain limitations affecting the quality of administrative VAS coverage. At present, there is no standardised methodology for measuring the coverage of VAS delivered through routine health services. To address this gap, we conducted a systematic review of the literature to identify and recommend methods to measure VAS coverage, with the aim of providing guidance to countries on the collection of consistent data for planning, monitoring and evaluating VAS programmes integrated into routine health systems. We searched the PubMed®, Embase®, Scopus, Google Scholar and World Health Organization (WHO) Global Index Medicus databases for studies published from 1 January 2000 to 1 January 2021, reporting original data on VAS coverage and methodologies used for measurement. We screened 2371 original titles and abstracts, assessed twenty-seven full-text articles and ultimately included eighteen studies. All but two studies used a coverage cluster survey (CCS) design to measure VAS coverage, adapting the WHO Vaccination Coverage Cluster Surveys methodology, by modifying sample size and sampling parameters. Annual two-dose VAS coverage was reported from only four studies. Until electronic-based systems to collect and analyse VAS data are equipped to measure routine two-dose VAS coverage using administrative data, CCSs that comply with the 2018 WHO Vaccination Coverage Cluster Surveys Reference Manual represent the gold-standard method for effective VAS programme monitoring.

Pertussis outbreak investigation in Saynt District, North eastern Ethiopia

Background: Bordetella pertussis is a highly contagious, vaccine-preventable respiratory illness, transmitted by coughing. Globally there were an estimated 24.1 million cases and 160,700 deaths in children under five years with most in Africa. Little is known about pertussis burden in Ethiopia. On 09/12/2019, the Saynt Woreda was notified about 62 cases concerning for pertussis. Methods and materials: We used a probable case definition (≥2 weeks cough with vomiting, apnea, or inspiratory whoop) to identify pertussis cases through medical record review and active case search. Laboratory confirmation was not conducted for the study. We conducted an unmatched case control study with 71 cases and 142 asymptomatic neighbor controls using a structured questionnaire. We reviewed diphtheria, tetanus, pertussis (DTP3) administrative immunization coverage, determined vaccine history by parental interview/vaccination card. Results: We identified 546 cases with attack rate of [AR] = 3/1000 population, highest in 012 kebele (AR = 113/1000).All cases were from 012 kebele which is the most remote in the district, but no death recorded. There was no deployed health extension worker in the health post for two months before the outbreak. DPT3 coverage in the district was 86.1%. Most cases were 5–14 age group. Common clinical symptoms included whoop 70 (32.2%) and posttussive vomiting 65 (29.9%) while, only 6 (2.76%) patients had hernia. Overall 106 (48.85%) of respondents were vaccinated, 44 (20.28%) not vaccinated and the remaining vaccination status were not known. Being exposed to a possible case at school (OR = 13.3, 95% CI = 1.43–123.34, p-value = 0.0227) and living with the affected person with pertussis in the family (OR = 3.14, 95% CI = 1.38–7.15, p-value = 0.006) were contributing factors for pertussis outbreak while knowing way of prevention (OR = 0.26, 95% CI = 0.08–0.84, p-value = 0.02) is a protective factor to pertussis. Conclusion: The outbreak occurred in hard to reach villages/kebele of amhara saint woreda with a weak surveillance system and late detection was happen. Close contact with cases in the family and at school were contributing factors for pertusis outbreak. Active case search should be strengthening to facilitate early detection and isolation.

Measles outbreak investigation in Kambia District, Sierra Leone-2018

Background: Measles, an acute highly infectious viral disease, remains one of the leading causes of childhood morbidity and mortality worldwide. Despite the availability of safe and effective vaccines, measles cases have been reported in Sierra Leone. On 29 October 2018, the Kambia district health management team was notified of a suspected measles outbreak. On 1 November 2019, we investigated the outbreak to confirm the diagnosis, assess the magnitude, identify potential risk factors, and institute control measures. Methods and materials: We defined a suspected case as any person with fever and maculopapular rash in Kambia district from 1st October 2018 and a probable case as any suspected case with epidemiologic link to a laboratory confirmed case. We reviewed medical records, interviewed parents, patients and collected blood samples for measles confirmation. We collected patients’ demographic, clinical and exposure history. We conducted active case search and needs assessment for measles reactive mass vaccination in the community. We conducted social mobilization and risk communication. Results: A total of 91 cases (14 laboratory-confirmed and 77 probable cases) with no deaths reported. The overall Attack Rate (AR) was 24.2/100,000 persons, with the highest AR (119.6/100,000 persons) among the 6–11 months age group. The median age was 24.5 months (range 4–348), and 48 (56%) were females. Four out of seven chiefdoms were affected and Gibnleh-Dixon chiefdom was the most affected (AR = 274.9/100,000). The first four detected cases had travel history to the neighboring Republic of Guinea, where there was a confirmed measles outbreak, and three of the four affected villages are close to the border. The district administrative vaccination coverage was 87%, however, of the total 84 eligible cases, only two had vaccination cards. Conclusion: A measles outbreak was confirmed in Kambia district which shares a border with Guinea. The importation of measles cases in a susceptible community might have contributed to the spread of measles in the affected chiefdoms. A reactive mass vaccination targeting children aged six months to 15 years was conducted and achieved coverage of 100.8%. We recommended strengthening routine immunization through increased outreach vaccination sessions to communities, supplementary vaccination and to strengthen cross border surveillance and response framework.

The impact of hepatitis B vaccination program in central Vietnam; evaluation by population-based, cross-sectional seroprevalence survey of HBsAg

Background: Vietnam is considered hyperendemic for hepatitis B and universal immunization for hepatitis B among infants has been implemented since 2003. To implement better disease control policies, effective impact evaluation of the vaccination program is warranted. Methods and materials: We conducted a stratified, multistage, cluster sampling survey of hepatitis B surface antigen (HBsAg) positivity among people aged 1–39 years old. Participants were randomly selected from the 4 provinces (Khanh Hoa, Ninh Thuan, Binh Dinh, Quang Ngai) in the central area of Vietnam via probability proportionate to size sampling. A face-to-face questionnaires and HBsAg rapid tests were administrated. Results: A total of 2078 participants were included into the study. The seroprevalence of HBsAg by age group for every 5years old was estimated as shown on the table below.Tabled 1agenHBsAg(+)95%CI1–42661.50%0.32–2.985–93663.01%1.25–4.7610–142981.01%0.00–2.1515–192493.61%1.28–5.9520–2416710.18%5.55–14.8125–292227.21%3.78–10.6430–3425211.11%7.20–15.0235–392589.30%5.73–12.87 Open table in a new tab In Vietnam, hepatitis vaccine was introduced in 1997 and was expanded nationwide in 2002. A birth dose was added to the immunization schedule in 2003. The decline in the prevalence of HBsAg in younger age groups may be attributed to the immunization program. However, the administrative birth dose coverage of Hepatitis B vaccine became temporally low after media reports of adverse events following immunization in 2007. High prevalence of HBsAg of HBsAg between the age of 5 and 9 in this area may be due to the low coverage of birth dose. Conclusion: Population based seroprevalence survey is able to provide valuable information to assess the effectiveness of previous vaccination and formulate future immunization policy. The survey with rapid field test is feasible and affordable way which can be applied in resource limited settings.

Lessons learned in the implementation of supplementary immunization activity (SIA) field guidelines for injectable vaccines – Experiences from Tanzania

BackgroundTo achieve Measles and Rubella elimination and Polio Endgame goals, Tanzania implemented country-wide integrated Supplementary Immunization Activities (SIAs) in October 2019 involving two injectable vaccines of MR and IPV. The SIAs targeted children aged between 9 and 59 months for Measles-Rubella and 18 to 42 months for IPV vaccines. This article aims to share lessons learnt in the implementation of SIAs field guidelines in Tanzania in 2019 to inform future implementation of the SIAs within and outside the country’s boundaries. MethodsFocus groups discussions (FGDs) were conducted among Regional Immunization and Vaccines Officers from all regions and National Supervisors and Partners responsible for implementing the SIAs. Key areas discussed were pre-planning activities, implementation, monitoring and evaluation of the SIAs based on key thematic areas including; planning and coordination, logistics management, trainings, and demand creation. Pre-described templates were used to guide the discussion and keep record of the discussions. ResultsThe SIAs achieved national target based on administrative coverage. This was due to a high sense of ownership of the SIAs and strong staff commitment to attain high coverage rates manifested through effective planning and coordination within and between levels; effective execution of SIAs activities; involvement of key stakeholders at all levels; and strong advocacy, communication and social mobilization activities. Despite the success observed through administrative coverage, the WHO target of attaining 95% coverage using the gold standard - national coverage survey, was not reached. The main barrier to success was inadequate and delayed disbursement of funding. ConclusionThe 2019 SIA achieved high administrative coverage as a result of effective coordination; adequate micro-planning; timely logistical preparations; and effective demand creation activities. Future campaigns need to give high priority to hard-to-reach and densely populated areas during planning and ensure timely disbursement of funds to the operational level during implementation.

Lot quality assurance sampling to assess coverage and compliance following mass drug administration to eliminate lymphatic filariasis in Fiji: A methodological approach.

BackgroundAssessing the quality of mass drug administration (MDA) rounds is a key component of lymphatic filariasis (LF) elimination programs. Routine collection of administrative coverage is unreliable, especially when pockets with low program coverage exist. To address this gap, we used lot quality assurance sampling (LQAS) following the 10th annual LF-MDA round in Fiji to explore whether there was any area in which target coverage was not reached. We also assessed the level of drug compliance and satisfaction with the LF-MDA implementation strategy.Methodology/principal findingsWe conducted a cross-sectional household survey in 3 divisions of Fiji. For LQAS, we defined 19 lots in 7 medical areas of the Suva sub-division and another 12 sub-divisions in the Central, Northern, and Eastern Divisions. A sample of 16 randomly selected household members was taken un each lot. We defined our decision rule as follows: if more than 1 person in a given lot did not swallow the medication, coverage was considered inadequate, i.e. less than 80%.Of the 7 lots in Suva sub-division and 12 lots in the 3 divisions, five and two lots, respectively, were identified as having inadequate coverage. The overall program coverage estimated from 304 samples was 92%, which was higher than the reported administrative coverage of 82%. About 98% of interviewees were offered the medication and 96% swallowed it. Non-participation arose from insufficient information on how to obtain the drugs. At least 92% were satisfied with the LF-MDA implementation strategy.ConclusionsAreas of low program coverage with results discordant with the reported administrative coverage existed in both urban and rural settings. Drug compliance and satisfaction were high, even after repeated rounds. We recommend increasing efforts to deliver the service in those areas with inadequate program coverage, as well as conducting timely coverage assessment through LQAS for corrective action.