Cost-effective Health Interventions Research Articles

Perspectives on the sustained engagement with digital health tools: protocol for a qualitative interview study among people living with Inflammatory Bowel Disease or irritable bowel syndrome

IntroductionDigital health tools can be beneficial in the care of patients with chronic conditions and have the potential for widespread impact as readily scalable and cost-effective health interventions. However, benefits...

Unlocking the night: Exploring the health impacts of night-time walking environments on health outcomes of older adults

Walking remains the primary form of physical activity for many older adults in China, and the quality of the walking environment at night may determine the frequency and duration of evening outings. This study reveals how night-time environmental features influence the health outcomes of older adults. Using the medical check-up records of 87,578 older adults from a public health service in the Beilin district of Xi'an city, China, the role of the night-time walking environment in managing chronic conditions was examined. A favorable night-time walking environment reduced the prevalence of chronic conditions and comorbidities among older adults. However, the health effects stemming from the night-time walking environment exhibited heterogeneity, with significant impacts only on metabolic conditions, such as hypertension and diabetes, while the effects on other conditions were not significant. Our findings supplement the theory of healthy aging by highlighting the potential value of the environment in managing chronic conditions, which may serve as a cost-effective health intervention for aging societies.

Persistence and heterogeneity of the effects of educating mothers to improve child immunisation uptake: Experimental evidence from Uttar Pradesh in India

Childhood vaccinations are among the most cost-effective health interventions. Yet, in India, where immunisation services are widely available free of charge, a substantial proportion of children remain unvaccinated. We revisit households 30 months after a randomised experiment of a health information intervention designed to educate mothers on the benefits of child vaccination in Uttar Pradesh, India. We find that the large short-term effects on the uptake of diphtheria–pertussis–tetanus and measles vaccination were sustained at 30 months, suggesting the intervention did not simply bring forward vaccinations. We apply causal forests and find that the intervention increased vaccination uptake, but that there was substantial variation in the magnitude of the estimated effects. We conclude that characterising those who benefited most and conversely those who benefited least provides policy-makers with insights on how the intervention worked, and how the targeting of households could be improved.

Strategies for engaging older adults and informal caregivers in health policy development: A scoping review.

Care for older adults is high on the global policy agenda. Active involvement of older adults and their informal caregivers in policy-making can lead to cost-effective health and long-term care interventions. Yet, approaches for their involvement in health policy development have yet to be extensively explored. This review maps the literature on strategies for older adults (65+years) and informal caregivers' involvement in health policy development. As part of the European Union TRANS-SENIOR program, a scoping review was conducted using the Joanna Briggs Institute's methodology. Published and grey literature was searched, and eligible studies were screened. Data were extracted from included studies and analysed using the Multidimensional Framework for Patient and Family Engagement in Health and Healthcare. A total of 13 engagement strategies were identified from 11 publications meeting the inclusion criteria. They were categorized as "traditional", "deliberative" and "others", adopting the World Bank's categorization of engagement methods. Older adults and informal caregivers are often consulted to elicit opinions and identify priorities. However, their involvement in policy formulation, implementation and evaluation is unclear from the available literature. Findings indicate that older adults and their informal caregivers do not often have equal influence and shared leadership in policy-making. Although approaches for involving older adults and their informal caregivers' involvement were synthesized from literature, we found next to no information about their involvement in policy formulation, implementation and evaluation. Findings will guide future research in addressing identified gaps and guide policy-makers in identifying and incorporating engagement strategies to support evidence-informed policy-making processes that can improve health outcomes for older adults/informal caregivers.

Double burden of malnutrition and associated factors among women of reproductive age in sub-Saharan Africa: a multilevel multinomial logistic regression analysis

BackgroundGlobally, malnutrition among women of reproductive age is on the rise and significantly contributing to non-communicable disease, deaths and disability. Even though the double burden of malnutrition (DBM) is a...

Factors that influence the availability of childhood vaccine in healthcare facilities at Tana River County, Kenya.

Routine vaccine is a cost-effective health intervention against vaccine preventable diseases (VPD). Tremendous gains have been realized since the introduction of vaccines. Despite the gains, access to the lifesaving commodity has remained a major obstacle globally. Various factors have been associated with vaccine stock-out. This research assessed the factors that influence the availability of vaccines in healthcare facilities at Tana River County in Kenya. Cross-sectional design was adopted. Census sampling technique was used where all 61 immunizing healthcare facilities were included. The study was carried out in Tana River County which is located in the coastal part of Kenya. A structured questionnaire was used to collect the data. The researchers requested for authorization from relevant bodies and consent from participants. Data were collected, cleaned and recorded in Microsoft excel. STATA version 14 was used to analyze data. Both descriptive and inferential statistics were used in the analysis at 0.05 level of significance. The study revealed that 62.71% of the facilities experienced routine vaccine stock-out. There was statistically significant association between availability of vaccines and work experience (p = 0.001), training on immunization services (p = 0.027), catchment area map with target population displayed in the facility (p = 0.049), and use of target population method in vaccine forecasting (p = 0.004). The independent predictor of vaccine availability was work experience (p = 0.025). There was inadequate vaccine forecasting, vaccine stock management practices and accountability. Work experience was the main factor that affected their availability in the health facilities.

STRATEGIES FOR INVOLVING OLDER ADULTS AND INFORMAL CAREGIVERS IN HEALTH POLICY DEVELOPMENT: A SCOPING REVIEW

Abstract Encouraging the active involvement of older adults and informal caregivers in policymaking can lead to cost-effective health and long-term care interventions and enhance the creation of responsive policies. As part of the European Union TRANS-SENIOR program, a scoping review was conducted using the Joanna Briggs Institute’s methodology. Published and grey literature was searched. Studies were included if they described the use/evaluation of methods for engaging older adults (65 years and above) and informal caregivers in local, national, or regional health policy development. Analysis was guided by the Multidimensional Framework For Patient And Family Engagement In Health And Health Care. Thirteen engagement strategies were identified from 11 publications meeting the inclusion criteria. Adopting the World Bank’s categorization of citizen engagement methods, strategies were categorized as traditional, deliberative, and others. Older adults and informal caregivers are often consulted to elicit opinions for agenda/priority setting. However, their involvement in other stages of the policy cycle: health policy formulation, implementation, and evaluation, was unclear from the literature. The described engagement methods suggested that older adults and their informal caregivers do not often have shared equal power and shared responsibility in policymaking. Findings will guide policymakers in identifying and incorporating engagement strategies to support evidence-informed policymaking processes that can improve health outcomes for older adults/informal caregivers. Future research is needed on the evaluation of involvement methods.

Barriers to COVID-19 vaccine uptake: classification and the role of Health Literacy and Media Literacy.

Vaccination is one of the most influential and cost-effective health interventions for preventing and reducing COVID-19 diseases. Unfortunately, the majority of the world's population is deprived of vaccination. Health Literacy (HL) and Media Literacy (ML) are essential to the COVID-19 vaccination. The present study investigates the barriers to COVID-19 vaccine uptake, focusing on classification and the roles of HL and ML. A cross-sectional study was conducted among people 18-65 years old in Sarab City, located in East Azerbaijan, Iran, between September to October 2020. Multistage cluster sampling was employed to recruit 298 people from Health Care Services Centers (HCCs). The results of this research demonstrated that about 32.6% of participants reported that they have fully injected COVID-19 vaccines. Also, HL was positively associated with ML (r = 0.214, p < 0.05). Barriers of COVID-19 vaccine uptake were classified into personal, interpersonal, group and organizational, society and decision-making factors. Besides, barriers to the COVID-19 vaccine were significantly correlated with HL (r = -0.298, p < 0.05) and ML (r = 0.266, p < 0.05). Additionally, in the hierarchical regression model, demographic characteristics accounted for 8.2% of the variation in barriers to the COVID-19 vaccine (F = 4.34; p = 0.001), that monthly income (ß = -0.237; p < 0.05) and marriage statues (ß = 0.131; p < 0.05) were statistically associated with low barriers. HL as predictor variables explained an additional 14.4% of variation in barriers of COVID-19 vaccine (F = 53.84; p < 0.001) and ML explained an extra 9.2% of the variation (F = 38.83; p < 0.001). In total, demographic characteristics, HL dimensions and ML were able to explain 31.8% of the variation in barriers to COVID-19 vaccine. According to the findings, various strategies are needed to increase the COVID-19 vaccination uptake. This is due to the fact that barriers to COVID-19 vaccination uptake are multifactorial. These facts can help health policymakers and healthcare providers design media-based interventions to reduce barriers to COVID-19 vaccination uptake among adults. Enhancing vaccine HL and ML for adults and improving vaccine confidence are of high priority.

Knowledge, attitudes, and practices of caregivers on childhood immunization in Okaikoi sub-metro of Accra, Ghana.

Immunization remains one of the most cost-effective health interventions. However, there are still issues of vaccine hesitancy especially in caregivers who are required to protect their children from vaccine-preventable diseases. This thwarts the overall vaccine coverage in disease-endemic areas such as sub-Saharan Africa. Therefore, to determine the factors that promote vaccine hesitancy in caregivers, this study sought to assess the knowledge, attitude, and practices of caregivers on childhood immunization in Okaikoi, a sub-metro of Accra in Ghana. A cross-sectional study on childhood immunization was conducted to determine the knowledge, attitudes, and practices of caregivers. A total of 120 caregivers with infants aged 12 months to 23 months were interviewed with a structured questionnaire containing open-ended and closed-ended queries. From the community, infants whose caregivers had adhered completely to immunization constituted 53.3% while the rest were partially immunized. The two main deterrents to complete immunization were time constraints (25.8%) and forgetfulness (17.5%). It was observed that vaccination uptake and maternal level of education, as well as vaccination adverse reaction, did not impact the completion of the EPI program by these caregivers. Unfortunately, it was noted that caregivers with higher education levels were unable to complete their vaccination schedules due to their busy work schedules. Nonetheless, the main deterrent to adhering to complete childhood immunization was poor maternal knowledge (58%). The study revealed that, the caregivers in the community had poor knowledge on vaccination and its benefits, and therefore, with no strict adherence to vaccination schedules. This promoted the incomplete immunization of children in the community by their caregivers. Also, since the main source of information with regard to immunization in the sub-metro was through the antenatal and postnatal child welfare clinics and the media, we recommend that the health workers collaborate with media personnel to ensure that standardized information is disseminated.

Knowledge, Attitude, and Behavior Related to COVID-19 Vaccine Acceptance: A Cross-Sectional Study

Objective: According to World Health Organization (WHO) recommendations, vaccination can save millions of lives,and it is widely known as one of the most successful and cost-effective health interventions. Nevertheless, some peopleare reluctant to be vaccinated because of potential side effects. This study aimed to analyze the effects of knowledge,attitudes, and behavior related to the coronavirus disease 2019 (COVID-19) vaccine acceptance.Material and Methods: This is a quantitative study that employed the cross-sectional approach and was conducted from December 2021 to February 2022. Data were collected from 520 samples aged 22-64 years chosen via simple random sampling. The data collection was carried out using a questionnaire via Google Forms. To analyze the acceptance of the COVID-19 vaccination program in the community, multiple linear regressions using the SPSS software version 25 were employed.Results: Knowledge (b=0.11, SE=0.05, 95% CI=0.01 to 0.21, p-value=0.030), attitude (b=0.08, SE=0.03, 95% CI=0.03 to 0.13, p-value=0.003), and behavior (b=0.07, SE=0.02, 95% CI=0.03 to 0.10, p-value&lt;0.001) affected the COVID-19 vaccine acceptance. The higher the knowledge about the COVID-19 vaccine, the higher the public acceptance of the vaccination program. Likewise, the more positive the public’s attitude towards the COVID-19 vaccine, the higher its acceptance of the vaccination. The better the public’s behavior related to COVID-19 vaccination, the higher the level of acceptance of the COVID-19 vaccine.Conclusion: Comprehensive knowledge, positive attitudes, and good behavior related to the COVID-19 vaccinationaffect the acceptance of COVID-19 vaccine by the public of Indonesia. Even when people have received a completeCOVID-19 vaccination, they should remain disciplined in implementing the recommended health protocols of the relevant institutions and organizations.

Effects of virtual reality guided meditation in older adults: the protocol of a pilot randomized controlled trial.

Virtual reality (VR) based meditation has been shown to help increase relaxation and decrease anxiety and depression in younger adults. However, this has not been studied in Randomized Controlled Trials (RCT) in the older adult population. The aim of this RCT is to assess the feasibility and acceptability of a VR-guided meditation intervention for community-dwelling older adults and its effect on stress and mental health. We will recruit 30 participants aged ≥ 60 years, whose perceived stress score (PSS) is > 14 (moderate stress), and randomize them 1:1 to the intervention or control waitlist group. The intervention will involve exposure to eight 15-min VR-guided meditation sessions distributed twice weekly for 4-weeks. Two modalities will be offered: in-home and at the hospital. Baseline and post-intervention assessments will evaluate perceived stress, anxiety, depression, sleep quality, quality of life, and mindfulness skills. Analyses will employ mixed methods repeated ANOVA tests. Qualitative analyses through semi-structured interviews and participant observation will be used to assess participants' experiences. Study outcomes include: (A) feasibility and acceptability compared to a waitlist control (B) stress, using the Perceived Stress Scale (PSS); (C) anxiety, and depression, using the Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9); (D) insomnia, quality of life and mindfulness skills, using the Athens Insomnia Scale (AIS), Quality of Life Questionnaire (EQ-5D-5L) and Five Facets Mindfulness Questionnaire Short Forms (FFMQ-SF), respectively. We will also measure immersive tendencies, sickness and sense of presence using the Simulator Sickness Questionnaire (SSQ) and the Presence Questionnaire (PQ). Virtual reality-guided meditation could be an acceptable, feasible, safe, and cost-effective novel alternative health intervention for improving older adults' mental health.Clinical trial registration: NCT05315609 at https://clinicaltrials.gov.

Emulating Target Trials With Real-World Data to Inform Health Technology Assessment: Findings and Lessons From an Application to Emergency Surgery

ObjectivesInternational health technology assessment (HTA) agencies recommend that real-world data (RWD) are used in some circumstances to add to the evidence base about the effectiveness and cost-effectiveness of health interventions. The target trial framework applies the design principles of randomized-controlled trials to RWD and can help alleviate inevitable concerns about bias and design flaws with nonrandomized studies. This article aimed to tackle the lack of guidance and exemplar applications on how this methodology can be applied to RWD to inform HTA decision making. MethodsWe use Hospital Episode Statistics data from England on emergency hospital admissions from 2010 to 2019 to evaluate the cost-effectiveness of emergency surgery for 2 acute gastrointestinal conditions. We draw on the case study to describe the main challenges in applying the target trial framework alongside RWD and provide recommendations for how these can be addressed in practice. ResultsThe 4 main challenges when applying the target trial framework to RWD are (1) defining the study population, (2) defining the treatment strategies, (3) establishing time zero (baseline), and (4) adjusting for unmeasured confounding. The recommendations for how to address these challenges, mainly around the incorporation of expert judgment and use of appropriate methods for handling unmeasured confounding, are illustrated within the case study. ConclusionsThe recommendations outlined in this study could help future studies seeking to inform HTA decision processes. These recommendations can complement checklists for economic evaluations and design tools for estimating treatment effectiveness in nonrandomized studies.

Adverse Events Following Immunization Among Children Under Two Years of Age: A Prospective Observational Study From North India.

Vaccination is one of the most cost-effective child survival health interventions. A single serious adverse event following immunization (AEFI) or a cluster of events may lead to a loss of public confidence in the program and a major setback to immunization coverage. This study was conducted to assess the incidence of AEFIs in children less than two years of age. A prospective community-based observational study was conducted in the North Indian state of Uttarakhandfrom October 2017 to February 2018. A total of 255 children who attended the selected sub-centres for immunization were finally included in the study. Follow-up home visits on the 8th and 30th day of vaccination were carried out to identify any occurrences of AEFIs. Among 255 children, 212 AEFIs from 152 vaccinated subjects were reported. The majority of the AEFIs were reported in the age group 0-1 years. The incidence of AEFIs was 33.0 per 100 doses of vaccines administered. The most common AEFI reported was fever (101, 47.6%), followed by swelling (53, 25.0%). Among the vaccines, Pentavalent + oral polio vaccine (OPV) (48.8 per 100 doses) was majorly responsible for AEFIs, followed by diphtheria pertussis tetanus (DPT) +measles and rubella (MR) + OPV (46.6 per 100 doses). Our findings revealed that although the incidence of AEFI reported was high, all of them were minor and no serious AEFIs were identified. The awareness among health professionals and the public regarding the reporting of AEFIs should be continued to increase the safety profile of vaccines.

A model for estimating costs and benefits of new vaccine technologies from the perspective of both buyers and sellers.

Although vaccination is widely considered one of the most cost-effective health interventions available, global coverage rates for many vaccines remain lower than necessary for disease elimination and eradication. New vaccine technologies can play an important role in addressing barriers to vaccination and increasing coverage rates. To identify and prioritize vaccine technology investments, decision makers must be able to compare the overall costs and benefits of each investment option. While these data points may exist, they are often confined to silos. Decision makers would benefit from a model that synthesizes this broad range of data and provides clear and actionable information. To facilitate vaccine investment, purchasing and deployment decisions, we developed a systematic and transparent cost-benefit model that estimates the value and risk of a given investment scenario from the perspective of both "buyers" (e.g., global donors, country governments) and "sellers" (e.g., developers, manufacturers) of vaccines. This model, which can be used to evaluate scenarios related to a single vaccine presentation or a portfolio of vaccine presentations, leverages our published approach for estimating the impact of improved vaccine technologies on vaccination coverage rates. This article presents a description of the model and provides an illustrative example application to a portfolio of measles-rubella vaccine technologies currently under development. Although the model is generally applicable to organizations involved in vaccine investment, manufacturing or purchasing, we believe it may be particularly useful to those engaged in vaccine markets that rely strongly on funding from institutional donors.

Augmenting Mental Health Support for Patients Accessing Different Degrees of Formal Psychiatric Care through a Supportive Text Messaging Program: Protocol for a Randomized Controlled Trial

Patients feel more vulnerable when accessing community mental health programs for the first time or after being discharged from psychiatric inpatient units. Long wait times for follow-up appointments, shortage of mental health professionals, lack of service integration, and scarcity of tailored support can weaken their connection to the health care system. As a result, patients can present low adherence, dissatisfaction with treatment, and recurrent hospitalizations. Finding solutions to avoid unnecessary high-cost services and providing tailored and cost-effective mental health interventions may reduce the health system burden and augment patient support. We propose implementing an add-on, supportive text messaging service (Text4Support), developed using cognitive-behavioural therapy (CBT) principles to augment mental health support for patients attending to or being discharged from psychiatric care in Nova Scotia, Canada. This randomized controlled trial aims to investigate the effectiveness of Text4Support in improving mental health outcomes and overall mental well-being compared with usual care. We also will examine the intervention's impact on health services utilization and patient satisfaction. The results from this study will provide evidence on stepped and technology-based mental health care, which will contribute to generating new knowledge about mental health innovations in various clinical contexts, which is not only helpful for the local context but to other jurisdictions in Canada and abroad that are seeking to improve their health care.

Economic evaluation of combined population-based screening for multiple blindness-causing eye diseases in China: a cost-effectiveness analysis

More than 90% of vision impairment is avoidable. However, in China, a routine screening programme is currently unavailable in primary health care. With the dearth of economic evidence on screening programmes for multiple blindness-causing eye diseases, delivery options, and screening frequencies, we aimed to evaluate the costs and benefits of a population-based screening programme for multiple eye diseases in China. We developed a decision-analytic Markov model for a cohort of individuals aged 50 years and older with a total of 30 1-year cycles. We calculated the cost-effectiveness and cost-utility of screening programmes for multiple major blindness-causing eye diseases in China, including age-related macular degeneration, glaucoma, diabetic retinopathy, cataracts, and pathological myopia, from a societal perspective (including direct and indirect costs). We analysed rural and urban settings separately by different screening delivery options (non-telemedicine [ie, face-to-face] screening, artificial intelligence [AI] telemedicine screening, and non-AI telemedicine screening) and frequencies. We calculated incremental cost-utility ratios (ICURs) using quality-adjusted life-years and incremental cost-effectiveness ratios (ICERs) in terms of the cost per blindness year avoided. One-way deterministic and simulated probabilistic sensitivity analyses were used to assess the robustness of the main outcomes. Compared with no screening, non-telemedicine combined screening of multiple eye diseases satisfied the criterion for a highly cost-effective health intervention, with an ICUR of US$2494 (95% CI 1130 to 2716) and an ICER of $12 487 (8773 to 18 791) in rural settings. In urban areas, the ICUR was $624 (395 to 907), and the ICER was $7251 (4238 to 13 501). Non-AI telemedicine screening could result in fewer costs and greater gains in health benefits (ICUR $2326 [1064 to 2538] and ICER $11 766 [8200 to 18 000] in rural settings; ICUR $581 [368 to 864] and ICER $6920 [3926 to 13 231] in urban settings). AI telemedicine screening dominated no screening in rural settings, and in urban settings the ICUR was $244 (-315 to 1073) and the ICER was $2567 (-4111 to 15 389). Sensitivity analyses showed all results to be robust. By further comparison, annual AI telemedicine screening was the most cost-effective strategy in both rural and urban areas. Combined screening of multiple eye diseases is cost-effective in both rural and urban China. AI coupled with teleophthalmology presents an opportunity to promote equity in eye health. National Natural Science Foundation of China.

Adult Immunization: A Neglected Domain

“Long Life for All” being the theme for this year’s World Immunization Week 2022, celebrated annually in the last week of April (24 to 30th April) aims to unite people on the idea that vaccines make it possible for people to pursue their dreams, protect loved ones and live a long and healthy life. It aims to highlight the collective action needed and to promote the use of vaccines to protect people of all ages against disease. Immunization is one of the world’s most successful and cost-effective health interventions available to avert vaccine preventable diseases and deaths. Since at least the 1400s, people have looked for ways to protect themselves against infectious disease. From the practice of “variolation” in the 15th century to today’s mRNA vaccines, immunization has a long history.For over two centuries, vaccines have helped in keeping people healthy starting from the first vaccine that was developed to provide protection against smallpox to the latest ones that are being used to prevent COVID-19.

Immunization Coverage among Children Aged Between 12-23 Months in West Pokot County, Kenya

Vaccination has been shown to be one of the most cost-effective health interventions worldwide. Despite the efforts made towards global immunization coverage, the number of unvaccinated and under-vaccinated infants is still high. The situation is no different in Kenya. Basic vaccination coverage reduced from 77% in 2008 to 70% in 2017. National basic vaccination coverage of 70% is significantly lower than the global target of 90% by the year 2020. There are gaping regional differences in immunization coverage. The lowest national immunization coverage is documented at 31% in West Pokot County. This study sought to identify the determinants of vaccination coverage among children between 12-23 months of age in West Pokot County. The study used a community-based cross-sectional design where mothers/guardians of children between 12-23 months old were randomly sampled. The objectives of the study were to estimate the immunization coverage, investigate factors influencing immunization coverage and determine the influence of health service utilization on immunization coverage. Binary logistic regression was conducted to determine the influence of the independent variables on the dependent variable. The findings showed that, majority (62.4%) of the mothers/guardians had partially immunized their children, followed by those who had fully immunized their children (36.6%) and lastly 1.1% had not immunized their children. Age of the mother/guardian is significantly associated with immunization coverage (OR = 1.128, p =0.000&lt;0.05). This suggests that the older the mother/guardian, the higher the chances of the child being fully immunized. The distance to nearest health facility was found to have no significant relationship with immunization coverage (p&gt;0.05). Respondents who paid for the services were more likely to have their children fully immunized than those who did not pay for the services (OR = 3.546, p =0.019&lt;0.05). It was also observed that Paternal occupation influences coverage OR = 2.006, P =0.035&lt;0.05), visiting the health facility in last year also influenced immunization (OR = 3.147, P =0.01&lt;0.05). The study concluded that the immunization coverage among children between 12-23 months in West Pokot County is below the set target. It is therefore recommended that the county government should intensify vaccination campaigns and develop policies aimed at economically empowering the residents of West Pokot County. Keywords: Immunization coverage, children aged between 12-23 months, West Pokot County

The burden of vaccine hesitancy for routine immunization in Yaounde-Cameroon: A cross-sectional study.

Immunization is the most cost-effective health intervention in the world yet, vaccination uptake is still low with less than 50% of children aged 12-23 months fully vaccinated in Cameroon by 2018. The objective of this study was to estimate the burden of vaccine hesitancy associated with routine vaccines in Yaounde-Cameroon. A two-stage cross-sectional cluster survey was conducted in Yaoundé in November 2021, targeting parents/guardians of children 0-59 months. Clusters were selected with probability proportionate to size (PPS) and household's selection done using a restricted sampling method. Data collection was done using an interviewer-administered questionnaire, "Core Closed Questions" and "Likert Scale Questions" proposed by the WHO Vaccine Hesitancy Technical Working Group in 2014. Vaccine hesitancy was analyzed as proportions of parent's/guardian's self-reported vaccine refusal or delay in vaccination with 95% confidence interval. This was stratified by household wealth level and tested using Chi-Square test to appreciate the effect of household wealth on vaccine hesitancy. A total of 529 participants were enrolled out of 708 visited, giving a non-response rate of 25%. In total, vaccine hesitancy was reported in 137(25.90[22.35-29.80] %), and oral polio vaccine(OPV) was the most affected vaccine with hesitancy of 10%. Vaccine hesitancy prevalence did not vary significantly across different households' wealth levels (p-value = 0.3786). However, in wealthy households' refusal of vaccines (14%) was less than in poorer households (20%). Lack of trust was reported as the leading cause of vaccine refusal (43%). Vaccine hesitancy prevalence in Yaounde is high and oral polio vaccine(OPV) was the most affected vaccine. The level of weath does not affect vaccine hesitancy and lack of trust was the leading cause of vaccine hesitancy related to routine immunization in Yaounde-Cameroon. We, recommend that the burden of vaccine hesitancy should be assessed at national scale and root causes investigated.

Sickle cell disease: A global health concern; pathophysiology, epidemiology and advances in point of care diagnostics

Sickle cell disease (SCD) is the most critical “hemoglobinopathy” worldwide in terms of frequency, and social impact. Recently, it is recognized as global health concern by World Health Organization (WHO). SCD affects approximately 5% of the world population with a various estimate in different continents. Deaths from SCD are evitable by cost effective diagnosis and efficient health interventions for management. Our comprehensive review focuses mainly on the prevalence of SCD, its associated clinical features including crisis, pulmonary pathobiology, muscular, neurological, hepatobiliary and ophthalmological complications along with frequent sepsis and priapism. Further, the present scenario of SCD diagnosis and confirmation requires sophisticated equipment, reagents and adequately trained laboratory persons, also there is unmet requirement for advance methods, to diagnose and monitor SCD that are both inexpensive and accessible. As new diagnostic methods are delayed in clinical trials and more are in pipeline, the purpose of this review is also provides an overview on emerging point of care (POC) techniques offering hope for detection and management of this unfortunate disease.