Coverage Measurement Research Articles

Effective coverage of newborn postnatal care in Ethiopia: Measuring inequality and spatial distribution of quality-adjusted coverage.

Neonatal health is a significant global public health concern, and the first two days of life are crucial for newborn survival. Most studies on newborn postnatal care have focused on crude coverage measures, which limit the evaluation of care quality. However, evidence suggests a shift towards emphasising effective coverage, which incorporates the quality of care when measuring intervention coverage. This research aimed to assess the effective coverage of newborn postnatal care in Ethiopia while also examining its inequalities and spatial distribution. The study used secondary data from the 2016 Ethiopian Demographic and Health Survey, which was a cross-sectional community-based study. A total weighted sample of 4169 women was used for analyses. We calculated crude coverage, which is the proportion who received a postnatal check within 48 hours of birth and quality-adjusted coverage (effective coverage), which is the proportion who received a postnatal check within 48 hours of birth and reported receipt of 6 or more contents of care provided by health care providers. Concentration index and concentration curves were used to estimate the socioeconomic-related inequalities in quality-adjusted newborn postnatal care. The spatial statistic was analysed by using Arc-GIS. The crude coverage of newborn postnatal care was found to be 13.2%, while the effective coverage was 9%. High-quality postnatal care was disproportionately concentrated among the rich. A spatial variation was found in quality-adjusted coverage of newborn postnatal care across regions. The findings suggest that there is a significant gap in the coverage and quality of postnatal care for newborns across regions in Ethiopia. The low rates of coverage and effective coverage, combined with the concentration of high-quality care among the rich and the spatial variation across regions, highlight the need for targeted interventions and policies to address the inequalities in access to high-quality postnatal care for newborns.

Three-dimensional Weight-Bearing CT Distance and Coverage Mapping Assessment of the 1st MTPJ and Sesamoid Joints in Patients with Hallux Valgus Deformity

Category: Bunion Introduction/Purpose: Three-dimensional (3D) Distance-Mapping (DM) and Coverage-Mapping (CM) use WBCT images to evaluate multiplanar elements of Hallux Valgus (HV), such as sesamoid subluxation, through analyzing joint space and joint coverage across entire bony interfaces. Previous methods have struggled to characterize sesamoid subluxation consistently, and the reliable assessment of these deformity patterns is essential in guiding HV treatment and impacts recurrence rates following correction. The objective was to (1) develop a 3D WBCT CM and DM algorithm to characterize the surface interaction of the 1st metatarsophalangeal-joint (MTPJ) and metatarsal-sesamoid joints in HV patients and controls (2) correlate DM and CM measurements with WBCT semi-automatic angular measurements in HV patients and controls (3) correlate DM, CM, and angular measurements with Visual Analog Scale (VAS) scores in HV patients. Methods: Retrospective case-control study assessing HV patients. 51-feet with HV who underwent a WBCT of the affected foot and 54-feet were included. Semi-automatic segmentation protocol extracted bone models, which were analyzed with specialized software. The 1st-MTPJ surface was divided into two-by-two grids to provide a more detailed analysis. Distance measurements obtained were used to create color-coded distance maps. Blue color represented expected distances in joint interaction (1 to 5 mm), red or yellow color represented arthritis or impingement (0 to 1mm), and pink color represented subluxation (>5mm). Further, color-coded coverage maps highlighted areas of relative coverage ( < 5mm) or uncoverage (>5mm) contrasting areas with normal joint interaction or subluxation (Figure). Pearson’s correlations were used to describe association between intraarticular distances, or JSW (joint space width), and coverage measurements with the following: intermetatarsal angle (IMA), Hallux-Valgus- Angle (HVA), Distal-Metatarsal-Articulation-Angle (DMAA), Visual-Analog-Scale (VAS), and Body-Mass-Index (BMI). P-values less than 0.05 were statistically significant. Results: Interobserver reliability was high for 1st-metatarsal-head (ICC 0.846,p < 0.001), medial-sesamoid-articulation (ICC 0.854,p < 0.001), and lateral-sesamoid-articulation (ICC 0.832,p < 0.001). HV patients demonstrated significantly decreased coverage in comparison to controls (42.7% vs. 50.1%,p < 0.001) and a relative decrease in 1st-MTPJ-coverage (-14.7%,p < 0.001) in comparison to controls. In HV, articular coverage was higher in patients for the plantar lateral quadrant (HV 88.6% vs. 83.0% Controls,p=0.0002) and decreased in dorsal-medial (HV 8.8% vs. 18.7% Controls,p < 0.0001) and plantar-medial quadrants. (HV 46.2% vs. 78.8% Controls,p < 0.0001). Significantly decreased coverage was observed in HV-patients in both the medial sesamoid- articulation (HV 31.1% vs. 54.4%, p< 0.0001) and lateral sesamoid-articulation (HV 22.6% vs. 46.0%,p < 0.0001). Correlations between the first-metatarsal-head distance/coverage measurements and BMI, pre-op VAS, IMA, HVA, and DMAA are summarized in figure. Conclusion: We developed a quantifiable WBCT distance and coverage map algorithm to assess 3D-joint-interaction, joint- coverage, and subluxation in patients with HV. We observed significant subluxation of the 1st-MTPJ in patients with HV when compared to controls, as well as significant subluxation of the metatarsal-sesamoid joint at the medial and lateral sesamoid-joints, with an apparent medial and dorsal deviation of the first-metatarsal, lateral and plantar deviation of the proximal-hallux-phalanx and Lateral subluxation of the sesamoids. Increased coverage of the 1st-metatarsal-head was associated with decreased IMA and DMAA. However, we found no significant correlation between the Visual-Analogue-Scale-(VAS) and DM, CM, and semi-automatic measurements.

Dawn‐Dusk Asymmetry of Energetic Electron at LEO During a Storm: Observation by FY3E

AbstractElectrons in Low Earth Orbit (LEO) have been a popular research topic since the early days of space exploration. However, due to the limited pitch angle coverage and energy resolution of past in‐situ measurements, there is still much to uncover about the radiation environment. Fortunately, the recently launched satellite FY3E, which is equipped with the Medium‐Energy Electron Detector, is changing this. FY3E is the world's first early‐morning‐orbit meteorological satellite for civil use. With the ability to provide full pitch angle coverage and discrete energy measurements of 30–600 keV electrons, we now have an unprecedented opportunity to investigate the dynamics of space radiation at LEO and Magnetosphere‐Ionosphere coupling. Using the newly available measurements, we have discovered that during storms, electron precipitation exhibits dawn‐dusk asymmetry up to 100 keV. At dawn sector downward electrons can be similar to trapped electrons, and the loss cone ratio (precipitating flux over trapped flux) can be as high as unity at L‐shell greater than 6. While at dusk barely precipitation can be seen. The flux of trapped, upward, downward and net precipitation are calculated, and separate energy flux spectra of downward, upward, and trapped electrons are presented for the first time. With significant upward electrons up to 200 keV, asymmetric local pitch angle is observed at dawn within intense precipitation. In light of these findings, FY3E reveals critical information for understanding the Magnetosphere‐Ionosphere Coupling process.

The Validation of Two-Dimensional and Three-Dimensional Radiographic Measurements of Host Bone Coverage in Total Hip Arthroplasty for Hip Dysplasia: A Comparison with Intra-Operative Measurements.

Several methods have been introduced to measure the host bone coverage of the acetabular component after total hip arthroplasty (THA). The aims of this study were (1) to validate two-dimensional- and three-dimensional-based host bone coverage measurements by comparing intra-operative measurements, and (2) to determine the minimum host bone coverage for achieving stable cup fixation after THA in hip dysplasia. The clinical outcomes of each patient were evaluated during their final follow-up period using the Harris Hip score (HHS). The coverage of the host bone was analyzed by comparing 2D-based, 3D-based, and intraoperative assessments. The mean HHS was increased significantly from 60.84 ± 14.21 pre-operatively to 93.13 ± 4.59 (p < 0.0001). The host bone coverage ratio measured intraoperatively was 83.67 ± 3.40%, while the ratio measured by 3D CT reconstruction was 82.72 ± 3.59%. There was a strong positive correlation between the intra-operative host bone coverage and the 3D-based one (r = 0.826, p < 0.0001). It is recommended that 3D-based measurements are used to evaluate the host bone coverage after THA in patients with hip dysplasia. In addition, achieving a minimum host bone coverage of 75% is recommended for the attainment of stable cup fixation.

Malaria vaccine coverage estimation using age-eligible populations and service user denominators in Kenya

BackgroundThe World Health Organization approved the RTS,S/AS01 malaria vaccine for wider rollout, and Kenya participated in a phased pilot implementation from 2019 to understand its impact under routine conditions. Vaccine delivery requires coverage measures at national and sub-national levels to evaluate progress over time. This study aimed to estimate the coverage of the RTS,S/AS01 vaccine during the first 36 months of the Kenyan pilot implementation.MethodsMonthly dose-specific immunization data for 23 sub-counties were obtained from routine health information systems at the facility level for 2019–2022. Coverage of each RTS,S/AS01 dose was determined using reported doses as a numerator and service-based (Penta 1 and Measles) or population (projected infant populations from WorldPop) as denominators. Descriptive statistics of vaccine delivery, dropout rates and coverage estimates were computed across the 36-month implementation period.ResultsOver 36 months, 818,648 RTSS/AS01 doses were administered. Facilities managed by the Ministry of Health and faith-based organizations accounted for over 88% of all vaccines delivered. Overall, service-based malaria vaccine coverage was 96%, 87%, 78%, and 39% for doses 1–4 respectively. Using a population-derived denominator for age-eligible children, vaccine coverage was 78%, 68%, 57%, and 24% for doses 1–4, respectively. Of the children that received measles dose 1 vaccines delivered at 9 months (coverage: 95%), 82% received RTSS/AS01 dose 3, only 66% of children who received measles dose 2 at 18 months (coverage: 59%) also received dose 4.ConclusionThe implementation programme successfully maintained high levels of coverage for the first three doses of RTSS/AS01 among children defined as EPI service users up to 9 months of age but had much lower coverage within the community with up to 1 in 5 children not receiving the vaccine. Consistent with vaccines delivered over the age of 1 year, coverage of the fourth malaria dose was low. Vaccine uptake, service access and dropout rates for malaria vaccines require constant monitoring and intervention to ensure maximum protection is conferred.

Microhabitat requirements of the uncompahgre fritillary butterfly (Boloria improba acrocnema) and climate change implications

The Uncompahgre fritillary butterfly (Boloria improba acrocnema Gall LF, Sperling FAH (1980) A new high altitude species of Boloria from southwestern Colorado (Nyphalidae), with a discussion of phenetics and hierarchical decisions. J Lepidopterists’ Soc 34:230–252 1980) was listed as federally endangered in 1991 and is considered a habitat indicator for alpine ecosystem health. They are found on patches of Salix nivalis in isolated habitats of the San Juan Mountains, Colorado, USA. Here, we estimated historical B. i. acrocnema abundance from annual distance sampling (2003–2020) at seven sub-colonies and sampled current (July 2021) measurements of herbaceous coverage, soil moisture content, and slope, aspect, and elevation at 700 sample sites. We used regression models to test the effects of these microhabitat characteristics on historical abundance. Our results show that increases in slope from 11° to 31°, individual coverage of five alpine plant species (S. nivalis, Geum rossii, Phacelia sericea, Noccaea fendleri, and Lewisia pygmaea), and soil moisture content between 0.09 m3/m3 and 0.38 m3/m3 positively influence butterfly abundance. However, increases in elevation, bare ground coverage, and presence of Salix planifolia, Aster alpinus, Antennaria media, and Androsace chamaejasme were correlated with lower abundance estimates.Implications for insect conservation Effects of climate change which decrease coverage of these alpine plant species, allow encroachment of lower elevation species, or reduce soil moisture will decrease B. i. acrocnema abundance. These results emphasize the extinction risk of B. i. acrocnema due to range limitations and prolonged drought conditions in the Western U.S. By defining additional resource requirements of B. i. acrocnema, we can model climate effects on survivorship and consider nearby microhabitats that may be habitable by this endangered species.

Correlation of Acromial Morphology With Risk and Direction of Shoulder Instability: An MRI Study

Background: The influence of bony morphology on the development of posterior shoulder instability is not well known. Purpose: To determine if acromial morphology, as measured on magnetic resonance imaging (MRI), is associated with posterior or anterior shoulder instability. Design: Cross-sectional study; Level of evidence, 3. Methods: MRI measurements of posterior acromial coverage (PAC), posterior acromial height (PAH), posterior acromial tilt (PAT), and anterior acromial coverage (AAC) were completed for 3 separate matched groups who underwent surgical intervention: posterior instability, anterior instability, and a comparison group of patients who underwent arthroscopic surgery for snapping scapula. Inclusion criteria were patients with recurrent instability <40 years of age without multidirectional instability, glenoid bone loss >13.5%, or glenoid retroversion >10%. Results: Overall, 37 patients were included in each group. PAC was significantly less in the posterior instability group than in the anterior instability and comparison groups (68.3° vs 88.7° vs 81.7°; P < .001). PAH was significantly greater in the posterior group than in the anterior instability group (11.0 mm vs −0.1 mm; P < .001) and comparison group (0.7 mm; P < .001). There was no difference between the posterior and anterior groups in terms of PAT or AAC (P = .45 and P = .05, respectively). PAT was significantly smaller in the posterior instability group than the comparison group (55.2° vs 62.2°; P = .026). The anterior and comparison groups were not significantly different in PAH or PAT (P = .874 and P = .067, respectively) but were significantly different in AAC (P = .026). Conclusion: A higher and flatter posterior acromion, as measured on preoperative MRI, appears to be associated with patients who require arthroscopic capsulolabral repair due to posterior shoulder instability. This information may help clinicians to both diagnose and predict the need for operative intervention for patients with posterior labral tears.

Sample plot design can affect the efficiency and accuracy of shrub coverage measurements in shrub-encroached grasslands

Shrub encroachment has become a global concern. The fraction of shrub coverage (FSC) is an important indicator that reflects the distribution of shrubs and the degree of shrub encroachment in grasslands. The line-point intercept (LPI) method is commonly used for FSC measurement in field surveys, but it’s often associated with issues of poor accuracy and low measurement efficiency. Here, we focus on Caragana microphylla shrub-encroached grassland as a case study. We used normalized difference vegetation index (NDVI) data obtained from unmanned aerial vehicle (UAV) to derive the actual values of FSC (FSCT) and to simulate measurements using the LPI method. We compared the results for measurements based on different sample plot designs, including variation in plot shape and line distribution, the number of sample lines, and the sample point spacings. The aim was to investigate the influence of these main parameters of sample plot design upon measurement results, in order to provide a reference for FSC measurements in field experiments. We first calculated FSCT and stratified the plots according to coverage levels. Based on this, we further evaluated the measurement accuracy of the LPI method under different parameter settings. The results revealed significant systematic errors in the measurement from circular plots. For square plots, the minimum number of lines required for the “high,” “medium,” and “low” coverage groups are 48, 16, and 8 (for 80% accuracy), and likewise, 108, 24, and 16 (for 90% accuracy), respectively. Futuremore, point spacings of 0.1 m and 0.5 m can achieve the same accuracy as the original spacing (0.02 m). We conclude that the systematic errors in circular plots are caused by the radial distribution of lines, whereas in square plots, achieving an efficient measurement requires considering different coverage levels, ensuring an adequate number of lines, and setting a relatively smaller point spacing.

Socioeconomic disparities in Rwanda’s under-5 population’s growth tracking and nutrition promotion: findings from the 2019–2020 demographic and health survey

BackgroundRegular growth monitoring can be used to evaluate young children’s nutritional and physical health. While adequate evaluation of the scope and quality of nutrition interventions is necessary to increase their effectiveness, there is little research on growth monitoring coverage measurement. The purpose of this study was to investigate socioeconomic disparities in under-5 Rwandan children who participate in growth monitoring and nutrition promotion.MethodsWe used data from the 2019–2020 Rwanda Demographic and Health Survey (RDHS), which included 8092under-5 children. Percentage was employed in univariate analysis. To examine the socioeconomic inequalities, concentration indices and Lorenz curves were used in growth monitoring and nutrition promotion among under-5 children.ResultsA weighted prevalence of 33.0% (95%CI: 30.6-35.6%) under-5 children growth monitoring and nutrition promotion was estimated. Growth monitoring and nutrition promotion among under-5 children had higher uptake in the most disadvantaged cohort, as the line of equality sags below the diagonal line in Lorenz curve. Overall, there was pro-poor growth monitoring and nutrition promotion among under-5 in Rwanda (Conc. Index = 0.0994; SE = 0.0111). Across the levels of child and mother’s characteristics, the results show higher coverage of under-5 growth monitoring and nutrition promotion in the most socioeconomic disadvantaged cohort.ConclusionThe study found a pro-poor disparity in growth monitoring and nutrition promotion among under-5 children in Rwanda. By implication, the most disadvantaged children had a higher uptake of growth monitoring and nutrition promotion. The Rwanda government should develop policies and programmes to achieve the universal health coverage for the well-off and underserved population.

Validating indicators for monitoring availability and geographic distribution of emergency obstetric and newborn care (EmoNC) facilities: A study triangulating health system, facility, and geospatial data.

Availability of emergency obstetric and newborn care (EmONC) is a strong supply side measure of essential health system capacity that is closely and causally linked to maternal mortality reduction and fundamentally to achieving universal health coverage. The World Health Organization's indicator "Availability of EmONC facilities" was prioritized as a core indicator to prevent maternal death. The indicator focuses on whether there are sufficient emergency care facilities to meet the population need, but not all facilities designated as providing EmONC function as such. This study seeks to validate "Availability of EmONC" by comparing the value of the indicator after accounting for key aspects of facility functionality and an alternative measure of geographic distribution. This study takes place in four subnational geographic areas in Argentina, Ghana, and India using a census of all birthing facilities. Performance of EmONC in the 90 days prior to data collection was assessed by examining facility records. Data were collected on facility operating hours, staffing, and availability of essential medications. Population estimates were generated using ArcGIS software using WorldPop to estimate the total population, and the number of women of reproductive age (WRA), pregnancies and births in the study areas. In addition, we estimated the population within two-hours travel time of an EmONC facility by incorporating data on terrain from Open Street Map. Using these data sources, we calculated and compared the value of the indicator after incorporating data on facility performance and functionality while varying the reference population used. Further, we compared its value to the proportion of the population within two-hours travel time of an EmONC facility. Included in our study were 34 birthing facilities in Argentina, 51 in Ghana, and 282 in India. Facility performance of basic EmONC (BEmONC) and comprehensive EmONC (CEmONC) signal functions varied considerably. One facility (4.8%) in Ghana and no facility in India designated as BEmONC had performed all seven BEmONC signal functions. In Argentina, three (8.8%) CEmONC-designated facilities performed all nine CEmONC signal functions, all located in Buenos Aires Region V. Four CEmONC-designated facilities in Ghana (57.1%) and the three CEmONC-designated facilities in India (23.1%) evidenced full CEmONC performance. No sub-national study area in Argentina or India reached the target of 5 BEmONC-level facilities per 20,000 births after incorporating facility functionality yet 100% did in Argentina and 50% did in India when considering only facility designation. Demographic differences also accounted for important variation in the indicator's value. In Ghana, the total population in Tolon within 2 hours travel time of a designated EmONC facility was estimated at 99.6%; however, only 91.1% of women of reproductive age were within 2 hours travel time. Comparing the value of the indicator when calculated using different definitions reveals important inconsistencies, resulting in conflicting information about whether the threshold for sufficient coverage is met. This raises important questions related to the indicator's validity. To provide a valid measure of effective coverage of EmONC, the construct for measurement should extend beyond the most narrow definition of availability and account for functionality and geographic accessibility.

A 10-m resolution impervious surface area map for the greater Mekong subregion from remote sensing images

High-resolution and multi-temporal impervious surface area maps are crucial for capturing rapidly developing urbanization patterns. However, the currently available relevant maps for the greater Mekong subregion suffer from coarse resolution and low accuracy. Addressing this issue, our study focuses on the development of accurate impervious surface area maps at 10-m resolution for this region for the period 2016–2022. To accomplish this, we present a new machine-learning framework implemented on the Google Earth Engine platform that merges Sentinel-1 Synthetic Aperture Radar images and Sentinel-2 Multispectral images to extract impervious surfaces. Furthermore, we also introduce a training sample migration strategy that eliminates the collection of additional training samples and automates multi-temporal impervious surface area mapping. Finally, we perform a quantitative assessment with validation samples interpreted from Google Earth. Results show that the overall accuracy and kappa coefficient of the final impervious surface area maps range from 92.75% to 92.93% and 0.854 to 0.857, respectively. This dataset provides comprehensive measurements of impervious surface coverage and configuration that will help to inform urban studies.

Out of pocket and catastrophic health spending in Mexico in the face of the COVID-19 pandemic

INTRODUCTION: The measurement of the financial coverage of a health system uses key indicators such as household out-of-pocket spending as well as catastrophic health spending. Said indicators depend on the financing structure of the health system as well as quality criteria and efficiency of the system in patient care. In the case of Mexico, in recent years there have been important changes in the structure of the health system in addition to suffering from the COVID-19 pandemic events that have significantly impacted the access to health of patients. Therefore, it is relevant to quantify the impact of these events on out-of-pocket spending and catastrophic spending on health in Mexico and have a robust diagnosis of the financial coverage of the system public health in Mexico.OBJECTIVES: The main objective of this study is to quantify out-of-pocket spending and catastrophic spending on health in Mexican households for the year 2020. Comparing these estimates with previous years given the recent changes in the Mexican health system as well as the effect of the COVID-19 pandemic in these indicators.METHODS: Based on the information available in the 2020 National Household Income and Expenditure Survey (ENIGH), out-of-pocket and catastrophic spending on health were estimated following the methodology proposed by the World Health Organization. A quantile regression was estimated to assess the effect of income distribution on out-of-pocket spending.RESULTS: In Mexico in 2020, 67.7% (24.2 million) of households had an out-of-pocket health expenditure (OOHE) and 6% of these households had a catastrophic health expenditure (CHE), with respect to all households this percentage represents 4.04%. According to the classification stipulated by the World Health Organization, healthcare has six expenditure components: orthopedics, medicines, maternity, hospital, alternative medicines, and ambulatory expenses. The three main expenditure was attributable to drugs (39.9%), ambulatory (25.3%), and hospital costs (20.3%).CONCLUSION: The effect of recent modifications to the public health system in Mexico in addition to the COVID-19 pandemic has been reflected in an increase in the percentage of households with out-of-pocket spending in Mexico, as well as the percentage of households with catastrophic spending in health. The main expense item is made in medicines, ambulatory care follow-up and hospitalization. It is a priority to establish efficient financial protection schemes that allow reversing this situation in terms of efficient access to health in Mexico.

Vision-based normalized canopy area estimation for variable nitrogen application in apple orchards

Normalized canopy area is a measure of spatial canopy fill or canopy coverage in a tree. It is an important factor for growers to consider in making various farming decisions, such as timing and amount of fertilization, pesticide application, and irrigation, as it gives a sense of the overall canopy growth. This study focused on estimating the normalized canopy area of apple trees using a ground-based stereo-vision system in a commercial orchard under natural lighting conditions. A color, depth, and height threshold, followed by a point density-based outlier removal was applied to segment the target tree canopies. The segmented canopy area was compared with the area estimated with manual segmentation, which showed an F1 score of 0.78. The overall growth of the tree canopies was then represented using normalized canopy area, which was calculated as a fraction of pixels occupied by the tree foliage over the total possible area a tree could occupy for a given tree spacing. It was found that the normalized canopy area of individual trees was highly correlated with the surface volume of the canopy (r = 0.7), which is a traditionally used parameter to assess or represent canopy growth. The estimated normalized canopy area was then compared against experts' nitrogen recommendation for the sample trees, which was based on their visual assessment of the vigor/growth of the trees. Four individual experts (one apple farmer, one orchard manager, and two horticulturists with research and outreach experience) were asked to provide their independent nitrogen recommendation and an average recommendation level was calculated. The comparison showed an overall correlation coefficient of -0.5, indicating an opposite relationship (higher the canopy density, lower the need for nitrogen and vice versa) between the normalized canopy area and the average of the experts' nitrogen recommendation. When the relationship between the normalized area and nitrogen recommendation level was assessed for individual experts, the correlation coefficient was estimated to be -0.86, -0.84, -0.96, and -0.78, respectively, for Expert1, Expert2, Expert3, and Expert4 respectively. The results from this study identified a critical measure for assessing nitrogen needs at individual tree levels in apple orchards and provides an automated tool to estimate the measure. The outcomes of this study could be used as a part of an integrated decision support system for orchard operations (e.g., fertilization or irrigation) that may include additional canopy characteristics such as spectral signature, trunk diameter, and rate of change of leaf color in the fall.

Predictors of timeliness of vaccination among children of age 12–23 months in Boricha district, Sidama region Ethiopia, in 2019

BackgroundTraditional measurement of vaccine coverage can mask the magnitude of timely uptake of vaccine. Hence, the optimal measurement of timeliness is unclear due to variations in vaccine schedule among countries in the world. In Ethiopia, Oral Polio Virus (OPV), Pentavalent, Tetanus, H. influenza type B, Hepatitis B, and Pneumonia-Conjugate Vaccine (PCV) are basic vaccines which are taken at birth, six weeks, ten weeks, and fourteen weeks respectively. Despite its importance, information is scarce about on-time vaccination in the study area. Therefore, this study aimed to assess prevalence and factors associated with on-time vaccination among children of age 12–23 months in Boricha district, Sidama Ethiopia, in 2019.MethodsA community based survey was conducted in Boricha district, Sidama region Ethiopia from January 1–30 in 2019. Study participants were selected using stratified multistage sampling technique. Kebeles were stratified based on residence. First, Kebeles were selected using random sampling. Then, systematic random sampling was employed to reach each household. Data were collected using structured and interviewer administered questionnaire. Logistic regression analysis was employed to identify factors associated with timely vaccination. Then, independent variables with p-value < 0.25 in COR were fitted further into multivariate logistic regression analysis model to control the possible cofounders. AOR with 95% CI and p-value < 0.05 was computed and reported as the level of statistical significance.ResultsFrom a total of 614 study participants, only 609 study participants have responded to questions completely making a response rate of 99.2%. Prevalence of timeliness of vaccination was 26.8% (95% CI: 25, 28) in this study. Factors like children of women with formal education (AOR = 5.3, 95%CI,2.7, 10.4), absence of antenatal care visit (AOR = 4.2,95%CI, 1.8,9.8), home delivery (AOR = 6.2,95%CI,4.0,9.3), lack of postnatal care (AOR = 3.7,95%CI,1.1,13.3), and lack of information about when vaccines completion date (AOR = 2.0, 95% CI,1.13,3.8) were factors influences timely vaccination among children of age 12–23 months.ConclusionPrevalence of on-time vaccination among children of age 12–23 months is lower than national threshold. Therefore, sustained health education on vaccination schedule and reminder strategies should be designed and implemented. Furthermore, maternal and child health care services should be enhanced and coordinated to improve on-time uptake of vaccine.

COVID-19 infections, hospitalizations, and mortality in Navarre (Spain) between February 2020 and September 2022

Between February 2020 and September 2022, SARS-CoV-2 has circulated uninterruptedly throughout Spain. This study analyses COVID-19 infections, hospitalizations, and deaths in Navarre. Enhanced epidemiological surveillance and results of seroepidemiological surveys were used to analyze COVID-19 infections, hospitalizations, and deaths, based on the vaccination coverage and other preventive measures applied from February 2020 to September 2022. A total of 295,424 COVID-19 cases were confirmed (45% of the population in Navarre); 8,594 required hospital admission (1.3%), 832 were admitted to intensive care units (1.3‰) and 1,725 died (2.6‰). Over the first wave of the pandemic, there were 1,934 hospitalizations and 529 deaths from confirmed COVID-19 cases over a few weeks; these figures dropped rapidly following lockdown. Until October 2021, SARS-CoV-2 circulation was modulated by non-pharmacological preventive measures. The subsequent relaxation of these measures led to a wide circulation of the omicron variant, increasing the number of cases by three-fold. The high vaccination coverage against COVID-19 introduced decisive changes in the epidemiology of the disease, reducing to less than 2%, 0.1%, and 0.5% the cases requiring hospitalization, intensive care unit admission, or that died, respectively. Initial lockdown and non-pharmacological preventive measures helped control SARS-CoV-2 transmission until vaccination was extended. Vaccination achieved a decisive reduction of the COVID-19 severity and lethality.

Impacts of marine heatwaves may be mediated by seabird life history strategies

Marine heatwaves (MHWs) are periods of anomalously warm water associated with changes in ocean structure, based on the horizontal advection of water masses and atmospheric exchange of heat. The longest MHWs persist for many months, and dramatic effects on marine life have been reported from around the world. As top-order predators, seabirds are particularly sensitive to MHWs, with high levels of mortality associated with some events, but not with others. Thus, prediction of impacts is not straightforward, as mortality is not linearly related to simple measures of MHW intensity, persistence, and areal coverage. We describe biological responses expected for seabirds, based on demographic parameters and the geographic proximity and phenological timing of MHWs with respect to seabirds. The expected interactions between seabirds and MHWs will be complex (with some responses likely to be unpredictable) and will extend over broad spatial and temporal scales. The spatial proximity of anomalous marine conditions to breeding colonies, their overlap with foraging areas, and the degree to which MHWs coincide with pre-breeding and breeding seasons presently generate the greatest pressures on seabird populations. We posit that area-restricted seabird species, in terms of movement and breeding strategies, are at greater risk from MHWs, but that non-linear effects complicate prediction. The impacts of MHWs on seabirds may be mediated by their life history strategies.

Effect of lockdown on routine immunization services in a tertiary care hospital of Rajasthan, India: quarterly analysis

Background: Lockdown was used as a tool to control COVID-19 but it has resulted in the disruption of routine immunization services both in India and globally. Present study aimed to estimate the effect of COVID-19 lockdown periods during years 2020 and 2021 on routine immunization at tertiary-care hospital in Jaipur, Rajasthan, India. Methods: A retrospective record-based observational study was conducted at paediatric tertiary-care hospital, Jaipur. Data were collected from the immunization records of the centre for the vaccines administered to children (0-16 years) under the universal immunization programme (UIP) from January 2019 to December 2021. Doses administered were assessed as a proxy measure of vaccine coverage. The vaccination trends were compared with base year 2019. unpaired ‘t’ test of significance and percent change were used for statistical analysis. Results: The effect of lockdown was maximum in the second quarter of both years 2020 and 2021 with the declination of the total vaccine doses administered by -49.9% and -36.2% respectively. The first lockdown period in year 2020 recorded maximum negative difference in dose of Td (10 years) (-98.4%) followed by DPT booster-2 (-83.6%). The second lockdown in year 2021 recorded maximum negative difference in dose of Td (16 years) (-62.5%) followed by Td-10 years (-58.1%) and DPT booster-2 (-56.5%). Conclusions: This study concludes that the least vaccine doses were administered in second quarter of both years which coincides with lockdown period. Hence during emergencies like lockdown other alternative arrangement for continuance of routine immunization may be implemented.

Paper 65: Novel CT-Derived 3D Modeling Assessing Dysplastic Hips Versus Controls Demonstrates Decreased 2D Lateral Center Edge Angle, but not Tönnis Angle, Predicts Decreased 3D Anterolateral Coverage

Paper 65: Novel CT-Derived 3D Modeling Assessing Dysplastic Hips Versus Controls Demonstrates Decreased 2D Lateral Center Edge Angle, but not Tönnis Angle, Predicts Decreased 3D Anterolateral Coverage

Poster 182: Acromial Morphology Influences Instability Risk and Direction: An MRI Study

Objectives: To determine if acromial morphology is associated with posterior or anterior shoulder instability as measured on MRI. Methods: MRI measurements of posterior acromial coverage (PAC), posterior acromial height (PAH), posterior acromial tilt (PAT), and anterior acromial coverage (AAC) were completed for three separate matched groups who underwent surgical intervention: posterior instability, anterior instability, and a comparison group of patients with who underwent arthroscopic surgery for snapping scapula. Inclusion criteria were patients with recurrent instability younger than 40 years of age without multidirectional instability, glenoid bone loss greater than 13.5% or glenoid retroversion greater than 10%. Results: Thirty-seven patients were included in each group. PAC was significantly less in the posterior instability group when compared to anterior and the comparison groups (68.3° vs. 88.7° vs. 81.7°, p&lt;.001). PAH was significantly greater in the posterior group than compared to the anterior instability patients (11.0 mm vs -0.1 mm, p&lt;.001) as well as the comparison patients (0.7 mm, p&lt;.001). There was no difference between the posterior and anterior groups in terms of PAT or AAC (p=0.45, p=0.05). PAT was significantly smaller in the posterior instability group than the comparison group (55.2 degrees vs 62.2 degrees, p=0.026). The anterior and comparison groups were not significantly different in PAH or PAT (p=8.74, p=0.067) but were significantly different with AAC (p=0.26). Conclusions: The posterior acromion is significantly higher and flatter in patients with posterior shoulder instability who require arthroscopic capsulolabral repair when measured on pre-operative MRI. This information may help clinicians to both diagnose and predict the need for operative intervention for patients with posterior labral tears.

Poster 118: False Profile Radiograph Sourcil-Edge and Bone-Edge Measurements Both Correlate to Different Weight-Bearing Regions of the Acetabulum: A Three-Dimensional Analysis

Objectives: The acetabular sourcil has been thought of as the radiographic representation of the weightbearing dome of the acetabulum; however, there are limited modern data to support this supposition. In the literature, assessment of weightbearing acetabular coverage has been described using both the sourcil-edge and bone-edge as anatomic landmarks, leading to confusion and controversy in classification of hip dysplasia, indications for hip preservation surgery, and intraoperative coverage assessment. The purpose of this study was to localize the three-dimensional (3D) anatomic correlates of the sourcil-edge and bone-edge radiographic position on false profile radiographs. The authors hypothesized that the sourcil-edge on the false profile represents anterolateral coverage while the bone-edge represents anterior coverage. Methods: Forty hips were grouped by large or small differences between bone-edge and sourcil-edge anterior center edge angles (ACEA). The small difference group comprised the lowest quartile of sourcil-edge to bone-edge difference of an initial cohort of 80 hips, while the large difference group comprised the highest quartile of difference. 3D surface mesh models and digitally reconstructed radiographs (DRRs) were generated from hip computed tomography scans using the 3D Slicer Image Computing Platform (Figures 1 &amp; 3). Sourcil-edge, bone-edge, and ACEAs were identified on DRRs and registered to the 3D models with fiducial markers. Intersection of bone-edge and sourcil-edge projection lines with the acetabular rim were obtained from the 3D models (Figures 2 &amp; 4). 3D Anterior acetabular rim morphology was correlated with ACEA difference. Results: The bone-edge and sourcil-edge projections intersected the acetabular rim at a mean of 2:08 ± 0:25 and 1:20 ± 0:24 o’clock, respectively. The 3D models consistently demonstrated that, in both large and small discrepancy groups, the sourcil-edge corresponded to an area just posterior to the AIIS projection while the bone-edge corresponded to the weight-bearing region inferior to the AIIS (Figures 2 &amp; 4). Additionally, in large discrepancy hips, the bone-edge corresponded to a more prominent acetabular coverage in the region of the AIIS than when compared to the small discrepancy hips. Conclusions: This study demonstrates that both the sourcil-edge and bone-edge projections on false profile radiographs correlate with differing weightbearing regions of the acetabulum. The sourcil-edge ACEA represents coverage at 1:20 o’clock on the acetabular rim and is consistently posterior to the AIIS, while the bone-edge measurement represents the region of the acetabular rim at 2:08 o’clock and is consistently inferior to the AIIS. In hips with a large discrepancy between bone-edge and sourcil-edge (highest quartile), ACEA measurement differs by a mean of 19.7 degrees based on the selection of these radiographic landmarks. These findings have substantial implications for hip preservation surgery technique and clinical decision making. A comprehensive understanding of femoral head coverage is essential for the treatment of young adult hip pathology. Although the sourcil and bone edge are two of the most important radiographic landmarks for assessment of acetabular dysplasia, descriptions of these landmarks are often over simplified. Some authors have advocated for greater utilization of measurements of coverage to the bone edge as it can be more consistently identified. Other authors have advocated for utilizing the sourcil-edge measurement as this is more representative of the “weight bearing dome”. These descriptions are limited as they do not improve our understanding of the anatomic and radiographic structure of the anterior acetabular rim. Although the concept of the “weight bearing dome” is classically described, it lacks anatomic precision. The present study clarifies the anatomic features of the acetabular rim that correspond to these radiographic features. Increased difference between the sourcil-edge and bone edge is generated by the differences in undulation of the anterosuperior acetabular rim. Acetabuli that have maximal anterior rim prominence at or near the superior-most aspect of the acetabulum (generally counterclockwise from the AIIS) tend to demonstrate smaller discrepancy between the bone-edge and sourcil-edge (Figure 4). Acetabuli that have maximal rim prominence medial and anterior to the superior-most aspect of the acetabulum generally demonstrate larger discrepancy (Figure 2). The present anatomic description can be utilized by the hip arthroscopist to better determine which areas of the anterior rim may cause impingement. Similarly, while conducting a periacetabular osteotomy, the surgeon may use this information to better understand how acetabular rotation is contributing to both anterior and anterolateral coverage. In conclusion, on false profile radiographs, the sourcil-edge corresponds to superior femoral head coverage, while the bone-edge corresponds to anterosuperior coverage. False profile radiographs with a large discrepancy between sourcil-edge and bone-edge measurements demonstrate a prominent weight bearing surface in the region of the AIIS. These data regarding the radiographic phenomena of the acetabular rim can aid in clinical decision-making and intraoperative technique.