Determination Of Coverage Research Articles

A cross-sectional study on determinants of immunization coverage in urban area Chidambaram, Tamil Nadu

Background: Immunization is one of the cost effective measures preventing approximately 2 to 3 million deaths in young children every year. Inspite of the progress in vaccination coverage challenges still remain for underserved and inaccessible children. It is therefore essential to evaluate the immunization coverage at periodic intervals and improve coverage in vulnerable areas.Methods: A cross-sectional study was conducted among 152 children aged 12 to 42 months in urban Chidambaram from September to October 2018. We collected details regarding immunization from vaccination card or mother’s recall. A pretested semi-structured proforma was used to collect sociodemographic variables. Data were collected, compiled and tabulated using microsoft excel and analyzed using SPSS 20.0 version.Results: Complete immunization coverage was 80.3% and 19.7% were partially immunized. Lack of awareness is the major reason for failure of full immunization (63.3%). Immunization coverage was higher when parents studied up to higher secondary or graduates (mother 91.3%, father 87.5%, p value 0.01), father do skilled jobs (91.9%, p value 0.02), among first birth ordered children (88.3%, p value 0.01), children born in healthcare facility and among mothers who received antenatal care during pregnancy (80.8% each, p value 0.04).Conclusions: Lack of awareness, parents’ literacy and occupation, place of birth, antenatal services and number of children in the family are important determinants of immunisation coverage. Apart from strengthening of infrastructure for better delivery of mother and child health services other issues also need to be addressed for better immunization practices.

Individual and community-level determinants of childhood vaccination in Ethiopia

BackgroundVaccines are one of our most important tools for preventing outbreaks and keeping the world safe. Most unvaccinated children live in the poorest countries including Ethiopia. Therefore, this study aimed to identify the determinants of vaccination coverage among children aged12–23 months in Ethiopia.MethodsA cross-sectional secondary data were obtained from the 2016 Ethiopian Demographic and Health Survey data (EDHS). A total of 1929 children were included. A Multilevel Proportional Odds Model was used to identify the individual and community-level factors associated with child vaccination.ResultAmong 1, 929 children, only 48.6% (95% CI: 46.3 to 50.8%) were fully vaccinated while 37.8% (95% CI: 35.7 to 40.1%) were partially vaccinated.. The multilevel ordinal logistic regression model reveled that housewife mother (AOR =1.522, 95%CI: 1.139, 2.034), institutional delivery (AOR =2.345, 95%CI: 1.766, 3.114),four or above antenatal care visits (AOR = 2.657; 95% CI: 1.906, 3.704), children of mothers with secondary or higher education (AOR = 2.008; 95% CI: 1.209, 3.334),Children whose fathers primary education (AOR = 1.596; 95% CI: 1.215, 2.096), from the rich households (AOR = 1.679; 95% CI: 1.233, 2.287) were significantly associated with childhood vaccination.ConclusionChild vaccination coverage in Ethiopia remains low. Therefore, there is a need to increase child vaccination coverage by promoting institutional delivery and prenatal care visits, as well as maternal tetanus immunization. Besides, public initiatives needed to improve child vaccination coverage, women’s and husband’s education, poor women, and further advancement of health care services for poor women, housewife women, women living in remote areas should be made to maintain further improvements in child vaccination. Furthermore, policies and programs aimed at addressing cluster variations in child vaccination need to be formulated and their implementation must be strongly pursued.

Determinants of postnatal care coverage among mothers and new-borns in India: Evidence from a nationally representative survey.

Despite efforts taken by the Government of India, still mothers and new-borns are excluded from the postnatal care services, especially during the critical first 24 h after delivery. Hence, we have done this study to find the determinants of postnatal care for mothers and new-borns in India. We have analysed the NFHS-4 data gathered from Demographic Health Survey programme. Stratification and clustering in the sample design was accounted using svyset command. Point estimates were reported as proportions with 95% Confidence Interval (CI). In total, 190,797 women who had at least one live birth were included. About 25.2% and 27.1% of the new-born received post-natal care within 24 and 48 h of delivery. The proportion of women who received post-natal care within 24 and 48 h after delivery was 63.4% and 65.2% respectively. Higher socioeconomic status, women living in Southern region, utilization of proper antenatal and intranatal care, and Caesarian mode of delivery had significantly higher postnatal care coverage among mothers and new-borns. This finding informs the policy makers regarding the status of postnatal care coverage, that can be incorporated to identify target populations for further strengthening of service delivery.

Determinants of Immunization Coverage and Associated Factors among Children aged under Two-Year-Old in the National Immunization Program of Mewat district, Haryana (2019-2020)

Background: Vaccination against childhood communicable diseases through Expanded Program on Immunization is one of the most cost-effective public health interventions. Additional 1.5 million child deaths can be prevented if global vaccination coverage is improved. Mewat district has one of India’s lowest immunization rates despite a long-standing Universal Immunization Program and continues to sustain a high prevalence of vaccine-preventable diseases. This study investigates determinants of immunization status among children aged 0-23 months. Methods: A community-based cross-sectional study was conducted from December 2019 to June 2020, among 800 children aged 0-23months, randomly selected in one rural and one urban ward each from all 4 blocks of Mewat. Socio-demographic conditions and vaccine-related data were collected using a semi-structured questionnaire. Immunization was assessed by vaccination card and by mother’s recall where the card was unavailable. Results:Mewat has increased full immunization coverage from 13.1% in 2015-16 to 59.4%. Immunization card was available with 68.5% (292/426) beneficiaries. Dropout rates for Pentavalent1 to Pentavalent3 was 27.5% and 54% for Bacillus Calmette-Guerin to measles. After adjusting for the state of residence, religion, gender, paternal education, health professional presence during birth, place of vaccination and knowledge of mother on due dose were significantly associated with full immunization. Awareness gap and fear of side effects for vaccines were main reasons of vaccine hesitancy. Conclusion: Full immunization coverage in the district is sub optimal and behind the desired coverage goal, mainly due to vaccine hesitancy. Enhancing community knowledge about the benefits of vaccination is recommended.

Out of pocket payment, affordability and availability of essential medicines in Africa: systematic review

Background: Availability and affordability of medicines are key determinants of universal health coverage, yet achieving them presents a major challenge especially in low-income countries. This study aims to overview the evidence on the accessibility of essential medicines in the African continent. Methods: A quantitative literature search published in English since 2014 was held from valid databases; such as, Scholar, Economic Literature, Global Health, PAIS International, and African Index Medicus. The search was erperformed from September 16 to 20, 2019. Two authors (G.A and D.T) screened the titles, reviewed the articles for inclusion, extracted the data, and conducted a quality assessment of the literature. The third author (N.A) commented on the review. We have used the universal definition of OOP, availability, and affordability. Results: Of 34, 06 articles initially identified, 19 were eligible for inclusion. These were cross-sectional and case-control household and health facility studies published in 2014 in Africa. They demonstrated that the availability of some essential medicine (antibiotics) >80% met WHO’s target. However, drugs for non-communicable diseases show unavailable that range within 20.1% to 60.8%. Households access health services mainly through OOP. An item patients’ expense more for, was fees for drugs (62.3%) (Congo) and was an expensive component of expenditure in private and public health facilities with a mean of 16.7USD and 25.5USD, respectively (Burkina-Faso). Drugs for non-communicable diseases were the most expensive than drugs for infectious diseases (median = 0.62 USD) (Ethiopia). The majority of core essential medicines in private and public outlets are unaffordable. There was a considerable variation in the affordability of basic treatment for infectious and non-communicable diseases. Interestingly, the potential source of inadequate availability of essential medicines and the presence of unaffordability was not investigated in Africa. Conclusion: Evidence suggests that even though, African countries show progress in coverage and affordability for some core essential medicines, it tills needs an effort to convey the WHO’s goal particularly for drugs of non-communicable disease. Future studies need to explore reasons for the persistent unavailability, unaffordability as well as high OOPs for medicines.

Toward understanding the underlying mechanisms of pelvic tilt reserve in adult spinal deformity: the role of the 3D hip orientation.

To explore 3D hip orientation in standing position in subjects with adult spinal deformity (ASD) presenting with different levels of compensatory mechanisms. Subjects with ASD (n = 159) and controls (n = 68) underwent full-body biplanar X-rays with the calculation of 3D spinopelvic, postural and hip parameters. ASD subjects were grouped as ASD with knee flexion (ASD-KF) if they compensated by flexing their knees (knee flexion ≥ 5°), and ASD with knee extension (ASD-KE) otherwise (knee flexion < 5°). Spinopelvic, postural and hip parameters were compared between the three groups. Univariate and multivariate analyses were then computed between spinopelvic and hip parameters. ASD-KF had higher SVA (67 ± 66mm vs. 2 ± 33mm and 11 ± 21mm), PT (27 ± 14° vs. 18 ± 9° and 11 ± 7°) and PI-LL mismatch (20 ± 26° vs - 1 ± 18° and - 13 ± 10°) when compared to ASD-KE and controls (all p < 0.05). ASD-KF also had a more tilted (34 ± 11° vs. 28 ± 9° and 26 ± 7°), anteverted (24 ± 6° vs. 20 ± 5° and 18 ± 4°) and abducted (59 ± 6° vs. 57 ± 4° and 56 ± 4°) acetabulum, with a higher posterior coverage (100 ± 6° vs. 97 ± 7° for ASD-KE) when compared to ASD-KE and controls (all p < 0.05). The main determinants of acetabular tilt, acetabular abduction and anterior acetabular coverage were PT, SVA and LL (adjusted R2 [0.12; 0.5]). ASD subjects compensating with knee flexionhave altered hip orientation, characterized by increased posterior coverage (acetabular anteversion, tilt and posterior coverage) and decreased anterior coverage which can together lead to posteriorfemoro-acetabular impingement, thus limiting pelvic retroversion. This underlying mechanism could be potentially involved in the hip-spine syndrome.

Trends in Erythropoiesis-stimulating agent use and blood transfusions for chemotherapy-induced anemia throughout FDA's risk evaluation and mitigation strategy lifecycle.

Erythropoiesis-stimulating agents (ESAs), indicated for treating some patients with chemotherapy-induced anemia (CIA), may increase the risk of tumor progression and mortality. FDA required a Risk Evaluation and Mitigation Strategy (REMS) to mitigate these risks. We assessed REMS impact on ESA administration and red blood cell (RBC) transfusion as surrogate metrics for REMS effectiveness. Retrospective cohort study including data from January 1, 2006 to December 31, 2018 for beneficiaries ≥65 years enrolled in Centers for Medicare & Medicaid Services (CMS) Medicare Parts A/B with a cancer diagnosis; patients with other indications for ESA use were excluded. Study time was divided into five periods demarcated by issuance of CMS National Coverage Determination (NCD) (Pre-NCD, Pre-REMS) and REMS milestones (Grace Period, REMS, post-REMS). Study outcomes were monthly proportion of chemotherapy episodes (CTEs) with concomitant ESA administration, with post-CTE ESA administration, and with RBC transfusions. Of 1 778 855 beneficiaries treated with CT, 308742 received concomitant ESA for CIA. The proportion of CTEs with concomitant and post-CTE ESA administration decreased Pre-REMS (9.0 percentage points [pp] and 3.5 pp, respectively). There were no significant post-REMS changes in the proportion of CTEs with concomitant (0.0 pp) and post-CTE ESA administration (0.1 pp). Fluctuation in RBC transfusions was <4 pp throughout the study period. Medicare beneficiaries showed a substantive decrease in ESA administration after NCD, with minimal impact by the REMS and its removal. Small changes in RBC transfusion over the study period were likely due to a national secular trend.

RETRACTED: Roxadustat for CKD Anemia – Starting the Jigsaw Puzzle, What Will the Finished Picture Show?

Anemia is a “classic” complication of advanced chronic kidney disease (CKD) and used to constitute a major unmet need in that no effective chronic treatments were available. In 1988, roughly 75% of dialysis patients had a hematocrit of < 30%.1 The ensuing symptom burden led to the frequent administration of blood transfusions, often resulting in systemic iron overload, especially in persons undergoing maintenance hemodialysis. In 1989, this changed dramatically with the introduction of the biologic, epoetin alfa, a first-in-class erythropoiesis-stimulating agent (ESA) that was approved via an orphan drug designation for the indication, “to elevate the red blood cell level […] and to decrease the need for transfusions […].”2 Subsequent uptake of ESAs was rapid, facilitated by a coverage determination from Medicare, and ESAs have since been a cornerstone of anemia treatment in persons with advanced CKD including those on dialysis.

Rules of Medical Necessity

Health insurance contracts have long excluded coverage for care that is “experimental” or not “medically necessary.” Historically, insurance policies defined these key terms of coverage using broad standards. For example, “medically necessary” care might be defined as care that is “generally accepted in the medical community.” This contractual structure provided insurers with significant flexibility when making coverage determinations, even though denying coverage could pad their bottom line. For this reason, lawmakers developed various tools to prevent insurers from exploiting their discretion to determine when care was “medically necessary” or “experimental.” These safeguards allowed insureds to challenge coverage denials internally within the insurance company, externally to an independent medical expert, and before courts via a contract law or ERISA cause of action. Additionally, state and federal mandates required insurers to cover specific medically necessary treatments and services. This Article documents a dramatic shift in health insurers’ contracts and practices from a standard-based approach to determining the medical and scientific appropriateness of health care towards a rule-based approach for making these determinations. It shows how health insurers have increasingly made incredibly detailed and specific rules of medical necessity part of their formal contractual obligations to policyholders. The Article then argues that health insurers’ shift from standards to rules for defining medically and scientifically appropriate health care undermines the effectiveness of traditional legal tools designed to constrain the risk of health insurer over-reaching. The Article concludes by exploring reforms that might effectively address the increasing rulification of medical necessity.

UBH Ruling Called an Enormous Victory for Patients, Wake-Up Call to Insurers

UBH Ruling Called an Enormous Victory for Patients, Wake-Up Call to Insurers

Trends and determinants of an acceptable antenatal care coverage in Ethiopia, evidence from 2005-2016 Ethiopian demographic and health survey; Multivariate decomposition analysis

Backgroundan acceptable antenatal care (ANC4+) is defined as attending at least four antenatal care visit, received at least one dose of tetanus toxoid (TT) injections and consumed 100 iron-folic acids (IFA) tablets/syrup during the last pregnancy. Since maternal health care service utilization continues to be an essential indicator for monitoring the improvements of maternal and child health outcomes. This study aimed to analyze the trends and determinants that contributed to the change in an acceptable antenatal care visit over the last 10 years in Ethiopia.MethodsNationally representative repeated cross-sectional survey was conducted using 2005, 2011, and 2016 Ethiopian Demographic and Health Survey datasets. The data were weighted and analyzed by STATA 14.1 software. Multivariate decomposition regression analysis was used to identify factors that contribute for the change in an acceptable antenatal care visit. A p-value < 0.05 was taken to declare statistically significant predictors to acceptable antenatal care visit.Resultsamong the reproductive age women the rate of an acceptable antenatal care visits was increased from 16% in 2005 to 35% in 2016 in Ethiopia. In the multivariate decomposition analysis, about 29% of the increase in acceptable antenatal care visit was due to a difference in composition of women (endowments) across the surveys. Residence, religion, husband educational attainment, and wealth status was the main source of compositional change factors for the improvements of an acceptable antenatal care visit. Almost two-thirds of an overall change in acceptable antenatal care visit was due to the difference in coefficients/ change in behavior of the population. Religion, educational attainment (both women and husband), and residence are significantly contributed to the change in full antenatal care visit in Ethiopia over the last decades.ConclusionBesides the relevance of receiving an acceptable antenatal care visit for pregnant women and their babies, an acceptable antenatal care visit was slightly increased over time in Ethiopia. Women’s characteristics and behavior change were significantly associated with the change in acceptable antenatal care visits. Public interventions needed to improve acceptable antenatal care coverage, women’s education, and further advancing of health care facilities in rural communities should be done to maintain the further improvements acceptable antenatal care visits.

Coverage determinants of breast cancer screening in Flanders: an evaluation of the past decade

BackgroundBreast cancer (BC) is the most common cancer in women in the developed world. In order to find developing cancers in an early stage, BC screening is commonly used. In Flanders, screening is performed in and outside an organized breast cancer screening program (BCSP). However, the determinants of BC screening coverage for both screening strategies are yet unknown.ObjectiveTo assess the determinants of BC screening coverage in Flanders.MethodsReimbursement data were used to attribute a screening status to each woman in the target population for the years 2008–2016. Yearly coverage data were categorized as screening inside or outside BCSP or no screening. Data were clustered by municipality level. A generalized linear equation model was used to assess the determinants of screening type.ResultsOver all years and municipalities, the median screening coverage rate inside and outside BCSP was 48.40% (IQR: 41.50–54.40%) and 14.10% (IQR: 9.80–19.80%) respectively. A higher coverage rate outside BSCP was statistically significantly (P < 0.001) associated with more crowded households (OR: 3.797, 95% CI: 3.199–4.508), younger age, higher population densities (OR: 2.528, 95% CI: 2.455–2.606), a lower proportion of unemployed job seekers (OR: 0.641, 95% CI: 0.624–0.658) and lower use of dental care (OR: 0.969, 95% CI: 0.967–0.972).ConclusionCoverage rate of BC screening is not optimal in Flanders. Women with low SES that are characterized by younger age, living in a high population density area, living in crowded households, or having low dental care are less likely to be screened for BC in Flanders. If screened, they are more likely to be screened outside the BCSP.

Predictors of immunization coverage among 12\u201323\u2009month old children in Ethiopia: systematic review and meta-analysis

BackgroundImmunization is one of modern medicine’s greatest achievements in the last three decades. Annually it can prevent nearly 2 to 3 million deaths. Understanding the determinants of effective immunization coverage is a critical undertaking. Accordingly, we set out to check the best available evidence of outstanding predictors of immunization coverage among children aged 12–23 months in Ethiopia.MethodElectronic databases including PubMed, Google Scholar, HINARI, and SCOPUS, Web of Science, African Journals Online, Ethiopian Medical Journals were searched. The search process, study selection, critical appraisal, and data extraction were done independently by two reviewers using Joanna Briggs Institute Meta-analysis for Review Instrument (JBI-MAStARI). The difference between reviewers was resolved with a third person. The risk of bias was assessed by the Newcastle Ottawa Tool for observational studies. Data were extracted using the Microsoft Excel checklist and exported to STATA 13. Heterogeneity was assessed using I2, Funnel plot and Egger’s test was used to check for publication bias.ResultsWe identified 26 studies with 15,042 children with mothers/caretakers to assess factors associated with immunization coverage and significant factors were: maternal formal education, (OR = 2.45; 95% CI: 1.62–3.72), paternal formal education, (OR = 1.01; 95% CI: 0.27–3.77), residence, (OR = 2.11; 95% CI: 1.00–4.45), birth at health facility (OR = 1.86; 95% CI: 0.99–3.49), family size less than four, (OR = 1.81; 95% CI: 1.16–2.84), knowledge on age of immunization to be completed (OR = 6.18;95% CI: 3.07–12.43), knowledge on immunization schedule (OR = 2.49; 95% CI: 1.35–4.59), time to travel to health faculties, (OR = 1.74; 95% CI: 0.62–4.89), antennal care, (OR = 3.11; 95% CI: 1.64–5.88), and tetanus toxoid vaccination, (OR = 4.82; 95% CI: 2.99–7.75).ConclusionOur findings showed that literacy, residence, awareness, family size, maternal health services use, and proximity of the health facilities were factors associated with full immunization. This implies that there is a need for primary health service expansion and health education to “hard to reach areas” to improve immunization coverage for children aged 12–23 months.

Identifying the determinants of health insurance coverage among Peruvian women of reproductive age: an assessment based on the national Peruvian demographic survey of 2017

BackgroundLike many other Latin America- and Caribbean countries, Peru has introduced a tax-financed health insurance scheme called “Sistema Integral de Salud (SIS)” to foster progress towards Universal Health Coverage. The scheme explicitly targets the poorest sections of the population. Our study explores levels of health insurance coverage and their determinants among Peruvian women following the introduction of SIS. We wish to determine the extent to which the introduction of SIS has effectively closed gaps in insurance coverage and for whom.MethodsRelying on the 2017 round of ENDES (Encuesta Nacional Demográfica y de Salud Familiar) survey, we analyzed data for 33,168 women aged 15–49. We used multinomial logistic regression to explore the association between health insurance coverage (defined as No Insurance, SIS, Standard Insurance) and women’s socio-demographic and economic characteristics.ResultsOut of the 33,168 women, 25.3% did not have any insurance coverage, 45.5% were covered by SIS and 29.2% were covered by a Standard Insurance scheme. Women in the SIS group were found to have lower educational levels, live in rural areas and more likely to be poorer. Women in the Standard insurance group were found to be more educated, more likely to be “Spanish”, and to be wealthier. Most uninsured women appeared to belong to a middle class, not poor enough to be eligible for SIS, but also not eligible for standard insurance.ConclusionsOur study confirms that SIS has been effective in increasing coverage among vulnerable women, with coverage rates comparable with those observed among men. Nevertheless, on its own, it has proven to be insufficient to ensure universal coverage among women. Further reforms are needed to ensure that coverage is extended to all population groups.

A hot topic in hot times: how media coverage of climate change is affected by temperature abnormalities

Media coverage of climate change is arguably a fundamental factor shaping climate change attitudes and possibly behaviors, but its trends and determinants are still underinvestigated. In this paper, we analyze a comprehensive dataset representing more than 1.7 million online news articles covering climate change in the 28 countries of the European Union in 22 different languages for the period 2014–2019. We combine our news dataset with observed temperature data to investigate whether and how temperature abnormalities influence media coverage of climate change. We find that the strongest determinants of media coverage are positive deviations from short-term average temperatures. Abnormalities with respect to average temperatures in recent years have stronger effects than abnormalities with respect to temperatures in baseline periods that climatologists use to identify changes in climate. This suggests that the media are less influenced by scientific accounts of climatic changes than by shorter-term changes in weather patterns.

A quantitative analysis of AES and XPS specifically applied in adsorption systems at submonolayer regime

An analysis of the intensity ratios, adsorbate over substrate and substrate over the clean one, is carried out, treating them as a system of two independent variables. This leads to simple formulas, ready to be applied to the determination of coverage up to the monolayer point, if elemental bulk standards are available. The procedure allows one more parameter to be found out compared with previous treatments. Formulas are produced for polycrystalline and single crystal elemental bulk standards. The coverage thus calculated turns out to be a function of the intensity from the adsorbate over that from the clean substrate. The analysis is applied successfully to the adsorption of Ba on the Ni(110) surface at submonolayer regime.

Trend and determinants of complete vaccination coverage among children aged 12-23 months in Ghana: Analysis of data from the 1998 to 2014 Ghana Demographic and Health Surveys.

Vaccination is proven to be one of the most cost-effective measures adopted to improve the health of children globally. Adhering to vaccines for children has the propensity to prevent about 1.5 million annual child deaths globally. This study sought to assess the trend and determinants of complete vaccination coverage among children aged 12-23 months in Ghana. The study was based on data from four rounds of the Ghana Demographic and Health Survey (GDHS 1998, 2003, 2008, and 2014). Information on 5,119 children aged 12-23 months were extracted from the children's files. Both bivariate and multivariate analyses were conducted to assess the factors associated with complete vaccination and statistical significance was pegged at p<0.05. We found that complete vaccination coverage increased from 85.1% in 1998 to 95.2% in 2014. Children whose mothers were in rural areas [aOR = 0.45; CI = 0.33-0.60] had lower odds of getting complete vaccination, compared to those whose mothers were in urban areas. Also, children whose mothers had a secondary level of education [aOR = 1.87; CI = 1.39-2.50] had higher odds of receiving complete vaccination, compared to those whose mothers had no formal education. Children whose mothers were either Traditionalists [aOR = 0.60; CI = 0.42-0.84] or had no religion [aOR = 0.58, CI = 0.43-0.79] had lower odds of receiving complete vaccination, compared to children whose mothers were Christians. The study revealed that there has been an increase in the coverage of complete vaccination from 1998 to 2014 in Ghana. Mother's place of residence, education, and religious affiliation were significantly associated with full childhood vaccination. Although there was an increase in complete childhood vaccination, it is imperative to improve health education and expand maternal and child health services to rural areas and among women with no formal education to further increase complete vaccination coverage in Ghana.

Unsafe Discharges: Ethics, Risk Reduction, and Obligations, Part 2

Unsafe Discharges: Ethics, Risk Reduction, and Obligations, Part 2

Spin-Crossover Complexes in Direct Contact with Surfaces

The transfer of the inherent bistability of spin crossover compounds to surfaces has attracted considerable interest in recent years. The deposition of the complexes on surfaces allows investigating them individually and to further understand the microscopic mechanisms at play. Moreover, it offers the prospect of engineering switchable functional surfaces. We review recent progress in the field with a particular focus on the challenges and limits associated with the dominant experimental techniques used, namely near-edge X-ray absorption fine structure (NEXAFS) spectroscopy and scanning tunneling microscopy (STM). One of the main difficulties in NEXAFS-based experiments is to ascertain that the complexes are in direct contact with the surfaces. We show that molecular coverage determination based on the amplitude of the edge-jump of interest is challenging because the latter quantity depends on the substrate. Furthermore, NEXAFS averages the signals of a large number of molecules, which may be in different states. In particular, we highlight that the signal of fragmented molecules is difficult to distinguish from that of intact and functional ones. In contrast, STM allows investigating individual complexes, but the identification of the spin states is at best done indirectly. As quite some of the limits of the techniques are becoming apparent as the field is gaining maturity, their detailed descriptions will be useful for future investigations and for taking a fresh look at earlier reports.

Determinants of complete immunizations coverage among children aged 12–23 months in Papua New Guinea

Abstract Introduction Vaccination is one of the most cost-effective measures adopted to prevent major deadly childhood diseases globally. Worldwide, the uptake of routine childhood vaccination has the propensity to prevent about 1.5 million annual deaths among children. This study examined the determinants of complete immunization coverage among children aged 12–23 months in Papua New Guinea. Methods The study was based on data from the 2016–18 Papua New Guinea Demographic and Health Survey. Information on 709 children aged 12–23 months was extracted from the children’s files. Both bivariate and multivariate analyses were done to assess the factors associated with complete immunisation coverage and statistical significance was pegged at p Results Complete immunization coverage was 39%. The odds of complete immunization was higher among children whose mothers had primary [AOR = 2.272, CI = 1.310, 3.941], secondary [AOR = 2.536, CI = 1.303, 4.937], and higher levels of education [AOR = 2.855, CI = 1.051, 7.750], compared to children whose mothers had no formal education. Children whose mothers were in the richest wealth quintile [AOR = 2.394, CI = 1.137, 5.038] had higher odds of receiving complete vaccination, compared to those whose mothers were in the poorest wealth quintile. Children whose mothers were married [AOR = 1.696, CI = 1.113, 2.587] had higher odds of receiving complete vaccination, compared to those whose mothers were cohabiting. Finally, children whose mothers attended postnatal check-up visits [AOR = 2.366, CI = 1.654, 3.385] had higher odds of receiving complete vaccination, compared to those whose mothers did not attend postnatal check-up visits. Conclusion Complete immunization coverage in Papua New Guinea is relatively low. Mothers’ educational level, wealth quintile, marital status, and postnatal care attendance play significant roles in the complete immunization of children aged 12–23 months in Papua New Guinea. This suggests that interventions such as health education and service expansion on immunization should be implemented, taking into consideration these factors.