Equitable Coverage Research Articles

Access to infertility care services towards Universal Health Coverage is a right and not an option

BackgroundIn Morocco, the national health plan 2025 was developed to promote Sexual and Reproductive Health (SRH) services for all. The principal aim was to achieve the Universal Health Coverage of SRH by 2030. For many years, health authorities’ efforts had focused on reducing maternal mortality through a widespread access to antenatal and obstetric care and family planning services. This has resulted in a significant gap between the availability of SRH components, namely obstetric and family planning care, and access to infertility services including Assisted Reproductive Technology (ART). The objective of this study is to answer two important questions. First, why some SRH programs and services are given priority by international and national political leaders while infertility care receives little attention; second, what are the factors that influence this prioritization?MethodsWe used Shiffman and Smith’s framework composed of four elements: the strength of the actors involved in the initiative, the power of the ideas they use to represent the health problem, the nature of the political contexts in which they operate and the characteristics of the services. We added a fifth element to the framework, the outcome. We applied this framework to the case of infertility services in Morocco. We conducted a desk review and interviews with actors involved in SRH and infertility care advocates as well as with decision makers involved in implementing Universal Health Coverage (UHC).ResultsOur results showed that despite the efforts made by the advocates of infertility care; the enactment in 2019 of a law regulating infertility care services; and the presence of two Assisted Reproductive Technology Units in the public sector, infertility services remain at an early stage of development hampered by multiple challenges. Among others, a lack of political entrepreneurs to ensure a strong leadership; the political windows were often missed; community members lacked consensus on a coherent public positioning of the problem, and advocates' perception and power of the idea lacked evidence and precise indicators of the problem.ConclusionTo ensure the convergence and alignment of all stakeholders, it is recommended to translate the regulation of infertility into measurable activities with defined human and financial resources, equitable fertility health coverage, and quality fertility care to respond to women and infertile couples’ needs, rights and dignity.

Controlled temperature chain for vaccination in low- and middle-income countries: a realist evidence synthesis.

ObjectiveTo evaluate the evidence describing how the controlled temperature chain approach for vaccination could lead to improved equitable immunization coverage in low- and middle-income countries.MethodsWe created a theory of change construct from the Controlled temperature chain: strategic roadmap for priority vaccines 2017–2020, containing four domains: (i) uptake and demand for the approach; (ii) compliance and safe use of the approach; (iii) programmatic efficiency gains from the approach; and (iv) improved equitable immunization coverage. To verify and improve the theory of change, we applied a realist review method to analyse published descriptions of controlled temperature chain or closely related experiences.FindingsWe evaluated 34 articles, describing 22 unique controlled temperature chain or closely related experiences across four World Health Organization regions. We identified a strong demand for this approach among service delivery providers; however, generating an equal level of demand among policy-makers requires greater evidence on economic benefits and on vaccination coverage gains, and use case definitions. Consistent evidence supported safety of the approach when integrated into special vaccination programmes. Feasible training and supervision supported providers in complying with protocols. Time-savings were the main evidence for efficiency gains, while cost-saving data were minimal. Improved equitable coverage was reported where vaccine storage beyond the cold chain enabled access to hard-to-reach populations. No evidence indicated an inferior vaccine effectiveness nor increased adverse event rates for vaccines delivered under the approach.ConclusionSynthesized evidence broadly supported the initial theory of change. Addressing evidence gaps on economic benefits and coverage gains may increase future uptake.

Conceptualising the Factors Influencing Community Health Workers’ Preparedness for ICT Implementation: A Systematised Scoping Review

Background: Globally, community health workers (CHW) are increasingly viewed as an integral part of the health system as opposed to simply being an extension of it. Given this view, most low- or middle-income countries (LMICs) have refocused their efforts on reorganising CHW initiatives to maximise their impact. The ongoing endeavours to augment the practice of community health workers using technological solutions are characterised by as many challenges as opportunities. In low- and middle-income countries, including South Africa, information and communication technology (ICT) has become a promising development in the enhancement of the equitable coverage of health services by community health workers. However, there has not been a wide-scale implementation and adoption of ICT; most technology initiatives fail to scale up during the implementation stage, which is attributable to human and context-related factors. Although there has been an effort to develop solutions to address ICT infrastructure and technical barriers, conceptualising an evidence-based understanding of the contextual and user-related factors that influence the efficacy of technology adoption by CHWs within their multidimensional system remains critical. Objective: The purpose of the study is to conceptualise the social factors to consider when implementing a bespoke ICT solution suited to the specific demands of CHWs in primary healthcare in developing contexts, with a particular focus on the South African context. Methodology: The methodology involves synthesizing, extracting, and consolidating the findings of a systematised scoping review into concepts and factors. The review adapts Arksey and O’Malley’s scoping review approach to the study and incorporates 59 relevant articles. Results: Although the knowledge base on CHWs is extensive, there is a considerable gap in addressing structural challenges within the community system, which contributes significantly to the overall performance of CHW programs. Factors promoting policy adaptations, common practice within the health system, CHW competencies, a community’s development in terms of knowledge and economic advancement, safety and security, the environment, and the socio-cultural context all play a significant role in facilitating or impeding the success of health interventions from the individual to the national level. Conclusions: Within several practical limitations, the study shows that despite the efforts of various developing countries to promote technology adoption, the barriers to ICT adoption outweigh the benefits gained in developing countries. The paper argues that addressing these challenges before and during implementation is critical. The authors conclude with some essential concerns about assisting CHWs towards realising the desired health outcomes through ICT.

Updated International Society of Geriatric Oncology COVID-19 working group recommendations on COVID-19 vaccination among older adults with cancer

Updated International Society of Geriatric Oncology COVID-19 working group recommendations on COVID-19 vaccination among older adults with cancer

Association between childhood immunisation coverage and proximity to health facilities in rural settings: a cross-sectional analysis of Service Provision Assessment 2013–2014 facility data and Demographic and Health Survey 2015–2016 individual data in Malawi

ObjectivesDespite significant progress in childhood vaccination coverage globally, substantial inequality remains. Remote rural populations are recognised as a priority group for immunisation service equity. We aimed to link facility and...

Addressing healthcare disparities and managed care considerations with continuous glucose monitoring.

About 37 million people in the United States have diabetes. Diabetes-related complications are costly and associated with substantial morbidity. By improving glucose control, continuous glucose monitoring (CGM) can reduce costs due to diabetes-related hospitalizations, hypoglycemia, and diabetic ketoacidosis. However, people of color and low socioeconomic status, populations with disproportionately high prevalence of diabetes, face significant inequity in accessing CGM technology. Potential reasons for CGM inequity include implicit bias and differences in coverage between commercial and government insurance. Recent changes to Medicare CGM eligibility criteria have eliminated blood glucose monitoring requirements. However, cost and CGM coverage requirements remain as barriers to the recommended use of this technology as defined in current clinical practice guidelines. Coverage expansion from durable medical equipment to the pharmacy benefit may improve access. Other strategies to optimize CGM utility overall include integrating CGM data directly into electronic health records for population health management and diabetes control performance measures based on CGM data in value-based contracts (VBCs). VBCs may encourage real-world data generation which in turn may bolster stakeholder support for the equitable use and coverage of CGM in diabetes management.

Communication of ecosystem services and disservices in local newspapers in Winnipeg, Canada

The global intensification of urbanization is driving a disconnect between humans and nature. Communicating ecosystem services (ES) and disservices (EDS) to city residents offers an opportunity to help reassociate people with ecological processes of the urban forest, benefiting support for urban forest management. It has been theorized that the complexity of ES and EDS may dissuade their coverage by journalists in print media. Further, the complexity of the interrelationship of ES and EDS could represent a challenge for communication. To examine communication of ES and EDS, we conducted a literature review of newspaper articles published in two prominent newspapers in Winnipeg, Manitoba between January 2010 and May 2021. During the study period, 114 urban forestry articles mentioned ES and/or EDS. Cultural services were the most frequently discussed, followed by regulating services. Provisioning services were discussed least which may reflect their reduced importance in urban forestry discourse/management. Twenty-three articles mentioned EDS, only eight of which also mentioned ES. Only six articles referenced the related ES to the EDS, all of which were in articles focused on tree planting. Despite the complexity of many ES discussed in the articles, the interrelatedness of some ES and EDS were not well described. Counter to previous newspaper reviews, we found that ES were discussed more than EDS. However, the communication of EDS remains an important component of urban forest discourse. While navigating communication on the intersection of ES and EDS may prove challenging in print journalism, we argue restructuring EDS communication such that it is framed in ES discourse could mitigate public concerns surrounding urban forestry, while creating equitable coverage of urban forest affairs. We identify the need for further research on the impact of social media and television as alternative venues for urban forestry discourse.

Early Lessons From Ethiopia in Establishing a Data Triangulation Process to Analyze Immunization Program and Supply Data for Decision Making.

Strengthening data use and quality is critical to achieving high, equitable immunization coverage. One approach that is being increasingly recognized as effective in improving data use and quality is data triangulation, which can provide more information for decision making in public health programs.In Ethiopia, immunization program data has had ongoing quality challenges, including timeliness, completeness, and accuracy. Some data are reported through different systems to different departments, and coordination between departments is limited.JSI, through the Universal Immunization through Improving Family Health Services (UI-FHS) project, introduced a data review process and an Excel tool for triangulating immunization program data and vaccine supply data to improve data quality and programmatic decision making. The user-friendly Immunization Data Triangulation Tool (IDTT) provides decision-support information-such as scoring of districts based on performance-and suggests follow-up actions. It also highlights gaps between vaccines supplied and consumed and helps managers determine the next steps to address programmatic, supply, or data quality issues.The data review process and IDTT were rolled out in 2 regions in Ethiopia. UI-FHS documented learning to understand the feasibility of the IDTT's application as a decision-making tool by conducting key informant interviews and observing how the IDTT was used at monthly data review meetings.Health managers who used the tool reported ease of use and clear benefits, including more accessible and synthesized data, which prompted decision making and actions to improve services and supply, such as expanding the number of immunization sites. Challenges with the availability of vaccine supply data hindered managers' ability to leverage triangulated data fully, but the data triangulation process prompted cross-departmental collaboration to address this gap.These early findings show promise in the ability of immunization programs to successfully use triangulated data to address challenges and provide lessons for introducing new tools or processes into health systems.

A review of health security and vaccine diplomacy during COVID-19 pandemic

The coronavirus disease 2019 (COVID-19) pandemic raises several public health concerns that impact various aspects of people's lives. The severity and spread of infection are extremely rapid, spreading out of control globally. Aside from illness and death, it presents a slew of long-term health concerns among the population. Therefore, the pandemic has manifested into a major health security issue, impacting the population globally. Health securitization refers to recognizing the presence of an existential health threat, and authorities can devote resources to manage the risks. Although vaccinations are required for long-term management of this disease, the vaccination procedure is often plagued by access, efficacy, and vaccine prioritization issues. By employing an interpretative social science approach, the article argues that the COVID-19 pandemic needs to be securitized at the state and international levels, and vaccines as public-good should be accessible to everyone without discrimination or prioritization and diplomatic interests. The study found, firstly, that many countries have adopted health securitization and coordinated efforts by international agencies. Secondly, vaccine hoarding by richer countries has created a disparity in the rate and coverage of vaccination in other regions. Thirdly, vaccine donation by richer countries is only a temporary solution. A robust vaccine allocation mechanism is needed for more comprehensive and equitable vaccination coverage.

Perioperative Experiences of Transgender Adults Seeking Gender-Affirming Surgery: A Qualitative Interview Study.

Transgender individuals have been systemically excluded from U.S. health care, creating barriers and disparities that other populations do not face. Gender-affirming surgery represents an emerging treatment modality for gender dysphoria, however, little is known about how transgender patients experience the perioperative pathway. This study sought to characterize the experiences of transgender patients seeking gender-affirming surgery and identify opportunities for improvement. A qualitative study was conducted at an academic medical center between July and December 2020. Semistructured interviews were conducted after a postoperative encounter with adult patients who had undergone gender-affirming surgery within the past year. A purposive sampling strategy was used to maximize representation across surgery types and surgeons. Recruitment continued until thematic saturation was reached. All invited patients agreed to participate, yielding 36 interviews (response rate=100%). Four major themes emerged. First, gender-affirming surgery was described as a major life event, often reflecting years of personal decision making and research. Second, participants stressed the importance of surgeon investment, surgeon experience caring for transgender patients, and individualized care in developing a strong relationship with their care team. Third, self-advocacy was necessary to navigate the perioperative pathway and overcome barriers. Last, participants discussed a lack of equity and provider awareness regarding transgender health issues, including correct pronoun usage, terminology, and insurance coverage. Patients undergoing gender-affirming surgery encounter unique perioperative barriers to care, which would benefit from targeted interventions in the health care system. To improve the pathway, our findings support the creation of multidisciplinary gender-affirmation clinics, greater emphasis on transgender care in medical education, and insurance policy reforms aimed at promoting consistent and equitable coverage.

BRCA1/2 testing among young women with breast cancer in Massachusetts, 2010-2013: An observational study using state cancer registry and All-Payer claims data.

BackgroundTesting for BRCA1/2 pathogenic variants is recommended for women aged ≤45 years with breast cancer. Some studies have found racial/ethnic and socioeconomic disparities in testing. We linked Massachusetts' All‐Payer Claims Database with Massachusetts Cancer Registry data to assess factors associated with BRCA1/2 testing among young women with breast cancer in Massachusetts, a state with high levels of access to care and equitable insurance coverage of breast cancer gene (BRCA) testing.MethodsWe identified breast cancer diagnoses in the Massachusetts Cancer Registry from 2010 to 2013 and linked registry data with Massachusetts All‐Payer Claims Data from 2010 to 2014 among women aged ≤45 years with private insurance or Medicaid. We used multivariable logistic regression to examine factors associated with BRCA1/2 testing within 6 months of diagnosis.ResultsThe study population included 2424 women; 80.3% were identified as non‐Hispanic White, 6.4% non‐Hispanic Black, and 6.3% Hispanic. Overall, 54.9% received BRCA1/2 testing within 6 months of breast cancer diagnosis. In adjusted analyses, non‐Hispanic Black women had less than half the odds of testing compared with non‐Hispanic White women (adjusted odds ratio [OR] = 0.45, 95% CI = 0.31, 0.64). Medicaid‐insured women had half the odds of testing compared with privately‐insured women (OR = 0.51, 95% CI = 0.41, 0.63). Living in lower‐income areas was also associated with lower odds of testing. Having an academically‐affiliated oncology clinician was not associated with testing.ConclusionSocioeconomic and racial/ethnic disparities exist in BRCA1/2 testing among women with breast cancer in Massachusetts, despite equitable insurance coverage of testing. Further research should examine whether disparities have persisted with growing testing awareness and availability over time.

Integrating public transportation and shared autonomous mobility for equitable transit coverage: A cost-efficiency analysis

As automated transportation technology advances, public transit agencies could consider how integrating autonomous vehicles and shuttles into existing transit systems affects equity. Capital and operating costs for automated mobility modes managed by public transit agencies are uncertain since few deployments have occurred to date. Automated vehicles and shuttles are agile for dynamic routing and can make use of the existing transportation infrastructure, but operating costs remain uncertain. This study aims to characterize the economic feasibility of improving transit coverage and transit equity of public transportation with shared automated mobility. Cost efficiency analysis compares direct operating costs of shared autonomous vehicles (SAVs) and autonomous shuttles to a conventional transit bus. Using Allegheny County, Pennsylvania as a case study, the analysis considers potentially adding shuttle or SAV service to expand service for the existing public transit system. The results suggest it is feasible to improve transit equity with shared AVs and shuttles at lower costs than buses on average. Revenue kilometers traveled, fleet size, and operating hours are the most important parameters that determine cost-efficiency. Transit planners and policymakers can use this analysis to inform shared autonomous mobility operation guidelines to ensure emerging technology services remain a complement to existing transit.

Analisis Perencanaan Vaksinasi COVID-19 di RSUD Dr. H. Ibnu Sutowo Baturaja Tahun 2021

Vaccination is an intervention that is considered effective to break the chain of Coronavirus Disease 2019 (COVID-19) transmission. In an effort to achieve high and equitable vaccination coverage, comprehensive planning is needed. This qualitative study aims to determine the general description of the COVID-19 vaccination planning at Dr. RSUD. H. Ibnu Sutowo Baturaja in 2021. Methods of data collection through in-depth interviews with 5 informants taken by purposive sampling that are Head of Medical Services, coordinator of vaccination, registration officer, screening officer, and vaccine giver vaccinator supported by observation and documentation. Data were analyzed including data reduction, data presentation, and verification. Planning for COVID-19 vaccination includes data collection of targets, establishment of health facilities, registration and verification of targets, calculation of vaccine needs and distribution and other logistics, preparation of advocacy plans, socialization, training, preparation of funding plans, and preparation of evaluation monitoring plans. The results showed that the vaccination targets were appropriate for each stage. Officer qualifications are appropriate. The schedule is in accordance with the target capacity and the principles of health protocols. Cold chain equipment inventory has been carried out previously. Targets can register either through the integrated application or by coming in person. Vaccine quantity planning and logistics have been in accordance with the target number and are provided by the Health Office. Limitations in logistics are complemented by hospital supplies. Advocacy, outreach and training have been planned. The hospital has not budgeted for COVID-19 vaccination activities, so it uses other fund allocations. In addition, there is no systematic evaluation monitoring plan. The hospital has carried out COVID-19 vaccination activities although there are still some although there are still some limitations

OPTIMALISASI PERAN KADER DALAM PEMBENTUKAN KELOMPOK PENDUKUNG ASI UNTUK MEWUJUDKAN KADARSIE (KELUARGA SADAR ASI EKSKLUSIF)

The success of Exclusive Breastfeeding requires many people to participate. One of those who need to participate is posyandu cadres. Cadre is a partner of the public health center to help carry out the programs and activities of the public health center to achieve equitable health coverage for infants and toddlers. One of those who need to participate is posyandu cadres. The purpose of this Community Service activity is to form a Breastfeeding Support Group (KP-ASI) through cadre training to create an exclusive breastfeeding aware family (KADARSIE). The results of the pre-test and post-test to determine the knowledge of cadres before and after training showed that there was an increase in knowledge of 26.7%, indicating that all cadres had good knowledge of exclusive breastfeeding materials after attending the training. The average score of cadres' attitudes towards exclusive breastfeeding was 82.7, indicating that cadres had a good attitude in supporting exclusive breastfeeding. The average score of breastfeeding technique skills is 86.1, and the average score of oxytocin massage skills is 84, indicating that almost all cadres have good skills as KP-ASI. The activity of optimizing the role of cadres in the formation of the ASI Support Group (KP-ASI) to realize the Exclusive Breastfeeding Awareness Family (KADARSIE) has been carried out. After the training, there was an increase in the knowledge of cadres about exclusive breastfeeding, and the attitude of cadres who support exclusive breastfeeding increased as well as increased skills of cadres in carrying out correct breastfeeding techniques and oxytocin massage.

Promoting immunization equity in Latin America and the Caribbean: Case studies, lessons learned, and their implication for COVID-19 vaccine equity

In 2020, the World Health Organization launched the Immunization Agenda 2030: A Global Strategy to Leave No One Behind, which prioritizes high equitable immunization coverage at the national level and in all districts. Achieving high and homogenous immunization coverage, which is all the more important within the current context of the COVID-19 pandemic and vaccine rollout, requires the strengthening of existing immunization activities and innovative approach to immunization promotion. This research applied a descriptive case study methodology to document the implementation of strategic multi-level alliances to promote equitable immunization access and demand in Colombia, Guyana, and Sucre, Bolivia. Data collection, carried out between September 2019 and March 2020, included documentary reviews, semi-structured interviews, focus groups, and site visits accompanied by discussions with relevant stakeholders. Case studies provide valuable examples of people-centered, partnership-based, country-owned, and data-guided approaches to promoting equitable immunization coverage, including multi-level partnerships to build technical capacity for the identification and measurement of social inequalities impacting immunization in Colombia; intersectoral and community collaboration for pro-equity emergency response to regional vaccine preventable disease outbreaks in Guyana; and strategic alliances with the education sector and civil society organizations for the introduction of the human papilloma virus (HPV) vaccine in Sucre, Bolivia. Lessons learned highlight avenues for improving the impact of multi-level, equity-focused capacity building, particularly at the local level; optimizing the use of data and resources, partnerships, and community and stakeholder education and empowerment. While impact studies are needed to better understand the quantitative contributions of such strategic alliances, these case studies illustrate their practical significance and reinforce the value of multi-level, intersectoral collaboration for enhancing equitable immunization access and demand. The experiences of Colombia, Guyana, and Sucre, Bolivia provide evidence-based insight to support pro-equity immunization program planning to ensure that no one is left behind and that everyone, everywhere receives the benefits of vaccines, both routine and for COVID-19.

Container-Based Sanitation Services and Attrition: An Examination of Drivers and Implications

Haiti is far from achieving the UN goal of sanitation access for all; 20% of the population has no sanitation access, and less than 0.1% of the country’s excreta is safely managed. Container-Based Sanitation (CBS) may be key to achieving timely and equitable sanitation coverage in Haiti’s cities. CBS can provide immediate sanitation access without preexisting infrastructure, and where permanent infrastructure is impractical. Investor caution and policy barriers, however, presently limit the growth of CBS solutions. Globally, most CBS services are provided by private organizations like EkoLakay, which provides a portable toilet and weekly excreta collection for a monthly fee. While the EkoLakay service is popular, attrition is high. This study examines the relationship between users and the service, and its role in improved sanitation accessibility. For this study, 633 active and former EkoLakay subscribers in Cap Haïtien were interviewed to reveal causes and implications of attrition. Households with active EkoLakay subscriptions are more likely than former subscribers to live in unauthorized informal residences and to lack energy or water infrastructure. A quarter of users unsubscribe voluntarily, after investing in permanent sanitation infrastructure. Over 30% of former users, however, reported unsubscribing due to economic challenges. Many involuntary terminations resulted in households losing access to private improved sanitation or reverting to open defecation, reducing progress toward global sustainability goals. Insights obtained contextualize the relationship between users and CBS services to inform public strategies for mitigating barriers to achieving universal safe sanitation.

Intent to Be Vaccinated against COVID-19 in Victoria, Australia.

Background: High vaccine uptake requires strong public support, acceptance, and willingness. Methods: A longitudinal cohort study gathered survey data every four weeks between 1 October 2020 and 9 November 2021 in Victoria, Australia. Data were analysed for 686 participants aged 18 years and older. Results: Vaccine intention in our cohort increased from 60% in October 2020 to 99% in November 2021. Vaccine intention increased in all demographics, but longitudinal trends in vaccine intention differed by age, employment as a healthcare worker, presence of children in the household, and highest qualification attained. Acceptance of vaccine mandates increased from 50% in October 2020 to 71% in November 2021. Acceptance of vaccine mandates increased in all age groups except 18–25 years; acceptance also varied by gender and highest qualification attained. The main reasons for not intending to be vaccinated included safety concerns, including blood clots, and vaccine efficacy. Conclusion: COVID-19 vaccination campaigns should be informed by understanding of the sociodemographic drivers of vaccine acceptance to enable socially and culturally relevant guidance and ensure equitable vaccine coverage. Vaccination policies should be applied judiciously to avoid polarisation.

A Stochastic Programming Model for Ambulance (Re)Location-Allocation Under Equitable Coverage and Multi-Layer Response Time

A Stochastic Programming Model for Ambulance (Re)Location-Allocation Under Equitable Coverage and Multi-Layer Response Time

Identification of risk areas and factors associated with the 2019 measles epidemic in the State of São Paulo, Brazil

This study aimed to analyze the occurrence of clusters and factors associated with the resurgence of measles cases from the largest epidemic of the post-elimination period in the State of São Paulo, Brazil, in 2019. Sociosanitary and care factors were analyzed by zero-inflated Poisson (ZIP) and ZIP models with structured and unstructured spatial effect. The SCAN statistic was used to analyze the occurrence of case clusters. Clusters of high-risk cases were identified in municipalities that make up the intermediate region of São Paulo. In the ZIP model, the following variables were observed as risk factors at the municipal level: household heads under 18 years old (adjusted RR =0 1.39; 95%CrI: 1.27-1.53), inequality in income distribution (adjusted RR = 36.67; 95%CrI: 26.36-51.15), unemployment in people over 18 years old (adjusted RR = 1.10; 95%CrI: 1.08-1.12), and non-existent street lighting (adjusted RR = 1.05; 95%CrI: 1.04-1.05). In the ZIP models with structured and unstructured spatial effect, the following variables were observed as risk factors: household heads under 18 years old (adjusted RR = 1.36; 95%CrI: 1.04-1.90) and inequality in income distribution (adjusted RR = 3.12; 95%CrI: 1.02-9.48). In both models, the coverage of health agents was presented as a protective factor. The findings reinforce the importance of intensifying measles surveillance actions articulated to the Family Health Strategy, especially in areas with greater social vulnerability, to ensure equitable and satisfactory vaccination coverage and reduce the risk of reemergence of the disease.

The cost of illness for childhood clinical pneumonia and invasive pneumococcal disease in Nigeria

BackgroundPneumococcal disease contributes significantly to childhood morbidity and mortality and treatment is costly. Nigeria recently introduced the pneumococcal conjugate vaccine (PCV) to prevent pneumococcal disease. The aim of this study...