Expansion Of Programs Research Articles

Assessing measles risk transmission in Iran: a utilization of the World Health Organization’s programmatic risk assessment tool,2022

BackgroundDespite successful efforts to eliminate measles in Iran, imported measles cases continue to be reported. Because measles is endemic in neighboring countries. This research aims to evaluate the risk of measles transmission in different regions of Iran.MethodsMeasles case-based surveillance data of the Expanded Program of Immunization containing 31 provinces and 463 districts from 2019 to 2021 were assessed. The WHO Measles Programmatic Risk Assessment tool was used to evaluate the risk of disease transmission in four domains: population immunity, surveillance quality, program delivery performance, and threat assessment. scores were categorized as low, medium, high, or very high risk.ResultsDuring 2019–2021, the average incidence of measles was 1.9 per 1 million. Chabahar and Mashhad with 76 and ./6per million reported the highest and lowest incidence respectively. All 463 districts were categorized as low risk in risk assessment. Andimeshk, Chabahar, and Bojnurd obtained the highest risk scores with 27, 24, and 25 respectively. All districts were classified as low risk for population immunity. The average coverage of (MMR1) and (MMR2) was 95% or higher. All districts received the minimum points for surveillance quality.ConclusionAll regions are placed at a low level of disease transmission risk. However, the tool is not able to assess the risk at the rural or peripheral sectors level. The indicators used in this tool are the same for all countries with different epidemiological features (elimination, endemic). Sensitivity analysis can optimize the use of this tool for countries with different disease conditions.

The Economic Impact of Workplace Mental Health Initiatives: A Comprehensive Analysis of Return on Investment and Organizational Performance

This study investigates the economic implications of implementing comprehensive mental health initiatives in the workplace. As mental health issues continue to rise globally, their impact on workforce productivity and organizational performance has become a critical concern for businesses. This research examines the relationship between investment in employee mental health programs and various economic indicators, including productivity, absenteeism, employee turnover, and overall organizational performance. We analyzed data from 100 medium to large-sized companies across diverse industries that have implemented mental health initiatives over the past five years. Our findings indicate a significant positive correlation between investment in mental health programs and improved economic outcomes, with an average return on investment (ROI) of 4:1. Furthermore, companies with robust mental health initiatives demonstrated lower absenteeism rates, reduced employee turnover, and increased overall productivity. This study contributes to the growing body of literature on the economics of mental health in the workplace and provides valuable insights for managers, policymakers, and organizational leaders considering the implementation or expansion of mental health programs.

The effect of the expansion of the Personal Assistance Service Program on the uptake of the National Health Screening in people with severe disability.

Korea operates the Personal Assistance Service (PAS) program, a social service program that assists with the daily activities and coping needs of individuals with disabilities. In January 2013, the eligibility to enroll in the PAS program was expanded to include all individuals with severe disabilities. As supporting individuals with disabilities is important in reducing disparities related to the uptake of health screening, this study investigated whether eligibility expansion of the PAS program was associated with increased participation in the National Health Screening Program (NHSP) among adults with severe disabilities. Nationwide data from Korea that included 24 701 individuals were used. The treatment group included individuals with severe disabilities, while the control group included those with mild disabilities. The difference-in-difference approach was used to estimate differences in participation in the NHSP between the two groups before and after the intervention period. A negative binomial distribution model was applied in the analysis with adjustment for all independent variables. The expansion of the PAS program was directly related to an increase in NHSP uptake by people with severe disabilities (increase by 0.044 times compared to the control group following the implementation of the policy). Expanding the eligibility for the PAS program was associated with an increase in NHSP participation among individuals with severe disabilities. These findings suggest the importance of supporting individuals with disabilities by increasing participation in health screenings to reduce potential related health disparities.

Spectrum and Incidence of Adverse Reactions Post Immunization in the Taiwanese Population (2014-2019): An Analysis Using the National Vaccine Injury Compensation Program.

Background: Post-marketing surveillance is crucial for gathering data on vaccine reactogenicity, enhancing public trust in immunization, and promoting vaccine uptake. This study aims to characterize adverse events following immunization (AEFIs) and estimate the incidence rates of adverse reactions (ARs) associated with vaccines included in Taiwan's Expanded Program on Immunization (EPI). This study utilizes data from Taiwan's Vaccine Injury Compensation Program (VICP). Methods: Vaccine injury claims submitted to the VICP between 2014 and 2019 were analyzed. ARs were defined as AEFIs adjudicated as "related" or "indeterminate" by the VICP committee. Data on the annual number of vaccine doses administered were obtained from the Taiwan CDC, which helped calculate the AR incidence rates. Results: A total of 491 AEFI claims were reviewed, with 327 (66.6%) categorized as ARs. The AEFIs were mainly associated with the Bacillus Calmette-Guérin (BCG) vaccine (43.4%) and the seasonal influenza vaccine (22.0%). Most EPI vaccines demonstrated low AR incidence rates, ranging from 1.68 to 13.6 per million doses, with the exception of BCG, which exhibited 162.5 ARs per million doses. Shifting BCG immunization from below 5 months to at least 5 months reduced osteomyelitis incidence significantly, from 41.4 to 7.9 (p = 0.0014), but increased abscess and lymphadenitis cases. Conclusions: EPI vaccines in Taiwan are highly safe, with minimal AR incidences in the general population. The BCG vaccine remains an exception, occasionally causing severe ARs like osteomyelitis. Adjusting the immunization schedule to an older age may mitigate some of these adverse effects.

Seafood traceability program design: Examination of the United States' Seafood Import Monitoring Program.

The United States' current Seafood Import Monitoring Program (SIMP) and a potential extension are undergoing review, yet quantitative evaluation of the current program is lacking. The SIMP is a traceability program aimed at reducing imports of seafood products that are of illegal, unreported, and unregulated (IUU) origin or associated with seafood fraud. We conducted a quantitative examination of the SIMP's current scope and design by synthesizing publicly available trade data along with measures of IUU fishing and seafood mislabeling. We found prioritized shipments amounted to 33% of 2016 imported tonnage. The SIMP species groups had higher IUU scores and mislabeling rates relative to non-SIMP groups, but the difference was consistent with random prioritization suggesting potential benefits from program expansion. Furthermore, two-thirds of imported volume lacked a mislabeling rate and 5% lacked species information, underlining the urgent need for improved open-access data on globalized seafood supply chains.

A-354 Evaluating Emergent POC Technology for Sickle Cell Testing in Resource Limited Settings

Abstract Background Sickle cell disease (SCD) represents a collection of inherited hematological disorders characterized by abnormal sickle-shaped erythrocytes resulting in an increased risk of morbidity and mortality. SCD represents a significant global health burden, affecting more than 300,000 newborns per year. Most of these births occur in resource limited areas, including sub-Saharan Africa, where the mortality rate before the age of five is estimated to be as high as 50-80% and the existing infrastructure and resources cannot support most current and robust methods that offer hemoglobin variant detection and quantification for the diagnosis and monitoring of SCD. While newborn screening programs (NBS) to identify individuals affected with SCD have demonstrated efficacy in reducing morbidity and early mortality, NBS programs are limited outside of the US and Europe and face many practical challenges for universal implementation in a resource limited setting. The need for inexpensive and reliable hemoglobin variant detection and quantification at the Point of Care is essential to the diagnosis and management of SCD in resource limited settings with a high prevalence of SCD, and the expansion of NBS programs. This study aims to evaluate an inexpensive testing strategy using two methodologies for POC screening and confirmation of SCD that could be supported in a low resource setting. Methods The two-step testing strategy for evaluation of POC testing for hemoglobin variant detection and quantification included testing residual specimens from normal and known sickle cell patients by first screening with the HemoTypeSC, a qualitative lateral flow immunoassay (LFIA) that has improved sensitivity and specificity from other available LFIA methodologies given the use of monoclonal antibodies for the detection of hemoglobin variants. Confirmatory testing and quantification of hemoglobin variants was accomplished with the use of the Gazelle POC test a miniaturized chip-based cellulose acetate electrophoresis device capable of identification and quantification of normal and variant hemoglobin. Statistical evaluation of device performance and clinical agreement between the device and known disease status was achieved in EP evaluator. Results The two-tier testing strategy demonstrated effective and inexpensive mechanism for SCD screening and confirmation. Overall, the HemoTypeSC and Gazelle demonstrated 100% qualitative agreement between methods, with the total cost of the two-tiered testing strategy estimated at under $6 per sample. Conclusions In conclusion, the two-tiered approach using the HemoTypeSC and Gazelle yielded a practical and cost-effective strategy for screening and confirmation of hemoglobin variants for the detection and monitoring of SCD. Both the strip and chip-based methodologies provide rapid results, are accessible at the point-of-care, and require minimal sample volume, a feature ideal for use in a pediatric population in low resource settings. Overall, these methods show promise for the use and expansion of NBS programs to improve public health initiatives for the diagnosis of SCD.

Re-election incentives and the adoption of early childhood development programmes: The case of the "Happy Child" Programme in Brazil

What incentives matter for governments to adopt pro-poor early childhood development (ECD) policies? This paper addresses this question by employing a regression discontinuity design (RDD) to study the effect of mayoral re-election incentives on the adoption of the “Happy Child” ECD Programme in Brazil. The analysis finds that municipalities with first-term mayors (those that were eligible for re-election for another consecutive mandate) had a higher probability of programme adoption by 2018 of over 10 percentage points. These results confirm theoretical expectations about the role of re-election incentives and provide a significant contribution on the institutional determinants of the expansion of ECD programmes in developing countries.

Implementation of an EMS-based naloxone distribution program: A qualitative evaluation.

We evaluated a novel leave-behind naloxone (LBN) program that allows Emergency Medical Services (EMS) personnel to distribute naloxone after an opioid overdose. Our objective was to explore EMS engagement and experiences with the program, as well as interest in education on addiction and harm reduction. We also assessed the acceptability of LBN programs among people who use drugs (PWUD). We conducted telephone interviews with EMS personnel and residents of substance use recovery housing between February and September 2023. EMS personnel described their direct experiences with the LBN program and perceived facilitating factors and barriers to naloxone distribution. First responder interactions and support for LBN were explored with PWUD. A rapid assessment method was used to analyze the interview data. Eighteen of the 23 EMS participants had distributed LBN; most agreed EMS agencies should have an LBN program. Barriers included forgetting, patient acuity, patients declining, and perceived liability. Facilitators included having a clear protocol, accessible kits, and minimal documentation burden. The majority expressed interest in harm reduction education. Eight of the 11 PWUD participants reported recent involvement in an opioid overdose. The majority supported LBN and felt comfortable receiving naloxone training from EMS. In this qualitative evaluation, we found broad support for EMS-based naloxone distribution among EMS personnel and PWUD. We identified several modifiable barriers to the success of such programs, which should be the subject of future investigation. EMS and harm reduction communities should support the expansion of LBN programs across the United States.

Mass screening of hepatitis B and C in Burkina Faso: seroprevalence update and impact of hepatitis B vaccine.

Updated data on the seroprevalences of hepatitis B and C viruses (HBV, HCV) are required to enable the adaptation of control strategies. In this study, we aimed to: (i) estimate the seroprevalences of HBsAg carriers and HCV exposure in the general population, and (ii) determine the impact of vaccination on HBV circulation since its introduction in 2006 in the Expanded Program on Immunization (EPI). From October 2020 to October 2022, a mass screening campaign was conducted in 10 cities across Burkina Faso. Individuals of all ages and genders who consented to participate were screened for viral markers (HBsAg, anti-HCV) using rapid diagnostic tests. The proportions of HBsAg carriers and HCV exposure were calculated using Stata, and logistic regression was used to assess the impact of HBV vaccination on HBsAg carriage. A total of 15,650 participants were enrolled in the study. Of these, 51.4% were women and the age range was from 1 to 97 years. All participants were screened for HBsAg and 7,507 were also screened for anti-HCV. Overall, the seroprevalence of HBsAg was 8.8% and 2.6% for anti-HCV. The results indicated that age, gender, and place of residence were associated with HBV infection. The prevalence of HBV and HCV infections remains high in Burkina Faso. Prevention strategies, including initial mass screening with rapid diagnostic tests and vaccination, need to be intensified.

Impact of oral azithromycin and intermittent preventive treatment with sulfadoxine-pyrimethamine regimen on child mortality in Sierra Leone: trial protocol for a randomised, two-arm, double-blinded, placebo-controlled clinical trial (ICARIA)

BackgroundAzithromycin has been shown to be beneficial in preventing infectious diseases, including malaria, infectious diarrhoea and pneumonia. A cluster randomised control trial on azithromycin MDA in children in Niger, Malawi and Tanzania found a reduction in all-cause under-five (U5) mortality in communities who received azithromycin compared to placebo. However, the reduction was largest and statistically significant only in Niger. The purpose of this trial is to evaluate the impact of azithromycin plus intermittent preventive treatment in infants (IPTi), recently renamed by the World Health Organisation as perennial malaria chemoprevention (PMC), with sulfadoxine-pyrimethamine (SP) on all-cause mortality up to 18 months of age in children living in areas of high mortality burden through the Expanded Program on Immunisation (EPI) in Sierra Leone.MethodsThe Improving Care through Azithromycin Research for Infants in Africa (ICARIA) trial is a phase III two-arm, individually randomised, double-blinded, placebo-controlled trial administering oral AZI (20 mg/kg bodyweight) at three time points to children attending EPI visits in Sierra Leone. A total of 20,560 infants attending the first EPI contact at around 6 weeks of age are recruited and randomised to AZI or placebo in a 1:1 ratio. The second and third AZI/placebo doses are given at 9 and 15 months of age. The primary outcome of the trial is all-cause mortality rate at 18 months of age assessed through mortality surveillance. Other trial outcomes include the impact on antimicrobial resistance, and on the immune response to certain key routine EPI immunisations, the safety of the intervention, the prevalence of SP resistance markers and the feasibility, and acceptability of adding AZI to the EPI programme.DiscussionThe trial will provide the evidence needed to inform policy regarding the adoption and large-scale implementation of AZI in areas of high-mortality burden in sub-Saharan Africa.Trial registrationClinicalTrials.gov NCT04235816. Registered on 22 January 2020.Pan-African Clinical Trials Registry PACTR202004540256535. Registered on 14 April 2020.

Medicaid's Political Development Since 1965: How a Fragmented and Unequal Program Has Expanded.

The Medicaid program has changed enormously over the past 60 years from a very restrictive program primarily attached to recipients on public assistance in 1965 to a much more expansive program allowing coverage for persons regardless of marital, parental or employment status. Incorporating the 'medically needy'-an ambiguous concept from the start-allowed states to include many different groups in Medicaid who are not traditionally thought of as poor. In addition, three structural features illuminate why the program has expanded and changed dramatically over time: federalism and intergovernmental financing, the dominance of the private sector, and fragmentation. Unequal treatment among Medicaid covered groups alongside partisan politics create a political discourse that often reveals Medicaid as a public subsidy for stigmatized groups, while hiding Medicaid's reach into the middle-class. This central political ideological tension collides with programmatic realities such that Medicaid strangely often suffers from a residual, retrenchment politics while at the same time benefiting from embeddedness making it extremely difficult to truly turn back the clock on Medicaid's expansion.

Reviewing the Pillars of Immunization: Essential Vaccines and Their Public Health Benefits.

Vaccination has lowered, across the globe, morbidity and mortality from infectious diseases. It is considered one of the basic principles of preventive health measures. The World Health Organization’s Expanded Programme on Immunization defined vaccinations that are required and their tremendous benefits to public health, which are discussed in this review article. These involve the vaccinations taken against most communicable diseases, such as COVID-19, polio, measles, rubella, pneumococcal diseases, rotavirus, human papillomavirus, tuberculosis, Haemophilus influenzae type B, diphtheria, pertussis, and tetanus. The article points out that quite a number of vaccinations have been proven effective and safe and if administered, could prevent serious disease, disability, and death. For example, vaccination against measles has been rated to be vital in the containment of outbreaks within nonimmune populations, while the DTP vaccine is paramount in decreasing the cases of pertussis, tetanus, and diphtheria. The effect of vaccination can be exemplified by the dramatic decrease in the occurrence of serious bacterial contagion in children since the introduction of conjugate vaccines against Hib and pneumococcus. Notwithstanding these successes, there are persistent obstacles, such as vaccine hesitancy, misinformation, and inequities in access to vaccines, all heightened by the COVID-19 pandemic. The article discusses the global impact of vaccination efforts under siege and appeals for further public health efforts toward the attainment of these goals.

An optimized strategy triggered at the 2nd immunization visit to prevent HIV acquisition by breastfeeding: a phase 2 trial in Burkina Faso (PREVENIR-PEV)

BackgroundMother-to-child transmission of HIV during breastfeeding remains a challenge in low- and middle-income countries (LMIC). A prevention package was initiated during the highly attended 2nd visit of the Expanded Program of Immunisation (EPI-2) to identify the undiagnosed infants living with HIV and reduce the postnatal transmission of infant exposed to HIV.MethodsPREVENIR-PEV is a non-randomized phase II clinical trial conducted at two health centres in Bobo Dioulasso (Burkina Faso). The study recruited mothers living with HIV aged 15 years and older with their singleton breastfed infants. During EPI-2 (at 8 weeks) and upon signature of the informed consent, a point-of-care early infant diagnosis (EID) was performed. HIV exposed uninfected (HEU) infants were followed-up until 12 months of age. High risk HEU infants (i.e., whose maternal viral load ≥ 1000 cp/mL at EPI-2 or M6) received an extended postnatal prophylaxis (PNP) with lamivudine until end of follow-up or the end of breastfeeding.ResultsBetween 4 December 2019 and 4 December 2020, 118 mothers living with HIV-1 were identified, and 102 eligible mother/infant pairs had their infants tested for HIV EID. Six infants were newly diagnosed with HIV, and 96 HEU infants were followed-up for 10 months. Among the participants followed-up, all mothers were prescribed antiretrovirals. All 18 infants eligible for PNP at either EPI-2 or 6 months (M6) were initiated on lamivudine. No HIV transmission occurred, and no serious adverse events were reported in infants receiving lamivudine.ConclusionsThe PREVENIR-PEV prevention package integrated into existing care is safe and its implementation is feasible in a LMIC with a low HIV prevalence. More research is needed to target mother/infant pairs not adhering to the intervention proposed in this trial.Trial registrationNCT03869944; first registered on 11/03/2019.

Relationship between Livestock Vaccination Programs and Mortality Rates in India

Purpose: To aim of the study was to analyze the relationship between livestock vaccination programs and mortality rates in India. Methodology: This study adopted a desk methodology. A desk study research design is commonly known as secondary data collection. This is basically collecting data from existing resources preferably because of its low cost advantage as compared to a field research. Our current study looked into already published studies and reports as the data was easily accessed through online journals and libraries. Findings: Vaccination programs for livestock in India significantly reduce mortality rates, particularly in cattle, sheep, and goats. Comprehensive vaccination decreases the incidence of infectious diseases, enhances herd immunity, and improves overall productivity. Regions with strong vaccination coverage see better livestock health and increased farmer livelihoods. Economic analyses show that the benefits of reduced mortality and increased productivity often outweigh the costs, highlighting the need for ongoing investment in veterinary health services and education to promote widespread vaccination. Unique Contribution to Theory, Practice and Policy: Health belief model (HBM), theory of planned behavior (TPB) & diffusion of innovations theory may be used to anchor future studies on the relationship between livestock vaccination programs and mortality rates in India. Practically, there is a need to strengthen the infrastructure for vaccine distribution, especially in remote and underserved areas. Policymakers should develop and enforce policies that support the expansion and optimization of livestock vaccination programs.

DNA Methylation signatures underpinning blood neutrophil to lymphocyte ratio during first week of human life

Understanding of newborn immune ontogeny in the first week of life will enable age-appropriate strategies for safeguarding vulnerable newborns against infectious diseases. Here we conducted an observational study exploring the immunological profile of infants longitudinally throughout their first week of life. Our Expanded Program on Immunization - Human Immunology Project Consortium (EPIC-HIPC) studies the epigenetic regulation of systemic immunity using small volumes of peripheral blood samples collected from West African neonates on days of life (DOL) 0, 1, 3, and 7. Genome-wide DNA methylation and single nucleotide polymorphism markers are examined alongside matched transcriptomic and flow cytometric data. Integrative analysis reveals that a core network of transcription factors mediates dynamic shifts in neutrophil-to-lymphocyte ratios (NLR), which are underpinned by cell-type specific methylation patterns in the two cell types. Genetic variants are associated with lower NLRs at birth, and healthy newborns with lower NLRs at birth are more likely to subsequently develop sepsis. These findings provide valuable insights into the early-life determinants of immune system development.

Impact of Plai-Zampen programs on librarians' professional development for technological advancement and management

The purose of this study is to assess the impact of the programs initiated by the Philippine Librarians Association, Inc.- Zamboanga Peninsula (PLAI-ZamPen) for the last 5 years on Librarians’ Professional Development for Technological Advancement and Management. It highlights librarians' adaptation to technological demands, emphasizing skills in software, systems, and data analysis. Employing a quantitative research design with a descriptive survey method, the study utilizes 86 librarian respondents to evaluate its profiles, program impact, and effectiveness variations based on library types, membership duration, and roles. Using tools like the Kruskal-Wallis H Test and Weighted Mean, the study provides a comprehensive analysis, emphasizing the importance of ongoing professional development for libraries to remain relevant and responsive in hybrid learning environments. The findings revealed a significant positive impact, with programs effectively equipping librarians with essential skills and fostering a culture of innovation. The analysis of membership demographics highlights a predominance of academic librarians and a mix of experienced and novice members, underscoring the inclusivity and effectiveness of PLAI-ZamPen's initiatives. In conclusion, this study this affirm that the programs initiated by PLAI-ZamPen significantly enhance librarians' professional development, particularly in the realms of technological advancement and management. The positive impact of the programs extend beyond individual skill enhancement; it also bolsters libraries' abilities to adapt to evolving community needs, thereby ensuring continued relevance and excellence in service delivery. It is recommended that continued innovation and expansion of professional development programs, focusing on emerging technological trends and management strategies will be taken into account. Thus, it will enhance librarians' proficiency in digital tools and foster global collaboration, ensuring that libraries remain essential hubs of knowledge and service excellence.

Human papillomavirus type-specific distribution in cervical intraepithelial neoplasia and cancer in The Gambia prior to HPV immunization programme: a baseline for monitoring the quadrivalent vaccine

BackgroundCervical cancer is the leading cause of cancer deaths in Gambian women. Current estimates indicate that 286 women are annually diagnosed with cervical cancer with a fatality rate of 70%. In an attempt to address this, in 2019 the quadrivalent HPV vaccine was incorporated into the Gambia’s Expanded Programme on Immunisation. The study aims to retrospectively assess the prevalence and distribution of high-risk HPV genotype in archived, formalin fixed paraffin embedded cervical biopsy tissues diagnosed with cervical cancer in the Gambia from year 2013–2022.MethodA total of 223 samples with histologically diagnosis of cervical cancer with adequate tissues were sectioned and deparaffinised, followed by HPV DNA extraction and the detection of HR-HPV by real-time multiplex PCR. The human β-globin gene was amplified in 119 samples, which were subsequently tested for HPV DNA.ResultsHPV was prevalent in 87.4% (104 of 119) cervical cancer cases, 12.6% (15/119) samples tested negative. Amongst cervical cancer cases, HPV 16 genotype was the most frequent type accounting for 53.8% (56 /104), followed by other HR-HPV genotypes 17.3% (18/104), and HPV genotype 18 was 15.4% (16/104). Furthermore, multiple HPV infections involving HPV 16 and /or 18 was detected in 14 cases as follows: HPV genotypes 16 and 18 (3.8%, 4 /104), HPV 16 and other HR-HPV (6.7%, 8/104), and HPV 18 and other HR-HPV (1.9%, 2/104). A significant association between age and diagnosis with cervical cancer (p = 0.02), and HPV genotype 16 (p = 0.04) was observed.ConclusionThere was no difference in the distribution of HPV 16 and 18 genotypes in cervical cancer cases in The Gambia in comparison with the global distribution. However, the high prevalence of cervical cancer cases with other HR-HPV, and combined infections of HPV 16 with other HR-HPV genotypes seen in this study, clearly shows that the nonavalent HPV vaccine could be more beneficial for The Gambia. This study provides The Gambia with a baseline data to use in policy decisions regarding future evaluation of the quadrivalent HPV vaccine in the country.

Governance matters: Exploring the impact of governance on routine immunization performance in 54 African countries: A 10-year (2012−2021) analysis using linear mixed models

BackgroundImmunization coverage across numerous African nations has, unfortunately, shown little improvement and, in some cases, has even decreased over the past decade, leaving millions of children vulnerable to vaccine-preventable diseases. While efforts to improve immunization performance have primarily focused on the health system, effective delivery of immunization services is intricately linked to a country's governance, which, in this context, reflects a government's ability to provide comprehensive services to its citizens. This study investigated the relationship between governance, measured using the Mo Ibrahim Index for African Governance, and the trajectory of immunization coverage for three vaccines in 54 African countries from 2012 to 2021. MethodsWe conducted an ecological study utilizing publicly available datasets, the WHO/UNICEF estimates of National Immunization Coverage and the Ibrahim Index of African Governance score (IIAG). We described the trends in routine immunization performance, evaluated and assessed the impact of governance on immunization coverage across 54 African countries for the period 2012 to 2021, using linear mixed models and focusing on three vaccines provided through the Expanded Program on Immunization (DTPCV1, DTPCV3, and MCV1). ResultsAmong the 54 African countries studied, 32 (59.3 %) witnessed an overall decrease (slope of change in immunization coverage over time < 0) in immunization coverage, with 16 (29.6 %) experiencing a significant decline (slope of change significantly different from zero (P < 0.05)) in coverage. For DTPCV3, 31 countries (57.4 %) demonstrated a decline in coverage, with 12 (22.2 %) being significant declines. Thirty-two countries (59.2 %) reported a decrease in MCV1 coverage over the analysis period, with 17 (31.5 %) significant. Across all three antigens, the IIAG overall score was positively associated with immunization coverage over time. One unit increase in the IIAG score correlated with an average annual increase of 0.64 (95 % CI: 0.35–0.93) percentage points in DTPCV1 coverage, 0.74 percentage points (95 % CI: 0.42–1.07) in DTPCV3 coverage, and 0.60 (95 % CI: 0.30–0.91) percentage points in MCV1 coverage. These findings suggest that an African country with an average IIAG score just one unit higher than their observed average value over the study period, would have achieved a 6.4 %, 7.4 %, and 6.0 % coverage for DTPCV1, DTPCV3, and MCV1, respectively, above its 2021 coverage levels. ConclusionThe Expanded Program on Immunization aspires to reach all eligible populations with life-saving vaccines, regardless of the context. We found that country governance may be an important determinant of immunization performance, potentially explaining the observed stagnation or decline in immunization performance and the heightened vulnerability of immunization programs to external shocks. Understanding the nexus between governance and service delivery suggests that immunization actors, funders, and other stakeholders may need to adjust their expectations of countries' immunization performance accordingly.

The evolution and formalization of anesthesia assistant roles across Canada.

The purpose of this Special Article is to document the evolution of the anesthesia assistant (AA) profession in Canada and summarize AA practice at Canadian institutions as it exists today, five decades after Quebec and 15years after most other provinces formalized AA practice. Through the Management Committee of the Association of Canadian University Departments of Anesthesia (ACUDA), we conducted a purposeful sampling of all ACUDA chairs or their delegates. We requested the following data: history of AAs becoming a reality in their particular province or region; potential recruitment pools; training programs and curricula; pathway to credentialing; funding, pay, retention, recruitment, and status of union representation; and metrics. Data were provided by 19 institutions in 8 provinces: Newfoundland and Labrador, Nova Scotia, Quebec, Ontario, Manitoba, Saskatchewan, Alberta, and British Columbia. Given the different health care governance structures across the provinces, AA roles vary in terms of its associated technical, clinical, and educational responsibilities. The role of AAs in supporting anesthesia care through equipment maintenance and assistance with airway management, resuscitation, and administration of regional anesthesia seems to be well established, as is their role in providing brief intraoperative relief for anesthesiologists during a stable period of anesthesia. Anesthesia assistant duties continue to evolve, becoming more aligned with the specific institution and less dependent on the supervising anesthesiologist. Apart from the initial metrics collected during the Ontario ACT implementation pilot projects, we are not aware of any formal metrics, current or ongoing, being collected across Canada, related to either patient safety events or perioperative efficiency. This compilation of pan-Canadian AA data shows diverse models of practice and highlights the value to patients and the health care system as a whole of incorporating these allied professionals into the anesthesia care team (ACT). The present findings allow us to offer suggestions for consideration during discussions of retention, recruitment, program expansion, and cross-country collection of metrics and other data. We conclude by making six recommendations: 1. recognize that implementation of ACTs is a key element in solving the challenge of an increasing surgical backlog; 2. develop, or facilitate the development of, metrics and increase data-sharing nationally to enable health care authorities to better understand the importance of AAs in patient safety and perioperative efficiency; 3. develop and implement funding strategies to lower the barriers to AA training such as hospital-sponsored positions, ongoing salary support, and return-of-service arrangements; 4. ensure that salaries appropriately reflect the increased level of training and added levels of responsibility of certified AAs; 5. develop long-term strategies to ensure stable funding, recruitment and retention, and a better match between the number of AA training positions and the need for newly certified AAs; and 6. engage all stakeholders to acknowledge that AAs, as knowledgeable and specifically trained assistants, not only fulfill their defined clinical role but also contribute significantly to patient safety and clinical efficiency by assuming nondirect patient care tasks.

HPV vaccination strategy for 14-year-old females and economic returns for cervical cancer prevention in Wuxi City, China: a cost effectiveness analysis

BackgroundSince December 2021, Wuxi, China has offered a two-dose human papillomavirus (HPV) vaccination to 14-year-old females for free. This study evaluated the costs and benefits of this vaccination scheduled in the Expanded Program on Immunization in Wuxi from the perspective of the cities’ demographic characteristics, economic development, and policy support.MethodsThe model-based economic evaluation used TreeAge Pro software to construct a decision tree-Markov model for the vaccination strategy in which 100,000 14-year-old females received two doses of bivalent HPV vaccine or no vaccination. Costs and effects of the strategy were assessed from a societal perspective through literature research and data obtained from the Wuxi Centre for Disease Control and Prevention. Univariate, multivariate, and probabilistic sensitivity analyses assessed the stability of the findings.ResultsThe cost of the bivalent HPV vaccine in Wuxi is 711.3 CNY. The two-dose of bivalent HPV vaccine for 100,000 14-year-old females would cost an additional 658,016 CNY compared to no vaccination, but would result in 1,960 Quality Adjustment Years of Life (QALYs). Using the per capita gross domestic product of 187,415 CNY in 2021 in Wuxi as the willingness-to-pay threshold, the vaccination strategy costs 3,357.37 CNY per QALY gained, which is much lower than the threshold, suggesting that it is a very cost-effective strategy. In addition, the vaccine strategy reduced the incidence of cervical cancer by 300 cases and cervical cancer deaths by 181 cases, representing a benefit-cost ratio of 2.86 (> 1) when health output outcomes were measured in monetary terms. These results suggested that the vaccination strategy was advantageous. Sensitivity analyses showed that changes in the parameters did not affect the conclusions and that the findings were robust.ConclusionsCompared to no vaccination, the delivery of two doses of bivalent HPV vaccine for 14-year-old females was a more highly cost-effective and optimal strategy.