[Show abstract][Hide abstract] ABSTRACT: Objective:
To evaluate the impact of the meningococcal A (MenA) vaccine introduction in Mali through mass campaigns on the routine immunization program and the wider health system.
We used a mixed-methods case-study design, combining semi-structured interviews with 31 key informants, a survey among 18 health facilities, and analysis of routine health facility data on number of routine vaccinations and antenatal consultations before, during, and after the MenA vaccine campaign in December 2010. Survey and interview data were collected at the national level and in 2 regions in July and August 2011, with additional interviews in January 2012.
Many health system functions were not affected—either positively or negatively—by the MenA vaccine introduction. The majority of effects were felt on the immunization program. Benefits included strengthened communication and social mobilization, surveillance, and provider skills. Drawbacks included the interruption of routine vaccination services in the majority of health facilities surveyed (67%). The average daily number of children receiving routine vaccinations was 79% to 87% lower during the 10-day campaign period than during other periods of the month. Antenatal care consultations were also reduced during the campaign period by 10% to 15%. Key informants argued that, with an average of 14 campaigns per year, mass campaigns would have a substantial cumulative negative effect on routine health services. Many also argued that the MenA campaign missed potential opportunities for health systems strengthening because integration with other health services was lacking.
The MenA vaccine introduction interrupted routine vaccination and other health services. When introducing a new vaccine through a campaign, coverage of routine health services should be monitored alongside campaign vaccine coverage to highlight where and how long services are disrupted and to mitigate risks to routine services.
Global Health: Science and Practice 02/2014; 2(1):117-129. DOI:10.9745/GHSP-D-13-00130
[Show abstract][Hide abstract] ABSTRACT: Meningitis remains a major health burden throughout Sahelian Africa, especially in heavily populated northwest Nigeria with an annual incidence rate ranging from 18 to 200 per 100000 people for 2000-11. Several studies have established that cases exhibit sensitivity to intra- and interannual climate variability, peaking during the hot and dry boreal spring months, raising concern that future climate change may increase the incidence of meningitis in the region. The impact of future climate change on meningitis risk in northwest Nigeria is assessed by forcing an empirical model of meningitis with monthly simulations of seven meteorological variables from an ensemble of 13 statistically downscaled global climate model projections from phase 5 of the Coupled Model Intercomparison Experiment (CMIP5) for representative concentration pathway (RCP) 2.6, 6.0, and 8.5 scenarios, with the numbers representing the globally averaged top-of-the-atmosphere radiative imbalance (in W m(-2)) in 2100. The results suggest future temperature increases due to climate change have the potential to significantly increase meningitis cases in both the early (2020-35) and late (2060-75) twenty-first century, and for the seasonal onset of meningitis to begin about a month earlier on average by late century, in October rather than November. Annual incidence may increase by 47% +/- 8%, 64% +/- 9%, and 99% +/- 12% for the RCP 2.6, 6.0, and 8.5 scenarios, respectively, in 2060-75 with respect to 1990-2005. It is noteworthy that these results represent the climatological potential for increased cases due to climate change, as it is assumed that current prevention and treatment strategies will remain similar in the future.
[Show abstract][Hide abstract] ABSTRACT: Objective:
We aimed to explore the impacts of new vaccine introductions on immunization programmes and health systems in low- and middle-income countries.
We conducted case studies of seven vaccine introductions in six countries (Cameroon, PCV;Ethiopia, PCV; Guatemala, rotavirus; Kenya, PCV; Mali, Meningitis A; Mali, PCV; Rwanda, HPV). Inter-views were conducted with 261 national, regional and district key informants and questionnaires were completed with staff from 196 health facilities. Routine data from districts and health facilities were gathered on vaccination and antenatal service use. Data collection and analysis were structured around the World Health Organisation health system building blocks.
The new vaccines were viewed positively and seemed to integrate well into existing health systems. The introductions were found to have had no impact on many elements within the building blocks framework. Despite many key informants and facility respondents perceiving that the new vaccine introductions had increased coverage of other vaccines, the routine data showed no change. Positive effects perceived included enhanced credibility of the immunisation programme and strengthened health workers' skills through training. Negative effects reported included an increase in workload and stock outs of the new vaccine, which created a perception in the community that all vaccines were out of stock in a facility. Most effects were found within the vaccination programmes; very few were reported on the broader health systems. Effects were primarily reported to be temporary, around the time of introduction only.
Although the new vaccine introductions were viewed as intrinsically positive, on the whole there was no evidence that they had any major impact, positive or negative, on the broader health systems.
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