Zeitschriftenartikel zum Thema „Immunization of children – South Africa – Hammanskraal“

Background: The United Nations’ 2030 Agenda for Sustainable Development argues for the combating of health inequalities within and among countries, advocating for “leaving no one behind”. However, child mortality in developing countries is still high and mainly driven by lack of immunization, food insecurity and nutritional deficiency. The confounding problem is the existence of socioeconomic inequalities among the richest and poorest. Thus, comparing South Africa’s and India’s Demographic and Health Surveys (DHS) of 2015/16, this study examines socioeconomic inequalities in under-five children’s health and its associated factors using three child health indications: full immunization coverage, food insecurity and malnutrition. Methods: Erreygers Normalized concentration indices were computed to show how immunization coverage, food insecurity and malnutrition in children varied across socioeconomic groups (household wealth). Concentration curves were plotted to show the cumulative share of immunization coverage, food insecurity and malnutrition against the cumulative share of children ranked from poorest to richest. Subsequent decomposition analysis identified vital factors underpinning the observed socioeconomic inequalities. Results: The results confirm a strong socioeconomic gradient in food security and malnutrition in India and South Africa. However, while full childhood immunization in South Africa was pro-poor (−0.0236), in India, it was pro-rich (0.1640). Decomposed results reported socioeconomic status, residence, mother’s education, and mother’s age as primary drivers of health inequalities in full immunization, food security and nutrition among children in both countries. Conclusions: The main drivers of the socioeconomic inequalities in both countries across the child health outcomes (full immunization, food insecurity and malnutrition) are socioeconomic status, residence, mother’s education, and mother’s age. In conclusion, if socioeconomic inequalities in children’s health especially food insecurity and malnutrition in South Africa; food insecurity, malnutrition and immunization in India are not addressed then definitely “some under-five children will be left behind”.

AbstractThis article originally delivered as a keynote address at the IAMS Tenth International Conference in Hammanskraal, South Africa, is a passionate call to attend to the atrocities being committed against Tamils in the "broken world" of contemporary Sri Lanka. As the author puts it: "Disbelief and forgetfulness are the weapons of those who are opposed to humanity therefore to God. Forgetfulness is the antidote to truth and truthfulness of memory. Looking at this indescribable suffering of the innocent I have often felt that we all live in a world that has become unresponsive to the cries of the poor and under privileged. Such an attitude calls for solidarity among the victims and the oppressed. We also live in a world where a common agenda seems to unite all those who have chosen to be the enemies of humanity. It is our duty to fight this mute silence of the world with the power of the WORD. We should allow the word of Truth about the poor and innocent about voiceless women, men and children, to seek refuge and self-exile. Let us speak this word to the powers that be. All that we carry with us now is the memory of our life and that of the death of our fellow Tamils."

Background: Inadequate vaccination coverage with increased risk of vaccine preventable disease outbreaks remain a problem in Africa. The aim of this study was to assess the vaccination coverage levels under the Expanded Program on Immunization (EPI) in a health area and to identify factors that affect vaccination coverage in view of providing valuable data for disease prevention. Methods: A cross-sectional household survey was conducted in August 2017 in the Mbonge health area, Southwest Cameroon. Clustered sampling technique was used to select study communities and a purposive sampling design was used to select households. An interviewer-administered questionnaire was used to obtain information from consenting caregivers of children aged 9–23 months. Vaccination coverage was assessed by consulting the vaccination cards and parents’ recall. In households with more than one child aged 9-23months, the youngest was chosen. Results: Overall, 300 caregivers were enrolled into the study. The average vaccination coverage for the past three years (2014-2016) was 34.0%. Two hundred and fifty-five (85%) children had vaccination cards. Amongst the children, 143 (47.7%) had taken all vaccines as recommended while 30 (10%) had not received a single dose. Factors significantly associated with incomplete vaccination status included: occupation (being a farmer) (p-value=0.011), marital status (married) (p-value=0.048), caregiver’s utilization of health facility (p-value=0.003), low levels of mothers’ utilization of antenatal care (ANC) services (p-value=0.000), and low knowledge on vaccination (p-value=0.000). Conclusion and Global Health Implications: Adequate vaccination coverage can be attained through good sensitization and health education for primary caregivers. Targeting families living far away from vaccination centers, using appropriate communication and vaccination strategies may improve vaccination coverage in the Mbonge Health Area of South West Region, Cameroon. Key words: • Assessment • Vaccination Coverage Expanded Program on Immunization • Mbonge Health Area • Cameroon • EPI Copyright © 2020 Ewang et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited.

Child mortality has increased in South Africa since 1990, despite a national policy of free primary healthcare for pregnant women and children under the age of five years. A significant number of women and children die during childbirth and 40% of stillbirths happen during labour. Lack of sufficient knowledge about primary health care (PHC) is costing South Africa greatly because many of the deaths of mothers, babies and young children could be avoided. Teenagers conceal pregnancy and that adds to higher risk of death among themselves and their unborn babies. Almost a half of all new-born babies die during the first 24 hours of birth, and 75% die in their first week of life. This study looks at primary health care by women in Vhembe by identifying knowledge and skills they possess to deal with health care issues. A 3-stage sample survey was conducted covering all the municipalities in the district. About 2660 women aged between 13 and 50 years were interviewed using structured questionnaire. Applying various statistical methods including logistic and regression modelling, this study shows that majority of the respondents know about PHC and that age and education of women are important factors affecting child’s health and survival in the Vhembe district. If Limpopo wants to reduce childhood mortality, this study recommends that efforts be made to educate women, especially teenagers about primary health care, immunization, oral rehydration therapy and attendance at clinics for pre-natal medical check-ups during pregnancy.

Background: age structured mathematical models have been used to evaluate the impact of rubella-containing vaccine (RCV) introduction into existing measles vaccination programs in several countries. South Africa has a well-established measles vaccination program and is considering RCV introduction. This study aimed to provide a comparison of different scenarios and their relative costs within the context of congenital rubella syndrome (CRS) reduction or elimination. Methods: we used a previously published age-structured deterministic discrete time rubella transmission model. We obtained estimates of vaccine costs from the South African medicines price registry and the World Health Organization. We simulated RCV introduction and extracted estimates of rubella incidence, CRS incidence and effective reproductive number over 30 years. Results: compared to scenarios without mass campaigns, scenarios including mass campaigns resulted in more rapid elimination of rubella and congenital rubella syndrome (CRS). Routine vaccination at 12 months of age coupled with vaccination of nine-year-old children was associated with the lowest RCV cost per CRS case averted for a similar percentage CRS reduction. Conclusion: At 80% RCV coverage, all vaccine introduction scenarios would achieve rubella and CRS elimination in South Africa. Any RCV introduction strategy should consider a combination of routine vaccination in the primary immunization series and additional vaccination of older children.

Sepsis and meningitis due to invasive group B Streptococcus (iGBS) disease during early infancy is a leading cause of child mortality. Recent systematic estimates of the worldwide burden of GBS suggested that there are 319,000 cases of infant iGBS disease each year, and an estimated 147,000 stillbirths and young-infant deaths, with the highest burden occurring in Sub-Saharan Africa. The following priority data gaps were highlighted: (1) long-term outcome data after infant iGBS, including mild disability, to calculate quality-adjusted life years (QALYs) or disability-adjusted life years (DALYs) and (2) economic burden for iGBS survivors and their families. Geographic data gaps were also noted with few studies from low- and middle- income countries (LMIC), where the GBS burden is estimated to be the highest. In this paper we present the protocol for a multi-country matched cohort study designed to estimate the risk of long-term neurodevelopmental impairment (NDI), socioemotional behaviors, and economic outcomes for children who survive invasive GBS disease in Argentina, India, Kenya, Mozambique, and South Africa. Children will be identified from health demographic surveillance systems, hospital records, and among participants of previous epidemiological studies. The children will be aged between 18 months to 17 years. A tablet-based custom-designed application will be used to capture data from direct assessment of the child and interviews with the main caregiver. In addition, a parallel sub-study will prospectively measure the acute costs of hospitalization due to neonatal sepsis or meningitis, irrespective of underlying etiology. In summary, these data are necessary to characterize the consequences of iGBS disease and enable the advancement of effective strategies for survivors to reach their developmental and economic potential. In particular, our study will inform the development of a full public health value proposition on maternal GBS immunization that is being coordinated by the World Health Organization.

Sepsis and meningitis due to invasive group B Streptococcus (iGBS) disease during early infancy is a leading cause of child mortality. Recent systematic estimates of the worldwide burden of GBS suggested that there are 319,000 cases of infant iGBS disease each year, and an estimated 147,000 stillbirths and young-infant deaths, with the highest burden occurring in Sub-Saharan Africa. The following priority data gaps were highlighted: (1) long-term outcome data after infant iGBS, including mild disability, to calculate quality-adjusted life years (QALYs) or disability-adjusted life years (DALYs) and (2) economic burden for iGBS survivors and their families. Geographic data gaps were also noted with few studies from low- and middle- income countries (LMIC), where the GBS burden is estimated to be the highest. In this paper we present the protocol for a multi-country matched cohort study designed to estimate the risk of long-term neurodevelopmental impairment (NDI), socioemotional behaviors, and economic outcomes for children who survive invasive GBS disease in Argentina, India, Kenya, Mozambique, and South Africa. Children will be identified from health demographic surveillance systems, hospital records, and among participants of previous epidemiological studies. The children will be aged between 18 months to 17 years. A tablet-based custom-designed application will be used to capture data from direct assessment of the child and interviews with the main caregiver. In addition, a parallel sub-study will prospectively measure the acute costs of hospitalization due to neonatal sepsis or meningitis, irrespective of underlying etiology. In summary, these data are necessary to characterize the consequences of iGBS disease and enable the advancement of effective strategies for survivors to reach their developmental and economic potential. In particular, our study will inform the development of a full public health value proposition on maternal GBS immunization that is being coordinated by the World Health Organization.

Background. Poliovirus isolates detected in persons or in the environment can fall into three major categories: wild, Sabin and Sabin-like, or vaccine-derived. Detection of wild or vaccine-derived poliovirus may constitute an emergency, which can be categorized as an event that can lead to an outbreak, depending on characteristics of the isolate and the context in which it appears. The aim of the study was investigation report of cVDPV2 outbreak in Bokh woreda of Dollo Zone, Somali regional state, Ethiopia. Methods. A team of experts drawn from different organizations was deployed to Bokh woreda to make detailed field investigation from May 25 to June 17, 2019. By using standard World Health Organization polio outbreak investigation checklist, document review of surveillance, immunization, and clinical data related to the case was made. Key informant’s interview was made to health professionals, managers, parents of case, woreda and kebele leaders, religious leaders, and HEWs related to acute flaccid paralysis outbreak. Result. The notified AFP case was a 39-month-old female from Angalo kebele of Bokh woreda, Dollo Zone. On 19th May 2019, the patient developed high grade fever and was taken to Angalo Health Post on 20th May 2019. As per the examination by a health extension worker, the child had high grade fever and neck stiffness with preliminary diagnosis of meningitis for which ceftriaxone injection was prescribed. Contact sample was taken from three children on 28th May 2019 and 29th May 2019 and was sent to Addis Ababa National Polio Laboratory. All contact stool samples were found to be positive for poliovirus type 2 and referred for sequencing in National Institute of Communicable Diseases (NICD), South Africa, the Regional Polio Reference Laboratory. Conclusion and Recommendation. The clinical presentation of the cases is compatible with poliovirus infection, improving the quality and coverage of supplementary polio immunization activities through proper planning; strict supervision and follow-up can reduce the occurrence of acute flaccid paralysis.

Approximately 100 million newborn children receive Bacille Calmette–Guérin (BCG) annually, because vaccination is consistently protective against childhood tuberculous meningitis and miliary TB. By contrast, BCG efficacy against pulmonary TB in children and adults is highly variable, ranging from 0% to 80%, though it tends to be higher in individuals who have no detectable prior exposure to mycobacterial infections, as judged by the absence of delayed-type hypersensitivity response (a negative tuberculin skin test, TST). The duration of protection against pulmonary TB is also variable, but lasts about 10 years on average. These observations raise the possibility that BCG revaccination, following primary vaccination in infancy, could be efficacious among TST-negative adolescents as they move into adulthood, the period of highest risk for pulmonary disease. To inform continuing debate about revaccination, this paper assesses the effectiveness and cost-effectiveness of revaccinating adolescents in a setting with intense transmission—Cape Town, South Africa. For a cost of revaccination in the range US$1–10 per person, and vaccine efficacy between 10% and 80% with protection for 10 years, the incremental cost per year of healthy life recovered (disability-adjusted life years, DALY) in the vaccinated population lies between US$116 and US$9237. The intervention is about twice as cost-effective when allowing for the extra benefits of preventing transmission, with costs per DALY recovered in the range US$52–$4540. At 80% efficacy, revaccination averted 17% of cases. Under the scenarios investigated, BCG revaccination is cost-effective against international benchmarks, though not highly effective. Cost-effectiveness ratios would be more favourable if we also allow for TB cases averted by preventing transmission to HIV-positive people, for the protection of HIV-negative people who later acquire HIV infection, for the possible non-specific benefits of BCG, for the fact that some adolescents would receive BCG for the first time, and for cost sharing when BCG is integrated into an adolescent immunization programme. These findings suggest, subject to further evaluation, that BCG revaccination could be cost-effective in some settings.

Abstract Background Data on risk factors for influenza-associated hospitalizations in low- and middle-income countries are limited. Methods We conducted active syndromic surveillance for hospitalized severe acute respiratory illness (SARI) and outpatient influenza-like illness (ILI) in 2 provinces of South Africa during 2012–2015. We compared the characteristics of influenza-positive patients with SARI to those with ILI to identify factors associated with severe disease requiring hospitalization, using unconditional logistic regression. Results During the study period, influenza virus was detected in 5.9% (110 of 1861) and 15.8% (577 of 3652) of SARI and ILI cases, respectively. On multivariable analysis factors significantly associated with increased risk of influenza-associated SARI hospitalization were as follows: younger and older age (<6 months [adjusted odds ratio {aOR}, 37.6], 6–11 months [aOR, 31.9], 12–23 months [aOR, 22.1], 24–59 months [aOR, 7.1], and ≥65 years [aOR, 40.7] compared with 5–24 years of age), underlying medical conditions (aOR, 4.5), human immunodeficiency virus infection (aOR, 4.3), and Streptococcus pneumoniae colonization density ≥1000 deoxyribonucleic acid copies/mL (aOR, 4.8). Underlying medical conditions in children aged <5 years included asthma (aOR, 22.7), malnutrition (aOR, 2.4), and prematurity (aOR, 4.8); in persons aged ≥5 years, conditions included asthma (aOR, 3.6), diabetes (aOR, 7.1), chronic lung diseases (aOR, 10.7), chronic heart diseases (aOR, 9.6), and obesity (aOR, 21.3). Mine workers (aOR, 13.8) and pregnant women (aOR, 12.5) were also at increased risk for influenza-associated hospitalization. Conclusions The risk groups identified in this study may benefit most from annual influenza immunization, and children <6 months of age may be protected through vaccination of their mothers during pregnancy.

Abstract Background Immunization represents one of the most effective intervention in public health. In the Sustainable Development Goals era, adequate vaccination services are still crucial for the prevention of infectious diseases and the reduction of under-5 mortality. However, in 2017 WHO estimated that children <1 year who did not receive the third dose of Diphtheria-Tetanus-Pertussis (DTP3) vaccine were 19.2 million globally, and 600000 of these were located in Angola, a Sub-Saharan country with an estimated DTP3 coverage of 52%. Since 2000, Italian Non-Governmental Organization (NGO) Doctors with Africa CUAMM supports the activity of the hospital of Chiulo in the commune of Mucope (district of Ombadja, south of Angola). Aim of the study is to describe the interventions implemented to strengthen the immunization services performed by the hospital Public Health Staff (PHS). Methods In May 2018 the NGO started to implement multiple interventions to enhance the number of vaccine doses administered. Firstly, outreach immunization sessions were reorganized and reinforced, for example involving local Community Health Workers in the identification of villages with a high burden of unvaccinated children. Other actions were the continuous training of the PHS in data collection and the increased collaboration with the Ombadja District Health Department in order to develop a more efficient vaccine supply chain at local level. Results In 2018, among children <1 year the PHS administered 19746 doses, with a 22.3% growth compared to 2017 (15349 doses). Doses administered during outreach sessions increased by 35.4% (6597 versus 4259 doses). Estimated DTP3 coverage in Mucope commune was 71% (2017, 59%). Conclusions The WHO “Reaching Every Community” strategy emphasizes the importance of high quality immunization services in hard-to-reach areas. The organisation of well-functioning immunization services requires a multifaceted approach by the involved stakeholders. Key messages In 2017, globally 19.2 million of children <1 year did not receive the recommended three DTP doses. Six-hundred thousand were located in Angola. To obtain and sustain an adequate vaccination coverage, especially in hard-to-reach areas, multiple and well-coordinated actions should be implemented by all the involved stakeholders.

AbstractGlobal response to COVID-19 pandemic has inadvertently undermined the achievement of existing public health priorities and laregely overlooked local context. Recent evidence suggests that this will cause additional maternal and childhood mortality and morbidity especially in low- and middle-income countries (LMICs). Here we have explored the contextual factors influencing maternal, neonatal and children health (MNCH) care in Bangladesh, Nigeria and South Africa amidst the pandemic. Our findings suggest that between March and May 2020, there was a reduction in utilisation of basic essential MNCH services such as antenatal care, family planning and immunization due to: a) the implementation of lockdown which triggered fear of contracting the COVID-19 and deterred people from accessing basic MNCH care, and b) a shift of focus towards pandemic, causing the detriment to other health services, and c) resource constraints. Taken together these issues have resulted in compromised provision of basic general healthcare. Given the likelihood of recurrent waves of the pandemic globally, COVID-19 mitigation plans therefore should be integrated with standard care provision to enhance system resilience to cope with all health needs. This commentary suggests a four-point contextualised mitigation plan to safeguard MNCH care during the pandemic using the observed countries as exemplars for LMIC health system adaptations to maintain the trajectory of progress regarding sustainable development goals (SDGs).

Background: Information on cost-effectiveness allows policy-makers to evaluate if they are using currently available resources effectively and efficiently. Our objective is to examine the cost-effectiveness of health interventions to improve maternal, newborn and child health (MNCH) outcomes, to provide global evidence relative to the context of two geographic regions. Methods: We consider interventions across the life course from adolescence to pregnancy and for children up to 5 years old. Interventions included are those that fall within the areas of immunization, child healthcare, nutrition, reproductive health, and maternal/newborn health, and for which it is possible to model impact on MNCH mortality outcomes using the Lives Saved Tool (LiST). Generalized cost-effectiveness analysis (GCEA) was used to derive average cost-effectiveness ratios (ACERs) for individual interventions and combinations (packages). Costs were assessed from the health system perspective and reported in international dollars. Health outcomes were estimated and reported as the gain in healthy life years (HLYs) due to the specific intervention or combination. The model was run for 2 regions: Eastern sub-Saharan Africa (SSA-E) and South-East Asia (SEA). Results: The World Health Organization (WHO) recommended interventions to improve MNCH are generally considered cost-effective, with the majority of interventions demonstrating ACERs below I$100/HLY saved in the chosen settings (low-and middle-income countries [LMICs]). Best performing interventions are consistent across the two regions, and include family planning, neonatal resuscitation, management of pneumonia and neonatal infection, vitamin A supplementation, and measles vaccine. ACERs below I$100 can be found across all delivery platforms, from community to hospital level. The combination of interventions into packages (such as antenatal care) produces favorable ACERs. Conclusion: Within each region there are interventions which represent very good value for money. There are opportunities to gear investments towards high-impact interventions and packages for MNCH outcomes. Cost-effectiveness tools can be used at national level to inform investment cases and overall priority setting processes.

Every year on 24 March, World Tuberculosis Day is commemorated annually, for raising the public awareness regarding devastating consequences of tuberculosison health and economic aspects of life. This helps to launch efforts to end the globalepidemic of tuberculosis. On the date of 24th March in 1882, Dr. Robert Koch announced about the discovery of bacterium that causes tuberculosis.1 It was held on 24th March 1982 first time by The World Health Organization at the 100th anniversary of Dr. Koch’s discovery. The target 3.3 of SDG calls for, by 2030, ending the epidemics of tuberculosis, malaria, AIDS, combat other communicable and water-borne diseases. A large number of people 1.7 billion, roughly 23% of the world's population suffered from tuberculosis. In the world, each year 1.5 million people died due to TB, proving it a leading infectious killer disease. Thirty countries having the high burden of TB, accounted for 87% of new TB cases during 2019.2 Among these, two thirds of the total cases were in India, Indonesia, China, Bangladesh, Philippines, Pakistan, Nigeria, and South Africa. An estimated 510,000 new TB cases are emerging each year in Pakistan. Among these about, 15 000 are developing drug resistant TB cases. Pakistan is bearing 61% of the TB burden in the EMRO. Tuberculosis is preventable and curable disease. The causative agent of tuberculosis, Mycobacterium tuberculosis, most often affect the lungs. The vaccine for tuberculosis (TB) disease is called BCG (Bacille Calmette-Guérin). In 1921, first patient was vaccinated with BCG vaccine, 13 years were spent in the making the vaccine. In countries where TB is common, BCG vaccine is given to infants and small children. It does not always protect people from getting TB. BCG vaccine is included in national Expanded Program on Immunization (EPI) in Pakistan and given at birth. To make TB free Pakistan through universal access to quality TB care, National TB Control Program (NTP) is striving for achieving Zero TB death by reducing 50% prevalence of TB in general population by 2025. The mode of transmission of TB from person to person is through the air. The TB germs are propelled into the air,when people with lung TB cough, sneeze or spit carelessly due to lack of awareness that they are participating in the spread of disease and weakening the efforts. These germs are when inhaled by other people, resulting in lung infection, which is called primary TB. From primary TB infection, majority of people recover withoutany further evidence of the disease. For years the infection may stay inactive (latent). People with TB infection are not contagious, do not have any symptoms, and do not put their friends, co-workers and family at risk. Many people who have latent TB infection never develop TB disease. In these people, the TB bacteria remain inactive for a lifetime without causing disease. But in other people, especially people who have weak immune systems, the bacteria become active, multiply, and cause TB disease. There is good news for people with TB disease! It can almost always be treated and cured with medicine. But the medicine must be taken as directed by Physician. The relapse rate differs by a country's incidence and control: 0–27% of TB relapses occur within 2 years after treatment completion and most relapses occur within 5 years; however, some relapses occur 15 years after treatment. A person who has genital tuberculosis can infect others through sexual contact. The most common means of spreading genital TB can be through blood or lymph. Hence, sexual contact can spread genital tuberculosis. Genital tuberculosis can spread to any other body organ, once it enters the body. Consuming a diet high in nutritious foods and beverages is a smart way to support and protect lung health. Coffee, dark leafy greens, fatty fish, peppers, tomatoes, olive oil, oysters, blueberries, and pumpkin are just some examples of foods and drinks that have been shown to benefit lung function. Milk can be used by TB patient. It is also a great source of protein, providing strength necessary to perform day-to-day activities. Directly observed treatment, short-course (DOTS, also known as TB-DOTS) is the name given to the tuberculosis (TB) control strategy recommended by the World Health Organization. According to WHO, "The most cost-effective way to stop the spread of TB in communities with a high incidence is by curing it. The usual treatment is: two antibiotics (isoniazid and rifampicin) for 6 months, two additional antibiotics (pyrazinamide and ethambutol) for the first 2 months of the 6-month treatment period. Groups with high rates of TB transmission are homeless persons, injection drug users, and persons with HIV infection are more susceptible for TB and persons who have immigrated from areas of the world with high rates of TB. The disease is prevalent mainly in the underprivileged sections of the society. The lack of knowledge in the masses and the communities is a factor that contributes largely to the spread of the disease. The theme of World TB Day 2020 was “It's TIME to end TB” and in 2021 it is,” Am I stopping TB” highlighting the importance of awareness. It is the time to fuel the awareness program with full energy, resources and ways. In such a scenario, there is always a need for new and innovative ideas to create mass awareness about tuberculosis. The more focus of this awareness campaign should be very much targeted towards people living in an area where there are a lot of people are with TB, or have been homeless or live in poorly ventilated or overcrowded housing and sufferers of a weakened immune system.