Canadian International Immunization Initiative (CIII2) / l’initiative canadienne d’immunisation internationale

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    Analysis of Helicobacter pylori isolates from Chile: occurrence of selective type 1 Lewis b antigen expression in lipopolysaccharide
    (2008) Altman, Eleonora; Fernandez, H; Chandan, V; Harrison, B A; Schuster, M W
    Previous studies have shown that the LPS of Helicobacter pylori isolated from North American and European hosts predominantly expresses type 2 Lewis x (Lex) and Ley epitopes, whilst the LPS from Asian strains has the capacity to express type 1 Lea and Leb structures. The aim of this study was to evaluate the expression of Le antigens and the cytotoxin-associated antigen (CagA) by H. pylori isolates from Chile. A total of 38 isolates were screened. The expression of Le antigens and CagA was determined by whole-cell indirect ELISA, using commercially available monoclonal anti-Le and polyclonal anti-CagA antibodies. LPS profiles of H. pylori isolates were assessed by gel electrophoresis and Western blotting. Expression of Lex and/or Ley epitopes was confirmed in 32/38 isolates (84 %), whilst 9/38 isolates (24 %) expressed type 1 Leb blood group determinants, in addition to type 2 Lex and Ley structures. Six strains (16 %) were non-typeable. The majority of H. pylori strains examined were CagA-positive (83.3 %).
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    Low male-to-female sex ratio of children born in India: national survey of 1.1 million households
    (2006-01) Jha, P; Kumar, R; Vasa, P; Dhingra, N; Thiruchelvam, D
    Background: Fewer girls than boys are born in India. Various hypotheses have been proposed to explain this low sex ratio. Our aim was to ascertain the contribution of prenatal sex determination and selective abortion as measured by previous birth sex. Methods: We analysed data obtained for the Special Fertility and Mortality Survey undertaken in 1998. Ever-married women living in 1.1 million households in 6671 nationally-representative units were asked questions about their fertility history and children born in 1997. Findings: For the 133 738 births studied for 1997, the adjusted sex ratio for the second birth when the preceding child was a girl was 759 per 1000 males (99% CI 731—787). The adjusted sex ratio for the third child was 719 (675—762) if the previous two children were girls. By contrast, adjusted sex ratios for second or third births if the previous children were boys were about equal (1102 and 1176, respectively). Mothers with grade 10 or higher education had a significantly lower adjusted sex ratio (683, 610—756) than did illiterate mothers (869, 820—917). Stillbirths and neonatal deaths were more commonly male, and the numbers of stillbirths were fewer than the numbers of missing births, suggesting that female infanticide does not account for the difference. Interpretation: Prenatal sex determination followed by selective abortion of female fetuses is the most plausible explanation for the low sex ratio at birth in India. Women most clearly at risk are those who already have one or two female children. Based on conservative assumptions, the practice accounts for about 0·5 million missing female births yearly, translating over the past 2 decades into the abortion of some 10 million female fetuses.
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    Prospective Study of One Million Deaths in India: Rationale, Design, and Validation Results
    (2005-12) Jha, Prabhat; Vendhan Gajalakshmi, Vendhan; Gupta, Prakash C; Kumar, Rajesh; Mony, Prem
    Background: Over 75% of the annual estimated 9.5 million deaths in India occur in the home, and the large majority of these do not have a certified cause. India and other developing countries urgently need reliable quantification of the causes of death. They also need better epidemiological evidence about the relevance of physical (such as blood pressure and obesity), behavioral (such as smoking, alcohol, HIV-1 risk taking, and immunization history), and biological (such as blood lipids and gene polymorphisms) measurements to the development of disease in individuals or disease rates in populations. We report here on the rationale, design, and implementation of the world’s largest prospective study of the causes and correlates of mortality. Methods and Findings: We will monitor nearly 14 million people in 2.4 million nationally representative Indian households (6.3 million people in 1.1 million households in the 1998–2003 sample frame and 7.6 million people in 1.3 million households in the 2004–2014 sample frame) for vital status and, if dead, the causes of death through a well-validated verbal autopsy (VA) instrument. About 300,000 deaths from 1998–2003 and some 700,000 deaths from 2004–2014 are expected; of these about 850,000 will be coded by two physicians to provide causes of death by gender, age, socioeconomic status, and geographical region. Pilot studies will evaluate the addition of physical and biological measurements, specifically dried blood spots. Preliminary results from over 35,000 deaths suggest that VA can ascertain the leading causes of death, reduce the misclassification of causes, and derive the probable underlying cause of death when it has not been reported. VA yields broad classification of the underlying causes in about 90% of deaths before age 70. In old age, however, the proportion of classifiable deaths is lower. By tracking underlying demographic denominators, the study permits quantification of absolute mortality rates. Household case-control, proportional mortality, and nested case-control methods permit quantification of risk factors. Conclusions: This study will reliably document not only the underlying cause of child and adult deaths but also key risk factors (behavioral, physical, environmental, and eventually, genetic). It offers a globally replicable model for reliably estimating cause-specific mortality using VA and strengthens India’s flagship mortality monitoring system. Despite the misclassification that is still expected, the new cause-of-death data will be substantially better than that available previously.
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    Human resource management in the Georgian National Immunization Program: a baseline assessment
    (2007-07) Esmail, Laura C; Cohen-Kohler, Jillian Clare; Djibuti, Mamuka
    Background: Georgia's health care system underwent dramatic reform after gaining independence in 1991. The decentralization of the health care system was one of the core elements of health care reform but reports suggest that human resource management issues were overlooked. The Georgian national immunization program was affected by these reforms and is not functioning at optimum levels. This paper describes the state of human resource management practices within the Georgian national immunization program in late 2004. Methods: Thirty districts were selected for the study. Within these districts, 392 providers and thirty immunization managers participated in the study. Survey questionnaires were administered through face-to-face interviews to immunization managers and a mail survey was administered to immunization providers. Qualitative data collection involved four focus groups. Analysis of variance (ANOVA) and Chi-square tests were used to test for differences between groups for continuous and categorical variables. Content analysis identified main themes within the focus groups. Results: Weak administrative links exist between the Centres of Public Health (CPH) and Primary Health Care (PHC) health facilities. There is a lack of clear management guidelines and only 49.6% of all health providers had written job descriptions. A common concern among all respondents was the extremely inadequate salary. Managers cited lack of authority and poor knowledge and skills in human resource management. Lack of resources and infrastructure were identified as major barriers to improving immunization. Conclusion: Our study found that the National Immunization Program in Georgia was characterized by weak organizational structure and processes and a lack of knowledge and skills in management and supervision, especially at peripheral levels. The development of the skills and processes of a well-managed workforce may help improve immunization rates, facilitate successful implementation of remaining health care reforms and is an overall, wise investment. However, reforms at strategic policy levels and across sectors will be necessary to address the systemic financial and health system constraints impeding the performance of the immunization program and the health care system as a whole.
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    Human resources for health challenges of public health system reform in Georgia
    (2008-05) Djibuti, Mamuka; Gotsadze, George; Mataradze, George; Menabde, George
    Background: Human resources (HR) are one of the most important components determining performance of public health system. The aim of this study was to assess adequacy of HR of local public health agencies to meet the needs emerging from health care reforms in Georgia. Methods: We used the Human Resources for Health Action Framework, which includes six components: HR management, policy, finance, education, partnerships and leadership. The study employed: (a) quantitative methods: from September to November 2004, 30 randomly selected district Centers of Public Health (CPH) were surveyed through face-to-face interviews with the CPH director and one public health worker randomly selected from all professional staff; and (b) qualitative methods: in November 2004, Focus Group Discussions (FGD) were held among 3 groups: a) 12 district public health professionals, b) 11 directors of district public health centers, and c) 10 policy makers at central level. Results: There was an unequal distribution of public health workers across selected institutions, with lack of professionals in remote rural district centers and overstaffing in urban centers. Survey respondents disagreed or were uncertain that public health workers possess adequate skills and knowledge necessary for delivery of public health programs. FGDs shed additional light on the survey findings that there is no clear vision and plans on HR development. Limited budget, poor planning, and ignorance from the local government were mentioned as main reasons for inadequate staffing. FGD participants were concerned with lack of good training institutions and training programs, lack of adequate legislation for HR issues, and lack of necessary resources for HR development from the government. Conclusion: After ten years of public health system reforms in Georgia, the public health workforce still has major problems such as irrational distribution and inadequate knowledge and skills. There is an urgent need for re-training and training programs and development of conducive policy environment with sufficient resources to address these problems and assure adequate functionality of public health programs.
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    System-level determinants of immunization coverage disparities among health districts in Burkina Faso : a multiple case study
    (BioMed Central, London, GB, 2009) Haddad, Slim; Bicaba, Abel; Feletto, Marta; Taminy, Elie; Kabore, Moussa
    This paper focuses on system-related factors that can explain disparities in immunization coverage among districts in Burkina Faso. This study shows that strong and committed leadership promotes an effective mobilization of teams and creates conditions for good performance in health districts. However, the discourse on factors that determine the performance of local health care favours technocratic and financial considerations, targeting institutional reforms, availability of resources, or accessibility of health services. The leadership role of those responsible for the district, and who may be labelled as “the human factor” in the performance of local health care systems is mentioned only marginally.
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    Determinants of parents' reticence toward vaccination in urban areas in Benin (West Africa)
    (BioMed Central, London, GB, 2009) Fourn, Léonard; Haddad, Slim; Fournier, Pierre; Gansey, Roméo
    Analysis of the data reveals those who are vaccination-reticent say it goes against the will of God, that it is a poison from the “white witch doctor,” and a sin. Members of the control group argued against this, but without conviction. They adhere to the principle of obedience to authority, a biblical precept invoked when the vaccinators oblige them to vaccinate their children. To limit the spread of this phenomenon among the religious population of the cities like Parakou and Cotonou in Benin, more detailed information and negotiation between health authorities and pastors of the churches are essential.
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    Evaluation of immunization coverage within the Expanded Program on Immunization in Kita Circle, Mali : a cross-sectional survey
    (BioMed Central, London, GB, 2009) Koumaré, Abdel Karim; Traore, Drissa; Haidara, Fatouma; Sissoko, Filifing; Traoré, Issa
    A survey in 2006 determined the level of vaccination coverage among children aged 12 to 23 months in Kita Circle (Mali), after implementation of the priority program to improve immunization coverage. According to the vaccination cards, results showed that 59.9% of the children were fully vaccinated, while according to the mothers’ declarations the rate was 74.1%. The study found no difference associated with parents’ knowledge about the expanded immunization diseases, distance from the health centre, or socio-economic status. The evaluation of the vaccination coverage rates shows that there is improvement but that efforts should continue.
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    Monitoring the performance of the Expanded Program on Immunization : the case of Burkina Faso
    (BioMed Central, London, GB, 2009) Haddad, Slim; Kabore, Moussa; Taminy, Emile; Feletto, Marta; Fournier, Pierre
    The article describes levels of immunization coverage and their trends according to an array of indicators. Performance differences are illustrated by amplitudes and maximum/minimum ratios. Results show that the health regions’ performances vary according to how they are evaluated (for instance on the basis of “full immunization coverage” which may include vaccination status of children who have not completed their vaccinations). The health regions encompass a variety of realities, and different efforts of intensity would be required to reach all the target populations. The study uses data from surveys carried out in Burkina Faso: 1993, 1998 and 2003 Demographic and Health Surveys.
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    Role of supportive supervision on immunization program outcome - a randomized field trial from Georgia
    (BioMed Central, London, GB, 2009) Djibuti, Mamuka; Gotsadze, George; Zoidze, Akaki; Mataradze, George; Esmail, Laura C.; Kohler, Jillian Clare
    The study documented the effects of “supportive supervision” on performance of the immunization program at the district(s) level in the Republic of Georgia. The intervention independently contributed to relative improvements in district-level service delivery outcomes such as vaccine wastage factors and the DPT-3 immunization coverage rate. The clear positive improvement in all service delivery outcomes across both the intervention and control districts can be attributed to an overall improvement in the Georgian population’s access to health care. Among immunization managers, the intervention contributed to improved knowledge of supportive supervision.
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    Assessment of factors associated with complete immunization coverage in children aged 12-23 months : a cross-sectional study in Nouna district, Burkina Faso
    (BioMed Central, London, GB, 2009) Sanou, Aboubakary; Simboro, Seraphin; Kouyaté, Bocar; Dugas, Marylène; Graham, Janice; Bibeau, Gilles
    This study identifies specific factors associated with immunization status in Nouna health district (Burkina Faso) in order to advance improved intervention strategies in this district and in those with similar environmental and social contexts. While comprehensive communication may improve understanding about immunization, local interventions should also take into account religious specificities and critical economic periods. Communication problems need to be examined; for instance, many respondents did not understand what the health workers wanted; and or they assumed their child was already totally immunized. Particular approaches that take into consideration local distinctions need to be applied.
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    Portrait of a lengthy vaccination trajectory in Burkina Faso : from cultural acceptance of vaccines to actual immunization
    (BioMed Central, London, GB, 2009) Dugas, Marylène; Dubé, Eric; Kouyaté, Bocar; Sanou, Aboubakary; Bibeau, Gilles
    Some obstacles still hamper the achievement of good vaccination coverage. In the health district of Nouna (Burkina Faso) three elements emerged from the analysis: the empirical conceptions of childhood diseases, the perceived efficacy of vaccine and the knowledge of appropriate age for vaccination uptake; the gap between the decision-making process and the actual achievement of vaccination; and the vaccination procedure leading to vaccination uptake.
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    Evidence-based discussion increases childhood vaccination uptake : a randomised cluster controlled trial of knowledge translation in Pakistan
    (BioMed Central, London, GB, 2009) Andersson, Neil; Cockcroft, Anne; Ansari, Noor M.; Omer, Khalid; Baloch, Manzoor
    The relatively low-cost knowledge translation intervention applied in this study significantly increased vaccine uptake, without relying on improved services, in a poor district (Lasbela, Pakistan) with limited access to services. The study results prove relevant towards better vaccination coverage in developing countries. The intervention comprised three structured discussions separately with male and female groups in each cluster. Adjusting for baseline differences between intervention and control clusters with generalized estimating equations, the intervention doubled the odds of measles vaccination in the intervention communities (OR 2.20, 95% CI 1.24-3.88). It trebled the odds of full DPT vaccination (OR 3.36, 95% CI 2.03-5.56).
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    Equity and vaccine uptake : a cross-sectional study of measles vaccination in Lasbela District, Pakistan
    (BioMed Central, London, GB, 2009) Mitchell, Steven; Andersson, Neil; Ansari, Noor Mohammad; Omer, Khalid; Legorreta Soberanis, José; Cockcroft, Anne
    Vaccination coverage is lower in most developing countries, particularly in the poorest segments of these countries. Although vaccination is theoretically free, this does not account for costs of travel to the facilities and time away from work or home. In both urban and rural areas, access to a government facility providing vaccinations, a key equity factor, was a determining factor for uptake. This cross-sectional study of communities in the Lasbela district of south Pakistan, explores knowledge, attitudes and discussion around measles vaccination. Findings illustrate the role of equity in determining vaccination uptake.
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    Knowledge synthesis of benefits and adverse effects of measles vaccination : the Lasbela balance sheet
    (BioMed Central, London, GB, 2009) Ledogar, Robert J.; Fleming, John; Andersson, Neil
    Specific local conditions may explain the low rates of measles among the unvaccinated, while the high vaccine failure rate is likely due to weaknesses in the vaccination delivery system. Community perception of these realities may have had some role in household decisions about whether to vaccinate, although the major discouraging factor was inadequate access to health care. The article provides a balance sheet approach to weighing the evidence regarding benefits and possible adverse effects of measles vaccination. The balance sheet synthesizes published information on risks of adverse effects of vaccination and risks for the same outcomes as complications of naturally occurring measles. The difference in risk of each outcome is presented as the risk difference (RD).
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    Increasing the demand for childhood vaccination in developing countries : a systematic review
    (BioMed Central, London, GB, 2009) Shea, Beverley; Andersson, Neil; Henry, David
    This article provides a systematic review of 60 studies of evidence for improving routine vaccination programs in developing countries. Mass media campaigns may be effective, but the impact depends on access to media and may be costly if run at a local level. Interventions to increase demand for routine childhood vaccination have not been adequately investigated. Collateral-free credit to poor women may improve their autonomy and capacity to care for their families, including vaccination. However, attempts to maintain or increase deteriorating vaccination coverage almost all focus on supply side interventions: improving availability and delivery of vaccines.
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    One size does not fit all : local determinants of measles vaccination in four districts of Pakistan
    (BioMed Central, London, GB, 2009) Cockcroft, Anne; Andersson, Neil; Omer, Khalid; Ansari, Noor M.; Khan, Amir; Chaudhry, Ubaid Ullah; Ansari, Umaira
    Common factors are associated with vaccination. However, despite common factors the pattern of variables related to measles vaccination differs between and within districts. In this study children were more likely to receive measles vaccination if their mother had any formal education, if she knew at least one vaccine preventable disease, and if she had not heard of any bad effects of vaccination. In rural areas, living within 5 km of a vaccination facility or in a community visited by a vaccination team were factors associated with vaccination, as was the mother receiving information about vaccinations.
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    Global immunization : status, progress, challenges and future
    (BioMed Central, London, GB, 2009) Duclos, Philippe; Okwo-Bele, Jean-Marie; Gacic-Dobo, Marta; Cherian, Thomas
    This paper briefly reviews global progress and challenges with respect to public vaccination programmes. New vaccine introduction should be viewed as an opportunity to strengthen immunization systems, increase vaccine coverage and reduce inequities of access to immunization services. Global vaccination coverage trends continued to be positive. The Global Immunization Vision and Strategy (GIVS) was developed by WHO and UNICEF as a framework for strengthening national immunization programmes by expanding the reach of immunization, including new vaccines, to every eligible person.
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    Fallacy of coverage : uncovering disparities to improve immunization rates through evidence; results from the Canadian International Immunization Initiative, Phase 2 - Operational Research Grants
    (BioMed Central, London, GB, 2009) Mhatre, Sharmila L.; Schryer-Roy, Anne-Marie
    The evidence points to a “fallacy of coverage,” and provides reasons for lack of effective immunization coverage. Five themes are: timeliness of immunization; social and gender inequities; vaccine efficacy; understanding demand side issues to tailor interventions; and national data sets that mask actual district level coverage rates. The research results demonstrate how locally generated evidence can inform immunization strategies to ensure that children who need to get vaccinated will get vaccinated, and vaccinated on time. Funding for improving immunization should focus not only on increasing coverage, but also on future diseases and vaccines.
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    Governance, Equity and Health : evaluation report 2006-2011
    (IDRC, Ottawa, ON, CA, 2010) IDRC. Governance, Equity and Health Program
    During the first four years of Phase II (2006 – 2010), the GEH program managed 97 projects, with recipient institutions in 34 countries. GEH supports Southern researchers and institutions committed to democracy, health equity and social justice by enabling knowledge-generation and exchange, and by influencing how research on health systems is conducted and applied, especially in the context of health reforms. This evaluation report presents some of GEH key research findings, summarizes GEH’s three most significant interlinked program outcomes, provides brief reflections on challenges faced in relation to each of these three outcome categories, and summarizes lessons learned.