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Article ; Online: Positioning implementation science in national immunization programmes to improve coverage equity and advance progress toward Immunization Agenda 2030: An urgent global health imperative.

Adamu, Abdu A / Ndwandwe, Duduzile / Jalo, Rabiu I / Wiysonge, Charles S

2024 Volume 20, Issue 1, Page(s) 2331872

Abstract: Despite the availability of effective vaccines for preventing common childhood infectious diseases, there is still significant disparities in access and utilization across many low- and middle-income countries (LMIC). The factors that drive these ... ...

Abstract	Despite the availability of effective vaccines for preventing common childhood infectious diseases, there is still significant disparities in access and utilization across many low- and middle-income countries (LMIC). The factors that drive these disparities are often multilevel, originating from individuals, health facilities, health systems and communities, and also multifaceted. Implementation science has emerged as a field to help address "know-do" gaps in health systems, and can play a significant role in strengthening immunization systems to understand and solve implementation barriers that limit access and uptake within their contexts. This article presents a reflexive perspective on how to position implementation research in immunization programmes to improve coverage equity. Furthermore, key points of synergy between implementation research and vaccination are highlighted, and some potential practice changes that can be applied within specific contexts were proposed. Using a human rights lens, it was concluded that the cost that is associated with implementation failure in immunization programmes is significant and unjust, and future directions for implementation research to optimize its application in practice settings have been recommended.
MeSH term(s)	Humans ; Child ; Global Health ; Implementation Science ; Vaccination ; Immunization ; Vaccines ; Immunization Programs
Chemical Substances	Vaccines
Language	English
Publishing date	2024-03-31
Publishing country	United States
Document type	Journal Article
ZDB-ID	2664176-8
ISSN	2164-554X ; 2164-5515
ISSN (online)	2164-554X
ISSN	2164-5515
DOI	10.1080/21645515.2024.2331872
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Article: Assessing the Implementation Determinants of Pilot Malaria Vaccination Programs in Ghana, Kenya, and Malawi through a Complexity Lens: A Rapid Review Using a Consolidated Framework for Implementation Research.

Adamu, Abdu A / Jalo, Rabiu I / Ndwandwe, Duduzile / Wiysonge, Charles S

Vaccines

2024 Volume 12, Issue 2

Abstract: In 2019, national immunization programs in Ghana, Kenya, and Malawi commenced the implementation of RTS,S/AS01 vaccination in large-scale pilot schemes. Understanding the implementation context of this malaria vaccination in the pilot countries can ... ...

Abstract	In 2019, national immunization programs in Ghana, Kenya, and Malawi commenced the implementation of RTS,S/AS01 vaccination in large-scale pilot schemes. Understanding the implementation context of this malaria vaccination in the pilot countries can provide useful insights for enhancing implementation outcomes in new countries. There has not yet been a proper synthesis of the implementation determinants of malaria vaccination programs. A rapid review was conducted to identify the implementation determinants of the pilot malaria vaccination programs in Ghana, Kenya, and Malawi, and describe the mechanism by which these determinants interact with each other. A literature search was conducted in November 2023 in PubMed and Google Scholar to identify those studies that described the factors affecting malaria vaccine implementation in Ghana, Kenya, and Malawi. Thirteen studies conducted between 2021 and 2023 were included. A total of 62 implementation determinants of malaria vaccination across all five domains of the consolidated framework for implementation research (CFIR) were identified. A causal loop diagram showed that these factors are interconnected and interrelated, identifying nine reinforcing loops and two balancing loops. As additional countries in Africa prepare for a malaria vaccine roll-out, it is pertinent to ensure that they have access to adequate information about the implementation context of countries that are already implementing malaria vaccination programs so that they understand the potential barriers and facilitators. This information can be used to inform context-specific systems enhancement to maximize implementation success. Going forward, primary implementation studies that incorporate the causal loop diagram should be integrated into the malaria vaccine implementation program to enable immunization program managers and other key stakeholders to identify and respond to emerging implementation barriers in a timely and systematic manner, to improve overall implementation performance.
Language	English
Publishing date	2024-01-23
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2703319-3
ISSN	2076-393X
ISSN	2076-393X
DOI	10.3390/vaccines12020111
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Article ; Online: Informal health sector and routine immunization: making the case for harnessing the potentials of patent medicine vendors for the big catch-up to reduce zero-dose children in sub-Saharan Africa.

Adamu, Abdu A / Jalo, Rabiu I / Ndwandwe, Duduzile / Wiysonge, Charles S

Frontiers in public health

2024 Volume 12, Page(s) 1353902

Abstract: The COVID-19 pandemic caused a surge in the number of unimmunized and under-immunized children in Africa. The majority of unimmunized (or zero-dose) children live in hard-to-reach rural areas, urban slums, and communities affected by conflict where ... ...

Abstract	The COVID-19 pandemic caused a surge in the number of unimmunized and under-immunized children in Africa. The majority of unimmunized (or zero-dose) children live in hard-to-reach rural areas, urban slums, and communities affected by conflict where health facilities are usually unavailable or difficult to access. In these settings, people mostly rely on the informal health sector for essential health services. Therefore, to reduce zero-dose children, it is critical to expand immunization services beyond health facilities to the informal health sector to meet the immunization needs of children in underserved places. In this perspective article, we propose a framework for the expansion of immunization services through the informal health sector as one of the pillars for the big catch-up plan to improve coverage and equity. In African countries like Nigeria, Ethiopia, Tanzania, and the Democratic Republic of Congo, patent medicine vendors serve as an important informal health sector provider group, and thus, they can be engaged to provide immunization services. A hub-and-spoke model can be used to integrate patent medicine vendors into the immunization system. A hub-and-spoke model is a framework for organization design where services that are provided by a central facility (hub) are complimented by secondary sites (spokes) to optimize access to care. Systems thinking approach should guide the design, implementation, and evaluation of this model.
MeSH term(s)	Child ; Humans ; Pandemics ; Vaccination ; Immunization ; Nigeria ; Ethiopia
Language	English
Publishing date	2024-03-07
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2711781-9
ISSN	2296-2565 ; 2296-2565
ISSN (online)	2296-2565
ISSN	2296-2565
DOI	10.3389/fpubh.2024.1353902
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Article ; Online: Toward political economy of sustainable financing for immunization in the World Health Organization African Region through a systems thinking lens.

Adamu, Abdu A / Essoh, Téné-Alima / Jalo, Rabiu I / Wiysonge, Charles S

International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases

2023 Volume 136, Page(s) 158–161

Abstract: There is an urgent need for countries in Africa to allocate more domestic financial resources to immunization so that national immunization programmes can attain self-reliance in line with World Health Organization's Immunization Agenda 2030. However, ... ...

Abstract	There is an urgent need for countries in Africa to allocate more domestic financial resources to immunization so that national immunization programmes can attain self-reliance in line with World Health Organization's Immunization Agenda 2030. However, resource allocation is fundamentally a political process because other competing needs exist. Political economy analysis (PEA) can guide policy influencers in their engagement with decision makers to tilt their interest in support of sustainable immunization financing. PEA can provide a deeper understanding of the potential constraints and facilitators of a policy direction to expand the fiscal space for immunization using domestic resources within the context of a country's socioeconomic and political realities. To further advance the usefulness of PEA for decision making, a systems thinking lens should be applied to account for the inherent complexity of the social systems involved in resource allocation and implementation. Several methods and tools of systems thinking already exist and can be employed. Causal loop diagrams, when incorporated in a PEA of sustainable financing for immunization can aid the identification of feedback loops which can be used as leverage points for intervention.
MeSH term(s)	Humans ; Vaccination ; Immunization ; World Health Organization ; Africa ; Systems Analysis
Language	English
Publishing date	2023-09-27
Publishing country	Canada
Document type	Journal Article
ZDB-ID	1331197-9
ISSN	1878-3511 ; 1201-9712
ISSN (online)	1878-3511
ISSN	1201-9712
DOI	10.1016/j.ijid.2023.09.017
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Article ; Online: Sustainable financing for vaccination towards advancing universal health coverage in the WHO African region: The strategic role of national health insurance.

Adamu, Abdu A / Jalo, Rabiu I / Muhammad, Ibrahim D / Essoh, Téné-Alima / Ndwandwe, Duduzile / Wiysonge, Charles S

Human vaccines & immunotherapeutics

2024 Volume 20, Issue 1, Page(s) 2320505

Abstract: There is a growing political interest in health reforms in Africa, and many countries are choosing national health insurance as their main financing mechanism for universal health coverage. Although vaccination is an essential health service that can ... ...

Abstract	There is a growing political interest in health reforms in Africa, and many countries are choosing national health insurance as their main financing mechanism for universal health coverage. Although vaccination is an essential health service that can influence progress toward universal health coverage, it is not often prioritized by these national health insurance systems. This paper highlights the potential gains of integrating vaccination into the package of health services that is provided through national health insurance and recommends practical policy actions that can enable countries to harness these benefits at population level.
MeSH term(s)	Humans ; Universal Health Insurance ; Healthcare Financing ; National Health Programs ; Africa ; World Health Organization ; Insurance, Health
Language	English
Publishing date	2024-02-27
Publishing country	United States
Document type	Journal Article
ZDB-ID	2664176-8
ISSN	2164-554X ; 2164-5515
ISSN (online)	2164-554X
ISSN	2164-5515
DOI	10.1080/21645515.2024.2320505
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Article ; Online: Exploring the factors contributing to low vaccination uptake for nationally recommended routine childhood and adolescent vaccines in Kenya.

Essoh, Tene-Alima / Adeyanju, Gbadebo Collins / Adamu, Abdu A / Tall, Haoua / Aplogan, Aristide / Tabu, Collins

BMC public health

2023 Volume 23, Issue 1, Page(s) 912

Abstract: Background: Vaccination remains the most effective means of reducing the burden of infectious disease among children. It is estimated to prevent between two to three million child deaths annually. However, despite being a successful intervention, basic ... ...

Abstract	Background: Vaccination remains the most effective means of reducing the burden of infectious disease among children. It is estimated to prevent between two to three million child deaths annually. However, despite being a successful intervention, basic vaccination coverage remains below the target. About 20 million infants are either under or not fully vaccinated, most of whom are in Sub-Saharan Africa region. In Kenya, the coverage is even lower at 83% than the global average of 86%. The objective of this study is to explore the factors that contribute to low demand or vaccine hesitancy for childhood and adolescent vaccines in Kenya. Methods: The study used qualitative research design. Key Informant Interviews (KII) was used to obtain information from national and county-level key stakeholders. In-depth Interviews (IDI) was done to collect opinions of caregivers of children 0-23 months and adolescent girls eligible for immunization, and Human papillomavirus (HPV) vaccine respectively. The data was collected at the national level and counties such as Kilifi, Turkana, Nairobi and Kitui. The data was analyzed using thematic content approach. A total of 41 national and county-level immunization officials and caregivers formed the sample. Results: Insufficient knowledge about vaccines, vaccine supply issues, frequent healthcare worker's industrial action, poverty, religious beliefs, inadequate vaccination campaigns, distance to vaccination centers, were identified as factors driving low demand or vaccine hesitancy against routine childhood immunization. While factors driving low uptake of the newly introduced HPV vaccine were reported to include misinformation about the vaccine, rumors that the vaccine is a form of female contraception, the suspicion that the vaccine is free and available only to girls, poor knowledge of cervical cancer and benefits of HPV vaccine. Conclusions: Rural community sensitization on both routine childhood immunization and HPV vaccine should be key activities post COVID-19 pandemic. Likewise, the use of mainstream and social media outreaches, and vaccine champions could help reduce vaccine hesitancy. The findings are invaluable for informing design of context-specific interventions by national and county-level immunization stakeholders. Further studies on the relationship between attitude towards new vaccines and connection to vaccine hesitancy is necessary.
MeSH term(s)	Infant ; Child ; Humans ; Adolescent ; Female ; Kenya/epidemiology ; Pandemics ; COVID-19 ; Vaccination ; Papillomavirus Infections/prevention & control ; Papillomavirus Vaccines/therapeutic use ; Uterine Cervical Neoplasms/prevention & control ; Health Knowledge, Attitudes, Practice
Chemical Substances	Papillomavirus Vaccines
Language	English
Publishing date	2023-05-19
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2041338-5
ISSN	1471-2458 ; 1471-2458
ISSN (online)	1471-2458
ISSN	1471-2458
DOI	10.1186/s12889-023-15855-w
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Article: Missed Opportunities for Vaccination and Associated Factors among Children Attending Primary Health Care Facilities in Cape Town, South Africa: A Pre-Intervention Multilevel Analysis.

Nnaji, Chukwudi A / Wiysonge, Charles S / Adamu, Abdu A / Lesosky, Maia / Mahomed, Hassan / Ndwandwe, Duduzile

Vaccines

2022 Volume 10, Issue 5

Abstract: Despite the substantial efforts at ensuring universal access to routine immunisation services among children in South Africa, major gaps in immunisation coverage remain. This study assessed the magnitude of missed opportunities for vaccination (MOV) and ... ...

Abstract	Despite the substantial efforts at ensuring universal access to routine immunisation services among children in South Africa, major gaps in immunisation coverage remain. This study assessed the magnitude of missed opportunities for vaccination (MOV) and associated factors among children aged 0-23 months attending primary health care (PHC) facilities in Cape Town. We used multilevel binomial logistic regression models to explore individual and contextual factors associated with MOV, with children aged 0-23 months at Level 1, nested within PHC facilities (Level 2). A total of 674 children and their caregivers were enrolled. MOV prevalence was 14.1%, ranging from 9.1% to 18.9% across sub-districts. Dose-specific MOV prevalence was highest for the second dose of measles vaccine (9.5%) and lowest for the first dose of rotavirus vaccine (0.6%). The likelihood of a child experiencing MOV was significantly associated with caregivers' low level of education (Odds ratio (OR) = 3.53, 95% credible interval (CrI): 1.13-11.03), recent receipt of immunisation messages (OR = 0.46, 95%CrI: 0.25-0.87), shared immunisation decision making by both parents (OR = 0.21, 95%CrI: 0.07-0.62) and health facility staff number (OR = 0.18, 95%CrI: 0.06-0.61). The burden of MOV among children in Cape Town is influenced by individual and contextual factors, which provide important opportunities for quality improvement and broader strategies to improve routine immunisation service delivery.
Language	English
Publishing date	2022-05-16
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2703319-3
ISSN	2076-393X
ISSN	2076-393X
DOI	10.3390/vaccines10050785
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Article: Individual journeys to tuberculosis care in Nigeria's private sector during the COVID-19 pandemic.

Oga-Omenka, Charity / Rosapep, Lauren / Baruwa, Elaine / Huria, Lavanya / Vasquez, Nathaly Aquilera / Faleye, Bolanle Olusola / Kafi, Md Abdullah Heel / Sassi, Angelina / Nwosu, Chimdi / Johns, Benjamin / Adamu, Abdu / Chijioke-Akaniro, Obioma / Anyaike, Chukwuma / Pai, Madhukar

BMJ global health

2024 Volume 9, Issue 1

Abstract: Background: Pre-COVID-19, individuals with tuberculosis (TB) in Nigeria were often underdiagnosed and untreated. TB services were mostly in the public sector with only 15% of new cases in 2019 reported from the private sector. Reports highlighted ... ...

Abstract	Background: Pre-COVID-19, individuals with tuberculosis (TB) in Nigeria were often underdiagnosed and untreated. TB services were mostly in the public sector with only 15% of new cases in 2019 reported from the private sector. Reports highlighted challenges in accessing care in the private sector, which accounted for 67% of all initial care-seeking. Our study examined patients' health seeking pathways for TB in Nigeria's private sector and explored any changes to care pathways during COVID-19. Methods: We conducted 180 cross-sectional surveys and 20 in-depth interviews with individuals having chest symptoms attending 18 high-volume private clinics and hospitals in Kano and Lagos States. Questions focused on sociodemographic characteristics, health-seeking behaviour, and pathways to care during the COVID-19 pandemic. All surveys and interviews were conducted in May 2021. Results: Most participants were male (111/180), with an average age of 37. Half (96/180) sought healthcare within a week of symptoms, while few (20/180) waited over 2 months. Individuals testing positive for TB had more health-seeking delays, and those testing negative for TB had more provider delays. On average, participants visited two providers in Kano and 1.69 in Lagos, with 61 of 180 in Kano and 48 of 180 in Lagos visiting other providers before the recruitment facility. Private providers were the initial encounters for most participants (60/180 in Kano, 83/180 in Lagos). Most respondents (164/180) experienced short-lived pandemic-related restrictions, affecting access to transportation, and closed facilities. Conclusions: This study showed a few challenges in accessing TB care, necessitating continued investment in healthcare infrastructure and resources, particularly in the private sector. Understanding the different care pathways and delays in care provides opportunities for targeted interventions to improve deployment of services closer to where patients first seek care.
MeSH term(s)	Humans ; Male ; Adult ; Female ; COVID-19 ; Cross-Sectional Studies ; Nigeria/epidemiology ; Pandemics ; Private Sector ; Tuberculosis/epidemiology ; Tuberculosis/therapy
Language	English
Publishing date	2024-01-09
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	2059-7908
ISSN	2059-7908
DOI	10.1136/bmjgh-2023-013124
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Article ; Online: Scoping review of African health histories: a protocol.

Karamagi, Humphrey Cyprian / Oduwole, Elizabeth O / Sy, Sokona / Adamu, Abdu A / Seydi, Aminata B W / Wiysonge, Charles S

BMJ open

2023 Volume 13, Issue 11, Page(s) e075787

Abstract: Introduction: The history of African health is closely entwined with the history of the continent itself-from precolonial times to the present day. A study of African health histories is critical to understanding the complex interplay between social, ... ...

Abstract	Introduction: The history of African health is closely entwined with the history of the continent itself-from precolonial times to the present day. A study of African health histories is critical to understanding the complex interplay between social, economic, environmental and political factors that have shaped health outcomes on the continent. Furthermore, it can shed light on the successes and failures of past health interventions, inform current healthcare policies and practices, and guide future efforts to address the persistent health challenges faced by African populations. This scoping review aims to identify existing literature on African health histories. Methods and analysis: The Arksey and O'Malley's framework for conducting scoping reviews will be utilised for the proposed review, which will be reported in compliance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines. The main review question is 'What literature exists on the history of health practices and healthcare delivery systems in Africa from the precolonial era through to the sustainable development goal era?' Keywords such as Africa, health and histories will be used to develop a search strategy to interrogate selected databases and grey literature repositories such as PubMed, Scopus, Web of Science and WHOLIS. Two authors will independently screen titles and abstracts of retrieved records. One author will extract data from articles that meet the inclusion criteria using a purposively designed data charting. The data would be coded and analysed thematically, and the findings presented narratively. Ethics and dissemination: The scoping review is part of a larger project which has approval from the WHO AFRO Ethics Research Committee (Protocol ID: AFR/ERC/2022/11.3). The protocol and subsequent review will be submitted to the integrated African Health Observatory and published in a peer-reviewed journal. Registration details: https://osf.io/xsaez/.
MeSH term(s)	Humans ; Africa ; Black People ; Databases, Factual ; Delivery of Health Care/ethnology ; Delivery of Health Care/history ; Delivery of Health Care/methods ; Gray Literature ; Review Literature as Topic ; Systematic Reviews as Topic
Language	English
Publishing date	2023-11-03
Publishing country	England
Document type	Clinical Trial Protocol ; Journal Article
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2023-075787
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Article ; Online: Effects of spinal manipulation or mobilization as an adjunct to neurodynamic mobilization for lumbar disc herniation with radiculopathy: a randomized clinical trial.

Danazumi, Musa Sani / Nuhu, Jibril Mohammed / Ibrahim, Shehu Usman / Falke, Mubarak Abubakar / Rufai, Salim Abubakar / Abdu, Usman Garba / Adamu, Isa Abubakar / Usman, Musbahu Hamisu / Daniel Frederic, Abah / Yakasai, Abdulsalam Mohammed

The Journal of manual & manipulative therapy

2023 Volume 31, Issue 6, Page(s) 408–420

Abstract: Objectives: To determine the long-term clinical effects of spinal manipulative therapy (SMT) or mobilization (MOB) as an adjunct to neurodynamic mobilization (NM) in the management of individuals with Lumbar Disc Herniation with Radiculopathy (DHR).: ... ...

Abstract	Objectives: To determine the long-term clinical effects of spinal manipulative therapy (SMT) or mobilization (MOB) as an adjunct to neurodynamic mobilization (NM) in the management of individuals with Lumbar Disc Herniation with Radiculopathy (DHR). Design: Parallel group, single-blind randomized clinical trial. Setting: The study was conducted in a governmental tertiary hospital. Participants: Forty (40) participants diagnosed as having a chronic DHR (≥3 months) were randomly allocated into two groups with 20 participants each in the SMT and MOB groups. Interventions: Participants in the SMT group received high-velocity, low-amplitude manipulation, while those in the MOB group received Mulligans' spinal mobilization with leg movement. Each treatment group also received NM as a co-intervention, administered immediately after the SMT and MOB treatment sessions. Each group received treatment twice a week for 12 weeks. Outcome measures: The following outcomes were measured at baseline, 6, 12, 26, and 52 weeks post-randomization; back pain, leg pain, activity limitation, sciatica bothersomeness, sciatica frequency, functional mobility, quality of life, and global effect. The primary outcomes were pain and activity limitation at 12 weeks post-randomization. Results: The results indicate that the MOB group improved significantly better than the SMT group in all outcomes ( Conclusion: This study found that individuals with DHR demonstrated better improvements when treated with MOB plus NM than when treated with SMT plus NM. These improvements were also clinically meaningful for activity limitation, functional mobility, and quality of life outcomes at long-term follow-up. Trial registration: Pan-African Clinical Trial Registry: PACTR201812840142310.
MeSH term(s)	Humans ; Intervertebral Disc Displacement/therapy ; Radiculopathy/therapy ; Sciatica ; Low Back Pain/therapy ; Manipulation, Spinal/methods ; Quality of Life ; Single-Blind Method
Language	English
Publishing date	2023-03-22
Publishing country	England
Document type	Randomized Controlled Trial ; Journal Article
ZDB-ID	920432-5
ISSN	2042-6186 ; 1066-9817
ISSN (online)	2042-6186
ISSN	1066-9817
DOI	10.1080/10669817.2023.2192975
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