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  1. Article ; Online: The societal cost of vaccine refusal: A modelling study using measles vaccination as a case study.

    Olivera Mesa, Daniela / Winskill, Peter / Ghani, Azra C / Hauck, Katharina

    Vaccine

    2023  Volume 41, Issue 28, Page(s) 4129–4137

    Abstract: Background: Increasing vaccine hesitancy and refusal poses a challenge to public health as even small reductions in vaccine uptake can result in large outbreaks of infectious diseases. Here we estimate the societal costs of vaccine refusal using measles ...

    Abstract Background: Increasing vaccine hesitancy and refusal poses a challenge to public health as even small reductions in vaccine uptake can result in large outbreaks of infectious diseases. Here we estimate the societal costs of vaccine refusal using measles as a case study.
    Methods: We developed a compartmental metapopulation model of measles transmission to explore how the changes in the size and level of social mixing between populations that are "pro-vaccination", and "anti-vaccination" impacts the burden of measles. Using the projected cases and deaths, we calculated the health, healthcare, direct medical costs, and productivity loss associated with vaccine refusal. Using measles in England as a case study, we quantified the societal costs that each vaccine refusal imposes on society.
    Findings: When there is a high level of mixing between the pro- and anti-vaccination populations, those that refuse to be vaccinated benefit from the herd immunity afforded by the pro-vaccination population. At the same time, their refusal to be vaccinated increases the burden in those that are vaccinated due to imperfect vaccines, and in those that are not able to be vaccinated due to other underlying health conditions. Using England as a case study, we estimate that this translates to a societal loss of GBP 292 million and disease burden of 17 630 quality-adjusted-life-years (sensitivity range 10 594-50 379) over a 20-year time horizon. Of these costs, 26 % are attributable to healthcare costs and 74 % to productivity losses for patients and their carers. This translates to a societal loss per vaccine refusal of GBP 162.21 and 0.01 (0.006-0.03) quality-adjusted-life-years.
    Interpretation: Our findings demonstrate that even low levels of vaccine refusal can have a substantial and measurable societal burden on the population. These estimates can support the value of investment in interventions that address vaccine hesitancy and vaccine refusal, providing not only improved public health but also potential economic benefits to society.
    MeSH term(s) Humans ; Vaccination ; Measles/epidemiology ; Disease Outbreaks ; Vaccination Refusal ; Health Care Costs ; Cost-Benefit Analysis ; Measles Vaccine
    Chemical Substances Measles Vaccine
    Language English
    Publishing date 2023-05-30
    Publishing country Netherlands
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 605674-x
    ISSN 1873-2518 ; 0264-410X
    ISSN (online) 1873-2518
    ISSN 0264-410X
    DOI 10.1016/j.vaccine.2023.05.039
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Estimating the burden of severe malarial anaemia and access to hospital care in East Africa.

    Winskill, Peter / Dhabangi, Aggrey / Kwambai, Titus K / Mori, Amani Thomas / Mousa, Andria / Okell, Lucy C

    Nature communications

    2023  Volume 14, Issue 1, Page(s) 5691

    Abstract: Severe malarial anaemia can be fatal if not promptly treated. Hospital studies may under-represent the true burden because cases often occur in settings with poor access to healthcare. We estimate the relationship of community prevalence of malaria ... ...

    Abstract Severe malarial anaemia can be fatal if not promptly treated. Hospital studies may under-represent the true burden because cases often occur in settings with poor access to healthcare. We estimate the relationship of community prevalence of malaria infection and severe malarial anaemia with the incidence of severe malarial anaemia cases in hospital, using survey data from 21 countries and hospital data from Kenya, Tanzania and Uganda. The estimated percentage of severe malarial anaemia cases that were hospitalised is low and consistent for Kenya (21% (95% CrI: 7%, 47%)), Tanzania (18% (95% CrI: 5%, 52%)) and Uganda (23% (95% CrI: 9%, 48%)). The majority of severe malarial anaemia cases remain in the community, with the consequent public health burden being contingent upon the severity of these cases. Alongside health system strengthening, research to better understand the spectrum of disease associated with severe malarial anaemia cases in the community is a priority.
    MeSH term(s) Humans ; Kenya/epidemiology ; Tanzania/epidemiology ; Anemia/epidemiology ; Malaria/complications ; Malaria/epidemiology ; Hospitals
    Language English
    Publishing date 2023-09-14
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2553671-0
    ISSN 2041-1723 ; 2041-1723
    ISSN (online) 2041-1723
    ISSN 2041-1723
    DOI 10.1038/s41467-023-41275-w
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Modeling resource allocation strategies for insecticide-treated bed nets to achieve malaria eradication.

    Schmit, Nora / Topazian, Hillary M / Pianella, Matteo / Charles, Giovanni D / Winskill, Peter / White, Michael T / Hauck, Katharina / Ghani, Azra C

    eLife

    2024  Volume 12

    Abstract: Large reductions in the global malaria burden have been achieved, but plateauing funding poses a challenge for progressing towards the ultimate goal of malaria eradication. Using previously published mathematical models ... ...

    Abstract Large reductions in the global malaria burden have been achieved, but plateauing funding poses a challenge for progressing towards the ultimate goal of malaria eradication. Using previously published mathematical models of
    MeSH term(s) Humans ; Insecticide-Treated Bednets ; Malaria/epidemiology ; Malaria/prevention & control ; Malaria, Falciparum/epidemiology ; Malaria, Falciparum/prevention & control ; Malaria, Vivax/epidemiology ; Malaria, Vivax/prevention & control ; Africa South of the Sahara/epidemiology
    Language English
    Publishing date 2024-02-08
    Publishing country England
    Document type Journal Article
    ZDB-ID 2687154-3
    ISSN 2050-084X ; 2050-084X
    ISSN (online) 2050-084X
    ISSN 2050-084X
    DOI 10.7554/eLife.88283
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Modelling the relative cost-effectiveness of the RTS,S/AS01 malaria vaccine compared to investment in vector control or chemoprophylaxis

    Topazian, Hillary M. / Schmit, Nora / Gerard-Ursin, Ines / Charles, Giovanni D. / Thompson, Hayley / Ghani, Azra C. / Winskill, Peter

    Vaccine. 2023 Apr. 18,

    2023  

    Abstract: The World Health Organization has recommended a 4-dose schedule of the RTS,S/AS01 (RTS,S) vaccine for children in regions of moderate to high P. falciparum transmission. Faced with limited supply and finite resources, global funders and domestic malaria ... ...

    Abstract The World Health Organization has recommended a 4-dose schedule of the RTS,S/AS01 (RTS,S) vaccine for children in regions of moderate to high P. falciparum transmission. Faced with limited supply and finite resources, global funders and domestic malaria control programs will need to examine the relative cost-effectiveness of RTS,S and identify target areas for vaccine implementation relative to scale-up of existing interventions. Using an individual-based mathematical model of P. falciparum, we modelled the cost-effectiveness of RTS,S across a range of settings in sub-Saharan Africa, incorporating various rainfall patterns, insecticide-treated net (ITN) use, treatment coverage, and parasite prevalence bands. We compare age-based and seasonal RTS,S administration to increasing ITN usage, switching to next generation ITNs in settings experiencing insecticide-resistance, and introduction of seasonal malaria chemoprevention (SMC) in areas of seasonal transmission. For RTS,S to be the most cost-effective intervention option considered, the maximum cost per dose was less than $9.30 USD in 90.9% of scenarios. Nearly all (89.8%) values at or above $9.30 USD per dose were in settings with 60% established bed net use and / or with established SMC, and 76.3% were in the highest PfPR₂₋₁₀ band modelled (40%). Addition of RTS,S to strategies involving 60% ITN use, increased ITN usage or a switch to PBO nets, and SMC, if eligible, still led to significant marginal case reductions, with a median of 2,653 (IQR: 1,741 to 3,966) cases averted per 100,000 people annually, and 82,270 (IQR: 54,034 to 123,105) cases averted per 100,000 fully vaccinated children (receiving at least three doses). Use of RTS,S results in reductions in malaria cases and deaths even when layered upon existing interventions. When comparing relative cost-effectiveness, scale up of ITNs, introduction of SMC, and switching to new technology nets should be prioritized in eligible settings.
    Keywords Plasmodium falciparum ; World Health Organization ; chemoprevention ; cost effectiveness ; insecticide application ; insecticide resistance ; malaria ; malaria vaccines ; mathematical models ; parasites ; people ; rain ; technology ; vector control ; Sub-Saharan Africa ; P. falciparum ; RTS,S ; Malaria vaccine ; Mathematical modelling ; AL ; DALY ; ICER ; IQR ; ITN ; MVIP ; PBO ; PfPR2-10 ; SMC ; SP + AQ ; USD ; WHO
    Language English
    Dates of publication 2023-0418
    Publishing place Elsevier Ltd
    Document type Article ; Online
    Note Pre-press version ; Use and reproduction
    ZDB-ID 605674-x
    ISSN 1873-2518 ; 0264-410X
    ISSN (online) 1873-2518
    ISSN 0264-410X
    DOI 10.1016/j.vaccine.2023.04.011
    Database NAL-Catalogue (AGRICOLA)

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  5. Article ; Online: Estimated impact of RTS,S/AS01 malaria vaccine allocation strategies in sub-Saharan Africa: A modelling study.

    Hogan, Alexandra B / Winskill, Peter / Ghani, Azra C

    PLoS medicine

    2020  Volume 17, Issue 11, Page(s) e1003377

    Abstract: Background: The RTS,S/AS01 vaccine against Plasmodium falciparum malaria infection completed phase III trials in 2014 and demonstrated efficacy against clinical malaria of approximately 36% over 4 years for a 4-dose schedule in children aged 5-17 months. ...

    Abstract Background: The RTS,S/AS01 vaccine against Plasmodium falciparum malaria infection completed phase III trials in 2014 and demonstrated efficacy against clinical malaria of approximately 36% over 4 years for a 4-dose schedule in children aged 5-17 months. Pilot vaccine implementation has recently begun in 3 African countries. If the pilots demonstrate both a positive health impact and resolve remaining safety concerns, wider roll-out could be recommended from 2021 onwards. Vaccine demand may, however, outstrip initial supply. We sought to identify where vaccine introduction should be prioritised to maximise public health impact under a range of supply constraints using mathematical modelling.
    Methods and findings: Using a mathematical model of P. falciparum malaria transmission and RTS,S vaccine impact, we estimated the clinical cases and deaths averted in children aged 0-5 years in sub-Saharan Africa under 2 scenarios for vaccine coverage (100% and realistic) and 2 scenarios for other interventions (current coverage and World Health Organization [WHO] Global Technical Strategy targets). We used a prioritisation algorithm to identify potential allocative efficiency gains from prioritising vaccine allocation among countries or administrative units to maximise cases or deaths averted. If malaria burden at introduction is similar to current levels-assuming realistic vaccine coverage and country-level prioritisation in areas with parasite prevalence >10%-we estimate that 4.3 million malaria cases (95% credible interval [CrI] 2.8-6.8 million) and 22,000 deaths (95% CrI 11,000-35,000) in children younger than 5 years could be averted annually at a dose constraint of 30 million. This decreases to 3.0 million cases (95% CrI 2.0-4.7 million) and 14,000 deaths (95% CrI 7,000-23,000) at a dose constraint of 20 million, and increases to 6.6 million cases (95% CrI 4.2-10.8 million) and 38,000 deaths (95% CrI 18,000-61,000) at a dose constraint of 60 million. At 100% vaccine coverage, these impact estimates increase to 5.2 million cases (95% CrI 3.5-8.2 million) and 27,000 deaths (95% CrI 14,000-43,000), 3.9 million cases (95% CrI 2.7-6.0 million) and 19,000 deaths (95% CrI 10,000-30,000), and 10.0 million cases (95% CrI 6.7-15.7 million) and 51,000 deaths (95% CrI 25,000-82,000), respectively. Under realistic vaccine coverage, if the vaccine is prioritised sub-nationally, 5.3 million cases (95% CrI 3.5-8.2 million) and 24,000 deaths (95% CrI 12,000-38,000) could be averted at a dose constraint of 30 million. Furthermore, sub-national prioritisation would allow introduction in almost double the number of countries compared to national prioritisation (21 versus 11). If vaccine introduction is prioritised in the 3 pilot countries (Ghana, Kenya, and Malawi), health impact would be reduced, but this effect becomes less substantial (change of <5%) if 50 million or more doses are available. We did not account for within-country variation in vaccine coverage, and the optimisation was based on a single outcome measure, therefore this study should be used to understand overall trends rather than guide country-specific allocation.
    Conclusions: These results suggest that the impact of constraints in vaccine supply on the public health impact of the RTS,S malaria vaccine could be reduced by introducing the vaccine at the sub-national level and prioritising countries with the highest malaria incidence.
    MeSH term(s) Child ; Child, Preschool ; Female ; Ghana ; Humans ; Incidence ; Infant ; Infant, Newborn ; Kenya ; Malaria/epidemiology ; Malaria/prevention & control ; Malaria Vaccines/administration & dosage ; Malaria Vaccines/pharmacology ; Malaria, Falciparum/epidemiology ; Malaria, Falciparum/prevention & control ; Malawi ; Male ; Models, Theoretical ; Public Health/statistics & numerical data
    Chemical Substances Malaria Vaccines
    Language English
    Publishing date 2020-11-30
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2185925-5
    ISSN 1549-1676 ; 1549-1277
    ISSN (online) 1549-1676
    ISSN 1549-1277
    DOI 10.1371/journal.pmed.1003377
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Taenia solium taeniasis/cysticercosis: From parasite biology and immunology to diagnosis and control.

    Dixon, Matthew A / Winskill, Peter / Harrison, Wendy E / Basáñez, Maria-Gloria

    Advances in parasitology

    2021  Volume 112, Page(s) 133–217

    Abstract: Infection with the pork tapeworm (Taenia solium) is responsible for a substantial global burden of disease, not only restricted to its impact on human health, but also resulting in a considerable economic burden to smallholder pig farmers due to pig ... ...

    Abstract Infection with the pork tapeworm (Taenia solium) is responsible for a substantial global burden of disease, not only restricted to its impact on human health, but also resulting in a considerable economic burden to smallholder pig farmers due to pig cysticercosis infection. The life-cycle, parasitology and immunology of T. solium are complex, involving pigs (the intermediate host, harbouring the larval metacestode stage), humans (the definitive host, harbouring the adult tapeworm, in addition to acting as accidental intermediate hosts) and the environment (the source of infection with eggs/proglottids). We review the parasitology, immunology, and epidemiology of the infection associated with each of the T. solium life-cycle stages, including the pre-adult/adult tapeworm responsible for human taeniasis; post-oncosphere and cysticercus associated with porcine and human cysticercosis, and the biological characteristics of eggs in the environment. We discuss the burden associated, in endemic settings, with neurocysticercosis (NCC) in humans, and the broader cross-sectoral economic impact associated both with NCC and porcine cysticercosis, the latter impacting food-value chains. Existing tools for diagnostics and control interventions that target different stages of the T. solium transmission cycle are reviewed and their limitations discussed. Currently, no national T. solium control programmes have been established in endemic areas, with further work required to identify optimal strategies according to epidemiological setting. There is increasing evidence suggesting that cross-sectoral interventions which target the parasite in both the human and pig host provide the most effective approaches for achieving control and ultimately elimination. We discuss future avenues for research on T. solium to support the attainment of the goals proposed in the revised World Health Organisation neglected tropical diseases roadmap for 2021-2030 adopted at the 73rd World Health Assembly in November 2020.
    MeSH term(s) Africa/epidemiology ; Age Factors ; Animals ; Asia/epidemiology ; Central America/epidemiology ; Cysticercosis/diagnosis ; Cysticercosis/epidemiology ; Cysticercosis/parasitology ; Cysticercosis/prevention & control ; Humans ; Life Cycle Stages ; Prevalence ; Sex Factors ; South America/epidemiology ; Swine ; Swine Diseases/diagnosis ; Swine Diseases/epidemiology ; Swine Diseases/parasitology ; Swine Diseases/prevention & control ; Taenia solium/growth & development ; Taenia solium/immunology ; Taenia solium/physiology ; Taeniasis/diagnosis ; Taeniasis/epidemiology ; Taeniasis/parasitology ; Taeniasis/prevention & control
    Language English
    Publishing date 2021-04-08
    Publishing country England
    Document type Journal Article
    ZDB-ID 165-x
    ISSN 2163-6079 ; 0065-308X
    ISSN (online) 2163-6079
    ISSN 0065-308X
    DOI 10.1016/bs.apar.2021.03.003
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Global impact of the first year of COVID-19 vaccination: a mathematical modelling study.

    Watson, Oliver J / Barnsley, Gregory / Toor, Jaspreet / Hogan, Alexandra B / Winskill, Peter / Ghani, Azra C

    The Lancet. Infectious diseases

    2022  Volume 22, Issue 9, Page(s) 1293–1302

    Abstract: Background: The first COVID-19 vaccine outside a clinical trial setting was administered on Dec 8, 2020. To ensure global vaccine equity, vaccine targets were set by the COVID-19 Vaccines Global Access (COVAX) Facility and WHO. However, due to vaccine ... ...

    Abstract Background: The first COVID-19 vaccine outside a clinical trial setting was administered on Dec 8, 2020. To ensure global vaccine equity, vaccine targets were set by the COVID-19 Vaccines Global Access (COVAX) Facility and WHO. However, due to vaccine shortfalls, these targets were not achieved by the end of 2021. We aimed to quantify the global impact of the first year of COVID-19 vaccination programmes.
    Methods: A mathematical model of COVID-19 transmission and vaccination was separately fit to reported COVID-19 mortality and all-cause excess mortality in 185 countries and territories. The impact of COVID-19 vaccination programmes was determined by estimating the additional lives lost if no vaccines had been distributed. We also estimated the additional deaths that would have been averted had the vaccination coverage targets of 20% set by COVAX and 40% set by WHO been achieved by the end of 2021.
    Findings: Based on official reported COVID-19 deaths, we estimated that vaccinations prevented 14·4 million (95% credible interval [Crl] 13·7-15·9) deaths from COVID-19 in 185 countries and territories between Dec 8, 2020, and Dec 8, 2021. This estimate rose to 19·8 million (95% Crl 19·1-20·4) deaths from COVID-19 averted when we used excess deaths as an estimate of the true extent of the pandemic, representing a global reduction of 63% in total deaths (19·8 million of 31·4 million) during the first year of COVID-19 vaccination. In COVAX Advance Market Commitment countries, we estimated that 41% of excess mortality (7·4 million [95% Crl 6·8-7·7] of 17·9 million deaths) was averted. In low-income countries, we estimated that an additional 45% (95% CrI 42-49) of deaths could have been averted had the 20% vaccination coverage target set by COVAX been met by each country, and that an additional 111% (105-118) of deaths could have been averted had the 40% target set by WHO been met by each country by the end of 2021.
    Interpretation: COVID-19 vaccination has substantially altered the course of the pandemic, saving tens of millions of lives globally. However, inadequate access to vaccines in low-income countries has limited the impact in these settings, reinforcing the need for global vaccine equity and coverage.
    Funding: Schmidt Science Fellowship in partnership with the Rhodes Trust; WHO; UK Medical Research Council; Gavi, the Vaccine Alliance; Bill & Melinda Gates Foundation; National Institute for Health Research; and Community Jameel.
    MeSH term(s) COVID-19 ; COVID-19 Vaccines ; Global Health ; Humans ; Models, Theoretical ; Vaccination ; Vaccines
    Chemical Substances COVID-19 Vaccines ; Vaccines
    Language English
    Publishing date 2022-06-23
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2061641-7
    ISSN 1474-4457 ; 1473-3099
    ISSN (online) 1474-4457
    ISSN 1473-3099
    DOI 10.1016/S1473-3099(22)00320-6
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Modelling the relative cost-effectiveness of the RTS,S/AS01 malaria vaccine compared to investment in vector control or chemoprophylaxis.

    Topazian, Hillary M / Schmit, Nora / Gerard-Ursin, Ines / Charles, Giovanni D / Thompson, Hayley / Ghani, Azra C / Winskill, Peter

    Vaccine

    2023  Volume 41, Issue 20, Page(s) 3215–3223

    Abstract: Background: The World Health Organization has recommended a 4-dose schedule of the RTS,S/AS01 (RTS,S) vaccine for children in regions of moderate to high P. falciparum transmission. Faced with limited supply and finite resources, global funders and ... ...

    Abstract Background: The World Health Organization has recommended a 4-dose schedule of the RTS,S/AS01 (RTS,S) vaccine for children in regions of moderate to high P. falciparum transmission. Faced with limited supply and finite resources, global funders and domestic malaria control programs will need to examine the relative cost-effectiveness of RTS,S and identify target areas for vaccine implementation relative to scale-up of existing interventions.
    Methods: Using an individual-based mathematical model of P. falciparum, we modelled the cost-effectiveness of RTS,S across a range of settings in sub-Saharan Africa, incorporating various rainfall patterns, insecticide-treated net (ITN) use, treatment coverage, and parasite prevalence bands. We compare age-based and seasonal RTS,S administration to increasing ITN usage, switching to next generation ITNs in settings experiencing insecticide-resistance, and introduction of seasonal malaria chemoprevention (SMC) in areas of seasonal transmission.
    Results: For RTS,S to be the most cost-effective intervention option considered, the maximum cost per dose was less than $9.30 USD in 90.9% of scenarios. Nearly all (89.8%) values at or above $9.30 USD per dose were in settings with 60% established bed net use and / or with established SMC, and 76.3% were in the highest PfPR
    Conclusions: Use of RTS,S results in reductions in malaria cases and deaths even when layered upon existing interventions. When comparing relative cost-effectiveness, scale up of ITNs, introduction of SMC, and switching to new technology nets should be prioritized in eligible settings.
    MeSH term(s) Child ; Humans ; Infant ; Malaria Vaccines ; Cost-Benefit Analysis ; Insecticides ; Malaria/prevention & control ; Malaria, Falciparum/prevention & control ; Malaria, Falciparum/epidemiology ; Chemoprevention
    Chemical Substances Malaria Vaccines ; Insecticides
    Language English
    Publishing date 2023-04-18
    Publishing country Netherlands
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 605674-x
    ISSN 1873-2518 ; 0264-410X
    ISSN (online) 1873-2518
    ISSN 0264-410X
    DOI 10.1016/j.vaccine.2023.04.011
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Analysis of the potential for a malaria vaccine to reduce gaps in malaria intervention coverage.

    Unwin, H Juliette T / Mwandigha, Lazaro / Winskill, Peter / Ghani, Azra C / Hogan, Alexandra B

    Malaria journal

    2021  Volume 20, Issue 1, Page(s) 438

    Abstract: Background: The RTS,S/AS01 malaria vaccine is currently being evaluated in a cluster-randomized pilot implementation programme in three African countries. This study seeks to identify whether vaccination could reach additional children who are at risk ... ...

    Abstract Background: The RTS,S/AS01 malaria vaccine is currently being evaluated in a cluster-randomized pilot implementation programme in three African countries. This study seeks to identify whether vaccination could reach additional children who are at risk from malaria but do not currently have access to, or use, core malaria interventions.
    Methods: Using data from household surveys, the overlap between malaria intervention coverage and childhood vaccination (diphtheria-tetanus-pertussis dose 3, DTP3) uptake in 20 African countries with at least one first administrative level unit with Plasmodium falciparum parasite prevalence greater than 10% was calculated. Multilevel logistic regression was used to explore patterns of overlap by demographic and socioeconomic variables. The public health impact of delivering RTS,S/AS01 to those children who do not use an insecticide-treated net (ITN), but who received the DTP3 vaccine, was also estimated.
    Results: Uptake of DTP3 was higher than malaria intervention coverage in most countries. Overall, 34% of children did not use ITNs and received DTP3, while 35% of children used ITNs and received DTP3, although this breakdown varied by country. It was estimated that there are 33 million children in these 20 countries who do not use an ITN. Of these, 23 million (70%) received the DTP3 vaccine. Vaccinating those 23 million children who receive DTP3 but do not use an ITN could avert up to an estimated 9.7 million (range 8.5-10.8 million) clinical malaria cases each year, assuming all children who receive DTP3 are administered all four RTS,S doses. An additional 10.8 million (9.5-12.0 million) cases could be averted by vaccinating those 24 million children who receive the DTP3 vaccine and use an ITN. Children who had access to or used an ITN were 9-13% more likely to reside in rural areas compared to those who had neither intervention regardless of vaccination status. Mothers' education status was a strong predictor of intervention uptake and was positively associated with use of ITNs and vaccination uptake and negatively associated with having access to an ITN but not using it. Wealth was also a strong predictor of intervention coverage.
    Conclusions: Childhood vaccination to prevent malaria has the potential to reduce inequity in access to existing malaria interventions and could substantially reduce the childhood malaria burden in sub-Saharan Africa, even in regions with lower existing DTP3 coverage.
    MeSH term(s) Africa South of the Sahara ; Child, Preschool ; Educational Status ; Female ; Humans ; Infant ; Insecticide-Treated Bednets/statistics & numerical data ; Malaria/prevention & control ; Malaria Vaccines/administration & dosage ; Male ; Odds Ratio ; Prospective Studies ; Rural Population ; Social Class ; Urban Population
    Chemical Substances Malaria Vaccines
    Language English
    Publishing date 2021-11-17
    Publishing country England
    Document type Journal Article
    ZDB-ID 2091229-8
    ISSN 1475-2875 ; 1475-2875
    ISSN (online) 1475-2875
    ISSN 1475-2875
    DOI 10.1186/s12936-021-03966-x
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Does integrated community case management (iCCM) target health inequities and treatment delays? Evidence from an analysis of Demographic and Health Surveys data from 21 countries in the period 2010 to 2018.

    Winskill, Peter / Mousa, Andria / Oresanya, Olusola / Counihan, Helen / Okell, Lucy C / Walker, Patrick G

    Journal of global health

    2021  Volume 11, Page(s) 4013

    Abstract: Background: Integrated community case management (iCCM) is a programme that can, via community health workers (CHWs), increase access to timely and essential treatments for children. As well as improving treatment coverage, iCCM has an additional equity- ...

    Abstract Background: Integrated community case management (iCCM) is a programme that can, via community health workers (CHWs), increase access to timely and essential treatments for children. As well as improving treatment coverage, iCCM has an additional equity-focus with the aim of targeting underserved populations. To assess the success of iCCM programmes it is important that we understand the contribution they are making to equitable health coverage.
    Methods: We analysed demographic and health survey data from 21 countries over 9 years to assess evidence and evaluate iCCM programmes. We summarise the contribution CHWs are making relative to other health care provider groups and what treatment combinations CHWs are commonly prescribing. We assessed the ability of CHWs to target treatment delays and health inequities by evaluating time to treatment following fever onset and relationships between CHWs and wealth, rurality and remoteness.
    Results: There was good evidence that CHWs are being successfully targeted to improve inequities in health care coverage. There is a larger contribution of CHWs in areas with higher poverty, rurality and remoteness. In six surveys CHWs were associated with significantly shorter average time between fever onset and advice or treatment seeking, whilst in one they were associated with significantly longer times. In areas with active CHW programmes, the contribution of CHWs relative to other health care provider groups varied between 11% to 45% of treatment visits. The distribution of types of treatment provided by CHWs was also very variable between countries.
    Conclusions: The success of an iCCM programme depends not only on increasing treatment coverage but addressing inequities in access to timely health care. Whilst much work is still needed to attain universal health care targets, and despite incomplete data, there is evidence that iCCM is successfully addressing treatment delays and targeting underserved populations.
    MeSH term(s) Case Management ; Child ; Community Health Workers ; Demography ; Humans ; Rural Population ; Time-to-Treatment
    Language English
    Publishing date 2021-03-01
    Publishing country Scotland
    Document type Journal Article
    ZDB-ID 2741629-X
    ISSN 2047-2986 ; 2047-2986
    ISSN (online) 2047-2986
    ISSN 2047-2986
    DOI 10.7189/jogh.11.04013
    Database MEDical Literature Analysis and Retrieval System OnLINE

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