RESUMEN
OBJECTIVES: To examine the characteristics of existing maternal tetanus immunization programmes for pregnant women in low- and middle-income countries (LMICs) and to identify and understand the challenges, barriers and facilitators associated with maternal vaccine service delivery that may impact the introduction and implementation of new maternal vaccines in the future. DESIGN: A mixed methods, cross sectional study with four data collection phases including a desk review, online survey, telephone and face-to-face interviews and in country visits. SETTING: LMICs. RESULTS: The majority of countries (84/95; 88%) had a maternal tetanus immunization policy. Countries with high protection at birth (PAB) were more likely to report tetanus toxoid-containing vaccine (TTCV) coverage targets > 90%. Less than half the countries included in this study had a TTCV coverage target of > 90%. Procurement and distribution of TTCV was nearly always the responsibility of the Expanded Programme on Immunization (EPI), however planning and management of maternal immunization was often shared between EPI and Maternal, Newborn and Child Health (MNCH) programmes. Receipt of TTCV at the same time as the antenatal care visit correlated with high PAB. Most countries (81/95; 85%) had an immunization safety surveillance system in place although only 11% could differentiate an adverse event following immunization (AEFI) in pregnant and non-pregnant women. CONCLUSIONS: Recommendations arising from the MIACSA project to strengthen existing services currently delivering maternal tetanus immunization in LMICs include establishing and maintaining vaccination targets, clearly defining responsibilities and fostering collaborations between EPI and MNCH, investing in strengthening the health workforce, improving the design and use of existing record keeping for immunization, adjusting current AEFI reporting to differentiate pregnant women and endeavoring to integrate the provision of TTCV within ANC services where appropriate.
Asunto(s)
Países en Desarrollo , Tétanos , Niño , Estudios Transversales , Femenino , Humanos , Inmunización , Recién Nacido , Embarazo , Atención Prenatal , Tétanos/prevención & control , VacunaciónRESUMEN
OBJECTIVE: To determine the prevalence of chronic typhoidal salmonellae amongst food vendors in Kumasi Ghana. DESIGN: A prospective study. SETTING: Sitting and itinerant food vendors in Kumasi. METHODS: Screening of 258 (230 females of 28 males) healthy food vendors for Salmonella typhi, and S. paratyphi A, B, and C, using stool culture, the widal test, and standard microbiological identification methods. MAIN OUTCOME MEASURES: Prevalence of chronic typhoidal Salmonellae carriers among food vendors in Kumasi. RESULTS: Typhoidal Salmonellae were isolated from six people, giving a carriage rate of 2.3%. Three of the Salmonellae isolated were S. typhi, and they had significant Widal agglutinin titres of > or = 1/160 and > or = 1/320 for 0 and H antigens, respectively. The other three were non-typhoidal Salmonellae. The three had S. typhi and the other three had titres of 1/80 or less for both 0 and H antigens, respectively. We have discussed the implications of this high carriage rate, and we have suggested the inclusion of screening for Salmonellae of the regular health screening exercise undertaken by food handlers to detect and monitor chronic carriers in the food industry, to help control salmonella diseases in the community. CONCLUSION: From our study, food handlers consitute a significant risk in the spread of enteric fever in Kumasi. We therefore, suggest the inclusion of screening for Salmonellae in the regular obligatory six-monthly examination required of food handlers and to monitor those found to be infected.
Asunto(s)
Portador Sano/epidemiología , Comercio , Servicios de Alimentación , Infecciones por Salmonella/epidemiología , Adolescente , Adulto , Anciano , Niño , Femenino , Ghana/epidemiología , Humanos , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVE: As part of a national accelerated campaign to eliminate measles, we conducted a study, to define the epidemiology of measles in the Central Region. DESIGN: A descriptive survey was carried out on retrospective cases of measles. SETTING: Patients were drawn from the three district hospitals (Assin, Asikuma and Winneba Hospitals) with the highest number of reported cases in the region. SUBJECTS: Records of outpatient and inpatient measles patients attending the selected health facilities between 1996 and 2000. Data on reported measles cases in all health facilities in the three study, districts were also analysed. MAIN OUTCOME MEASURES: The distribution of measles cases in person (age and sex), time (weekly, or monthly, trends) and place (residence), the relative frequency, of cases, and the outcome of treatment. RESULTS: There was an overall decline in reported cases of measles between 1996 and 2000 both in absolute terms and relative to other diseases. Females constituted 48%-52% of the reported 1508 cases in the hospitals. The median age of patients was 36 months. Eleven percent of cases were aged under nine months; 66% under five years and 96% under 15 years. With some minor variations between districts, the highest and lowest transmission occurred in March and September respectively. Within hospitals, there were sporadic outbreaks with up to 34 weekly cases. CONCLUSION: In Ghana, children aged nine months to 14 years could be appropriately targeted for supplementary, measles immunization campaigns. The best period for the campaigns is during the low transmission months of August to October. Retrospective surveillance can expediently inform decisions about the timing and target age groups for such campaigns.
Asunto(s)
Sarampión/epidemiología , Adolescente , Niño , Preescolar , Gráficos por Computador , Recolección de Datos , Femenino , Ghana/epidemiología , Hospitales de Distrito/estadística & datos numéricos , Humanos , Lactante , Masculino , Sarampión/mortalidad , Sarampión/prevención & control , Estudios RetrospectivosRESUMEN
Three hundred and seven healthy food handlers and 34 blood-culture positive enteric fever patients were screened for Salmonellae agglutinins using the Widal test. Of the 307 healthy food handlers, only 3 (1.0%) had an anti-O titre of > or = 1/160 and 8 (2.6%) an anti-H titre of > or = 1/320 for Salmonella typhi, but the majority, 214 (69.7%) and 149 (48.5%) had titres of < 1/20 for O and H agglutinins respectively. Similar agglutinin titres were also seen for S. Paratyphi A, B, and C. In the 34 enteric fever patients, for S typhi, based on anti-O titre of > or = 1/160, 25 persons showed a significant titre, a sensitivity of 73.5%, and a specificity of 99.0%. And 21 persons showed a significant titre of > or = 1/320 for anti-H, a sensitivity of 61.8% and a specificity of 97.4%. Based on these findings, titres of > or = 1/160 and > or = 1/320 for anti-0 and anti-H respectively, were considered diagnostic for enteric fever in Kumasi, Ghana.