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Lot quality assurance sampling for monitoring immunization coverage in Madras City.

OBJECTIVE: To explore the usefulness of Lot Quality Assurance Sampling (LQAS) to identify divisions in a city that had immunization coverage levels of 80% for any of the four EPI vaccines. METHODS: Only 43 divisions were considered for the study, the stratification factor being the death rate. The hypothesis that 80% coverage is 'unacceptable' was stipulated. Critical value (the number of unimmunized children) was chosen as 3. A simple random sample of 36 children in the age-group 12-23 months was taken from each selected division. Since sampling frames of children were not available, a simple random sample of 36 households was selected. Immunization status of each child was assessed by interviewing the child's mother/guardian. If the number of unimmunized children exceeded 3, then the division was regarded having coverage level 80% and rejected. RESULTS: The coverage was classified as unacceptable(i. e., below 80%) in 19 divisions for Polio and DPT vaccines, in 26 divisions for Measles vaccine and in 4 divisions for BCG vaccine. The average time spent for undertaking the LQAS survey was 6 man-days per division. CONCLUSION: This study demonstrated the utility of the LQAS technique in identifying 'unsatisfactory' pockets in Madras City, when the overall coverage was satisfactory. The technique will have greater application with an increase in the number of large units (cities/districts) having an overall coverage of 90% or more.

Health Care Surveys↗

Assessing immunization coverage in private practice.

To achieve national health objectives of eliminating most childhood vaccine-preventable diseases by the year 2010, all health care providers will have to improve the immunization rates of their patients. Currently, immunization rates of children 19 to 35 months of age are less than national objectives, suggesting a need for optimized immunization services. A key strategy for improving age-appropriate immunization coverage by health care providers is the assessment of immunization coverage. Because most (62%), immunization services in the United States are delivered in the private sector, a concerted effort in private practice is critical to improving immunization rates. Assessment of immunization coverage of patients enrolled in private practice serves 1) to measure the overall performance of the practice in providing the standard of care, 2) to identify strategies for improving coverage, and 3) to document the quality of health services delivered (report card). Assessment of immunization coverage has been demonstrated in several practice settings to be highly effective in improving immunization rates. All types of physicians should benefit from assessing immunization coverage of their patients. Simple assessment tools are available at no cost to the public and can be obtained by contacting the Centers for Disease Control and Prevention. These tools include a manual self-assessment or a computerized software package (CASA) to fit the needs of the practice.

Centers for Disease Control and Prevention, U.S.↗

[Estimating the coverage of systematic vaccinations among the Balearic Island infant population].

BACKGROUND: In order for vaccination programs to be carried out properly, it is essential for the vaccination coverage to be known. On the Balearic Islands, the reported coverage was much less than for the rest of Spain. The objective of this study is that of estimating the coverage of the vaccinations included on the recommended schedule up to 18 months of age (4 doses of oral polio, tetanus and diphtheria; 3 doses of whooping cough; 1 dose of measles, rubella and mumps). METHODS: A descriptive, cross-sectional study of the population base. The ideal-time frequency distribution estimators and the corresponding confidence intervals were calculated at 95% (CI95%) for a sample of the resident two-year-old (born in 1995) Balearic Island population selected by means of a single-stage conglomerate random sampling based on census sections. The National Public Health System and National Health Institute vaccination records were reviewed, the data from the vaccination document having been requested from the families and the clinical record from the private pediatricians by telephone. RESULTS: The sample included 606 children, it having been possible to obtain full information on 532 children. Full information was obtained on 377 cases (62%) from the public health sector records. The least degree of coverage was found for the diphtheria vaccine, 518 children having been fully vaccinated, 96.8% (CI95% = 94.8-98.1), the highest degree of coverage having been found for the whooping cough vaccine, 537 children, 98.9% (CI95% = 97.5-99.5). CONCLUSIONS: Good vaccination coverage was found to exist on the Balearic Islands, being similar to what has been being estimated for Spain as a whole. The objective included within the Polio Eradication Plan is accomplished, very little information being gathered from the public sector.

Catchment Area, Health↗

Tetanus toxoid coverage as an indicator of serological protection against neonatal tetanus.

OBJECTIVE: A Multiple-Indicator Cluster Survey (MICS) was conducted at mid-decade in more than 60 developing countries to measure progress towards the year 2000 World Summit for Children goals. These goals included the protection of at least 90% of children against neonatal tetanus through the immunization of their mothers, as measured by tetanus toxoid (TT) coverage. In the Central African Republic (CAR), serological testing was added to the MICS to understand better the relationship between survey estimates of TT coverage and the prevalence of serological protection. METHODS: In the CAR MICS, mothers of children younger than one year of age gave verbal histories of the TT vaccinations they had received, using the MICS TT questionnaire. A subsample of mothers was tested for tetanus antitoxin, using a double-antigen enzyme-linked immunoadsorbent assay (ELISA). Seropositivity was defined as a titre of > or =0.01 IU/ml, and TT coverage was defined as the proportion of mothers protected at delivery, according to their history of TT vaccinations. FINDINGS: Among the 222 mothers in the subsample, weighted TT coverage was 74.4% (95% Confidence Interval (CI); 67.0% - 81.7%) and tetanus antitoxin seroprevalence was 88.7% (95% CI; 83.2% - 94.2%). The weighted median antitoxin titre was 0.35 IU/ml. CONCLUSIONS: Tetanus toxoid coverage in the CAR was lower than the prevalence of serological protection against neonatal tetanus. If this relationship holds for other countries, TT coverage estimates from the MICS may underestimate the extent to which the year 2000 goal for protecting children against neonatal tetanus was reached. We also showed that a high level of serological protection had been achieved in a country facing major public health challenges and resource constraints.

Central African Republic↗

Coverage of carious roots by a subepithelial connective tissue graft.

PURPOSE: To assess whether coverage of an untreated or restored carious root lesion with a subepithelial connective tissue graft would provide a predictable, esthetically acceptable result and prevent further caries progression. MATERIALS AND METHODS: Twenty-seven teeth from 13 patients with root caries and gingival recessions of 3.4 +/- 0.2 mm (mean +/- SEM) were treated with subepithelial connective tissue grafts. Eighteen teeth had untreated caries, and the other nine had composite or glass-ionomer restorations. The carious dentin and the plastic restorations were removed prior to the surgical procedure. The exposed roots were thoroughly planed and covered by a subepithelial connective graft with no further root treatment or conditioning. The teeth were examined periodically from 1-6 years post-treatment for retention of root surface coverage and presence of carious lesions. RESULTS: The mean root coverage recession left after the treatment was 0.3 +/- 0.1 mm, with coverage of 92.4 +/- 2.4%. Significant differences (P< 0.05) were found between the coverage of roots with carious lesions that had not been restored and those that had restorations removed. However, since the number of teeth with restorations was limited, further study is required to confirm this difference. In 18 cases, complete coverage of the recession was achieved. The results were stable, and no further recessions or recurrent caries were detected.

Adult↗

Vaccination coverage among children entering school--United States, 2002-03 school year.

All states require proof of vaccination for children before school entry, and a summary of that coverage is reported to CDC. Rather than reporting vaccination status on school entry, state reports to CDC reflect coverage attained after evaluating students' vaccination status and ensuring that all children receive required vaccines. School vaccination requirements have been credited with ensuring high coverage, and one of the national health objectives for 2010 is to sustain > or =95% vaccination coverage among children in kindergarten through the first grade (objective 14-23). This report presents data regarding vaccination coverage from the 50 states and the District of Columbia (DC)* for the 2002-03 school year, which highlight high reporting rates and overall high coverage. Findings indicate that vaccines required by each state and the methods for surveying schools vary. CDC is working with states to standardize data collection procedures.

Child↗

Vaccination coverage before and after primary health care implementation and trend of target diseases in Al Hassa, Saudi Arabia.

There were two objectives of this study. The first was to determine the impact of vaccination coverage in the first year of life on the trend of the expanded program of immunization (EPI) target diseases in Al Hassa. The second was to determine the impact of primary health care (PHC) implementation in Al Hassa on vaccination coverage. A correlation matrex was computed for all the variables to determine the correlation between vaccination coverage by type of vaccine and reported cases of EPI target diseases. A negative correlation was noticed between Bacillus Calmette Guerin (BCG), Oral Polio Vaccine (OPV), Diphtheria, Pertussis and Tetanus (DPT) and measles vaccine and reported cases of corresponding diseases. This negative correlation was significant (P = 0.043) between measles vaccine and reported measles cases. The average vaccination coverage in the first year of life based on the total number of births significantly increased in 1988 and 1989 compared to the preceding four years (P < 0.01). It is concluded that with increased vaccination coverage in the first year of life against EPI target diseases, the number of reported corresponding diseases decreased, and that PHC implementation improved the vaccination coverage in Al Hassa.

Communicable Diseases↗

Coverage of pilot parenteral vaccination campaign against canine rabies in N'Djaména, Chad.

Canine rabies, and thus human exposure to rabies, can be controlled through mass vaccination of the animal reservoir if dog owners are willing to cooperate. Inaccessible, ownerless dogs, however, reduce the vaccination coverage achieved in parenteral campaigns. This study aimed to estimate the vaccination coverage in dogs in three study zones of N'Djaména, Chad, after a pilot free parenteral mass vaccination campaign against rabies. We used a capture-mark-recapture approach for population estimates, with a Bayesian, Markov chain, Monte Carlo method to estimate the total number of owned dogs, and the ratio of ownerless to owned dogs to calculate vaccination coverage. When we took into account ownerless dogs, the vaccination coverage in the dog populations was 87% (95% confidence interval (CI), 84-89%) in study zone I, 71% (95% CI, 64-76%) in zone II, and 64% (95% CI, 58-71%) in zone III. The proportions of ownerless dogs to owned dogs were 1.1% (95% CI, 0-3.1%), 7.6% (95% CI, 0.7-16.5%), and 10.6% (95% CI, 1.6-19.1%) in the three study zones, respectively. Vaccination coverage in the three populations of owned dogs was 88% (95% CI, 84-92%) in zone I, 76% (95% CI, 71-81%) in zone II, and 70% (95% CI, 66-76%) in zone III. Participation of dog owners in the free campaign was high, and the number of inaccessible ownerless dogs was low. High levels of vaccination coverage could be achieved with parenteral mass vaccination. Regular parenteral vaccination campaigns to cover all of N'Djaména should be considered as an ethical way of preventing human rabies when post-exposure treatment is of limited availability and high in cost.

Animals↗

The use of COSAS in the analysis of vaccination coverage in urban, peri-urban and rural populations in the Edendale/Vulindlela district of KwaZulu.

A repeat vaccination coverage survey has been conducted in the Edendale/Vulindlela district of KwaZulu. The survey data were processed using the Coverage Survey Analysis System (COSAS) developed by the World Health Organisation (WHO) through its Expanded Programme on Immunisation (EPI). A modified random cluster sampling method was used to select 281 children between the ages of 12 and 23 months. Of the children surveyed, 83% were in possession of Road-to-Health cards (RTHCs). The best estimate of overall coverage for doses up to and including the second doses of polio and diphtheria, pertussis and tetanus (DPT) was 85% or higher, but estimates for polio 3 and measles, at 72% and 67% respectively, remain suboptimal. Stratification of coverage into urban, peri-urban and rural categories revealed that the major contribution to the fall-off in coverage, after the second dose of polio and DPT, came from children in the peri-urban category with estimates of 52% for polio 3 and 38% for measles. The fact that coverage in the peri-urban population for doses up to and including polio 2 was 78% or higher indicated that the peri-urban influence responsible for this drop-out effect occurred between the approximate ages of 5 and 8 months. This identified populations in informal peri-urban settlements as a priority group for urgent intervention and further study. The estimation of missed opportunities at visits when vaccinations are normally given, found in this survey to occur in 17% of children, was a useful feature of COSAS and provided a basis for a specific intervention.

Cluster Analysis↗

Disparities in the coverage of cancer information in ethnic minority and mainstream mass print media.

BACKGROUND: Significant disparities in cancer mortality exist as a function of ethnicity and race in North America. Little is known, however, about the presentation of cancer information in mass media that targets ethnic minority groups. OBJECTIVES: 1) To evaluate the volume and type of cancer coverage and the readability of cancer articles in Canadian mainstream and ethnic minority newspapers; and 2) to compare newspaper coverage of cancer with Canadian cancer mortality. DESIGN: Seven mainstream and 25 ethnic minority (Jewish, First Nations, Black/Caribbean, East Indian) English-language newspapers were assessed for cancer coverage in the year 2000. Articles were analyzed by using frequencies and nonparametric tests. The total number of cancer articles (N=171) in ethnic minority papers and a random 20% from mainstream papers were also evaluated for readability level by using SMOG. RESULTS: There were a total of 748 cancer articles (721 mainstream; 27 ethnic). Coverage was weighted towards breast cancer (20.1% mainstream, 33.3% ethnic of cancer articles) and contained little or no coverage of prostate (7.4% mainstream, 8.6% ethnic), colorectal (3.9% mainstream, 3.7% ethnic), or lung (3.9% mainstream, 0 ethnic) cancers. The mean SMOG readability scores were Grades 12.7 and 13.2 for mainstream and ethnic papers, respectively. Readability scores differed significantly in ethnic newspapers, with the most difficult (highest readability) levels in East Indian (Grade 16.3) and the easiest (lowest readability) levels in First Nations (Grade 11.3) papers. Cancer articles were not highly culturally tailored, as measured by identification of specific ethnic minority groups within ethnic and mainstream newspapers. CONCLUSIONS: Cancer coverage in ethnic and mainstream newspapers did not accurately reflect the leading causes of cancer death in Canada. Results also suggest the need for the collection of cancer data by ethnic minority group in Canada. Without the disaggregation of cancer statistics by ethnicity, we cannot inform high-risk subgroups of the population and appropriately tailor cancer prevention and treatment programs.

Asian People↗

[Immunization coverage in the Monkey Bay Head zone Malawi].

OBJECTIVE: To assess the immunization coverage of children in the Monkey Bay head zone, Malawi where the Icelandic International Development Agency (ICEIDA) has been working to improve health care services in the recent years. MATERIALS AND METHODS: A 30 by 7 cluster sample survey, as defined by WHO's Expanded Programme on Immunization (EPI) was conducted to estimate immunization coverage of children aged 12-23 months for tuberculosis (BCG), diphtheria, tetanus and pertussis (DTP), polio (OPV) and measles immunizations. The Head Zone consists of 97 villages with a population of around 105,000 inhabitants. Five health centres provide immunization services in the area. In total were 217 children in 30 clusters randomly selected and their immunization status by card or history registered. RESULTS: Immunization coverage by card or history was 97% for BCG, and 99%, 95% and 85% for DTP1, DTP2 and DTP3 respectively. Coverage of OPV1, OPV2 and OPV3 by card or history was 99%, 93% and 85% respectively. Coverage for measles by card or history was 78%. Fully immunized children by card or history were 152 or 70%. Two children had not received any immunizations. Drop-out rate from DTP1 to DTP3 vaccination by immunization card or history was 14.5%, and drop-out from DTP1 to Measles by card or history was 21%. CONCLUSION: These results indicate that access to childhood immunization in the Monkey Bay head zone is good while drop-out rate is high. This indicates that access to health services is adequate. However, the coverage of measles appears to be insufficient to prevent outbreaks, and must be improved. The efficacy in delivering immunization can be improved and enhanced utilization of the services offered should be sought.

BCG Vaccine↗

Influenza vaccination coverage among persons aged 50-64 years enrolled in commercial managed health-care plans--United States, 2003-04 and 2004-05 influenza seasons.

To combat an unexpected shortage of influenza vaccine in the fall of 2004, CDC issued guidance to direct available vaccine supplies to persons in designated priority groups (e.g., persons aged >/=65 years, persons with certain health conditions, health-care workers, and close contacts of persons at high risk for complications from influenza). Analyses of influenza vaccination coverage for the 2004-05 influenza season indicated that coverage levels for adults in priority groups nearly reached the levels of previous years, whereas coverage levels among adults not in priority groups were approximately half the levels of the 2003-04 season. These findings suggested that national public health actions to direct available vaccine supply to persons at high risk for complications from influenza during the supply disruption were successful. To assess influenza vaccination coverage among persons aged 50-64 years for the 2004-05 influenza season relative to the 2003-04 season and to estimate the effect of shortages on selected subgroups, the National Committee for Quality Assurance (NCQA) analyzed data from a survey of persons enrolled in commercial managed care health plans. This report summarizes the findings of that analysis, which indicated that, although vaccination coverage declined substantially from 2003-04 to 2004-05 among all subgroups in this age range, respondents who were older or who reported poorer health status exhibited smaller relative declines in vaccination coverage between the two seasons.

Aged↗

[Hyperspectral remote sensing estimation models on vegetation coverage of natural grassland].

By using ASD FieldSpec Pro FR spectroradiometer, the spectral measurement of natural grassland in Xilingole Leaguer of Inner Mongolia was performed, with the vegetation coverage of natural grassland calculated, and the correlation of 25 hyperspectral feature variables with the vegetation coverage of natural grassland was analyzed. The results showed that there were 17 variables correlated significantly with the vegetation coverage of natural grassland, among which, the correlation coefficient between vegetation coverage and the area of red edge peak calculated as the sum of the amplitudes between 680 nm and 780 nm (sigma dr 680 - 780 nm) was the highest, with the value of 0.781. The basic experimental data including the vegetation coverage and canopy reflectance of natural grassland were classified into two groups. One group was used as the training sample to build the regression models with one-sample linear method, nonlinear method, and stepwise analysis method, while the other was used as the testing sample to test the precision of regression models. It was suggested that the variable of the area of red edge peak calculated as the sum of amplitudes between 680 nm and 780 nm (sigma dr 680 - 780 nm) was the best one to univariate general linear model, with a standard deviation of 10.4% and an estimation precision of 83.99%, while the stepwise regression technique was not effective to estimate the grassland coverage with raw hyperspectral canopy reflectance.

Conservation of Natural Resources↗

National, state, and urban area vaccination coverage among children aged 19-35 months--United States, 2005.

The National Immunization Survey (NIS) provides vaccination coverage estimates among children aged 19-35 months for each of the 50 states and selected urban areas. Findings from the 2005 NIS include nationwide increases in coverage with >/=3 and >/=4 doses of pneumococcal conjugate vaccine (PCV) and continued high levels of coverage for the other recommended vaccines and vaccine series. In addition, no racial/ethnic disparities in coverage estimates were observed in the 4:3:1:3:3:1 vaccine series, the recommended series for children aged 19-35 months that includes DTP/DT/DTaP; poliovirus vaccine; measles, mumps, and rubella vaccine (MMR); Haemophilus influenzae type b vaccine; hepatitis B vaccine; and varicella vaccine. An important accomplishment indicated by the 2005 NIS data is the achievement of <50% coverage for the full series of PCV (>/=4 doses) and <80% coverage for >/=3 doses within 5 years after being added to the U.S.-recommended childhood immunization schedule in 2000. This occurred despite shortages of this vaccine during 2001-2004, which might have affected accessibility to PCV.

Child, Preschool↗

Using linked program and birth records to evaluate coverage and targeting in Tennessee's WIC program.

Public health nutrition programs are intended to serve low-income families who are at greater nutritional risk than the general population. Not all persons who are program-eligible are at equal risk, however. It would be desirable to evaluate a program's ability to enroll persons from higher risk backgrounds in the population (coverage) and, conversely, the extent to which those enrolled in this program are at higher risk (targeting). A method for the evaluation of coverage and targeting was developed using data from the Tennessee Women, Infants, and Children Special Supplemental Food Program (WIC) linked with birth certificates. The linked computer file was created by matching the name and date of birth in both record files. The birth records were the common source of information used to characterize the risk background for both the WIC and non-WIC participants. Maternal sociodemographic information on the birth records was used to define the health risk background of each child. The coverage and targeting of "at-risk" children were computed and compared for 50 counties or county-aggregates in Tennessee. Considerable variation in the coverage and targeting rates of at-risk children was observed among Tennessee counties, although the counties within each WIC administrative region tended to have similar coverage and targeting patterns. Using the existing data in linked program and vital records provides a direct evaluation of a program. Coverage and targeting evaluation can be used to detect underserved populations within small geographic areas.

Birth Certificates↗

Cluster survey for vaccination coverage in Sohag Governorate, October 1989.

This cluster survey for vaccination coverage in Sohag Governorate was carried out for the six vaccine preventable diseases in children below 2 years and tetanus toxoid for pregnant mothers. It reveals that vaccination coverage in Sohag is still far below the universal child immunization goal of 80% coverage by the year 1990. Fully vaccinated children were 17.2%. Vaccination coverage was better in urban (44.8%) than in rural areas (7%). Vaccination coverage was higher in males (67.6%) than in females (32.4%). Measles had the best level of coverage (66.1%) while B.C.G. was the least (20.9%). Fifty percent of mothers were covered by two doses of tetanus toxoid. The most common reasons for drop out were unaware of need for return for second and third doses (32.6%) and vaccine not available (21.7%). Evaluation of most important vaccination activities to be performed in link with the cold chain in the thirty health units of the thirty cluster areas of Sohag Governorate was performed.

BCG Vaccine↗

[Strategy for controlling poliomyelitis in Mexico: greater vaccination coverage of children less than 1 year of age].

In spite of the widespread use of oral poliovirus vaccine, some countries have not achieved an optimal control of poliomyelitis. According to Sabin, this fact is due to a lack of immunization coverage of children under one year of age. In this study, the relationship between the general morbidity rate for polio and vaccination coverage of children under one year of age, in people protected by the Mexican Institute of Social Security, is analyzed. There is a negative correlation between these two variables: the lesser the coverage, the greater the rates. There is also a correlation between the rate of polio and the rate of polio for the year prior to each of the years of the study period. In a multiple regression model, both the coverage and the rate for the previous year were significantly correlated with the rate of polio. In order to get an optimum control of this disease, it is advantageous to consider that it is not enough to increase the coverage but that this coverage must be opportune, i.e., in the first year of life.

Humans↗

Thailand Expanded Program on Immunization: a ten-years review of coverage and impact on EPI target diseases.

The national immunization coverage in Thailand for all types of vaccine has been steadily increasing since 1978, when the EPI was formally launched. The coverage in 1987 was 96% for BCG, 75% for DPT, 74% for OPV, and 60% for TT. Measles vaccine, which started only in late 1984, had the lowest coverage, 51%, in 1987. During the period 1982-1987, the drop-out rates between the first and third dose of DPT and OPV decreased dramatically from 69% to 13% and from 42% to 13% respectively. Sampling surveys of immunization coverage showed higher coverage for DPT and OPV than those from reporting in all regions, especially in the capital city which has a high concentration of the private health sector. Only the northeastern region had less coverage from surveys than from reporting. Following the launch of EPI, the disease incidence demonstrated a clearly downward trend for diphtheria, poliomyelitis, and measles, while in the case of pertussis and neonatal tetanus, slower of still fluctuating declines were observed. The reported age-specific incidences per 100,000 population in 1986 for children 0-4 years were as follows: 4 for diphtheria, 0.9 for poliomyelities, 180 for measles, 14 for pertussis, and 10 for tetanus.

Communicable Disease Control↗