Karachi, the largest city in Pakistan, having high population growth and a complex health care environment, has highest density of unimmunized (zero dose) and under-immunized children. The main reasons of low immuniza...Karachi, the largest city in Pakistan, having high population growth and a complex health care environment, has highest density of unimmunized (zero dose) and under-immunized children. The main reasons of low immunization coverage in Karachi were lack of governance and accountability in a duplicative and fragmented health management structure, weak and inequitable immunization services, and lack of demand and trust among people for immunization services. The Expanded Programme on Immunization (EPI), Ministry of Health (MOH) in Sindh Province spearheaded a structured and collaborative process to develop strategies for addressing inequity in immunization services towards achieving Universal Immunization Coverage (UIC) in Karachi. The process included a situation analysis with gathering quantitative and qualitative information on the root causes of zero-dose and inequity of the immunization services. The strategies and interventions were developed with multi-layer input and feedback of the stakeholders and partners, and focusing primarily to address gaps in three program areas: governance, leadership and accountability;immunization service delivery;and building demand and trust among the people. The interventions were further prioritized for high-risk areas;identified based on maximum number zero-dose children, presence of large slum areas, measles outbreak and on-going circulation of wild poliovirus. Finally, costing for the Roadmap activities was done through consultation with partners and aligning domestic and external (donor) resources. In this paper, we have highlighted the unique process the Sindh Government undertook in collaboration with the stakeholders and partners to develop strategies and interventions for addressing inequity in urban immunization services in Karachi towards achieving Universal Immunization Coverage (UIC). Similar processes can be adapted, as a potential model, for developing strategies to achieve universal health coverage in the cities of Pakistan and in other countries.展开更多
Background:Myanmar lies in the Greater Mekong Subregion where there is artemisinin-resistant Plasmodium falciparum malaria.As the artemisinin compound is the pillar of effective antimalarial therapies,containing the s...Background:Myanmar lies in the Greater Mekong Subregion where there is artemisinin-resistant Plasmodium falciparum malaria.As the artemisinin compound is the pillar of effective antimalarial therapies,containing the spread of artemisinin resistance is a national and global priority.The use of insecticide-treated bed nets/long-lasting insecticidal nets(ITNs/LLINs)is the key intervention for ensuring the reduction of malaria transmission and the spread of resistant strains,and for eventually eliminating malaria.This study aimed at assessing household ownership of,access to,and utilization of bed nets in areas of Myanmar with and without artemisinin resistance containment measures.Methods:Secondary data from a nationwide community-based malaria survey conducted by the National Malaria Control Program in 2014 were analyzed.Based on evidence of artemisinin resistance,Myanmar was divided into tiers 1,2,and 3:townships in tiers 1 and 2 were aggregated as the Myanmar Artemisinin Resistance Containment(MARC)areas and were compared with tier 3 townships,which were defined as non-MARC areas.The chi-square test was used to compare groups,and the level of significance was set at P≤0.05.Results:Of the 6328 households assessed,97.2%in both MARC and non-MARC areas had at least one bed net(any type),but only 63%of households had ITNs/LLINs.Only 44%of households in MARC areas and 24%in non-MARC areas had adequate numbers of ITNs/LLINs(one ITN/LLIN per two persons,P<0.001).Nearly 44%of household members had access to ITNs/LLINs.Regarding the utilization of ITNs/LLINs,45%of household members used them in MARC areas and 36%used them in non-MARC areas(P<0.001,desired target=100%).Utilization of ITNs/LLINs among children aged below five years and pregnant women(high malaria risk groups)was low,at 44%and 42%,respectively.Conclusions:This study highlights the nationwide shortfalls in the ownership of,access to,and utilization of ITNs/LLINs in Myanmar,which is of particular concern in terms of containing the spread of artemisinin resistance.It highlights the need for priority attention to be paid and mobilization of resources in order to improve bed net coverage and utilization through bed net distribution and/or social marketing,information dissemination,and awareness-raising.展开更多
Background:Myanmar lies in the Greater Mekong sub-region of South-East Asia faced with the challenge of emerging resistance to artemisinin combination therapies(ACT).Migrant populations are more likely than others to ...Background:Myanmar lies in the Greater Mekong sub-region of South-East Asia faced with the challenge of emerging resistance to artemisinin combination therapies(ACT).Migrant populations are more likely than others to spread ACT resistance.A vital intervention to reduce malaria transmission,resistance spread and eliminate malaria is the use of bed nets.Among seasonal and stable migrants in an artemisinin resistance containment region of Myanmar,we compared a)their household characteristics,b)contact with health workers and information material,and c)household knowledge,access and utilization of bed nets.Methods:Secondary data from community-based surveys on 2484 migrant workers(2013 and 2014,Bago Region)were analyzed of which 37%were seasonal migrants.Bed net access and utilization were assessed using a)availability of at least one bed net per household,and b)one bed net per two persons,and c)proportion of household members who slept under abed net during the previous night(Indicator targets=100%).Results:Over 70%of all migrants were from unstable work settings with short transitory stays.Average household size was five(range 1-25)and almost half of all households had children under-five years.Roughly 10%of migrants were night-time workers.Less than 40%of households had contact with health workers and less than 30%had exposure to information education and communication(IEC)materials,the latter being significantly lower among seasonal migrants.About 70%of households were aware of the importance of insecticide-treated bed-nets/long-lasting insecticidal nets(ITNs/LLINs),but knowledge on insecticide impregnation and retreatment of ITNs was poor(<10%).Although over 95%of households had access to at least one bed net,the number with one bed net per two persons was grossly inadequate(13%for stable migrants and 9%for seasonal migrants,P=0.001).About half of all household members slept under a bed net during the previous night.Conclusions:This study reveals important short-falls in knowledge,access and utilization of bed nets among migrants in Myanmar.Possible ways forward include frequent distribution campaigns to compensate for short transitory stays,matching household distributions to household size,enhanced information campaigns and introducing legislation to make mosquito repellents available for night-time workers at plantations and farms.Better understanding through qualitative research is also merited.展开更多
文摘Karachi, the largest city in Pakistan, having high population growth and a complex health care environment, has highest density of unimmunized (zero dose) and under-immunized children. The main reasons of low immunization coverage in Karachi were lack of governance and accountability in a duplicative and fragmented health management structure, weak and inequitable immunization services, and lack of demand and trust among people for immunization services. The Expanded Programme on Immunization (EPI), Ministry of Health (MOH) in Sindh Province spearheaded a structured and collaborative process to develop strategies for addressing inequity in immunization services towards achieving Universal Immunization Coverage (UIC) in Karachi. The process included a situation analysis with gathering quantitative and qualitative information on the root causes of zero-dose and inequity of the immunization services. The strategies and interventions were developed with multi-layer input and feedback of the stakeholders and partners, and focusing primarily to address gaps in three program areas: governance, leadership and accountability;immunization service delivery;and building demand and trust among the people. The interventions were further prioritized for high-risk areas;identified based on maximum number zero-dose children, presence of large slum areas, measles outbreak and on-going circulation of wild poliovirus. Finally, costing for the Roadmap activities was done through consultation with partners and aligning domestic and external (donor) resources. In this paper, we have highlighted the unique process the Sindh Government undertook in collaboration with the stakeholders and partners to develop strategies and interventions for addressing inequity in urban immunization services in Karachi towards achieving Universal Immunization Coverage (UIC). Similar processes can be adapted, as a potential model, for developing strategies to achieve universal health coverage in the cities of Pakistan and in other countries.
基金The program was funded by the World Health Organization/Special Programme for Research and Training in Tropical Diseases(WHO/TDR)Impact grant to two TDR alumni from the DMRThe funders had no role in study design,data collection and analysis,decision to publish,or preparation of the paper.
文摘Background:Myanmar lies in the Greater Mekong Subregion where there is artemisinin-resistant Plasmodium falciparum malaria.As the artemisinin compound is the pillar of effective antimalarial therapies,containing the spread of artemisinin resistance is a national and global priority.The use of insecticide-treated bed nets/long-lasting insecticidal nets(ITNs/LLINs)is the key intervention for ensuring the reduction of malaria transmission and the spread of resistant strains,and for eventually eliminating malaria.This study aimed at assessing household ownership of,access to,and utilization of bed nets in areas of Myanmar with and without artemisinin resistance containment measures.Methods:Secondary data from a nationwide community-based malaria survey conducted by the National Malaria Control Program in 2014 were analyzed.Based on evidence of artemisinin resistance,Myanmar was divided into tiers 1,2,and 3:townships in tiers 1 and 2 were aggregated as the Myanmar Artemisinin Resistance Containment(MARC)areas and were compared with tier 3 townships,which were defined as non-MARC areas.The chi-square test was used to compare groups,and the level of significance was set at P≤0.05.Results:Of the 6328 households assessed,97.2%in both MARC and non-MARC areas had at least one bed net(any type),but only 63%of households had ITNs/LLINs.Only 44%of households in MARC areas and 24%in non-MARC areas had adequate numbers of ITNs/LLINs(one ITN/LLIN per two persons,P<0.001).Nearly 44%of household members had access to ITNs/LLINs.Regarding the utilization of ITNs/LLINs,45%of household members used them in MARC areas and 36%used them in non-MARC areas(P<0.001,desired target=100%).Utilization of ITNs/LLINs among children aged below five years and pregnant women(high malaria risk groups)was low,at 44%and 42%,respectively.Conclusions:This study highlights the nationwide shortfalls in the ownership of,access to,and utilization of ITNs/LLINs in Myanmar,which is of particular concern in terms of containing the spread of artemisinin resistance.It highlights the need for priority attention to be paid and mobilization of resources in order to improve bed net coverage and utilization through bed net distribution and/or social marketing,information dissemination,and awareness-raising.
基金The program was funded by WHO/TDR Impact grant to two TDR alumni from DMR.The funders had no role in study design,data collection and analysis,decision to publish,or preparation of the manuscript.
文摘Background:Myanmar lies in the Greater Mekong sub-region of South-East Asia faced with the challenge of emerging resistance to artemisinin combination therapies(ACT).Migrant populations are more likely than others to spread ACT resistance.A vital intervention to reduce malaria transmission,resistance spread and eliminate malaria is the use of bed nets.Among seasonal and stable migrants in an artemisinin resistance containment region of Myanmar,we compared a)their household characteristics,b)contact with health workers and information material,and c)household knowledge,access and utilization of bed nets.Methods:Secondary data from community-based surveys on 2484 migrant workers(2013 and 2014,Bago Region)were analyzed of which 37%were seasonal migrants.Bed net access and utilization were assessed using a)availability of at least one bed net per household,and b)one bed net per two persons,and c)proportion of household members who slept under abed net during the previous night(Indicator targets=100%).Results:Over 70%of all migrants were from unstable work settings with short transitory stays.Average household size was five(range 1-25)and almost half of all households had children under-five years.Roughly 10%of migrants were night-time workers.Less than 40%of households had contact with health workers and less than 30%had exposure to information education and communication(IEC)materials,the latter being significantly lower among seasonal migrants.About 70%of households were aware of the importance of insecticide-treated bed-nets/long-lasting insecticidal nets(ITNs/LLINs),but knowledge on insecticide impregnation and retreatment of ITNs was poor(<10%).Although over 95%of households had access to at least one bed net,the number with one bed net per two persons was grossly inadequate(13%for stable migrants and 9%for seasonal migrants,P=0.001).About half of all household members slept under a bed net during the previous night.Conclusions:This study reveals important short-falls in knowledge,access and utilization of bed nets among migrants in Myanmar.Possible ways forward include frequent distribution campaigns to compensate for short transitory stays,matching household distributions to household size,enhanced information campaigns and introducing legislation to make mosquito repellents available for night-time workers at plantations and farms.Better understanding through qualitative research is also merited.
