Methods and challenges in measuring the impact of national pneumococcal and rotavirus vaccine introduction on morbidity and mortality in Malawi

Bar-Zeev, Naor; Kapanda, Lester; King, Carina; Beard, James; Phiri, Tambosi; Mvula, Hazzie; Crampin, Amelia C.; Mwansambo, Charles; Costello, Anthony; Parashar, Umesh D.; Tate, Jacqueline E.; Verani, Jennifer R.; Whitney, Cynthia G.; Heyderman, Robert S.; Cunliffe, Nigel A.; French, Neil

doi:10.1016/j.vaccine.2015.04.053

Cited by 22 publications

(27 citation statements)

References 34 publications

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“…The introduction of new vaccines for diseases endemic in LMICs without prior use in countries with strong pharmacovigilance systems requires specific safety monitoring strategies [23,24]. Post-licensure evaluation of vaccine safety, effectiveness or impact is associated with methodological challenges in low resource settings [25,26].…”

Section: Introductionmentioning

confidence: 99%

Introducing new vaccines in low- and middle-income countries: challenges and approaches

Guignard

Praet

Jusot

et al. 2019

Expert Review of Vaccines

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Introduction: The number of new vaccine introductions (NVIs) in low and middle-income countries (LMICs) has markedly increased since 2010, raising challenges to often overstretched and underfunded health care systems. Areas covered: We present an overview of some of these challenges, focusing on programmatic decisions, delivery strategy, information and communication, pharmacovigilance and post-licensure evaluation. We also highlight field-based initiatives that may facilitate NVI. Expert commentary: Some new vaccines targeting populations other than infants require alternative delivery strategies. NVIs impact upon existing supply chain management, in particular vaccines with novel characteristics. A lack of understanding about immunization and misconceptions may be detrimental to NVI, as well as insufficient or poorly trained health care workforce. Many barriers exist to achieving good vaccination coverage. Real-world evaluation of vaccine safety, effectiveness and impact in LMICs may be limited by lack of robust demographic and disease epidemiology data, as well as limited health care and surveillance infrastructure. A thorough planning phase is crucial to define the most suitable delivery strategy based on the vaccine's and country's specificities. A communication plan and social mobilization are essential. Implementation research and innovative approaches applied to logistics, delivery, communication and program evaluation can facilitate NVI. ARTICLE HISTORY

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Section: Introductionmentioning

confidence: 99%

Introducing new vaccines in low- and middle-income countries: challenges and approaches

Guignard

Praet

Jusot

et al. 2019

Expert Review of Vaccines

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“…To guard against the emerging replacement serotypes such as 19A [14] and expand serotype coverage, higher valency PCVs (PCV10 and PCV13) were licensed. PCV13 was introduced in Malawi in 2011 [15] , which targets serotypes 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F and 23F.…”

Section: Introductionmentioning

confidence: 99%

Population genetic structure, antibiotic resistance, capsule switching and evolution of invasive pneumococci before conjugate vaccination in Malawi

Chaguza

Cornick

Andam

et al. 2017

Vaccine

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“…Full details of the population surveillance system used by the VacSurv Study have been previously described [21,23]. Brie y, deaths in children aged 0-59 months, including stillbirths, were registered retrospectively from October 2011 to February 2012, and prospectively from March 2012 to June 2016.…”

Section: Mortality Surveillancementioning

confidence: 99%

The Added Value of An Open Narrative in Verbal Autopsies – A Mixed-Methods Evaluation from Malawi

Loh

Fottrell

Beard

et al. 2020

Preprint

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Background: The World Health Organization’s standardised verbal autopsy (VA) instrument consists of closed questions, ascertaining signs and symptoms of illness preceding death, and an optional open narrative. As VA analyses increasingly use automated algorithms, the inclusion of narratives should be justified. We evaluated the role of open narratives on VA processes, data quality and respondent emotion.Methods: A mixed-methods analysis was conducted using VA process data for deaths of children aged 0–59 months between April 2013 and November 2016 in Mchinji district, Malawi. Deaths were randomised at the point of interview to receive closed questions only or an open narrative followed by closed questions. Upon concluding the VA, interviewers self-completed questions relating to respondent emotions. Logistic regression was conducted to determine associations with visible emotions during VAs. A group discussion with the interviewers was conducted at the project end, to understand field experiences and explore future recommendations. Qualitative data were coded using deductive themes.Results: A total of 2509 VAs were included, with 49.8% (n = 1341) allocated to open narratives. Narratives lasted a median of 7 minutes (range: 1–113 minutes). Interviewers reported improved respondent rapport and felt narratives improved data quality, although there was no difference in the proportion of deaths with an indeterminate cause (5.3% vs. 6.1%). The majority of respondents did not display visible emotions during VA (81%). Those with a narrative had higher, but not statistically significant, odds of displaying emotion (aOR: 1.20; 95% CI: 0.98, 1.47). Factors associated with visible emotions were: infant deaths compared to neonates; deaths at a health centre or en-route to hospital versus home; and higher socio-economic status. Non-parental respondents and increased time between death and interview were associated with lower odds of emotion.Conclusion: Conducting an open narrative at the start of the VA to build rapport, something valued by the interviewers, may outweigh the additional time taken and slight increase in respondents becoming emotional. However, undue burdens associated with narratives may be further justified if the quality and utility of information from the narrative was promoted through standardised recommendations.

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Methods and challenges in measuring the impact of national pneumococcal and rotavirus vaccine introduction on morbidity and mortality in Malawi

Cited by 22 publications

References 34 publications

Introducing new vaccines in low- and middle-income countries: challenges and approaches

Introducing new vaccines in low- and middle-income countries: challenges and approaches

Population genetic structure, antibiotic resistance, capsule switching and evolution of invasive pneumococci before conjugate vaccination in Malawi

The Added Value of An Open Narrative in Verbal Autopsies – A Mixed-Methods Evaluation from Malawi

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