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Routine vaccination coverage in low- and middle-income countries: further arguments for accelerating support to child vaccination services.
Global Health Action. 2013; 6:20343.BACKGROUND AND OBJECTIVE: The Expanded Programme on Immunization was introduced by the World Health Organization (WHO) in all countries during the 1970s. Currently, this effective public health intervention is still not accessible to all. This study evaluates the change in routine vaccination coverage over time based on survey data and compares it to estimations by the WHO and United Nations Children's Fund (UNICEF). DESIGN: Data of vaccination coverage of children less than 5 years of age was extracted from Demographic and Health Surveys (DHS) conducted in 71 low- and middle-income countries during 1986-2009. Overall trends for vaccination coverage of tuberculosis, diphtheria, tetanus, pertussis, polio and measles were analysed and compared to WHO and UNICEF estimates. RESULTS: From 1986 to 2009, the annual average increase in vaccination coverage of the studied diseases ranged between 1.53 and 1.96% units according to DHS data. Vaccination coverage of diphtheria, tetanus, pertussis, polio and measles was all under 80% in 2009. Non-significant differences in coverage were found between DHS data and WHO and UNICEF estimates. CONCLUSIONS: The coverage of routine vaccinations in low- and middle-income countries may be lower than that previously reported. Hence, it is important to maintain and increase current vaccination levels.
Lancet. 2007 May 26; 369(9575):1768-1769.In today's Lancet, Steven Radelet and Bilal Siddiqi examine the associations between evaluation scores assigned by the Global Fund to Fight AIDS, Tuberculosis and Malaria to recipient countries and characteristics of grants and countries. This analysis complements a previous look at the capacity of recipient countries to disburse Global Fund money. The selection of the outcome variable-grant scores and disbursement rates-differed, but both analyses included several common programmatic and country-specific variables. Both studies found that poor countries are not disadvantaged compared with middle-income recipients in terms of performance. The fundamental question for both studies, however, is what does the selected outcome variable measure. Grant performance scores from the Global Fund have several limitations. First, the recipients define the numerical targets for each quarter for the progress indicators. The scores do not allow for comparisons of progress across recipients compared with baseline. An A recipient has not necessarily increased coverage of key interventions more than a B1 recipient. Category A represents grants reaching or exceeding expectations, whereas B1 covers grants that have adequate performance. Second, validation of reported progress against programmatic benchmarks is inherently difficult in countries with weak health-information systems. Progress on delivery of interventions has not been assessed with population-based measurements of the delivery of the interventions funded by the grants, but rather on more upstream processes or provider-based data-collection mechanisms. Third, the evaluation process is not entirely independent and includes progress monitoring by local agents selected by the Fund. (excerpt)