Browsing by Author "Rudd C"

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A Preliminary Assessment of Rotavirus Vaccine Effectiveness in Zambia.
(2016-May-01) Beres LK; Tate JE; Njobvu L; Chibwe B; Rudd C; Guffey MB; Stringer JS; Parashar UD; Chilengi R; Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.; Centre for Infectious Disease Research in Zambia, Lusaka Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.; Centre for Infectious Disease Research in Zambia, Lusaka.; University of North Carolina School of Medicine, Chapel Hill.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
BACKGROUND: Diarrhea is the third leading cause of child death in Zambia. Up to one-third of diarrhea cases resulting in hospitalization and/or death are caused by vaccine-preventable rotavirus. In January 2012, Zambia initiated a pilot introduction of the Rotarix live, oral rotavirus vaccine in all public health facilities in Lusaka Province. METHODS: Between July 2012 and October 2013, we conducted a case-control study at 6 public sector sites to estimate rotavirus vaccine effectiveness (VE) in age-eligible children presenting with diarrhea. We computed the odds of having received at least 1 dose of Rotarix among children whose stool was positive for rotavirus antigen (cases) and children whose stool was negative (controls). We adjusted the resulting odds ratio (OR) for patient age, calendar month of presentation, and clinical site, and expressed VE as (1 - adjusted OR) × 100. RESULTS: A total of 91 rotavirus-positive cases and 298 rotavirus-negative controls who had under-5 card-confirmed vaccination status and were ≥6 months of age were included in the case-control analysis. Among rotavirus-positive children who were age-eligible to be vaccinated, 20% were hospitalized. Against rotavirus diarrhea of all severity, the adjusted 2-dose VE was 26% (95% confidence interval [CI], -30% to 58%) among children ≥6 months of age. VE against hospitalized children ≥6 months of age was 56% (95% CI, -34% to 86%). CONCLUSIONS: We observed a higher point estimate for VE against increased severity of illness compared with milder disease, but were not powered to detect a low level of VE against milder disease.
Costs of introducing pneumococcal, rotavirus and a second dose of measles vaccine into the Zambian immunisation programme: Are expansions sustainable?
(2016-Jul-29) Griffiths UK; Bozzani FM; Chansa C; Kinghorn A; Kalesha-Masumbu P; Rudd C; Chilengi R; Brenzel L; Schutte C; Center for Infectious Disease Research in Zambia (CIDRZ), Plot 5032 Great North Road, Lusaka, Zambia.; World Bank, Zambia Country Office, Banc ABC House, Church Road, Lusaka, Zambia.; Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom. Electronic address: ulla.griffiths@lshtm.ac.uk.; Bill and Melinda Gates Foundation, 1300 I Street, NW Suite 200, Washington, DC, United States.; Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom.; Perinatal Health Research Unit, University of the Witwatersrand, Chris Hani Baragwanath Hospital, Soweto, South Africa.; Strategic Development Consulting (SDC), Pietermaritzburg, South Africa.; World Health Organization, Lusaka, Zambia.
BACKGROUND: Introduction of new vaccines in low- and lower middle-income countries has accelerated since Gavi, the Vaccine Alliance was established in 2000. This study sought to (i) estimate the costs of introducing pneumococcal conjugate vaccine, rotavirus vaccine and a second dose of measles vaccine in Zambia; and (ii) assess affordability of the new vaccines in relation to Gavi's co-financing and eligibility policies. METHODS: Data on 'one-time' costs of cold storage expansions, training and social mobilisation were collected from the government and development partners. A detailed economic cost study of routine immunisation based on a representative sample of 51 health facilities provided information on labour and vaccine transport costs. Gavi co-financing payments and immunisation programme costs were projected until 2022 when Zambia is expected to transition from Gavi support. The ability of Zambia to self-finance both new and traditional vaccines was assessed by comparing these with projected government health expenditures. RESULTS: 'One-time' costs of introducing the three vaccines amounted to US$ 0.28 per capita. The new vaccines increased annual immunisation programme costs by 38%, resulting in economic cost per fully immunised child of US$ 102. Co-financing payments on average increased by 10% during 2008-2017, but must increase 49% annually between 2017 and 2022. In 2014, the government spent approximately 6% of its health expenditures on immunisation. Assuming no real budget increases, immunisation would account for around 10% in 2022. Vaccines represented 1% of government, non-personnel expenditures for health in 2014, and would be 6% in 2022, assuming no real budget increases. CONCLUSION: While the introduction of new vaccines is justified by expected positive health impacts, long-term affordability will be challenging in light of the current economic climate in Zambia. The government needs to both allocate more resources to the health sector and seek efficiency gains within service provision.
Menstrual hygiene management in rural schools of Zambia: a descriptive study of knowledge, experiences and challenges faced by schoolgirls.
(2019-Jan-05) Chinyama J; Chipungu J; Rudd C; Mwale M; Verstraete L; Sikamo C; Mutale W; Chilengi R; Sharma A; United Nations Children's Fund, P.O Box 33610, Lusaka, Zambia.; Centre for Infectious Disease Research in Zambia, P.O Box 34681, Lusaka, Zambia. chinyama.joyce@yahoo.com.; Department of Public Health, Section of Health promotion, School of Medicine, University of Zambia, P.O Box 50110, Lusaka, Zambia.; Centre for Infectious Disease Research in Zambia, P.O Box 34681, Lusaka, Zambia.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
INTRODUCTION: While in school, girls require an environment that is supportive of menstrual hygiene management (MHM) in order to ensure regular school attendance and participation. Little is known about schoolgirls access to and practice of MHM in rural Zambia. This study explores girls' experiences of MHM in rural schools of Zambia from the perspectives of schoolgirls, schoolboys and community and school-based adults key to MHM for schoolgirls. METHODS: In July and August 2015, we conducted this qualitative exploratory study in six rural schools of Mumbwa and Rufunsa districts of Zambia. Twelve in-depth interviews (IDIs) and six focus group discussions (FGDs) were conducted among girls ages 14-18 who had begun menstruating. Two FGDs with boys ages 14-18 and 25 key informant interviews were also conducted with teachers, female guardians and traditional leaders to provide the context within which schoolgirls practice MHM. RESULTS: Most girls reported learning about menstruation only at menarche and did not know the physiological basis of menstruation. They reported MHM-related challenges, including: use of non-absorbent and uncomfortable menstrual cloth and inadequate provision of sanitary materials, water, hygiene and sanitation facilities (WASH) in schools. In particular, toilets did not have soap and water or doors and locks for privacy and had a bad odor. Girls' school attendance and participation in physical activities was compromised when menstruating due to fear of teasing (especially by boys) and embarrassment from menstrual leakage. Boys said they could tell when girls were menstruating by the smell and their behaviour, for instance, moving less and isolating themselves from their peers. Girls complained of friction burns on their inner thighs during their long journey to school due to chaffing of wet non-absorbent material used to make menstrual cloth. Girls preferred to dispose used menstrual materials in pit latrines and not waste bins for fear that they could be retrieved for witchcraft against them. Though traditional leaders and female guardians played a pivotal role in teaching girls MHM, they have not resolved challenges to MHM among schoolgirls. CONCLUSION: When menstruating, schoolgirls in rural Zambia would rather stay home than be uncomfortable, inactive and embarrassed due to inadequate MHM facilities at school. A friendly and supportive MHM environment that provides education, absorbent sanitary materials and adequate WASH facilities is essential to providing equal opportunity for all girls.
Rotavirus landscape in Africa-Towards prevention and control: A report of the 8th African rotavirus symposium, Livingstone, Zambia.
(2015-Jun-26) Rudd C; Mwenda J; Chilengi R; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia. Electronic address: cheryl.rudd@cidrz.org.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; WHO-Africa Regional Office, Brazzaville, Congo.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
The 8th African Rotavirus Symposium was held in Livingstone, Zambia from the 12-13 June 2014. Over 130 delegates from 35 countries - 28 from African nations - participated in this symposium, which included scientists, clinicians, immunisation managers, public health officials, policymakers and vaccine manufacturers. The theme for the symposium was Rotavirus Landscape in Africa-Towards Prevention and Control. At the time of the symposium, a total of 21 African countries had introduced the rotavirus vaccine into their national immunisation schedules. This meeting was particularly timely and relevant to review early data on vaccine adoption and impact from these countries. The concluding panel discussion proposed several recommendations for areas of focus moving forward in rotavirus advocacy and research.