acase@tulane.edu

acase@tulane.edu

acase@tulane.edu

acase@tulane.edu

Immunization has been used as an upstream, protective measure in public health for decades. Although immunization programs have been introduced in Pakistan, new and emerging infectious disease remains a concern in the country. The province of Sindh, Pakistan is of special concern because of its large rural population.<p>The purpose of this study was to: 1) determine and compare complete and age-appropriate immunization uptake in children 12 to 36 months and birth to 9 months, respectively living in Sindh, Pakistan in 1994 and 1997; and 2) determine the correlates of complete and age-appropriate immunization in children 12 to 36 months and birth to 9 months, respectively living in Sindh, Pakistan in 1997.<p>This study reviewed data that was collected as part of the School Nutrition Program (SNP) and Family Health Project (FHP) in 1994 and 1997, respectively. Analyses included immunization data on 1877 children from the SNP survey and 1694 children from the FHP survey.<p>Females were found to have higher statistically significantly age-appropriate uptake than males in 1997 (p=0.015). Complete immunization status was also found to vary significantly by district of residence in 1994 and 1997 (p<0.001). Both complete and age-appropriate immunization status was found to decrease from 1994 to 1997.<p>Multivariable logistic regression revealed that not owning a radio, electricity, or bicycle was indicative of lower odds of complete immunization uptake (OR<1, p<0.05). Other correlates predictive of lower odds of complete immunization included owning a water pump (OR=0.360), not having a Lady Health Worker (LHW) visit the home (OR=0.489), living in a kucha house (OR=0.637), and living in Tharparkar (OR=0.290), Badin (OR=0.599), or Mirpur Khas (OR=0.271).<p>A similar regression analysis revealed childs sex, ownership of a refrigerator, and having heard of contraception to be correlates of age-appropriate immunization (p<0.05). Females had higher odds of age-appropriate immunization (OR=1.851) compared to males. Not having a refrigerator was indicative of lower odds (OR=0.079). Not having heard of at least one type of contraception was a predictor age-appropriate immunization (OR=1.925).

Immunization has been used as an upstream, protective measure in public health for decades. Although immunization programs have been introduced in Pakistan, new and emerging infectious disease remains a concern in the country. The province of Sindh, Pakistan is of special concern because of its large rural population.<p>The purpose of this study was to: 1) determine and compare complete and age-appropriate immunization uptake in children 12 to 36 months and birth to 9 months, respectively living in Sindh, Pakistan in 1994 and 1997; and 2) determine the correlates of complete and age-appropriate immunization in children 12 to 36 months and birth to 9 months, respectively living in Sindh, Pakistan in 1997.<p>This study reviewed data that was collected as part of the School Nutrition Program (SNP) and Family Health Project (FHP) in 1994 and 1997, respectively. Analyses included immunization data on 1877 children from the SNP survey and 1694 children from the FHP survey.<p>Females were found to have higher statistically significantly age-appropriate uptake than males in 1997 (p=0.015). Complete immunization status was also found to vary significantly by district of residence in 1994 and 1997 (p<0.001). Both complete and age-appropriate immunization status was found to decrease from 1994 to 1997.<p>Multivariable logistic regression revealed that not owning a radio, electricity, or bicycle was indicative of lower odds of complete immunization uptake (OR<1, p<0.05). Other correlates predictive of lower odds of complete immunization included owning a water pump (OR=0.360), not having a Lady Health Worker (LHW) visit the home (OR=0.489), living in a kucha house (OR=0.637), and living in Tharparkar (OR=0.290), Badin (OR=0.599), or Mirpur Khas (OR=0.271).<p>A similar regression analysis revealed childs sex, ownership of a refrigerator, and having heard of contraception to be correlates of age-appropriate immunization (p<0.05). Females had higher odds of age-appropriate immunization (OR=1.851) compared to males. Not having a refrigerator was indicative of lower odds (OR=0.079). Not having heard of at least one type of contraception was a predictor age-appropriate immunization (OR=1.925).

Introduction: In the new century, worldwide health professionals face new pressures for changes towards more cost-effective and sustainable health care for all populations. Globalization creates daunting challenges as well as new opportunities for institutions and health professionals being more connected and rethink their strategies toward an interprofessional practice. Although Health professionals are paying increased attention to issues of global health, there are no current competency assessment tools appropriate for evaluating their competency in global health. This study aims to assess global health competencies of family medicine residents, nursing, physiotherapy and occupational therapy students in five universities across Ontario, Canada Methods: A total of 429 students participated in the Global Health Competency Survey, drawn from family medicine residency, nursing, physiotherapy and occupational therapy programs of five universities in Ontario, Canada. The surveys were evaluated for face and content validity and reliability. Results: Factor analysis was used to identify the main factors to be included in the reliability analysis. Content validity was supported with one floor effect in the “racial/ethnic disparities” variable (36.1%), and few ceiling effects. Seven of the twenty-two variables performed the best (between 34% and 59.6%). For the overall rating score, no participants had floor or ceiling effects. Five factors were identified which accounted for 95% of the variance. Cronbach’s alpha was >0.8 indicating that the survey items had good internal consistency and represent a homogeneous construct. The results of the survey demonstrated that self-reported knowledge confidence in global health issues and global health skills were low for family medicine residents, nursing, physiotherapy and occupational therapy’ students. The percentage of residents and students who self-reported themselves confident was less than 60% for all global health issues. Conclusion: The Global Health Competency Survey demonstrated good internal consistency and face and content validity. The new century requires professionals competent in global health. Improvements in the core competencies in global health can be a bridge to a more equal world. Institutions must offer interprofessional approaches and a curriculum that exposes them to a varied learning methods and opportunities to improve their knowledge and skills in global health.

Background: In many countries, a significant proportion of medicines traded and consumed are of poor or variable quality. Meanwhile, failures in appropriately framing and responding to the problem have led to a proliferation of public health and governance challenges. Objective: To examine the issues exacerbating the trade and consumption of medicines of poor or variable quality, as well as present locally relevant strategies. Methods: Analytic triangulation was applied to the synthesis of publicly available documents. Results: Where economic and regulatory environments are less structured, supply chain security strategies that fixate on ‘counterfeits’ often fail in limiting the prevalence of poor quality medicines. In addition to a multivariate drug quality classification chart, three quality frameworks are presented for examining appropriate policy strategies in mediating drug quality. Conclusion: These tools can assist stakeholders in determining more locally relevant and context-specific strategies, while interrogating the proposition for greater transparency vis-à-vis drug quality.

Background: In many countries, a significant proportion of medicines traded and consumed are of poor or variable quality. Meanwhile, failures in appropriately framing and responding to the problem have led to a proliferation of public health and governance challenges. Objective: To examine the issues exacerbating the trade and consumption of medicines of poor or variable quality, as well as present locally relevant strategies. Methods: Analytic triangulation was applied to the synthesis of publicly available documents. Results: Where economic and regulatory environments are less structured, supply chain security strategies that fixate on ‘counterfeits’ often fail in limiting the prevalence of poor quality medicines. In addition to a multivariate drug quality classification chart, three quality frameworks are presented for examining appropriate policy strategies in mediating drug quality. Conclusion: These tools can assist stakeholders in determining more locally relevant and context-specific strategies, while interrogating the proposition for greater transparency vis-à-vis drug quality.

Dengue is a mosquito-borne disease that has gone from isolated sylvatic spill-overs to a pathogen of global public health importance in less than a century. Surveillance and control efforts have continually lagged behind contemporary needs and this thesis investigates the pressing need to reassess the current geographic limits and case burden of dengue including how these are measured. First, the global distribution of reported dengue infections was mapped. In many areas dengue reporting is sparse as it can be asymptomatic or clinically similar to other diseases. The maps identified surveillance gaps, particularly in Africa and the Middle East, where targeted efforts are needed to reliably measure the contemporary global extent of dengue transmission. Second, the global case burden of dengue was estimated by pairing risk maps with longitudinal cohort study data. This gave the first cartographic estimate of dengue cases and at 390 million per year (95&percnt; CI: 284-528) was over three times the World Health Organization official estimate. Reconciling these estimates with reported case data allowed an assessment of existing national surveillance strategies. Third, existing methods for outbreak identification were compared. High burden dengue outbreaks are preventable if timely and appropriate measures are applied. This analysis suggested, however, that commonly used outbreak definitions are not consistent, which could have an adverse effect on outbreak response. An alternative framework for outbreak identification based on healthcare capacities is thus outlined. Fourth, an analysis was undertaken that quantified how mosquito vectors place geographic and seasonal limits on dengue transmission. This involved updating estimates of mosquito longevity which were integrated with temperature-dependent dynamic transmission models to produce global maps. These suggested that while temperature places strong limits on the distribution of dengue in some settings, mosquito ecology may be more important in others. Finally, these findings are discussed in the context of global dengue surveillance gaps, with recommendations of how these can be addressed at a time when providing an evidence base for deployment of new control strategies will be critical.