Public Health Programs Greatly Reduce Infant Mortality in Costa Rica

1986 ◽  
Vol 12 (3) ◽  
pp. 103
2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
C Urquidi ◽  
M T Valenzuela

Abstract Background EPI is one of the successful public health programs for the control and prevention of infectious diseases worldwide. In Latin America and the Caribbean, EPI achieved high rates of vaccination and reached both the eradication of poliomyelitis (1994) and the elimination of the indigenous transmission on the measles virus (2016). Between 2006 and 2011, 174. 000 deaths were also avoided. Objective To identify exogenous conditions that were in place before the establishment of the EPI, which contributed to a better implementation of the program and increased vaccine coverage levels since 1980. Methods an exploratory mixed ecological study with information from twenty-five Latin American and the Caribbean countries were studied in 1980. The exogenous variables were: Number of nurses per 10.000 inhabitants (as a proxy level for the level of development of the health services), Infant mortality (progress of health conditions), Annual GDP (Economy growth in production), and Human Development Index (HDI). The primary outcome was vaccine coverage (measles and OPV3) from 1980 to 2013, and secondary outcomes were inter and intersectoral coordination of PNI. The effects were estimated through regression models. Results In the univariate models, there was a positive relationship between HDI and vaccination coverage, and an inverse effect of infant mortality; an obvious situation since it is expected that as vaccination coverage increased, infant mortality declines. The number of nurses had a positive relationship between inter and intersectoral coordination. In the multivariate model, three of the four exogenous variables explained 35.7% of the increase in coverage: number of nurses, HDI, and GDP. Conclusions Exogenous factors played an essential role in the improvement of the immunizations program in Latin America and the Caribbean countries, as well as could be for other public health interventions. Key messages Economy growth and Human Development are essential for the implementation of public health programs. The level of development of health services contributes to the success of a public health program.


2005 ◽  
Vol 10 (1) ◽  
pp. 25-38 ◽  
Author(s):  
Hilde Iversen ◽  
Torbjørn Rundmo ◽  
Hroar Klempe

Abstract. The core aim of the present study is to compare the effects of a safety campaign and a behavior modification program on traffic safety. As is the case in community-based health promotion, the present study's approach of the attitude campaign was based on active participation of the group of recipients. One of the reasons why many attitude campaigns conducted previously have failed may be that they have been society-based public health programs. Both the interventions were carried out simultaneously among students aged 18-19 years in two Norwegian high schools (n = 342). At the first high school the intervention was behavior modification, at the second school a community-based attitude campaign was carried out. Baseline and posttest data on attitudes toward traffic safety and self-reported risk behavior were collected. The results showed that there was a significant total effect of the interventions although the effect depended on the type of intervention. There were significant differences in attitude and behavior only in the sample where the attitude campaign was carried out and no significant changes were found in the group of recipients of behavior modification.


Vaccines ◽  
2021 ◽  
Vol 9 (3) ◽  
pp. 281
Author(s):  
Andrea Haekyung Haselbeck ◽  
Birkneh Tilahun Tadesse ◽  
Juyeon Park ◽  
Malick M. Gibani ◽  
Ligia María Cruz Espinoza ◽  
...  

Typhoid fever remains a significant health problem in sub-Saharan Africa, with incidence rates of >100 cases per 100,000 person-years of observation. Despite the prequalification of safe and effective typhoid conjugate vaccines (TCV), some uncertainties remain around future demand. Real-life effectiveness data, which inform public health programs on the impact of TCVs in reducing typhoid-related mortality and morbidity, from an African setting may help encourage the introduction of TCVs in high-burden settings. Here, we describe a cluster-randomized trial to investigate population-level protection of TYPBAR-TCV®, a Vi-polysaccharide conjugated to a tetanus-toxoid protein carrier (Vi-TT) against blood-culture-confirmed typhoid fever, and the synthesis of health economic evidence to inform policy decisions. A total of 80 geographically distinct clusters are delineated within the Agogo district of the Asante Akim region in Ghana. Clusters are randomized to the intervention arm receiving Vi-TT or a control arm receiving the meningococcal A conjugate vaccine. The primary study endpoint is the total protection of Vi-TT against blood-culture-confirmed typhoid fever. Total, direct, and indirect protection are measured as secondary outcomes. Blood-culture-based enhanced surveillance enables the estimation of incidence rates in the intervention and control clusters. Evaluation of the real-world impact of TCVs and evidence synthesis improve the uptake of prequalified/licensed safe and effective typhoid vaccines in public health programs of high burden settings. This trial is registered at the Pan African Clinical Trial Registry, accessible at Pan African Clinical Trials Registry (ID: PACTR202011804563392).


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