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Background Coverage of iron folic-acid (IFA) supplementation is a key indicator for tracking programmatic progress within and across countries. However, the validity of maternal report of this information during household surveys has yet to be determined. Objective This study aimed to examine the validity of maternal recall of receipt of IFA supplementation during antenatal care and factors associated with accuracy of maternal recall. Methods A longitudinal cohort design was employed. The direct observation of the IFA received during all antenatal care visits at the five study health posts served as the "gold standard" to the maternal report of IFA received during the postpartum interview. Individual-level validity was assessed by calculating indicator sensitivity, specificity and area under the operating curve (AUC). The inflation factor (IF) measured population-level bias. A multivariable log-binomial model was used to assess factors associated with accurate recall. Results The majority (95.8%) of women were observed receiving IFA during pregnancy. Women overreported the number IFA tablets received compared to what was observed during ANC visits (mean difference = 45 tablets). Maternal report of any IFA receipt was moderate (AUC = 0.60, 95% CI: 0.50, 0.71) and population bias was low (IF = 1.01). However, the individual-level validity was poor across the seven IFA tablet count categories; the AUC for categories ranged from misleading to moderate. Driven by the trend of maternal overreport, the inflation factor indicated that maternal report drastically underestimated the coverage of lower tablet categories and overestimated the coverage of higher tablet counts. Accuracy of maternal report was not associated with months since last ANC observation nor any maternal characteristics. Conclusions Maternal report of the amount of IFA supplementation received during pregnancy produced extremely biased population coverage and performed poorly to moderately for individual level validity. It is imperative to improve this indicator, as it is used in global frameworks and national program planning.

Background Health insurance is an essential aspect of healthcare. This is because it enables the insured to acquire timely and essential healthcare services, besides offering financial protection from catastrophic treatment costs. This paper seeks to establish gender differentials and determinants of health insurance coverage in Zambia. Methods The data used in this study was obtained from the 2018 Zambia Demographic and Health Survey. Data were analyzed using STATA 13.0 software and focused on descriptive and Probit regression analyses. Results The study reveals that for women and men, age, wealth category, education, and professional occupation are positively associated with health insurance while being self-employed in the agricultural sector negatively influences health insurance coverage for both sexes. Other variables have gender-specific effects. For instance, being in marital union and having a clerical occupation increases the probability of having health insurance for women while being in the services, skilled, and unskilled manual occupations increases the probability of having health insurance for men. Further, residing in rural areas reduces the probability of having health insurance for men. Conclusion The study concludes that there are differences in factors that influence health insurance between women and men. Hence, this study highlights the need to enhance health insurance coverage by addressing the different factors that influence health insurance coverage among men and women. These factors include enhancing education, job creation, diversifying insurance schemes, and gender consideration in the design of National Health Insurance Scheme.

Testing is the process of evaluating a system by manual or automated means. While Regression Test Selection (RTS) discards test cases and Test Suite Minimization (TSM) shows diminution in fault detection rate, Test Case Prioritization (TCP) does not discard test cases. Test Case Prioritization techniques can be coverage or historical information based or model based. It can also be cost-time aware or requirement-risk aware. GUI/Web applications need special prioritization mechanism. In this paper, 90 scholarly articles ranging from 2001 to 2018 have been reviewed. We have explored IEEE, Wiley, ACM Library, Springer, Taylor & Francis and Elsevier database. We have also described each prioritization method with their findings and subject programs. This paper includes a chronological catalogue listing of the reviewed papers. We have framed three research questions which sum up the frequently used prioritization metrics, regularly used subject programs and the distribution of different prioritization techniques. To the best of our knowledge, this is the first review with a detail report of the last 18 years of TCP techniques. We hope this article will be beneficial for both beginners and seasoned professionals.

Background Universal coverage with long-lasting insecticidal nets (LLINs) is an essential component of malaria control programmes. Three-yearly mass distribution of LLINs in Papua New Guinea (PNG) has been successful in reducing infection transmission since 2009, but malaria prevalence ramped up from 2015 onwards. Although LLIN universal coverage is mostly achieved during these campaigns, it may not be related with net use over time. Uses given to LLINs and non-compliance of this strategy were evaluated. Methods A knowledge, attitude and practice (KAP) cross-sectional study was conducted in Lihir Islands, PNG, 2–2.5 years after the last LLIN mass distribution campaign. Data on bed net ownership, use and maintenance behaviour was collected using a household questionnaire administered by trained community volunteers. Logistic regression models were used to identify factors associated with owning at least one LLIN and sleeping under a LLIN the previous night. Results Among 2694 households surveyed, 27.4 % (95 % CI: 25.8–29.2) owned at least one LLIN and 8.7 % (95 % CI: 7.6–9.8) had an adequate LLIN coverage (at least one LLIN for every two people). Out of 13,595 individuals in the surveyed households, 13.6 % (95 % CI: 13.0-–4.2) reported having slept under a LLIN the preceding night. Determinants for sleeping under LLIN included living in a household with adequate LLIN coverage [adjusted OR (aOR) = 5.82 (95 % CI: 3.23–10.49)], household heads knowledge about LLINs [aOR = 16.44 (95 % CI: 8.29–32.58)], and female gender [aOR = 1.92 (95 % CI: 1.53–2.40)] (all p-values Conclusions Two years after mass distribution, LLIN coverage and use in Lihir Islands is extremely low. Three yearly distribution campaigns may not suffice to maintain an acceptable LLIN coverage unless knowledge on maintenance and use is promoted trough educational campaigns.

BackgroundCivil society organizations (CSOs) are important in health care delivery. They have the potential to play significant roles in immunization-related services, such as advocacy, health education, demand creation and resource mobilization. Their roles are often indispensable, diverse and beneficial in reducing infant morbidity and mortality due to vaccine-preventable diseases. This study explored the potential barriers to and facilitators of CSO engagement in increasing immunization coverage in Odukpani Local Government Area of Cross River State, Nigeria.MethodsThe study adopted qualitative data collection methods. Twenty-two focus group discussion (FGD) sessions, three in-depth interviews (IDIs) and 26 key informant interviews (KIIs) were conducted. Appropriate guides (FGD guide, IDI guide and KII guide) were used to conduct face-to-face interviews and the discussions. The FGDs, KIIs and IDIs were audio-recorded and transcribed. A framework analysis approach involving five key stages of analysis (familiarization with data, identification of thematic framework, indexing, charting, mapping/interpretation) was used for data analyses and presentation.ResultsCSOs encounter barriers in the course of their immunization advocacy, communication and social mobilization due to male child preference, leading to shielding of male children and not allowing them to be given immunization, as well as patriarchy, safety concerns, religious concerns, anti-vaccine misinformation and rumours, low perception of effectiveness and efficacy of vaccines, inaccessibility of localities, low health literacy and superstitious beliefs. Various community structures, such as the institution of the village head, elders’ council and town crier (announcer), and the existence of change agents, act as facilitators of immunization advocacy and uptake. Factors such as traditional control mechanisms including masquerades and religion act as either barriers or facilitators depending on the community and the mode of deployment. CSO members are willing to overcome these barriers and leverage the facilitators.ConclusionsFor successful engagement in immunization-related services, there are barriers in the study area that CSOs should overcome, such as male child preference and geographic inaccessibility, as well as facilitators that they should leverage such as traditional information dissemination systems and enforcement of compliance by the chiefs and elders’ council.

The general concept of maritime security operations is that the daily presence at sea is carried out by ships and aircraft of the Indonesian Navy's maritime patrol. The maritime patrol pattern used today is the warships as the major element. The warships will carry out patrols in randomly determined sectors. This pattern has many challenges, namely operational planning that is not good and requires a large operating budget, the number of warships and the available budget is limited, and the speed of movement towards the target. The Indonesian Navy Aviation Center has Maritime Patrol Aircraft that have not been used optimally. Extensive and rapid observation is an advantage of aircraft surveillance. KRIs patrolling the area can save fuel by waiting for information from air monitoring patrol aircraft, thereby saving operational costs. In this paper, the assignment of Maritime Patrol Aircraft is optimized based on coverage and operating costs on ideal and real radar conditions using Goal Programming and Fuzzy Inference System (FIS) methods. The optimization results show that the maximum total Coverage Area secured by the Maritime Patrol Aircraft in ideal conditions is wider while in real conditions it is small. The small coverage area is caused by the reduced coverage ability of the radar in real conditions. Mamdani Fuzzy Logic calculation allows us to predict the operational costs that must be incurred if we want a certain coverage area.

Background In China, enterovirus 71 (EV71) is the major etiological agents of hand foot mouth disease that poses severe risks to children’s health. Since 2015, three inactivated EV71 vaccines have been approved for use. Previous studies indicated the high willingness of EV71 vaccination in eastern China. However, few studies have assessed coverage and utilization patterns of EV71 vaccine in China. Methods Children born during 2012–2018 were sampled and their records were abstracted from Ningbo childhood immunization information management system. Descriptive statistics characterized the study population and assessed coverage and timeliness for EV71 vaccination. Simultaneous administration patterns as well as type of EV71 vaccine used were also evaluated. Bivariate and multivariable analysis was used to examine the relationship of socio-demographic characteristics with vaccination coverage and timeliness. Results Of 716,178 children living in Ningbo. One hundred seventy-two thousand two hundred thirty-six received EV71 vaccine with a coverage rate of 24.05% and only 8.61% received vaccination timely. 21.97% of children received the complete two dose EV71 series but only 6.49% completed timely. Vaccination coverage and timeliness increased significantly from 2012 birth cohort to 2018 birth cohort. Relatively higher coverage and timeliness were observed in resident children, Inner districts, high socioeconomic areas and large-scaled immunization clinics. Of 329,569 doses of EV71 vaccine, only 5853(1.78%) doses were administered at the same day as other vaccines. Conclusions There is a need for increasing EV71 vaccination coverage and timeliness as well as eliminating disparities among different populations. Our study highlights the importance of simultaneous administration to increasing coverage and timeliness of EV71 vaccination.

Introduction: Ayushman Bharat scheme, otherwise called as Pradhan Mantri Jan Arogya Yojana (PMJAY), is a National Health Protection Scheme introduced on 23 September 2018 by the government of India to aid the economically disadvantaged families. Aim: The study was initiated to estimate the coverage, utilization, and impact of Ayushman Bharat scheme in the rural field practice area of Saveetha Medical College and Hospital, Chennai. Settings and Design: This is the cross-sectional study conducted in the rural field practice area of Saveetha Medical College and Hospital, Chennai. Methods and Material: This cross-sectional study done among 300 households in Mappedu region of Thiruvallur district, Tamil Nadu. Simple random sampling was done to choose the study participants to reach the sample size of 300. Data was collected using semi-structured questionnaire. After the entry of data, the descriptive statistics was presented in frequency tables and graph. Result: The study found that out of 300 households only about 42.33% of the households were covered under Ayushman Bharat scheme. Among the households covered under Ayushman Bharat scheme, 47.24% households have availed Ayushman Bharat scheme in the past 1 year and only 10% of those availed the scheme has spent additional amount for health care. Around 39.88% of the households not having Ayushman Bharat scheme has faced financial burden because of health care expenditure. Conclusion: Creating awareness, appropriate governance, and working toward quality assurance, prompt referral pathways in both public and private healthcare providers can make Ayushman Bharat scheme effective.

Background Umbilical cord hygiene prevents sepsis, a leading cause of neonatal mortality. The World Health Organization recommends 7.1% chlorhexidine digluconate (CHX) application to the umbilicus after home birth in high mortality contexts. In Bangladesh and Nepal, national policies recommend CHX use for all facility births. Population-based household surveys include optional questions on CHX use, but indicator validation studies are lacking. The Every Newborn Birth Indicators Research Tracking in Hospitals (EN-BIRTH) was an observational study assessing measurement validity for maternal and newborn indicators. This paper reports results regarding CHX. Methods The EN-BIRTH study (July 2017–July 2018) included three public hospitals in Bangladesh and Nepal where CHX cord application is routine. Clinical-observers collected tablet-based, time-stamped data regarding cord care during admission to labour and delivery wards as the gold standard to assess accuracy of women’s report at exit survey, and of routine-register data. We calculated validity ratios and individual-level validation metrics; analysed coverage, quality and measurement gaps. We conducted qualitative interviews to assess barriers and enablers to routine register-recording. Results Umbilical cord care was observed for 12,379 live births. Observer-assessed CHX coverage was very high at 89.3–99.4% in all 3 hospitals, although slightly lower after caesarean births in Azimpur (86.8%), Bangladesh. Exit survey-reported coverage (0.4–45.9%) underestimated the observed coverage with substantial “don’t know” responses (55.5–79.4%). Survey-reported validity ratios were all poor (0.01 to 0.38). Register-recorded coverage in the specific column in Bangladesh was underestimated by 0.2% in Kushtia but overestimated by 9.0% in Azimpur. Register-recorded validity ratios were good (0.9 to 1.1) in Bangladesh, and poor (0.8) in Nepal. The non-specific register column in Pokhara, Nepal substantially underestimated coverage (20.7%). Conclusions Exit survey-report highly underestimated observed CHX coverage in all three hospitals. Routine register-recorded coverage was closer to observer-assessed coverage than survey reports in all hospitals, including for caesarean births, and was more accurately captured in hospitals with a specific register column. Inclusion of CHX cord care into registers, and tallied into health management information system platforms, is justified in countries with national policies for facility-based use, but requires implementation research to assess register design and data flow within health information systems.

Background Respectful maternal and newborn care (RMNC) is an important component of high-quality care but progress is impeded by critical measurement gaps for women and newborns. The Every Newborn Birth Indicators Research Tracking in Hospitals (EN-BIRTH) study was an observational study with mixed methods assessing measurement validity for coverage and quality of maternal and newborn indicators. This paper reports results regarding the measurement of respectful care for women and newborns. Methods At one EN-BIRTH study site in Pokhara, Nepal, we included additional questions during exit-survey interviews with women about their experiences (July 2017–July 2018). The questionnaire was based on seven mistreatment typologies: Physical; Sexual; or Verbal abuse; Stigma/discrimination; Failure to meet professional standards of care; Poor rapport between women and providers; and Health care denied due to inability to pay. We calculated associations between these typologies and potential determinants of health – ethnicity, age, sex, mode of birth – as possible predictors for reporting poor care. Results Among 4296 women interviewed, none reported physical, sexual, or verbal abuse. 15.7% of women were dissatisfied with privacy, and 13.0% of women reported their birth experience did not meet their religious and cultural needs. In descriptive analysis, adjusted odds ratios and multivariate analysis showed primiparous women were less likely to report respectful care (β = 0.23, p-value p-value 0.037) than women identifying as Chettri/Brahmin. Women who had caesarean section were less likely to report poor care during childbirth (β = − 0.42; p-value Conclusions Measurement of respectful care at exit interview after hospital birth is challenging, and women generally reported 100% respectful care for themselves and their baby. Specific questions, with stratification by mode of birth, women’s age and ethnicity, are important to identify those mistreated during care and to prioritise action. More research is needed to develop evidence-based measures to track experience of care, including zero separation for the mother-newborn pair, and to improve monitoring.

Because of the severe attenuation property, the communication area size of the millimeter-wave (mmWave) band is much smaller than that of the sub-6 GHz band, and the mmWave antennas must be placed at higher density, which means that a strong cost constraint is imposed on the system design. This paper aims to provide guidelines for the development of mmWave 28 GHz antenna devices by geometrically clarifying, via a numerical simulation, the number of antenna elements, the power supply, and the antenna installation conditions required for a 1000 m2 coverage of the “nano-area”. The simulation results, assuming a simple line-of-sight situation with no blockages or reflectors, show that the coverage area over 1000 m2 requires at least a power supply P0 = 1, 3, 4 and 8 dBm for 8 × 8-, 8 × 4-, 8 × 2-, and 8 × 1-element antenna arrays, respectively, for an antenna height H = 1.5 and 4.5 m and a received power sensitivity of -70 dBm. We conclude that these parameter results of the number of elements, the power supply, and the antenna height for “nano-area”coverage are important for the system design of mmWave antenna placement.

Autonomous vehicle (AV) technology started to shift the perception of the transportation systems. However, for AVs to operate at their optimum capabilities, they need to go through a comprehensive testing and verification process. While a large amount of research and funding has been provided for solving this problem, there is still a lack of a systematic method to develop standardized tests that can be used to judge if the decision-making capability functions are within acceptable parameters. To that end, the tests need to cover all possible situations that an AV may run into. This paper focuses on defining the notion of coverage mathematically when using pseudo-randomly generated simulations for testing. The approach defines new equivalence relations between scenes, which are the systems’ various states, to achieve this goal. Considering the substantial need for computation, even with the obtained coverage, we also introduce the mathematical definition of a sub-scene and additional strategies, such as expanding the equivalence classes of scenes and combining actors in scenes, to reduce the amount of testing required to certify AVs.

Energy recharging in wireless rechargeable sensor networks (WRSNs) has acquired much attention in recent years. In literature, many recharging path construction algorithms have been proposed. Most of them considered that all sensors are equally important and designed algorithms to increase the number of recharged sensors or decrease the path length of the mobile charger. However, different sensors have different coverage contributions. Recharging the sensors with larger coverage contribution can achieve better surveillance quality. The proposed recharging scheduling algorithm is divided into three phases, including the Initialization, Recharging Scheduling and Path Construction Phases. In the second phase, this paper proposed two recharging scheduling algorithms, namely the Cost-Effective (CE) algorithm and Cost-Effective with Considerations of Coverage and Fairness ( $C^{2}F$ ) algorithm. The proposed two algorithms construct paths for the mobile charger and select the recharging sensors based on the higher weight in terms of larger coverage contribution and smaller path cost. Performance results show that the CE and $C^{2}F$ algorithms yield better performance in terms of the fairness of recharging, recharging stability and coverage ratio, as compared with the existing studies.

Road coverage will be a key issue for the success of connected car applications. In this work, a comprehensive analysis of radio signal strength fluctuations on roads in a Long Term Evolution (LTE) system is presented. For this purpose, a measurement campaign based on drive tests was carried out to assess the coverage levels that can be expected on ordinary roads by normal in-car terminals in a country of the European Union. Measurements were collected on 1,000 km of road by 2 vehicles covering the same route. By comparing signal level samples at the same geographical location, taken at slightly different times, a statistical model of fluctuations is derived. Then, the impact of different factors (e.g., shadowing, environment, handover, etc.) on the signal level received from the serving cell is assessed. Results show that large deviations of signal level (up to 23 dB) are observed at the same geographical location.

Introduction: Lymphatic filariasis or elephantiasis is the most debilitating and disfiguring scourge among all diseases which imposes severe social and economic burden. Currently an estimated 63crores people are at a risk of filariasis in 256 endemic districts across 16 states and 5 union territories in India. National filarial control programme is operational since 1955 in India and the current goal is achieving elimination of filariasis by 2020through Mass Drug Administration (MDA). Objective: To assess the coverage, compliance and causes for noncompliance of MDA in the study districts. Method: A cross sectional descriptive study was conducted in October 2019 and January 2020 in Koppal and Bidar districts respectively. Randomly four clusters were selected, three from rural area and one from urban area. All the residents of a cluster were included except subjects aged below 2 years and pregnant women. Data collection was done by household survey using a standard questionnaire. Results: Total populations of 2043 subjects residing in 480 houses were included. The coverage rate was95.44 &94.73% with compliance rate of 91.61% &93.12% in Koppal & Bidar districts, respectively. The effective coverage rate was 87.44 %& 88.2% in Koppal & Bidar districts respectively. Drug consumption by DOT was 95.1% in Koppal&85.8% in Bidar district. Conclusions: The coverage& compliance of MDA was found to be satisfactoryas it was >65%.Consumption of MDA by DOT to be more emphasized to reduce coverage compliance gap and increase the effective coverage rate.

Background: Seasonal influenza vaccination coverage remains low in most areas of China. Its influencing factors and barriers in various populations receiving influenza vaccinations need to be well understood to promote vaccination. Methods: A cross-sectional survey was conducted with residents in 48 communities. Vaccination status in the 2018–2019 influenza season and reasons for or against vaccination were surveyed. The potential factors influencing vaccination uptake were determined using bivariate logistic regression. Results: In total, 1301 of the 11053 respondents received an influenza vaccine during the 2018–2019 season with a coverage rate of 11.8% (95% CI, 11.2–12.4). The vaccine coverage was highest among children (26.6%, 95%CI: 24.8–28.5), followed by adults (8.2%, 95%CI: 7.4–9.0) and elderly people (7.3%, 95%CI: 6.5–8.1) (p

OBJECTIVE: To provide evidence on the effects of expansions to private and public insurance programs on adolescent specialty substance use disorder (SUD) treatment use. DATA SOURCE/STUDY SETTING: The Treatment Episodes Data Set (TEDS), 1996 to 2017. STUDY DESIGN: A quasi‐experimental difference‐in‐differences design using observational data. DATA COLLECTION: The TEDS provides administrative data on admissions to specialty SUD treatment. PRINCIPAL FINDINGS: Expansions of laws that compel private insurers to cover SUD treatment services at parity with general health care increase adolescent admissions by 26% (P

Receding gum line is common condition with diverse etiology, one being periodontitis and the other principally linked to mechanical factors, mainly tooth brushing. Mucogingival surgical management have better prognosis if reason for recession being mechanical factors in contrast to periodontal disease induced etiology. Prognosis based classification proposed by Miller suggest a good to excellent for type I and II whereas for remaining types the prognosis is less. Among various periodontal plastic surgery procedures, a sub epithelial connective tissue graft [SCTG] do have better predictability. This case report presents a clinical scenario where lateral sliding flap procedures was employed in conjunction with Subepithial connective tissue graft in class III type of Millers recession with a keyobjective to benefit periodontal health through reconstruction of damaged /lost tissues thereby improving patient’s appearance. Post-op evaluation, demonstrated an upsurge in the soft tissue volume and increase of keratinized tissue.

BACKGROUND: Self‐employed workers are 10% of the US labor force, with growth projected over the next decade. Whether existing policy mechanisms are sufficient to ensure health insurance coverage for self‐employed workers, who do not have access to employer‐sponsored coverage, is unclear. OBJECTIVE: To determine whether self‐employment is associated with lack of health insurance coverage. DATA SOURCES: Secondary analysis of Medical Expenditure Panel Survey (MEPS) data collected 2014‐2017. STUDY DESIGN: Participants were working age (18‐64 years), employed, civilian noninstitutionalized US adults with two years of Medical Expenditure Panel Survey (MEPS) participation in 2014‐2017. We compared those who were employees vs those who were self‐employed. Key outcomes were self‐report of health insurance coverage, and of delaying needed medical care. DATA EXTRACTION METHODS: Longitudinal design among individuals who were employees during study year 1, comparing health insurance coverage among those who did vs did not transition to self‐employment in year 2. PRINCIPAL FINDINGS: 16 335 individuals, representing 121 473 345 working‐age adults, met inclusion criteria; of these, 147, representing 1 097 582 individuals, transitioned to self‐employment. In unadjusted analyses, 25.7% of those who became self‐employed were uninsured in year 2, vs 8.1% of those who remained employees (P

Background The techniques of amplifying genetic materials have enabled the extensive study of several biological activities outside the biological milieu of living systems. More recently, this approach has been extended to amplify population of genes, from evolutionarily related gene family for detection and evaluation of microbial consortial with several unique potentialities (e.g., enzymatic degradability). Conceivably, primer mixtures containing substitutions of different bases at specific sites (degenerate primers) have enabled the amplification of these genes in PCR reaction. However, the degenerate primer design problem (DPD) is a constraint to designing this kind of primer. To date, different algorithms now exist to solve various versions of DPD problem, many of which, only few addresses and satisfy the criteria to design primers that can extensively cover high through-put sequences while striking the balance between specificity and efficiency. The highly degenerate primer (HYDEN) design software program primarily addresses this variant of DPD problem termed “maximum coverage-degenerate primer design (MC-DPD)” and its heuristics have been substantiated for optimal efficiency from significant successes in PCR. In spite of the premium presented for designing degenerate primers, literature search has indicated relatively little use of its heuristics. This has been thought to result from the complexity of the program since it is run only by command-line, hence limiting its accessibility. To solve this problem, researchers have optionally considered the manual design of degenerate primers or design through software programs that provides accessibility through a graphical user interface (GUI). Realizing this, we have attempted in this study to provide a user-friendly approach for researchers with little or no background in bioinformatics to design degenerate primers using HYDEN Results Virtual Tests of our designed degenerate primer pair through in silico PCR substantiated the correspondence between efficiency and coverage with the target sequences as pre-defined by the initial HYDEN output, thereby validating the potentials of HYDEN to effectively solve the MC-DPD problem. Additionally, the designed primer-pair mechanistically amplified all sequences used as a positive control with no amplification observed in the negative controls. Conclusion In this study, we provided a turnkey protocol to simplify the design of degenerate primers using the heuristics of the HYDEN software program.

High coverage of human papillomavirus (HPV) vaccination is key to the eventual elimination of infection and cervical cancer. Monitoring coverage, in a digital vaccine registry, is therefore essential to detect problems. For example, misinformation about dangers from HPV vaccine generated in Denmark a decline in coverage among girls age 12–17, from 80% in 2013 down to 37% in 2015, when remedial actions made it rise again., The availability of human papillomavirus (HPV) vaccines and screening tests has raised the possibility of globally eliminating cervical cancer, which is caused by HPV. Cervical cancer is a very common malignancy worldwide, especially among deprived women. High vaccination coverage is key to the containment and eventual elimination of the infection. Public HPV vaccination programmes in Italy and Denmark were swiftly established and are among the most successful worldwide. Still, in both countries, it has been challenging to achieve and maintain the recommended coverage of > 80% in girls. In a well‐studied Italian region, vaccination coverage in girls at age 15 years (World Health Organization's gold standard) reached 76% in 2015 but decreased to 69% in 2018, likely due to work overload in public immunization centres. In Denmark, doubts about safety and efficacy of the HPV vaccine generated a decline in coverage among girls age 12–17, from 80% in 2013 down to 37% in 2015, when remedial actions made it rise again. Insights from these two countries are shared to illustrate the importance of monitoring coverage in a digital vaccine registry and promptly reacting to misinformation about vaccination.

A systematic literature review of Medline and Embase databases was conducted to describe rotavirus (RV) vaccine coverage for a complete series, timing of receipt of all doses in the series, and predictors of RV vaccination coverage in the US for two licensed RV vaccines (RV1, RV5). Nine publications were included in the review. RV vaccination coverage rates of under 80% suggest RV vaccines are underutilized relative to the Healthy People 2020 target and other childhood vaccines. About 50–90% of children initiating RV vaccination complete the series and coverage for a complete series is lower for black and Hispanic children (vs. whites), uninsured or Medicaid insured (vs. privately insured), and for foreign-born (vs. US-born) children. Series completion is significantly greater in children receiving DTaP, RV1 (vs. RV5), and for those receiving routine care from a pediatrician. There is a need to design and implement better RV immunization strategies for US children.

The study illustrates the pattern of organizational communication on journalist's coverage in the Vice President's agenda. Journalists from various media form informational organizations in fulfilling the task of getting news. This study used a constructivist paradigm with a descriptive qualitative approach. The method used was a case study. Data collection was done by observing the journalist's communication patterns when reporting the vice president's agenda. In-depth interviews were conducted to journalists who conducted coverage in the vice president's office in 2019 and the vice president's secretariat. Other data were obtained from documents. This study found that organizational information communication was formed between journalists, vice president secretariat, and vice president itself. In terms of reporting, journalists follow information from the vice president's secretariat. However, journalists have many ways to get information about the Vice President's internal agenda. Communication patterns showed that journalists do their work by pursuing information from several sources.

Over the past 15 y, several vaccines have been added to the recommended immunization schedule for adolescents in the United States. In addition to annual influenza vaccination, the Advisory Committee on Immunization Practices recommends tetanus, diphtheria, and pertussis (Tdap), meningococcal conjugate (MenACWY), and human papillomavirus (HPV) vaccine for routine administration at ages 11–12 y, and a second dose of MenACWY at age 16. A vaccine against meningococcal disease caused by serogroup B (MenB) is also available and recommended for shared clinical decision-making. Though notable gains in uptake have been achieved for some adolescent vaccines, coverage varies considerably with lower rates for HPV vaccine and second dose of MenACWY. Coverage for MenB is especially low. While extensive research has focused on barriers to and solutions for higher uptake of HPV vaccine, limited attention has been given to the reasons for lower uptake of meningococcal vaccines among older adolescents. This purpose of this commentary is to discuss barriers to and solutions for higher uptake of meningococcal vaccines among older adolescents, and to identify gaps in knowledge that can inform research efforts going forward.

The combined vaccine against diphtheria, tetanus, pertussis, hepatitis B, poliomyelitis, and Haemophilus influenzae b (DTPa-HBV-IPV/Hib, Infanrix Hexa, GSK) has been used for childhood immunization in Australia according to a two-, four-, six-month schedule since 2009. We reviewed data available in the Australian National Notifiable Diseases Surveillance System, annual vaccination coverage reports, the Database of Adverse Event Notifications, and peer-reviewed literature to assess vaccine coverage rates, incidence of all six vaccine preventable diseases, and the safety profile of DTPa-HBV-IPV/Hib vaccine in Australian infants over a period of ten years of exclusive use. Between 2009 and 2018 vaccine coverage for infants aged 12 months increased from 91.7% to 94.0% and from 84.9% to 92.6% for all and for Indigenous infants, respectively. Over the same time period, there were no reports of poliomyelitis, diphtheria or tetanus in infants

Vaccines are a key strategy to promote healthy aging, but vaccine coverage remains below target levels in at-risk adults and older individuals. We present here the results of a multidisciplinary consensus conference convened to perform a multidimensional assessment of vaccination in geriatric medicine, with a view to developing a well-defined strategy for the promotion of vaccines in older people. We discuss recommended vaccines in older individuals, and describe the wide regional heterogeneity between regions in the Italian context. The main obstacles to implementation of vaccines in practice are reviewed, as well as potential strategies to remove these barriers. Finally, the importance of including vaccines and vaccination in undergraduate and postgraduate medical education is underlined. The information summarized in this document is expected to help develop educational and promotional initiatives to achieve greater uptake of vaccines among older individuals, as a key means to promote healthy aging.

Background: Immunization is amongst the most cost-effective public health interventions for reducing childhood morbidity and mortality. However, globally 9 million deaths of children occur as a result of vaccine-preventable diseases in which 4.4 million are from the sub-Saharan region. Therefore, this study aimed to assess barriers for complete vaccination coverage among under five years children in Mogadishu, Somalia. Methods: A community-based cross-sectional study was conducted between April to July 2019 in Mogadishu-Somalia. Two-stage cluster sampling with systematic random sampling was used to select a sample of 820 households. Data was collected through a structured, interviewer administrator questionnaire. In case more eligible children found at a single selected household, one child was randomly selected and the information related to immunization was interviewed from his/her caregiver. Results: The overall, fully vaccinated under 5 years children were found to be 45.2%. Immunization was found to be increased by being a younger caregiver (β=-0.024, P-Value=0.019) being father with secondary and above education (AOR = 1.755, 95% CI = 1.161–2.655, P-value = 0.008), being a young child (β = −0.018, P- value = 0.011), being children from birth order of fifth and above (AOR = 1.539, 95% CI = 1.011–2.343, P- value = 0.044), being a married caregiver (AOR = 4.101, 95% CI=1.062-15.835, P-value = 0.041), increased monthly family income (β =0.003, P- value = 0.000), availability of vaccine at the time of visit (AOR = 6.147, 95% CI = 1.943–19.441, P- value = 0.002), cost affordability of vaccine (AOR = 1.951, 95% CI = 1.238–3.076, P- value = 0.004), being born at health facility (AOR = 1.517, 95% CI = 1.104–2.086, P- value = 0.010), having good knowledge on immunization (AOR = 1.125, 95% CI = 1.070–1.181, P- value = 0.001), having good practice on immunization (AOR = 2.756, 95% CI = 2.233–3.402, P- value = 0.001) and having good perception on vaccine (AOR = 4.976, 95% CI = 2.183–11.340, P- value = 0.001). Conclusion: The result of this study has revealed that the proportion of fully immunized under-5 children in Mogadishu is very low. Several factors were found to the barriers achieving full immunization coverage. Steps to promote health education and vaccine availability should be lounged.

Background The aim of the study was to determine the coverage of intermittent preventive treatment of malaria in pregnancy (IPTp) and its relationship with delivery outcomes among obstetric referral cases at the district level of healthcare. Methods An implementation research within three districts of the Greater Accra region was conducted from May 2017 to February 2018, to assess the role of an enhanced inter-facility communication system on processes and outcomes of obstetric referrals. A cross-sectional analysis of the data on IPTp coverage as well as delivery outcomes for the period of study was conducted, for all the referrals ending up in deliveries. Primary outcomes were maternal and neonatal complications at delivery. IPTp coverage was determined as percentages and classified as adequate or inadequate. Associated factors were determined using Chi square. Odds ratios (OR, 95% CI) were estimated for predictors of adequate IPTp dose coverage for associations with delivery outcomes, with statistical significance set at p = 0.05. Results From a total of 460 obstetric referrals from 16 lower level facilities who delivered at the three district hospitals, only 223 (48.5%) received adequate (at least 3) doses of IPTp. The district, type of facility where ANC is attended, insurance status, marital status and number of antenatal clinic visits significantly affected IPTp doses received. Adjusted ORs show that adequate IPTp coverage was significantly associated with new-born complication [0.80 (0.65–0.98); p = 0.03], low birth weight [0.51 (0.38–0.68); p Conclusion IPTp coverage remains low in the study setting and is affected by type of health facility that ANC is received at, access to health insurance and number of times a woman attends ANC during pregnancy. This study also confirmed earlier findings that, as an intervention IPTp prevents bad outcomes of pregnancy, even among women with obstetric referrals. It is important to facilitate IPTp service delivery to pregnant women across the country, improve coverage of required doses and maximize the benefits to both mothers and newborns.

Background The World Health Organization recommends recording vaccination status according to maternal recall in countries where administrative reporting systems are insufficiently reliable, as maternal recall in developing countries has been shown to be quite reliable compared with data from vaccination cards. This study aimed to investigate childhood vaccination coverage and its determinants according to the mothers’ presentation of vaccination cards. Methods The data come from the 2017 Senegalese Demographic and Health Survey, a nationally representative household survey of women aged 15–49 years, with a questionnaire focusing on children’s health. This analysis was restricted to children aged 12–35 months (n = 4032) and it assessed vaccination coverage and associated sociodemographic factors with weighted multivariate logistic regressions. Stratified multivariate logistic regressions were also performed to investigate factors associated with routine childhood immunization uptake of the Bacillus Calmette-Guérin (BCG) vaccine, recommended for administration shortly after birth, as well as of the vaccines against yellow fever and measles (recommended at 9 months). Results Comparison of vaccination coverage estimates according to the vaccination card or parental recall resulted in a 5–10% difference in estimated coverage for the BCG, pentavalent, measles, and yellow fever vaccines, but a huge difference for the polio vaccine (93.0% with the card, 32.0% without it). Presentation of the vaccination card was correlated with mothers’ attendance at health facilities (suggesting it serves as a concrete manifestation of a bond between mothers and the healthcare system) and their region of residence, but it was not correlated with usually strong predictors of childhood vaccination, such as maternal education level. Factors associated with vaccinations differed depending on whether they were administered shortly after birth or later on. Conclusions Maternal recall was found to be quite reliable except for oral polio vaccination, which raises the possibility that complete immunization coverage rates could have been significantly underestimated due to potential confusion between injection and vaccination. Considering the ability to present vaccination cards as the materialization of a bond with the healthcare system, the decision path leading to vaccination among those who lack such a bond appears longer and more likely to be driven by supply-side effects.

Highlights • 1,156,863 girls received first dose HPV vaccine between 2011 and 2018 in Rwanda. • An initial school-grade-targeted catch-up transited to routine 12 yrs vaccination. • Census-level coverage was 10–40% for girls born in 1993–1995, 50–65% for 1996–2000. • Census-level coverage was 80–90% for 2001–2006 cohorts vaccinated at 12 years. • Birth cohorts provide clearer picture of HPV vaccine coverage in Rwanda., Background In 2011, Rwanda became the first African nation to implement a national human papillomavirus (HPV) vaccination program, conceived to protect girls aged

WOS: 000526412600010, This study proposes a distributed cluster-based routing algorithm, distributed clustering with decreased uncovered nodes (DiCDU), alleviating the uncovered node problem occurring after the election of cluster heads. For the purpose of increasing the performance of the system in terms of the lifetime of the network, an energy-based cluster head election without requiring any extra control message is used. Moreover, an energy saving mode is proposed, in which the nodes perform static clustering controlled by predefined thresholds to conserve batteries. Extensive simulations are conducted for different values of cluster radius and the number of nodes and proposed schema is compared with similar methods, including a time-based cluster-head selection algorithm for low-energy adaptive clustering hierarchy, a clustering algorithm based on time delay, and regional energy aware clustering with the isolated nodes, for the death of the first, the half and the last nodes with the number of uncovered nodes. The results show that DiCDU outperforms compared approaches for all values of cluster radius and the number of nodes.

Objective:We assessed the role of home visits by Shasthya Shebika (SS) – female volunteer community health workers (CHWs) – in improving the distribution of micronutrient powder (MNP), and explored the independent effects of caregiver–provider interaction on coverage variables.Design:We used data from three cross-sectional surveys undertaken at baseline (n 1927), midline (n 1924) and endline (n 1540) as part of an evaluation of a home fortification programme. We defined an exposure group as one that had at least one SS visit to the caregiver’s household in the 12 months preceding the survey considering three outcome variables – message (ever heard), contact (ever used) and effective coverage (regular used) of MNP. We performed multiple logistic regressions to explore the determinants of coverage, employed an ‘interaction term’ and calculated an odds ratio (OR) to assess the modifying effect of SS’s home visits on coverage.Settings:Sixty-eight sub-districts from ten districts of Bangladesh.Participants:Children aged 6–59 months and their caregivers.Results:A home visit from an SS positively impacts message coverage at both midline (ratio of OR 1·70; 95 % CI 1·25, 2·32; P < 0·01) and endline (ratio of OR 3·58; 95 % CI 2·22, 5·78; P < 0·001), and contact coverage both at midline (ratio of OR 1·48; 95 % CI 1·06, 2·07; P = 0·021) and endline (ratio of OR 1·74; 95 % CI 1·23, 2·47; P = 0·002). There was no significant effect of a SS’s home visit on effective coverage.Conclusions:The households visited by BRAC’s volunteer CHWs have better message and contact coverage among the children aged 6–59 months.

Objectives This protocol outlines a systematic review methodology, aiming to assess the recent evidence-base for the impact of testing strategies and approaches on access to testing, testing coverage, and linkage to care for populations at risk for specific curable sexually transmitted infections (STIs) (chlamydia, gonorrhoea, syphilis, trichomoniasis, and Mycoplasma genitalium infections). Data sources These include MEDLINE, Embase, PsycINFO, Global Health, Cochrane Database, Epistemonikos, CINAHL Plus, and Web of Science Core Collection. Review methods Papers reporting primary data from 1 January 2012 onwards will be included. Titles, abstracts, and full texts will be reviewed for inclusion, and data will be extracted using a pre-specified and piloted data extraction form, by two independent reviewers. Experts in the field will be contacted and interviewed for further information about ongoing or unpublished studies. A narrative synthesis of the findings will be conducted. Discussion Outcomes of this study will inform policy makers, national and international programme coordinators, public health and clinical experts, and civil society organisations involved in STI prevention and control in EU/EEA countries and elsewhere. The review will provide a direction for future researchers and programmers seeking to improve STI testing services among key populations at high risk for STIs. Systematic review registration In accordance with guidelines outlined in the PRISMA-P methodology, this protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 30 January 2019: CRD42019118261.

In this paper, we present the radiated mode indoor radio coverage performance study of a co-existing dual technology, dual 4×4 Multiple Input Multiple Output (MIMO) antenna platform. The antenna platform is targeted to be used for low power wireless radio Base Station (BS) applications. One of the 4×4 MIMO antenna pairs operates in the 2.5–2.7 GHz licensed Long Term Evolution (LTE) band while the other MIMO antenna pair operates in the 2.4 GHz unlicensed Wireless Fidelity (Wi-Fi) Industrial Scientific Medical (ISM) band. This radio performance study is carried out to analyze, predict and verify the impact of multi-radio co-existence on the radiated mode indoor coverage performance in an Over-The-Air (OTA) scenario. The study involves OTA radio propagation modeling, prediction and verification both for a near field and far field scenario. While the near field coverage is studied in a small form factor controlled shield box environment, the far field coverage study is undertaken over a 780 ft2 indoor enterprise coverage area. The test result shows the worst case LTE signal level is –77.7, –75, and –76.03 dBm, respectively, over a 3.6 m obstructed radial Line Of Sight (LOS) distance.

The coverage of traditional Wireless Sensor Networks (WSNs) is limited by node energy and data redundancy, which forces WSNs to be interrupted abnormally. Therefore, Cooperative-optimization Coverage Algorithm based on Sensor Cloud Systems in Intelligent Computing (CoC-SCS) is proposed. First, the algorithm determines the location information of the Focus Target Nodes (FTNs), and uses the Genetic Algorithm (GA) to give the node path planning. Second, the mutation parameters and the controllable threshold parameters are used in order to control the event domain nodes. Optimizing clustering makes the clustering of the nodes to be more uniform, so that it can improve the search ability of the global target nodes and even reduce the nodes energy consumption. Third, the adaptation function covers the continuity of the covered target positions and the monitoring range of the nodes. Optimization is also performed to achieve the goals of increasing network coverage and extending the network lifetime. Finally, simulation results show that the proposed CoC-SCS algorithm compared with other three algorithms in this paper has improved 11.27% and 16.35% on average in terms of network coverage, network lifetime, etc., and 13.95% in terms of network energy overhead, thereby we can further verify that CoC-SCS algorithm has strong stability and effectiveness.

Advanced receiver autonomous integrity monitoring (ARAIM) is a new technology that can reduce the vertical protection level (VPL) by optimizing the probability of configuration information to improve availability. Compared with traditional receiver autonomous integrity monitoring (RAIM), the powerful vertical guidance capability of ARAIM highlights its advantages. This paper improves ARAIM performance by reducing the difference between the two most important view solutions affecting the VPL and the all-in-view solution while satisfying the accuracy. First, this paper proposes new constellation configurations suitable for GPS/BDS, which is a nontraditional constellation itself; second, this paper proposes a method called EA-ARAIM for improving ARAIM performance. The results show that for the depleted constellation in the case of visible satellite reduction, the coverage can increase from 59.97% to 76.63% with the assistance of EA-ARAIM. Even for the optimistic constellation, where there is not much room to improve availability, the improved algorithm can increase the coverage to approximately 3%. Finally, compared with the simulation data used in most of the literature, this paper uses real data obtained from MGEX for analysis.

© 2021, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.Children with chronic neurological diseases, including cerebral palsy (CP), are especially susceptible to vaccine-preventable infections and face an increased risk of severe respiratory infections and decompensation of their disease. This study aims to examine age-appropriate immunization status and related factors in the CP population of our country. This cross-sectional prospective multicentered survey study included 18 pediatric neurology clinics around Turkey, wherein outpatient children with CP were included in the study. Data on patient and CP characteristics, concomitant disorders, vaccination status included in the National Immunization Program (NIP), administration, and influenza vaccine recommendation were collected at a single visit. A total of 1194 patients were enrolled. Regarding immunization records, the most frequently administrated and schedule completed vaccines were BCG (90.8%), hepatitis B (88.9%), and oral poliovirus vaccine (88.5%). MMR was administered to 77.3%, and DTaP-IPV-HiB was administered to 60.5% of patients. For the pneumococcal vaccines, 54.1% of children received PCV in the scope of the NIP, and 15.2% of children were not fully vaccinated for their age. The influenza vaccine was administered only to 3.4% of the patients at any time and was never recommended to 1122 parents (93.9%). In the patients with severe (grades 4 and 5) motor dysfunction, the frequency of incomplete/none vaccination of hepatitis B, BCG, DTaP-IPV-HiB, OPV, and MMR was statistically more common than mild to moderate (grades 1–3) motor dysfunction (p = 0.003, p < 0.001, p < 0.001, p < 0.00, and p < 0.001, respectively). Physicians’ influenza vaccine recommendation was higher in the severe motor dysfunction group, and the difference was statistically significant (p = 0.029). Conclusion: Children with CP had lower immunization rates and incomplete immunization programs. Clinicians must ensure children with CP receive the same preventative health measures as healthy children, including vaccines. What is Known:• Health authorities have defined chronic neurological diseases as high-risk conditions for influenza and pneumococcal infections, and they recommend vaccines against these infections.• Children with CP have a high risk of incomplete and delayed immunization, a significant concern given to their increased healthcare needs and vulnerability to infectious diseases.What is New:• Influenza vaccination was recommended for patients hospitalized due to pneumonia at a higher rate, and patients were administered influenza vaccine more commonly.• Children with CP who had higher levels of motor dysfunction (levels 4 and 5) were more likely to be overdue immunizations.

Polymer matrix composites (PMCs) are the most used in aerospace fields due to their special mechanical properties coupled with reduced weight. Metallic structures can be manufactured on the surface of PMCs producing hybrid constructions with intriguing characteristics. The cold spray technology (CS) seems to be the best solution for the manufacturing of metallic coatings on polymer-based substrates. However, the last researches on PMCs metallization through CS were carried out without taking into account a proper manufacturing of the substrates. Therefore, the customized manufacturing of PMCs used as substrates for CS deposition represents a crucial aspect to be considered, the target surface should be designed and manufactured to fit better the CS requirements. In this scenario, the Fused Filament Fabrication method (FFF) is the best solution for tailored composites manufacturing. Therefore, this work aims to develop a novel manufacturing route to produce innovative composite structures by using the FFF technology for the 3D-printed polymer-based substrate and the cold spray technology for the 3D-printed metal deposition. The novelty is that, for the first time, the polymer-based substrates will be designed and manufactured “ad hoc” for the cold spray metallization by using the rapid prototyping 3D-printing process successfully integrated with CS technology.

Background Many LMICs have implemented Publicly Funded Health Insurance (PFHI) programmes to improve access and financial protection. The national PFHI scheme implemented in India for a decade has been recently modified and expanded to cover free hospital care for 500 million persons. Since increase in annual cover amount is one of the main design modifications in the new programme, the relevant policy question is whether such design change can improve financial protection for hospital care. An evaluation of state-specific PFHI programmes with vertical cover larger than RSBY can help answer this question. Three states in Southern India - Andhra Pradesh, Karnataka and Tamil Nadu have been pioneers in implementing PFHI with a large insurance cover. Methods The current study was meant to evaluate the PFHI in above three states in improving utilisation of hospital services and financial protection against expenses of hospitalization. Two cross-sections from National Sample Survey’s health rounds, the 60th round done in 2004 and the 71st round done in 2014 were analysed. Instrumental Variable method was applied to address endogeneity or the selection problem in insurance. Results Enrollment under PFHI was not associated with increase in utilisation of hospital care in the three states. Private hospitals dominated the empanelment of facilities under PFHI as well as utilisation. Out of Pocket Expenditure and incidence of Catastrophic Health Expenditure did not decrease with enrollment under PFHI in the three states. The size of Out of Pocket Expenditure was significantly greater for utilisation in private sector, irrespective of insurance enrollment. Conclusion PFHI in the three states used substantially larger vertical cover than national scheme in 2014. The three states are known for their good governance. Yet, the PFHI programmes in all three states failed in fulfilling their fundamental purpose. Increasing vertical cover of PFHI and using either ‘Trusts’ or Insurance-companies as purchasers may not give desired results in absence of adequate regulation. The study raises doubts regarding effectiveness of contracting under PFHIs to influence provider-behavior in the Indian context. Further research is required to find solutions for addressing gaps that contribute to poor financial outcomes for patients under PFHI.

The present study aimed to assess the effectiveness and impact on treatment coverage of integrating severe acute malnutrition (SAM) treatment at the health hut level by community health workers (CHWs). This study was a non-randomized controlled trial, including two rural communes in the health district of Mayahi: Maïreyreye (control) and Guidan Amoumoune (intervention). The control group received outpatient treatment for uncomplicated SAM from health facilities (HFs), while the intervention group received outpatient treatment for uncomplicated SAM from HFs or CHWs. A total of 2789 children aged 6–59 months with SAM without medical complications were included in the study. The proportion of cured children was 72.1% in the control group, and 77.2% in the intervention group. Treatment coverage decreased by 8.3% in the control area, while the group of CHWs was able to mitigate that drop and even increase coverage by 3%. This decentralized treatment model of acute malnutrition with CHWs allowed an increase in treatment coverage while maintaining a good quality of care. It also allowed the early inclusion of children in less severe conditions. These results may enhance the Niger Ministry of Health to review the management of SAM protocol and allow CHWs to treat acute malnutrition.

Background In low tuberculosis (TB) incidence countries, contact investigation (CI) requires not missing contacts with TB infection or disease without unnecessarily evaluating non-infected contacts. Aim We assessed whether updated guidelines for the stone-in-the-pond principle and their promotion improved CI practices. Methods This retrospective study used surveillance data to compare CI outcomes before (2011–2013) and after (2014–2016) the guideline update and promotion. Using negative binomial regression and logistic regression models, we compared the number of contacts invited for CI per index patient, the number of CI scaled-up according to the stone-in-the-pond principle, the TB and latent TB infection (LTBI) testing coverage, and yield. Results Pre and post update, 1,703 and 1,489 index patients were reported, 27,187 and 21,056 contacts were eligible for CI, 86% and 89% were tested for TB, and 0.70% and 0.73% were identified with active TB, respectively. Post update, the number of casual contacts invited per index patient decreased statistically significantly (RR = 0.88; 95% CI: 0.79–0.98), TB testing coverage increased (OR = 1.4; 95% CI: 1.2–1.7), and TB yield increased (OR = 2.0; 95% CI: 1.0–3.9). The total LTBI yield increased from 8.8% to 9.8%, with statistically significant increases for casual (OR = 1.2; 95% CI: 1.0–1.5) and community contacts (OR = 2.0; 95% CI: 1.6–3.2). The proportion of CIs appropriately scaled-up to community contacts increased statistically significantly (RR = 1.8; 95% CI: 1.3–2.6). Conclusion This study shows that promoting evidence-based CI guidelines strengthen the efficiency of CIs without jeopardising effectiveness. These findings support CI is an effective TB elimination intervention.

Background Routinely collected health facility data usually captured and stored in Health Management Information Systems (HMIS) are potential sources of data for frequent and local disaggregated estimation of the coverage of reproductive, maternal, newborn, and child health interventions (RMNCH), but have been under-utilized due to concerns over data quality. We reviewed methods for estimation of national or subnational coverage of RMNCH interventions using HMIS data exclusively or in conjunction with survey data from low- and middle-income countries (LMICs). Methods We conducted a comprehensive review of studies indexed in PubMed and Scopus to identify potential papers based on predefined search terms. Two reviewers screened the papers using defined inclusion and exclusion criteria. Following sequences of title, abstract and full paper reviews, we retained 18 relevant papers. Results 12 papers used only HMIS data and 6 used both HMIS and survey data. There is enormous lack of standards in the existing methods for estimating RMNCH intervention coverage; all appearing to be highly author dependent. The denominators for coverage measures were estimated using census, non-census and combined projection-based methods. No satisfactory methods were found for treatment-based coverage indicators for which the estimation of target population requires the population prevalence of underlying conditions. The estimates of numerators for the coverage measures were obtained from the count of users or visits and in some cases correction for completeness of reporting in the HMIS following an assessment of data quality. Conclusions Standard methods for correcting numerators from HMIS data for accurate estimation of coverage of RMNCH interventions are needed to expand the use of these data. More research and investments are required to improve denominators for health facility-derived statistics. Improvement in routine data quality and analytical methods would allow for timely estimation of RMNCH intervention coverage at the national and subnational levels.

A Wireless Sensor Network (WSN) is connected if a communication path exists among each pair of sensor nodes (motes). Maintaining reliable connectivity in WSNs is a complicated task, since any failure in the nodes can cause the data transmission paths to break. In a k-connected WSN, the connectivity survives after failure in any k-1 nodes; hence, preserving the k-connectivity ensures that the WSN can permit k-1 node failures without wasting the connectivity. Higher k values will increase the reliability of a WSN against node failures. We propose a simple and efficient algorithm (PINC) to accomplish movement-based k-connectivity restoration that divides the nodes into the critical, which are the nodes whose failure reduces k, and non-critical groups. The PINC algorithm pickups and moves the non-critical nodes when a critical node stops working. This algorithm moves a non-critical node with minimum movement cost to the position of the failed mote. The measurements obtained from the testbed of real IRIS motes and Kobuki robots, along with extensive simulations, revealed that the PINC restores the k-connectivity by generating optimum movements faster than its competitors., Scientific and Technological Research Council of Turkey (TUBITAK) [113E470]; University of Antwerp and Flanders Make (a strategic research center) [43169], FundingThis research was funded by The Scientific and Technological Research Council of Turkey (TUBITAK) with the project number 113E470 and University of Antwerp and Flanders Make (a strategic research center) under grant number 43169.

Background Lifestyle intervention studies often use self-reported measures of diet as an outcome variable to measure changes in dietary intake. The presence of measurement error in self-reported diet due to participant failure to accurately report their diet is well known. Less familiar to researchers is differential measurement error, where the nature of measurement error differs by treatment group and/or time. Differential measurement error is often present in intervention studies and can result in biased estimates of the treatment effect and reduced power to detect treatment effects. Investigators need to be aware of the impact of differential measurement error when designing intervention studies that use self-reported measures. Methods We use simulation to assess the consequences of differential measurement error on the ability to estimate treatment effects in a two-arm randomized trial with two time points. We simulate data under a variety of scenarios, focusing on how different factors affect power to detect a treatment effect, bias of the treatment effect, and coverage of the 95% confidence interval of the treatment effect. Simulations use realistic scenarios based on data from the Trials of Hypertension Prevention Study. Simulated sample sizes ranged from 110-380 per group. Results Realistic differential measurement error seen in lifestyle intervention studies can require an increased sample size to achieve 80% power to detect a treatment effect and may result in a biased estimate of the treatment effect. Conclusions Investigators designing intervention studies that use self-reported measures should take differential measurement error into account by increasing their sample size, incorporating an internal validation study, and/or identifying statistical methods to correct for differential measurement error.

Background: The SARS-CoV-2 vaccine has been widely rolled out globally in the general populations. However, specific data on vaccination confidence, willingness or coverage among health care workers (HCWs) has been less reported. Methods: A cross-sectional online survey was conducted to specify the basic data and patterns of vaccination confidence, willingness and coverage among HCWs nationwide. Results: In total, 2386 out of 2583 (92.4%) participants were enrolled for analysis, and the rates of confidence in vaccine, professional institutes and government were 75.1%, 85.2% and 85.4%, respectively. The overall vaccination coverage rate was 63.6% which was adjusted as 82.8% for participants under current medical conditions or having contraindications. Confidence in vaccine safety was shown to be the most related factor to willingness among doctors, nurses, medical technicians and hospital administrators, while confidence in vaccine effectiveness as well as trust in government played the key role in formulating public health employees’ willingness. 130 (7.1% of 1833) participants reporting willingness still not been vaccinated regardless of contraindications. Multivariate analysis among willingness participants showed that males, aged over 30 years, public health employees and higher vaccination confidence had significantly higher vaccination rates with ORs (95% confidence intervals) as 1.64 (1.08–2.49), 3.14 (2.14–4.62), 2.43 (1.46–4.04) or 2.31 (1.24–4.33). Conclusions: HCWs’ confidence, willingness and coverage rates to the vaccine were generally at high levels. Heterogeneity among HCWs should be considered for future vaccination promotion strategies. The population’s confidence in vaccination is not only the determinant to their willingness, but also guarantees their actual vaccine uptake.

Background Providing sufficient numbers of human resources for health is essential for effective and accessible health services. Between 2013 and 2018, the Brazilian Ministry of Health implemented the Programa Mais Médicos (PMM) (More Doctors Programme) to increase the supply of primary care doctors in underserved areas of the country. This study investigated the association between PMM and infant health outcomes and assessed if heterogeneity in the impact of PMM varied by municipal socio-economic factors and health indicators. Methods An ecological longitudinal (panel) study design was employed to analyse data from 5565 Brazilian municipalities over a 12-year period between 2007 and 2018. A differences-in-differences approach was implemented using longitudinal fixed effect regression models to compare infant health outcomes in municipalities receiving a PMM doctor with those that did not receive a PMM doctor. The impact of PMM was assessed on aggregate and in municipality subgroups. Results On aggregate, the PMM was not significantly associated with changes in infant or neonatal mortality, but the PMM was associated with reductions in infant mortality rate (IMR) (of − 0.21; 95% CI: − 0.38, − 0.03) in municipalities with highest IMR prior to the programme’s implementation (where (IMR) > 25.2 infant deaths per 1000 live births). The PMM was also associated with an increase in the proportion of expectant mothers receiving seven or more prenatal care visits but only in municipalities with a lower IMR at baseline and high density of non-PMM doctors and community health workers before the PMM. Conclusions The PMM was associated with reduced infant mortality in municipalities with the highest infant mortality rate prior to the programme. This suggests effectiveness of the PMM was limited only to the areas of greatest need. New programmes to improve the equitable provision of human resources for health should employ comprehensive targeting approaches balancing health needs and socio-economic factors to maximize effectiveness.

Background: concerns have been raised regarding a potential surge of COVID-19 in pregnancy, secondary to the rising numbers of COVID-19 in the community, easing of societal restrictions, and vaccine hesitancy. Although COVID-19 vaccination is now offered to all pregnant women in the United Kingdom; limited data exist on its uptake and safety. Objective: this study aimed to investigate the uptake and safety of COVID-19 vaccination among pregnant women. Study design: this was a cohort study of pregnant women who gave birth at St George's University Hospitals National Health Service Foundation Trust, London, United Kingdom, between March 1, 2020, and July 4, 2021. The primary outcome was uptake of COVID-19 vaccination and its determinants. The secondary outcomes were perinatal safety outcomes. Data were collected on COVID-19 vaccination uptake, vaccination type, gestational age at vaccination, and maternal characteristics, including age, parity, ethnicity, index of multiple deprivation score, and comorbidities. Further data were collected on perinatal outcomes, including stillbirth (fetal death at ?24 weeks’ gestation), preterm birth, fetal and congenital abnormalities, and intrapartum complications. Pregnancy and neonatal outcomes of women who received the vaccine were compared with that of a matched cohort of women with balanced propensity scores. Effect magnitudes of vaccination on perinatal outcomes were reported as mean differences or odds ratios with 95% confidence intervals. Factors associated with antenatal vaccination were assessed with logistic regression analysis. Results: Data were available for 1328 pregnant women of whom 140 received at least 1 dose of the COVID-19 vaccine before giving birth and 1188 women who did not; 85.7% of those vaccinated received their vaccine in the third trimester of pregnancy and 14.3% in the second trimester of pregnancy. Of those vaccinated, 127 (90.7%) received a messenger RNA vaccine and 13 (9.3%) a viral vector vaccine. There was evidence of reduced vaccine uptake in younger women (P=.001), women with high levels of deprivation (ie, fifth quintile of the index of multiple deprivation; P=.008), and women of Afro-Caribbean or Asian ethnicity compared with women of White ethnicity (P[removed].05 for all): stillbirth (0.0% vs 0.2%), fetal abnormalities (2.2% vs 2.5%), postpartum hemorrhage (9.8% vs 9.0%), cesarean delivery (30.8% vs 34.1%), small for gestational age (12.0% vs 12.8%), maternal high-dependency unit or intensive care admission (6.0% vs 4.0%), or neonatal intensive care unit admission (5.3% vs 5.0%). Intrapartum pyrexia (3.7% vs 1.0%; P=.046) was significantly increased but the borderline statistical significance was lost after excluding women with antenatal COVID-19 infection (P=.079). Mixed-effects Cox regression showed that vaccination was not significantly associated with birth at, NA

Double fortified salt (DFS) has proven efficacy in addressing iron deficiency and anaemia, thus improving maternal and child nutrition outcomes. However, DFS delivery in large‐scale settings is less understood, with limited documentation of its fidelity of implementation (FOI). We assessed the FOI of the DFS intervention in Uttar Pradesh, India, to improve the design and implementation of such programmes that aim to reduce the anaemia burden, especially in women of reproductive age (WRA). We conducted in‐depth interviews with DFS programme staff (n = 25) and end‐user WRAs (23), guided by a programme impact pathway. We transcribed and thematically analysed the interviews and used an adapted analytic framework to document FOI across four domains—objects of intervention, implementation staff, implementation context and target of implementation. DFS utilisation remained low due to a combination of factors including poor product quality, distribution challenges, ineffective promotion and low awareness amongst end‐user WRAs. Motivation levels were higher amongst district‐level staff compared to frontline staff, who lacked supervisory support and effective incentives to promote DFS. Three typologies of DFS users emerged—‘believers’, ‘thrifters’ and ‘naysayers’—who indicated differing reasons for DFS purchase and its use or nonuse. The implementation of the DFS programme varied significantly from its theorised programme impact pathway. The adapted analytic framework helped document FOI and assess the programme's readiness for impact assessments and subsequent scale‐up. The programme needs product quality improvements, incentivised distribution and stronger promotion to effectively deliver and improve the realisation of its potential as an anaemia prevention strategy.

Highlights • This paper presents a new method for generating 50K diverse synthetic time series. • We present a discussion on time series characteristics and metrics with a view to understanding time series diversity. • We developed a robust framework for validating diversity in synthetic time series generation., Graphical abstract, In order for researchers to deliver robust evaluations of time series models, it often requires high volumes of data to ensure the appropriate level of rigor in testing. However, for many researchers, the lack of time series presents a barrier to a deeper evaluation. While researchers have developed and used synthetic datasets, the development of this data requires a methodological approach to testing the entire dataset against a set of metrics which capture the diversity of the dataset. Unless researchers are confident that their test datasets display a broad set of time series characteristics, it may favor one type of predictive model over another. This can have the effect of undermining the evaluation of new predictive methods. In this paper, we present a new approach to generating and evaluating a high number of time series data. The construction algorithm and validation framework are described in detail, together with an analysis of the level of diversity present in the synthetic dataset.