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Almost 20 million children globally do not get routine vaccines, 1.4 million of which reside in Pakistan. Immunization coverage in rural settings of Pakistan, comprising >60% population, is lower than their urban counterparts. Barriers such as distant-centers, lack of transportation, and restrictions on women to travel alone, exacerbate the problem. We introduced immunization carpool services in rural settings to facilitate vaccination of < 2 years children. Low-coverage immunization clinics were selected based on availability of vaccinators and vaccines in Shikarpur, a rural district in Pakistan. Local transport providers were identified and vehicles were rented-in. Community mobilization was done through awareness sessions and branding vehicles. Data was recorded on the number of round trips and immunization visits facilitated by each vehicle. Details of children transported and feedback on carpool services were captured from caregivers. Immunization coverage was calculated using the government’s electronic immunization registry data. Between January to October 2020, 6 vehicles were deployed, which provided free transport services in 98 catchment areas of 4 immunization clinics. On average, each vehicle completed 420 (SD: 58.2) round trips and facilitated 781 (SD: 171) immunization visits. A total of 2,391 children were enrolled, 1,182 (49.7%) of them were females and 1,197 (50%) aged <6months. Enrolled children compared to non-enrolled at the same immunization clinic, showed 19.1% higher coverage rate for penta-3 (81% vs 68%, p < 0.00) and 23.6% for measles-2 (73% vs 57%, p < 0.00). Immunization timeliness among enrolled children increased by 4.8% for penta-3 (9% vs 4%, p < 0.00) and 18% for measles-2 (25% vs 7%, p < 0.00). Reported advantages of services include time-saving (92%), cost-saving (79%), and reduced dependence on family members (95%). Immunization carpool service is well accepted by rural women and can improve immunization coverage and equity in rural areas. Key messages: Provision of commuting options can overcome accessibility barriers and has the potential to improve immunization coverage and timeliness. Free transport services for rural women could aid in promoting gender equity and reducing urban-rural disparities. [ABSTRACT FROM AUTHOR]

Background: In Mexico, 47.7% of newborns are breastfed within the first hour of life and 28.6% are exclusively breastfed until 6 months of age, which does not meet the WHO definition of successful breastfeeding. Attitudes are expressed through beliefs, emotions and intentions wich represent a link between attitude and behavior, that is, a strong predictor of behavior. In Pakistan, cervical cancer is the third most frequent cancer among women. Most cases are caused by sexually-acquired infection with human papillomaviruses (HPV). Vaccination of adolescent girls against HPV significantly reduces the incidence of cervical cancer. HPV vaccination is available in Pakistan, but plans to develop a HPV vaccination program are currently at a very early stage. We conducted a formative study to explore adolescent girls' perspectives on HPV and cervical cancer, and collected their recommendations for implementing an HPV vaccination program. We conducted qualitative focus group discussions (FGDs), with unmarried adolescent girls aged 16- 19 years, residing in Karachi. We conducted four FGDs with 12 participants each. The topic guide assessed i) girls' knowledge of cervical cancer and HPV vaccination, ii) vaccination decision-making dynamics within families, and iii) factors girls would consider essential for the successful implementation of HPV vaccination program. Overall, participants displayed a positive attitude towards the HPV vaccine. However, many basic concepts related to female reproductive health were unfamiliar to them. Female relatives were indicated as girls' preferred point of contact for discussions on HPV and cervical cancer, but fathers were portrayed as the definitive decision-making authority on vaccination. Girls gave critical input for the development of a HPV vaccination program. Eligible girls should be recruited through individual household visits and the vaccine should be administered at community-based camps, which would ensure both good accessibility and a large outreach. A solid foundation of trust between girls' families, program managers, and other stakeholders emerged as a key asset for the program's success. Adolescents demonstrated great capacity and shared recommendations for a future program's acceptability. Integrating their perspectives will be essential to design an effective program in local context. Key messages: Adolescent girls' perspectives should be incorporated to develop context-specific recommendations for the implementation of a HPV vaccination program. Community-based camps and household visits by adolescent girls to recruit the target population could potentially increase program penetration among communities. [ABSTRACT FROM AUTHOR]

Purpose: The complications reported after sentinel lymph node biopsy (SLNB) for melanoma is highly variable in the worldwide literature; the overall complication rate varies between 1.8% and 29.9%. With heterogeneous reporting of morbidity data, no 'average' complication rates of this procedure have been reported. This systematic review aims to determine the complications rates associated with SLNB., Methods: A systematic review of English-language literature from 2000 to 2015, which reported morbidity information about SLNB for melanoma, was performed. The methodological quality of the included studies was performed using the methodological index for non-randomised studies (MINORS) instrument and Detsky score. Pooled proportions of specific post-operative complications were constructed using a random effects statistical model, and subgroups including lymph node basin and continent of origin of the study were compared., Results: After application of inclusion and exclusion criteria, 21 articles progressed to the final analysis. 9047 patients were included. The overall complication rate was 11.3% (95% CI: 8.1-15.0). The incidence of infection was 2.9% (95% CI 1.5-4.6); seroma 5.1% (95% CI: 2.5-8.6); haematoma 0.5% (95% CI: 0.3-0.9) lymphoedema 1.3% (95% CI: 0.5-2.6) and nerve injury 0.3% (95% CI: 0.1-0.6). There was no statistically significant difference in morbidity between the sites of SLNB or between continents., Discussion: This study provides information about the incidence of complications after SLNB. It can be used to counsel patients about the procedure and it sets a benchmark against which surgeons can audit their practice., (Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.)