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Objective To assess human papillomavirus (HPV) vaccination coverage after demonstration projects conducted in India, Peru, Uganda and Viet Nam by PATH and national governments and to explore the reasons for vaccine acceptance or refusal. Methods Vaccines were delivered through schools or health centres or in combination with other health interventions, and either monthly or through campaigns at fixed time points. Using a two-stage cluster sample design, the authors selected households in demonstration project areas and interviewed over 7000 parents or guardians of adolescent girls to assess coverage and acceptability. They defined full vaccination as the receipt of all three vaccine doses and used an open-ended question to explore acceptability. Findings Vaccination coverage in school-based programmes was 82.6% (95% confidence interval, CI: 79.3-85.6) in Peru, 88.9% (95% CI: 84.7-92.4) in 2009 in Uganda and 96.1% (95% CI: 93.0-97.8) in 2009 in Viet Nam. In India, a campaign approach achieved 77.2% (95% CI: 72.4-81.6) to 87.8% (95% CI: 84.3-91.3) coverage, whereas monthly delivery achieved 68.4% (95% CI: 63.4-73.4) to 83.3% (95% CI: 79.3-87.3) coverage. More than two thirds of respondents gave as reasons for accepting the HPV vaccine that: (i) it protects against cervical cancer; (ii) it prevents disease, or (iii) vaccines are good. Refusal was more often driven by programmatic considerations (e.g. school absenteeism) than by opposition to the vaccine. Conclusion High coverage with HPV vaccine among young adolescent girls was achieved through various delivery strategies in the developing countries studied. Reinforcing positive motivators for vaccine acceptance is likely to facilitate uptake. Objectif Evaluer la couverture vaccinale anti-papillomavirus humain (VPH) suite a des projets pilotes menes en Inde, au Perou, en Ouganda et au Viet Nam par le PATH et par les gouvernements nationaux, et etudier les raisons de l'acceptation ou du refus de la vaccination. Methodes Les vaccins etaient delivres par des ecoles ou des centres de soins ou conjointement a d'autres interventions sanitaires, et de facon mensuelle ou par des campagnes ponctuelles. En utilisant un echantillonnage en grappes a deux etapes, les auteurs ont selectionne des menages dans des zones de projet pilote et ont interroge plus de 7 000 parents ou tuteurs d'adolescentes afin d'evaluer la couverture et l'acceptabilite du vaccin. Ils ont defini la vaccination complete comme etant la prise de l'ensemble des trois doses vaccinales et ont eu recours a des questions ouvertes pour etudier l'acceptabilite. Resultats La couverture vaccinale, pour les programmes en milieu scolaire, etait de 82,6% (intervalle de confiance de 95%, IC: 79,3-85,6) au Perou, de 88,9% (IC de 95%: 84,7-92,4) en 2009 en Ouganda et de 96,1% (IC de 95%: 93.0-97,8) en 2009 au Viet Nam. En Inde, une approche de type campagne a permis de realiser une couverture allant de 77,2% (IC de 95%: 72,4-81,6) a 87,8% (IC de 95%: 84,3-91,3), alors que la delivrance mensuelle a permis de realiser une couverture allant de 68,4% (IC de 95%: 63,4-73,4) a 83,3% (IC de 95%: 79,3-87,3). Plus des deux tiers des personnes interrogees ont justifie l'acceptation du vaccin VPH pour les raisons suivantes: (i) il protege contre le cancer du col de l'uterus; (ii) il empeche la maladie, ou (iii) les vaccins sont bons. Le refus etait plus souvent justifie par des considerations liees au programme (par ex. l'absenteisme scolaire) que par une opposition au vaccin. Conclusion Une couverture elevee du vaccin VPH parmi les jeunes filles a ete obtenue par differentes strategies de delivrance dans les pays en voie de developpement a l'etude. Le renforcement des elements de motivation positifs pour l'acceptation du vaccin est susceptible d'en faciliter la prise. Objetivo Evaluar la cobertura de la vacunacion del virus del papiloma humano (VPH) despues de los proyectos de demostracion Ilevados a cabo por PATH y los gobiernos nacionales en la India, Peru, Uganda y Vietnam, asi como examinar las razones de aceptacion o rechazo de la vacuna. Metodos Las vacunas se suministraron en colegios o centros de salud, o en combinacion con otras intervenciones sanitarias, mensualmente o por medio de campanas realizadas en momentos especificos. Mediante el uso de un diseno de muestreo por conglomerados de dos fases, los autores seleccionaron hogares en areas del proyecto de demostracion y entrevistaron a mas de 7000 padres o tutores de ninas adolescentes para evaluar su cobertura y aceptabilidad. Definieron la vacunacion completa como el momento en el que se habian recibido las tres dosis de vacuna y utilizaron una pregunta de interpretacion abierta para examinar la aceptabilidad. Resultados La cobertura de la vacunacion en programas realizados en colegios fue del 82,6% (Intervalo de confianza del 95%, IC: 79,3-85,6) en Peru, 88,9% (IC del 95%: 84,7-92,4) en Uganda, en el ano 2009, y del 96,1% (IC del 95%: 93,0-97,8) en Vietnam, tambien en el ano 2009. En la India, un enfoque de campana consiguio del 77,2% (IC del 95%: 72,4-81,6) al 87,8% (95% IC: 84,3-91,3) de cobertura, mientras que el suministro mensual consiguio una cobertura del 68,4% (IC del 95%: 63,4-73,4) al 83,3% (95% IC: 79,3-87,3). Mas de dos tercios de los participantes indicaron como razones para la aceptacion de la vacuna dei VPH que: (i) protege del cancer de cuello de utero; (ii) previene la enfermedad o (iii) las vacunas son buenas. El rechazo fue mas habitual en base a consideraciones programaticas (p. ej., absentismo escolar) que por el rechazo a la vacuna. Conclusion Con la vacuna del VPH se consiguio una alta cobertura entre chicas adolescentes jovenes mediante diversas estrategias de su ministro en los paises en desarrollo estudiados. Es probable que el refuerzo de las motivaciones positivas para la aceptacion de facilite su aceptacion., Introduction The global burden of cervical cancer is large and is increasing and it disproportionately affects low-resource countries. (1) In 2008 there were approximately 529 000 new cases and over [...]

Objective: Undernutrition is prevalent among pregnant women in Cambodia. The provision of fortified dietary supplements is one strategy to help pregnant women meet their nutritional needs. Corn Soya Blend Plus (CSBP) is a widely used prenatal dietary supplement in areas with high rates of undernutrition and food insecurity. However, little is known about its acceptability during pregnancy. The present study aimed to identify factors that affected the acceptability and consumption of CSBP supplements among pregnant women.Design: Women completed a structured interview designed to provide information on facilitators of and barriers to utilization. In addition, six focus groups were conducted with a subset of women (n 70) to further explore attitudes, perceptions and experiences related to CSBP use.Setting: Two districts in Kampong Chhnang Province, Cambodia.Subjects: Pregnant women (n 288) participating in a cluster-randomized trial of CSBP.Results: The acceptability of CSBP was influenced by sensory attributes, family support, peer influences, and attitudes related to diet, nutritional status and weight gain in pregnancy. Attaining adequate nutrition was considered less important than other concerns during pregnancy, particularly anxiety related to the costs of delivery and postpartum care. Acceptance was lower among new mothers due to fears of weight gain. Health benefits were common reasons for continued use and minor side-effects, such as nausea, were not major barriers to consumption.Conclusions: CSBP was generally well accepted in this population. However, organoleptic factors and perceptions regarding nutrition and weight gain in pregnancy, particularly for first-time mothers, were barriers to increasing acceptance among Cambodian women. [ABSTRACT FROM AUTHOR]

Background Introduction of human papillomavirus (HPV) vaccine in national programs has proceeded apace since 2006, mostly in high-income countries. Recently concluded pilots of HPV vaccination in low-income countries have provided important lessons learned for these settings; however, rigorous evaluations of the feasibility of these delivery strategies that effectively reach young adolescents have been few. This paper presents results from a qualitative evaluation of a demonstration program which implemented school-based and health center-based HPV vaccinations to all girls in grade 6, or 11 years of age, for two years in four districts of Vietnam. Methods Using semi-structured interviews of 131 health and education staff from local, district, province, and national levels and 26 focus-group discussions with local project implementers (n = 153), we conducted a qualitative two-year evaluation to measure the impact of HPV vaccinations on the health and education systems. Results HPV vaccine delivery at schools or health centers was made feasible by: a. close collaboration between the health and education sectors, b. detailed planning for implementation, c. clearly defined roles and responsibilities for project implementers, d. effective management and supervision of vaccinations during delivery, and e. engagement with community organizations for support. Both the health and education systems were temporarily challenged with the extra workload, but the disruptions were short-lived (a few days for each of three doses) and perceived as worth the longer-term benefit of cervical cancer prevention. Conclusion The learning from Vietnam has identified critical elements for successful vaccine delivery that can provide a model for other countries to consider during their planning of national rollout of HPV vaccine. [ABSTRACT FROM AUTHOR]