service delivery

Accurate immunization delivery costs are necessary for assessing the cost-efectiveness and strategic planning needs of immunization programs. From a database of empirical immunization costing studies, we extracted estimates of the delivery cost per dose for routine childhood immunization services, excluding vaccine costs. We estimated the prediction model using the results from 29 individual studies, covering 24 countries. The predicted economic cost per dose for routine delivery of childhood vaccines (2018 US dollars), not including the price of the vaccine, was $1.87 (95% uncertainty interval $0.64–4.38) across all LMICs. By individual cost category, the programmatic economic cost per dose for routine delivery of childhood vaccines was $0.74 ($0.26–1.70) for labor, $0.26 ($0.08–0.67) for supply chain, $0.22 ($0.06–0.57) for capital, and $0.65 ($0.20–1.66) for other service delivery costs. The cost estimates from this analysis provide a broad indication of immunization delivery costs that may be useful when accurate local data are unavailable.

This study’s objective was to determine the prevalence of TB among mentally ill patients in Afghanistan. A cross-sectional study was conducted in five public health facilities and one private facility. All patients in those centers were screened for TB, and the diagnosis of TB was made with GeneXpert or made clinically by a physician. Out of 8,598 patients registered, 8,324 (96.8%) were reached and 8,073 (93.9%) were screened for TB, of whom 1,703 (21.1%) were found to be presumptive TB patients. A total of 275 (16.7%) were diagnosed with all forms of TB, of whom 90.5% were women. The overall prevalence of TB among mentally ill patients was 3,567/100,000—20 times higher than the national incidence rate. TB was independently associated with married and widowed adults, young adults, females, and oral sleep drug users. TB among mentally ill patients is very high, and we recommend that TB care and prevention services be integrated into mental health centers.

Lessons learned from treating patients with HIV infection can inform care systems for other chronic conditions. For antiretroviral treatment, attending appointments on time correlates with medication adherence; however, HIV clinics in East Africa, where attendance rates vary widely, rarely include systems to schedule appointments or to track missed appointments or patient follow-up.

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