Impact of a measles outbreak response immunization campaign: Maroua, Cameroon, 2009.

A large measles outbreak occurred in Maroua, Cameroon during October 2008-April 2009; a nine-day outbreak response immunization (ORI) campaign was initiated 15 weeks after the start of the outbreak during high transmission season. To assess the impact of ORI, we described changes to case counts and characteristics before and after ORI, and the reporting efficiency of measles cases to the surveillance system. A sharp decrease in cases occurred from 555 cases during the period before ORI to 162 cases during the period after ORI; reporting efficiency was 79.5% before ORI and 93.0% after ORI. These findings highlight the potential benefits of rapid implementation of recommended ORI strategies during measles outbreaks in Africa.

Measles mortality reduction and pre-elimination in the African region, 2001-2009.

INTRODUCTION: In 2001, countries in the African region adopted the measles-associated mortality reduction strategy recommended by the World Health Organization and the United Nations Children's Fund. With support from partners, these strategies were implemented during 2001-2009. METHODS: To assess implementation, estimates of the first dose of measles vaccination through routine services (MCVI) and reported coverage for measles supplemental immunization activities (SIAs) were reviewed. Measles surveillance data were analyzed. RESULTS: During 2001-2009, regional MCV1 coverage increased from 56% to 69%, and >425 million children received measles vaccination through 125 SIAs. Measles case-based surveillance was established in 40 of 46 countries; the remaining 6 have aggregated case reporting. From 2001 through 2008, reported measles cases decreased by 92%, from 492,116 to 37,010; however, in 2009, cases increased to 83,625. CONCLUSIONS: The implementation of the recommended strategies led to a marked decrease in measles cases in the region; however, the outbreaks occurring since 2008 indicate suboptimal vaccination coverage. To achieve high MCV1 coverage, provide a second dose through either periodic SIAs or routine services, and to ensure further progress toward attaining the regional measles pre-elimination goal by 2012, a renewed commitment from implementing partners and donors is needed.

The impact of a reproductive health franchise on client satisfaction in rural Nepal.

This study evaluates the impact of a nurse and paramedic reproductive health franchise in rural Nepal on client satisfaction and utilization of services. A quasi-experimental study design, with baseline and follow-up measurements on nonequivalent control groups, was used to assess the effects of the intervention. The study collected data from exit interviews with male and female clients at clinics and from household interviews with married women. Our assessment covers the project's performance for about a year of actual implementation. Client satisfaction with the quality of services increased across a range of indicators at intervention clinics but not at control clinics. Overall satisfaction with services also increased only at intervention clinics but not at control clinics. Consistent with these changes, loyalty increased among clients of franchised clinics. The analysis showed a positive relationship between client satisfaction and loyalty. Although the project's implementation was examined over a relatively short period of time, there appears to have been a net positive effect of the intervention on obtaining family planning products from medical stores/pharmacies. The study shows that franchising reproductive health services increases a provider's interest in delivering better quality services in rural areas of a developing country.