@article{VanGestelShaikhVermijsetal., author = {Van Gestel, Raf and Shaikh, Mujaheed and Vermijs, Flore and Riumallo-Herl, Carlos}, title = {Health programme spillover effects on childhood vaccination in India: a difference-in-differences analysis of the Zinc and Oral Rehydration Salts Programme using retrospective demographic health surveys data}, series = {BMJ Public Health}, volume = {3}, journal = {BMJ Public Health}, number = {2}, doi = {10.1136/bmjph-2024-001743}, abstract = {Background Childhood immunisation coverage has stagnated globally and even declined in some countries during recent decades. We aimed to evaluate whether a public health programme targeted at diarrhoeal disease also impacted, as a spillover effect from the programme, immunisation coverage. Methods Retrospective data from the 2015/2016 Indian Demographic Health Survey were obtained on 142 921 children, born to mothers in the 5 years leading up to the survey. A difference-in-differences study was performed to compare the completed child vaccination rates before and after the Clinton Health Access Initiative Zinc (CHAI)/Oral Rehydration Salts Programme in 2012, and between covered (Madhya Pradesh and Uttar Pradesh) and non-covered states. Results The CHAI programme was associated with an increase in basic child vaccination coverage (one dose of BCG (Bacille Calmette-Gu{\´e}rin) and measles, and three doses of DTP (diphtheria, tetanus and pertussis) and polio vaccines) of 5.27 percentage points (95\% CI 3.48 to 7.05). This increase was concentrated among male children, and no differences were found by wealth quintiles, maternal education or sanitation. Different intensities of the CHAI initiative across districts in Uttar Pradesh were not associated with different vaccination coverage rates. Conclusions Existing studies rarely evaluate spillover effects or unintended consequences of public health campaigns. We find that a public health programme to reduce diarrhoeal diseases was associated with increased vaccination coverage in India. These findings highlight the potential horizontal health effects of disease-specific public campaigns and household behaviour responses to the programme. The evidence shows that actionable approaches to improve immunisation coverage exist that do not exclusively rely on vaccination campaigns.}, language = {en} } @article{ShaikhOtaVanGestel, author = {Shaikh, Mujaheed and Ota, Elsa and Van Gestel, Raf}, title = {Childhood immunization and competing mortality risks in Kenya: A longitudinal analysis for multiparous mothers}, series = {The Journal of Pediatrics}, journal = {The Journal of Pediatrics}, doi = {10.1016/j.jpeds.2023.113590}, abstract = {Objective To assess the relationship between childhood immunization and mortality risks for non-vaccine-preventable diseases (Competing Mortality Risks or CMR) in Kenya. Study Design A combination of the Global Burden of Disease and Demographic Health Survey (DHS) data is used to measure basic vaccination status, CMR, and control variables for each child in the DHS data. A longitudinal analysis was performed. This uses within-mother variation between children to compare the vaccine decisions for different children, who are exposed to different mortality risks. The analysis also distinguishes between overall and disease-specific risks. Results The study included 15,881 children born between 2009 and 2013, who were at least 12 months old at the time of interview and not part of a twin birth. Mean basic vaccination rates ranged from 27.1\% to 90.2\% and mean CMR from 85.80 to 913.63 deaths per 100,000 across different counties. A one-unit increase in mortality risk from diarrhea, the most prevalent disease among children in Kenya, is associated with a 1.1 percentage point decline in basic vaccination status. On the other hand, mortality risks for other diseases and HIV increase the likelihood of vaccination. The effect of CMR was found to be stronger for children with higher birth orders. Conclusions A significant negative correlation between severe CMR and vaccination status is found, which has important implications for immunization policies, particularly in Kenya. Interventions aimed at reducing the most severe CMR, such as diarrhea, and targeted towards multiparous mothers may improve childhood immunization coverage.}, language = {en} }