Publications by authors named "Zoe Sakas"

New vaccines, technologies, and regulations, alongside increased demand for vaccines, all require prioritization and coordination from key players within the vaccine sector. Inter-agency Coordinating Committees (ICC) support decision-making and coordination at the national-level and act as key drivers for sustainable improvements in vaccination programming. We utilized a previous qualitative case study, which investigated critical success factors for high routine immunization coverage in Zambia from 2000-2018, specifically to study the Zambian ICC.

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Objectives: Community health workers are essential to front-line health outreach throughout low-income and middle-income countries, including programming for early childhood immunisation. Understanding how community health workers are engaged for successful early childhood vaccination among countries who showed success in immunisation coverage would support evidence-based policy guidance across contexts.

Design: We employed a multiple case study design using qualitative research methods.

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Objective: Senegal has demonstrated catalytic improvements in national coverage rates for early childhood vaccination, despite lower development assistance for childhood vaccines in Senegal compared with other low-income and lower-middle income countries. Understanding factors associated with historical changes in childhood vaccine coverage in Senegal, as well as heterogeneities across its 14 regions, can highlight effective practices that might be adapted to improve vaccine coverage elsewhere.

Design: Childhood vaccination coverage rates, demographic information and health system characteristics were identified from Senegal's Demographic and Health Surveys (DHS) and Senegal national reports for years 2005-2019.

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Objectives: Vaccination averts an estimated 2-3 million deaths annually. Although vaccine coverage improvements across Africa and South Asia have remained below global targets, several countries have outperformed their peers with significant increases in coverage. The objective of this study was to examine these countries' vaccination programmes and to identify and describe critical success factors that may have supported these improvements.

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Article Synopsis
  • This study aims to explore factors that improve childhood vaccination rates in Nepal, Senegal, and Zambia, focusing on facilitators and barriers to implementing interventions over the past 20 years.
  • Through interviews and discussions with public health leaders and community members, the research utilized a framework to analyze key elements impacting vaccination programs, identifying common themes across the three countries.
  • The study found that successful implementation relied on strong communication networks, clear goals, prioritization of health, and supportive external policies, while challenges included insufficient resources, lack of knowledge, and meeting patients' needs.
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  • Childhood vaccinations play a crucial role in reducing infectious diseases, but increasing vaccine hesitancy poses a challenge to global coverage improvements.
  • The study examined factors influencing sustained vaccination rates in Zambia, Nepal, and Senegal, evaluating them against the 5C psychological framework (confidence, complacency, convenience, communication, and culture).
  • Successful interventions included targeted health education, community engagement, and involvement of local leaders, highlighting the importance of understanding and addressing the psychological and social factors that drive vaccination demand.
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The vaccine community has produced extensive evidence on vaccine hesitancy, but research to understand the factors that affect public trust in vaccines and vaccine confidence among Black, Indigenous and People of Color (BIPOC) remains limited. To enrich extant literature, we present themes from 332 stories collected from predominantly BIPOC communities in New York City that explored motivators for vaccination during the COVID-19 pandemic. Stories were collected by trained community health workers from December 2021 to June 2022.

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Background: The essential components of a vaccine delivery system are well-documented, but robust evidence is lacking on policies and implementation strategies are operationalized to drive catalytic improvements in coverage. To address this gap, we identified success factors that supported improvements in routine immunization coverage in Senegal, especially from 2000 to 2019.

Methods: We identified Senegal as an exemplar in the delivery of childhood vaccines through analysis of DTP1 and DTP3 coverage data.

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Background: Few countries are likely to achieve universal sanitation within the next decade as sustaining household sanitation coverage remains a critical challenge. This study aimed to investigate factors that may have supported or hindered sustainability of sanitation coverage 1-2 years after the completion of an integrated, area-wide sanitation program in 4 countries.

Methods: We conducted qualitative analyses to identify factors related to the sustainability of sanitation coverage in Bhutan, Kenya, Nepal, and Zambia, 2 years after completion of the Sustainable Sanitation and Hygiene for All program.

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Introduction: The essential components of a vaccine delivery system are well-documented, but robust evidence on how and why the related processes and implementation strategies drive catalytic improvements in vaccination coverage are not well established. To address this gap, we identified critical success factors that may have led to substantial improvements in routine childhood immunization coverage in Nepal from 2000 through 2019.

Methods: We identified Nepal as an exemplar in the delivery of early childhood immunization through analysis of DTP1 and DTP3 coverage data.

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Introduction: While many studies have implemented programs to increase sanitation coverage throughout the world, there are limited rigorous studies on the sustainability of these sanitation programs.

Methods: Between 2014 and 2018, the rural Sustainable Sanitation and Hygiene for All (SSH4A) approach was implemented by SNV in sub-Saharan Africa and Asia. Repeated cross-sectional household surveys were administered annually throughout program implementation and 1 to 2 years following completion of program activities.

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Introduction: The essential components of a vaccine delivery system are well-documented, but robust evidence on how and why the related processes and implementation strategies prove effective at driving coverage is not well-established. To address this gap, we identified critical success factors associated with advancing key policies and programs that may have led to the substantial changes in routine childhood immunization coverage in Zambia between 2000 and 2018.

Methods: We identified Zambia as an exemplar in the delivery of childhood vaccines through analysis of DTP1 and DTP3 coverage data.

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Article Synopsis
  • * The research focuses on Nepal, Senegal, and Zambia to understand what led to their significant improvements in vaccine coverage from 2000 to 2018 using established implementation science frameworks.
  • * Ethical data collection from participants will inform findings, which will be shared through peer-reviewed articles, presentations, and online resources, all overseen by relevant institutional review boards.
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  • Adaptations to programming can enhance effectiveness but may harm the underlying theory of change if not managed carefully.
  • A case study of rural WaSH programming in Nepal revealed 45 adaptations made, focusing on outcomes like toilet construction and community engagement.
  • While most adaptations met their goals, certain sanctions led to negative community reactions and sustainability issues, suggesting that less pressured and more acceptable adaptations can still drive positive change.
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Introduction: Women's active participation is important for inclusive water, sanitation, and hygiene (WaSH) programs, yet gender roles that limit women's access to formal education and employment may reduce their skills, experience, and capacity for implementation. This paper explores differences between men and women implementers of rural WaSH programs in implementation approaches, challenges, and sources of support for implementation, and success in achieving program quality outcomes.

Methods: We interviewed 18 men and 13 women in community-based implementation roles in four districts of Nepal.

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Introduction: Increasing use of cleaner fuels, such as liquefied petroleum gas (LPG), and abandonment of solid fuels is key to reducing household air pollution and realising potential health improvements in low-income countries. However, achieving exclusive LPG use in households unaccustomed to this type of fuel, used in combination with a new stove technology, requires substantial behaviour change. We conducted theory-grounded formative research to identify contextual factors influencing cooking fuel choice to guide the development of behavioural strategies for the Household Air Pollution Intervention Network (HAPIN) trial.

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Few rural sanitation programs have documented large increases in sanitation coverage or have assessed if interventions equitably increase sanitation coverage for vulnerable groups. We characterize the impact of the Sustainable Sanitation and Hygiene for All (SSH4A) approach on key program WASH (water, sanitation, and hygiene) indicators, and also assess if these increases in WASH coverage are equitably reaching vulnerable groups. The SSH4A approach was administered in 12 program areas in 11 countries, including Bhutan, Ethiopia, Ghana, Indonesia, Kenya, Mozambique, Nepal, South Sudan, Tanzania, Uganda, and Zambia.

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  • Researchers managed to extract the mitochondrial genome (mitogenome) of bed bugs from high-throughput sequencing data that was initially aimed at studying their nuclear genome.
  • The assembled mitogenome shows a characteristic bias toward AT nucleotide composition, which is common among various insect species.
  • Phylogenetic analysis of protein-coding genes reveals that bed bugs belong to a paraphyletic group within the Cimicomorpha clade of the Hemiptera order.
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