Papers by robert steinglass
The Lancet, Jul 1, 2023
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In November-December 1989 in Karachi Pakistan a study compared the mechanical performance and use... more In November-December 1989 in Karachi Pakistan a study compared the mechanical performance and user acceptability of the nonreusable syringe SOLOSHOT with those of a conventional disposable syringe. 24 experienced and 24 inexperienced vaccinators with various levels of training used the syringes. The 2 syringes were essentially equal in terms of mechanical performance (99.9% for conventional and 98.7% for SOLOSHOT). All the conventional syringes could be used again compared to just 9 of the 2400 (0.4%) SOLOSHOT syringes (p < .001). Absence of metal clips were responsible for making 0.4% of SOLOSHOT syringes reusable. A higher proportion of functional SOLOSHOT syringes could not be used at all due to vaccinator errors and events (e.g. syringe falling on the floor) compared to conventional syringes (3.5% vs. 0.8%; p < .001). Experienced vaccinators wasted significantly fewer SOLOSHOT syringes than inexperienced vaccinators (2% vs. 6.2%; p < .001). The vaccinators considered SOLOSHOT significantly superior to conventional syringes in terms of ease of vaccine withdrawal presence of air in the syringe after withdrawing the vaccine ease of air expulsion and residual vaccine in the syringe after injection (p < .001). Further vaccinators using SOLOSHOT syringes were less likely to attempt blood aspiration than those using conventional syringes (29.3% vs. 38%; p < .05). The sterile technique and ease of aspiration were basically similar for both syringes. Training in the use of SOLOSHOT significantly improved vaccinators performance in may categories. Vaccinators preferred SOLOSHOT syringes in almost all categories including overall performance (p < .001). They preferred conventional syringes only for ease of aspirating blood (p < .01). SOLOSHOT surpassed WHOs friction requirements for auto-destruct disposable syringes. In conclusion SOLOSHOT syringes are safe and effective. Thus WHOs Expanded Program on Immunization could replace disposable syringes with SOLOSHOT syringes.
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The Pan African medical journal, 2017
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Unsterile needles andsyringes maytransmit blood-borne infectious agents suchasHIVandhepatitis B v... more Unsterile needles andsyringes maytransmit blood-borne infectious agents suchasHIVandhepatitis B virus. Theemergence ofthesediseases asmajorpublic health concerns andtherisk ofnosocomial transmission hasheightened interest inthedevelopment ofsingle-use injection devices. WHO and UNICEFembarked onaprogramme todevelop andintroduce thesedevices in1987.We report ona field trial inKarachi, Pakistan, oftheSoloShotTm (SS)plastic disposable syringe, whichhasa metal clip inthesyringe barrel toprevent second-time withdrawal oftheplunger. A conventional disposable syringe (CS)wasusedasacomparison. We observed 48vaccinators giving 2400injections withthe SSand1440withtheCS;98.7%ofSSperformed asdesigned. Theaverage volumerequired per delivered dosewascomparable forthetwosyringes andwasdelivered morequickly withSS.Training andexperience hadasmall butstatistically significant effect onseveral aspects ofSSuse.Vaccinators whoindicated asyringe preference preferred SSon7outof9indicators. SSissafeandeff...
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PubMed, Sep 1, 2014
Objectives: The Malawi Ministry of Health (MOH) and its immunisation partners conducted a trainin... more Objectives: The Malawi Ministry of Health (MOH) and its immunisation partners conducted a training needs assessment in May 2013 to assess the current status of immunisation training programmemes in health training institutions, to identify unmet training needs, and to recommend possible solutions for training of health workers on a regular basis. Design: A cross-sectional, descriptive study. Setting: Health training institutions in Malawi, a developing country that does not regularly update its curricula to include new vaccines and management tools, nor train healthcare workers on a regular basis. Subjects: Researchers interviewed Malawi's central immunisation manager, three zonal immunisation officers, six district officers, 12 health facility immunisation coordinators, and eight principals of training institutions. Results: All health training institutions in Malawi include immunisation in their preservice training curricula. However, the curriculum is not regularly updated; thus, the graduates are not well equipped to provide quality services. In addition, the duration of the training curriculum is inadequate, and in-service training sessions for managers and service providers are conducted only on an ad hoc basis. Conclusion: All levels of Malawi's health system have not met sufficient training needs for providing immunisations, and the health training institutions teach their students with outdated materials. It is recommended that the training institutions update their training curricula regularly and the service providers are trained on a regular basis.
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World Journal of Vaccines, 2023
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Bulletin of The World Health Organization, Aug 1, 2022
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BMC Public Health
Background As of October 2021, 47 (80%) of the 59 countries, identified at highest risk for Mater... more Background As of October 2021, 47 (80%) of the 59 countries, identified at highest risk for Maternal and Neonatal Tetanus (MNT), had been validated for elimination. We assessed sustainability of MNT elimination (MNTE) in 28 countries that were validated during 2011‒2020. Methods We assessed the attainment of the following MNTE sustainability indicators: 1) ≥ 90% coverage with three doses of Diphtheria-Tetanus-Pertussis vaccine (DTP3) among infants
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This document reports the process and results of an 18-month public health communication program ... more This document reports the process and results of an 18-month public health communication program carried out in the Russian Federation by the Basic Support for Institutionalizing Child Survival (BASICS) Project a global child survival project. In response to a request from the US Agency for International Development (USAID) Mission in Moscow for assistance in combating a virulent diphtheria epidemic in the Russian Federation a team of technical experts from BASICS and USAID visited Russia in March 1995. In effect the BASICS program was designed to introduce social marketing to Russian counterparts who would need to shift to a market orientation see the Russian population as clients and market to them accordingly. Working with BASICS in diphtheria control and other immunization efforts Russians learn some of the marketing skills needed to play this new role particularly the skills needed to conduct an information education and communication campaign. The following chapter describes t...
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Vaccine, 2021
Highlights • A seroprotective tetanus titer indicates a toddler has received pentavalent vaccine.... more Highlights • A seroprotective tetanus titer indicates a toddler has received pentavalent vaccine.• Serosurveys document increased seroprevalence post-measles vaccination campaigns.• Vaccination coverage/serosurveys can assess interventions to improve immunizations.
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Vaccine, 2018
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Child Survival Basics, 1996
Many countries made great progress during the past decade in establishing immunization delivery s... more Many countries made great progress during the past decade in establishing immunization delivery systems and raising vaccination coverage. Reported global vaccination coverage increased from 10% in 1974 to 80% today. However national immunization programs will face greater challenges during the 1990s as they work to increase vaccination coverage and control vaccine-preventable diseases. The global disease control goals for the decade include reducing measles morbidity by 90% reducing measles mortality by 95% eradicating poliomyelitis worldwide and eliminating neonatal tetanus. The new independent states of the former Soviet Union must continue to battle the reemergence of diphtheria through mass immunization campaigns while other countries add hepatitis B vaccine to their immunization schedules. Eradicating polio controlling diphtheria and measles hepatitis B and the promise of disease control in sections on planning social mobilization surveillance and coordination are discussed.
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This report on polio eradication encourages effective monitoring and accurate disease surveillanc... more This report on polio eradication encourages effective monitoring and accurate disease surveillance to improve the quality of health services and disease control and eradication initiatives. The information and tools in the report evolved from actual use during National Immunization Days (NIDs) and from field assessments in several African countries. While most of the materials were developed for polio eradication, the concepts and tools also apply to routine health services. National and district Ministry of Health program managers can use the report as a reference guide to monitor and supervise their country programs. For field staff and managers, the report is a valuable reference tool for planning country activities. The report's five sections include (1) a process that can be used to monitor services during NIDs, including a comprehensive list of indicators; (2) instructions for developing effective supervision checklists to assess the quality of performance during NIDs; (3)...
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JAMA, 2009
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International Journal of Epidemiology, 1993
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The Resources for Child Health Project (REACH) did a meta-analysis of 2 data sets (life tables an... more The Resources for Child Health Project (REACH) did a meta-analysis of 2 data sets (life tables and causes of death from 48 countries during 1946-1964 and a longitudinal analysis of mortality in England and Wales) to examine the link between infant deaths and causes of death and between them and the primary care infrastructure. This study should make the debate between primary health care (PHC) and selective PHC (SPHC) more clear. The data were arranged by infant mortality rate (IMR) into high IMR (120-140) medium IMR (60-119) and low IMR (24-59). The researchers examined the mean contribution of each cause of death. As IMR decreased diarrhea-related deaths rose absolutely and as a proportion of total deaths from the high to medium groups. Further as IMR fell neonatal tetanus deaths decreased greatly and basically did not exist at the low level group. Measles-related deaths were greatest in the high IMR group. Infectious and parasitic diseases (including malaria) contributed greatly ...
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Vaccine
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Vaccine Reports, 2016
Abstract Introduction A cluster vaccination coverage survey was conducted in two districts, Dowa ... more Abstract Introduction A cluster vaccination coverage survey was conducted in two districts, Dowa and Ntchisi, in Malawi to measure the vaccination coverage of children 12–23 months old and identify factors impacting the utilization of vaccination service. Methods A cross-sectional descriptive cluster survey with 30 clusters and 10 children per cluster was administered in each district including a total of 601 children surveyed. 57 village heads and 60 health surveillance assistants (HSAs) were also interviewed. Findings The vaccination card availability was very high in both districts (94%). Vaccination coverage by card plus history of mothers was very high, above 93% for all antigens, and the coverage by card alone was also high with a range of pentavalent 1 coverage of 91% in Ntchisi and 83% in Dowa to measles coverage of 81% and 83% in Dowa and Ntchisi respectively. However, the percentage of valid doses administered to fully immunized children was low (60% in Dowa and 49% in Ntchisi). About 10% of the pentavalent 1 doses in Dowa and 9% in Ntchisi were administered before six weeks of age and 7% and 8% of the pentavalent 3 doses in Dowa and Ntchisi districts respectively were administered in less than 28 days after pentavalent 2 . Similarly, 15% of measles doses in both Dowa and Ntchisi districts were administered before 270 days. The main reason for no vaccination was vaccine stock outs at health facility level. The majority of village heads are satisfied with the vaccination service in their communities. Health surveillance assistants (HSAs), village heads and religious leaders all play major roles in mobilization for vaccination service in the two districts. Conclusion Dowa and Ntchisi districts have high vaccination coverage, however many children receive invalid doses. This finding calls for immediate action to educate the service providers on administration of valid doses.
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Newborn Vaccination is identified as a critical parameter for evaluating the overall performance ... more Newborn Vaccination is identified as a critical parameter for evaluating the overall performance of immunization programs with guidelines clearly advocating for administration of BCG, OPV zero dose and Hepatitis B birth dose to newborns. However in spite of sustained improvement in full immunization coverage in India, coverage of newborn vaccines has remained traditionally low.The USAID supported Maternal and Child Health Integrated Program (MCHIP), operational in India from 2009 – 2014 provided technical support to the Universal Immunization Program (UIP) at the National level and in the states of Jharkhand and Uttar Pradesh. During the project period, MCHIP undertook an assessment in 46 selected health facilities across 5 districts of the two states to study the implementation of the newborn vaccination program. Key findings from the assessment included a lack of knowledge among staff about the benefits of newborn vaccination, absence of written guidelines, unavailability of one v...
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Papers by robert steinglass