International Journal of Epidemiology
Volume 45 Issue 2 April 2016
http://ije.oxfordjournals.org/content/current

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Editorials
African partnerships through the H3Africa Consortium bring a genomic dimension to longitudinal population studies on the continent
Michèle Ramsay1,*, Osman Sankoh2,3,
as members of the AWI-Gen study and the H3Africa Consortium
Author Affiliations
1Sydney Brenner Institute for Molecular Bioscience and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa,
2INDEPTH Network, Kanda, Accra, Ghana and
3Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
*Corresponding author. E-mail: michele.ramsay@wits.ac.za
[Extract]
A health and epidemiological transition is enveloping the African continent from the southern and northern regions where the prevalence of obesity has rapidly increased over the past three decades.1 In the wake of the transition to increased urbanization follow increased rates of hypertension, stroke and type 2 diabetes (T2D). Despite the widespread HIV, TB and malaria epidemics, age-standardized mortality for non-communicable diseases (the probability of dying from one of the four main NCDs—CVD, cancer, chronic respiratory disease and diabetes) between the ages of 30 and 70 years (comparable estimates for 2012) is over 25% in South Africa compared with less than 15% in North America and Europe.2

Good health-related epidemiological data from most African populations are sparse. When accessing global data on non-communicable diseases, it becomes clear that many African countries have no data; in some there is sporadic reporting on specific variables and then there are pockets of excellent data, albeit usually on smaller cohorts, or only in specific regions. For this reason, African health data are often modelled and predictions are based on models that are supported with little and sub-optimal information. This highlights an urgent need to support more systematic approaches to collecting epidemiological data in Africa…

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Health Policies and Interventions
Loss of confidence in vaccines following media reports of infant deaths after hepatitis B vaccination in China
Int. J. Epidemiol. (2016) 45 (2): 441-449 doi:10.1093/ije/dyv349
Wenzhou Yu, Dawei Liu, Jingshan Zheng, Yanmin Liu, Zhijie An, Lance Rodewald, Guomin Zhang, Qiru Su, Keli Li, Disha Xu, Fuzhen Wang, Ping Yuan, Wei Xia, Guijun Ning, Hui Zheng,
Yaozhu Chu, Jian Cui, Mengjuan Duan, Lixin Hao, Yuqing Zhou, Zhenhua Wu, Xuan Zhang,
Fuqiang Cui, Li Li, and Huaqing Wang
Abstract
Background: China reduced hepatitis B virus (HBV) infection by 90% among children under 5 years old with safe and effective hepatitis B vaccines (HepB). In December 2013, this success was threatened by widespread media reports of infant deaths following HepB administration. Seventeen deaths and one case of anaphylactic shock following HBV vaccination had been reported.
Methods: We conducted a telephone survey to measure parental confidence in HepB in eleven provinces at four points in time; reviewed maternal HBV status and use of HepB for newborns in birth hospitals in eight provinces before and after the event; and monitored coverage with hepatitis B vaccine and other programme vaccines in ten provinces.
Results: HepB from the implicated company was suspended during the investigation, which showed that the deaths were not caused by HepB vaccination. Before the event, 85% respondents regarded domestic vaccines as safe, decreasing to 26.7% during the event. During the height of the crisis, 30% of parents reported being hesitant to vaccinate and 18.4% reported they would refuse HepB. Use of HepB in the monitored provinces decreased by 18.6%, from 53 653 doses the week before the event to 43 688 doses during the week that Biokangtai HepB was suspended. Use of HepB within the first day of life decreased by 10% among infants born to HBsAg-negative mothers, and by 6% among infants born to HBsAg-positive mothers. Vaccine refusal and HepB birth dose rates returned to baseline within 2 months; confidence increased, but remained below baseline.
Conclusions: The HBV vaccine event resulted in the suspension of a safe vaccine, which was associated with a decline of parental confidence, and refusal of vaccination. Suspension of a vaccine can lead to loss of confidence that is difficult to recover. Timely and credible investigation, accompanied by proactive outreach to stakeholders and the media, may help mitigate negative impact of future coincidental adverse events following immunization.

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Effectiveness of a pay-for-performance intervention to improve maternal and child health services in Afghanistan: a cluster-randomized trial
Cyrus Y Engineer, Elina Dale, Anubhav Agarwal, Arunika Agarwal, Olakunle Alonge, Anbrasi Edward, Shivam Gupta, Holly B Schuh, Gilbert Burnham, and David H Peters
Int. J. Epidemiol. (2016) 45 (2): 451-459 doi:10.1093/ije/dyv362
Abstract
Background: A cluster randomized trial of a pay-for-performance (P4P) scheme was implemented in Afghanistan to test whether P4P could improve maternal and child (MCH) services.
Methods: All 442 primary care facilities in 11 provinces were matched by type of facility and outpatient volume, and randomly assigned to the P4P or comparison arm. P4P facilities were given bonus payments based on the MCH services provided. An endline household sample survey was conducted in 72 randomly selected matched pair catchment areas (3421 P4P households; 3427 comparison).The quality of services was assessed in 81 randomly sampled matched pairs of facilities. Data collectors and households were blinded to the intervention assignment. MCH outcomes were assessed at the cluster level.
Results: There were no substantial differences in any of the five MCH coverage indicators (P4P vs comparison): modern contraception(10.7% vs 11.2% (P = 0.90); antenatal care: 56.2% vs 55.6% (P = 0.94); skilled birth attendance (33.9% vs 28.5%, P = 0.17); postnatal care (31.2% vs 30.3%, P = 0.98); and childhood pentavalent3 vaccination (49.6 vs 52.3%, P = 0.41), or in the equity measures. There were substantial increases in the quality of history and physical examinations index (P = 0.01); client counselling index (P = 0.01); and time spent with patients (P = 0.05). Health workers reported limited understanding about the bonuses.
Conclusions: The intervention had minimal effect, possibly due to difficulties communicating with health workers and inattention to demand-side factors. P4P interventions need to consider management and community demand issues.