Conectar
by Chamberline E. Ozigbu, Zhenlong Li, Bankole Olatosi, James W. Hardin, Nicole L. Hair
While prior studies have identified sociodemographic correlates of zero-dose status within populations in sub-Saharan Africa (SSA), few have applied spatial regression techniques to explore geographic variability in these relationships. We aimed to address this gap using data from Demographic and Health Surveys conducted in SSA between 2010 and 2020. Our sample comprised children aged 12–59 months in 33 countries and 329 survey regions. Data were aggregated to the first-level administrative unit prior to analysis. First, using ordinary least squares regression, we documented global relationships between theoretically important sociodemographic characteristics and zero-dose prevalence. Next, we identified patterns, i.e., geographic clustering, of zero-dose prevalence. Finally, using multiscale geographically weighted regression, we described spatial variability in relationships between sociodemographic characteristics and zero-dose prevalence. We detected 27 regions with higher than expected concentrations of zero-dose children. All but one of these hot spots were observed in 7 Western and Central African countries; only 1 was located in an Eastern African country. Regions with higher proportions of mothers with no antenatal care visits were consistently found to have higher rates of zero-dose children. In contrast, relationships between zero-dose prevalence and indicators of religious affiliation, delivery site, maternal age, maternal education, and maternal employment were found to vary locally in terms of their strength and/or direction. Study findings underscore spatial disparities in zero-dose prevalence within SSA and, further, highlight the importance of geographically informed strategies to effectively address immunization gaps. Implementing targeted interventions based on regional sociodemographic dynamics is crucial for achieving comprehensive vaccination coverage in SSA.Stroke is the second leading cause of death worldwide, with the greatest burden in low- and middle-income countries (LMICs). Haemorrhagic stroke or spontaneous intracranial haemorrhage (sICH), including intraparenchymal haemorrhage (IPH) and subarachnoid haemorrhage (SAH), has the highest mortality and morbidity. Local management practices for haemorrhagic stroke vary greatly between geographical regions. The Planetary Outcomes after Intracranial Haemorrhage study aims to provide a global snapshot of the patient characteristics, processes of care and short-term outcomes of patients being treated for sICH across high- and low-income settings. It will also describe variation seen in care processes and available resources and time delays to receiving care. A greater understanding of the current state of sICH care is essential to identify possible interventions and targets for improved standards of care in all settings.
We describe a planned prospective, multicentre, international observational cohort study of patients admitted to hospital for management of sICH. We will include patients of all ages presenting to hospital with imaging evidence of sICH (IPH, intraventricular haemorrhage and/or SAH). The study will collect patient, care process and short-term outcome data, following patients for up to 30 days (or until discharge or death, whichever occurs first). Any centre globally where patients with sICH are admitted and managed can participate, targeting a sample size of 712 patients. The study will recruit centres worldwide through pre-existing research networks and by dissemination through neurosurgical and stroke conferences and courses. Each participating centre will complete a site questionnaire alongside patient data collection.
The study has received ethical approval by the University of Cambridge (PRE.2024.070). Participating centres will also confirm that they have undergone all necessary local governance procedures prior to starting local data collection. The findings will be disseminated via open access peer-reviewed journals, relevant conferences and other professional networks and lay channels, including the study website (https://plotich.org/) and social media channels (@plotichstudy).
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