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Endorsed by the World Health Assembly in 2020, the Immunization Agenda 2030 (IA2030) strives to reduce morbidity and mortality from vaccine-preventable diseases across the life course (1). This report, which updates a previous report (2), presents global, regional,* and national vaccination coverage estimates and trends as of 2020. Changes are described in vaccination coverage and the numbers of unvaccinated and undervaccinated children as measured by receipt of the first and third doses of diphtheria, tetanus, and pertussis-containing vaccine (DTP) in 2020, when the COVID-19 pandemic began, compared with 2019. Global estimates of coverage with the third dose of DTP (DTP3) and a polio vaccine (Pol3) decreased from 86% in 2019 to 83% in 2020. Similarly, coverage with the first dose of measles-containing vaccine (MCV1) dropped from 86% in 2019 to 84% in 2020. The last year that coverage estimates were at 2020 levels was 2009 for DTP3 and 2014 for both MCV1 and Pol3. Worldwide, 22.7 million children (17% of the target population) were not vaccinated with DTP3 in 2020 compared with 19.0 million (14%) in 2019. Children who did not receive the first DTP dose (DTP1) by age 12 months (zero-dose children) accounted for 95% of the increased number. Among those who did not receive DTP3 in 2020, approximately 17.1 million (75%) were zero-dose children. Global coverage decreased in 2020 compared with 2019 estimates for the completed series of Haemophilus influenzae type b (Hib), hepatitis B vaccine (HepB), human papillomavirus vaccine (HPV), and rubella-containing vaccine (RCV). Full recovery from COVID-19-associated disruptions will require targeted, context-specific strategies to identify and catch up zero-dose and undervaccinated children, introduce interventions to minimize missed vaccinations, monitor coverage, and respond to program setbacks (3).

Routine health information system (RHIS) data are essential in driving decision making and planning in health systems as well as health programs. However, despite their importance, these data are underutilized, and the underlying individual-level facilitators and barriers to use remain understudied. In this research, we applied the Integrated Behavior Model (IBM) to examine how attitudes toward RHIS data, perceived norms concerning RHIS data use, and the ability to use RHIS data influence the demand and use of RHIS data among stakeholders in Senegal. Using data from interviews with respondents working at national levels of malaria, HIV, and TB control programs in Senegal, we used a framework analysis approach to apply the IBM behavioral constructs and identify their linkages to RHIS data use. We found that attitudes about the quality, availability, and relevance of RHIS data for decision making were important in driving data use among respondents. Institutional expectations, organizational protocols, policies, and practices around RHIS data ultimately shape social norms around the use of the data. Although we found that perceived ability and self-efficacy to use RHIS data were not barriers to RHIS data use among stakeholders at the strategic levels of their respective organizations, these were reported to be barriers at lower levels of the health system. Low perceived control of the RHIS data production process ultimately reduced RHIS data use for decision making among the strategic-level respondents. We recommend context-specific reexamination of existing RHIS interventions with a renewed emphasis on behavioral aspects of data use. The IBM can help guide practitioners, policy makers, and academics to address multiple socioecological factors that influence data use behavior when recommending RHIS and data use solutions.

Background Increasing the performance of routine health information systems (RHIS) is an important policy priority both globally and in Senegal. As RHIS data become increasingly important in driving decision-making in Senegal, it is imperative to understand the factors that determine their use. Methods Semi-structured interviews were conducted with 18 high- and mid-level key informants active in the malaria, tuberculosis and HIV programmatic areas in Senegal. Key informants were employed in the relevant divisions of the Senegal Ministry of Health or nongovernmental / civil society organizations. We asked respondents questions related to the flow, quality and use of RHIS data in their organizations. A framework approach was used to analyze the qualitative data. Results Although the respondents worked at the strategic levels of their respective organizations, they consistently indicated that data quality and data use issues began at the operational level of the health system before the data made its way to the central level. We classify the main identified barriers and facilitators to the use of routine data into six categories and attempt to describe their interrelated nature. We find that data quality is a central and direct determinant of RHIS data use. We report that a number of upstream factors in the Senegal context interact to influence the quality of routine data produced. We identify the sociopolitical, financial and system design determinants of RHIS data collection, dissemination and use. We also discuss the organizational and infrastructural factors that influence the use of RHIS data. Conclusions We recommend specific prescriptive actions with potential to improve RHIS performance in Senegal, the quality of the data produced and their use. These actions include addressing sociopolitical factors that often interrupt RHIS functioning in Senegal, supporting and motivating staff that maintain RHIS data systems as well as ensuring RHIS data completeness and representativeness. We argue for improved coordination between the various stakeholders in order to streamline RHIS data processes and improve transparency. Finally, we recommend the promotion of a sustained culture of data quality assessment and use.

Approximately 214 million women of reproductive age lack adequate access to contraception for their family planning needs, yet patterns of contraceptive availability have seldom been examined. With growing demand for contraceptives in some areas, low contraceptive method availability and stockouts are thought to be major drivers of unmet need among women of reproductive age, though evidence for this is limited. In this research, we examined trends in stockouts, method availability and consumption of specific contraceptive methods in urban areas of four sub-Saharan African countries (Burkina Faso, Democratic Republic of Congo, Kenya and Nigeria) and India. We used representative survey data from the Performance Monitoring for Action Agile Project that were collected in quarterly intervals at service delivery points (SDP) stratified by sector (public vs private), with all countries having five to six quarters of surveys between 2017 and 2019. Among SDPs that offer family planning, we calculated the percentage offering at least one type of modern contraceptive method (MCM) for each country and quarter, and by sector. We examined trends in the percentage of SDPs with stockouts and which currently offer condoms, emergency contraception, oral pills, injectables, intrauterine devices and implants. We also examined trends of client visits for specific methods and the resulting estimated protection from pregnancy by quarter and country. Across all countries, the vast majority of SDPs had at least one type of MCM in-stock during the study period. We find that the frequency of stockouts varies by method and sector and is much more dynamic than previously thought. While the availability and distribution of long-acting reversible contraceptives (LARCs) were limited compared to other methods across countries, LARCs nonetheless consistently accounted for a larger portion of couple years of protection. We discuss findings that show the importance of engaging the private sector towards achieving global and national family planning goals.

The Performance Monitoring and Accountability 2020 (PMA2020) project implemented a multi-country sub-project called PMA Agile, a system of continuous data collection for a probability sample of urban public and private health facilities and their clients that began November 2017 and concluded December 2019. The objective was to monitor the supply, quality and consumption of family planning services. In total, across 14 urban settings, nearly 2300 health facilities were surveyed three to six times in two years and a total sample of 48,610 female and male clients of childbearing age were interviewed in Burkina Faso, Democratic Republic of Congo, India, Kenya, Niger and Nigeria. Consenting female clients with access to a cellphone were re-interviewed by telephone after four months; two rounds of the client exit, and follow-up interviews were conducted in nearly all settings. This paper reports on the PMA Agile data system protocols, coverage and early experiences. An online dashboard is publicly accessible, analyses of measured trends are underway, and the data are publicly available.

Delivery of high-quality efficient health services is a cornerstone of the global agenda to achieve universal health coverage. Digital health interventions for service delivery, such as digital health-enhanced referral coordination and mobile clinical decision support systems, demonstrate considerable potential to improve the quality and comprehensiveness of care received by patients but require greater standardization and engagement of health workers at different levels of the health system for effective scale up., Background: Delivery of high-quality efficient health services is a cornerstone of the global agenda to achieve universal health coverage. According to the World Health Organization, health service delivery is considered good when equitable access to a comprehensive range of high-quality health services is ensured within an integrated and person-centered continuum of care. However, good health service delivery can be challenging in low-resource settings. In this review, we summarize and discuss key advances in health service delivery, particularly in the context of using digital health strategies for mitigating human resource constraints. Methods: The review updates the foundational systematic review conducted by Agarwal et al. in 2015. We used PubMed, EMBASE, and CINAHL to find relevant English-language peer-reviewed articles published 2018. Our search strategy for MEDLINE was based on MeSH (medical subject headings) terms and text words of key articles that we identified a priori. Our search identified 92 articles. After screening, we selected 24 articles for abstract review, of which only 6 met the eligibility criteria and were ultimately included in this review. Results: Despite encouraging advances in the evidence base on digital strategies for health service delivery, the current body of evidence is still quite limited in 3 main areas: the effectiveness of interventions on health outcomes, improvement in health system efficiencies for service delivery, and the human capacity required to implement and support digital health strategies at scale. Two particular areas, digital health-enhanced referral coordination and mobile clinical decision support systems, demonstrate considerable potential to improve the quality and comprehensiveness of care received by patients, but they require a greater level of standardization and an expanded scope of health worker engagement across the health system in order to scale them up effectively. Conclusions: Additional research is urgently needed to inform the effectiveness of interventions on health outcomes, improvement in health system efficiencies, and cost-effectiveness of service delivery. In particular, more documentation and research on ways to standardize and engage health workers in digital referral and clinical decision support systems can provide the foundation needed to scale these promising approaches in low- and middle-income settings.

The use of a large number of organic pollutants results in the accumulation of effluents at the places of production and the environment. These substances are, therefore, dangerous for living organisms and can cause heavy environmental damage. Hence, to cure these problems certain methods were used for the elimination of organic effluents. Indeed, the methods of elimination through magnetic adsorption and/or separation prove to be effective in the treatment of certain wastes, but the effectiveness of each one of these methods depends on several characteristics and also present limitations according to the pollutants they adsorb. This review examines on the one hand the capacity of certain elements of these methods in the elimination of certain pollutants and on the other hand the advantages and limits of these methods. Elements like biochars, biosorbents and composite materials are used due to their very strong porosity which makes it possible for them to develop an important contact surface with the external medium, at low costs, and the possibility of producing them from renewable sources. The latter still run up however against the problems of formation of mud and regeneration. Depollution by magnetic separation is also used due to its capacity to mitigate the disadvantages of certain methods which generally lead to the formation of mud and overcoming also the difficulties like obtaining an active material and at the same time being able to fix the pollutants present in the effluents to treat and sensitize them to external magnetic fields.

Biochar, coal produced by pyrolysis and used as an amendment, has several advantages and has proven to be a promising avenue for sustainable agriculture. However, the current manufacturing methods, the conditions of pyrolysis and the biomasses used produce biochars of very variable qualities which can differently affect the productivity of the ground and the outputs of plants. Currently, no study makes it possible to elucidate the influence of the physicochemical properties of the biochars on the structure and the microbial diversity of the soil. The aim of this review was to understand how the physicochemical properties of a biochar affect its capacity: to reduce the emissions of greenhouse gases; to improve the growth of hothouse plants; to improve the effectiveness of the use of manures and water; and to modify the structure and the diversity of the bacterial communities in a horticultural substrate and a mineral soil. These biochars were produced under various conditions. The analyses show that the addition of biochar can stimulate certain groups of bacteria involved in carbon and nitrogen cycles and possibly those involved in the development of plants. This review identifies the important physicochemical properties of the biochars, which will be able to better guide agricultural producers and industries manufacturing substrates containing peat, in the choice of a biochar favorable to the growth of plants and a more durable agriculture.

Wastewater treatment for urban areas has become a very important factor in the improvement of environmental quality. Increasing rates of urbanisation has increased environmental stresses, emphasising the importance of environmental protection. Sewage treatment is the most effective method to improve water quality. However, a recent increase in the sewage treatment rates has not improved the overall water quality in China. Data collected from the China Statistical Yearbooks has shown that there has been an increase in sewage treatment rates, particularly in larger cities. With 3350 wastewater treatment facilities ranging from super large facilities that can cater to a population of 1 million, to small facilities that cater to smaller populations of less than 100 000. The overall water quality remained low due to the unavailability of wastewater pipelines to connect to the WWTP. Possible ways to improve the situation is to introduce water reuse systems, which requires a certain percentage of water is expected to return to the water supply. This will replenish stressed water sources as well as provide incentive to ensure wastewater is effectively transported for treatment.

Microbial fuel cell (MFC) air cathode present a great potential among other configurations due to its simple design, low cost and direct use oxygen from air as terminal electron acceptor which could help to save tremendous energy used for aeration in conventional wastewater treatment. However, at the cathode oxygen reduction reaction which is vital to generate high power density is naturally slow, therefore a catalyst is needed to overcome its reaction over-potential. Platinum (Pt) is the standard used catalyst in large number of oxidation reduction reactions whether in basic or acidic electrolytes. But, due to its high cost and limited resources it doesn’t make it a sustainable candidate for scaling up of this juvenile technology. Activated carbon was found to be a low cost and environmental friendly Oxygen reduction reaction (ORR) catalyst in microbial fuel cell, but still exhibit lower catalytic behavior in its bare form which results in low power output. In this review we aims at making an overview of different promising technologies currently used to boost Activated carbon catalytic performance toward ORR in MFC air cathode and compare their outcomes in terms of catalytic behavior and MFC power output to the standard Pt and bare activated carbon catalysts. Advantages, disadvantages and bottlenecks of these techniques also will be discussed.