Search Results (348)

Background: Liberia modernized vaccination data systems in 2023–2025 by piloting a District Health Information System (DHIS2)-based Digital Vaccination Registry (Electronic Immunization Registry, EIR) to address the limitations of paper-based workflows and of a proprietary COVID-19 electronic platform (offline gaps, lack of unique identifiers, performance issues and cost). Objective: To assess a pilot platform by evaluating training, registry use and device management, utility for routine immunization, vaccine logistics and Adverse Events Following Immunization (AEFI) data, and routine immunization data quality in the DHIS2 mobile application compared with paper registers. Methods: Using the Public Health Informatics Institute’s Collaborative Requirements Development Methodology, stakeholders defined requirements, trained users and implemented a pilot. Mixed methods were used; a mini data audit was performed, and qualitative data were collected across 19 facilities in Montserrado, Gbarpolu and Grand Bassa. Seventy-eight health workers were trained to use the DHIS2 mobile application. Results: The future state design replaces paper aggregation steps with real-time mobile entry to a national registry and dashboard. Dual entry persisted during high-volume periods. The mini data audit found discrepancies between facility paper registers and DHIS2-EIR entries for child enrollment data and, Bacillus Calmette Guérin and Diphtheria–Pertussis–Tetanus dose administration records Participants attributed these discrepancies to internet and device problems and challenges navigating the system. Participants requested a training manual, improved connectivity at point of service, integration with supportive supervision, additional staff and system features (field to record hospital number, automated next visit date, and vaccination status prompts). Conclusions: Lessons from the pilot will inform country-wide implementation, including planned linkage with electronic birth and death registration to enable a unique child identifier and reduce manual errors and delays. Full article

Background/Objectives: Streptococcus pneumoniae remains a major cause of morbidity and mortality in Egypt, yet pneumococcal conjugate vaccines (PCVs) are not included in the national immunization program. Recent commitments to domestic vaccine manufacturing and temporary Gavi support create a timely decision context for policymakers to assess whether PCV introduction is cost-effective, affordable, and sustainable within Egypt’s health financing constraints. This study evaluates the cost-effectiveness, budget impact, and return on investment (ROI) of PCV introduction in Egypt. Methods: A deterministic, age-structured dynamic transmission model was developed to estimate the health and economic outcomes of PCV introduction over a 20-year horizon from a healthcare payer perspective. The analysis was conducted in line with the Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) guidelines. The model captures direct and indirect effects across all age groups and includes pneumonia, meningitis, non-pneumonia non-meningitis invasive disease, and acute otitis media. Scenarios assessed immediate versus delayed introduction, alternative PCV10-to-PCV13 pathways, and domestic manufacturing price assumptions. Outcomes included deaths averted, incremental cost-effectiveness ratios (ICERs) relative to GDP per capita, budget impact, and ROI using the value of statistical life. Results: Immediate PCV13 introduction was projected to avert 139,451 deaths across all age groups over 20 years, with an ICER of 523.31 USD per DALY averted equal to 0.16 × GDP per capita. The total budget impact was USD 124.9 million per year without Gavi support and USD 120.9 million with support, yielding an ROI of 23.1. Delaying the introduction substantially reduced health gains and economic returns. Pathways involving initial PCV10 introduction followed by transition to PCV13 achieved similar health outcomes with a lower budget impact and higher ROI. Conclusions: PCV introduction in Egypt represents a high-value investment. Immediate introduction maximizes health and economic benefits, while delayed introduction entails substantial opportunity costs. Alternative PCV10-to-PCV13 pathways offer a more affordable route with a similar long-term impact. Full article

Background: Many countries in sub-Saharan Africa are at risk of inadequate calcium intake, yet no data exist for vulnerable population groups in Madagascar. We aimed to assess daily calcium intake, the major contributing food sources, and the prevalence of inadequate intake in young children, adolescents, and women of reproductive age. Methods: The 2024 National Micronutrient Survey used a two-stage probabilistic design across all 23 regions. The daily calcium intake was estimated using a food frequency questionnaire that focused on calcium-rich foods that are commonly consumed in Madagascar and the calcium concentration measured in drinking water. Results: Calcium intake was low across all population groups, averaging 200–300 mg/d in adolescents and women and below 180 mg/d in young children. The prevalence of inadequate intake exceeded 96% in every population group. While calcium intake increased with increasing household wealth in children, the opposite pattern was observed for adolescents and women, whose intake decreased with increasing wealth. The main contributors to calcium intake were cassava leaves, cassava roots, small fresh and dried fish eaten with bones, drinking water across all population groups, and breastmilk in young children. Conclusions: The calcium intake is low throughout Madagascar and across all demographic groups. Strategies to improve intake are urgently needed and should include promoting continued breastfeeding and the consumption of calcium-rich, locally available, affordable foods such as small fish eaten with bones and leafy green vegetables, alongside a consideration of wheat flour fortified with calcium. Full article

Background: At the end of each year, stakeholders of the Essential Immunization Programme (EPI) in the DR Congo meet to review progress made and lessons learned from the implementation of the Annual Operational Plan (AOP) and to set priorities for the following year. This paper presents a conference report that summarizes the main outcomes of the 2025 annual review meeting, which took place from 15 to 20 December 2025, and attracted 76 participants. Conference takeaways: While the 2024 WUENIC data show that the DR Congo is off-track for the 2030 Immunization agenda targets for all antigens, the administrative coverages were reported as optimal in 2025. EPI activities are planned based on administrative coverages, likely overestimated. In 2025, 47% of health zones in North-Kivu, South-Kivu and Ituri (49 out of 104) were fully or partially controlled by armed groups, leading to partial disruptions of immunization service delivery. In 2025, the DR Congo successfully launched the measles–rubella vaccine introduction preceded by a catch-up vaccination campaign in children aged from 6 months to 14 years old and continued to roll out malaria vaccines using a phased approach. Conclusions: Learning from the implementation of the 2025 AOP, the EPI stakeholders adopted a set of priority actions for the immunization programme in 2026. Full article

Background: Self-awareness is a core psychosocial competence supporting emotional regulation, adaptive coping, and psychological well-being during late adolescence and emerging adulthood—a developmental period marked by identity exploration and heightened vulnerability to stress. Life skills education programs, such as UNICEF’s Basic Life Skills Training Program (BLSTP), aim to strengthen these competencies; however, empirical evidence on the effectiveness of structured self-awareness interventions remains limited in low- and middle-income countries, leaving a significant gap in culturally grounded preventive research. Methods: A randomized controlled trial was conducted with 60 Pakistani university students aged 18–24 years, randomly assigned to an experimental group or a waitlist control group. The experimental group received the self-awareness module of the BLSTP, targeting self-esteem, stress management, emotional regulation, and positive thinking through structured group sessions. Standardized self-report measures were administered at pre-test, post-test, and follow-up. Data were analyzed using repeated-measures ANOVA. Results: Compared to the control group, participants in the experimental group showed significant improvements across all self-awareness subdomains, with large effect sizes (partial η² = 0.46–0.84). Gains were maintained at follow-up, indicating sustained intervention effects. Conclusions: The BLSTP self-awareness module appears to be an effective and culturally appropriate preventive intervention for enhancing key psychosocial competencies in late adolescents and emerging adults. Full article

Background/Objectives: Kenya’s diet-related non-communicable disease burden is rising alongside the consumption of ultra-processed foods. Kenya finalized a national nutrient profile model (KNPM) in 2025, drawing on the WHO African regional model (WHO NPM). The objective of this study was to examine labelling practices and the healthiness of packaged products available in Kenya, including domestically produced and imported items, to identify policy priorities to strengthen nutrient profiling, surveillance, and alignment with international standards. Methods: Packaged food and beverage data were obtained from Innova Market Insights. The proportion of products meeting minimum Codex nutrition labelling requirements was determined. The proportion of products that met the nutrient criteria set out under the KNPM (draft and final versions) and WHO NPM was examined overall and by category. Agreement between nutrient profile models was determined using Fleiss’ kappa. Results: Of 5587 products, 21% displayed minimum Codex nutrient requirements. Labelling was more complete among imported compared to domestic products (40% vs. 14%). Sales-weighted eligibility was low: 15% (WHO NPM and draft KNPM) and 17% (final KNPM). Agreement across models was 82% (k = 0.44) and was highest between the WHO NPM and the final KNPM (95%; k = 0.66). Beverage patterns reflected stricter thresholds in the WHO NPM and the final KNPM. Conclusions: Kenya’s packaged food supply is inadequately labelled, with a large proportion not meeting the nutritional requirements set out in the final KNPM or WHO NPM. Mandatory, Codex-aligned nutrition labelling is necessary to ensure full operationalization of the KNPM, with regular review to reflect evolving food environments. Full article

Background/Objectives: Infant acute malnutrition increases the risk of morbidity and mortality but also has adverse effects on growth, cognitive development, and quality of life. Ready-to-use therapeutic foods (RUTFs) represent the standard treatment in moderate (MAM) or severe acute malnutrition (SAM) cases, but acceptability and adherence in culturally diverse settings remain poorly understood. To evaluate the acceptability and adherence to RUTF treatment among children with MAM or SAM in rural and indigenous communities of three Mexican states. Methods: We conducted a mixed-methods study in Chihuahua, Guerrero, and Chiapas between February and August 2024. A total of 66 children aged 6–59 months with confirmed MAM or SAM diagnoses were enrolled, with 48 completing the study. Acceptability was assessed by weighing leftovers of the consumption RUTF sachet and using 5-point hedonic scales evaluating taste, texture, appearance, and smell. Adherence was measured by comparing consumed versus prescribed RUTF sachets. Semi-structured interviews with primary caregivers explored perceptions, barriers, and facilitators of RUTF use. Results: Consumption-based acceptability was achieved by 85% of participants. On the 5-point hedonic scale, 77% of participants rated RUTF as pleasant or very pleasant. Overall treatment adherence was adequate (≥70%) in 79.2% of cases. Qualitative information revealed primary caregivers’ perceptions about weight gain and increased appetite as benefits. Conclusions: Since acceptability and adherence were adequate and a high score was obtained on the hedonic scale, which led to an improvement in the nutritional status of MAM or SAM cases, the feasibility and acceptability of RUTFs in highly vulnerable community contexts in Mexico was reaffirmed. Full article

Background/Objectives: The COVID-19 pandemic presented an urgent global need to quickly vaccinate health workers (HWs). We used this unique circumstance to assess whether mature influenza vaccination programs for HWs facilitated rapid deployment of COVID-19 vaccines in low- and middle-income countries (LMICs). Methods: We used publicly available population-level COVID-19 vaccination coverage data from the World Health Organization (WHO) COVID-19 PowerBI Dashboard for 60 LMICs to investigate general population coverage with the COVID-19 vaccine over the first year of vaccine rollout. We also evaluated country-level policy and program data reported to the WHO–United Nations Children’s Fund (UNICEF) electronic Joint Reporting Form (eJRF) in 2022 or earlier to determine if the presence of a mature (≥2 years of influenza vaccine introduction in HWs prior to 2019) HW influenza vaccination program was associated with more rapid COVID-19 vaccine deployment and/or pandemic preparedness. We used a mixed-effects beta regression model to investigate whether having a mature HW influenza vaccination program was associated with COVID-19 vaccination coverage levels and/or deployment timeliness. Finally, to provide a better understanding of the possible relationship between the presence of a mature HW influenza vaccination program and the COVID-19 vaccine rollout, we analyzed interview data collected during COVID-19 vaccine post-introduction evaluations (cPIEs). Results: Twenty-four of our study countries (40%) had mature HW influenza vaccination programs prior to the COVID-19 pandemic, and 16 (27%) participated in cPIEs. The overall adjusted mean general-population COVID-19 vaccination coverage at 12 months post-deployment in countries with mature HW influenza vaccination programs was 46% (95% CI: (35%, 56%)), compared with 25% (95% CI: (19%, 32%)) in countries without such programs. Vaccination coverage was 2.5 times higher in countries with mature programs (adjusted odds ratio 2.5, 95% CI: (1.5, 4.5); p = 0.001). Conclusions: Our analysis suggests that mature influenza vaccination programs for HWs were associated with timelier and more complete COVID-19 vaccination rollout. Full article

Background/Objectives: Emerging evidence suggests that multiple micronutrient supplements (MMS) provide additional benefits for maternal and neonatal health compared with iron and folic acid (IFA) supplements. To achieve effective coverage, acceptability, and adherence—and to inform a nationwide rollout of MMS—it is essential to understand the context-specific factors that shape implementation. This study evaluated the pilot implementation of MMS in Rwanda to identify key enablers, areas for improvement, and challenges related to antenatal care (ANC) attendance and MMS use. Methods: Data were collected through a survey of 3257 women who attended ANC services, seven focus group discussions with 35 ANC attendees, and key informant interviews with 20 ANC nurses and 21 community health workers. Results: Pregnant women reported high ANC attendance (74%) and MMS consumption (79%), largely driven by strong motivation and awareness of MMS benefits. Strategies to remember daily intake and to manage side effects supported adherence, as did reminders, motivation, and information from family members and healthcare providers. Limited patient-centered counselling, financial constraints, barriers to accessing ANC services, and product stock-outs were key areas for strengthening service delivery in Rwanda. Conclusions: Sustaining high ANC attendance and MMS adherence as the program transitions from the pilot phase to national scale-up is essential. Improving counseling quality and strengthening supply chains may reinforce ANC services and support sustained MMS adherence, with benefits for maternal and child health. Full article

Background/Objectives: Child undernutrition remains a major public health in Djibouti, yet conventional anthropometric indicators may underestimate its true burden by failing to capture overlapping forms of malnutrition. The Composite Index of Anthropometric Failure (CIAF) provides a more comprehensive assessment by identifying children experiencing one or multiple anthropometric deficits. This study aimed to estimate the prevalence and determinants of undernutrition among children under five years of age in Djibouti using the CIAF. Methods: This study is a secondary analysis of data from the nationally representative 2023 Multisectoral Survey conducted in Djibouti. A cross-sectional design with a two-stage stratified cluster sampling method was used to collect data on a national random sample (n = 2103) of children aged 6–59 months. Standardized anthropometric measurements were used to derive conventional indicators (stunting, wasting, and underweight) and the CIAF. Binary logistic regression analyses were performed to identify factors associated with anthropometric failures, adjusting for child, household, and contextual characteristics. Results: Based on conventional indicators, 23.4% of children were stunted, 20.0% were underweight, and 9.9% were wasted. Using the CIAF, 36.9% of children experienced at least one anthropometric failure, including 18.8% with multiple concurrent failures. Boys, children aged 6–47 months, those living in nomadic households, and those residing in specific regions had significantly higher risks of undernutrition. Socioeconomic indicators and household food security were not independently associated with undernutrition after adjustment. Conclusions: More than one-third of children under five in Djibouti experience undernutrition when assessed using the CIAF, revealing a substantial hidden burden not captured by conventional indicators alone. Incorporating the CIAF into routine nutrition surveillance could improve identification of vulnerable children and support more targeted, context-specific interventions. Full article

Background: Integrating palliative care (PC) into primary health care (PHC) is essential for achieving Universal Health Coverage and reducing avoidable suffering. Despite global progress in PC development, the extent to which PC is effectively embedded within PHC systems remains unclear, particularly in low- and middle-income countries. Colombia illustrates this gap, with an advanced legal framework but persistent territorial inequities. This study explored how national experts conceptualize PC integration into PHC to inform the development of context-sensitive indicators. Methods: A directed thematic analysis was conducted using qualitative comments from a modified Delphi process (pre-Delphi, Round 1, Round 2). Coding was guided by the WHO model for PC development and the WHO–UNICEF Operational Framework for PHC, combining deductive and inductive approaches to identify recurrent themes. Results: A total of 230 qualitative comments from experts in PC, PHC, and public health were analyzed. Experts described integration as the alignment of policy, education, service delivery, and community participation within PHC structures. They emphasized that laws and training programs alone are insufficient; integration depends on implementation capacity, equitable access, and locally responsive systems. Rural areas were identified as facing the greatest barriers, including limited trained staff, restricted medicine availability, and weak referral pathways. Conclusions: Experts understood PC integration into PHC as a dynamic and ethical process linking system design with human experience. Strengthening equity, workforce preparation, and community engagement is essential to translate policy into practice and to develop meaningful indicators for health system improvement. Full article

Background: The Coronavirus Disease 2019 (COVID-19) remains a major global public health issue. People living with HIV (PLHIV) are among the vulnerable groups facing a higher risk of severe outcomes. Combining COVID-19 vaccination with HIV services can improve access and utilization of the vaccine among PLHIV although effective methods of delivery are yet to be ascertained. We conducted a scoping review to identify and describe models for delivering COVID-19 vaccines through HIV care services in low- and middle-income countries (LMICs). Methods: We used PRISMA-ScR guidelines to conduct the review. On 3rd and 4th February 2025, we searched PubMed, Web of Science, Cochrane Library, and EMBASE for studies on integrated COVID-19 vaccine delivery for PLHIV. Results: Three studies from sub-Saharan Africa reported call-back strategy, diverse partnership, and mixed service delivery models for implementing COVID-19 vaccination in HIV care services. Key strategies that were used included building capacity, generating demand, managing the supply chain, and involving stakeholders. The outcomes showed significant increases in vaccination coverage among PLHIV and reduced vaccine wastage. Conclusions: Integrating COVID-19 vaccination into HIV services is practical and effective in LMICs. It makes use of current infrastructure, partnerships, and local innovations. Full article

Background: The COVID-19 pandemic exposed both the fragility and importance of long-term care facilities (LTCFs). In this context, seasonal influenza vaccination is more than a routine intervention, it is a measurable indicator of system readiness. Methods: We conducted a secondary analysis of the validated 2022 WHO–UNICEF Joint Reporting Form (JRF) on Immunization for all 194 Member States, extracting (i) policy inclusion of older adults and LTCF residents/staff and (ii) availability of numeric coverage data. Findings were interpreted alongside evidence on vaccine effectiveness and delivery in LTCFs as proxies for operational preparedness. Results: Of 194 countries, 128 (66%) reported a national influenza-vaccination policy. Among these, 109 (56%) recommended vaccination for older adults, while only 84 (43%) explicitly included LTCF residents (few countries explicitly named staff). Numeric coverage for older adults was reported by 54 countries (median 55%, range 0–103%), with 13 meeting the WHO ≥75% target. No country reported specific coverage for LTCF residents or staff. Evidence from trials and observational studies shows that vaccination reduces hospitalisation and mortality among residents and that higher staff uptake is associated with fewer resident infections and improved continuity of operations. Facilities achieving high joint coverage appear to reflect stronger governance, supply chains, data systems, and infection-prevention capacity, the same elements required for pandemic response. Conclusion: Influenza vaccination in LTCFs functions as both a barometer and a mechanism of preparedness. Three practical levers should be recognised as core readiness functions: explicit inclusion of LTCF residents and staff in national policy; routine, public reporting of resident and staff coverage; and timely, resourced on-site delivery before seasonal peaks. Embedding these features would better protect those at highest risk and strengthen overall health-system resilience. Full article

Iron deficiency anaemia (IDA) affects 25% of the global population, with detrimental effects on the health of women and children. Treatments with iron supplements offer temporary relief but often yield adverse effects, hindering patient adherence. Additionally, IDA is associated with oxidative stress, which becomes significantly exacerbated during iron supplementation. Our study aimed to address this challenge by developing a plant-based nutritional formula rich in bioavailable iron and antioxidants devoid of adverse effects. Chemical analysis of edible plants, focused on the content of iron and iron absorption inhibitors, guided formula development. In vivo studies on rats with IDA evaluated iron bioavailability from the formulated plant-based nutraceuticals. Results of animal studies showed significant improvements in IDA-associated blood parameters after 28 days of oral administration of the nutraceuticals. Additionally, the nutraceuticals did not impede the benefits of iron supplementation. These findings strongly indicate that plant-based nutraceuticals can serve as an effective source of bioavailable iron, potentially improving treatment adherence and at the same time aligning with ongoing WHO and UNICEF initiatives to enhance IDA management. Full article