INTRODUCTION: Optimal immunisation programme service delivery and childhood vaccine coverage remains an ongoing challenge in South Africa. Previous health systems approaches have made recommendations on how to address identified barriers but detailed local implementation studies are lacking. This study aimed to improve immunisation service delivery in children under 24 months in Khayelitsha, Western Cape Province using an adaptive, co-design approach to assess and improve childhood immunisation service delivery at the clinic level. METHODS: A rapid, adaptive approach to identification of barriers and assessment of current childhood immunisation service delivery was developed with three clinics in Khayelitsha, Western Cape Province. This informed a short co-design process with key stakeholders and service providers to develop local interventions targeted at high priority barriers. Interventions were implemented for 4-6 months and evaluated using theory-based evaluation tools. Clinic service delivery, satisfaction and changes to clinic processes and parent engagement and knowledge were measured. RESULTS: Interventions developed included weekly community immunisation education radio sessions, daily clinic health talks, immunisation education and promotion materials and service provider and parent quality checklists. Evaluation post-intervention showed improvement in parents'/guardians' knowledge about immunisation, parent engagement and service provider commitment to improvement in service quality. Radio sessions and immunisation education and communication materials were deemed most useful by parents and providers. CONCLUSION: Immunisation service delivery can be strengthened using an adaptive, clinic-led assessment process which can effectively identify barriers, inform co-designed interventions and be evaluated over a short period. This approach provides a framework to guide future local participatory action research to more effectively improve childhood immunisation service delivery and other child health services in under-resourced settings.
Andrea Timothy, David J. Coetzee, Chris Morgan et al.
OBJECTIVES: Despite significant progress in childhood vaccination coverage globally, substantial inequality remains. Remote rural populations are recognised as a priority group for immunisation service equity. We aimed to link facility and individual data to examine the relationship between distance to services and immunisation coverage empirically, specifically using a rural population. DESIGN AND SETTING: Retrospective cross-sectional analysis of facility data from the 2013-2014 Malawi Service Provision Assessment and individual data from the 2015-2016 Malawi Demographic and Health Survey, linking children to facilities within a 5 km radius. We examined associations between proximity to health facilities and vaccination receipt via bivariate comparisons and logistic regression models. PARTICIPANTS: 2740 children aged 12-23 months living in rural areas. OUTCOME MEASURES: Immunisation coverage for the six vaccines included in the Malawi Expanded Programme on Immunization schedule for children under 1 year at time of study, as well as two composite vaccination indicators (receipt of basic vaccines and receipt of all recommended vaccines), zero-dose pentavalent coverage, and pentavalent dropout. FINDINGS: 72% (706/977) of facilities offered childhood vaccination services. Among children in rural areas, 61% were proximal to (within 5 km of) a vaccine-providing facility. Proximity to a vaccine-providing health facility was associated with increased likelihood of having received the rotavirus vaccine (93% vs 88%, p=0.004) and measles vaccine (93% vs 89%, p=0.01) in bivariate tests. In adjusted comparisons, how close a child was to a health facility remained meaningfully associated with how likely they were to have received rotavirus vaccine (adjusted OR (AOR) 1.63, 95% CI 1.13 to 2.33) and measles vaccine (AOR 1.62, 95% CI 1.11 to 2.37). CONCLUSION: Proximity to health facilities was significantly associated with likelihood of receipt for some, but not all, vaccines. Our findings reiterate the vulnerability of children residing far from static vaccination services; efforts that specifically target remote rural populations living far from health facilities are warranted to ensure equitable vaccination coverage.
Nicole E. Johns, Ahmad Reza Hosseinpoor, Mike Chisema et al.
Background: Immunisation is a protective measure against infectious diseases and is one of the most crucial public health interventions (WHO, 2019). Mothers face challenges which are facility-related factors such as long waiting times, stock-outs and negative staff attitudes, as well as cultural and religious beliefs held by mothers and families, which further shape whether children receive vaccinations (Wiysonge et al, 2020; South Africa qualitative study, 2023). Purpose: The aim of the study was to assess the experiences of mothers in accessing childhood immunisation services from the perspective of mothers in the paediatric outpatient department at a tertiary hospital in South Africa. Methodology: A quantitative cross-sectional design approach was used to investigate the challenges faced by mothers when accessing childhood vaccination. A probability sampling method was used to sample 221 respondents by means of systemic sampling. Data was collected by means of self-administered questionnaire. Validity was ensured through face and content validity. The reliability was ensured through clear and detailed instructions as well as pilot testing. Data was collected and analyzed using Statistical Package for Social Science (SPSS) version 27. The results analyzed were then carefully interpreted to identify key trends and patterns. The data analyzed was presented visually through tables and charts to make the findings easier to understand and interpret. Results: The study comprised of 222 participants. The study results showed that majority of mothers knew and understood enough about immunization and their advantages. However, long waiting times, high transport expenses and vaccine shortages made it difficult for many of the mothers and impacted schedule adherence. According to the study’s findings, expanding vaccine coverage requires improving service accessibility, effectiveness and ongoing health education. Conclusion: The study revealed that mothers face several challenges when accessing childhood immunisation services, including long waiting times, lack of information regarding vaccines and limited accessibility. These barriers negatively impact immunisation uptake and threaten child health outcomes. Recommendations: Addressing the challenges that mothers face when accessing immunisation through improved health education, resource allocation, and community engagement is essential to strengthen immunisation coverage.
Vhulenda Maranda, Tinyiko Chawane, Hakhakhi Mphaphuli et al.
There is a paucity of reference early childhood development (ECD) data at community level in rural Africa. Our objective was to conduct a comprehensive assessment of ECD in rural Zimbabwe and determine the impact of stunting and schistosome infections on ECD. Using the Griffiths Scales of Child Development, we conducted a cross sectional assessment of Eye and Hand Coordination (EHC), Personal-Social-Emotional (PSE), Language and Communication (LC), Foundations of Learning (FL) and Gross Motor (GM) domains and the summary General Development (GD) in 166 children aged 6-72 months. The effects of stunting, malnutrition and Schistosoma haematobium infection on ECD was determined. The impact of praziquantel curative treatment of schistosome infection on the developmental scores was determined through a longitudinal follow up at 6 and 12 months. From an initial 166 children, 11 were found to have developmental deficits warranting further investigation. Of the remaining 155, 58.7% recorded a good (≥ average) score for the overall General Development (GD). Proportions of children scoring above the cut-off (≥ average) for each domain were GM (84.5%), PSE (80.6%), EHC (61.9%), FL (43.9%) and LC (44.5%). The prevalence of stunting was 26.8% (95% CI = 20.1%-34.8%) Scores for stunted children were significantly lower for EHC (p = 0.0042), GM (p = 0.0099), and GD (p = 0.0014) with the fraction of lower scores attributable to stunting being GM = 63.4%, GD = 46.6%, EHC = 45%, and LC = 21%. S. haematobium infection prevalence was 39.7% and mean infection intensity was 5.4 eggs/10 ml urine. Infected children had poorer cognitive performance scores for the FL (p = 0.0005) with 30.8% of poor FL attributable to the infection. Performance in all domains improved to the expected normal or above reference levels at 6 and 12 months post curative treatment of schistosome infections. Our study documented reference values for ECD in rural Zimbabwean children. The study detected deficiencies in the FL domain, which were more pronounced in children, infected with schistosomes, highlighting the need for provision of cognitive stimulation tools and access to early childhood foundation education. There is also need for improved child nutrition and treatment of schistosome infections to improve child development outcomes.
Francisca Mutapi, Lorraine Tsitsi Pfavayi, Derick Nii Mensah Osakunor et al.
This study investigates the short-term impacts of an aggregate socioeconomic shock on household food consumption and children’s nutrition using the case of the COVID-19 pandemic in Mozambique. In response to the economic downturn, households are expected to adjust their food choices both in terms of quality, towards cheaper and unhealthier food, and quantity, reducing diet diversification and increasing the exposure to malnutrition, mainly for children. Empirical evidence on such immediate effects is still scarce, mainly due to a lack of data. This paper aims to fill the evidence gap by relying on household survey data from 2019–20, which includes a detailed consumption module and anthropometric measures for children under five. We use a repeated cross-sectional econometric analysis to look at the variation in household food consumption and child nutrition before and after the pandemic. The results show that there has been a significant reduction in household food consumption and per capita caloric intake and an increase in stunting, especially among newborn children.
Child well-being is particularly relevant to South African social workers given the country’s high rates of violence, poverty, inequality, unemployment, HIV/AIDS, and poor schooling outcomes. Guided by a social constructivist theoretical lens, and located within an interpretive qualitative research design, the aim of the study was to determine whether children’s drawings and teacher interviews can differentiate qualitatively between children with positive well-being and those with compromised well-being. Children aged 6–8 years whose parents/caregivers were recipients of Child Support Grants (CSGs) were asked to draw a picture of themselves and their families and teachers were asked about the children’s functioning. Findings from triangulation of drawings and interviews suggested that while a firm diagnosis of emotional, behavioral, or cognitive disorder could not be reached, it was possible to differentiate between children with positive well-being and those whose well-being appeared to be compromised by developmental delay, learning difficulties, emotional problems, behavioral problems, and/or social issues. It is therefore recommended that social workers make greater use of children’s drawings and educator interviews as assessment tools. However, one should not rely solely on children’s drawings, but should rather combine drawings with child and educator interviews. Findings also highlight the need for South African social workers to develop indicators that are culturally and ecologically applicable to African children.
International development agencies often support community-based organisations (CBOs) to improve the wellbeing of children and their families. The relevance, impact, and sustainability of these funding partnerships are neither widely nor consistently understood. This article discusses the CBO leader and practitioner perspective on social change and partnering. Surveys, interviews, and convenings involving CBOs from nine sub-Saharan African countries found that – distinct from international aid’s focus on program implementation and service delivery, many CBOs focus on mobilising, engaging, and empowering the community to take charge of their own development. Donor–CBO partnering arrangements should integrate this role and definition of effectiveness.
Susan Wilkinson-Maposa, Sadaf Shallwani, Mary Kabati et al.
This systematic review examines how professional parents manage parenting responsibilities amid demanding work schedules and increasing career pressures. In recent years, much of professional parents' time has been consumed by work-related obligations, often at the expense of parenting and family engagement. This imbalance is reflected in parents’ behaviors towards their children, as the pursuit of professional success frequently carries hidden costs that compromise children's emotional and developmental well-being. The study employed the PRISMA methodology to ensure a rigorous and transparent review process. Using three search strategies, relevant empirical and peer-reviewed research articles published up to 24 October 2024 were identified across multiple databases, including ResearchGate, Google Scholar, Taylor & Francis, and Scopus. The primary aim of the study is to raise awareness among professional parents, organizations, and policymakers regarding the importance of balancing work demands with parenting responsibilities. By recognizing how professional success may inadvertently undermine family relationships, parents and employers can adopt more supportive practices that allow for healthier work-family integration, ultimately benefiting both professional parents and their children.
South Africa is a diverse country characterised by stark inequalities that undermine early childhood development (ECD). Caregivers of young children play a critical role in providing nurturing care to mitigate against risks to ECD. The aim of this qualitative study was to explore caregivers’ perceptions of factors influencing ECD in a low-income, urban South African setting, from a social ecological perspective. Individual interviews were conducted with 15 caregivers of 3-5-year-old children from three low-income communities in Cape Town, and a reflexive thematic analysis approach was adopted. In the family and home context, caregivers spoke about their role in developing, nurturing, providing, protecting, and disciplining their children. Risks in this context included low socioeconomic status, dysfunctional relationships, and caregiver mental health; resources related to early learning and social support. In the preschool / school context, caregivers discussed the value of early learning, and priorities for selecting early childhood care and education settings. In the community context, risks included violence and crime, whereas resources mentioned were social support, community programmes, and infrastructure. Caregivers also shared perceptions of the community’s role in their child’s development. These findings should be considered in light of the structural violence experienced in low-income settings in South Africa in order to holistically address risks and amplify protective factors for promoting ECD and the provision of nurturing care in these settings.
Catherine Elizabeth Draper, Caylee J. Cook, Steven James Howard et al.
BACKGROUND: Providing nurturing care for young children is essential for promoting early child development (ECD). However, there is limited knowledge about how mothers and fathers across diverse contexts in sub-Saharan Africa care for their children and from whom they receive guidance and support in their caregiving roles. We aimed to examine caregivers' nurturing care practices and sources of parenting knowledge in rural Mozambique. METHODS: This is a secondary analysis using data from a qualitative evaluation of a pilot intervention to improve nurturing care for early child health and development within existing health systems. The evaluation was conducted across three primary care health facilities and their catchment areas in Nampula province, Mozambique. For this study, we analyzed data from in-depth interviews conducted with 36 caregivers (32 mothers and 4 fathers) to investigate mothers' and fathers' daily caregiving experiences. Data were analyzed using thematic content analysis. RESULTS: Caregivers described various caregiving roles relating to general caregiving of young children (e.g., feeding, bathing, caring for child's health) and stimulation (e.g., play and communication) activities. Mothers more commonly engaged in general caregiving activities than fathers, whereas both mothers and fathers engaged in stimulation activities. Other family members, including siblings, grandparents, and aunts/uncles, were also actively engaged in general caregiving activities. With respect to sources of parenting knowledge, caregivers received parenting guidance and support primarily from their own mothers/parents and facility-based health providers. CONCLUSIONS: These findings highlight the importance of adopting a holistic approach involving caregivers and their context and reveal potential strategies to promote caregiving and ECD in rural Mozambique and similar contexts.
Marilyn N. Ahun, Lilia Bliznashka, Svetlana Karuskina‐Drivdale et al.
