Child Marriage (before the age of 18) affects over 12 million young women globally, annually. Despite acknowledgement of the negative impacts of the practice on reproductive health, mental health consequences are largely overlooked. Given the ability for poor mental health to intensify other health and social challenges, understanding the mental health consequences linked to child marriage is vital. Our study is the first to examine how mental health is approached in current literature on child marriage. Our conceptual framework was informed by a rapid assessment of key issues in the field. Systematic searches of papers published between 2000-2020 were completed on four electronic databases with no language restrictions. Our protocol was registered on Prospero (CRD42019139685). Articles were assessed using PRISMA guidelines, and their quality assessed using the Joanna Briggs Institute Critical Appraisal Tools. Of the 4,457 records identified, 21 papers meeting inclusion criteria were analysed using narrative synthesis. The final sample included 5 qualitative, 1 mixed-methods and 15 quantitative studies (14 cross-sectional and 1 longitudinal study) reporting on data from 12 countries, largely in the global south. Intimate partner violence, poverty, challenges in childbirth and isolation were identified as social factors linked to emotional distress by those married as children. Depression was the most reported mental disorder. Anxiety, phobias, psychological distress, substance misuse, negative well-being and anti-social personality disorder were reported less frequently. Findings highlight that while significant emotional distress and specific mental health conditions are linked to child marriage, gaps in our understanding remain. Future studies are needed to; clarify directionality in these relationships; understand the mental health needs of young men, LGBTQI communities and those in humanitarian settings. Given the well documented cyclical relationship between social determinants and mental health conditions, we outline a series of community-oriented interventions which blend psychological, social and structural support to promote mental health and wellbeing in the contexts of child marriage.
Rochelle A. Burgess, Mairi Jeffery, Sabina Adhiambo Odero et al.
International legal standards for children’s rights and Girl Child Rights, strengthened by the global commitment of Agenda 2030 for Sustainable Development and its SDG5 on gender equality set, as a priority, the elimination of all forms of violence against girl children and girl adolescents. Among them, harmful traditional practices, including child, forced and early marriage and female genital mutilations (FGMs), tend to re-produce, increasingly, in European countries, in connection to migration processes and the extensión of habitats of meaning, therefore, representing a new challenge for States, receiving significant migration flows. In this framework, our anthropology of implementation work, by a gendered qualitative approach, aims at shedding light on this topic, proposing the case of France, in comparison to the on-going debate in other European countries and reflecting on the role of institutions and the close relationship between culture and legislation for implementation.
Abstract Early marriage persists in many countries in spite of legal prohibition. The role of income shocks and bride price norms is investigated in the context of Turkey. Using data from the Turkey Demographic and Health Surveys 1998 to 2018, rainfall shocks are exploited as an exogenous source of variation of household income. To study the role of marital payments, measures of shocks are interacted with a province-level indicator based on past prevalence of bride price. Estimation results show that girls exposed to a large negative shock during adolescence have a higher probability of being married before 15, if living in provinces with a high prevalence of bride price. More arranged and forced marriages are found after severe shocks in those provinces. Results suggest that daughter marriage, as a response to mitigate negative income shocks, is not limited to the poorest countries, and still contributes to household strategies in Turkey.
INTRODUCTION: Respiratory syncytial virus (RSV) poses a significant health burden on infants, particularly during their first RSV season. Immunoprophylactic strategies, such as the administration of nirsevimab, a long-acting monoclonal antibody, have been developed to prevent RSV lower respiratory tract disease (LRTD). This study evaluated the public health and economic impact of nirsevimab or maternal immunisation (MI) compared with standard of practice (SoP) in the United Kingdom (UK). METHODS: A static decision-analytic model was employed to track the UK birth cohort during their first RSV season. The model incorporated UK-specific data on costs, epidemiology and healthcare resource utilisation. Three strategies were compared: historical SoP (pre-September 2024), universal immunisation with nirsevimab and MI. Outcomes measured included RSV-related primary care (PC) visits, accident and emergency (AE) visits, hospitalisations, intensive care unit (ICU) admissions and deaths. The model also considered the impact of recurrent wheezing episodes, all-cause LRTD hospitalisations and non-medically attended RSV-LRTDs. RESULTS: Under the current SoP, RSV was estimated to cause 375,154 total health events and 24,360 RSV-LRTD hospitalisations (including ICU admissions) annually, resulting in an economic burden of £252 million. Universal immunisation with nirsevimab could prevent 208,691 total health events and 16,664 hospitalisations (including ICU admissions) and reduce costs by £105.7 million. MI showed a reduction in RSV-related outcomes but was less effective than nirsevimab, especially in preventing hospitalisations and ICU admissions or protecting infants born outside the RSV season. CONCLUSIONS: Universal immunisation with nirsevimab for all infants during their first RSV season could significantly reduce both the health and economic burden of RSV in the UK. This strategy is more effective than MI, particularly in reducing severe RSV outcomes and protecting infants born outside the RSV season, thus offering substantial benefits across the infant population.
Mersha Chetty, Paul Costello, Benjamin Yarnoff et al.
OBJECTIVE: Countries routinely offering acellular pertussis vaccine, where long-term protection is not sustained, have the challenge of selecting an optimal schedule to minimise disease among young infants. We conducted a narrative systematic review and synthesis of information to evaluate different pertussis immunisation strategies at controlling pertussis disease, hospitalisation, deaths, and vaccine effectiveness among young infants. METHODS: We conducted a review of the literature on studies about the primary, booster, and/or maternal vaccination series and synthesised findings narratively. Countries offering the first three doses of vaccine within six-months of life and a booster on or before the second year or life were defined as accelerated primary and booster schedules, respectively. Countries offering primary and booster doses later were defined as extended primary and booster schedules. All search results were screened, and articles reviewed and reconciled, by two authors. The Risk of Bias in Non-randomised Studies of Intervention tool was used to evaluate the risk of bias. FINDINGS: A total of 98 studies were included in the analyses and the following recurring themes were described: timing of vaccination, vaccine coverage, waning immunity/vaccine effectiveness, direct and indirect effectiveness, switching from an accelerated to extended schedule, impact of changes in testing. The risk of bias was generally low to moderate for most studies. CONCLUSION: Comparing schedules is challenging and there was insufficient evidence to that one schedule was superior to another. Countries must select a schedule that maintains high vaccine coverage and reduced the risk of delaying the delivery vaccines to protect infants.
BACKGROUND: Pregnancy is a high-risk time for excessive weight gain. The rising prevalence of obesity in women, combined with excess weight gain during pregnancy, means that there are more women with obesity in the postnatal period. This can have adverse health consequences for women in later life and increases the health risks during subsequent pregnancies. OBJECTIVE: The primary aim was to produce evidence of whether or not a Phase III trial of a brief weight management intervention, in which postnatal women are encouraged by practice nurses as part of the national child immunisation programme to self-monitor their weight and use an online weight management programme, is feasible and acceptable. DESIGN: The research involved a cluster randomised controlled feasibility trial and two semistructured interview studies with intervention participants and practice nurses who delivered the intervention. Trial data were collected at baseline and 3 months later. The interview studies took place after trial follow-up. SETTING: The trial took place in Birmingham, UK. PARTICIPANTS: Twenty-eight postnatal women who were overweight/obese were recruited via Birmingham Women's Hospital or general practices. Nine intervention participants and seven nurses were interviewed. INTERVENTIONS: The intervention was delivered in the context of the national child immunisation programme. The intervention group were offered brief support that encouraged self-management of weight when they attended their practice to have their child immunised at 2, 3 and 4 months of age. The intervention involved the provision of motivation and support by nurses to encourage participants to make healthier lifestyle choices through self-monitoring of weight and signposting to an online weight management programme. The role of the nurse was to provide regular external accountability for weight loss. Women were asked to weigh themselves weekly and record this on a record card in their child's health record ('red book') or using the online programme. The behavioural goal was for women to lose 0.5-1 kg per week. The usual-care group received a healthy lifestyle leaflet. MAIN OUTCOME MEASURES: The primary outcome was the feasibility of a Phase III trial to test the effectiveness of the intervention, as assessed against three traffic-light stop-go criteria (recruitment, adherence to regular self-weighing and registration with an online weight management programme). RESULTS: The traffic-light criteria results were red for recruitment (28/80, 35% of target), amber for registration with the online weight loss programme (9/16, 56%) and green for adherence to weekly self-weighing (10/16, 63%). Nurses delivered the intervention with high fidelity. In the qualitative studies, participants indicated that the intervention was acceptable to them and they welcomed receiving support to lose weight at their child immunisation appointments. Although nurses raised some caveats to implementation, they felt that the intervention was easy to deliver and that it would motivate postnatal women to lose weight. LIMITATIONS: Fewer participants were recruited than planned. CONCLUSIONS: Although women and practice nurses responded well to the intervention and adherence to self-weighing was high, recruitment was challenging and there is scope to improve engagement with the intervention. FUTURE WORK: Future research should focus on investigating other methods of recruitment and, thereafter, testing the effectiveness of the intervention. TRIAL REGISTRATION: Current Controlled Trials ISRCTN12209332. FUNDING: ; Vol. 25, No. 49. See the NIHR Journals Library website for further project information.
Amanda Daley, Kate B Jolly, Natalie J. Ives et al.
Maintaining high vaccine coverage (VC) for pediatric vaccinations is crucial to ensure herd immunity, reducing the risk of vaccine-preventable diseases (VPD). The Italian vaccination Law (n. 119/2017) reinforced mandates for polio, diphtheria, tetanus, and hepatitis B, extending the mandate to pertussis, Haemophilus influenzae type b, chickenpox, measles, mumps, and rubella, for children up to 16 years of age. We analyzed the national temporal trends of childhood immunization rates from 2014 to 2019 to evaluate the impact of the mandatory reinforcement law set in 2017 as a sustainable public health strategy in Italy. In a 3-year period, 9 of the 10 compulsory vaccinations reached the threshold of 95% and VC for chicken pox increased up to 90.5%, significantly. During the same period, the recommended vaccinations (against meningococcus B and C, pneumococcus, and rotavirus) also recorded a significant increase in VC trends. In conclusion, although the reinforcement of compulsory vaccination generated a wide public debate that was amplified by traditional and social media, the 3-year evaluation highlights positive results.
Michela Sabbatucci, Anna Odone, Carlo Signorelli et al.
INTRODUCTION: School-based vaccine programme delivery offers convenience to parents, and reduces the burden on primary care capacity. Vaccine coverage among school-age children is lower in Hackney (northeast London), and post-pandemic coverage recovery has been limited in Hackney compared to London and England. Hackney is home to the largest Orthodox Jewish (OJ) population in Europe where most children attend independent faith schools. This study aimed to assess (i): vaccine programme delivery gaps via independent OJ schools in Hackney; and (ii) the primary care catch-up and commissioning strategies undertaken to help close gaps. METHODS: Qualitative evaluations of national incident responses for poliovirus and measles tailored to underserved communities in northeast London (2022-24). Data consisted of in-depth semi-structured interviews (n = 53) with public health professionals, healthcare practitioners, community partners, and OJ parents. Vaccine clinic visits (n = 11) were conducted in northeast London, affording additional (n = 43) focused and opportunistic interviews with OJ parents attending for catch-up. RESULTS: Evaluating the delivery of routine and outbreak vaccination campaigns to school-age children demonstrates that independent OJ schools in Hackney are a key programme delivery gap, directly impacting access to catch-up and routine adolescent programmes. OJ parents reported that they did not receive relevant vaccine programme information and invitations for school-age children via independent faith schools. Primary care-led outreach clinics were hosted to offer school-age immunisations to OJ adolescents, but did not offer HPV vaccines. Sub-commissioning community organisations to liaise with independent schools may be a strategy to help resolve this delivery gap, but would require responsibilities within school-age immunisation partnerships to be clearly assigned. CONCLUSION: Limitations in vaccine programme delivery via independent faith schools in northeast London may play a role in suboptimal vaccination coverage. Programme gaps must be addressed to help ensure that every eligible child is invited for, and can access, routine vaccination via accessible pathways.
BACKGROUND: Recently, the number of measles and pertussis cases increased worldwide, including in the Netherlands. As schools are important in transmission of several vaccine-preventable diseases, we systematically assessed childhood vaccination coverage in the Netherlands among primary school children by birth cohort for all school denominations. METHODS: We linked nationwide vaccination data with sociodemographic registries for children born 2013-2020 attending primary school on 01-10-2024. Vaccination status for MMR (at 14 months), DTaP-IPV (at (2)3-5-11 months), and DTaP-booster (at 4 years) was retrieved from the immunisation register. Vaccination coverage was stratified by school denomination, birth year and sociodemographic characteristics. Poisson regression assessed independent associations between denomination and vaccination uptake. RESULTS: MMR and DTaP-IPV coverage was high (>94 %) in general, Catholic, Protestant, collaborative, and other schools, but lower in Anthroposophical (78 % MMR, 77 % DTaP-IPV), Islamic (74 % MMR, 75 % DTaP-IPV), and Orthodox Protestant schools (57 % MMR, 58 % DTaP-IPV). DTaP-IPV booster coverage was lower than the primary series, ranging from 50 % (Orthodox Protestant) to 88 % (Catholic/Protestant). Primary coverage remained stable for most denominations (overall 95 %) but declined at Islamic schools (MMR: 87 % to 59 %, DTaP-IPV: 88 % to 60 %) and moderately at Orthodox Protestant schools (MMR: 60 % to 54 %, DTaP-IPV: 60 % to 55 %), while coverage at Anthroposophical schools fluctuated (MMR: range 76-81 %, DTaP-IPV: range 74-79 %). Adjusting for sociodemographic variables had little impact. CONCLUSIONS: Although most unvaccinated children attend schools with high coverage, clustering at Orthodox Protestant, Anthroposophical, and increasingly Islamic schools poses ongoing outbreak risks. Further research on vaccination barriers, drivers, and the role of social networks is needed to better understand vaccination decisions.
Joyce Pijpers, Annika M. van Roon, Susan van den Hof et al.
BACKGROUND: Respiratory syncytial virus (RSV) infection is a major cause of severe lower respiratory tract infections in newborns and young infants, especially during the winter season from October to March. In Switzerland, RSV infection represents a leading cause of hospital admissions among newborns. Since October 2024, a long-acting monoclonal antibody, nirsevimab (Beyfortus®), has been available in Switzerland for standard care in newborns. OBJECTIVES: This paper presents a multidisciplinary, standardised protocol for the administration of nirsevimab, as well as immunisation data from the first season of application in 2024/25 at a tertiary centre in Switzerland. METHODS: A protocol for implementing the RSV immunisation strategy was developed at University Hospital Zurich by a multidisciplinary team of obstetricians, neonatologists, nurses, from in- and outpatient services. The focus was on prenatal counselling during outpatient consultations as well as inpatient procedures on maternity and neonatology wards. The goal was to provide expectant parents with consistent information by different healthcare professionals. Neonatal immunisation data from the first season in 2024/25 (25 October to 31 March ) were retrieved from patient charts (Yes/No) in a retrospective, quality control, observational cohort study. All newborns discharged from the maternity ward or the neonatology unit of our centre were included in the analysis. RESULTS: The protocol included early and multidisciplinary parental education, offering consistent oral and written information, as well as opportunities to discuss their questions regarding the new immunisation, ensured informed consent and enabled timely administration of nirsevimab by healthcare professionals in the obstetrics and neonatology units. Over the 2024/25 season, 78% of the newborns were immunised before leaving hospital care: 78% (588/758) of newborns discharged home from the maternity ward were immunised and 82% (125/153) of those discharged home from the neonatology unit were immunised. CONCLUSION: The implementation of passive RSV immunisation was overall successful with an immunisation rate of around 80% for the first season in 2024/25.
