The rate of immunization in children remains very low in many countries in Africa. The reason for this is identified as poverty, lack of education among mothers, unavailability of healthcare, and lack of community education. However, until now, there does not exist any review in the literature that evaluates the combined effect of these four factors as determinants of childhood immunisation in Africa. Hence, the current systematic review undertaken herein aims to investigate the influence of the previously mentioned determinants of childhood immunisation. In order to accomplish this, a systematic search was carried out in the following databases: PubMed/MEDLINE, Scopus, Web of Science, Google Scholar, African Journals Online. The result of the search was the selection of articles mentioning any number of determinants presented and providing results on childhood immunization. Twenty-seven articles met the inclusion criteria. Poor children had 1.8-4.2 times lower immunization odds. Maternal education had the strongest effect (OR: 1.9-5.6). There were also other significant variables in terms of health care access (OR: 1.6-3.8) and community awareness (OR: 1.3-1.7). Interactions among determinants strengthened their impacts. Poverty, maternal education, healthcare access, and community awareness have an association between one another, whereby these factors act as determinants of immunization decisions in Africa. Hence, there is a need for different/intersectoral approaches based on various determinants to enhance immunization coverage.
Background: In South Africa, the Department of Basic Education removed the non-profit organisation (NPO) registration mandate for early childhood development (ECD) programmes. The aim was to alleviate administrative burdens. If the messaging is not received correctly, it could lead to the inaccurate belief that all programmes are subsidy-eligible without any formal registration, potentially risking the quality and sustainability of ECD services. Aim: This study investigated the determinants influencing the decision of ECD centres to register as NPOs prior to the NPO registration mandate. Setting: A nationwide ECD census was conducted in all nine South African provinces. Methods: Data from 39 176 centres were analysed quantitatively to investigate the association between ECD centre registration as an NPO and various independent variables. Results: The findings show that 68.34% of ECD centres were registered as NPOs. The odds ratio (OR) of receiving a subsidy (OR 10.17; 7.82–13.22), having a bank account (OR 4.20; CI 3.01–5.72) and the ECD programme being part of a wider network (OR 1.81; CI 1.46–2.26) were strong predictors of ECD NPO registration. Conclusion: Subsidies matter in encouraging ECD centres to formalise their operations. ECDs that are part of wider networks have an opportunity to access resources, information and support that can enhance operational effectiveness. Contribution: The study provides empirical evidence to guide policy decisions and resource allocation, which can potentially lead to improved service quality and access to resources for children and families to support the growth and sustainability of the ECD sector in South Africa.
The Malaria Vaccine Pilot Evaluation (MVPE) is a joint initiative of the World Health Organisation’s Department of Immunization, Vaccines and Biologicals, and the Global Malaria Programme, to evaluate the effectiveness of the RTS,S/AS01 malaria vaccine delivered through the routine immunisation services in Kenya, Malawi and Ghana, over 4 years. In the phase 3 trial of the vaccine conducted from 2009 to 2014, in children who received four vaccine doses (three primary doses and a fourth dose 18 months later), the incidence of uncomplicated malaria and of severe malaria were reduced by 39% and 32% respectively over 4 years of follow-up. For every 1000 children vaccinated with 4 doses, a total of 1774 cases of malaria and 40 hospital admissions due to malaria were averted over about 4 years1. A total of 19 cases of severe malaria were averted, cases which, without the enhanced access to care provided in the context of the trial, might have led to death. The vaccine therefore could have a substantial public health impact. The current vaccination schedules include three primary doses to be administered before 9 months of age and a fourth dose at about 2 years of age. This involves three to four additional vaccination visits than are currently recommended in this age range. The MVPE seeks to determine the impact realised in practice when the vaccine is introduced in areas of high to moderate malaria incidence in three countries with year-round malaria transmission. The programme will evaluate the safety of RTS,S/AS01 in routine use, the feasibility of administering four doses of the vaccine, and the impact of the vaccine at population level, using a cluster-randomized design. The vaccine is being introduced sub-nationally in pilot areas in each of the three countries, by the EPI programme. Within the pilot area in each country, districts (in Ghana), subcounties (in Kenya), and clusters of equivalent population (in Malawi), have been randomized to either introduce the vaccine in 2019 (implementation clusters), or to delay introduction until the initial introduction has been evaluated (comparison clusters). Thus, the evaluation will use a cluster-randomized design. Community reporters will document all deaths occurring in children under 5 years of age in the implementation and comparison clusters. Hospital surveillance is being established in sentinel hospitals in a subset of clusters to monitor the incidence of admission with malaria and other conditions. Vaccine administration will be delivered through, and monitored by, the Expanded Programme for Immunization (EPI) in each country and uptake of RTS,S/AS01RTS,S will also be measured independently through cluster-sample household surveys. The MVPE will determine whether the introduction of RTS,S/AS01RTS,S leads to a reduction in child deaths, and a reduction in the incidence of hospital admission with severe malaria, over the 4 years of the implementation programme (MVIP, Malaria Vaccine Implementation Programme). The MVPE also addresses three safety signals that were observed in the phase 3 trial but whose significance was unclear: an unexplained excess of meningitis cases in RTS,S/AS01 recipients, an excess in cerebral malaria cases among RTS,S/AS01 recipients who developed severe malaria and, among the relatively small number of deaths that occurred in the trial, an excess of deaths among girls who received RTS,S/AS01 compared to girls who did not receive RTS,S/AS01. The data to be collected over 4 years will inform a policy decision about wider use of RTS,S/AS01 as a means to reduce malaria morbidity and mortality, when provided in addition to existing malaria control measures. It is anticipated that sufficient data to assess the safety signals are likely to be available after the first 2 years of the evaluation. At that time, all available data would be reviewed, including outcomes related to safety of the vaccine in routine use (meningitis, cerebral malaria, mortality by gender, AEFI), the impact on severe malaria and all-cause mortality, coverage of the first 3 doses, preliminary data on administration of the 4th dose, and cost-effectiveness assessment. A recommendation about wider use of the vaccine might therefore be made before final impact data are available, recognizing that the impact in any setting will depend on coverage and timeliness of vaccination and the malaria burden, which may differ from those in the MVIP.
How to cite: Bondesio, N 2026, ‘The integration of indigenous knowledge systems into early childhood development curriculum frameworks’, in T Moodley, S Stofile & R Govender (eds.), Holistic and inclusive education practices for young learners in South Africa: From early childhood to Foundation Phase, The University of the Western Cape Faculty of Education Book Series, vol. 2, AOSIS Books, Cape Town, pp. 81–102. https://doi.org/10.4102/aosis.2026.BK568.05
Abscondment from hospital poses risks to patients. The epidemiology of abscondment from hospitals remains unclear in Malawi and other sub-Saharan African settings. This case-control study used data from a hospital surveillance of the Malaria Vaccine Implementation Program in four district hospitals in Malawi to describe factors associated with abscondment among paediatric inpatients. The cases and controls (1:1 match) were children aged 1–59 months hospitalised with an acute medical illness. The cases were children who absconded from the hospital. Controls were children admitted within ± 7 days of the admission date of the corresponding cases who did not abscond, residing in the same geographical cluster. Baseline characteristics between cases and controls were compared using the chi-squared test of independence or Fisher’s Exact test. Over the period of analysis, 2.17% (454/20925) of admitted patients absconded. Severe anaemia was more prevalent in cases than controls (17.54% (50/285) vs. 8.91% (27/303), p < 0.01). Hospital stay longer than three days was more prevalent in cases than controls (42.22% (141/334) vs. 25.40% (112/441), p < 0.01). In this analysis, hospital stay for > 3 days and severe anaemia showed possible trends towards increased odds of abscondment, hence may warrant further investigation as potential indicators for the prevention of abscondment.
Kelvin M. Maziya, Madalitso D. Zulu, Christopher C. Stanley et al.
How to cite: Moodley, T & Stofile, S 2026, ‘Holistic and inclusive education practice in early childhood development’, in T Moodley, S Stofile & R Govender (eds.), Holistic and inclusive education practices for young learners in South Africa: From early childhood to Foundation Phase, The University of the Western Cape Faculty of Education Book Series, vol. 2, AOSIS Books, Cape Town, pp. 3–22. https://doi.org/10.4102/aosis.2026.BK568.01
Background Surveillance of adverse events following immunization (AEFI) and appropriate reporting are essential ingredients of an effective immunization programme. Despite increasing recognition by caregivers, the response to it remains a major problem, with the majority being inappropriate. This study is therefore intended to determine the prevalence, pattern, and determinants of caregivers’ response regarding AEFI in Nigerian hospitals. Methodology A descriptive cross-sectional study was conducted among 368 caregiver-infant pairs across 3 Nigerian hospitals, using semi-structured questionnaires to document sociodemographic characteristics and the prevalence, pattern, and determinants of caregivers’ response. Statistical analyses were performed using SPSS version 27. Predictors of AEFI and determinants of caregivers’ response were assessed using Pearson’s chi-square and logistic regression. A p-value < 0.05 was considered statistically significant. Results The prevalence of AEFI was 71.7%, with inconsolable crying/irritability, fever, and swelling at the vaccination site as the leading cases. Infant age, weight, and gestational status at birth were predictors of AEFI occurrence. Only 8 (3.0%) caregivers presented at a healthcare facility when AEFI was noticed (appropriate response), while 360 (97.0%) did not (inappropriate). The relationship of the caregiver to the vaccinated infant (mother) was found to be a determinant of caregivers’ response to the occurrence of AEFI. Conclusion An increasing prevalence of AEFI that was not followed by an optimally appropriate response from caregivers has been demonstrated. This calls for more public enlightenment focusing on the need to report AEFI at healthcare facilities, as this will help in ensuring vaccine safety and improvement in the immunization programme.
Sunday Charles Adeyemo, Funso Abidemi Olagunju, Abimbola Ololade Odeyemi et al.
How to cite: Fagan, D 2026, ‘Integrating artificial intelligence into early childhood development: Afrocentric and inclusive approaches’, in T Moodley, S Stofile & R Govender (eds.), Holistic and inclusive education practices for young learners in South Africa: From early childhood to Foundation Phase, The University of the Western Cape Faculty of Education Book Series, vol. 2, AOSIS Books, Cape Town, pp. 63–78. https://doi.org/10.4102/aosis.2026.BK568.04
Hepatitis B is a leading preventable cause of liver cancer, and in high-burden settings most chronic infection is acquired around birth. Nigeria carries Africa’s largest hepatitis B burden. Preventing mother-to-child transmission requires a chain of antenatal steps: testing pregnant women, acting on the result, and vaccinating the newborn. No nationally representative study has assembled these into a single prevention cascade. We built the first national hepatitis B mother-to-child prevention cascade for Nigeria and measured how far it falls from the World Health Organization’s triple-elimination targets. We analysed the 2023-24 Nigeria Demographic and Health Survey, the first Nigerian survey to carry both a maternal hepatitis B module and infant birth-dose records. Among 13,341 women with a most recent live birth in the preceding three years, each linked to that child’s immunisation record, we estimated coverage at each cascade step (antenatal attendance, hepatitis B testing in antenatal care, result received, and the infant birth dose) using complex-survey methods, and examined patterning by wealth, education, residence, travel time, and region. Although 72% of mothers attended antenatal care, only 12.3% (95% CI 11.4-13.2) were tested for hepatitis B there, and among the few tested almost all received a result: the loss fell at testing, not at result-return. The infant birth dose reached 55.0% (53.1-56.9), 35 points below target, and ran at a level unrelated to maternal testing, consistent with universal, non-targeted delivery; place of delivery, not maternal testing, was the dominant correlate of an infant receiving it. Both steps were steeply patterned: antenatal testing ranged from 2.6% in the poorest wealth quintile to 32.4% in the richest, and was lowest in the North-West, the zone with Nigeria’s highest prevalence. Nigeria already reaches most mothers through antenatal care but rarely uses that contact to test for hepatitis B, and the universal birth dose is only half delivered. The country is far from elimination, and furthest where the virus is commonest. Integrating hepatitis B testing into antenatal care, made free and weighted toward the highest-burden north, would convert contact already achieved into protection.
Samson Ikenna Abanni, Bifom Melwin Ekure, Jean Omotosho
Malnutrition is a major cause of childhood morbidity and mortality, affecting children’s growth and development. This study aimed to identify the factors associated with malnutrition among children aged 0 to 59 months at Bonassama District Hospital in Douala. A descriptive and analytical cross-sectional study was conducted from July 2025 to April 2026 among children aged 0 to 59 months seen in the pediatrics and immunization units. Data were collected using a questionnaire administered to parents. Nutritional status was assessed according to WHO standards, and associated factors were identified through multivariate analysis. Among the children studied, 82.2% had normal nutritional status and 17.8% were malnourished. After adjustment, the factors significantly associated with malnutrition were type of housing (modern house: AOR = 2.10; 95% CI: 1.03–4.01; p = 0.044), tenant status (AOR = 3.01; 95% CI: 1.53–6.78; p < 0.001), history of respiratory infection (AOR = 2.12; 95% CI: 1.20–5.35; p = 0.019), and occasional use of health services (AOR = 2.23; 95% CI: 1.05–5.21; p = 0.030). Mothers’ knowledge of essential food groups was not significantly associated with malnutrition. Malnutrition remains a significant problem among children under five years of age in Bonassama. Prevention strategies should incorporate health, socioeconomic, and environmental factors to improve screening and management of at-risk children.
Godfroy Rostant Pokam Djoko, Murielle Tsobgny Nguefack, Devis Sobnang
