BackgroundDespite progress, sub-Saharan African countries (SSA) face immunisation disparities. Rwanda has high rates, but the drivers of success are unclear. There's a gap in understanding inequalities and a lack of comparative equity analyses with other SSA countries.MethodsThis study analysed population-based survey data from 17 SSA countries, including Rwanda, among two-year-old children. Full immunisation included all recommended vaccines, according to age and the national immunisation schedule. For Rwanda, the coverage was assessed across six inequality dimensions using frequencies, percentages, and 95% CIs. Absolute (Difference, SII) and relative (Ratio, RCI) measures of inequalities were plotted over time. Population Attributable Risk (PAR) and Fraction (PAF) were estimated for public health impact. Equiplots visualised inequalities across countries.ResultsBetween 2000 and 2019, Rwanda’s full immunisation coverage rose from 76% to 96%. Despite substantial reductions in inequalities in full immunisation coverage in Rwanda between 2000 and 2019, subnational disparities remained the most pronounced, with PAR decreasing from 15.40% to 3.10%, while wealth and place of residence inequalities persisted at low levels (wealth PAR 1.53%; residence PAR 1.43% in 2019). Equiplots highlight that, while Rwanda made significant progress in narrowing gaps across all the equity dimensions, other SSA countries showed wide socioeconomic, educational, and geographic gaps.ConclusionRwanda’s experience with full child immunisation highlights the importance of strong primary healthcare systems and equity-focused delivery strategies, offering transferable lessons for reducing immunisation inequalities across sub-Saharan Africa.
Albert NDAGIJIMANA, Michael Habtu, Theoneste Mutsindashyaka et al.
Effective complementary feeding is essential for infant growth, development, and prevention of malnutrition. This study assessed the attitude and practice of effective weaning techniques and identified factors influencing these practices among breastfeeding mothers attending the antenatal clinic at General Hospital Koko, Koko/Besse Local Government Area, Kebbi State, Nigeria. A descriptive cross-sectional design was adopted. The target population comprised 90 eligible breastfeeding mothers with children aged 6–24 months, from which a sample of 73 respondents was obtained using Taro Yamane’s formula. A self-structured 25-item questionnaire covering demographic characteristics, attitude, practice, and influencing factors was used for data collection. The instrument was subjected to face and content validity and test-retest reliability, yielding a reliability coefficient of 0.81. Data were analyzed using descriptive statistics with SPSS version 25. All 73 questionnaires were retrieved. Respondents demonstrated a generally positive attitude toward effective weaning techniques, with a grand mean of 3.0. They also reported positive weaning practices, with a grand mean of 3.0, particularly in hygienic preparation of foods, hand hygiene, introduction of complementary foods at six months, and avoidance of harmful foods. Financial status was the most strongly identified influencing factor (mean = 3.3), followed by lack of knowledge and health workers’ advice (mean = 3.0 each). The study concludes that although mothers demonstrated favourable attitudes and reported appropriate practices, economic constraints, knowledge gaps, family influence, and other contextual factors may affect effective weaning. Strengthening nutrition education and counselling through antenatal and community-based services is recommended.
Almustapha Lawal Ahmad, Danjuma Aishatu, Sani Gaddafi Wasagu et al.
Child mortality and morbidity remain significant public health concerns in sub-Saharan Africa, with universal health coverage (UHC) for children under five identified as a critical strategy for addressing these issues. This study explored professional nurses’ perspectives on the engagement of caregivers in community- and home-based care practices as a pathway to advancing UHC in Vhembe District, South Africa. A qualitative descriptive explorative design was employed. It involved 15 purposefully selected professional nurses from two primary healthcare centres. Data were collected through semi-structured individual interviews conducted between March and June 2022 and analysed using Braun and Clarke’s thematic analysis framework. Three overarching themes and seven sub-themes emerged. The first theme highlighted the empowerment of caregivers through knowledge dissemination and enhanced decision-making capacity. The second theme emphasised active parental participation in child health, including involvement in assessments, recognition of danger signs, and utilisation of the Road to Health booklet (RtHB). The third theme addressed barriers to effective caregiver engagement, notably the influence of traditional health beliefs and literacy challenges among grandmothers. Findings revealed the pivotal role of nurses in facilitating caregiver involvement and suggest that strengthening community-based strategies may contribute significantly to achieving UHC for children under five, particularly in low- resource settings. Tailored interventions addressing cultural and educational barriers are essential to optimise caregiver participation and improvement of child health outcomes.
Abstract Background There are two distinct failure points in childhood immunization: children who receive no immunization (“zero-dose”); and children who start but do not complete the immunization series (“dropout”). Two failure points to address are possible: ‘zero-dose’, where children receive no first doses; and ‘dropout’, where children begin but do not complete the immunization series. These are plausibly different failure points that require different interventions. Nigeria has the largest number of children with zero doses in absolute numbers in the world. The newly released Nigeria Demographic and Health Survey (NDHS) 2023–24 is used to describe failure cases and to compare the performance of machine learning techniques with standard regression in predicting them. Methods We analyzed 4,937 children aged 12-23 months (the age range covered by the WHO/UNICEF children’s recode) in the NDHS. Survey-weighted logistic regression was used to model ZDS and dropout (Penta1 received vs. Penta3 not received) and to compare them with the WHO/UNICEF national coverage estimates (WUENIC). With the same held-out test data, each of three additional algorithms - elastic net, random forest, and XGBoost - was compared to logistic regression, and sampling weights were added to each. Geographic clustering, after adjusting for individual-level effects, was quantified using a mixed-effects model with a state-level random intercept. Results Zero-dose prevalence was 37.3% (implied Penta1 coverage 62.7%), compared with the WUENIC national estimate of 71% Penta1 coverage; incomplete series coverage was at 9.1% (14.5% of Penta1 recipients), and full vaccination coverage was at 53.6%, which is lower than the administratively weighted global coverage estimates (67% Penta3). The associations of zero-dose status were strong and independent for maternal education, facility delivery, attending ANC, and household wealth, whereas these factors were surprisingly weak, albeit statistically significant for Maternal education and Facility delivery, and not significant for the other factors in the dropout group. After full adjustment, religious affiliation (among Muslims) remained an independent predictor of zero dose, even though clustering by state was adjusted for. Survey-weighted logistic regression performed best for both outcomes (zero-dose AUC=0.825; dropout AUC=0.613), whereas XGBoost performed worst for both. Only 4.7% of the residual variation in dropout could be accounted for by state of residence, but 11.2% could be accounted for by zero-dose status. Conclusions Zero-dose status as well as dropout are characterized by very different predictor profiles and are, therefore, separate policy problems and should not be treated as a single “coverage gap”. There was no improvement in prediction performance in terms of algorithmic complexity compared to a correctly specified logistic regression for either outcome.
Eloghosa Aisosa Nosa-Ihaza, Michael Chiebuka Ogidi, Stephen Okello Odeke et al.
Problem/Condition: Sub-Saharan Africa and South Asia have the highest rates of stillbirths and rates of death among children aged <5 years, with many countries in those regions unlikely to meet the 2030 goal of ending preventable deaths among newborns and children aged <5 years. Conventional mortality surveillance (determining cause of death through interviews with family members or caregivers [i.e., verbal autopsy] and vital registration) in areas with high mortality often lacks laboratory confirmation of causes and incompletely identifies maternal contributors and comorbid conditions, providing information that is insufficiently specific to guide prevention efforts. Period Covered: December 2016-December 2024. Description of System: The Child Health and Mortality Prevention Surveillance (CHAMPS) network generates standardized, laboratory-confirmed data on causes and preventability of deaths among neonates, infants, and children aged <5 years and stillbirths in areas with high mortality. During 2016-2024, CHAMPS operated in seven countries (Bangladesh, Ethiopia, Kenya, Mali, Mozambique, Sierra Leone, and South Africa) through population-defined catchment areas. Eligibility required residence in a CHAMPS catchment area for ≥4 months before death or, for children aged <4 months, since birth. Deaths were investigated using a standardized postmortem approach that included minimally invasive tissue sampling (MITS), laboratory investigations (conventional and molecular microbiology and histopathology), interviews with family members or caregivers (i.e., verbal autopsy), and pediatric and maternal clinical record abstraction. Multidisciplinary determination of cause-of-death (DeCoDe) panels integrated evidence to assign causes (including multiple causes per death) and assess preventability. Results: During 2016-2024, a total of 18,784 eligible deaths were identified; families consented to CHAMPS enrollment for 15,612 (83.1%) of these deaths. MITS was completed for 9,415 deaths and DeCoDe was completed for 8,500 (90.3% of MITS-investigated deaths); a total of 3,199 (37.6%) were stillbirths; 3,230 (38.0%) were neonatal deaths; and 2,071 (24.4%) were deaths of infants (aged 28 days to <12 months) and children (aged ≥12 to <60 months). Stillbirths were predominantly attributed to perinatal asphyxia or hypoxia (79.1%), often with maternal hypertensive disorders, placental abnormalities, chorioamnionitis, and other medical conditions (e.g., diabetes). Neonatal deaths involved preterm complications (39.7%); asphyxia or hypoxia (37.7%), which often is linked to maternal and intrapartum care; and sepsis (36.5%), commonly resulting from infection with Klebsiella pneumoniae and Acinetobacter baumannii. Among infants and children, leading causes of death included lower respiratory infections (37.4%), sepsis (36.9%), malnutrition (27.3%), malaria (22.1%), and diarrheal disease (17.3%). Multiple conditions in the causal chain were common among neonates (44.3% with two or more conditions) and infants and children (67.9% with two or more conditions). Postmortem anthropometry indicated high levels of moderate or severe undernutrition among infants and children; among those with available measurements, nonmutually exclusive anthropometric indicators included underweight (61.3%), wasting (61.3%), and stunting (43.0%), according to the World Health Organization's Child Growth Standards. Among neonatal, infant, and child deaths (excluding stillbirths), infection contributed to 3,146 (59.3%) deaths. Among neonatal, infant, and child deaths with one or more pathogens identified in the causal chain (n = 2,749), 44.5% were polymicrobial, with gram-negative bacteria predominating. Main maternal conditions, most commonly placental complications and hypertensive disorders of pregnancy, were assigned for 71.1% of stillbirths and 58.2% of neonatal deaths. Of 7,558 deaths with a preventability assessment, 6,103 (80.7%) were considered preventable or possibly preventable through improvements in already available maternal, newborn, and child health interventions; primary opportunities included strengthened antenatal care, obstetric management, and infection control. Interpretation: CHAMPS complements conventional mortality surveillance by providing standardized, laboratory-confirmed, postmortem evidence on causes and preventability of stillbirths and of deaths among neonates, infants, and children aged <5 years across areas with high mortality. Findings demonstrate that preventable infections, suboptimal antenatal care, intrapartum complications, preterm birth, and malnutrition account for most deaths and also involve maternal and health care system factors. The predominance of infections caused by gram-negative bacteria highlights the need to strengthen infection prevention and control and to develop preventive tools, including vaccines. Public Health Action: Four of every five deaths were potentially preventable with timely implementation of established maternal, newborn, and child health interventions. CHAMPS demonstrates that high-precision postmortem MITS is feasible in resource-constrained settings and provides data critical to improve maternal and child health planning, practice, and policy. Certain components of CHAMPS (e.g., standardized MITS training, targeted diagnostics, and multidisciplinary review) could be adapted to strengthen routine surveillance and mortality review systems where feasible.
Zachary J. Madewell, Ziyaad Dangor, Portia C. Mutevedzi et al.
Childhood malnutrition remains a major public health challenge in low- and middle-income countries, contributing substantially to morbidity and mortality among children under five. Although nutrition education is widely promoted to improve infant and young child feeding practices, evidence on its effects when delivered through routine health services in Kenya over a nine-month period remains limited. This study evaluated the effect of a structured facility-based nutrition education intervention comprising interactive group sessions with practical food demonstrations on the nutritional status of children aged 6-23 months in Nyeri County, Kenya. A longitudinal quasi-experimental study was conducted between May 2021 and March 2022 in two purposively selected Level IV hospitals (Karatina, intervention; Othaya, control). A total of 451 mothers, each paired with one child (220 intervention, 231 control), were enrolled and followed for nine months (360 retained). Mothers in the intervention arm attended three quarterly sessions of about 60-75 minutes, each pairing interactive learning with hands-on food demonstrations using locally available ingredients and content drawn from the Kenya Ministry of Health Infant and Young Child Nutrition counselling cards. Mothers in the control arm received the facility's routine maternal and child health education. Children's anthropometry was measured at baseline and at 3, 6, and 9 months, and weight-for-length, weight-for-age, and length-for-age Z-scores were derived against the WHO Child Growth Standards to classify wasting, underweight, and stunting. Because each child was measured repeatedly, intervention effects were assessed primarily using generalized estimating equations (GEE) modelling the arm × time interaction, supported by prevalence changes, net intervention effects, and chi-square or Fisher's exact tests, with significance set at 5%. The two arms were comparable in nutritional status at baseline. By nine months, the prevalence of wasting declined from 7.3% to 4.1% in the intervention arm compared with 8.5% to 8.3% in the control arm (net intervention effect − 3.0 percentage points). Generalized estimating equations that accounted for repeated measures within children showed no statistically significant arm × time interactions for wasting (OR 1.01, 95% CI 0.94–1.09, p = 0.73), underweight or stunting. A structured facility-based nutrition education programme integrating food demonstrations was associated with a favourable but non-significant reduction in wasting over the nine-month period. Nutrition education should be strengthened alongside nutrition-sensitive interventions, including improved household food security, water, sanitation and hygiene, and social protection programmes, to achieve sustained improvements in child nutritional status. Key words:nutrition education; facility-based; child nutritional status; quasi-experimental study; net-effect intervention; generalized estimating equations; Nyeri; Kenya
Anthropometric indices have become practical tools for evaluating the nutritional status of populations. Understanding the nutritional status of children has far-reaching implications for promoting the health of future generations. The necessity for routine blood pressure screening in children was debated in the past, the main argument against it being that essential hypertension is an adult disease and there was no evidence that screening apparently healthy children for hypertension is rewarding. Its value as a screening tool for hypertension in adults has long been documented. This study has been designed to assess the relationship between nutritional status and blood pressure among apparently healthy primary school pupils aged 6–12 years in Zaria Local Government Area, Kaduna State. The study was conducted on 219 pupils randomly selected from public and private schools using a table of random numbers. Blood pressure was measured after 5 minutes of rest in the sitting position with an aneroid sphygmomanometer and a cuff suitable to the pupil’s arm circumference according to WHO standard procedures. Nutritional and growth status were determined using z-score for BMI-for-age and height-for-age (HA). Pearson correlation was used to determine the correlation coefficients between anthropometric indices and blood pressure parameters. Study findings revealed a z-score of < -3 in 4.34% (n=5) of boys and 1.92% (n=2) of girls as severe wasting while severe stunting was recorded to be 2.61% (n=3) in boys and 1.92% (n=2) in girls. Significant differences (P ≤ 0.05) were not observed between severe thinness or stunting between boys and girls P ≤ 0.05 level of significant. Pearson correlation revealed a positive correlation between weight and Systolic BPs, Diastolic BPs and mean arterial pressures of the subjects ( r =0.77, 0.61, and 0.74 respectively). The study found out that severe malnutrition exists among the pupils, as significant percentages of the school children were thin and stunted. Blood pressure increased with age and was higher among pupils from private schools than among those from public schools.
Ubangida Suleiman, Olumuyiwa Adeyemi Owolabi, Abbas Olagunju et al.
Inroduction Maternal perceptions of indigenous foods and dietary diversity are crucial in shaping infant nutrition and preserving cultural food practices. Addressing these perspectives is vital to overcoming local nutritional challenges. This study investigated mothers’ perception on indigenous foods and their inclusion in the diets of infants aged 6 to 23 months in Kitui County, Kenya. Study also, examined the association between infants’ dietary diversity and maternal perceptions on indigenous foods. Methods In this cross-sectional study, 402 infant-mother pairs were enrolled. Dietary diversity was assessed using a dietary diversity questionnaire. Mothers provided insights into their perceptions regarding indigenous foods. Results and discussion The average dietary diversity score for the infants was low at 2.47 ± 0.02, with only 30.3% consuming more than four food groups in the past 24 h. About 36.6% of mothers reported that their infants accepted/liked indigenous foods whereas 94.5% considered them expensive, 59.2% perceived them as nutritious/health. Additionally, only 4.7 and 17.4% of mothers indicated that indigenous foods were readily available and easy to prepare, respectively. Dietary diversity was significantly associated with infant acceptance of indigenous food ( p = 0.021), perceived nutrition/health benefit ( p < 0.001), availability ( p = 0.016) and ease of preparation ( p < 0.001). Key predictors of indigenous food consumption included infants’ acceptance of the foods, affordability, perceived nutritional benefits, availability, and ease of preparation. Multi-level interventions targeting food production, intrahousehold food security, and maternal nutrition behaviors, such as providing appropriate recipes, cooking training, and demonstrations, could promote the consumption of nutrient-rich indigenous foods. Enhancing the accessibility and availability of these foods is crucial. This can be achieved by supplying quality seeds, climate-resilient livestock breeds, essential farm inputs, water harvesting technologies, and providing extension support services. These measures could bolster indigenous food production and intake, thereby improving infant nutrition.
Adolescent mental health is an urgent global priority, yet services remain severely inaccessible throughout Southern Africa. Zimbabwean youth are particularly vulnerable to mental health challenges from adverse childhood experiences including food insecurity, sexual and emotional violence, climate change-induced disasters, and national economic difficulties but research is extremely limited. To address this gap, this study examined trauma symptoms and resilience among a large school-based sample of urban and rural Zimbabwean adolescents. A cluster randomized controlled trial was conducted to evaluate the impact of Singing to the Lions, a biopsychosocial workshop for trauma-affected youth in Zimbabwe. Adolescents were randomized by school (n = 13) to an immediate intervention arm or waitlist control arm. Baseline data, including adolescents' demographics, trauma symptoms, and resilience characteristics were analyzed to investigate the prevalence of trauma symptoms and that association with resilience characteristics. The baseline sample (n = 1,342) ranged in age from 12-18 years (x-=14.8); the majority of children were girls (54.6%) and rural (52.4%). Of 18 possible trauma symptoms, youth endorsed an average of 7.6 trauma symptoms (SD = 4.5) with significantly higher rates among girls (t[1325]=3.39, p = .0007). Trauma symptoms were significantly inversely correlated with resilience characteristics including self-esteem (r = -.36, p < .001), hope (r = -.07, p = .01), self-calming (r = -.30, p < .001), and social support (r = -.23, p < .001); however, there was no association between symptoms and self-efficacy. No statistically significant differences in trauma symptom prevalence were found based on children's age, grade, or community (rural versus urban). The high prevalence of trauma symptoms and expressions of trauma found in this study are consistent with the limited previous adolescent mental health research from Sub-Saharan Africa. Results contribute to the sparse knowledge base on trauma-affected youth and adolescent mental health in Zimbabwe more broadly and highlight the need for evidence-based practices that are culturally grounded and contextually specific for the region.
Colleen M. Fisher, Roswitta Gatsi, Natasha Venables et al.
Climate-related disasters are becoming increasingly frequent and severe, posing major threats to child health and nutrition, particularly in low- and middle-income countries (LMICs). These events disrupt food systems, health services, water and sanitation infrastructure, and caregiving practices, increasing the risk of undernutrition among children under five years of age. This narrative review synthesised current evidence on the effects of climate-related disasters on child nutrition and infant and young child feeding (IYCF) practices in LMICs. A narrative review of peer-reviewed literature published up to June 2025 was conducted using PubMed, ScienceDirect, Web of Science, and Google Scholar. Studies were eligible if they examined the association between climate-related disasters including droughts, floods, cyclones, and climate variability and nutritional outcomes or feeding practices among children under five years in LMICs. Findings were synthesised narratively because of substantial heterogeneity in study designs, exposures, and outcome measures. Eleven studies met the inclusion criteria. Most were conducted in Sub-Saharan Africa and South Asia. Droughts and floods were the most frequently investigated climate-related disasters and were consistently associated with increased risks of stunting, wasting, and underweight. Several studies also reported disruptions to breastfeeding and complementary feeding practices, worsening household food insecurity, increased maternal psychological distress, and reduced access to essential health and nutrition services following disasters. Children living in rural and resource-constrained settings were consistently identified as the most vulnerable. Climate-related disasters adversely affect child nutrition through multiple interconnected pathways, including reduced food availability, increased infectious diseases, disruption of feeding practices, and weakened health systems. Strengthening climate-resilient nutrition programmes, protecting infant and young child feeding during emergencies, and integrating nutrition into disaster preparedness and climate adaptation policies are essential to improve child health outcomes in LMICs.
Nomagugu Ndlovu, Makhosi Mahlangu, Nomagugu Minenhle Sibanda et al.
