OBJECTIVE: To explore the readiness of health managers to integrate effective coverage into routine monitoring of maternal and child health (MCH) services in two rural districts of Ghana. METHODS: An exploratory qualitative study was conducted among purposively selected district and subdistrict health managers in Kintampo North and Kintampo South, Ghana. Two rounds of in-depth interviews explored participants' perceptions and implementation considerations regarding the use of effective coverage. Between the two rounds, participants took part in a 3-month pilot implementation phase. This phase included workshops, hands-on training and planning sessions. During this period, participants were trained to compute and interpret effective coverage using routine data and to explore its application to MCH monitoring and evaluation. Data were analysed thematically in NVivo V.17 using Braun and Clarke's six-phase approach. RESULTS: Following the learning sessions, participants reported an understanding of the components of effective coverage and how to compute and apply the indicator using routine district data. They also reported confidence in computing and interpreting the indicator. In the follow-up interviews, participants expressed willingness to integrate the indicator into routine monitoring processes. However, they identified technical and logistical challenges and inadequate data in the current national health information management system. CONCLUSION: Health managers in rural Ghana expressed willingness to integrate effective coverage into the routine monitoring and evaluation of MCH programmes. However, limited availability of routine data within the national health information management system remains a major barrier to implementation.
Ferguson Saapiire, Charlotte Tawiah, Francis Agbokey et al.
Sierra Leone's health system remains highly dependent on external aid, with donor funding accounting for approximately 47% of total health expenditure between 2020 and 2024, compared with a government contribution of around 25-26%. Recent reductions in development assistance for health, including a sharp in-year contraction of USAID-supported health programming during 2024-25 and an approximately 15% reduction in Global Fund allocations, have exposed major structural vulnerabilities in the health financing system. We conducted a rapid mixed-methods study to examine the effects of recent and anticipated aid reductions and the resilience responses emerging across Sierra Leone's health system. The study drew on a review of 19 documents and 11 key informant interviews with stakeholders from government, development partners, civil society, non-governmental organisations, and independent experts. Documentary and interview data were analysed descriptively and thematically, and findings were integrated during interpretation. Several service areas were identified as highly exposed to financing disruption, including reproductive, maternal, newborn and child health, HIV, tuberculosis, immunisation, and pharmaceutical supply chains. However, available evidence indicates that immediate service disruptions have so far been limited, and current data do not support firm conclusions about which services have been most affected. Maternal health and immunisation indicators remained comparatively stable in the short term. Documents and interviewees indicated that absorptive responses have prioritised core commodities and selected priority services, while reducing expenditure on outreach, supervision, training, logistics, and other enabling functions. Interviewees reported that households were absorbing much of the financial burden through increased out-of-pocket spending, forgone care, and informal coping mechanisms. Sierra Leone's response shows elements of absorptive and adaptive resilience, but several coping strategies show features consistent with maladaptive resilience and risk becoming maladaptive if prolonged, because they shift costs downward, threaten to deepen inequity, and erode the operational foundations of the health system.
Augustus Osborne, Maria Paola Bertone, Halimatu Kamara et al.
Protecting newborns and infants before birth: Accelerating equitable maternal vaccine introduction in low-and middle-income countriesEach year, neonatal infections-including pneumonia, sepsis, and meningitis-cause more than 550 000 newborn deaths globally, many occurring before newborns and infants can benefit from routine infant immunization.1 Maternal immunization offers a powerful and tested solution: protecting infants before birth.The success of the maternal tetanus toxoid (TT) vaccine program bears this out: when pregnant women received at least two doses of TT vaccine, global neonatal tetanus deaths fell by 94%. 2 New maternal vaccines for Respiratory Syncytial Virus (RSV)-and potentially soon for Group B Streptococcus (GBS)-could further improve newborn and infant survival.For women, families, and their obstetricians and midwives, this early window of vulnerability is a critical time.Prevention of infant death is a global priority but is most urgent in low-and middle-income countries (LMICs), where nearly 95% of the deaths occur and where access to alternative prevention strategies is most constrained.RSV is a major cause of viral pneumonia in young children and in LMICs, causing more than 100 00 child deaths every year and the hospitalization of 1.4 million infants aged under Annettee Nakimuli 1
Annettee Nakimuli, Kate Fay, Michelle J. Groome et al.
BACKGROUND: Evidence on paediatric mpox during contemporary African clade IIb outbreaks remains limited. We described paediatric cases in Sierra Leone's 2024-2025 clade IIb G.1 outbreak by person, time, and place and examined clinical care, outcomes, vaccination records, and documented exposures. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a retrospective descriptive study using the national District Health Information Software 2 (DHIS2) mpox database, supplemented by patient charts and outbreak-investigation forms. Among 5,466 cases with recorded age, 415 (7.6%) were children younger than 15 years; 188 (45.3%) were aged 0-4 years, 121 (29.2%) were aged 5-9 years, and 106 (25.5%) were aged 10-14 years. Of 415 paediatric cases, 411 were laboratory-confirmed. Outcome was recorded for 261 children; three died (1.1%, exact 95% CI 0.2 to 3.3). Care location was recorded for 285 children; 216 (75.8%) received hospital care for isolation, clinical management, or both. Three sporadic paediatric cases of mpox-like illness were reported from 2017 through 2024; notifications then rose rapidly from April 2025 and peaked in May. Western Area Urban accounted for 195/413 cases with known district; crude notified paediatric rates were highest in Western Area Urban, Koinadugu, and Falaba. Household or caregiving contact was the most common documented exposure among 246 classifiable investigation forms (141, 57.3%). Mpox vaccination status was recorded for 27/54 cases aged 12-14 years; six were vaccinated. CONCLUSIONS/SIGNIFICANCE: Children were not spared during Sierra Leone's clade IIb outbreak. Response plans should include children in case finding, contact follow-up, clinical care, and vaccination assessment. DHIS2 should capture epidemiologic links, clinical outcomes, vaccine eligibility and status, and potential exposure settings through standardised fields.
Eric Nzirakaindi Ikoona, Lucy Namulemo, Mary Magdalene Sinnah et al.
Malnutrition among children is a crucial public health issue. Children in critical care units may suffer from nutritional vulnerability due to their underlying disease or barriers to nutrient delivery. Early detection and management of malnutrition may improve clinical outcomes. To evaluate the nutritional status of critically ill children admitted to the pediatric intensive care unit (PICU) and its prognostic outcome. This observational prospective cohort research entailed 250 children admitted to the PICU. All participants were assessed at admission and weekly thereafter for 28 days. Nutritional status was evaluated using anthropometric measurements and the PYMS and STRONGkids scores. The PRISM score was used to assess illness severity on the day of admission. 59.2% of patients were underweight and/or stunted at admission and 59% at day 28 of follow-up. PYMS, and STRONGkids scores were significantly higher among underweight and/or stunted on day 1 and during follow-up (p < 0.05). Multivariable regression analysis demonstrated that admission PRISM score was an independent predictor of mortality (aOR 1.50, 95% CI 1.19-1.88, p = 0.001), mechanical ventilation requirement (aOR 1.18, 95% CI 1.07-1.31, p = 0.001), and feeding interruptions (aOR 1.29, 95% CI 1.16-1.45, p < 0.001). Socioeconomic status was independently associated with feeding interruptions and length of stay. CONCLUSION: Underweight and/or stunting was common among PICU patients. PYMS and STRONGkids were effective in identifying nutritional risk. After adjustment for confounding variables, clinical severity rather than baseline malnutrition independently predicted adverse clinical outcomes. WHAT IS KNOWN: • Underweight and/or stunting were prevalent among children admitted to the PICU and this represent a crucial public health problem. • Both PYMS and STRONGkids were useful screening tools for identifying children at risk of malnutrition. WHAT IS NEW: • This study demonstrated that clinical severity and the need for inotropic support were the primary independent predictors of adverse outcomes. • The baseline malnutrition was not independently associated with mortality, mechanical ventilation, feeding interruptions, or length of PICU stay.
Aya Osama Mohamed, Asmaa El Sayed, Dina Mohamed Hassan et al.
Background Child stunting remains a major public health challenge in the Democratic Republic of the Congo (DRC), reflecting persistent inequalities in child nutrition and health outcomes. This study examines the distribution and spatial variation of height-for-age z-scores (HAZ) among children under five, while also assessing the influence of selected demographic and socioeconomic factors. Methods Data were obtained from the 2023–2024 Demographic and Health Survey (DHS-8). A structured additive regression model was then applied to assess the effects of child age and maternal education, allowing for nonlinear relationships through smooth functions. To capture geographic heterogeneity, spatial effects were decomposed into structured (spatially correlated) and unstructured (area-specific random) components, enabling the identification of regional clustering and residual province-level variation in stunting. Results Geographic analysis reveals substantial regional disparities in stunting prevalence across the 26 provinces of the DRC. The province of Kwilu emerges as a major hotspot with very high levels of stunting, while several provinces fall within medium to high prevalence categories, indicating that stunting is a widespread issue across the country. Model results highlight important nonlinear relationships for certain predictors. Child’s age shows a strong negative trend with stunting risk: younger children have higher log-odds of stunting, and the risk decreases sharply with age. Maternal education displays a weaker and nonlinear association, with generally small effects across most education levels and greater uncertainty at higher levels of schooling. Spatial modeling further demonstrates that geographic factors significantly contribute to variation in stunting outcomes. Both structured spatial effects, indicating regional clustering, and unstructured spatial effects, reflecting province-specific deviations, contribute to the observed patterns. The combined spatial effect suggests persistent geographic disparities even after adjusting for covariates, although uncertainty varies across regions. Conclusions The findings underscore the importance of geographic context and early childhood factors in shaping stunting outcomes in the DRC, highlighting the need for targeted, context-specific interventions to address persistent nutritional inequalities.
Stunting merupakan permasalahan yang berkaitan dengan pemenuhan kesehatan, gizi, pengasuhan, dan lingkungan yang mendukung tumbuh kembang anak sehingga pencegahannya memerlukan keterlibatan keluarga dan masyarakat. Kegiatan pengabdian kepada masyarakat ini bertujuan memberdayakan kader PKK melalui GERDARA (Gerakan Ramah Anak dan Perempuan) serta membentuk Pos Sahabat Aman sebagai wadah edukasi, komunikasi, pemberdayaan, dan pendampingan masyarakat dalam mendukung pencegahan stunting di Desa Sukamantri. Kegiatan menggunakan pendekatan pemberdayaan partisipatif yang meliputi identifikasi masalah dan potensi, sosialisasi dan edukasi, penguatan partisipasi kader, pembentukan Pos Sahabat Aman, pendampingan, serta evaluasi dan penyusunan rencana keberlanjutan. Peserta kegiatan terdiri atas 28 kader PKK dari tujuh dusun di Desa Sukamantri, sedangkan evaluasi dilakukan menggunakan lembar observasi keterlaksanaan GERDARA dan checklist capaian pembentukan Pos Sahabat Aman. Berdasarkan simulasi pengisian yang perlu diverifikasi dengan data lapangan, keterlaksanaan GERDARA mencapai 92,50% dengan kategori sangat baik dan capaian pembentukan Pos Sahabat Aman mencapai 90% dengan kategori sangat baik. Stunting is a problem related to the fulfilment of children’s health, nutritional, caregiving, and supportive environmental needs; therefore, its prevention requires the involvement of families and communities. This community service activity aimed to empower Family Welfare Empowerment (PKK) cadres through GERDARA (Child- and Women-Friendly Movement) and to establish the Pos Sahabat Aman (Safe Friends Post) as a platform for community education, communication, empowerment, and assistance in supporting stunting prevention in Sukamantri Village. The activity employed a participatory empowerment approach comprising problem and potential identification, socialisation and education, strengthening cadre participation, establishment of the Pos Sahabat Aman, mentoring, as well as evaluation and the development of a sustainability plan. The participants consisted of 28 PKK cadres from seven hamlets in Sukamantri Village, while the evaluation was conducted using a GERDARA implementation observation sheet and a checklist of achievements in establishing the Pos Sahabat Aman. Based on a simulated completion that requires verification against field data, GERDARA implementation reached 92.50%, categorised as very good, while the achievement of establishing the Pos Sahabat Aman reached 90%, also categorised as very good.
Devi Rahmiati, Salma Rahma Kusnita, Maya Sri Rahayu et al.
Abstract Managing pain, anxiety, and agitation in the pediatric intensive care unit (PICU) is often challenging. Pharmacological sedation and analgesia with opioids and benzodiazepines are essential components of PICU management. Although these are effective, they carry risks of adverse outcomes, including delirium, prolonged mechanical ventilation (MV), opioid tolerance, withdrawal syndrome, and poor neurodevelopmental outcomes. Recently, non-pharmacological interventions (NPIs) have shown promise to be used as an adjunct to multimodal sedation and analgesia strategies. In this narrative review, we synthesize available evidence regarding NPIs in reducing pain, agitation, and sedation requirements in critically ill children. NPIs, including environmental modifications, cognitive strategies, family-centered care, and sensory-based therapies, demonstrated a beneficial role in reducing procedural pain and anxiety, improving sedation levels, and decreasing sedative exposure. Distraction techniques (virtual reality, video) showed the most consistent evidence for reducing procedural pain, while delirium prevention bundles, including environmental interventions, improve sleep and reduce the incidence of delirium. However, heterogeneity in study design and outcome measures limits comparability. Non-pharmacological strategies can be used as adjuncts to pharmacologic sedation and analgesia in the PICU in integration with a multimodal “comfort bundle” approach. High-quality multicenter trials are required to standardize implementation and evaluate long-term outcomes.
Abstract Background Working with goals is a critical yet often overlooked aspect of youth mental health and addictions care, with the potential to strengthen therapeutic relationships, support shared decision‐making, and improve outcomes. Despite its importance, there is no cohesive, equity‐centered guidance for working with youth on their goals. This review critically examines existing practice principles for working with youth aged 10–25 on goals within mental health and addictions services, with a particular focus on how equity, diversity, and inclusion are, or are not, embedded in these recommended approaches. Methods A narrative review methodology was employed to synthesize insights from both academic literature and clinical guidebooks published between 2003 and 2023. Searches were conducted across PubMed, EMBASE, Cochrane Library, Web of Science, and supplemented with general web searches to capture diverse perspectives from research and practice. Fifty‐three publications were selected and analyzed using thematic and content analysis via MAXQDA software. Results Four key themes were identified: (1) semi‐structured and strategic approaches to goal‐setting, including the use of routine outcome measures and progress monitoring; (2) youth‐ and family‐centered engagement strategies; (3) conceptual framing of goals within therapeutic processes; and (4) a nascent but growing emphasis on embedding EDI and cultural safety into goal‐oriented practices. Conclusion Findings underscore the importance of moving beyond standardized, clinician‐driven approaches to more inclusive, collaborative, and youth‐informed goal practices.
Madison Nugent, Drew Burchell, Jill Chorney et al.
Basic sanitation is a structural determinant of public health, and its inadequacy is directly associated with the occurrence of waterborne diseases and the exacerbation of socio-environmental inequalities.This study analyzes and compares the relationship between basic sanitation conditions and public health indicators in the Capim Dourado Territory (TO), Brazil, and in Singapore, investigating how public policy instruments and urban governance models influence these outcomes.A mixed-methods approach was adopted, consisting of an integrative review of the scientific literature and a documentary analysis of secondary data from institutional sources-SNIS, ANA, SES-TO, IBGE, WHO, and PUB.The results indicate that Tocantins has high water supply coverage (90.1%), especially in the Capim Dourado Territory (97.62%), but significant deficits in sanitary sewage systems persist in smaller municipalities.An association was identified between limitations in sanitation infrastructure and greater vulnerability to acute diarrheal diseases and hepatitis A. The literature confirms that planning instruments-such as the Municipal Basic Sanitation Plans (PMSBs) and intermunicipal consortia-contribute to the reduction of infant and fetal mortality, with a more pronounced effect in economically more developed municipalities.A comparison with Singapore demonstrates that integrated governance, long-term planning, the use of urban monitoring technologies, and sustained financing are key conditions for achieving universal access to services.It is concluded that advancing sanitation in Tocantins requires integrated strategies, prioritizing sanitary sewage systems, strengthening the PMSBs, consolidating regionalization, and ensuring ongoing coordination between sanitation, health surveillance, and smart city governance.
Kamila Chaves Moura Sá Sá, César Martins Barbosa, Laura Picoreli Nicodemo et al.
