ABSTRACTIntroduction. Malaria vaccination is an important additional strategy for preventing childhood malaria, but successful implementation depends on caregiver confidence and reliable service delivery. Evidence from conflict-affected settings in Cameroon remains limited. This study explored perspectives on malaria vaccine acceptance, hesitancy and implementation challenges in the North-West Region of Cameroon. Materials and Methods. A qualitative component was nested concurrently within a mixed-methods study in selected communities and health facilities in Bamenda and Bamenda III Health Districts. In-depth interviews were conducted with 18 mothers of children under five years, and key-informant interviews involved 26 healthcare workers and malaria vaccine programme implementers. Data were analysed thematically through familiarisation, coding, development and review of themes, and interpretation in relation to the study objectives. Results. Mothers described concerns about vaccine safety and effectiveness, fear of future vaccine resistance, limited vaccine availability, inadequate knowledge, and negative reports from early recipients. Implementers described caregiver hesitancy, poor community awareness, insecurity and difficult access to communities, vaccine shortages and supply delays, inadequate training and staffing, and cultural and religious beliefs. The findings showed a persistent gap between willingness to vaccinate and the practical availability and accessibility of vaccination services. Conclusion. Malaria vaccine acceptance may be undermined by both demand-side concerns and supply-side constraints. RÉSUMÉIntroduction. La vaccination contre le paludisme constitue une stratégie complémentaire importante pour prévenir le paludisme chez l’enfant, mais le succès de sa mise en œuvre dépend de la confiance des personnes qui s’occupent des enfants et de la fiabilité des services fournis. Les données issues de zones touchées par des conflits au Cameroun restent limitées. Cette étude a exploré les points de vue sur l’acceptation du vaccin contre le paludisme, les réticences à l’égard de celui-ci et les défis liés à sa mise en œuvre dans la région du Nord-Ouest du Cameroun. Matériel et méthodes. Un volet qualitatif a été intégré simultanément à une étude utilisant des méthodes mixtes, menée dans des communautés et des établissements de santé sélectionnés des districts sanitaires de Bamenda et de Bamenda III. Des entretiens approfondis ont été menés auprès de 18 mères d’enfants de moins de cinq ans, et des entretiens avec des informateurs clés ont été réalisés auprès de 26 professionnels de santé et responsables de la mise en œuvre du programme de vaccination contre le paludisme. Les données ont été analysées de manière thématique à travers les étapes suivantes : familiarisation, codage, élaboration et révision des thèmes, puis interprétation au regard des objectifs de l’étude. Résultats. Les mères ont fait part de leurs inquiétudes concernant la sécurité et l’efficacité du vaccin, de leur crainte d’une future résistance au vaccin, de la disponibilité limitée du vaccin, d’un manque de connaissances et de témoignages négatifs émanant des premiers bénéficiaires. Les responsables de la mise en œuvre ont évoqué les hésitations des aidants, la faible sensibilisation de la communauté, l’insécurité et la difficulté d’accès aux communautés, les pénuries de vaccins et les retards d’approvisionnement, l’insuffisance de la formation et des effectifs, ainsi que les croyances culturelles et religieuses. Les résultats ont mis en évidence un écart persistant entre la volonté de vacciner et la disponibilité et l’accessibilité concrètes des services de vaccination. Conclusion. L’acceptation du vaccin contre le paludisme peut être compromise tant par des préoccupations du côté de la demande que par des contraintes du côté de l’offre.
Basic immunization coverage in the working area of Grogol Primary Health Center has not yet reached the national target, highlighting the need for effective strategies to improve maternal compliance with childhood immunization schedules. This study aimed to analyze the effect of a Google Calendar–based immunization reminder on maternal compliance with the basic immunization schedule for infants. A quasi-experimental study with a pretest–posttest control group design was conducted among 60 mothers of infants aged 0–9 months, selected using purposive sampling. Participants were assigned to an intervention group (n=30), which received Google Calendar–based immunization reminders, or a control group (n=30), which received routine immunization services. Compliance was assessed using the Maternal and Child Health (MCH) Handbook observation sheet and a Guttman-scale questionnaire. Data were analyzed using the McNemar and Chi-square tests, with a significance level of p<0.05. Compliance in the intervention group increased from 46.7% at baseline to 83.3% after the intervention (p=0.013), whereas the control group showed a non-significant increase from 36.7% to 46.7% (p=0.250). Post-test comparison demonstrated significantly higher compliance in the intervention group than in the control group (p=0.003). Google Calendar–based reminders effectively improved maternal compliance with the infant basic immunization schedule by providing timely automated notifications. This simple digital intervention has the potential to support immunization services and enhance immunization coverage in primary healthcare settings.
Laksmita Galuh Adityarie, Dwi Estuning Rahayu, Finta Isti Kundarti et al.
The study examines the role of institutional engagement in shaping child immunisation outcomes in the Barak Valley region of Assam, India, focusing on frontline health workers. Using primary survey data collected from 400 households across selected rural and urban communities, the analysis finds that more-frequent interactions with accredited social health activists are strongly associated with higher odds of full immunisation. Households that report limited or no contact with frontline health workers are significantly less likely to have fully immunised children. These findings indicate an association between institutional engagement and immunisation coverage. Beyond confirming the importance of frontline health workers, the study suggests that the intensity of institutional engagement is a stronger predictor of complete child immunisation than rural–urban location. The findings suggest that strengthening the quality and continuity of household-level outreach may yield greater public health gains than interventions based solely on geographic targeting, particularly in underserved and resource-constrained regions.
This study explored the efficacy of using university-initiated students as communicators in health promotion interventions. Also, the study examined how such a project can assist in meeting some Sustainable Development Goals (SDGs) in Osun and Oyo States. The study adopted a qualitative narrative and documentary research design and reviewed relevant literature from academic journals and UN-WHO policy documents on Osun and Oyo States in Nigeria. The study revealed that university-initiated volunteer students serve as intermediaries who communicate the complex nature of health issues to members of various communities and debunk myths. Also, they mobilize communities to participate in disease prevention and promotion of mother and child-care health services. The findings further revealed students’ contributions directly towards the realization of Sustainable Development Goals (SDGs 3, 4, 5, 10, and17). Following the revelations, it was recommended that there should be establishment of a more institutionalised protocol/policy frame, adequate training/capacity enhancement for the student volunteers. Also, there is a need for more funding and better co-operation with other external partners to surmount the obvious constraints encountered during the volunteer operation.
J. O. Olorede, Mutiu Adeniyi Afolabi, M. A. Azeeez
Maternal mortality remains a significant public health challenge in low- and middle-income countries. Maternal sepsis, severe anaemia, delayed referral, and inadequate access to emergency obstetric care continue to contribute to maternal and neonatal morbidity, particularly in rural India. Strengthening Comprehensive Emergency Obstetric and Newborn Care (CEmONC) services at Community Health Centres (CHCs) is essential for improving pregnancy outcomes and reducing preventable maternal deaths. This case series describes five representative maternal health interventions undertaken at Community Health Centre (CHC) Faridpur, Bareilly, Uttar Pradesh. The series includes emergency management of maternal sepsis with severe anaemia, life-saving emergency caesarean section in a critically ill pregnant woman following unsuccessful referral, implementation of a telephonic follow-up system for high-risk pregnancies, promotion of respectful maternity care through innovative discharge practices, and strengthening of institutional delivery services. Timely clinical assessment, multidisciplinary teamwork, adherence to evidence-based obstetric protocols, and patient-centred care resulted in favourable maternal and neonatal outcomes while improving continuity of antenatal care and community confidence in public health services. This case series demonstrates that strengthened emergency obstetric services, early recognition of high-risk conditions, coordinated multidisciplinary management, and innovative maternal health interventions can substantially improve maternal and neonatal outcomes in rural secondary healthcare settings. The experiences from CHC Faridpur provide a practical model for enhancing quality maternity care in resource-constrained environments.
Objectives. To compare childhood vaccination coverage in Albania, Montenegro, North Macedonia, and Serbia and assess divergence between DTP3 and later measles-containing vaccine coverage during 2019-2023. Material and methods. A retrospective comparative ecological time-trend study used WHO/UNICEF Estimates of National Immunization Coverage (WUENIC) for DTP3, MCV1, and MCV2. Annual trends, change from the 2019 baseline to the lowest value in 2020-2021, subsequent change to 2023, and the DTP3-MCV1 difference were described. The DTP3-MCV1 difference was defined as an ecological indicator of divergence between early infant-series vaccination and later measles-vaccination contact, not as an individual dropout measure. No inferential modeling was performed because only five annual observations per indicator were available. Results. Albania maintained DTP3 coverage at 97% in 2023, while its DTP3-MCV1 difference widened from 4 to 14 percentage points. Montenegro had persistently low coverage across the selected indicators and a 57-point DTP3-MCV1 difference in 2023. North Macedonia narrowed this difference from 17 to 13 points, while Serbia narrowed it from 10 to 9 points and returned MCV2 to its 2019 value. No country reached at least 95% for both measles doses in 2023. Conclusions. DTP3 and MCV1 followed different country-level patterns during 2019-2023. Albania maintained high DTP3 coverage but showed widening DTP3-MCV1 divergence, whereas North Macedonia and Serbia showed partial narrowing, and Montenegro retained a very wide difference. These findings are descriptive and hypothesis-generating; the DTP3-MCV1 comparison is ecological and should not be interpreted as individual dropout, continuity, or causality.
ABSTRACT Importance Nirsevimab, a monoclonal antibody against RSV, was implemented in France in September 2023. Recently, rare resistance-associated substitutions were described in RSV but the effectiveness according to lineages remains unclear. Objective We aimed to estimate the effectiveness of nirsevimab against hospitalization for RSV bronchiolitis according to RSV lineages. Design We conducted a multicenter test-negative case-control study from October 15, 2023 to March 15, 2025. Setting This study was based on data from three national multicentric prospective studies. The 12 participating centers were secondary or tertiary hospital with a pediatric department located in France. Participants We included all children younger than 12 months who were hospitalized for RSV bronchiolitis in one of the participating centers in France during the two first RSV epidemic seasons following the implementation of nirsevimab (from October 15, 2023 to February 29, 2024, and from October 10, 2024 to March 15, 2025). Main outcomes and measures The main outcome of the study was the RSV test result of bronchiolitis cases. RSV whole-genome sequencing was performed using a tiled amplicon approach covering the complete viral genome, as previously described in the POLYRES studies. We estimated the effectiveness of nirsevimab by a multivariable logistic regression model adjusted for potential confounders. We estimated the adjusted risk of immunization failure for each lineage by calculating relative odds ratio to a reference lineage. A range of sensitivity analyses were conducted. Results We included 3019 infants with bronchiolitis among which 2273 had a positive RSV test (case patients) and 746 had a negative RSV test (control patients). Overall, 373/2273 (16.4%) case patients were immunized by nirsevimab versus 423/746 (56.7%) control patients. The adjusted effectiveness of nirsevimab against hospitalization for bronchiolitis was 88.4% (95% CI, 84.5–91.4) with RSV-B and 79.4% (95% CI, 73.7–83.8) with RSV-A. The risk of immunization failure was 3.2-fold (95% CI 1.8–5.7) higher for lineages derived from A.D.3 than for lineages derived from B.D.4.1. Conclusion and relevance In this multicentric case-control study, we observed that nirsevimab effectiveness was variable across RSV lineages, with a lower effectiveness against A.D.3 lineages compare to others. Further surveillance is needed to confirm these findings and assess their implication on RSV lineages epidemiology as nirsevimab use expands. KEYPOINT Question Does the effectiveness of nirsevimab against hospitalization for RSV-bronchiolitis change based on the RSV lineages? Findings In this case-control test negative design study that include 3019 infants, the effectiveness of nirsevimab against hospitalization for bronchiolitis was significantly higher with RSV-B than with RSV-A. Specifically, we found a 3.2-fold risk of immunization failure with lineages derived from A.D.3 than with lineages with highest effectiveness. Meaning This study suggest that nirsevimab effectiveness varies substantially across RSV lineages, with lineages derived from A.D.3 less susceptible to nirsevimab. This highlight the importance of molecular and clinical surveillance over the coming years of wide nirsevimab use.
Mathieu Barbier, Corinne Lévy, Robert Cohen et al.
Abstract Respiratory syncytial virus (RSV) is a leading cause of infant morbidity and hospitalisation in the UK. Postnatal monoclonal antibody (mAb) immunisation can protect infants, but implementation depends on parental acceptance. We surveyed 12,326 UK parents of children under 18 years in August–September 2024, measuring intent to accept a hypothetical RSV mAb injection for an infant if free through the National Health Service. We estimated national and sub-national intent using multilevel regression and poststratification aligned to UK census data, assessed socio-demographic and behavioural determinants, and embedded an online randomised controlled trial in which a control arm received no additional timing or disease-burden information and six intervention arms varied this information. Estimated national RSV mAb intent was high, with 88.8% leaning towards or definitively intending to immunise, although only 54.0% expressed firm intent. Intent was slightly lower in urban areas, especially London, and among older parents, those born outside the UK, and some ethnic minority groups. Belief in vaccine safety, importance, and trust in health workers were strong positive predictors of intent. Information that the mAb would be administered shortly after birth reduced post-exposure intent relative to control, highlighting the importance of timing, framing, and communication for equitable uptake across groups.
J. Happenhofer, M. Carreno, Alexandre de Figueiredo
BACKGROUND: Malaria is a major health issue in sub-Saharan Africa, including Guinea, affecting children under five and rural populations, with a prevalence of up to 30% in some areas. Although long-lasting insecticidal nets (LLINs) are effective, inequalities in access and use persist across wealth, geography, and age groups; however, detailed data are limited. This study assessed socioeconomic inequalities in LLIN access and use among children and adolescents. METHODS: We analysed data from a cohort study conducted between March 2022 and February 2023 in Maferinyah, rural Guinea, with monthly visits to households of children and adolescents aged 1-19. Socioeconomic position (SEP) was derived using an asset index and categorised into terciles. LLIN access and use-given-access were analysed using mixed logistic regression models adjusted for sociodemographic and seasonal factors. Socioeconomic inequalities were quantified using concentration and Erreygers indices with cluster bootstrap confidence intervals. Pathway and decomposition analyses assessed the contribution of access to LLIN to inequalities in effective LLIN use (defined as use regardless of access). RESULTS: The odds of LLIN access were higher among middle-SEP (aOR = 3.84; 95% CI 1.31-11.96) and high-SEP households (aOR = 3.76; 95% CI 1.18-12.71) than among low-SEP households. Inequalities in effective LLIN use were driven by disparities in access rather than by use behaviour. Although LLIN use among those with access exceeded 80% across all socioeconomic groups, effective use in the overall study population was lower among low-SEP households (29.6%). Significant pro-rich socioeconomic inequalities were observed for both LLIN use (Erreygers index (EI) = 0.386; 95% CI 0.151-0.594) and access (EI = 0.412; 95% CI 0.168-0.636). Decomposition analysis suggested that socioeconomic inequality in effective LLIN use was almost entirely explained by differences in access (98.8% of the total variance). CONCLUSIONS: Malaria prevention in rural Guinea is unequal, leaving poorer children and adolescents less protected than wealthier ones. This gap stems from unequal access to LLINs rather than differences in net use among households with nets. The study showed that the poorest families did not have access to nets in the first place. Addressing this inequity requires improved distribution strategies targeting the poorest and most vulnerable households, rather than behavioural interventions for net use only.
Almamy Amara Touré, Sidikiba Sidibé, Soledad Colombe et al.
Respiratory syncytial virus (RSV) is one of the leading causes of acute lower respiratory tract infection, bronchiolitis, pneumonia, and hospitalization among infants and young children, with the highest risk of severe disease observed in infants younger than six months, preterm infants, and children with bronchopulmonary dysplasia, congenital heart disease, immunocompromising conditions, and other underlying comorbidities.In Mexico, available evidence demonstrates a substantial clinical burden and a predominant seasonal circulation from September to March.In recent years, the development of novel preventive strategies has transformed the approach to RSV prevention, particularly through maternal immunization with a bivalent prefusion F protein vaccine and passive immunoprophylaxis with long-acting monoclonal antibodies.This position statement from the Mexican Academy of Pediatrics reviews the epidemiological, clinical, and real-world effectiveness evidence regarding currently available strategies for the prevention of RSV infection in the pediatric population.Maternal vaccination between 32 and 36 weeks of gestation promotes transplacental antibody transfer and provides protection to infants during the first months of life.Monoclonal antibodies, particularly nirsevimab, have demonstrated significant reductions in lower respiratory tract infection, hospitalization, intensive care unit admission, and severe RSV-associated disease, with a favorable safety profile.Based on disease burden, national seasonality, availability of preventive products, and the characteristics of the Mexican health care system, the Mexican Academy of Pediatrics proposes a complementary and progressive strategy
Rosa María Wong‐Chew, María del C. Espinosa-Sotero, Ana Elena Limón-Rojas et al.
