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Diphtheria in the Kazakh SSR in 1958–1961: Epidemiological Dynamics and Initial Results of Mass Immunisation

The article examinesthe change in the epidemiological situation in the Kazakh SSR at theturn of the 1950s and 1960s, considering the shift towards the mass immunisation of children. The objective of the study is to identify the rates, territorial characteristics and factors of the dynamics of incidence in 1958 –1961, as well as to evaluate the initial results of the vaccination program. The source base consisted of archival reports and statistical documents from health authorities and the sanitary-epidemiological service. These documents contained information on regions, urban and rural areas, age groups, vaccination status, disease focality, clinical forms, laboratory confirmation and disease outcomes. The comparative-historical, problemchronological and statistical methods were employed. The material was analysed using the endogenousprimary approach, which links epidemiological results with the internal capabilities of the republican healthcare system. The scientific novelty lies in the comprehensive introduction of little-studied statistical tables to research circulation, which made it possible to reconstruct regional processes that were not reflected in All-Union or average republic dynamics. A review of the evidence suggests that the situation remained tense at the end of the 1950s. Following a decline in the number of patients, 10,733 cases were registered in 1959. In 1960, their number decreased to 7,500, and in 1961 it was approximately half that of the previous period. However, it should be noted that the positive dynamics were not synchronous: in 1959–1960, growth continued in some areas, while the directions of change in cities and rural areas often differed. Despite the overall decline in 1961, cases in several territories continued to exceed the national average. A comparison of age and vaccination data confirmed the protective effect of vaccination but showed that nominal coverage alone was not sufficient for protection. The diseases observed in vaccinated and revaccinated children required consideration of the completeness of the vaccination course, the timing of the revaccination and the quality of the vaccines. Continued active transmission of the infection was indicated by cases in organised groups, multiple focal spots and registered outbreaks. It was concluded that mass immunisation was a decisive factor in the epidemiological shift. However, its impact was gradual and uneven across different territories. By 1961, the Republic had entered a period of steady decline in disease incidence, though it had not yet achieved full control of the infection. The effectiveness of the campaign was determined by a combination of factors, including vaccination coverage, organisational quality, laboratory surveillance, early diagnosis, hospitalisation and timely treatment.

Zhanna Mazhitova, Aigul Zhalmurzina, Zhangeldy Bimoldin et al.

Factors Associated with Incomplete Childhood Immunization among Children Aged 12–36 Months in Burkina Faso

Childhood immunization remains one of the most effective public health interventions to preventvaccine-preventable diseases.In Burkina Faso, incomplete immunization schedules remain a challenge amid insecurity, population displacement, and health system disruptions.This study aimed to identify factors associated with incomplete immunization and the vaccination dropout rate in children aged 12 to 36 months.A secondary analysis of the 2021 Burkina Faso Demographic and Health Survey (2021-DHS-BF) data was performed.Incomplete immunization was defined as a child not receiving all recommended routine vaccine doses by 15 months of age.Factors associated with incomplete immunization were identified using modified Poisson regression with generalized estimating equations; adjusted prevalence ratios (aPR) with 95% confidence intervals were reported at a 5% significance threshold.Among the 2,375 children who met the eligibility criteria in the 2021-DHS-BF dataset, 1,482 (66.0%) had not completed their immunization schedule.The dropout rate between the first and third doses of the pentavalent vaccine was 11.0%.Maternal occupation (Saler: aPR = 0.89, 95% CI: 0.80-0.98 and farmer/selfemployed: aPR = 0.93; 0.85, 95% CI: 0.78-0.94)and being treated with respect "sometimes" at health facilities (aPR = 1.14, 95% CI: 1.02-1.27)were associated with an incomplete immunization schedule.Strengthening person-centered care, improving post-first-dose follow-up, and expanding community-based outreach strategies could improve immunization schedule completion.

O PAPEL DA EDUCAÇÃO EM SAÚDE NO ENFRENTAMENTO DA HESITAÇÃO VACINAL NA INFÂNCIA E ADOLESCÊNCIA

This article aimed to discuss the role played by health education in tackling vaccine hesitancy, a complex and multifactorial phenomenon capable of compromising vaccination coverage rates and favoring the reappearance of vaccine-preventable diseases among children and adolescents. The work of PIBEX scholarship student, in the VacinAção Extension Project, sought to analyze the scientific evidence related to the role of health education in reducing vaccine hesitancy, identifying different forms of intervention, how they can be applied, and the effects they have generated. This is an integrative literature review carried out in the Virtual Health Library, Latin American and Caribbean Literature in Health Sciences, and Scientific Electronic Library Online databases, gathering articles published between 2016 and 2025, in Portuguese and English, related to health education, vaccine hesitancy, and educational interventions. The studies indicated that such strategies can expand knowledge by clarifying doubts and strengthening trust in vaccines, showing greater potential than standardized actions already implemented. It is concluded that health education can contribute to tackling vaccine hesitancy when developed on the basis of dialogue and personalization, being continuous and adapted according to the needs of each child, adolescent, and/or guardian.

Gabrielly Boiko Ribeiro, Beatriz de Toledo Nogueira, Luiza Tatiana Forte et al.

Implementing Somalia's National Transformation Plan 2025–2029 for health-system reform: a policy and practice review of governance, financing, and institutional readiness

Somalia's National Transformation Plan (NTP) 2025–2029 presents an ambitious health-reform agenda centred on maternal and child health, workforce development, health-system strengthening, regulation, financing, digitalisation, and emergency preparedness. The policy challenge is whether the institutional conditions required for implementation can be assembled in a fragile, federal, highly aid-dependent and predominantly mixed-provider health system. This Policy and Practice Review critically examines the implementation readiness of the NTP health chapter and proposes a sequenced framework for converting national commitments into measurable results. A structured narrative review was undertaken from June to July 2026 using peer-reviewed literature, national policy documents, and reports from governmental and international institutions. Evidence was interpreted through the health-policy triangle, the updated Consolidated Framework for Implementation Research (CFIR), applied prospectively to anticipated determinants, and a health-system resilience lens. The synthesis generated six interdependent proposed readiness foundations: a negotiated federal-state governance compact; a technically validated, costed and sequenced operational plan; sustainable financing and strategic purchasing; workforce and regulatory capacity; integrated information, monitoring and public accountability systems; and shock-responsive adaptive management. Important policy strengths include explicit targets for service coverage, workforce expansion, hospital rehabilitation, regulation and digital health. Key risks include inconsistent or under-specified targets and baselines, uncertain fiscal pathways, weak federal-state role specification, and dependence on external resources and non-state providers. Comparative evidence suggests that contracting and pooled financing can expand services when stewardship, fiduciary safeguards, workforce integration, community accountability and learning systems develop concurrently. We propose a phased 2026–2029 pathway prioritising technical validation, essential-service continuity, subnational compacts, workforce payroll transition, interoperable data systems and annual public performance reviews. The proposed framework is prospective and has not yet been empirically validated; consultation with federal and subnational authorities, providers, partners, civil society and communities is required before formal adoption.

Nor Haji Osman, Dahir Osman Mohamed, Hamdi Mohamud Osman et al.

Evaluating the Impact of the Oxford R21 Malaria Vaccine on Child Mortality in High-Burden Regions of Nigeria

Malaria remains one of the leading causes of child mortality in Nigeria, with the disease claiming the lives of hundreds of thousands of children under five each year. Despite significant advances in malaria prevention and treatment, the burden of the disease continues to be disproportionately high, particularly in high-burden regions. The Oxford R21 malaria vaccine, which has demonstrated unprecedented efficacy in clinical trials, offers a promising new tool in the fight against malaria in sub-Saharan Africa. This article explores the potential impact of the R21 vaccine on child mortality in Nigeria, highlighting its effectiveness, the challenges to its successful implementation, and the broader implications for the nation’s malaria control strategy. The article examines the efficacy of the R21 vaccine, which has shown 77% protection against malaria in young children, significantly outperforming previous malaria vaccine candidates. It also addresses the public health implications, projecting that widespread vaccine distribution could lead to a 30-40% reduction in malaria-related child deaths in Nigeria. Furthermore, the article discusses the need for a coordinated, multi-sectoral approach to vaccine rollout, which includes robust logistics, public awareness campaigns, and addressing vaccine hesitancy. The article concludes that the R21 vaccine has the potential to transform Nigeria’s malaria control efforts, contributing to the long-term goal of malaria elimination. However, achieving its full potential will require strong policy support, sustainable funding, and collaboration between international and local stakeholders. The successful deployment of the vaccine could mark a new era in malaria control, significantly reducing child mortality and improving overall child health in Nigeria.

Iyanuoluwapo O. Adeleye

From ashes to numbers: the Punjab partition of 1947 as a historical social determinant of health evidence from NFHS-4, NFHS-5 and NFHS-6 (2015–2024)

Punjab National Family Health Survey (NFHS) profile presents a paradox that contemporary health systems analysis cannot resolve. A state that leads north India in institutional delivery rates (94.3%, NFHS-5, highest in the region) and records one of its lowest infant mortality rates (approximately 14 per 1,000 live births, NFHS-5) simultaneously records child anemia at 71.1% (NFHS-5, exceeding the national figure of 67.1%), overweight or obesity in women aged 15 - 49 years at over 41% (among India five highest states), a caesarean section rate of 38.5% (far above WHO 10-15% optimal threshold), and a sex ratio at birth of only 904 girls per 1,000 boys. This review undertakes a descriptive secondary analysis of Punjab's health profile across NFHS-4 (2015 - 16), NFHS-5 (2019 - 21), and NFHS-6 (2023 - 24), integrating NFHS-6 national comparator data released in May 2026. It argues that this paradox cannot be explained by contemporary policy variables alone. The Green Revolution agricultural model itself, the product of refugee economic reconstruction after the Partition of 1947, created a dietary monoculture that underlies the present burden of anaemia. Partition-derived intergenerational trauma contributes to the chronic stress physiology measurable in community health indicators. The cultural devaluation of women entrenched during Partition's systematic gendered violence persists in a skewed sex ratio. The opioid epidemic is geographically concentrated in historically displaced border districts. Punjab NFHS data, read against its specific Partition history, establishes a case for recognizing the 1947 catastrophe as a historical social determinant of health with implications for community medicine practice and public health policy in Punjab and its diaspora.

Gurshan Singh Gill, Hemant Biwal

Health Insurance and Maternal Healthcare Utilisation in Nepal: Evidence from the Nepal Demographic and Health Survey 2022

Abstract Background Access to maternal healthcare services is essential for improving maternal and neonatal health outcomes. Health insurance can reduce financial barriers to healthcare access and may facilitate utilisation of maternal health services, and contextualized evidence can further support policy development and implementation. This study assessed the association between health insurance coverage and utilisation of antenatal care (ANC), institutional delivery, skilled birth attendance and postnatal care (PNC) services among women in Nepal. Methods This study used data from the 2022 Nepal Demographic and Health Survey (NDHS), a nationally representative cross-sectional survey. The analysis included women aged 15–49 years who had a live birth within the 24 months preceding the survey. Inverse probability of treatment weighting (IPTW) based on propensity scores was applied to balance measured socioeconomic and demographic characteristics between insured and uninsured women. Weighted marginal structural models were used to estimate the association between health insurance coverage and maternal health-care utilisation outcomes. Robustness was assessed using alternative propensity score specifications and E-values for unmeasured confounding. Results Among 14,845 women interviewed, 2,078 reported a recent live birth and were included in the analysis (unweighted; 1,998 when survey-weighted). Of these, 201 (9.7%) had health insurance coverage and 1,877 (90.3%) were uninsured. After adjustment using IPTW, health insurance coverage was associated with significantly higher utilisation of maternal healthcare services. Insured women had more than twice the odds of attending at least four ANC visits compared with uninsured women (AOR 2.14; 95% CI 1.15–3.98). Similarly, insured women had higher odds of receiving a PNC check-up within two days of delivery (AOR 2.05; 95% CI 1.28–3.27) and receiving PNC from a skilled provider (AOR 1.94; 95% CI 1.23–3.06). Although insurance coverage was positively associated with institutional delivery (AOR 1.55; 95% CI 0.91–2.62) and skilled birth attendance (AOR 1.57; 95% CI 0.90–2.72), these associations did not reach statistical significance. Conclusion Health insurance coverage was associated with greater utilisation of antenatal and postnatal healthcare services among women in Nepal. However, no significant association was observed for institutional delivery or skilled birth attendance. Expanding health insurance coverage, particularly among underserved populations, may help improve maternal healthcare utilisation and support progress towards universal health coverage and maternal health-related Sustainable Development Goals.

Yash Raj Lamsal, Abdulaziz Mohammed Hussen, Joyce Linda Browne et al.

National viral hepatitis control program in India: current status and SWOT analysis

Viral hepatitis is a public health problem in India. The National Viral Hepatitis Control Program (NVHCP) launched in 2018 paved a way in India’s journey towards universal health coverage but gaps remain in diagnostics, peripheral capacity, vaccine supply, and pediatric treatment access. This review maps the history of the program in India, its current status, gaps, and opportunities toward the 2030 elimination goals. For the purpose of this review, a comprehensive search of literature was conducted examining technical and operational guidelines, management protocols, policy documents, and review articles to understand India's journey towards viral hepatitis control. The program demonstrates multiple strengths including strong government commitment, comprehensive national guidelines, free diagnosis and treatment services, robust preventive strategies, and trained master trainers. However, several weaknesses exist as well like insufficient diagnostic infrastructure, limited molecular testing capacity, inadequate trained manpower at peripheral centers, erratic hepatitis B vaccine supply, vertical transmission prevention gaps, and no free treatment provision for children. The opportunities outlined include newer WHO guidelines extending treatment to children and adolescents, point-of-care diagnostic facilities, public-private partnerships, one-stop centers, dried blood spot testing, treat-all approaches, and establishing an adult immunization program. Major threats foreseen are competing national health programs diverting resources, dropout from diagnosis-treatment cascade, public and healthcare worker stigma, and limited private practitioner participation in the program. Although NVHCP has a robust framework aligned with global strategies, addressing gaps in awareness, logistics, and peripheral-level manpower through equity-focused innovation is essential to achieve 2030 elimination targets and advance universal health coverage.

Alanah Bethany Syiemlieh, Madhu Kumari Upadhyay

Outcome of Measles in Vaccinated versus Unvaccinated Children under 5 years of age

Objective: To determine the frequency of measles vaccination among children under 5 years of age presenting with measles and to compare the outcomes between vaccinated and unvaccinated children. Outcomes were defined as (i) prolonged hospital admission of two days or more (primary outcome, taken as the marker of severe disease) and (ii) measles-related complications (secondary outcome). Methods: This descriptive cross-sectional study was conducted at the Department of Paediatrics, Benazir Bhutto Hospital, Rawalpindi, from October 2025 to December 2025, and reported in accordance with the STROBE guidelines for cross-sectional studies. A total of 150 children aged 1–5 years of either sex were enrolled using non-probability consecutive sampling. Measles was defined by the WHO clinical case definition (fever ≥38 °C with a generalised maculopapular rash lasting ≥3 days, together with at least one of cough, coryza, or conjunctivitis). A child was classified as vaccinated when at least one dose of a measles-containing vaccine given at or after 9 months of age was documented on the Expanded Program on Immunisation (EPI) card, and as unvaccinated when no dose was documented. Children with chickenpox, other skin infections, congenital anomalies, chronic illnesses, immunocompromised status, or incomplete vaccination records were excluded. Groups were compared using the chi-square test, and effect sizes were reported as odds ratios (OR), risk ratios (RR), and absolute risk differences with 95% confidence intervals (CI). Results: The mean age of the children was 3.18 ± 1.21 years, and the mean weight was 12.46 ± 2.84 kg. Of the 150 children, 38 (25.3%) were vaccinated, and 112 (74.7%) were unvaccinated. Prolonged hospital admission was required by 57 of 112 (50.9%) unvaccinated children compared with 10 of 38 (26.3%) vaccinated children (OR 2.90, 95% CI 1.29–6.53; RR 1.93, 95% CI 1.10–3.39; absolute risk difference 24.6%, 95% CI 7.8–41.4; p = 0.009). Complications were observed in 73 (48.7%) children overall, with pneumonia being the most common complication in 34 (22.7%), followed by diarrhoea in 21 (14.0%), otitis media in 10 (6.7%), and encephalitis in 8 (5.3%). The overall frequency of complications did not differ significantly between unvaccinated (55/112, 49.1%) and vaccinated (18/38, 47.4%) children (OR 1.07, 95% CI 0.51–2.24; p = 0.853). Conclusion: Unvaccinated children < 5 years of age with measles had a significantly greater need for prolonged hospital admission than vaccinated children, indicating that measles vaccination attenuates the severity of illness in children who acquire the infection. The overall frequency of complications did not differ significantly between the two groups; this null result should be interpreted cautiously, given the small number of vaccinated children and the correspondingly wide confidence interval. These findings support the need to strengthen routine measles immunisation coverage in children under 5 years of age. Keywords: Measles; Measles Vaccine; Vaccination; Child, Preschool; Hospitalization; Treatment Outcome; Immunization Programs; Pakistan.

Amber Khalid, Muhammad Asim, Sana Abid et al.