ABSTRACT Objective This study theorizes how and empirically analyzes the extent linkages to illiberal world culture shape child mortality. Methods I test these arguments using fixed‐effects panel regression models of worldwide country‐year data from 1960 to 2024. Results Affiliations with illiberal intergovernmental organizations and the global density of these organizations are associated with declines in child mortality. In contrast, a higher global proportion of autocracies is associated with increased child mortality. Conclusion Illiberal world‐cultural structures have heterogeneous consequences for child health. These findings offer a new explanation for cross‐national and longitudinal variation in child mortality and explore the boundaries of the emerging literature on the post‐liberal turn in world society.
Abstract Background Measles has resurged globally in the post-pandemic period as routine immunisation recovery remains below the two-dose threshold required to interrupt transmission. Bangladesh, previously nearing measles–rubella elimination, entered 2026 with widening coverage gaps, depleted vaccine stocks, and increasing numbers of missed children. We conducted a situation analysis to assess the scale, concentration, and programmatic implications of the outbreak. Methods We performed a rapid mixed-evidence review from 11–15 April 2026 using data from WHO, UNICEF, DGHS bulletins, PubMed/MEDLINE, ReliefWeb, SEARO updates, and Bangla-language media. Of 46 records screened, 19 were included. Analysis was based on aggregated, publicly available surveillance and programme data. Findings The DGHS measles press release dated 15 April 2026 reported cumulative totals since 15 March of 19,161 suspected cases, 2,973 confirmed cases, 166 suspected deaths, and 32 confirmed deaths; a WHO update dated 15 April reported 58 affected districts. The cumulative suspected-case burden was spatially concentrated: Dhaka and Rajshahi together accounted for 62.7% of suspected cases, and the division-level HHI was 0.255. Children under five comprised 81% of cases, including 34% infants under nine months. Vaccination status showed 72% zero-dose and 16% partially vaccinated cases. Valid MR1 coverage declined from 88.6% in 2019 to 86.1% in 2023, while valid MR2 coverage declined from 89.1% to 80.7%, indicating a widening immunity gap. Interpretation The resurgence reflects accumulated immunity gaps rather than vaccine failure, driven by subnational inequities and programme disruption. Urgent priorities include targeted vaccination campaigns, restoration of vitamin A supplementation, strengthening paediatric care capacity, and integrating real-time surveillance into outbreak response.
Md. Kamrujjaman, Faizunnesa Khondaker, Alvi Ahmed Sarker et al.
Background: Persistently low and inequitable childhood immunization coverage remains an important public health concern, particularly among socially and economically disadvantaged populations.Fieldpractice-level data that align with the national surveys are needed to understand local drivers of immunization inequity.Objectives: This study aimed to determine the association between selected sociodemographic factors and full immunization status, to assess the extent and pattern of socioeconomic inequality in full immunization coverage, and to describe disparities by gender, geographic location, and urban-rural residence among children aged 12-23 months.Methods: A community-based cross-sectional study was conducted from August to October 2023 among 400 children aged 12-23 months (200 urban, 200 rural), selected by multistage random sampling from the fieldpractice areas of Osmania Medical College, Hyderabad, Telangana, India.Full immunization status was verified against Mother and Child Protection Cards and Anganwadi Centre records.Associations were assessed using the chi-squared test; socioeconomic inequality was quantified using the Erreygers Concentration Index, and Fairlie decomposition was used to identify contributors to the socioeconomic gap.Results: Among 400 children, 228 (57.0%) were fully immunized and 172 (43.0%) were non-fully immunized.Full immunization was significantly associated with socioeconomic status (SES), place of residence, sex, and birth order.Coverage was higher among children from the upper socioeconomic class (152/224, 67.86%) than the lower socioeconomic class (76/176, 43.18%; p<0.001), among urban (130/200, 65.0%) than rural children (98/200, 49.0%; p=0.002), and among males (140/226, 61.95%) than females (88/174, 50.57%; p=0.030).Maternal age, maternal education, and religion were not significantly associated with immunization status.A pro-rich distribution was evident (Concentration Index +0.1067; Erreygers Index +0.2432; Wagstaff Index +0.2481), with an absolute SES gap of 24.68 percentage points.Fairlie decomposition explained 1.96 percentage points (7.9%) of the observed gap; urban residence (+136.9%)and Hindu religion (+60.1%)widened the gap, whereas first birth order (-53.1%),male sex (-25.4%), and maternal literacy (-24.8%)narrowed it.The SES equity gap was wider among females (+34.15 percentage points) than males (+18.57) and among urban (+52.74)than rural children (-5.11).Closing the SES gap could increase overall coverage by 10.86 percentage points, corresponding to a population attributable fraction of 16.0%.Conclusion: Full immunization coverage in this population remains below global targets and shows a pattern by SES, residence, and gender, with disadvantage compounding among lower-SES girls and lower-SES urban households.Because measured sociodemographic factors explained less than one-tenth of the observed inequality, closing this gap will likely require health system and supply-side interventions alongside household-targeted approaches.
Shadan Butool, Rafath Unnisa Begum, Prafful K Butti et al.
Uganda ranks third with the highest malaria cases globally, highlighting limitations in existing prevention efforts. Malaria vaccination is a key promising strategy to reduce both morbidity and severity among children under 5 (U5) years. In April 2025, Uganda introduced a four-dose R21 malaria vaccine for U5s. We assessed willingness to vaccinate with the malaria vaccine and associated factors among caregivers of U5s to support vaccine rollout in the targeted population. In March 2025, we conducted a cross-sectional study at the Maternal and Child Health unit of Masaka Regional Referral Hospital among 292 caretakers. We generated caretaker attendance lists daily to serve as sampling frames and developed a sampling interval. We used systematic sampling to obtain the total sample size. We administered a questionnaire assessing caregivers’ willingness to vaccinate, and identified associated factors using modified Poisson regression. We interviewed 292 caretakers, 250(86%) were female and 249(85%) indicated willingness to vaccinate their children. Prior experience with adverse events following immunization (AEFIs) (adjusted prevalence ratio [aPR]=0.2,95%Confidence Interval [CI]0.05-0.5), having other relatives than biological parents as main decision makers (aPR 0.2, 95%CI0.04-0.9) and having tertiary education (aPR 0.14, 95%CI0.04-0.6) were associated with reduced willingness to vaccinate, while receipt of malaria Intermittent Preventive Treatment in pregnancy (IPTp) (aPR 6.2, 95%CI1.6-23) and trust in vaccine safety (aPR 13, 95%CI4.0-43) were associated with increased willingness to vaccinate. Majority of the caretakers were not aware of the malaria vaccine butwere willing to vaccinate their children when oriented. AEFI history, household decision-making roles, and education level were associated with reduced willingness, while having received malaria IPTp and trust in vaccine safety were associated with increased willingness to vaccinate. We recommended providing malaria vaccine information through antenatal care, preparing health workers to address the AEFI history and vaccine-safety concerns and prioritizing safety-focused messaging over general awareness messaging.
Annet Mary Namusisi, Richard Migisha, Dominic Kizza et al.
Background & Objective: Tetanus toxoid vaccination is a recommended preventive measure during pregnancy; however, coverage remains low in several developing countries, including Indonesia. No studies have specifically examined the effect of tetanus vaccine doses on Immunoglobulin G (IgG) levels in Indonesian pregnant women. Therefore, the present study was conducted with aim to determine tetanus-specific IgG antibody levels in this population.Materials & Methods: This analytical descriptive study with a case-control design was conducted at Sitti Khadijah 1 Women's and Children's Hospital in Makassar, Indonesia. Pregnant women were divided into two groups based on whether they had or neither received tetanus-diphtheria vaccinations during pregnancy. Serum levels of tetanus-specific IgG antibodies were measured using an Enzyme-Linked Immunosorbent Assay (ELISA) kit. Data analysis was performed using SPSS (version 27.0). P<0.05 was considered statistically significant.Results: A total of 112 pregnant women were enrolled. A significant association was found between tetanus toxoid vaccination and IgG levels, with vaccinated women exhibiting higher IgG concentrations (P<0.001). Furthermore, women who received two vaccine doses had significantly higher IgG levels compared to those receiving only one dose (P=0.003). Age, body mass index, gravidity, and educational level did not significantly influence IgG levels (P>0.05).Conclusion: Two doses of tetanus toxoid vaccination during pregnancy significantly increase IgG antibody levels in pregnant women. These findings reinforce the importance of expanding tetanus immunization coverage among pregnant women, particularly in Indonesia, to include the second dose through effective health policies and programs.
Ikhmah Sulistyowati, St. Maisuri T. Chalid, Irnawati Bahar et al.
Stunting adalah permasalahan gizi yang berlangsung dalam jangka panjang dan dapat dipengaruhi oleh praktik pemberian MP-ASI yang belum sesuai. Hasil studi awal di wilayah kerja Puskesmas Windusengkahan memperlihatkan bahwa pemahaman sebagian ibu mengenai cara pemberian MP-ASI yang tepat masih terbatas. Tujuan penelitian ini adalah menganalisis pengaruh pendidikan kesehatan terhadap pengetahuan ibu mengenai pemberian MP-ASI pada anak usia 6–24 bulan sebagai salah satu langkah pencegahan stunting. Penelitian kuantitatif ini menerapkan desain pre-experimental one group pretest-posttest. Sebanyak 87 ibu yang mempunyai anak usia 6–24 bulan dipilih dengan proportionate stratified random sampling, kemudian dilakukan simple random sampling menggunakan undian. Pengumpulan data menggunakan kuesioner pengetahuan dan analisis dilakukan dengan Wilcoxon Signed Rank Test. Pada pengukuran awal, 83 responden (95,4%) termasuk kategori pengetahuan kurang dan 4 responden (4,6%) kategori baik; rerata jawaban benar sebanyak 22. Sesudah memperoleh pendidikan kesehatan, 84 responden (96,6%) mencapai kategori pengetahuan baik dan 3 responden (3,4%) masih berada pada kategori kurang, dengan rerata 29 jawaban benar. Hasil uji Wilcoxon memperoleh p=0,000. Dengan demikian, pendidikan kesehatan memberikan pengaruh yang bermakna terhadap peningkatan pengetahuan ibu mengenai pemberian MP-ASI. Abstract Background: Stunting reflects a long-term nutritional problem, and inappropriate complementary feeding is one of the factors that may contribute to its occurrence. An initial assessment in the Windusengkahan Community Health Center service area indicated that several mothers still had insufficient understanding of proper complementary feeding. Objective: This study examined whether health education could improve mothers’ knowledge concerning complementary feeding among children aged 6–24 months as part of stunting prevention. Methods: A quantitative pre-experimental study with a one-group pretest-posttest design was conducted. Eighty-seven mothers of children aged 6–24 months were recruited through proportionate stratified random sampling followed by simple random selection using a lottery. Knowledge was measured with a questionnaire and the data were tested using the Wilcoxon Signed Rank Test. Results: At baseline, 83 mothers (95.4%) were classified as having insufficient knowledge and 4 (4.6%) as having good knowledge; the mean number of correct responses was 22. Following the health education session, 84 mothers (96.6%) reached the good-knowledge category and 3 (3.4%) remained in the insufficient category, with a mean of 29 correct responses. The Wilcoxon analysis produced p=0.000. Conclusion: Health education produced a statistically significant increase in mothers’ knowledge about complementary feeding.
Sielmy Noerfadilah, Herni Kurnia, Endang Nurrochmi et al.
Anemia pada kehamilan merupakan masalah Kesehatan yang umum terjadi sehingga dapat meningkatkan risiko komplikasi bagi ibu dan janin. Di wilayah kerja Puskesmas Plered, dari 82 ibu hamil trimester III hingga April 2026 terdapat 10 ibu yang teridentifikasi mengalami anemia. Penelitian ini bertujuan menganalisis hubungan kepatuhan konsumsi tablet tambah darah (TTD) dengan kejadian anemia pada ibu hamil. Penelitian ini menggunakan desain analitik observasional dengan pendekatan case control terhadap 50 ibu hamil trimester III. Data kepatuhan diperoleh melalui lembar pemantauan konsumsi TTD, sedangkan status anemia ditentukan berdasarkan kadar hemoglobin yang tercatat pada buku KIA dan rekam medis. Analisis pada penelitian ini dilakukan secara univariat dengan hasil sebanyak 40 responden (80%) patuh mengonsumsi TTD dan 10 responden (20%) tidak patuh serta kejadian anemia ditemukan pada 10 responden (20%) dan analisis bivariat menggunakan uji chi-square dengan hasil p=0,000 sehingga terdapat hubungan antara kepatuhan konsumsi tablet tambah darah dengan kejadian anemia pada ibu hamil. Abstract Anemia during pregnancy is a common health problem that may increase the risk of complications for both mothers and fetuses. In the working area of Plered Community Health Center, among 82 third-trimester pregnant women as of April 2026, 10 were identified as having anemia. This study aimed to analyze the relationship between adherence to iron and folic acid tablet (IFA) consumption and the occurrence of anemia among pregnant women. An observational analytic study with a case-control approach was conducted involving 50 third-trimester pregnant women. Adherence to IFA consumption was assessed using an IFA consumption monitoring form, while anemia status was determined based on hemoglobin levels recorded in the Maternal and Child Health (MCH) handbook and medical records. Univariate analysis showed that 40 respondents (80%) were adherent to IFA consumption, while 10 respondents (20%) were non-adherent. Anemia was identified in 10 respondents (20%). Bivariate analysis using the Chi-square test demonstrated a statistically significant association between adherence to IFA consumption and the occurrence of anemia (p = 0.000). These findings indicate that adherence to iron and folic acid supplementation is significantly associated with the occurrence of anemia among pregnant women.
Putri Andriyani, Dyah Widiyastuti, Yeni Fitrianingsih et al.
Latar Belakang: Stunting merupakan masalah gizi kronis yang berdampak pada pertumbuhan fisik, perkembangan kognitif, produktivitas, dan kualitas sumber daya manusia. Salah satu faktor yang berhubungan dengan stunting adalah riwayat Berat Badan Lahir Rendah (BBLR). Penelitian ini bertujuan mengetahui hubungan riwayat BBLR dengan status stunting pada balita di wilayah kerja Puskesmas Pasawahan Kabupaten Kuningan. Metode: Penelitian menggunakan desain analitik observasional dengan pendekatan case control. Sampel berjumlah 750 balita usia 12–59 bulan, terdiri atas 150 balita stunting sebagai kasus dan 600 balita tidak stunting sebagai kontrol (1:4). Data diperoleh dari aplikasi e-PPGM (Sigizi Kesga) tahun 2024–2025 dan dianalisis secara univariat serta bivariat menggunakan uji chi-square dan Odds Ratio (OR). Hasil: Sebanyak 710 balita (94,7%) tidak memiliki riwayat BBLR dan 40 (5,3%) memiliki riwayat BBLR. Terdapat hubungan signifikan antara riwayat BBLR dan stunting (p<0,001), dengan OR 6,45 (95% CI 3,284–12,678). Kesimpulan: Riwayat BBLR berhubungan signifikan dengan stunting. Pencegahan perlu dimulai sejak kehamilan melalui pelayanan antenatal, pemantauan gizi ibu, pencegahan BBLR, dan intervensi pada 1.000 Hari Pertama Kehidupan. Abstract Background: Stunting is a chronic nutritional problem affecting physical growth, cognitive development, productivity, and human resource quality. One factor associated with stunting is a history of Low Birth Weight (LBW). This study aimed to determine the association between LBW history and stunting among children under five in the working area of Pasawahan Community Health Center, Kuningan Regency. Methods: This observational analytic study used a case-control design. The sample comprised 750 children aged 12–59 months, including 150 stunted children as cases and 600 non-stunted children as controls (1:4). Data were obtained from the e-PPGM (Sigizi Kesga) application for 2024–2025 and analyzed using univariate and bivariate analyses with the chi-square test and Odds Ratio (OR). Results: A total of 710 children (94.7%) had no LBW history, while 40 (5.3%) had a history of LBW. LBW history was significantly associated with stunting (p<0.001), with an OR of 6.45 (95% CI 3.284–12.678). Conclusion: LBW history was significantly associated with stunting. Prevention should begin during pregnancy through antenatal care, maternal nutritional monitoring, prevention of LBW, and interventions during the first 1,000 days of life.
Dian Oktapiani, Endang Nurrochmi, Suratmi Suratmi et al.
Introduction Child undernutrition remains a major public health problem in low- and middle-income countries. Timor-Leste has one of the highest childhood stunting rates worldwide, affecting an estimated 47% of children under 5 years. Repeated exposure to enteric pathogens is increasingly recognised as a contributor to malnutrition, yet the interplay between enteric infection, environmental exposure and socioeconomic factors remains poorly understood in this setting. This protocol describes a longitudinal birth cohort study, conducted within a One Health framework, examining early-life enteric pathogen exposure and its relationship with nutritional outcomes in Timor-Leste. Methods and analysis This mixed-methods longitudinal birth cohort study, part of the Bacteria, Enteropathy and Nutrition research programme, is being conducted in three municipalities of Timor-Leste (Dili, Ermera and Ainaro) from November 2024 to October 2027. We will recruit 450 infants at birth and follow them for 24 months, with home visits at 3 monthly intervals in year 1 and 6 monthly intervals in year 2. Faecal, food, water, soil and domestic animal samples will be tested for bacterial, viral and parasitic pathogens; child growth will be assessed using anthropometry. Structured surveys, household observations and in-depth interviews will capture food safety practices, feeding behaviours and socioeconomic factors. Associations between enteric infection and child growth will be assessed using multivariable regression and longitudinal mixed-effects models; qualitative data will be analysed thematically. Ethics and dissemination Ethical approval has been granted by the Human Research Ethics Committee and Veterinary Research Ethics Committee of the Ministry of Health, Timor-Leste (1827/INSP-TL/UEPD-AL/X/2024), Menzies School of Health Research (EC00153) and the Australian National University (H/2024/0964). Written informed consent will be obtained from parents or guardians. Findings will be disseminated through peer-reviewed publications, conference presentations, community workshops and policy briefs in English and Tetum.
Under Sustainable Development Goal (SDG) 6, specifically Target 6.2, the international community committed to ensuring access to adequate and equitable sanitation and hygiene for all, with particular attention to the needs of women, girls, and individuals in vulnerable situations. Despite this commitment, public sanitation continues to be treated as a discretionary amenity rather than a core public service essential for dignity, mobility, and social participation. This paper examines the gap between the normative framework of SDG 6.2 and the lived realities of sanitation use through an integrated analytical approach that combines international comparative data with an exploratory empirical study conducted in Hungary. Moving beyond conventional metrics of access such as facility counts or service levels, the research highlights how formal equality in provision may translate into substantive inequalities in use. It demonstrates how capacity constraints, maintenance failures, and the lack of care-integrated and inclusive design generate disproportionate burdens for women, while drawing on selected international literature to reflect on broader exclusion and safety concerns in gender-segregated sanitation systems. The findings suggest that current monitoring frameworks, including indicator 6.2.1a, inadequately capture the qualitative dimensions of sanitation access, particularly those related to usability, safety, and dignity in public space. In response, the paper argues for a conceptual shift from infrastructure-based metrics toward a more comprehensive understanding of sanitation as a component of gendered and inclusive urban citizenship. The paper briefly reflects on implications for urban planning and governance, highlighting the relevance of institutional accountability and more inclusive, user-sensitive sanitation design within the broader human rights framework of the United Nations. Keywords: public sanitation, gendered citizenship, gender equality, right to sanitation
