The World Health Organization's Decision Framework for Vaccination in Acute Humanitarian Emergencies remains the principal global guide for vaccination prioritization and decision-making in crisis settings. However, it gives insufficient attention to sustaining vaccination as a matter of justice, as a means of upholding established human rights norms and the values that vaccines provide in these contexts. We argue that, if children living in conflict settings are to enjoy the same fundamental rights to life and health as children elsewhere, vaccination must be recognized as more than an emergency‑response intervention. We therefore propose a broader perspective to support guiding decisions to sustaining vaccination services that enhance the medium- and long-term resilience of health systems, and justice in conflict settings. We categorize the benefits and values of vaccination in conflict settings into three types: intrinsic, instrumental, and symbolic. We contend that vaccines are valuable in all three ways during humanitarian emergencies, and that this overlapping value means global health actors should prioritize sustaining vaccine delivery for children during conflicts.
Majdi M. Sabahelzain, Oliver Razum, Julie Leask et al.
Imunisasi merupakan upaya preventif penting dalam menurunkan angka kesakitan dan kematian akibat Penyakit yang Dapat Dicegah dengan Imunisasi (PD3I). Meskipun program imunisasi telah dilaksanakan secara rutin, cakupan imunisasi dasar lengkap di beberapa daerah masih belum optimal, termasuk di Desa Serang Mekar, Kecamatan Ciparay, Kabupaten Bandung. Penelitian ini bertujuan untuk mengetahui faktor ibu dalam pemberian imunisasi lengkap pada balita di Posyandu RW 17. Metode yang digunakan adalah deskriptif kuantitatif dengan pendekatan cross-sectional . Data diperoleh dari data sekunder dan wawancara menggunakan kuesioner kepada ibu balita. Hasil penelitian menunjukkan bahwa pendidikan ibu paling banyak didapat ibu yang memiliki Pendidikan SD, pekerjaan ibu paling banyak didapat pada ibu yang bekerja, jumlah anak (paritas) paling banyak didapat pada ibu grande multipara. Oleh karena itu, peningkatan edukasi kesehatan dan penguatan dukungan ibu sangat diperlukan guna meningkatkan cakupan imunisasi. Penelitian ini diharapkan dapat menjadi bahan pertimbangan bagi tenaga kesehatan dan pemerintah dalam merancang intervensi yang tepat. Abstract Immunization is a crucial preventive effort to reduce morbidity and mortality caused by Vaccine-Preventable Diseases (VPD). Although routine immunization programs have been implemented, the coverage of complete basic immunization in several regions remains suboptimal, including in Serang Mekar Village, Ciparay Subdistrict, Bandung Regency. This study aims to determine maternal factors in providing complete immunization toddlers at Posyandu RW 17. The research design used is descriptive quantitative with a cross-sectional approach. Data were obtained through secondary data extraction and structured questionnaires for mothers of toddlers. The results of the study showed that the highest maternal education was obtained by mothers who had elementary school education, the highest maternal occupation was obtained by working mothers, the highest number of children (parity) was obtained by grande multipara mothers. Therefore, enhancing maternal health education and strengthening family involvement are essential to improve immunization coverage. This study is expected to serve as a reference for health workers and policymakers in designing effective interventions to increase immunization rates.
Mutiara alia Zahra, Hanny Yuli Andini, Lara Santi Indah
Background Despite improvements in maternal, newborn, and child health (MNCH) service coverage in Malawi, completion of the continuum of care (CoC) remains low and unequally distributed across socioeconomic groups. This study quantified socioeconomic inequality in MNCH CoC completion and its determinants. Methods We analyzed pooled data from the 2010, 2015–16, and 2024 Malawi Demographic and Health Surveys, including 18,741 women with a live birth; analytic samples were 15,552 women for maternal CoC and 7,625 children aged 12–23 months for full CoC. Wealth-related inequality was assessed using Erreygers concentration indices. Multivariable and multilevel logistic regression identified determinants of CoC completion, while Wagstaff, Oaxaca–Blinder, Fairlie, and inequality-of-opportunity decompositions identified inequality contributors. Results Full CoC completion rose from 1.4% (2010) to 6.8% (2024); maternal CoC rose from 4.9% to 17.4%. Women completed an average of 8.3 of 11 interventions. Pro-rich inequality persisted for maternal CoC (Erreygers index = 0.036, p < 0.001); inequality in full CoC was smaller and not statistically significant (0.004, p = 0.497). Women's education, particularly higher education, was the strongest and most consistent predictor of completion (adjusted OR: 3.42 maternal, 3.45 full CoC, pooled). Contributors varied by method: education, wealth, and rural residence dominated the Wagstaff decomposition, while education, age, and parity contributed more consistently in the Oaxaca–Blinder and Fairlie decompositions. Circumstance variables reproduced the entirety of observed maternal CoC inequality, falling to 78.7% when wealth was excluded. Conclusions Although MNCH CoC coverage improved substantially in Malawi, socioeconomic inequalities persisted, particularly for maternal CoC, and were closely linked to structural circumstances. Policies improving geographic access, expanding girls’ and women's education, and addressing structural barriers may support more equitable progress toward Sustainable Development Goal 3.
OBJECTIVES This study aimed to determine immunisation status and identify demographic, socioeconomic, access-related, and caregiver factors associated with incomplete immunisation among children under five years. METHODOLOGY This descriptive cross-sectional study enrolled 345 children who presented to the Department of Paediatrics, Ayub Teaching Hospital, Abbottabad, from October 2025 to April 2026 using non-probability consecutive sampling. Parents or guardians completed a pre-tested structured questionnaire, and immunisation status was verified from Expanded Programme on Immunisation records when available and supplemented with caregiver recall. Children were categorised as fully, partially, or not immunised. We assessed associations using chi-square tests and Cramer's V, followed by binary logistic regression for incomplete immunisation. RESULTSThe mean child age was 28.15 ± 17.19 months. Overall, 212 (61.4%) children were fully immunised, 103 (29.9%) partially immunised, and 30 (8.7%) non-immunised. Frequently reported barriers were fear of side effects (49.0%), lack of schedule knowledge (42.6%), and unawareness of the need for immunisation (41.2%). Immunisation status was significantly associated with residence, socioeconomic status, parental education, and parental occupation. After adjustment, low socioeconomic status, unawareness of follow-up doses, misconceptions about contraindications, lack of a nearby vaccination facility, concern about lost wages, and poor schedule knowledge independently predicted incomplete immunisation. CONCLUSION More than one-third of children had incomplete immunisation. Improving completion requires caregiver education, clear counselling about contraindications and adverse effects, reliable reminders for subsequent doses, and practical service-delivery measures that reduce geographic and economic barriers for vulnerable families. Targeted outreach should consistently prioritise rural and socioeconomically disadvantaged households.
Ali Maalik, Saima Gillani, Manahil Shamraiz et al.
The cultural emphasis on mothers' individual responsibility and choice regarding their children's health is often considered a key factor behind vaccine hesitancy, especially among the middle class in Western countries. Drawing on qualitative interviews with vaccine-hesitant Russian mothers, this article broadens this discussion in two ways. First, it shifts the focus from women as autonomous decision-makers to examining how they share vaccination-related responsibilities with other family members. Second, it situates these dynamics within Russian healthcare and childcare-institutional settings where neoliberal trends coexist with socialist legacies and strong state control. The study shows that beneath the surface of responsibilised and seemingly individualistic mothering lies a network of care and familial commitment that frames vaccination decision-making. This is particularly relevant for institutional contexts that promote individual health responsibility without consistently supporting it, thereby fuelling parental distrust in vaccinations and making family involvement essential for navigating volatile welfare environments.
Age is a crucial factor in the transmission and development of infectious illnesses; nevertheless, age-specific patterns in Hepatitis B Virus (HBV) incidence remain little investigated in rural Nigerian populations. This research analyses the age-stratified prevalence of HBV cases in the Kaura Namoda Local Government Area, Zamfara State, Nigeria, utilising hospital-based data from 2019 to 2023. Confirmed HBV cases were classified into three age categories: children (0– 9 years), teenagers (10–19 years), and adults (20 years and older). Analysis of secondary data from Kauran Namoda General Hospital indicated that the adult demographic exhibited the highest prevalence, succeeded by teenagers, whilst children demonstrated the lowest infection rates. The low incidence among children is probably attributable to the efficacy of Nigeria's standard baby immunisation initiatives. Nonetheless, adolescents and adults—many of whom were born before to the advent of mass vaccination—continue to be susceptible due to occupational exposure, customary practices employing unsterilised tools, and restricted access to catch-up immunisation. These findings highlight the necessity of broadening HBV control methods beyond paediatric immunisation. The report advocates for age-specific treatments, including health education aimed at adolescents in schools, mobile outreach services for adults, and the incorporation of HBV immunisation into workplace health programs. Catch-up immunisation initiatives must be expanded to address immunity deficiencies in older demographics. Comprehending the varying impact of HBV across age groups is crucial for attaining equitable and thorough disease management. This study provides critical insights to guide targeted, age-responsive interventions designed to mitigate HBV transmission and attain eradication objectives in high-risk rural communities.
The rise in vaccine-preventable diphtheria diseases underscores the issue of vaccine hesitancy in Nigeria that undermines herd immunity and results in the re-emergence of diphtheria outbreaks. Knowledge and awareness of diphtheria resurgence among people of Plateau State, as well as signs and symptoms, is a challenge. This research examines the diphtheria vaccine hesitancy among individuals in Plateau State, Nigeria. The study employed a cross-sectional approach, utilizing questionnaires and interviews for data collection. A total sample size of 389 participants was involved through using Cochran’s William formula of 1963, and areas selected were LGAs that had recorded diphtheria infection previously (Wase, Jos-North, Kenam, Bokkos, Pankshin, Barkin-Ladi, Langtang, and Mikang LGAs). The study considered the inclusion of male and female, both infected victims and non-infected victims, where it excluded laboratory tests, children, and disabled people from the selected environment. The ethical considerations included contacting the Plateau State Ministry of Health and the Plateau State Hospital Management Board, as well as maintaining confidentiality. The study analyzed the data using simple statistics, including frequency/percentage, mean, and standard deviation, as well as factor analysis to determine the primary factors contributing to vaccine hesitancy in Plateau State. The findings reveal low knowledge and a lack of awareness about the re-emergence of the disease, as well as a limited understanding of its signs and symptoms. Others, unsure of the vaccine, lack confidence among health personnel due to fears of infertility and negative beliefs about vaccine safety. Poor awareness, self-negative assumptions, and parental decision-making regarding household vaccination are major factors identified. Thus, recommendations were made appropriately to encourage herd immunity.
Introduction In Papua New Guinea, acute lower respiratory infection (ALRI) is the most common reason for childhood hospitalisation and death. Recent changes in epidemiology, diagnostic approaches and vaccine policy warrant re-examination of the aetiology of ALRI. Methods A matched case-control study was performed using nasopharyngeal samples collected from a prospective study recruiting children < 5 years of age with moderate/severe pneumonia (cases) and community controls (2013–16). Respiratory viruses and Bordetella pertussis detection was undertaken using an in-house multiplex real-time reverse-transcriptase polymerase chain reaction (qRT-PCR) assay and the frequency of pathogen detection reported. Using multivariate logistic regression models, the population-attributable fraction was estimated. Results From the original sample cohort, 251 ALRI cases and 251 healthy matched controls were assessed. The median age was 12 months. One or more respiratory viruses were identified in 159 cases (63.3%) and 82 controls (32.7%). Rhinovirus was most frequently detected in both cases (23.1%) and controls (19.5%), followed by respiratory syncytial virus (HRSV; 21.8% and 2.0% respectively) and parainfluenza virus type 3 (HPIV3; 16.2% and 2.5% respectively). Co-infections were frequently detected. Significant differences in detection between cases and controls were observed for HRSV, influenza A, HPIV1, HPIV3, and seasonal human coronavirus types HCoV-NL63 and HCoV-229E. We estimated that respiratory viruses were responsible for at least 39.7% (95% CI: 28.2–49.4%) of ALRI. Discussion Respiratory viruses are a major contributor to ALRI in children < 5 years of age in this population, with HRSV representing a key pathogen. This underscores the need for targeted intervention strategies and ongoing surveillance of viral aetiology.
Vaccine hesitancy and immunization inequity remain major public health challenges in Nigeria, where limited access, uneven service delivery, and weak confidence in vaccines continue to constrain progress toward universal immunization coverage. This narrative review examined the public health determinants of vaccine hesitancy, the role of misinformation in shaping vaccine decisions, and the health system strategies that may improve equitable uptake. The literature search period spanned 2008 to 2026, drawing on evidence from biomedical, public health, behavioral, and policy studies to capture both routine childhood immunization and vaccine acceptance in the COVID 19 era. The reviewed evidence shows that vaccine hesitancy in Nigeria is not driven by a single factor, but by a combination of structural and social influences. Low coverage is closely linked to poverty, rural residence, distance to health facilities, insecurity, weak primary care, poor antenatal contact, and geographical inequities that leave many children zero dose or under immunized. Hesitancy is also shaped by low trust in health authorities, fear of side effects, doubts about vaccine effectiveness, religious interpretation, gendered decision making, and limited health literacy. In parallel, misinformation has become a powerful driver of resistance, especially through social media and video platforms where conspiracy narratives, fear-based content, and doubts about government intentions amplify uncertainty and reduce confidence. The review also indicates that uptake improves when interventions go beyond information sharing and address the realities of access and trust. Community engagement, trusted local communication, mobile reminders, stronger primaryhealth care delivery, women centered empowerment strategies, and culturally responsive outreach were repeatedly associated with better uptake and stronger acceptance. Overall, the evidence suggests that reducing vaccine hesitancy in Nigeria requires an integrated response that combines reliable service delivery, misinformation control, community partnership, and equity focused policy action. Such an approach is essential for improving immunization coverage, reducing the burden of zero dose children, and advancing the country’s broader public health goals.
Background: Nigeria introduced single-dose HPV vaccination for girls aged 9-14 in 2023, reaching approximately 60% aggregate coverage by 2025. While an important achievement, this remains short of the 90% coverage called for under the WHO's 90-70-90 cervical cancer elimination targets, and further scale-up depends on reaching out-of-school girls. In this study we used a model of HPV transmission in Nigeria to quantify the residual cervical cancer burden under continued adolescent delivery, assess how additional screening scale-up and equity assumptions modify it, and identify the effective coverage requirements for an infant HPV vaccination program to be non-inferior to the existing adolescent strategy. Methods: We used HPVsim, an agent-based microsimulation calibrated to Nigerian sexual behavior, HPV prevalence, and cervical cancer incidence, to project new cervical cancer cases and age-standardized incidence over 2025-2100 under scenarios which vary vaccination delivery mode (status-quo adolescent, WHO 90-70-90 adolescent scale-up, and 60/75/90% infant delivery), screening coverage (opportunistic 15% vs. scaled 70% aggregate), and the degree to which primary school completion correlated with vaccination (odds ratio 1 vs. 5) and with screening (odds ratio 1 vs. 3). Infant delivery scenarios were run at hypothetical effective-vaccine-efficacy-at-exposure values of 50%, 70%, and 95% - scenario inputs bracketing the plausible waning range, not evidence-based estimates of infant vaccine performance (no HPV vaccine trial has enrolled anyone below age 10). Each scenario was run at 50 replicates (10 calibration draws, 5 seeds); reported outcomes are the median across replicates and uncertainty ranges are interquartile (25th-75th percentile). Results: Continuation of Nigeria's current adolescent program is projected to avert 1.82 million cervical cancer cases (IQR 1.65-1.90 million; 95% UI 1.39-2.02 million) over 2025-2100 (a 53% reduction relative to no vaccination, IQR 51-55%; 95% UI 46-58%), with age-standardized incidence falling from 19.7 to 7.8 per 100,000 by 2100. However, 82% of the near-term (2025-2075) burden is projected to fall on the pre-2015 birth cohort, i.e. women already beyond the vaccination target age, leaving approximately 945,000 residual cases (IQR 905K-1.00M; 95% UI 835K-1.14M) in this cohort. Scaling up screening to WHO targets was estimated to avert a further ~387K cases (IQR 331-424K; 95% UI 269-515K), roughly 25% of the residual burden; results were about 6-8% better if the scale-up instead reached all women equitably regardless of education. Under a hypothetical scenario of infant vaccination at 90% coverage and 95% effective vaccine efficacy at exposure (matching adolescent-age performance), outcomes were comparable to full WHO adolescent scale-up (49% vs. 54% reduction in vaccine-targetable cohort cancers), but under a hypothetical 50% effective efficacy at Nigeria's DTP3-anchored 62% coverage the strategy averted only a fraction of these cancers. Conclusions: The near-term cervical cancer burden in Nigeria is dominated by cohorts vaccination cannot reach; scaling screening for them is the more consequential lever over the coming three decades and rests on established evidence. Findings on infant HPV delivery are exploratory and hypothesis-generating: they depend on three unverified empirical prerequisites - infant HPV vaccine immunogenicity in the first months of life, durability of protection across the ~15-25-year interval to peak HPV exposure, and coverage achievable through Nigeria's routine childhood immunization platform - and should not be read as a basis for any policy recommendation contingent on infant HPV delivery until those prerequisites are established.
Robyn Margaret Stuart, Ifeoma Umeh, Christopher Gill et al.
