ABSTRACT Background Rapidly urbanising complex ecosystems present several challenges to the organisation, availability, and accessibility of healthcare services. This study describes the availability and distribution of health facilities offering services, with a focus on maternal and newborn health services in the seven health districts of Grand Conakry, Methods This study using primary data from a census of health facilities (June 2025). Finally, healthcare landscape was drawn up using the GPS coordinates collected, based on the boundaries of the seven including health districts. The census started with an existing list of 459 facilities and snowball sampling was used to identify facilities that were not initially on the list. We collected information on basic facility characteristics and GPS coordinates. Results A total of 795 health facilities exist in Grand Conakry, with 564 facilities which were not on the initial lists, 104 were either closed, out of service, or refused to participate. The questionnaire was completed by 691 health facilities. The private sector dominated the landscape and was mainly concentrated in the Ratoma and Matoto health districts; with most facilities (63%) not reporting to the national health information system, in contrast to those in public sector (85.7%). 332/691 facilities reported providing childbirth care, and 132 of them (40%) offered caesarean section, while 87 (26%) offered blood transfusions. Conclusion Despite the high number of facilities, geographic imbalances in distribution exist. Equitable access to healthcare in rapidly urbanising Grand Conakry requires strengthening urban health planning and public-private collaboration regarding ongoing rapid urbanisation in Grand Conakry. Key messages What is already known on this topic? The rapid urbanisation of Grand Conakry is accompanied by an expansion in healthcare provision, but information on the geographical distribution and characteristics of healthcare facilities, particularly for maternal and neonatal care is limited and incomplete. What this study adds? A significant number of healthcare facilities operating in Grand Conakry are missing from existing health authority lists. Healthcare provision is largely dominated by the private sector. The availability of comprehensive emergency obstetric and neonatal care services remains limited, and only 4% of facilities offer childbirth care that is completely free of charge (all public). How this study might affect research, practice or policy? The comprehensive facility list generated by this census strengthens healthcare system planning for maternal and neonatal care provision, including improving referral networks in Grand Conakry.
Nafissatou Dioubate, Aline T. Semaan, Rehema Ouko et al.
Abstract Research highlights the benefits of singing in early childhood for the development of cognitive, language, emotional and social skills. Grounded in this theoretical framework, this article draws on data from Statistics South Africa’s, The General Household Survey (2023), to examine patterns of parental singing across different socioeconomic groups. This survey does not measure the efficacy of singing in early childhood, but it does provide insights into disparities in the exposure to home singing among young children. Various analytical techniques were used to analyze the data, such as descriptive analysis, bivariate analysis, regression analysis, and multivariate analysis. The findings of the analyses highlight the disparities in music exposure and singing practices across socioeconomic backgrounds and educational levels in South Africa. Children from high socio-economic backgrounds have access to regular singing activities in the home as well as access to better early childhood development programmes that incorporate regular singing activities. The findings underscore the need for policy intervention and structured programmes that promote access to singing opportunities in early childhood particularly for children in low socio-economic communities.
Abstract Background Neonatal mortality remains disproportionately high in sub-Saharan Africa (SSA), accounting for nearly half of all deaths in children under five. Although antenatal care, skilled birth attendance, and postnatal care are individually associated with improved newborn survival, few studies have examined whether their integrated receipt as a continuum of care (CoC) confers additional protection against neonatal death, particularly after accounting for sociodemographic confounding and heterogeneity across country contexts. Methods A pooled cross-sectional analysis was conducted using DHS-8 Births Recode files from five countries: Nigeria (2024), Mali (2023–2024), Congo DRC (2023–2024), Kenya (2022), and Lesotho (2023–2024). The analytical sample comprised 37,351 births within the 36-month postnatal care reference window. Complete CoC was defined as receipt of adequate antenatal care (≥4 visits with first-trimester initiation), skilled birth attendance, and postnatal care within 48 hours for the mother or newborn. Neonatal mortality was defined as death within 27 days of birth. Survey-weighted logistic and log-Poisson regression models estimated adjusted odds ratios (aOR) and adjusted prevalence ratios (aPR). G-computation quantified the population attributable fraction (PAF). Country-specific heterogeneity was examined through random-effects meta-analysis (DerSimonian-Laird method) and a two-level multilevel logistic regression model. Results The overall neonatal mortality rate was 29.3 per 1,000 live births (95% CI: 27.6–31.0). Complete CoC prevalence was 19.2% (95% CI: 18.5–19.9%), ranging from 7.8% in Congo DRC to 47.8% in Lesotho. In unadjusted analysis, complete CoC was associated with a 24% reduction in neonatal death odds (cOR: 0.764, 95% CI: 0.583–1.000, p = 0.050). After adjustment for wealth, education, residence, parity, maternal age, child sex, and country, the association was substantially attenuated and non-significant (aOR: 0.961, 95% CI: 0.717–1.289; aPR: 0.962, 95% CI: 0.722–1.282). The PAF under universal complete CoC was 3.2%. The pooled meta-analytic estimate was aOR 0.718 (95% CI: 0.447–1.152), with moderate heterogeneity (I² = 38.9%; τ² = 0.089). Country-specific estimates ranged from aOR 0.455 (95% CI: 0.256–0.810) in Kenya to 1.447 (95% CI: 0.496–4.220) in Lesotho. Conclusion Complete continuity of maternal healthcare was not independently associated with reduced neonatal mortality after full adjustment, suggesting that the unadjusted benefit was attributable to sociodemographic selection rather than a direct causal pathway. These findings underscore the insufficiency of service utilisation metrics in isolation and highlight the need to address the structural and contextual determinants that simultaneously constrain both care access and neonatal survival. Country-level heterogeneity in the CoC-mortality relationship points to the importance of tailored, context-specific interventions.
Sustainable Development Goal 8 calls for full, freely chosen and productive employment and decent work for all. However, Evidence from statistics shows that employment opportunities have continued to diminish world over and that the shortage of jobs is expected to continue in the near future. Africa bears the brunt for this unemployment situation. The good news however, is that early childhood education in Africa is growing in leaps and bounce and is expected to continue growing as awareness around it intensifies. By making a critical analysis of pertinent literature, this paper sought to establish evidence to the fact that development in the early childhood education might be the magic bullet for the unemployment menace in Africa. It was expected to inspire policy makers to step-up investment in early childhood education and mark it as a career of choice for the 21st century and beyond.
BACKGROUND: Despite global progress, significant disparities persist in routine childhood vaccination coverage, commonly in low- and middle-income countries, including Ethiopia. Ethiopia has made considerable progress in extending immunization services through the national Expanded Program on Immunization. However, still significant coverage gaps remain, particularly among the vulnerable population such as urban slums and pastoralist areas. This study seeks to capture the perspectives of healthcare professionals and program managers to understand the challenges, best practices, and opportunities for strengthening immunization service delivery in these marginalized settings. METHODS: An exploratory qualitative study was conducted in urban slum and pastoralist areas of Ethiopian regions from November to December, 2023. Purposive sampling technique was used to select 39 key informants, including healthcare providers, health extension workers, maternal and child health directors, Woreda Immunization officers, and focal persons. The interview guides were developed with Human-Centered Designand the World Health Organization's behavioral and social drivers frameworks. Open Code software version 4.03 was used to perform thematic analysis, employing both deductive and inductive coding approaches. Inter-coder reliability and daily debriefing were used to ensure the trustworthiness of the study. RESULTS: Key barriers affecting the routine childhood immunization service included inconsistent vaccine supply, limited cold-chain capacity, low financing, high workloads, and challenges in reaching these populations. However, best practices such as community engagement, involvement of local community structures, mobile teams and the inclusion of the private sector demonstrated notable successes. Healthcare professionals recommended improving supply chains, enhancing healthcare providers training and supervision, and increasing community awareness as crucial strategies to reach under-immunized groups. CONCLUSION: This study identified that persistent health system challenges remain in delivery of routine childhood vaccination, while there is best practices in some areas. Strengthening health system capacity in terms of human power and necessary, combined with active community engagement, is essential to achieving equitable vaccine coverage among under-immunized populations.
This chapter focuses on the challenges and opportunities associated with the implementation of peace education programs in Africa. Peace education programs are used widely to create peaceful environments for at-risk children. Their intended goals are to end violence through modeling human consciousness to resolve conflicts peacefully and to provide children with a stable socioeconomic future. Using a systematic review of literature, the authors examine how humanitarian agencies with support from the World Bank utilize peace education programs to create safety nets for former child soldiers in Africa. The challenges and opportunities of such programs are examined. The authors then propose for the adoption of a community-based participatory practice to facilitate the sustainability of peace education programs. The chapter will benefit at-risk children in war-torn African regions and all stakeholders involved in the creation of safe environments for children.
Background Under-five mortality remains disproportionately high in least developed countries (LDCs), despite expanded access to routine childhood immunisation. This study examined six vaccine-specific associations with under-five mortality, the moderating role of government health expenditure (GHE), and variation across the mortality distribution. Methods An ecological longitudinal panel of 41 LDCs covering 2000 to 2023 was analysed. Six vaccine-specific models were estimated separately using country fixed effects with Driscoll-Kraay standard errors. Moderation was assessed using interactions between within-country-centred vaccine coverage and GHE. Split-panel jackknife method-of-moments quantile regression evaluated effects at the 25th, 50th, and 75th conditional quantiles. Results The findings showed vaccine-specific asymmetry, with direct and GHE-moderated effects varying in magnitude, significance and direction across the six vaccines. A 1% increase in coverage of the third dose of the diphtheria-tetanus-pertussis vaccine (DTP3), measles-containing vaccine (MCV), third dose of the Haemophilus influenzae type b vaccine (Hib3), and third dose of the polio vaccine (Pol3) was associated with reductions in under-five mortality of 0.229%, 0.162%, 0.072%, and 0.243%, respectively. Coverage of the third dose of the hepatitis B vaccine (HepB3) and Bacillus Calmette-Guérin vaccine (BCG) showed no significant average association. GHE attenuated the inverse associations for DTP3, MCV, BCG, and Pol3, strengthened the HepB3 association, and did not significantly moderate Hib3. Vaccine effects were generally strongest at the upper mortality quantile. Out-of-pocket health expenditure was positively associated with mortality, whereas gross domestic product per capita and basic sanitation coverage were inversely associated. Conclusions Routine immunisation was associated with improved child survival in LDCs, but the benefits varied by vaccine, financing conditions, and mortality level. Policies should prioritise effective delivery, preventive expenditure, and high-mortality populations.
Onome Bendalene Irikefe, Bernard Ojonugwa Anthony, Precious Suru Uleyo et al.
Adequate infrastructure plays a critical role in early childhood development (ECD) facilities providing high-quality early learning services. An ECD facility is a partial care facility that provides an early childhood programme that encompasses early learning and the development of children before they start formal schooling. Hence early learning in South Africa is primarily accommodated in privately owned facilities that range from registered to unregistered facilities. For this reason, the inadequate infrastructure that characterises conditions under which most ECD facilities operate in South Africa has been noted with concern in numerous studies. This paper assesses the state of the physical infrastructure of ECDfacilities in Philippi, an impoverished township in the City of Cape Town in the Western Cape. Owing to the regulatory function of the state in the ECD sector, through which compliance standards have to be met to secure subsidisation, the authors analyse the impact of ECD legislation on the state of ECD infrastructure in Philippi. The analysis shows statistical differences in the infrastructure of 10 registered and 10 unregistered facilities. The infrastructure differs partly due to the registration status and the location in which the facilities are situated. We therefore deduce that the current state’s avoidance of infrastructure investment in ECD facilities amounts to the denial of positive early learning outcomes to these children in Philippi.
The Nigeria Basic Health Care Provision Fund (BHCPF) is one of the most significant reforms in health financing in Nigeria. It was created to strengthen Nigeria's health sector, improve access to healthcare, strengthen Primary Health Centres (PHCs), support emergency response and public health security, and support vulnerable groups. The BHCPF is also intended to accelerate the country's shift towards Universal Health Coverage (UHC), so that Nigerians can access equitable and affordable medical care. The National Health Act of 2014 (Section 11) established the BHCPF specifically to guarantee steady funding for essential healthcare services. It helps lower the out-of-pocket costs that push families into poverty and concentrates on improving health outcomes for those who need it most — women, children, and low-income communities. This review provides an overview of what is known about the BHCPF since 2014, including how it was developed, how it has been used in practice, what has worked, how it is managed, and where it continues to face challenges. As of 2026, official documents, policy papers, and research articles present a mixed but broadly positive picture. The BHCPF has enhanced access to critical care, improved facility budget control, expanded the number of people covered by health insurance, and improved the consistency of PHC funding. However, implementation has been limited by governance concerns, delays in fund release, inadequate state-level capacity, weak accountability, and persistent regional inequities. The review concluded that although the BHCPF is a transformative health financing model, its future viability depends on reinforcing accountability frameworks, strengthening state-level preparedness, improving transparency, and ensuring sustainable funding.
Emmanuel Bola Jonah, Mary Ojonema Onoja- Alexander, Ogwuche Igoche John et al.
Background: South Africa has migrated the responsibility for early childhood development (ECD) centres from the Department of Social Services to the Department of Basic Education. This functional shift has ushered in consultations and discussions on how best to implement ECD, including opportunities the change may bring.Aim: By anchoring the understanding of ECD services in nurturing care, this study aimed to elucidate the provision of appropriate, inclusive services in early childhood development, including early childhood intervention, for children with disabilities in South Africa against the backdrop of the migration of services from one government ministry to another.Methods: This is an analytical article based on South African literature on ECD services, including interventions, with particular attention to children with disabilities, basing our understanding of these services in nurturing care.Results: We elucidate how the ideals of the Nurturing Care Framework can be achieved in the context of children with disabilities in South Africa using five themes: the need to localise services, developing tools and strategies for screening and early intervention, enhancing the efficacy of caregivers, supporting and training staff and collaborations.Conclusion: It is necessary to empower caregivers and professionals to address early childhood intervention and ECD needs of children with disabilities. Early childhood development centres are an important context for nurturing care, providing opportunities to promote and sustain health amongst a large number of children. Considering the function shift of ECD services in South Africa, these centres are well positioned to further nurturing care to children with disabilities through the provision of supportive environments that promote health and well-being.
Amani Karisa, Chantal Samuels, Brian Watermeyer et al.
