Investigated strategies for stakeholder cooperation in Early Childhood Education (ECE) in Zambia. Emphasized collaboration between government, educators, families, and community organizations. Applied an interpretivist-phenomenological design with qualitative methods (interviews, observations, document review). Involved 10 purposively selected participants. Identified key barriers and enablers of stakeholder engagement. Recommended improved communication, stakeholder training, and formal collaboration policies.
Background Child mortality remains a major public health challenge in low- and middle-income countries, with Sub-Saharan Africa carrying a disproportionate share of the global burden. In South Africa, rural and under-resourced areas such as Mount Fletcher in the Eastern Cape continue to record high rates of preventable under-five deaths. The effectiveness of national and provincial health promotion strategies depends heavily on local awareness, acceptance, and participation, yet little is known about how caregivers in rural communities such as Mount Fletcher understand and experience these interventions. Objective To explore the awareness and perceptions of health promotion strategies among caregivers to reduce child mortality in Mount Fletcher, and to identify the barriers and facilitators influencing their uptake. Methods A qualitative descriptive study was conducted among 20 mothers and primary caregivers of children under five years attending Taylor Bequest Clinic in Mount Fletcher, Elundini Local Municipality. Participants were selected through purposive sampling and took part in semi-structured, audio-recorded interviews conducted in isiXhosa or English. Data were transcribed verbatim and analysed thematically using ATLAS.ti (version 8), guided by the Health Belief Model. Results Participants demonstrated good awareness of core child-survival interventions, including immunisation, exclusive breastfeeding, nutrition, hygiene, and clinic attendance, and generally held positive attitudes toward health promotion services and healthcare workers. However, participants identified substantial barriers to the uptake of these strategies, including poverty, transport costs and distance to health facilities, long clinic waiting times and staff shortages, and the continued influence of traditional and cultural beliefs on health-seeking behaviour. Conclusion Caregivers in Mount Fletcher are broadly aware of, and hold favourable attitudes toward, child health promotion strategies, but structural, economic, and cultural barriers continue to limit their consistent use. Strengthening community health worker outreach, addressing health system constraints, and engaging traditional and community leaders alongside biomedical health education may help translate existing awareness into more consistent uptake of child mortality reduction interventions in similar rural South African settings.
Lulama Lathitha Faku, Mirabel Kah-Keh Nanjoh, Luviwe Lutotswana et al.
How to cite: Bloch, C & Moodley, T 2026, ‘The indigenisation of early childhood education in South Africa: Finding synergies with Froebelian principles’, in T Moodley, S Stofile & R Govender (eds.), Holistic and inclusive education practices for young learners in South Africa: From early childhood to Foundation Phase, The University of the Western Cape Faculty of Education Book Series, vol. 2, AOSIS Books, Cape Town, pp. 143–161. https://doi.org/10.4102/aosis.2026.BK568.08
OBJECTIVE: To develop a machine learning (ML)-based predictive model for assessing the risk of zero-dose children using Demographic Health Survey data in sub-Saharan Africa. METHODS: This study analysed pooled Demographic and Health Survey data from 27 countries in sub-Saharan Africa collected between 2016 and 2024. Data preprocessing included imputation, balancing of unequal classes and systematic feature selection. Seven ML models were trained and evaluated using performance metrics such as accuracy, recall and F1-score. Feature importance was interpreted using SHapley Additive exPlanations (SHAP)-based analysis. RESULTS: Among the seven models evaluated, LightGBM demonstrated the best overall performance, achieving the highest accuracy (80%), sensitivity (91%), and area under the receiver operating characteristic curve (AUROC = 0.78). SHAP analysis identified place of delivery, antenatal care attendance, maternal tetanus vaccination, household wealth and maternal education as top predictors. DISCUSSION: Our findings suggest that machine learning, particularly LightGBM and XGBoost, is moderately effective in predicting the risk of zero-dose vaccination among children. This approach facilitates the easy identification of children most at risk of missing life-saving vaccinations. CONCLUSION: The LightGBM model predict children at zero-dose risk, enabling early identification and supporting intervention strategies. Future studies will scale these models using larger, routine datasets for practical implementation.
Despite its pivotal role in young children's development and learning, early childhood care and education (ECCE) remains undervalued and under-resourced, with its professional status and recognition often ambiguous. In South Africa, ECCE professionals experience dislocation and marginality within a fragmented system, hindering their efforts to achieve professionalism and consistency in recognition and status. This article examines workforce professionalism in South Africa's ECCE sector, analysing the interplay between policy ideologies and teachers’ understandings. A dual lens of democratic professionalism and transformative feminist perspectives was employed to analyse the sector's challenges within a highly unequal socio-economic landscape. The study combined document analysis of the Policy on Minimum Requirements for Programmes Leading to Qualifications in Higher Education for Early Childhood Development Educators (MRQECDE), and data collection through an online questionnaire with a purposive sample of 208 ECCE teachers from 73 ECCE centres in the Ekurhuleni district of Gauteng province. Findings reveal tensions between qualification-centric policies and teachers’ experiences, highlighting how systemic constraints and intersectional disadvantages affect workforce professionalism. Whilst teachers internalised policy ideologies on qualifications, they demonstrate agency by reimagining alternative pathways for their professionalism. This study contributes to global debates on ECCE professionalism, particularly to contexts where predominantly feminised workforce experience similar structural challenges. A more inclusive and context-responsive approach to professionalism is essential – one that adopts an empowerment framework and prioritises the recognition of marginalised voices.
Colwyn Deborah Martin, Hasina Ebrahim, Mary Clasquin-Johnson et al.
Background Recent evidence suggests that just over a third of children aged 12–23 months in Nigeria have received basic antigens as recommended by the expanded programme on immunisation schedule; just over a quarter have received all first year antigens. Approximately 18% of children in Nigeria are classified as ‘zero-dose’. We assessed the status of immunisation services in Kano and Lagos States of Nigeria to inform the design of interventions to address high numbers of zero-dose and under-immunised children in these states. Methods We used a mixed-methods study design. We collected information from caregivers (including female and male caregivers; and caregivers of zero-dose, under-immunised, and immunised children), and healthcare workers. We conducted focus groups and key informant interviews amongst caregivers of zero-dose and non-zero-dose children. We interviewed caregivers and observed vaccination sessions. We carried out facility observation of vaccination sessions. Data collection tools were adapted from the WHO expanded programme on immunisation review guidelines. Results Whilst we identified many positive practices - and exit interviews suggested high satisfaction with vaccination services - we identified important areas for improving services. Specific challenges related to the: 1) staff (including insufficient staff to operate vaccination activities, poor information exchange with caregivers, low planning capacity, sub-optimal health and safety practices, and abrasive healthcare worker attitudes); 2) facility (including unwelcoming and uncomfortable facility environments and occasional vaccine shortages), and 3) programme design/delivery (including poor planning/service integration, and insufficient resources for transportation/outreach services). Conclusion We suspect that many of the identified challenges are interrelated (e.g. insufficient staff numbers, and an uncomfortable facility environment, may contribute to poor interaction between healthcare workers and caregivers) and that addressing some of these challenges may have cascading effect on vaccination coverage. A better understanding of improving service design and delivery to incentivise visits to vaccination services is needed.
AdekunleGaniyu Salaudeen, Oladimeji Akeem Bolarinwa, Catherine R. McGowan et al.
The purpose of this study was to establish parents’ perceptions of the involvement of males as early childhood development (ECD) teachers. The research adopted a qualitative approach and used a case study design to allow interaction with the subjects and to draw conclusions based on their diverse perceptions. A sample was drawn from the Khami District population that comprised 10 parents, four administrators, four female teachers and two male teachers. Two sampling techniques, namely convenience and purposive sampling, were used. Convenience sampling allowed the researcher to select a small sample where participants were chosen on the basis of being accessible and convenient. Only parents with children taught by male teachers were purposively sampled. Ethical considerations were observed during data collection by explaining to participants that participation was voluntary, with confidentiality guaranteed. Online questionnaires, telephone interviews and virtual focus group discussions were used to collect data, making it easy to maintain social distancing during the Covid-19 lockdown. The following are some of the major findings of this study: parents have mixed perceptions about the involvement of males as ECD teachers; female teachers and school administrators have more positive perceptions about the involvement of males as ECD teachers because they are viewed as qualified for their job. However, in spite of the positive perceptions established about male teachers, some factors such as gender and societal inclinations still cause parents to have fears about the involvement of males as ECD teachers. The study recommends that more male teachers should be recruited to balance gender representation and more workshops and refresher courses for both parents and teachers should be conducted to develop trust.
OBJECTIVES: To estimate the national under-5 mortality rate (U5MR) in Somalia and identify maternal and child-level determinants of child survival using data from the 2020 Somali Health and Demographic Survey (SHDS). DESIGN: Secondary analysis of a nationally representative, community-based, cross-sectional survey. SETTING: Somalia, including urban, rural and nomadic populations across all regions. PARTICIPANTS: A total of 52 198 children under 5 years of age (3161 deaths and 49 037 survivors) born to women of reproductive age (15-49 years) who participated in the 2020 SHDS. MAIN OUTCOME MEASURES: Under-5 mortality, defined as the probability of a child dying before reaching the age of 5 years (0-59 months). RESULTS: The U5MR in Somalia was 65 per 1000 live births (95% CI 62.3 to 66.7). Multivariable logistic regression indicated that children residing in rural or nomadic settings had significantly higher odds of mortality (adjusted OR (AOR)=2.03; 95% CI 1.15 to 3.61) compared with urban residents. Multiple births were associated with a fourfold increase in the odds of death (AOR=4.35; 95% CI 1.94 to 9.73). Longer birth intervals were protective; a preceding interval of 19-23 months (AOR=0.49; 95% CI 0.26 to 0.94) and a succeeding interval of ≥20 months (AOR=0.44; 95% CI 0.29 to 0.66) were associated with lower odds of mortality compared with shorter intervals. Lack of maternal health facility visits showed a marginal, non-significant association with higher odds of mortality (AOR=1.57; 95% CI 0.97 to 2.53; p=0.066). CONCLUSIONS: Somalia's U5MR remains critically high and far from the 2030 Sustainable Development Goal target of 25 per 1000 live births. Identified risk factors are largely preventable. Public health policies should prioritise expanding healthcare infrastructure in rural areas and promoting family planning services to support optimal birth spacing, enhancing child survival.
Hamze G. Dahir, Ahmed Tahir Ahmed, Mohamed Arab Abdilahi
Three decades into democracy, the conspicuous prevalence of immoral and unethical behaviour in South African society is indisputable. In 1997, this society was alerted to “a moral timebomb” (RSA, MRM, 2000) and a 2019 review report (DPME, 2019) confirmed the erosion of its social fabric and morality. Over the years, various initiatives and programmes aimed at inspiring or restoring morals, values and ethics emerged. However, these patchy, disconnected attempts have failed to stem the tide of social deterioration. Research indicates that interventions for behaviour and attitude changes are most efficacious in the early childhood phase. Accordingly, a doctoral study (Padayachee, 2022) proposed an early childhood development integral education and Ubuntu approach to foster the values of social responsibility and citizenship in preschoolers. The study included, in the exploratory phase, the category of values education, which is the focus of this paper. Data were gathered through focus group interviews with early childhood development staff, parents and community members in six pre-schools and analysed thematically. The findings on this specific category are presented to validate the argument that the explicit inclusion of values in early childhood development has the potential to build progressively a foundation for a moral and ethical society and possibly impact social transformation in South Africa.
INTRODUCTION: Floods and heatwaves are becoming more frequent and intense and can disrupt routine maternal and child health (MCH) services. Previous reviews have not systematically examined how context and mechanisms may shape adaptation outcomes. This realist-informed systematic review examines how, why and under what conditions interventions support access to, utilisation of and continuity of routine MCH services during flood and heat events. METHODS AND ANALYSIS: The search strategy was developed by integrating terms from 17 related reviews, refined with the author team and checked by an experienced London School of Hygiene & Tropical Medicine librarian. The initial database search was conducted on 16 May 2025 and the search was updated on 30 April 2026. Eight databases were searched: Web of Science, Ovid MEDLINE, EMBASE, Global Health, EconLit, GreenFILE, CINAHL and ProQuest Environmental Science & Public Policy. Records published between January 2000 and April 2026 were eligible. Search results were imported into EndNote and deduplicated. Title-and-abstract screening and full-text assessment were conducted independently by two reviewers for the initial search and are ongoing for the updated search, with ASReview being used to prioritise records during title-and-abstract screening. Data extraction across the full review evidence base remains ongoing using a structured template covering study context, intervention characteristics, mechanisms, outcomes, costs and implementation conditions. Study settings will be classified by country income group, health system context and Köppen-Geiger climate zone to compare evidence across settings and, where appropriate, to identify possible climate analogues for exploratory, context-specific assessment. Climate-zone similarity will not be used to infer intervention transferability or future effectiveness. The synthesis will be guided by the WHO Climate-Resilient Health Systems framework, Meadows' leverage-points framework and realist-informed C-M-O reasoning. Interventions will be grouped to identify where they operate within the health system and which health system components and vulnerabilities they address. Findings will be reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance. ETHICS AND DISSEMINATION: Ethical approval is not required because the review uses published literature and does not involve human participants. The findings will be disseminated through a peer-reviewed systematic review publication. They will inform the design, improvement and scaling of interventions intended to maintain routine MCH services and strengthen health system resilience to floods and heatwaves across diverse settings. REGISTRATION DETAILS: The review was not prospectively registered with PROSPERO.
Sisay E. Debele, Fiammetta Maria Bozzani, Grace Mushinda-Musonda et al.
