Background: Maternal and neonatal tetanus remains a major public health concern in Somalia, where low immunization coverage contributes to preventable mortality. Despite global progress, Somalia continues to report suboptimal tetanus-toxoid (TT) vaccine uptake due to conflict, weak health systems, and socioeconomic barriers. This study examined multilevel factors associated with the number of TT injections before birth among Somali women. Methods: We analyzed data from the Somali Health and Demographic Survey (2020), including 4841 pregnant women aged 15-49. A mixed-effects negative binomial regression model addressed overdispersion, excess zeros, and hierarchical structure (region and residence). Model fit was assessed using Akaike (AIC) and Bayesian (BIC) information criteria. Results: Only 32.6% of women received at least one TT injection, whereas 67.4% received none. Higher TT uptake was associated with older age (IRR = 1.62; 95% CI = 1.09-2.42), higher wealth (IRR = 1.49; 95% CI = 1.01-2.18), prior vaccination (IRR = 1.76; 95% CI = 1.44-2.16), antenatal care visits (IRR = 1.02; 95% CI = 1.01-1.04), employment (IRR = 1.41; 95% CI = 1.00-1.97), clinic deliveries (IRR = 1.23; 95% CI = 1.01-1.50), and health insurance (IRR = 5.24; 95% CI = 1.04-26.47). Conversely, zero uptake was more likely among nomadic women (AOR = 1.40; 95% CI = 1.06-1.85), those with no prior vaccination (AOR = 3.64; 95% CI = 2.76-4.80), home deliveries (AOR = 1.42; 95% CI = 1.18-1.71), no phone ownership (AOR = 1.31; 95% CI = 1.02-1.68), and women whose husbands lacked education (AOR = 1.27; 95% CI = 1.02-1.58). Conclusion: TT vaccine coverage among pregnant women in Somalia remains critically low and is shaped by socioeconomic inequities, healthcare access, and household decision-making. Strengthening antenatal care integration, targeted outreach for nomadic populations, economic empowerment, health education, and expanding insurance coverage are essential to improve maternal immunization and eliminate neonatal tetanus.
Jama Mohamed, Hamse Mohamed Amoud, Ahmed Ismail Mohamed et al.
Background: This article examines the development of early childhood development (ECD) home-visiting services in South Africa.Aim: To examine the factors that could support the success of home-visiting programmes as well as to explore the experiences of bachelor’s-level home visitors rendering such services.Setting: This study was conducted in the Eastern Cape, a highly impoverished area of South Africa.Methods: It begins with a discussion of the emergence of home-visiting as a strategy for the delivery of ECD services in South Africa and a review of the literature on ECD home-visiting, particularly with highly vulnerable, impoverished families. Next a focus group conducted with a small sample of home visitors as part of a multi-faceted community assessment is described. The results are examined within the context of challenges facing this particular part of South Africa and the nation as a whole.Results: Four themes emerged as most prominent: (1) encountering the effects of extreme family poverty, (2) identifying high rates and multiple aspects of child maltreatment, (3) encountering scarce resources in high-need areas and (4) finding rewards and maintaining a desire to continue serving challenging populations.Conclusion: This study provides a unique window on the challenges that ECD home visitors are likely to encounter when working with families living in extreme poverty, the resourcefulness that home visitors often demonstrate and the rewards to be found in this work.
Drones are changing healthcare delivery, particularly in sub-Saharan Africa (SSA), where traditional logistics face geographical, infrastructural, and resource limitations. This review maps where drones have been used in SSA, how they have been used, the outcomes and challenges, and the potential to expand drone systems to address other healthcare problems. A rapid scoping review methodology was employed, sourcing literature from Google Scholar, PubMed, SCOPUS, Web of Science, Cairn.info, and grey literature using targeted keywords such as 'drones,' 'medicine delivery,' and 'sub-Saharan Africa' to build a search query. Twenty-nine papers met the inclusion criteria, covering 12 countries, although the evidence base was heavily concentrated in Ghana and included a mix of peer-reviewed articles, technical reports, and media or organisational sources. Drone delivery systems have improved healthcare logistics across SSA by reducing delivery times, addressing rural access issues, improving maternal, neonatal, infectious disease, and emergency outcomes, and optimising supply chains. However, challenges such as payload limitations, dependency on donor funding, regulatory and policy restrictions, and workforce shortages hinder scalability. Drones have great potential for healthcare delivery in SSA, offering rapid, efficient, and cost-effective solutions that are transferable to non-communicable diseases (NCDs) and to potential and emerging applications such as vector surveillance and public health messaging. While their contributions to improving maternal health and emergency response are notable, addressing systemic issues is crucial. Drones show promise for improving healthcare logistics in underserved settings, but their long-term value depends on resolving regulatory, infrastructural, workforce, and financing constraints, and on generating stronger comparative generalisable evidence.
A child must be exposed to early learning situations and assisted in developing the skills and ways of functioning to develop, thrive, and be ready for school. It is established that poor school readiness preparation (SRP) negatively impacts subsequent learning outcomes. A qualitative study was conducted in Gugulethu, a poor community in the Western Cape province in South Africa, to determine how Early Childhood Development centres in a poor community prepare children for schooling. The study involved a sample of 12 community-based ECD centres. Interviews and focus group discussions were conducted with direct role-players, including principals, practitioners, and ECD industry key informants. Data was enriched through direct observation of operations at each facility. The study found that all the community-based ECD centres struggle to provide quality SRP. Contributing factors include limited ECD practitioner training, education resources, infrastructure, and facility management. Because these conditions relate to poverty, they affect the SRP of most children in poorer communities, such as Gugulethu, who tend to only have access to under-resourced ECD centres. The study concludes that, given the appalling performance of South Africa’s basic education system, the government has to accept that improving its learning outcomes begins with vastly improving the SRP of children from birth
Flooding is an increasing threat in rapidly growing cities, yet evidence on how heavy rainfall affects access to healthcare within cities and whether impacts are greater for vulnerable populations remains limited. This study quantifies how flooding changes walking access to healthcare in Kampala, Uganda, and how these changes are distributed across areas that differ in their population-level risk of undernutrition and poor maternal and child health outcomes. We conducted a cross-sectional ecological geospatial modelling study across Kampala and its whole population (approximately 1.8 million residents). We estimated walking travel time to the nearest public or private not-for-profit healthcare facility and hospitals under baseline and flood conditions. Flood scenarios were based on a hydrodynamic model simulating 15 rainfall events ranging from 20 to 100 mm over 1, 3, or 6 hours. Travel speeds accounted for caregivers walking with young children. Outcomes were population-weighted changes in travel time, summarised at parish level and compared across vulnerability groups. Here we show that flooding increases travel time across all scenarios, with larger effects for hospital access. Population-weighted mean increases in travel time range from 11.5 to 19.3 minutes for all facilities and from 23.4 to 56.3 minutes for hospitals across scenarios. In high-intensity storms, increases are greater in more vulnerable areas, particularly for hospital access, with largest disruptions in peripheral areas. Flooding reduces access to healthcare in Kampala and disproportionately affects more vulnerable populations. These findings show how extreme rainfall can widen inequalities in access to maternal and child health and nutrition services and support planning. Floods can make it harder for caregivers with young children to reach healthcare facilities. We studied Kampala, Uganda, to estimate how floods change walking time to healthcare. We combined maps of land, roads, water, and elevation with realistic walking speeds on wet surfaces and tested fifteen flood situations, from lighter, longer storms to intense, short ones. Here we show that travel times increased in every case: by about 19 minutes on average to the nearest clinic and 56 minutes to the nearest hospital for the most intense one-hour storms. Delays were greatest in high-vulnerability neighbourhoods and outer areas, while central areas changed less. These results can guide service placement. Lubbers et al. conduct a cross-sectional geospatial modelling study across Kampala to estimate how heavy rainfall affects healthcare access. They show that flooding reduces access to healthcare and disproportionately affects more vulnerable populations, resulting in widened inequalities.
New evidence suggests that over four months after the closure of early childhood development (ECD) programmes on 18 March 2020, the ECD sector was likely to be operating at less than a quarter of its pre-lockdown levels. Of the 38 percent of respondents from the new NIDS-CRAM survey reporting that children aged 0-6 in their households had attended ECD programmes before the lockdown in March, only 12 percent indicated that children had returned to these programmes by mid-July, well after programmes were allowed to reopen. Using these findings, we estimate that just 13 percent of children aged 0-6 were attending ECD programmes by mid-July to mid-August compared to 47 percent in 2018. The last time that ECD attendance rates were as low as this was in the early 2000s. At this point it is not yet clear what proportion of these declines are only temporary, or whether there will be a lasting impact on ECD enrolment in the country. This dramatic contraction in the ECD sector relates to prohibitive costs to reopening ‘safely’ imposed by the regulatory environment, coupled with shocks to the demand side for ECD programmes (both in terms of reduced household incomes and parent fears of children contracting COVID-19). When viewed from a broader socio-economic lens, the threat of ECD programme closures across the nation will have impacts beyond ECD operators to the lives of millions of children, millions of households and millions of adults who rely on these ECD services. A swift intervention by government is necessary to save this important sector and limit the ripple effect of programme closures on multiple layers of society.
Background: Somalia has one of the highest maternal mortality ratios globally, with low antenatal care coverage and low skilled birth attendance. In Puntland, Somalia, the Marwo Caafimaad programme trains female community health workers to provide reproductive health education, basic care and referrals. Aim: To assess the experiences of mothers and female community health workers accessing and implementing the Marwo Caafimaad programme in Puntland, Somalia. Methods: In 2022, we conducted focus group discussions with 45 eligible mothers accessing services through the Marwo Caafimaad programme in 7 villages of Puntland, Somalia, and in-depth interviews with 9 community health workers involved in implementing the programme. We analysed the data thematically using Dedoose version 9.0.107. Results: The mothers valued the programme for providing trusted, home-based support and reducing barriers to care related to distance, cost and family responsibilities. Female community health workers reported strong community acceptance and supportive supervision of the programme. Both groups identified lack of local maternal and child health care centres, shortage of medicines and supplies, inadequate staffing, limited refresher training, and delayed or insufficient remuneration as barriers limiting programme impact. Conclusion: The services provided by Marwo Caafimaad were highly valued in the remote communities of Puntland, however, resource and workforce constraints limited the impact of these services. Additional investment in local facilities, supplies, remuneration, workforce expansion, and training is needed to strengthen the programme.
Ayan Mohamed, Kathleen West, James Pfeiffer et al.
Background: The professional development (PD) of early childhood teachers is of strategic importance in higher education and the profession given the need to improve responsiveness and progress towards millennium goals. Aim: The purpose was to analyse classroom practices and teachers’ experiences of PD programmes, through the theoretical lens of the UNESCO ICT Competency Framework for Teachers to construct an authentic data-based model, which can be used to understand PD challenges and guide decisions about the improvement of education quality. Setting: The study was conducted in Gauteng with teachers from a selection of early childhood centres. Methods: A phenomenological inquiry explored the settings and practices of 23 selected teachers in Gauteng province. Interview and observation data were analysed for content categories and grounded theory articulations. Results: The main finding is that teachers facing everyday educational challenges benefit from school-based support and available media but need additional learning to advance their professional aspirations. The grounded theory analyses of the data highlighted that early childhood practices and articulated development needs are best explained as authentic caring. This was conceptualised metaphorically as garden spaces where careful tending, deliberate planning and various elements of nurturing knowledge may harmoniously be blended. The model extends prevailing theories of PD and the flipped ICT Competency Framework for Teachers. Conclusion: The model of authentic caring is a grounded theory articulation based upon beliefs of practising EC teachers. Contribution: The article provides a comprehensive online teacher professional development framework for EC teachers, emphasising authenticity, care and alignment with global educational standards.
Knowledge sharing in medical education is a continuous exchange of skills and expertise between scientists.Paediatric virology is a rapidly developing, new scientific field of medicine, which enhances multidisciplinary, expertise knowledge sharing between paediatric health professionals and scientists of different subspecialties.The present review discusses the recent core topics in paediatric viral infectious diseases discussed during the 11th Workshop on Paediatric Virology organised by the Institute of Paediatric Virology and presents its key messages, including: i) The history of smallpox vaccination; ii) the role of viral co-infections triggering invasive bacterial diseases; iii) the surge of invasive group A streptococcal disease during the post-coronavirus disease 2019 (COVID-19) era; iv) foetal brain imaging findings in maternal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection; v) the diabetogenic role of Coxsackie viruses in childhood; vi) adenovirus-related central nervous system manifestations in the paediatric population; vii) new challenges and opportunities of hepatis D virus infection in children; viii) the Swedish up-to-date human papillomavirus vaccination experience in childhood.
Ioannis Mammas, Anna Kramvis, Anastasia Stouraiti et al.
How to cite: Du Plooy, L 2026, ‘The benefits and hurdles of integrating STEAM in early childhood development: An analysis of selected literature’, 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. 45–61. https://doi.org/10.4102/aosis.2026.BK568.03
