BACKGROUND: Malaria is a major health issue in sub-Saharan Africa, including Guinea, affecting children under five and rural populations, with a prevalence of up to 30% in some areas. Although long-lasting insecticidal nets (LLINs) are effective, inequalities in access and use persist across wealth, geography, and age groups; however, detailed data are limited. This study assessed socioeconomic inequalities in LLIN access and use among children and adolescents. METHODS: We analysed data from a cohort study conducted between March 2022 and February 2023 in Maferinyah, rural Guinea, with monthly visits to households of children and adolescents aged 1-19. Socioeconomic position (SEP) was derived using an asset index and categorised into terciles. LLIN access and use-given-access were analysed using mixed logistic regression models adjusted for sociodemographic and seasonal factors. Socioeconomic inequalities were quantified using concentration and Erreygers indices with cluster bootstrap confidence intervals. Pathway and decomposition analyses assessed the contribution of access to LLIN to inequalities in effective LLIN use (defined as use regardless of access). RESULTS: The odds of LLIN access were higher among middle-SEP (aOR = 3.84; 95% CI 1.31-11.96) and high-SEP households (aOR = 3.76; 95% CI 1.18-12.71) than among low-SEP households. Inequalities in effective LLIN use were driven by disparities in access rather than by use behaviour. Although LLIN use among those with access exceeded 80% across all socioeconomic groups, effective use in the overall study population was lower among low-SEP households (29.6%). Significant pro-rich socioeconomic inequalities were observed for both LLIN use (Erreygers index (EI) = 0.386; 95% CI 0.151-0.594) and access (EI = 0.412; 95% CI 0.168-0.636). Decomposition analysis suggested that socioeconomic inequality in effective LLIN use was almost entirely explained by differences in access (98.8% of the total variance). CONCLUSIONS: Malaria prevention in rural Guinea is unequal, leaving poorer children and adolescents less protected than wealthier ones. This gap stems from unequal access to LLINs rather than differences in net use among households with nets. The study showed that the poorest families did not have access to nets in the first place. Addressing this inequity requires improved distribution strategies targeting the poorest and most vulnerable households, rather than behavioural interventions for net use only.
Almamy Amara Touré, Sidikiba Sidibé, Soledad Colombe et al.
Respiratory syncytial virus (RSV) is one of the leading causes of acute lower respiratory tract infection, bronchiolitis, pneumonia, and hospitalization among infants and young children, with the highest risk of severe disease observed in infants younger than six months, preterm infants, and children with bronchopulmonary dysplasia, congenital heart disease, immunocompromising conditions, and other underlying comorbidities.In Mexico, available evidence demonstrates a substantial clinical burden and a predominant seasonal circulation from September to March.In recent years, the development of novel preventive strategies has transformed the approach to RSV prevention, particularly through maternal immunization with a bivalent prefusion F protein vaccine and passive immunoprophylaxis with long-acting monoclonal antibodies.This position statement from the Mexican Academy of Pediatrics reviews the epidemiological, clinical, and real-world effectiveness evidence regarding currently available strategies for the prevention of RSV infection in the pediatric population.Maternal vaccination between 32 and 36 weeks of gestation promotes transplacental antibody transfer and provides protection to infants during the first months of life.Monoclonal antibodies, particularly nirsevimab, have demonstrated significant reductions in lower respiratory tract infection, hospitalization, intensive care unit admission, and severe RSV-associated disease, with a favorable safety profile.Based on disease burden, national seasonality, availability of preventive products, and the characteristics of the Mexican health care system, the Mexican Academy of Pediatrics proposes a complementary and progressive strategy
Rosa María Wong‐Chew, María del C. Espinosa-Sotero, Ana Elena Limón-Rojas et al.
Background: Universal immunization programme (UIP) is widely recognised as one of the most effective, equitable and cost-effective public health intervention. In India UIP have cover 26 million infants and 29 million pregnant women through more than 13 million immunization sessions annually. However, tribal communities continue to face barriers to accessing institutional healthcare services, including financial, geographical, socio-cultural, and systematic barriers. Inadequate infrastructure, shortage of trained healthcare personnel, irregular outreach services and poor transportation networks are the problems and existing challenges faced by tribal communities in accessing health care from primary health care settings. This study aimed to access immunization coverage among tribal children and explores community experiences of institutional health services related to immunization. A mixed method approach incorporating quantitative and qualitative methods was adopted. Quantitative data were collected to access immunization status among children review of their mother and child protection (MCP) card. While qualitative data were obtained through in-depth interview and focus group discussion. Results indicates that only 13.3% children were fully immunized, where as 86.7% were partially immunized. Participants attributed incomplete vaccination to lack of awareness, lack of interest, fear of side effects and reliance on cultural practices and beliefs. The present study demonstrates that the immunization gap among the tribal communities is not merely a consequence of inadequate awareness or vaccine acceptance, but reflects a broader structural and organizational gap in delivery immunization services. Accessibility, continuity, organisation and responsiveness of institutional services, operating with the socioeconomic and cultural context of tribal households are critical determinants of effective immunization.
The article examinesthe change in the epidemiological situation in the Kazakh SSR at theturn of the 1950s and 1960s, considering the shift towards the mass immunisation of children. The objective of the study is to identify the rates, territorial characteristics and factors of the dynamics of incidence in 1958 –1961, as well as to evaluate the initial results of the vaccination program. The source base consisted of archival reports and statistical documents from health authorities and the sanitary-epidemiological service. These documents contained information on regions, urban and rural areas, age groups, vaccination status, disease focality, clinical forms, laboratory confirmation and disease outcomes. The comparative-historical, problemchronological and statistical methods were employed. The material was analysed using the endogenousprimary approach, which links epidemiological results with the internal capabilities of the republican healthcare system. The scientific novelty lies in the comprehensive introduction of little-studied statistical tables to research circulation, which made it possible to reconstruct regional processes that were not reflected in All-Union or average republic dynamics. A review of the evidence suggests that the situation remained tense at the end of the 1950s. Following a decline in the number of patients, 10,733 cases were registered in 1959. In 1960, their number decreased to 7,500, and in 1961 it was approximately half that of the previous period. However, it should be noted that the positive dynamics were not synchronous: in 1959–1960, growth continued in some areas, while the directions of change in cities and rural areas often differed. Despite the overall decline in 1961, cases in several territories continued to exceed the national average. A comparison of age and vaccination data confirmed the protective effect of vaccination but showed that nominal coverage alone was not sufficient for protection. The diseases observed in vaccinated and revaccinated children required consideration of the completeness of the vaccination course, the timing of the revaccination and the quality of the vaccines. Continued active transmission of the infection was indicated by cases in organised groups, multiple focal spots and registered outbreaks. It was concluded that mass immunisation was a decisive factor in the epidemiological shift. However, its impact was gradual and uneven across different territories. By 1961, the Republic had entered a period of steady decline in disease incidence, though it had not yet achieved full control of the infection. The effectiveness of the campaign was determined by a combination of factors, including vaccination coverage, organisational quality, laboratory surveillance, early diagnosis, hospitalisation and timely treatment.
Zhanna Mazhitova, Aigul Zhalmurzina, Zhangeldy Bimoldin et al.
Childhood immunization remains one of the most effective public health interventions to preventvaccine-preventable diseases.In Burkina Faso, incomplete immunization schedules remain a challenge amid insecurity, population displacement, and health system disruptions.This study aimed to identify factors associated with incomplete immunization and the vaccination dropout rate in children aged 12 to 36 months.A secondary analysis of the 2021 Burkina Faso Demographic and Health Survey (2021-DHS-BF) data was performed.Incomplete immunization was defined as a child not receiving all recommended routine vaccine doses by 15 months of age.Factors associated with incomplete immunization were identified using modified Poisson regression with generalized estimating equations; adjusted prevalence ratios (aPR) with 95% confidence intervals were reported at a 5% significance threshold.Among the 2,375 children who met the eligibility criteria in the 2021-DHS-BF dataset, 1,482 (66.0%) had not completed their immunization schedule.The dropout rate between the first and third doses of the pentavalent vaccine was 11.0%.Maternal occupation (Saler: aPR = 0.89, 95% CI: 0.80-0.98 and farmer/selfemployed: aPR = 0.93; 0.85, 95% CI: 0.78-0.94)and being treated with respect "sometimes" at health facilities (aPR = 1.14, 95% CI: 1.02-1.27)were associated with an incomplete immunization schedule.Strengthening person-centered care, improving post-first-dose follow-up, and expanding community-based outreach strategies could improve immunization schedule completion.
This article aimed to discuss the role played by health education in tackling vaccine hesitancy, a complex and multifactorial phenomenon capable of compromising vaccination coverage rates and favoring the reappearance of vaccine-preventable diseases among children and adolescents. The work of PIBEX scholarship student, in the VacinAção Extension Project, sought to analyze the scientific evidence related to the role of health education in reducing vaccine hesitancy, identifying different forms of intervention, how they can be applied, and the effects they have generated. This is an integrative literature review carried out in the Virtual Health Library, Latin American and Caribbean Literature in Health Sciences, and Scientific Electronic Library Online databases, gathering articles published between 2016 and 2025, in Portuguese and English, related to health education, vaccine hesitancy, and educational interventions. The studies indicated that such strategies can expand knowledge by clarifying doubts and strengthening trust in vaccines, showing greater potential than standardized actions already implemented. It is concluded that health education can contribute to tackling vaccine hesitancy when developed on the basis of dialogue and personalization, being continuous and adapted according to the needs of each child, adolescent, and/or guardian.
Gabrielly Boiko Ribeiro, Beatriz de Toledo Nogueira, Luiza Tatiana Forte et al.
Somalia's National Transformation Plan (NTP) 2025–2029 presents an ambitious health-reform agenda centred on maternal and child health, workforce development, health-system strengthening, regulation, financing, digitalisation, and emergency preparedness. The policy challenge is whether the institutional conditions required for implementation can be assembled in a fragile, federal, highly aid-dependent and predominantly mixed-provider health system. This Policy and Practice Review critically examines the implementation readiness of the NTP health chapter and proposes a sequenced framework for converting national commitments into measurable results. A structured narrative review was undertaken from June to July 2026 using peer-reviewed literature, national policy documents, and reports from governmental and international institutions. Evidence was interpreted through the health-policy triangle, the updated Consolidated Framework for Implementation Research (CFIR), applied prospectively to anticipated determinants, and a health-system resilience lens. The synthesis generated six interdependent proposed readiness foundations: a negotiated federal-state governance compact; a technically validated, costed and sequenced operational plan; sustainable financing and strategic purchasing; workforce and regulatory capacity; integrated information, monitoring and public accountability systems; and shock-responsive adaptive management. Important policy strengths include explicit targets for service coverage, workforce expansion, hospital rehabilitation, regulation and digital health. Key risks include inconsistent or under-specified targets and baselines, uncertain fiscal pathways, weak federal-state role specification, and dependence on external resources and non-state providers. Comparative evidence suggests that contracting and pooled financing can expand services when stewardship, fiduciary safeguards, workforce integration, community accountability and learning systems develop concurrently. We propose a phased 2026–2029 pathway prioritising technical validation, essential-service continuity, subnational compacts, workforce payroll transition, interoperable data systems and annual public performance reviews. The proposed framework is prospective and has not yet been empirically validated; consultation with federal and subnational authorities, providers, partners, civil society and communities is required before formal adoption.
Nor Haji Osman, Dahir Osman Mohamed, Hamdi Mohamud Osman et al.
Malaria remains one of the leading causes of child mortality in Nigeria, with the disease claiming the lives of hundreds of thousands of children under five each year. Despite significant advances in malaria prevention and treatment, the burden of the disease continues to be disproportionately high, particularly in high-burden regions. The Oxford R21 malaria vaccine, which has demonstrated unprecedented efficacy in clinical trials, offers a promising new tool in the fight against malaria in sub-Saharan Africa. This article explores the potential impact of the R21 vaccine on child mortality in Nigeria, highlighting its effectiveness, the challenges to its successful implementation, and the broader implications for the nation’s malaria control strategy. The article examines the efficacy of the R21 vaccine, which has shown 77% protection against malaria in young children, significantly outperforming previous malaria vaccine candidates. It also addresses the public health implications, projecting that widespread vaccine distribution could lead to a 30-40% reduction in malaria-related child deaths in Nigeria. Furthermore, the article discusses the need for a coordinated, multi-sectoral approach to vaccine rollout, which includes robust logistics, public awareness campaigns, and addressing vaccine hesitancy. The article concludes that the R21 vaccine has the potential to transform Nigeria’s malaria control efforts, contributing to the long-term goal of malaria elimination. However, achieving its full potential will require strong policy support, sustainable funding, and collaboration between international and local stakeholders. The successful deployment of the vaccine could mark a new era in malaria control, significantly reducing child mortality and improving overall child health in Nigeria.
Punjab National Family Health Survey (NFHS) profile presents a paradox that contemporary health systems analysis cannot resolve. A state that leads north India in institutional delivery rates (94.3%, NFHS-5, highest in the region) and records one of its lowest infant mortality rates (approximately 14 per 1,000 live births, NFHS-5) simultaneously records child anemia at 71.1% (NFHS-5, exceeding the national figure of 67.1%), overweight or obesity in women aged 15 - 49 years at over 41% (among India five highest states), a caesarean section rate of 38.5% (far above WHO 10-15% optimal threshold), and a sex ratio at birth of only 904 girls per 1,000 boys. This review undertakes a descriptive secondary analysis of Punjab's health profile across NFHS-4 (2015 - 16), NFHS-5 (2019 - 21), and NFHS-6 (2023 - 24), integrating NFHS-6 national comparator data released in May 2026. It argues that this paradox cannot be explained by contemporary policy variables alone. The Green Revolution agricultural model itself, the product of refugee economic reconstruction after the Partition of 1947, created a dietary monoculture that underlies the present burden of anaemia. Partition-derived intergenerational trauma contributes to the chronic stress physiology measurable in community health indicators. The cultural devaluation of women entrenched during Partition's systematic gendered violence persists in a skewed sex ratio. The opioid epidemic is geographically concentrated in historically displaced border districts. Punjab NFHS data, read against its specific Partition history, establishes a case for recognizing the 1947 catastrophe as a historical social determinant of health with implications for community medicine practice and public health policy in Punjab and its diaspora.
Abstract Background Access to maternal healthcare services is essential for improving maternal and neonatal health outcomes. Health insurance can reduce financial barriers to healthcare access and may facilitate utilisation of maternal health services, and contextualized evidence can further support policy development and implementation. This study assessed the association between health insurance coverage and utilisation of antenatal care (ANC), institutional delivery, skilled birth attendance and postnatal care (PNC) services among women in Nepal. Methods This study used data from the 2022 Nepal Demographic and Health Survey (NDHS), a nationally representative cross-sectional survey. The analysis included women aged 15–49 years who had a live birth within the 24 months preceding the survey. Inverse probability of treatment weighting (IPTW) based on propensity scores was applied to balance measured socioeconomic and demographic characteristics between insured and uninsured women. Weighted marginal structural models were used to estimate the association between health insurance coverage and maternal health-care utilisation outcomes. Robustness was assessed using alternative propensity score specifications and E-values for unmeasured confounding. Results Among 14,845 women interviewed, 2,078 reported a recent live birth and were included in the analysis (unweighted; 1,998 when survey-weighted). Of these, 201 (9.7%) had health insurance coverage and 1,877 (90.3%) were uninsured. After adjustment using IPTW, health insurance coverage was associated with significantly higher utilisation of maternal healthcare services. Insured women had more than twice the odds of attending at least four ANC visits compared with uninsured women (AOR 2.14; 95% CI 1.15–3.98). Similarly, insured women had higher odds of receiving a PNC check-up within two days of delivery (AOR 2.05; 95% CI 1.28–3.27) and receiving PNC from a skilled provider (AOR 1.94; 95% CI 1.23–3.06). Although insurance coverage was positively associated with institutional delivery (AOR 1.55; 95% CI 0.91–2.62) and skilled birth attendance (AOR 1.57; 95% CI 0.90–2.72), these associations did not reach statistical significance. Conclusion Health insurance coverage was associated with greater utilisation of antenatal and postnatal healthcare services among women in Nepal. However, no significant association was observed for institutional delivery or skilled birth attendance. Expanding health insurance coverage, particularly among underserved populations, may help improve maternal healthcare utilisation and support progress towards universal health coverage and maternal health-related Sustainable Development Goals.
Yash Raj Lamsal, Abdulaziz Mohammed Hussen, Joyce Linda Browne et al.
