Mortality following severe acute malnutrition (SAM) remains high in Africa. Some children with SAM have altered immune responses and impaired neurodevelopment; however, whether vitamin D deficiency contributes to these poor outcomes remains unclear. We conducted a cross-sectional analysis of circulating 25-hydroxyvitamin D [25(OH)D] concentrations at hospital discharge (25(OH)D) in 442 children aged 0-59 months with SAM at one hospital in Lusaka, Zambia, and two hospitals in Harare, Zimbabwe. Also, we investigated the relationship between 25(OH)D concentrations and host factors. In 442 children, plasma 25(OH)D concentrations were measured using ELISA. Vitamin D deficiency was identified in 33/442 (7.5%; 95% CI: 5.2-10.3) children, all of whom were from Zimbabwe. A multivariable regression model that included age, sex, HIV status, season, oedema, cerebral palsy, and country demonstrated significantly higher 25(OH)D levels among children aged 6-11 months (adjusted (adj) ratio; 1.3; 95% CI: 1.1, 1.6; P = 0.003), 12-23 months (adj ratio; 1.5; 95% CI: 1.3, 1.8; P < 0.001), and 24-59 months (adj ratio; 1.5; 95% CI: 1.3, 1.8; P < 0.001) compared with those <6 months. Sampling during the cool season (adj ratio; 1.2; 95% CI: 1.1, 1.3; P = 0.002), absence of cerebral palsy (adj ratio; 1.2; 95% CI: 1.1, 1.4; P = 0.002) and residence in Zambia (adj ratio; 1.2; 95% CI: 1.1, 1.2; P < 0.001) were associated with higher concentrations of 25(OH)D, even after excluding children <6 months. These findings indicate that vitamin D status among children with SAM is significantly influenced by age, seasonality, cerebral palsy, and geographical location. To facilitate management and improve clinical outcomes in these children, we recommend further investigation into whether the current vitamin D content in ready-to-use therapeutic foods is sufficient for all children and whether additional supplementation improves clinical outcomes, especially in high-risk groups. If deficiency is present, we recommend that children be managed in accordance with local guidelines and policies.
Tracy Naomi Phiri, Cherlynn Dumbura, Kuda Mutasa et al.
This paper examines the persistent urban–rural divide in early childhood care and education (ECCE) teacher professional development in South Africa. Drawing on peer-reviewed literature, policy analysis, and comparative data, the study explores how geographic location influences access to accredited training, qualification levels, institutional support, material resources, and professional identity. Urban ECCE teachers benefit from proximity to higher education institutions, regular workshops, and structured career pathways, while rural practitioners often face isolation, under-resourcing, and lack of formal recognition. The paper further analyses structural and contextual constraints in rural settings, such as infrastructural deficits, digital exclusion, and policy implementation failures. Through teachers’ lived experiences, the paper presents a grounded understanding of the inequities that shape professional development trajectories. Comparative indicators highlight the systemic nature of these inequalities and the urgent need for targeted, context-sensitive policy interventions. The paper concludes with practical recommendations to strengthen rural ECCE teacher development through inclusive governance, localized training models, resource redistribution, and the recognition of experiential knowledge.
How to cite: Stofile, S & Ngece, S 2026, ‘Writing anxiety: A barrier to early isiXhosa literacy development’, 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. 247–263. https://doi.org/10.4102/aosis.2026.BK568.12
INTRODUCTION: Recent reports from Kampala indicate low uptake and completion of the human papillomavirus (HPV) vaccine among adolescents, especially amongst those living with HIV. However, the drivers of this low uptake are poorly understood. This study aimed to determine the current HPV vaccine coverage; assess the knowledge, attitude and practices influencing HPV vaccine uptake among adolescent girls living with HIV; and pilot an HPV vaccination program while documenting lessons learned and experiences at two urban HIV treatment centres the Joint Clinical Research Centre (JCRC) and Mildmay Uganda in Kampala, Uganda. METHODS: This was a descriptive cross-sectional mixed methods study employing both qualitative and quantitative data collection methods, carried out between 03/12/2024-30/08/2025, among adolescent girls living with HIV in Kampala, Uganda. A total of 371 were enrolled, of which 182 from JCRC and 189 from Mild May Uganda. At enrolment, 11 adolescents declined consent to participate. Quantitative data on knowledge of HPV and HPV vaccination was collected through interviews, with any additional demographic data being obtained from medical records at the treatment centres. Qualitative data included four focused group discussions (FGDs) of adolescent girls and 32 key informant interviews (KIIs) with focal health workers (Paediatricians, nurses, counsellors) at the two centres were conducted. RESULTS: Overall, 138/371 (37%) of the adolescents reported having heard about the HPV vaccine, while 233/371 (63%) had not. At enrolment, only 51 out of 371 (14%) participants had initiated vaccination. Among those who initiated vaccination, 51% had received only the first dose. By the end of the study, 342/371 (92%) of adolescents had completed the recommended two doses of the HPV vaccine. This study focused on increasing vaccine uptake amongst the HIV positive adolescents at the two centres. Most adolescents with a good level of knowledge about HPV or those attending school reported to have initiated vaccination. Identified barriers to vaccine uptake included inadequate knowledge about HPV and the benefits of vaccination; limited availability of HPV vaccines, and the absence of routine HPV immunisation programs within HIV treatment centres or programs specifically targeting adolescents living with HIV. CONCLUSION: In these two urban HIV care and treatment centres, vaccination against HPV among eligible adolescents is way lower than recommended 90 percent. Adolescent girls living with HIV demonstrated low levels of knowledge about the HPV vaccine and poor access to vaccination services, despite being receptive to vaccination. This study showed that HPV vaccine uptake can be substantially improved within HIV care and treatment centers by reducing barriers to HPV vaccination uptake when the vaccines are made readily available and accessible, either in existing HIV care and treatment centres or in the new integrated care centres in areas where government programs have moved to implement HIV care integration into mainstream medical services.
Oliver Ombeva Malande, Deogratias Munube, Julia Jerono Songok et al.
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.
