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.
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.
