This chapter focuses on the challenges and opportunities associated with the implementation of peace education programs in Africa. Peace education programs are used widely to create peaceful environments for at-risk children. Their intended goals are to end violence through modeling human consciousness to resolve conflicts peacefully and to provide children with a stable socioeconomic future. Using a systematic review of literature, the authors examine how humanitarian agencies with support from the World Bank utilize peace education programs to create safety nets for former child soldiers in Africa. The challenges and opportunities of such programs are examined. The authors then propose for the adoption of a community-based participatory practice to facilitate the sustainability of peace education programs. The chapter will benefit at-risk children in war-torn African regions and all stakeholders involved in the creation of safe environments for children.
Background Under-five mortality remains disproportionately high in least developed countries (LDCs), despite expanded access to routine childhood immunisation. This study examined six vaccine-specific associations with under-five mortality, the moderating role of government health expenditure (GHE), and variation across the mortality distribution. Methods An ecological longitudinal panel of 41 LDCs covering 2000 to 2023 was analysed. Six vaccine-specific models were estimated separately using country fixed effects with Driscoll-Kraay standard errors. Moderation was assessed using interactions between within-country-centred vaccine coverage and GHE. Split-panel jackknife method-of-moments quantile regression evaluated effects at the 25th, 50th, and 75th conditional quantiles. Results The findings showed vaccine-specific asymmetry, with direct and GHE-moderated effects varying in magnitude, significance and direction across the six vaccines. A 1% increase in coverage of the third dose of the diphtheria-tetanus-pertussis vaccine (DTP3), measles-containing vaccine (MCV), third dose of the Haemophilus influenzae type b vaccine (Hib3), and third dose of the polio vaccine (Pol3) was associated with reductions in under-five mortality of 0.229%, 0.162%, 0.072%, and 0.243%, respectively. Coverage of the third dose of the hepatitis B vaccine (HepB3) and Bacillus Calmette-Guérin vaccine (BCG) showed no significant average association. GHE attenuated the inverse associations for DTP3, MCV, BCG, and Pol3, strengthened the HepB3 association, and did not significantly moderate Hib3. Vaccine effects were generally strongest at the upper mortality quantile. Out-of-pocket health expenditure was positively associated with mortality, whereas gross domestic product per capita and basic sanitation coverage were inversely associated. Conclusions Routine immunisation was associated with improved child survival in LDCs, but the benefits varied by vaccine, financing conditions, and mortality level. Policies should prioritise effective delivery, preventive expenditure, and high-mortality populations.
Onome Bendalene Irikefe, Bernard Ojonugwa Anthony, Precious Suru Uleyo et al.
Adequate infrastructure plays a critical role in early childhood development (ECD) facilities providing high-quality early learning services. An ECD facility is a partial care facility that provides an early childhood programme that encompasses early learning and the development of children before they start formal schooling. Hence early learning in South Africa is primarily accommodated in privately owned facilities that range from registered to unregistered facilities. For this reason, the inadequate infrastructure that characterises conditions under which most ECD facilities operate in South Africa has been noted with concern in numerous studies. This paper assesses the state of the physical infrastructure of ECDfacilities in Philippi, an impoverished township in the City of Cape Town in the Western Cape. Owing to the regulatory function of the state in the ECD sector, through which compliance standards have to be met to secure subsidisation, the authors analyse the impact of ECD legislation on the state of ECD infrastructure in Philippi. The analysis shows statistical differences in the infrastructure of 10 registered and 10 unregistered facilities. The infrastructure differs partly due to the registration status and the location in which the facilities are situated. We therefore deduce that the current state’s avoidance of infrastructure investment in ECD facilities amounts to the denial of positive early learning outcomes to these children in Philippi.
The Nigeria Basic Health Care Provision Fund (BHCPF) is one of the most significant reforms in health financing in Nigeria. It was created to strengthen Nigeria's health sector, improve access to healthcare, strengthen Primary Health Centres (PHCs), support emergency response and public health security, and support vulnerable groups. The BHCPF is also intended to accelerate the country's shift towards Universal Health Coverage (UHC), so that Nigerians can access equitable and affordable medical care. The National Health Act of 2014 (Section 11) established the BHCPF specifically to guarantee steady funding for essential healthcare services. It helps lower the out-of-pocket costs that push families into poverty and concentrates on improving health outcomes for those who need it most — women, children, and low-income communities. This review provides an overview of what is known about the BHCPF since 2014, including how it was developed, how it has been used in practice, what has worked, how it is managed, and where it continues to face challenges. As of 2026, official documents, policy papers, and research articles present a mixed but broadly positive picture. The BHCPF has enhanced access to critical care, improved facility budget control, expanded the number of people covered by health insurance, and improved the consistency of PHC funding. However, implementation has been limited by governance concerns, delays in fund release, inadequate state-level capacity, weak accountability, and persistent regional inequities. The review concluded that although the BHCPF is a transformative health financing model, its future viability depends on reinforcing accountability frameworks, strengthening state-level preparedness, improving transparency, and ensuring sustainable funding.
Emmanuel Bola Jonah, Mary Ojonema Onoja- Alexander, Ogwuche Igoche John et al.
Background: South Africa has migrated the responsibility for early childhood development (ECD) centres from the Department of Social Services to the Department of Basic Education. This functional shift has ushered in consultations and discussions on how best to implement ECD, including opportunities the change may bring.Aim: By anchoring the understanding of ECD services in nurturing care, this study aimed to elucidate the provision of appropriate, inclusive services in early childhood development, including early childhood intervention, for children with disabilities in South Africa against the backdrop of the migration of services from one government ministry to another.Methods: This is an analytical article based on South African literature on ECD services, including interventions, with particular attention to children with disabilities, basing our understanding of these services in nurturing care.Results: We elucidate how the ideals of the Nurturing Care Framework can be achieved in the context of children with disabilities in South Africa using five themes: the need to localise services, developing tools and strategies for screening and early intervention, enhancing the efficacy of caregivers, supporting and training staff and collaborations.Conclusion: It is necessary to empower caregivers and professionals to address early childhood intervention and ECD needs of children with disabilities. Early childhood development centres are an important context for nurturing care, providing opportunities to promote and sustain health amongst a large number of children. Considering the function shift of ECD services in South Africa, these centres are well positioned to further nurturing care to children with disabilities through the provision of supportive environments that promote health and well-being.
Amani Karisa, Chantal Samuels, Brian Watermeyer et al.
Childhood immunization is a vital public health strategy for reducing morbidity and mortality associated with vaccine-preventable diseases. However, despite ongoing efforts by government and health agencies in Nigeria, immunization coverage remains suboptimal in many rural communities, including Jada Local Government Area of Adamawa State. This study examines the factors affecting the utilization of childhood immunization programmes in the area. The study adopts a descriptive research design, focusing on mothers and caregivers of children within the immunization age group. Data are collected using structured questionnaires, interview and analyzed to identify key determinants influencing immunization uptake. Findings reveal that limited knowledge and awareness of immunization benefits, misconceptions about vaccine safety, and negative cultural or religious beliefs significantly affect participation in immunization programmes. Additionally, socioeconomic factors such as low income, illiteracy, and competing domestic responsibilities hinder caregivers’ ability to access immunization services. Health system-related challenges are also identified, including inadequate healthcare facilities, long distances to vaccination centers, irregular vaccine supply, and insufficient healthcare personnel. Poor communication and lack of effective community mobilization further contribute to low immunization coverage. The study concludes that a combination of socio-cultural, economic, and institutional factors affects the success of childhood immunization programmes in Jada Local Government Area. It recommends intensified public health education, improved accessibility of immunization services, strengthening of healthcare systems, and active community engagement to enhance immunization uptake and safeguard child health.
Vaccine equity remains a major public health challenge in many low-and middle-income countries, where socioeconomic and spatial disparities continue to limit equitable access to childhood immunization services.Evidence regarding the independent drivers of vaccine equity in Plateau North Senatorial District, Nigeria, remains scarce.A cross-sectional study conducted in district among 400 mothers aged 15-49 years whose youngest child was aged 12-23 months.A multistage stratified sampling technique was used to select respondents across the six Local Government Areas of Plateau North Senatorial District.Data were collected using structured questionnaires and in-depth interviews.Descriptive statistics summarized respondents' characteristics, while Chi-square tests and binomial logistic regression analyses were used to identify factors associated with childhood immunization at a 5% significance level.Most respondents were aged 25-29 years (28.8%),tertiary education (51.0%), lived in rented accommodation (77.3%), resided in peri-urban communities (48.0%), travelled 3-4 km to access health facilities (58.5%) and 1-7 antenatal care visits (58.0%).Chisquare analysis showed that housing ownership status (χ² = 7.647, p = 0.022) had significant associations with childhood immunization.Binomial logistic regression revealed that housing ownership status (AOR = 2.074; 95% CI: 1.315-3.270;p = 0.002) and settlement type (AOR = 0.730; 95% CI: 0.545-0.978;p = 0.035) were significant independent predictors of childhood immunization.Maternal age, maternal education, distance to health facilities, and means of transportation were not significantly associated with childhood immunization after adjustment.The study concludes that vaccine equity in Plateau North Senatorial District is primarily influenced by socioeconomic and spatial inequalities.Interventions aimed at improving childhood immunization should prioritize disadvantaged households and underserved settlements through targeted outreach programmes, equitable healthcare delivery, and policies that reduce financial and geographic barriers to vaccination.
Introduction:Child malnutrition is a persistent global challenge. It is the cause of nearly 45% of global child mortalities. To ensure positive child health outcomes, integrated multisectoral approaches among families, communities, and government systems to ensure positive child health outcomes are neccesary.Objectives:This study identifies how different care support systems can be linked to ensure optimal childhood nutrition outcomes in South Africa. This is through multisectoral approaches from the early childhood development (ECD) practitioners' perspective.Materials and Methods:We integrated the components of the different support systems and multisectoral approaches. The conceptional framework of the causes of malnutrition by The United Nations Children's Fund (UNICEF) recognizes that malnutrition is due to inadequate care services, diet, and care practices influenced by individual, household, community, and structural determinants. While the Nurturing Care Framework, which looks at how policies and services can support families, parents, and other communities in providing nurturing care.Design:A sequential mixed methods approach was used. For the quantitative method, we did a cross-sectional descriptive analysis of 2 966 children who were under-five years' old in the 2017 South African National Income Dynamics Study (NIDS) between July and August 2022, we conducted five in-depth interviews with ECD practitioners using this qualitative method, and the data was analyzed using thematic analysis. Data was triangulated to understand the factors influencing children’s nutritional outcomes and to provide the narratives of ECD practitioners. This enabled us to highlight challenges and opportunities in linking children to services they need.Results:This study showed that 22.16% of children were stunted, 16.40% were overweight, and 5.04% were underweight. ECD practitioners reported a lack of support received at health facilities and other social services when making referrals, a lack of parental support in nutrition programmes, systemic challenges experienced in getting ECD centers registered, and the ECD's inability to qualify for subsidized nutrition grants.Conclusion:It is critical for us to understand the challenges and opportunities for multisector collaboration. This understanding will enable strategies and policies aimed at providing efficient and effective service referral and service delivery to improve childhood malnutrition in South Africa.
Background Childhood vaccine hesitancy is a significant public health concern. In Nigeria, it remains a major barrier to achieving optimal immunization uptake, contributing to preventable morbidity and mortality. Yet there remains a significant research gap on the synthesis of health communication strategies to address parental hesitancy to childhood vaccination. The primary aim and original contribution of the present review is to synthesize health communication strategies to address parental hesitancy to childhood vaccination in Nigeria. Method The review strategy was underpinned by the Population, phenomenon of interest and context (PICo) model. Hence, the population (parents, carers, or primary caregivers of children between the ages of 0 and 3 years), the phenomenon of interest (health communication strategies to address parental hesitancy to childhood vaccination), and the context (vaccine hesitancy). For qualitative studies, the PICo strategy, which is a modified version of PICO, was used. Boolean operators (AND/OR/NOT) were used to ensure rigor in adopting informed search terms. Six databases were searched for published articles between 2017 and March 2026. N = 12 studies met the inclusion criteria, and the relevant data were synthesized and analyzed using a thematic synthesis approach. The review protocol was pre-registered on the PROSPERO Registry (no. CRD420261303323). Findings The synthesized studies and analyses yielded the following main findings: (i) Media campaign strategies, (ii) State-sponsored communication strategies, (iii) Community-centered strategies, and (iv) Phone-based strategies. Conclusion Childhood vaccine hesitancy remains a major challenge in Nigeria. The review recommends that vaccine communication be culturally attuned and multi-channeled (e.g., embedding community-centered mechanisms—particularly those involving trusted religious and traditional leaders, media platforms, and mobile phone text messaging). It also recommends that vaccine communication be responsive to both structural constraints and community information need to address parental hesitancy to childhood vaccine uptake.
BACKGROUND: Childhood immunization is an important part of public health efforts to reduce morbidity and mortality from diseases that can be prevented by vaccination. Sub-Saharan Africa (SSA) has the lowest childhood immunization coverage and the highest child mortality rate in the world. Therefore, this study aimed to assess community variation in childhood immunization and to identify determinant factors associated with childhood immunization using mixed effect count regression models. METHOD: This study used data from the 2012-2022 Demographic and Health Survey (DHS), which included 195,000 children between the ages of 12 and 23 months in 33 SSA countries. A various mixed-effects count regression model were employed to identify the variables associated with the prevalence of childhood vaccination. RESULT: In SSA, the mean average childhood immunization was 5.47 (95% CI = 5.46, 5.48), with an 8.38 variance. The mixed effect zero-inflated Poisson model fit the data the best, with the lowest DIC, AIC, and BIC values. The results of the model showed that working mothers, mothers with secondary or higher education (IRR = 1.119; 95% CI: 1.114, 1.125), rich wealth status (IRR = 1.077; 95% CI: 1.073, 1.082), having a health card (IRR = 1.265; 95% CI: 1.258, 1.271), being exposed to the media (IRR = 1.082; 95%CI: 1.077, 1.086), institutional delivery (IRR = 1.168; 95% CI: 1.163, 1.174), receiving eight or more ANC visits (IRR = 1.301; 95% CI: 1.288, 1.314), receiving vitamin A (IRR = 1.350; 95% CI: 1.344, 1.355), using a contraceptive (IRR = 1.187; 95% CI: 1.182, 1.192) and receiving Postnatal Care (PNC) (IRR = 1.075; 95% CI: 1.071, 1.080), were associated with a higher incidence of childhood immunization. While children in rural areas (IRR = 0.972; 95%CI: 0.968, 0.976) had a lower prevalence of childhood vaccinations than children in urban areas. CONCLUSION: SSA had a low coverage of childhood vaccination with significant disparities among countries. Therefore, it is essential to prioritize public health initiatives that target low-income households, rural mothers, uneducated parents, and those who have not utilized maternal health care services for the sake of increasing the coverage of childhood immunizations that in turn enhances the health of children. Furthermore, it is imperative to create policies and initiatives that tackle regional and national variations in childhood immunization rates and to actively work toward their implementation.
