Conventionally, vaccine design has focused on identifying antigens that induce durable T and B cell memory and provide long term protection against subsequent encounters with the same pathogen. Unconventionally, a growing number of epidemiological, preclinical, and clinical studies demonstrate that live vaccines, including Bacillus Calmette Guérin (BCG), measles-containing vaccines, and oral polio vaccine, induce protection through trained immunity, a form of metabolically and epigenetically mediated memory in innate immune cells and their progenitors. This concept is particularly relevant during early life, when adaptive immune responses are constrained and innate immunity represents the principal line of host defence. In this review, we discuss the unique characteristics of neonatal and infant immunity, summarize current evidence for trained immunity induced by childhood vaccines, and describe the bidirectional interplay between innate and adaptive immune memory. We further highlight the potential of trained immunity to broaden protection against severe infections, improve vaccine efficacy, and provide therapeutic opportunities for non-infectious paediatric diseases, including cancer and allergic disorders. Harnessing trained immunity represents a conceptual shift in paediatric vaccinology and may guide the development of next generation vaccines that provide broader and more resilient protection during the period of greatest immunological vulnerability.
ChenRongRong Cai, Lubnaa Hossenbaccus, Eva Kaufmann
BACKGROUND: Mother-to-child transmission (MTCT) is an important route of new hepatitis B virus (HBV) infections. In Africa, limited and conflicting data on the effectiveness of hepatitis B birth dose vaccination (HepB-BD) have contributed to fragmented adoption and sub-optimal implementation. We aimed to assess the effectiveness of timely HepB-BD in preventing HBV MTCT in Ethiopia. METHODS: We conducted a multi-centre cross-sectional observational study in Ethiopia from May 2022 to June 2024. We identified mothers who had tested positive for hepatitis B surface antigen (HBsAg) during pregnancy and assessed mother-infant pairs at 6-12 months post-partum for HBV MTCT. We stratified effectiveness of HepB-BD by maternal risk profile (HBV DNA level, hepatitis B e-antigen (HBeAg) status). RESULTS: The analysis included 387 children born to HBV-positive, HIV-negative mothers who had completed routine HBV vaccination (HepB3). The median age of infant testing was 10 months (IQR 7.0-11). Overall MTCT risk was 5.2% (95% CI 3.4,7.8). MTCT was significantly lower among infants receiving HepB-BD alone (0/39, 0% [95% CI 0-9.0]) compared to those without immunoprophylaxis at birth (20/131, 15.3% [95% CI 10.1-22.4]) (p = 0.009). No transmission occurred with HepB-BD plus HBIg (0/217, 0% [95% CI 0-1.7]). Maternal viral load >200,000 IU/ml (AOR 16.6, 95% CI 4.82,57.19) and HBeAg positivity (AOR 4.21, 95% CI 1.08,16.44) were associated with increased MTCT risk amongst infants without immunoprophylaxis at birth. CONCLUSIONS: In Ethiopia, the current vaccination series starting at 6 weeks is insufficient to prevent HBV MTCT. Timely HepB-BD is highly effective in reducing HBV MTCT and should be prioritised for scale-up in Africa.
Nega Berhe, Hailemichael Desalegn, Hiwot Mengistu et al.
Abstract Objectives To estimate age trajectories of infant mortality among Palestinian refugees using electronic health records, addressing the scarcity of reliable mortality data in forced displacement settings. Setting Palestinian refugees living in Gaza, West Bank, Jordan, Syria and Lebanon. Design We fitted a Bayesian Negative Binomial model to observed death counts, using a flexible parametric function (a shifting power function) to capture the shape of the infant mortality curve, across strata to infer age trajectories of infant mortality. Participants Palestinian refugees born in 2010–2020 and registered with UNRWA health services in Gaza, West Bank, Jordan, Syria and Lebanon. The sample was stratified by sex, field, gestational age and birth cohort. Main outcome measures Survival rate to age 1. Results Overall, the survival rate to age 1 was 98.64%, with slightly lower rates for males (98.57%) than females (98.68%). Across settings, West Bank refugees had the lowest infant mortality (99.08% survival rate), and Jordan refugees had the highest (98.22% survival rate). Results by gestational age showed a 98.85% survival rate at age 1 among term births compared to a 73.32% survival rate among very preterm births. Survival rates by cohort (births up to 2015 or after) were 98.78% and 98.42%, respectively. Conclusion Our findings highlight the potential of electronic health records for mortality monitoring in forced displacement settings as they reveal consistent mortality trajectories by sex and gestational age, while identifying meaningful variation across refugee settings and subgroups. Summary boxes What is already known in this topic We searched PubMed and Google Scholar for articles published between Jan 1, 2000, and Feb 20, 2026, in English, using the terms “Palestinian refugees,” “infant mortality,” “neonatal mortality,” and “UNRWA.” We found a handful of studies estimating infant mortality among Palestinian refugees, mostly based on household surveys (eg, MICS, national statistical office surveys) or UNRWA surveys using preceding birth techniques. The preceding birth technique has notable limitations, including recall bias, small sample sizes, and selection bias. The majority of these studies focus exclusively on Palestinian refugees residing in Gaza. Estimates for Gaza suggest a sustained decline, from around 127 deaths per 1,000 births in 1960 to 20.2 per 1,000 births in 2006, with a slowdown thereafter and an increase in more recent years. A combined estimate (excluding Syria) across four settings where Palestinian refugees reside measures infant mortality at 18 per 1,000 births in 2011. What this study adds This study uses a unique data linkage bringing together UNRWA’s obstetric and child health records, providing more extensive information and a larger sample size than previous studies. This is also the first study to assess the data quality of these electronic records and to estimate age trajectories of infant mortality among Palestinian refugees. We developed a statistical strategy that estimated infant mortality trajectories covering all five UNRWA fields (Gaza, Jordan, Lebanon, Syria, and the West Bank) for children born in 2010-2020, and examined differences across subpopulations by sex, field, gestational age and cohort.
Maternal healthcare-seeking behaviour (MHSB) is a key determinant of childhood vaccination rates. In rural Nigeria, MHSB remains low and has been associated with poor maternal and child health outcomes. However, empirical evidence linking MHSB to timely childhood immunisation, particularly among agricultural households in rural Nigeria, is limited. This study therefore examined the effect of maternal healthcare-seeking behaviour on timely childhood vaccination among agricultural households in rural Nigeria. The study utilised secondary data from the 2018 Nigeria Demographic and Health Survey (NDHS). Information on vaccines received by children, prenatal care, timing of first antenatal visit, number of antenatal visits, skilled birth attendance, and postnatal care was extracted for 2,751 rural women with under-five children in agricultural households. Data was analysed using descriptive statistics, multiple correspondence analysis (MCA) to generate the MHSB index, and an extended ordered probit model. The findings show that women in agricultural households in rural Nigeria moderately utilise maternal healthcare services, with a mean MHSB index of 0.54, while 55.83% of children were unimmunised. Maternal healthcare-seeking behaviour and husband’s education significantly improved partial vaccination status, while husband’s education and mother’s full-time employment in agriculture were associated with improved full vaccination status in children. Maternal healthcare-seeking behaviour positively influences child immunisation status among agricultural households in rural Nigeria. Strengthening policies that promote maternal healthcare utilisation and expanding access to antenatal and vaccination services particularly through community and market-based health centres and male involvement are essential to improving vaccination coverage in rural Nigeria.
Mobolaji Victoria Adejoorin, Kabir Kayode Salman, Mutiat Bukola Salawu et al.
Abstract Adverse childhood experiences, such as abuse and neglect, have been shown to have longstanding negative consequences on a child’s development and outcomes. Studies have noted that there is variation in how youth in child welfare respond to adversity, yet few studies have examined the psychometrics of measures of resilience in this population. In particular, the 14-item Resilience Scale (RS-14) is a widely used instrument yet has not been evaluated for use with adolescents in child welfare populations. The purpose of the study was to describe the levels of resilience reported by adolescent girls involved in the child welfare system and to evaluate the reliability, validity, and factor structure of this scale in this population. Participants were 249 adolescent girls, ages 12–19, who were involved in the child welfare system. Interviews assessed resilience, symptoms of post-traumatic stress, depression, social problem-solving, and demographic variables. Results indicated that levels of resilience among the participants were in the moderate range. The RS-14 demonstrated evidence of good internal consistency and test–retest reliability. Convergent and discriminant validity were established. Confirmatory factor analysis testing a single-factor solution resulted in a weak model fit. A follow-up exploratory factor analysis supported a two-factor solution. Findings suggest this instrument is an appropriate tool for use in child welfare populations.
Pregnancy is a highly anticipated stage in a woman’s life, yet it is also a period associated with various health risks. Pregnancy complications and warning signs may go unrecognized, including nutritional problems that can adversely affect maternal and fetal health. Several maternal and pregnancy-related nutritional issues remain prevalent, such as chronic energy deficiency (CED), low birth weight (LBW), and anemia. This study aimed to determine the effectiveness of a nutrition education intervention using the Nutrition Snakes and Ladders game in improving pregnant women’s knowledge and attitudes toward nutrition during pregnancy. A quantitative quasi-experimental study was conducted using a non-equivalent pretest–posttest control group design at Banjarejo Community Health Center. A total of 40 pregnant women were recruited through cluster random sampling and allocated into an intervention group receiving the Nutrition Snakes and Ladders* educational game (n = 20) and a control group receiving conventional education through the Maternal and Child Health (MCH) Handbook (n = 20). Data were collected using a validated and reliable questionnaire and analyzed using the Wilcoxon Signed-Rank test and Mann–Whitney U test, with a significance level of 0.05. Following the intervention, the proportion of pregnant women with good nutritional knowledge in the intervention group increased to 95.0%, while those demonstrating positive attitudes reached 100.0%. The Wilcoxon test revealed a statistically significant difference in knowledge and attitudes before and after the intervention (p = 0.000). Furthermore, the Mann–Whitney U test demonstrated significant differences in knowledge and attitudes between the intervention and control groups (p = 0.001). The Nutrition Snakes and Ladders game was shown to be an effective educational medium for improving pregnant women’s nutritional knowledge and attitudes. As an interactive and easy-to-understand approach, this game may serve as an alternative health education strategy to support improved maternal and fetal health during pregnancy.
Verlingga Diah Oktiasa Putri, Triana Septianti Purwanto, Tinuk Esti Handayani et al.
Introduction: Breastfeeding is a double-duty action proposed to protect simultaneously against undernutrition and overnutrition, yet the shape of the duration–response relationship between breastfeeding and nutritional status in early childhood remains contested, particularly in settings experiencing the double burden of malnutrition. This review aimed to synthesise primary evidence published in the last five years on the association between breastfeeding duration (≤1, 3–5, 6, 6–11 and ≥12 months) and the full spectrum of nutritional status (stunting, underweight, normal weight, overweight and obesity) in children aged 2–6 years. Methods: The study strictly adhered to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020 guidelines. Randomised controlled trials (RCT), prospective and retrospective cohort, case-control and cross-sectional studies were eligible; systematic reviews and meta-analyses were excluded from the evidence tables but used in the discussion. Risk of bias was appraised with a ROBINS-E-adapted domain tool and the Newcastle–Ottawa Scale (NOS) for observational studies and RoB 2 for randomised evidence. Where estimates were comparable, ratio measures were oriented as longer/any versus shorter/no breastfeeding and pooled using DerSimonian–Laird random-effects models, with subgroup, leave-one-out, cumulative, meta-regression and small-study analyses. Certainty was graded with GRADE. Results: 41 studies from 25 countries met eligibility (40 observational, one secondary analysis of a cluster-RCT), comprising more than 161,000 children in the 37 studies that reported sample size. Twenty-seven studies addressed over-nutrition and 13 under-nutrition. Longer or any breastfeeding was associated with lower odds of overweight/obesity (10 estimates from 9 studies; pooled ratio 0.71, 95% CI 0.63–0.80; I² = 60.8%; 95% prediction interval 0.50–1.01), robust to leave-one-out and trim-and-fill adjustment (0.73, 0.64–0.83). The association was stronger for exclusive breastfeeding (0.61, 0.53–0.71) than any/full breastfeeding (0.76, 0.66–0.86; P-between = 0.036) and for obesity (0.55, 0.43–0.71). All seven continuous estimates showed lower BMI z-scores with longer breastfeeding (−0.02 to −0.50). For stunting, pooling was dominated by extreme heterogeneity (0.49, 0.08–3.17; I² = 98.4%) driven by a national survey showing higher stunting with breastfeeding into the third year; after its exclusion the association was protective and homogeneous (0.27, 0.19–0.38; I² = 0%). Most observational studies had some concerns (65.0%) or high (35.0%) overall risk of bias, principally from confounding and recall-based exposure measurement. Discussion: The evidence is compatible with a protective, approximately monotonic association between longer (particularly exclusive) breastfeeding and overweight/obesity at 2–6 years, with benefit already apparent after 3–5 months and extending beyond 12 months. For linear growth, exclusive breastfeeding to 6 months and continued breastfeeding into the second year are associated with less stunting, whereas the apparent harm of breastfeeding beyond 24 months in food-insecure settings is most plausibly explained by reverse causation and inadequate complementary feeding rather than by breast milk itself. Conclusion: Longer breastfeeding is associated with a more favourable nutritional status in early childhood, particularly lower overweight and obesity, with low-certainty evidence; the association with stunting depends on complementary-feeding context and is of very low certainty. Programmes should protect exclusive breastfeeding for six months and continued breastfeeding with adequate complementary feeding, while future cohorts should use prospectively recorded duration categories and causal designs.
Stunting is a disorder of child growth that is caused by a mother’s nutritional status during pregnancy, suboptimal breastfeeding practices, and dietary patterns that do not meet nutritional needs. One of the regions implementing the stunting reduction policy is Sidoarjo Regency under its Health Department. However, less research specifically analyzing how the Health Department integrates organizational, program, resource support, and institutional strategies as the leading sector for accelerating stunting reduction. Therefore, this study aims to analyze the strategies of the Sidoarjo Regency Health Department to hasten the reduction of stunting and explain how integrating these four strategic dimensions contributes to achieving this goal. This study employed a qualitative method, and the research informants included officials from the Sidoarjo District Health Department, health workers, Posyandu cadres, and other stakeholders involved in the program’s implementation. The results show that accelerating the reduction of stunting requires integrating Corporate Strategy, Program Strategy, Resource Support Strategy, and Institutional Strategy into a mutually supportive governance system. Corporate Strategy provides direction for policy and organizational governance; Program Strategy translates policy into integrated interventions; Resource Support Strategy ensures the availability of resources; and Institutional Strategy strengthens cross-sectoral collaboration. Therefore, the effectiveness of implementation is determined by the integration of all four dimensions through mechanisms of coordination, monitoring and evaluation, organizational learning, and continuous feedback. The proposed conceptual model expands on Kooten’s strategic perspective by positioning strategic integration as the foundation of adaptive governance in accelerating the reduction of stunting.
Fajar Muharram, Fauzan Romadlon, Dian Alviana et al.
Professional development for Early Childhood Education (ECE) teachers requires a growth mindset to address instructional challenges and limited access to training, particularly in rural areas. This study aims to examine the association between growth mindset and professional development orientation among ECE teachers in Manggarai Regency, East Nusa Tenggara, Indonesia. Using a descriptive quantitative survey approach, data were collected through a closed-ended Likert-scale questionnaire completed by 29 teachers. Data were analyzed using descriptive statistics (means, standard deviations, and score ranges) across four categories: growth mindset, professional engagement, reflective teaching, and perceived impacts on children’s behavior. The results indicate a strong growth mindset (M = 3.98) and high professional engagement (M = 4.03), although participation in learning communities varied; reflective teaching was also high (M = 3.94), and teachers reported increased children’s independence and learning enthusiasm (M = 3.98). These findings imply the need for context-specific training and strengthened teacher collaboration/learning communities to enhance reflective practice and improve the quality of ECE provision.
Malda district is presently facing a complex nutrition challenge marked by the co–existence of undernutrition and rising lifestyle-related diseases. High levels of anemia, child stunting and underweight persists among women and young children, while overweight, diabetes and hypertension are increasingly observed among adult women. Although calorie intake may be adequate in many households, poor dietary diversity and limited intake of nutrient-rich foods contribute to hidden hunger. Field-level assessments by ICAR-CISH KVK indicated inadequate diversity in household diets, particularly among women. In response, structured nutri-garden models were promoted to enhance yearround availability of vegetables, fruits, legumes and herbs within homesteads. The circular and rectangular models, supported by season-wise crop planning, align with ICMR–NIN dietary guidelines and offer a practical, affordable and locally adaptable strategy to improve diet quality and strengthen household nutritional security in Malda district.
Pavuluri Yasaswini, DUSHYANT KUMAR RAGHAV, Shivam et al.
