Background: Immunization is among the most cost-effective public health interventions, but awareness does not necessarily translate into timely completion of the schedule. This study assessed mothers' knowledge, attitude, and practice (KAP) regarding immunization of under-five children and factors associated with immunization status. Methods: A hospital-based cross-sectional study was conducted at the pediatric outpatient department of Assam Medical College and Hospital, Dibrugarh, from June 2015 to May 2016. In all, 360 mothers of under-five children were interviewed using a predesigned, pretested proforma. Associations were tested using chi-square and Fisher exact tests, with p<0.05 considered significant. Results: Overall, 322 mothers (89.44%) were aware of childhood immunization, the commonest source being health facilities (40.99%). Knowledge regarding the purpose of immunization (72.78%) and the correct starting age at birth (85%) was good; however, schedule-specific knowledge was weaker, notably the correct age for measles (46.67%) and the number of DPT doses (41.67%). Attitudes were largely favourable (86.11% considered immunization important). However, only 264 children (73.33%) were completely immunized; 51 (14.17%) were partially immunized and 45 (12.50%) unimmunized. Child sickness (46.88%) and lack of knowledge (39.58%) were the leading reasons for incomplete immunization, and lack of knowledge accounted for 62.38% of missed scheduled doses. Maternal literacy was associated with immunization knowledge, and immunization status with child sex and maternal religion (p<0.05). Conclusions: A clear knowledge–practice gap was evident; awareness and attitudes were favourable, but about one in four children was incompletely immunized. Schedule-specific counselling, appropriate advice during childhood illness and reduction of access barriers may help convert favourable attitudes into timely immunization.
Background: Respiratory syncytial virus (RSV) is a major cause of acute lower respiratory infection (ALRI) in infants, with low- and middle-income countries (LMICs) bearing a disproportionately high burden. While novel RSV prophylactic products including long-acting monoclonal antibodies and a maternal vaccine are being rolled out for protecting the general infant population in high-income countries, implementation in LMICs is only expected by 2028, potentially exacerbating health inequities. We aimed to assess regional inequality in infant RSV disease burden with and without the implementation of these interventions. Methods: We re-analysed the previous global RSV disease burden dataset in infants by WHO regions and World Bank Income Classification for the year of 2019 as a baseline, using generalised linear mixed-effects models. We developed a static deterministic model that explicitly accounted for the varied risks for RSV admission by birth month and chronological age in month and projected the annual RSV-associated ALRI hospital admissions and RSV-attributable deaths under two scenarios: a no-implementation scenario that assumed the same hospital admission and mortality rates to the 2019 baseline, and a June-2025 product use scenario that was based on country-level implementation status of novel RSV prophylactic products as of June 2025; the two scenarios were then compared to estimate the impact of the current implementation of novel prophylactic products. We further calculated the ratio of RSV-attributable deaths between the highest and lowest burden quintiles (Q5-Q1 ratio) to assess inequality under the two scenarios. Findings: At baseline, the African Region had the highest incidence of RSV-associated ALRI (117.4 per 1000 person-years, 95% uncertainty range, UR: 60.0-229.8) and highest RSV-attributable mortality rate (0.97 per 1000 person-years, 95% UR: 0.76-1.31) while having the lowest RSV-associated ALRI hospital admission rate (12.6 per 1000 person-years; 95% UR: 7.5-21.3); the Eastern Mediterranean Region had the highest hospital admission rate (29.9 per 1000 person-years, 95% UR: 14.2-63.2). The regional variations in incidence, hospital admission, and mortality rates persisted when further stratifying the above estimates by country income level. As of June 2025, nirsevimab and maternal RSVpreF had been licensed in 54 and 64 countries, respectively, with 16 and 12 countries introducing them into their national immunisation programmes. A total of 4,641,000 doses of nirsevimab and 1,955,000 doses of RSVPreF were estimated to be administered annually under the June-2025 product use scenario globally. Administration of both products was projected to jointly avert 91,000 (95% UR: 75,000-118,000) RSV-associated ALRI hospital admissions and 300 (95% UR: 210-470) RSV-attributable deaths in infants annually, corresponding to 3.7% (95% UR: 2.7-4.9) and 0.4% (95% UR: 0.3-0.7) of the global admissions and deaths, respectively. Approximately 90% of averted hospital admissions and over 70% of averted deaths in infants occurred in high-income countries (81,000 [95% UR: 66,000-108,000] and 220 [95% UR: 140-390], respectively), corresponding to reductions of 33.2% (95% UR 31.0-35.9) and 29.1% (95% UR 22.6-35.2); by contrast, the relative reduction of admissions and deaths in middle-income countries was less than 5%, and no reduction was expected in low-income countries. Globally, substantial inequality was observed in the RSV-attributable overall mortality burden under the no-implementation scenario, with the Q5-Q1 ratio of RSV-attributable deaths estimated at 18.3 (95% UR: 11.7-27.5). The June-2025 product use scenario was associated with a possible slight increase in global inequality, with the Q5-Q1 ratio rising to 20.8 (95% UR: 13.0-31.7). Interpretation: The global RSV burden in 2019 varied substantially by region and income level, with the African Region exhibiting the highest incidence and mortality but the lowest hospitalisation rates. The current implementation of novel RSV prophylactic products, characterised by widespread licensing and use in high-income countries and lack of availability in LMICs, particularly the African Region, is projected to yield only modest reductions in the global infant RSV disease burden. Critically, inequitable access to these products may exacerbate existing inequalities in RSV mortality burden. These findings underscore the urgent need for targeted strategies to accelerate the introduction and scale-up of infant RSV immunisation programmes in LMICs. Funding: World Health Organization and National Natural Science Foundation of China (82473692).
Pakistan is one of the ten countries with the least vaccinated children, and remains to face continued challenges, including endemic polio and periodic measles outbreaks. This study examines the regional disparities of basic vaccination coverage and the impact of socio-economic factors on its improvement between 2006 and 2018 by utilizing the data from the Pakistan Demographic and Health Surveys (PDHSs). The findings divulge significant regional disparities, with children in Sindh, Khyber Pakhtunkhwa (KP), and Balochistan being 18, 13.5, and 21.6 percentage points less likely, respectively, to be fully immunized as compared to children in Punjab. Higher household wealth correlates with increased immunization likelihood, and children of educated mothers are significantly more likely to be fully immunized. Moreover, male children are more likely to be fully immunized than female children, and antenatal care and institutional births further enhance vaccination rates. A nonlinear decomposition analysis shows a 20.2 percentage point increase in coverage during this period, with given factors explaining 45% of this rise. These results underscore the need for targeted interventions in underserved regions, socio-economic support for low-income families, educational initiatives for mothers, and enhanced antenatal care and institutional delivery services to improve nationwide vaccination rates.
Muhammad Irfan Malik, Muhammad Nadeem, Asad Ul Islam Khan
OBJECTIVES: Infant respiratory syncytial virus (RSV) prevention has moved from selective palivizumab prophylaxis toward broader protection through long-acting monoclonal antibodies and maternal vaccination. We examined how this research area evolved and whether original studies address evidence needed for implementation at scale. MATERIALS AND METHODS: We conducted a bibliometric analysis and evidence-gap mapping study of Web of Science Core Collection records from 1998 to 2025. The bibliometric corpus included 2004 publications; 1581 original articles underwent relevance screening and targeted audit, yielding 1227 studies for evidence-gap mapping. Analyses compared 1998-2022 with 2023-2025. A random sample of 150 articles was used to validate relevance screening. RESULTS: Publication output rose sharply after 2022, with 2023-2025 accounting for 35.0% of the bibliometric corpus. Earlier work centered on palivizumab, preterm infants, and hospitalization; recent studies increasingly addressed nirsevimab, maternal RSV vaccination, implementation, and vaccine candidates. Hospitalization outcomes, disease burden, monoclonal antibody strategies, and real-world effectiveness were well represented, whereas coverage/uptake, acceptance, equity, safety monitoring, economic evaluation, applicability to low- and middle-income countries, and coordination between maternal vaccination and infant monoclonal antibodies were less common. Validation showed 86.7% agreement (Cohen's kappa = 0.52). CONCLUSIONS: The literature has shifted toward broad infant RSV protection, but implementation-relevant evidence remains uneven. Comparative and program-level research is needed to determine how maternal vaccination and infant monoclonal antibody strategies can be implemented and coordinated across health systems while minimizing missed opportunities for protection.
The first 1,000 days, from conception to a child's second birthday, shape maternal survival, newborn health and the course of early child development. Nurses and midwives deliver most of the care received in this period, yet evidence on their contribution is usually reported one stage at a time. This narrative review brings that evidence together across the whole continuum. PubMed/MEDLINE, Scopus, Web of Science, CINAHL, Embase, the Cochrane Library, WHO IRIS and UNICEF repositories were searched for English-language publications from January 2019 to June 2026, and current WHO guidance was consulted. Eighteen key studies were charted and synthesised thematically. Midwife continuity of care increased spontaneous vaginal birth and reduced caesarean and instrumental birth, although its effect on preterm birth was small or uncertain. Midwife-delivered bundles for postpartum haemorrhage, basic newborn resuscitation training, deferred cord clamping and immediate kangaroo mother care reduced severe morbidity or mortality in trials from low- and middle-income countries. Kangaroo mother care also lowered maternal depressive symptoms, and breastfeeding support reduced early cessation of exclusive breastfeeding. Parenting programmes improved early child development, whereas intensive nurse home visiting in one large trial did not change birth outcomes. Two-way mobile health communication increased antenatal attendance and skilled birth attendance. Three gaps remain: in coverage, in quality and in continuity between facility and community, with the second year of life the least studied. Closing them requires adequate nursing and midwifery staffing, competency-based education and services that follow the mother–child pair through all 1,000 days.
Basic immunization coverage in the working area of Grogol Primary Health Center has not yet reached the national target, highlighting the need for effective strategies to improve maternal compliance with childhood immunization schedules. This study aimed to analyze the effect of a Google Calendar–based immunization reminder on maternal compliance with the basic immunization schedule for infants. A quasi-experimental study with a pretest–posttest control group design was conducted among 60 mothers of infants aged 0–9 months, selected using purposive sampling. Participants were assigned to an intervention group (n=30), which received Google Calendar–based immunization reminders, or a control group (n=30), which received routine immunization services. Compliance was assessed using the Maternal and Child Health (MCH) Handbook observation sheet and a Guttman-scale questionnaire. Data were analyzed using the McNemar and Chi-square tests, with a significance level of p<0.05. Compliance in the intervention group increased from 46.7% at baseline to 83.3% after the intervention (p=0.013), whereas the control group showed a non-significant increase from 36.7% to 46.7% (p=0.250). Post-test comparison demonstrated significantly higher compliance in the intervention group than in the control group (p=0.003). Google Calendar–based reminders effectively improved maternal compliance with the infant basic immunization schedule by providing timely automated notifications. This simple digital intervention has the potential to support immunization services and enhance immunization coverage in primary healthcare settings.
Laksmita Galuh Adityarie, Dwi Estuning Rahayu, Finta Isti Kundarti et al.
The study examines the role of institutional engagement in shaping child immunisation outcomes in the Barak Valley region of Assam, India, focusing on frontline health workers. Using primary survey data collected from 400 households across selected rural and urban communities, the analysis finds that more-frequent interactions with accredited social health activists are strongly associated with higher odds of full immunisation. Households that report limited or no contact with frontline health workers are significantly less likely to have fully immunised children. These findings indicate an association between institutional engagement and immunisation coverage. Beyond confirming the importance of frontline health workers, the study suggests that the intensity of institutional engagement is a stronger predictor of complete child immunisation than rural–urban location. The findings suggest that strengthening the quality and continuity of household-level outreach may yield greater public health gains than interventions based solely on geographic targeting, particularly in underserved and resource-constrained regions.
Maternal mortality remains a significant public health challenge in low- and middle-income countries. Maternal sepsis, severe anaemia, delayed referral, and inadequate access to emergency obstetric care continue to contribute to maternal and neonatal morbidity, particularly in rural India. Strengthening Comprehensive Emergency Obstetric and Newborn Care (CEmONC) services at Community Health Centres (CHCs) is essential for improving pregnancy outcomes and reducing preventable maternal deaths. This case series describes five representative maternal health interventions undertaken at Community Health Centre (CHC) Faridpur, Bareilly, Uttar Pradesh. The series includes emergency management of maternal sepsis with severe anaemia, life-saving emergency caesarean section in a critically ill pregnant woman following unsuccessful referral, implementation of a telephonic follow-up system for high-risk pregnancies, promotion of respectful maternity care through innovative discharge practices, and strengthening of institutional delivery services. Timely clinical assessment, multidisciplinary teamwork, adherence to evidence-based obstetric protocols, and patient-centred care resulted in favourable maternal and neonatal outcomes while improving continuity of antenatal care and community confidence in public health services. This case series demonstrates that strengthened emergency obstetric services, early recognition of high-risk conditions, coordinated multidisciplinary management, and innovative maternal health interventions can substantially improve maternal and neonatal outcomes in rural secondary healthcare settings. The experiences from CHC Faridpur provide a practical model for enhancing quality maternity care in resource-constrained environments.
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.
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.
