Abstract Background Access to maternal healthcare services is essential for improving maternal and neonatal health outcomes. Health insurance can reduce financial barriers to healthcare access and may facilitate utilisation of maternal health services, and contextualized evidence can further support policy development and implementation. This study assessed the association between health insurance coverage and utilisation of antenatal care (ANC), institutional delivery, skilled birth attendance and postnatal care (PNC) services among women in Nepal. Methods This study used data from the 2022 Nepal Demographic and Health Survey (NDHS), a nationally representative cross-sectional survey. The analysis included women aged 15–49 years who had a live birth within the 24 months preceding the survey. Inverse probability of treatment weighting (IPTW) based on propensity scores was applied to balance measured socioeconomic and demographic characteristics between insured and uninsured women. Weighted marginal structural models were used to estimate the association between health insurance coverage and maternal health-care utilisation outcomes. Robustness was assessed using alternative propensity score specifications and E-values for unmeasured confounding. Results Among 14,845 women interviewed, 2,078 reported a recent live birth and were included in the analysis (unweighted; 1,998 when survey-weighted). Of these, 201 (9.7%) had health insurance coverage and 1,877 (90.3%) were uninsured. After adjustment using IPTW, health insurance coverage was associated with significantly higher utilisation of maternal healthcare services. Insured women had more than twice the odds of attending at least four ANC visits compared with uninsured women (AOR 2.14; 95% CI 1.15–3.98). Similarly, insured women had higher odds of receiving a PNC check-up within two days of delivery (AOR 2.05; 95% CI 1.28–3.27) and receiving PNC from a skilled provider (AOR 1.94; 95% CI 1.23–3.06). Although insurance coverage was positively associated with institutional delivery (AOR 1.55; 95% CI 0.91–2.62) and skilled birth attendance (AOR 1.57; 95% CI 0.90–2.72), these associations did not reach statistical significance. Conclusion Health insurance coverage was associated with greater utilisation of antenatal and postnatal healthcare services among women in Nepal. However, no significant association was observed for institutional delivery or skilled birth attendance. Expanding health insurance coverage, particularly among underserved populations, may help improve maternal healthcare utilisation and support progress towards universal health coverage and maternal health-related Sustainable Development Goals.
Yash Raj Lamsal, Abdulaziz Mohammed Hussen, Joyce Linda Browne et al.
Viral hepatitis is a public health problem in India. The National Viral Hepatitis Control Program (NVHCP) launched in 2018 paved a way in India’s journey towards universal health coverage but gaps remain in diagnostics, peripheral capacity, vaccine supply, and pediatric treatment access. This review maps the history of the program in India, its current status, gaps, and opportunities toward the 2030 elimination goals. For the purpose of this review, a comprehensive search of literature was conducted examining technical and operational guidelines, management protocols, policy documents, and review articles to understand India's journey towards viral hepatitis control. The program demonstrates multiple strengths including strong government commitment, comprehensive national guidelines, free diagnosis and treatment services, robust preventive strategies, and trained master trainers. However, several weaknesses exist as well like insufficient diagnostic infrastructure, limited molecular testing capacity, inadequate trained manpower at peripheral centers, erratic hepatitis B vaccine supply, vertical transmission prevention gaps, and no free treatment provision for children. The opportunities outlined include newer WHO guidelines extending treatment to children and adolescents, point-of-care diagnostic facilities, public-private partnerships, one-stop centers, dried blood spot testing, treat-all approaches, and establishing an adult immunization program. Major threats foreseen are competing national health programs diverting resources, dropout from diagnosis-treatment cascade, public and healthcare worker stigma, and limited private practitioner participation in the program. Although NVHCP has a robust framework aligned with global strategies, addressing gaps in awareness, logistics, and peripheral-level manpower through equity-focused innovation is essential to achieve 2030 elimination targets and advance universal health coverage.
Objective: To determine the frequency of measles vaccination among children under 5 years of age presenting with measles and to compare the outcomes between vaccinated and unvaccinated children. Outcomes were defined as (i) prolonged hospital admission of two days or more (primary outcome, taken as the marker of severe disease) and (ii) measles-related complications (secondary outcome). Methods: This descriptive cross-sectional study was conducted at the Department of Paediatrics, Benazir Bhutto Hospital, Rawalpindi, from October 2025 to December 2025, and reported in accordance with the STROBE guidelines for cross-sectional studies. A total of 150 children aged 1–5 years of either sex were enrolled using non-probability consecutive sampling. Measles was defined by the WHO clinical case definition (fever ≥38 °C with a generalised maculopapular rash lasting ≥3 days, together with at least one of cough, coryza, or conjunctivitis). A child was classified as vaccinated when at least one dose of a measles-containing vaccine given at or after 9 months of age was documented on the Expanded Program on Immunisation (EPI) card, and as unvaccinated when no dose was documented. Children with chickenpox, other skin infections, congenital anomalies, chronic illnesses, immunocompromised status, or incomplete vaccination records were excluded. Groups were compared using the chi-square test, and effect sizes were reported as odds ratios (OR), risk ratios (RR), and absolute risk differences with 95% confidence intervals (CI). Results: The mean age of the children was 3.18 ± 1.21 years, and the mean weight was 12.46 ± 2.84 kg. Of the 150 children, 38 (25.3%) were vaccinated, and 112 (74.7%) were unvaccinated. Prolonged hospital admission was required by 57 of 112 (50.9%) unvaccinated children compared with 10 of 38 (26.3%) vaccinated children (OR 2.90, 95% CI 1.29–6.53; RR 1.93, 95% CI 1.10–3.39; absolute risk difference 24.6%, 95% CI 7.8–41.4; p = 0.009). Complications were observed in 73 (48.7%) children overall, with pneumonia being the most common complication in 34 (22.7%), followed by diarrhoea in 21 (14.0%), otitis media in 10 (6.7%), and encephalitis in 8 (5.3%). The overall frequency of complications did not differ significantly between unvaccinated (55/112, 49.1%) and vaccinated (18/38, 47.4%) children (OR 1.07, 95% CI 0.51–2.24; p = 0.853). Conclusion: Unvaccinated children < 5 years of age with measles had a significantly greater need for prolonged hospital admission than vaccinated children, indicating that measles vaccination attenuates the severity of illness in children who acquire the infection. The overall frequency of complications did not differ significantly between the two groups; this null result should be interpreted cautiously, given the small number of vaccinated children and the correspondingly wide confidence interval. These findings support the need to strengthen routine measles immunisation coverage in children under 5 years of age. Keywords: Measles; Measles Vaccine; Vaccination; Child, Preschool; Hospitalization; Treatment Outcome; Immunization Programs; Pakistan.
BACKGROUND: Cameroon introduced the RTS, S/AS01 malaria vaccine into routine expanded immunisation (EPI) in 2024, targeting 42 priority health districts. We assessed changes in total malaria burden between intervention and non-intervention districts over 2023-2025. METHODS: We conducted a retrospective, quasi-experimental, ecological longitudinal study using a difference-in-differences (DiD) approach on routine district-level surveillance data from 206 districts (42 intervention, 164 non-intervention) for 2023-2025. Outcomes included severe malaria rate (per 1,000 children < 5), uncomplicated malaria rate, all malaria-related hospitalisations, and malaria mortality rate (per 100,000). Crude pre-post changes and DiD were calculated. Adjusted linear DiD models with district and year fixed effects and cluster-robust standard errors were also fitted. Subgroup analyses examined interactions with seasonal malaria chemoprevention (SMC), intermittent preventive treatment in infants (IPTi), insecticide-treated nets (ITNs), and ecological region. RESULTS: Baseline characteristics differed significantly: intervention districts had higher ITN coverage (60.2% vs. 45.5%, p = 0.006), higher IPT coverage (35.1% vs. 24.4%, p = 0.001), and larger populations (median 121,284 vs. 89,592, p = 0.029). From 2023 to 2025, intervention districts experienced larger declines in all outcomes. Crude DiD showed a 2.6 per 1000 (15%) reduction in severe malaria, 8.1 per 1000 (22%) reduction in uncomplicated malaria, 5.3 per 1000 (28%) reduction in hospitalisations, and 4.1 per 100,000 (26%) reduction in malaria deaths. Adjusted linear DiD estimates were not statistically significant (e.g., severe malaria coefficient - 0.54, 95% CI - 11.07 to 9.99, p = 0.920). Subgroup analyses indicated the largest effects in the Sahel (crude rate ratio 0.78) and added benefit when the vaccine was combined with SMC (additional - 5.6 per 1000 reduction). In 2025 alone, vaccination averted an estimated 7,200 severe cases, 12,800 uncomplicated cases, 5,300 hospitalisations, and 77 deaths. CONCLUSION: Crude trends show favourable declines in malaria burden in intervention districts, but adjusted estimates were null, likely due to selection bias and low power. These findings support continued vaccine scale-up and use of routine data for monitoring, while acknowledging the limitations of non-randomised evaluations.
Objective: To determine the frequency of enteric fever in children presenting with acute febrile illness in Islamabad, Pakistan. Methods: This was a cross-sectional study, conducted in the department of Paediatrics, Islamabad Medical Complex, Islamabad, from 1st of October 2024 to 30th of April 2025. After obtaining ethical approval, this study included 179 children with acute febrile illness. After a thorough clinical evaluation, venous samples from all patients were sent for diagnosis of enteric fever via blood culture. Data were analysed using SPSS version 22. The data were stratified according to the effect modifiers. Statistical significance was set at p ≤0.05. Results: The ages ranged from 1-12 years (median = 7, IQR = 4–10), and weights ranged from 8–48 kg (median = 27, IQR = 16–39). The duration of fever varied between 5 and 14 days (median = 10, IQR = 8–12), and the recorded temperature ranged from 38.6°C to 40.0°C (median = 39.2°C, IQR = 38.8–39.5°C). Of the 179 patients, 21 (11.7%; 95% CI: 7.4–17.4%) had enteric fever confirmed by blood culture. The data were stratified according to the effect modifiers (Table I). There was no difference between subgroups of age, sex, area of residence, maternal educational status, weight, and fever duration (p = 0.903, 0.967, 0.418, 0.383, 0.359, and 0.321, respectively). Enteric fever was significantly higher in the low socioeconomic status group (p = 0.015). Conclusion: Our study suggests that enteric fever is a high-burden disease in the paediatric population in Islamabad, responsible for 11.7% (95% CI: 7.4–17.4%) of acute febrile illnesses, with a significantly high impact on those from low socioeconomic status. Studies incorporating multiple centres and areas would provide more comprehensive data. Keywords: Typhoid Fever; Paratyphoid Fever; Fever; Cross-Sectional Studies; Socioeconomic Factors.
The roles of the frontline health workers (auxiliary nurse midwives (ANMs) and Accredited Social Health Activists (ASHAs)) in Indian public health system has been invaluable. Originally aimed at delivering the maternal and child health services, their roles have been changing with the changing public health needs of the country. They primarily provide preventive, promotive and some administrative roles encompassing various health programs including communicable and non-communicable diseases. The health workers also document their activities and outcomes in both the register-based and mobile application-based formats. These reports are critical in monitoring and evaluating the programs and as a support to a careful decision making. However, the capacity of these health workers’ in balancing their abilities and workload is unfortunately one of the most often ignored aspect within the primary health care delivery. Additionally, their challenges are worsened with inadequate services of the essential training and supervision programs that are required for strengthening of skills and adequate execution of duties and responsibilities. Thus, to enhance efficient public health delivery, India must consider additional human resource allocation and task shifting options at the earliest.
The World Health Organization's Decision Framework for Vaccination in Acute Humanitarian Emergencies remains the principal global guide for vaccination prioritization and decision-making in crisis settings. However, it gives insufficient attention to sustaining vaccination as a matter of justice, as a means of upholding established human rights norms and the values that vaccines provide in these contexts. We argue that, if children living in conflict settings are to enjoy the same fundamental rights to life and health as children elsewhere, vaccination must be recognized as more than an emergency‑response intervention. We therefore propose a broader perspective to support guiding decisions to sustaining vaccination services that enhance the medium- and long-term resilience of health systems, and justice in conflict settings. We categorize the benefits and values of vaccination in conflict settings into three types: intrinsic, instrumental, and symbolic. We contend that vaccines are valuable in all three ways during humanitarian emergencies, and that this overlapping value means global health actors should prioritize sustaining vaccine delivery for children during conflicts.
Majdi M. Sabahelzain, Oliver Razum, Julie Leask et al.
Imunisasi merupakan upaya preventif penting dalam menurunkan angka kesakitan dan kematian akibat Penyakit yang Dapat Dicegah dengan Imunisasi (PD3I). Meskipun program imunisasi telah dilaksanakan secara rutin, cakupan imunisasi dasar lengkap di beberapa daerah masih belum optimal, termasuk di Desa Serang Mekar, Kecamatan Ciparay, Kabupaten Bandung. Penelitian ini bertujuan untuk mengetahui faktor ibu dalam pemberian imunisasi lengkap pada balita di Posyandu RW 17. Metode yang digunakan adalah deskriptif kuantitatif dengan pendekatan cross-sectional . Data diperoleh dari data sekunder dan wawancara menggunakan kuesioner kepada ibu balita. Hasil penelitian menunjukkan bahwa pendidikan ibu paling banyak didapat ibu yang memiliki Pendidikan SD, pekerjaan ibu paling banyak didapat pada ibu yang bekerja, jumlah anak (paritas) paling banyak didapat pada ibu grande multipara. Oleh karena itu, peningkatan edukasi kesehatan dan penguatan dukungan ibu sangat diperlukan guna meningkatkan cakupan imunisasi. Penelitian ini diharapkan dapat menjadi bahan pertimbangan bagi tenaga kesehatan dan pemerintah dalam merancang intervensi yang tepat. Abstract Immunization is a crucial preventive effort to reduce morbidity and mortality caused by Vaccine-Preventable Diseases (VPD). Although routine immunization programs have been implemented, the coverage of complete basic immunization in several regions remains suboptimal, including in Serang Mekar Village, Ciparay Subdistrict, Bandung Regency. This study aims to determine maternal factors in providing complete immunization toddlers at Posyandu RW 17. The research design used is descriptive quantitative with a cross-sectional approach. Data were obtained through secondary data extraction and structured questionnaires for mothers of toddlers. The results of the study showed that the highest maternal education was obtained by mothers who had elementary school education, the highest maternal occupation was obtained by working mothers, the highest number of children (parity) was obtained by grande multipara mothers. Therefore, enhancing maternal health education and strengthening family involvement are essential to improve immunization coverage. This study is expected to serve as a reference for health workers and policymakers in designing effective interventions to increase immunization rates.
Background Despite improvements in maternal, newborn, and child health (MNCH) service coverage in Malawi, completion of the continuum of care (CoC) remains low and unequally distributed across socioeconomic groups. This study quantified socioeconomic inequality in MNCH CoC completion and its determinants. Methods We analyzed pooled data from the 2010, 2015–16, and 2024 Malawi Demographic and Health Surveys, including 18,741 women with a live birth; analytic samples were 15,552 women for maternal CoC and 7,625 children aged 12–23 months for full CoC. Wealth-related inequality was assessed using Erreygers concentration indices. Multivariable and multilevel logistic regression identified determinants of CoC completion, while Wagstaff, Oaxaca–Blinder, Fairlie, and inequality-of-opportunity decompositions identified inequality contributors. Results Full CoC completion rose from 1.4% (2010) to 6.8% (2024); maternal CoC rose from 4.9% to 17.4%. Women completed an average of 8.3 of 11 interventions. Pro-rich inequality persisted for maternal CoC (Erreygers index = 0.036, p < 0.001); inequality in full CoC was smaller and not statistically significant (0.004, p = 0.497). Women's education, particularly higher education, was the strongest and most consistent predictor of completion (adjusted OR: 3.42 maternal, 3.45 full CoC, pooled). Contributors varied by method: education, wealth, and rural residence dominated the Wagstaff decomposition, while education, age, and parity contributed more consistently in the Oaxaca–Blinder and Fairlie decompositions. Circumstance variables reproduced the entirety of observed maternal CoC inequality, falling to 78.7% when wealth was excluded. Conclusions Although MNCH CoC coverage improved substantially in Malawi, socioeconomic inequalities persisted, particularly for maternal CoC, and were closely linked to structural circumstances. Policies improving geographic access, expanding girls’ and women's education, and addressing structural barriers may support more equitable progress toward Sustainable Development Goal 3.
OBJECTIVES This study aimed to determine immunisation status and identify demographic, socioeconomic, access-related, and caregiver factors associated with incomplete immunisation among children under five years. METHODOLOGY This descriptive cross-sectional study enrolled 345 children who presented to the Department of Paediatrics, Ayub Teaching Hospital, Abbottabad, from October 2025 to April 2026 using non-probability consecutive sampling. Parents or guardians completed a pre-tested structured questionnaire, and immunisation status was verified from Expanded Programme on Immunisation records when available and supplemented with caregiver recall. Children were categorised as fully, partially, or not immunised. We assessed associations using chi-square tests and Cramer's V, followed by binary logistic regression for incomplete immunisation. RESULTSThe mean child age was 28.15 ± 17.19 months. Overall, 212 (61.4%) children were fully immunised, 103 (29.9%) partially immunised, and 30 (8.7%) non-immunised. Frequently reported barriers were fear of side effects (49.0%), lack of schedule knowledge (42.6%), and unawareness of the need for immunisation (41.2%). Immunisation status was significantly associated with residence, socioeconomic status, parental education, and parental occupation. After adjustment, low socioeconomic status, unawareness of follow-up doses, misconceptions about contraindications, lack of a nearby vaccination facility, concern about lost wages, and poor schedule knowledge independently predicted incomplete immunisation. CONCLUSION More than one-third of children had incomplete immunisation. Improving completion requires caregiver education, clear counselling about contraindications and adverse effects, reliable reminders for subsequent doses, and practical service-delivery measures that reduce geographic and economic barriers for vulnerable families. Targeted outreach should consistently prioritise rural and socioeconomically disadvantaged households.
Ali Maalik, Saima Gillani, Manahil Shamraiz et al.
