Uganda ranks third with the highest malaria cases globally, highlighting limitations in existing prevention efforts. Malaria vaccination is a key promising strategy to reduce both morbidity and severity among children under 5 (U5) years. In April 2025, Uganda introduced a four-dose R21 malaria vaccine for U5s. We assessed willingness to vaccinate with the malaria vaccine and associated factors among caregivers of U5s to support vaccine rollout in the targeted population. In March 2025, we conducted a cross-sectional study at the Maternal and Child Health unit of Masaka Regional Referral Hospital among 292 caretakers. We generated caretaker attendance lists daily to serve as sampling frames and developed a sampling interval. We used systematic sampling to obtain the total sample size. We administered a questionnaire assessing caregivers’ willingness to vaccinate, and identified associated factors using modified Poisson regression. We interviewed 292 caretakers, 250(86%) were female and 249(85%) indicated willingness to vaccinate their children. Prior experience with adverse events following immunization (AEFIs) (adjusted prevalence ratio [aPR]=0.2,95%Confidence Interval [CI]0.05-0.5), having other relatives than biological parents as main decision makers (aPR 0.2, 95%CI0.04-0.9) and having tertiary education (aPR 0.14, 95%CI0.04-0.6) were associated with reduced willingness to vaccinate, while receipt of malaria Intermittent Preventive Treatment in pregnancy (IPTp) (aPR 6.2, 95%CI1.6-23) and trust in vaccine safety (aPR 13, 95%CI4.0-43) were associated with increased willingness to vaccinate. Majority of the caretakers were not aware of the malaria vaccine butwere willing to vaccinate their children when oriented. AEFI history, household decision-making roles, and education level were associated with reduced willingness, while having received malaria IPTp and trust in vaccine safety were associated with increased willingness to vaccinate. We recommended providing malaria vaccine information through antenatal care, preparing health workers to address the AEFI history and vaccine-safety concerns and prioritizing safety-focused messaging over general awareness messaging.
Annet Mary Namusisi, Richard Migisha, Dominic Kizza et al.
Background & Objective: Tetanus toxoid vaccination is a recommended preventive measure during pregnancy; however, coverage remains low in several developing countries, including Indonesia. No studies have specifically examined the effect of tetanus vaccine doses on Immunoglobulin G (IgG) levels in Indonesian pregnant women. Therefore, the present study was conducted with aim to determine tetanus-specific IgG antibody levels in this population.Materials & Methods: This analytical descriptive study with a case-control design was conducted at Sitti Khadijah 1 Women's and Children's Hospital in Makassar, Indonesia. Pregnant women were divided into two groups based on whether they had or neither received tetanus-diphtheria vaccinations during pregnancy. Serum levels of tetanus-specific IgG antibodies were measured using an Enzyme-Linked Immunosorbent Assay (ELISA) kit. Data analysis was performed using SPSS (version 27.0). P<0.05 was considered statistically significant.Results: A total of 112 pregnant women were enrolled. A significant association was found between tetanus toxoid vaccination and IgG levels, with vaccinated women exhibiting higher IgG concentrations (P<0.001). Furthermore, women who received two vaccine doses had significantly higher IgG levels compared to those receiving only one dose (P=0.003). Age, body mass index, gravidity, and educational level did not significantly influence IgG levels (P>0.05).Conclusion: Two doses of tetanus toxoid vaccination during pregnancy significantly increase IgG antibody levels in pregnant women. These findings reinforce the importance of expanding tetanus immunization coverage among pregnant women, particularly in Indonesia, to include the second dose through effective health policies and programs.
Ikhmah Sulistyowati, St. Maisuri T. Chalid, Irnawati Bahar et al.
Stunting adalah permasalahan gizi yang berlangsung dalam jangka panjang dan dapat dipengaruhi oleh praktik pemberian MP-ASI yang belum sesuai. Hasil studi awal di wilayah kerja Puskesmas Windusengkahan memperlihatkan bahwa pemahaman sebagian ibu mengenai cara pemberian MP-ASI yang tepat masih terbatas. Tujuan penelitian ini adalah menganalisis pengaruh pendidikan kesehatan terhadap pengetahuan ibu mengenai pemberian MP-ASI pada anak usia 6–24 bulan sebagai salah satu langkah pencegahan stunting. Penelitian kuantitatif ini menerapkan desain pre-experimental one group pretest-posttest. Sebanyak 87 ibu yang mempunyai anak usia 6–24 bulan dipilih dengan proportionate stratified random sampling, kemudian dilakukan simple random sampling menggunakan undian. Pengumpulan data menggunakan kuesioner pengetahuan dan analisis dilakukan dengan Wilcoxon Signed Rank Test. Pada pengukuran awal, 83 responden (95,4%) termasuk kategori pengetahuan kurang dan 4 responden (4,6%) kategori baik; rerata jawaban benar sebanyak 22. Sesudah memperoleh pendidikan kesehatan, 84 responden (96,6%) mencapai kategori pengetahuan baik dan 3 responden (3,4%) masih berada pada kategori kurang, dengan rerata 29 jawaban benar. Hasil uji Wilcoxon memperoleh p=0,000. Dengan demikian, pendidikan kesehatan memberikan pengaruh yang bermakna terhadap peningkatan pengetahuan ibu mengenai pemberian MP-ASI. Abstract Background: Stunting reflects a long-term nutritional problem, and inappropriate complementary feeding is one of the factors that may contribute to its occurrence. An initial assessment in the Windusengkahan Community Health Center service area indicated that several mothers still had insufficient understanding of proper complementary feeding. Objective: This study examined whether health education could improve mothers’ knowledge concerning complementary feeding among children aged 6–24 months as part of stunting prevention. Methods: A quantitative pre-experimental study with a one-group pretest-posttest design was conducted. Eighty-seven mothers of children aged 6–24 months were recruited through proportionate stratified random sampling followed by simple random selection using a lottery. Knowledge was measured with a questionnaire and the data were tested using the Wilcoxon Signed Rank Test. Results: At baseline, 83 mothers (95.4%) were classified as having insufficient knowledge and 4 (4.6%) as having good knowledge; the mean number of correct responses was 22. Following the health education session, 84 mothers (96.6%) reached the good-knowledge category and 3 (3.4%) remained in the insufficient category, with a mean of 29 correct responses. The Wilcoxon analysis produced p=0.000. Conclusion: Health education produced a statistically significant increase in mothers’ knowledge about complementary feeding.
Sielmy Noerfadilah, Herni Kurnia, Endang Nurrochmi et al.
Anemia pada kehamilan merupakan masalah Kesehatan yang umum terjadi sehingga dapat meningkatkan risiko komplikasi bagi ibu dan janin. Di wilayah kerja Puskesmas Plered, dari 82 ibu hamil trimester III hingga April 2026 terdapat 10 ibu yang teridentifikasi mengalami anemia. Penelitian ini bertujuan menganalisis hubungan kepatuhan konsumsi tablet tambah darah (TTD) dengan kejadian anemia pada ibu hamil. Penelitian ini menggunakan desain analitik observasional dengan pendekatan case control terhadap 50 ibu hamil trimester III. Data kepatuhan diperoleh melalui lembar pemantauan konsumsi TTD, sedangkan status anemia ditentukan berdasarkan kadar hemoglobin yang tercatat pada buku KIA dan rekam medis. Analisis pada penelitian ini dilakukan secara univariat dengan hasil sebanyak 40 responden (80%) patuh mengonsumsi TTD dan 10 responden (20%) tidak patuh serta kejadian anemia ditemukan pada 10 responden (20%) dan analisis bivariat menggunakan uji chi-square dengan hasil p=0,000 sehingga terdapat hubungan antara kepatuhan konsumsi tablet tambah darah dengan kejadian anemia pada ibu hamil. Abstract Anemia during pregnancy is a common health problem that may increase the risk of complications for both mothers and fetuses. In the working area of Plered Community Health Center, among 82 third-trimester pregnant women as of April 2026, 10 were identified as having anemia. This study aimed to analyze the relationship between adherence to iron and folic acid tablet (IFA) consumption and the occurrence of anemia among pregnant women. An observational analytic study with a case-control approach was conducted involving 50 third-trimester pregnant women. Adherence to IFA consumption was assessed using an IFA consumption monitoring form, while anemia status was determined based on hemoglobin levels recorded in the Maternal and Child Health (MCH) handbook and medical records. Univariate analysis showed that 40 respondents (80%) were adherent to IFA consumption, while 10 respondents (20%) were non-adherent. Anemia was identified in 10 respondents (20%). Bivariate analysis using the Chi-square test demonstrated a statistically significant association between adherence to IFA consumption and the occurrence of anemia (p = 0.000). These findings indicate that adherence to iron and folic acid supplementation is significantly associated with the occurrence of anemia among pregnant women.
Putri Andriyani, Dyah Widiyastuti, Yeni Fitrianingsih et al.
Latar Belakang: Stunting merupakan masalah gizi kronis yang berdampak pada pertumbuhan fisik, perkembangan kognitif, produktivitas, dan kualitas sumber daya manusia. Salah satu faktor yang berhubungan dengan stunting adalah riwayat Berat Badan Lahir Rendah (BBLR). Penelitian ini bertujuan mengetahui hubungan riwayat BBLR dengan status stunting pada balita di wilayah kerja Puskesmas Pasawahan Kabupaten Kuningan. Metode: Penelitian menggunakan desain analitik observasional dengan pendekatan case control. Sampel berjumlah 750 balita usia 12–59 bulan, terdiri atas 150 balita stunting sebagai kasus dan 600 balita tidak stunting sebagai kontrol (1:4). Data diperoleh dari aplikasi e-PPGM (Sigizi Kesga) tahun 2024–2025 dan dianalisis secara univariat serta bivariat menggunakan uji chi-square dan Odds Ratio (OR). Hasil: Sebanyak 710 balita (94,7%) tidak memiliki riwayat BBLR dan 40 (5,3%) memiliki riwayat BBLR. Terdapat hubungan signifikan antara riwayat BBLR dan stunting (p<0,001), dengan OR 6,45 (95% CI 3,284–12,678). Kesimpulan: Riwayat BBLR berhubungan signifikan dengan stunting. Pencegahan perlu dimulai sejak kehamilan melalui pelayanan antenatal, pemantauan gizi ibu, pencegahan BBLR, dan intervensi pada 1.000 Hari Pertama Kehidupan. Abstract Background: Stunting is a chronic nutritional problem affecting physical growth, cognitive development, productivity, and human resource quality. One factor associated with stunting is a history of Low Birth Weight (LBW). This study aimed to determine the association between LBW history and stunting among children under five in the working area of Pasawahan Community Health Center, Kuningan Regency. Methods: This observational analytic study used a case-control design. The sample comprised 750 children aged 12–59 months, including 150 stunted children as cases and 600 non-stunted children as controls (1:4). Data were obtained from the e-PPGM (Sigizi Kesga) application for 2024–2025 and analyzed using univariate and bivariate analyses with the chi-square test and Odds Ratio (OR). Results: A total of 710 children (94.7%) had no LBW history, while 40 (5.3%) had a history of LBW. LBW history was significantly associated with stunting (p<0.001), with an OR of 6.45 (95% CI 3.284–12.678). Conclusion: LBW history was significantly associated with stunting. Prevention should begin during pregnancy through antenatal care, maternal nutritional monitoring, prevention of LBW, and interventions during the first 1,000 days of life.
Dian Oktapiani, Endang Nurrochmi, Suratmi Suratmi et al.
Introduction Child undernutrition remains a major public health problem in low- and middle-income countries. Timor-Leste has one of the highest childhood stunting rates worldwide, affecting an estimated 47% of children under 5 years. Repeated exposure to enteric pathogens is increasingly recognised as a contributor to malnutrition, yet the interplay between enteric infection, environmental exposure and socioeconomic factors remains poorly understood in this setting. This protocol describes a longitudinal birth cohort study, conducted within a One Health framework, examining early-life enteric pathogen exposure and its relationship with nutritional outcomes in Timor-Leste. Methods and analysis This mixed-methods longitudinal birth cohort study, part of the Bacteria, Enteropathy and Nutrition research programme, is being conducted in three municipalities of Timor-Leste (Dili, Ermera and Ainaro) from November 2024 to October 2027. We will recruit 450 infants at birth and follow them for 24 months, with home visits at 3 monthly intervals in year 1 and 6 monthly intervals in year 2. Faecal, food, water, soil and domestic animal samples will be tested for bacterial, viral and parasitic pathogens; child growth will be assessed using anthropometry. Structured surveys, household observations and in-depth interviews will capture food safety practices, feeding behaviours and socioeconomic factors. Associations between enteric infection and child growth will be assessed using multivariable regression and longitudinal mixed-effects models; qualitative data will be analysed thematically. Ethics and dissemination Ethical approval has been granted by the Human Research Ethics Committee and Veterinary Research Ethics Committee of the Ministry of Health, Timor-Leste (1827/INSP-TL/UEPD-AL/X/2024), Menzies School of Health Research (EC00153) and the Australian National University (H/2024/0964). Written informed consent will be obtained from parents or guardians. Findings will be disseminated through peer-reviewed publications, conference presentations, community workshops and policy briefs in English and Tetum.
Under Sustainable Development Goal (SDG) 6, specifically Target 6.2, the international community committed to ensuring access to adequate and equitable sanitation and hygiene for all, with particular attention to the needs of women, girls, and individuals in vulnerable situations. Despite this commitment, public sanitation continues to be treated as a discretionary amenity rather than a core public service essential for dignity, mobility, and social participation. This paper examines the gap between the normative framework of SDG 6.2 and the lived realities of sanitation use through an integrated analytical approach that combines international comparative data with an exploratory empirical study conducted in Hungary. Moving beyond conventional metrics of access such as facility counts or service levels, the research highlights how formal equality in provision may translate into substantive inequalities in use. It demonstrates how capacity constraints, maintenance failures, and the lack of care-integrated and inclusive design generate disproportionate burdens for women, while drawing on selected international literature to reflect on broader exclusion and safety concerns in gender-segregated sanitation systems. The findings suggest that current monitoring frameworks, including indicator 6.2.1a, inadequately capture the qualitative dimensions of sanitation access, particularly those related to usability, safety, and dignity in public space. In response, the paper argues for a conceptual shift from infrastructure-based metrics toward a more comprehensive understanding of sanitation as a component of gendered and inclusive urban citizenship. The paper briefly reflects on implications for urban planning and governance, highlighting the relevance of institutional accountability and more inclusive, user-sensitive sanitation design within the broader human rights framework of the United Nations. Keywords: public sanitation, gendered citizenship, gender equality, right to sanitation
ABSTRACT Background and Aims Recent reports indicate a rising prevalence of acute malnutrition among children in Afghanistan. This retrospective hospital‐based study was conducted at Guzara District Hospital in Herat and aimed to investigate the severity, treatment outcomes, and monthly trends of acute malnutrition among children aged 0–59 months and potential determinants from May 2020 to March 2022. Methods For this study, the data were collected from the hospital malnutrition treatment register, a standardized logbook in which demographic, anthropometric, treatment, and outcome data of admitted children were recorded. The study included 253 children, with malnutrition severity assessed using weight‐for‐height Z ‐scores (WHZ), mid‐upper arm circumference (MUAC), and bilateral oedema. Information on age, sex, and location was also collected. In addition, treatment outcomes were obtained from the hospital registration book. WHZ, MUAC, age, sex, location, and oedema refer to characteristics recorded at baseline (admission). Group differences were analysed using Chi‐squared and Kruskal–Wallis tests, with Monte Carlo simulations for small counts. Results Results showed a high burden of severe acute malnutrition (SAM). Based on WHZ, 77.9% of children were classified as SAM, and 14.68% presented with bilateral oedema. Among children older than 6 months, and among children with available MUAC data ( n = 109), 74.3% had a MUAC < 115 mm. Moderate acute malnutrition (MAM) was identified in 11.46% using WHZ and 18.34% using MUAC. Regarding outcomes, 42.29% recovered, and 41.50% were referred to outpatient care, while 7.11% were referred to inpatient care, 3.55% defaulted, and 5.53% had missing outcome data. Treatment outcomes varied, with children aged 6–59 months and those with oedema requiring more extended care. Additionally, malnutrition cases increased in summer 2021. Conclusion This study highlights the significant burden of SAM at Guzara Hospital, especially among children under 12 months, a seasonal rise in cases, and the association between treatment outcomes and malnutrition indicators.
ABSTRACT Objective To evaluate the feasibility, safety, and clinical outcomes of transcervical epiglottic suspension in respiratory support‐dependent infants with Type III laryngomalacia. Methods This retrospective case series at a single‐center tertiary children's hospital included consecutive infants with endoscopically confirmed Type III laryngomalacia who were dependent on respiratory support because of upper airway obstruction. These infants underwent transcervical epiglottic suspension between January 1, 2024, and December 31, 2025. Because all eligible infants treated during the study period were included, no a priori sample size calculation was performed. Outcomes included procedural success, operative time, suture duration, perioperative complications, liberation from respiratory support, avoidance of tracheostomy, improvement in airway obstruction, feeding recovery, and catch‐up growth. Results Fifteen infants were included. Median age at surgery was 58 days. Primary procedural success was achieved in 14 of 15 infants and in all infants after revision. All infants were liberated from respiratory support, and none required tracheostomy. Airway obstruction scores improved significantly after surgery ( p < 0.001). Median operative time was 20 min, median blood loss was 1 mL, median suture duration was 35 days, and median time to full oral feeding was 35 days. Among 10 infants with preoperative growth impairment, eight achieved normal weight‐for‐age status at final follow‐up. Adverse events included premature suture detachment in two infants and minor cutaneous pressure injury in one infant; no severe complications occurred. Conclusion Transcervical epiglottic suspension was feasible and was associated with rapid liberation from respiratory support and an acceptable safety profile in high‐risk infants with Type III laryngomalacia. Level of Evidence 4
PURPOSE: Accurate measurement of liver, spleen, and kidney size plays a central role in pediatric diagnostics. Contemporary sonographic percentile data are needed to support interpretation of organ dimensions in clinical practice. This study aimed to generate age-specific clinical reference percentiles for abdominal organ size based on a large real-world pediatric ultrasound cohort. METHODS AND MATERIALS: This retrospective analysis included 27,696 clinically indicated pediatric abdominal ultrasound examinations conducted between 2000 and 2025 at a major urban tertiary-care center in Germany. Standardized organ measurements were obtained by experienced pediatric radiologists. Patients were not excluded on the basis of underlying pathology. Age-specific clinical percentile curves (P3-P97) were generated using Generalized Additive Models for Location, Scale, and Shape (GAMLSS) to capture non-linear growth patterns. RESULTS: From 27,696 examinations of children aged 0-18, organ-specific measurements comprised 12,254 livers, 12,703 spleens, 16,254 right kidneys, and 16,516 left kidneys. All organs demonstrated non-linear growth trajectories. No overall statistically significant sex differences were observed in this cohort for spleen (p = 0.195), liver (p = 0.517), right kidney (p = 0.712), or left kidney (p = 0.797). Owing to the retrospective design, sex-specific variation within individual age strata cannot be excluded. The left kidney was consistently larger than the right (p<0.0001), with a mean difference of 2-5 mm. CONCLUSION: This study presents contemporary clinical percentile curves for liver, spleen, and kidney dimensions derived from one of the largest Central European pediatric ultrasound datasets published to date. The curves provide population-specific benchmarks for interpreting pediatric abdominal organ dimensions in real-world clinical practice and aim to support standardized assessment across the full pediatric age range.
Elena Höhne, Sebastian Fischer, Jennifer Gotta et al.
