Detecting the circulation of poliovirus in its early stages is paramount for swift public health action. While environmental surveillance (ES) is promising for enhancing early pathogen detection, the influence of spatial arrangement of ES sites on early detection remains unclear. Here, we aim to assess the early detection ability of ES by varying the number and location of ES sites using the simulation-based approach utilising geographic and demographic characteristics of South Africa as a case study of a non-endemic country. We developed a stochastic meta-population model among unimmunised children aged under 5 years old, assuming a single introduction of wild poliovirus serotype 1. We constructed six scenarios by combining three importation risk distributions (predicated on population size, approximations of international inbound travel volume and border crossing volume) with two ES site layout strategies (proportionate to population size and importation risks via land border crossings). We showed a modest number of strategically positioned ES sites can achieve a high early detection ability given assumed importation risks were geographically confined while dispersed importation risks reduced the effectiveness of ES. Our sensitivity analysis suggested that implementing the ES across large areas with low sampling frequency consistently resulted in a better early detection ability against various importation scenarios than implementing the ES in limited areas with high sampling frequency. Although we acknowledge the challenges of translating our simulated outcomes for real-world situations, our study has implications for deciding the scale and site selection of ES.
Background Tuberculosis (TB) remains a significant public health challenge in rural Indonesia, where structural barriers, limited health literacy, and persistent stigma hinder effective disease control. Systematic exploration of contextual obstacles and opportunities for youth empowerment interventions in TB control remains limited. Objective This study explored contextual barriers and opportunities to enhance TB awareness and community involvement in rural Indonesia, using the PRECEDE-PROCEED model to identify predisposing, enabling, and reinforcing factors influencing TB control behaviours. Methods An exploratory qualitative study using a phenomenological approach was conducted in Central Java, Indonesia (February-August 2024). Data were collected through semi-structured interviews with 18 key informants and two focus group discussions with 11 participants. Reflexive thematic analysis was conducted using NVivo 12, with trustworthiness ensured through prolonged engagement, triangulation, member checking, and COREQ adherence. Results Nine themes emerged across three domains. Predisposing factors included persistent TB misconceptions and stigma characterised by fear, shame, and social avoidance. Enabling factors comprised structural barriers (inadequate housing, poor ventilation), weaknesses in TB detection (human resource shortages, low TPT coverage), suboptimal health cadre effectiveness, and resource constraints. Reinforcing factors encompassed inconsistent treatment supervision, limited multi-stakeholder involvement, notably absent educational institution engagement, and programme evaluation gaps. Critically, these barriers interacted across domains through cascading mechanisms, with stigma amplifying system weaknesses and undermining supervision. Conclusion TB control in rural Indonesia faces interconnected barriers across all three PRECEDE-PROCEED domains. Young people and schools are underutilised resources with strong potential as agents of change, justifying the development of community-based youth empowerment interventions.
Background COVID-19 vaccines were recommended for the pediatric population in the Philippines in February 2022, after adults, due to both the direct and indirect effects of COVID-19. Despite ongoing vaccination efforts in the Philippines, pediatric COVID-19 vaccination uptake remains low. As such, this study aimed to determine the enablers and barriers of pediatric COVID-19 vaccination uptake amongst children 5-11 years in the Philippines. Methods A cross-sectional survey among 546 caregivers of children aged 5-11 years was conducted onsite in three selected regions in the Philippines with low COVID-19 vaccine coverage between July and October 2023. Multivariable logistic regression was performed to identify factors associated with pediatric COVID-19 vaccination uptake. Results Of the respondents, 143 caregivers had at least one child vaccinated against COVID-19, while 395 had none. The most common reasons for vaccination were protection against COVID-19 (93.7%), influence of government-mandated regulations (48.3%), and recommendation of healthcare workers (19.6%). High vaccine confidence (79%), high perceived vaccine benefit (81.1%), and perceived need for vaccination (78.3%) were enablers of vaccination. Among those who did not vaccinate, the most common reasons were distrust in vaccine safety (58.5%), perception that the child was too young (25.3%), and the child not wanting to get vaccinated (18.2%). Caregivers who decided not to vaccinate also had concerns about side effects (35.7%), low perceived need for COVID-19 vaccination (21.5%), and disagreed at requiring vaccinations for schooling (26.3%). Caregiver age [aOR = 3.00; 95% CI 1.65-5.46 for adults 30-45 years vs. aOR = 2.65; 95% CI 1.17-5.5.99 for adults 46-59 years], and perceived need for vaccination (OR = 2.56; 95% CI 1.31-5.03) were associated with pediatric COVID-19 vaccination uptake in the multivariable analysis. These factors were compared to caregivers aged 18-29 and those who responded 'neutral' to the survey, respectively. Conclusions Key factors associated with COVID-19 pediatric vaccination uptake in the Philippines were perceived protection against COVID-19 illness, government mandated regulations and healthcare worker recommendations, while non-vaccination was associated with safety concerns, and children's age and preference to not be vaccinated. Understanding the social and behavioral drivers among caregivers may help policy decision-makers and implementers develop targeted interventions to enhance uptake of COVID-19 and routine childhood vaccines.
Papillomas, predominantly caused by low-risk Human papillomavirus (HPV), can affect the respiratory tract and conjunctiva. This nationwide Danish registry study assesses the HPV vaccination programme's effectiveness in preventing juvenile laryngeal and conjunctival papillomas. Incidence rates were calculated using national registry data from 2005/2008 to 2024. In the Danish Pathology Registry, 33 juvenile laryngeal and 134 conjunctival papilloma patients were identified using SNOMED codes. HPV subtyping was performed in-house for laryngeal biopsies lacking prior data, yielding results for 27 patients. HPV-6 or -11 was identified in 74.1% of cases. Vaccination status was retrieved for conjunctival patients and for mothers of laryngeal patients. The incidence rate of juvenile laryngeal papillomas was 0.190 per 100,000 (2005-2013) and 0.107 (2014-2024) (p = 0.145). No mothers of laryngeal patients had received HPV vaccination before delivery. Conjunctival papilloma incidence declined from 2008 to 2024, with an annual percent change of -5.3% (p = 0.002). A total of 22 conjunctival patients were vaccinated before first biopsy, with a median interval of 5 years and 8 months between first dose and biopsy. In Denmark, juvenile laryngeal papilloma incidence remained low and occurred only in children of unvaccinated mothers, while conjunctival papillomas showed a significant decline consistent with a protective effect of the HPV vaccination programme.
Introduction: Despite global improvements in immunization, major gaps persist. By 2024, an estimated 14.3 million infants, predominantly in low- and middle-income countries (LMICs), remained zero-dose (ZD), never having received even the first DTP vaccine. In 2022, 33 million children missed their measles vaccination (22 million missed the first dose, 11 million missed the second dose), highlighting entrenched structural, behavioral, and systemic barriers that continue to exclude marginalized populations. Addressing these inequities requires innovative, context-adapted approaches that strengthen primary health care (PHC) and extend services to the hardest-to-reach populations. Objectives: This study aims to document and synthesize implementation research (IR) projects on immunization programs in LMICs, identifying key enablers and effective strategies that reduce inequities, improve outcomes, and support efforts to reach ZD children. Methods: We conducted a retrospective multiple-case study of 36 IR projects across 13 LMICs, embedded within an evidence review framework and complemented by policy analysis. Data were drawn from systematic document reviews and validation discussions with project leads. A total of 326 strategies were extracted, coded using a structured codebook, and mapped to the WHO-UNICEF PHC Levers for Action. Descriptive analysis synthesized patterns across service delivery and policy outcomes, including coverage gains, improved microplanning, community engagement, and system integration. Results: Of the 326 immunization strategies identified, most (76.1%) aligned with operational PHC levers, particularly monitoring and evaluation (19.3%), workforce development (18.7%), and models of care (12%). Digital technologies (11.7%) were increasingly deployed for real-time tracking and oversight. Core strategic levers comprised 23.9% of strategies, with community engagement (8.9%) and governance frameworks (7.7%) emerging as critical enablers, though sustainable financing (4%) and private-sector engagement (0.9%) were rarely addressed. While the majority of projects focused on routine immunization (n = 32), only a few directly targeted ZD children (n = 3). Interventions yielded improvements in both service delivery and policy outcomes. Improvements in microplanning and data systems (23.5%) reflected the increased uptake of digital dashboards, GIS-enabled tools, and electronic registries. Community engagement (16.2%) emphasized the influence of local leaders and volunteers in building trust, while health system strengthening (15.7%) invested in cold chain, supervision, and workforce capacity. Coverage gains (10.6%) were achieved through delivery innovations, though sustainable financing remained a critical problem (3.4%). Conclusions: Reaching ZD children requires equity-driven strategies that combine digital innovations, community engagement, and resilient system planning. Sustained progress depends on strengthening governance, financing, and research. Embedding IR in immunization programs generates actionable evidence, supports context-specific strategies, and reduces equity gaps, offering practical insights that complement health system research and advance the Immunization Agenda 2030.
Background We have previously determined that the occurrence of missed vaccination opportunities in children in Cape Town, South Africa, is shaped by both individual and contextual factors. These factors present valuable openings for enhancing quality and implementing broader strategies to enhance the delivery of routine Immunisation services. Methods Here, we are further reporting regional-level data on the coverage and factors influencing vaccination completion within a similar study population, based on extensive data analysis from the 2016 South African Demographic and Health Survey. Results and discussion The study reveals commendable vaccination coverage for most vaccines within recommended schedules, with high rates of initial vaccinations at birth and during the primary vaccination schedule. However, there are notable areas for improvement, particularly in ensuring complete coverage for the second measles vaccine and the 18-month vaccine. Socio-demographic factors also play a role, with maternal education and caregiver awareness campaigns showing the potential to positively influence vaccination completeness. This study emphasises the importance of timely vaccinations during the early months of life and underscores the need for interventions to maintain coverage as children age. Specific sub-districts, such as Tygerberg, may require targeted efforts to enhance vaccination completeness. Additionally, assessing caregiver knowledge about child vaccination is deemed vital, as it can impact vaccination decisions and adherence. Conclusions The findings provide valuable insights for public health interventions in Cape Town, aimed at reducing the burden of vaccine-preventable diseases and ensuring the health of the region's youngest population.
Introduction To meet the health demands in urban areas, the cadre of ASHA was created to work as a Community Health Worker (CHW) based in the community, delivering services under various programmes. It is necessary to assess the work profile of the ASHA workers to understand the challenges faced by them and to motivate them to perform their responsibilities effectively and efficiently. Objectives To assess the performance of services delivered by ASHA workers in the Health Care Centres. Methodology The study was conducted in Urban and Rural Health Centre of a Medical College, Bengaluru. In-depth interviews were conducted on 26 ASHA workers to collect information about factors influencing their performance, training, and financial aspects. Data was entered into Microsoft Excel and analysed with SPSS version 22. Quantitative data was expressed using descriptive statistics. For analysis of in-depth interviews, themes were identified and findings were reported by using Consolidated Criteria for Reporting Qualitative Research. Results The mean age of the women was 36.5±5.4 years all were married and of Hindu religion. The majority of the ASHA workers have completed 10th Standard, 16 (61.53%). 30.76% of the ASHA workers had 13 years of experience, though they lacked knowledge and had poor performance in the areas of child health and tuberculosis. Conclusion The need of the hour is to reinforce the ASHA workers with knowledge and financial incentives on a regular basis for the betterment of the society.
Introduction Fragmentation in immunisation reporting systems pose challenges in measuring vaccine coverage for First Nations children in Canada. Some Nations have entered into data-sharing agreements with the province of Alberta's health ministry, enabling novel opportunities to calculate coverage. Methods Partnering with a First Nations community in Alberta, this retrospective cohort study calculated routine childhood vaccine coverage. Administrative data for vaccines delivered within and outside the community were linked to calculate partial and complete immunisation coverage in 2013-2019 at ages 2 and 7 years for children living in the community. We also compared vaccine coverage each year for (a) children who were and were not continuous community residents and (b) children who received or not their first vaccine at the on-reserve community health centre. We also calculated the mean complete coverage across all study years with 95% CIs. Results For most vaccines, coverage was higher (p<0.05) at ages 2 and 7 years for children that received their first vaccine at the First Nations health centre, compared with those who received their first dose elsewhere. For example, for pneumococcal vaccine, the mean level of complete coverage in 2-year-olds was 55.7% (52.5%-58.8%) for those who received their first vaccine in the community, compared with 33.3% (29.4%-37.3%) for those who did not; it was also higher at 7 years (75.6%, 72.7%-78.5%, compared with 55.5%, 49.7%-61.3%). Conclusion Initiating the vaccine series at the on-reserve community health centre had a positive impact on coverage. The ability to measure accurate coverage through data-sharing agreements and vaccine record linkage will support First Nations communities in identifying individual and community immunity. The findings also support the transfer of health funding and service delivery to First Nations to improve childhood immunisation uptake.
Cervical cancer remains a significant public health challenge in the WHO Eastern Mediterranean Region (EMR), with significant implications for women's health and sustainable development. Despite being largely preventable, the EMR reported high prevalence of new cases and deaths in 2022. The burden is expected to increase by 2050. Primary healthcare (PHC) offers a cost-effective platform for delivering essential health services, such as human papilloma virus vaccination and early detection and referral programmes, which are crucial for reducing cervical cancer incidence and mortality. The paper discusses the role of PHC in cervical cancer interventions, showcasing successful examples from EMR countries and examining barriers like resource constraints, sociocultural factors and systemic inefficiencies. It also proposes solutions, such as enhancing infrastructure and human resources, fostering public-private partnerships and adopting innovative screening methods. By addressing these gaps and leveraging PHC's potential, EMR countries can improve cervical cancer outcomes and promote health equity for girls and women across the region.
Background Despite being an underserved ethnic minority group, characteristics which have been associated with low vaccine uptake, the Bangladeshi community in the UK exhibits high childhood vaccination uptake for several vaccines, including measles, mumps and rubella compared with several ethnic groups. This study explored key enablers for early childhood vaccination uptake among the Bangladeshi community in East London, UK. Methods A qualitative study using semi-structured interviews was conducted with 23 Bangladeshi parents 11 primary healthcare professionals (HCPs) and 5 community service providers (CSPs) involved in delivering childhood vaccination services, predominantly in the East London borough of Tower Hamlets. Parents were recruited purposively from the community while HCPs and CSPs were recruited from relevant organisations. The Social Ecological Model (SEM) was used as a theoretical framework for data collection and analysis. Data were analysed thematically. Results Multilevel vaccination enablers identified by parents, HCPs and CSPs across the different levels of the SEM included: parental trust in the immunisation programme and HCPs; a rigorous call and recall service; the normalisation of receiving childhood vaccinations within the Bangladeshi community and the availability of culturally tailored and accessible vaccination services. Conclusions This study highlights how multi-level trust in a vaccination programme can propel positive vaccine uptake in an underserved, ethnic minority population. Our findings suggest culturally sensitive, person-centred delivery of vaccination services, alongside leveraging community dynamics and trusted social networks, are imperative to meeting the informational, linguistic and cultural needs that facilitate vaccine uptake within the Bangaldeshi community. We recommend using existing trusted community networks to disseminate tailored vaccine information and actively reminding parents about due vaccinations to promote uptake amongst other underserved, ethnic minority communities with low uptake in high-income settings. Further research involving non-immunising parents is recommended to gain more comprehensive insight into vaccine decision-making within this community.
