BACKGROUND: Achieving timely childhood vaccination is a challenge in low- and middle-income countries (LMICs). A three-month intervention called 10 + 10 + 30 involved 10-minute serial radio drama on vaccination, 10-minute community health worker discussion, and a 30-minute phone-in by listeners was implemented in Jimma Zone, Ethiopia. The goal was to increase childhood vaccination and improve child health outcomes. There is limited evidence of the cost-effectiveness of a radio-only intervention on childhood vaccination in LMICs. Thus, the aim of this study was to examine the cost-effectiveness of 10 + 10 + 30 radio campaign. METHODS: A scenario modeling design using evidence from a quasi-experimental trial in two districts of Jimma Zone in Ethiopia. The priority populations were all under-five children living in Ethiopia in 2021. The main outcome measures were the proportion of incremental full childhood vaccination coverage, total number of lives saved (mortality avoided), and cost per disability-adjusted life years averted. RESULTS: From an estimated unit campaign cost of about US$0.04 per child, we projected a 134% increase in full vaccination coverage, equivalent to an additional 8 million fully vaccinated under-five children. If implemented at scale, the intervention had the potential to reduce under-five mortality by about 32%, corresponding to 288,000 lives saved and an estimated cost per averted disability-adjusted life year (DALY) of US$78. CONCLUSION: The study provides evidence to show that a radio vaccination campaign at scale in Ethiopia may have the potential to increase full childhood vaccination coverage, reduce under-five mortality and be cost-effective in terms of averted DALYs. TRIAL REGISTRATION: This trial was retrospectively registered with ClinicalTrial.gov as NCT04913714 on the 4th of June 2021.
Bernard Appiah, Evans Otieku, Lakew Abebe Gebretsadik et al.
Community birth attendants (CBAs) represent an insufficiently integrated resource in childhood immunization programs, particularly in urban slum communities where healthcare access remains challenging. Their role as birth attendants has been well documented, however, understanding their role in infant vaccination uptake is crucial for improving immunization uptake and child welfare. This study explored the knowledge of CBAs about infant immunization and assessed their roles in promoting vaccination uptake in urban slum communities of Ibadan, Nigeria. A narrative study design was employed across eight urban slum communities in three local government areas of Ibadan. Six focus group discussions were conducted with 37 CBAs using an interview guide developed in Yoruba language. Data were analyzed using content analysis, guided by the knowledge, attitude and practice model. CBAs had a good understanding of immunization as a disease prevention strategy and had comprehensive knowledge of birth dose vaccines' (BCG, OPV, Hepatitis B) names and timing. However, knowledge about the other immunization visits' timing varied considerably among them. CBAs generally had positive attitude towards immunization. They played diverse roles in immunization process including community mobilization for immunization campaigns, health education, referral to immunization clinics, appointment reminders, identification and support of zero-dose children, and providing transportation assistance when mothers were unable to attend clinics. Their trusted position within communities and informal collaboration with primary health centers positioned them as vital intermediaries in vaccination uptake. Key barriers included limited vaccine knowledge, lack of formal recognition by healthcare workers, and poor self-efficacy in navigating vaccination procedures. Despite knowledge gaps and systemic barriers, CBAs serve as crucial facilitators of infant immunization in urban slum communities in Ibadan, through their trusted relationships and comprehensive support activities. Formal integration of CBAs into immunization programs, coupled with targeted training and recognition, could significantly enhance vaccination coverage in disadvantaged urban populations.
Peer-reviewed article·PubMed (US National Library of Medicine)·
Background/Objectives: Childhood vaccine refusal may negatively affect immunization programs in Türkiye, where regional clusters of hesitancy have emerged despite high national coverage. This study aimed to identify sociodemographic, behavioral, and vaccine confidence-related factors independently associated with childhood vaccine refusal in Konya, Türkiye. Methods: An unmatched case-control study was conducted between July and October 2025 in family health centers across Konya. Cases were parents who had refused at least one routine childhood vaccine (n = 406); controls were parents whose children had completed all routine vaccinations (n = 412). Data were collected through face-to-face interviews using a 47-item structured questionnaire and the Turkish version of the Vaccine Hesitancy Scale (VHS). Independent associations were assessed using multivariable logistic regression, with multicollinearity evaluated by variance inflation factors. Results: Maternal employment (aOR = 0.371, 95% CI: 0.218-0.633), parental COVID-19 vaccination (aOR = 0.131, 95% CI: 0.086-0.200), mother's complete childhood immunization (aOR = 0.418, 95% CI: 0.262-0.667), tetanus vaccination during pregnancy (aOR = 0.259, 95% CI: 0.159-0.421), and neonatal vitamin K administration (aOR = 0.256, 95% CI: 0.132-0.497) were independently associated with lower refusal odds. Higher number of children (aOR = 1.281) and perceived vaccine-related adverse events in the social environment (aOR = 16.982, 95% CI: 9.914-29.089) increased refusal odds. VHS scores were significantly lower in the refusal group (22.2 ± 6.4 vs. 39.8 ± 6.5; p < 0.001), indicating greater hesitancy. Notably, 21.9% of refusing parents reported being advised by a healthcare professional not to vaccinate. Conclusions: Childhood vaccine refusal in Konya was associated with sociodemographic, behavioral, preventive health-related, and vaccine confidence-related factors. The findings suggest relatively reduced engagement with selected preventive health practices, greater reliance on non-professional information sources, and lower vaccine confidence among refusing parents. Interventions should focus on strengthening healthcare-professional communication, trust-building, transparent risk communication, and evidence-based social media strategies.
Peer-reviewed article·PubMed (US National Library of Medicine)·
UNLABELLED: Despite global progress in hepatitis B (HB) control, assessing herd immunity and the hidden burden of infection remains critical. AIM: This study aimed to comprehensively evaluate immunity to hepatitis B virus and HB marker prevalence in the Belgradian population (Serbia) based on infection/vaccination status and socio-demographic characteristics. MATERIALS AND METHODS: A cross-sectional study was conducted in Belgrade in May 2024, involving 2,533 individuals. Serological markers (HBsAg, anti-HBc, anti-HBs) were evaluated using ELISA. Statistical analysis included the calculation of 95% confidence intervals, the χ2 test, and Spearman's correlation analysis. RESULTS: The overall HBsAg prevalence was 1.0% (25/2,533), classifying Serbia as a low-endemicity region. The seroprevalence of anti-HBc and anti-HBs was 8.7% (220/2,533) and 21.6% (547/2,533), respectively. A clear age-dependent trend was observed. Markers of infection (HBsAg, anti-HBc) increased significantly with age (rs = 0.823 and rs = 0.898, respectively) among adults, peaking in the 70+ years group for anti-HBc (22.2%, 42/189). In contrast, protective anti-HBs antibodies showed a negative correlation with age (rs = -0.75), being most prevalent in children and young adults (76.9%, 10/13, in the group 1-5 years). Vaccination coverage also showed a strong negative correlation with age (rs = -0.95), declining from 82.3% (93/113) among individuals under 18 to 4.6% (16/345) among retirees. These correlations clearly illustrate differing epidemiological profiles. They range from high natural viral circulation among older, unvaccinated cohorts to effective infection control through vaccine-induced immunity in the younger generation. A low level of population awareness was identified: only 1.1% (28/2,533) of respondents reported a history of HBV, whereas serological data indicated that 8.7% (220/2,533) of the population had markers of viral exposure. CONCLUSION: The study confirms the success of the universal child vaccination program in Serbia, which has led to the formation of a protected younger generation. However, a significant susceptible stratum persists among the adult population, alongside a high rate of undiagnosed infections, particularly in the older adults. These findings underscore the necessity of implementing targeted adult screening programs and optimizing vaccination strategies to achieve HB elimination.
Peer-reviewed article·PubMed (US National Library of Medicine)·
BACKGROUND: To characterize the epidemiological profile, population seroprotection levels, and economic impact of varicella in Chongqing, and to provide evidence to optimize immunization strategies to reduce incidence and economic burden. METHODS: The epidemiological trends of varicella in Chongqing were ascertained from routine surveillance data (2011-2024). Population sero-epidemiology was evaluated using a randomized cross-sectional serosurvey (n = 960, 2024), and economic burden was estimated from 14,779 outpatient and 298 inpatient cases (2019-2022). Statistical analyses (descriptive statistics, Chi-squared test, Kruskal-Wallis test, and Wilcoxon rank-sum test) were conducted to quantify incidence trends, factors associated with antibody levels, and heterogeneity in economic burden. RESULTS: A total of 301,714 cases were reported during 2011-2024, with 53.56% in children < 15 years. Incidence exhibited an inverted U-shaped trend. The overall crude varicella IgG seroprevalence was 78.33% (geometric mean concentration, GMC: 351.3 mIU/mL). Notably, children (< 15 years) showed a significant seroprotection gap (seroprevalence: 70.54%; GMC: 240 mIU/mL), which aligned with their disproportionately high incidence. Two-dose vaccination was associated with significantly higher seropositivity (83.50% vs. 66.07%) and GMC (343.7 vs. 189.1 mIU/mL) than one dose (p < 0.01). Adults aged > 50 years exhibited the highest GMC (744.7 mIU/mL) and seropositivity (96.15%), aligning with the lowest incidence recorded in 2024. The pediatric inpatients (< 15 years) had a higher burden ($1375.74 vs. $1012.70, p < 0.01) than individuals over 15 years. CONCLUSIONS: Varicella incidence remains high and children show suboptimal seroprotection against varicella in Chongqing. The disease imposes a substantial financial burden, particularly among pediatric inpatients. It is recommended to expand two-dose varicella vaccine immunization coverage to reduce both incidence and disease burden.
Ning Yao, Shanshan Kuang, Jiuyang Deng et al.
Peer-reviewed article·PubMed (US National Library of Medicine)·
INTRODUCTION: Malnutrition remains a major public health issue in the Democratic Republic of Congo, particularly affecting marginalized indigenous populations. Socioeconomic, cultural, and environmental factors contribute to their vulnerability. This study aims to identify factors associated with malnutrition among Pygmy children under five years of age in the Bafwasende territory. METHODOLOGY: A cross-sectional descriptive study was conducted among children and their mothers/caregivers in Bafwasende, Tshopo province. Data were collected using KoboCollect and analyzed with SPSS. Nutritional status was assessed using WHO Anthro Z-Scores to evaluate underweight, stunting, and wasting. Descriptive statistics were applied, with absolute and relative frequencies used for categorical variables. RESULTS: Among 455 children, 28,4% suffer from acute malnutrition(wasting), 69,0% have stunting, and 47,3% have underweight. Children from low-food consumption households, with food expenditures of less than 5,000 CDF, as well as those aged 6 to 11 months, are most at risk. Malnutrition is also more common among children of very young, uneducated, or separated mothers. CONCLUSION: The study highlights an alarming situation, requiring targeted interventions adapted to the cultural and socio-economic realities of indigenous peoples to improve their health and nutrition.
Nono Mangaza, Bernard Kennedy Nkongolo, Marie-Claire Muyer
Nutritional status has been compromised by ongoing war and restrictions on food deliveries in the Gaza Strip. We developed a mathematical model that outputs retrospective estimates and scenario-based projections of acute malnutrition prevalence among children given caloric intake and other factors. We present here the model and its application to the crisis in Gaza. We extended an existing mechanistic model for weight change as a function of energy balance, calibrating it to represent variability in growth curves observed in pre-war Gaza. We simulated open cohorts of children exposed to time-varying caloric intake, infant exclusive breast-feeding prevalence, incidence of infectious disease and coverage of malnutrition treatment, while allowing for adult caloric sacrifice to supplement child intake in times of food scarcity. The model accurately replicates growth standards, pre-war growth patterns and expected parameter dependencies. It suggests that a considerable increase in acute malnutrition occurred in northern Gaza during early 2024. Projections for late 2024 include a serious nutritional emergency if relatively pessimistic assumptions are made about food availability. The model may hold considerable promise for informing decisions in humanitarian response but requires further validation and development.
BACKGROUND: Stunting remains a significant public health challenge in Indonesia and may affect children’s neuromotor development, including fine motor coordination required for effective toothbrushing. Impaired oral hygiene behaviors in stunted children may contribute to increased caries burden and reduced oral health–related quality of life (OHRQoL). OBJECTIVE: To investigate the relationship between toothbrushing ability, caries burden, and OHRQoL among stunted and non-stunted preschool children in Bandung, Indonesia. METHODS: A cross-sectional study was conducted among 554 children aged 1–5 years selected through consecutive sampling from identified stunting loci. Clinical assessments of caries (def-t index) and oral hygiene (Debris Index from OHI-S) were conducted by calibrated dentists. Toothbrushing ability was assessed using a structured checklist, and OHRQoL was assessed using the validated Indonesian version of the Parental-Caregiver Perception Questionnaire (P-CPQ). Statistical analyses included descriptive statistics and chi-square tests to examine bivariate associations, with linear-by-linear association tests for ordinal variables. RESULTS: Nutritional status was significantly associated with toothbrushing ability (p = 0.034) and OHRQoL (p < 0.001), but not with caries burden (p = 0.924). Toothbrushing ability was significantly associated with caries burden (p < 0.001) and oral hygiene (p < 0.001). Oral hygiene was also associated with caries burden (p < 0.001). Brushing frequency (p = 0.048) and technique (p = 0.027) differed significantly by nutritional status, whereas brushing duration, parental assistance, and grip type did not. No significant associations were observed between caries burden, oral hygiene, toothbrushing ability, and OHRQoL, likely due to the highly skewed distribution of OHRQoL categories, with 97.5% classified as “very low impact.” CONCLUSION: Stunted children demonstrated poorer toothbrushing ability compared to their non-stunted peers, and caries burden was closely related to oral hygiene and brushing practices. Nutritional status was associated with OHRQoL, although other variables showed no significant relationship due to limited variability in OHRQoL scores. Integrating oral health promotion with nutrition improvement programs may support better oral and general health outcomes among nutritionally vulnerable populations.
Peer-reviewed article·PubMed (US National Library of Medicine)·
The delivery platform for growth monitoring and promotion (GMP) programs to improve child nutrition remains debated. This study compared the impact of facility-based plus non-governmental organization supported home-based GMP (FGMP + NGO-supported HGMP) versus facility-based GMP (FGMP) on child nutritional status in rural Bangladesh. Using a quasi-experimental design, 1,519 children aged 6-12 months were enrolled in each program and assessed at baseline and after 12 months. The primary outcome was linear growth (length-for-age Z-scores, LAZ), while secondary outcomes included weight-for-age (WAZ), weight-for-height (WHZ), stunting, wasting, and underweight prevalence, minimum dietary diversity, minimum meal frequency, and caregivers' complementary feeding practices. Child linear growth (Difference-in-difference, D-I-D: -4.5; 95% CI: -15.2, 6.1) and weight (D-I-D: -3.5; 95% CI: -11.7, 4.6) faltered in both groups, with no significant differences between the programs. Stunting (D-I-D: 2.8%; 95% CI: -1.3, 7.1) and wasting (D-I-D: 0.43%; 95% CI: -3.2, 4.1) prevalence increased equally across programs. Underweight prevalence rose more in FGMP + NGO-supported HGMP (D-I-D: 4.7%; 95% CI: 1.7,7.8) than in FGMP programs. Caregivers in FGMP areas showed slight improvements in complementary feeding practices (D-I-D: -1.4%; 95% CI:-6.5, 3.7) and significantly improved meal frequency (D-I-D: -4.7%; 95% CI: -9.1,-0.3). No significant differences were observed in minimum dietary diversity (D-I-D: -1.5%; 95% CI: -6.1, 3.1) or acceptable diet (D-I-D: -2.0%; 95% CI: -6.6, 2.6) between the programs. Findings highlight the need to strengthen both FGMP and FGMP + NGO-supported HGMP programs by actively engaging caregivers and incorporating the influential role of family members and local social networks, which appeared to have a stronger impact on child feeding practices than GMP providers.
Muttaquina Hossain, Md Ahshanul Haque, A S G Faruque et al.
Survival
Peer-reviewed article·PubMed (US National Library of Medicine)·
BACKGROUND: Preterm infants are at risk of growth faltering at term age. Our primary objective is to assess post-discharge growth patterns in these infants and investigate the association between growth faltering and neurodevelopment. METHODS: We divided the sample into two groups according to growth during the initial hospital stay: infants who suffered from growth faltering (GF, loss of >1 weight z-score from birth to 36 weeks postmenstrual age, n = 115) and infants who did not suffer from GF (non-growth faltering, NGF, n = 85). RESULTS: The NFG group weight z-score was significantly lower at 36 postmenstrual ages (PMA) compared to birth (p < 0.001), at 1-year corrected age (CA), it was significantly higher than at birth (p = 0.0026), and by 2 years CA, there were no differences compared to the birth z-scores. In the GF infants' group, statistical differences were found at all time points. At 3 and 6 months, CA GF infants were still in weight z-score values lower than -1 point compared to the birth median value. At 12 and 24 months CA, they still had not achieved birth z-score values (p < 0.001). In the Parent Report of Children's Abilities-Revised (PARCA), NGF infants had a higher score in the language development scale at 2 years than GF infants (88.5 [78.5; 96.5] vs. 84.5 [69.5; 91.5], p = 0.03). The Bayley-III test was available for 35 infants. We found a significant difference in motor development, with a higher score in the NGF group (94 [88; 100] vs. 85 [79; 91], p = 0.03). CONCLUSIONS: In this cohort study, GF is associated with growth differences till 2 years CA, and with lower scores in neurodevelopment assessment.
