Liberia instituted a National Community Health Assistant Program (NCHAP) to increase primary healthcare access for residents living >5 km from health facilities. We evaluated the impact of this program on under-five mortality in rural Grand Bassa County as it was rolled out, between 2018 and 2022. The program was implemented in a stepped manner two districts at-a-time across Grand Bassa County from 2018 to 2022, allowing for a quasi-experimental observational stepped-wedge impact evaluation. We conducted a household census in 2022 to collect birth and death histories from all mothers in the program catchment area. We fitted mixed-effects Cox proportional hazards models to estimate the relative hazard of death among children <5 in the before- and under-intervention periods. We also compared data from the 2022 survey with a 2018 baseline household survey to estimate changes in care-seeking and healthcare service delivery coverage. We surveyed 22,315 female respondents about 32,743 children <5 who contributed person-time to the analysis. We found no difference in <5 mortality between the before- and under-intervention periods (unadjusted U5MR under intervention was higher at 62.0 versus 56.3 deaths per live births; adjusted hazard ratio 1.03 (95%CI 0.82-1.31). Care-seeking from a qualified healthcare provider for fever, diarrhea, or acute respiratory infection increased (27.0% to 53.7%; p < 0.001); and care-seeking decreased from drugstores (16.4% to 4.9%, p < 0.001) and black-market providers (42.4% to 22.7%, p < 0.001). Full vaccination among 12-23-month-olds decreased (16.2% in 2018 to 3.5% in 2022 (p < 0.001)) while facility-based delivery increased (41.0% to 57.1% (p < 0.001)). We detected no reduction in under-five mortality during initial implementation of the national CHA program in one Liberian county. Coverage of childhood treatment for high-priority conditions improved, and we observed a shift in care-seeking to trained providers. These results suggest potential program benefits, but additional interventions, some of which are already underway, will be needed to reduce under-five mortality.
Hawa I. Obaje, Emily E. White, Mardieh Dennis et al.
ABSTRACTBackground. Routine childhood immunization is one of the most effective public health interventions for preventing morbidity and mortality from vaccine-preventable diseases among children under five. However, vaccination uptake may be influenced by caregiver knowledge, access to health services, and vaccination-related practices. In Mali, disparities in immunization coverage persist across regions and socioeconomic groups, with limited data on the combined influence of these factors in the Kayes Health District. This study aimed to assess the determinants of routine childhood immunization uptake among caregivers of children under five years in the Kayes Health District, Mali. Methods. We conducted a community-based cross-sectional study among 361 caregivers of children under five years using a structured interviewer-administered questionnaire. Data covered sociodemographic characteristics, access to vaccination services, caregiver knowledge, vaccination practices, service availability, and satisfaction. Descriptive statistics were used to summarize the findings. Results. Most respondents were female (99%), and 59% were aged 17–25 years. Educational attainment was low, with 62% having no formal education or only primary education. One-third (33%) lived more than 5 km from a health facility, and 27.7% walked to vaccination sites. Most respondents knew that vaccination should start at birth (81%), and 99% possessed a vaccination card. Reported vaccination coverage was high, with 92% of children up to date with their vaccination schedule. However, 47% of respondents could not identify vaccine-preventable diseases, and 32% had not received explanations about vaccine benefits. Conclusion. Routine immunization uptake was high, but gaps remain in caregiver knowledge, geographic accessibility, and communication between healthcare providers and caregivers. Targeted public health interventions are needed to sustainably strengthen vaccination coverage, particularly among low-education caregivers and communities living far from health facilities.RÉSUMÉ Introduction. La vaccination de routine est l'une des interventions de santé publique les plus efficaces pour prévenir la morbidité et la mortalité chez les enfants de moins de cinq ans. Cependant, l'adoption de la vaccination peut être influencée par les connaissances des aidants, l'accès aux services de santé et les pratiques vaccinales. Au Mali, des disparités persistent dans la couverture vaccinale entre les régions et les groupes socio-économiques. Cette étude avait pour but d'évaluer les déterminants de la vaccination de routine chez les enfants de moins de cinq ans dans le district sanitaire de Kayes, au Mali. Méthodes. Nous avons mené une étude transversale communautaire auprès de 361 aidants d'enfants de moins de cinq ans à l'aide d'un questionnaire structuré administré en entretien direct. Les données couvraient les caractéristiques sociodémographiques, l'accès aux services de vaccination, les connaissances des aidants, les pratiques vaccinales, la disponibilité des services et la satisfaction. Des statistiques descriptives ont résumé les résultats. Résultats. La plupart des répondants étaient des femmes (99 %), et 59 % avaient entre 17 et 25 ans. Le niveau d'instruction était faible, avec 62 % n'ayant aucune éducation formelle ou seulement l'école primaire. Un tiers (33 %) vivaient à plus de 5 km d'un centre de santé, et 27,7 % s'y rendaient à pied. La plupart savaient que la vaccination devait débuter à la naissance (81 %), et 99 % possédaient un carnet de vaccination. La couverture vaccinale déclarée était élevée, avec 92 % des enfants à jour de leur calendrier vaccinal. Cependant, 47 % ne pouvaient identifier les maladies évitables par la vaccination, et 32 % n'avaient pas reçu d'explications sur les bénéfices des vaccins. Conclusion. La couverture vaccinale était élevée, mais des lacunes persistent dans les connaissances des aidants, l'accessibilité géographique et la communication entre les prestataires et les aidants. Des interventions ciblées sont nécessaires pour renforcer durablement la couverture vaccinale.
This study explored the efficacy of using university-initiated students as communicators in health promotion interventions. Also, the study examined how such a project can assist in meeting some Sustainable Development Goals (SDGs) in Osun and Oyo States. The study adopted a qualitative narrative and documentary research design and reviewed relevant literature from academic journals and UN-WHO policy documents on Osun and Oyo States in Nigeria. The study revealed that university-initiated volunteer students serve as intermediaries who communicate the complex nature of health issues to members of various communities and debunk myths. Also, they mobilize communities to participate in disease prevention and promotion of mother and child-care health services. The findings further revealed students’ contributions directly towards the realization of Sustainable Development Goals (SDGs 3, 4, 5, 10, and17). Following the revelations, it was recommended that there should be establishment of a more institutionalised protocol/policy frame, adequate training/capacity enhancement for the student volunteers. Also, there is a need for more funding and better co-operation with other external partners to surmount the obvious constraints encountered during the volunteer operation.
J. O. Olorede, Mutiu Adeniyi Afolabi, M. A. Azeeez
BACKGROUND: Malaria is a major health issue in sub-Saharan Africa, including Guinea, affecting children under five and rural populations, with a prevalence of up to 30% in some areas. Although long-lasting insecticidal nets (LLINs) are effective, inequalities in access and use persist across wealth, geography, and age groups; however, detailed data are limited. This study assessed socioeconomic inequalities in LLIN access and use among children and adolescents. METHODS: We analysed data from a cohort study conducted between March 2022 and February 2023 in Maferinyah, rural Guinea, with monthly visits to households of children and adolescents aged 1-19. Socioeconomic position (SEP) was derived using an asset index and categorised into terciles. LLIN access and use-given-access were analysed using mixed logistic regression models adjusted for sociodemographic and seasonal factors. Socioeconomic inequalities were quantified using concentration and Erreygers indices with cluster bootstrap confidence intervals. Pathway and decomposition analyses assessed the contribution of access to LLIN to inequalities in effective LLIN use (defined as use regardless of access). RESULTS: The odds of LLIN access were higher among middle-SEP (aOR = 3.84; 95% CI 1.31-11.96) and high-SEP households (aOR = 3.76; 95% CI 1.18-12.71) than among low-SEP households. Inequalities in effective LLIN use were driven by disparities in access rather than by use behaviour. Although LLIN use among those with access exceeded 80% across all socioeconomic groups, effective use in the overall study population was lower among low-SEP households (29.6%). Significant pro-rich socioeconomic inequalities were observed for both LLIN use (Erreygers index (EI) = 0.386; 95% CI 0.151-0.594) and access (EI = 0.412; 95% CI 0.168-0.636). Decomposition analysis suggested that socioeconomic inequality in effective LLIN use was almost entirely explained by differences in access (98.8% of the total variance). CONCLUSIONS: Malaria prevention in rural Guinea is unequal, leaving poorer children and adolescents less protected than wealthier ones. This gap stems from unequal access to LLINs rather than differences in net use among households with nets. The study showed that the poorest families did not have access to nets in the first place. Addressing this inequity requires improved distribution strategies targeting the poorest and most vulnerable households, rather than behavioural interventions for net use only.
Almamy Amara Touré, Sidikiba Sidibé, Soledad Colombe et al.
Childhood immunization remains one of the most effective public health interventions to preventvaccine-preventable diseases.In Burkina Faso, incomplete immunization schedules remain a challenge amid insecurity, population displacement, and health system disruptions.This study aimed to identify factors associated with incomplete immunization and the vaccination dropout rate in children aged 12 to 36 months.A secondary analysis of the 2021 Burkina Faso Demographic and Health Survey (2021-DHS-BF) data was performed.Incomplete immunization was defined as a child not receiving all recommended routine vaccine doses by 15 months of age.Factors associated with incomplete immunization were identified using modified Poisson regression with generalized estimating equations; adjusted prevalence ratios (aPR) with 95% confidence intervals were reported at a 5% significance threshold.Among the 2,375 children who met the eligibility criteria in the 2021-DHS-BF dataset, 1,482 (66.0%) had not completed their immunization schedule.The dropout rate between the first and third doses of the pentavalent vaccine was 11.0%.Maternal occupation (Saler: aPR = 0.89, 95% CI: 0.80-0.98 and farmer/selfemployed: aPR = 0.93; 0.85, 95% CI: 0.78-0.94)and being treated with respect "sometimes" at health facilities (aPR = 1.14, 95% CI: 1.02-1.27)were associated with an incomplete immunization schedule.Strengthening person-centered care, improving post-first-dose follow-up, and expanding community-based outreach strategies could improve immunization schedule completion.
Malaria remains one of the leading causes of child mortality in Nigeria, with the disease claiming the lives of hundreds of thousands of children under five each year. Despite significant advances in malaria prevention and treatment, the burden of the disease continues to be disproportionately high, particularly in high-burden regions. The Oxford R21 malaria vaccine, which has demonstrated unprecedented efficacy in clinical trials, offers a promising new tool in the fight against malaria in sub-Saharan Africa. This article explores the potential impact of the R21 vaccine on child mortality in Nigeria, highlighting its effectiveness, the challenges to its successful implementation, and the broader implications for the nation’s malaria control strategy. The article examines the efficacy of the R21 vaccine, which has shown 77% protection against malaria in young children, significantly outperforming previous malaria vaccine candidates. It also addresses the public health implications, projecting that widespread vaccine distribution could lead to a 30-40% reduction in malaria-related child deaths in Nigeria. Furthermore, the article discusses the need for a coordinated, multi-sectoral approach to vaccine rollout, which includes robust logistics, public awareness campaigns, and addressing vaccine hesitancy. The article concludes that the R21 vaccine has the potential to transform Nigeria’s malaria control efforts, contributing to the long-term goal of malaria elimination. However, achieving its full potential will require strong policy support, sustainable funding, and collaboration between international and local stakeholders. The successful deployment of the vaccine could mark a new era in malaria control, significantly reducing child mortality and improving overall child health in Nigeria.
Age is a crucial factor in the transmission and development of infectious illnesses; nevertheless, age-specific patterns in Hepatitis B Virus (HBV) incidence remain little investigated in rural Nigerian populations. This research analyses the age-stratified prevalence of HBV cases in the Kaura Namoda Local Government Area, Zamfara State, Nigeria, utilising hospital-based data from 2019 to 2023. Confirmed HBV cases were classified into three age categories: children (0– 9 years), teenagers (10–19 years), and adults (20 years and older). Analysis of secondary data from Kauran Namoda General Hospital indicated that the adult demographic exhibited the highest prevalence, succeeded by teenagers, whilst children demonstrated the lowest infection rates. The low incidence among children is probably attributable to the efficacy of Nigeria's standard baby immunisation initiatives. Nonetheless, adolescents and adults—many of whom were born before to the advent of mass vaccination—continue to be susceptible due to occupational exposure, customary practices employing unsterilised tools, and restricted access to catch-up immunisation. These findings highlight the necessity of broadening HBV control methods beyond paediatric immunisation. The report advocates for age-specific treatments, including health education aimed at adolescents in schools, mobile outreach services for adults, and the incorporation of HBV immunisation into workplace health programs. Catch-up immunisation initiatives must be expanded to address immunity deficiencies in older demographics. Comprehending the varying impact of HBV across age groups is crucial for attaining equitable and thorough disease management. This study provides critical insights to guide targeted, age-responsive interventions designed to mitigate HBV transmission and attain eradication objectives in high-risk rural communities.
The rise in vaccine-preventable diphtheria diseases underscores the issue of vaccine hesitancy in Nigeria that undermines herd immunity and results in the re-emergence of diphtheria outbreaks. Knowledge and awareness of diphtheria resurgence among people of Plateau State, as well as signs and symptoms, is a challenge. This research examines the diphtheria vaccine hesitancy among individuals in Plateau State, Nigeria. The study employed a cross-sectional approach, utilizing questionnaires and interviews for data collection. A total sample size of 389 participants was involved through using Cochran’s William formula of 1963, and areas selected were LGAs that had recorded diphtheria infection previously (Wase, Jos-North, Kenam, Bokkos, Pankshin, Barkin-Ladi, Langtang, and Mikang LGAs). The study considered the inclusion of male and female, both infected victims and non-infected victims, where it excluded laboratory tests, children, and disabled people from the selected environment. The ethical considerations included contacting the Plateau State Ministry of Health and the Plateau State Hospital Management Board, as well as maintaining confidentiality. The study analyzed the data using simple statistics, including frequency/percentage, mean, and standard deviation, as well as factor analysis to determine the primary factors contributing to vaccine hesitancy in Plateau State. The findings reveal low knowledge and a lack of awareness about the re-emergence of the disease, as well as a limited understanding of its signs and symptoms. Others, unsure of the vaccine, lack confidence among health personnel due to fears of infertility and negative beliefs about vaccine safety. Poor awareness, self-negative assumptions, and parental decision-making regarding household vaccination are major factors identified. Thus, recommendations were made appropriately to encourage herd immunity.
Vaccine hesitancy and immunization inequity remain major public health challenges in Nigeria, where limited access, uneven service delivery, and weak confidence in vaccines continue to constrain progress toward universal immunization coverage. This narrative review examined the public health determinants of vaccine hesitancy, the role of misinformation in shaping vaccine decisions, and the health system strategies that may improve equitable uptake. The literature search period spanned 2008 to 2026, drawing on evidence from biomedical, public health, behavioral, and policy studies to capture both routine childhood immunization and vaccine acceptance in the COVID 19 era. The reviewed evidence shows that vaccine hesitancy in Nigeria is not driven by a single factor, but by a combination of structural and social influences. Low coverage is closely linked to poverty, rural residence, distance to health facilities, insecurity, weak primary care, poor antenatal contact, and geographical inequities that leave many children zero dose or under immunized. Hesitancy is also shaped by low trust in health authorities, fear of side effects, doubts about vaccine effectiveness, religious interpretation, gendered decision making, and limited health literacy. In parallel, misinformation has become a powerful driver of resistance, especially through social media and video platforms where conspiracy narratives, fear-based content, and doubts about government intentions amplify uncertainty and reduce confidence. The review also indicates that uptake improves when interventions go beyond information sharing and address the realities of access and trust. Community engagement, trusted local communication, mobile reminders, stronger primaryhealth care delivery, women centered empowerment strategies, and culturally responsive outreach were repeatedly associated with better uptake and stronger acceptance. Overall, the evidence suggests that reducing vaccine hesitancy in Nigeria requires an integrated response that combines reliable service delivery, misinformation control, community partnership, and equity focused policy action. Such an approach is essential for improving immunization coverage, reducing the burden of zero dose children, and advancing the country’s broader public health goals.
Background: Nigeria introduced single-dose HPV vaccination for girls aged 9-14 in 2023, reaching approximately 60% aggregate coverage by 2025. While an important achievement, this remains short of the 90% coverage called for under the WHO's 90-70-90 cervical cancer elimination targets, and further scale-up depends on reaching out-of-school girls. In this study we used a model of HPV transmission in Nigeria to quantify the residual cervical cancer burden under continued adolescent delivery, assess how additional screening scale-up and equity assumptions modify it, and identify the effective coverage requirements for an infant HPV vaccination program to be non-inferior to the existing adolescent strategy. Methods: We used HPVsim, an agent-based microsimulation calibrated to Nigerian sexual behavior, HPV prevalence, and cervical cancer incidence, to project new cervical cancer cases and age-standardized incidence over 2025-2100 under scenarios which vary vaccination delivery mode (status-quo adolescent, WHO 90-70-90 adolescent scale-up, and 60/75/90% infant delivery), screening coverage (opportunistic 15% vs. scaled 70% aggregate), and the degree to which primary school completion correlated with vaccination (odds ratio 1 vs. 5) and with screening (odds ratio 1 vs. 3). Infant delivery scenarios were run at hypothetical effective-vaccine-efficacy-at-exposure values of 50%, 70%, and 95% - scenario inputs bracketing the plausible waning range, not evidence-based estimates of infant vaccine performance (no HPV vaccine trial has enrolled anyone below age 10). Each scenario was run at 50 replicates (10 calibration draws, 5 seeds); reported outcomes are the median across replicates and uncertainty ranges are interquartile (25th-75th percentile). Results: Continuation of Nigeria's current adolescent program is projected to avert 1.82 million cervical cancer cases (IQR 1.65-1.90 million; 95% UI 1.39-2.02 million) over 2025-2100 (a 53% reduction relative to no vaccination, IQR 51-55%; 95% UI 46-58%), with age-standardized incidence falling from 19.7 to 7.8 per 100,000 by 2100. However, 82% of the near-term (2025-2075) burden is projected to fall on the pre-2015 birth cohort, i.e. women already beyond the vaccination target age, leaving approximately 945,000 residual cases (IQR 905K-1.00M; 95% UI 835K-1.14M) in this cohort. Scaling up screening to WHO targets was estimated to avert a further ~387K cases (IQR 331-424K; 95% UI 269-515K), roughly 25% of the residual burden; results were about 6-8% better if the scale-up instead reached all women equitably regardless of education. Under a hypothetical scenario of infant vaccination at 90% coverage and 95% effective vaccine efficacy at exposure (matching adolescent-age performance), outcomes were comparable to full WHO adolescent scale-up (49% vs. 54% reduction in vaccine-targetable cohort cancers), but under a hypothetical 50% effective efficacy at Nigeria's DTP3-anchored 62% coverage the strategy averted only a fraction of these cancers. Conclusions: The near-term cervical cancer burden in Nigeria is dominated by cohorts vaccination cannot reach; scaling screening for them is the more consequential lever over the coming three decades and rests on established evidence. Findings on infant HPV delivery are exploratory and hypothesis-generating: they depend on three unverified empirical prerequisites - infant HPV vaccine immunogenicity in the first months of life, durability of protection across the ~15-25-year interval to peak HPV exposure, and coverage achievable through Nigeria's routine childhood immunization platform - and should not be read as a basis for any policy recommendation contingent on infant HPV delivery until those prerequisites are established.
Robyn Margaret Stuart, Ifeoma Umeh, Christopher Gill et al.
