On March 13, 2020, the government of South Sudan implemented emergency lockdown measures in response to the COVID-19 pandemic. Fears that the pandemic would reverse efforts by the government and civil society to keep girls in school were realized and reported incidences of teen pregnancy increased. Prior to the pandemic, early marriage and teen pregnancy in South Sudan were already of extreme concern, as the country reported the seventh-highest child marriage rate in the world. Countrywide data from 2019 indicated that only 34 percent of the students who sat for primary exams were girls. We conducted this qualitative study to explore the resilience factors that adolescent mothers and pregnant adolescents relied on during the COVID-19 lockdowns in Maiwut Town, South Sudan, to enable them to return to school and continue their education. Our research revealed that, despite struggling to meet their basic needs, receiving weak support from their social networks, and experiencing violence and persistent negative gender roles, these adolescent mothers and pregnant adolescents exhibited resilience in their aspirations to return to school and become financially independent. By centering this research on the voices of this vulnerable population, we are able to recommend what we argue are more effective and targeted interventions for organizations that are working in this and similar emergency contexts.
Purpose: The purpose of the study is to determine socio-demographic and economic predictors influencing immunization coverage among under-5 children of nomadic pastoralists in selected manyattas in Garissa County, Kenya Methodology: The study was a cross sectional study design on immunization coverage in Balambala Sub County in Garisa County. The population was selected from household residents of Manyattas in Balambala, among families who had children for immunization. The inclusion criteria was the guardians/caretakers of children aged 0-60 months in Manyattas of Balambala Sub County in Garisa County, whose parents/Caregivers gave informed consent to participate in the study. Children must have resided in Balambala Sub County for more than 6 months. Systematic sampling method was used to collect data from the sample. Data collection was done by use of questionnaires on social demographic and economic factors associated with children immunization. SPSS version 12 was used for analysis where Univariate and multivariable analysis was done to determine association between socio-demographic and economic factors and immunization among children under five years. Ethics Review committee approval no ISERC/MSc/015/2024 was obtained. Findings: The analysis of factors associated with immunization coverage among caregivers reveals significant associations with several socio-demographic characteristics. Caregivers’ age emerged as a critical factor, with those aged 35-44 showing the highest rate of fully immunized children at 88.2%, while caregivers aged 45 and above had the lowest full immunization rate at 37.5%. Caregivers from households earning more than KSh 20,000 had the highest rate of fully immunized children (92.9%), while those earning less than KSh 10,000 had the lowest rate (65.2%). Unique Contribution to Theory Practice and Policy: Enhance education and awareness by implementing community-based education and awareness programs to improve health literacy among caregivers, particularly focusing on the importance of completing the full immunization schedule. health education initiatives should target caregivers with no or low levels of formal education and involve community health volunteers for effective dissemination of information.
Mohameedkhalar Adan, Dennis Magu, Patrick Mwirigi Mburugu et al.
The health system is the primary vehicle for the delivery of nutrition-specific interventions that aim to reduce maternal and child malnutrition. The integration of nutrition interventions into existing health interventions is promising, but to ensure that no one is left behind requires that access to essential health services is equitably distributed. This study aims to assess trends and socioeconomic inequalities in coverage of reproductive, maternal, newborn and child health (RMNCH) and assess its association with child nutritional outcomes in Ethiopia. Using the Ethiopian Demographic and Health Survey (2005, 2011, 2016, and 2019), we estimated the coverage of RMNCH interventions in Ethiopia using the co-coverage index, which is a count of the number of interventions accessed. We assessed the trend and inequalities in co-coverage and evaluated its association with child nutritional outcomes like stunting, wasting, and minimum dietary diversity (MDD). The national co-coverage index has shown a significant increase over the 2005-2019 period. However, all of the RMNCH interventions constituting the co-coverage index showed a pro-rich and pro-urban distribution (p < 0.05). The highest inequality, based on the slope index of inequality (SII), was observed for skilled assistance during delivery (SII: 80.4%), followed by access to an improved source of drinking water (SII: 62.6%), and antenatal care visits (SII: 55.5%). The low coverage in RMNCH and the observed inequality were associated with stunting, wasting, and MDD. Reducing socioeconomic inequality in RMNCH is key to achieve the health, nutrition and equity-related goals of the Sustainable Development Goals.
BACKGROUND: In developing countries like Ethiopia, about 3 million children's deaths are attributed to vaccine-preventable diseases. Studies especially that try to explain the urban to rural vaccination coverage discrepancy are limited in the study area. This study aimed to assess full vaccination coverage and associated factors among children aged 12-23 months in rural and urban kebeles of Pawi district. METHODS: A community-based comparative cross-sectional study among urban and rural kebeles was conducted. A multistage sampling method was used to select 456 rural and 229 urban. Data were collected from mothers/caregivers using interviewer-administered questionnaires and vaccination cards. Full vaccination coverage was estimated for both urban and rural kebeles. Multivariable logistic regression analysis was used to identify factors associated with full vaccination. Adjusted Odds Ratio with a 95% confidence interval was reported. RESULTS: Full vaccination coverage was 67% (95% CI 63% -71%) and 60% (95% CI: 54% -66%) among rural and urban residents, respectively. Educational status of the father (AOR=2.69; 95% CI, 1.61-4.48), using postnatal care (PNC) (AOR=2.60; 95% CI, 1.58-4.29), discussion on side effect and contraindications of vaccines (AOR=1.82 95% CI, 1.16-2.88), and Institutional delivery (AOR=4.39, 95% CI 2.17-8.87) were factors significantly associated with full vaccination among rural children, whereas using Knowledge on immunization schedules (AOR=1.92 95% CI, 1.03-3.60), PNC (AOR=3.19; 95% CI, 1.57-6.47), discussion on side effects and contraindications of vaccines (AOR=2.75; 95% CI, 1.4-5.3) were notably associated with full vaccination among urban children. CONCLUSION: The study reveals vaccination coverage was higher in rural compared to urban kebeles but it is still far below the WHO recommended target. Therefore interventions shall be made to improve the coverage especially by using the identified factors like improving PNC service and promoting institutional delivery and health education.
BACKGROUND: Though Ethiopia has made significant progress in childhood vaccination, many children remain unvaccinated, making it the third largest contributor to the global burden of zero-dose children. Zero-dose children are those who doesn't receive the first dose of diphtheria, tetanus and pertussis containing vaccine. Identifying geographic inequities of zero-dose prevalence and the factors influencing it could help to effectively reach and identify at-risk children and to design tailored intervention. OBJECTIVES: This study aimed to assess the geographical inequities and predicting factors of zero-dose children aged 12-23 month in Ethiopia. METHODS: We used a population-based survey data. A total of 6,212 children aged 12-23 were included. The spatial autocorrelation was employed to examine geographic variations in zero-dose children. Getis-Ord Gi* statistics was used for hotspot analyses. A Kriging interpolation technique used to estimate values of zero-dose at unmeasured locations based on known values of zero-dose at observed locations. The Geographic Weighted Regression (GWR) analysis was used to elicit determinants of geographic difference in zero-dose children. Adjusted R2 and Akaike Information Criteria (AICc) were used to compare the models. RESULTS: The prevalence of zero-dose children was 24.8% [CI: 23.7%-25.8%] ranged from 0.9% in Addis Ababa to 40.7% in Somali region. The zero-dose prevalence varied across the study area (Moran's I = 0.193; P-value<0.0001). Significantly higher proportions of zero doses (hotspot areas) were identified in the north and south Somali, northwest Afar, East Amhara, and southern Oromia regions. GWR analysis showed that no ANC utilization, no TT/Td vaccination, poor perceptions on immunization, and far distance to healthcare facilities contributed to these geographic variations. CONCLUSION: This study revealed that the prevalence of Zero-dose is unacceptably high, with geographic inequities varying across the country. Factors such as ANC utilization, TT/Td vaccination, perceptions of immunization, and distance to healthcare facilities contributed to these geographic differences. This underscores the importance of designing and implementing tailored interventions to identify and reach zero-dose children. Such an approach could help achieve the national and global immunization goal of leaving no one behind by providing equitable access to immunization.
Berhanu Fikadie Endehabtu, Kassahun Alemu, Shegaw Anagaw Mengiste et al.
OBJECTIVE: The objective of this study is to assess the determinants of BCG vaccination in Ethiopia from 2016 Ethiopia Demographic and Health Survey (EDHS). SETTING: Since Ethiopia has nine regional states and two administrative cities, sample was taken from all the divisions. The population-based sample was intended to provide estimates of key indicators for the country. PARTICIPANT: The sampling frame used for the 2016 EDHS is the Ethiopia Population and Housing Census. From 15 683 women recorded in EDHS dataset, women with no child (n=10 379) were excluded from the study. Therefore, the total sample size for this study was 5304 women. The outcome variable was BCG immunisation status of children. RESULT: Out of the study participants (n=5304), the majority were in between 20 and 34 years of age (73.8%). The median age of the respondents was 28.4 (SD=±6.5) years old. Prevalence of BCG vaccination was 63.6% (n=3373) and BCG vaccination coverage in urban residents was higher (88%) than rural residents (57.3%). Mothers' age between 20 up to 34 (Adjusted odds ratio (AOR)=1.48; 95% CI: 1.13 to 1.93) and between 35 up to 49 (AOR=1.83; 95% CI: 1.35 to 2.46) were more likely to vaccinate their child's than those mothers' age less than 20. Mothers settled in urban areas were two times more likely to vaccinate their child's than those living in rural areas (AOR=1.94; 95% CI: 1.45 to 2.60). Mothers with greater antenatal visits show higher BCG vaccination, Antenatal Care (ANC) 4 and above (AOR=3.48; 95% CI: 2.91 to 4.15). BCG vaccination is higher for mothers delivered at non-governmental organisation health facility than home (AOR=2.9; 95% CI: 1.69 to 4.96). Maternal occupation and wealth index also had a significant association with BCG vaccination. CONCLUSION: BCG vaccination coverage, in this study, was lower and determinant factors for BCG vaccination were residence, mother's age, place of delivery, mother's antenatal visit, wealth index and mother's occupation.
Abstract Introduction The most common indirect impact of the Coronavirus Disease 2019 (COVID-19) pandemic has been the interruption of routine immunisation services, resulting in a significant decline in childhood immunisation rates, particularly during the early stages of the pandemic. This study aimed to explore the socio-demographic characteristics associated with continued routine immunisation in Rwanda. Methods A cross-sectional survey was conducted between January 3 rd to March 31 st , 2022 amongst mothers from five districts in Rwanda. Multinomial logistic regression was used to determine associations between demographic characteristics and the willingness to vaccinate children, considering the impact of the COVID-19 pandemic on vaccination attitudes. Results Among the 2,045 mothers surveyed, 92.2% and 91.6% admitted that their religion and culture support immunisation respectively. Marital status, educational status, and average monthly income were significantly associated with culture and tradition. Out of the 2,045 mothers, 77.3% and 58.7% were concerned about the serious adverse effects of vaccines and COVID-19 vaccines, while 8.1% were concerned with the safety of COVID-19 vaccines. With the exception of age, marital status, and the number of children in the immunisation age bracket, there was a significant association between the perceived risks of vaccination and all other socio-demographic characteristics. Conclusion Global routine immunisation was disrupted throughout the duration of the COVID-19 pandemic. However, Rwanda’s initial preparedness to combat infectious diseases such as Ebola minimized the influence of COVID-19 on routine immunisation in the country. This study suggests an association between routine immunisation and factors such as culture, financial constraints, vaccine misinformation, concern about adverse effects of vaccines, and apprehensions over the safety of COVID-19 vaccines.
Edward Mbonigaba, Fengyun Yu, Mark Donald C. Reñosa et al.
Abstract Background Vaccination remains a cornerstone of global child health, offering one of the most cost-effective interventions for reducing childhood morbidity and mortality caused by vaccine-preventable diseases (VPDs). Despite this, global vaccination coverage has recently declined, particularly in low- and middle-income countries. In Rwanda, although the national childhood immunization rate has reached 95%, gaps remain in reaching the last mile. Community Health Workers (CHWs) have played an instrumental role in promoting and delivering immunization services across hard-to-reach communities. Yet, little is known about the specific contributions of CHWs to these gains, particularly in rural settings such as Burera District, Northern Rwanda. The study aimed to (1) investigate the factors influencing CHWs’ intervention in promoting childhood vaccination, (2) examine the impact of CHWs on vaccination coverage among children under five, and (3) explore the perspectives of caregivers on CHWs’ intervention in childhood vaccination coverage. Methods A mixed-methods approach was adopted, combining quantitative surveys with 345 CHWs and qualitative key informant interviews (KIIs) with selected caregivers of children under five benefiting from CHWs vaccination intervention. Quantitative data were collected through structured questionnaires and analyzed using descriptive statistics, and multivariable logistic regression in STATA 18. Thematic analysis was used to analyze qualitative data obtained from five KIIs across Burera’s five major health center catchment areas. Results CHWs in Burera were predominantly female (67.5%), married (98.8%), with primary-level education (86.1%), and most engaged in farming (98.6%). A large proportion (94.5%) had received training on vaccination services, and 98.3% regarded under-five vaccination as “very important.” Over 50% reported facilitating community vaccination events twice per month. CHWs were actively involved in community mobilization and advocacy, with 93.9% participating in campaign planning. CHW activities included referring children to health facilities (58.0%) and conducting home-based vaccination outreach (42.0%). From caregivers’ perspectives, CHWs played critical roles in health education, timely reminders for appointments, and home-based vaccination services. Thematic analysis of interviews revealed strong trust in CHWs, who were seen as vital liaisons between the community and the formal health system. Barriers noted included logistical challenges and the need for more consistent training and communication support for CHWs. Over 55% of CHWs recommended more structured community awareness campaigns to further enhance immunization uptake. Conclusion CHWs are central to Rwanda’s success in achieving high childhood vaccination coverage, especially in rural areas like Burera District. Their interventions in education, mobilization, and service delivery have significantly contributed to bridging gaps in access and awareness. However, sustaining and enhancing these gains requires continued investment in CHW training, supervision, and logistical support. Findings from this study provide critical insights for policymakers and health planners to strengthen community-based vaccination strategies and reach the last mile by 2030 in alignment with Sustainable Development Goal (SDG) 3.b.
Michee Nshimayesu, Barnabas Tobi Alayande, Marie Consolatrice Sage Ishimwe et al.
Abstract Introduction: The study aimed to investigate the immunization status of children aged 1 to 2 years in Juba County, South Sudan, and to identify factors associated with their immunization coverage. Methods: A cross-sectional survey design was employed, with Juba being purposively sampled and the Payams in Juba being stratified, followed by the random sampling of villages within these Payams. Data was collected through structured interviews and analyzed using SPSS v22, incorporating descriptive and inferential statistics. Findings: The study revealed that more than three-quarters of the children had received all the recommended vaccines, with the BCG vaccine being the most commonly received, while the measles vaccine was the least received. The study identified several factors associated with immunization coverage, including parental age, religious affiliation, knowledge of the benefits of immunization, maternal economic activity, and perceived flexibility of immunization services provided at healthcare facilities. Notably, the prevalence of reception of all vaccines was lower among children whose parents were aged 18–25 years and born-again Christians, while it was higher among children whose parents recognized the benefits of immunization. Additionally, children whose mothers were engaged in economic activities were less likely to receive all primary vaccines. Furthermore, the study found that the flexibility of immunization services at healthcare facilities was associated with lower immunization coverage. Conclusion: The study highlighted that while the proportion of children in Juba receiving all vaccines is relatively high, it still falls below the global standard of 90%. The immunization status of children in Juba was found to be primarily influenced by parental characteristics, with institutional characteristics playing a smaller role. These findings underscore the importance of targeted interventions to address specific parental and institutional factors that may hinder optimal immunization coverage in Juba County, South Sudan.
BACKGROUND: During the millennium development goals period, reduction in under-five mortality (U5M) and increases in child health intervention coverage were characterised by sub-national disparities and inequities across Kenya. The contribution of changing risk factors and intervention coverage on the sub-national changes in U5M remains poorly defined. METHODS: Sub-national county-level data on U5M and 43 factors known to be associated with U5M spanning 1993 and 2014 were assembled. Using a Bayesian ecological mixed-effects regression model, the relationships between U5M and significant intervention and infection risk ecological factors were quantified across 47 sub-national counties. The coefficients generated were used within a counterfactual framework to estimate U5M and under-five deaths averted (U5-DA) for every county and year (1993-2014) associated with changes in the coverage of interventions and disease infection prevalence relative to 1993. RESULTS: Nationally, the stagnation and increase in U5M in the 1990s were associated with rising human immunodeficiency virus (HIV) prevalence and reduced maternal autonomy while improvements after 2006 were associated with a decline in the prevalence of HIV and malaria, increase in access to better sanitation, fever treatment-seeking rates and maternal autonomy. Reduced stunting and increased coverage of early breastfeeding and institutional deliveries were associated with a smaller number of U5-DA compared to other factors while a reduction in high parity and fully immunised children were associated with under-five lives lost. Most of the U5-DA occurred after 2006 and varied spatially across counties. The highest number of U5-DA was recorded in western and coastal Kenya while northern Kenya recorded a lower number of U5-DA than western. Central Kenya had the lowest U5-DA. The deaths averted across the different regions were associated with a unique set of factors. CONCLUSION: Contributions of interventions and risk factors to changing U5M vary sub-nationally. This has important implications for targeting future interventions within decentralised health systems such as those operated in Kenya. Targeting specific factors where U5M has been high and intervention coverage poor would lead to the highest likelihood of sub-national attainment of sustainable development goal (SDG) 3.2 on U5M in Kenya.
Peter M. Macharia, Noel K. Joseph, Robert William Snow et al.
