Abstract Introduction Globally, adolescent pregnancy and marriage contribute to high school dropout rates. Girls who drop out of school early tend to have poorer health indicators than those who continue their education. In 1997, the government of Zambia, through the Ministry of Education, introduced the Re-entry Policy to facilitate adolescent girls who had dropped out of school to continue their education. However, since this policy enactment, there has not been any formal study to explore the facilitators and challenges of its implementation. This study explored factors influencing the re-engagement of school dropout girls into the education system following the enactment of the Re-entry Policy in Zambia. Methods This was a qualitative study conducted in three priority districts in Zambia between September and October 2022. We conducted 26 key informant interviews with officials from the district government department, implementing partners, community members, and parent-teacher association representatives, 14 in-depth interviews, and 5 focus-group discussions with girls who re-engaged into the education system and those who had not returned to school. Data were collected on the reasons why girls had dropped out, facilitators of their re-engagement, and challenges experienced during and/or after the re-engagement process. Data analysis was conducted using a reflexive thematic analysis approach, following a structured coding process. Results Factors influencing girls to drop out of school included socioeconomic constraints, gender roles and inequality, long distances to schools, and inadequate and unsafe boarding facilities. Conversely, factors facilitating girls’ return to school included the recognition of the value of education as a means for achieving personal development, a supportive policy environment, educational sponsorships, the engagement of community and traditional leadership in ending child marriages. However, the challenges for re-engaging girls back to school included limited comprehensive sponsorship and funding opportunities, limited implementing partners funding opportunities for girls to stay in school, and inadequate community awareness of the Re-entry Policy. Suggested strategies to address the challenges that girls face in re-engaging them back to school included an expansion of existing limited school infrastructure and increased implementation of Comprehensive Sexuality Education (CSE) in schools. Conclusion Socioeconomic, cultural, and structural factors rank among the major challenges that limit girls’ re-entry and retention in the school system. Therefore, increasing resources and opportunities for scholarships, expanding school infrastructure, and engaging stakeholders to improve access to and delivery of quality education are essential measures to enable girls to attain their educational potential. Policy Implications The findings highlight the need for strengthening existing policies to address socioeconomic constraints, gender inequality, and unsafe boarding to reduce dropout rates . Additionally, increasing educational sponsorship, community awareness of the Re-entry Policy, community leadership, and parents’ involvement in preventing child pregnancies and marriages is essential. Finally, the government should expand the school infrastructure, strengthen the implementation of CSE to facilitate overcoming the current challenges, and support girls’ return to school for social development.
Malizgani Paul Chavula, Batuli Habib, Hikabasa Halwiindi et al.
Background: Adolescent pregnancy poses significant global health challenges, particularly in regions with weak healthcare systems, and is linked to the third Sustainable Development Goal on health. It is associated with high rates of maternal and child morbidity and mortality, with hypertensive disorders, haemorrhage, infections, low birth weight, and preterm delivery being common issues. In Sub-Saharan Africa, adolescent pregnancy accounts for 10-30% of maternal deaths. The Research Initiative to Support the Empowerment of Girls (RISE) project in rural Zambia aimed to reduce early childbearing by providing economic support to girls and their families, along with community interventions to enhance sexual and reproductive health knowledge.Objective: This study explored the experiences of adolescent pregnancy among girls who participated in the RISE project in Chibombo and Chisamba districts, Zambia.Methods: A qualitative phenomenological approach was used, involving 20 girls aged 15-19 years who had experienced pregnancy and received support from the RISE project. The study was conducted in schools within Chibombo and Chisamba districts, including Kampekete, Chombela, Kalala, and Kapopo.Results: Most participants were 18 years old, in their 9th grade, and from Chibombo district. They typically became pregnant at 16 years of age. Participants reported adverse social and health consequences of early pregnancy, such as social and family neglect, fistula, school dropout, depression, low self-esteem, and forced marriage. The RISE project was viewed positively for its financial support, education on re-entry policy, awareness of early marriage dangers, contraceptive knowledge, and life skills training. Contributing factors to adolescent pregnancy included poverty, peer pressure, traditional practices, and lack of sexual education. Barriers to contraceptive access included prejudice, inaccessibility, and cultural factors.Conclusion: Adolescent pregnancy in rural Zambia poses severe health and social challenges. The RISE project demonstrates the importance of targeted interventions in reducing early childbearing and supporting affected girls' reintegration into education and society.
Inonge Lubasi, JOHN SOKO, Malizgani Paul Chavula et al.
Abstract In this article, we explore the sociocultural constraints that undermine rural adolescent girls’ agency in resisting early child marriage in a gender-unequal context in Zimbabwe. Drawing on interviews with 20 rural high school girls aged 14 to 17, we analyze how intersecting forces—patriarchal authority, family control, economic precarity, and institutional complicity curtail girls’ autonomy. Findings reveal how fear of familial rejection, the lack of safe spaces, the silencing of girls’ voices, and the normalization of early child marriage converge to limit resistance. The involvement of authority figures in abuse, cultural responses to early pregnancy, and limited access to information further intensify girls’ vulnerability. Dismantling early child marriage requires transformative interventions that challenge patriarchal norms and foster collective empowerment in structurally marginalized rural sub-Saharan Africa.
BACKGROUND: Between 2010 and 2016, the proportion of children 12-23 months of age who received full immunization in Malawi decreased from 81% to 76%. Most studies on immunization have mainly focused on the risk factors of vaccination coverage while data on dropouts and equity gaps is very scanty. Thus the aim of the present study was to describe the trend in immunization coverage, dropout rates and effective immunization coverage (EIC) among children ages 12-23 months in Malawi. METHODS: Secondary analyses of the cross-sectional data obtained from the three waves of the Demographic and Health Surveys (2004, 2010 and 2015-16) were conducted. Using bottleneck analysis, outputs were generated based on service coverage, demand/equity (service utilization) and quality (full immunization). The World Health Organization benchmarks were used to assess gaps in the immunization coverage indicators. RESULTS: The coverage was >90.0% in most of the antigens while full immunization status was estimated at 65%, 84% and 73% in 2004, 2010 and 2015, respectively. The highest coverage was observed in Bacillus Calmette-Guérin (BCG) and lowest in oral polio vaccine 1 (OPV1). OPV1 coverage was <90% in the 2004 cohort year, while pentavalent 3 (Penta3) and measles-containing vaccine 1 (MCV1) coverages were <90% in 2004. Dropout rates of Penta3 and MCV1 were significantly >10% in 2004. The logistic regression analyses showed that children were significantly less likely to be immunized with Penta3 and MCV1 in all cohort years compared with Penta1. CONCLUSIONS: Although immunization coverage was in line with the national and district targets for various antigens, full vaccination coverage (FVC) is still lagging behind. Furthermore, the dropout rates for Penta3 and MCV1 showed upside U-shaped patterns. Thus health education, supervision and orientation of service providers are urgently needed to address disparities that are existing in FVC.
Kondwani Mmanga, Tisungane Edward Mwenyenkulu, Owen Nkoka et al.
BACKGROUND: Current evidence indicates that children are relatively spared from direct COVID-19-related morbidity and mortality, but that the indirect effects of the pandemic pose significant risks to their health and wellbeing. OBJECTIVES: To assess the impact of the local COVID-19 outbreak on routine child health services. METHODS: The District Health Information System data set for KwaZulu-Natal (KZN) provincial health services was accessed, and monthly child health-related data were extracted for the period January 2018 - June 2020. Chronological and geographical variations in sentinel indicators for service access, service delivery and the wellbeing of children were assessed. RESULTS: During April - June 2020, following the start of the COVID-19 outbreak in KZN, significant declines were seen for clinic attendance (36%; p=0.001) and hospital admissions (50%; p=0.005) of children aged <5 years, with a modest recovery in clinic attendance only. Among service delivery indicators, immunisation coverage recovered most rapidly, with vitamin A supplementation, deworming and food supplementation remaining low. Changes were less pronounced for in- and out-of-hospital births and uptake rates of infant polymerase chain reaction testing for HIV at birth, albeit with wide interdistrict variations, indicating inequalities in access to and provision of maternal and neonatal care. A temporary 47% increase in neonatal facility deaths was reported in May 2020 that could potentially be attributed to COVID-19-related disruption and diversion of health resources. CONCLUSIONS: Multiple indicators demonstrated disruption in service access, service delivery and child wellbeing. Further studies are needed to establish the intermediate- and long-term impact of the COVID-19 outbreak on child health, as well as strategies to mitigate these.
BACKGROUND: Children born to adolescent mothers are more vulnerable to infant mortality and morbidity than those born to adult mothers. HIV-exposed children have lower antibody protection against vaccine-preventable diseases at birth compared to unexposed children. In South Africa, 17 % of adolescent girls aged 15-19 years are mothers, yet vaccination coverage and timeliness among their children is underreported. METHODS: This study estimated age-appropriate vaccination coverage and timeliness among children (n = 1080) of adolescent mothers (n = 1015) in the Eastern Cape, South Africa. Mother-child dyads were recruited through healthcare and community-based sampling strategies. Vaccination data were abstracted from 1013 home-based child health records (2017-2019). Coverage is reported for Diphtheria-Tetanus-Pertussis 3rd dose (DTP3), under-1 vaccination among children over 12 months (n = 613) and measles 2nd dose (MCV2) among children over 24 months (n = 382) using proportions with 95 % confidence intervals (95 %CI). Timeliness is defined as receiving each vaccination within 4 weeks of recommended age. Findings are disaggregated by maternal HIV-status. RESULTS: Overall, 27.3 % of adolescent mothers were living with HIV. Coverage of DTP3 was 85.6 % (95 %CI: 82.6-88.3 %), under-1 coverage was 53.2 % (95 %CI: 49.1-57.2 %), and MCV2 coverage was 62.3 % (95 %CI: 57.2-67.2 %). Vaccination coverage was lower among children of adolescent mothers living with HIV (AMLHIV) than unexposed children (DTP3 80.3 % vs 88.2 % p-value: 0.01; under-1 46.5 % vs 56.4 % p-value: 0.02; MCV2 55.4 % vs 67.1 % p-value: 0.02). Timeliness of vaccinations declined over time from 98.0 % at birth, 70.7 % at 14 weeks, 71.9 % at 9 months and 37.3 % at 18 months. CONCLUSION: Vaccination coverage among children of adolescent mothers in the Eastern Cape are below national targets. Children of AMLHIV had lower coverage than HIV-unexposed children. Further research is needed to identify risk factors associated with incomplete and delayed vaccinations among this group, particularly among HIV-exposed children. Enhanced vaccination campaigns may be required for children of adolescent mothers.
Camille Wittesaele, Elona Toska, Lucie Dale Cluver et al.
Background: Immunization is one of the most successful public health initiatives. The World Health Organization in 2017 estimated that immunization averts about 2 to 3 million deaths every year. About 29,000 children worldwide under the age of five die every day, mainly from vaccine-preventable diseases. Uptake of vaccines with multiple doses up to the last dose has been a prob-lem. Incomplete immunization against diseases leads to the reappearance of childhood vaccine-preventable diseases (VPD) and consequently high infant mortality. The paper explored the rea-sons for incomplete of child immunization schedule in Lusaka district, Zambia. Methods: The study employed a concurrent mixed method design where both quantitative and qualitative methods were used. This particular paper focuses on the results from the qualitative component where Focus Group Discussions (FGDs) and Key Informant Interviews (KIIs) were conducted with mothers and community health workers. Thematic analysis was used to analyse the data. Results: The study found that mothers were generally aware of vaccines and knew the benefits of the vaccines. The reasons for incomplete child immunisation include the mothers’ negative percep-tions such as the fear of side effects of the vaccines, mothers’ unwillingness to bring the child for immunisation. Bad treatment of mothers by health workers and various social factors such as the mother having to attend to social engagements like funerals and weddings also contributed to in-complete child immunisation. Economic factors included a lack of transport money and mothers having to attend work are additional reasons for incomplete child immunization. Conclusion: The reasons for incomplete child immunisation revealed by this study reflect complex individual, interpersonal, health systems, and social cultural contexts within which mothers live in their daily lives. There is need for more comprehensive and multi sectoral approach to improve the completion of immunisation schedules in children
Eddie Kashinka, Chama Mulubwa, Tulani Francis L. Matenga et al.
BACKGROUND: Vaccine safety surveillance is an essential requirement in vaccination programmes. It supports signal identification, hypothesis generation, and the identification and rectification of gaps in vaccine pharmacovigilance systems. The objectives of this study were to determine the characteristics and trends of adverse events following immunisation (AEFI) and to assess the performance of the Zimbabwe Expanded Immunisation Programme safety surveillance system. METHODS: We carried out a descriptive study of passively collected vaccine-related Individual Case Safety Report (ICSR) data submitted to the World Health Organization global adverse drug reaction database (VigiBase®) from Zimbabwe during the period 1997 to 2017. We extracted AEFI/ICSR data using VigiLyze® for analysis with respect to the demographic distribution, AEFI characteristics, reporting trends over time, ICSR timeliness and case completeness. RESULTS: A total of 272 vaccine-related ICSRs were included in the analyses with a median completeness score of 0.90 interquartile range, IQR (0.63; 0.90). The overall annual reporting rate was 0.58 per 100,000 vaccine doses and the AEFI reporting ratio ranged between 0 and 30.2 AEFI reports per 100,000 surviving infants. The majority of ICSRs were male (55.3%; p value = 0.641) and the median age was 12 (0-168) months. The majority of ICSRs were reported in children who had received measles (n = 133; 48.9%) and OPV/DTP-Hib-HepB (n = 107; 39.3%) vaccines. Of the 387 observed AEFIs, 301 (77.8%) were systemic events and 86 (22.2%) were local reactions. Systemic events were more frequently reported with doses containing the measles antigen (n = 190; 49.1%) while local events were associated with the multiple antigen OPV/DTP-Hib-HepB (n = 62; 16.0%). The multiple antigen OPV/DTP-Hib-HepB was associated with higher rates for injection site abscess (n = 57), pyrexia (n = 27), diarrhea (n = 15), vomiting (n = 12), and seizures (n = 6). The measles antigen was associated with higher rates for rash (n = 44), ocular disorders (n = 26), pyrexia (n = 26), urticaria (n = 22), diarrhea (n = 8), and vomiting (n = 12). CONCLUSIONS: Most of the ICSRs were associated with measles and OPV/DTP-Hib-HepB vaccines. Zimbabwe's vaccine safety surveillance system is still developing and is not yet fully functional. However, the current system provides a reference point for the monitoring of the ongoing AEFI reporting trends and characteristics.
In recent years there have been outbreaks of vaccine-preventable childhood illnesses across the globe, and in various parts of South Africa (SA). This has raised the debate about mandatory vaccination as a means to improving immunisation coverage, and to address the need for an improved prevention strategy to minimise the risk of such outbreaks. This article explores the legal avenues available within the SA context by which mandatory vaccination could be applied, with a particular focus on the options for legislative amendments, as well as an exploration of foreign court decisions in which parties were compelled to immunise children.
Background: Children in Malawi face nutritional risks related to low-quality diets and chronic malnutrition. Objective: This study evaluated the impact of a 1-y early childhood development (ECD) center-based agriculture and nutrition intervention aimed at improving household production diversity, maternal knowledge on child nutrition and feeding practices, and children's diets and anthropometric measures. Methods: A longitudinal cluster-randomized controlled trial was implemented in 60 community-based childcare centers (CBCCs), covering 1248 preschool children (aged 36-72 mo) and 304 younger siblings (aged 6-24 mo). CBCCs were randomly assigned to 1) a control group providing the Save the Children's ECD program or 2) a treatment group providing a standard ECD program with additional activities to improve nutritious food production and behavior change communication to improve diets and care practices for young children. Primary outcomes were household production and production diversity, preschooler enrollment and attendance, and dietary intake measured by quantitative 24-h recall and minimum diet diversity for younger siblings. Secondary outcomes included anthropometric measures for preschoolers and younger siblings, child development scores for preschoolers, and women's asset ownership and time use (the latter 2 are not discussed in this article). We used difference-in-difference (DID) estimates to assess impacts. Results: Compared with the control group, preschool children in the intervention group had greater increases in nutrient intakes and in dietary diversity. No impacts on anthropometric measures were seen in preschoolers. Younger siblings in the intervention group had greater increases in height-for-age z scores than did children in the control group (DID: 0.44; P < 0.05) and greater reductions in the prevalence of stunting (DID: -17 percentage points; P < 0.05). The plausibility of the impact on growth in younger siblings was supported by effects along program impact pathways, including production of nutritious foods, caregiver knowledge, and dietary diversity. Conclusion: Implementing an integrated agriculture and nutrition intervention through an ECD platform benefited children's diets and reduced stunting among younger siblings of targeted preschoolers. This trial was registered on the ISRCTN registry as ISCRCTN96497560.
Aulo Gelli, Amy Margolies, Marco Santacroce et al.
