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Exploring mothers' and grandmothers' perceptions of animal-source complementary foods in the diets of young children in The Gambia: A qualitative study.
Get PDFBackgroundIn The Gambia, many children consume diets that are lacking in nutrients that are essential for their growth and development. This study aims to explore Gambian mothers' and grandmothers' perceptions around animal source foods (meat, eggs, milk etc.) in order to inform future interventions focused on improving child feeding practices.MethodsIn July and August 2023, nine semi - structured focus group discussions were conducted with mothers and grandmothers in two settings in The Gambia. A purposeful sample of participants were recruited with the support of each local Medical Research Council clinic. Data were analysed using the framework method and thematic analysis. Participants included 19 mothers and 12 grandmothers in a semi-rural area and 12 mothers and 12 grandmothers in a rural area, caring for children 6-24 and grandmothers were in separate groups.ResultsKnowledge gaps were identified in both settings regarding aspects of complementary feeding, such as the appropriate timing and methods for introducing animal source foods to children's diets. Differences were noted in the availability and dissemination of infant and young child feeding information in the two settings, emphasising the crucial role of contextual factors in shaping future programmes. The accessibility and affordability of animal source foods, was found to be a key determinant of their inclusion into children's diets. A reliance on commercially available complementary foods was common in both settings.ConclusionThis study reveals disparities between current complementary feeding practices and guidelines in this setting. It also underscores context-specific barriers caregivers encounter in offering diverse complementary foods, including animal source foods. A high reliance on commercially available complementary foods was also uncovered, particularly in Keneba. Further research is recommended to aid the development of context- specific interventions
Rethinking a hybrid malaria chemoprevention delivery strategy for children in sub-perennial settings: a modelling study integrating age- and seasonally-targeted delivery.
Get PDFBACKGROUND: The World Health Organization recommends perennial malaria chemoprevention (PMC), generally using sulfadoxine-pyrimethamine (SP) to children at high risk of severe Plasmodium falciparum malaria. Currently, PMC is given up to age two in perennial transmission settings. However, no recommendation exists for perennial settings with seasonal variation in transmission intensity, recently categorized as 'sub-perennial'. Tailored chemoprevention strategies are needed to protect children during seasons and ages of highest malaria risk. The seasonal dimension must adequately cover seasonally increased risk periods, alongside interventions that address year-round, lower intensity transmission. This study proposes a hybrid malaria chemoprevention (HMC) strategy, integrating two delivery components: (1) existing PMC, and (2) additional monthly SP doses during the higher-risk rainy season, ensuring a one-month gap between any two doses. METHODS: Using a validated individual-based malaria model combined with pharmacological models of drug action (OpenMalaria), the potential public health impact of the proposed HMC (for children 03-24 months), and an age-expanded HMC (referred to as HMC + , for children 03-36 months), under different drug sensitivity, coverage, and prevalence (5-70%) assumptions were examined. RESULTS: The models predicted higher efficacy of HMC and HMC + compared to PMC alone in children under age three, estimating HMC and HMC + provide 2.1 (1.6-2.6) (median (interquartile range)) and 2.9 (2.2-3.6) times (relative fold increase in burden averted) against clinical, and 2.0 (0.6-3.4) and 3.3 (0.8-5.8) against severe cases, respectively. This led to a median protective efficacy of 31.8% (25.4-38.2%), 44.9% (36.9-52.9%) against clinical, and 16.1% (7.0-25.2%), 26.4% (14.4-38.4%) against severe cases by HMC and HMC + , respectively, across the prevalence, drug sensitivity, and coverage assumptions. Under model assumptions, the results indicated a positive net impact for children under five years of age, outweighing the limited potential for delayed malaria. CONCLUSION: Substantially increased public health benefits might be achieved by adding seasonally-targeted chemoprevention to current PMC in sub-perennial malaria transmission settings. Effectiveness-implementation studies will be crucial to generate empirical evidence of public health impact including on the disease burden averted, safety, and cost-effectiveness of the hybrid approach. Such studies should also explore determinants of implementation success including operational feasibility, coverage, and acceptability of proposed dosing strategies to inform deployment decisions
A cross-sectional analysis of the impact of lady health worker visits in the prenatal and postnatal period on the uptake of continuum of care interventions and childhood mortality in Pakistan.
Get PDFBACKGROUND: Community health workers are crucial in bridging the gap between health care facilities and the general population. In Pakistan, the lady health worker (LHW) program was launched in 1994 to enhance access to essential health care services. However, the overall quality of care provided by LHWs and its impact on population-level coverage of key maternal, newborn, and child health (MNCH) interventions and mortality remain insufficiently understood.
METHODS: We conducted a cross-sectional analysis using data from 32 106 households with at least one woman of reproductive age across eight districts in Pakistan. Of these households, 63% were located within LHW catchment areas. We categorised households into three groups: 1) no contact with LHWs, 2) at least one contact during either pregnancy or post-delivery, and 3) at least one contact each during both pregnancy and post-delivery.
RESULTS: We observed a clear gradient in the uptake of pregnancy-related and MNCH interventions across the three groups. For instance, four antenatal care visits were reported as 25.3% in group A, 29.4% in group B, and 36.2% in group C (P < 0.001). Similar trend followed for skilled birth attendance; 54.4% group A, 58.7% group B, and 64.4% group C (P < 0.001). Measles vaccination coverage was 32.3% in group A, 35.2% in group B, and 49.7% in group C (P < 0.001). However, there was no evidence of significant differences in neonatal (P = 0.862), postnatal (P = 0.121), or child mortality (P = 0.319) across the three groups.
CONCLUSIONS: Increased LHW contact enhances MNCH intervention uptake, though other mechanisms may contribute. Effectiveness depends on service quality, referral systems, and systemic barriers. Strengthening training, optimising referrals, and integrating community health initiatives are vital for sustainability. Addressing workforce shortages, gender challenges, and financial constraints is crucial. Future research should examine sociocultural and programmatic factors influencing health care access and outcomes.
REGISTRATION: Clinicaltrials.gov NCT04184544
Effect of Perinatally Acquired HIV Infection on Cognitive Function and Educational Attainment in Adolescents in the Era of Antiretroviral Therapy: A Cross-sectional Study in Zimbabwe.
No full textPURPOSE: HIV infection in children is associated with neurocognitive deficits. Whether these deficits persist as children age is unclear. We investigated the effect of HIV infection on cognition among adolescents with perinatally acquired HIV (AWH). METHODS: In this cross-sectional study, AWH aged 11-19 years taking antiretroviral therapy for ≥6 months were recruited from a public-sector HIV clinic in Harare, Zimbabwe. An age-matched HIV-negative comparison group was recruited from the same catchment area. Cognitive function was evaluated using the Kaufman Assessment Battery for Children, second Edition (KABC-II) and National Institute for Health Cognition Battery. Multivariable linear regression was used to investigate the association between HIV and cognition. RESULTS: Overall, 507 adolescents (253 AWH, 254 HIV-negative), mean age 15 (SD 2.5) years and 53% female, participated. Adjusting for age, sex, socioeconomic status and maternal education, AWH scored lower than HIV-negative peers on KABC-II Mental Processing Index (MPI) (adjusted mean difference (AMD) -3.01 [95% CI -4.95, -1.07]) and KABC-II nonverbal index (AMD -4.37 [95% CI -6.26, -2.48]). Lower KABC-II MPI scores interacted with stunting in AWH (nonstunted AWH: AMD -1.40 [95% CI -3.56, 0.76]; stunted AWH: AMD -6.30 [95% CI -9.05, -3.54]). AWH also scored lower than HIV-negative peers on the National Institute for Health Cognition Battery Fluid Cognition Score (AMD -2.74 [95% CI -5.08, -0.41]). Among those in school, 71/190 (37.4%) AWH versus 35/194 (18.0%) HIV-negative participants were two or more school grades below expected for age (≤2), (p < 0.001). School grade ≤2 was associated with lower KABC-II MPI scores in AWH (mean difference -3.76 [95% CI -6.53, -0.98]). DISCUSSION: Cognitive function in AWH was impaired compared to HIV-negative peers, which translated to poorer educational outcomes
Epidemiology of Community-acquired Bacteremia Among Children One to Fifty-nine Months of Age Admitted to a Tertiary Hospital in Harar, Eastern Ethiopia.
Get PDFBACKGROUND: Community-acquired bacteremia is a leading cause of mortality in children <5 years of age in Ethiopia, yet data on etiology are scarce. We described the etiology and risk factors for bacteremia and in-hospital mortality in a tertiary hospital in eastern Ethiopia.
METHODS: Clinical surveillance was conducted at Hiwot Fana Comprehensive Specialized Hospital from December 2021 to November 2023. All admitted children 29 days to 59 months old were eligible for blood culture collection, excluding elective surgery or poisoning.
RESULTS: Of 3384 admissions, 2366 were sampled; 2070 had uncontaminated blood cultures, and 236 (11.4%) had bacteremia. The incidence risk was 69.7 per 1000 admissions. Klebsiella oxytoca (n = 59, 25.0%) and Klebsiella pneumoniae (n = 30, 12.7%) were the most common pathogens. The leading Gram-positive pathogen was Streptococcus pneumoniae (n = 16, 6.8%). Gram-negative bacteria showed high resistance to ampicillin and gentamicin. Of 2070, 122 died, yielding a case fatality ratio of 13.1% in bacteremia cases compared to 5.0% in nonbacteremic cases. Severe wasting [adjusted odds ratio, 1.49, (95% confidence interval: 1.10-2.01)] was associated with bacteremia risk. Bacteremic cases had a high risk of death across all nutritional statuses, while nonbacteremic admissions exhibited increased mortality risk with the severity of the nutritional status.
CONCLUSION: A high proportion of children admitted to Hiwot Fana Comprehensive Specialized Hospital had bacteremia with attendant high mortality. K. oxytoca was the commonest cause, showing significant resistance to first-line antimicrobials
Cost-effectiveness of lifelong eculizumab versus disease monitoring of aHUS.
Get PDFBACKGROUND: Atypical haemolytic uraemic syndrome (aHUS) is a rare but severe condition caused by complement dysregulation. Eculizumab prophylaxis prevents recurrence and improves survival, yet the benefits of lifelong treatment for patients are uncertain and the long-term costs for health services are substantial. This economic evaluation applied the results from the Stopping Eculizumab Treatment Safely in aHUS (SETS aHUS) trial and assessed the cost-effectiveness of replacing lifelong eculizumab with a disease monitoring strategy over the long term. METHODS: A Markov model was used to estimate cost and quality-adjusted life years (QALYs) for a treatment withdrawal and disease monitoring strategy over the long term. Results from the SETS aHUS trial informed the risk of relapse diagnosis or progression, utility values and additional healthcare use. Time to relapse diagnosis was extrapolated using parametric survival functions. RESULTS: The treatment withdrawal and disease monitoring strategy increased average patient QALYs by 0.08 [95% credible interval (CrI) -0.33-0.53], and reduced patient costs by £4 234 196 (95% CrI -£684 495 to -£6 403 694) compared with the lifelong delivery of eculizumab. The impact on survival estimates was low, as withdrawal patients had an average reduction of 0.0005 patient life years (LYs) (95% CrI -0.0029-0) over an 80-year time horizon. Withdrawal and monitoring had a 64% likelihood of being more effective and less costly than lifelong treatment. Results remained robust across multiple scenarios exploring uncertainties. CONCLUSION: Treatment withdrawal and disease monitoring was cost-effective compared with lifelong eculizumab therapy. Its adoption is expected to substantially reduce costs per patient and may improve average patient quality of life
Maternal iron status and total immunoglobulin-G influence transplacental antibody transfer across eight diverse geographical settings.
Get PDFTransfer of antibodies across the placenta provides critical early life protection for neonates against infection. Understanding factors influencing efficient transfer is vital for enhancing neonatal immunity and improving maternal vaccination strategies. Stored maternal and cord serum samples from studies in The Gambia, Guatemala, Mali, The Netherlands, Pakistan, Thailand, UK and Vietnam were processed for measles plaque reduction neutralisation titres (PRNT), and measles, mumps and rubella immunoglobulin G (IgG) (multiplex immunoassay) at a central laboratory (N = 557 pairs). Nutritional indicators (ferritin, soluble transferrin receptor, retinol binding protein) and total IgG, were measured in subsets of maternal serum. Transplacental transfer ratios (TPTRs) were calculated and factors associated with maternal IgG, cord IgG and TPTRs explored in multivariable regression. At delivery, most mothers (range 78 % Guatemala to 100 % Pakistan, Netherlands) and infants (range 86 % Guatemala to 100 % Netherlands, UK) had PRNT above the threshold of clinical protection (0.12 IU/mL). Maternal and cord antibody concentrations across diverse geographical settings were highly correlated. TPTRs were highest in high-income countries; geometric mean range 0.7 (Pakistan) to 2.2 (Netherlands), and were correlated across antigens. However, TPTRs varied widely within low/middle-income countries. In models adjusting for country, higher maternal total IgG was consistently associated with lower TPTR. In multivariable regression, lower iron status, indicated by increasing soluble transferrin receptor concentration, was significantly associated with lower TPTR for measles neutralising antibody. There is marked geographical variation in TPTRs, and following adjustment for this, measurable factors in maternal blood can inform estimates of transplacental transfer efficiency
The Israeli eye care system through a public and global health lens.
Get PDFGlobal eye health is increasingly recognized as integral to achieving universal health coverage (UHC), with equity, access, and service integration serving as key indicators of system performance. Israel provides a distinctive case study, having established UHC through the 1994 National Health Insurance Law, which guarantees essential services to all residents. This review assesses Israel’s eye care system through a public and global health lens, applying the WHO health system building blocks to examine its organization, strengths, and persistent challenges. Israel benefits from strong integration of eye care within its universal framework, a high density of specialists, and wide availability of advanced services; yet inequities remain, particularly for lower-income and peripheral populations who face financial and geographic barriers to advanced treatment and consistent follow-up. Priority reforms include strengthening primary and community-based services, redistributing the workforce, and adopting nationally representative data and global indicators such as effective cataract surgical coverage (eCSC). Israel’s experience highlights both the potential and limits of universalism, offering lessons for countries seeking to integrate eye health into broader health planning as part of the global drive toward UHC.
SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13584-025-00731-2
Determinants of human papillomavirus vaccination decision-making in Japan: a scoping review exploring contextual, social, and adolescent-specific influences.
Get PDFBACKGROUND: Human papillomavirus (HPV) vaccination coverage in Japan was initially over 70 %, but it dramatically declined following 2013 media reports of adverse events, leading to public fear and suspension of proactive government recommendations for the HPV vaccine. Despite the resumption of the recommendations in 2022, public trust remains low, with 40.9 % of girls and mothers still undecided about HPV vaccination. This review synthesises evidence on the determinants of HPV vaccination decision-making among caregivers and adolescent girls in Japan and identifies research gaps to guide future research.
METHODS: A literature search was conducted in three databases, Medline, Embase and Scopus. The search timeframe was between January 2009 and July 2025. Studies were selected, focusing on research that examined influences on HPV vaccination decision-making in Japan. Identified influences were categorised using the World Health Organization (WHO) Strategic Advisory Group of Experts on Immunisation vaccine hesitancy matrix.
RESULTS: This review identified a wide range of determinants influencing HPV vaccination decision-making, including contextual, individual and group, and vaccine-specific factors. Contextual influences, such as government recommendations and negative media coverage, played a significant role in shaping public attitudes. Individual and group factors, including knowledge, healthcare provider recommendations, and peer norms, were also critical. Vaccine-specific issues, such as concerns about safety and cultural barriers further complicated decision-making. Three key research gaps were also identified: (1) insufficient exploration of contextual influences, including Japan's unique socio-cultural landscape and historical mistrust; (2) limited understanding of how adolescents navigate social group influences and integrate conflicting information into their decisions; and (3) a lack of focus on the specific perceptions of adolescent girls.
CONCLUSIONS: Addressing these gaps requires interdisciplinary research that incorporates socio-cultural, behavioural and systemic perspectives. Further research and tailored interventions are essential to rebuild public trust and increase HPV vaccine uptake in Japan
Shea Butter Application to the Umbilical Stump Resulting in Omphalitis and Leclercia adecarboxylata Bacteremia in a Neonate: A Case Report.
Get PDFLeclercia adecarboxylata is a gram-negative, rod-shaped bacterium commonly found in nature. Its pathogenicity is mild and often results in asymptomatic carriage. However, it can cause sepsis and other life-threatening illnesses in immunocompromised individuals. Based on previous literature, the common practice of applying many unsafe substances, such as shea butter, to the umbilical cord of newborns for healing remains a significant risk factor for omphalitis and neonatal sepsis in developing countries. This case report describes a neonate showing signs of omphalitis and bacteremia, following the use of shea butter on the umbilical cord. A 10-day-old male neonate presented with irritability, refusal to breastfeed, and an erythematous, tender umbilical stump. The blood culture result yielded a gram-negative rod, Leclercia adecarboxylata, sensitive to cephalosporin, chloramphenicol, and gentamicin. The newborn was treated with empirical first-line antibiotics according to national guidelines: intravenous (IV) ampicillin and gentamicin for 6 days. The child fully recovered. Therefore, we emphasize the ongoing need for community-level awareness of proper umbilical cord care at the grassroots in developing countries. Additionally, early bacterial detection and antimicrobial management based on local antibiogram data are vital for successful patient outcomes