This paper analysed the adoption of single-dose HPV vaccination policy in Ethiopia, Uganda, and Tanzania three using the Health Policy Triangle Framework. Peer-reviewed and grey literature published up to December 2024 were screened using pre-set inclusion and exclusion criteria, with data extracted and summarised through rapid qualitative analysis. The following common themes emerged across all three countries: i. Political will to address cervical cancer as a public health priority was central to initiating policy revision. ii. This was further supported by WHO endorsement of the single-dose schedule and national evidence on disease burden and single-dose efficacy. iii. National Immunisation Technical Advisory Groups played a pivotal role in providing evidence-based guidance to policymakers. These findings highlight key considerations for HPV vaccination policy revision in comparable settings.
Equitable health services
This paper quantifies geographical losses in health facility accessibility resulting from flooding compounded by a doctors' strike in Kenya. Pre-flood baseline and three post-flood scenarios were defined using satellite-derived flooding extents, with travel times estimated via a least-cost path algorithm across 10,995 health facilities. Pre-flood, average travel time to the nearest facility was 19.6 minutes, with 94% of the population accessing care within 30 minutes and 20 of 47 counties averaging under 2 hours. Under maximal flood extents, 30-minute coverage dropped to 73%, only 5 counties retained under 2 hours' travel time, and county-level coverage losses ranged from 1% to 51%. In arid counties, populations facing over 2 hours' travel time rose from 4–12% to 15–31%. Integrating disaster preparedness into county health planning is argued to be essential to strengthening nationwide health system responses.
This study examined the spatial distribution, maternal and child health (MCH) integration, and determinants of family planning (FP) service provision in Lubumbashi. Data were drawn from a 2023 census of 1267 health facilities. Descriptive analyses summarised FP service availability by health zone, sector, facility type, MCH integration, monthly birth volume, medicine stock, and mean cost of vaginal birth. Multilevel logistic regression identified facility-level determinants of FP provision. Geospatial analyses mapped service availability using 1 km coverage buffers, population-adjusted facility density, and FP-MCH integration levels by health zone. FP provision was strongly associated with high monthly birth volumes, public ownership, and integration with MCH services. Geospatial mapping showed that 94.3% of women live within 1 km of a facility offering FP, but service density and FP-MCH integration were lower in peripheral health zones. Despite near-universal geographic access, MCH integration remains suboptimal and coverage gaps persist in peripheral areas. The authors recommend that underserved health zones be prioritised for both facility-based and outreach FP interventions, and for subsidised or free services in areas dominated by private for-profit facilities. Additional demand-side barriers — including stockouts, costs, fear of side effects, misinformation, and partner-related constraints — are argued to warrant further investigation.
This study evaluated the program’s effectiveness in mitigating pandemic-related health and economic inequities in Trans-Nzoia County, Kenya, a region with significant pre-existing vulnerabilities. The authors conducted a mixed-methods study using an explanatory sequential design in 2023, collecting data from 609 women in 3 cohorts: continuous participants, discontinued participants and women without exposure. Continuous participants achieved significantly higher rates of postpartum visits and exclusive breastfeeding, with reduced disparities in essential maternal health services, albeit with lower health insurance uptake and minimal improvements in Poverty Probability Index scores. While the pandemic disrupted health services, membership provided continuity of care through adapted community health worker services. Pandemic-related restrictions limited the program’s economic benefits, potentially due to the program’s shift in focus toward health service delivery, intensifying existing economic inequities. The results highlight the need for robust government support and social protection to address underlying economic vulnerabilities for women, integrating community health workers into formal health systems and strengthening their linkages with formal financial systems.
This study explored the integration of traditional and complementary medicine in health systems and identify the enablers and barriers to the process, with a focus on low- and middle-income countries, with 56% of included papers from African countries. Traditional and complementary medicine was found to have the potential to strengthen various aspects of health systems, particularly in health-service delivery and products. The most commonly mentioned determinants influencing integration of traditional and complementary medicine were policies and finance, resource availability, and efficacy, quality and safety. The findings highlight the role of policies and finance in supporting integration of traditional and complementary medicine, and the need to ensure the quality and safety of traditional products through scientific methods. Reforms in medical education and strategic resource allocation are argued to be needed to create the conditions for successful integration of traditional and complementary medicine.
This study assessed knowledge, attitudes, and practices related to antibiotics among community health workers (CHW) for children with acute respiratory illness in rural Uganda. A total of 63 of 67 CHW completed both baseline and follow-up surveys, and 15 CHW were interviewed. The median age of the full cohort was 40 years with 9.5 years of CHW experience. Almost all CHW identified amoxicillin as an antibiotic at baseline, and most associated antibiotics with treating bacterial diseases. Most perceived antibiotics as harmful to patients when prescribed unnecessarily. At follow-up, more CHW disagreed that antibiotics should be prescribed when in doubt. They welcomed additional education about antimicrobial resistance and diagnostic tools to advance antimicrobial stewardship. CHW were overall familiar with antibiotics and their potential harms. They were eager to gain knowledge regarding advance antimicrobial stewardship and AMR and share it with their communities. CHW are argued to represent an underutilized resource for advance antimicrobial stewardship interventions and should be included in their design and implementation.
This paper assessed the extent and trends of inequalities in full immunization coverage among one-year-olds from the 2007 and 2013 rounds of the DRC Demographic and Health Surveys, and the 2010 and 2017 rounds of the DRC Multiple Indicator Cluster Surveys. The national coverage of full immunization among one-year-olds significantly decreased from 30.7% in 2007 to 21.7% in 2017. Significant disparities in full immunization coverage across the four dimensions of inequality were observed in all study periods. In 2017, for example, the authors recorded substantial economic, maternal education-based, place of residence-based and regional inequalities in full immunization coverage. Economic, urban‒rural, and regional relative inequalities followed a U-shaped trend, while absolute inequalities remained constant or decreased. However, inequality based on maternal education remained constant across all summary measures over time. The decreasing trend of the national full immunization coverage among one-year-olds over the ten-year study period masked substantial and persistent socioeconomic and geographic inequalities. To reduce inequalities in full immunization coverage in the DRC, the authors call for urgent equity-driven interventions to address poverty, illiteracy, and inadequate infrastructure, particularly in rural and underserved regions. Strengthening the health workforce and improving the vaccine supply chain are also seen to be crucial to ensuring equitable access to immunization services.
This systematic review evaluated strategies and interventions implemented in low- and middle-income countries (LMICs) to prevent and manage infectious disease outbreaks during humanitarian crises from 2018 to 2023. Utilizing a comprehensive literature search across Scopus, PubMed, and Web of Science, the authors identified eleven studies from 1,415 unique articles. The research examined diverse interventions including vaccination campaigns, epidemiologic surveillance, and integrated health services across multiple countries. Case studies from Haiti, Mozambique, Thailand, India, the Philippines, Yemen, Uganda, South Sudan, and Nigeria demonstrated the effectiveness of multimodal, targeted, and collaborative responses to complex health emergencies. The findings highlighted the critical importance of adaptable healthcare systems and international collaboration in addressing infectious disease risks during humanitarian crises. Despite successful interventions, the study noted persistent challenges such as infrastructure limitations, insecurity, and logistic constraints that impede comprehensive public health emergency preparedness.
This cross-sectional study examined vaccine acceptance factors among 2,312 participants in Zimbabwe and Sierra Leone using the Health Belief Model and Theory of Planned Behaviour frameworks. Using adjusted logistic regression models accounting for gender, age, education, and location, researchers found high vaccine uptake correlated with heightened perceived COVID-19 threat, recognized vaccination benefits, stronger perceived behaviour control, and fewer barriers to vaccination. Conversely, low uptake was linked to diminished perceived threats, fewer perceived benefits, weaker perceived behaviour control, and heightened perceptions of barriers. Results underscore the importance of theoretical constructs in understanding vaccine uptake variations and suggest public health campaigns should focus on reshaping risk perceptions, addressing obstacles, emphasizing vaccination benefits, and fostering a sense of self-efficacy within target communities.
This qualitative study explored tuberculosis stigma in rural South Africa through interviews with 18 health workers and 15 patients. Using Link and Phelan's theoretical model, researchers found that TB infection prevention and control measures sometimes exacerbated stigma through physical isolation and mask-wearing requirements. Patients and health workers had contrasting perspectives: patients focused on communal benefit while health workers emphasized negative impacts on patient relationships. Recommendations included improving TB education, promoting respectful communication, emphasizing communal safety, and implementing universal precautions rather than targeted measures. The study suggests using ubuntu (an African humanist framework) to guide stigma mitigation interventions and policy changes.