Joseph Magoola

Malawi’s adverse events following immunization (AEFI) passive surveillance system depends on healthcare workers’ (HCWs) knowledge, attitudes, and practices to accurately detect and report AEFI cases. However, in the absence of routine AEFI training, reporting challenges persist. To address this, a structured training wasdeveloped and implemented in six districts. This public health assessment evaluated knowledge retention and changes in AEFI reporting among frontline HCWs followingtraining. In April 2021, a two-day in-person training on AEFI identification and reporting was administered to 312 HCWs in Karonga, Nkhata Bay, Mchinji, Ntchisi, Balaka, and Machinga districts. Districts were non-probability purposively selected based on location and participation in the Malaria Vaccine pilot study. HCWs were selected bywork department. A quantitative survey evaluation was conducted immediately before training (pre-test), immediately after training (post-test 1), and one year later (post-test 2). District AEFI reporting data were collected through desk review. Paired t-tests and linear regression were used to assess knowledge retention over time. Of 312 trained HCWs, 286 (92%) participated in post-test 2. Most were nurses (38.8%), followed by health surveillance assistants (HSAs) (23.7%). The average pre-test score was 51.0% (SD 9.7), increasing to 74.4% (SD 14.13) after training and 63.5% (SD 12.29) at one year. Knowledge retention after 12 months showed a significant mean percentage point increase from pre-test to post-test 2 of 12.5 (95% confidence interval (CI)10.1 to 14.8, p-value <0.0001). Nkhata Bay had higher post-test 2 scores, with a mean percentage-point increase of 5.712 (1.592 – 9.833, p-value <0.007). HSA post-test 2 scores were significantly lower than other HCWs, with an effect size of -8.032 (-12.70 – -3.361, p-value <0.001). All six districts experienced increased annual AEFI reporting. Training improved HCWs’ AEFI knowledge; however, knowledge declined by one year compared with immediate post-training levels. Refresher trainings may help maintain knowledge over time.

The ongoing Ebola outbreak in the Democratic Republic of Congo (DRC) and Uganda has highlighted a persistent but often underappreciated challenge in outbreak response: disease control cannot succeed without community trust. Reports of attacks on Ebola treatment centres, hostility toward health workers and burial teams, and the escape of suspected patients from treatment facilities demonstrate how fear and mistrust can undermine outbreak control efforts. Drawing on lessons from previous Ebola outbreaks, this commentary argues that Risk Communication and Community Engagement (RCCE) should be recognised as a core public health intervention rather than a supporting activity. Sustained investment in trust-building, community participation, social science expertise, and community feedback systems is essential for effective outbreak preparedness and response. In Ebola response, trust is not merely a communication objective; it is a lifesaving intervention.

Background: In Uganda, COVID-19-related disruptions increased the number of children who missed scheduled routine vaccination (defaulters). Identifying and following up with defaulter children is important for improving vaccination coverage. This paper describes Uganda’s experience in revitalizing community-led defaulter tracking to improve vaccination coverage post-COVID-19 in four purposefully selected districts. Methods: During two 6-month periods in 2022 and 2024, healthcare workers (HCWs) worked with village health teams (VHTs) to review health facility-based immunization registers, identify and track defaulters aged 0 to 59 months. VHTs visited identified defaulters’ homes, reviewed vaccination histories and reminded caregivers to bring defaulters to immunization sites for catch-up vaccination. Results: Overall, 20,922 defaulters were identified by health register review; VHTs located 15,749 (75.3%) through household visits, of whom 3688 (23.4%) were verified as previously vaccinated based on their home-based vaccination records, leaving 12,061 as true defaulters. Among the true defaulters, 9662 (80.1%) received at least one catch-up vaccination after follow-up by the VHT. The most frequently administered catch-up vaccines were measles–rubella first dose (MR1) at 55.4%, followed by diphtheria–tetanus–pertussis third dose (DTP3) at 48.3% and Bacillus Calmette–Guérin (BCG) at 47.4%. Among the 2399 children who remained unvaccinated after follow-up, the most common reasons were relocation outside the original catchment area (49.5%) and caregiver intention to vaccinate later (16.3%). Conclusion: Community-led defaulter tracking was feasible and improved vaccination uptake in post-COVID-19 Uganda. Strengthening the quality and availability of health facility immunization data, along with targeted community engagement, caregiver reminders and integrated vaccination services would improve identification and follow-up of defaulters, reducing population immunity gaps.

In January 2025, the United States of America (US) suspended all foreign aid, pending reviews to ensure alignment with American strategic interests. This decision significantly disrupted humanitarian assistance and healthcare services, particularly in low-and-middle-income countries that have been the biggest beneficiaries of US aid. The suspension has exacerbated funding gaps in critical sectors, including disease prevention, maternal health, and emergency response. As a result, African governments must urgently reassess their health financing strategies, reducedependency on external donors through increased domestic resource mobilization, innovative financing mechanisms, and strengthened public-private partnerships. These strategies are essential to safeguard African healthcare systems against future financial uncertainties and external policy shifts.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Globally, suboptimal vaccine coverage is a major public health concern. According to Uganda’s 2016 Demographic and Health Survey, only 49% of 12-23 month olds had received all recommended vaccinations by 12 months of age. Innovative ways are needed to increase coverage and reduce drop-out, including increasing awareness of caregivers to bring children for timely vaccination. This research builds upon a growing mobile health system in Uganda to use personalized, automated text messages to remind caregivers of upcoming vaccination visits. Objective: To evaluate a personalized, automated caregiver mobile phone delivered text message reminder intervention to reduce the proportion of children who start but do not complete the vaccination series for children 12 months of age and younger in select health facilities in Arua District. Methods: A two arm, multi-center, parallel groups randomized controlled trial was conducted in four health facilities providing vaccination services in and around the town of Arua. Caregivers were recruited and interviewed at the time of their children’s first dose of pentavalent vaccine (containing diphtheria, tetanus, pertussis, hepatitis B, and Haemophilus influenzae type b antigens), typically at 6 weeks of age of the child. All participants received the standard of care, defined as the health worker providing child vaccination home-based records to caregivers, as available, and providing verbal instruction of when to return for the next visit. At the end of each day, caregivers and their children were randomized by computer either to receive or not to receive personalized, automated text message reminders for their subsequent vaccination visits according to the national schedule. Study personnel conducted post-intervention follow-up interviews with participants at the health facilities during the children’s measles-containing vaccine visit or outside the health facility (generally at the caregiver’s home) after the last child in the study reached one year of age; a questionnaire was administered and data from the child’s vaccination card was extracted. In addition, focus group discussions were conducted to assess caregiver acceptability of the intervention; economic data was collected to evaluate the incremental costs and the cost-effectiveness of the intervention; and health facility records review forms were completed to capture service delivery process indicators. Results: Enrollment concluded in August 2016. Follow-up interviews of study participants, including data extraction from the children’s vaccination cards; data extraction from the health facility immunization registers; completion of the health facility records review forms; and focus group discussions were completed by December 2017. Conclusions: Prompting of health seeking behavior with reminders has been shown to improve health intervention uptake in many contexts, including via mobile technology. Mobile phone ownership continues to grow in Uganda, so their use in health interventions like this study is logical and should be evaluated with scientifically rigorous study designs. Clinical Trial: Clinicaltrials.gov NCT04177485; https://clinicaltrials.gov/ct2/show/NCT04177485.

BACKGROUND Globally, suboptimal vaccine coverage is a public health concern. According to Uganda’s 2016 Demographic and Health Survey, only 49% of 12- to 23-month-old children received all recommended vaccinations by 12 months of age. Innovative ways are needed to increase coverage, reduce dropout, and increase awareness among caregivers to bring children for timely vaccination. OBJECTIVE This study evaluates a personalized, automated caregiver mobile phone–delivered text message reminder intervention to reduce the proportion of children who start but do not complete the vaccination series for children aged 12 months and younger in select health facilities in Arua district. METHODS A two-arm, multicenter, parallel group randomized controlled trial was conducted in four health facilities providing vaccination services in and around the town of Arua. Caregivers of children between 6 weeks and 6 months of age at the time of their first dose of pentavalent vaccine (Penta1; containing diphtheria, tetanus, pertussis, hepatitis B, and Haemophilus influenzae type b antigens) were recruited and interviewed. All participants received the standard of care, defined as the health worker providing child vaccination home-based records to caregivers as available and providing verbal instruction of when to return for the next visit. At the end of each day, caregivers and their children were randomized by computer either to receive or not receive personalized, automated text message reminders for their subsequent vaccination visits according to the national schedule. Text message reminders for Penta2 were sent 2 days before, on the day of, and 2 days after the scheduled vaccination visit. Reminders for Penta3 and the measles-containing vaccine were sent on the scheduled day of vaccination and 5 and 7 days after the scheduled day. Study personnel conducted postintervention follow-up interviews with participants at the health facilities during the children’s measles-containing vaccine visit. In addition, focus group discussions were conducted to assess caregiver acceptability of the intervention, economic data were collected to evaluate the incremental costs and cost-effectiveness of the intervention, and health facility record review forms were completed to capture service delivery process indicators. RESULTS Of the 3485 screened participants, 1961 were enrolled from a sample size of 1962. Enrollment concluded in August 2016. Follow-up interviews of study participants, including data extraction from the children’s vaccination cards, data extraction from the health facility immunization registers, completion of the health facility record review forms, and focus group discussions were completed by December 2017. The results are expected to be released in 2021. CONCLUSIONS Prompting health-seeking behavior with reminders has been shown to improve health intervention uptake. Mobile phone ownership continues to grow in Uganda, so their use in vaccination interventions such as this study is logical and should be evaluated with scientifically rigorous study designs. CLINICALTRIAL ClinicalTrials.gov NCT04177485; https://clinicaltrials.gov/ct2/show/NCT04177485 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/17262

Road traffic injuries (RTIs) are commonly under-reported in low-and-medium-income countries. This study aimed to estimate the number of RTIs and determine the magnitude of under-reporting by traffic police and hospital registries. A two-source capture-recapture method was applied to RTI data from police and hospital registries. Seven matching variables; sex of the injured, date, place, time, day of crash and road user type were used to get the matched cases. Police independently reported 46 RTIs and the hospitals reported 206 RTIs. Using the capture-recapture analysis, both sources estimated 313 RTIs (95% CI 273–343). The police registry captured 14.4% of the estimated number of RTIs and the hospitals captured 60.4%. The estimated number of RTIs was higher than reported by either the police or the hospitals alone. Neither the police nor the hospitals provided accurate data on RTIs, calling for the strengthening of both sources of data.

The study aimed to determine the drowning burden in four Ugandan lakeside districts; the prevalence of life jacket use, and community knowledge and attitudes regarding water safety. Subjects were recruited as they disembarked from boats. A structured questionnaire was used for demographics, experience on water, details of incidents in water, and awareness of drowning prevention measures. Focus group discussions (FGDs) and key informant interviews were held. The study interviewed 544 participants; 81.1% male, 86.8% below 45 years, and 51.1% involved in the fishing industry. A quarter (26.1%) of the respondents were observed wearing life jackets as they disembarked. Participants who had been in a boat that nearly capsized (57.8%), or that actually capsized (21.7%), were no more likely to wear life jackets than those who had not had these experiences. Three quarters (73.2%) did not know how to call for rescue, and only 48.7% could swim. There drowning fatality rate in this community was 502 deaths per 100,000 population. Majority of drowning events occurred during transportation (51.7%) or fishing (39.0%). The most frequently mentioned factors were stormy weather and overloading. Drowning is a common threat to young adults in the fishing communities around Lake Victoria. Few preventive interventions are in place.