Akhona Victress Mazingisa

Water, sanitation, and hygiene (WASH) services are essential for learner health and equitable education. Persistent gaps in WASH infrastructure and hygiene provision remain a major challenge in low- and middle-income countries. We assessed WASH interventions, learner knowledge and perceptions, and implementation challenges and opportunities in five selected primary schools in eThekwini District, South Africa. We conducted a cross-sectional study among Grade 7 learners using a structured questionnaire adapted from the World Health Organization (WHO) Surveillance of WASH in Schools Tool, complemented by observational checklists. Stratified random sampling yielded 129 participants (76 girls and 53 boys), with a 72% response rate. Quantitative data were analysed using Chi-square, Fisher’s exact, and Kruskal–Wallis tests, as appropriate. Although drinking water access was generally reliable, significant gaps were observed in sanitation privacy, soap and toilet paper availability, cleanliness, and menstrual hygiene facilities. Female learners consistently reported poorer conditions than males (p < 0.05). The Hygiene Access Index differed significantly across gender and age groups (p < 0.05), reflecting inequitable provision of hygiene materials. Despite educational initiatives, substantial shortcomings persist in school WASH systems, particularly regarding sanitation privacy, hygiene supplies, and menstrual hygiene management, with potential implications for learner health, educational participation, gender equity, and school attendance. Sustaining gender-responsive WASH systems is essential for improving learner health and promoting equitable educational environments. Sustainable WASH systems refer to the consistent availability, functionality, maintenance, and equitable use of WASH infrastructure and services over time, supported by institutional capacity and behavioural adherence. These findings highlight the need for implementation-focused and systems-oriented approaches to strengthen sustainable WASH service delivery in resource-constrained school settings.

Water, sanitation, and hygiene (WASH) services are essential for learner health and equitable education. Persistent gaps in WASH infrastructure and hygiene provision, particularly those affecting girls, remain a major challenge in low- and middle-income countries. We assessed WASH interventions, learner knowledge and perceptions, and implementation challenges and opportunities in primary schools in eThekwini District, South Africa. We conducted a cross-sectional study among Grade 7 learners using a structured questionnaire adapted from the WHO Surveillance of WASH in Schools Tool, complemented by observational checklists. Stratified random sampling yielded 129 participants (76 girls, 53 boys); 72% response rate. Quantitative data were analysed using Chi-square, Fisher’s exact, and Kruskal–Wallis tests as appropriate. Although drinking water access was generally reliable, significant gaps were observed in sanitation privacy, soap and toilet paper availability, cleanliness, and menstrual hygiene facilities. Female learners consistently reported poorer conditions than males (p < 0.05). The Hygiene Access Index differed significantly across gender and age groups (p < 0.05), reflecting inequitable provision of hygiene materials. Despite educational initiatives, substantial shortcomings persist in school WASH infrastructure and hygiene provision, disproportionately affecting girls’ dignity, well-being, and school participation. Sustaining gender-responsive WASH systems is essential for improving learner health and promoting equitable educational environments.

Background: This scoping review aims to systematically examine the extent of the literature on African health histories throughout the pre-colonial, colonial, post-independence, primary health care (PHC), Millennium Development Goals (MDG), and Sustainable Development Goals (SDG) periods. Methods: This scoping review followed the Arksey and O’Malley framework, enhanced by Levac’s updates and adaptations from the Joanna Briggs Institute’s methodology. Data from eligible records were extracted based on inclusion criteria and summarized narratively. Results: We included 83 records, of which the majority (n = 70) were narrative reviews. Eighteen of these provide evidence from Africa as a whole, while country-specific evidence was obtained from 21 countries. South Africa had the most records (n = 17), followed by Ghana (n = 6) and Nigeria (n = 6). The majority of evidence came from the colonial period (n = 13), followed by the PHC and MDG periods (n = 12 each). Health systems in the pre-colonial era were rooted in indigenous practices and community-driven systems; the colonial period introduced Western-style health care systems; the post-independence period focused on health promotion initiatives and infectious disease eradication; the PHC era focused on community-centered health care and equitable service provision; the MDG era expanded on targeted interventions for infectious diseases, and the SDG era aims to build resilient and inclusive health care systems towards universal health coverage. Conclusion: This review revealed diverse influences on health systems from the pre-colonial to SDG eras. However, these records are not exhaustive and require country-specific records, archived documents, and a centralized repository. Addressing these gaps will provide a comprehensive understanding of African health histories and aid in future health interventions.

Introduction: Klebsiella pneumoniae is a major cause of neonatal sepsis in Africa and a WHO priority pathogen for vaccine development. With growing antimicrobial resistance and limited treatment options, maternal vaccination offers a potential preventive strategy. This scoping review synthesises evidence on K. pneumoniae vaccine research in Africa and highlights gaps to guide future research and development priorities Methods: A systematic PubMed search was conducted on 1 September 2025 to identify studies on K. pneumoniae vaccine research in Africa. Additional searches were conducted in ClinicalTrials.gov, the Pan-African Clinical Trials Registry and the WHO International Clinical Trials Registry Platform. Eligible studies were screened, and data were extracted and synthesised using a framework focused on disease burden, vaccine development and implementation considerations. Results: A total of 14 studies published between 2008 and 2024 met the inclusion criteria, with most (11/14) published in the last 5 years. Studies reported a high burden of K. pneumoniae infections across multiple African countries, particularly in neonatal sepsis and meningitis. While genomic and immunological studies provided insights into vaccine target selection, no K. pneumoniae vaccine trials were identified in Africa. Modelling studies suggest that maternal immunisation with a 70% effective vaccine could prevent approximately 400 000 neonatal sepsis cases and 80 000 deaths annually worldwide, including Africa. Key research gaps include limited epidemiological surveillance and absence of immune correlates of protection. Conclusions: Despite the high burden of K. pneumoniae neonatal infections in Africa, vaccine research remains in its early stages, with no ongoing clinical trials on the continent. Strengthening surveillance systems, advancing vaccine candidates and integrating K. pneumoniae vaccination into existing maternal immunisation programmes are critical next steps. Multisectoral collaboration among researchers, policymakers and continental and global health organisations will be essential to accelerate vaccine development and ensure equitable access in Africa.

Objectives: This scoping review mapped antimicrobial resistance (AMR)-related interventions in WHO African region against the five strategic objectives of the WHO Global Action Plan (GAP) on AMR and identified evidence gaps limiting progress. Design: A scoping review using the Arksey and O’Malley framework, enhanced by Levac et al and Joanna Briggs Institute methodology; reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR). Data sources: PubMed, CINAHL, Web of Science and Scopus searched on 9 December 2025, with grey literature from Google Scholar and Google (first 100 hits). Eligibility criteria: Studies of any design reporting interventions addressing GAP strategic objectives—stewardship, surveillance, infection prevention, education or economic approaches in the WHO African region. Data extraction and synthesis: Data were charted using a pilot-tested Excel tool by GAP strategic objective and evidence gaps and research considerations were synthesised thematically. Results: Forty-nine studies (2016–2025) were included, with country-specific evidence concentrated in South Africa, Ethiopia, Kenya, Ghana and Nigeria. Most evaluated antimicrobial stewardship or awareness/training interventions in tertiary hospitals, showing improvements in prescribing, knowledge and occasional cost savings but few assessed long-term effects or resistance trends. Surveillance had advanced but remained limited by weak laboratory capacity, diagnostic coverage, data quality and limited use of AMR/antimicrobial use data in practice. Evidence on infection prevention, vaccination and One Health interventions was scarce and no full economic evaluations were identified. Conclusions: AMR research in the African region clusters around antimicrobial stewardship and awareness in tertiary hospitals, leaving infection prevention, vaccination, One Health approaches and economic evaluation substantially underrepresented across the GAP framework. Closing these gaps will require longer-term implementation research, context-specific economic analyses and broader geographical coverage to generate the evidence needed to operationalise the global AMR research agenda in Africa.

The Expanded Programme on Immunization (EPI) has significantly advanced public health in Africa over the past 50 years, with vaccination contributing to a 52% reduction in infant mortality and saving more than 51 million lives. Despite this progress, persistent vaccine stock management challenges undermine immunization coverage and equity across the continent. Frequent stock-outs, cold chain gaps, and limited local manufacturing capacity disrupt service delivery, particularly at primary health care facilities. This commentary examines the successes, current challenges, and emerging innovations in Africa's vaccine stock management system. Digital solutions, such as electronic logistics management information system (eLMIS), stock visibility tools, and artificial intelligence-driven platforms are enhancing stock tracking and reducing wastage. Workforce development initiatives across the continent such as the Strategic Training Executive Programme (STEP), and local manufacturing investments in countries like South Africa, Senegal, and Rwanda are reshaping the supply chain landscape. To sustain these gains, strategic investments in resilient cold chain infrastructure, strengthened data systems, and coordinated regional polices are essential. Strengthening vaccine stock management at service delivery points is critical for achieving Immunization Agenda 2030 goals and building robust systems capable of delivering equitable immunization coverage across Africa.

Background: Despite growing recognition of vaccination social science as essential to immunization strategies, the field’s evolution, geographic distribution, and research patterns remain poorly characterized. This study provides the first comprehensive mapping of the social science literature on vaccination over eight decades. Methods: We conducted a bibliometric analysis of peer-reviewed publications indexed in PubMed from their inception, using a systematic search strategy that combined vaccination and social science terms. Publications were analyzed using the Bibliometrix R package (version 5.0) to examine temporal trends, author productivity, institutional contributions, geographic distribution, and thematic evolution globally. Results: We retrieved 8005 eligible publications. Analysis highlighted three chronological research phases: sporadic early work (1945–1980, n = 85), sustained growth (1981–2019, n = 2743), and unprecedented expansion since the COVID-19 era (2020–2024, n = 4563). Annual publications reached a peak in 2022 (n = 1686). Research spans 146 countries but remains concentrated in high-income countries, with the United States (n = 10,230), China (n = 3796), and Canada (n = 2288) leading production. The top 20 institutions were from the United States (n = 8), United Kingdom (n = 4), and Canada (n = 3), with a few institutions from African countries. International collaboration was moderate (19.44%). Thematic analysis revealed a clear evolution from biological science (1963–1999) to socio-behavioural science, with an emphasis on vaccine hesitancy, trust, communication, and health equity (2015–2024). Conclusions: Vaccination social science has grown steadily over the decades, with a sharp rise in research during the COVID-19 pandemic. Most studies were from high-income countries, underscoring the need for enhanced social science capacity in low- and middle-income countries. As the focus of immunization efforts shifts toward issues like vaccine hesitancy and trust, broader collaboration and inclusion will be key to improving vaccine uptake worldwide.

Africa's vaccine supply chains have evolved over five decades from rudimentary systems to increasingly complex and resilient networks. This paper traces their development from the establishment of the Expanded Programme on Immunisation (EPI) in the 1970s through successive phases of expansion and innovation. Key milestones include the growth of cold chain infrastructure, procurement mechanisms, digital information systems, and the emergence of regional coordination and local manufacturing initiatives. Persistent challenges such as limited infrastructure, workforce capacity, and regulatory strength remain, yet, recent advances highlight Africa's capacity for adaptation. The COVID-19 pandemic exposed critical vulnerabilities but also accelerated progress. Understanding this evolution provides lessons for strengthening supply chains and advancing vaccine security, with artificial intelligence offering new opportunities for optimisation.

Background: South Africa launched a school-based human papillomavirus (HPV) vaccination programme in 2014 and has achieved a national coverage of more than 80%. However, there is subnational variation in coverage, with eThekwini District in the province of KwaZulu-Natal having the lowest coverage at 40%. Knowledge of the factors associated with vaccine acceptance in this district would inform tailored strategies to improve coverage, which could be extrapolated to similar settings. We conducted this cross-sectional study to assess the factors associated with HPV vaccine acceptance in eThekwini District. Methods: We used stratified random sampling to select caregivers of children aged 9–14 years in the district. We interviewed participants in April–May 2023 and employed bivariate and multivariate logistic regression models to assess the factors associated with HPV vaccine acceptance. Results: Of 793 individuals contacted, 713 (89.9%) participated. Most were women (86.1%) and had a mean age of 42.6 ± 11.6 years and secondary or lower education (83.8%). Most participants knew about the HPV vaccination programme (86.0%) and accepted HPV vaccination (93.5%). The latter includes 42.9% who had already vaccinated their daughters and 50.6% who were willing to allow their daughters to be vaccinated. A negligible proportion was either undecided (2.1%) or unwilling (4.4%) to accept HPV vaccination. Awareness of the programme (adjusted odds ratio [aOR] 5.22; 95% confidence interval [95%CI] 2.01–13.56), confidence in vaccine safety (aOR 19.69; 95%CI 5.86–66.15), and endorsement by religious leaders (aOR 5.06; 95%CI 1.56–16.45) were independent predictors of vaccine acceptance. Conclusions: Our findings highlight the critical role of the provision of information and education about the benefits and safety of HPV vaccination.

The Expanded Programme on Immunisation demonstrated remarkable success for 50 years, accounting for 52% reduction in infant mortality in Africa. As antimicrobial resistance (AMR) continues to be a threat in Africa, responsible for 250,000 deaths in WHO African region in 2019, vaccines offer proven solutions. Studies from South Africa demonstrate that pneumococcal conjugate vaccines significantly reduced drug-resistant pneumococcal infections, with 67-96% reductions in resistant strains. Increasing immunisation coverage in Africa, reduces disease burden while providing a cost-effective strategy to combat antimicrobial resistance.