Background: Maternal and neonatal tetanus (MNT) remains a public health threat in low- and middle-income countries due to suboptimal coverage of complete-dose maternal immunization. Although TT and Td vaccines are clinically effective, their cost-effectiveness in different country contexts needs systematic assessment. Purpose: To evaluate the cost-effectiveness of maternal tetanus toxoid (TT) and tetanus-diphtheria (Td) vaccination in developing countries, focusing on economic outcomes and contextual variations. Methods: This systematic review followed PRISMA 2020 guidelines. Literature was searched in PubMed, Scopus, ScienceDirect, Wiley, and Crossref. Inclusion criteria comprised CEA/CUA studies on maternal TT/Td immunization in developing countries. Reporting quality was assessed using the CHEERS 2022 checklist. Results: From 2,040 records, four studies met inclusion criteria. All reported maternal TT/Td vaccination as highly cost-effective, with ICERs ranging from USD 3.61 to 15,600 per DALY or life-year saved. Key uncertainties included vaccine effectiveness and distribution costs, while program efficiency varied by local health system conditions. Conclusion: Complete-dose maternal TT/Td immunization is a highly cost-effective public health intervention in resource-limited settings. However, policy implementation must be adapted to local contexts and supported by robust sensitivity analysis and reliable primary data.

In Peru, the national immunization schedule includes Bacillus Calmette–Guérin (BCG), Diphtheria–Tetanus–Pertussis (DTaP), Measles–Mumps–Rubella (MMR), and Poliomyelitis (Pol) vaccines. Despite their proven role in reducing infant morbidity and mortality, coverage remains uneven and is potentially influenced by access to communication media. We analyzed data from 37,791 mother–child pairs with children aged 18–24 months from the nationally representative Demographic and Family Health Survey (ENDES) 2021–2024. Using generalized linear models with a Poisson family and log link, we estimated adjusted prevalence ratios (PRa) for associations between complete vaccination and access to various media types (newspaper, radio, television, internet, computer, landline, mobile phone), accounting for the complex survey design through sampling weights, stratification, and clustering. Complete vaccination was reported for 94.1% of children for BCG, 85.5% for DTaP, 86.3% for Pol, and 52.9% for MMR. Mobile phone or smartphone ownership was consistently associated with higher completion across all vaccines, ranging from a 12% increase for BCG (PRa 1.12; 95% CI 1.03–1.21) to a 43% increase for MMR (PRa 1.43; 95% CI 1.15–1.77). Radio access was positively associated with DTaP (PRa 1.03; 95% CI 1.00–1.05) and Pol (PRa 1.04; 95% CI 1.01–1.06). Speaking a language other than Spanish or Quechua was linked to lower coverage, particularly for MMR (PRa 0.67; 95% CI 0.56–0.82) and DTaP (PRa 0.76; 95% CI 0.68–0.86). These findings suggest that expanding culturally and linguistically tailored communication strategies through both traditional and digital media, especially mobile phones and radio, could improve vaccination uptake, particularly for MMR, DTaP, and Pol.

Background: Women’s empowerment has been significantly associated with improved child health outcomes. Cambodia, amid a rapid socioeconomic transition, offers a critical setting to examine how advancements in women’s empowerment over the past decade have influenced child immunization completion within the first two years of life. Methods: Data from the Cambodia Demographic and Health Surveys conducted in 2010, 2014, and 2021–22, encompassing 9222 women with recent births, were analyzed. Empowerment was measured across literacy and information access, employment, and decision-making domains. Multinomial logistic regression assessed associations between empowerment factors and completion of oral polio (OPV), diphtheria–tetanus–pertussis (DTP), pneumococcal conjugate (PCV), and measles–rubella (MR) vaccines, adjusting for demographic and socioeconomic variables. Results: Between 2010 and 2022, women’s empowerment in Cambodia improved significantly, marked by higher literacy rates, nearly half of women completing primary education, and expanded digital access, with 82.4% owning mobile phones and approximately 50% using the internet daily. While non-working women slightly increased, agricultural employment declined by 20%, and cash earnings rose from 48.7% to 82.5%. Most women participated in major household decision-making, either independently or jointly. Completion rates for OPV, DTP, and PCV ranged from 79% to 83%, while just over half of children were fully vaccinated against measles. Higher maternal education and cash earnings were positively associated with OPV, DTP, and PCV completion but negatively associated with measles vaccination. Women in agricultural work were less likely to complete measles vaccination for their children than non-working women. Joint decision-making regarding the use of respondents’ income was associated with a higher likelihood of measles non-completion (OR = 2.26, 95% CI: 1.13–4.51), whereas joint decision-making about respondents’ health care was associated with a higher likelihood of measles completion (OR = 0.42, 95% CI: 0.21–0.83). Conclusions: Women’s empowerment remains a key determinant of vaccination outcomes in Cambodia. The distinct pattern observed for measles suggests that vaccines scheduled for older ages encounter greater structural and behavioral barriers. To overcome these challenges, strategies should focus on enhancing defaulter tracking, implementing reminder systems, expanding outreach and catch-up programs, and improving the convenience of vaccination services.

This study aims to identify the factors that cause parents to refuse Diphtheria Tetanus immunization for children's health at the Talang Bakung Health Center, Jambi City, and analyze the legal strategies implemented by the Jambi City Regional Government in overcoming these rejections. The research method used is empirical legal research with a qualitative approach. Data was collected through interviews, observations, and documentation of related parties such as health workers, parents, and local government officials. Data analysis was carried out in a descriptive analytical manner by relating relevant field findings and legal theories. The results of the study showed that immunization refusal by parents was caused by several factors, including concerns about Post-Immunization Adverse Events (AEFIs), lack of understanding of vaccine benefits, the influence of misinformation on social media, and low trust in health workers. Social, cultural, and religious factors also contribute to strengthening resistance to immunization programs. The Jambi City Regional Government implements a persuasive and educational legal strategy by emphasizing increasing public health literacy through integrated socialization, the involvement of religious and community leaders, and the affirmation of legal policies based on Law Number 17 of 2023 concerning Health and Government Regulation Number 28 of 2024. In addition, the Regional Government strengthens legal protection for health workers and regulates the mechanism for handling AEFIs in a transparent manner to foster public trust. This legal strategy has proven effective in reducing immunization refusal rates and increasing community participation, although ongoing efforts are still needed to strengthen legal awareness and overall public health.

The global diphtheria incidence has fallen following widespread use of the diphtheria–tetanus–pertussis (DTP) vaccine; pockets of low coverage and disrupted health services continue to fuel outbreaks. Somalia, already challenged by conflict-related displacement and fragile health infrastructure, declared a national diphtheria outbreak on 19 August 2025. We analysed weekly case-based surveillance data reported through Somalia’s Integrated Disease Surveillance and Response (IDSR) system and the DHIS2 electronic platform (Epi-weeks 1–33, 2025) on the platform. Vaccination-coverage trends were extracted from WHO/UNICEF Estimates of National Immunization Coverage (WUENIC, 2000–2024). Supplementary information was obtained from the Ministry of Health situation reports and partner briefs. By Epi-week 33 (ending 17 August 2025), 1811 suspected diphtheria cases (17 laboratory-confirmed) and 89 deaths were recorded (case-fatality rate 5%). Children < 5 years accounted for 56% of cases; 87% of patients had no documented diphtheria immunization. Weekly incidence accelerated sharply after Epi-week 20, with the largest surges in Puntland, South-West State and the Benadir Regional Administration. DTP-1 coverage increased from 40 to 60% (2000–2018) to 79% in 2022 but plateaued at 70% in 2024; DTP-3 coverage reached 71% in 2022 yet remains insufficient for herd protection. Despite targeted ring vaccination and distribution of diphtheria antitoxin (DAT), constrained vaccine and DAT supplies, insecurity, and access barriers hamper outbreak control. Somalia’s diphtheria resurgence underscores how conflict, displacement, and uneven immunization can reverse hard-won gains against vaccine-preventable diseases. Closing routine-coverage gaps, guaranteeing timely DAT and antibiotic access, expanding real-time surveillance, and intensifying community engagement are urgent priorities to halt transmission and avert additional deaths. Prompt mobilization of national leadership, donors, and technical partners is essential to contain the outbreak and restore progress toward diphtheria elimination.

Background: Despite remarkable progress in expanding access to childhood vaccines in the last two decades, global coverage with the third dose of the diphtheria–tetanus–pertussis-containing vaccine (DTP3) has recently plateaued, with many countries yet to meet the targets of the Immunization Agenda 2030 (IA2030). As countries cluster around the 80% coverage mark, further gains require targeted interventions for unreached populations. This analysis disaggregates children missing DTP3 into three groups—zero dose (ZD), missed DTP (MD), and drop-out (DO)—which, with DTP3, form four mutually exclusive groups, and examines which of these groups contributes most to coverage changes across countries. Methods: A total of 295 Demographic and Health Surveys from 1986 to 2023 were analyzed across 80 countries, comprising over 2.4 million children. Children were classified into mutually exclusive groups: DTP3, ZD, MD, and DO. We described trends over time and conducted decomposition analyses using a naïve approach and a structural model with isometric log-ratio transformations and causal mediation pathways. Results: Among the 2.4 million children across 80 countries, 63.8% had received DTP3, while 16.2% were DO, 8.8% were MD, and 11.2% were ZD. Countries showed important variations: some mainly reduced ZD, others reduced MD or DO, many achieved balanced progress, and a few experienced setbacks. The naïve model showed that coverage changes reflected different combinations of shifts across ZD, MD, and DO depending on context. The structural model indicated that DO had the strongest direct association with DTP3 coverage, followed by MD and ZD. Conclusions: This analysis highlights the differential contribution of intermediate groups to coverage variations over time. Understanding the association between coverage gains and shifts in ZD, MD, or DO can complement existing strategies to inform targeted planning and accelerate progress towards IA2030 equity goals.

INTRODUCTIONChildhood vaccination coverage has declined in recent years in many countries, including the Netherlands.AIMTo understand differences in coverage between population subgroups in the Netherlands over time, we studied sociodemographic factors associated with measles–mumps–rubella (MMR) and diphtheria–tetanus–pertussis–poliomyelitis (DTaP-IPV) vaccination.METHODSWe conducted a national retrospective database study including children born between 2008 and 2020. Individual-level data linkage allowed examination of associations of sociodemographic variables with MMR and DTaP-IPV vaccination status at age 2 years. We calculated coverage for each variable, stratified by birth cohort. Multivariable Poisson regression assessed independent associations and changes in coverage over time.RESULTSMMR coverage decreased in all population subgroups (overall 95% in cohort 2008 and 89% in cohort 2020), more substantially in some. In multivariable analysis, children of non-Dutch origin, particularly Moroccan and Turkish origin, showed more pronounced declines (respectively −25% and −12% as children of Dutch origin in cohort 2020). Among children not attending daycare and children living in larger families (≥ 4 children), coverage declined faster than in those attending daycare and living in smaller families (both −12% in cohort 2020). Coverage among children of self-employed mothers and children in the lowest income households was lower than among children of mothers in employment and the highest income households (respectively −8% and −7% in cohort 2020). Trends for DTaP-IPV vaccination were nearly identical.CONCLUSIONChildhood vaccination coverage in the Netherlands declined substantially, with increasing disparities between sociodemographic groups. Vaccination efforts should be prioritised to protect public health equitably.

Developing countries face a nutrition transition, leading to a double or triple burden of malnutrition. In Ethiopia, the extent and socioecological drivers of this burden remain understudied. This study aims to analyze the spatial distribution of the double and triple burden of malnutrition and the role of socioeconomic and environmental factors in children aged 6-59 months. Data on stunting and overweight/obesity were obtained from the 2016 Ethiopian Demographic and Health Survey (EDHS), while data on micronutrient deficiencies were sourced from the Ethiopian Public Health Institute. A geostatistical model using Integrated Nested Laplace Approximation (INLA) within a Bayesian framework was employed to examine the role of Geo-socio-ecological Factors and predict the distribution of overweight/obesity, stunting, and micronutrient deficiencies and their co-occurrence. We observed significant overlaps in different types of malnutrition: stunting and overweight/obesity in Oromia; and overweight/obesity and zinc deficiency in Amhara, Tigray, Oromia, and Somali regions. There was also a notable regional variation in the triple burden of malnutrition: Oromia region faces overweight/obesity, stunting, and iron deficiency, while the central Ethiopia and Amhara regions experience overweight/obesity, stunting, and vitamin A deficiency. The Diphtheria Tetanus Pertussis (DTP) vaccine was negatively associated with vitamin A deficiency (β = -0.23; 95% CrI: -0.43, -0.04) and stunting (β = -0.13; 95% CrI: -0.22, -0.04). Additionally, soil nitrogen (g/kg of soil), which affects agricultural productivity, is associated with a decrease in iron deficiency (β = -0.57; 95% CrI: -0.93, -0.23) and zinc deficiency (β = -0.44; 95% CrI: -0.67, -0.19). The present finding shows that Ethiopia is experiencing both a double and triple burden of malnutrition, with a significant overlap of overweight/obesity, stunting, and micronutrient deficiencies (i.e. triple burden) across the country. This highlights the need for geographically targeted integration of services that address all forms of malnutrition. The Diphtheria Tetanus Pertussis (DTP) vaccine was negatively associated with stunting and VAD, likely due to its role in reducing infectious and diarrheal diseases, highlighting the potential for integrating health coverage with nutritional intervention. Soil nitrogen density was also negatively associated with iron and zinc deficiencies, possible due to its role on plant growth and nutrient composition, underscoring the need to promote soil-specific fertilizer use as part of nutrition-sensitive agricultural strategies.

Background: Zero-dose children represent a critical challenge for achieving universal immunization coverage in sub-Saharan Africa. This study applies the Three Delays Model to examine multilevel factors associated with zero-dose children. Methods: We analyzed data from 30,500 children aged 12–23 months across 28 sub-Saharan African countries using demographic and health surveys (2015–2024). Zero-dose status was defined as not receiving the first dose of diphtheria–tetanus–pertussis vaccine. Multilevel logistic regression models examined individual-, community-, and country-level determinants. Results: Overall, zero-dose prevalence was 12.19% (95% confidence interval: 11.82–12.56), ranging from 0.51% in Rwanda to 40.00% in Chad. Poor maternal health-seeking behavior showed the strongest association (odds ratio (OR) 12.00, 95% credible interval: 9.78–14.55). Paternal education demonstrated clear gradients, with no formal education increasing odds 1.52-fold. Maternal empowerment factors were significant: lack of decision-making power (OR = 1.23), financial barriers (OR = 1.98), and no media access (OR = 1.32). Low community literacy and low country-level health expenditure were associated with increased zero-dose prevalence. Substantial clustering persisted at community (19.5%) and country (18.7%) levels. Conclusions: Zero-dose children concentrate among the most disadvantaged populations, with maternal health-seeking behavior as the strongest predictor. Immediate policy actions should integrate antenatal care with vaccination services, target high-parity mothers, eliminate financial barriers, and increase health expenditure to 15% of national budgets.

Recent advances on the syntheses of oligosaccharides and the corresponding glycoconjugates towards development of vaccine candidates against invasive Neisseria meningitidis strains.

Background: Health service readiness is a crucial factor in delivering high-quality antenatal care (ANC). Health facilities must be equipped with the necessary tools, medications, and adequately trained personnel to provide effective ANC services. Inadequate service readiness can lead to decreased utilization of ANC services, potentially increasing the risk of complications and maternal morbidity. Ensuring a high standard of care is essential to reducing maternal and newborn mortality and achieving the health-related targets of the Sustainable Development Goals. This study aimed to assess the service readiness for quality ANC service by public health institutions in Lumbini Province. Materials and Methods: An institution-based cross-sectional study was conducted in 30 public health facilities in Lumbini Province, Nepal, using a 30-cluster sampling method. Face-to-face interviews with ANC service providers were carried out using a pretested structured questionnaire to assess service readiness. A validated observation checklist was used to evaluate the availability of drugs, equipment, and other essential items. Results: Among the 30 ANC service providers surveyed, 23.3% of the surveyed providers do not supply folic acid supplements and 10% of the institutions do not provide tetanus diphtheria (TD) vaccination. 33% of the health facilities lack appropriate IEC and BCC materials and 43.3% of the providers reported that their health institutions lack Reproductive Health (RH) clinical protocols and related guidelines and 44.7% of health institutions surveyed do not have quality assurance activities. Conclusion: This study identified several gaps in the critical aspects of service readiness in the health institutions of Lumbini province. These deficiencies directly impact the ability of healthcare providers to deliver effective, timely, and standardized care to pregnant women. Considering these findings, it is essential that health institutions in Lumbini province need to ensure the resources are consistently available, enable healthcare providers to deliver more comprehensive, standardized, and high-quality care.

Immunization is one of the most effective and efficient public health efforts in preventing diseases and reducing mortality rates in children such as smallpox, polio, tuberculosis, hepatitis B, diphtheria, measles, rubella, congenital rubella syndrome (CRS), tetanus, pneumonia (lung inflammation) and meningitis (inflammation of the brain membrane) (Nandi &amp; Shet, 2020). Data from the Indonesian Ministry of Health in 2020 showed that vaccination coverage in the 3rd and 4th months was months. However, efforts can be made to increase child vaccination coverage to 80% and that does not include DT, MR2, and HPV vaccinations. As, measles data is only 45%, diphtheria-tetanus (DT) is around 40% (Indonesian Ministry of Health, 2021). To determine the relationship between maternal knowledge and the completeness of basic immunization in children at the Raden Omas Posyandu. This study uses a quantitative research design with a cross-sectional method. The population in this study consisted of mothers who had children aged 12 to 18 months at Posyandu Raden Omas, totaling 36 mothers. The statistical results showed a relationship between maternal knowledge and the completeness of basic immunization in children p-value (0.048). Most respondents had good knowledge, as many as 13 respondents (36.1%). Sufficient knowledge, as many as 13 respondents (36.1%). Insufficient knowledge, as many as 10 respondents or 27.8%. Most respondents had incomplete immunization, namely 18 respondents (50%).

BackgroundDiphtheria has been re-emerging around the world at alarming rates, raising concerns about emergency preparedness, especially when global supplies of life-saving diphtheria antitoxin are insufficient. Outbreaks have occurred in areas with suboptimal coverage of the three-dose diphtheria tetanus and pertussis (DTP3) vaccine and regions experiencing conflict, but systematic studies assessing the association between these variables and the risk of diphtheria emergence are limited. This population-level study investigated the relationship between fatalities from armed conflict, childhood DTP3 vaccination coverage, and the presence of reported diphtheria cases in countries in the World Health Organization’s (WHO) African region from 2017 to 2024.MethodsThe analysis was conducted at a subnational geographic scale (I countries = 35, N subnational regions = 541). Data sources include DTP3 coverage from the Demographic Health Surveys (DHS), conflict-related fatalities from the Armed Conflict Location and Event Database (ACLED), and diphtheria cases from the WHO. We first assessed whether a history of fatalities from armed conflict is a predictor of childhood DTP3 coverage using mixed-effects beta regression. To assess the relationship between conflict and diphtheria emergence, we fit a crude logistic regression model to assess their overall association in the study period, as well as repeated measures mixed-effects models to estimate the relationship between time-varying rates of conflict-related fatalities and diphtheria status, adjusting for diphtheria vaccine coverage estimates.ResultsConflict and subsequent childhood DTP3 vaccine coverage were negatively associated (odds ratio [OR] = 0.93, 95% CI 0.88–0.98). Conflict is also a significant predictor of diphtheria presence, both in the crude (OR = 1.41, 95% CI 1.17–1.68) and best-fitting repeated measures model (OR = 30.30, 95% CI 23.30–39.39), though risk varied by location. The best-fit model also associated lower estimates of diphtheria risk in areas with high (> 80%) and low (< 25%) vaccine coverage, though this is possibly due to underreporting of the true burden of disease in low-resource settings.ConclusionsThis exploratory analysis indicates that conflict-related fatalities are potentially helpful indicators of subnational diphtheria risk in countries in the WHO African region from 2017 to 2024. Further, it may be especially useful in cases where estimates of population-level diphtheria immunity are limited.

BackgroundVaccination plays a pivotal role in safeguarding the health and wellbeing of children worldwide, preventing the spread of infectious diseases, and reducing mortality rates. Despite significant progress in global immunisation efforts, disparities in vaccination coverage persist in Madagascar. This study examines the factors associated with full vaccination coverage among children aged 12–23 months in Madagascar.MethodsWe analysed a cross-sectional dataset from the 2021 Madagascar Demographic and Health Survey (MDHS). A total of 2,250 mothers with children aged 12 to 23 months were extracted from the children’s dataset. Vaccination coverage was evaluated based on maternal self-report and child vaccination card observations. A weighted multivariable binary logistic regression analysis was used to examine the factors associated with full vaccination coverage. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were used to present the results of the factors associated with full vaccination coverage. Stata 13.0 was used to perform all the analyses.ResultsWe found that 48.9% of children aged 12–23 months were fully vaccinated. Vaccination coverage for Bacille Calmette-Guérin (BCG), third-dose polio, third-dose of diphtheria–tetanus–pertussis (DPT), and measles was 78.1%, 58.6%, 68.4%, and 63.9%, respectively. Mothers aged 35 to 49 (aOR: 1.69; 95% CI: 1.08–2.64) were more likely to have their children fully vaccinated compared to women aged 15–24. Children born to mothers with secondary or higher education (aOR:1.68; 95% CI:1.15–2.45) were more likely to receive full vaccination than those whose mothers had no formal education. Mothers within the middle-class wealth index (aOR: 1.48; 95% CI: 1.04–2.12) were more likely to have their children fully vaccinated compared to the poorest category. Mothers who were working (aOR: 1.45; 95% CI: 1.06–1.98) had higher odds of full childhood vaccination compared to those who were not working. Compared to mothers who delivered their babies at home or other places, those who delivered their babies at the health facility (aOR:1.57; 95% CI: 1.22–2.02) were more likely to vaccinate their children . Mothers who had less than eight (1–7) antenatal care visits (aOR: 3.63; 95% CI: 2.30–5.72) and those with 8 or more visits (aOR: 1.20; 95% CI: 1.35–6.51) were more likely to have their children vaccinated fully compared to those with zero antenatal care visits. Mothers exposed to media (aOR: 1.65; 95% CI: 1.26–2.16) were more likely to fully vaccinate their children than their unexposed counterparts.ConclusionFull childhood vaccination coverage is low in Madagascar. Factors identified to be associated with vaccination coverage were maternal age, education, place of delivery, working status, antenatal care visits, and media access. Collaboration between the Ministry of Health and local authorities is recommended in Madagascar to improve vaccination coverage, promote antenatal care, clean delivery practices and access to skilled birth attendants, raise parental awareness, and enhance healthcare workers’ communication about vaccination schedules through various media channels.

Background: Maternal health refers to the health of women during pregnancy, delivery, and the postpartum period, and the services include promotive, preventive, therapeutic, and rehabilitative health services for mothers and children provided by health facilities. Maternal and child health services are a priority program for community health. The main objective of this study was to assess the utilization of maternal health services among married women of reproductive age (MWARA). Methods: A quantitative descriptive cross-sectional study design was adopted to assess the utilization of maternal health services. The 157 MWARA aged between 19 and 45 years were employed for this study from June to July 2024 at Tamankhola Rural Municipality, Baglung District, Gandaki Province, Nepal. The study employed a simple random sampling technique to select the wards, and a purposive sampling technique was used to get respondents. A face-to-face interview with a semi-structured questionnaire among MWARS who had at least one child under two years was applied. The data were gathered, and univariate analysis was done by using IBM SPSS version 27 to disseminate the study's findings. Results: Out of 157 respondents, nearly half (42.8%) belonged in nuclear families, while a little bit more than half (58.59%) belonged in joint families. Most respondents (63.69%) married before the age of 20, and similarly (61.15%) had their first pregnancy at this young age. The majority of women (91.72%) had visited a health facility by walking on their feet. The utilization of antenatal care (ANC) services at least four or more times was found to be 97.45%, where a significant number (2.55%) of women didn’t utilize recommended ANC services as per protocol. Likewise, 66.88% were counseled on delivery preparation, 76.43% on breastfeeding, and 61.15% on recognizing pregnancy danger signs. Similarly, all the women (100%) received the Tetanus Diphtheria (TD) vaccine, and all mothers gave birth in a healthcare facility and found that all the mothers received recommended postnatal care (PNC), viz. most of them (96.2%) had three PNC visits, while few of them (3.8%) received only two PNC services. Conclusion and Recommendation: The study found that most women utilized ANC, delivery and neonatal care, and PNC services, with fully institutional delivery, and there were no home deliveries, which led to low pregnancy complications and mostly normal deliveries. All women received PNC services, and most of the newborns were bathed after an hour of birth. Likewise, a significant number of women received vitamin A and IFA supplements after delivery. The investigators recommended that the policymaker reform the policy that incorporates the provision of maternal health services planning, implementation, and evaluation primarily by the local government with data-driven decision-making practice since maternal health is a concurrent responsibility of three tiers of government.

Abstract Background: Tetanus–diphtheria-containing vaccine is still recommended for pregnant women even in countries that declared the elimination of neonatal tetanus and consequently the maternal tetanus. Many factors may affect vaccination during pregnancy. Knowledge is a key factor that greatly affects pregnant women. Objective: The objective of this study was to assess the knowledge and attitude of tetanus–diphtheria vaccine among pregnant women and to find any association between vaccine knowledge and attitude and study variables (age, educational status, employment, family income, socioeconomic status [SES], and antenatal care [ANC]). Subjects and Methods: A cross-sectional study was conducted in Baghdad city. Data collection was from March 1, 2023, to May 30, 2023. Thirteen primary health-care centers and two teaching hospitals were chosen conveniently to be included in the study. Total number of participants were 329 primigravida pregnant women. An interview questionnaire was used to collect quantitative data related to the knowledge and attitude of women about tetanus–diphtheria immunization and tetanus infection. Results: the study found that 73.6% of women had an accepted level of knowledge, 11.8% had an optimal level of knowledge, while 14.5% had a poor level of knowledge. Higher knowledge and attitude levels were significantly higher among older age group women and those with higher level of education and SES. ANC attendance and work status showed statistical insignificance regarding the level of knowledge and attitude. Women identify ANC and family members and friends as their primary sources of information about tetanus infection and immunization. Conclusions: Women’s knowledge was acceptable regarding tetanus infection and tetanus–diphtheria immunization. It is possible for proper health education targeting young women to prevent the occurrence of maternal neonatal tetanus. This might be possible with proper use of mass media to increase awareness.

Chemical conjugation of polysaccharides to protein carriers has become essential in carbohydrate vaccine development to enhance the poor immunogenicity of glycans. Neutral and uncharged carbohydrates induce T-cell independent responses, failing to produce robust IgG antibodies or sustained T-cell memory and conjugating native or synthetic glycans with carrier proteins such as the Cross-Reactive-Material-197 (CRM197) diphtheria toxin mutant, tetanus toxoid, or protein D of H. influenzae eliciting T-cell-dependent immune responses and class switching that produces high-affinity antibodies. This chapter describes the most commonly used synthetic glycoconjugates preparation strategy involving a spacer and a linker carrying a functional group, mostly amine, that couples the synthetic glycan to the carrier protein through its primary amine side chains of lysine residues and N-terminus. Our detailed protocol aims to advance the development of carbohydrate-binding antibodies that target tumor-associated carbohydrate antigens and expand our toolbox in the war against cancer.

A reduced-dose recombinant pertussis vaccine booster in Thai adolescents: a phase 2/3, observer-blinded, randomised controlled, non-inferiority trial

TEMPORARY REMOVAL: Improving the timeliness and equity of preschool childhood vaccinations: Mixed methods evaluation of a quality improvement programme in primary care

The effect of BCG revaccination on the response to unrelated vaccines in urban Ugandan adolescents (POPVAC C): an open-label, randomised controlled trial