Explore the vast range of titles available.

ObjectivesThis study aims: (1) to identify and describe similarities and differences in both adult and child COVID-19 vaccine hesitancy, and (2) to examine sociodemographic, perception-related and behavioural factors influencing vaccine hesitancy across five West African countries.DesignCross-sectional survey carried out between 5 May and 5 June 2021.Participants and setting4198 individuals from urban and rural settings in Burkina Faso, Guinea, Mali, Senegal and Sierra Leone participated in the survey.Study registrationThe general protocol is registered on clinicaltrial.gov.ResultsFindings show that in West Africa at the time only 53% of all study participants reported to be aware of COVID-19 vaccines, and television (60%, n=1345), radio (56%; n=1258), social media (34%; n=764) and family/friends/neighbours (28%; n=634) being the most important sources of information about COVID-19 vaccines. Adult COVID-19 vaccine acceptance ranges from 60% in Guinea and 50% in Sierra Leone to 11% in Senegal. This is largely congruent with acceptance levels of COVID-19 vaccinations for children. Multivariable regression analysis shows that perceived effectiveness and safety of COVID-19 vaccines increased the willingness to get vaccinated. However, sociodemographic factors, such as sex, rural/urban residence, educational attainment and household composition (living with children and/or elderly), and the other perception parameters were not associated with the willingness to get vaccinated in the multivariable regression model.ConclusionsPrimary sources of information about COVID-19 vaccines include television, radio and social media. Communication strategies addressed at the adult population using mass and social media, which emphasise COVID-19 vaccine effectiveness and safety, could encourage greater acceptance also of COVID-19 child vaccinations in sub-Saharan countries.Trial registration numberNCT04912284.

ObjectivesThis study aims to identify the factors influencing vaccine hesitancy, willingness and its variation over time in order to inform more responsive strategies for increasing vaccination uptake. The specific objectives are: (1) to describe and compare levels of COVID-19 vaccine hesitancy among the general population in rural and urban settings in West Africa over time and (2) to identify factors associated with COVID-19 vaccination willingness and hesitancy among the general population across five West African countries over time.DesignFollowing a baseline survey (Wave I), three serial cross-sectional surveys (Waves II-IV) were implemented.SettingThe study was conducted in Burkina Faso, Guinea, Mali, Senegal and Sierra Leone from November 2021 to July 2022.ParticipantsA total of 13 571 study participants were included in the study (n=4373, n=4593 and n=4605 for survey Waves II, III and IV, respectively). Inclusion criteria were being 18 years or older, living in the study area and willing to provide informed consent. A two-stage sampling strategy was used to select the sample from among the general population.Primary and secondary outcomesPrimary outcomes were the variability of vaccine hesitancy over time and across the five West African countries. Secondary outcomes were factors associated with vaccine willingness.ResultsA small but steady increase in hesitancy to COVID-19-vaccination can be observed across countries, with an upward trend of vaccine hesitancy reported by 952 participants (33.9 %) in Wave II, 1055 (37.3%) in Wave III and 1089 (38.1%) in Wave IV. Among the countries included, Senegal shows the highest level of vaccine hesitancy (‘Definitely no’ and ‘Probably no’ ranging from 50.2% to 56.0% and 26.2 to 28.3%, respectively). At the same time, Senegal has the lowest vaccination coverage overall. Across all five countries and survey waves, the primary factor associated with vaccination willingness is fear of experiencing severe COVID-19 disease (Wave II: OR 0.42, 95% CI 0.34 to 0.51, Wave III: OR 0.48, 95% CI 0.40 to 0.59 and Wave IV: OR 0.54, 95% CI 0.44 to 0.66). Perceived improved financial status seems to influence willingness to get vaccinated negatively (OR 0.57, 95% CI 0.40 to 0.81) and unlike in Western, Educated, Industrialised, Rich and Democratic countries, men seem more reluctant to get vaccinated than women (OR 0.77, 95%, CI 0.65 to 0.93).ConclusionsOur findings suggest that vaccine hesitancy should be monitored over time to inform communication strategies, which are responsive to changes in vaccination-related public sentiments. Additionally, a focus on social solidarity and the importance of women in vaccination advocacy can help improve COVID-19 vaccination coverage in West Africa.Trial registration numberThe general protocol is registered on clinicaltrial.gov (protocol number: NCT04912284).

Background The WHO set the global immunisation threshold for COVID-19 at 70% to achieve worldwide protection against the disease. To date, global COVID-19 vaccine coverage is still below this threshold, in particular in several sub-Saharan African (SSA) countries, such as Madagascar. While factors influencing COVID-19 vaccine hesitancy have been widely explored in the past few years, research on drivers of COVID-19 vaccine uptake remains scarce. This study aimed at investigating drivers associated with COVID-19 vaccine uptake in the Boeny region of Madagascar. Methods The study used a cross-sectional survey design to collect data on drivers of vaccine uptake from a sample of adults recruited from 12 healthcare facilities between November 2022 and February 2023. Relative and absolute frequencies were used to summarize participants’ characteristics. Prevalence ratios were estimated by Poisson regression to identify and compare sociodemographic and motivational drivers of vaccine uptake among those who were willing to get vaccinated against COVID-19 with those who had already been vaccinated. Results A total of 928 participants aged between 18 and 76 years were included in the study. Among those recruited, 44.9% ( n  = 417) had already been vaccinated and 55.1% ( n  = 511) were willing to receive their first dose of COVID-19 vaccine on the day of the interview. The proportions of those respondents who live in urban areas (56.5% vs. 43.8%) and who have high school or university education (46.6% vs. 35.8%) were higher for the uptake group, whereas the proportion of employed respondents (66.3% vs. 56.5%) was higher among those willing to get vaccinated. Vaccine being free of charge (aPR = 1.77 [CI 95%: 1.45–2.17]) and being able to travel again (aPR = 1.61 [CI 95%: 1.30–1.98]) were the drivers most strongly associated with higher vaccine uptake after adjustment for sociodemographic factors. Conclusions This study shows that actual COVID-19 vaccine uptake is influenced by a different set of factors than willingness to get vaccinated. Taking this difference in drivers into account can inform more tailored vaccination strategies to increase worldwide coverage.

Background The COVID-19 pandemic has highlighted the need for more effective immunization programs, including in limited resource settings. This paper presents outcomes and lessons learnt from a COVID-19 vaccination campaign (VC), which used a tailored adaptive strategy to optimise vaccine uptake in the Boeny region of Madagascar. Methods Guided by the Dynamic Sustainability Framework (DSF), the VC implementation was regularly reviewed through multi-sectoral stakeholder feedback, key informant interviews, problem-solving meetings, and weekly monitoring of outcome indicators to identify and apply key adaptations. Qualitative data on processes were collected and analysed using a rapid assessment approach. Outcome indicators, including pre- and post-VC vaccine hesitancy and trends in vaccine doses administered, were analysed using generalized linear models. Additionally, vaccination coverage, geographic reach, and target population characteristics, and sustainability indicators, such as staff trained, facilities equipped, and degree of integration of operational and educational materials were also tracked. Results Key strategy adaptations included using a proactive campaign approach, community-led awareness and outreach, particularly in remote areas, and addressing cold chain, waste management, vaccine transport, and information technology (IT) equipment gaps. Over six months, 24,888 COVID-19 vaccines were administered. The adapted strategy led to an 8% increase in doses administered weekly (RR = 1.08, CI 95%: 1.01-1.15). However, vaccine hesitancy among the unvaccinated population remained unchanged (∆ = 0.02, CI 95%: -0.04-0.08). In terms of sustainability, 340 staff were trained, and 10 primary healthcare facilities were equipped and refurbished. Conclusions Implementing collaborative, multi-sectoral vaccination strategies that integrate healthcare services with proactive outreach and community-driven campaigns are effective in increasing vaccine coverage in resource-limited settings. It demonstrates how theory-based adaptive strategies can enhance vaccination rates, even if they do not significantly impact COVID-19 vaccine hesitancy within the community. More generally, this initiative has important implications for adult vaccination programmes other than those related to COVID-19.

Introduction Although an essential frontline service in the prevention of child morbidity and mortality, there are indications that routine vaccinations have been disrupted during the COVID-19 pandemic. The present study aimed to compare vaccination coverage before COVID-19 in Mali in 2019 and during COVID-19 in 2020. Objective To compare vaccination coverages before COVID-19 in Mali in 2019 and during COVID-19 in 2020. Design Cross-sectional study. Setting and participants We collected routine immunization data from 2019 to 2020 of children under one year in the health district of Commune V in Bamako which includes twelve community health centers (CSCom). Results Considering all vaccines together, coverage in 2019 was higher than in 2020 (88.7% vs. 71,6%) (p < 10 − 3 , Fig. 1). In 2020, low proportions of children vaccinated were observed in May (51.1%) two months after the first COVID-19 case in Mali on March 25, 2020. For all vaccines, the mean number of children vaccinated was significantly higher in 2019 (before COVID-19) as compared to 2020 (during COVID-19) (p < 0.05). However, in September and October 2019 BCG vaccine coverage was lower in 2019 as compared to 2020 (p < 10 − 3 ). Conclusion COVID-19 pandemic has affected routine childhood vaccine coverage in Commune V of Bamako, particularly in May 2020. Therefore, new strategies are needed to improve vaccine coverage in young children below 1.

Background The goal to eliminate the parasitic disease of poverty schistosomiasis as a public health problem is aligned with the 2030 United Nations agenda for sustainable development goals, including universal health coverage (UHC). Current control strategies focus on school-aged children, systematically neglecting adults. We aimed at providing evidence for the need of shifting the paradigm of schistosomiasis control programs from targeted to generalized approaches as key element for both the elimination of schistosomiasis as a public health problem and the promotion of UHC. Methods In a cross-sectional study performed between March 2020 and January 2021 at three primary health care centers in Andina, Tsiroanomandidy and Ankazomborona in Madagascar, we determined prevalence and risk factors for schistosomiasis by a semi-quantitative PCR assay from specimens collected from 1482 adult participants. Univariable and multivariable logistic regression were performed to evaluate odd ratios. Results The highest prevalence of S. mansoni, S. haematobium and co-infection of both species was 59.5%, 61.3% and 3.3%, in Andina and Ankazomborona respectively . Higher prevalence was observed among males (52.4%) and main contributors to the family income (68.1%). Not working as a farmer and higher age were found to be protective factors for infection. Conclusions Our findings provide evidence that adults are a high-risk group for schistosomiasis. Our data suggests that, for ensuring basic health as a human right, current public health strategies for schistosomiasis prevention and control need to be re-addressed towards more context specific, holistic and integrated approaches.

Background Schistosoma haematobium and S. mansoni are endemic in Madagascar, but reliable diagnostic tools are often lacking, contributing to exacerbate transmission and morbidity. This study evaluated the diagnostic accuracy of three tests for schistosome infection in Malagasy adults from areas of medium to high endemicity. Methods This cross-sectional study enrolled adults from three primary health care centres in Madagascar. Urine and blood samples were tested for schistosome infection using polymerase chain reaction (PCR), up-converting reporter particle lateral flow for the circulating anodic antigen (UCP-LF CAA), and point-of-care circulating cathodic antigen (POC-CCA) tests. Bayesian latent class models were used to assess diagnostic accuracies and disease prevalence. Results Of 1339 participants, 461 were from  S. haematobium  and 878 from  S. mansoni  endemic areas. Test detection rates were 52% (POC-CCA), 60% (UCP-LF CAA), and 66% (PCR) in the S. haematobium area, and 54%, 55%, and 59% respectively in the S. mansoni area. For S. haematobium , PCR and UCP-LF CAA showed high sensitivity (Se, median 95.2% and 87.8%) but moderate specificity (Sp, 60.3% and 66.2%), while POC-CCA performed moderately (Se: 64.5%; Sp: 59.6%). For S. mansoni , PCR and POC-CCA demonstrated high diagnostic accuracy (Se > 90%, Sp > 80%), while UCP-LF CAA showed good sensitivity (79.9%) but moderate specificity (69.7%). Conclusions While population-level prevalence estimates were similar across tests, individual-level agreement was only low to moderate. Our findings suggest that optimal diagnostic strategies should be tailored to specific endemic settings, continued development of accurate diagnostics suitable for highly endemic settings remains a priority. Graphical Abstract

Seasonal malaria chemoprevention (SMC) is recommended by the World Health Organization for the sub-Sahel region in sub-Saharan Africa for preventing malaria in children 3 months old to younger than 5 years. Since 2016, the Malian National Malaria Control Program has deployed SMC countrywide during its high malaria transmission season at a rate of 4 monthly cycles annually. The standard SMC regimen includes sulfadoxine-pyrimethamine (SP) plus amodiaquine (AQ). Resistance against SP is suspected to be rising across West Africa; therefore, assessing the effectiveness of an alternative antimalarial drug for SMC is needed to provide a second-line regimen when it is ultimately needed. It is not well understood whether SMC effectively prevents malaria in children aged 5 years or older. The primary goal of the study is to compare 2 SMC regimens (SP-AQ and dihydroartemisinin-piperaquine [DHA-PQ]) in preventing uncomplicated Plasmodium falciparum malaria in children 3 months to 9 years old. Secondly, we will assess the possible use of DHA-PQ as an alternative SMC drug in areas where resistance to SP or AQ may increase following intensive use. The study design is a 3-arm cluster-randomized design comparing the SP-AQ and DHA-PQ arms in 2 age groups (younger than 5 years and 5-9 years) and a control group for children aged 5-9 years. Standard SMC (SP-AQ) for children younger than 5 years was provided to the control arm, while SMC with SP-AQ was delivered to children aged 3 months to 9 years (arm 2), and SMC with DHA-PQ will be implemented in study arm 3 for children up to 9 years of age. The study was performed in Mali's Koulikoro District, a rural area in southwest Mali with historically high malaria transmission rates. The study's primary outcome is P falciparum incidence for 2 SMC regimens in children up to 9 years of age. Should DHA-PQ provide an acceptable alternative to SP-AQ, a plausible second-line prevention option would be available in the event of SP resistance or drug supply shortages. A significant byproduct of this effort included bolstering district health information systems for rapid identification of severe malaria cases. The study began on July 1, 2019. Through November 2022, a total of 4556 children 3 months old to younger than 5 years were enrolled. Data collection ended in spring 2023, and the findings are expected to be published later in early 2024. Routine evaluation of antimalarial drugs is needed to establish appropriate SMC age targets. The study goals here may impact public health policy and provide alternative therapies in the event of drug shortages or resistance. ClinicalTrials.gov NCT04149106, https://clinicaltrials.gov/ct2/show/NCT04149106. DERR1-10.2196/51660.

Sustainable and effective strategies to increase disease awareness and vaccination willingness are crucial in limited-resource settings for the prevention of infectious diseases such as COVID-19. Yet, in the region of sub-Saharan Africa COVID-19 vaccination rates remain considerably lower than in other world regions. This study aims to assess the effects of a multisectoral dialogue-based COVID-19 awareness-raising intervention implemented in the Jaxaay-Parcelles commune in Dakar Metropolitan Area, Senegal. This study adopted a quasi-experimental design. The STOP COVID-19 intervention was developed through a multisectoral collaboration involving academia, non-governmental organisations, local authorities and active community engagement initiatives. Community volunteers delivered the awareness-raising sessions through household visits. Data on the outcomes were collected through population-based repeated cross-sectional surveys, prior to the intervention (n = 863) and post-intervention (n = 737). A difference-in-difference analysis with propensity score weighting was used to explore changes in community awareness and attitudes towards COVID-19 and vaccination against the disease between the intervention and control groups before and after the STOP COVID-19 campaign. From August to November 2021, 124 awareness-raising sessions were organized. Difference-in-difference analysis showed a significant relative decrease in the proportion of insufficiently informed individuals about COVID-19 vaccination in the intervention site (DID = -0.10, CI 95 %: −0.21, −0.003). The intervention was associated with a less pronounced increase in COVID-19 vaccine hesitancy (DID = -0.11, CI 95 %: −0.21, −0.01) and did not affect the attitudes towards paediatric vaccination (DID = 0.02, CI 95 %: −0.07, 0.11). Our results suggest that our multisectoral dialogue-based intervention conceptualised and implemented through active community engagement can be effective in limited-resource settings to enhance population awareness about COVID-19 and vaccination against the disease. The insights gained from the intervention can be used to inform future vaccination campaigns and other public health interventions in similar settings. •COVID-19 awareness-raising intervention was implemented in Dakar, Senegal•Difference-in-difference analysis was used to evaluate the intervention effects•STOP COVID-19 enhanced population awareness and reduced COVID-19 vaccine hesitancy•Multisectoral collaboration and community engagement were key to intervention success

Ce travail rend compte d’une enquête épistémologique auprès des futurs professeurs de mathématiques de l’Ecole Normale Supérieure de Bamako. Elle met en évidence entre la définition intuitive et la définition précise de la limite celle qui émerge et qui est la mieux utilisée par les étudiants après avoir suivi un cours sur la notion de limite, les conceptions des étudiants sur l’obstacle épistémologique la limite peut être atteinte ou non, l’écart entre la définition intuitive et la définition précise, les connaissances mobilisables pour appliquer la définition précise, la raison d’être de la définition précise et les limites de la définition intuitive en la mettant en confrontation avec la définition formelle. Pour s’y prendre, nous ferons une étude historico-épistémologique de la notion de limite pour mettre en évidence les obstacles liés à celle-ci, étudier l’efficacité de la définition précise dans le traitement de ces obstacles, d’autre part nous élaborerons un questionnaire adressé aux futurs professeurs de mathématiques que nous analyserons à la lumière de la théorie anthropologique de la didactique.