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Cryptococcal meningitis is a major complication of HIV infection. In this phase 3, randomized, controlled trial in sub-Saharan Africa, a single dose of liposomal amphotericin B induction therapy combined with fluconazole and flucytosine for cryptococcal meningitis was shown to be noninferior to standard induction therapy with amphotericin B deoxycholate and was associated with fewer adverse events.

Background: Immunisation remains one of the most effective and cost-efficient public health interventions for preventing infectious diseases in children. Despite global progress, Sub-Saharan Africa (SSA) continues to face challenges in achieving equitable immunisation coverage. Gender-related disparities, rooted in sociocultural and structural inequalities, significantly influence the prevalence of zero-dose and under-immunised children in the region. This review critically examines the gender-associated barriers to routine childhood immunisation in SSA to inform more inclusive and equitable health interventions. Methods: A critical literature review was conducted generally following some steps of the PRISMA-P and CRD guidelines. Using the Population–Concept–Context (PCC) framework, studies were selected that examined gender-related barriers to routine immunisation for children under five in Sub-Saharan Africa. Comprehensive searches were performed across PubMed, Google Scholar, and relevant organisational websites, targeting articles published between 2015 and 2025. A total of 3683 articles were retrieved, with 24 studies ultimately meeting the inclusion criteria. Thematic analysis was used to synthesise the findings. Results: Four major themes emerged: (1) women’s empowerment and autonomy, including limited decision-making power, financial control, and the impact of gender-based violence; (2) male involvement and prevailing gender norms, where patriarchal structures and low male engagement negatively influenced vaccine uptake; (3) socioeconomic and structural barriers, such as poverty, geographic inaccessibility, maternal workload, and service availability; and (4) education, awareness, and health system responsiveness. Conclusions: Gender dynamics have a significant impact on childhood immunisation outcomes in Sub-Saharan Africa. Future policies must integrate these insights to improve immunisation equity and reduce preventable child morbidity and mortality across the region.

IntroductionChildhood tuberculous meningitis (TBM) is a devastating disease. The long-standing WHO recommendation for treatment is 2 months of intensive phase with isoniazid (H), rifampicin (R), pyrazinamide (Z) and ethambutol (E), followed by 10 months of isoniazid and rifampicin. In 2022, WHO released a conditional recommendation that 6 months of intensified antituberculosis therapy (ATT) could be used as an alternative for drug-susceptible TBM. However, this has never been evaluated in a randomised clinical trial. Trials evaluating ATT shortening regimens using high-dose rifampicin and drugs with better central nervous system penetration alongside adjuvant anti-inflammatory therapy are needed to improve outcomes.Methods and analysisThe Shortened Intensive Therapy for Children with Tuberculous Meningitis (SURE) trial is a phase 3, randomised, partially blinded, factorial trial being conducted in Asia (India and Vietnam) and Africa (Uganda, Zambia and Zimbabwe). It is coordinated by the Medical Research Council Clinical Trial Unit at University College London (MRCCTU at UCL). 400 children (aged 29 days to <18 years) with clinically diagnosed TBM will be randomised, using a factorial design, to either a 24-week intensified regimen (isoniazid (20 mg/kg), rifampicin (30 mg/kg), pyrazinamide (40 mg/kg) and levofloxacin (20 mg/kg)) or the standard 48-week ATT regimen and 8 weeks of high-dose aspirin or placebo. The primary outcome for the first randomisation is all-cause mortality, and for the second randomisation is the paediatric modified Rankin Scale (mRS), both at 48 weeks. Nested substudies include pharmacokinetics, pharmacogenetics, pathophysiology, diagnostics and prognostic biomarkers, in-depth neurodevelopmental outcomes, MRI and health economics.Ethics and disseminationLocal ethics committees at all participating study sites and respective regulators approved the SURE protocol. Ethics approval was also obtained from UCL, UK (14935/001). Informed consent from parents/carers and assent from age-appropriate children are required for all participants. Results will be published in international peer-reviewed journals, and appropriate media will be used to summarise results for patients and their families and policymakers.Trial registrationISRCTN40829906 (registered 13 November 2018).

An adverse event following immunisation is any untoward medical occurrence which follows vaccination. Frequency of adverse events ranges from 13% to 34% and they should be reported regardless of severity. From the beginning of 2016 to mid-2017, Guruve district in Zimbabwe did not report any AEFIs. This suggests the surveillance system may be failing to detect adverse events. We therefore evaluated the AEFI surveillance system in Guruve district. We conducted a surveillance system evaluation using the updated Centers for Disease Control guidelines for evaluating public health surveillance systems. We interviewed health workers and caregivers of babies under 2 years in Guruve district. We also reviewed all records on AEFI surveillance for the period of January 2016 to November 2017. We recruited 31 health workers and 33 caregivers into the study. Between January 2016 and mid-2017, 39% of the caregivers had children who had suffered AEFIs and 45% of the health workers had encountered AEFIs but none had been notified. The main reasons for failure to report AEFIs included health workers' fear of personal consequences and caregivers thinking that an adverse event was not serious enough to report. Knowledge of the surveillance system was good amongst the majority of health workers. All the resources needed by the surveillance system were available. We concluded that health workers in Guruve district were afraid to report adverse events following immunization and caregivers were reluctant to report mild adverse events hence the surveillance system was performing poorly and was not useful. However, the stability of the system and the good knowledge gives a good foundation for improving the surveillance system.

While maternal influences on childhood immunization have been extensively studied in sub-Saharan Africa (SSA), paternal socioeconomic factors remain underexplored despite their potential impact on vaccination outcomes. This systematic review and meta-analysis aimed to synthesize current evidence on the influence of paternal characteristics on full childhood immunization status in SSA. A comprehensive literature search was conducted in PubMed, Google Scholar, Embase, and Scopus for studies published between January 2014 and March 2025. Studies were included if they examined paternal factors, such as education, employment, and decision-making power, in relation to childhood immunization among children under five in SSA. Data were extracted from 16 eligible studies, and a meta-analysis was conducted using MetaXL and IBM SPSS to calculate pooled prevalence and effect sizes. The Downs and Black checklist was used for risk of bias assessment. Of the 16 studies included, seven contributed data to the meta-analysis on full immunization. The pooled prevalence of full immunization was 60 % (95 % CI: 37–81 %) across SSA. Children of fathers with primary education or higher were nearly three times more likely to be fully immunized than those whose fathers had no formal education (OR = 2.72, 95 % CI: 1.22–6.03, I2 = 98 %). While the association between paternal employment status and child immunization was statistically non-significant (OR = 1.74, 95 % CI: 0.10–29.20, I2 = 91 %), qualitative findings suggest employment influences health-seeking behavior. Decision-making power within households also emerged as an important factor, with joint parental decision-making linked to higher immunization coverage. Interventions aiming to improve immunization outcomes should consider strategies to engage fathers, promote joint decision-making, and address underlying gender norms. Further research is needed to understand better the mechanisms through which paternal factors influence vaccine uptake in diverse SSA settings.