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Background The suspension and/or termination of many programmes funded through the United States Agency for International Development (USAID) by the new US administration has severe short- and long-term negative impacts on the health of people worldwide. We draw attention to the termination of the Demographic and Health Surveys (DHS) Program, which includes nationally representative surveys of households, DHS, Malaria Indicator Surveys [MIS]) and health facilities (Service Provision Assessments [SPA]) in over 90 low- and middle-income countries. USAID co-funding and provision of technical support for these surveys has been shut down. Main body The impact of these disruptions will reverberate across local, regional, national, and global levels and severely impact the ability to understand the levels and changes in population health outcomes and behaviours. We highlight three key impacts on (1) ongoing data collection and data processing activities; (2) future data collection and consequent lack of population-level health indicators; and (3) access to existing data and lack of support for its use. Conclusions We call for immediate action on multiple fronts. In the short term, universal access to existing data and survey materials should be restored, and surveys which were planned or in progress should be completed. In the long term, this crisis should serve as a tipping point for transforming these vital surveys. We call on national governments, regional organisations, and international partners to develop sustainable alternatives that preserve the principles (standardised questionnaires, backward compatibility, open access data with rigorous documentation) which made the DHS Program an invaluable global health resource.

Background The RTS,S/AS01 malaria vaccine is currently being evaluated in a cluster-randomized pilot implementation programme in three African countries. This study seeks to identify whether vaccination could reach additional children who are at risk from malaria but do not currently have access to, or use, core malaria interventions. Methods Using data from household surveys, the overlap between malaria intervention coverage and childhood vaccination (diphtheria-tetanus-pertussis dose 3, DTP3) uptake in 20 African countries with at least one first administrative level unit with Plasmodium falciparum parasite prevalence greater than 10% was calculated. Multilevel logistic regression was used to explore patterns of overlap by demographic and socioeconomic variables. The public health impact of delivering RTS,S/AS01 to those children who do not use an insecticide-treated net (ITN), but who received the DTP3 vaccine, was also estimated. Results Uptake of DTP3 was higher than malaria intervention coverage in most countries. Overall, 34% of children did not use ITNs and received DTP3, while 35% of children used ITNs and received DTP3, although this breakdown varied by country. It was estimated that there are 33 million children in these 20 countries who do not use an ITN. Of these, 23 million (70%) received the DTP3 vaccine. Vaccinating those 23 million children who receive DTP3 but do not use an ITN could avert up to an estimated 9.7 million (range 8.5–10.8 million) clinical malaria cases each year, assuming all children who receive DTP3 are administered all four RTS,S doses. An additional 10.8 million (9.5–12.0 million) cases could be averted by vaccinating those 24 million children who receive the DTP3 vaccine and use an ITN. Children who had access to or used an ITN were 9–13% more likely to reside in rural areas compared to those who had neither intervention regardless of vaccination status. Mothers’ education status was a strong predictor of intervention uptake and was positively associated with use of ITNs and vaccination uptake and negatively associated with having access to an ITN but not using it. Wealth was also a strong predictor of intervention coverage. Conclusions Childhood vaccination to prevent malaria has the potential to reduce inequity in access to existing malaria interventions and could substantially reduce the childhood malaria burden in sub-Saharan Africa, even in regions with lower existing DTP3 coverage.

Malawi is midway through its current Malaria Strategic Plan 2017–2022, which aims to reduce malaria incidence and deaths by at least 50% by 2022. Malariometric data are available with health surveillance data housed in District Health Information Software 2 (DHIS2) and household survey data from two recent Malaria Indicator Surveys (MIS) and a Demographic and Health Survey (DHS). Strengths and weaknesses of the data were discussed during a consultative meeting in Lilongwe, Malawi in July 2019. The first 3 days included in-depth exploration and analysis of surveillance and survey data by 13 participants from the National Malaria Control Programme, district health offices, and partner organizations. Key indicators derived from both DHIS2 and MIS/DHS sources were analysed with three case studies, and presented to stakeholders on the fourth day of the meeting. Applications of the findings to programmatic decision-making and strategic plan evaluation were critiqued and discussed.

The Demographic and Health Surveys (DHS) Program has supported three household Malaria Indicator Surveys (MIS) in Madagascar. The results of 13 key malaria indicators from these surveys have been mapped as continuous surfaces using model-based geostatistical methods. The opportunities and limitations of these mapped outputs were discussed during a workshop in Antananarivo, Madagascar in July 2018, attended by 15 representatives from various implementation, policy and research stakeholder institutions in Madagascar. Participants evaluated the findings from the maps, using these to develop figures and narratives to support their work in the control of malaria in Madagascar.

In Ethiopia, despite efforts to increase modern contraceptive use, prevalence remains relatively low. This study aimed to identify factors associated with modern contraceptive use among married women of reproductive age in Ethiopia. We performed a cross-sectional study analyzing 5,684 weighted samples using SPSS version 20. We employed logistic regression model to examine the association between sociodemographic factors and modern contraceptive use. The adjusted odds ratios and 95% confidence intervals (CI) were calculated. Among currently married women, 38.2% were using modern contraceptives. Injectable contraceptives were the most popular method (60.1%), followed by implants (23%), pills (6.7%), IUDs (5.4%), LAM (2.8%), and others (2.0%). Logistic regression analysis revealed that, women age 20–24 (AOR = 4.044, 95% CI: 2.883–5.674), urban residence (AOR = 1.32, 95% CI: 1.09–1.59), no education (AOR = 0.548, 95% CI: 0.419–0.718), no knowledge of modern contraceptive (AOR = 0.039, 95% CI: 0.014–0.107), and poor wealth index (AOR = 0.45, 95% CI: 0.38–0.53) were significant associated with modern contraceptive use. To enhance family planning in Ethiopia, interventions should increase access to diverse contraceptive methods, especially in rural areas. Community awareness initiatives and government programs can help individuals make informed reproductive health choices. Public education through media, community-based efforts, and effective counseling is also essential.

Background Bacillus Calmette-Guérin (BCG) vaccination is a cornerstone of childhood immunisation programs, protecting against tuberculosis (TB), a major public health concern. Sierra Leone, a West African nation, faces challenges in achieving equitable and high BCG immunisation coverage. This study delves into the trends and inequalities in BCG coverage among one-year-old children in Sierra Leone between 2008 and 2019. Methods Three rounds of data from the Sierra Leone Demographic and Health Surveys (2008, 2013, and 2019) were used to analysed to examine the inequalities in BCG coverage. Simple measures of inequality [Difference (D) and Ratio (R)] and complex measures of inequality [Population Attributable Ratio (PAR) and Fraction (PAF)] were calculated in the World Health Organization’s Health Equity Assessment Toolkit (WHO’s HEAT) software. The measures were calculated separately for each of the three surveys for age groups of women, level of education, economic status, residential areas, gender, and sub-national provinces, and their estimates were compared. Results The findings revealed that BCG immunisation coverage in Sierra Leone has increased significantly from 2008 (82.0%) to 2019 (96.3%). Age-related inequalities between children of older mothers (20-49) and younger mothers (15-19) increased from a Difference of -4.7 percentage points in 2008 to 4.8 percentage points in 2019. The PAF increased from zero in 2008 to 0.4% in 2019. This means that in the absence of age-related inequalities, the national average of BCG immunisation coverage would have increased by 0.4%. Economic-related inequalities between children of mothers in Quintile 5 (richest) and Quintile 1 (poorest) decreased from a Difference of 9.2 percentage points in 2008 to 1.2 percentage points in 2019. Educational-related inequalities between children of mothers with secondary/higher education and no education decreased from a Difference of 14.1 percentage points in 2008 to 0.4 percentage points in 2019. The PAF decreased from 13.3% in 2008 to 0.2% in 2019, indicating that without educational-related inequalities the setting average of BCG immunisation coverage would have increased by 0.2%. Place of residence-related inequalities between children of mothers living in urban areas and rural areas decreased from a Difference of 9.3 percentage points in 2008 to 0.7 percentage points in 2019. The PAF decreased from 8.5% in 2008 to 0.5% in 2019 indicating that the national average of BCG immunisation coverage would have increased by 0.5% without place of residence-related inequalities. The sex of the child-related inequalities between male and female children decreased from a Difference of 5.4 percentage points in 2008 to 0.7 percentage points in 2019. The PAF decreased from 3.3% in 2008 to 0.4% in 2019 indicating that the national average of BCG immunisation coverage would have increased by 0.4% without sex of the child-related inequalities. Provincial inequalities decreased from a Difference of 18.5 percentage points in 2008 to 2.3 percentage points in 2019. The PAF decreased from 14.3% in 2008 to 1.1% in 2019 indicating that the national average of BCG immunisation coverage would have increased by 1.1% without provincial inequalities. Conclusion The findings indicate a substantial improvement in BCG immunisation coverage in Sierra Leone among one-year-olds, reflecting successful public health initiatives. However, age-related inequalities have worsened, with coverage among children of younger mothers declining relative to those of older mothers, suggesting a need for targeted interventions for this population. In contrast, economic, educational, sex, and place of residence-related inequalities have notably decreased, indicating progress in equitable access to immunisation across different socioeconomic strata. Additionally, provincial inequalities have decreased significantly, yet a difference of 2.3 percentage points remains, highlighting the need for continued efforts to ensure that all provinces, receive adequate healthcare resources and outreach. The absence of economic-related inequality by 2019 is particularly encouraging, as it suggests that economic barriers to immunisation have been effectively addressed. Furthermore, the reduction in educational and provincial inequalities highlights the effectiveness of strategies aimed at improving access and awareness in underserved areas.

Background Malaria remains a major public health concern in Sub-Saharan Africa, where prevention efforts such as insecticide-treated nets (ITNs) play a critical role in reducing transmission. However, malaria prevalence varies across geographic areas and household contexts, including differences in mosquito bed net utilization (treated, untreated, or absent), as well as other environmental and socioeconomic determinants. Understanding the spatial distribution of malaria and how it varies across households with different bed net utilization patterns can provide descriptive insights to support malaria control programs. This study aimed to describe and map the spatial distribution of malaria among households with different mosquito bed net utilization categories (no net, treated net, and untreated net) across 19 sub-Saharan African countries. Method A community-based cross-sectional study was conducted using the most recent Demographic and Health Survey (DHS) data from 19 sub-Saharan African countries. The analysis included 126,424 individuals who underwent malaria rapid diagnostic testing across 11,594 survey clusters. Malaria infection status was measured at the individual level, while spatial analyses were conducted at the cluster (enumeration area) level, the primary sampling unit used in DHS surveys. Data were cleaned, weighted, and analyzed using Stata version 17, accounting for the DHS complex sampling design (sampling weights, clustering, and stratification). Malaria prevalence and corresponding 95% confidence intervals were estimated. Spatial patterns of malaria distribution were explored using ArcGIS version 10.7 and SaTScan™ version 10.0.2. Result The pooled malaria prevalence across 19 sub-Saharan African countries was 24.0% (95% CI 18–30%), with regional variation observed: Central Africa recorded the highest prevalence at 26% (95% CI 18–34%), followed by West Africa at 25% (95% CI 15–35%), and East Africa at 20% (95% CI 10–31%). Regarding bed net usage, 49.17% (95% CI 48.89–49.45%) reported no bed net, 48.06% (95% CI 47.78–48.34%) used insecticide-treated nets (ITNs), and 2.77% (95% CI 2.68–2.86%) used untreated bed nets. Malaria prevalence was highest among no bed net users with 32.75%, followed by 28.91% among untreated bed net users and 13.23% among ITN users. Spatial analysis indicated significant spatial clustering of malaria cases (Global Moran’s I = 0.159, Z-score = 239.06, p ≤ 0.001). Hotspot areas identified by the Getis-Ord Gi* statistic included Benin, Burkina Faso, Togo, Uganda, Rwanda, and parts of Republic of the Congo and Mozambique. SaTScan analysis detected 34 significant malaria clusters overall, with 23 clusters among no bed net users, 25 among ITN users, and 12 among untreated bed net users. Conclusion Despite ongoing malaria control efforts, malaria prevalence remains substantial across sub-Saharan Africa, with notable regional and spatial disparities observed across areas with different bed net utilization patterns. These descriptive spatial findings highlight geographic heterogeneity in malaria burden and may help inform geographically targeted malaria control strategies. Strengthening access to insecticide-treated nets, improving community awareness, and prioritizing identified hotspot areas may contribute to strengthening malaria control efforts toward achieving global malaria reduction targets by 2030.

Immunity gaps caused by COVID-19-related disruptions highlight the importance of catch-up vaccination. Number of countries offering vaccines in second year of life (2YL) has increased, but use of 2YL for catch-up vaccination has been variable. We assessed pre-pandemic use of 2YL for catch-up vaccination in three countries (Pakistan, the Philippines, and South Africa), based on existence of a 2YL platform (demonstrated by offering second dose of measles-containing vaccine (MCV2) in 2YL), proportion of card availability, and geographical variety. We conducted a secondary data analysis of immunization data from Demographic and Health Surveys (DHS) in Pakistan (2017–2018), the Philippines (2017), and South Africa (2016). We conducted time-to-event analyses for pentavalent vaccine (diphtheria-tetanus-pertussis-Hepatitis B-Haemophilus influenzae type b [Hib]) and MCV and calculated use of 2YL and MCV visits for catch-up vaccination. Among 24–35-month-olds with documented dates, coverage of third dose of pentavalent vaccine increased in 2YL by 2%, 3%, and 1% in Pakistan, Philippines, and South Africa, respectively. MCV1 coverage increased in 2YL by 5% in Pakistan, 10% in the Philippines, and 3% in South Africa. In Pakistan, among 124 children eligible for catch-up vaccination of pentavalent vaccine at time of a documented MCV visit, 45% received a catch-up dose. In the Philippines, among 381 eligible children, 38% received a pentavalent dose during an MCV visit. In South Africa, 50 children were eligible for a pentavalent vaccine dose before their MCV1 visit, but only 20% received it; none with MCV2. Small to modest vaccine coverage improvements occurred in all three countries through catch-up vaccination in 2YL but many missed opportunities for vaccination continue to occur. Using the 2YL platform can increase coverage and close immunity gaps, but immunization programmes need to change policies, practices, and monitor catch-up vaccination to maximize the potential.

Domestic violence against women is a prevalent in Liberia, with nearly half of women reporting physical violence. However, research on the biosocial factors contributing to this issue remains limited. This study aims to predict women’s vulnerability to domestic violence using a machine learning approach, leveraging data from the Liberian Demographic and Health Survey (LDHS) conducted in 2019–2020. We employed seven machine learning algorithms to achieve this goal, including ANN, KNN, RF, DT, XGBoost, LightGBM, and CatBoost. Our analysis revealed that the LightGBM and RF models achieved the highest accuracy in predicting women’s vulnerability to domestic violence in Liberia, with 81% and 82% accuracy rates, respectively. One of the key features identified across multiple algorithms was the number of people who had experienced emotional violence. These findings offer important insights into the underlying characteristics and risk factors associated with domestic violence against women in Liberia. By utilizing machine learning techniques, we can better predict and understand this complex issue, ultimately contributing to the development of more effective prevention and intervention strategies. Highlights Chi-square association was used to determine the significant factors for Domestic violence (DV) in Liberia by using LDHS 2019–20 data. LightGBM and RF performed the best of all seven machine learning models, with the highest accuracy and F1 score. Victims of emotional violence were the most important feature of almost every model.

Background Despite many efforts to provide children with legal existence over the last decades, 1 in 4 children under the age of 5 (166 million) do not officially exist, with limited possibility to enjoy their human rights. In Latin America and the Caribbean, Haiti has one of the highest rates of undocumented births. This study aimed to analyze the prevalence and the determinant factors of undocumented childhood in Haiti. Methods For analysis of undocumented childhood and related socioeconomic determinants, data from the 2016/17 Haiti demographic and health survey were used. The prevalence and the associated factors were analyzed using descriptive statistics and the binary logistic regression model. Results The prevalence of undocumented childhood in Haiti was 23% (95% CI: 21.9–24.0) among children under-five. Among the drivers of undocumented births, mothers with no formal education (aOR = 3.88; 95% CI 2.21–6.81), children aged less than 1 year (aOR = 20.47; 95% CI 16.83–24.89), children adopted or in foster care (aOR = 2.66; 95% CI 1.67–4.24), children from the poorest regions like “Artibonite” (aOR = 2.19; 95% CI 1.63–2.94) or “Centre” (aOR = 1.51; 95% CI 1.09–2.10) or “Nord-Ouest” (aOR = 1.61; 95% CI 1.11–2.34), children from poorest households (aOR = 6.25; 95% CI 4.37–8.93), and children whose mothers were dead (aOR = 2.45; 95% CI 1.33–4.49) had higher odds to be undocumented. Conclusion According to our findings, there is an institutional necessity to bring birth documentation to underprivileged households, particularly those in the poorest regions where socioeconomic development programs are also needed. Interventions should focus on uneducated mothers who are reknown for giving birth outside of medical facilities. Therefore, an awareness campaign should be implemented to influence the children late-registering behavior.