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Background: There is a consensus among scholars, policymakers, and implementers that addressing the complex nature of intimate partner violence (IPV) requires a collaborative response. However, there is limited literature on how various professionals work collaboratively to address the needs of women with disabilities who experience IPV. This study combines the perspectives of women with disabilities and those of professionals to understand collaboration in providing IPV services to women with disabilities.

Methods: Twenty-nine in-depth interviews were conducted with 18 IPV service providers and 11 women with disabilities. The data were analyzed using reflective thematic analysis.

Results: The findings are presented under three themes: the first shows a consensus among different IPV service providers and disabled women on the importance of collaboration when supporting victims of IPV with disabilities; the second depicts the common ways in which collaboration occurs when supporting women with disabilities; and the third illuminates the critical elements that boost effective collaboration.

Conclusion: Supporting IPV victims with disabilities requires active collaboration at both an internal and external level. Strengthening collaboration among different actors requires trust, specified roles, and the allocation of adequate resources.

This study explored the experiences and perceptions of professional service providers offering services to women with disabilities exposed to intimate partner violence (IPV). Eighteen in-depth interviews were conducted with service providers working in health care, social work, the police, women’s shelters, and the Centre for Violence Against Women. Our findings suggest that providing adequate IPV services to women with disabilities requires coordination and collaboration. IPV services were organized around five overarching themes: finding services; assessing the risk; identification; protection and care; and becoming independent. This approach was helpful for women who faced disability-related challenges in accessing IPV services.

Objectives: Six million children were under-vaccinated in 2022. Our study aimed to 1) quantify the magnitude of under-vaccination variation between health facilities, 2) assess to which extent individual and health center level factors contributed to the variation, 3) identify individual and health facility factors associated with under-vaccination, and 4), explore rural vs. urban health facility variations.

Methods: We used data from 61,839 children from The Gambia national routine vaccination register. We cross tabulated under-vaccination status across study variables and fitted two-level random intercept multilevel logistic regression models to measure variance, contribution to the variance, and factors associated with the variance and under-vaccination.

Results: We found that 7% of the prevalence of under-vaccination was due to variation between health facilities. Thirty-seven percent of the variation was explained by individual and health center variables. The variables explained 36% of the variance in urban and 19% in rural areas. Children who were not vaccinated at 4 months or with delayed history, due for vaccination in the rainy season, and health facilities with very small or large population to health worker ratios had higher under-vaccination odds.

Conclusion: Our study indicates that one of the pathways to improving vaccination coverage is addressing factors driving under-vaccination inequities between health facilities through urban-rural differentiated strategies.

Background: Current data suggests a high prevalence of intimate partner violence (IPV) among women withdisabilities (WWDs), yet there is still scanty research on the experiences of this population regarding access andutilization of IPV services.

Methods: Using qualitative in-depth data obtained from WWDs, our current study sought to identify factors thathinder WWDs from accessing and utilizing IPV services.

Results: This study showed that WWDs exposed to IPV encountered multilevel barriers nested at differentsocietal levels as they attempted to access violence-rated services. At the individual level, the identity category ofdisability, not knowing about certain forms of violence, and being better off silent were the main explanations fornot using IPV services. The role of personal connections was the main factor that influenced the utilization ofIPV services, at the interpersonal level while at the organizational level, a lack of effective communication, powerimbalances, inadequate resources, and failures to follow response standards were identified as the major barriers tousing IPV services. Societal incompetence, as exemplified by treating violence as a taboo and the lack ofregulations criminalizing psychological violence, was the main barrier at the societal level.

Conclusions: Our findings suggest that regarding WWDs, improving their access and utilization of IPV servicesrequires interventions that address barriers at societal multiple levels including the individual, interpersonal,organizational, and societal levels. This should include early interventions and programs that not only targetWWDs but also include other key players such as service providers on violence recognition and improve thequality of services. There is a need to also review laws and regulations regarding psychological violence and thenature of interventions in place for this type of violence. 

Introduction: The Hepatitis B virus that can cause liver cancer is highly prevalent in the Gambia, with one in ten babies at risk of infection from their mothers. Timely hepatitis B birth dose administration to protect babies is very low in The Gambia. Our study assessed whether 1) a timeliness monitoring intervention resulted in hepatitis B birth dose timeliness improvements overall, and 2) the intervention impacted differentially among health facilities with different pre-intervention performances.

Methods: We used a controlled interrupted time series design including 16 intervention health facilities and 13 matched controls monitored from February 2019 to December 2020. The intervention comprised a monthly hepatitis B timeliness performance indicator sent to health workers via SMS and subsequent performance plotting on a chart. Analysis was done on the total sample and stratified by pre-intervention performance trend.

Results: Overall, birth dose timeliness improved in the intervention compared to control health facilities. This intervention impact was, however, dependent on pre-intervention health facility performance, with large impact among poorly performing facilities, and with uncertain moderate and weak impacts among moderately and strongly performing facilities, respectively.

Conclusion: The implementation of a novel hepatitis B vaccination timeliness monitoring system in health facilities led to overall improvements in both immediate timeliness rate and trend, and was especially helpful in poorly performing health facilities. These findings highlight the overall effectiveness of the intervention in a low-income setting, and also its usefulness to aid facilities in greatest need of improvement.

Background: Over the past decades the number of young people using disability pensions (DP) has gradually increased in Europe but the reasons for this change are poorly understood. We hypothesize that teenage parenthood could be associated with an increased risk of receiving early DP. The aim of this study was to examine the association between having a first child at age 13-19 and receiving DP at age 20-42 (here called early DP).

Methods: A longitudinal cohort study was undertaken based on national register data obtained from 410,172 individuals born in Sweden in 1968, 1969, and 1970. Teenage mothers and fathers were followed until age 42 and compared to non-teenage parent counterparts to examine their early receipt of DP. Descriptive analysis, Kaplan-Meier curves, and Cox regression analyses were performed.

Results: The proportion of teenage parents was more than twice higher in the group that received early DP (16%) compared to the group that did not receive early DP (6%) during the study duration. A higher proportion of teenage mothers and fathers started to receive DP at 20-42 years old compared to non-teenage parents, and the difference between the two groups increased during the observation period. A strong association was observed between being a teenage parent and receiving early DP, significant both independently and after adjusting for the year of birth and the father's level of education. From the age of 30 to 42 years, teenage mothers used early DP more often than teenage fathers or non-teenage parents, and this difference also increased during the follow-up period.

Conclusion: A strong association was found between teenage parenthood and the use of DP between 20 and 42 years of age. Teenage mothers used DP more than teenage fathers and non-teenage parents.

Introduction: Identifying actionable targets is crucial to improve overall and equity in vaccination coverage, and in line with the global Immunization Agenda 2030. Therefore, this study seeks to assess the prevalence of missed opportunities for simultaneous vaccination (MOSVs) and their impact on vaccination coverage and urban-rural inequity in The Gambia.

Methods: We used data of children aged 12-23 months from The Gambia 2019/2020 demographic and health survey (weighted n = 1355) with seen vaccination cards. We analyzed: the frequency of MOSVs; percentage point coverage reduction attributable to MOSVs for 18 vaccine doses and full basic vaccination; and MOSVs' contribution to urban-rural coverage inequity through Blinder-Oaxaca decomposition.

Results: Sixty percent of children experienced MOSVs, in both urban and rural areas, but urban MOSVs were more seldom corrected (35.9 % vs 45.3 %). All eighteen vaccine doses assessed could have achieved between one to eleven percentage points higher coverage if MOSVs had been avoided, with full basic vaccination gaining even more. While MOSV correction did not impact overall urban-rural coverage inequity, it did exacerbate (explained coefficient = -0.1007; P = 0.002) inequities among children who experienced MOSVs, explaining 95 % of the observed difference.

Conclusion: Our study highlights the prevalence and negative impact of MOSVs on overall vaccination coverage. Although MOSVs did not contribute significantly to the total urban-rural inequity in coverage, they have detrimental effects on vaccination coverage and urban-rural inequity among children who had experienced MOSVs. Addressing MOSVs, can enhance coverage and reduce the risk of under-vaccination, aligning with global initiatives.

Background: Over the past years, Mozambique has implemented several initiatives to ensure equitable coverage to health care services. While there have been some achievements in health care coverage at the population level, the effects of these initiatives on social inequalities have not been analysed.

Objective: The present study aimed to assess changes in socioeconomic and geographical inequalities (education, wealth, region, place of residence) in health care coverage between 2015 and 2018 in Mozambique.

Methods: The study was based on repeated cross-sectional surveys from nationally representative samples: the Survey of Indicators on Immunisation, Malaria and HIV/AIDS in Mozambique (IMASIDA) 2015 and the 2018 Malaria Indicator survey. Data from women of reproductive age (15 to 49 years) were analysed to evaluate health care coverage of three indicators: insecticide-treated net use, fever treatment of children, and use of Fansidar malaria prophylaxis for pregnant women. Absolute risk differences and the slope index of inequality (SII) were calculated for the 2015 survey period and the 2018 survey period, respectively. An interaction term between the socioeconomic and geographical variables and the period was included to assess inequality changes between 2015 and 2018.

Results: The non-use of insecticide-treated nets dropped, whereas the proportion of women with children who were not treated for fever and the prevalence of women who did not take the full Fansidar dose during pregnancy decreased between 2015 and 2018. Significant reductions in the inequality related to insecticide-treated net use were observed for all socioeconomic variables. Concerning fever treatment, some reductions in socioeconomic inequalities were observed, though not statistically significant. For malaria prophylaxis, the SII was significant for education, wealth, and residence in both periods, but no significant inequality reductions were observed in any of these variables over time.

Conclusions: We observed significant reductions of socioeconomic inequalities in insecticide-treated net use, but not in fever treatment of children and Fansidar prophylaxis for pregnant women. Decision-makers should target underserved populations, specifically the non-educated, poor, and rural women, to address inequalities in health care coverage.

Introduction: Postpartum contraception is vital for maternal and child health, and reduces the risk of infant mortality. The Health Belief Model (HBM) is a widely accepted framework for exploring health behaviors, such as contraceptive use. Therefore, this study aimed to investigate the factors influencing postpartum contraceptive use in Nigeria and to contextualize the findings within the framework of the HBM.

Methods: This study was a secondary analysis of cross-sectional data collected from the Demographic Health Survey conducted in Nigeria (NDHS). In total, 28,041 women were included in this study. Self-reported contraceptive use was the outcome, while the explanatory variables included maternal age, place of residence, region of residence, religion, marital status, educational level, household wealth quintiles, knowledge of the ovulatory cycle, decision-maker for health care, and distance to health care facilities. Descriptive statistics and multivariate logistic regression were used to summarize and identify factors influencing postpartum contraceptive use. The HBM was used to discuss the main findings.

Results: The prevalence of postpartum contraceptive use in Nigeria is 27%. Our findings showed that the odds of using contraceptives during the postpartum period were higher among women who knew their ovulation cycles, lived in urban areas in the southern region, had no distance barriers to health care, and were 25–49 years old. Education, wealth, and marital status also increase the odds of contraceptive use. However, women who lived in the northeast and northwest regions or shared decision-making with their partners had lower odds.

Conclusion: This study highlights the need for region-specific and age-focused interventions to increase contraceptive use in Nigeria. Additionally, increasing accessibility and affordability of contraceptives for younger and economically disadvantaged women, along with promoting women's autonomy in decision-making, can further enhance contraceptive use across Nigeria.

Background and Objective: The number of zero-dose and under-vaccinated children has passed 20 million following the COVID-19 pandemic. Reducing missed opportunities for vaccination is recommended as a key strategy for increasing coverage because it involves utilising existing vaccination sites. To generate actionable evidence for coverage and equality improvement targeting, this study aimed to estimate the frequencies of missed opportunities for simultaneous vaccination (MOSVs) and their correction by residential area and assess the impact of MOSVs on full vaccination and coverage of vaccine doses in The Gambia.

Methods: Data of children with cards aged 12–23 months from The Gambia 2019/2020 demographic and health survey was used (weighted n = 1355). We measured the number of children who experienced at least 1 MOSV any time before the survey and the proportions of children who later 1) received all doses, 2) received some doses, and 3) never received any dose by residence. Finally, valid coverage with and without MOSVs was estimated for all eligible vaccine doses.

Results: More than half of the children surveyed experienced at least one MOSV, and more than half of the MOSVs were later corrected. A quarter of the children who experienced MOSVs did not have them corrected. Rural and urban residents had similar experiences in the proportion of MOSVs, but children in urban areas had their MOSVs not corrected more frequently. Seventeen of eighteen vaccine doses in the national schedule would have coverage gains without MOSVs, with some gaining as much as nine percentage points in coverage.

Conclusions: Missed opportunities for simultaneous vaccination are frequent, negatively affecting coverage and differentially impacting rural and urban areas, and should be targeted for vaccination improvement. Our study emphasizes the importance of MOSVs for vaccination coverage and the need to implement the WHO missed opportunities for vaccination strategy.