Compared to other regions of the world, sub-Saharan Africa has made limited progress in the implementation and performance of nationwide human papillomavirus (HPV) vaccination programmes. Without urgent intervention, this will serve to undermine cervical cancer elimination efforts in this region. The primary intent of this narrative review is to highlight the programmatic successes and challenges of the school-based HPV vaccination programme in South Africa since its inception in 2014, with the aim of contributing to the evidence base needed to accelerate implementation and improve programme performance in other sub-Saharan African countries. As of 2020, the proportion of adolescent girls aged 15 years who had received at least one dose of the HPV vaccine at any time between ages 9–14 years was 75%, while 61% had completed the full recommended two-dose schedule. This gives some indication of the reach of the South African HPV vaccination programme over the past 6 years. Despite this, vaccine coverage and dose completion rates have persistently followed a downward trend, slowing progress toward attaining global elimination targets. There is evidence suggesting that declining public demand for the HPV vaccine may be a result of weakening social mobilization over time, inadequate reminder and tracking systems, and vaccine hesitancy. Another concern is the disproportionate burden of HPV and HIV co-infections among adolescent girls and young women in South Africa, which predisposes them to early development of invasive cervical cancer. Moving forward, national policy makers and implementers will have to explore reforms to current age eligibility criteria and vaccine dose schedules, as well as implement strategies to support vaccine uptake among populations like out-of-school girls, girls attending private schools, and HIV positive young women. Additional opportunities to strengthen the South African HPV vaccination programme can be achieved by scaling up the co-delivery of other adolescent health services such as comprehensive sexual and reproductive health and rights education, deworming, and health screening. This calls for reinforcing implementation of the integrated school health policy and leveraging existing adolescent health programmes and initiatives in South Africa. Ultimately, establishing tailored, adolescent-centered, integrated health programmes will require guidance from further operational research.

Highlights Immunisation coverage has an inverse relationship with age, while delay in vaccine uptake has a direct relationship with age. High vaccine coverage rates do not translate to timely receipt of routine childhood vaccines. Time-at-risk for vaccine preventable diseases is positively associated with increasing immunisation age timepoints. Preschool attendance and having adult caregivers are protective against delaying vaccine uptake. Low and upper-middle socio-economic quartiles are associated with delayed uptake of routine childhood vaccines.

Medicines have been re-purposed as therapeutics for COVID-19 and it is with great interest that we read the publication entitled, “Effects of Vitamin D Supplementation on COVID-19 Related Outcomes: A Systematic Review and Meta-Analysis” [...]

Background Low and middle-income countries remain disproportionately affected by high rates of childhood mortality, often caused by preventable conditions. Clinical practice guidelines (CPGs) are essential policy tools in supporting implementation of effective, safe, and cost-effective healthcare. High-quality evidence-based CPGs play a key role in improving clinical management aiming to impact child mortality. We aimed to identify and assess the quality of CPGs for newborn and child health published in South Africa, Nigeria and Malawi.Methods We searched relevant websites (June–July 2022), for publicly available national and subnational de novo or adapted CPGs, addressing newborn and child health in the three countries. Pairs of reviewers independently extracted information from eligible CPGs (scope, topic, target population and users, responsible developers, stakeholder consultation process, adaptation description, assessment of evidence certainty). We appraised CPG quality using the Appraisal of Guidelines for Research & Evaluation (AGREE II) instrument.Results We identified 40 CPGs from the three countries. Of these, 8/40 reported being adopted from a parent CPG. More CPGs (n = 19) provided guidance on communicable diseases than on non-communicable diseases (n = 8). CPGs were most often developed by national health ministries and professional societies. Eighteen CPGs reported on stakeholder consultation; with Nigeria (10/11) and Malawi (3/6) faring better than South Africa (5/23) in reporting this activity. GRADE was used in 1/7 CPGs that reported assessing certainty of evidence. Overall CPGs scored well on two AGREE II domains: scope and purpose median (IQR) score 68% (IQR 47–83), and clarity of presentation 81% (67–94). Domains critical for ensuring credible guidance scored below 20%: rigour of development 11% (4–32) and editorial independence 6% (0–27).Conclusion Topics covered by the identified CPGs did not always match country level burden of disease likely representing substantial gaps in available guidance for healthcare providers, parents, caregivers, and patients. Our study found low AGREE II scores for CPG development processes, possibly undermining the credibility of the available CPGs to provide evidence-informed care. Our findings highlight the importance of ongoing efforts to strengthen capacity and support CPG development with collaboration between policymakers, researchers and the public.