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  • First malaria vaccine for babies approved for use

    First malaria vaccine for babies approved for use

    The first malaria treatment suitable for babies and very young children has been approved for use.

    It’s expected to be rolled out in African countries within weeks.

    Until now there have been no approved malaria drugs specifically for babies.

    Instead they have been treated with versions formulated for older children which presents a risk of overdose.

    In 2023 – the year for which the most recent figures are available – malaria was linked to around 597,000 deaths.

    Almost all of the deaths were in Africa, and around three quarters of them were children under five years old.

    Malaria treatments for children do exist but until now, there was none specifically for the very youngest babies and small children, who weigh less than 4.5kg or around 10lb.

    Instead they have been treated with drugs designed for older children.

    But that presents risks, as doses for these older children may not be safe for babies, whose liver functions are still developing and whose bodies process medicines differently.

    Experts say this has led to what is described as a “treatment gap”.

    Now a new medicine, developed by the drug company Novartis, has been approved by the Swiss authorities and is likely to be rolled out in regions and countries with the highest rates of malaria within weeks.

    Novartis is planning to introduce it on a largely not-for-profit basis.

    The company’s chief executive, Vas Narasimhan, says this is an important moment.

    “For more than three decades, we have stayed the course in the fight against malaria, working relentlessly to deliver scientific breakthroughs where they are needed most.

    “Together with our partners, we are proud to have gone further to develop the first clinically proven malaria treatment for newborns and young babies, ensuring even the smallest and most vulnerable can finally receive the care they deserve.”

    The drug, known as Coartem Baby or Riamet Baby in some countries, was developed by Novartis in collaboration with the Medicines for Malaria Venture (MMV), a Swiss-based not-for-profit organisation initially backed by the British, Swiss and Dutch Governments, as well as the World Bank and the Rockefeller Foundation.

    Eight African nations also took part in the assessment and trials of the drug and they are expected to be among the first to access it.

    Martin Fitchet, CEO of MMV, says this is another important step on the road towards ending the huge toll taken by malaria.

    “Malaria is one of the world’s deadliest diseases, particularly among children. But with the right resources and focus, it can be eliminated.

    “The approval of Coartem Baby provides a necessary medicine with an optimised dose to treat an otherwise neglected group of patients and offers a valuable addition to the antimalarial toolbox.”

    Dr Marvelle Brown, associate professor at the University of Hertfordshire’s School of Health, Medicine and Life Sciences, says this should be seen as a major breakthrough in saving the lives of babies and young children.

    “The death rate for malarial infections, particularly in sub-Saharan Africa is extremely high – over 76% of deaths occur in children under five years old.

    “Increase in death from malaria is further compounded in babies born with sickle cell disease, primarily due to a weak immune system.

    “From a public health perspective, Novartis making this not-for-profit can help with reducing inequality in access to healthcare.”

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  • Ryder Cup 2025: Open Championship and Scottish Open are biggest qualifying weeks – Donald

    Ryder Cup 2025: Open Championship and Scottish Open are biggest qualifying weeks – Donald

    Europe’s Ryder Cup hopefuls are entering “the two biggest weeks left before qualification ends” for the biennial match against the United States, says captain Luke Donald.

    This week’s Scottish Open at the Renaissance Club near Edinburgh is followed by the Open Championship at Royal Portrush in Northern Ireland.

    And Donald, who led Europe to a 16½-11½ victory in Rome two years ago, is counting on his key players to step up this month.

    “These are big weeks against the strongest fields so you want to see the top guys play well,” Donald told BBC Scotland.

    “There are some guys that have pretty much staked a claim for their place in the team but there are a few spots definitely open and these weeks are big for those guys.”

    Rory McIlroy is the only player to have mathematically guaranteed his spot in the 12-strong team that will face the US at Bethpage Black in New York in September.

    English pair Tommy Fleetwood and Tyrrell Hatton are in second and third on the list with qualifying ending after the British Masters on 24 August – the US qualifying period ends on 17 August after the PGA Tour’s BMW Championship.

    The top six make the team with Donald picking the six others, while the US team will be selected in a similar way by their skipper Keegan Bradley.

    Scotland’s Robert MacIntyre is currently fourth on the European list and has really kicked on from making his Ryder Cup debut in 2023, where he was unbeaten, winning two-and-a-half points out of three.

    The 28-year-old from Oban followed victory at last year’s Canadian Open by winning the Scottish Open, which is co-sanctioned by the DP World Tour and PGA Tour.

    “It helped him really grow as a golfer and gave him the belief that he could perform with the very best,” said Donald of MacIntyre’s Ryder Cup experience.

    And the Englishman added that he has been “very impressed” by the way MacIntyre has “adapted his game to the US”.

    The world number 14 has made 15 cuts from his 17 PGA Tour events this season, including his runner-up finish at last month’s US Open, where he finished one shot behind champion JJ Spaun at Oakmont.

    “When you make that transition from playing mostly in Europe to playing over there, it is difficult,” said Donald.

    “The fields are deeper. It’s harder. But he was still consistent and I was watching his stats quite a lot.

    “Even from when he qualified in Rome to where he was before the second place in the US Open, his stats were quite a bit better.

    “He won twice last year, in Canada and here [Scottish Open at Renaissance Club]. I saw the improvement in statistics and it was only a matter of time before he had a really, really good week and he almost pulled it off.”

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  • Latest ‘Tiger King’ twist finds ‘Doc’ Antle facing possible prison sentence for animal trafficking

    Latest ‘Tiger King’ twist finds ‘Doc’ Antle facing possible prison sentence for animal trafficking

    Five years after the true crime documentary “Tiger King” captivated a country shut down by COVID-19, the final legal troubles for one of its main characters will be resolved Tuesday in a courtroom in South Carolina.

    Bhagavan “Doc” Antle faces up to 10 years in prison for trafficking in exotic animals and money laundering after pleading guilty in November 2023.

    Exactly what punishment prosecutors are asking for and any arguments for leniency from Antle’s attorneys were kept from the public before Tuesday morning’s hearing in federal court in Charleston.

    Three others who pleaded guilty in his investigation received either probation or a four-month prison sentence.

    Antle’s sentence is the final true-life chapter of the Tiger King saga. The Netflix series debuted in March 2020 near the peak of COVID-19 restrictions.

    The show centered on dealers and conservationists of big cats, focusing on disputes between Joe Exotic, a collector and private zookeeper from Oklahoma, and Carole Baskin, who runs Big Cat Rescue in Florida.

    Exotic, whose real name is Joseph Maldonado-Passage, is serving a 21-year federal prison sentence for trying to hire two different men to kill Baskin.

    Antle, who owns a private zoo called Myrtle Beach Safari, appeared in the first season of the documentary and was the star of the third season.

    Antle’s zoo was known for charging hundreds or thousands of dollars to let people pet and hold baby animals like lions, tigers and monkeys that were so young they were still being bottle-fed. Customers could have photos or videos made. Antle would sometimes ride into tours on an elephant.

    Myrtle Beach Safari remains open by reservation only, according to its website. Antle has remained out on bail since his arrest in June 2022.

    Antle’s federal charges were brought after the Tiger King series.

    Prosecutors said he sold or bought cheetahs, lions, tigers and a chimpanzee without the proper paperwork. And they said in a separate scheme, Antle laundered more than $500,000 that an informant told him was being used to get people into the U.S. illegally to work.

    Antle was used to having large amounts of money he could move around quickly, investigators said.

    The FBI was listening to Antle’s phone calls with the informant as he explained a baby chimpanzee could easily cost $200,000. Private zookeepers can charge hundreds of dollars for photos with docile young primates or other animals, but the profit window is only open for a few years before the growing animals can no longer be safely handled.

    “I had to get a monkey, but the people won’t take a check. They only take cash. So what do you do?” Antle said according to a transcript of the phone call in court papers.

    Two of Antle’s employees have already been sentenced for their roles in his schemes.

    Meredith Bybee was given a year of probation for selling a chimpanzee while Andrew “Omar” Sawyer, who prosecutors said helped Antle launder money, was given two years of probation.

    Jason Clay, a Texas private zoo owner, pleaded guilty to illegally selling a primate and was sentenced to four months in prison, while charges were dropped against California ranch owner Charles Sammut.

    Antle was also convicted in 2023 in a Virginia court of four counts of wildlife trafficking over sales of lions and was sentenced to two years of prison suspended “upon five years of good behavior.” An appeals court overturned two of the convictions, ruling that Virginia law bans the sale of endangered species but not their purchase.

    Antle was found not guilty of five counts of animal cruelty at that same Virginia trial.

    Copyright 2025 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed without permission.

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  • Regional Disparities and Maternal Sociodemographic Determinants of Ful

    Regional Disparities and Maternal Sociodemographic Determinants of Ful

    Background

    Childhood immunization remains one of the most cost-effective public health interventions for reducing morbidity and mortality from vaccine-preventable diseases.1,2 Globally, immunization prevents an estimated four to five million deaths annually, primarily from diseases such as measles, diphtheria, pertussis, tetanus, and polio.3–5 Despite its well-documented benefits, immunization coverage remains suboptimal in many low- and middle-income countries (LMICs), including Nigeria, where disparities in vaccine uptake persist across socioeconomic, geographic, and demographic groups.6–8

    Nigeria accounts for a significant proportion of the global burden of vaccine-preventable diseases, with immunization coverage consistently falling below recommended targets.9 According to the Nigeria Demographic and Health Survey (NDHS) 2018, only 31% of children aged 12–23 months received all basic vaccines, far below the 90% global target set by the WHO.10 Immunization coverage in Nigeria is characterized by wide regional and socioeconomic disparities, with children in northern, rural, and low-income households facing the greatest barriers to vaccine uptake.11,12 These disparities contribute to Nigeria’s persistently high rates of infant and child mortality, which remain among the highest globally.13,14

    Several factors influence childhood immunization coverage, including maternal education, socioeconomic status, geographic location, cultural beliefs, and healthcare access.11,12,15 Maternal education is particularly important, as higher levels of education have been associated with greater vaccine awareness, improved health-seeking behaviors, and higher immunization uptake.16 Economic status also plays a crucial role, with children from wealthier households being more likely to receive complete immunization due to fewer financial barriers to healthcare access.17

    Geographic and infrastructural challenges further hinder immunization efforts in Nigeria. Children residing in rural and remote areas often experience limited access to healthcare facilities, long travel distances, and inadequate vaccine supply chains, all of which contribute to missed immunization opportunities.18,19 In northern Nigeria, sociocultural and religious beliefs also play a significant role, with some communities exhibiting vaccine hesitancy due to misconceptions about vaccine safety and efficacy.20,21 Past incidents of vaccine boycotts and misinformation campaigns have exacerbated these concerns, further reducing vaccine acceptance in certain regions.22–24

    In addition to individual and household-level factors, systemic challenges within Nigeria’s healthcare system contribute to low immunization coverage.25 Inconsistent vaccine supply chains, weak health infrastructure, and inadequate funding for immunization programs have been persistent issues.26,27 The country also faces poor data collection and monitoring systems, which hinder effective tracking of immunization defaulters and planning for targeted interventions.14,28,29 Addressing these barriers requires a multifaceted approach, including improving maternal education, expanding healthcare infrastructure, engaging community leaders, and implementing financial support programs for low-income families.29

    While previous studies have explored sociodemographic determinants of childhood immunization in Nigeria, gaps remain in understanding how these factors interact across different regions and socioeconomic groups. Our focus on maternal sociodemographic factors was guided by existing evidence linking maternal characteristics to child health outcomes and by the data availability in the NDHS, which primarily collects information from mothers. This study aims to examine the prevalence, regional disparities, and sociodemographic predictors of full immunization coverage among children aged 12–23 months in Nigeria. The findings will provide evidence-based insights to inform policies and interventions aimed at improving immunization coverage and reducing preventable childhood deaths”.

    Methods

    Study Setting, Design, and Data Source

    This study utilized data from the 2018 Nigeria Demographic and Health Survey (NDHS), a nationally representative survey conducted across Nigeria’s six geopolitical zones: North Central, North East, North West, South East, South South, and South West. The NDHS is part of the Demographic and Health Surveys (DHS) program, which collects comprehensive health and demographic data from women of reproductive age (15–49 years) and children under five years. The study employed a cross-sectional design, analyzing data from the Kids Recode (KR) dataset of the 2018 NDHS. The KR dataset contains detailed information on child health indicators, including immunization status, as well as maternal sociodemographic and reproductive health data.

    Study Population and Sampling

    The study population included women aged 15–49 years from the 2018 NDHS who had given birth in the past five years. While the unit of analysis was the child aged 12–23 months, data were obtained from their mothers. Therefore, the study population comprised women aged 15–49 years with eligible children, while the target population for the study’s outcomes was children aged 12–23 months, totalling 2453 children, as they are expected to have completed the full vaccination schedule.

    Survey Instrument and Data Collection

    The 2018 NDHS employed a structured Woman’s Questionnaire to gather data on sociodemographic characteristics, reproductive health, service utilization, and child health indicators, including immunization status. Information on vaccination coverage was collected using two methods: verification of vaccination cards when available, where interviewers recorded vaccination dates directly onto the questionnaire, and mothers’ verbal reports when cards were unavailable or incomplete. This dual approach allowed for a comprehensive assessment of vaccination status among children. The structured Woman’s Questionnaire used in the 2018 NDHS is publicly available via the DHS Program website (https://dhsprogram.com/Methodology/Survey-Types/DHS-Questionnaires.cfm)”.

    Study Variables

    The dependent variable in this study was full immunization coverage (FIC), defined according to World Health Organization (WHO) guidelines.30 A child was considered fully immunized if they had received the following vaccines: one dose of Bacillus Calmette-Guérin (BCG) for tuberculosis, three doses of diphtheria-pertussis-tetanus (DPT) vaccine, at least three doses of polio vaccine, and one dose of measles vaccine. The immunization status variable was recoded into a binary outcome: “fully immunized” (1) if the child had received all recommended vaccines, and “not fully immunized” (0) if the child had missed one or more doses. Responses such as “vaccination date on card” were categorized as “fully immunized”, while “no vaccination” or “don’t know” responses were categorized as “not fully immunized”. Responses based solely on maternal recall or marked cards without dates were excluded from the analysis due to potential inaccuracies.

    The independent variables included sociodemographic characteristics of the mothers, such as age, educational attainment, marital status, religion, wealth index, distance to the nearest health facility, employment status, number of living children, sex of the household head, place of residence (urban/rural), and region of residence.

    Statistical Analysis

    Descriptive statistics were used to summarize the sociodemographic characteristics of the study population and the prevalence of FIC. Bivariate and multivariable logistic regression analyses were conducted to examine the associations between sociodemographic factors and immunization status. Crude odds ratios (CORs) and adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were calculated to quantify the strength and significance of these associations. A p-value of <0.05 was considered statistically significant.

    All analyses were performed using Stata version 17, with sampling weights applied to account for the complex survey design. Data visualization tools, including pie charts, bar charts, and geographical maps, were generated using GeoPandas in Python with GADM map data for Nigeria. These visualizations were used to illustrate regional disparities in immunization coverage and the spatial distribution of immunization rates across Nigeria.

    Results

    Sociodemographic Characteristics of Mothers

    The study analyzed data from 2453 mothers with children aged 12–23 months, and their sociodemographic characteristics are summarized in Table 1. The majority of mothers (27.9%) were aged 25–29 years, followed by those aged 30–34 years (21.7%) and 20–24 years (20.2%). The smallest proportion of mothers (1.7%) were aged 45–49 years. Education levels varied, with 37.8% of mothers having no formal education, while 14.9% had primary education, 37.1% had secondary education, and 10.3% had higher education. Most mothers were married (92.3%), while 3.3% were cohabiting, 2.2% had never been in a union, and 1.4% were divorced or separated.

    Table 1 Sociodemographic Characteristics of Mothers (N=2453)

    Regarding socioeconomic status, 19.7% of mothers belonged to the poorest wealth quintile, whereas 21.1% were in the richest quintile. A majority of mothers (69.3%) were currently employed. In terms of residence, 54.9% lived in rural areas, while 45.1% resided in urban settings.

    Prevalence of Full Immunization Coverage

    The overall prevalence of full immunization coverage among children aged 12–23 months was 26.0%, indicating that 74.0% of children were not fully immunized (Figure 1).

    Figure 1 Full Immunization Coverage in Nigeria.

    Regional Disparities in Full Immunization Coverage (FIC)

    There were substantial regional variations in full immunization coverage (Figure 2). The North West had the lowest coverage at 13.0%, followed by the North East (18.0%) and North Central (22.0%). The highest immunization rates were observed in the South East (41.50%), South South (41.0%), and South West (34.0%). The geographic disparities in full immunization coverage are further illustrated in Figure 3.

    Figure 2 Immunization coverage across Regions of Nigeria.

    Figure 3 Map of Nigeria showing Full Immunization Coverage across Regions of Nigeria.

    Bivariate Analysis of Maternal Characteristics and Full Immunization Coverage

    Bivariate analysis showed significant associations between FIC and maternal characteristics such as age, education, wealth index, employment, distance to a health facility, and religion (Table 2). Full immunization rates increased with maternal age, with mothers aged 35–39 years having the highest immunization rates (33.98%), while those aged 15–19 years had the lowest coverage (11.27%). Compared to younger mothers, older mothers had significantly higher odds of fully immunizing their children (COR: 3.66, 95% CI: 1.88–7.15, p < 0.001).

    Table 2 Bivariate Analysis of Mothers’ Characteristics and Immunization Coverage

    Higher levels of maternal education were associated with increased immunization rates. Mothers with higher education had the highest immunization rate (45.86%), followed by those with secondary education (34.76%) and primary education (28.41%). Compared to mothers with no formal education, those with higher education were significantly more likely to fully immunize their children (COR: 6.67, 95% CI: 4.51–9.86, p < 0.001). Similarly, wealth status played a crucial role in immunization uptake. Full immunization rates were lowest among children from the poorest households (11.27%) and highest among children from the richest households (45.86%). Children from the highest wealth quintile were significantly more likely to be fully immunized than those from the lowest quintile (COR: 6.67, 95% CI: 4.61–9.65, p < 0.001).

    Employment status was also associated with immunization coverage. Children of employed mothers had a higher immunization rate (28.26%) compared to those of unemployed mothers (21.14%) (COR: 1.47, 95% CI: 1.15–1.87, p = 0.002). Access to health facilities influenced immunization uptake, as mothers who reported that distance was “not a big problem” had higher immunization rates (29.27%) compared to those who considered distance a major barrier (18.17%) (COR: 1.86, 95% CI: 1.36–2.55, p < 0.001). Additionally, religious affiliation was significantly associated with immunization status. Immunization coverage was higher among Christian mothers (36.28%) compared to Muslim mothers (17.40%) (COR: 0.32, 95% CI: 0.23–0.45, p < 0.001).

    Multivariable Analysis of Maternal Predictors of Full Immunization Coverage

    After adjusting for confounders, maternal education, wealth index, and regional variations remained significant predictors of full immunization coverage (Table 3). Maternal education remained a strong determinant, as mothers with higher education were significantly more likely to fully immunize their children compared to those with no education (AOR: 1.87, 95% CI: 1.10–3.18, p = 0.022). Household wealth status also played a crucial role, with children from the richest households having over three times higher odds of full immunization coverage compared to those from the poorest households (AOR: 3.20, 95% CI: 1.95–5.25, p < 0.001).

    Table 3 Multivariable Association Factors with Full Immunization Coverage

    Regional differences persisted in the multivariable analysis. Compared to the North West, children from the South East (AOR: 2.00, 95% CI: 1.16–3.46, p = 0.013) and South South (AOR: 1.73, 95% CI: 0.99–3.02, p = 0.052) were significantly more likely to be fully immunized. These findings highlight the persistent inequities in immunization coverage across Nigeria, emphasizing the need for targeted interventions in regions with low immunization uptake.

    Discussion

    This study examined the factors influencing full immunization coverage among children aged 12–23 months in Nigeria, highlighting significant disparities based on sociodemographic, economic, and geographic factors. It is important to distinguish between immunization coverage—defined as the proportion of children who received all recommended vaccines—and uptake, which may refer to partial or incomplete vaccination. The findings indicate that only 26% of children were fully immunized, far below the World Health Organization (WHO) target of 90% coverage for essential childhood vaccines.30 This finding is consistent with previous NDHS-based studies reporting full immunization rates between 23–31% across Nigeria. However, some regional or community-based studies report slightly higher rates due to focused interventions or sampling differences. Regional disparities were also notable, with the North West (13%) and North East (18%) having the lowest immunization rates, while the South East (41.5%) and South South (41%) had the highest. These findings reflect longstanding inequalities in healthcare access, cultural influences, and socioeconomic factors, which continue to hinder immunization uptake in Nigeria.31

    Maternal education emerged as a key determinant of immunization coverage. The results showed that children of mothers with higher education were significantly more likely to be fully immunized compared to those whose mothers had no formal education. This aligns with previous studies in sub-Saharan Africa, which indicate that educated mothers are more likely to seek preventive healthcare services and understand the importance of immunization.16,18,32 Education empowers women to make informed health decisions, increases awareness of vaccine-preventable diseases, and enhances trust in modern healthcare systems. Expanding access to education, particularly for girls, is essential for improving childhood immunization rates.16,33

    Wealth status also played a significant role in determining immunization uptake. The study found that children from the richest households were more than three times more likely to be fully immunized compared to those from the poorest households. This supports prior research demonstrating that financial stability improves healthcare access, allowing families to afford transportation costs and out-of-pocket expenses associated with immunization.34,35 Conversely, poorer households often face economic constraints that limit healthcare utilization, exacerbating immunization inequities. Implementing financial support programs, such as conditional cash transfers and immunization incentives, may help increase vaccine coverage among low-income families.36

    Geographic disparities in immunization coverage were evident, with children in rural and northern regions being less likely to be fully immunized compared to their urban and southern counterparts. These findings are consistent with studies showing that rural areas have limited access to healthcare facilities, leading to delays in childhood vaccinations.37–39 Distance to a health facility was a significant barrier in this study, as mothers who reported distance as a “big problem” were significantly less likely to fully immunize their children. Poor road networks, inadequate vaccination outreach programs, and security concerns in some northern regions further compound these challenges.11 Strengthening community-based immunization programs, expanding mobile vaccination units, and integrating immunization services into routine child health visits could help improve coverage in hard-to-reach areas.40

    Religious affiliation was another factor influencing immunization coverage. The study revealed that children born to Christian mothers had significantly higher immunization rates than those born to Muslim mothers. This may be linked to differences in health-seeking behaviors, religious beliefs, and vaccine acceptance.41,42 Previous studies have reported vaccine hesitancy in some religious communities, often driven by misconceptions about vaccine safety, fertility concerns, and distrust in Western medicine.21,43 Addressing religious and cultural resistance through engagement with religious leaders, culturally appropriate health education campaigns, and targeted community outreach is critical to overcoming vaccine hesitancy.21

    Conclusion

    This study highlights the low full immunization coverage (26%) among children aged 12–23 months in Nigeria, with significant regional, socioeconomic, and demographic disparities. Maternal education, household wealth status, and geographic location were strong predictors of immunization uptake. Geographic disparities were evident, with children in northern and rural regions facing lower immunization rates compared to those in urban and southern areas. Barriers such as distance to health facilities, financial constraints, and religious or cultural hesitancy contribute to the suboptimal vaccine coverage observed in this study. Addressing these barriers through education, financial support programs, community engagement, and improved healthcare accessibility is essential to achieving Nigeria’s immunization targets. Strengthening routine immunization services and expanding outreach programs, particularly in underserved regions, will be critical in reducing vaccine-preventable diseases and improving child survival outcomes.

    Recommendations

    To improve childhood immunization coverage in Nigeria, several strategies are recommended based on recent findings. Expanding education programs for women is crucial, as increasing female education enhances maternal health literacy and vaccine awareness, with long-term benefits for immunization uptake. Improving healthcare access in rural and underserved areas involves strengthening primary healthcare infrastructure, expanding mobile vaccination units, and integrating immunization services into routine child health visits. Implementing financial support programs, such as conditional cash transfers and immunization incentives, can assist low-income families in accessing vaccination services. Enhancing community-based immunization outreach through community health workers can improve coverage, especially in regions with vaccine hesitancy. Engaging religious and community leaders is vital for addressing vaccine hesitancy by promoting culturally appropriate campaigns. Strengthening immunization data systems with electronic records and improved surveillance will ensure accurate tracking of vaccinated children. By implementing these strategies, Nigeria can improve immunization coverage, move closer to the WHO-recommended target of 90% vaccine coverage, and reduce childhood morbidity and mortality from vaccine-preventable diseases.

    Study Limitations

    This study has some limitations. First, its cross-sectional design prevents causal inferences, as only associations between predictors and immunization coverage were examined. Additionally, the study relied on self-reported immunization data, which may be subject to recall bias. Moreover, the use of secondary data limits control over variable definitions, measurement accuracy, and missing data. Some vaccinations may have been misclassified due to reliance on maternal recall or incomplete health cards. Future research should incorporate longitudinal data and immunization registry validation to improve data accuracy. Despite these limitations, this study provides valuable insights into the determinants of immunization coverage in Nigeria and offers evidence-based recommendations for improving vaccine uptake.

    Data Sharing Statement

    The datasets supporting the findings of this study are derived from the 2018 Nigeria Demographic and Health Survey (NDHS), which is publicly available. These data can be accessed directly from The DHS Program website: https://dhsprogram.com/.

    Ethical Consideration

    This study involved the secondary analysis of publicly available and de-identified data from the 2018 Nigeria Demographic and Health Survey (NDHS). The research was reviewed and deemed exempt from full ethical review by the Federal University Birnin Kebbi Research Ethics Committee, in accordance with national guidelines for secondary data use. The 2018 NDHS, as the primary data source, was conducted following established ethical standards and originally approved by the National Health Research Ethics Committee (NHREC) and the ICF Institutional Review Board. During the original data collection, written informed consent was obtained from all participants aged 15 years and older, with consent for minors obtained from their guardians. All data utilized in this study were analyzed in a manner that ensured participant anonymity and maintained strict confidentiality.

    Acknowledgment

    The authors acknowledge the DHS Program for making the data available for this research.

    Author Contributions

    All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the revision to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

    Funding

    There is no funding to report.

    Disclosure

    The authors declare no competing interest in this work.

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    12. Mohammed Y, Reynolds HW, Waziri H, et al. Exploring the landscape of routine immunization in Nigeria: a scoping review of barriers and facilitators. Vaccine. 2024;42. doi:10.1016/j.vaccine.2024.126222

    13. UNICEF DATA [Internet]. [cited January 30, 2025]. Nigeria (NGA) – Demographics, Health & Infant Mortality. Available from: https://data.unicef.org/country/nga/. Accessed July 07, 2025.

    14. unicef Nigeria-equity-profile-health.pdf – Google Search [Internet]. [cited January 30, 2025]. Available from: https://www.google.com/search?q=unicef+Nigeria-equity-profile-health.pdf&sca_esv=d690b6a826c360f1&ei=ZK2bZ-OpCL2Hp84P5szGuAw&ved=0ahUKEwjj6_ST852LAxW9w8kDHWamEccQ4dUDCBE&uact=5&oq=unicef+Nigeria-equity-profile-health.pdf&gs_lp=Egxnd3Mtd2l6LXNlcnAiKHVuaWNlZiBOaWdlcmlhLWVxdWl0eS1wcm9maWxlLWhlYWx0aC5wZGZI-BRQAFiaE3AAeAGQAQCYAawFoAG-J6oBAzUtOLgBA8gBAPgBAvgBAZgCAKACAJgDAJIHAKAHiAs&sclient=gws-wiz-serp. Accessed July 07, 2025.

    15. Kuuyi A, Kogi R. Factors contributing to immunization coverage among children less than 5 years in Nadowli-Kaleo District of Upper West Region, Ghana. PLOS Global Public Health. 2024;4(8):e0002881. doi:10.1371/journal.pgph.0002881

    16. Gebreyesus A, Tesfay K. Effect of maternal education on completing childhood vaccination in Ethiopia: systematic review and meta-analysis. Sci Rep. 2024;14(1):17453. doi:10.1038/s41598-024-68182-4

    17. Budu E, Dadzie LK, Salihu T, et al. Socioeconomic inequalities in modern contraceptive use among women in Benin: a decomposition analysis. BMC Women’s Health. 2023;23(1):444. doi:10.1186/s12905-023-02601-y

    18. Adesina MA, Olufadewa II, Oladele RI, Solagbade A, Olaoyo C. Determinants of childhood immunization among rural mothers in Nigeria. Popul Med. 2023;5(September):1–7. doi:10.18332/popmed/171542

    19. Bangura JB, Xiao S, Qiu D, Ouyang F, Chen L. Barriers to childhood immunization in sub-Saharan Africa: a systematic review. BMC Public Health. 2020;20:1108. doi:10.1186/s12889-020-09169-4

    20. Sato R, Takasaki Y. Vaccine Hesitancy and refusal: behavioral evidence from rural Northern Nigeria. Vaccines. 2021;9(9):1023. doi:10.3390/vaccines9091023

    21. Agbede GT, Emezirinwune D, Adedokun T, Idowu-Collins P. Vaccine hesitancy in Nigeria: overcoming cultural, linguistic and religious obstacles. Info Impact. 2024;15(1):153–168.

    22. Pertwee E, Simas C, Larson HJ. An epidemic of uncertainty: rumors, conspiracy theories and vaccine hesitancy. Nature Med. 2022;28(3):456–459. doi:10.1038/s41591-022-01728-z

    23. Ruggeri K, Vanderslott S, Yamada Y, et al. Behavioural interventions to reduce vaccine hesitancy driven by misinformation on social media. BMJ. 2024;384. doi:10.1136/bmj-2023-076542

    24. Okoro YO, Ayo-Farai O, Maduka CP, Okongwu CC, Sodamade OT. A review of health misinformation on digital platforms: challenges and countermeasures. Int J Appl Res Soc Sci. 2024;6(1):23–36. doi:10.51594/ijarss.v6i1.689

    25. Alkenbrack S, Kurowski C, Hafez R, et al. Immunization Financing Assessment. Immunization Financing Assessment: Nigeria Health, Nutrition and Population (HNP) Discussion Paper. Vol. 10. Washington DC: International Bank for Reconstruction and Development/World Bank; 2018:35422.

    26. Olutuase VO, Iwu-Jaja CJ, Akuoko CP, Adewuyi EO, Khanal V. Medicines and vaccines supply chains challenges in Nigeria: a scoping review. BMC Public Health. 2022;22:1–15. doi:10.1186/s12889-021-12361-9

    27. Diamond Oganyi J. Challenges of medicine supply in Nigeria. Newport Int J Scientific Exp Sci. 2023;3(2):159–162.

    28. Eze II, Ogbu M, Ossai EN, Ekenna A, Okoronkwo I, Onwujekwe O. Enhancing workforce capacity to improve immunization data quality using low dose high-frequency intervention approach in Ebonyi State, Nigeria: a randomized controlled study. Niger J Clin Pract. 2023;26(Suppl 1):S82–91. doi:10.4103/njcp.njcp_576_22

    29. Fatiregun AA, Awogu C. Accuracy and quality of routine immunisation data monitoring system in two South-Eastern Districts of Nigeria. Nigerian Health J. 2013;13(2):62–68.

    30. Immunization coverage [Internet]. [cited February 5, 2025]. Available from: https://www.who.int/news-room/fact-sheets/detail/immunization-coverage. Accessed July 07, 2025.

    31. Ogunniyi TJ. Revealing the challenges and efforts of routine immunization coverage in Nigeria. Health Sci Rep. 2024;7(8):e70000. doi:10.1002/hsr2.70000

    32. Fadl N, Abdelmoneim SA, Gebreal A, Youssef N, Ghazy RM. Routine childhood immunization in Sub-Saharan Africa: addressing parental vaccine hesitancy. Public Health. 2024;226:66–73. doi:10.1016/j.puhe.2023.10.049

    33. Amoah A, Issaka J, Ayebeng C, Okyere J. Influence of women empowerment on childhood (12–23 months) immunization coverage: recent evidence from 17 sub-Saharan African countries. Trop Med Health. 2023;51(1):63. doi:10.1186/s41182-023-00556-2

    34. Yim V, Cabrera M, Lomazzi M, Moore M. Sustainable financing of immunization programs: a narrative review of the literature. Popul Med. 2024;6(January):1–9. doi:10.18332/popmed/177169

    35. Petu A. Towards immunization financing sustainability in Africa. J Immunol Sci. 2018;13:89. doi:10.29245/2578-3009/2018/si.1113

    36. CDC. Vaccines & Immunizations. 2024 [cited January 31, 2025]. Vaccination Programs. Available from: https://www.cdc.gov/vaccines/hcp/imz-best-practices/vaccination-programs.html. Accessed July 07, 2025.

    37. Freeman RE, Leary CS, Graham JM, et al. Geographic proximity to immunization providers and vaccine series completion among children ages 0–24 months. Vaccine. 2023;41(17):2773–2780. doi:10.1016/j.vaccine.2023.03.025

    38. Albers AN, Thaker J, Newcomer SR. Barriers to and facilitators of early childhood immunization in rural areas of the United States: a systematic review of the literature. Preventive Med Rep. 2022;27:101804. doi:10.1016/j.pmedr.2022.101804

    39. Evans MV, Andréambeloson T, Randriamihaja M, et al. Geographic barriers to care persist at the community healthcare level: evidence from rural Madagascar. PLOS Glob Public Health. 2022;2(12):e0001028. doi:10.1371/journal.pgph.0001028

    40. Xie YJ, Liao X, Lin M, et al. Community engagement in vaccination promotion: systematic review and meta-analysis. JMIR Public Health Surveillance. 2024;10(1):e49695. doi:10.2196/49695

    41. Santos TM, Cata-Preta BO, Wendt A, et al. Religious affiliation as a driver of immunization coverage: analyses of zero-dose vaccine prevalence in 66 low-and middle-income countries. Front Public Health. 2022;10:977512. doi:10.3389/fpubh.2022.977512

    42. Costa JC, Weber AM, Darmstadt GL, Abdalla S, Victora CG. Religious affiliation and immunization coverage in 15 countries in Sub-Saharan Africa. Vaccine. 2020;38(5):1160–1169. doi:10.1016/j.vaccine.2019.11.024

    43. Kibongani Volet A, Scavone C, Catalán-Matamoros D, Capuano A. Vaccine hesitancy among religious groups: reasons underlying this phenomenon and communication strategies to rebuild trust. Front Public Health. 2022;10:824560. doi:10.3389/fpubh.2022.824560

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  • Data Careers 101: Where to Start and How to Stand Out

    This session is designed to help students demystify data-related career paths, with a focus on commercial and business analytics roles. It aims to highlight how students from varied academic backgrounds can enter and succeed in data-driven functions.

    About the Speaker:

    M. Shaheer Bhatti, Manager of Digital Growth & Analytics at Mobilink Microfinance Bank Ltd, brings several years of industry experience, having worked across multiple data and growth functions. His session will offer insights into core skills, certifications, and the real-world application of analytics in business environments.

    To register for the event, please click here. 


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  • Williamson, Bracewell skip New Zealand’s tour to Zimbabwe

    Williamson, Bracewell skip New Zealand’s tour to Zimbabwe

    Kane Williamson © Getty Images

    Kane Williamson and Michael Bracewell will skip the upcoming two-test tour of Zimbabwe with the blessing of New Zealand Cricket, while paceman Ben Sears has been ruled out by a side injury.

    Rob Walter, who replaced Gary Stead as coach last month, named his first test squad on Tuesday, awarding a call-up to uncapped young fast bowler Matt Fisher and recalling experienced hands Ajaz Patel and Henry Nicholls.

    “Kane and Michael were up front with New Zealand Cricket about their availability for this tour during the contracting process,” Walter said in a news release.

    “While all test matches are hugely special and important, the fact these tests aren’t part of the World Test Championship did influence the discussions on this occasion.

    “We will obviously miss their talent and class, but it allows an opportunity to others and we’re lucky to be able to call on the likes of Ajaz and Henry who are both proven performers at test level.”

    All-rounder Bracewell has been allowed to miss the tour to play in The Hundred in England, while paceman Kyle Jamieson has elected to stay in New Zealand for the birth of his first child.

    Jamieson’s absence offers potential opportunities for Fisher and Jacob Duffy, who has played short-format matches for New Zealand but is yet to win a test cap, in the two matches in Bulawayo in late July and early August.

    TEAM: Tom Latham (captain), Tom Blundell, Devon Conway, Jacob Duffy, Matt Fisher, Matt Henry, Daryl Mitchell, Henry Nicholls, Will O’Rourke, Ajaz Patel, Glenn Phillips, Rachin Ravindra, Mitch Santner, Nathan Smith, Will Young


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  • Devon mother treated with game-changing diabetes drug

    Devon mother treated with game-changing diabetes drug

    Andrea Ormsby

    BBC News, Devon

    BBC Patient, Hannah Robinson, wearing a red and white checked dress sitting in a hospital room smiling at a nurse standing in front of her, wearing a blue tunic and taking her blood pressureBBC

    Hannah Robinson, 36, said she felt “very privileged” to be part of the trial

    A Devon woman is one of the first adults in the UK to trial what medics call a groundbreaking drug for type 1 diabetes.

    The new drug, Teplizumab, works by reprogramming the immune system to stop it mistakenly attacking pancreatic cells which produce insulin.

    It is said to delay the need for insulin by up to three years, but must be given at the earliest stage of the disease to be effective.

    Hannah Robinson, 36, from Exeter, who is taking the drug after discovering during pregnancy she was in the early stages of developing type 1 diabetes, said she felt “very privileged” to be part of the trial.

    About 4.6m people in the UK have diabetes, with more than 270,000 living with type 1, according to the NHS.

    There is currently no cure and most need daily insulin to manage blood sugar levels and reduce the risk of complications.

    Targets underlying problem

    Some children are also being treated with the drug across the UK.

    In type 1 diabetes, the immune system attacks beta cells in the pancreas, hindering their ability to produce insulin, which regulates blood sugar levels.

    Teplizumab trains the immune system to stop attacking these cells, delaying the need for insulin by up to three years, according to medics.

    Dr Nick Thomas, the diabetes consultant treating Ms Robinson at the Royal Devon and Exeter Hospital (RD&E), said Teplizumab was the first therapy “which actually targets the underlying problem”.

    However, it must be given at the earliest stage of the disease to be effective.

    Experts at the RD&E and the University of Exeter are leading research that includes using genetics combined with autoantibody testing to spot individuals at high risk of developing type 1 diabetes.

    This means they can be monitored and potentially offered the drug if eligible, transforming the way type 1 diabetes is managed, they said.

    Prof Richard Oram, from the University of Exeter and consultant physician at the RD&E, said the trial of the new drug was “extremely exciting and motivating”.

    “Here in Exeter, we are undertaking cutting-edge clinical research to help us find more people at risk and discover how we can prevent them from developing type 1 diabetes,” he said.

    Teplizumab is approved in the United States and is currently under review by the UK’s National Institute for Health and Care Excellence.

    The drug is not yet routinely available in the UK and the team at the Royal Devon University Healthcare NHS Foundation Trust was granted special permission to treat Ms Robinson with the new medication.

    The mother-of-two said it would be incredible to find a cure for type 1 diabetes.

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  • SANZAAR Teams Announced for World Rugby U20 Championship Matchday #3

    SANZAAR Teams Announced for World Rugby U20 Championship Matchday #3

    Round 2 in Italy brought four wins out of four for the SANZAAR teams. The big match in Round three is Australia v England with a Finals spot up for grabs to the winner. Unbeaten South Africa face Scotland having made the semi-finals, while New Zealand play Ireland, and Argentina play France in must win matches.

    Where is it?

    Rugby’s future stars will play matches across four cities in the Lombardia and Veneto regions of Italy – Calvisano, Rovigo, Verona and Viadana.

    What are the dates?

    The tournament runs from 29 June up to the final on 19 July.

    [Matchday 1: Sunday, 29 June]

    [Matchday 2: Friday, 4 July]

    Matchday 3: Wednesday, 9 July

    Matchday 4: Monday, 14 July

    Matchday 5: Saturday, 19 July

     

    Click HERE for official tournament website and information

     

    Loose forward Thando Biyela will lead the Junior Springboks in their third and final Pool A match at the World Rugby U20 Championship against Scotland at the Stadio San Michele in Calvisano.

     

    Even though the SA U20 side show several rotational changes from the team that beat England in their previous group match in Rovigo, the match-23 to face Scotland is a strong combination filled with experience.

     

    Fullback Gilermo Mentoe, right wing Cheswill Jooste, outside centre Gino Cupido, and flyhalf Vusi Moyo are retained from the starting fifteen that defeated England on Friday evening.

     

    Upfront, Matt Romao (loose forward), Jaco Grobbelaar (lock), Jean Erasmus and Oliver Read (both props), and Jaundre Schoeman (hooker) all provided impact off the bench against Australia and England, and are now in the starting pack.

     

    According to Kevin Foote, the Junior Springbok head coach, they’ve named a team that will play this important pool game with real purpose and pride against a very good Scotland side. A win will solidify the Junior Boks’ top spot in Pool A.

     

    “We are fortunate that the players in our match-23 have experience playing for the Junior Boks against Georgia, in the U20 Rugby Championship, and also in our warm-up matches against Kenya,” said Foote.

     

    “Thando has captained us already earlier this year, Stephanus Linde played for us against Georgia, while Matt Romao was our Man of the Match against Argentina in the Rugby Championship.”

     

    “Jaco Williams, Jaco Grobbelaar, and Oliver Reid have all seen a lot of action in the two previous group matches, while we have more experience that will come off the bench in Herman Lubbe, JJ Theron, Batho Hlekani, and Haashim Pead.”

     

    Foote said they have done their homework on Scotland, know what to expect from them, and have a very healthy respect for the Scottish.

     

    “We have a strong desire to improve and we are determined to keep building on our game model, and to make sure we maintain our synergy and cohesion as a team,” he said.

     

    “Everyone understands the threat that Scotland brings, and we feel they have played some good rugby. They attack well and their set piece has been solid; so, they will pose a very big threat for us, and we will not underestimate them. We are looking forward to meeting an exciting challenge on Wednesday.”

     

    Junior Springbok team to face Scotland in Calvisano:

    15. Gilermo Mentoe, 14. Cheswill Jooste, 13. Gino Cupido, 12. Dominic Malgas, 11. Jaco Williams, 10. Vusi Moyo, 9. Ceano Everson, 8. Stephanus Linde, 7. Matt Romao, 6. Thando Biyela (captain), 5. Morne Venter, 4. Jaco Grobbelaar, 3. Jean Erasmus, 2. Jaundre Schoeman1. Oliver Reid

    Replacements: 16. Siphosethu Mnebelele, 17. Phiwayinkosi “Rambo” Kubheka, 18. Herman Lubbe, 19. JJ Theron, 20. Batho Hlekani, 21. Haashim Pead, 22. Ian van der Merwe, 23. Demitre Erasmus.

    Australia U20s coach Chris Whitaker has turned to Sevens star Aden Ekanayake as they look to take down England.

    Ekanayake has been handed his first start of the year at number eight as part of several changes from the team that defeated Scotland.

    The Gordon product will link up with Reds flanker Charlie Brosnan, who started at lock against South Africa, and Tom Robinson in the back-row.

    Finn Baxter makes his return to the starting side at loosehead prop, with the second-row combination of skipper Eamon Doyle and Joe Mangelsdorf once again selected.

    Joey Fowler starts at flyhalf, partnering with Reds scrum-half James Martens, who had a hand in several tries during last week’s win.

    It’s the lone change to the starting backline, with Sid Harvey, Cooper Watters and Nicholas Conway staying as the back-three.

    Ollie Barrett and Eli Langi have been added to the bench as Whitaker opts for a 6-2 split.

    The Australians need a bonus point win over the defending champions and results to go their way if they are to keep their slim semi-final hopes alive. The top team from each pool and the highest-ranked second place team will advance to the finals, with the rest to play off for position.

    Australia U20 team to play England in Verona:

    1. Finn Baxter (ACT Brumbies, Gungahlin Eagles), 2. Lipina Ata (ACT Brumbies, Gungahlin Eagles), 3. Edwin Langi (NSW Waratahs, Eastern Suburbs), 4. Joe Mangelsdorf (NSW Waratahs, Sydney University), 5. Eamon Doyle (c) (NSW Waratahs, Sydney University), 6. Charlie Brosnan (Queensland Reds, Brothers), 7. Tom Robinson (Queensland Reds, University of Queensland), 8. Aden Ekanayake (Australia Sevens), 9. James Martens (Queensland Reds, GPS Rugby Club), 10. Joey Fowler (NSW Waratahs, Sydney University), 11. Nicholas Conway (Queensland Reds, Wests Bulldogs), 12. Malakye Enasio (ACT Brumbies, Gungahlin Eagles), 13. Liam Grover (NSW Waratahs, Sydney University), 14. Cooper Watters (NSW Waratahs, Eastern Suburbs), 15. Sid Harvey (NSW Waratahs, Eastern Suburbs)

    Replacements: 16. Ollie Barrett (Western Force, Associates RUFC), 17. Nathaniel Tiitii (NSW Waratahs, Eastern Suburbs), 18. Trevor King (Queensland Reds, Souths), 19. Ollie Aylmer (ACT Brumbies, Gordon), 20. Eli Langi (ACT Brumbies, Tuggeranong Vikings), 21. Toby Brial (NSW Waratahs, Eastern Suburbs), 22. Hwi Sharples (NSW Waratahs, Sydney University), 23. Joe Dillon (ACT Brumbies, Canberra Royals)

    Argentina Pumitas, coached by Nicolás Fernández Miranda beat Spain by 33-30 in round two and now must beart France, which is the leader of the group after they beat Wales by 35-21.

    Carlos Mohapp, assistant coach of the U20, elaborated on the preparation for the last group stage match: “We are preparing well for the match with a  focus on defence, we believe that we have to improve some aspects. We are going to have to counter France’s attacks and we will try to make them uncomfortable from the contact side. W know that they are very strong in continuous play, so we will try to dominate at the points of contact.”

    “We are also focused on having a lot of the ball because they feed on disorderly play and lost balls. Another aspect that we want to improve is in the first minutes of the game, we have started slowly in past matches.”

    In addition, he referred to the possibility of qualifying for the semifinals: “The boys are eager and energetic because we are facing a unique and spectacular opportunity, we are just one step away from qualifying.”

    Pumitas team to play France in Verona:

    1. LEASH, Diego (CAE), 2. LEDESMA AROCENA, Tadeo (SIC), 3. RAPETTI, Tomás (Alumni), 4. DUCLOS, Tomás (Los Tordos RC), 5. NEIGHBORHOODS, Alejandro (Olivos), 6. BENITEZ, Franco (Tilcara), 7. STOREY, Pampa (CASI), 8. NEYRA, Santiago (Alumni), 9. GRIFFO, Fabricio (Palermo Bajo), 10. FERNÁNDEZ MIRANDA, Ramon (Hindu), 11. LESCANO, Baptist (CAE), 12. LEDESMA, Felipe (captain) (SIC), 13. COLL, Pedro (Tigres RC), 14. SILVA, Timothy (SIC), 15. SENILLOSA, Pascal (Hindu)

    Replacements:, 16. OTAÑO, Jerónimo (Los Tordos RC), 17. RINS, Nicanor (Uru Curé), 18. GALVÁN, Gael (Pucará), 19. GARCÍA IANDOLINO, Álvaro (Los Tordos RC), 20. DANDE, Tomás (Huirapuca RC), 21. REGGIARDO, Valentino (French Sport), 22. CORDERO, Matías (Los Tilos), 23. VIEYRA, Aquiles (Alumni).


    The New Zealand U20 team to take on Ireland at the World Rugby Under 20 Championship has been named. A win will guarantee progression through to the semi-final stage, as the team looks to beat their third-place finish in 2024.

    Captain Manumaua Letiu returns to the starting line-up, joining the Auckland prop duo of Sika Pole and Robson Faleafā in the front row. Pole, hailing from the Manukau Rovers Rugby Football Club, has started every game New Zealand has played this year.

    Also starting in every game this year is USA-born, Australian-raised lock Xavier Treacy. He will pair with Jayden Sa in the second row.

    On the wing are two New Zealand Sevens players, Frank Vaenuku and Maloni Kunawave. Both players made their debut at the Perth SVNS in January of this year, becoming All Blacks Sevens # 319 and # 320 respectively.

    New Zealand Under 20 team v Ireland in Calvisano:

    1. Sika Pole, 2. Manumaua Letiu (c), 3. Robson Faleafā, 4. Xavier Treacy, 5. Jayden Sa, 6. Finn McLeod, 7. Caleb Woodley, 8. Mosese Bason (vc), 9. Dylan Pledger (vc), 10. Will Cole, 11. Maloni Kunawave, 12. Jack Wiseman, 13. Cooper Roberts, 14. Frank Vaenuku, 15. Rico Simpson (vc)

    Replacements: 16. Shaun Kempton, 17. Israel Time, 18. Dane Johnston, 19. Aisake Vakasiuola, 20. Micah Fale, 21. Jai Tamati, 22. James Cameron, 23. Stan Solomon

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  • Toddlers enjoy Water Babies sponsored fancy dress swim event

    Toddlers enjoy Water Babies sponsored fancy dress swim event

    Toddlers and parents across south-west England have describing having a splashing time raising money for charity.

    The children’s swimming school Water Babies hosted a sponsored Splashathon in Exeter, in which toddlers and parents took part in water challenges while wearing pirates and sea creatures fancy dress.

    The event raises money for the Children’s Alliance and Tommy’s charities and organisers said they hoped more than £650,000 would be raised nationwide this year.

    Water Babies helper Lucy Abraham said this year’s outfits were “brilliant”.

    The Exeter swim was among events held between 23 June and 6 July.

    Ms Abraham said: “It’s so much fun, I love watching all the parents and the children competing in all the challenges and challenging themselves as well and the outfits are brilliant.”

    She explained there is also an important safety lesson for the children.

    She said: “It’s not likely that you would be wearing a swimsuit if you accidentally fell into water – so feeling what it’s like to try and swim in clothing is a safety skill as well.”

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  • Long-term aflibercept treatment for choroidal neovascularization in ch

    Long-term aflibercept treatment for choroidal neovascularization in ch

    Introduction

    Central serous chorioretinopathy (CSC) is a choroidal disease characterized by a chronic course and complications resulting from increased damage to the retinal pigment epithelium (RPE).1 CSC occurs mainly in younger than 50 years men, but this gender predilection decreases with age.2 Complications of CSC include choroidal neovascularization (CNV), subretinal hemorrhage, bullous CSC, and fibrin deposition, which can develop into a subretinal fibrous scar.1

    CNV in CSC has been reported with the incidence ranging from 2% to 18% in previous studies.2–4 The female sex, chronic CSC, choroidal vascular hyperpermeability, and a poor baseline best-corrected visual acuity (BCVA) are risk factors for type 1 CNV in patients with CSC.4 With the introduction of optical coherence tomography angiography (OCT-A), CNV can be more easily detected non-invasively, without the difficulties caused by conventional dye angiography. Using OCT-A, CNV network has been detected in almost 45% to 54% of eyes with chronic CSC, which was higher than that of previous studies.5,6

    The development of intravitreal anti-vascular endothelial growth factor (anti-VEGF) drugs has significantly improved the treatment results of patients with retinal neovascularization and CNV.7–10 There is good evidence for the efficacy of intravitreal aflibercept in CNV secondary to age-related macular degeneration, myopia, pseudoxanthoma elasticum and chorioretinitis.9–12

    To date, there is no standard treatment for CSC complicated with CNV. Anti-VEGF agent is commonly used for CNV in chronic CSC, and its intravitreal administration has become the first-line treatment.13 Previous studies have demonstrated the varying results of intravitreal injections of anti-VEGF (ranibizumab, aflibercept) with different patterns of administration for the treatment of CNV in chronic CSC. MINERVA STUDY demonstrated the treatment efficacy of ranibizumab pro re nata (PRN) protocol in adult patients with CNV because of an uncommon cause enrolled.13 Nevertheless, anatomical non-response, characterized by persistent fluid, is often observed despite a monthly as-needed regimen treatment with ranibizumab and aflibercept.14 Another study has shown that anatomical treatment response is better in the upload of six over three initial anti-VEGF injections in patients with CNV secondary to CSC.15 A treat-and-extend (TAE) regimen protocol is used to treat patients with type 1 CNV in chronic CSC. Prospective study provides evidence that an aflibercept monotherapy TAE regimen can produce good visual and anatomical outcomes over 12 months while extending the interval between the injections.16

    However, limited information is available on the long-term results of aflibercept in type 1 CNV secondary to chronic CSC. Therefore, the purpose of the present study was to report three-year treatment results of intravitreal aflibercept for type 1 CNV in chronic CSC using a TAE regimen.

    Methods

    Study Design and Setting

    This was a prospective, single-center interventional study, The Filatov Institute of Eye Diseases and Tissue Therapy of the National Academy of Medical Sciences of Ukraine included patients who were treated with aflibercept for type 1 CNV in chronic CSC between January 2019 and December 2024. Written informed consent for study participation was obtained from the patients and approved by the local ethics committees in accordance with the principles of the Declaration of Helsinki. Protocol was approved by the Ethics Committee of The Filatov Institute of Eye Diseases and Tissue Therapy of the National Academy of Medical Sciences of Ukraine (approval number: 1, 2021).

    Patient Selection

    The study included patients with active type 1 CNV secondary to chronic CSC, with typical symptoms in multimodal imaging on spectral domain optical coherence tomography (SD-OCT), fluorescein angiography (FA) and OCT-A as follows: RPE changes, intraretinal fluid (IRF), subretinal fluid (SRF), subfoveal choroidal thickness (SFCT) on SD-OCT; leakage on FA; and identified neovascular network on OCT-A; age ≥18 years old. Exclusion criteria were: diseases of the macula that may affect visual acuity (polypoidal choroidal vasculopathy, age-related macular degeneration, high myopia of ≥-6.00 diopter spherical equivalent, diabetic retinopathy, retinal vascular occlusion, and any hereditary disease of the retina), other eye diseases that affect visual acuity (for example, glaucoma), intraocular surgery (except uncomplicated cataract surgery carried out more than 3 months before the start of the study), presence of acute intraocular or periocular inflammatory processes; general diseases in stage of decompensation (for example, diabetes mellitus, hypertension), and inability to obtain patient consent.

    Treatment

    All patients received 3 initial loading intravitreal injections of 2 mg (0.05 mL) aflibercept every 4 weeks, followed by a TAE protocol. The protocol included administration of aflibercept at 4-weekly intervals until IRF and/or SRF resolution; thereafter, the dosing interval was extended by 2 weeks. If there were signs of disease activity (SD-OCT evidence of IRF and/or SRF, reduction in BCVA) the interval between injections was reduced by 2 weeks.17

    Study Visits

    All patients underwent a comprehensive examination: decimal BCVA, biomicroscopy, measurement of intraocular pressure, color fundus photo, FA (TRC 50-EX; Topcon, Japan), SD-OCT and OCT-A (SOCT Copernicus OPTOPOL Technology S.A., Zawiercie, Poland). Decimal BCVA measured with standard Snellen chart, comprehensive ocular examination and OCT imaging were performed at each follow-up visit. FA, color fundus photo and OCT-A were performed at baseline and each follow-up visit as needed on an individual basis. SD-OCT was used to evaluate central retinal thickness (CRT), SFCT, and the presence of IRF or/and SRF. CRT was defined as the average thickness of the macula in the central 1mm diameter circle of the Early Treatment Diabetic Retinopathy Study grid, and was calculated automatically using bundled software. SFCT was assessed by manually measuring the distance between Bruch’s membrane and the inner scleral surface at the central fovea.18 Complete fluid resolution in the macula was determined by the absence of IRF or/and SRF on SD-OCT. Diagnosis of type 1 CNV was obtained by FA and OCT-A were used to determine CNV. Safety was assessed by the occurrence of any adverse events including an increase in intraocular pressure, RPE and/or choroid atrophy, RPE tears, retinal detachment, endophthalmitis or uveitis during all follow-up periods.

    Criteria for Assessing Treatment Outcome

    The primary outcome was decimal BCVA at year 3. The secondary outcomes included CRT and SFCT, IRF or/and SRF resolution, number of injections, treatment-free interval and safety at year 3.

    Statistical Analysis

    Statistical analysis was performed with TIBCO® Statistica 14.0.1 (TIBCO Software Inc. Palo Alto, CA, USA). In this study, continuous data were presented as mean and standard deviation (SD); categorical data were shown as percentages and frequencies, % (n). The clinical characteristics were compared during follow-up using paired t-tests. The t-tests and Fisher’s exact test were used to compare clinical characteristics between the naive and PDT-treated patients. In all statistical analysis procedures, a p value of < 0.05 was used for statistical significance.

    Results

    Demographics

    In total, 36 patients (36 eyes) with type 1 CNV secondary to chronic CSC were included in the study, and 34 patients (34 eyes) with completed the 3-year follow-up. Two patients dropped out for reasons unrelated to the treatment: one patient discontinued visits for unknown reasons, and one patient was excluded due to violation of the treatment schedule.

    Mean age of patients was 55 years (SD; 15), 15 were male (44%) and 19 were female (56%). Mean baseline decimal BCVA was 0.44 (SD; 0.35). At baseline, distribution of fluid was as followed: SRF in 31 patients (91%), IRF in 7 patients (21%), and both SRF and IRF in 4 patients (12%). Hyperreflective subretinal exudation was identified in 6 patients (18%). Sixteen patients (47%) had received photodynamic therapy (PDT) previously. The main demographic and baseline clinical parameters of the studied patients are shown in Table 1.

    Table 1 Baseline demographics of Patients with Type 1 CNV Secondary to Chronic CSC (n=34)

    Visual and Anatomic Outcomes

    Mean decimal BCVA increased significantly from 0.44 (SD; 0.35) at baseline to 0.6 (SD; 0.3, p ˂ 0.001) at year 1, 0.61 (SD; 0.3, p ˂ 0.001) at year 2 and 0.59 (SD; 0.31, p ˂ 0.001) at year 3 (shown in Figure 1). At year 3, 71% (24 out of 34 patients) gained BCVA improvement, 26% (9 out of 34 patients) ‒ stabilization of BCVA and 3% (1 out of 34 patients) had BCVA decreased.

    Figure 1 Change in mean decimal BCVA from baseline to year 3.

    Abbreviation: BCVA, best-corrected visual acuity.

    Mean CRT decreased significantly from 315 (SD; 90) μm at baseline to 225 (SD; 43, p ˂ 0.001) μm at year 1, 223 (SD; 40, p ˂ 0.001) μm at year 2 and 224 (SD; 49, p ˂ 0.001) μm at year 3 (shown in Figure 2).

    Figure 2 Change in mean CRT from baseline to year 3.

    Abbreviation: CRT, central retinal thickness.

    Mean SFCT decreased significantly from 398 (SD; 156) μm at baseline to 352 (SD; 133, p ˂ 0.001) μm at year 1, 354 (SD; 128, p ˂ 0.001) μm at year 2 and 355 (SD; 129, p ˂ 0.001) μm at year 3 (shown in Figure 3).

    Figure 3 Change in mean SFCT from baseline to year 3.

    Abbreviation: SFCT, subfoveal choroidal thickness.

    Overall, after intravitreal aflibercept in 65% (22 out of 34 eyes) showed complete resolution of fluid at 1 year follow-up. Complete resorption of fluid was noted in 68% (23 eyes out of 34) at 2 years and 73% (25 eyes out of 34) at 3 years.

    Treatment and Treatment Interval

    During all follow-up period, the total mean number of aflibercept injections was 18.0 (SD; 5.6). Mean number of injections per year was 7.6 (SD; 1.9) at year 1, 5.6 (SD; 2.2) at year 2 and 4.9 (SD; 3.1) at year 3 (shown in Figure 4).

    Figure 4 Columns graph showing mean number of aflibercept injections in patients with type 1 CNV secondary to chronic CSC at different time points.

    Abbreviations: CNV, choroid neovascularisation; CSC, central serous chorioretinopathy.

    Mean treatment-free interval was 10.0 (SD; 4.0) weeks after 1 year. After 2 years, mean interval aflibercept injection increased to 12.7 (SD; 6.0) weeks. After 3 years, mean treatment interval was extended up to 15.3 (SD; 7.6) weeks.

    Outcomes of Intravitreal Aflibercept in PDT-Treated and Naive Patients

    We compared baseline patient characteristics and outcomes after intravitreal aflibercept injections in PDT-treated and naive patients (Table 2). The PDT-treated group included 16 patients (16 eyes) who had received PDT before inclusion in the study, and the naive group ‒ 18 patients (18 eyes). There was no significant difference in age, sex, baseline decimal BCVA, SFCT, and the presence of IRF or/and SRF, subretinal hyperreflective deposits between the two groups. However, patients in the treated group had initial thicker mean CRT.

    Table 2 Baseline Characteristics and 3-year Outcomes in Treated and Untreated Patients on Aflibercept Received

    At baseline, mean decimal BCVA was 0.39 (SD; 0.36) in the PDT-treated group and 0.49 (SD; 0.34) in the naive group. At baseline, mean decimal BCVA in the treated group compared to the untreated group was not statistically different (p = 0.4). At year 3, mean decimal BCVA was 0.48 (SD; 0.29) in the PDT-treated group and 0.71 (SD; 0.31) in the naive group. At year 3, mean decimal BCVA in the PDT-treated group compared to the naive group was statistically different (p = 0.04). There was a statistically significant difference between baseline and year 3 in mean decimal BCVA in both groups (p ˂ 0.05).

    Baseline mean CRT was 347 (SD; 95) µm in the PDT-treated group and 283 (SD; 78) µm in the naive group. At baseline, mean CRT in the PDT-treated group compared to the naive group was statistically different (p = 0.04). At year 3, mean CRT in the PDT-treated group was 234 (SD; 63) μm and 214 (SD; 31) μm in the naive group. At year 3, there was a significant decrease in mean CRT to compare with baseline in both groups (p ˂ 0.001). At year 3, difference in mean CRT between the PDT-treated group and the naive group was not significant (p = 0.2).

    At baseline, mean SFCT was 376 (SD; 143) μm in the PDT-treated group and 420 (SD; 174) µm in the naive group. At baseline, mean SFCT in the PDT-treated group compared to the naive group was not statistically different (p = 0.4). At year 3, mean SFCT in the PDT-treated group was 340 (SD; 131) μm and 369 (SD; 134) μm in the naive group. At year 3, there was a significant decrease in mean SFCT to compare with baseline in both groups (p ˂ 0.01). At year 3, difference in mean SFCT between the PDT-treated group and the naive group was not significant (p = 0.5).

    At year 3, complete resolution of fluid in the PDT-treated group was 56% (9 eyes out of 16) and in the naive group ‒ 89% (16 eyes out of 18). There was a significant difference in complete resolution of fluid between the PDT-treated group and the naive group (p = 0.01).

    During all follow-up period, mean number of aflibercept injections was 20.1 (SD; 5.3) in the PDT-treated group and 15.9 (SD; 5.8) in the naive group. Treated patients received significantly more injections than untreated patients (p = 0.03).

    After 3 years, the mean treatment interval was 11.2 (SD; 6.0) in the PDT-treated group and 19.3 (SD; 7.0) in the naive group. Mean treatment-free interval was significantly longer in the naive patients than in the PDT-treated patients (p = 0.001).

    Adverse Events

    There were no systemic serious adverse events during the observation period. There were no complications including endophthalmitis, retinal detachment, or atrophy to the RPE and/or choroid. One eye developed progression of cataract. At year 2, in one case was performed phacoemulsification with implantation of an intraocular lens.

    Discussion

    Currently, there is no single view on the standard treatment of CNV as a consequence of chronic CSC. Anti-VEGF therapy and PDT, or a combination of both, are commonly used to treat these patients.19,20 More authors are increasingly opting for intravitreal antiangiogenic therapy as monotherapy for CNV in CSC patients, reporting the effectiveness of this approach.15,21,22 The global shortage of verteporfin has also influenced this trend, as it has further restricted the use of PDT in patients with CSC since July 2021.23

    There are two primary strategies for personalised intravitreal anti-VEGF therapy. Treatment can be performed as needed when signs of recurring fluid leakage appear. Alternatively, a “treat and extend” strategy can be used, extending the intervals between treatments as long as the macula remains dry.24 Clinicians favour TAE as it allows longer intervals between treatments and decreases the total number of clinic visits.25 The TAE regimen typically consists of ≥3 monthly loading doses, followed by treatment intervals that are gradually extended by two to four weeks, up to 12 to 16 weeks. If disease activity relapses, the next injection is given and the inter-injection interval is reduced by 2–4 weeks until the fluid resolves, after which the intervals between procedures can be extended again. The results of the current study demonstrated that intravitreal aflibercept for type 1 CNV secondary chronic CSC using a TAE regimen can lead to sustained improvements in BCVA and anatomical outcomes.

    Different numbers of loading injections are discussed for the treatment of chronic neovascular CSC. We used 3 loading injections and our study extended the mean interval between injections to 15.3 (SD; 7.6) weeks at year 3. During the follow-up period, the total mean number of aflibercept injections was 18.0 (SD; 5.6). Mean decimal BCVA increased significantly from 0.44 (SD; 0.35) at baseline to 0.59 (SD; 0.31, p ˂ 0.001) at year 3; CRT decreased from 315 (SD; 90) μm to 224 (SD; 49, p ˂ 0.001) μm; SFCT decreased from 398 (SD; 156) μm to 355 (SD; 129, p ˂ 0.001) μm. Complete resorption of fluid was noted in 73% (25 eyes out of 34) at 3 years. Schworm et al for neovascular CSC used 6 consecutive monthly (34±3 days intervals) loading injections of ranibizumab or aflibercept. The mean CRT decreased from 346±61 to 257±57 μm after the sixth injection, while the mean logMAR visual acuity improved from 0.65±0.35 to 0.49±0.29. Extended loading of 6 injections, as opposed to 3 injections, resulted in an additional mean decrease in CRT (280±46 μm versus 257±57 μm).15

    This research showed that aflibercept treatment was more effective in BCVA improvement in PDT-untreated patients at 3-year follow-up. Reduction in CRT and SFCT was similar in the PDT-treated and naive groups at 3 years. During follow-up, the mean number of aflibercept injections was 20.1 (SD; 5.3) in the PDT-treated group and 15.9 (SD; 5.8) in the naive group. PDT-treated patients received significantly more injections than naive patients, which may be due to the effect of PDT on choriocapillaries, subsequent choriocapillaries insufficiency, and secondary hypoxia, promoting the growth of CNV.26 In our study, the mean interval between injections was extended to 11.2 weeks (SD; 6.0) in the PDT-treated group and 19.3 weeks (SD; 7.0) in the naive group after 3 years.

    Hu et al reported the results of a retrospective study that assessed the clinical outcomes of half-dose PDT for CSC with type 1 CNV detected by routine OCT-A screening. In this study, nineteen eyes (55.9%) underwent a single PDT session without recurrence over a 3-year follow-up period (predominantly eyes with a point source of leakage). Fifteen eyes (44.1%) received additional anti-VEGF, PDT, or both due to persistent or recurrent SRF (predominantly eyes with diffuse oozing on the FA). Patients were monitored monthly until the SRF was fully reabsorbed, and subsequently quarterly. The mean sessions of half-dose PDT was 1.50±0.75 and the mean number of anti-VEGF injections was 1.38±3.34. BCVA improved from 0.38±0.33 to 0.20±0.22 (p < 0.001). The mean central macular thickness was significantly reduced, along with a decrease in choroidal thickness. The authors noted a significant increase in CNV size at the end of the follow-up period, despite the resolution of SRF in most cases.27 It can be speculated that the therapeutic effect of VEGF inhibitors or PDT in pachychoroidal disease may be due to a temporary decrease in choroidal hyperpermeability.

    CNV is not the only factor responsible for SRF accumulation. The occurrence of SRF in patients with CNV due to CSC may be caused by the underlying pachychoroid.15 CNV can be inactive even with the subretinal fluid present, while the absence of SRF does not definitively indicate that CNV progression has not occurred.14 Thus, confirmation of SRF absence is insufficient for reliable control of chronic CSC with CNV. Treatment of chronic neovascular CSC should be continued under FA and OCT-A fundus control despite subretinal fluid resorption. In such cases, the TAE regimen during intravitreal anti-VEGF therapy is justified, as it allows for a significant extension of the intervals between treatments, thereby reducing the burden on both the doctor and the patient.

    This study has several limitations. Firstly, the sample size is relatively small (n=34) in this study makes it difficult to fully evaluate the results after treatment. Second, single-center design and lack of external validation. Third, our study does not allow us to compare the efficacy of different angiogenesis inhibitors and different anti-VEGF therapy strategies in the treatment of chronic neovascular CSC, which will be the subject of subsequent studies. Additionally, indocyanine-green angiography was not performed to identify the choroidal vascular changes before and after treatment.

    Despite these limitations, the results demonstrated that the intravitreal aflibercept TAE strategy significantly improved BCVA and resulted in complete resorption of SRF in 73% of patients with chronic neovascular CSC at 3-year follow-up. We believe that long-term management of chronic CSC with CNV necessitates fundus monitoring using FA and OCT-A, even after subretinal fluid absorption. This research indicated for the first time that aflibercept treatment was more effective in improving BCVA in naive patients with chronic neovascular CSC and required significantly fewer injections at the three-year follow-up compared to PDT-treated patients.

    Conclusion

    To summarize, intravitreal aflibercept using a TAE regimen improved visual and anatomical outcomes of patients with type 1 CNV secondary to chronic CSC in 3-year follow-up. Previously naive patients showed a better visual outcome and higher incidence of complete resorption of fluid with lower number of aflibercept injections and longer treatment-free intervals. However, further study is necessary to verify our findings with a larger sample size.

    Abbreviations

    CSC, central serous chorioretinopathy; RPE, retinal pigment epithelium; CNV, choroidal neovascularization; BCVA, best corrected visual acuity; OCT-A, optical coherence tomography angiography; anti-VEGF, anti-vascular endothelial growth factor; PRN, pro re nata; TAE, treat-and-extend; SD-OCT, spectral domain optical coherence tomography; FA, fluorescein angiography; IRF, intraretinal fluid; SRF, subretinal fluid; SFCT, subfoveal choroidal thickness; CRT, central retinal thickness; SD, standard deviation; PDT, photodynamic therapy.

    Author Contribution

    All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

    Funding

    This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

    Disclosure

    Andrii Korol is a consultant and speaker for Novartis, Thea, Bayer and Roche. The authors have no other potential conflicts of interest in this work.

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