Countries across the globe are currently experiencing a third or fourth wave of SARS-CoV-2 infections; therefore, the need for effective vaccination campaigns is higher than ever. However, effectiveness of these campaigns in disease reduction is highly dependent on vaccination uptake and coverage in susceptible populations. Therefore, this systematic review and meta-analysis estimated the vaccination intention and identified determinants of willingness and hesitancy. This study updates the existing body of literature on vaccination willingness, and was conducted according to the PRISMA guidelines. PubMed was searched for publications, selecting only studies published between 20 October 2020 and 1 March 2021, in English, with participants aged >16 years of age. The search identified 411 articles, of which 63 surveys were included that accounted for more than 30 countries worldwide. The global COVID-19 vaccination willingness was estimated at 66.01% [95% CI: 60.76–70.89% I² = 99.4% [99.3%; 99.4%]; τ² = 0.83]. The vaccination willingness varied within as well as between countries. Age, gender, education, attitudes and perceptions about vaccines were most frequently observed to be significantly associated with vaccine acceptance or refusal.

Objectives: Coverage of the continuum of maternal and neonatal care, including antenatal care (ANC), childbirth and early postnatal care (PNC), is critically low across sub‐Saharan Africa. Meanwhile, related monitoring remains neglected. We quantified coverage gaps along the continuum of maternal and neonatal care in rural Guinea‐Bissau and assessed background factors associated with continuum‐of‐care completion.Methods: In a cross‐sectional study using data from the Bandim Health Project's nationally representative rural health and demographic surveillance system (HDSS), we assessed individual‐level obtainment of ≥1, ≥4 and ≥8 ANC contacts (ANC1/4/8), facility‐based childbirth and PNC within 24 h postpartum for HDSS‐registered births between 1 February 2023 and 31 January 2024. Among facility births, we also assessed postpartum admission ≥24 h. We defined continuum‐of‐care completion as the obtainment of ANC4, facility‐based childbirth and PNC within 24 h and investigated associations between background factors (household assets, maternal age, education, parity, region, ethnicity, health facility distance and recall time) and continuum‐of‐care completion in regression models.Results: Among 2258 births, 35% (n = 798) completed the continuum of care; 22% (n = 494) obtained none of the contributing services. Individual service coverage ranged from 6% (ANC8, n = 128) to 99% (ANC1, n = 2236). Individual coverage of the services included in the continuum‐of‐care assessment was 62% (n = 1403) for ANC4, 56% (n = 1268) for facility‐based childbirth and 52% (n = 1167) for PNC. Continuum‐of‐care completion differed by region and ethnicity. Living near a health facility, higher maternal education, more household assets, low parity and longer recall time were associated with higher continuum‐of‐care completion.Conclusions: Continuum‐of‐care completion is low in rural Guinea‐Bissau and not fully reflected by individual coverage indicators. This calls for a higher focus on continuum‐of‐care coverage and related gaps, both locally and globally. Meanwhile, the identified higher reporting of continuum‐of‐care completion with longer maternal recall questions the use of survey data and beckons for monitoring based on timely routine data.

Objectives: Human resource shortages create bottlenecks to preventive maternal and child health service provision in low‐resource settings, making ad‐hoc service rationing at the point of care necessary. Little is known about how healthcare providers prioritise. We explored healthcare providers' rationing decisions for preventive maternal and child health services in rural Guinea‐Bissau through an experimental vignette design considering situational and care‐seeker characteristics and performance goals. Methods: We implemented two vignette experiments, one for antenatal care, and one for childhood vaccinations. At 55 health facilities, providers were requested to state their willingness to provide antenatal care/vaccination given a scenario of an acute facility‐level human‐resource shortage and combinations of contextualised factors, summarised in 16 vignettes per experiment: provider‐care‐seeker relationship (stranger/related) and distance (close/far) between care‐seeker residence and facility (both experiments); gestational age (2nd/3rd trimester) and consultation number (1st/4th) (antenatal care experiment); child age (5/13 months), vaccine sought (Bacillus Calmette‐Guérin/3rd Pentavalent vaccine (Penta3)), and number of other children waiting (3/12) (vaccination experiment). We also inquired about facility and interviewee characteristics. Using multilevel logistic regressions, we assessed associations between the factors and providers' stated willingness for each experiment. Results: We interviewed a total of 159 healthcare providers; 112 provided antenatal care, 118 vaccinations. Interviewees in the antenatal care experiment stated willingness for antenatal care provision for 94% (1691/1792) of the vignettes (range across vignettes: 88%–99%). Last pregnancy trimester, long distance, and providers' work experience were associated with stated increased willingness. In the vaccination experiment, the interviewees stated their willingness to vaccinate for 72% (1357/1887) of the vignettes (range: 54%–95%). Younger child age, long distance, a higher number of other children waiting, and inquiring Penta3 rather than Bacillus Calmette‐Guérin were associated with stated increased willingness, and we found a statistically significant interaction between age and the inquired vaccine. Conclusions: Situational and care‐seeker characteristics and performance goals may influence facility‐based ad‐hoc service rationing in rural Guinea‐Bissau.