Children with chronic medical conditions are more susceptible to developing a serious negative outcome from corona virus disease 2019 (COVID-19) than healthy children. This study investigated the extent of COVID-19 vaccine hesitancy (VH) and its predictors in parents of children with chronic liver disease (CLD) in Egypt. Methods: A cross-sectional study was conducted at the National Liver Institute from September to October 2022, using a random sampling method. Data were collected using the validated Arabic version of parents’ attitudes about childhood vaccines (PACV) scale. Structural equation modeling (SEM) and discriminant analysis were used to identify direct and indirect determinants of VH. Results: Of the 173 participating parents, 81.5% hesitated to vaccinate their child. Relevant characteristics for hesitancy included being the mother of the child (88.2%), younger than 40 years (92.9%), illiterate (92%), unemployed (88.8%), without health insurance (87.8%), unvaccinated against COVID-19 (97.2%), refused to complete vaccinations (85.7%), and not having chronic disease (85.7%) (p < 0.05). Previous COVID-19 infection of children motivated vaccination (p < 0.0001). Median total PACV, attitude, and trust scores were significantly higher in the hesitant group than the vaccinated group (p = 0.023). SEM suggests that child age and family size have a direct effect, while education level, and income have indirect effects on parents’ hesitancy. The model showed acceptable goodness of fit (GFI = 0.994, CFI = 1, RMSEA < 0.0001). A 92.9% corrected classification of the discriminator VH variables was determined using the discriminant analysis model (safety and efficacy, attitude and trust, child age, and family size). Conclusions: Many socioeconomic factors significantly affect parents’ attitudes toward their child’s vaccination. Thus, increasing parents’ awareness of the importance of childhood vaccination, especially among this risky group, may enhance their decision-making ability regarding vaccinating their children.

Background: Globally, infectious diseases, including pneumonia, diarrhea, and malaria, along with pre-term birth complications, birth asphyxia and trauma, and congenital anomalies remain the leading causes of death for under-five mortality (U5M). This study aimed to identify the geospatial pattern of U5M in Alexandria and its key determinants.Methodology: We analyzed the geospatial distribution of 3064 deaths registered at 24 health offices reported from January 1, 2018 to June 30, 2019. We adopted two methods of analysis: geospatial analysis and the structural equation model (SEM).Result: Neonates represented 58.7% of U5M, while post-neonates and children were 31.1%, 10.2%respectively. Male deaths were significantly higher compared to females (P = 0.036). The main leading causes of U5M were prematurity (28.32%), pneumonia (11.01%), cardiac arrest (10.57%), congenital malformation (9.95%), and childhood cardiovascular diseases (9.20%). The spatial distribution of U5M (including the most common three causes) tends to be clustered in western parts of Alexandria (El Hawaria, Bahig, Hamlis, and Ketaa Maryiut). SEM showed the total effects of exogenous and intermediate variables on U5M. The U5M proportionately increased by living in rural areas (8.48), followed by crowding rate (8.35), household size (1.36), population size (0.52), and illiteracy average (0.06). On the contrary, the U5M decreased with increasing access to sanitation (-0.17) and access to drinking water (-4.55).Conclusion: Illiteracy, and poor locality characteristics (household size, population density, and access to water supply and sanitation) were statistically significant predictors of U5M.

Background: Egypt's population increased by 10 million between 2011 and 2014 and the total fertility rate increased to 3.5 births per woman. Aims: This paper aimed to evaluate the direct and intermediate factors that could explain this increase in the total fertility rate. Methods: Data from the 2000 and 2014 Egypt Demographic and Health Surveys were used. The average number of births per woman in the 3 years before the survey was used as a proxy for total fertility rate. A structural equations model was used to measure the total effect of direct and intermediate variables on number of births per woman. Results: The effect of the intermediate variables on births per woman was stronger than the direct factors in both health surveys. In the 2000 and 2014 surveys, the intermediate factors with the greatest effect were: unmet need for family planning methods, discontinuation of using family planning methods in the 5 years before the survey, number of discontinuations of using family planning methods in the 3 years before the survey and child death under 5 years. In the 2000 survey, the direct factors affecting a decline in births per woman were: exposure to family planning messages, woman's work status, wealth index and woman's age 3 years before the survey. In the 2014 health survey, the effect of these variables on fertility declined. This decrease contributed to increasing the total fertility rate to 3.5 births per woman. Conclusion: Population policies should reintensify efforts to reduce the fertility rate based on the factors that influence fertility, such as family planning messages.