Delayed acceptance or refusal of COVID-19 vaccines may increase and prolong the threat to global public health and the economy. Identifying behavioural determinants is considered a critical step in explaining and addressing the barriers of vaccine refusal. This study aimed to identify the behavioural determinants of COVID-19-vaccine acceptance and provide recommendations to design actionable interventions to increase uptake of the COVID-19 vaccine in six lower- and middle-income countries. Taking into consideration the health belief model and the theory of reasoned action, a barrier analysis approach was employed to examine twelve potential behavioural determinants of vaccine acceptance in Bangladesh, India, Myanmar, Kenya, the Democratic Republic of the Congo (DRC), and Tanzania. In all six countries, at least 45 interviews with those who intended to get the vaccine (“Acceptors”) and another 45 or more interviews with those who did not (“Non-acceptors”) were conducted, totalling 542 interviews. Data analysis was performed to find statistically significant (p < 0.05) differences between Acceptors and Non-acceptors of COVID-19 vaccines and to identify which beliefs were most highly associated with acceptance and non-acceptance of vaccination based on the estimated relative risk. The analysis showed that perceived social norms, perceived positive and negative consequences, perceived risk, perceived severity, trust, perceived safety, and expected access to COVID-19 vaccines had the highest associations with COVID-19-vaccine acceptance in Bangladesh, Kenya, Tanzania, and the DRC. Additional behavioural determinants found to be significant in Myanmar and India were perceived self-efficacy, trust in COVID-19 information provided by leaders, perceived divine will, and perceived action efficacy of the COVID-19 vaccines. Many of the determinants were found to be significant, and their level of significance varied from country to country. National and local plans should include messages and activities that address the behavioural determinants found in this study to significantly increase the uptake of COVID-19 vaccines across these countries.

: Diarrhea is one of the leading causes of childhood illness and a major cause of infant and child mortality globally. In the Reducing Enteropathy, Undernutrition, and Contamination in the Environment (REDUCE) prospective cohort study, we investigated the association between diarrheal disease awareness and handwashing with soap among caregivers of children under 5 years of age. A total of 259 caregivers of children under 5 years of age in Walungu Territory, South Kivu, Democratic Republic of the Congo (DRC), were administered an open-ended questionnaire assessing awareness of diarrheal disease transmission and prevention, and key times to wash hands with soap. An overall diarrhea awareness score was developed based on the responses to these items. Five-hour structured observation of handwashing behaviors was conducted at the 6-month follow-up. Diarrheal disease awareness among caregivers was low. Only 32% of caregivers were able to correctly identify a method of diarrhea prevention. The median diarrhea awareness score was 3 out of 10 (SD: 1.7, range: 0–9). During structured observation, 9% of caregivers washed their hands with soap at a food-related event and 9% washed their hands with soap at a stool-related event. Higher diarrheal disease awareness was associated with an increased odds of handwashing with soap at food-related events (odds ratio: 1.40, 95% confidence interval: 1.03, 1.90). Our findings emphasize the need for targeted water, sanitation, and hygiene interventions to increase diarrhea awareness and facilitate handwashing with soap among caregivers of children under 5 years in rural DRC.

Background: Globally, iron-deficiency anemia is the most common micronutrient deficiency and a leading cause of disability-adjusted life years lost among adolescent girls 10–19 years of age. Adolescent girls’ voices are often excluded from shaping the interventions and policies designed to support them. We used participatory formative research methods—photovoice and adolescent-centered design (ACD)—to explore nutrition-related challenges, opportunities, and preferences among adolescent girls in Monapo District, Mozambique, and used the findings to contextualize a nutrition curriculum and supplement delivery platform. Methods: We purposively selected 16 girls from three rural and peri-rural secondary schools divided equally into two age groups (13–16 years and 17–20 years) and asked them to take photos of their food environment. Following a week of photo-taking, participants discussed their photos using the SHOWeD methodology in two workshops and in follow-up individual interviews. We also conducted three ACD group discussions with girls 13 to 20 years, each consisting of 10 to 12 participants, to explore consumption and supplement packaging preferences. Results: Thematic analysis of photos and transcripts showed that participants preferred locally grown foods and indigenous protein sources and were actively engaged in agriculture and household chores, highlighting opportunities for nutritional improvement. However, their nutrition was constrained by seasonal food shortages, inequitable household responsibilities compared to boys, and limited social capital. While school-based supplementation is the standard practice, participants strongly preferred to take supplements at home to avoid stigma and benefit from the comfort and privacy of their own homes. We used these insights to refine the adolescent nutrition curriculum and design a multiple micronutrient supplementation delivery platform. Conclusions: Photovoice provided rich visual data about the lived experiences of adolescent girls in a fragile and resource-constrained context, without the influence of an external researcher interpreting everyday realities, and elicited valuable insights into the barriers, opportunities, and potential improvements in nutrition programming. Integrating photovoice and ACD into program design can increase program acceptability and potential for effectiveness. This research also highlights the need to prioritize adolescent engagement and underscores the inadequacy of one-size-fits-all approaches, such as school-based supplementation programs.

Vaccine hesitancy for COVID-19 is a major obstacle to achieving high vaccine coverage. Low vaccine confidence among college students is one factor fueling the COVID-19 pandemic in the U.S.The purpo...

Community Health Workers (CHWs) in low- and middle-income countries are essential in providing primary health care to remote communities. However, due to limited diagnostic tools, CHWs often struggle to correctly identify childhood illnesses, especially pneumonia. We conducted a prospective pilot study and used qualitative research methods to evaluate acceptability and feasibility of a multimodal pulse oximeter used by CHWs during their integrated community case management (iCCM) of childhood illness consultations in rural Burundi. We used purposive sampling to recruit CHWs and trained them to use the oximeters during household iCCM consultations for children 6–59 months of age. After eight weeks of using the devices, we conducted eight focus group discussions to evaluate experiences and perceptions of the device among CHWs and caregivers. Our thematic analysis, based upon deductive and inductive reasoning, identified the following themes: durability, storability, trust, self-efficacy, child agitation, ease of using the device, and interpretation of parameters. CHWs deemed the devices highly acceptable and took pride in safely storing them but reported challenges in utilizing respiration rate, pulse, and oxygen saturation (though temperature was understood). Child agitation was a barrier to oximeter use, especially among children 6–12 months. Additional CHW capacity-building on interpreting parameters is needed when using oximeters during household iCCM consultations in Burundi, including an iCCM job aid (decision-making tree) with oxygen saturation and respiratory rate cut-offs for treatment and/or referral. Training and using child-calming techniques could be an important strategy for obtaining quality measurements. While CHWs and caregivers highly valued the oximeters during sick child visits, the devices may be better utilized and scalable at the health facility level.

Iron‐deficiency anemia is the most common micronutrient deficiency and a leading cause of disability‐adjusted life years among adolescent girls and young women (AGYW) globally. Although multiple micronutrient supplementation (MMS) provides a broader range of micronutrients than iron‐folic acid supplementation (IFAS) prior to conception, the acceptability of MMS and home‐based supplementation strategies remains underexplored. We assessed the acceptability of MMS, IFAS, and a contextualized nutrition curriculum delivered via school clubs in a two‐arm cluster‐randomized trial across three rural secondary schools in Monapo District, Mozambique. Fourteen teachers (clusters) were randomized to deliver either weekly school‐based IFAS or daily home‐based MMS. A total of 492 AGYW aged 13–20 years were enrolled (240 IFAS; 252 MMS); both arms received the same nutrition curriculum. Participants in both arms reported increased energy, improved appetite, and relief from menstrual symptoms. IFAS was significantly more acceptable than MMS for smell, and some participants perceived the once‐weekly IFAS regimen as less burdensome than daily MMS. Some AGYW also reported that male peers perceived MMS as birth control, or assumed the girls were pregnant, due to the image of a pregnant woman on the pill bottle. Ratings of the nutrition curriculum and teachers' facilitation were positive in both arms. Participants generally preferred the regimen they were assigned, and family support facilitated adherence. These findings suggest home‐based supplementation may be a feasible and acceptable strategy for reaching in‐school and out‐of‐school AGYW in Mozambique. Including boys in future interventions and redesigning the MMS label could help reduce misconceptions and enhance acceptability.