Humanitarian crises increasingly disrupt immunization systems, accelerating transmission of vaccine-preventable diseases (VPDs). Despite a robust global response architecture, reactive vaccination campaigns in humanitarian settings remain poorly documented, frequently delayed, and operationally constrained. We conducted a structured search of published and grey literature to identify and describe reactive vaccination campaigns for five VPDs, including measles, poliomyelitis, diphtheria, meningococcal meningitis, and yellow fever, across humanitarian settings between 2015 and 2024, drawing on 316 published and grey literature sources including WHO Disease Outbreak News, GOARN, and ReliefWeb. Given substantial gaps in publicly available reporting, findings are presented as a perspective to document implementation gaps and draw practical lessons rather than as a systematic review. Of 132 identified outbreaks, reactive vaccination campaigns were documented in 83 (63
This study is a descriptive epidemiological analysis of a multistate dengue fever outbreak in Sudan during a period of intense armed conflict and mass displacement. This study is an analysis of national surveillance data conducted using reports collected between August 2024 and July 2025. Variables, including case counts, fatalities, and internally displaced persons (IDPs) per state, were calculated and analyzed with R software 4.2.2 (Version 2025.05.1 + 513). A total of 13,371 cases and 21 fatalities were reported across 10 states. Notably, Khartoum State, a conflict-affected region, recorded the highest number of cases (n = 8040), while Kassala reported the highest number of deaths (n = 9). Kassala State documented the highest number of dengue cases among IDPs (472), followed by Khartoum (69). The findings highlight the need for strengthened dengue surveillance and vector control in conflict-affected settings, where disruption of health services may complicate outbreak prevention and response. Not applicable.
Measles is among the most transmissible human infections, and delays in outbreak detection and response can rapidly amplify community transmission. The 7-1-7 target provides an operational benchmark for evaluating outbreak detection, notification, and early response. We assessed the timeliness of measles outbreak detection, notification, and response in Uganda during 2025 using the 7-1-7 framework to identify opportunities for improving response performance. We assessed 46 laboratory-confirmed measles outbreaks reported in Uganda during 2025 with complete 7-1-7 data. Outbreak timeline data were abstracted from rapid response investigation reports, district records, and laboratory data. Detection (T1) was measured from outbreak emergence to first recording by the surveillance system, notification (T2) from detection to notification of public health authorities, and response (T3) from notification to achievement of the final applicable early response milestone. Timeliness was summarised using medians, IQRs, and proportions meeting each target; new and recurrent outbreaks were compared using Fisher’s exact tests with exact 95
Sierra Leone’s hospital system faces persistent challenges, including high maternal and under-five mortality, infrastructure and supply deficits, workforce shortages, fragmented governance, and high out-of-pocket health expenditure. These constraints limit the contribution of hospitals to Universal Health Coverage (UHC) and service delivery. In response, the Ministry of Health (MoH) developed the first National Hospital Strategy for Service Delivery Transformation 2025–2030. We conducted a mixed-methods policy analysis case study of the development of the hospital strategy. The analysis was guided by the Walt and Gilson Health Policy Analysis Triangle, focusing on context, content, process, and actors. Data sources included a desk review of policy documents, assessments of nine purposively selected hospitals, fifteen key informant interviews with health sector stakeholders, and three validation workshops using a modified nominal group technique, a structured consensus method in which participants generate priorities individually, present them in turn, discuss them as a group, and then rank them. The accountability for reasonableness framework was applied to assess the procedural legitimacy of the strategy development process. The strategy was shaped by Sierra Leone’s epidemiological, economic, institutional, and health system context, including high mortality rates, limited fiscal space, weak infrastructure, severe shortages of skilled health workers, irregular supply of essential medicines, and fragmented hospital governance. These contextual factors informed a strategic vision for an equitable, accessible, affordable, resilient, and transformative hospital system. The strategy includes ten interlinked strategic objectives covering legal and regulatory reform, governance, financing, infrastructure, human resources, service delivery, supply chain management, health information systems and research, human rights and community engagement, and emergency preparedness. The development process was iterative and participatory, involving MoH leadership, hospital managers, clinicians, district health teams, development partners, professional associations, civil society, and community representatives. Assessed against the accountability for reasonableness framework by the author team, the process showed features consistent with procedural legitimacy, including evidence-informed priority-setting, stakeholder deliberation, iterative revision, and political endorsement, although formal public appeals mechanisms were limited. The development of Sierra Leone’s first hospital strategy illustrates how structured policy analysis, evidence synthesis, and participatory deliberation can support the formulation of a context-sensitive hospital reform agenda in a low-income setting. The analysis covers strategy formulation only. It makes no claim about implementation or health outcomes, which remain to be evaluated. The experience offers transferable lessons for countries seeking to strengthen hospitals as part of progress toward UHC, while highlighting the importance of sustained financing, implementation capacity, accountability and monitoring.
Cardiovascular disease (CVD) remains a leading cause of mortality in Thailand. We evaluated trends in CVD risk-factor profiles and predicted 10-year CVD risk among individuals receiving outpatient hypertension care under the Universal Health Coverage framework to inform national prevention strategies and guide risk-stratification policies. We conducted a repeated cross-sectional study using nationwide data from the Thailand DM/HT study (2011–2018), including 226,420 adults with hypertension. Ten-year predicted CVD risk was estimated using the 2019 World Health Organization Southeast Asia region-specific scores (laboratory-based [n = 123,042] and non-laboratory-based [n = 143,025] models). Concordance was evaluated among 119,134 participants. Counterfactual simulations estimated the potential impact of optimizing modifiable risk factors. Between 2011 and 2018, smoking and hyperlipidemia prevalences declined, whereas obesity (body mass index ≥ 25 kg/m2) increased from 44.9
