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ABSTRACT Objective: The objective of this study was to report two cases of successive multiple spontaneous bilateral pneumothorax in children with massive lung involvement due to Langerhans cell histiocytosis (LCH), emphasizing the possibility of this differential diagnosis for the general pediatrician. Additionally, published cases describing pediatric patients with pulmonary manifestations of LCH were reviewed in the literature. Case description: Case #1: A 3-year-old male patient with a sudden episode of spontaneous right-sided pneumothorax, surgically drained. After 2 months, he experienced two new episodes of contralateral pneumothorax. A pulmonary lymph node biopsy revealed the diagnosis of LCH. He underwent bilateral video-assisted thoracic surgery and mini-thoracotomy with mechanical pleurodesis, in addition to chemotherapy, requiring prolonged hospitalization. Case #2: A 4-year-old boy with progressive dyspnea and wheezing for 5 months. A pulmonary biopsy revealed LCH. He developed significant respiratory distress and right pneumothorax, requiring drainage. Silver nitrate pleurodesis and different chemotherapy regimens were performed. Both patients responded well to multiple chemotherapy treatments, surgeries, and intensive care support. Comments: LCH is a challenging disease. Its clinical manifestation is variable, and pulmonary involvement occurs in about 10–15% of cases. We consider specialized surgical management and multidisciplinary support essential for the treatment of patients with massive pulmonary LCH. Although rare, massive pulmonary involvement by LCH should be considered in cases of recurrent pneumothorax in children.

Introduction Human papillomavirus (HPV) infection is the most prevalent sexually transmitted infection worldwide. HPV vaccination is an important tool to prevent and control HPV infection and its complications. Despite carrying the severe burden of disease, HPV vaccine coverage in Africa remains low. The aim of the current review is to evaluate the factors associated with HPV vaccination acceptance among adolescent men and women, young men and women, parents/caregivers, men who have sex with men, healthcare workers and programme managers in Africa.Methods and analysis We will include peer-reviewed quantitative studies. We will search PubMed, Scopus, PsycInfo, Web of Science and Cochrane Central Register of Controlled Trials, with no language restriction, to identify eligible studies. Two review authors will independently screen the titles and abstracts of the search output in Covidence to select potentially eligible studies. The same two reviewers will independently screen the full-text of all identified potentially eligible articles to identify studies meeting inclusion criteria. Two review authors will independently extract data from eligible studies using a predefined data extraction form. Two review authors will independently assess the risk of bias in each included study, using the Effective Public Health Practice Project ‘Quality Assessment Tool for Quantitative Studies’. We will assess the quality of evidence using the method for Grading of Recommendations Assessment, Development and Evaluation.Ethics and dissemination Ethical approval is not required for this study because we will use already published data. The results of this review will be disseminated through peer-reviewed publication and conference presentation.PROSPERO registration number CRD42023475810.

Background Unpredictable events, such as the outbreak of infectious diseases and humanitarian crises, are putting a strain on health care systems. As a result, African countries will need to prepare themselves with appropriate strategies to withstand such occurrences. Therefore, the purpose of this scoping review was to map available evidence about what type and what components of health systems are needed to help countries cope with health emergencies and to foster health system resilience in the WHO African Region. Methods A systematic search was performed independently in Scopus and PubMed electronic databases as well as grey literature. Studies were selected based on set eligibility criteria based on the Joanna Brigg’s Institute (JBI) methodology for scoping reviews. The key findings were focused on health system resilience and were mapped based on the WHO’s core health system components. Our data were tabulated, and a narrative synthesis was conducted. Results A total of 28 studies were included in this scoping review, mostly conducted in the WHO African Region and region of the Americas. Studies focused on a variety of strategies, such as the continuous delivery of essential services, the strengthening of the health workforce, including community health care workers, community engagement, the provision of protective mechanisms for the health workforce, and flexible leadership and governance measures. Conclusion Our findings suggest that strategies to improve health system resilience must include all areas of the healthcare delivery process, including primary care. A resilient health system should be ready for a crisis and have adaptable policies in place to offer adequate response at all levels, as well as post-recovery planning. Such health systems should also seek for continuous improvement. More research is needed to assess the efficacy of initiatives for improving health system resilience, particularly in vulnerable African health systems.

Upon passing matric, countless students choose to study further at Technical and Vocational Training Colleges (TVETs). Nevertheless, some of these students seem to be unable to attain the qualification that they studied for as they struggle with placements for Work Integrated Learning (WIL), which is a requirement for completion of the qualification. Various research has been done investigating the importance of WIL in enhancing student employability and the acquisition of practical skills; however, few have focused on the placement of students in employment centers. This study’s objective was to investigate the challenges that the selected TVET college faces when placing students. This research study adopted a qualitative research methodology. A case study design and constructivism approach were used. Data were collected through open-ended interviews and focus groups. Purposive and snowball sampling techniques were used. The study revealed that there was an elephant in the room. The students faced challenges such as a lack of funding, personnel shortages, geographic location of the colleges, etc. that led to other challenges, as explained in the study. The study concluded that the college had various challenges in placing students for WIL, and thus they had a huge backlog. These range from inconsistency in placement, the inability to prepare and guide students before and during placement, a lack of support, and a lengthy waiting period. A number of recommendations, such as a complete overhaul of the WIL placement process, the recruitment of competent personnel, and widening the pool of funders to fast-track the process and minimize the backlog, are suggested.

This study examined the stress encountered and stress-coping skill used by the school principals, enabling the development of an improvement program for workrelated outcomes in educational contexts. An adapted survey questionnaire was distributed to school principals and teachers-in-charge of public schools in the Asturias district of the Cebu division in the Philippines. The first part of the survey questionnaire collected personal and professional details from school principals, while the second assessed their performance. Five categories of stressors were identified: administrative responsibilities, administrative constraints, interpersonal relationships, intrapersonal conflicts, and employers' expectations. The respondents' stress-coping strategies were then analyzed for their suitability and effectiveness in stress management. The data were analyzed using frequency, simple percentages, weighted means, and correlation coefficients, which revealed the extent of the stress they encountered from each of the five categories of stressors as well as the stresscoping strategies preferred by the school principal and observed by other teachers. Based on the findings, it is recommended that an improvement program be developed for work-related outcomes in educational contexts, focusing on school principals and stress management, which may be referred to as the Dynamic Administrative Performance Network.

Introduction Leveraging data science could significantly advance the understanding of the health impacts of climate change and air pollution to meet health systems’ needs and improve public health in Africa. This scoping review will aim to identify and synthesise evidence on the use of data science as an intervention to address climate change and air pollution-related health challenges in Africa.Methods and analysis The search strategy will be developed, and the search will be conducted in the Web of Science, Scopus, CAB Abstracts, MEDLINE and EMBASE electronic databases. We will also search the reference lists of eligible articles for additional records. We will screen titles, technical reports, abstracts and full texts and select studies reporting the use of data science in relation to the health effects and interventions associated with climate change and air pollution in Africa.Ethics and dissemination There are no formal ethics requirements as we are not collecting primary data. Results, once published, will be disseminated via conferences and shared with policy-makers and public health, air pollution and climate change key stakeholders in Africa.

The Covid-19 pandemic has created various challenges that allowed academic stakeholders to reflect on the concerns encountered by school administrators, teachers, and students. Many studies focused on the challenges of professional journalists. However, only a few studies on student journalists were explored. In this regard, this study aimed to describe and analyze the challenges of student journalists at the height of the Covid-19 pandemic. A qualitative research design was used in this research. Grounded in this study were the student journalists’ personal experiences and narration of their expressed challenges as writers of the Nation Builder, the official student publication of a state university. Thematic analysis using Braun and Clarke’s (2006) Model was used to analyze the qualitative data gathered. Findings show that there were five identified themes such as health-related issues, ICT-related issues, connectivity-related issues, adaptability-related issues, and journalism-related issues. There are action plans that need to be implemented to sustain the interest of student journalists to write newsworthy articles. Training programs and capacity-building activities could be organized to boost the confidence of the students in coping with the pandemic.

Purpose: The circular economy is a key issue for any company, city, or institution. The linear economy model, based on "take, make, use and waste" of products and resources, has discarded potentially valuable resources and caused serious contamination problems. In contrast, the circular economy (CE) model is a strategic paradigm whose purpose is to regenerate and conserve resources through closed material loops and the sustainable use of energy in its processes. Therefore, a growing number of companies are applying different tools and techniques to implement the CE principles to innovate their products, services, and processes, achieving promising results. Thus, the main objective of this study is to suggest an implementation model named “Circular clock” based on a set of tools and techniques which firms may use for implementing CE. Design/methodology/approach: The paper presents an empirical analysis based on the triangulation method that includes three different data sources: semi-structured interviews in Spain, academic literature and books, and non-academic publications from institutions and consultancy firms. Findings: The most relevant result of this study is the proposal of a Circular Clock model for circular economy implementation is based on six fields of action define in the academic literature: take, make, distribute, use, recover, and industrial symbiosis. Moreover, this study may serve as guidance in facilitating the strategic adoption of eco-innovation practices in firms' transition to a CE. Research limitations/implications: The sample of companies that participated in the triangulation is exploratory; however, this limitation is overcome by reviewing academic literature and institutional reports. On the other hand, academics could expand the selection of tools with subsequent studies. Practical implications: The current study is based on the triangulation method, which was vital to balance the theory and practice provided by academic sources, reports, and books. In addition, this study has improved our understanding of the goals or intentions that may motivate firms to implement the CE and align them with the suggested set of tools. Consequently, this study is relevant to support practitioners in selecting a tool based on the goal they want to achieve towards circular economy implementation. Social implications: This research suggests several tools; however, each organization could adapt some that it already knows. Therefore, firms and implementation leaders should customize the circle with short lines in each case. Moreover, the clock bells represent the deadline considering that every CE implementation process requires a deadline to ensure its success in micro-level or firms. Originality/value: The "circular clock" provides a didactic way for sustainability leaders, consultants, or companies to facilitate the implementation of the circular economy by choosing the field of action on which they want to focus and the most appropriate tool according to their strategy, objective, and budget. Therefore, this model is based on the balance between theory and practice.

Background: Delivery of safe and reliable healthcare to patients and the healthcare workforce shortage amidst growing demand has been major challenge to the healthcare system. Addressing this challenge calls for designing or redesigning of healthcare work system. Work system design which is usually associated with productivity in manufacturing offers a wide spectrum of applicability in addressing this challenge of healthcare system. Despite the availability of primary studies on work system design in healthcare, there are sparse published reviews in specific contexts. This scoping review explores the existing evidence to understand the state of the art of work system design in healthcare. Methods: The scoping review adopts the methodology of Joanna Briggs Institute for scoping review which is based on the methodological framework of Arksey and O’Malley. The search will be done on PubMed, Scopus, and Web of Science for the identification of eligible studies. A grey literature search will also be performed. A two-phase screening and extraction of data will be done by two independent reviewers. Data extraction will be done on a pre-piloted data extraction form. The findings will be presented in tables, figures, and a narrative summary. The scoping review will highlight the state of the art, gaps in knowledge and provide directions for future research. Ethics and dissemination: This is a scoping review of primary studies and therefore ethical approval is not required. The report of the findings will be presented in line with the PRISMA reporting guidelines for scoping reviews (PRISMA-ScR). The results will be submitted to a peer-reviewed scientific journal for publication and presented at relevant conferences.

In this Cochrane Corner, we highlight the main findings of a Cochrane Review by Flumignan et al. entitled ‘Anticoagulants for people hospitalised with COVID‐19’ and discuss the implications of these findings for research and practice in South Africa. In particular, we underscore the need for additional, high‐quality, randomised controlled trials comparing different intensities of anticoagulation in patients with COVID‐19 illness. Individuals in the intensive care unit and those hospitalised with another illness who are incidentally found to be infected with SARS‐CoV‐2 should still only be treated with prophylactic‐dose low‐molecular‐weight heparin.

Oil storage tank farms are complex systems and the eventual failure of one of their components could affect the whole system. A risk assessment requires identifying the magnitude of the damage that can occur under certain load levels. Fragility curves for oil storage tanks with a floating roof are obtained in this work, to estimate the probability of exceeding a given damage state under wind loads. Steel tanks with height-diameter ratio between 0.20 and 0.60 designed with American Petroleum Institute standard 650 are analyzed. The loads are represented by wind-speed and the structural response of the tank is evaluated through computational simulations using finite element analyses. Damage is characterized by deformations in the geometry of the cylinder and wind girder. Damage levels are obtained using linear bifurcation analysis and geometric nonlinear analysis with imperfections, and loads are related to wind speed based on wind data of Patagonia in Argentina. The fragility curves are constructed by means of a log-normal distribution. The results allow establishing ranges of wind speeds for which the damage can affect the integrity of the tank. It is expected that the present results serve as the basis for the development of simplified models, so that a much larger tank database may be considered.

Abstract Objectives Low-and-middle-income countries (LMICs) bear a disproportionate burden of cervical cancer mortality. We aimed to identify what is currently known about barriers to cervical cancer screening among women in LMICs and propose remedial actions. Design This was a systematic review using Medical Subject Headings (MeSH) terms in Google Scholar, PubMed, Scopus, and Web of Science databases. We also contacted medical associations and universities for grey literature and checked reference lists of eligible articles for relevant literature published in English between 2010 and 2020. We summarized the findings using a descriptive narrative based on themes identified as levels of the social ecological model. Setting We included studies conducted in LMICs published in English between 2010 and 2020. Participants We included studies that reported on barriers to cervical cancer screening among women 15 years and older, eligible for cervical cancer screening. Results Seventy-nine articles met the inclusion criteria. We identified individual, cultural/traditional and religious, societal, health system, and structural barriers to screening. Lack of knowledge and awareness of cervical cancer in general and of screening were the most frequent individual level barriers. Cultural/traditional and religious barriers included prohibition of screening and unsupportive partners and families, while social barriers were largely driven by community misconceptions. Health system barriers included policy and programmatic factors, and structural barriers were related to geography, education and cost. Underlying reasons for these barriers included limited information about cervical cancer and screening as a preventive strategy, poorly resourced health systems that lacked policies or implemented them poorly, generalised limited access to health services, and gender norms that deprioritize the health needs of women. Conclusion A wide range of barriers to screening were identified across most LMICs. Urgent implementation of clear policies supported by health system capacity for implementation, community wide advocacy and information dissemination, strengthening of policies that support women’s health and gender equality, and targeted further research are needed to effectively address the inequitable burden of cervical cancer in LMICs.

Background: Delivery of safe and reliable healthcare to patients and the healthcare workforce shortage amidst growing demand has been major challenge to the healthcare system. Addressing this challenge calls for designing or redesigning of healthcare work system. Work system design which is usually associated with productivity in manufacturing offers a wide spectrum of applicability in addressing this challenge of healthcare system. Despite the availability of primary studies on work system design in healthcare, there are sparse published reviews in specific contexts. This scoping review explores the existing evidence to understand the state of the art of work system design in healthcare. Methods: The scoping review adopts the methodology of Joanna Briggs Institute for scoping review which is based on the methodological framework of Arksey and O’Malley. The search will be done on PubMed, Scopus, and Web of Science for the identification of eligible studies. A grey literature search will also be performed. A two-phase screening and extraction of data will be done by two independent reviewers. Data extraction will be done on a pre-piloted data extraction form. The findings will be presented in tables, figures, and a narrative summary. The scoping review will highlight the state of the art, gaps in knowledge and provide directions for future research. Ethics and dissemination: This is a scoping review of primary studies and therefore ethical approval is not required. The report of the findings will be presented in line with the PRISMA reporting guidelines for scoping reviews (PRISMA-ScR). The results will be submitted to a peer-reviewed scientific journal for publication and presented at relevant conferences.

BackgroundArtificial intelligence (AI) is a broad outlet of computer science aimed at constructing machines capable of simulating and performing tasks usually done by human beings. The aim of this scoping review is to map existing evidence on the use of AI in the delivery of medical care.MethodsWe searched PubMed and Scopus in March 2022, screened identified records for eligibility, assessed full texts of potentially eligible publications, and extracted data from included studies in duplicate, resolving differences through discussion, arbitration, and consensus. We then conducted a narrative synthesis of extracted data.ResultsSeveral AI methods have been used to detect, diagnose, classify, manage, treat, and monitor the prognosis of various health issues. These AI models have been used in various health conditions, including communicable diseases, non-communicable diseases, and mental health.ConclusionsPresently available evidence shows that AI models, predominantly deep learning, and machine learning, can significantly advance medical care delivery regarding the detection, diagnosis, management, and monitoring the prognosis of different illnesses.

The aim of this study was to identify key challenges of practice that departmental heads (DHs) face during their transition from a teacher to their DH role. The study was based on Bridges' transition theory. The researcher employed a qualitative research methodology and interviewed 15 DHs working in the Department of Basic Education's Tshwane South district. A thematic analysis of the collected data showed that the DHs experienced four main challenges during the transition process: negative change in teachers' attitudes and behaviours, a lack of management/leadership skills, a lack of subject knowledge and heavy workloads and time constraints. Based on the above findings, the researcher concluded that transitioning from teacher to DH is more difficult than meets the eye. These findings imply that policymakers, researchers, school principals and teachers should work together to minimise challenges and ensure a smooth transition to the DH role for newly appointed DHs.

Background: Delivery of safe and reliable healthcare to patients and the healthcare workforce shortage amidst growing demand has been major challenge to the healthcare system. Addressing this challenge calls for designing or redesigning of healthcare work system. Work system design which is usually associated with productivity in manufacturing offers a wide spectrum of applicability in addressing this challenge of healthcare system. Despite the availability of primary studies on work system design in healthcare, there are sparse published reviews in specific contexts. This scoping review explores the existing evidence to understand the state of the art of work system design in healthcare. Methods: The scoping review adopts the methodology of Joanna Briggs Institute for scoping review which is based on the methodological framework of Arksey and O’Malley. The search will be done on PubMed, Scopus, and Web of Science for the identification of eligible studies. A grey literature search will also be performed. A two-phase screening and extraction of data will be done by two independent reviewers. Data extraction will be done on a pre-piloted data extraction form. The findings will be presented in tables, figures, and a narrative summary. The scoping review will highlight the state of the art, gaps in knowledge and provide directions for future research. Ethics and dissemination: This is a scoping review of primary studies and therefore ethical approval is not required. The report of the findings will be presented in line with the PRISMA reporting guidelines for scoping reviews (PRISMA-ScR). The results will be submitted to a peer-reviewed scientific journal for publication and presented at relevant conferences.

Background: In 2021 the South African government launched a large COVID-19 immunization campaign with the goal of reaching more than 40 million individuals. Nonetheless, certain international largely internet-based surveys at the time showed a significant proportion of vaccine hesitancy in South Africa. This study aims to determine and co-create with local stakeholders a comprehensive understanding of vaccine hesitancy and opportunities to support the promotion of other COVID-19 health-promoting behaviours at community level. Methods: A mixed-methods multiple case-study design; informed by the socio-ecological model of behaviour change. Four socio-economically diverse communities across South Africa will be selected and data collection will take place concurrently through three iterative phases. Phase 1 will provide insights into community experiences of COVID-19 (response) through desktop mapping exercises, observations, in-depth interviews, and focus group discussions (FGDs) designed as expression sessions with local stakeholders. Phase 2 will explore the extent and drivers of community acceptance of COVID-19 vaccines. This phase will comprise a survey based on WHO’s Behavioural and Social Drivers of Vaccination tool as well as further FGDs with community members. Phase 3 will involve cross-case study syntheses and presentation of findings to national role-players. Discussion: This study will provide ground up, locally responsive, and timeous evidence on the factors influencing COVID-19 health-seeking behaviours to inform ongoing management and mitigation of COVID-19 in South Africa. It will also provide insights into the applicability of a novel vaccine hesitancy model in Africa.

Graves’ disease (GD) is the leading cause of hyperthyroidism and diffuse toxic goiter in iodine-sufficient geographical areas. GD is associated with classical manifestations such as ophthalmopathy and thyroid dermopathy, in addition to diffuse goiter, which may be the site of carcinomas, as a complication. Case report: A 52-year-old woman presented with goiter and symptoms compatible with hyperthyroidism, such as heat intolerance, weight loss, fatigue, increased sweat, tachycardia, fine tremors, increased intestinal transit, anxiety, emotional lability, insomnia, exophthalmos, and pretibial myxedema. A complementary investigation confirmed the diagnosis of hyperthyroidism (high free T4 and total T3 levels and low thyroid-stimulating hormone - TSH levels). Ultrasound images showed diffuse enlargement of the thyroid lobes by approximately 10 times and the presence of three thyroid nodules, one of which was larger than 2 cm with heterogeneous echogenicity and vascularization throughout the nodule; ultrasound- guided fine needle aspiration revealed cytology compatible with Bethesda IV; scintigraphy revealed a low uptake area (cold nodule) amid a diffuse high-uptake goiter. A thyroidectomy was performed, and the anatomical specimen diagnosis revealed papillary thyroid carcinoma in the right lobe, with adjacent parenchyma compatible with GD. Histopathological examination of the skin showed the presence of myxedema compatible with Graves’ dermopathy. The patient evolved with the normalization of TSH levels and a reduction of cutaneous manifestations. Conclusion: GD abnormalities may not be restricted to the classic clinical manifestations, and a careful investigation may reveal the coexistence of carcinomas.

The purpose of the study is to investigate and compare consumers' food safety perceptions in three Mediterranean countries (Greece, Italy, and Spain). A survey was carried out based on a structured questionnaire focusing on food safety-related issues concerning food characteristics, the labeling of systems implemented by food companies such as the Quality Management System and the Food Safety Management System, consumer trust in the food supply chain, and consumer illusion of food control. Information was collected from individuals located in those three countries (2,664 respondents), which share common characteristics. The results indicate that there is a significant heterogeneity in consumers' food safety perceptions in the three countries. The Spanish sample has the greatest level of trust in the supply chain in terms of food safety and the highest level of illusion of food control. The Italians evaluate the food characteristics and the QMS-FSMS's labeling higher than the Spanish and the Greeks. This multinational study brings to light the different types of food safety concerns of consumers from three Mediterranean countries.

We summarise a Cochrane review of qualitative evidence that explored parents’ views and practices around routine childhood vaccination, and provide implications for research and practice that are relevant to the South African (SA) context. Many public health interventions to encourage vaccination are informed by an assumption that vaccine hesitancy is due to a lack of knowledge or irrational forms of thinking. The findings from this review suggest that childhood vaccination views and practices are complex social processes that are shaped by multiple factors and carry a variety of meanings. As such, we suggest that biomedical approaches must be supplemented by more nuanced and sociopolitically informed strategies for enhancing and sustaining childhood vaccination practices in SA.

Significant progress has been made in vaccine development worldwide. This study examined the WHO African Region’s vaccine introduction trends from 2000 to 2022, excluding COVID-19 vaccines. We extracted data on vaccine introductions from the WHO/UNICEF joint reporting form for 17 vaccines. We examined the frequency and percentages of vaccine introductions from 2000 to 2022, as well as between two specific time periods (2000–2010 and 2011–2022). We analysed Gavi eligible and ineligible countries separately and used a Chi-squared test to determine if vaccine introductions differed significantly. Three vaccines have been introduced in all 47 countries within the region: hepatitis B (HepB), Haemophilus influenzae type b (Hib), and inactivated polio vaccine (IPV). Between 2011 and 2022, HepB, Hib, IPV, the second dose of measles-containing vaccine (MCV2), and pneumococcal conjugate vaccine (PCV) were the five most frequently introduced vaccines. Hepatitis A vaccine has only been introduced in Mauritius, while Japanese encephalitis vaccine has not been introduced in any African country. Between 2000–2010 and 2011–2022, a statistically significant rise in the number of vaccine introductions was noted (p < 0.001) with a significant positive association between Gavi eligibility and vaccine introductions (p < 0.001). Significant progress has been made in the introduction of new vaccines between 2000 and 2022 in the WHO African Region, with notable introductions between 2011 and 2022. Commitments from countries, and establishing the infrastructure required for effective implementation, remain crucial.

Vaccine-preventable diseases (VPDs) remain a significant public health challenge, particularly in sub-Saharan Africa. The high burden of VPDs in this region necessitates the need for continued investigation and intervention. This paper presents a bibliometric analysis of research on VPDs in children in sub-Saharan Africa in the last 10 years to capture the current state of research in the field. This study used a systematic search for articles published between 2013 and 2022 in the Web of Science Core Collection database and, subsequently, scientometric techniques for data analyses and interpretation. Annual scientific production of publications on the research of VPDs in children in sub-Saharan Africa increased from 2013 to 2019 and then gradually declined. South Africa had the most VPD studies (n = 148; 16.2%), followed by Nigeria, Ghana, Kenya, The Gambia, Malawi, Ethiopia, and the Republic of Congo. The Vaccine journal published the most. The Pan African Medical Journal was the most frequent destination journal based in Africa. The commonly studied pathogens were Streptococcus pneumoniae and Haemophilus influenzae. Research productivity increased exponentially in the pre-COVID era and declined in the past two years, so more VPD research in this region is needed.

Vaccine hesitancy is a phenomenon where individuals delay or refuse to take some or all vaccines. The objective of this study was to conduct a global bibliometric analysis of research productivity and identify country level indicators that could be associated with publications on vaccine hesitancy. We searched PubMed and Web of Science for publications from 1974 to 2019, and selected articles focused on behavioral and social aspects of vaccination. Data on country-level indicators were obtained from the World Bank. We used Spearman’s correlation and zero-inflated negative-binomial regression models to ascertain the association between country level indicators and the number of publications. We identified 4314 articles, with 1099 eligible for inclusion. The United States of America (461 publications, 41.9%), Canada (84 publications, 7.6%) and the United Kingdom (68 publications, 6.2%) had the highest number of publications. Although various country indicators had significant correlations with vaccine hesitancy publications, only gross domestic product (GDP) and gross national income (GNI) per capita were independent positive predictors of the number of publications. When the number of publications were standardized by GDP, the Gambia, Somalia and Malawi ranked highest in decreasing order. The United States, Canada and United Kingdom ranked highest (in that order) when standardized by current health expenditure. Overall, high-income countries were more productive in vaccine hesitancy research than low-and-middle-income countries. There is a need for more investment in research on vaccine hesitancy in low-and-middle-income countries.