Catholic University of South Sudan

Amidst global policy reforms including the 2024 amendments to the International Health Regulations (IHR) and the ongoing Pandemic Agreement negotiations, there is a renewed emphasis on sustainability, equity, and multisectoral coordination in global health security. However, the operationalization of sustainability in core assessment tools-such as the WHO Joint External Evaluation (JEE) and the WOAH Performance of Veterinary Services (PVS)-remains poorly defined and underdeveloped, particularly as they relate to low- and middle-income countries (LMICs). We conducted a qualitative study involving semi-structured interviews with 29 global experts across human, animal and environment health from both high and low/middle income countries affiliated with the One Health High-Level Expert Panel, the World Bank Pandemic Fund Technical Advisory Panel, and technical focal points from Quadripartite institutions. Using thematic analysis grounded in the Social Construction Framework and an adapted Schell et al. sustainability model, we explored how sustainability is conceptualized and measured across human, animal, and environmental health domains. Participants critiqued existing tools for framing sustainability narrowly, including their focus on short-term processes and compliance, rather than long-term outcomes, equity, or resilience. Sectoral and contextual differences emerged: human health experts emphasized workforce and financing; animal health experts stressed economic and institutional continuity; environmental health experts highlighted ecosystem resilience and intergenerational equity. LMIC respondents underscored the impact of donor dependency, weak local ownership, and limited transition planning. Several determinants of sustainability-such as financing, governance, workforce retention, and community engagement-are already measured in existing reporting tools but are not explicitly or coherently framed as sustainability indicators. We recommend that future iterations of JEE and PVS incorporate a clear definition of sustainability and explicitly integrate sustainability metrics, aligned with the revised IHR, the One Health Joint Plan of Action, relevant SDG targets and national planning cycles. Tools must also reflect sectoral and contextual nuances and integrate long-term monitoring frameworks that promote domestic accountability. In the field of One Health and GHS, strengthening the sustainability components of these tools is essential to build equitable and resilient health systems globally.

Cesarean birth (CB) rates are increasing globally, with a current prevalence of 21.1% and a projected prevalence of 28.5% by 2030. Conversely, assisted vaginal birth (AVB) rates are declining, with reported rates of less than 10% in low- and middle-income countries (LMICs) and 10%-15% in high-income countries (HICs). In some African countries, AVB rates are as low as <1%. Declining AVB rates are attributable to lack of appropriate skills, equipment, and trained personnel, especially in LMICs, fear of litigation, and misconceptions that CB is safer, paucity of local guidelines and policies encouraging AVB, and increasingly accessible, acceptable, and safer CB techniques, amongst others. Optimizing appropriate care and decision making around CB and mode of birth is now a public health priority, especially given the significantly higher morbidity and mortality associated with CB compared to vaginal birth. Increasing AVB rates can potentially reduce CB rates, therefore improving maternity safety. This paper reviews the current best evidence on AVB and makes recommendations for good practice, including indications and prerequisites for AVB, who to determine who is suitable for AVB, choice of instrument, sequential application of instrument, when to abandon AVB, analgesia, antibiotic prophylaxis and episiotomy for AVB, special situations such as fetal macrosomia, maternal viral infections, previous CB, and risks and benefits of AVB versus second stage CB. An AVB safety checklist is included to reduce the risk of complications. We conclude by recommending that all maternity care providers and skilled birth attendants, including obstetricians, obstetric trainees/residents, interns, and midwives, should be trained and competent to perform AVB, to potentially reduce the current CB epidemic and its associated higher mortality and morbidity.

Maridi County is an onchocerciasis-endemic area in South Sudan. Annual community-directed treatment with ivermectin (CDTi) was instituted in Maridi since the early 2000s, but with low coverage. In 2021, the CDTi programme was strengthened to a six-monthly programme. Additionally, the community-based vector control strategy "Slash and Clear" has been implemented since 2019 at the Maridi Dam, the only blackfly breeding site in the area. This study assessed the effect of these reinforced onchocerciasis elimination interventions on the Onchocerca volvulus seroprevalence among young children, an indicator of ongoing transmission. Baseline and follow-up serosurveys were conducted in Maridi in 2019 (prior to strengthening onchocerciasis elimination efforts) and 2023, respectively. During both surveys, children aged three to nine years were recruited from five study sites situated at different distances from the Maridi Dam. Ov16 antibodies were detected via rapid diagnostic tests (RDTs) using whole blood obtained by finger-pricking the participants. Baseline and follow-up Ov16 prevalence rates were calculated and compared. In 2019, the Ov16 seroprevalence among children aged three to nine years was 24.5% compared to 30.6% in 2023 (p=0.22). Both surveys found a particularly high Ov16 seroprevalence in the study site closest to the Maridi Dam (35.0% in 2019 and 44.0% in 2023, p=0.52). The Ov16 seroprevalence had a non-significant decreasing trend in the three-year-old children, from 12.5% (3/24) in 2019 to 8.8% (3/34) in 2023 (p=0.65). The persistent Ov16 RDT seropositivity among three-year-old children in 2023 indicates ongoing O. volvulus transmission. Therefore, further strengthening of the onchocerciasis elimination programme is required. The study highlights the utility of RDTs in monitoring onchocerciasis transmission in highly endemic settings.

No Abstract.

BackgroundSouth Sudan has one of the world’s poorest health indicators due to a fragile health system and a combination of socio-cultural, economic and political factors. This study was conducted to identify barriers to utilisation of institutional childbirth services in Rumbek North County.MethodsData were collected through 14 focus group discussions with 169 women and 45 men, and 18 key informant interviews with community leaders, staff working in health facilities, traditional birth attendants, and the staff of the County Health Department. Data were analysed using inductive content analysis.ResultsThe barriers to institutional childbirth were categorised under four main themes: 1) Issues related to access and lack of resources: long distance to health facilities, lack of transportation means, referral problems, flooding and poor roads, and payments in health facilities; 2) Issues related to the socio-cultural context and conflict: insecurity, influence of the husband, lack of birth preparedness, domestic chores of women, influence of culture; 3) Perceptions about pregnancy and childbirth: perceived benefit of institutional childbirth, low childbirth risk perception, and medicalisation of childbirth including birth being perceived to be natural, undesirable birth practices, privacy concerns, and fear of caesarean section; and 4) Perceptions about the quality of care: inadequate health facility infrastructure and perceived neglect during admission.ConclusionsMultiple factors hinder institutional childbirth in Rumbek North. Some of the factors such as insecurity and poor roads are outside the scope of the health sector and will require a multi-sectoral approach if childbirth services are to be made accessible to women. Detailed recommendations to increase utilisation of childbirth services in the county have been suggested.