Review Article
Infant and Child Mortality and Its Risk Factors in
Sub-Saharan Africa: The Contribution of Healthcare Delivery
Issue:
Volume 14, Issue 4, August 2026
Pages:
153-164
Received:
7 May 2026
Accepted:
8 June 2026
Published:
8 July 2026
DOI:
10.11648/j.sjph.20261404.11
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Abstract: Background. Infant and child mortality remains a key indicator of population health in sub-Saharan Africa (SSA), where the risk of death before age five is more than six times higher than in Europe. Biological, maternal, socio-economic and environmental factors interact with the organisation of healthcare delivery, whose impact on under-five mortality has not yet been comprehensively synthesised. This scoping review aimed to map the risk factors for under-five mortality documented in SSA between 2003 and 2023, with particular attention to components of healthcare delivery. Methods. A scoping review was conducted following the Arksey & O’Malley framework as updated by Levac et al., and aligned with the PRISMA-ScR guidelines and the JBI manual. The research question followed the PCC format, targeting infants (0 -11 months) and children under five. Four sources were searched (PubMed/MEDLINE, Web of Science, African Index Medicus, Google Scholar), complemented by grey literature. Double-blind screening (Rayyan) and standardised extraction were conducted by two independent reviewers. A structured narrative synthesis was performed. Results. Twenty-nine documents were retained (19 original studies and 10 contextual documents) covering Western, Eastern, Southern and Central Africa. Four groups of determinants emerged: (i) biological and perinatal factors (malaria, acute respiratory infections, diarrhoea, prematurity, perinatal asphyxia, sickle-cell disease, breastfeeding); (ii) maternal and obstetric factors (maternal education, parity, antenatal care, three-delays model); (iii) socio-economic and environmental determinants (poverty, rural residence, WASH); (iv) healthcare delivery (geographical and financial access, quality of care, continuum of care). User-fee exemption policies and Universal Health Coverage have increased service use but may widen pro-rich inequalities in the absence of targeted measures and parallel quality improvements. Conclusion. Infant and child mortality in SSA is multifactorial and socially structured. In Senegal, the effectiveness of free-care policies depends on improving quality of care, addressing socio-environmental determinants, and pursuing an explicit territorial and social equity strategy. Rigorous impact evaluations are needed to inform future reforms.
Abstract: Background. Infant and child mortality remains a key indicator of population health in sub-Saharan Africa (SSA), where the risk of death before age five is more than six times higher than in Europe. Biological, maternal, socio-economic and environmental factors interact with the organisation of healthcare delivery, whose impact on under-five mortal...
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Research Article
On Some Curiosities of Tumor Immunotherapy
Moses Schorr-Tschudnowski*
Issue:
Volume 14, Issue 4, August 2026
Pages:
165-170
Received:
3 June 2026
Accepted:
17 June 2026
Published:
17 July 2026
DOI:
10.11648/j.sjph.20261404.12
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Abstract: This article discusses unresolved questions and contradictions in modern tumor immunotherapy, focusing specifically on the state of the immune system, checkpoint inhibitors (CPIs), chemo-immunotherapy, and the significance of systemic immune system activation. The discussion begins with the observation that, despite significant progress, the clinical success of CPI therapies remains severely limited, and the individual baseline status of the immune system is rarely taken into account in oncological immunotherapy. Drawing on the authors' own clinical experience, it is argued that robust immune system activation via PAMP-based therapy—combined with low-dose chemotherapy and reduced CPI dosages—can lead to improved tumor control while simultaneously reducing toxicity. Particular attention is paid to the role of natural killer (NK) cells, which, in the authors' view, is underestimated in current immuno-oncology. Furthermore, the article explores the interrelationships between immune status, body temperature, the tumor microenvironment, tumor mutation rates, and therapeutic efficacy. The article advocates for an individualized immuno-oncological treatment approach that systematically evaluates and specifically modulates the functional state of the immune system, thereby enhancing the effectiveness of existing immunotherapies. Such a post-treatment strategy has the potential to improve relapse prevention, long-term survival, and cure rates in cancer patients.
Abstract: This article discusses unresolved questions and contradictions in modern tumor immunotherapy, focusing specifically on the state of the immune system, checkpoint inhibitors (CPIs), chemo-immunotherapy, and the significance of systemic immune system activation. The discussion begins with the observation that, despite significant progress, the clinic...
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