Cause Of Under-five Mortality Research Articles

A landscape analysis of the key global stakeholders working on interventions around preterm birth that improve neonatal mortality and morbidity.

Background Over a decade after the landmark ‘Born too Soon’ report, preterm birth remains a leading cause of under-five mortality. Addressing its global burden is key to meeting United Nations Sustainable Development Goal 3; to end preventable deaths of newborns and children by 2030. We conducted a landscape analysis to explore the types of organisations addressing preterm birth, highlight the scope of interventions and initiatives, and identify gaps and opportunities for shared learning. Methods We combined google searches with citation searching, and opinion of experts in child health, to identify the major global stakeholders working to improve outcomes of preterm birth, with evidence of activity since 2012. We conducted a thematic analysis and narrative synthesis of key stakeholder websites to categorise their functions and priorities, and the types of interventions they were implementing. Results A total of 38 key organisations and 28 interventions were derived from the searches. Organisations were thematically grouped into knowledge sharing (n = 15), knowledge production (n = 12), funders (n = 6), legislation and advocacy (n = 15), implementer (n = 14) and network organisations (n = 11). Interventions covered a wide scope of functions including education (n = 11), research (n = 10), resources (n = 7), legislation (n = 2), and health systems (n = 2) interventions. The majority of global stakeholders were funded from and headquartered within high-income settings. Discussion There is scope for significant learning across global stakeholders, in particular to support carers in low-resource settings. Further opportunities for impact include a need for community-based initiatives and whole systems approach that address the long-term needs of preterm babies and their families, particularly in low- and middle-income countries (LMIC) settings. Greater knowledge production and funding from LMICs is needed to create contextually relevant resources and address implementation challenges.

Risk Factor of Paediatric Community-Acquired Pneumonia in Wajo Regency, Indonesia

Background: Pneumonia is the second highest cause of under-five mortality in Indonesia. This study aimed to analyse the risk factors for pneumonia among under-fives in Wajo Regency. Methodology: This type of research was a quantitative study using a case-control study design. The population was all children in the working areas of Salewangeng Health Centre, Penrang Health Centre, and Belawa Health Centre. The sample size was 224 children consisting of 112 cases and 112 controls. The odds ratio test and logistic regression were used to evaluate the data. Results: Risk factors associated with pneumonia were under-five nutritional status (OR=3.563; 95%CI=1.57-8.65; p=0.0008), indoor smoke exposure (OR=5.852; 95%CI=2.88-12.36; p=0.000), maternal age (OR=2.575; 95%CI=1.45-4.58; p=0.0005), and number of children in the family (OR=3.133; 95%CI=1.65-6.05; p=0.0002). Conclusions: The most influential risk factor for under-five pneumonia was indoor smoke exposure. The probability of pneumonia among under-fives who were exposed to indoor smoke, had a maternal age 30 years, and had poor nutritional status was 89.8%. It is recommended for the community to reduce smoking activities in the house and reduce the use of mosquito coils to prevent smoke exposure to children at home.

Causes of infant and under-five (under-5) morbidity and mortality among hospitalized patients in Southern Nigeria: A hospital based study.

Rate and pattern of under-five mortality is a reflection of a society's healthcare system and quality of life. This study is aimed at reviewing the causes of infants and under-five morbidity and mortality in Calabar, Southern Nigeria. This study used retrospective descriptive cross-sectional design. We did a retrospective collation of data on under-five morbidity and mortality from 2012 to 2017 of under-five patients admitted or died while in admission in University of Calabar Teaching Hospital. The causes of morbidity and mortality were reported based on International Classification of Diseases 10 (ICD-10). The morbidity, mortality and fatality rates were computed. A total of 11,416 under-five admissions and 391 deaths were recorded within the study period giving a fatality rate of 3.4%. Age 1-4 years category represented 50.5% of the admissions while infants (<1 year) constitute majority of the deaths (64.7%). There were 5652 infant admissions and 253 infant deaths giving fatality rate of 4.5% within the study period. Males constituted majority (55.8%) of under-five morbidity whereas females constituted majority (51.2%) of the deaths. Conditions originating from perinatal period; and infectious and parasitic diseases were the leading broad cause of under-five mortality. Specific disease analysis showed sepsis/septicemia; congenital infectious and parasitic diseases; slow fetal growth, malnutrition and short gestation as the chief causes of both infant and under-five mortality. The leading causes of under-five deaths in the studied population are amenable. Improved healthcare and antenatal will be of immense benefit.

Determinants of Under-five Mortality Due to Pneumonia: A Negative Binomial Regression Analysis

Pneumonia is one of the main causes of under-five mortality in Indonesia. In under-fives, pneumoniais the number one killer in the world. Meanwhile, in Indonesia, it ranks second after diarrhea. Onaverage, the disease affects half a million children a year. This study aims to identify and analyze therisk of variables that affect the number of under-five mortality due to pneumonia in Indonesia in 2021.The novelty of this research focuses on the macro variables used, making it easier for policy makers tomake decisions. The research method used is negative binomial regression. The results showed that thehighest number of under-five mortality due to pneumonia was in Central Java Province. Meanwhile, thelowest was in Jambi Province, South Sumatra, Riau Islands, DKI Jakarta, North Kalimantan, SoutheastSulawesi, and Papua. The per capita income significantly reduces the number of under-five mortalitydue to pneumonia, while the number of under-fives with severe pneumonia significantly reduces thenumber of under-five mortality due to pneumonia in Indonesia. The government needs attention toreduce the death rate of children under five due to pneumonia by providing social protection in thefields of health and education for underprivileged communities.

Delay in healthcare seeking for young children with severe pneumonia at Mulago National Referral Hospital, Uganda: A mixed methods cross-sectional study.

Globally, pneumonia is the leading infectious cause of under-five mortality, and this can be reduced by prompt healthcare seeking. Data on factors associated with delays in seeking care for children with pneumonia in Uganda is scarce. The study aimed to determine the prevalence, factors associated with delay, barriers, and facilitators of prompt healthcare seeking for children under five years of age with severe pneumonia attending Mulago National Referral Hospital (MNRH) Uganda. A mixed methods cross-sectional study was conducted among 384 caregivers of children with severe pneumonia at MNRH. Quantitative data was collected using interviewer-administered structured questionnaires and qualitative data through focus group discussions with caregivers. Descriptive statistics were used to determine the prevalence of delay in care seeking. Logistic regression analysis was used to determine the factors that were independently associated with delay in seeking healthcare. Content thematic analysis was used to analyze for barriers and facilitators of prompt healthcare seeking. The prevalence of delay in seeking healthcare was 53.6% (95% CI: 48.6-58.6). Long distance to a hospital (AOR = 1.94, 95% CI 1.22-3.01, p value = 0.003), first seeking care elsewhere (AOR = 3.33, 95% CI 1.85-6.01, p value = 0.001), and monthly income ≤100,000 UGX (28 USD) (AOR = 2.27,95% CI 1.33-3.86, p value = 0.003) were independently associated with delay in seeking healthcare. Limited knowledge of symptoms, delayed referrals, self-medication, and low level of education were barriers to prompt healthcare seeking while recognition of symptoms of severe illness in the child, support from spouses, and availability of money for transport were key facilitators of early healthcare seeking. This study showed that more than half of the caregivers delayed seeking healthcare for their children with pneumonia symptoms. Caregivers who first sought care elsewhere, lived more than 5 km from the hospital, and earned less than 28 USD per month were more likely to delay seeking healthcare for their children with severe pneumonia. Limited knowledge of symptoms of pneumonia, self-medication, and delayed referral hindered prompt care-seeking. Key facilitators of prompt care-seeking were accessibility to health workers, support from spouses, and recognition of symptoms of severe illness in children. There is a need for programs that educate caregivers about pneumonia symptoms, in children less than five years.

AMBA CUP: Ensuring Accuracy in Measurement of Volume of Water for Salt Sugar Solution or Oral Rehydration Solution Preparation in Diarrhea Management.

Diarrhea remains a major cause of under-five mortality globally. In 2016, it accounted for 8% of under-five mortality worldwide. Most of these deaths occur in developing countries. Fluid replacement using Oral Rehydration Solution (ORS) or Salt Sugar Solution (SSS), has been the mainstay of diarrhea management. Gaps in knowledge and practice regarding the preparation of these solutions have been identified by various researchers. One challenge encountered by healthcare providers and caregivers of under-five children has been lack of a standard, easy to clean cup for measurement of accurate volume of water for ORS or SSS preparation. Soft drink bottles, which are currently being used, are difficult to clean because of their narrow necks. More so, the size and volume of these bottles change so often that non-numerate caregivers get easily confused. The aim of this paper is to introduce the AMBA CUP, an easy-to-clean cup that can be used to accurately measure one litre of water for SSS or ORS preparation.

Incidence and predictors of mortality among neonates admitted with perinatal asphyxia at west Oromia tertiary hospitals, Ethiopia, 2022

BackgroundPerinatal asphyxia is one of the preventable and treatable causes of neonatal mortality. However, it is the fifth-largest cause of under-five mortality. Even with management advancements, it remains one of the key public health issues in underdeveloped countries, including Ethiopia. Comorbidities are also understated; therefore, adequate information regarding the incidence of death and its predictors is required.MethodsA four-year retrospective follow-up study was conducted from October 3 to November 2, 2022. From a total sample size, of 655, 616 data were collected by nurse through follow-up reviews charts using Kobo Toolbox software. The data was exported to STATA Version 14 for analysis. The Cox proportional hazard assumption was checked, and the model for the data was selected using Akaike Information Criteria. Finally, an adjusted hazard ratio with 95% CI was computed, and variables with a P-value < 0.05 in the multivariable analysis were taken as significant predictors of death.ResultThe overall incidence of mortality was 38.86/1000 (95% CI: 33.85–44.60). The median time of follow-up was 15 days (95% CI: 14–20). The proportion of deaths was 202 (32.79%, 95% CI: 29.18–36.61) among neonates with perinatal asphyxia. While the distance from health facility > 10 km is (AHR: 2.25; 95% CI: 1.60–3.17), direct oxygen (AHR: 1.83; 95% CI: 1.35–2.48), APGAR score (Appearance, Pulse, Grimace, Activity, and Respiration) < 3 at the fifth minute (AHR: 2.63; 95% CI: 1.03–6.73), prolonged rupture of membrane (AHR: 1.41; 95% CI: 1.02–1.94), and stage III hypoxic ischemic encephalopathy (AHR: 2.02; 95% CI: 1.18–3.47) were predictors of mortality among neonates with perinatal asphyxia.ConclusionAccording to this study’s findings, high neonatal mortality due to perinatal asphyxia requires proper intervention regarding membrane rupture, APGAR score (Appearance, Pulse, Grimace, Activity, and Respiration), oxygen use, stage III hypoxic-ischemic encephalopathy, and residence distance.

Child drowning prevention: GPS and LoRa based emergency alert system

UNICEF recently published in the "Country Office Report 2021" about the mortality of children in Bangladesh, "Every day, 30 children die from drowning – Bangladesh's second leading cause of under-five mortality. Drowning is preventable, and most cases occur within a child's home community." Bangladesh is a country of rivers, which means Bangladesh called a riverine country located in South Asia. The Center for Injury Prevention and Research conducted a survey, Around 19000 people of (all types of ages) drown every year in Bangladesh. Among them, 14500 which mean 77% are children. In our research, the emergency alert system is designed to be cost-effective and user-friendly for village communities in Bangladesh. The system is divided into two components: the kid is equipped with the transmitter, and the receiver is placed at home. The transmitter and receiver both use a LoRa transmission module that can communicate accurately within a 300-meter range (coverage up to 10 Kilometers) and can transmit 256 bytes of data. The transmitter collects geolocation data using a GPS module and sends the data to the receiver using the LoRa module. The receiver module is configured by setting up the geolocation of risky places. The receiver will send SMS or buzzing the receiver to alert the parents when the transmitter or kid is nearby risky places. The Equirectangular approximation method calculates the distance between children's positions from risky areas. Additionally, the transmitter and receiver may communicate encrypted messages using AES 128-bit symmetric encryption technology compatible with Arduino Nano controller. Thus, our emergency alert system can save children from drowning in the home environment.

Challenges and recommendations for addressing under-five pneumonia morbidity and mortality in Nigeria.

Pneumonia is a severe infection and one of the most common causes of mortality among children under five years of age, when not appropriately managed. Infection of the lungs by bacteria, viruses, or fungi and consequent inflammation may lead to cough and difficult breathing. Some of the key predisposing factors are malnutrition and air pollution. WHO reports that Africa has the highest burden of global child mortality, and 16% of all deaths in pneumonia, were children under five years of age in 2016. This study aimed to explore how health providers perceive pneumonia as a cause of under-five mortality in Nigeria. A qualitative study design with in-depth interviews and focus group discussions was used to explore and understand nurses and pediatricians' views regarding the pneumonia situation, vaccinations, and preventive suggestions to reduce under five pneumonia deaths in Nigeria. Two themes and four categories emerged: participant's anxiety over the situation, their views on impediments, current policies and strategies, and suggestions on addressing severe pneumonia. The results from this study highlight contextual issues playing major roles in pneumonia mortality among children in Nigeria, which will need approaches on several levels to address them.

Maternal occupational risk factors and preterm birth: Protocol for a systematic review and meta-analysis.

Preterm birth, which accounts for 33.1% of neonatal death globally, is the main cause of under-five mortality. A growing number of studies indicate that occupational risk factors during pregnancy are linked to an increased likelihood of poor pregnancy outcomes. The effect of physical occupational risks on preterm birth has received very little attention, and previous reviews have produced inconclusive results. This systematic review aims to update the evidence on the relationship between maternal physical occupational risks and preterm birth. We will search electronic databases including Ovid Medline, Embase, Emcare, CINAHL, Scopus, and Web of science to find peer-reviewed studies examining the relationship between six common maternal physical occupational risks (heavy lifting, prolonged standing, heavy physical exertion, long working hours, shift work, and whole-body vibrations) and preterm birth. Articles published in English after 1 January 2000 will be included without geographic restrictions. Two reviewers will screen titles and abstracts independently, and then select full-text articles that meet inclusion criteria. Methodological quality of the included studies will be evaluated using the Joanna Briggs Institute (JBI) critical appraisal method. The quality of evidence across each exposure and the outcome of interest will be examined by using the GRADE (Grade of Recommendations, Assessment, Development, Evaluation) method. Accordingly, a high level of evidence will lead to "strong recommendations". A moderate level of evidence will lead to "practice considerations". For all evidence levels below moderate, the message will be "not enough evidence from the scientific literature to guide policymakers, clinicians, and patients. If data permits, a meta-analysis will be conducted using Stata Software. In case where meta-analysis is not possible, we will perform a formal narrative synthesis. Evidence suggests that preterm birth is linked to a number of maternal occupational risk factors. This systematic review will update, compile, and critically review the evidence on the effect of maternal physical occupational risk on preterm birth. This systematic review will provide guidance to support decision-makers including maternal and child health services, other health care providers, and government policy agencies. PROSPERO registration number: CRD42022357045.

A landscape analysis of the key global stakeholders working on interventions around preterm birth that improve neonatal mortality and morbidity.

Background Over a decade after the landmark ‘Born too Soon’ report, preterm birth remains a leading cause of under-five mortality. Addressing its global burden is key to meeting United Nations Sustainable Development Goal 3; to end preventable deaths of newborns and children by 2030. We conducted a landscape analysis to explore the types of organisations addressing preterm birth, highlight the scope of interventions and initiatives, and identify gaps and opportunities for shared learning. Methods We combined google searches with citation searching, and opinion of experts in child health, to identify the major global stakeholders working to improve outcomes of preterm birth, with evidence of activity since 2012. We conducted a thematic analysis and narrative synthesis of key stakeholder websites to categorise their functions and priorities, and the types of interventions they were implementing. Results A total of 38 key organisations and 28 interventions were derived from the searches. Organisations were thematically grouped into knowledge sharing (n = 15), knowledge production (n = 12), funders (n = 6), legislation and advocacy (n = 15), implementer (n = 14) and network organisations (n = 11). Interventions covered a wide scope of functions including education (n = 11), research (n = 10), resources (n = 7), legislation (n = 2), and health systems (n = 2) interventions. The majority of global stakeholders were funded from and headquartered within high-income settings. Discussion There is scope for significant learning across global stakeholders, in particular to support carers in low-resource settings. Further opportunities for impact include a need for community-based initiatives and whole systems approach that address the long-term needs of preterm babies and their families, particularly in low- and middle-income countries (LMIC) settings. Greater knowledge production and funding from LMICs is needed to create contextually relevant resources and address implementation challenges.

Correlation between fine particulate matter air pollution and under-five children mortality in Indonesia: A secondary data analysis of WHO Global Health Observatory

Background: Fine particulate matter (PM2.5) is an environmental factor contributing to the death rate. However, few studies have demonstrated the association between PM2.5 and the under-five mortality rate. Objective: To determine the correlation between PM2.5 and under-five children mortality in Indonesia. Methods: A secondary data analysis of the WHO Global Health Observatory on Environmental Pollution and Children Mortality during 2012-2016 was conducted. The environmental pollution was measured by PM2.5 levels (μg/m3) in rural, urban, and both areas. Mortality data were categorized by specific causes—meningitis/encephalitis, acute lower respiratory infection, diarrhoeal diseases, tetanus, prematurity, birth asphyxia, and congenital anomalies. Data were analyzed using Mann-Whitney and Spearman correlations. Results: The PM2.5 total concentration in urban areas was greater than in rural areas for four years (18.4±1.19 vs. 15.4±1.1, p = 0.016). Prematurity, acute lower respiratory infection, and birth asphyxia were the leading causes of under-five mortality. The PM2.5concentration in urban and rural areas was significantly associated with an acute lower respiratory infection, tetanus, prematurity, birth asphyxia, and congenital anomalies (p &lt;0.05). Additionally, the PM2.5 concentration was negatively correlated with tetanus, prematurity, birth asphyxia, and congenital anomalies (p &lt;0.001; r = -0.8, -0.8, -0.82, -0.83, respectively). Conclusion: PM2.5 air pollution was correlated with tetanus, prematurity, birth asphyxia, and congenital anomalies from 2012-2016 in Indonesia. Further action is needed to handle the sources of air pollution contamination to preventing under-five mortality in the community.

Prevalence and risk factors of diarrhea among children less than five years of age in the rural suburbs of Dire Dawa, Eastern Ethiopia; Robust Poisson Regression Analysis.

Diarrhea is the second leading cause of under-five mortality in Ethiopia. Information on the prevalence and the impacting factors of diarrhea in the rural suburbs of Dire Dawa is inadequate. This study was aimed at determining risk factors of diarrhea among children less than five years of age in the rural suburbs of Dire Dawa, eastern Ethiopia. A cross-sectional study was conducted from 02 May 2018, to 31 May 2018. The required 1146 children for this study were selected from the rural suburbs of Dire Dawa using multi-stage sampling. Both bi-variable and multivariable Robust Poisson regressions were used for identifying the risk factors. Explanatory variables with a p-value < 0.05 were considered as independently associated with diarrhea. The prevalence of diarrhea among the children was 23% (95% CI: 20.7 - 25.4). The type of house floor (aPR [adjusted prevalence ratio] = 0.89, 95% CI: 0.84 - 0.95) and sharing latrine with neighbours (aPR = 1.18, 95% CI: 1.09 - 1.26) were the significant factors associated with childhood diarrhea. Earthen house floor and shared use of latrine were the risk factors associated with childhood diarrhea. Hence, improving the house floor condition and construction of private latrine together with health education are recommended.

Determinant of ARI Incident in Toddlers in The Working Area of Tomia Health Center Wakatobi Regency

Infections in the upper respiratory tract are the cause of under-five mortality and are also a crucial health problem in Indonesia, the main cause in the Tomia Health Center area which every year has increased, namely in 2018 the prevalence of toddler ARI cases by 9,4%, in 2019 by 12,8% while in 2020 increased to 17,0%. The motivation behind the review is to discover the determinant of ARI events in toddlers in the Working Area of Tomia Health Center Wakatobi Regency. This kind of examination is an insightful study with a Cross-Sectional Study plan. The review populace was all moms who had toddlers in the Tomia Health Center Work Area as numerous as 705 people with a sample number of 88 toddlers taken proportionally random sampling. The analysis method uses the Chi-Square test. The results of the study with Chi-Square test showed that the ventilation variables of the house obtained values (X2calculated= 27.381 and = 0.581), occupancy density (X2count= 27.929 and = 0.586) air pollution in the house (X2count= 22,863 and = 0.533) and floor type (X2count= 19.939 and = 0.499). The conclusion pf this study that there is a relationship between home ventilation, occupancy density, air contamination in the house and the kind of floor with the rate of ARI in toddlers in the Tomia Health Center Work Area. It is recommended to the Tomia Health Center to further improve counselling related to the importance of a health-qualified home environment.

Effectiveness of 13-valent pneumococcal conjugate vaccine on radiological primary end-point pneumonia among cases of severe community acquired pneumonia in children: A prospective multi-site hospital-based test-negative study in Northern India.

Community acquired pneumonia (CAP) is a leading cause of under-five mortality in India and Streptococcus pneumoniae is the main bacterial pathogen for it. Pneumococcal Conjugate Vaccine 13 (PCV13) has been introduced in a phased manner, in the national immunization program of India since 2017/2018. The primary objective of this study was to evaluate the effectiveness of PCV13 on chest radiograph (CXR)-confirmed pneumonia, in children hospitalized with WHO-defined severe CAP. This prospective, multi-site test-negative study was conducted in a hospital-network situated in three districts of Northern India where PCV13 had been introduced. Children aged 2-23 months, hospitalized with severe CAP and with interpretable CXR were included after parental consent. Clinical data was extracted from hospital records. CXRs were interpreted by a panel of three independent blinded trained radiologists. Exposure to PCV13 was defined as ≥2 doses of PCV13 in children aged ≤ 12 months and ≥ 1 dose(s) in children > 12 months of age. Our outcome measures were CXR finding of primary endpoint pneumonia with or without other infiltrates (PEP±OI); vaccine effectiveness (VE) and hospital mortality. From 1st June 2017-30th April 2021, among 2711 children included, 678 (25.0%) were exposed to PCV1. CXR positive for PEP±OI on CXR was found in 579 (21.4%), of which 103 (17.8%) were exposed to PCV. Adjusted odds ratio (AOR) for PEP±OI among the exposed group was 0.69 (95% CI, 0.54-0.89, p = 0.004). Adjusted VE was 31.0% (95% CI: 11.0-44.0) for PEP±OI. AOR for hospital mortality with PEP±OI was 2.65 (95% CI: 1.27-5.53, p = 0.01). In severe CAP, children exposed to PCV13 had significantly reduced odds of having PEP±OI. Since PEP±OI had increased odds of hospital mortality due to CAP, countrywide coverage with PCV13 is an essential priority.

Under age five children survival times in Nigeria: a Bayesian spatial modeling approach

BackgroundNigeria is among the top five countries in the world with the highest under-five mortality rates. In addition to the general leading causes of under-five mortality, studies have shown that disparity in sociocultural values and practices across ethnic groups in Nigeria influence child survival, thus there is a need for scientific validation. This study quantified the survival probabilities and the impact of socioeconomic and demographic factors, proximate and biological determinants, and environmental factors on the risk of under-five mortality in Nigeria.MethodsThe Kaplan-Meier survival curve, Nelson Aalen hazard curve, and components survival probabilities were estimated. The Exponential, Gamma, Log-normal, Weibull, and Cox hazard models in a Bayesian mixed effect hierarchical hazard modeling framework with spatial components were considered, and the Deviance and Watanabe Akaike information criteria were used to select the best model for inference. A 5% level of significance was assumed throughout this work. The 2018 Nigeria Demographic and Health Survey dataset was used, and the outcome variable was the time between birth and death or birth and the date of interview for children who were alive on the day of the interview.ResultsFindings show that the probability of a child dying within the first two months is 0.04, and the probability of a boy child dying before attaining age five is 0.106, while a girl child is 0.094 probability. Gender, maternal education, household wealth status, source of water and toilet facility, residence, mass media, frequency of antenatal and postnatal visits, marital status, place of delivery, multiple births, who decide healthcare use, use of bednet are significant risk factors of child mortality in Nigeria. The mortality risk is high among the maternal age group below 24 and above 44years, and birth weight below 2.5Kg and above 4.5Kg. The under-five mortality risk is severe in Kebbi, Kaduna, Jigawa, Adamawa, Gombe, Kano, Kogi, Nasarawa, Plateau, and Sokoto states in Nigeria.ConclusionThis study accentuates the need for special attention for the first two months after childbirth as it is the age group with the highest expected mortality. A practicable way to minimize death in the early life of children is to improve maternal healthcare service, promote maternal education, encourage delivery in healthcare facilities, positive parental attitude to support multiple births, poverty alleviation programs for the less privileged, and a prioritized intervention to Northern Nigeria.

Malaria among under-five children in Ethiopia: a systematic review and meta-analysis

BackgroundGlobally, malaria is among the leading cause of under-five mortality and morbidity. Despite various malaria elimination strategies being implemented in the last decades, malaria remains a major public health concern, particularly in tropical and sub-tropical regions. Furthermore, there have been limited and inconclusive studies in Ethiopia to generate information for action towards malaria in under-five children. Additionally, there is a considerable disparity between the results of the existing studies. Therefore, the pooled estimate from this study will provide a more conclusive result to take evidence-based interventional measures against under-five malaria.MethodsThe protocol of this review is registered at PROSPERO with registration number CRD42020157886. All appropriate databases and grey literature were searched to find relevant articles. Studies reporting the prevalence or risk factors of malaria among under-five children were included. The quality of each study was assessed using the Newcastle–Ottawa Quality Assessment Scale (NOS). Data was extracted using Microsoft Excel 2016 and analysis was done using STATA 16.0 statistical software. The pooled prevalence and its associated factors of malaria were determined using a random effect model. Heterogeneity between studies was assessed using the Cochrane Q-test statistics and I2 test. Furthermore, publication bias was checked by the visual inspection of the funnel plot and using Egger’s and Begg’s statistical tests.ResultsTwelve studies with 34,842 under-five children were included. The pooled prevalence of under-five malaria was 22.03% (95% CI 12.25%, 31.80%). Lack of insecticide-treated mosquito net utilization (AOR: 5.67, 95% CI 3.6, 7.74), poor knowledge of child caretakers towards malaria transmission (AOR: 2.79, 95% CI 1.70, 3.89), and living near mosquito breeding sites (AOR: 5.05, 95% CI 2.92, 7.19) were risk factors of under-five malaria.ConclusionMore than one in five children aged under five years were infected with malaria. This suggests the rate of under-five malaria is far off the 2030 national malaria elimination programme of Ethiopia. The Government should strengthen malaria control strategies such as disseminating insecticide-treated mosquito nets (ITNs), advocating the utilization of ITNs, and raising community awareness regarding malaria transmission.

Prevalence and associated risk factors of preterm birth among neonates in referral hospitals of Amhara Region, Ethiopia.

IntroductionPreterm birth (PTB) is the largest direct cause of neonatal mortality and the second leading cause of under-five mortality following pneumonia. Although there are studies conducted before, the magnitude of PTB remains a major issue in most developing countries including Ethiopia. Therefore, this study aims to assess the prevalence and associated factors of premature birth among newborns delivered in Amhara Region Referral Hospitals, Northern Ethiopia.MethodsA hospital-based cross-sectional study was undertaken from February to April 2020. A systematic sampling technique was used to select 482 mother-newborn pairs. The data were collected by interviewing the mothers and reviewing their charts using a structured and pretested questionnaire. The outcome variable was preterm birth. Data were entered using Epi-data version 4.6 and then analyzed using STATA software (version 14). Bivariable and multivariable logistic regression analyses were done to determine the risk factors associated with premature birth.ResultsIn this study, the prevalence of premature birth was 11.41% (95% CI: 8.9, 14.6%). In multivariable logistic regression model; maternal age < 20 years (Adjusted odds ratio (AOR) = 7.8: 95% CI 2.3–26), preeclampsia (AOR = 5: 95% CI 2.3–11), premature rupture of membrane (AOR = 3.9: 95%CI 1.6–9.0), chronic medical illness (AOR = 4.6:95% CI2.1–10), and history of stillbirth (AOR = 2.7: 95% CI 1.1–7.3) were significantly associated with preterm birth.ConclusionThe study indicates preterm birth is a major public health problem among newborns delivered in Amhara region referral hospitals. The risk factors associated with preterm birth are maternal age <20 years, preeclampsia, premature rupture of membranes, chronic medical illness, and history of stillbirth. Therefore, public health interventions have to be made to reduce the burden of prematurity through early detection and management of preeclampsia, premature rupture of membranes, and chronic medical illness. Obstetric care providers should give due attention to women with an age of <20 years and a history of stillbirth.

Impact of preventive and early treatment of childhood pneumonia and diarrhea in Ethiopia, analysis from Health Management Information System (HMIS) report 2010 -2016

Background: In Ethiopia mortality in children younger than five years it has dropped from 202 in 1990 to 55 in 2019 (EDHS 2019). Pneumonia and diarrhea are the two leading causes of under-five mortality. They have overlapping risk factors, such as poverty, undernutrition, and poor hygiene. Ethiopia introduced Integrated Community Case management (ICCM) is strategy to treat sick children in communities. Pneumococcal Conjugate vaccine was introduced in 2010, and Rotavirus vaccine was in 2013.This research was conducted to assess the changes in morbidity and mortality in children due to pneumonia and diarrhea based on HMIS data. Methodology: Diarrhea and pneumonia morbidity, admission, and mortality data of under five children were extracted from 2002/09 EFY to 2008/16 GC, annual Federal Ministry of Health and Health related indicators bulletin. Proportion of morbidity, admission, mortality, and change in percentage analyzed and compared using significant test. Results: Morbidity due to pneumonia to total under five morbidity increased from 2.6% to 8.7%, and that of diarrhea from 2.3% to 11.8% in six years (2010 to 2016) p-0.000. Admission due to pneumonia decreased from 5% to 4.5%, (10% reduction), p-0.009 and that of diarrhea 3.4%, to 1.3%, (63% reduction), p-0.000. Mortality due pneumonia decreased from 2.7%, to 1.4 %, (48% reduction), p-0.113, that of diarrhea decreased from 1.9% to 0.9%, (53% reduction), p-0.42. The change in morbidity and admission were significant, but that of mortality was not significant. Conclusion: The increase in morbidity of pneumonia and diarrhea might be due to increase in health service utilization. The decline in admission and mortality of both diseases showed that introduction of new vaccines of, Rota, and early treatment in health posts using ICCM algorisms, have significant contribution. Standard quality treatment, prevention by improving immunization quality and coverage, maximum utilization of health service, is necessary to further decrease, admission and mortality.

Prevalence of Enteropathogenic Escherichia coli and Rotavirus Antigen among Diarrheic Children Attending Selected Hospitals in Abeokuta, Nigeria: A Comparative Study

Background: Diarrheal infections are one of the leading causes of sickness and death all over the world. It is the second-most common cause of under-five mortality, accounting for over half a million deaths annually. In Abeokuta, the etiology of diarrheagenic bacteria and diarrheagenic viruses has not been well studied.&#x0D; Objective: To determine the prevalence of Enteropathogenic Escherichia coli and Rotavirus Antigen among Diarrheic Children attending Selected Hospitals in Abeokuta, Nigeria: A Comparative study.&#x0D; Methods: A total of 315 stool samples were collected from children 0–5 years of age across three selected hospitals. With a wooden spatula, 5ml of fecal sample was scooped and decanted into clean, labeled screw-capped tubes. Rotavirus antigen screening was performed according to the manufacturers’ instructions, while EPEC screening was performed using cultural, biochemical, and stereotyping methods.&#x0D; Results: From the sample screening performed, 30 (37.04%) were EPEC positive, whereas 51 (62.96%) were positive for rotavirus. Dissemination of children based on ageshowed that children between 7–12 months had the most elevated predominance of Rotavirus infection 17 (33.33%) while the lowest predominance was observed in children between 0–2 months 4 (7.84%). Furthermore, the highest predominance of EPEC diseases was observed in children between 7–12 months 12 (40%) and the lowest predominance in children between 19–24 months 2 (6.67%).&#x0D; Conclusion: This study had demonstrated a higher prevalence of Rotavirus infection as compared to EPEC diseases among Diarrheic Children within the study location.