Children Under-five Years Research Articles

Food, Health Habits and Anthropometric Indices of Under-Five Aged Children in Imo State, Nigeria

This study examined the food and health habits and anthropometric indices of under-5 aged children in Mbieri, Mbaitolu Local Government Area (L.G.A) in Imo State, Nigeria. Cross-sectional descriptive research design was used for the study. Research methodology included assessment of nutritional status by anthropometric measurements to determine the weight, height and age of children. Dietary intake and food habits assessment was determined using a 24-hour recall. The respondents were mothers with children under five years or caregivers where the mother did not live with the child. Using interviewer-administered questionnaire, information on socio-demographics, dietary history/pattern, food habits, health information and anthropometric measurements of selected pupils was obtained. Data collected were summarised and analysed using statistical package for social sciences (SPSS) programme. Results from analysed data were presented in frequencies, percentages and means. Findings of the study showed that 7.6% and 6.5% of the children were moderately and severely stunted, 1.1% and 5.4% were moderately and severely wasted, 10.9% and 7.6% were moderately and severely overweight and 6.5% and 1.1% were moderately and severely underweight. Spearman correlation coefficient tests were used to determine relationships between dietary intake, food habit, health and nutritional status of children under five years. A level of P≤0.05 was used to indicate statistical significance in all analysis.

Environmental and Nutritional Determinants of Diarrhoea Disease Among Children Under Five Years in Rwanda: A Secondary Data Analysis of the Rwanda Demographic and Health Survey 2014-15

Background 
 Diarrhoea remains one of the leading of causes of deaths in children under five years old globally. Children under five years are more vulnerable to diarrhea especially those from low and middle countries. The aim of this study was to explore the environmental and nuttitional factors associated with diarrhea among children underfive years in Rwanda.
 Methods 
 A secondary data analysis of the Rwanda Demographic and Heralth Survey 2014-2015 (RDHS 2014-2015) was used. A total sample of 7,558 children under five years old was included. The data were analysed using Stata 13. Bivariate with Chi-square test and multivariable logistic regression analysis were performed to assess the relashionship of factors associsted with diarreha. A 95% confidence interval and a significance level of 0.05 were set.
 Results 
 Two environmental factors (Source of drinking water and shared toilets facilities with other households) were associated with child diarrhea. P-values: 0.029, OR:1.79, CI [1.06-3.01]; 0.019, OR:1.26, CI: [1.04-1.53] respectively. None of the selected nutritional factors was associated with childhood diarrhea.
 Conclusion
 Based on the findings, drinking borehole water and shared toilet facilities were associated with diarrhea. The study therefore recommends the provision of potable water and supporting/enabling the households to own toilets.
 Rwanda J Med Health Sci 2020;3(3):280-290

Derivation and internal validation of a data-driven prediction model to guide frontline health workers in triaging children under-five in Nairobi, Kenya

Background: Many hospitalized children in developing countries die from infectious diseases. Early recognition of those who are critically ill coupled with timely treatment can prevent many deaths. A data-driven, electronic triage system to assist frontline health workers in categorizing illness severity is lacking. This study aimed to develop a data-driven parsimonious triage algorithm for children under five years of age. Methods: This was a prospective observational study of children under-five years of age presenting to the outpatient department of Mbagathi Hospital in Nairobi, Kenya between January and June 2018. A study nurse examined participants and recorded history and clinical signs and symptoms using a mobile device with an attached low-cost pulse oximeter sensor. The need for hospital admission was determined independently by the facility clinician and used as the primary outcome in a logistic predictive model. We focused on the selection of variables that could be quickly and easily assessed by low skilled health workers. Results: The admission rate (for more than 24 hours) was 12% (N=138/1,132). We identified an eight-predictor logistic regression model including continuous variables of weight, mid-upper arm circumference, temperature, pulse rate, and transformed oxygen saturation, combined with dichotomous signs of difficulty breathing, lethargy, and inability to drink or breastfeed. This model predicts overnight hospital admission with an area under the receiver operating characteristic curve of 0.88 (95% CI 0.82 to 0.94). Low- and high-risk thresholds of 5% and 25%, respectively were selected to categorize participants into three triage groups for implementation. Conclusion: A logistic regression model comprised of eight easily understood variables may be useful for triage of children under the age of five based on the probability of need for admission. This model could be used by frontline workers with limited skills in assessing children. External validation is needed before adoption in clinical practice.

Predictors and outcome of first line treatment failure among under-five children with community acquired severe pneumonia at Bugando Medical Centre, Mwanza, Tanzania: A prospective cohort study.

Despite recent advances in management and preventive strategies, high rates of first line antibiotics treatment failure and case fatality for Severe Community Acquired Pneumonia (SCAP) continue to occur in children in low and middle-income countries. This study aimed to identify the predictors and outcome of first line antibiotics treatment failure among children under-five years of age with SCAP admitted at Bugando Medical Centre (BMC) in Mwanza, Tanzania. The study involved under-five children admitted with SCAP, treated with first line antibiotics as recommended by WHO. Patients with treatment failure at 48 hours were shifted to second line of antibiotics treatment and followed up for 7 days. Generalized linear model was used to determine predictors of first line antibiotics treatment failure for SCAP. A total of 250 children with SCAP with a median age of 18 [IQR 9-36] months were enrolled, 8.4% had HIV infection and 28% had acute malnutrition. The percentage of first line antibiotics treatment failure for the children with SCAP was 50.4%. Predictors of first line treatment failure were; presentation with convulsion (RR 1.55; 95% CI [1.11-2.16]; p-value 0.009), central cyanosis (RR 1.55; 95% CI [1.16-2.07]; p-value 0.003), low oxygen saturation (RR 1.28; 95% CI [1.01-1.62]; p-value 0.04), abnormal chest X-ray (RR 1.71; 95% CI [1.28-2.29]; p-value <0.001), HIV infection (RR 1.80; 95% CI [1.42-2.27]; p-value 0.001), moderate acute malnutrition (RR 1.48; 95% CI [1.04-2.12]; p-value = 0.030) and severe acute malnutrition (RR 2.02; 95% CI [1.56-2.61]; p-value<0.001). Mortality in children who failed first line treatment was 4.8%. Half of the children with SCAP at this tertiary center had first line antibiotics treatment failure. HIV infection, acute malnutrition, low oxygen saturation, convulsions, central cyanosis, and abnormal chest X-ray were independently predictive of first line treatment failure. We recommend consideration of second line treatment and clinical trials for patients with SCAP to reduce associated morbidity and mortality.

Derivation and internal validation of a data-driven prediction model to guide frontline health workers in triaging children under-five in Nairobi, Kenya

Background: Many hospitalized children in developing countries die from infectious diseases. Early recognition of those who are critically ill coupled with timely treatment can prevent many deaths. A data-driven, electronic triage system to assist frontline health workers in categorizing illness severity is lacking. This study aimed to develop a data-driven parsimonious triage algorithm for children under five years of age. Methods: This was a prospective observational study of children under-five years of age presenting to the outpatient department of Mbagathi Hospital in Nairobi, Kenya between January and June 2018. A study nurse examined participants and recorded history and clinical signs and symptoms using a mobile device with an attached low-cost pulse oximeter sensor. The need for hospital admission was determined independently by the facility clinician and used as the primary outcome in a logistic predictive model. We focused on the selection of variables that could be quickly and easily assessed by low skilled health workers. Results: The admission rate (for more than 24 hours) was 12% (N=138/1,132). We identified an eight-predictor logistic regression model including continuous variables of weight, mid-upper arm circumference, temperature, pulse rate, and transformed oxygen saturation, combined with dichotomous signs of difficulty breathing, lethargy, and inability to drink or breastfeed. This model predicts overnight hospital admission with an area under the receiver operating characteristic curve of 0.88 (95% CI 0.82 to 0.94). Low- and high-risk thresholds of 5% and 25%, respectively were selected to categorize participants into three triage groups for implementation. Conclusion: A logistic regression model comprised of eight easily understood variables may be useful for triage of children under the age of five based on the probability of need for admission. This model could be used by frontline workers with limited skills in assessing children. External validation is needed before adoption in clinical practice.

Self-Medication Practices Among Mothers Having Children Under Five-Years

Background: Worldwide the practice of self medication among mothers for their children has been reported to increase daily. The use of available medication without doctor`s prescription can lead to its inappropriate use and serious adverse drug effect leading to poor health consequences for children. The aim of this present study is to assess the self-medication practices among mothers having children under-five years. A descriptive research design was utilized for this study. The study was conducted at the Out-Patient department of Alexandria University Children’s Hospital (AUCH) at EL-Shatby. The study sample comprised 400 mothers having children under-five years. One tool was used for data collection: Self medication practice of mother having children under-five years structure interview schedules. Results of the present study revealed that about two thirds of the study subject did not consult the pediatrician regarding common health problems specifically in cases of cough, vomiting, diarrhea and fever. There was a statistical significant association between mothers educational levels, work, residence, socio-economic level and number of children with the tendency to self medicate their child. Conclusion: the results of this study concluded that, more than two thirds of mothers self medicated their children without doctor consultation regarding common health problems in case of cough, vomiting, diarrhea and fever. In addition, one third of the mothers self medicated their children even with doctor consultation. Recommendations: The study highlights the need for an educational program, workshops and videos/booklets to improve mother practice regarding medication dose according age and weight of child by doctor consultation and educate the mothers about harmful impact of self medication practice on health consequences of children less than five years. Policy should be developed for advertisement of drugs to include discouragement of practice of self-medication

Prevalence and determinants of intimate partner violence against mothers of children under-five years in Central Malawi

BackgroundIntimate partner violence (IPV) against women is a global human rights violation and a public health problem. The phenomenon is linked to adverse health effects for women and children. Mothers of young children in Malawi can be particularly at risk because of gender-based power imbalances. The objectives of this study were to examine the prevalence and the risk factors of IPV against mothers of children under-five years of age in rural Malawi.MethodsA multistage, cross-sectional study design was used. A sample of 538 mothers of young children was randomly selected from postnatal clinics in Dowa district. The WHO’s Violence against women screening instrument was used to collect data. Logistic regressions were used to determine risk factors that were associated with IPV against mothers.ResultsOverall prevalence of all four forms of IPV against mothers of under-five children was 60.2%. The prevalence of IPV controlling behavior, psychological, physical, and sexual violence were 74.7, 49.4, 43.7 and 73.2% respectively. In multivariate analyses, mothers whose partners had extra marital affairs were more likely to experience controlling behavior (AOR: 4.97, 95% CI: 2.59–8.55, P = 0.001), psychological (AOR: 2.14, 95% CI: 1.486–3.472, P = 0.001) and physical (AOR: 2.29, 95% CI: 1.48–3.94, P = 0.001) violence than mothers whose partners did not have extra marital affairs. Mothers whose partners consume alcohol were more likely to experience sexual violence (AOR: 2.00, 95% CI: 1.17–3.41, P = 0.001) than mothers whose partners did not drink. Finally, mothers who spent more than 30 min drawing water were at greater risk of experiencing IPV than mothers who spent less than 30 min.ConclusionThis study found a significantly higher prevalence of IPV against mothers of under-five children in rural Malawi compared to women in the general population. Micro and macro-level programs aimed at mitigating the partners’ potential risk behaviors identified in this study are suggested. Public health programs that support increased household access to safe water are also recommended to help undermine IPV against mothers.

The impact of women's empowerment on their children's early development in 26 African countries.

BackgroundEvery year more than 200 million children under-five years fail to achieve their full developmental potential in low- and middle-income countries (LMICs). Although women´s empowerment has been associated with improved child health and development outcomes, this is a topic little studied in LMICs. We investigated the associations between women´s empowerment and early childhood development among a sample population of 84537 children aged 36-59 months from national health surveys of 26 African countries.MethodsWe used data from Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) ranging from 2010 to 2018. Four developmental domains were assessed among children using the Early Childhood Development Index: literacy-numeracy, physical, learning and socioemotional. Women’s empowerment in attitude to violence, social independence and decision-making was evaluated using the SWPER global, a validated survey-based index. We reported effect sizes for each country and a combined estimate of the association. The study covers all countries with surveys in the region and uses a novel approach for measuring women’s empowerment, the SWPER.ResultsAcross all countries, 15.1% of the children were on track in the literacy-numeracy domain, 92.3% in physical, 81.3% in learning and 67.8% in socio-emotional. The odds of a child being on track in literacy-numeracy increased by 34% (odds ratio (OR) = 1.34; 95% confidence interval (CI) = 1.31-1.37), 88% (OR = 1.88; 95% CI = 1.85-1.91) and 34% (OR = 1.34; 95% CI = 1.29-1.39), with a one standard deviation increase in the scores of attitudes to violence, social independence and decision-making domains of empowerment, respectively. No effect of empowerment was observed for the other domains of child development.ConclusionsOur results show a consistent positive effect of empowerment on the literacy-numeracy domain of child development cross-nationally in Africa and this was particularly evident for the social independence domain of the SWPER. Programs and interventions may also consider addressing the reduction of gender inequalities to improve child development.

Risk Factors Associated with Malnutrition among Children Under-Five Years in Sub-Saharan African Countries: A Scoping Review.

Background/Purpose: Malnutrition is a significant global public health burden with greater concern among children under five years in Sub-Saharan Africa (SSA). To effectively address the problem of malnutrition, especially in resource-scarce communities, knowing the prevalence, causes and risk factors associated with it are essential steps. This scoping review aimed to identify the existing literature that uses classical regression analysis on nationally representative health survey data sets to find the individual socioeconomic, demographic and contextual risk factors associated with malnutrition among children under five years of age in Sub-Sahara Africa (SSA). Methods: The electronic databases searched include EMBASE (OVID platform), PubMed (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, Web of Science (WoS) and Cochrane Library. Only papers written in the English language, and for which the publication date was between 1 January 1990 and 31 July 2020, were included. Results: A total of 229 papers were identified, of which 26 were studies that have been included in the review. The risk factors for malnutrition identified were classified as child-related, parental/household-related and community or area-related. Conclusions: Study-interest bias toward stunting over other anthropometric indicators of malnutrition could be addressed with a holistic research approach to equally address the various dimension of the anthropometric indicators of malnutrition in a population.

Socio-demographic and Healthcare-seeking Predictors of Undernutrition among Children Under-five Years of Age in a Western District of Nepal.

Undernutrition is highly prevalent in Nepal, which interferes with physical and mental development among children. It is one of the severe health problems contributing to the significant portion of the disease burden. This study aimed to explore socio-demographic and healthcare-seeking related predictors of undernutrition among children under five years old in Dang, Nepal. This was a descriptive cross-sectional study. A sample of 426 children was participated through stratified proportionate random sampling to identify socio-demographics and healthcare-seeking predictors of undernutrition. Multivariable regression was applied to identify the independent predictors of undernutrition. This study found that children below 24 months of age were more likely to be undernourished than children aged 24-36 months. Female children (OR=2.32, 95% CI: 1.19-4.54), illiterate or non-formally educated women (OR=4.09, 95% CI: 1.84-9.08), mother's occupation other than a housewife (OR=13.05, 95% CI: 4.19-40.68), labor work of father (OR=2.40, 95% CI: 1.04-5.57) had increased risk of undernutrition among children. Similarly, food insufficiency from their land, antenatal care visit, postnatal care visit, and delivery place were significantly associated with childhood undernutrition among children. Conclusions: The study showed that undernutrition among children is associated with age and gender of children, educational attainment of the mother, food sufficiency, health-seeking practices of the mother during pregnancy, delivery, and postnatal.Socio-demographics and health-seeking practices related predictors must be explicitly considered to address undernutrition among children under the age of five years.

ESTIMATION OF INFANT MORTALITY AND UNDER-FIVE MORTALITY BY PLACE OF RESIDENCE AND RELIGION AND ITS PREDICTIVE FACTORS IN NORTHEAST INDIA

Background: Infant mortality rate (IMR) and under five mortality rates (UFMR) are the sensitive indicators to assess health status and indicators of overall progress of a country. In India, IMR and UFMR is relatively high, and is unable to achieve the Millennium Development Goal (MDG) by 2015. Northeastern states of India depict a captivating trend in child mortality according to the report of NFHS-4 (2015-16). Therefore, the objective of this study is to estimate infant and under five mortality by place of residence and religion. In addition, to determine the factors affecting infant and under-five death. Data and Methods: This study utilizes data of National Family Health Survey (NFHS-4). Eight northeastern states and 37,167 children under-five years were included in the analysis. Synthetic cohort probability method was used to calculate IMR and UFMR. To find the nature of the association between infant and under five death with selected socioeconomic characteristics, Bivariate analysis, and Binary logistic regression were used. Result: Study revealed that children in rural areas has higher risk of infant and under five mortality. Muslims has the highest IMR and UFMR i.e. 52 and 56 per 1000 live births respectively. Adjusted odds ratio shows that wealth index, size of child, sex of child, caesarean-section delivery has impact on infant and under five death at 95% CI and p-value (&lt;=0.05). However, in contrary with existing literature, adjusted odds ratio shows that there is negative association between age of mother, mother education, place of delivery with infant and under five death at 95% CI and p-value (&lt;=0.05).

Respiratory health effect of exposure to Indoor Microbiome on children under-five: a meta-analysis

Background/AimThe association between specific microbial agents such as mold within the indoor environment and adverse respiratory outcome among children under-five years of age has been widely reported but none have investigated the risk of exposure to the microbiome within the indoor environment. The aim of this review is to summarize published association between exposure to the microbiome within the indoor environment and respiratory endpoints among under-five children (U5-C).MethodsElectronic scientific repositories; PUBMED, WEB OF SCIENCE, GREENFILE, EMBASE and Cochrane library were searched and screened through January 2020 for published reports for inclusion in the meta-analysis. Studies were eligible for inclusion if it reported an adjusted measure of risk for any of the respiratory outcomes associated with exposure to indoor microbiome, including the relative risk (RR) or odds ratio (OR) and CI. The pooled effective estimates was computed using inverse of variance method for weighting. Sensitivity analysis was used to evaluate the potential effect of individual studies on the overall estimates, while heterogeneity was evaluated by I2 statistics using RevMan 5.3.ResultsFifteen studies were eligible for inclusion in our meta-analysis. Exposure to a higher concentration of indoor microbiome was associated with an increased risk of wheeze [1.20 (1.03, 1.41), P &lt; 0.02,I2 = 76%], allergic rhinitis [1.25 (1.02, 1.54), P = 0.03,I2 = 65%] and acute respiratory infections [1.35 (1.12, 1.62), P = 0.002,I2 = 59%] among under-five children. The risk was stronger with exposure to fungi/molds [1.42 (1.27, 1.59), P &lt; 0.00001;I2 = 31%] than endotoxins [1.09 (0.93, 1.29), P = 0.29;I2 = 72%].ConclusionsThe pooled effect estimate indicates an increased risk of adverse respiratory outcomes among U-5C. Therefore, interventions addressing exposure to microbiome within the indoor environment should be considered in the management of respiratory outcomes among under-five children.

Double burden of malnutrition and its association with infant and young child feeding practices among children under-five in Thailand.

This study examined the prevalence of stunting-overweight and socio-demographic determinants among children under-five years of age, as well as associations with infant and young child feeding (IYCF) among children aged 6-23 months. Secondary data analysis based on the Thailand Multiple Indicator Cluster Survey 2015-2016. Cross-national study. Nationally representative sample of children under-five years of age (n 12 313). The prevalence of wasting, stunting, overweight and stunting-overweight was 5·3, 10·5, 10·1 and 1·6 %, respectively. In multivariate analyses, children under 6 months, children from low and middle wealth tertiles, and children living in rural areas were prone to being wasted. Male children, low wealth tertile and a non-Thai speaking household head were positively and children aged 48-59 months and a one-child household were inversely associated with stunting. Children from a low wealth tertile were less likely to be overweight, while older age, male children and children from a one-child household were more likely to be overweight. Stunting-overweight was associated with children aged 24-47 months, male children, mothers having secondary education, a one-child household, a non-Thai speaking household head and an urban area. In terms of IYCF indicators, despite no association with stunting and stunted-overweight children, current breast-feeding and inadequate meal frequency were associated with being wasting, while current breast-feeding and dietary diversity were inversely associated with being overweight. This study revealed the double burden of malnutrition at the individual and population levels among Thai children under-five, which calls for concrete integrated interventions to tackle all forms of malnutrition.

Association between health insurance membership and anaemia among children under-five years. Evidence from Ghana.

IntroductionAnaemia is prevalent among children in developing countries. The main objective of this study was to assess the association between health insurance membership and anaemia among Ghanaian children under-five years.MethodsWe obtained Ghana’s Multiple Indicators Cluster Survey, 2011 dataset from the United Nations International Children’s Emergency Fund. Data were analyzed with the aid of Stata/IC, version 15.ResultsThe prevalence of anaemia among Ghanaian children under-five years was estimated to be 57%. Majority (73%) of the children were not insured. Health insurance membership was found to be a significant predictor of anaemia among children under-five years.ConclusionHealth insurance membership is a protective factor against anaemia among children under-five years. In the quest to eradicate anaemia among children, stakeholders would have to review the benefit package of the National Health Insurance Scheme coupled with prioritizing anaemia prevention interventions among more vulnerable children.

The burden and correlates of childhood undernutrition in Tanzania according to composite index of anthropometric failure

BackgroundUndernutrition is a public health problem worldwide. Tanzania has made significant achievements in the reduction of childhood undernutrition over the past two decades. However, the exact burden of undernutrition was under-estimated when using conventional indices of stunting, wasting and underweight. The objective of this study was to determine the overall prevalence of undernutrition, describe the trends and examine the correlates associated with undernutrition among children under-five years using the composite index of anthropometric failure (CIAF). This study aims to understand the real burden and drivers of undernutrition to improve design, implementation and monitoring of appropriate interventions to ameliorate all form of childhood undernutrition in the country.MethodsAbout 37,205 mother-child pairs were retrieved and analyzed from the Tanzania Demographic and Health Surveys (TDHS) conducted in various years from 1991, 1996, 1999, 2004–05, 2009–10, to 2015–16. The anthropometric data of children under-five years were used to determine the overall burden and trends of undernutrition using CIAF. The recent TDHS surveys from 2005 to 2015 were used to examine the correlates of CIAF. To determine the correlates, multivariate analysis was conducted to estimate the prevalence ratios (PR) with 95% confidence intervals (CI) using Poisson regression with robust variance.ResultsThe prevalence of CIAF declined significantly from 50% in 1991 to 38.2% in 2015 (p < 0.001). The correlates of CIAF vary across surveys. The multivariate analysis of recent 2015 survey revealed that the prevalence of CIAF was significantly higher for older children (p < 0.001), children living in rural areas (p = 0.028), and those born with non-educated (p = 0.009) or single mothers (p = 0.008). The prevalence of CIAF was significantly lower for girls (p < 0.001), being born with overweight/obese mothers (p < 0.001), living with older head of the household (p < 0.001) or living in richest household (p < 0.001). Moreover, children who were born with low birth weight (p < 0.001), or having fever (p = 0.044) were most likely to have anthropometric failure. However, consumption of diversified diet was not found to be associated with anthropometric failure (p > 0.05).ConclusionAbout one in every three under-five years children are suffering from either one or multiple forms of anthropometric failure in Tanzania. There is a significant decline trends in overall burden of undernutrition in Tanzania from the past 25 years, as measured by CIAF. Multiple factors including those related to mothers, children and household socio-economic characteristics have the potential to influence childhood undernutrition. Efforts to reduce the burden of undernutrition should mainly focus on reducing poverty and raising people’s living standards.

The roles of social economic status and undernutrition in regional disparities of the under‐five mortality rate in Vietnam

From 2005 to 2017, the prevalence of mortality in Vietnamese children under five years old showed large regional disparities. In 2017, mortality in the wealthiest region was 12.6‰, whereas the most disadvantaged region it was three times as high, at 36‰. This study aims to identify factors affecting regional disparities of the under-five mortality rate (U5MR) in Vietnam. We applied Structural Equation Modelling to estimate the degree and the pathway through which undernutrition and socio-economic status (SES) contributed to the under-five mortality disparities. SES is estimated as a common latent factor of three socio-economic measures, that is, education, poverty and income. The direct effect of SES on U5MR is at 2.16 through the underweight pathway, which is 5 times higher than the effect of underweight on U5MR. Through the stunting channel, this direct impact is 1.43, nearly twice as high as the impact of the stunting rate. SES also has an indirect effect on U5MR through these undernutrition pathways. In total, we estimate that an increase in SES index will make the U5MR increase by 2.73‰. Among the three indicators of SES, poverty conveys the strongest signal of a considerable change in SES, thus to a subsequent change in U5MR. Among two types of undernutrition, the effect of stunting on U5MR is dominant, more than 3 times as high as that of underweight. These findings have important implications for socio-economic and health interventions: those that strongly focus on the reduction of regional poverty and stunting rates would be effective in bridging the regional gap in the U5MR in Vietnam.

Prévalence et tendance du paludisme avec anémie chez les enfants de moins de cinq ans dans le district de Jasikan, Ghana

Background: Malaria remains a major killer of children under-five, claiming the life of one child every two minutes globally. Despite the several interventions to reduce malaria and anemia, these diseases remain global public concerns. Aim: This study assessed the prevalence and trend of malaria and anemia in children under-five years from 2012 to 2016. Subjects and methods: We conducted a descriptive cross-sectional study among children under-five with malaria and anemia who received care at the hospital in Jasikan town, Ghana from 2012 to 2016. We computed descriptive statistics to describe the data. STATA version 14 was used to carry out the analyses. Binary logistic regression was used to determine the strength of association at a 5% significance level (P&lt;0.05). Results: Out of 30,082 malaria cases, 835 were with anemia from 2012 to 2016. This study found an overall proportion of malaria with anemia as 28 per 1,000. The year 2014 recorded the highest proportion of 38 per 1,000 malaria cases of malaria with anemia. Overall, the prevalence rate of malaria and anemia cases were found to be 61.5% and 4.4% respectively. Children within 24-35 months’ age group contributed the highest (28.3%) and 0-11 months accounted for the lowest (12.9%) malaria with anemia cases. The majority of malaria with anemia cases 63.6% occurred in the rainy season, between June to July. Conclusion: The proportion of malaria with anemia was high among children under-five and most children having malaria with anemia live in rural areas and during the rainy season. Keywords: Prevalence, Trend, Malaria, Anemia, Under-five, Children, Jasikan, Ghana.

Prevalence and trend of malaria with anemia among under-five children in Jasikan District, Ghana

Background: Malaria remains a major killer of children under-five, claiming the life of one child every two minutes globally. Despite the several interventions to reduce malaria and anemia, these diseases remain global public concerns. Aim: This study assessed the prevalence and trend of malaria and anemia in children under-five years from 2012 to 2016. Subjects and methods: We conducted a descriptive cross-sectional study among children under-five with malaria and anemia who received care at the hospital in Jasikan town, Ghana from 2012 to 2016. We computed descriptive statistics to describe the data. STATA version 14 was used to carry out the analyses. Binary logistic regression was used to determine the strength of association at a 5% significance level (P&lt;0.05). Results: Out of 30,082 malaria cases, 835 were with anemia from 2012 to 2016. This study found an overall proportion of malaria with anemia as 28 per 1,000. The year 2014 recorded the highest proportion of 38 per 1,000 malaria cases of malaria with anemia. Overall, the prevalence rate of malaria and anemia cases were found to be 61.5% and 4.4% respectively. Children within 24-35 months’ age group contributed the highest (28.3%) and 0-11 months accounted for the lowest (12.9%) malaria with anemia cases. The majority of malaria with anemia cases 63.6% occurred in the rainy season, between June to July. Conclusion: The proportion of malaria with anemia was high among children under-five and most children having malaria with anemia live in rural areas and during the rainy season. Keywords: Prevalence, Trend, Malaria, Anemia, Under-five, Children, Jasikan, Ghana.

Effect of lipid-based nutrient supplement-Medium quantity on reduction of stunting in children 6-23 months of age in Sindh, Pakistan: A cluster randomized controlled trial.

BackgroundChronic childhood malnutrition, or stunting, remains a persistent barrier to achieve optimal cognitive development, child growth and ability to reach full potential. Almost half of children under-five years of age are stunted in the province of Sindh, Pakistan.ObjectiveThe primary objective of this study was to test the hypothesis that the provision of lipid-based nutrient supplement—medium-quantity (LNS-MQ) known as Wawamum will result in a 10% reduction in risk of being stunted at the age of 24 months in the intervention group compared with the control group.DesignA cluster randomized controlled trial was conducted in Thatta and Sujawal districts of Sindh province, Pakistan. A total of 870 (419 in intervention; 451 in control) children between 6–18 months old were enrolled in the study. The unit of randomization was union council and considered as a cluster. A total of 12 clusters, 6 in each study group were randomly assigned to intervention and control group. All children received standard government health services, while children in the intervention group also received 50 grams/day of Wawamum.ResultsChildren who received Wawamum were found to have a significantly reduced risk of stunting (RR = 0.91, 95% CI; 0.88–0.94, p<0.001) and wasting (RR = 0.78, 95% CI; 0.67–0.92, p = 0.004) as compared to children who received the standard government health services. There was no evidence of a reduction in the risk of underweight (RR = 0.94, 95% CI; 0.85–1.04, p = 0.235) in the intervention group compared to the control group. Statistically significant reduction in anaemia in the intervention group was also found as compared to the control group (RR = 0.97, 95% CI; 0.94–0.99, p = 0.042). The subgroup analysis by age, showed intervention effect is significant in reduction of risk of stunting in younger children of aged 6–12 month (RR = 0.83, 95% CI; 0.81–0.86, p = <0.001) and their older peers aged 13–18 month- (RR = 0.90, 95% CI; 0.83–0.97, p = 0.008). The mean compliance of Wawamum was 60% among children.ConclusionsThe study confirmed that the provision of Wawamum to children 6–23 months of age is effective in reducing the risk of stunting, wasting and anaemia. This approach should be scaled up among the most food insecure areas/households with a high prevalence of stunting to achieve positive outcomes for nutrition and health. This study was registered at clinicaltrials.gov as NCT02422953.Clinical Trial Registration Number: NCT02422953

Socio-economic Determinants of Increasing Household Food Insecurity during and after a Drought in the District of iLembe, South Africa

ABSTRACT In 2015 and 2016, South Africa experienced a severe drought resulting in water restrictions and food price inflation. A year later, while the proportion of food secure households remained constant, the proportion of those experiencing severe food insecurity increased. This paper investigates the socio-economic determinants of increasing food insecurity during and after the drought. Two cross-sectional household surveys were carried out in the district of iLembe in November 2016 and 2017. Household food insecurity was measured using the Coping Strategies Index. The results indicated changes in socio-economic determinants of food insecurity over time, with the poorest households experiencing the worst levels of food insecurity. After the drought, having a child under-five years was positively associated with food insecurity, while being located in a rural area was negatively associated. Policies that limit household vulnerability to price inflation, and interventions that protect poorer households from the effects of drought should be considered.