Children Aged Under-five Years Research Articles

The trend of unintentional injury-related mortality among children aged under-five years in China, 2010–2020: a retrospective analysis from a national surveillance system

BackgroundIn this study, we estimated the trend of unintentional injury mortality among children aged under-five years in China during 2010–2020.MethodsData were obtained from China’s Under 5 Child Mortality Surveillance System (U5CMSS). The total unintentional injury mortality and all specific-causes unintentional injury mortality was calculated, annual numbers of deaths and live births were adjusted by a 3-year moving average under-reporting rate. The Poisson regression model and the Cochran-Mantel-Haenszel method were used to calculate the average annual decline rate (AADR) and the adjusted relative risk (aRR) of the unintentional injury mortality.ResultsIn 2010–2020, a total of 7,925 unintentional injury-related deaths were reported in U5CMSS, accounting for 18.7% of all reported deaths. The overall proportion of unintentional injury-related deaths to total under-five children deaths has increased from 15.2% to 2010 to 23.8% in 2020 (χ2 = 227.0, p < 0.001), the unintentional injury mortality significantly decreased from 249.3 deaths per 100,000 live births in 2010 to 178.8 deaths per 100,000 live births in 2020, with an AADR 3.7% (95%CI 3.1–4.4). The unintentional injury mortality rate decreased from 2010 to 2020 in both urban (from 68.1 to 59.7 per 100,000 live births) and rural (from 323.1 to 230.0 per 100,000 live births) areas (urban: χ2 = 3.1, p < 0.08; rural: χ2 = 113.5, p < 0.001). The annual rates of decline in rural areas and urban areas were 4.2% (95%CI 3.4–4.9) and 1.5% (95%CI 0.1–3.3), respectively. The leading causes of unintentional injury mortality were suffocation (2,611, 32.9%), drowning (2,398, 30.3%), and traffic injury (1,428, 12.8%) in 2010–2020. The cause-specific of unintentional injury mortality rates decreased with varying AADRs in 2010–2020, except for traffic injury. The composition of unintentional injury-related deaths also varied by age group. Suffocation was the leading cause in infants, drowning and traffic injury were the leading causes in children aged 1–4 years. Suffocation and poisoning has high incidence in October to March and drowning has high in June to August.ConclusionThe unintentional injury mortality rate of children aged under-five years decreased significantly from 2010 to 2020 in China, but great inequity exists in unintentional injury mortality in urban and rural areas. Unintentional injuries are still an important public health problem affecting the health of Chinese children. Effective strategies should be strengthened to reduce unintentional injury in children and these policies and programmes should be targeted to more specific populations, such as rural areas and males.

Causes of death in HIV-infected and HIV-uninfected children aged under-five years in western Kenya.

Describe the causes of death among infants and children less than 5 years stratified by HIV status. Cross-sectional analysis of causes of death ascertained through minimally invasive tissue sampling (MITS) in the Kenya Child Health and Mortality Prevention Surveillance site. We included decedents aged 28 days to less than 5 years, whose death was reported within 36 h, underwent MITS, and had HIV test results and causes of death determined. MITS specimens were tested using Taqman Array Cards, culture, cytology, histopathology and immunohistochemistry and HIV PCR. A panel evaluated epidemiologic, clinical, verbal autopsy and laboratory data to assign causes of death using ICD-10 guidelines. Causes of death and etiological agents were stratified by HIV status. Of 176 included decedents, 14% (n = 25) were HIV-infected, median viral load was 112 205 copies/ml [interquartile range (IQR) = 9349-2 670 143). HIV-disease (96%; n = 24) and malnutrition (23%; n = 34) were the leading underlying causes of death in HIV-infected and HIV-uninfected decedents, respectively. Malnutrition was more frequent in the causal chain of HIV-infected (56%; n = 14) than HIV-uninfected decedents (31%; n = 49) (P value = 0.03). Viral pneumonia was twice as common in HIV-infected (50%; n = 9) than HIV-uninfected decedents (22%; n = 7) (P value = 0.04). Nearly all HIV-infected decedents' underlying cause of death was HIV disease, which was associated with malnutrition. Our findings underscore the need for strengthening early identification and management of HIV-infected children. Prevention, early diagnosis and treatment of malnutrition could be instrumental in improving the survival of HIV-infected and HIV-uninfected children.

Association of child survival with birth size and mother’s BMI: a human right approach

PurposeChildren are the most vulnerable group owing to long lasting impact of the violation of human rights in term of proper nutrition and their right to live. The purpose of this paper is to assess the risk of child mortality associated with size of child at birth and mother’s anemia level in northern India.Design/methodology/approachThe data were used from 2015–2016 National Family Health Survey (NFHS). The participants (n = 41,412) were children aged under-five years from north Indian state of Uttar Pradesh. The main outcome measure was child deaths defined by under-five mortality. The univariate, bivariate and multivariate analyses were used in data analysis. Kaplan–Meier analyses, Log-rank tests and Cox’s regression analyses were performed to fulfill the objective of the study.FindingsThere were a total of 2,835 deaths out of 41,412 births in the past five years preceding the survey period. Children of very small size at birth were significantly two and half times more likely to die than children of average size at birth. The estimated adjusted hazard ratio indicated that the children of severely anemic mothers were significantly 1.5 times more likely to die compared to children of not anemic mothers. Size of child at birth, mother’s anemia level, mother’s age at time of her first birth, wealth index and mother’s education were significantly associated with the under-five mortality in northern India.Research limitations/implicationsThe limitation of this study is recall errors arising from the dates of birth and death given by women interviewed in the survey were minimized by restricting the analyses to births within the five-year period preceding the survey.Practical implicationsThis study advocates the promotion of comprehensive prevention strategies through appropriate institutional mechanism would be the best intervention or adaptive mechanism to reduce the adverse impact of size of child at birth, mother’s anemia level on under-five mortality in Uttar Pradesh, India.Originality/valueThis research is original. This study enjoys a unique importance by exploring effect of size of child at birth and mother’s anemia on child survival in developing countries like India.

Post Vaccination Epidemiology and Genotyping of Rotavirus Gastroenteritis at a Tertiary Care Centre of North-East Rajasthan.

To estimate the proportion of rotavirus diarrhea among hospitalized children aged under-five years, to determine the circulating rotavirus genotypes and to know impact rotavirus vaccine on prevalence and severity of rotavirus diarrhea. This study was a hospital based cross-sectional observational study conducted over a period of 29 mo (September 2017 through January 2020). Stool samples were collected from children who fall within the age range of 0-59 mo with acute diarrhea attending emergency or needing admission. Stool samples were tested for rotavirus by the enzyme linked immune-sorbent assay (ELISA) and genotyped using published methods. Out of 1480 samples, 360 (24.32%) cases were positive for rotavirus by ELISA, majority of them were male (62.97%). Maximum rotavirus positivity was found in the age group of <11 mo (55.27%). Statistically significance difference was seen in episodes of diarrhea and experience of vomiting in rotavirus diarrhea cases. Highest prevalence has been seen during winter season. The most prevalent G and P type combinations were G3P [8] strains [122 (34.08%)], G2P [4] [83 (23.18%)], G1P [8] [27 (7.54%)] and G9P [4] [20 (5.59%)]. Mixed strains contribute a significant proportion of stool sample. Rotavirus is an important cause of diarrhea in hospitalized children. There is continued circulation of G9 and G12 strains and the emergence of G3P [8] as most common strain.

Determinants of anaemia among children aged under five years in Assam, India

Background: Childhood anaemia is a major public health threat that can increase susceptibility to infections, risk of mortality together with serious degrading consequences on cognitive and physical development. The aim was to examine the prevalence of anaemia in children aged under-five years in Assam, India, exploring 2015-2016 National Family Health Survey (NFHS-4) data.Methods: Statistical analysis is performed on the cross-sectional data of 10,309 children from 2015-2016 National Family Health Survey (NFHS-4), using binary logistic regression model, to assess the significance of some risk factors of child anaemia. Anaemia was diagnosed by WHO cut-off points on hemoglobin level.Results: The prevalence of child anaemia was 35.7 per cent in Assam, India, with mean haemoglobin concentration 11.36 gm/dl (95% CI, 11.32-11.38); male and female being equaled proportionately anaemic. Out of 27 districts in Assam, the highest prevalence was found in Dibrugarh (52.2 per cent), followed by Nalbari (46.7 per cent) and Darrang (45.6 per cent); and the least prevalence was found in Karbi-Anglong (24.4 per cent). The findings indicate that rural children and lower age-groups were at greater risk of anaemia. Higher birth order, low level of maternal education, low level of maternal nutrition and non-intake of iron supplements during pregnancy increased the risk of anaemia among children (p&lt;0.05).Conclusions: The findings suggest a need for proper preventive measures to combat child anaemia. Rural population should be given special attention. Maternal education, nutrition, and birth control measures should be priorities in the programs.

Determinants of anaemia among children aged under-five years in Meghalaya, India

Abstract: Childhood anaemia poses serious threats to public health and may impair growth, cardiac function and cognitive and physical development. It also causes in-creased susceptibility to infections. Statistical analysis was performed on the cross-sectional data of 2957 children from 2015-2016 National Family Health Survey (NFHS-IV), using binary logistic regression model, to assess the significance of some risk factors of child anemia. Anemia was diagnosed by WHO cut-off points on hemoglobin level. The mean haemoglobin concentration was 114.19 g/dl (95% CI, 113.55-114.83) with the prevalence of child anaemia as 60.4% in Meghalaya. Of the 7 districts in Meghalaya (as per the seven-district classification used in NFHS-4), the highest prevalence was found in West Garo Hills (70.4 per cent), followed by Ri- Bhoi (67.7 per cent) and East Garo Hills (66.4 per cent) and the least prevalence was found in East Khasi Hills (45.6 per cent). The results of binary logistic risk factors showed higher likelihood of anaemia for lower age groups and higher birth orders (p &lt;0.05). Keywords: Meghalaya; Children; Anaemia; Risk factors; Logistic Regression.

Determinants of anaemia among children aged under-five years in Meghalaya, India

Childhood anaemia poses serious threats to public health and may impair growth, cardiac function and cognitive and physical development. It also causes increased susceptibility to infections. Statistical analysis was performed on the cross-sectional data of 2957 children from 2015-2016 National Family Health Survey (NFHS-IV), using binary logistic regression model, to assess the significance of some risk factors of child anemia. Anemia was diag-nosed by WHO cut-off points on hemoglobin level. The mean haemoglobin concentration was 114.19 g/dl (95% CI, 113.55-114.83) with the prevalence of child anaemia as 60.4% in Meghalaya. Of the 7 districts in Meghalaya (as per the seven-district classification used in NFHS-4), the highest prevalence was found in West Garo Hills (70.4 per cent), followed by Ri- Bhoi (67.7 per cent) and East Garo Hills (66.4 per cent) and the least prevalence was found in East Khasi Hills (45.6 per cent). The results of binary logistic risk factors showed higher likelihood of anaemia for lower age groups and higher birth orders (p &lt;0.05).

Palestinian Nurses’ and Doctors’ Perceptions and Practices Regarding the Prevention of Injuries to Children in the Home: An Explorative Qualitative Study

ABSTRACTUnintentional injuries are a growing global public health problem that causes mortality, morbidity, and disability among children. These injuries are common among under-fives and form a significant burden on healthcare systems, particularly in low- and middle-income countries. Nurses and doctors have a major role to play in the prevention of home injuries, as expressed in many international reports. In Palestine, there is a paucity of research in this area. Therefore, this study aims to explore nurses’ and doctors’ perceptions and practices regarding the prevention of home injuries among children aged under-five years. A qualitative approach was followed, whereby semi-structured interviews were undertaken with 24 nurses and doctors who worked with children in a primary health care setting. The derived data were analyzed using thematic analysis. This study found that most of the nurses and doctors who were interviewed reported positive attitudes toward working on this topic; the majority of them attempted to work on injury prevention. Nevertheless, they needed further support to fulfil this potential role, as they faced many barriers in their daily practice in this area. Policy makers could potentially take advantage of this attitude and support them by providing training, resources, and time for them to implement this role.

Childhood diarrhoea: assessment of knowledge, attitude and practices among mothers attending the tertiary care hospital - an observational analytical study

Background: Diarrhoea is a major killer of children under-five, accounting for about 8% of deaths. For children aged under-five years, a median of three episodes of diarrhea occur per child-year. Assessment of knowledge, attitude and practice of mothers of under-five children.Methods: All mothers of under-five years who attended out-patient department of Pediatrics within the study period were interviewed. A total 200 mothers were assessed regarding the knowledge, attitude and practices towards childhood diarrhoea. Results: Majority of mothers were aware of the definition and cause of diarrhoea (77% and 55% respectively). On the contrary, knowledge regarding preparation and use of home-made ORS was not known to majority of mothers. Regarding practices of mothers, 100% of mothers were using safe drinking water. However, only 60% and 30% practiced hand-washing after defecation and before handling food respectively. Conclusions: Mothers need to be encouraged to start ORS before consulting a doctor. Personal and food hygiene practices need to be improved among the study population.

Source of drinking water and the prevalence of diarrhoea among children aged under-five in Ghana - recent evidence

Diarrhoeal diseases are among the leading causes of morbidity and mortality in children in low-and middle-income countries. Although the government of Ghana has implemented some interventions with reasonable successes over the years, diarrhoea morbidity still remains a public health concern. For instance, it was reported in the 2008 Ghana Demographic and Health Survey (GDHS) that one out of every five (20%) children below five years of age had diarrhoea in the two weeks preceding the survey while the 2014 GDHS revealed an incidence of 12%. This paper examines the association between source of drinking water and the prevalence of diarrhoea among children aged under-five years using propensity score matching. The study found that drinking from improved water sources rather increases the odds of diarrhoea by about 1.3 times and this effect persists in both the unmatched and matched samples. We proffer potential explanations for this rather puzzling finding. The paper concludes that the Ghana Standards Authority should regularly monitor sachet water and other 'improved water sources' for its microbial quality to ensure that Ghanaians are offered clean and safe drinking water in order to curb the incidence of diarrhoea among children.

Source of drinking water and the prevalence of diarrhoea among children aged under-five in Ghana - recent evidence

Diarrhoeal diseases are among the leading causes of morbidity and mortality in children in low-and middle-income countries. Although the government of Ghana has implemented some interventions with reasonable successes over the years, diarrhoea morbidity still remains a public health concern. For instance, it was reported in the 2008 Ghana Demographic and Health Survey (GDHS) that one out of every five (20%) children below five years of age had diarrhoea in the two weeks preceding the survey while the 2014 GDHS revealed an incidence of 12%. This paper examines the association between source of drinking water and the prevalence of diarrhoea among children aged under-five years using propensity score matching. The study found that drinking from improved water sources rather increases the odds of diarrhoea by about 1.3 times and this effect persists in both the unmatched and matched samples. We proffer potential explanations for this rather puzzling finding. The paper concludes that the Ghana Standards Authority should regularly monitor sachet water and other 'improved water sources' for its microbial quality to ensure that Ghanaians are offered clean and safe drinking water in order to curb the incidence of diarrhoea among children.

Household air pollution and under-five mortality in India (1992-2006).

BackgroundHousehold air pollution (HAP) - predominantly from cooking fuel is a major public health hazard and one of the leading causes of respiratory illness and deaths among children under-five years in India. This study investigates the association between HAP from cooking fuel and under-five mortality using India’s National Family and Health Survey (NFHS) datasets over the period 1992–2006 (total of 166,382 children), and the extent to which the association differed by environmental and behavioral factors affecting level of exposure.MethodsThe association between HAP and under-five mortality of three age-groups (neonatal age between 0–28 days, post-neonatal age between 1–11 months and children aged between 12–59 months) was examined using multi-level logistic regression models.ResultsHAP was associated with mortality among children aged under-five (OR = 1.30, 95%CI = 1.18-1.43, P < 0.001) and was more strongly associated in sub-group analyses of post-neonatal mortality (OR = 1.42, 95%CI = 1.19-1.71, P < 0.001) and child mortality (OR = 1.42, 95%CI = 1.05-1.91, P = 0.021) than neonatal mortality (OR = 1.23, 95%CI = 1.09-1.39, P = 0.001). The association was stronger for households in rural areas and for households without a separate kitchen using polluting fuel, and in women who had never breastfed for all age-groups.ConclusionUse of cooking fuel in the household is associated with increased risk of mortality in children aged under-five years. Factors relating to access to clean fuels, improvements in infrastructure and household design and behavioral factors are discussed, and can result in further declines in under-five mortality in India.

Association between malaria and malnutrition among children aged under-five years in Adami Tulu District, south-central Ethiopia: a case-control study.

BackgroundMalaria and malnutrition are the major causes of morbidity and mortality in under-five children in developing countries such as Ethiopia. Malnutrition is the associated cause for about half of the deaths that occur among under-five children in developing countries. However, the relationship between malnutrition and malaria is controversial still, and it has also not been well documented in Ethiopia. The aim of this study was to assess whether malnutrition is associated with malaria among under-five children.MethodsA case–control study was conducted in Adami Tulu District of East Shewa Zone in Oromia Regional State, Ethiopia. Cases were all under-five children who are diagnosed with malaria at health posts and health centres. The diagnosis was made using either rapid diagnostic tests or microscopy. Controls were apparently healthy under-five children recruited from the community where cases resided. The selection of the controls was based on World Health Organization (WHO) cluster sampling method. A total of 428 children were included. Mothers/caretakers of under-five children were interviewed using pre-tested structured questionnaire prepared for this purpose. The nutritional status of the children was assessed using an anthropometric method and analyzed using WHO Anthro software. A multivariate logistic analysis model was used to determine predictors of malaria.ResultsFour hundred twenty eight under-five children comprising 107 cases and 321 controls were included in this study. Prevalence of wasting was higher among cases (17.8 %) than the controls (9.3 %). Similarly, the prevalence of stunting was 50.5 % and 45.2 % among cases and controls, respectively. Severe wasting [Adjusted Odds Ratio (AOR) =2.9, 95 % CI (1.14, 7.61)] and caretakers who had no education [AOR = 3, 95 % CI (1.27, 7.10)] were independently associated with malarial attack among under-five children.ConclusionChildren who were severely wasted and had uneducated caretakers had higher odds of malarial attack. Therefore, special attention should be given for severely wasted children in the prevention and control of malaria.

Non Medical Interventions for Childhood Diarrhoea Control:Way Forward in Nepal

Diarrhoeal diseases remain a major cause of mortality of children aged under-five years in the developing countries including Nepal. The transmission of diarrhoea mostly caused by biological agents and is facilitated by the behavioural, social and environmental factors. More recently, the concept of prevention altering these factors is getting momentum. To recommend the most effective non medical intervention that can prevent and control childhood diarrhoeal disease in Nepal. Literature review was conducted to analyse the successful interventions in developing countries. Peer review articles were accessed from "Science Direct", "Google Scholar", and "PubMed". Interventions focussing on social and environmental determinants of diarrhoea were included. Four interventions (with primary focus in social and environmental determinants of diarrhoeal disease) were purposively selected, summarized and discussed. Saniya programme (Burkina Faso 1995 to 1998) is considered successful in modifying the risk behaviours. Intensive hand washing programme (Pakistan 2002 to 2003), a cluster randomized controlled trail, was not sustainable as the results did not last long once the free supply of soap was stopped. School Led Total Sanitation (Nepal 2006) is a participatory, community centred program whose focus is on local ownership. This program approach is effective and feasible for scaling up in Nepal. Global Public Private Partnership for Hand washing with Soap (Ghana 2002) was based on the marketing researches and hence yielded effective results. Combination of School Led Total Sanitation and Global Public Private Partnership for hand washing with soap suits Nepal. These interventions focus on creating demand, changing behaviour and thereby, improving the sanitation status.

Prevalence and associated factors of partially/non-immunization of under-five in Goma city, Democratic Republic of Congo: a community-based cross-sectional survey.

IntroductionAt the East part of DRC, anecdotal reports are advancing several causes of unsuccessful campaigns of vaccination by the time going: rumors about use of vaccines for killing purpose, injection of vaccine to decrease the reproductive potential in coming generations, use of vaccines by some rebellions and neighboring countries to kill children indirectly, ineffectiveness of vaccines currently on the market. While those rumors seem to be less reliable, potential beneficiaries are taking them seriously and justifying a reluctance to bring their children or siblings for immunization. Against this above background, our community Primary Health Care team indicates that still, in Goma city in general and even in the referral hospital catchment area, there are children who have never been vaccinated.ObjectivesTo determine the prevalence and determinants of non-immunization of under-five children in Goma City.Study designCross-sectional community-based survey.MethodsA sample size of 384 children aged under-five years from the target population was used for the study. The ratio of under-five years of age Goma city to the total population of Goma city for the year 2012 was considered as the study population frame.ResultsThe prevalence of under-five non-immunized children was 25.7%. There was an association between immunization status of children and their gender, school characteristics, age, sibling, the level of literacy, the marital status of their parents and the age of their mothers.ConclusionFor improving the quality of under-five children immunization, the medical authorities must consider these different determinants.

Mothers’ Demand for Preventive Health Care for Children aged Under-Five Years: The Case of Utilization of Insecticide-Treated Bednets in Ghana.

Child health outcomes remain one of the most important barometers for measuring the overall social and economic well being of a country. Malaria is endemic in sub-Saharan Africa, being the major cause of under-five mortality in Ghana. An effective strategy to combat the widespread malaria morbidity among children aged under-five is the utilization of preventive health care via Insecticide Treated Bednets (ITNs). This paper examines the socio-economic factors influencing the adoption and usage of ITNs by mothers or care-givers for children aged under-five years. Logistic regression is employed for the empirical estimation. The study finds that low-income households, age of the child, area of residence, distance to the nearest health facility and distance to food market inter alia significantly predict mother’s adoption and utilization of ITN among children aged-under five. It is also worth-noting that women who had experienced childhood mortality in the last five years preceding the survey were 37 percentage points more likely to have their children sleep under ITN. In addition, mothers who profess the Catholic faith were 2.4 times more likely to have their children sleep under ITN compared to their counterparts who are traditionalist. The paper contributes to the general debate on preventive health care.