Children In Low-income Countries Research Articles

Factors associated with stunting in under-five children with environmental enteropathy in slum areas of Jimma town, Ethiopia.

Stunting is a major public health issue with a significant influence on the health and development of children in low-income countries, where it affects up to 32% of children. Nutritional intake is impacted by alterations in intestinal permeability and underlying chronic inflammation, which hinder children's normal linear growth. Environmental enteropathy is a poorly understood condition with chronic intestinal inflammation. The purpose of this study was to identify the magnitude of stunting, change in growth, and factors associated with stunting and change in height for the age Z-score of children with an elevated lactulose-to-mannitol ratio. An observational follow-up study was conducted to follow children with an elevated lactulose-to-mannitol ratio for changes in their linear growth. A lactulose-mannitol test was performed to identify children with elevated lactulose-to-mannitol ratios, indicative of environmental enteropathy. After a 1-year follow-up, anthropometry was repeated to assess their linear growth. A multivariable logistic regression analysis was performed to identify the independent predictors for stunting in children with elevated lactulose-to-mannitol ratios. All tests were two-sided, and a p-value of <0.05 was considered significant. The prevalence of stunting in children with an elevated L:M at baseline and end line was found to be 72.4% (95% CI: 60.3, 84.5) and 78.4% (95% CI: 66.7, 90.2), respectively. In a multivariate analysis, a low dietary diversity score (<4 food groups), presence of flies and insects in the toilet area, poor handwashing practices during a critical time, and MUAC z < -2 were significantly associated with stunting. Flies and insects in the toilet area and unsafe disposal of feces were significantly associated with changes in HAZ in children with elevated lactulose-to-mannitol ratios, an indicator of environmental enteropathy. Most of the children with an elevated lactulose-to-mannitol ratio in the study population were stunted, and no significant change in their linear growth was observed after 1-year follow-up. Therefore, further investigation and urgent intervention are needed to prevent environmental enteropathy and stunting among under-five children in this community who are exposed to very poor sanitary conditions and other risk factors for malnutrition.

Intakes from healthy and unhealthy food groups and obesity among 5- to 9-year-old South African children

The global pandemic of paediatric overweight and obesity, along with undernutrition among children in low-income countries pose challenges for future health. Unhealthy dietary intake among children is of great concern(1). The aim of this study was to determine the association between intakes from healthy and unhealthy food groups and adiposity among 5- to 9-year-old South African children (n = 920). Conventional dietary intake assessment methods are burdensome; therefore, a short unquantified food frequency questionnaire was developed based on the WHO Global school-based student health survey, which focused on healthy and unhealthy food groups. The new questionnaire includes four healthy food groups (fruits, vegetables, milk, meats) and six unhealthy food groups (hot sugar-sweetened beverages (SSBs), cold SSBs, cookies, candies, salty snacks, fast foods) with five different responses of frequency of intake per week. The food groups reflect foods generally eaten by South African school children. The questionnaire was completed by the parents. Weight and height were measured and WHO BMI z-score (BAZ) was calculated(2). Descriptive statistics were reported using median and interquartile range. Frequency of intakes from food groups were compared across tertiles of BAZ using the Kruskal-Wallis test. The correlation between frequency of intakes from different food groups, and between the food groups and BAZ was calculated. The children reported similar daily intakes from the milk (35.3%), cold SSBs (33%) and hot SSBs groups (27%). Fruit (14%) and vegetables (9.6%) were consumed daily by a small percentage of children, while animal source protein foods (meat, fish, poultry, eggs) were consumed daily by 39% of children. The most frequent daily consumed snacks were salty snacks, e.g. crisps (13.2%), candy (11.1%) and cookies (5.3%), while fast foods were consumed once per week by the largest proportion of children (60.7%). Based on the WHO BMI z-scores, 15.2% of children were overweight, 4.4% were obese and 3.8% were underweight. Children in the highest two tertile groups of BAZ had a higher median weekly frequency of SSB intake (5, IQR 1,7), compared to those in the lowest BAZ tertile (3, IQR 1,7). No other differences were found between frequency of food group intake across BAZ tertiles. There was a weak positive correlation between BAZ and the frequency of SSB intake (r = 0.08, = 0.015), as well as between frequency of milk intake and frequency of SSB intake (r = 0.13, P&lt;0.001), but a weak negative correlation between the frequency of vegetable intake and frequency of SSB intake (r = −0.08, P = 0.01). In conclusion, low fruit and vegetable intakes, combined with regular SSB intakes are evident in this group of children. The frequency of SSB intake was positively associated with adiposity, and SSB intake apparently replaced vegetable intake, but not milk intake among the children.

Estimation of Rotavirus Associated Diarrheal Disease Burden Amongst Primary School Children of Sindh

Introduction: Human Rotavirus Virus (HRV) is amongst the common enteric viral diarrheal diseases that indirectly or directly influence school-going children in low-income countries. Inadequate information exists on the presence of rotavirus, with reference to drinking water supplies of primary schools in Sindh, Pakistan. Aims &amp; Objectives: We estimated the risk of rotavirus-associated diarrhea through drinking water. The study further compared the HRV-associated risk of diarrheal disease by a type of water source. Place and Duration of Study: A cross-sectional survey was conducted in ten representative districts of Sindh from February 2022 to December 2022. The samples for drinking water were collected from primary schools of ten representative districts of Sindh. This study was a part of the WASH Project funded by USAID (USPCASW Seed Grant P-II) Material &amp; Methods: We selected 425 samples of drinking water from primary schools based on pre-defined selection criteria. We used a Quantitative Microbial Risk Analysis using indicator organisms, i.e., E. coli, to predict the possible health risks of rotavirus. Data was entered and analyzed on SPSS version 26. The graphs were developed using Arc GIS version 3. Morbidity and mortality were predicted using the Quantitative Microbial Risk Assessment (QAMRA) model. Results: Our data revealed that the highest daily risk of HRV-associated diarrhea amongst school children was 11 per 10,000 schoolchildren, resulting in 8.4% annual risk, and the minimum risk was estimated to be 1 in 10,000 children. The burden of diseases for rotavirus using the QAMRA model revealed the severity of the diarrhea. Majority of the children presented with mild diarrhea (86%) followed by severe, and the probability of death was less than &lt;1%. The daily risk of HRV infection was highest (estimated to be 7 and 11%) in pupils of Southern Sindh, with an annual risk of 17.4% to 40%. Conclusion: Our study concluded that the children in the primary schools of Sindh were exposed to poor drinking water quality. The surface water source poses the highest risk of HRV-related diarrhea to school children. Thus, it is highly recommended that point-of-use drinking water treatment systems be adopted. The water sanitation and hygiene (WASH) resources are interlinked, so each resource impacts the other; hence, schools urgently need to invest in providing adequate WASH facilities to stop enteric virus transmission through drinking water sources.

The association between different types of amino acid intake and physical growth among children

Background & aimsRestricted linear growth and abnormal weight status are commonly observed among children in low-income countries, possibly due to inadequate protein intake. Considering the role of protein intake and amino acid (AA) synthesis in growth and development, it has been suggested that there may be an association between AA intake and physical growth. We aimed to investigate the association between different types of AA intake and physical growth among children. MethodsA cross-sectional study including 780 six-year-old children referred to 10 health care centers for vaccination between October 2017 and March 2018 was conducted. Anthropometric data was collected using standard methods, and dietary intake was assessed using a validated food-frequency questionnaire (FFQ)‏ in an interview by a trained technician. ResultsChildren in the highest tertile (3rd) of branched-chain amino acids (BCAA) intake had a higher weight-for-age z-score (WAZ) (P = 0.02) and body mass index-for-age z-score (BAZ) (P = 0.001) compared to those in the lowest tertile (1rd). Interestingly, BAZ was significantly associated with the highest tertile of acidic AA intake (P = 0.04), while an inverse association was observed between the highest tertile of aromatic AA (phenylalanine and tyrosine) intake and BAZ (P = 0.01) . No significant associations were observed between the highest tertile of sulfuric, aliphatic, or neutral AA and BAZ, height-for-age z-score (HAZ) or WAZ. Further, underweight was associated with the 3rd tertile of aromatic, alcoholic, aliphatic or neutral AA and BCAA intake. Aliphatic and neutral AA intake was also increased the risk of overweight. Finally, stunted growth patterns were associated with the highest tertile of acidic, alcoholic. ConclusionFindings presented in this study showed that higher BAZ and WAZ are associated with 3rd tertiles of BCAA intake, but lower BAZ were associated with 3rd tertiles of aromatic AA (phenylalanine and tyrosine) intake.Future research in other populations are needed to confirm these findings.

Gross motor developmental delay and associated factors among under-five children attending public health facilities of Dessie city, Ethiopia

BackgroundChild psychomotor development and factors affecting it today is the subject of interest of many studies, in particular by the experts involved in the protection and improvement of children’s health. There is limited evidence on developmental delay among under-five children in low-income countries like Ethiopia. The aim of this study was to assess gross motor developmental delay and associated factors among under-five children attending public health facilities of Dessie city, Ethiopia.MethodsFacility based cross sectional study design was used among under-five children attending under-five OPD in public health facilities of Dessie town from July 1, 2020 to August 15, 2021. A total of, 417 under-five children were systematically selected based on their average number of clients in a month. A pretested structured questionnaire was used for data collection, and data was entered into Epi-data 3.1 version and it was exported to STATA version 14 for analysis. Binary logistic regression analysis was used to identify factors associated with the outcome variable. Odds ratio with 95% confidence interval was used to show the strength and direction of association respectively and P-value less than 0.05 is used to declare statistical significance.ResultsThe overall proportion of gross motor developmental delay among under-five children attending health facilities of Dessie city, Ethiopia was 16.31%, 95% CI: (13.05, 20.19). Increased age of the child [AOR = 0.97, 95% CI: (0.96, 0.99)], increased gestational age during pregnancy [AOR = 0.47, 95% CI: (0.37, 0.65)], being male [AOR = 5.26, 95% CI: (1.76, 15.67)], having history of alcohol intake during pregnancy [AOR = 7.40, 95% CI: (2.36, 23.25)], taking iron during pregnancy [AOR = 0.04, 95% CI: (0.01, 0.15)], facing fetal and/or maternal complication [AOR = 4.98, 95% CI: (1.20, 20.62)], having instrumental delivery [AOR = 9.78, 95% CI: (2.48, 38.60)] were significantly associated with gross motor developmental delay.ConclusionsThe gross motor developmental delay among under-five children was higher as compared to other literatures. This study indicated that, age and sex of the child, iron and alcohol intake during pregnancy, gestational age, mode of delivery and any complication to her and or her neonate were independent variables which showed statistical significant association. The physicians should advise mothers to take iron-folic acid supplement properly and to avoid intake of alcohol during pregnancy. In addition, they should focus on those mothers who faced any complication to her and/or her neonate and better to discourage instrumental delivery unless there are no other options.

A Video Game to Help the Fight Against the Vicious Tapeworm in Africa

The pork tapeworm, Taenia solium, is the agent causing the most important parasitic infection worldwide due to its substantial economic and health impacts, disproportionally affecting low-income countries. Health education should form a core component in control efforts and sustain control strategies proposed by the World Health Organization (WHO), such as human treatments. Traditional health education methods have shown to be less effective. Therefore, in the field of tropical medicine, new, engaging ways to teach affected populations are needed. Within the project ‘Gaming 4 Health’ we developed an educational video game aimed at instructing school-going children in low-income countries about the tapeworm and how to prevent it. Building on the principles of gamified learning and the self-determination theory, we created the educational video game the ‘Tapeworm game’. The game was developed by a multidisciplinary team, following the game design research cycle which included five steps: game planning, game design, prototyping, play testing and evaluation. The Tapeworm game is a multi-player video game set in an African village. The game’s objective is to educate players about the tapeworm and how to prevent the the spread of disease. Players create their own avatar and learn about disease prevention by exploring the village, engaging in minigames and preforming complementary actions, such as washing hands and visiting the toilet. Points are earned by playing the minigames and performing the actions correctly within a given time. The more points a player accumulates, the higher they climb on the leader boards. Rewards are unlocked based on performance and competence and displayed as stars, badges, and avatar customizations. This makes the game exiting and keeps children fully immersed, motivating them to learn, improve and continue playing the videogame. With this videogame our goal is to educate, raise awareness and advance the control of the pork tapeworm as part of the WHO’s 2030 goals for Neglected Tropical Diseases.

Treatment of bone infections in children in low-income countries – A practical guideline based on clinical cases

In low-income countries (LIC), the management of bone infections is a huge challenge. A high number of patients are in the pediatric age group. Children and adolescents exhibit good bone healing potential offering treatment options that mainly rely on the biological response of the infected bone. The purpose of this article is to highlight treatment options for these patients in LIC, which is based on clinical cases that illustrate the principles of the treatment, focusing on bone reaction and healing potential.First, identification of emergency cases is of importance. Sepsis of the patient due to bone infections is a life-threatening disease that requires immediate surgical attention with abscess incision. It should be tailored to the surgeon's experience and local conditions to avoid unwanted complications, such as excessive bleeding, fracture or bone loss.In non-septic patients, uncomplicated cases should be distinguished from complicated cases as the first might often require only abscess incision, particularly in small children, without any other major surgical intervention.Biomechanical stability and bone formation capacity, soft tissue conditions and joint involvement are decisive factors differentiating uncomplicated from complicated cases. Central treatment column is the immobilization of the infected bone with simple methods, such as plaster of Paris, braces or external fixation. This is intended to provide sufficient stability to allow for new bone formation that subsequently downsizes the infection site and that can bridge previously infected non-union sites or bone defects. In most cases, antibiotic treatment is not performed as antibiotics are not available or affordable.Severe soft tissue defects remain a major challenge as microvascular surgical experience is often required for reliable coverage, for which referral to one of the very few specialized centers is recommended. Major bone defects should also be treated in centers with sufficient expertise for bone reconstruction procedures. Regular follow-ups are important to ensure healing and to avoid aggravation of the disease.Encouraging success rates can be achieved by these treatment principles. However, it should not be forgotten that poverty in these countries, including limited access to health care, remains one of the world's most important problems.

Magnitude and Determinant Factors of Pediatrics Seizures in Pediatrics Emergency Unit at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia, 2020: A Retrospective and Descriptive Study.

One of the most prevalent medical problems affecting kids is epilepsy, which is the most prevalent chronic neurological condition in kids in both developed and developing nations. The spectrum of diseases that make up childhood epilepsy syndromes ranges from mild to potentially fatal. Children may experience seizures due to a variety of illnesses, such as infection, severe brain injury, and anatomical deformity. It is the foremost visit calculates in neurological and cognitive impedance in children in low-income countries as well as the foremost common reason for pediatric clinic confirmations in children from destitute countries. All things considered, constrained things have been conducted in Ethiopia. Hence, this ponder points to survey the size and related variables of pediatric seizures among children conceded to Tikur Anbessa pediatric emergency. By looking through 256 patient charts, an institution-based retrospective cross-sectional analysis was done. Data collection utilized a systematic checklist that had been evaluated beforehand. The EpiData version 4.4.2.2 was used to enter the data, which was then exported for analysis to the SPSS version 25. Binary logistic regression and descriptive statistics were employed. Variables from the bivariate analysis that had a p-value of less than 0.25 were carried over to multivariate analysis. The strength and existence of the link were assessed using adjusted odds ratios with a 95% confidence interval and a p-value of 0.05, respectively. Patients' ages ranged from 3.7 to 2.8 years on average. 4.5% of patients had seizures, and 155 of them (60.5%) were men, with a male-to-female ratio of (1.5 : 1). Males and females experienced seizures on average at 1.3 (95% CI: 1.1, 1.5) and 2 (95% CI: 1.6, 2.5) years old, respectively. AOR: 2.68 (95% CI: 1.192, 6.68, p = 0.02) and AOR: 2.8 (95% CI: 2.576, 5.302, p = 0.04) both demonstrated statistically significant correlations with pediatric seizure. A vast number of children experienced convulsions, with generalized seizures being the most prevalent form. The chances of a child having a seizure were linked to their family history and where they were born. Therefore, health workers and other people who are involved in healthcare need to work harder on the factors that they have already identified.

Secondary school teachers' perception of quality management practices in Ethiopia: Implications for quality education for all

Background: Most children in low-income countries complete their elementary education with low competency in essential reading, writing, and arithmetic skills. Besides, about 250 million students are not learning the basics, most of whom have spent at least four years in school, and this failure is coined the global learning crisis. This study aimed to examine educational quality management practices perceived by secondary school teachers. Methods: The study employed a multilevel mixed-method design. Employing a simple random sampling technique, the researcher selected 251 teachers from 10 secondary schools in the research regions. He collected data through a researcher-designed questionnaire, school standards, and student achievement records from November 2018 to March 2019. He analyzed data from a questionnaire using frequency, percentage, mean, Pearson correlation, and exploratory factor analysis. The document review concerning quality management was analyzed using content analysis to triangulate the quantitative findings. Results: At the school level, the study revealed the impracticality of laboratories. Besides, incompetent and unmotivated teachers and students ran the education business from the input side. At the same level, principals' management practices on staff development and encouraging parents to support their schools were low. The principals' management practices in the teaching-learning process were also undesirable at the classroom level. Overall, the study revealed incredibly insufficient input, process, and output management in the study context. Conclusion: Hence, the study concluded that it is difficult to achieve the very objectives of producing creative, critical, and problem-solving individuals through this type of educational provision and its management. Due to this, it is not easy to achieve quality education for all goals.

Secondary school teachers' perception of quality management practices in Ethiopia: implications for quality education for all

Background: Most children in low-income countries complete their elementary education with low competency in essential reading, writing, and arithmetic skills. Besides, about 250 million students are not learning the basics, most of whom have spent at least four years in school, and this failure is coined the global learning crisis. This study aimed to examine educational quality management practices perceived by secondary school teachers. Methods: The study employed a multilevel mixed-method design. Employing a simple random sampling technique, the researcher selected 251 teachers from 10 secondary schools in the research regions. He collected data through a researcher-designed questionnaire, school standards, and student achievement records from November 2018 to March 2019. He analyzed data from a questionnaire using frequency, percentage, mean, Pearson correlation, and exploratory factor analysis. The document review concerning quality management was analyzed using content analysis to triangulate the quantitative findings. Results: At the school level, the study revealed the impracticality of laboratories. Besides, incompetent and unmotivated teachers and students ran the education business from the input side. At the same level, principals' management practices on staff development and encouraging parents to support their schools were low. The principals' management practices in the teaching-learning process were also undesirable at the classroom level. Overall, the study revealed incredibly insufficient input, process, and output management in the study context. Conclusion: Hence, the study concluded that it is difficult to achieve the very objectives of producing creative, critical, and problem-solving individuals through this type of educational provision and its management. Due to this, it is not easy to achieve quality education for all goals.

Estimating global and regional between-country inequality in routine childhood vaccine coverage in 195 countries and territories from 2019 to 2021: a longitudinal study.

Global routine childhood vaccine coverage has plateaued in recent years, and the COVID-19 pandemic further disrupted immunisation services. We estimated global and regional inequality of routine childhood vaccine coverage from 2019 to 2021, particularly assessing the impacts of the COVID-19 pandemic. We used longitudinal data for 11 routine childhood vaccines from the WHO-UNICEF Estimates of National Immunization Coverage (WUENIC), including 195 countries and territories in 2019-2021. The slope index of inequality (SII) and relative index of inequality (RII) of each vaccine were calculated through linear regression to express the difference in coverage between the top and bottom 20% of countries at the global and regional levels. We also explored inequalities of routine childhood vaccine coverage by WHO regions and unvaccinated children by income groups. Globally between January 1, 2019 and December 31, 2021, most childhood vaccines showed a declining trend in coverage, and therefore an increasing number of unvaccinated children, especially in low-income and lower-middle-income countries. Between-country inequalities existed for all 11 routine childhood vaccine coverage indicators. The SII for the third dose of diphtheria-tetanus-pertussis-containing vaccine (DTP3) coverage was 20.1 percentage points (95% confidence interval: 13.7, 26.5) in 2019, and rose to 23.6 (17.5, 30.0) in 2020 and 26.9 (20.0, 33.8) in 2021. Similar patterns were found for RII results and in other routine vaccines. In 2021, the second dose of measles-containing vaccine (MCV2) coverage had the highest global absolute inequality (31.2, [21.5-40.8]), and completed rotavirus vaccine (RotaC) coverage had the lowest (7.8, [-3.9, 19.5]). Among six WHO regions, the European Region consistently had the lowest inequalities, and the Western Pacific Region had the largest inequalities for many indicators, although both increased from 2019 to2021. Global and regional inequalities of routine childhood vaccine coverage persisted and substantially increased from 2019 to 2021. These findings reveal economic-related inequalities by vaccines, regions, and countries, and underscore the importance of reducing such inequalities. These inequalities were widened during the COVID-19 pandemic, resulting in even lower coverage and more unvaccinated children in low-income countries. Bill & Melinda Gates Foundation.

Assessment of Serum Vitamin D Status and Its Associated Health Problem Among Children With Protein Energy Malnutrition: A Cross-Sectional Research Study in Central Rural India.

Background Protein energy malnutrition (PEM) is a condition that results from inadequate intake of both macronutrients and micronutrients, leading to a lack of energy. The condition can manifest quickly or gradually, ranging from mild to severe. It predominantly affects children in low-income countries who do not receive enough calories and proteins. In developed nations, it is more prevalent among older individuals. PEM is more common in children as they consume less protein. In rare cases in developed countries, it may result from fad diets or a lack of knowledge about children's nutritional requirements, especially in cases of milk allergy. Vitamin D plays a critical role in bone growth and development by facilitating the absorption of calcium and phosphorus from food and supplements. Additionally, vitamin D has been linked to a reduced risk of infections, immune system disorders, diabetes, high blood pressure, and heart disease. Aims and objectives The primary objective of this study is to evaluate serum vitamin D levels and their relationship with health complications in children affected by PEM. The specific aim is to estimate the serum vitamin D levels in children with PEM who exhibit symptoms of being underweight, stunting (limited linear growth), wasting (abrupt weight loss), or edematous malnutrition (kwashiorkor). Additionally, this study seeks to analyze the correlation between serum vitamin D levels and the associated health problems in children with PEM. Materials and methods This cross-sectional study employed an analytical research approach. A total of 45 children with PEM participated in the study. Data were collected through a venipuncture method, and serum vitamin D level was assessed using an enhanced chemiluminescence method. The children's pain was assessed using a visual analogue scale, and developmental delay was evaluated using an assessment chart. Data were analyzed using SPSS Version 22 (IBM Corp., Armonk, NY). Results The study's results indicate that a considerable proportion of children, specifically 46.6%, were deficient in vitamin D, whereas 42.2% exhibited insufficiency and only 11.2% had sufficient levels of the vitamin. Pain assessment using the visual analogue scale classification revealed that 15.6% of children reported no pain, 60% reported mild pain, and 24.4% reported moderate pain. The mean and standard deviation of vitamin D levels correlated with developmental delay were 4.22±0.212 and 5.34±0.438, respectively. Similarly, the mean and standard deviation of vitamin D levels correlated with pain were 4.22±0.212 and 2.98±0.489, respectively. The Pearson correlation coefficient for vitamin D levels and pain was 0.010, with a significant level of 0.989, significantly lower than the tabulated value at a 5% significance level. Conclusion Based on the study's findings, it was concluded that children who suffer from PEM are at a risk of developing vitamin D deficiency, which can result in adverse health outcomes, including developmental delay and pain.

Dietary Protein Intake in Young Children in Selected Low-Income Countries Is Generally Adequate in Relation to Estimated Requirements for Healthy Children, Except When Complementary Food Intake Is Low

Background Previous research indicates that young children in low-income countries (LICs) generally consume greater amounts of protein than published estimates of protein requirements, but this research did not account for protein quality based on the mix of amino acids and the digestibility of ingested protein.Objective: Our objective was to estimate the prevalence of inadequate protein and amino acid intake by young children in LICs, accounting for protein quality.Methods: Seven data sets with information on dietary intake for children (6–35 mo of age) from 6 LICs (Peru, Guatemala, Ecuador, Bangladesh, Uganda, and Zambia) were reanalyzed to estimate protein and amino acid intake and assess adequacy. The protein digestibility–corrected amino acid score of each child's diet was calculated and multiplied by the original (crude) protein intake to obtain an estimate of available protein intake. Distributions of usual intake were obtained to estimate the prevalence of inadequate protein and amino acid intake for each cohort according to Estimated Average Requirements.Results The prevalence of inadequate protein intake was highest in breastfeeding children aged 6–8 mo: 24% of Bangladeshi and 16% of Peruvian children. With the exception of Bangladesh, the prevalence of inadequate available protein intake decreased by age 9–12 mo and was very low in all sites (0–2%) after 12 mo of age. Inadequate protein intake in children <12 mo of age was due primarily to low energy intake from complementary foods, not inadequate protein density.Conclusions Overall, most children consumed protein amounts greater than requirements, except for the younger breastfeeding children, who were consuming low amounts of complementary foods. These findings reinforce previous evidence that dietary protein is not generally limiting for children in LICs compared with estimated requirements for healthy children, even after accounting for protein quality. However, unmeasured effects of infection and intestinal dysfunction on the children's protein requirements could modify this conclusion.

Ülke Gelir Gruplarına Göre Anne ve Çocuk Sağlığının Değerlendirilmesi: Tanımlayıcı Bir Çalışma

Objective: The economic situation of countries is one of the important determinants of health. The aim of this study is to evaluate the socioeconomic inequalities in maternal and child health using the indicators of maternal and child health of countries by World Bank's income classification. Material and Methods: In the research, 166 countries were included. The data were analyzed using IBM SPSS Statistics (Ver. 20). The Kruskal-Wallis H test was used to analyze whether variables about maternal and child health differ according to country income groups. The significance level was accepted as p<0.05. Mann-Whitney U test was used to understand from which groups the difference originated. Results: As a result of this study, it was determined that maternal and child health variables differed statistically significantly between country groups according to the World Bank income classification. Conclusion: Using the World Bank's income classification, this study highlights socioeconomic inequalities in maternal and child health. Although very serious risks in maternal and child health are not observed in high-income and upper-middle-income countries, there remain problems, particularly in low-income and lower-middleincome countries. The results show that children in low-income countries have more limited access to important health interventions such as vaccines and medical care. Eliminating inequalities in maternal and child health should be seen as a necessity for achieving the Sustainable Development Goals. Global cooperation is considered necessary to reduce socioeconomic inequalities in maternal and child health. International organizations are expected to support these countries with seriously aid.

Phototherapy services for newborns with jaundice: Availability and practices in Southeast Nigeria

Severe neonatal hyperbilirubinemia remains a cause of neurologic damage in children in low-income countries. Phototherapy, which is the standard of care for neonatal hyperbilirubinemia is not only necessary but an essential neonatal service that should be readily available in all health facilities with maternal and newborn services. The study describes the availability and distribution of phototherapy service in secondary health facilities in Southeast Nigeria. This was a cross-sectional descriptive study carried out in four of the largest cities in Southeast Nigeria using purposive and convenient sampling methods. A questionnaire was administered and information regarding the availability of phototherapy machines, its use and availability of personnel was obtained. A total of 77 facilities were surveyed. Fifty-five (71.4%) of the studied facilities manage jaundice in their facility. Of these, 45/55 (81.8%) use phototherapy in the management of jaundice in newborns. The most used phototherapy is Light-Emitting Diode (LED) (42.2%). Others were fluorescent (26.6%), fabricated LED (11.1%) and fabricated fluorescent (20%). Routine serum bilirubin assay was done in 60 (77.9%) facilities even though majority was done in laboratories outside the facility. Non-invasive serum bilirubin monitoring was available in only two facilities. Only 21 (47.7%) had a servicing protocol for their phototherapy machines, and just 12 (27.7%) of these services were offered by a biomedical engineer. Phototherapy use in secondary health facilities is suboptimal. There is urgent need for states health authorities to collaborate with private health facilities especially those offering maternal and child services in provision of phototherapy machines and help in the training health workers for optimal management of neonatal hyperbilirubinemia.

Bayesian spatio-temporal modelling of child anemia in Ethiopia using conditional autoregressive model

Anemia is a common health problem for women and under five children in low income countries. According to the WHO, anemia is considered a serious public health problem when the prevalence is greater than 40%. The prevalence of anemia among children under five in Ethiopia changes over time, and is spatially correlated because it is influenced by environmental, socio-economic and other related factors. However, to our knowledge, there is no small area level estimates of anemia among children under five in Ethiopia. Therefore, this study aimed to assess zonal level estimates of anemia using a Bayesian spatio-temporal conditional autoregressive modeling approach. The data for the study was extracted from the Ethiopian Demographic and Health Surveys (EDHS) from 2005 to 2016. A sample of 18,939 children aged 6–59 months were considered for this study. A Bayesian spatio-temporal conditional autoregressive model was implemented to identify the risk of child anemia. Smoothed relative risks along with the 95% credible interval were reported. The queen’s adjacency matrix method was used in spatial smoothing and in estimating the relative risk. The prevalence of anemia among children aged 6–59 months in Ethiopia was 54% in 2005, 44% in 2011 and 57% in 2016. This study showed that low maternal education, low socio-economic status of women, and maternal anemia at zone level were strongly associated with child anemia in Ethiopia. Therefore, enhancing education for women, improving women's socioeconomic status, and mitigating maternal anemia are crucial to reduce the prevalence of childhood anemia in Ethiopia.

Recovery rate of severe acute malnourished children aged 6-59 months enrolled in outpatient therapeutic program at health posts of Central Gondar zone, Ethiopia.

Background: Inadequate intake of food is one of the causes of malnutrition and has significant impact on the deaths of children in low-income countries. Community-based management of acute malnutrition was endorsed as a strategy to alleviate such burdens of child morbidity and mortality associated with malnutrition. Despite outpatient therapeutic program has decentralized to health post level, there is still a lack of adequate evidence regarding the recovery rates from outpatient therapeutic program at health post level in Ethiopia. In addition, the previous body of articles did not show the local situations, particularly the recovery rates of severe acute malnutrition children from outpatient therapeutic program in the central Gondar zone, Ethiopia. Aim: This study aimed to assess recovery rate and associated factors among severe acute malnourished children enrolled to outpatient therapeutic program at health posts of Central Gondar zone, Ethiopia. Methods: This study was a facility-based retrospective cross-sectional study conducted on 349 children who had managed for severe acute malnutrition in outpatient therapeutic program in Central Gondar zone from March to May 2021. A structured and pre-tested data extraction checklist adapted from literatures was used to collect the data. The children were selected using consecutive sampling from 39 health posts. Data were entered, cleaned, coded and analyzed using Stata version 14 software. Binary logistic regression was fitted to identify factors associated with recovery rate from outpatient therapeutic program. Adjusted odds ratio with 95% confidence interval and p-value <0.05 were used to declare the variables statistically significant with the recovery rate from outpatient therapeutic program. Results: The successful recovery rate for severe acute malnourished children admitted to outpatient therapeutic program was 74.2% (95% CI: 69.3, 78.6). False recovery, death, default, non-responder and medical transfer out rates were 12.6%, 8.6%, 2.9%, 0.9% and 0.9%, respectively. In addition, the average weight gain of children was 4.4 g/kg/day for the length of stays, and the average length of stay was also 6.7 (±1.3SD) weeks. Breastfeeding status (AOR = 1.72; 95% CI: 1.05, 2.83), antibiotics (amoxicillin) provision (AOR = 2.14; 95% CI: 1.07, 4.25) and vitamin A supplementation (AOR = 1.93; 95% CI: 1.13, 3.30) were positively associated with the recovery rate of severe acute malnourished children admitted to outpatient therapeutic program. Conclusion: In this study, we found that the recovery, death and default rates were in the acceptable ranges of sphere standards. Therefore, health extension workers shall manage to shape service providers of outpatient therapeutic program with severe acute malnutrition management protocol. Special attention was also needed to build capacity of health extension workers to alleviate knowledge gaps on children enrolled to and discharge from outpatient therapeutic program at health posts. Dietary counselling is essentially required to improve maternal diets, which can affect the nutritional status of breastmilk.

Secondary school teachers' perception of quality management practices in Ethiopia: Implications for quality education for all

Background: Most children in low-income countries complete their elementary education with low competency in essential reading, writing, and arithmetic skills. Besides, about 250 million students are not learning the basics, most of whom have spent at least four years in school, and this failure is coined the global learning crisis. This study aimed to examine educational quality management practices perceived by secondary school teachers. Methods: The study employed a multilevel mixed-method design. Employing a simple random sampling technique, the researcher selected 251 teachers from 10 secondary schools in the research regions. He collected data through a researcher-designed questionnaire, school standards, and student achievement records from November 2018 to March 2019. He analyzed data from a questionnaire using frequency, percentage, mean, Pearson correlation, and exploratory factor analysis. The document review concerning quality management was analyzed using content analysis to triangulate the quantitative findings. Results: At the school level, the study revealed the impracticality of laboratories. Besides, incompetent and unmotivated teachers and students ran the education business from the input side. At the same level, principals' management practices on staff development and encouraging parents to support their schools were low. The principals' management practices in the teaching-learning process were also undesirable at the classroom level. Overall, the study revealed incredibly insufficient input, process, and output management in the study context. Conclusion: Hence, the study concluded that it is difficult to achieve the very objectives of producing creative, critical, and problem-solving individuals through this type of educational provision and its management. Due to this, it is not easy to achieve quality education for all goals.

Development of Two Mouse Models for Vaccine Evaluation against Cryptosporidiosis.

ABSTRACTCryptosporidiosis was shown a decade ago to be a major contributor to morbidity and mortality of diarrheal disease in children in low-income countries. A serious obstacle to develop and evaluate immunogens and vaccines to control this disease is the lack of well-characterized immunocompetent rodent models. Here, we optimized and compared two mouse models for the evaluation of vaccines: the Cryptosporidium tyzzeri model, which is convenient for screening large numbers of potential mixtures of immunogens, and the Cryptosporidium parvum-infected mouse pretreated with interferon gamma-neutralizing monoclonal antibody.

Oocyst Shedding Dynamics in Children with Cryptosporidiosis: a Prospective Clinical Case Series in Ethiopia.

ABSTRACTKnowledge on the duration of Cryptosporidium oocyst shedding, and how shedding may be affected by subtypes and clinical parameters, is limited. Reduced transmission may be a secondary benefit of cryptosporidiosis treatment in high-prevalence areas. We conducted a prospective clinical case series in children of <5 years presenting with diarrhea to a health center and a hospital in Ethiopia over an 18-month period. Stool samples were collected repeatedly from children diagnosed with cryptosporidiosis for up to 60 days. Samples were examined, and Cryptosporidium shedding was quantified, using auramine phenol, immunofluorescent antibody staining, and quantitative PCR (qPCR). In addition, species determination and subtyping were used to attempt to distinguish between new infections and ongoing shedding. Duration and quantity of shedding over time were estimated by time-to-event and quantitative models (sex- and age-adjusted). We also explored how diarrheal severity, acute malnutrition, and Cryptosporidium subtypes correlated with temporal shedding patterns. From 53 confirmed cryptosporidiosis cases, a median of 4 (range 1 to 5) follow-up stool samples were collected and tested for Cryptosporidium. The median duration of oocyst shedding was 31 days (95% confidence interval [CI], 26 to 36 days) after onset of diarrhea, with similar estimates from the quantitative models (31 days, 95% CI 27 to 37 days). Genotype shift occurred in 5 cases (9%). A 10-fold drop in quantity occurred per week for the first 4 weeks. Prolonged oocyst shedding is common in a pediatric clinical population with cryptosporidiosis. We suggest that future intervention trials should evaluate both clinical efficacy and total parasite shedding duration as trial endpoints.IMPORTANCE Cryptosporidiosis is an important cause of diarrhea, malnutrition, and deaths in young children in low-income countries. The infection spreads from person to person. After infection, prolonged release of the Cryptosporidium parasite in stool (shedding) may contribute to further spread of the disease. If diagnosis and treatment are made available, diarrhea will be treated and deaths will be reduced. An added benefit may be to reduce transmission to others. However, shedding duration and its characteristics in children is not well known. We therefore investigated the duration of shedding in a group of young children who sought health care for diarrhea in a hospital and health center in Ethiopia. The study followed 53 children with cryptosporidiosis for 2 months. We found that, on average, children released the parasite for 31 days after the diarrhea episode started. Point-of-care treatment of cryptosporidiosis may therefore reduce onward spread of the Cryptosporidium parasite within communities and households.