Children In sub-Saharan Africa Research Articles

Estimated distribution of malaria cases among children in sub-Saharan Africa by specified age categories using data from the Global Burden of Diseases 2019

BackgroundChildren in sub-Saharan Africa (SSA) remain the most vulnerable to malaria and malaria mortality. This study estimated the disease burden and distribution of Plasmodium falciparum malaria among children with age categories (0 to < 2 years, 2 to < 6 years, 6 to < 12 years, ≥ 12 years) in SSA.MethodsData on the number of cases and incidence rates of P. falciparum malaria by age group from the Institute of Health Metrics and Evaluation (GBD 2019) for 11 countries in SSA was employed in this study. The best-fitting distribution of P. falciparum malaria cases by prespecified age categories was derived using a combination of a Log-normal and Weibull distribution.ResultsPlasmodium falciparum malaria was 15.4% for ages 0 to < 2 years, 30.5% for 2 to < 6 years, 17.6% for 6 to < 12 years, and 36.5% for ≥ 12 years based on data from countries in SSA. The results have important implications for the current drive by the FDA and EMA to ensure the representativeness of real-world populations in clinical trials evaluating the safety and efficacy of medication exposure.ConclusionsThe theoretical distributions of P. falciparum malaria will help guide researchers in ensuring that children are appropriately represented in clinical trials and other interventions aiming to address the current burden of malaria in SSA.

Prevent the Spread of Malarial Disease for Sustainable Development

This article explores the intricacies of malaria, concentrating on the parasite Plasmodium falciparum's most harmful form. Malaria still poses a serious threat to world health, killing over 400,000 people each year and impacting mostly young children in Sub-Saharan Africa, despite decades of control attempts. Despite its low efficacy, RTS, S, the first licensed malaria vaccine, is currently being tested in various African countries. There has been an overall fall in malaria infections, albeit the reduction varies geographically. Traditional control measures like bed nets and insecticides, combined with medical treatment, have helped. It is essential to comprehend the biology of malaria transmission since asymptomatic cases help spread the disease and not all infections have severe symptoms. The complex mechanics of the parasite's life cycle are examined in detail in this article, with a focus on the function of PfEMP1 proteins in immune evasion. The wide variability of PfEMP1 complicates the creation of vaccines. Hopes for a potential disease vaccine are increased by the attention paid to EPCR-binding phenotypes about cerebral malaria, although causal links still require explanation. The study emphasizes the need for cutting-edge methods, such as systems biology and machine learning, to decipher the intricate immunological and parasitological processes, and asks for a deeper comprehension of parasite-host interactions. The paper also highlighted difficulties in accurately estimating disease frequency, particularly in low-transmission environments with common submicroscopic illnesses. For efficient surveillance and management, the significance of researching gametocyte dynamics, transmission volume, and parasite genetic diversity is emphasized. The article's conclusion emphasizes the need for a holistic strategy, which includes a deeper comprehension of local vector ecologies, to fully address the problems caused by malaria and pave the way for more efficient control strategies.

Assessing risk factors for malaria and schistosomiasis among children in Misungwi, Tanzania, an area of co-endemicity: A mixed methods study.

Malaria and schistosomiasis are two major parasitic vector-borne diseases that are a particular threat to young children in Sub-Saharan Africa. In the present study, we investigated factors that are associated with malaria, schistosomiasis, and co-infection among school-aged children, using an explanatory sequential mixed-methods approach. A cross-sectional study was conducted in January 2022 in Misungwi, Tanzania, that sampled 1,122 children aged 5 to 14 years old for malaria and schistosomiasis infection. Mixed-effect logistic regression models were used to assess the association between infection prevalence or seroprevalence, and environmental determinants that create favorable conditions for vectors and parasites and social determinants that relate to disease exposure. Community mapping combined with direct field observations were conducted in August 2022 in three selected villages from the cross-sectional study to understand specific water use behaviors and to identify potential malaria mosquito larval breeding sites and freshwater snail habitat. The prevalence of malaria, seroprevalence of schistosomiasis, and co-infection in this study were 40.4%, 94.3%, and 38.1%, respectively. Individual-level factors emerged as the primary determinants driving the association with infection, with age (every one-year increase in age) and sex (boys vs girls) being statistically and positively associated with malaria, schistosomiasis, and co-infection (P<0.05 for all). Community maps identified many unimproved water sources in all three villages that were used by humans, cattle, or both. We found that children primarily fetched water, and that unprotected wells were dedicated for drinking water whereas ponds were dedicated for other domestic uses and cattle. Although not identified in the community maps, we found hand pumps in all three villages were not in use because of unpleasant taste and high cost. This study improves our understanding of individual, social and environmental factors that are associated with malaria, schistosomiasis, and co-infection, which can inform potential entry points for integrated disease prevention and control.

Prevalence and risk factors associated with malaria infection in children under two years of age in southern Togo prior to perennial malaria chemoprevention implementation

BackgroundMalaria remains the leading cause of mortality and morbidity in young children in sub-Saharan Africa. To prevent malaria in children living in moderate-to-high malaria transmission areas, the World Health Organization has recommended perennial malaria chemoprevention (PMC). Prior to piloting PMC implementation in southern Togo, a household survey was conducted to estimate malaria infection prevalence in children under 2 years of age (U2).MethodsA cross-sectional community-based household survey was conducted in the Haho district in the Togo Plateaux region. A three-stage random sampling method was used to select study participants aged 10–23 months whose caretakers gave informed consent. The prevalence of Plasmodium infection, defined as a positive rapid diagnostic test (RDT), was estimated with 95% confidence interval (CI). Clinical malaria was defined as having a positive RDT plus fever (≥ 37.5 °C) or history of fever in the last 24 h. Mixed-effects logistic regression models were used to assess the child’s, caretaker’s, and household’s factors associated with malaria infection.ResultsA total of 685 children were included in the survey conducted January–February in 2022 (dry season). Median age was 17 months (interquartile range: 13–21). About 80% of the children slept under a bed net the night before the interview. Malaria infection prevalence was 32.1% (95% CI 27.7–37.0) with significant area variation (cluster range: 0.0–73.3). Prevalence of clinical malaria was 15.4% (95% CI 12.2–19.2). Children whose caretakers were animist (aOR: 1.71, 95% CI 1.19–2.46) and those living in mother-headed households (aOR: 2.39, 95% CI 1.43–3.99) were more likely to have a positive RDT. Living more than 5 km away from the nearest health facility (aOR: 1.60, 95% CI 1.04–2.44) and presence of two or more under-5-years children in the household (aOR: 1.44, 95% CI 1.01–2.07) were also associated with increased risk of infection.ConclusionOne-third of the children U2 who participated in this survey had malaria infection, thus PMC could be a promising strategy to reduce malaria burden in young children in Plateaux region. Reinforcement of outreach services and targeting the poorest households should be prioritized to reduce the inequity in malaria prevention in children exposed to the infection.

Burden of respiratory syncytial virus diseases among under 5 children in Sub-Saharan Africa: A systematic review and meta-analysis

BackgroundRespiratory syncytial virus (RSV) is the most common cause of acute lower respiratory infections (ALRIs) in young children. To design preventive efforts in sub-Saharan Africa, a better knowledge of the true role of RSV in pediatric ALRIs is required. Therefore we conducted a systematic review and meta-analysis of case–control studies to estimate the etiological role of RSV to ALRIs in under 5 years children in sub-Saharan Africa. MethodsThis study was done according to PRISMA guidelines. PubMed, EMBASE, SCOPUS, Web of Sciences databases, and Google Scholar were used to retrieve articles. STATA software version 17 was used for data analysis. The results of all the included studies were standardized to odds ratios (ORs) with accompanying 95 % confidence intervals (95 % CIs) and the pooled estimates of ORs, attributable fraction among the exposed (AFE), and population attributable fraction (PAF) were reported. The heterogeneity was assessed using Cochrane chi-square (I 2) statistics. ResultA total of 6200 cases and 4986 controls from 14 articles that fulfilled the inclusion criteria were included. The pooled prevalence of RSV among cases and controls was 23.52 % [95 % CI (20.68–26.47)] and 4.33 % [95 % CI (3.11–5.73)], respectively. The pooled OR is 7.04 [95 % CI (4.41–11.24)], which indicated a significant association between RSV and ALRI. Among ALRIs cases positive for RSV, the proportion of disease that was not attributable to the background rate (AFE) was 85.8 % [95 % CI (77.3–91.1)]. The fraction of ALRIs children that can be attributed to RSV (PAF) was 20.2 % [95 % CI (16–24.1)]. ConclusionThis study showed clear associations between RSV and ALRI hospitalization in young children in sub-Saharan Africa indicating the need for prophylactic measures against RSV in this age group.

Determinants of cord care practices among caregivers in a level 5 facility in Kenya

Background: Globally, in the year 2020, 2.4 million children died with the likelihood of a child in Sub-Saharan Africa to die in their first month after birth being ten times higher compared to that in developed countries. Infection is a leading cause of mortality among infants with a significant number being attributed to umbilical cord infections. The aim of the study was to assess cord care practices and the associated factors among mothers and care givers at the Mombasa County referral hospital in Kenya. Methods: This was a facility-based descriptive cross-sectional study conducted in the maternal child health/family planning clinic at a level 5 public health facility in Mombasa County, Kenya. Systematic random sampling was employed to select study respondents. Quantitative data was analyzed using SPSS version 21. The association of the dependent and independent variables was assessed using Pearson Chi-square statistics. A p&lt;0.05 was considered significant at 95% CI. Results: Slightly below half (43.6%) of the respondents had practiced inappropriate cord care. Inappropriate cord care practices reported included the use of breast milk (24.3%), herbal substances (17.8%), warm salty water (16.4%), saliva (15.1%), soot (11.2%), black soil (7.9%) and coconut oil (7.2%). Socio-cultural beliefs regarding cord care were prevalent among the respondents. Socio-demographic characteristics, facility-related factors, and socio-cultural factors were associated with cord care practices (p&lt;0.05). Conclusions: There is a need to enhance health education regarding cord care among women in the health facilities and community. Strategies to enhance scale- up of chlorhexidine use should be explored.

Subjects' Sociodemographics Influence the Transmission Patterns of Diarrheagenic Escherichia coli Pathotypes among Children under 5 Years in Nakuru County.

Diarrheagenic Escherichiacoli (DEC) infections constitute the leading causes of morbidity and mortality among children in Sub-Saharan Africa. However, little has so far been done to properly reveal the pathogenic endowments of DEC in these populations. We evaluated 4 DEC strains among children under 5 years. A cross-sectional study design was employed among 384 positive cases. There was a significant decline in infections associated with DEC as the children grew older (χ2[12] = 87.366: P = [0.000]. A total of 56 (14.6%) cases were 0-12 months, 168 (43.8%) were 13-24 months, 88 (22.9%) were 25-36 months, 40 (10.4%) were 37-48 months, and 32 (8.3%) were 49-60 months. A total of 248 (64.6%) male subjects exhibited more susceptibility to DEC infections than their female counterparts (n = 136 [35.4%]) (χ2[3] =13.313: P = [0.004]. Subjects from urban areas (n = 248 [64.6%]), significantly bored the brunt of infections than those from rural areas (n = 136 [35.4%]) (χ2[3] = 35.147: P = [0.000]. The prevalence of DEC appeared significantly higher during rainy seasons (n = 269 [70.1%]). Young age, male gender, crowding, and rainy season play a central role in the transmission of DEC pathotypes.

Child Fostering in a Changing Climate: Evidence from Sub-Saharan Africa.

An extensive social science literature has examined the effects of climate change on human migration. Prior studies have focused largely on the out-migration of working-age adults or entire households, with less attention to migration and other forms of geographic mobility among other age groups, including youth. In this study, we focus on the implications of climate variability for the movement of children by examining the association between climate exposures and the in- and out-fostering of children in sub-Saharan Africa. We link high-resolution temperature and precipitation records to data from the Demographic and Health Surveys for 23 sub-Saharan African countries. We fit a series of regression models to measure the overall associations between climate exposures and each outcome, and then evaluate whether these associations are moderated by socioeconomic status, the number of children in the household, and the prevalence of fostering in each country. Precipitation is positively associated with in-fostering overall, and these effects are especially strong among households who already have at least one child and in countries where child fostering is common. We find no overall relationship between either temperature or precipitation exposures and out-fostering, but we do detect significant effects among households with many children and those with more-educated heads. In sum, our findings suggest climate variability can influence child mobility, albeit in complex and in some cases context-specific ways. Given the socioeconomic and health implications of fostering, these results underline another pathway through which climate exposures can affect children's wellbeing. More broadly, this study shows that new attention to the links between climate variability, child fostering, and other understudied forms of spatial mobility is needed to fully understand the effects of climate change on human populations.

Factors associated with mother's healthcare-seeking behavior for symptoms of acute respiratory infection in under-five children in sub-Saharan Africa: a multilevel robust Poisson regression modelling

BackgroundTimely and appropriate treatment for childhood illness saves the lives of millions of children. In low-middle-income countries such as sub-Saharan Africa (SSA), poor healthcare-seeking behavior for childhood illnesses is identified as a major contributor to the increased risk of child morbidity and mortality. However, studies are limited on Factors associated with mother's healthcare-seeking behavior for symptoms of acute respiratory infection in under-five children in sub-Saharan Africa.ObjectiveTo examine factors associated with a mother's healthcare-seeking behavior for symptoms of acute respiratory infection in under-five children in sub-Saharan Africa.MethodsA secondary data analysis was conducted based on the latest Demographic and Health Survey (DHS) data of 36 sub-Saharan African countries. A total weighted sample of 16,925 mothers who had under-five children with acute respiratory infection symptoms was considered. The Intraclass Correlation Coefficient (ICC), Median Odds Ratio (MOR), and Likelihood Ratio (LR) tests were done to assess the presence of clustering. Model comparison was made based on deviance (-2LLR) value. Variables with a p-value < 0.2 in the bivariable multilevel robust Poisson analysis were considered for the multivariable analysis. In the multivariable multilevel robust Poisson regression analysis, the Adjusted Prevalence Ratio (APR) with the 95% Confidence Interval (CI) was reported to declare the statistical significance and strength of the association.ResultsThe prevalence of mother's healthcare-seeking behavior for symptoms of acute respiratory infection in under-five children in SSA was 64.9% (95% CI: 64.2%, 65.7%). In the multivariable analysis; mothers who attained primary education (APR = 1.11, 95% CI: 1.08, 1.15), secondary education (APR = 1.13, 95% CI: 1.09, 1.18), and higher education (APR = 1.19, 95% CI: 1.11, 1.27), belonged to the richest household (APR = 1.07: 95% CI: 1.02, 1.12), had media exposure (APR = 1.11, 95% CI: 1.08, 1.15), currently working (APR = 1.08, 95% CI: 1.06, 1.11), had ANC use (APR = 1.25: 95% CI: 1.17, 1.35), health facility delivery (APR = 1.10, 95% CI: 1.07, 1.14), belonged to West Africa (APR = 1.04, 95% CI: 1.01, 1.08) and being in the community with high media exposure (APR = 1.04, 95% CI: 1.02, 1,07) were significantly associated with higher prevalence of mother's healthcare-seeking behavior for symptoms of acute respiratory infection in under-five children. On the other hand, distance to a health facility (APR = 0.87, 95% CI: 0.84, 0.91), and being in central Africa (APR = 0.87, 95% CI: 0.84, 0.91) were significantly associated with a lower prevalence of mother's healthcare-seeking behavior for symptoms of acute respiratory infection in under-five children.ConclusionMother's healthcare-seeking behavior for symptoms of acute respiratory infection in under-five children. It was influenced by maternal education, maternal working status, media exposure, household wealth status, distance to the health facility, and maternal health care service use. Any interventions aiming at improving maternal education, maternal healthcare services, and media access are critical in improving mothers' healthcare-seeking behavior for symptoms of acute respiratory infection in under-five children, hence lowering the prevalence of ARI-related death and morbidity.

Children and adolescents educational gender gaps across the lifecourse in sub-Saharan Africa: On the role of mothers' lack of empowerment as a barrier for girls' educational performance

We estimate the impact of lack of mothers’ empowerment on an array of educational outcomes for their children in sub-Saharan Africa (SSA), focusing on the gender gap. Further, we look into how this operates by the degree of marginalisation of communities and on weakening educational transfers. We find that gender inequality is still a significant barrier in SSA compounded by weak mothers’ empowerment for improving educational outcomes for girls in comparison to boys. Thus, different barriers behind weak women agency need to be addressed to improve gender inequality across SDG4 gender-targets in the region.

Systematic Mapping of Research on Vaccine-Preventable Diseases in Children in Sub-Saharan Africa: A Decennial Scientometric Analysis.

Vaccine-preventable diseases (VPDs) remain a significant public health challenge, particularly in sub-Saharan Africa. The high burden of VPDs in this region necessitates the need for continued investigation and intervention. This paper presents a bibliometric analysis of research on VPDs in children in sub-Saharan Africa in the last 10 years to capture the current state of research in the field. This study used a systematic search for articles published between 2013 and 2022 in the Web of Science Core Collection database and, subsequently, scientometric techniques for data analyses and interpretation. Annual scientific production of publications on the research of VPDs in children in sub-Saharan Africa increased from 2013 to 2019 and then gradually declined. South Africa had the most VPD studies (n = 148; 16.2%), followed by Nigeria, Ghana, Kenya, The Gambia, Malawi, Ethiopia, and the Republic of Congo. The Vaccine journal published the most. The Pan African Medical Journal was the most frequent destination journal based in Africa. The commonly studied pathogens were Streptococcus pneumoniae and Haemophilus influenzae. Research productivity increased exponentially in the pre-COVID era and declined in the past two years, so more VPD research in this region is needed.

Post-Discharge Risk of Mortality in Children under 5 Years of Age in Western Kenya: A Retrospective Cohort Study.

Limited evidence suggests that children in sub-Saharan Africa hospitalized with all-cause severe anemia or severe acute malnutrition (SAM) are at high risk of dying in the first few months after discharge. We aimed to compare the risks of post-discharge mortality by health condition among hospitalized children in an area with high malaria transmission in western Kenya. We conducted a retrospective cohort study among recently discharged children aged < 5 years using mortality data from a health and demographic surveillance system that included household and pediatric in-hospital surveillance. Cox regression was used to compare post-discharge mortality. Between 2008 and 2013, overall in-hospital mortality was 2.8% (101/3,639). The mortality by 6 months after discharge (primary outcome) was 6.2% (159/2,556) and was highest in children with SAM (21.6%), followed by severe anemia (15.5%), severe pneumonia (5.6%), "other conditions" (5.6%), and severe malaria (0.7%). Overall, the 6-month post-discharge mortality in children hospitalized with SAM (hazard ratio [HR] = 3.95, 2.60-6.00, P < 0.001) or severe anemia (HR = 2.55, 1.74-3.71, P < 0.001) was significantly higher than that in children without these conditions. Severe malaria was associated with lower 6-month post-discharge mortality than children without severe malaria (HR = 0.33, 0.21-0.53, P < 0.001). The odds of dying by 6 months after discharge tended to be higher than during the in-hospital period for all children, except for those admitted with severe malaria. The first 6 months after discharge is a high-risk period for mortality among children admitted with severe anemia and SAM in western Kenya. Strategies to address this risk period are urgently needed.

E47 Low prevalence and mortality associated with COVID-19 in sub-Saharan African Children and adolescents: hypotheses from a literature review

Abstract Background Severe acute respiratory syndrome coronavirus 2 continues to spread around the world, particularly in sub-Saharan Africa. However, outside South Africa, as in adults, the pandemic has had very little impact on African children and adolescents, despite very low vaccination coverage. In addition, cases of multisystemic inflammatory syndrome in children were anecdotal in sub-Saharan Africa. Aims To identify plausible hypotheses that may explain the low prevalence and mortality of Covid-19 in children in sub-Saharan Africa. Methods A narrative review of the literature Results We have identified five major hypotheses that may explain the low prevalence and mortality of COVID-19 in children and adolescents in sub-Saharan Africa: 1) the lack of a proper epidemiological study; 2) the youthfulness of the population in sub-Saharan Africa, for a disease that essentially concerns elderly subjects with comorbidities; 3) immunomodulation due to frequent contact with certain infectious agents and/or vaccines, 4) cross-reactive immunity between SARS-CoV-2 and different strains of human coronaviruses of different lineage, and 5) the widespread and off-label use of antimalarials and other drugs such as zinc, vitamin C and other complementary therapies. Conclusion All these hypotheses deserve to be confirmed in these populations by specific studies with a rigorous design. Ethics None declared.

Zinc bioaccessibility in finger millet porridge blended with zinc-dense mushroom

IntroductionZinc deficiency is a common health problem among people who rely heavily on cereal-based foods. Consequently, most people from low-income families, particularly young children in Sub-Saharan Africa, who rely mainly on cereal-based meals, have suffered from Zinc deficiency-related health issues. It is therefore recommended that children who show signs of zinc deficiency like poor growth and cognitive impairment be fed zinc-rich meals; however, in severe cases, they should be given zinc supplements to reduce risks of morbidity and mortality. In that regard, since edible mushrooms are nutritionally rich and contains essential minerals as well as health-promoting compounds, they are a promising tool for improving the nutritional and health quality of commonly carbohydrate-rich foods. ObjectiveThe objective of this study was to examine the Zinc bioaccessibility and sensory properties of HMT finger millet porridge blended with Zinc-dense mushroom. MethodsOyster mushroom (Pleurotus ostreatus) was grown on rice straw enriched with zinc sulfate at various concentrations. After reaching full maturity, the mushrooms were harvested, dried, and milled into a fine powder. Zinc-rich mushroom powder was mixed with millet flour in various proportions and used to prepare porridge. The zinc bioaccessibility in millet-mushroom flour blends was determined using a simulation method of gastro intestinal digestion. In addition, panelists comprising of mothers and caregivers of children aged between 6 and 23 months were asked to evaluate the sensory attributes of millet-mushroom porridge. ResultsAdding Zinc to growth substrates had a significant (p˂0.05) effect on mushroom yield. Control substrates without Zinc yielded 120 g of mushroom per kilogram substrate. However, when 100 mg Zinc was added to the substrate, the yield increased by 65.6%. The study further noted that substrates with Zinc beyond 100 mg had a negative effect on mushroom yield. Consequently, substrates with the highest Zinc level (600 mg) produced the lowest mushroom yields. Increasing substrates Zinc content, on the other hand, had positive effect on mushroom Zinc levels. Substrates without Zinc produced mushrooms containing 8.9 mg Zinc, which increased by 30.9% when 600 mg Zinc was added. Furthermore, HMT finger millet porridge without mushrooms had a phytates: Zinc molar index of 60.3, which decreased to 34 when 20% (w/w) mushroom proportions were added. Despite having the highest bioaccessible Zinc with the least effect on texture and appearance, a 20% mushroom proportion in HMT finger millet porridge considerably compromised the taste, aroma and general consumer acceptability. ConclusionAmending HMT finger millet flour with mushroom powder improved Zinc bioaccessibility of the porridge. However, when added beyond a certain limit, mushroom reduced organoleptic qualities of the porridge, which affected overall consumer acceptance. The study recommends, therefore, that mushroom powder be added to finger millet flour in the appropriate proportions to enhance nutritional and health benefits of porridge while minimizing possible negative impacts on sensory properties.

Using cash transfers to promote child health equity: an analysis ofLesotho's Child Grants Program.

Cash transfers (CTs) are increasingly popular tools for promoting social inclusion and equity in children in sub-Saharan Africa. However, less is known about their implications for reducing the health gap between the beneficiary and non-beneficiary children in the community. Using Lesotho's Child Grants Program (CGP) as a case study, we aim to understand better the potential for CT programmes to reduce the gap in child health in the targeted communities. Using a triple difference model, we examine to what extent CGP improved child health outcomes in eligible households compared with non-eligible households in treatment communities vs control communities and to what extent this effect varied in different population subgroups. We find that the child health gap by beneficiary children's health outcomes catching-up on the health of non-beneficiary children narrowed but that eduction was not statistically significant. However, such a 'catch-up' effect among beneficiaries was observed for selected nutrition outcomes amongst female-headed households and subjective child health assessment for comparatively more food-secure households. This study highlights the potential and limitations of CT programmes like the CGP to address health inequalities in preschool children for selected population subgroups in the community.

Concurrent stunting and overweight or obesity among under-five children in sub-Saharan Africa: a multilevel analysis

BackgroundGlobally, the co-occurrence of stunting and overweight or obesity (CSO) in the same individual is becoming an emerging layer of malnutrition and there is a paucity of information in low- and middle-income countries, particularly in sub-Saharan Africa. Hence, this study aimed to determine the pooled prevalence and determinants of concurrent stunting and overweight or obesity among under-five children in SSA.MethodsSecondary data analysis was conducted from a recent nationally representative Demographic and Health Survey dataset of 35 SSA countries. A total weighted sample of 210,565 under-five children was included in the study. A multivariable multilevel mixed effect model was employed to identify the determinant of the prevalence of under-5 CSO. The Intra-class Correlation Coefficient (ICC) and Likelihood Ratio (LR) test were used to assess the presence of the clustering effect. A p-value of p < 0.05 was used to declare statistical significance.ResultThe pooled prevalence of concurrent stunting and overweight/obesity among under-five children was 1.82% (95% CI: 1.76, 1.87) in SSA. Across the SSA regions, the highest prevalence of CSO was reported in Southern Africa (2.64%, 95% CI: 2.17, 3.17) followed by the Central Africa region (2.21%, 95% CI: 2.06, 2.37). Under five children aged 12–23 months (AOR = 0.45, 95% CI: 0.34, 0.59), 24–35 months (AOR = 0.41, 95% CI: 0.32, 0.52), 36–59 months (AOR = 055, 95% CI: 0.43, 0.70), ever had no vaccination (AOR = 1.25, 95% CI: 1.09, 1.54), under-five children born from 25 to 34 years mother (AOR = 0.75, 95% CI: 0.61, 0.91), under-five children born from overweight/obese mothers (AOR = 1.63, 95% CI: 1.14, 2.34), and under-five children living in West Africa (AOR = 0.77, 95% CI: 0.61, 0.96) were significant determinants for under-five CSO.ConclusionConcurrent stunting and overweight or obesity is becoming an emerging layer of malnutrition. Under five children born in the SSA region had almost a 2% overall risk of developing CSO. Age of the children, vaccination status, maternal age, maternal obesity, and region of SSA were significantly associated with under-five CSO. Therefore, nutrition policies and programs should base on the identified factors and promote a quality and nutritious diet to limit the risk of developing CSO in early life.

Early-life air pollution and green space exposures as determinants of stunting among children under age five in Sub-Saharan Africa.

Childhood malnutrition is a major public health issue in Sub-Saharan Africa (SSA) and 61.4 million children under the age of five years in the region are stunted. Although insight from existing studies suggests plausible pathways between ambient air pollution exposure and stunting, there are limited studies on the effect of different ambient air pollutants on stunting among children. Explore the effect of early-life environmental exposures on stunting among children under the age of five years. In this study, we used pooled health and population data from 33 countries in SSA between 2006 and 2019 and environmental data from the Atmospheric Composition Analysis Group and NASA's GIOVANNI platform. We estimated the association between early-life environmental exposures and stunting in three exposure periods - in-utero (during pregnancy), post-utero (after pregnancy to current age) and cumulative (from pregnancy to current age), using Bayesian hierarchical modelling. We also visualise the likelihood of stunting among children based on their region of residence using Bayesian hierarchical modelling. The findings show that 33.6% of sampled children were stunted. In-utero PM2.5 was associated with a higher likelihood of stunting (OR = 1.038, CrI = 1.002-1.075). Early-life exposures to nitrogen dioxide and sulphate were robustly associated with stunting among children. The findings also show spatial variation in a high and low likelihood of stunting based on a region of residence. This study explores the effect of early-life environmental exposures on child growth or stunting among sub-Saharan African children. The study focuses on three exposure windows - pregnancy, after birth and cumulative exposure during pregnancy and after birth. The study also employs spatial analysis to assess the spatial burden of stunted growth in relation to environmental exposures and socioeconomic factors. The findings suggest major air pollutants are associated with stunted growth among children in sub-Saharan Africa.

Out-of-pocket costs and catastrophic healthcare expenditure for families of children requiring surgery in sub-Saharan Africa

BackgroundOut-of-pocket healthcare costs leading to catastrophic healthcare expenditure pose a financial threat for families of children undergoing surgery in Sub-Saharan African countries, where universal healthcare coverage is often insufficient. MethodsA prospective clinical and socioeconomic data collection tool was used in African hospitals with dedicated pediatric operating rooms installed philanthropically. Clinical data were collected via chart review and socioeconomic data from families. The primary indicator of economic burden was the proportion of families with catastrophic healthcare expenditures. Secondary indicators included the percentage who borrowed money, sold possessions, forfeited wages, and lost a job secondary to their child’s surgery. Descriptive statistics and multivariate logistic regression were performed to identify predictors of catastrophic healthcare expenditure. ResultsIn all, 2,296 families of pediatric surgical patients from 6 countries were included. The median annual income was $1,000 (interquartile range 308–2,563), whereas the median out-of-pocket cost was $60 (interquartile range 26–174). Overall, 39.9% (n = 915) families incurred catastrophic healthcare expenditure, 23.3% (n = 533) borrowed money, 3.8% (n = 88%) sold possessions, 26.4% (n = 604) forfeited wages, and 2.3% (n = 52) lost a job because of the child’s surgery. Catastrophic healthcare expenditure was associated with older age, emergency cases, need for transfusion, reoperation, antibiotics, and longer length of stay, whereas the subgroup analysis found insurance to be protective (odds ratio 0.22, P = .002). ConclusionA full 40% of families of children in sub-Saharan Africa who undergo surgery incur catastrophic healthcare expenditure, shouldering economic consequences such as forfeited wages and debt. Intensive resource utilization and reduced insurance coverage in older children may contribute to a higher likelihood of catastrophic healthcare expenditure and can be insurance targets for policymakers.

Micronutrient intake status and associated factors in children aged 6–23 months in sub-Saharan Africa

Micronutrient deficiency has serious consequences across all ages worldwide, particularly in sub-Saharan Africa. Poor micronutrient (MN) consumption among children remains a major public health concern in many countries. Low literacy, poor diets, a lack of access to healthcare, and insufficient agricultural productivity made proper micronutrient consumption difficult, despite numerous interventions. Thus, this research aimed to determine the adequate intake of MNs among 6–23 months of age children in sub-Saharan Africa. Initially, a two-stage stratified sampling technique was applied for the selected recent demographic and health survey data. The data source was the (2015–2020) standard demographic and health surveys (DHS) among 20 Sub-Saharan African countries. Micronutrient intake status (the outcome variable) was determined using either food rich in Vitamin A or iron consumed within the previous 24 hr or multiple micronutrient powder or iron supplementation within the previous 07 days or vitamin A supplementation or deworming within 06 months. A generalized linear mixed model based on Modified Poisson regression and robust error variance was used to identify factors associated with children’s adequate micronutrient intake. An adjusted Prevalence Ratio (aPR) with a 95% confidence interval was used to identify factors, strength and direction of the association. The total samples of 65,187 children aged 6–23 months were included. Of all, 73.99% (95% CI: 73.65, 74.32) of children had adequate intake of micronutrients. Maternal education (primary (aPR = 1.04, 95% CI: 1.02, 1.06) and secondary (aPR = 1.07, 95% CI: 1.04, 1.09)), father’s education (primary (aPR = 1.03, 95% CI: 1.01, 1.05) and secondary (aPR = 1.04, 95% CI: 1.02, 1.06)), occupational status of the mother (aPR = 1.04, 95% CI: 1.02, 1.06), pregnancy interval (aPR = 0.97, 95% CI: 0.95, 0.99), exclusive breastfeeding status (aPR = 0.83, 95% CI: 0.82, 0.85), birthweight (average (aPR = 1.03, 95% CI: 1.01, 1.05) and larger than average (aPR = 1.04, 95% CI: 1.02, 1.06)), multiple/twin at birth (aPR = 0.94, 95% CI: 0.91, 0.98), child age (aPR = 1.22, 95% CI: 1.19, 1.25), number of children in home (aPR = 1.02, 95% CI: 1.01, 1.03), ANC utilization (aPR = 1.20, 95% CI: 1.15, 1.27), place of birth (AOR = 0.93, 95% CI: 0.91, 0.95), rich households (aPR = 1.03, 95% CI: 1.01, 1.05), and countries from Central (aPR = 1.07, 95% CI: 1.04, 1.09), South Africa (aPR = 1.07, 95% CI: 1.03, 1.11), and West African (aPR = 0.95, 95% CI: 0.92, 0.99) were associated with level of micronutrients intake status. The prevalence of adequate intake of MN was considerable. Variables at the child, family and community levels were associated with adequate intake of micronutrients. Consequently, stakeholders’ involvement is required in healthcare and community settings.

Blood transfusion for children in sub-Saharan Africa: 200 years on

In 1818, James Blundell completed the first successful human blood transfusion. This life-saving medical intervention has revolutionised patient care globally in the past two centuries. Nevertheless, many challenges remain in implementing safe blood transfusion procedures, particularly in sub-Saharan Africa 1 Ala F Allain JP Bates I et al. External financial aid to blood transfusion services in sub-Saharan Africa: a need for reflection. PLoS Med. 2012; 9e1001309 Crossref PubMed Scopus (53) Google Scholar where demand predominantly centres on acute paediatric severe anaemia and haemorrhagic complications of pregnancy and trauma. Severe anaemia, when the haemoglobin concentration drops below 6 g/dL, is very common in children admitted to hospital in sub-Saharan Africa. Infectious diseases, nutritional deficiencies, and sickle cell anaemia are the major underlying causes of anaemia. Outcomes remain unsatisfactory, with high mortality and high hospital readmission rates within 6 months of initial admission. 2 Phiri KS Calis JC Faragher B et al. Long term outcome of severe anaemia in Malawian children. PLoS One. 2008; 3e2903 Crossref PubMed Scopus (75) Google Scholar World Blood Donor Day on June 14, 2023, calls for donors to “Give blood, give plasma, share life, share often”. Not only is this a day to celebrate the charitable contributions of blood donors, it is an important opportunity to raise awareness that every pint of blood donated results in critically important life-sustaining therapy, especially for children in sub-Saharan Africa.