Children In sub-Saharan Africa Research Articles

Factors associated with adverse nutritional status of children in sub-Saharan Africa: Evidence from the Demographic and Health Surveys from 31 countries.

Undernutrition is linked to almost half of all deaths in under‐five children. In 2019, 144 million under‐five children suffered from stunting and 47 million suffered from wasting. This study examined the factors that influence adverse nutritional status of children in sub‐Saharan Africa. The study used data from the Demographic and Health Surveys (DHS) of 31 countries, which involved 189,195 children under age 5. Binary logistic regression was used to examine the relationships between the independent variables and adverse nutritional status of children. About 26% of the children in the 31 countries in sub‐Saharan Africa considered in this study are stunted, 6% are wasted and 21% are underweight. Close to 31% of children whose mothers have no education are stunted, 9% are wasted and 28% are underweight. Adverse nutritional status of children is significantly associated with maternal age, education, household wealth, residence, antenatal care attendance, mass media exposure, child's sex and size of child at birth. This study has shown that adverse nutritional status of children is a major challenge in sub‐Saharan Africa. Efforts at improving nutritional status of children should include poverty alleviation initiatives at individual and household levels, increase in women's educational level and improvement in living conditions in rural areas.

Prevalence and determinants of severity levels of anemia among children aged 6-59 months in sub-Saharan Africa: A multilevel ordinal logistic regression analysis.

Anemia is a major public health problem affecting more than half of children under the age of five globally. It has serious short- and long-term consequences including growth retardation, impaired motor and cognitive development, and increased morbidity and mortality. Despite anemia is the leading cause of child mortality in sub-Saharan Africa, there is limited evidence on the prevalence and determinants of anemia among under-five children in sub-Saharan Africa. Therefore, this study aimed to investigate the prevalence and determinants of severity levels of anemia among children aged 6-59 months in sub-Saharan Africa. This study was based on the most recent Demographic and Health Survey (DHS) data of 32 sub-Saharan African countries. A total weighted sample of 135,619 children aged 6-59 months was included in the study. Considering the hierarchical nature of DHS data and the ordinal nature of anemia, a multilevel ordinal logistic regression model was applied. Proportional odds assumption was tested by Brant test and it was satisfied (p-value = 0.091). Besides, deviance was used for model comparison. Variables with a p-value ≤0.2 in the bivariable analysis were considered for the multivariable analysis. In the multivariable multilevel proportional odds model, the Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) were reported for potential determinant factors of severity levels of anemia. The overall prevalence of anemia among children aged 6-59 months in sub-Saharan Africa was 64.1% [95% CI: 63.9%, 64.4%]. Of which, 26.2% were mildly anemic, 34.9% moderately anemic and 3% severely anemic. Poor maternal education, lower household wealth status, large family size, being male child, multiple births, having fever in the last two weeks, having diarrhea in the last two weeks, higher-order birth, maternal anemia, underweight, wasted, and stunted were significantly associated with increased odds of higher levels of anemia. Whereas, being 24-59 months age, taking drugs for an intestinal parasite, and born from mothers aged ≥ 20 years were significantly associated with lower odds of higher levels of anemia. Severity levels of anemia among children aged 6-59 months in sub-Saharan Africa was a major public health problem. Enhancing maternal education, providing drugs for an intestinal parasite, designing interventions that address maternal anemia, febrile illness, and diarrheal disease, and strengthening the economic status of the family are recommended to reduce childhood anemia. Furthermore, it is better to strengthen the strategies of early detection and management of stunted, wasted, and underweight children to decrease childhood anemia.

Long-term outcomes of early initiated antiretroviral therapy in sub-Saharan children: a Cameroonian cohort study (ANRS-12140 Pediacam study, 2008\u20132013, Cameroon)

BackgroundIn most studies, the virological response is assessed during the first two years of antiretroviral treatment initiated in HIV-infected infants. However, early initiation of antiretroviral therapy exposes infants to very long-lasting treatment. Moreover, maintaining viral suppression in children is difficult. We aimed to assess the virologic response and mortality in HIV-infected children after five years of early initiated antiretroviral treatment (ART) and identify factors associated with virologic success in Cameroon.MethodsIn the ANRS-12140 Pediacam cohort study, 2008–2013, Cameroon, we included all the 149 children who were still alive after two years of early ART. Virologic response was assessed after 5 years of treatment. The probability of maintaining virologic success between two and five years of ART was estimated using Kaplan-Meier curve. The immune status and mortality were also studied at five years after ART initiation. Factors associated with a viral load < 400 copies/mL in children still alive at five years of ART were studied using logistic regressions.ResultsThe viral load after five years of early ART was suppressed in 66.8% (60.1–73.5) of the 144 children still alive and in care. Among the children with viral suppression after two years of ART, the probability of maintaining viral suppression after five years of ART was 64.0% (54.0–74.0). The only factor associated with viral suppression after five years of ART was achievement of confirmed virological success within the first two years of ART (OR = 2.7 (1.1–6.8); p = 0.033).ConclusionsThe probability of maintaining viral suppression between two and five years of early initiated ART which was quite low highlights the difficulty of parents to administer drugs daily to their children in sub-Saharan Africa. It also stressed the importance of initial viral suppression for achieving and maintaining virologic success in the long-term. Further studies should focus on identifying strategies that would enhance better retention in care and improved adherence to treatment within the first two years of ART early initiated in Sub-Saharan HIV-infected children.

The impact of viraemia on inflammatory biomarkers and CD4+ cell subpopulations in HIV-infected children in sub-Saharan Africa.

To determine the impact of virological control on inflammation and cluster of differentiation 4 depletion among HIV-infected children initiating antiretroviral therapy (ART) in sub-Saharan Africa. Longitudinal cohort study. In a sub-study of the ARROW trial (ISRCTN24791884), we measured longitudinal HIV viral loads, inflammatory biomarkers (C-reactive protein, tumour necrosis factor alpha, interleukin 6 (IL-6), soluble CD14) and (Uganda only) whole blood immunophenotype by flow cytometry in 311 Zimbabwean and Ugandan children followed for median 3.5 years on first-line ART. We classified each viral load measurement as consistent suppression, blip/post-blip, persistent low-level viral load or rebound. We used multi-level models to estimate rates of increase or decrease in laboratory markers, and Poisson regression to estimate the incidence of clinical events. Overall, 42% children experienced viral blips, but these had no significant impact on immune reconstitution or inflammation. Persistent detectable viraemia occurred in one-third of children and prevented further immune reconstitution, but had little impact on inflammatory biomarkers. Virological rebound to ≥5000 copies/ml was associated with arrested immune reconstitution, rising IL-6 and increased risk of clinical disease progression. As viral load testing becomes more available in sub-Saharan Africa, repeat testing algorithms will be required to identify those with virological rebound, who need switching to prevent disease progression, whilst preventing unnecessary second-line regimen initiation in the majority of children with detectable viraemia who remain at low risk of disease progression.

Diagnostic, Therapeutic and Evolutionary Peculiarities of Spinal Trauma in Children in Sub-Saharan Africa: Experience of Senegal

Introduction: Spinal trauma in children is rare, accounting for 1 and 10% of all spinal traumas. They constitute an entity in their own right due to the injuries they cause. Difficulties (diagnostic) and modalities (therapeutic), different from those of adults the growth of children. The lack of studies in Sub-Saharan Africa leads us to carry out this study focused on the traumatic spine of the child. Patients and Methods: Over a period of 8 and a half years from January 2012 to June 2020, we retrospectively studied 44 cases involving 4 Senegalese hospitals, 3 of which were in the capital and 1 in the province, including children up to the age of 16 who had suffered spinal trauma. Results: Forty-four children were retained, a frequency of 7.11%, with an average age of 10.5 years; sex ratio: 1.6. The most frequent aetiologies were: falls (from trees, from buildings): 41%; play accidents and accidents on public roads: 20.4% each. The average consultation time was 31.3 days. 34% of the patients were ASIA E patients. The majority of patients had performed a spine CT scan as an imaging examination, i.e. 95.4%. The most common site of injury was cervical with 61.3%. The most frequent lesions were: fractures, fracture-luxations and dislocations with 27.3%, 25% and 25% respectively. Five patients had associated lesions, i.e. 11.3% (4 head traumas, 9.1% and 1 pelvic trauma, 1.9). Most of the treatment was surgical (43% orthopaedic, 38.6%) and functional (16%). The post-therapy neurological evaluation (ASIA - backward step) was: A: 25%; B: 2.3%; C: 7%; D: 13.7%; E: 52.3%. We noted 3 deaths and 4 patients were re-operated. There were no consolidation complications such as pseudoarthrosis. Conclusion: Trauma to the spine in children, like any bone trauma, responds well to orthopaedic treatment. Deaths are often related to upper cervical spine injuries or occur in the context of polytrauma. Follow-up should be carried out over several years to detect possible complications at an early stage. Delays in treatment due to the difficulties of punctual medicalised transport remain the challenge to be met in our environment.

Interactive radio, social network sites and development in Africa: a literature review study

Purpose The technology determinism theory facilitated in assessing the impact of interactive radio and social network sites (SNSs) on development factors such as education, agriculture, health, and governance, by conducting an integrative and comprehensive literature review focusing on African countries. This paper aims to conduct this literature review to provide comprehensive empirical evidence on the impact of interactive radio and SNSs on development in Africa. Design/methodology/approach This study examined articles that were retrieved from online databases including EBSCOhost, Elsevier, Science Direct, SAGE Journals, Springer and Wiley Online Library. The keywords used included interactive radio, radio, development in Africa, SNS, agriculture, education, health, peace and governance. Search phrases were formulated using boolean operators “AND” and “OR.” Findings Study results revealed that interactive radio and SNSs improve knowledge among farmers and allow the dissemination of information on innovative agricultural techniques, which supports the adoption of sustainable practices. Interactive radio promotes political accountability because the strategies provide the voiceless and powerless communities with a platform to express themselves. This paper discovers that the incorporation of SNS with existing multimedia communication facilitates the dissemination of health-related information on illnesses such as Ebola, HIV, hypertension, diabetes and Polio, and interactive radio and SNS promote education among marginalized communities and under-served rural schools. Research limitations/implications The findings on the impact of interactive radio and SNSs do not represent all 54 countries in Africa. Although the studies included in this literature review were conducted in several countries such as South Africa, Nigeria, Somalia, Kenya, Malawi, Ghana, Tanzania, Uganda and Zambia, this limited the generalizability of the findings and recommendations. Also, the other potential limitation is that using the inclusion-exclusion criteria could have resulted in bias when selecting the studies to include in the review. Practical implications The paper might serve as a valuable source of information for students, academics and entrepreneurs where the impact of interactive radio and SNSs on agriculture, education, health and governance, which are core determinants of development in Africa, has been assessed for further case studies in this area. Social implications The use of interactive radio has helped in decreasing health issues caused by a deficiency in vitamin A among children in sub-Saharan Africa. Originality/value The development of sustainable and effective interactive radio programs is dependent on the collaboration of the core stakeholders such as governmental ministries, donor organizations and the mass communication sector. Numerous open sources on technology radio stations are available to employ social media managers to help in the application of knowledge.

Blood transfusion and mortality in children with severe anaemia in a malaria-endemic region

ABSTRACT Background In children in sub-Saharan Africa, severe anaemia (SA) is an important cause of mortality, and malaria is a primary cause. The World Health Organization (WHO) recommends blood transfusion for all children with haemoglobin (Hb) <4 g/dL and for those with Hb 4–6 g/dL with signs of instability. In sub-Saharan Africa, evidence of the effect on mortality of transfusion in children with SA with and without malaria is mixed. Aim To determine in children with and without malaria whether receipt of transfusion was associated with lower mortality at WHO transfusion thresholds. Methods This was a retrospective cohort study of 1761 children with SA (Hb ≤6 g/dL) admitted to Kamuzu Central Hospital in Malawi. In those whose Hb was 4–6 g/dL, mortality was compared by transfusion, stratified by haemoglobin, malaria status and signs of instability. Results Children with profound anaemia (Hb <4 g/dL) and malaria were the only subgroup who had a significant decrease in the odds of in-hospital death if they received a transfusion (OR 0.43, p = 0.01). Although children with Hb 4–6 g/dL and at least one sign of instability had higher mortality than children with none, there was no difference in the odds of mortality between those who received a transfusion and those who did not (OR 1.16, p = 0.62). Conclusions This study suggests that transfusion of children with profound anaemia and malaria may confer increased in-hospital survival. An understanding of the factors associated with mortality from SA will allow for interventions to prioritise the provision of limited blood.

Determinants of full childhood immunization among children aged 12\u201323 months in sub-Saharan Africa: a multilevel analysis using Demographic and Health Survey Data

BackgroundSub-Saharan Africa is one of the highest under-five mortality and low childhood immunization region in the world. Children in Sub-Saharan Africa are 15 times more likely to die than children from high-income countries. In sub-Saharan Africa, more than half of under-five deaths are preventable through immunization. Therefore, this study aimed to identify the determinant factors of full childhood immunization among children aged 12–23 months in sub-Saharan Africa.MethodsData for the study was drawn from the Demographic and Health Survey of nine sub-Saharan African countries. A total of 21,448 children were included. The two-level mixed-effects logistic regression model was used to identify the individual and community-level factors associated with full childhood immunizationResultThe prevalence of full childhood immunization coverage in sub-Saharan Africa countries was 59.40% (95% CI: 58.70, 60.02). The multilevel logistic regression model revealed that secondary and above maternal education (AOR = 1.38; 95% CI: 1.25, 1.53), health facility delivery (AOR = 1.51; 95% CI: 1.41, 1.63), fathers secondary education and above (AOR = 1.28, 95% CI: 1.11, 1.48), four and above ANC visits (AOR = 2.01; 95% CI: 1.17, 2.30), PNC visit(AOR = 1.55; 95% CI: 1.46, 1.65), rich wealth index (AOR = 1.26; 95% CI: 1.18, 1.40), media exposure (AOR = 1.11; 95% CI: 1.04, 1.18), and distance to health facility is not a big problem (AOR = 1.42; 95% CI: 1.28, 1.47) were significantly associated with full childhood immunization.ConclusionThe full childhood immunization coverage in sub-Saharan Africa was poor with high inequalities. There is a significant variation between SSA countries in full childhood immunization. Therefore, public health programs targeting uneducated mothers and fathers, rural mothers, poor households, and those who have not used maternal health care services to promote full childhood immunization to improve child health. By enhancing institutional delivery, antenatal care visits and maternal tetanus immunization, the government and other stakeholders should work properly to increase child immunization coverage. Furthermore, policies and programs aimed at addressing cluster variations in childhood immunization need to be formulated and their implementation must be strongly pursued.

Geostatistical modeling of malaria prevalence among under-five children in Rwanda

BackgroundMalaria has continued to be a life-threatening disease among under-five children in sub-Saharan Africa. Recent data indicate rising cases in Rwanda after some years of decline. We aimed at estimating the spatial variations in malaria prevalence at a continuous spatial scale and to quantify locations where the prevalence exceeds the thresholds of 5% and 10% across the country. We also consider the effects of some socioeconomic and climate variables.MethodsUsing data from the 2014-2015 Rwanda Demographic and Health Survey, a geostatistical modeling technique based on stochastic partial differential equation approach was used to analyze the geospatial prevalence of malaria among under-five children in Rwanda. Bayesian inference was based on integrated nested Laplace approximation.ResultsThe results demonstrate the uneven spatial variation of malaria prevalence with some districts including Kayonza and Kirehe from Eastern province; Huye and Nyanza from Southern province; and Nyamasheke and Rusizi from Western province having higher chances of recording prevalence exceeding 5%. Malaria prevalence was found to increase with rising temperature but decreases with increasing volume for rainfall. The findings also revealed a significant association between malaria and demographic factors including place of residence, mother’s educational level, and child’s age and sex.ConclusionsPotential intervention programs that focus on individuals living in rural areas, lowest wealth quintile, and the locations with high risks should be reinforced. Variations in climatic factors particularly temperature and rainfall should be taken into account when formulating malaria intervention programs in Rwanda.

The Critical Need for Pooled Data on Coronavirus Disease 2019 in African Children: An AFREhealth Call for Action Through Multicountry Research Collaboration.

Globally, there are prevailing knowledge gaps in the epidemiology, clinical manifestations, and outcomes of SARS-CoV-2 infection among children and adolescents; however, these gaps are especially wide in African countries. The availability of robust age-disaggregated data is a critical first step in improving knowledge on disease burden and manifestations of COVID-19 among children. Furthermore, it is essential to improve understanding of SARS-CoV-2 interactions with comorbidities and co-infections such as HIV, tuberculosis, malaria, sickle cell disease and malnutrition, which are highly prevalent among children in sub-Saharan Africa. The African Forum for Research and Education in Health (AFREhealth) COVID-19 Research Collaboration on Children and Adolescents is conducting studies across Western, Central, Eastern, and Southern Africa to address existing knowledge gaps. This consortium is expected to generate key evidence to inform clinical practice and public health policymaking for COVID-19, while concurrently addressing other major diseases affecting children in African countries.

Birth weight, growth, nutritional status and mortality of infants from Lambaréné and Fougamou in Gabon in their first year of life.

Malnutrition and low birth weight (LBW) are two common causes of morbidity and mortality among children in sub-Saharan Africa. Both malnutrition and LBW affect early childhood development with long term consequences that may vary in their degree depending on the geographical setting. This study evaluates growth, nutritional status and mortality of infants from Lambaréné and Fougamou in Gabon from a birth cohort of a malaria in pregnancy clinical trial (NCT00811421). A prospective longitudinal birth cohort conducted between 2009 and 2012, included infants that were followed up from birth until their first-year anniversary. The exposure of interest was low birth weight and the outcomes explored were growth represented by weight gain, the nutritional status including stunting, wasting and underweight, and the mortality. Scheduled follow-up visits were at one, nine and 12 months of age. Logistic regression was used to assess the association between low birth weight and growth and nutritional outcomes, and cox regression was used for mortality. A total of 907 live-born infants were included in the analysis. The prevalence of LBW was 13% (115). At one month of life, out of 743 infants 10% and 4% presented with stunting and underweight, respectively, while these proportions increased at 12 months of life to 17% and 21%, respectively, out of 530 infants. The proportion of infants with wasting remained constant at 7% throughout the follow-up period. Stunting and underweight were associated with LBW, adjusted odds ratio (aOR): 2.6, 95% confidence interval (95%CI): 1.4-4.9 and aOR: 4.5, 95%CI: 2.5-8.1, respectively. Preterm birth was associated with stunting, aOR: 2.7, 95%CI: 1.2-6.3 and underweight, aOR: 5.4, 95%CI: 1.7-16.1 at one month of life. Infants with LBW were at higher hazard of death during the first year of life, adjusted hazard ratio 4.6, 95%CI: 1.2-17.0. Low birthweight infants in Gabon are at higher risks of growth and nutritional deficits and mortality during the first year of life. Tailored interventions aiming at preventing adverse pregnancy outcomes including LBW, early detection and appropriate management of growth, and nutritional deficits in infants are necessary in Gabon.

Disciplinary practices among orphaned children in Sub-Saharan Africa.

ObjectivesThis study considers whether orphans’ experiences with physically and psychologically violent discipline differ from non-orphans in sub-Saharan Africa, and to what extent national, community, household, caretaker, and child characteristics explain those differences.MethodsWe use cross-sectional Multiple Indicator Cluster Surveys (MICS) administered between 2010–2017 in 14 sub-Saharan African countries. The sample included 125,197 children, of which 2,937 were maternal orphans, 9,113 were paternal orphans, and 1,858 were double orphans. We estimate the difference between orphans and non-orphans experience of harsh discipline using multivariable logistic regressions with country fixed effects and clustered standard errors.ResultsFindings show that orphaned children experience less harsh discipline in the home. With the exception of double orphans’ experience with physically violent discipline, these differences persisted even after controlling for a rich set of child, household, and caretaker characteristics.ConclusionsWe propose two alternative explanations for our surprising findings and provide a supplementary analysis to help arbitrate between them. The evidence suggests that orphaned children (especially those with a deceased mother) are less likely to experience harsh discipline because of lower caretaker investment in their upbringing. We encourage future research to draw on in-depth interviews or household surveys with discipline data from multiple children in a home to further unpack why orphans tend to experience less harsh punishment than other children.

Strengthening System and Implementation Research Capacity for Child Mental Health and Family Well-being in Sub-Saharan Africa.

Children in Sub-Saharan Africa (SSA) experience high rates of mental health problems, and the region has limited access to mental health resources and research capacity to address the needs. Despite the success of numerous evidence-based interventions (EBIs) and emerging methodology from the field of implementation science for addressing child mental health needs, most EBIs and implementation science methodology have not been applied in SSA contexts. The SMART-Africa Center aims to address these child welfare, mental health, services, and EBI implementation research gaps by establishing a regional trans-disciplinary collaborative center and studying strategies to strengthening mental health system and implementation research capacity. Our paper describes the overall framework and strategies that SMART-Africa team developed to strengthen capacity in three SSA countries (Ghana, Kenya, and Uganda) while focusing on its contextualization for the Kenyan school-community mental health settings. Methods to document the progress and impacts are also described. The design of the system and research strengthening activities is guided by a SMART-Africa Capacity Building framework. Two areas of capacity are focused. Mental health system capacity focuses on building political wills, leadership, transdisciplinary partnership, and stakeholders' global competency in evidence child mental health policy, intervention, and service implementation research. Implementation research capacity building focuses on building researchers' implementation research competency by carrying out an EBI implementation research (using a Hybrid Type II effectiveness-implementation). For illustration purpose, we describe how the system strengthening strategies has been applied in Kenya, and how the mixed methods design applied to assess the value and impacts of the capacity building activities. Feedback data and evaluation data collection using qualitative and quantitative methods for both areas of capacity building are still ongoing. Data will be analyzed and compared across countries in 2020-2021. Our work has shown some feasibility of applying the theory-guided system strengthening model in improving child mental health service system and research capacity in one of the three SMART-Africa partnering countries. Our mental health landscape and resource mapping in Kenya also illustrated that capacity building in SSA countries involved complex dynamic, history, and some overlap efforts with multiple partnerships, and these are critical to consider in training activity and evaluation design.

ASSESSMENT OF CHILD MORTALITY IN CHILDREN UNDER FIVE YEARS AT THE COAST GENRAL TEACHING AND REFERRAL HOSPITAL, KENYA

According to World Health Organization, children in Sub-Saharan Africa are more affected where the cases of deaths are 15 times more than the children in high income countries (WHO 2019). The carried out an assessment of child mortality at the Coast General teaching and Referral Hospital by looking at the prevalence, risk factors associated and utilization of Maternal Child Health services at the hospital. The study used a cross sectional study design where the target populations were children delivered as well as those seeking health services at the hospital. The study recruited a sample size of 384 participants. Structured questionnaire was used to collect quantitative data and interview for qualitative data then data was analyzed using SPSS version 20. The study results were presented using tables and pie charts. The study findings show that child mortality rate stands at 31%, 54.9% of the mothers had given birth to children with more than 2.5kg and 50.8% developed pregnancy or delivery complication. Bivariate analysis finding show that age during the first birth (p=0.036), placenta and umbilical cord complication (p=0.007), hospital delivery (p=0.000) to be statistically significant to child mortality. KEY WORDS: child mortality, hospital delivery, maternal and health care

Trends and outcomes following intentional injuries in pediatric patients in a resource-limited setting.

Intentional injuries pose a significant, yet underreported threat to children in sub-Saharan Africa. We sought to evaluate intentional injuries trends and compare outcomes between unintentional and intentional injuries in pediatric patients presenting to a tertiary care facility in Malawi. We performed a review of pediatric (≤15years old) trauma patients presenting to Kamuzu Central Hospital, Lilongwe, Malawi, from 2009 to 2018. Patient characteristics and outcomes were compared based on the injury intent, using bivariate and multivariate regression analysis. We included 42,600 pediatric trauma patients in the study. Intentional injuries accounted for 5.9% of all injuries. Children with intentional injuries were older (median, 10 vs. 6years, p < 0.001), more likely to be male (68.4% vs. 63.9%, p < 0.001), and had significantly lower mortality (0.8% vs. 1.4%, p = 0.02) than those with unintentional injuries There was no significant change in the incidence of or mortality associated with intentional injuries. On multivariable regression, increasing age, head and cervical spine injury, night-time presentation, penetrating injury, and alcohol use were associated with increased risk of intentional harm. Intentional injury remains a significant cause of pediatric trauma in Malawi without decreasing hospital presentation incidence or mortality. In sub-Saharan Africa, there is a need to develop comprehensive plans and policies to protect children. II.

How does school travel time impact children’s learning outcomes in a developing country?

Nearly 88% of children in sub-Saharan Africa will not be able to read by the time they complete primary school. We explore this phenomenon by using household data from the Ghana Living Standards Survey to examine the link between school travel time and children’s learning outcomes. Using district variations in school density to resolve endogeneity associated with children’s travel time to school and their learning outcomes, we find that more than 90% of children travel on foot to school and this negatively affects their ability to read and write in English or French as well as their ability to read and write in their native languages. We further show that boys, children in rural areas and those who travel more than the 75th percentile travel time (30 minutes) have poorer learning outcomes. Our findings highlight number of class hours missed and poor health as the main channels through which school travel time affects learning outcomes. Policy initiatives to improve children’s learning should consider reducing the costs associated with their school travel time. Considering that governments have limited resources with competing needs, policies aimed at reducing travel time should generally target children who commute more than 30 minutes to school and those in rural locations.

Inland fisheries critical for the diet quality of young children in sub-Saharan Africa

The world will not reach Sustainable Development Goal 2 ‘Zero Hunger’ by 2030 unless we address micronutrient deficiencies, particularly amongst infants and children in developing countries. Fish are nutrient-rich and are valued to improve diet quality. We examined the diets of 6328 children in rural sub-Saharan Africa. Most children had inadequate diet diversity. Of those that did have higher diet diversity, 20% relied on eating fish from nearby inland fisheries as their only flesh food. Results suggest that food systems failed to provide fish or other flesh foods to 65% of rural children. To improve diet quality of children living more than 5 km from inland fisheries, strategies are needed to extend the reach of fish value chains and improve access to fish.

Dendritic cell responses to Plasmodium falciparum in a malaria-endemic setting

BackgroundPlasmodium falciparum causes the majority of malaria cases worldwide and children in sub-Saharan Africa are the most vulnerable group affected. Non-sterile clinical immunity that protects from symptoms develops slowly and is relatively short-lived. Moreover, current malaria vaccine candidates fail to induce durable high-level protection in endemic settings, possibly due to the immunomodulatory effects of the malaria parasite itself. Because dendritic cells play a crucial role in initiating immune responses, the aim of this study was to better understand the impact of cumulative malaria exposure as well as concurrent P. falciparum infection on dendritic cell phenotype and function.MethodsIn this cross-sectional study, the phenotype and function of dendritic cells freshly isolated from peripheral blood samples of Malian adults with a lifelong history of malaria exposure who were either uninfected (n = 27) or asymptomatically infected with P. falciparum (n = 8) was assessed. Additionally, plasma cytokine and chemokine levels were measured in these adults and in Malian children (n = 19) with acute symptomatic malaria.ResultsWith the exception of lower plasmacytoid dendritic cell frequencies in asymptomatically infected Malian adults, peripheral blood dendritic cell subset frequencies and HLA-DR surface expression did not differ by infection status. Peripheral blood myeloid dendritic cells of uninfected Malian adults responded to in vitro stimulation with P. falciparum blood-stage parasites by up-regulating the costimulatory molecules HLA-DR, CD80, CD86 and CD40 and secreting IL-10, CXCL9 and CXCL10. In contrast, myeloid dendritic cells of asymptomatically infected Malian adults exhibited no significant responses above the uninfected red blood cell control. IL-10 and CXCL9 plasma levels were elevated in both asymptomatic adults and children with acute malaria.ConclusionsThe findings of this study indicate that myeloid dendritic cells of uninfected adults with a lifelong history of malaria exposure are able to up-regulate co-stimulatory molecules and produce cytokines. Whether mDCs of malaria-exposed individuals are efficient antigen-presenting cells capable of mounting an appropriate immune response remains to be determined. The data also highlights IL-10 and CXCL9 as important factors in both asymptomatic and acute malaria and add to the understanding of asymptomatic P. falciparum infections in malaria-endemic areas.

Genital Chlamydia Trachomatis Infection: Prevalence, Risk Factors and Adverse Pregnancy and Birth Outcomes in Children and Women in sub-Saharan Africa.

Genital Chlamydia trachomatis (CT) has adverse health outcomes for women and children. In pregnant women, the infection causes adverse obstetric outcomes including pelvic inflammation, ectopic pregnancy, and miscarriage. In children, it causes adverse birth outcomes such as skin rash, lesions, limb abnormalities, conjunctivitis, neurological damage, and even death. This article discusses genital CT prevalence, risk factors, and adverse pregnancy and birth outcomes among women and children in sub-Saharan Africa as well as challenges associated with the mitigation of the disease. A comprehensive search of databases including PubMed, ResearchGate, and Google Scholar was conducted using keywords such as genital chlamydia trachomatis, adverse pregnancy outcomes, adverse birth outcomes, and sub-Saharan African. We found that genital CT prevalence rates in some sub-Saharan Africa countries were higher than others and that risk factors such as the lack of condom use, having multiple sexual partners, and low educational levels contribute to the transmission of the infection. We also found that negative cultural practices, illiteracy among women, and the lack of access to screening services during pregnancy are some of the challenges associated with CT mitigation in sub-Saharan Africa. To reduce genital CT transmission in sub-Saharan Africa, efforts must be made by country governments to eliminate negative cultural practices, promote female literacy, and provide access to screening services for pregnant women.

Cash Transfers and Child Nutrition: Evidence from sub-Saharan Africa

This paper summarises the arguments and counterarguments within the scientific discussion on cash transfers and child nutrition. The main purpose of the research is to assess the effectiveness of cash transfers in improving nutritional outcomes in vulnerable children in sub-Saharan Africa. Systematisation of the literary sources indicates that studies have justified cash transfer as social-income support that addresses a vital social determinant of health (income) for children in low-and-middle-income countries. The methodological basis of this study is a systematic review that searched a wide range of academic and grey literature databases, including PubMed, Cochrane Library and Google Scholar. This study included cluster-randomised controlled trials (R.C.T.s), randomised controlled trials, quasi-experimental studies, mixed-methods studies, and non-randomised cluster trials. Studies included in this systematic review were screened for their eligibility. The systematic review uses the Cochrane data collection form to extract data from the included studies. It was not feasible to statistically combine the results of the studies due to the heterogeneity of most of the studies. Preferably, the review employs a narrative synthesis to present the estimated effects of cash transfers on children’s nutritional outcomes. The systematic review presents the results of data synthesis, of which eleven studies met the inclusion criteria. Overall, the evidence from the systematic review indicates that cash transfer programmes targeted at children effectively improve anthropometric and nutritional outcomes. Further research is needed to spell out the multiple pathways to how cash transfers improve children’s nutritional outcomes. Moreover, this systematic review shows the importance of cash transfers in improving child nutrition. Policymakers should continue to employ institutional mechanisms to strengthen the nutritional status of children, especially the vulnerable ones since cash transfer intervention is a temporary measure.