Children U5 Research Articles

Role of Women's Empowerment in Improving the Nutritional Status of Children Under Five Years of Age: An Insight From the National Family Health Survey-5.

Background Childhood malnutrition remains a global concern, especially in low- and middle-income countries, and is known to create an intergenerational cycle of illness and poverty. Women's empowerment has gained global recognition as a potential catalyst for improving child nutrition. The objective of this research was to investigate the association between women's empowerment factors and the nutritional status of children under five years of age. Methods The study used data from the National Family Health Survey-5, conducted in India between 2019 and 2021 by the International Institute of Population Sciences, Mumbai. A weighted sample of 29,491 mother-child pairs was analyzed. The odds ratio for women's empowerment and sociodemographic factors associated with the nutritional status of children under five years of age was calculated using Pearson's chi-square test and multiple logistic regression. Results The study foundthat the sex of the child (OR = 1.066, 95% CI: 1.017 to 1.117; p-value: 0.008), birth order (OR = 0.824, 95% CI: 0.780 to 0.871; p-value < 0.001), education of the mother (OR = 1.356, 95% CI: 1.255 to 1.464; p-value < 0.001), education of the father (OR = 1.227, 95% CI: 1.140 to 1.320; p-value < 0.001), having a bank or savings account that she uses (OR = 1.151, 95% CI: 1.084 to 1.221; p-value < 0.001), having a mobile phone that she uses (OR = 1.184, 95% CI: 1.125 to 1.246; p-value < 0.001), and wealth index (OR = 1.597, 95% CI: 1.514 to 1.684; p-value < 0.001) were significant predictors of undernutrition in children under the age of five (U5). Conclusion Women's empowerment factors play a significant role in improving childhood nutrition. In the study, male sex, higher birth order, lower parental education, poor wealth index, maternal lack ofaccess to a bank or a savings account, and lack of mobile phone ownership were found to besignificant predictors of undernutrition in children U5. The findings underscore the importance of family planning, financial inclusion, access to mobile phones, and higher education for women as important factors that can help improve the nutritional status of children under five years of age. Policymakers can utilize these insights to make targeted strategies for women's empowerment, thus improving the nutritional status of children. However, being a secondary data analysis, our research is constrained by the variables available in the dataset. Further research is required to better comprehend the complex relationship between women empowerment and child nutrition.

Assessment of pre-referral treatment for malaria, diarrhea, and pneumonia by rural community health workers in Southwestern Uganda: a cross-sectional study

BackgroundPre-referral treatment aims to stabilize the child’s condition before transferring them to a higher level of healthcare. This study explored pre-referral treatment for diarrhea, malaria and pneumonia in children U5. The study aims to assess pre-referral treatment practices among community health workers (CHWs) for children aged 2 to 59 months diagnosed with malaria, diarrhea, and pneumonia.MethodsConducted in 2023, this study employed a quantitative retrospective analysis of secondary data gathered from March 2014 to December 2018. Among the subjects, 171 patients received pre-referral treatment, serving as the foundation for categorical data analysis, presenting proportions and 95% confidence intervals across different categories.ResultsIn this cohort, 90 (53%) of the 177 children U5 were male, and age distribution showed 39 (23%), 70 (41%), and 62 (36%) in the 2–11 months, 12–35 months, and 36–60 months categories, respectively. Rapid Diagnostic Test (RDT) malaria results indicated a negative outcome in 83(60%) and positive in 55 (40%) of cases. Symptomatically, 45 (26%) had diarrhea, 52 (30%) exhibited fast breathing, and 109 (63%) presented with fever. Furthermore, 59 (35%) displayed danger signs, while 104 (61%) sought medical attention within 24 h.ConclusionThe study analyzed a sample of 171 children under 5 years old to assess various characteristics and variables related to pre-referral treatment. The findings reveal notable proportions in gender distribution, age categories, RDT results, presence of diarrhea, fast breathing, fever, danger signs, and timely medical visits. The results highlight the need to strengthen pre-referral treatment interventions and enhance iCCM programs.

Policy and Governance Towards Eliminating of Malaria Among Children Under Five in Four Districts of Ghana

Malaria contributes significantly to the increasing mortality rate among Ghana's children under-five years of age (U5). This study sought to analyze how policies, actors, and institutions play out and interact in Ghana´s public health sector and how they affect the health outcomes of children U5 in early childhood malaria in four districts. The study findings show current health policies to tackle malaria among children U5. However, there were apparent discrepancies between policy intent and actual implementation, just as other key stakeholders are not adequately involved in policy formulations and executions in the districts. The study concludes that a functioning health system governance is critical to achieving desired results in eradicating malaria among children U5 in the four communities understudied.&#x0D; Keywords: children U5, governance, healthcare, health policy, malaria

Differential Impact of Exposure to PM2.5 Composition and Contributing Sectors on Anemia Prevalence Amongst Children Under age five in India

Anemia, a condition of low red blood cell count and diminished hemoglobin levels, is highly prevalent in India. India has one of the highest anemia prevalence approx. 60% among children under age five (U5) in the world. Ambient PM2.5 exposure has been identified as a potential risk factor for anemia via systemic inflammation. Moreover, whether the impact varies with PM2.5 composition and sources contributing to such components is not known. Here, we examine the differential impact of exposure to ambient PM2.5 components on anemia prevalence among children U5 in India using exposure data from the CMAQ model and satellite-derived PM2.5, health data from the NFHS-IV. Here we focus on the exposure to PM2.5 components such as Black Carbon, Organic Carbon, nitrate (NO3), ammonium (NH4), sulfate, soil, and others, during the early life period. We use multilevel models adjusted for the risk factors - smoking, cooking fuel, BMI, wealth, and residence to assess the impact of PM2.5 components on anemia prevalence among children. At the ecological level, for every IQR increase in ambient PM2.5 exposure, the odds ratio for average anemia prevalence is 1.19 (95% UI: 1.17,1.22). For each IQR of NO3, anemia prevalence increased with an odds ratio of 1.26 (95% UI: 1.24,1.29). For the corresponding increase in NH4, others, BC, OC, SO4, and soil, anemia prevalence increased by odds ratio 1.19 (95% UI: 1.17,1.21), 1.16 (95% UI: 1.14, 1.18), 1.15 (95% UI: 1.13, 1.17), 1.11 (95% UI: 1.09, 1.13), 1.12 (95% UI: 1.11,1.13), and 1.10 (95% UI: 1.08,1.11), respectively. Sectorally, the domestic sector has the highest impact, followed by the unorganized sectors, road dust, agriculture waste, industry, etc. Our results will support the policymakers to target specific sectors that are contributing to exposure to PM2.5 and its components and, in turn, causing lethal health impacts. Keywords- Anemia, PM2.5, LMICs

Hypoxaemia prevalence and management among children and adults presenting to primary care facilities in Uganda: A prospective cohort study.

Hypoxaemia (low blood oxygen) is common among hospitalised patients, increasing the odds of death five-fold and requiring prompt detection and treatment. However, we know little about hypoxaemia prevalence in primary care and the role for pulse oximetry and oxygen therapy. This study assessed the prevalence and management of hypoxaemia at primary care facilities in Uganda. We conducted a cross sectional prevalence study and prospective cohort study of children with hypoxaemia in 30 primary care facilities in Uganda, Feb-Apr 2021. Clinical data collectors used handheld pulse oximeters to measure blood oxygen level (SpO2) of all acutely unwell children, adolescents, and adults. We followed up a cohort of children aged under 15 years with SpO2<93% by phone after 7 days to determine if the patient had attended another health facility, been admitted, or recovered. Primary outcome: proportion of children under 5 years of age with severe hypoxaemia (SpO2<90%). Secondary outcomes: severe (SpO2<90%) and moderate hypoxaemia (SpO2 90-93%) prevalence by age/sex/complaint; number of children with hypoxaemia referred, admitted and recovered. We included 1561 children U5, 935 children 5-14 years, and 3284 adolescents/adults 15+ years. Among children U5, the prevalence of severe hypoxaemia was 1.3% (95% CI 0.9 to 2.1); an additional 4.9% (3.9 to 6.1) had moderate hypoxaemia. Performing pulse oximetry according to World Health Organization guidelines exclusively on children with respiratory complaints would have missed 14% (3/21) of severe hypoxaemia and 11% (6/55) of moderate hypoxaemia. Hypoxaemia prevalence was low among children 5-14 years (0.3% severe, 1.1% moderate) and adolescents/adults 15+ years (0.1% severe, 0.5% moderate). A minority (12/27, 44%) of severely hypoxaemic patients were referred; 3 (12%) received oxygen. We followed 87 children aged under 15 years with SpO2<93%, with complete data for 61 (70%), finding low rates of referral (6/61, 10%), hospital attendance (10/61, 16%), and admission (6/61, 10%) with most (44/61, 72%) fully recovered at day 7. Barriers to referral included caregiver belief it was unnecessary (42/51, 82%), cost (8/51, 16%), and distance or lack of transport (3/51, 6%). Hypoxaemia is common among acutely unwell children under five years of age presenting to Ugandan primary care facilities. Routine pulse oximetry has potential to improve referral, management and clinical outcomes. Effectiveness, acceptability, and feasibility of pulse oximetry and oxygen therapy for primary care should be investigated in implementation trials, including economic analysis from health system and societal perspectives.

Acceptability, usability and efficacy of an automatic respiratory monitor in determining fast breathing: A pilot study in a tribal tea garden in India.

Childhood pneumonia is one of the leading causes of mortality among under-five children. It is responsible for 15% of all deaths of children U5, killing 808,694 children in 2017 (1). Traditional visual inspection and manual count method is used to detect and classify fast-breathing, a key indicator of Pneumonia. In response to UNICEF's call for a reliable diagnostic tool, Philips was the first to respond with the Children's Automatic Respiratory Monitor for measuring fast breathing objectively. UNICEF and Philips Foundation initiated a field study to test the acceptability, usability and efficacy of the Automatic Respiratory Monitor in Determining Fast Breathing in low resource setting environments. Philips Foundation partnered up with the Directorate of Medical Education in West Bengal, India to conduct the field study amongst community healthcare workers and beneficiaries in a rural district of West Bengal. In collaboration with North Bengal Medical College & Hospital, a community-based study was conducted in a tribal tea garden of Naxalbari block. Acceptability and usability of the device was assessed through structtured interviews and dialogues with community health workers (CHWs), caregivers and local healthcare practitioners. Efficacy of the device was represented by the inter-rater agreement between the traditional visual inspection and manual count method and the device reading. A descriptive community based mixed method study was conducted. Satisfaction among community healthcare workers (CHWs) and beneficiaries was found to be promising across all study parameters. The paper captures the study methods, statistical analysis of the data, the conclusions, areas of further research and recommends community-wide use of the device in objectively measuring fast breathing among children under the age of five years.

Community Mortality Due to Respiratory Syncytial Virus in Argentina: Population-based Surveillance Study.

BackgroundMany deaths in infants from low-middle income countries (LMICs) occur at home or upon arrival to health facilities. Although acute lower respiratory tract illness plays an important role in community mortality, the accuracy of mortality rates due to respiratory syncytial virus (RSV) remains unknown.MethodsAn active surveillance study among children aged under 5 years old (U5) was performed in Buenos Aires, Argentina, between January and December 2019, to define the burden and role of RSV in childhood community mortality.ResultsA total of 63 families of children U5 participated in the study. Based on a combined approach of tissue sampling, verbal autopsies, and expert’s analysis, RSV infection was found in the causal chain of 11 from 12 cases with positive molecular biology results in respiratory samples. The estimated mortality rate due to RSV among infants was 0.27 deaths/1000 live births. The mean age of RSV-related household deaths was 2.8 months of age (standard deviation [SD] 1.7), and 8/12 were male infants (66.7%). Dying at home from RSV was associated with Streptococcus pneumoniae and/or Moraxella catarrhalis lung coinfection (75%), living in slums and settlement (odds ratio [OR], 17.09; 95% confidence interval [CI], 1.3–219.2), and other underlying comorbidities (OR, 14.87; 95% CI, 1.3–164.6).ConclusionsInfant community mortality rates due to RSV are higher than those reported in industrialized countries and similar to those reported in hospital-based studies in the same catchment population.

Household Hunger, Poverty, and Childcare in 5 States of Nigeria and Their Impacts on Nutritional Outcomes in Preschool Children.

This article presents findings from baseline surveys in 5 states of Nigeria to assess the nutritional outcomes on target groups on attaining the UN Sustainable Development Goal 2. The augmented regression technique was applied to analyze data from a sample of 1642 households with at least 1 child under the age of 5 years (U5) and their mothers or caregivers out of a total of 2500 households that were drawn from the 250 enumeration areas of the Nigeria Bureau of Statistics in the 5 states. The results support the growing evidence base that poverty and household hunger are pervasive. The incidence of poverty highlights inequalities among states. The combination of poverty and hunger was mirrored in the damning extent to which all forms of malnutrition coexisted in children U5, particularly during the second year of infancy and among poor households. Evidence from this study points to poor dietary quality of complementary food rather than other childcare practices as majorly responsible for child malnutrition. Child wellness was positively affected by maternal health-seeking behavior but negatively by the poverty probability index of the household. Notably, maternal health-seeking behavior played a more relevant role in child wellness than mothers' educational attainment.

Time-to-Recovery from Severe Pneumonia and Its Determinants Among Children Under-Five Admitted to University of Gondar Comprehensive Specialized Hospital in Ethiopia: A Retrospective Follow-Up Study; 2015–2020

BackgroundPneumonia, which is an infection and inflammation of an air-space in the lungs due to an impurity. Child mortality due to pheumonia is estimated at 921,000 children under 5 years (U5) in 2015.ObjectiveTo determine the TTR and factors of severe pneumonia among U5 children admitted at UOGCSH, Northwest Ethiopia.withMethodsA facility-based retrospective follow-up study was conducted on children U5 severe pneumonia from 2015 to 2020. The data were collected using pre-test and structured questionnaires. Statistical analysis was performed using Stata version 14.1.ResultThe average TTR was 3 days IQR (3–6). TTR from severe pneumonia was 13.5 (95% CI: 13.54–17.15) per 100-persons. The cumulative time for children at risk was 1112 days, with a TTR of 29.7 per 100 children per day. Severity, signs and symptoms of pneumonia (AHR, 3.88 (95% CI =3.12–5.57)); mode of infancy feeding (cows milk feeding) (AHR, 2.4, (95% CI: 2.22–6.6)), and formula feeding (AHR, 0.68, (95% CI 0.58–1.25)) as compared to breastfeeding; nutritional status (underweight) (AHR, 2.2, (95% CI: (2.1–3.76)) as compared to normal, age (2–3-years) (AHR, 1.4, (95% CI: 1.31–2.22)), and ≥4-years (AHR, 1.32, (95% CI: 1.3–2.32)) as compared to age of ≤1 year were important factors of TTR.ConclusionThe overall TTR was 3 days IQR (2–6). This study identifies severity, signs, and symptoms of pneumonia, Mode of infancy feeding (cows milk feeding, formula feeding), nutritional status, and age were main determinants of TTR.

Cost and cost-effectiveness of indoor residual spraying with pirimiphos-methyl in a high malaria transmission district of Mozambique with high access to standard insecticide-treated nets

BackgroundAs malaria cases increase in some of the highest burden countries, more strategic deployment of new and proven interventions must be evaluated to meet global malaria reduction goals.MethodsThe cost and cost-effectiveness of indoor residual spraying (IRS) with pirimiphos-methyl (Actellic®300 CS) were assessed in a high transmission district (Mopeia) with high access to pyrethroid insecticide-treated nets (ITNs), compared to ITNs alone. The major mosquito vectors in the area were susceptible to primiphos-methyl, but resistant to pyrethoids. A decision analysis approach was followed to conduct deterministic and probabilistic sensitivity analyses in a theoretical cohort of 10,000 children under five years of age (U5) and 10,000 individuals of all ages, separately. Model parameters and distributions were based on prospectively collected cost and epidemiological data from a cluster-randomized control trial and a literature review. The primary analysis used health facility-malaria incidence, while community cohort incidence and cross-sectional prevalence rates were used in sensitivity analyses. Lifetime costs, malaria cases, deaths and disability-adjusted life-years (DALYs) were calculated to determine the incremental costs per DALY averted through IRS.ResultsThe average IRS cost per person protected was US$8.26 and 51% of the cost was insecticide. IRS averted 46,609 (95% CI 46,570–46,646) uncomplicated and 242 (95% CI 241–243) severe lifetime cases in a theoretical children U5 cohort, yielding an incremental cost-effectiveness ratio (ICER) of US$400 (95% CI 399–402) per DALY averted. In the all-age cohort, the ICER was higher: US$1,860 (95% CI 1,852–1,868) per DALY averted. Deterministic and probabilistic results were consistent. When adding the community protective effect of IRS, the cost per person protected decreased (US$7.06) and IRS was highly cost-effective in children U5 (ICER = US$312) and cost-effective in individuals of all ages (ICER = US$1,431), compared to ITNs alone.ConclusionThis study provides robust evidence that IRS with pirimiphos-methyl can be cost-effective in high transmission regions with high pyrethroid ITN coverage where the major vector is susceptible to pirimiphos-methyl but resistant to pyrethroids. The finding that insecticide cost is the main driver of IRS costs highlights the need to reduce the insecticide price without jeopardizing effectiveness.Trial registration: ClinicalTrials.gov identifier NCT02910934 (Registered 22 September 2016). https://clinicaltrials.gov/ct2/show/NCT02910934?term=NCT02910934&draw=2&rank=1

Effects of Hand-Washing Facilities with Water and Soap on Diarrhea Incidence among Children under Five Years in Lao People's Democratic Republic: A Cross-Sectional Study.

Diarrhea is a leading cause of death among children under five (U5) in Lao People’s Democratic Republic (PDR). This study assessed the association between the presence of household hand-washing facilities with water and soap and diarrhea episodes among children U5 in Lao PDR. Data from the Lao Social Indicator Survey II were used. The outcome variable was diarrhea episodes in the two weeks preceding the survey. The main predictor variable was the presence of household hand-washing facilities with or without water and/or soap. Mixed-effect logistic regression analysis was used to assess the association, controlling for clustering, and other predictor variables. Of the 8640 households surveyed with 11,404 children, 49.1% possessed hand-washing facilities with both water and soap and 34.7% possessed hand-washing facilities with water alone. Children whose households possessed hand-washing facilities with water alone were significantly more likely to have a diarrhea episode compared to children whose households possessed hand-washing facilities with both water and soap (8.1% vs. 5.9%; odds ratio, 1.49; 95% confidence interval, 1.22–1.81). The association remained significant even after adjusting for other predictors. The absence of soap in hand-washing facilities was associated with higher odds of having a diarrhea episode among children U5 in Lao PDR.

Maternal employment and child nutritional status in Uganda.

Nearly half of all deaths among children under five (U5) years in low- and middle-income countries are a result of under nutrition. This study examined the relationship between maternal employment and nutrition status of U5 children in Uganda using the 2016 Uganda Demographic and Health Survey (UDHS) data. We used a weighted sample of 3531 children U5 years born to working women age 15-49. Chi-squared tests and multivariate logistic regressions were used to examine the relationship between maternal employment and nutritional outcomes while adjusting for other explanatory factors. Results show that children whose mothers had secondary education had lower odds of stunting and underweight compared with children whose mothers had no formal education. Children who had normal birth weight had lower odds of stunting, wasting and being underweight compared with children with low birth weight. Children whose mothers engaged in agriculture and manual work had higher odds of stunting compared with those whose mothers engaged in professional work. Additionally, children whose mothers were employed by nonfamily members had higher odds of wasting and being underweight compared with children whose mothers were employed by family members. Other determinants of child nutritional status included region, age of the mother, and age and sex of the child. Interventions aimed at improving the nutritional status of children of employed women should promote breastfeeding and flexible conditions in workplaces, target those of low socio-economic status and promote feeding programs and mosquito net use for both mothers and children.

The Correlation Between Life Expectancy and Disaster Risk

A healthy community is a community resilient to disaster. The Sendai Framework for Disaster Risk Reduction considers disaster impacts on health and encourages the implementation of disaster medicine and access to mental health services. Life expectancy (LE) is a basic statistic that indicates public health achievements and social development, including the health system, infrastructure, and accurate vital statistics. Thus, we hypothesized that LE corelates with disaster risk and strategies to achieve long LE can help achieving disaster risk reduction. We compared the disaster risk obtained from Index for Risk Management (INFORM) with the LE of both genders at birth to identify which component of INFORM risk correlates with LE. A correlation analysis revealed that overall INFORM risk negatively correlated with LE. The natural hazard category did not correlate with LE, but the human hazard category, vulnerability, and lack of coping capacity negatively correlated with LE. In the vulnerability dimension, indicators of socioeconomic vulnerability, health conditions, and children U5 negatively correlated with LE. In the lack of coping capacity dimension, indicators of communication, physical infrastructure, and access to health care negatively correlated with LE. Japan has achieved the longest LE and a low INFORM risk because of its lower vulnerability and reduced lack of coping capacity, including healthrelated indicators. In a cluster analysis of LE and INFORM categories of risk, we divided countries into four clusters and found categories that could be improved. Compared with another global disaster risk index, the Word Risk Index (WRI), the INFORM risk index seems to represent the overall disaster risk better, though they have different aspects of risk evaluation. The WRI is also negatively correlated with LE, supporting our hypothesis. In conclusion, LE is an important indicator of disaster risk and strategies to achieve long LE can be effective and important strategies in disaster risk reduction.

Next wave of interventions to reduce under-five mortality in Rwanda: a cross-sectional analysis of demographic and health survey data

BackgroundSustained investments in Rwanda’s health system have led to historic reductions in under five (U5) mortality. Although Rwanda achieved an estimated 68% decrease in the national under U5 mortality rate between 2002 and 2012, according to the national census, 5.8% of children still do not reach their fifth birthday, requiring the next wave of child mortality prevention strategies.MethodsThis is a cross-sectional study of 9002 births to 6328 women age 15–49 in the 2010 Rwanda Demographic and Health Survey. We tested bivariate associations between 29 covariates and U5 mortality, retaining covariates with an odds ratio p < 0.1 for model building. We used manual backward stepwise logistic regression to identify correlates of U5 mortality in all children U5, 0–11 months, and 12–59 months. Analyses were performed in Stata v12, adjusting for complex sample design.ResultsOf 14 covariates associated with U5 mortality in bivariate analysis, the following remained associated with U5 mortality in multivariate analysis: household being among the poorest of the poor (OR = 1.98), child being a twin (OR = 2.40), mother having 3–4 births in the past 5 years (OR = 3.97) compared to 1–2 births, mother being HIV positive (OR = 2.27), and mother not using contraceptives (OR = 1.37) compared to using a modern method (p < 0.05 for all). Mother experiencing physical or sexual violence in the last 12 months was associated with U5 mortality in children ages 1–4 years (OR = 1.48, p < 0.05). U5 survival was associated with a preceding birth interval 25–50 months (OR = 0.67) compared to 9–24 months, and having a mosquito net (OR = 0.46) (p < 0.05 for both).ConclusionsIn the past decade, Rwanda rolled out integrated management of childhood illness, near universal coverage of childhood vaccinations, a national community health worker program, and a universal health insurance scheme. Identifying factors that continue to be associated with childhood mortality supports determination of which interventions to strengthen to reduce it further. This study suggests that Rwanda’s next wave of U5 mortality reduction should target programs in improving neonatal outcomes, poverty reduction, family planning, HIV services, malaria prevention, and prevention of intimate partner violence.

Diarrheal diseases among children under five years in Brong Ahafo Region, Ghana, 2016

Introduction: diarrhoea is the frequent and excessive discharge of bowels caused by a wide range of agents. Rotavirus is the most common agent that causes acute watery diarrhoea in children under five years (U5). Globally, Diarrheal Diseases (DD) account for 1 in 9 deaths in children U5. In Ghana, rotavirus vaccine is administered in two doses at six and ten weeks. DD in children U5 from Brong Ahafo Region (BAR) were analyzed to establish trends and long-term changes, describe reasons for changes, determine where cases were occurring, detect aberrations in the patterns and determine the data quality.

Diarrheal diseases and household sanitary practices in Kakuuto County, Rakai District, Uganda, 2016

Introduction: limited data about population attributable fraction (PAF) due to the household sanitary practices associated with diarrheal diseases among children U5. This study assessed household sanitary practices associated with diarrheal diseases among U5 and suggested suitable interventions to direct policy to enhance decline in burden of diarrheal diseases among children U5 year in Kakuuto County.

Determinants of Utilization and Community Experiences with Community Health Volunteers for Treatment of Childhood Illnesses in Rural Sierra Leone

In 2010, at the same time as the national roll out of the Free Health Care Initiative (FHCI), which removed user fees for facility based health care, trained community health volunteers (CHVs) were deployed to provide integrated community case management of diarrhea, malaria and pneumonia to children under 5 years of age (U5) in Kambia and Pujehun districts, Sierra Leone. After 2 years of implementation and in the context of FHCI, CHV utilization rate was 14.0 %. In this study, we examine the factors associated with this level of CHV utilization. A cross-sectional household-cluster survey of 1590 caregivers of 2279 children U5 was conducted in 2012; with CHV utilization assessed using a multiple logistic regression model. Focus groups and in-depth interviews were also conducted to understand communities' experiences with CHVs. Children with diarrhea (OR = 3.17, 95 % CI: 1.17-8.60), from female-headed households (OR = 4.55, 95 % CI: 1.88-11.00), and whose caregivers reported poor quality of care as a barrier to facility care-seeking (OR = 8.53, 95 % CI: 3.13-23.16) were more likely to receive treatment from a CHV. Despite low utilization, caregivers were highly familiar and appreciative of CHVs, but were concerned about the lack of financial remuneration for CHVs. CHVs remained an important source of care for children from female-headed households and whose caregivers reported poor quality of care at health facilities. CHVs are an important strategy for certain populations even when facility utilization is high or when facility services are compromised, as has happened with the recent Ebola epidemic in Sierra Leone.

Removing the User Fees for the Under-Fives' Simple Malaria Treatment in Cameroon: Effect on the Health Services Utilization

Background: Access to free diagnoses and treatments has been shown to be a major determinant in malaria control. The Cameroonian government launched in February 2011 the exemption of the under-fives' simple malaria treatment policy. This study aimed at assessing the main effect of the policy on services utilization. Methods: A concurrent mixed-method research using time series data collected in July 2011 and April 2012, and qualitative data collected in April 2012 was conducted. Content analysis was used for the qualitative data. For the quantitative data, a proxy was used to measure living standards by calculating a composite index using principal component analysis. Results: General outpatients consultations and of the under-five (U5) increased to about 10% during the year 2011 compared to the year 2010 (before the policy). The average number of consultations for simple malaria cases in children U5 increased in the months following the launch of the policy then started declining from September 2011. The proportion of U5 who was exempted from payment of drugs increased from 19.6% to 32.9% at 4 and 12 months after the implementation of the policy. In contrast there was no effect in reducing inequalities among socioeconomic groups: the rural and lowest socio-economic households benefit less from the exemption measure (RR respectively 2.7, 1.6). Two thirds of U5 who used health services for uncomplicated malaria paid on average 2940 FCFA (6 $USA) for the treatment. The major part of this cost was made on the acquisition of artemisinin combination therapy (1680 FCFA/3.5 $USA).

Malaria indicator survey 2009, South Sudan: baseline results at household level

BackgroundSouth Sudan has borne the brunt of years of chronic warfare and probably has the highest malaria burden in sub-Saharan Africa. Malaria is the leading cause of morbidity and mortality in the country. This nationally representative survey aimed to provide data on malaria indicators at household level across the country.MethodsIn 2009, data were collected using a two-stage random cluster sample of 2,797 households in 150 census enumeration areas during a Malaria Indicator Survey (MIS) in South Sudan. The survey determined parasite and anaemia prevalence in vulnerable population groups and evaluated coverage, use and access to malaria control services. Standardized Roll Back Malaria Monitoring and Evaluation Reference Group (RBM-MERG) MIS household and women’s questionnaires were adapted to the local situation and used for collection of data that were analysed and summarized using descriptive statistics.ResultsThe results of this survey showed that 59.3% (95% CI: 57.5-61.1) of households owned at least one mosquito net. The proportion of the population with access to an ITN in their household was 49.7% (95% CI: 48.2-51.2). The utilization of insecticide-treated nets was low; 25.3% (95% CI: 23.9-26.7) for children under five (U5) and 35.9% (95% CI: 31.9-40.2) of pregnant women (OR: 1.66 (1.36-2.01); P =0.175). Prevalence of infection was 24.5% (95% CI: 23.0-26.1) in children U5 and 9.9% (95% CI: 7.4-13.1) in pregnant women. About two thirds (64%) of children U5 and 46% of pregnant women were anaemic. Only 2% of households were covered by indoor residual spraying (IRS) the previous year. Data shows that 58% reported that malaria is transmitted by mosquitoes, 34% mentioned that the use of mosquito nets could prevent malaria, 41% knew the correct treatment for malaria, and 52% of the children received treatment at a health facility.ConclusionThe observed high malaria prevalence could be due to low levels of coverage and utilization of interventions coupled with low knowledge levels. Therefore, access and utilization of malaria control tools should be increased through scaling up coverage and improving behaviour change communication.

Factors associated with mosquito net use by individuals in households owning nets in Ethiopia

Ownership of insecticidal mosquito nets has dramatically increased in Ethiopia since 2006, but the proportion of persons with access to such nets who use them has declined. It is important to understand individual level net use factors in the context of the home to modify programmes so as to maximize net use. Generalized linear latent and mixed models (GLLAMM) were used to investigate net use using individual level data from people living in net-owning households from two surveys in Ethiopia: baseline 2006 included 12,678 individuals from 2,468 households and a sub-sample of the Malaria Indicator Survey (MIS) in 2007 included 14,663 individuals from 3,353 households. Individual factors (age, sex, pregnancy); net factors (condition, age, net density); household factors (number of rooms [2006] or sleeping spaces [2007], IRS, women's knowledge and school attendance [2007 only], wealth, altitude); and cluster level factors (rural or urban) were investigated in univariate and multi-variable models for each survey. In 2006, increased net use was associated with: age 25-49 years (adjusted (a) OR = 1.4, 95% confidence interval (CI) 1.2-1.7) compared to children U5; female gender (aOR = 1.4; 95% CI 1.2-1.5); fewer nets with holes (Ptrend = 0.002); and increasing net density (Ptrend < 0.001). Reduced net use was associated with: age 5-24 years (aOR = 0.2; 95% CI 0.2-0.3). In 2007, increased net use was associated with: female gender (aOR = 1.3; 95% CI 1.1-1.6); fewer nets with holes (aOR [all nets in HH good] = 1.6; 95% CI 1.2-2.1); increasing net density (Ptrend < 0.001); increased women's malaria knowledge (Ptrend < 0.001); and urban clusters (aOR = 2.5; 95% CI 1.5-4.1). Reduced net use was associated with: age 5-24 years (aOR = 0.3; 95% CI 0.2-0.4); number of sleeping spaces (aOR [per additional space] = 0.6, 95% CI 0.5-0.7); more old nets (aOR [all nets in HH older than 12 months] = 0.5; 95% CI 0.3-0.7); and increasing household altitude (Ptrend < 0.001). In both surveys, net use was more likely by women, if nets had fewer holes and were at higher net per person density within households. School-age children and young adults were much less likely to use a net. Increasing availability of nets within households (i.e. increasing net density), and improving net condition while focusing on education and promotion of net use, especially in school-age children and young adults in rural areas, are crucial areas for intervention to ensure maximum net use and consequent reduction of malaria transmission.