Children Under-5 Years Research Articles

Developing Caregiver Led mHealth Solutions for Screening and Managing Childhood Wasting in the Mama Aweza Trial in Kenya

Abstract Objectives Globally, only 17% of children with wasting receive treatment. In Kenya, 4% of the 7 million children under-5 years of age are wasted and 26% are stunted. The Mama Aweza trial will test whether a two-way short message service (SMS) mobile health system, the Maternal Administered Malnutrition Monitoring System (MAMMS), can increase the coverage of malnutrition management programs in low-and-middle income countries. Methods Five formative focus group discussions (FGDs) were conducted with caregivers at an immunization clinic in Migori County, Kenya to inform feasibility and content of SMS messages in the MAMMS system. Caregivers were asked to explain anticipated facilitators and barriers to participation in a SMS program to facilitate home-based mid upper-arm circumference (MUAC) monitoring. FGDs also reviewed educational messages that accompany weekly SMS reminders to measure and report their child's MUAC. The feedback from these FGDs was included in the clinical trial, which begun in August 2019. Results The most anticipated challenge to responding to weekly messages was the use of a shared phone particularly that the SMS would be deleted or the caregiver would not be informed of the message. The greatest anticipated challenge for sending messages was and not knowing how to send a SMS. Overall, 52 messages were written on the following topics: developmental milestones, encouragement, fever, diarrhea, malaria, ear infections, sanitation and hygiene, vaccinations, respiratory illness, and kitchen gardening. To date, 144 mother-infant dyads have been enrolled and 77 randomly assigned to the MAMMS arm. Sixty-nine (90%) caregivers have responded to ≥1 message and 503 (68%) of 742 automated messages have received a response. At enrollment, 21 (27%) of caregivers in the MAMMS arm reported a shared phone, with no current evidence that caregivers sharing a phone respond less than those with their own phone. Conclusions Caregivers found SMS-based malnutrition screening to be acceptable and engaging. In regions with high literacy and high mobile phone ownership, such as Kenya, SMS supported home MUAC monitoring may improve malnutrition screening coverage and lead to earlier identification and treatment. Funding Sources Thrasher Research Foundation 14,656.

Protocol: Dietary Intake and Nutritional Status of School-Aged Children in Sindh and Punjab, Pakistan

Abstract Objectives Healthy eating habits in childhood promote optimal growth and development. With rapid globalization and urbanization, dietary patterns have been negatively impacted in many countries. For households and ultimately children, there is increased access to unhealthy, nutrient-poor, ultra-processed foods. In Pakistan, there is a persistent high burden of undernutrition and micronutrient deficiencies coupled with rising overweight and obesity. The recent Pakistan Demographic and Health Survey 2017–18 and National Nutrition Survey 2018 has offered insights into the nutritional status of children under-5 years, adolescents and women of reproductive age. However, there is a marked absence of school-aged children (5–9.9 years) within these surveys, and other school-based surveys miss children out-of-school. As such, the objectives of this research are to determine dietary intake, investigate the household and retail food environments and its association with nutritional status. Methods A multi-stage complex household survey was developed for the provinces of Sindh and Punjab, Pakistan. Both in-school and out-of-school-aged children are eligible to participate. Three core modules will be administered to the total sample of children (n = 3832) (and their caregivers): Module 1: Household, Module 2: Child and Module 3: Child Anthropometric Assessment. Three expanded modules will be administered to a subsample of children (n = 1691): Module 4: 24-hour Dietary Recall, Module 5: Child Biochemical Collection and Module 6: Food Environment. Results Preliminary results will be available in May 2020. Conclusions Given our limited knowledge of dietary intake and food environments of school-aged children in Pakistan, this research aims to provide an understanding of both upstream predictors and downstream health outcomes in order to inform policy and develop an evidence-based school health and nutrition intervention planned for 2021. Funding Sources The survey was undertaken under the auspices of the Ministries of Health, Punjab and Sindh, Pakistan with technical support from the Mother & Child Care & Research Inc. and Aga Khan University, Pakistan. Financial support was provided by the Trust for Vaccines & Immunizations Pakistan, MCCR, Governments, with additional unrestricted funding from the Societe des Produits Nestle Ltd, Switzerland.

RISK FACTORS FOR UNDERNUTRITION IN CHILDREN UNDER FIVE YEARS OF AGE IN TENOM, SABAH, MALAYSIA

Undernutrition is the result of complex interplay of factors such as household food security, childcare, feeding practices, nutrition and sanitation. Therefore, this study aimed to determine the prevalence of stunting, wasting, underweight based on WHO child growth standards 2006 and undernutrition based on Composite Index Anthropometric Failure (CIAF) and its association with the biological, behavioural, socio-economic and physical environment factors among children under-5 years. This was a cross sectional study involving children aged between 6 and 59 months recruited through stratified random sampling from the Tenom district. Sociodemographic background was obtained from mothers via a questionnaire. Height and weight measurements were measured using standardised instrument. The height-for-age, weight-for-age and BMI-for-age were classified according to the WHO Child Growth Standard 2006. Bivariate analysis and multivariate logistic regression analysis were conducted. The prevalence of undernutrition based on CIAF was 42.3%, underweight 34.7%, stunting 33.3% and wasting 10.0%. After adjusting for all confounders, childhood undernutrition was significantly associated with unimproved sanitation (adjusted OR 2.98, 95% CI: 1.082 to 8.225) and frequent illness (adjusted OR 2.07, 95% CI: 1.015 to 3.274). These findings support the association of biological and physical environmental factors with the nutritional status of children under-5 years old.

Identification of Cryptosporidium parvum Oocysts among Hospitalized Children under-5years in Northeastern Nigeria

Cryptosporidium parvum is among the major pathogens causing diarrheal diseases in children. It is of major public health significance due to its low infectious dose and its oocysts are highly resistant to chlorination, common household disinfectants and survive long periods in the environment. This study was designed to evaluate the occurrence of Cryptosporidium parvum oocysts in stool of hospitalized children under-5 years. One hundred and fifty (150) stool samples were collected from one hundred and fifty children (Male:Female = 1:1.08, Mean Age±S.D=22.08 months ± 21.02) and were processed using the modified Ziehl-Nelson method for identification of protozoan oocysts. Out of the one hundred and fifty (150) stool samples analyzed, 16 tested positive to oocysts of C. parvum, which gives a parasite prevalence rate of 10.7%. This was observed to be higher among male patients (52.0%) and children between the age 32-41 months (31.3%). Parasite prevalence in relation to age of patients was statistically not significant (X2=0.105, DF=1, P-value = 0.74591, p<0.05). Other intestinal protozoan parasites identified include Entamoeba histolytica (1.33%) and Giardia lamblia (2.60%).

Genetic Diversity of Human Rotavirus A Among Hospitalized Children Under-5 Years in Lebanon.

Human rotavirus remains a major cause of gastroenteritis worldwide despite the availability of effective vaccines. In this study, we investigated the genetic diversity of rotaviruses circulating in Lebanon. We genetically characterized the VP4 and VP7 genes encoding the outer capsid proteins of 132 rotavirus-associated gastroenteritis specimens, previously identified in hospitalized children (<5 years) from 2011 to 2013 in Lebanon. These included 43 vaccine-breakthrough specimens and the remainder were from non-vaccinated subjects. Phylogenetic analysis of VP4 and VP7 genes revealed distinct clustering compared to the vaccine strains, and several substitutions were identified in the antigenic epitopes of Lebanese specimens. No unique changes were identified in the breakthrough specimens compared to non-breakthroughs that could explain the occurrence of infection in vaccinated children. Further, we report the emergence of a rare P[8] OP354-like strain with a G9 VP7 in Lebanon, possessing high genetic variability in their VP4 compared to vaccine strains. Therefore, human rotavirus strains circulating in Lebanon and globally have accumulated numerous substitutions in their antigenic sites compared to those currently used in the licensed vaccines. The successful spread and continued genetic drift of these strains over time might undermine the effectiveness of the vaccines. The effect of such changes in the antigenic sites on vaccine efficacy remains to be assessed.

The burden and risks of pediatric pneumonia in Nigeria: A desk-based review of existing literature and data.

Pneumonia is a leading killer of children under-5 years, with a high burden in Nigeria. We aimed to quantify the regional burden and risks of pediatric pneumonia in Nigeria, and specifically the states of Lagos and Jigawa. We conducted a scoping literature search for studies of pneumonia morbidity and mortality in under-5 children in Nigeria from 10th December 2018 to 26th April 2019, searching: Cochrane, PubMed, and Web of Science. We included grey literature from stakeholders' websites and information shared by organizations working in Nigeria. We conducted multivariable logistic regression using the 2016 to 2017 Multiple Cluster Indicators Survey data set to explore factors associated with pneumonia. Descriptive analyses of datasets from 2010 to 2019 was done to estimate trends in mortality, morbidity, and vaccination coverage. We identified 25 relevant papers (10 from Jigawa, 8 from Lagos, and 14 national data). None included data on pneumonia or acute respiratory tract infection burden in the health system, inpatient case-fatality rates, severity, or age-specific pneumonia mortality rates at state level. Secondary data analysis found that no household or caregiver socioeconomic indicators were consistently associated with self-reported symptoms of cough and/or difficulty breathing, and seasonality was inconsistently associated, dependant on region. There is a clear evidence gap around the burden of pediatric pneumonia in Nigeria, and challenges with the interpretation of existing household survey data. Improved survey approaches are needed to understand the risks of pediatric pneumonia in Nigeria, alongside the need for investment in reliable routine data systems to provide data on the clinical pneumonia burden in Nigeria.

Missed Opportunity for Routine Immunization and Its Associated Factors in Gozamen District Health Centers, Northwestern Ethiopia.

Background. Vaccine- preventable diseases constitute a major cause of morbidity and mortality in children under-5 years of age in Ethiopia and other developing countries. There are limited studies conducted on this aspect in Ethiopia especially in Gozamen district. Objectives. To assess missed opportunity for routine immunization and its associated factors among children aged <24 months in Gozamen district health centers. Methods. Institutional based cross-sectional study exit interview was conducted on 422 mothers with under 2 years old children. Data was collected using the standard World Health Organization’s missed opportunity tool. Vaccines examined in this study were BCG, OPV0, OPV1, PCV1, rota 1, penta valant 1, OPV2, PCV2, rota2, pentavalant 2, OPV3, PCV3, IPV, pentavalant 3, and measles vaccine. The vaccination status of the children was assessed by a structured questionnaire based on vaccination cards or mothers/caregiver verbal responses. Binary and multivariable logistic regression analysis were used to identify factors associated with missed opportunities for routine immunization among children aged <24 months. Result. The prevalence of missed opportunity for this study was 74.9% ; major vaccines with high missed opportunity were OPV0 (67.8), BCG (17.3%), and Measles (14%). Home delivery, lack of vaccination center near the village, unable to attend formal education and younger age (0-12 months) were independently associated with missed opportunity for routine immunization. Conclusion. The prevalence of missed opportunities for routine immunization in Gozamen district health centers was high. Health centers should give routine immunization services regularly.

Acute Diarrhea in Children Under-5 Years at Tanah Kali Kedinding Primary Health Care Surabaya

Diarrhea is a disease that still be a health problem in the world, including Indonesia. The number of cases of diarrhea in children under five in East Java had increased in prevalence from 6.6% in 2013 to 10.7% in 2018. Deaths in diarrhea usually occurred as a result of severe dehydration which 70% -80% of them were children under-5 years. This study aimed to know the characteristics of children under-5 years who had acute diarrhea at Tanah Kali Kedinding Primary Health Care in September 2018 - January 2019. This type of research was a descriptive study, where the results was only a picture, using a cross-sectional approach. Statistical analysis was performed to describe the characteristics of each patient by using a frequency descriptive test. The results of this study found that in September 2018 - January 2019, of 116 children under-5 years suffering from acute diarrhea in the Tanah Kali Kedinding Health Care, Surabaya, most of them were females, within 1-2 years, had exclusive breastfeeding, had parents with the last education graduated from high school and family income under minimum of wage in Surabaya. It is hoped that this research will become a source of information for the Government and Primary Health Care to reduce the incidence of acute diarrhea.

Knowledge, attitude and practice among mothers regarding common childhood illness

Background: Since 1990 the global under-5 mortality rate has dropped from 91 deaths per 1000 live births in 1990 to 43 in 2015. But the rate of this reduction in under-5 mortality was insufficient to reach the MDG target of a two-thirds reduction of 1990 mortality levels by the year 2015. Leading causes of death in children under-5 years are preterm birth complications, pneumonia, birth asphyxia, diarrhoea and malaria.Methods: Present study is a cross sectional observational study conducted in the Department of Paediatrics, in JJM Medical College, Davanagere. Source of data was primary caregivers (mothers, fathers, grandparents, other relatives or guardians) of children between the age group of 1 month-5 years. This study is a structured questionnaire based cross-sectional observational study. Data collected was analysed using descriptive and inferential statistics.Results: Out of the 350 primary caregivers, 146(41.71%) were mothers, 97(27.71%) were fathers, 57(16.28%) were grandparents. Taboos and cultural beliefs to ward of illness were commonly practiced among this study group. 26% believed in skin branding their children during febrile episodes or convulsions. 8% believed that ear piercings would prevent diarrhoeal illnesses and infant deaths while 6% felt that amulets prevent respiratory illness and mortality. Overall knowledge among primary caregivers regarding common childhood illnesses was found to be good.Conclusions: Knowledge and attitude among primary caregivers regarding common childhood illnesses is favourable but the practices and perceptions are not satisfactory. Improving literacy rates will have a significant impact on reduction of childhood mortality. Socioeconomic development of the urban community can improve care seeking behaviour during the childhood illness.

Integrated and simplified approaches to community management of acute malnutrition in rural Kenya: a cluster randomized trial protocol

BackgroundIn many low income countries, the majority of acutely malnourished children are either brought to the health facility late or never at all due to reasons related to distance and associated costs. Integrated community case management (iCCM) is an integrated approach addressing disease and malnutrition through use of community health volunteers (CHVs) in children under-5 years. Evidence on the potential impact and practical experiences on integrating community-based management of acute malnutrition as part of an iCCM package is not well documented. In this study, we aim to investigate the effectiveness and cost effectiveness of integrating management of acute malnutrition into iCCM.MethodsThis is a two arm parallel groups, non-inferiority cluster randomized community trial (CRT) employing mixed methods approach (both qualitative and quantitative approaches). Baseline and end line data will be collected from eligible (malnourished) mother/caregiver-child dyads. Ten community units (CUs) with a cluster size of 24 study subjects will be randomized to either an intervention (5 CUs) and a control arm (5 CUs). CHV in the control arm, will only screening and refer MAM/SAM cases to the nearby health facility for treatment by healthcare professionals. In the intervention arm, however; CHVs will be trained both to screen/diagnose and also treat moderate acute malnutrition (MAM) and severe acute malnutrition (SAM) without complication. A paired-matching design where each control group will be matched with intervention group with similar characteristics will be matched to ensure balance between the two groups with respect to baseline characteristics. Qualitative data will be collected using key informant and in-depth interviews (KIIs) and focused group discussions (FGDs) to capture the views and experiences of stakeholders.DiscussionOur proposed intervention is based on an innovative approach of integrating and simplifying SAM and MAM management through CHWs bring the services closer to the community. The trial has received ethical approval from the Ethics Committee of AMREF Health Africa - Ethical and Scientific Review Committee (AMREF- ESRC), Nairobi, Kenya. The results will be disseminated through workshops, policy briefs, peer-reviewed publications, and presented to local and international conferences.Trial registrationPACTR201811870943127; Pre-results. 26 November 2018.

Determinants of trends in neonatal, post-neonatal, infant, child and under-five mortalities in Tanzania from 2004 to 2016

BackgroundUnder-five mortality is still a major health issue in many developing countries like Tanzania. To achieve the Sustainable Development Goal target of ending preventable child deaths in Tanzania, a detailed understanding of the risk factors for under-five deaths is essential to guide targeted interventions. This study aimed to investigate trends and determinants of neonatal, post-neonatal, infant, child and under-five mortalities in Tanzania from 2004 to 2016.MethodsThe study used combined data from the 2004–2005, 2010 and 2015–2016 Tanzania Demographic and Health Surveys, with a sample of 25,951 singletons live births and 1585 under-five deaths. We calculated age-specific mortality rates, followed by an assessment of trends and determinants (community, socioeconomic, individual and health service) of neonatal, postneonatal, infant, child and under-five mortalities in Cox regression models. The models adjusted for potential confounders, clustering and sampling weights.ResultsBetween 2004 and 2016, we found that neonatal mortality rate remained unchanged, while postneonatal mortality and child mortality rates have halved in Tanzania. Infant mortality and under-five mortality rates have also declined. Mothers who gave births through caesarean section, younger mothers (< 20 years), mothers who perceived their babies to be small or very small and those with fourth or higher birth rank and a short preceding birth interval (≤2 years) reported higher risk of neonatal, postneonatal and infant mortalities.ConclusionOur study suggests that there was increased survival of children under-5 years in Tanzania driven by significant improvements in postneonatal, infant and child survival rates. However, there remains unfinished work in ending preventable child deaths in Tanzania.

Factors associated with neonatal mortality in the African Great Lakes region: A pooled analysis of national surveys

# Background Neonatal mortality is a major public health problem and accounts for about one third of the deaths of children under-5 years. The aim of this study was to estimate the rate and predisposing factors associated with neonatal mortality in the African Great Lakes region (Burundi, Congo Democratic Republic, Kenya, Rwanda, Tanzania and Uganda). # Methods The study used cross-sectional data from the most recent Demographic and Health Survey of countries in the African Great Lakes region. A total sample of 56600 neonatal deaths of singleton live-born infants was reported across the region. Neonatal mortality was defined as the death of a newborn within the first 28 days of life. Cox regression model was used to identify factors associated with neonatal mortality in the African Great Lakes region. # Results The Democratic Republic Congo had the highest neonatal mortality rate per 1000 births (19, 95% confidence interval (CI)=17-21) within the region followed by Uganda (18, 95% CI=16-21) and Tanzania (16, 95% CI=14-19). Multilevel logistic regression analysis shows that factors significantly associated with neonatal mortality were: Sex of child (male neonates; hazard ratio (HR)=0.79, 95% CI=0.65-0.96), perceived birth size (small neonates; HR=1.88, 95% CI=1.47-2.39), birth order and birth interval (first child; HR=3.05, 95% CI=2.28-4.07), 4th or more child with \> 2 years birth interval (HR=0.48, 95% CI=0.36-0.66), previous death of baby (HR=10.3, 95% CI=7.75-13.68), non-usage of contraceptives (HR=1.81, 95% CI=1.43-2.29), non-receipt of tetanus toxoid injection (HR=1.36, 95% CI=1.04-1.78), no antenatal care visits (HR=1.62, 95% CI=1.06-2.48), and delivery through caesarean section (HR=1.89, 95% CI=1.40-2.55). # Conclusions To meet the Sustainable Development Goals (SDGs) target for neonatal mortality, interventions should focus on increasing access to good quality healthcare services for women and their newborns as well as family planning services and home-based neonatal care services.

Factors associated with neonatal mortality in the African Great Lakes region: A pooled analysis of national surveys

# Background Neonatal mortality is a major public health problem and accounts for about one third of the deaths of children under-5 years. The aim of this study was to estimate the rate and predisposing factors associated with neonatal mortality in the African Great Lakes region (Burundi, Congo Democratic Republic, Kenya, Rwanda, Tanzania and Uganda). # Methods The study used cross-sectional data from the most recent Demographic and Health Survey of countries in the African Great Lakes region. A total sample of 56600 neonatal deaths of singleton live-born infants was reported across the region. Neonatal mortality was defined as the death of a newborn within the first 28 days of life. Cox regression model was used to identify factors associated with neonatal mortality in the African Great Lakes region. # Results The Democratic Republic Congo had the highest neonatal mortality rate per 1000 births (19, 95% confidence interval (CI)=17-21) within the region followed by Uganda (18, 95% CI=16-21) and Tanzania (16, 95% CI=14-19). Multilevel logistic regression analysis shows that factors significantly associated with neonatal mortality were: Sex of child (male neonates; hazard ratio (HR)=0.79, 95% CI=0.65-0.96), perceived birth size (small neonates; HR=1.88, 95% CI=1.47-2.39), birth order and birth interval (first child; HR=3.05, 95% CI=2.28-4.07), 4th or more child with \> 2 years birth interval (HR=0.48, 95% CI=0.36-0.66), previous death of baby (HR=10.3, 95% CI=7.75-13.68), non-usage of contraceptives (HR=1.81, 95% CI=1.43-2.29), non-receipt of tetanus toxoid injection (HR=1.36, 95% CI=1.04-1.78), no antenatal care visits (HR=1.62, 95% CI=1.06-2.48), and delivery through caesarean section (HR=1.89, 95% CI=1.40-2.55). # Conclusions To meet the Sustainable Development Goals (SDGs) target for neonatal mortality, interventions should focus on increasing access to good quality healthcare services for women and their newborns as well as family planning services and home-based neonatal care services.

A space-time analysis of recurrent malnutrition-related hospitalisations in Kilifi, Kenya for children under-5 years

BackgroundGlobally, malnutrition underlies 45% of under-5 s mortality, mainly from potentiating common infections such as diarrhoea and pneumonia. Malnutrition as a public health problem is not evenly disbursed because of disparities in food insecurity and health, and children commonly suffer recurrent episodes of opportunistic infections. We aimed to understand better the spatial and temporal structure of multiple paediatric hospital admissions associated with malnutrition-related illnesses. This paper aimed to investigate the spatial-temporal variations in malnutrition-related recurrent morbidity of children under-5 years from the Kilifi County in Kenya between 2002 and 2015.MethodsThe study included data from children under-5 years old who had more than one admission to a rural district hospital in Kenya within the Kilifi Health and Demographic Surveillance System (KHDSS). The primary outcome was a malnutrition-related admission, based on wasting (WHZ < -2) or nutritional oedema. Individual, household and environmental level covariates were examined as exposures. We first fitted a SARIMA model for the temporality, and the Moran’s Index affirmed spatial clustering in malnutrition admissions. Kulldorf Statistics using SaTScan were applied to detect hotspots. Then, bivariate analysis was done using repeated values tabulation and analysis of covariance (ANCOVA). Inferential analysis was done using a mixed effect multivariable negative-binomial regression model, adjusting for spatiotemporal random effects.ResultsA total of 2821 children were admitted more than once, giving a total of 6375 admissions. Of these 6375 admissions, 1866 were malnutrition-related, and 3.9% (109/2821) of the children with repeat admissions died. There was a seasonal pattern of re-admissions, peaking from May to July over the years. Hotspots were found in both the Northern and Southern areas of the KHDSS, while the areas near Kilifi Town were least affected. We found that disease severity was most likely associated with a malnutrition re-admission to the hospital.ConclusionDisease severity was strongly associated with admission with malnutrition but its effect reduced after adjusting for the spatial and temporal random effects. Adjusting for clustering in space and in time (spatial-temporal) in models helps to improve the understanding of recurrent hospitalisations involving malnutrition.

Does education offset the effect of maternal disadvantage on childhood anaemia in Tanzania? Evidence from a nationally representative cross-sectional study

BackgroundDespite being preventable, anaemia is a major public health problem that affects a sizable number of children under-five years globally and in Tanzania. This study examined the maternal factors associated with the risk of anaemia among under-five children in Tanzania. We also assessed whether higher maternal education could reduce the risks of anaemia among children of women with poor socio-economic status.MethodsData was drawn from the 2015–16 Tanzania demographic and health survey and malaria indicator survey for 7916 children under five years. Adjusted odds ratios were estimated by fitting a proportional odds model to examine the maternal risk factors of anaemia. Stratified analysis was done to examine how the relationship differed across maternal educational levels.ResultsThe findings revealed that maternal disadvantage evident in young motherhood [AOR:1.43, 95%CI:1.16–1.75], no formal education [AOR:1.53, 95%CI:1.25–1.89], unemployment [AOR:1.31, 95%CI:1.15–1.49], poorest household wealth [AOR:1.50, 95%CI:1.17–1.91], and non-access to health insurance [AOR:1.26, 95%CI: 1.03–1.53] were risk factors of anaemia among children in the sample. Sub-group analysis by maternal education showed that the risks were not evident when the mother has secondary or higher education. However, having an unmarried mother was associated with about four-times higher risk of anaemia if the mother is uneducated [AOR:4.04, 95%CI:1.98–8.24] compared with if the mother is currently in union.ConclusionFindings from this study show that a secondary or higher maternal education may help reduce the socio-economic risk factors of anaemia among children under-5 years in Tanzania.

Female labor force participation, paid maternity, caste system and under-5 mortality in Nepal

Purpose The under-5 mortality rate in Nepal remains high in comparison to neighboring countries and developed nations. The result of this problem on Nepal’s social, economic, political and cultural development makes it an urgent priority requiring the Nepalese Government to address this issue. The purpose of this paper is to find out if Nepal’s high female labor force participation (FLFP), the caste system and no paid maternity leave are contributing factors to under-5 deaths in Nepal. Design/methodology/approach Data for this study were taken from Nepal’s cross-sectional demographic health survey 2016–2017. The study sample included 5,060 children born to 3,074 mothers in the five years preceding the survey. Data were collected by interviewing respondents via a structured questionnaire selected through stratified random sampling methods. Findings The study found that the hazard ratio for FLFP, the caste of the mother and paid maternity were 1.145, 1.485 and 0.556, respectively, with a p-value &lt;0.001. Therefore, the risk of death in children under-5 years for a working mother, a Terai caste mother and a mother who did not get paid maternity was 14, 45 and 48 percent, respectively, higher than for non-working mothers, mothers from other castes and mothers who got paid maternity. Originality/value This research demonstrated that FLFP, the caste of the mother and paid maternity leave are important factors for determining the risk of death in children under the age of 5.

Determinants of under-5 mortality in Burkina Faso.

The aim of this article is to determine the factors associated with under-5 mortality and their evolution from 1993 to 2010 and to analyse the contributors of socioeconomic inequalities in mortality of children under-5 years during the same period. The data used in this study were derived from the four rounds of Demographic and Health Survey (DHS) conducted in Burkina Faso in 1993, 1998 and 2010. Concentration measurement, logistics regression and Oaxaca-Blinder decomposition method were used to analyse data. Multivariate analysis revealed that being the first child (odds ratio = 1.8 for 1993, 1.7 for 1998, 1.2 for 2003 and 1.3 for 2010) or a twin (odds ratio = 4.5 for 1993, 2.8 for 1998, 2.7 for 2003 and 4.8 for 2010) were also significantly associated with the probability of dying. The variable (parity) was the main contributor to the part of the inequality due to differences in group characteristics and that would be due to the fact that women from poor households have greater parity compared to those from rich households. For a reduction in mortality and inequalities related to mortality, the implementation of actions in favour of poor households and promotion of family planning programmes for birth spacing will be required.

Campylobacter, a zoonotic pathogen of global importance: Prevalence and risk factors in the fast-evolving chicken meat system of Nairobi, Kenya.

Campylobacteriosis is a leading foodborne zoonosis worldwide, and is frequently associated with handling and consumption of poultry meat. Various studies indicate that Campylobacter causes a substantial human disease burden in low to middle-income countries, but data regarding the organism’s epidemiology in countries like Kenya are scarce. In sub-Saharan Africa, 3.8 million deaths of children under-5 years of age are reported annually. Of those, 25% are caused by diarrheal diseases, and Campylobacter is one of the most frequently isolated bacteria from diarrheic children. With the growth of urban conglomerates, such as Kenya’s capital, Nairobi, changes in diets, food production systems, and retailing dynamics, it is likely that exposure and susceptibility to this pathogen will change. Therefore, the importance of Campylobacter disease burden in Kenya may increase further. The objectives of this study were: 1) to determine the prevalence of Campylobacter spp. in Nairobi’s small-scale chicken farms and meat retailers, and 2) to identify potential risk factors associated with its presence in those sites. The prevalence data provides the first detailed baseline for this pathogen in the urban Kenyan context. The risk factors provide context-specific insights for disease managers. A cross-sectional study of broiler, indigenous chicken farms, and chicken meat retailers, was conducted in a peri-urban, low to middle-income area (Dagoretti), and a very-low income informal settlement (Kibera) of Nairobi. Chicken faeces were collected using one pair of boot socks per farm, and 3 raw chicken meat samples were purchased per retailer. Samples were cultured for viable Campylobacter spp. using mCCDA, followed by blood agar plates in aerobic/microaerobic conditions for prevalence calculations. A questionnaire-based survey on sanitary, sourcing and selling practices was conducted at each site for risk factor identification using logistic regression analyses. A total of 171 farm premises and 53 retailers were sampled and interviewed. The prevalence results for Campylobacter spp. were between 33 to 44% for broiler and indigenous chicken farms, 60% and 64% for retailers, in Dagoretti and Kibera, respectively. Univariable logistic regression showed an association between Campylobacter spp. presence and the easiness of cleaning the display material used by the retailer. Restricting access to the flock was also associated with the pathogen’s presence. Multivariable logistic regression identified the selling of defrosted meat as a retailer risk factor (OR: 4.69; 95% CI: 1.31–19.97), calling for more investigation of the reported repetitive freezing-thawing processes and cold chain improvement options. At the farm-level, having a pen floor of material not easy to clean was found to increase the risk (OR: 2.31; 95%CI: 1.06–5.37). The relatively high prevalence of Campylobacter spp. across different areas and value chain nodes indicates a clear human exposure risk. The open nature of both small-scale broiler and indigenous chicken production practices with low biosecurity, hygiene and informal transactions, likely plays a role in this. While gradual improvement of farm biosecurity is recommended, risk factors identified suggest that consumer education and enforcement of basic food safety principles at the retailer end of the food continuum represent key targets for risk reduction in informal settings.

Respiratory viruses among children with non-severe community-acquired pneumonia: A prospective cohort study

BackgroundCommunity-acquired pneumonia (CAP) causes a major burden to the health care system among children under-5 years worldwide. Information on respiratory viruses in non-severe CAP cases is scarce. ObjectivesTo estimate the frequency of respiratory viruses among non-severe CAP cases. Study designProspective study conducted in Salvador, Brazil. Out of 820 children aged 2–59 months with non-severe CAP diagnosed by pediatricians (respiratory complaints and radiographic pulmonary infiltrate/consolidation), recruited in a clinical trial (ClinicalTrials.gov Identifier NCT01200706), nasopharyngeal aspirate samples were obtained from 774 (94.4%) patients and tested for 16 respiratory viruses by PCRs. ResultsViruses were detected in 708 (91.5%; 95%CI: 89.3–93.3) cases, out of which 491 (69.4%; 95%CI: 65.9–72.7) harbored multiple viruses. Rhinovirus (46.1%; 95%CI: 42.6–49.6), adenovirus (38.4%; 95%CI: 35.0–41.8), and enterovirus (26.5%; 95%CI: 23.5–29.7) were the most commonly found viruses. The most frequent combination comprised rhinovirus plus adenovirus. No difference was found in the frequency of RSVA (16.1% vs. 14.6%; P = 0.6), RSVB (10.9% vs. 13.2%; P = 0.4) influenza (Flu) A (6.3% vs. 5.1%; P = 0.5), FluB (4.5% vs. 1.8%; P = 0.09), parainfluenza virus (PIV) 1 (5.1% vs. 2.8%; P = 0.2), or PIV4 (7.7% vs. 4.1%; P = 0.08), when children with multiple or sole virus detection were compared. Conversely, rhinovirus, adenovirus, enterovirus, bocavirus, PIV2, PIV3, metapneumovirus, coronavirus OC43, NL63, 229E were significantly more frequent among cases with multiple virus detection. ConclusionsRespiratory viruses were detected in over 90% of the cases, out of which 70% had multiple viruses. Several viruses are more commonly found in multiple virus detection whereas other viruses are similarly found in sole and in multiple virus detection.

Ownership and utilization of long-lasting insecticide nets among caregivers of children under-5 years in Ogun State, Nigeria: A rural–urban comparison

Background: Long-lasting insecticides nets (LLINs) are a key prevention tool that has been found to reduce uncomplicated malaria by 51% and decrease all-cause mortality by 18% in children. LLINs have been shown to be effective in reducing childhood morbidity and mortality by reducing mosquito bites while sleeping. This is a comparative cross-sectional study designed to determine and compare the ownership and utilization of LLINs among caregivers of children under 5 years in a rural and an urban area of Ogun State. Materials and Methods: A community-based comparative cross-sectional study on 575 caregivers of children under 5 years living in the urban and rural area of Ogun State was done using a multistage cluster sampling technique to recruit respondents. A pretested semi-structured interviewer-administered questionnaire was used to collect information on LLINs ownership and use. Analysis and statistical calculation were done using SPSS version 20.0. Relationships between categorical variables were tested using Chi-square test with P = 0.05. Logistic regression model was used to describe predictors of LLIN ownership and utilization among the respondents. Results: The study shows that 80% of caregivers of under-five living in the rural area compared with 63.5% living in the urban area owned LLINs (P