Children Under-5 Years Research Articles

Geographically weighted logistic regression model for identifying risk factors for malaria infection among under-5 children in Ghana

Malaria remains a significant public health challenge globally, particularly affecting children under-5 years of age due to their underdeveloped immune systems. Identifying the risk factors associated with malaria infection in this vulnerable group is crucial for improving policy formulation and creating effective training programs. However, there is limited information on how the relationship between malaria risk and associated factors varies across different regions, especially among children in Ghana. This is important because understanding these spatial variations can enhance targeted interventions including area remediation and resource allocation. To address this gap, a geographically weighted logistic regression (GWLR) model was developed to identify spatially varying risk factors for malaria infection among children under five in Ghana. The model was built on the premise that the relationship between malaria and potential risk factors is not uniform across geographic areas. Data from the Ghana Malaria Indicator Survey collected through the demographic and health survey program were used for analysis. The study found that the GWLR model fit the data better than the conventional binary logistic regression (BLR) model, based on the information criterion used and mode evaluation metrics. The results indicated that risk factors for malaria such as a child's age, anaemia status, dwellings sprayed, place of residence, electricity access, NHIS (National Health Insurance Scheme) coverage, age of the household head, and household wealth index, were non-stationary across the study area. These findings underscore the importance of spatially tailored interventions to reduce malaria risk in children under-5. The results contribute to the body of literature on malaria risk factors and provide valuable insights for Ghana's national malaria control policies, potentially enhancing the effectiveness of future public health strategies.

Evaluating the impact of the global evidence, local adaptation (GELA) project for enhancing evidence-informed guideline recommendations for newborn and young child health in three African countries: a mixed-methods protocol

BackgroundPoverty-related diseases (PRD) remain amongst the leading causes of death in children under-5 years in sub-Saharan Africa (SSA). Clinical practice guidelines (CPGs) based on the best available evidence are key to strengthening health systems and helping to enhance equitable health access for children under five. However, the CPG development process is complex and resource-intensive, with substantial scope for improving the process in SSA, which is the goal of the Global Evidence, Local Adaptation (GELA) project. The impact of research on PRD will be maximized through enhancing researchers and decision makers’ capacity to use global research to develop locally relevant CPGs in the field of newborn and child health. The project will be implemented in three SSA countries, Malawi, South Africa and Nigeria, over a 3-year period. This research protocol is for the monitoring and evaluation work package of the project. The aim of this work package is to monitor the various GELA project activities and evaluate the influence these may have on evidence-informed decision-making and guideline adaptation capacities and processes. The specific project activities we will monitor include (1) our ongoing engagement with local stakeholders, (2) their capacity needs and development, (3) their understanding and use of evidence from reviews of qualitative research and, (4) their overall views and experiences of the project.MethodsWe will use a longitudinal, mixed-methods study design, informed by an overarching project Theory of Change. A series of interconnected qualitative and quantitative data collections methods will be used, including knowledge translation tracking sheets and case studies, capacity assessment online surveys, user testing and in-depth interviews, and non-participant observations of project activities. Participants will comprise of project staff, members of the CPG panels and steering committees in Malawi, South Africa and Nigeria, as well as other local stakeholders in these three African countries.DiscussionOngoing monitoring and evaluation will help ensure the relationship between researchers and stakeholders is supported from the project start. This can facilitate achievement of common goals and enable researchers in South Africa, Malawi and Nigeria to make adjustments to project activities to maximize stakeholder engagement and research utilization. Ethical approval has been provided by South African Medical Research Council Human Research Ethics Committee (EC015-7/2022); The College of Medicine Research and Ethics Committee, Malawi (P.07/22/3687); National Health Research Ethics Committee of Nigeria (01/01/2007).

Knowledge Level of Caregivers on Immunization for Children (under-5 Years) in Nigeria

Background: Families, especially mothers are the major role players with regard to their children’s immunization. This study empirically Knowledge Level of Caregivers on Immunization for Children under-5 years in Delta North Senatorial District of Delta State, Nigeria. Materials and Methods: A well self-structured questionnaires drawn from caregivers of under-5 children who were disposed to immunization in the nine (9) local government areas in Delta North senatorial district was used. However, the questionnaires were distributed to 3843 caregivers across the Nine (9) local government areas under study but the researcher was able to successfully retrieve 3624, representing 94% of the sample size.. Two major hypotheses were tested using analysis of variance (ANOVA) regression analysis with the aid of SPSS. Results: The data showed that 3030, representing about 85.0% of the respondents were mothers while the remaining 544 (15.0%) were male (fathers) with under-5 children in Delta North Senatorial District The findings shows that the knowledge level of caregivers, and enablers are respectively statistically significant in the immunization of under-5 children in Delta North senatorial district of Delta State, Nigeria. Conclusion: It is therefore concluded that for the immunization to becomes successfully performed caregivers must have basic or advanced education and training to avoid the an increased mortality rate of death to children below five (5) years old.

Analysis of some socio-economic factors affecting maternal health in Nigeria

This study examined socio-economic factors affecting maternal health in Nigeria. Mothers and children are at the highest risk of disease and death. Deaths of infants and children under-5 years are peculiar and closely related to maternal health, and the risk of death of children increases if their mothers die in childbirth. This study employed secondary data obtained from World Bank, CBN, and Nigeria Demographic and Health Survey from 1990 to 2022. Using the Error Correction Model (ECM), the data were subjected to regression analysis, where we estimated the relationship between dependent variable (maternal mortality) and independent variables (poverty rate, literacy rate, and level of government expenditure on health). The results show that poverty, literacy and government provision of healthcare facilities are major socio-economic factors affecting maternal health in Nigeria. This study therefore, recommended increase in budgetary allocation to the health sector, diversification of the economy aimed at poverty reduction, and the enforcement of free and compulsory basic education especially for the girl child, as the panacea for poor maternal health in Nigeria. Keywords: Mortality, Poverty, Literacy.

Prediction of incomplete immunization among under-five children in East Africa from recent demographic and health surveys: a machine learning approach

The World Health Organization as part of the goal of universal vaccination coverage by 2030 for all individuals. The global under-five mortality rate declined from 59% in 1990 to 38% in 2019, due to high immunization coverage. Despite the significant improvements in immunization coverage, about 20 million children were either unvaccinated or had incomplete immunization, making them more susceptible to mortality and morbidity. This study aimed to identify predictors of incomplete vaccination among children under-5 years in East Africa. An analysis of secondary data from six east African countries using Demographic and Health Survey dataset from 2016 to the recent 2021 was performed. A total weighted sample of 27,806 children aged (12–35) months was included in this study. Data were extracted using STATA version 17 statistical software and imported to a Jupyter notebook for further analysis. A supervised machine learning algorithm was implemented using different classification models. All analysis and calculations were performed using Python 3 programming language in Jupyter Notebook using imblearn, sklearn, XGBoost, and shap packages. XGBoost classifier demonstrated the best performance with accuracy (79.01%), recall (89.88%), F1-score (81.10%), precision (73.89%), and AUC 86%. Predictors of incomplete immunization are identified using XGBoost models with help of Shapely additive eXplanation. This study revealed that the number of living children during birth, antenatal care follow-up, maternal age, place of delivery, birth order, preceding birth interval and mothers’ occupation were the top predicting factors of incomplete immunization. Thus, family planning programs should prioritize the number of living children during birth and the preceding birth interval by enhancing maternal education. In conclusion promoting institutional delivery and increasing the number of antenatal care follow-ups by more than fourfold is encouraged.

Evaluation of Factors Associated with Malaria Infection Among Children Under-5 Years Who Received SMC 1

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IJCM_15A: Health-seeking behaviour among Fishermen community mothers of under-five children on childcare– A cross-sectional study

Background: Globally in 2020 an estimated 5 million children under5 years died mostly from preventable and treatable causes. India ranks second worldwide in under5 mortality (WHO2020). Health of the children is strongly dependent on parental healthcare behaviour Fishermen-community possesses unique characteristics of a folk-society, Major portion of the life of fishermen is spent at sea, mothers assume a vital place with regard to the upbringing of the children. Objective: To study the health-seeking behaviour among Fishermen- community mothers of under-five children during acute illness and factors associated with it Methodology: A cross sectional study was conducted among 100 Mothers of Under five children in a Fishermen community, Kovalam, Chengalpattu district of Tamil Nadu over a period of 3months (October 2023–November 2023). Data collection was done using interviewer administered semi-structured questionnaire, statistical analysis was done using SPSS v21.0 Results: In total, 100 mothers with mean age of 27± 3.3 years participated in the study, all of them reported of some health morbidity. The proportion of health seeking behaviour in terms of appropriate and prompt care among the study population was 42%. The reason for delayed health care seeking among the participants were due to over-the-counter drugs(33%), self-medication(17%) and home remedies(8%). Among them 84% sought health care from private health facility. Appropriate and prompt care has found to be significantly associated with the age of the child less than 2 years (OR-3.485,95%CI-1.449-8.382), educational status of the mother (above high-school) (OR-3,95%CI-1.328-6.977), extended family type (OR- 2.679,95%CI-1.151-6.233) and perception about severity of illness during an episode of acute illness. Conclusion: Appropriate Health-seeking behaviour and seeking prompt care among parents of children was inadequate. Utilization of public health facility was less. Hence, steps can be taken to sensitize the mothers about the services available in the public health care facility.

Determinants of Handwashing at Critical Times Among Mothers/Caregivers of Children Under-Five Years Old: Panel Data Evidence From Rural Afghanistan.

Very few studies have used panel data regression models to estimate the determinants of handwashing with water and soap at critical times in a developing country. To analyse the predictors of handwashing with water and soap at critical times among mother/caregivers of children under-5 years in rural Afghanistan. This study used data from 1208 mothers/caregivers of children under-5 years who were selected and interviewed at baseline and endline in 7 provinces using systematic probability proportional-to-size sampling method. Mother/caregivers with access to handwashing facility with water and soap had 1.20 higher odds of washing hands at 5 critical times. Treatment at public facility, an indirect proxy of health education and having children under 2 years was associated with 1.07 and 1.05 higher odds of washing hands at 5 critical times. Access to handwashing with water and soap, treatment at public facility and children under 2 years were significant and robust to alternative specification of handwashing at least 3 times. Mothers/caregivers who reported contracting infectious diseases in the past 6 months had 1.04- and 1.52-times higher odds of handwashing at 5 critical times and at least 3 times respectively. Access to handwashing facility with water and soap, health education, children under 2 years and occurrence of infectious diseases were the predictors of appropriate handwashing behaviour. Therefore, there is need to improve the availability of handwashing facilities with clean water and soap to promote appropriate handwashing behaviour at critical times. In addition, there is need to promote activities that increase disposable income for households to purchase soap and handwashing facilities. There is need to promote healthcare seeking behaviour for mothers to access medical treatment and health hygiene education at public facilities vital for prevention of infectious diseases.

Characteristics and Clinical Outcomes of Vaccine-Eligible US Children Under-5 Years Hospitalized for Acute COVID-19 in a National Network.

In June 2022, the mRNA COVID-19 vaccination was recommended for young children. We examined clinical characteristics and factors associated with vaccination status among vaccine-eligible young children hospitalized for acute COVID-19. We enrolled inpatients 8 months to <5 years of age with acute community-acquired COVID-19 across 28 US pediatric hospitals from September 20, 2022 to May 31, 2023. We assessed demographic and clinical factors, including the highest level of respiratory support, and vaccination status defined as unvaccinated, incomplete, or complete primary series [at least 2 (Moderna) or 3 (Pfizer-BioNTech) mRNA vaccine doses ≥14 days before hospitalization]. Among 597 children, 174 (29.1%) patients were admitted to the intensive care unit and 75 (12.6%) had a life-threatening illness, including 51 (8.5%) requiring invasive mechanical ventilation. Children with underlying respiratory and neurologic/neuromuscular conditions more frequently received higher respiratory support. Only 4.5% of children hospitalized for COVID-19 (n = 27) had completed their primary COVID-19 vaccination series and 7.0% (n = 42) of children initiated but did not complete their primary series. Among 528 unvaccinated children, nearly half (n = 251) were previously healthy, 3 of them required extracorporeal membrane oxygenation for acute COVID-19 and 1 died. Most young children hospitalized for acute COVID-19, including most children admitted to the intensive care unit and with life-threatening illness, had not initiated COVID-19 vaccination despite being eligible. Nearly half of these children had no underlying conditions. Of the small percentage of children who initiated a COVID-19 primary series, most had not completed it before hospitalization.

Anemia prevalence and its predictors among children under-five years in Ghana. A multilevel analysis of the cross-sectional 2019 Ghana Malaria Indicator Survey.

Despite the implementation of anemia control interventions in Ghana, anemia prevalence is still high in children under-fives. Reducing the prevalence of anemia requires identifying and targeting associated critical risk factors. This study seeks to identify predictors of anemia among children under-fives in Ghana. Nationally representative data from the 2019 Ghana Malaria Indicator Survey was used in this study. Both fixed and random effects (multilevel) logistic regression models were applied to 2434 children to identify critical factors associated with anemia. In this study, 54% (95% confidence interval [CI] 52.0-57.0) of children under-5 years were anemic. Infants were more likely to be anemic (66.7%) compared with other children below 5 years. In the multivariable multilevel model, the risk of anemia was found to be higher in younger children especially 6-11 months old (adjusted odds ratio [aOR] = 3.59, CI: 2.54-5.08) and 12-23 months old (aOR = 2.97, CI: 2.08-4.23), children who had malaria (aOR = 1.53, CI: 1.13-2.06), children whose mothers were not registered but not covered with health insurance (aOR = 1.45, CI: 1.21-1.74) or were not even registered for insurance (aOR = 1.49, CI: 1.15-1.93), children born to adolescent mothers (aOR = 2.21, CI: 1.36-3.57), children born to non-Christian mothers (Islam [aOR = 1.53, CI: 1.17-2.00]), children born to families of poorer households (poorest [aOR = 3.01, CI: 1.64-5.51]; poorer [aOR = 2.56, CI: 1.65-3.98]); middle (aOR = 2.03, CI: 1.32-3.11) and richer (aOR = 1.78, CI: 1.19-2.64), and children who lived in either Upper East (aOR = 2.03, CI: 1.26-3.26) or Central (aOR = 2.52, CI: 1.42-4.47) regions. Significant unobserved community-level differences in anemia prevalence were observed. The probability of anemia in children under-fives differs substantially from one community to another, and the prevalence remains high. The identified critical risk factors should be addressed. Multifaceted and targeted approaches are needed to help reduce the anemia prevalence in this setting to achieve the multiple United Nation's Sustainable Development Goals, which are related to risk and prevalence of anemia by 2030.

Transitions from hospital to home: A mixed methods study to evaluate pediatric discharges in Uganda.

The World Health Organization (WHO) Integrated Management of Childhood Illness (IMCI) guidelines recognize the importance of discharge planning to ensure continuation of care at home and appropriate follow-up. However, insufficient attention has been paid to post discharge planning in many hospitals contributing to poor implementation. To understand the reasons for suboptimal discharge, we evaluated the pediatric discharge process from hospital admission through the transition to care within the community in Ugandan hospitals. This mixed methods prospective study enrolled 92 study participants in three phases: patient journey mapping for 32 admitted children under-5 years of age with suspected or proven infection, discharge process mapping with 24 pediatric healthcare workers, and focus group discussions with 36 primary caregivers and fathers of discharged children. Data were descriptively and thematically analyzed. We found that the typical discharge process is often not centered around the needs of the child and family. Discharge planning often does not begin until immediately prior to discharge and generally does not include caregiver input. Discharge education and counselling are generally limited, rarely involves the father, and does not focus significantly on post-discharge care or follow-up. Delays in the discharge process itself occur at multiple points, including while awaiting a physical discharge order and then following a discharge order, mainly with billing or transportation issues. Poor peri-discharge care is a significant barrier to optimizing health outcomes among children in Uganda. Process improvements including initiation of early discharge planning, improved communication between healthcare workers and caregivers, as well as an increased focus on post-discharge care, are key to ensuring safe transitions from facility-based care to home-based care among children recovering from severe illness.

Risk factors for inpatient mortality among children with severe acute malnutrition in Zimbabwe and Zambia

Background/ObjectivesMalnutrition underlies 45% of deaths in children under-5 years annually. Children hospitalised with complicated severe acute malnutrition (SAM) have unacceptably high mortality. We aimed to identify variables from early hospital admission (baseline factors) independently associated with inpatient mortality in this cohort to identify those most at risk.Subjects/MethodsObservational study of 745 children aged 0–59 months admitted with complicated SAM at three hospitals in Zimbabwe/Zambia. Children underwent anthropometry and clinical assessment by a study physician within 72 h of enrolment, and caregivers provided sociodemographic data. Children were followed-up daily until discharge/death. A multivariable survival analysis identified the baseline factors independently associated with mortality.Results70/745 (9.4%) children died in hospital. Age between 6–23 months [aHR 6.53, 95%CI 2.24–19.02], higher mid-upper arm circumference [aHR 0.73, 95%CI 0.59–0.89], presence of oedema [aHR 2.22, 95%CI 1.23–4.05], shock [aHR 8.18, 95%CI 3.79–17.65], sepsis [aHR 3.13, 95%CI 1.44–6.80], persistent diarrhoea [aHR 2.27, 95%CI 1.18–4.37], lack of a toilet at home [aHR 4.35, 95%CI 1.65–11.47], and recruitment at one Harare site [aHR 0.38, 95%CI 0.18–0.83] were all independently associated with inpatient mortality. Oedematous children had a significantly higher birthweight [2987 g vs 2757 g, p < 0.001] than those without oedema; higher birthweight was weakly associated with mortality [aHR 1.50 95%CI 0.97–2.31].ConclusionsChildren with oedema, low MUAC, baseline infections, shock and lack of home sanitation had a significantly increased risk of inpatient mortality following hospitalisation for complicated SAM. Children with high-risk features may require additional care. A better understanding of the pathophysiology of SAM is needed to identify adjunctive interventions.

The added value of using of pulse oximeter into the integrated management of childhood illness guidelines to better identify and manage severe cases among children under-5 years old in west africa, june 2021 to june 2022

The added value of using of pulse oximeter into the integrated management of childhood illness guidelines to better identify and manage severe cases among children under-5 years old in west africa, june 2021 to june 2022

Association between extreme rainfall and acute respiratory infection among children under-5 years in sub-Saharan Africa: an analysis of Demographic and Health Survey data, 2006–2020

ObjectiveDespite an increase in the number of studies examining the association between extreme weather events and infectious diseases, evidence on respiratory infection remains scarce. This study examined the association between...

Could combined rapid diagnostic testing for malaria and c-reactive protein be helpful for the diagnosis and management of febrile illnesses in children under-5 years of age in rural Burkina Faso?

BackgroundFebrile illnesses are among the most important reasons for medical consultation in sub-Saharan Africa and are frequently treated with antimicrobials due to the unavailability of appropriate diagnostic tools. This practice leads to antimicrobial resistance, with increasing mortality and morbidity as result. One of the few accessible diagnostic tools available in low resource settings is malaria rapid diagnostic tests (mRDTs) which contributed to reducing the over-prescription of anti-malarials, but cannot guide antibiotic prescriptions. To circumvent this problem, we explored whether combined testing with mRDT and c-reactive protein (CRP) could improve the diagnosis of febrile illnesses and subsequent prescription of antibiotics.MethodsClinical specimens (blood, stool and urine) collected from 396 febrile children (axillary temperature of ≥ 37.5 °C) were analyzed with rapid diagnostic tests (malaria and CRP) and microbiology culture to establish the possible cause of fever. Actual antimicrobial prescriptions given to the children were compared with those that could be given based on combined CRP-malaria testing.ResultsIn total, 68.7% (272/396) of malaria cases were diagnosed by mRDT-Pf-HRP-2. CRP test was positive in 84.3% (334/396) of the children, but bacterial infections were confirmed in 12.4% (49/396) of them. A possible cause of fever could not be established in 20.5% (81/396) of cases. Based on the diagnostic practice in place, 265 of the children with a positive mRDT-Pf-HRP-2 received anti-malarial treatment. Furthermore, 89.5% (111/124) of negative mRDT results received antibiotic treatment and 37.1% (46/124) received antimalarial treatment. Of these 124 cases, 80 had positive CRP tests and 44 negative CRP tests. If the results of CRP testing are considered, 44 CRP/mRDT negative children would not get antibiotic treatment, resulting in a 35.5% reduction in antibiotic prescriptions. However, 2 cases with a bacterial infection would be denied appropriate treatment.ConclusionCombining mRDT-PfHRP2 with CRP testing is particularly useful in children for whom both tests are negative as it results in a reduction of antibiotics prescriptions. However, there is a risk to miss potential severe bacterial infections and a close follow-up of these cases is strongly recommended.

Multilevel analysis of individual- and community-level determinants of birth certification of children under-5 years in Nigeria: evidence from a household survey

Promoting birth certification is central to achieving legal identity for all - target 16.9 of the 2030 Sustainable Development Goals. Nigeria is not on track to achieve this goal with its low coverage of birth certification (BC). This study is aimed at identifying patterns of BC and its associated individual- and community-level factors, using pooled cross-sectional data from three rounds (2008, 2013, and 2018) of the nationally representative Nigerian Demographic and Health Survey. A weighted sample of 66,630 children aged 0–4 years was included, and a two-level multilevel logistic model which accommodates the hierarchical nature of the data was employed. Of the total sample, 17.1% [95% CI: 16.3–17.9] were reported to be certified. Zamfara state (2.3, 95% CI: 0.93–3.73) and the Federal Capital Territory (36.24, 95% CI: 31.16–41.31) reported the lowest and the highest BC rates. Children with an SBA [AOR = 1.283, 95% CI: 1.164–1.413] and with at least one vaccination [AOR = 1.494, 95% CI: 1.328–1.681] had higher odds of BC. The AOR for mothers with at least one prenatal visit was 1.468 [95% CI: 1.271–1.695], and those aged 30–34 years at the time of birth [AOR = 1.479, 95% CI: 1.236–1.772] had the highest odds. Further, the odds of BC increased the most for mothers [AOR = 1.559, 95% CI: 1.329–1.829] and fathers [AOR = 1.394, 95% CI: 1.211–1.605] who were tertiary-educated. In addition, children in middle-income [AOR = 1.430, 95% CI: 1.197–1.707] or rich wealth HHs [AOR = 1.776, 95% CI: 1.455–2.169] or those whose families had bank accounts [AOR = 1.315, 95% CI: 1.187–1.456] had higher odds. Living in non-poor and within close proximity to a registration center (RC) act as protective factors for BC, while living in poor communities [AOR = 0.613, 95% CI: 0.486–0.774] and more than 10kms from an RC reduce the odds of BC [AOR = 0.466, 95% CI: 0.377–0.576]. The study identified several protective and risk factors which policymakers can adopt as strategic areas for universal birth certification. National and sub-national programs should integrate non-formal institutions as well as target child and maternal utilization of healthcare services to promote BC in Nigeria.

Food provision in early childhood development centres in Harare, Zimbabwe

&#x0D; &#x0D; &#x0D; &#x0D; Background. Poor nutrition practices result in malnutrition, a public health concern that affects a third of children globally. In Zimbabwe, ~27.6% of children under-5 years old are stunted. Some of these children spend long hours in early childhood development centres (ECDCs). Children can receive half to two-thirds of their daily food intake while in care, making ECDCs an ideal entry point to influence child nutrition positively. There are no specific nutrition guidelines for ECDCs in Zimbabwe.&#x0D; Objective. The study aimed to investigate food provision at ECDCs of the Northern-Central District of Harare.Methods. A descriptive, cross-sectional study with an analytical component was conducted in 15 ECDCs. Fifteen ECD managers (ECDMs) and 14 food handlers (FHs) were included in the study. An observational checklist allowed recording of food preparation and hygiene practices. The Dietary Diversity Score (DDS) of the menu was calculated using the Food and Agriculture Organisation (FAO) 9-group DDS sheet.Results. Inadequate food storage facilities and food handling practices were observed. Staff had minimal nutrition-related training. Staff displayed a positive attitude towards their role in providing healthy meals. Barriers to serving healthy meals were inadequate funds, children’s food preferences, unrealistic parental expectations, and external factors. The mean DDS score for menus was 2.8. Meals consisted mainly of starchy items, legumes and meat, and lacked fruit and dairy items.Conclusion. National guidelines can improve children’s dietary intake while in day care. In alignment with Sustainable Development Goals 2 and 3, food provision at ECDCs should be a priority.&#x0D; &#x0D; &#x0D; &#x0D;

Childhood anaemia levels among under-5 children in Namibia and their associated sociodemographic factors: A multivariate ordinal modelling approach.

Anaemia is a serious global public health problem with high prevalence (>40%) in children particularly in low- and middle-income countries including Namibia with a current 46.1% prevalence rate. This study was aimed at examining the sociodemographic factors influencing the occurrence of childhood anaemia levels in Namibia. A multivariate ordinal regression model was applied to statistically identify potential sociodemographic factors associated with anaemia levels among children under-5 years old using data collected from the 2013 NDHS. The odds of having mild anaemia level was lower for sociodemographic characteristics such as mother's age, total children ever born, health insurance coverage, child's residency, child's age and main language spoken at home. The odds of having moderate anaemia level was higher for characteristics such as mother's age, place of residence, highest education level and child's diarrhoea status, while it was lower for characteristics such as age of head of household, total children ever born, health insurance coverage and sex of child. Similarly, the odds of having severe anaemia level was higher for characteristics such as region, place of residence, highest education level, number of household members, wealth index, health insurance coverage, child's residency and child's diarrhoea status, while it was lower for characteristics such as total children ever born and sex of child. It is therefore recommended that the policies and practices concerning anaemia diagnosis, treatment and prevention in the country be substantially revised by policy-makers, starting with the known prevalent causes and identified sociodemographic factors from this study.

Improving wasting among children under-5 years in Malawi: The role of farm input subsidies.

Wasting among children under-5 years remains a public health problem in Malawi, despite the quest to improve food availability through Farm Input Subsidy Program (FISP). As such, the study examined the link between FISP and child wasting. Using Malawi Integrated Household Panel Surveys for 2013, 2016, and 2019, two-stage least squares approach was employed to run a Cobb Douglas production function and a correlated Random Effects (CRE) Model to account for endogeneity challenges and an unbalanced panel dataset. The study hypothesized the role of FISP to dietary diversity at the household level on child wasting [weight-for-height (WHZ)]. Based on the analysis, the study found that household access to FISP coupons was not a stand-alone predictor for low wasting among children under-5 years. However, increased maize production due to FISP coupon access significantly correlated with lower wasting likelihood incidences at the household level. Worth to note, that in 2015/16, households that had accessed FISP coupons and were in the central region had higher wasting probabilities among the children under-5 years in Malawi compared to other counterparts panels. This implies challenges to addressing wasting among children under-5 years– which can be attributed to higher redemption costs of the FISP coupon. Therefore, the current study suggests that input subsidies can improve the reduction of wasting among children under-5 years through specific pathways, among them, increased maize production and considering appropriate targeted approaches to ensure households access the inputs for sustained food availability, which in turn enhances improved the children under-5 years health dividends in Malawi.

Measurement tools and indicators for assessing nurturing care for early childhood development: A scoping review.

Nurturing care encompasses five components that are crucial for supporting early childhood development: good health, adequate nutrition, opportunities for early learning, responsive caregiving, and safety and security. While there has been increasing attention in global public health towards designing and delivering programs, services, and policies to promote nurturing care, measurement has focused more on the components of health and nutrition, with less attention to early learning, responsive caregiving, and safety and security. We conducted a scoping review to identify articles that measured at least one nurturing care outcome in a sample of caregivers and/or children under-5 years of age in low- and middle-income countries (LMICs). We systematically searched five electronic bibliographic databases for peer-reviewed articles published from database inception until November 30, 2020. We first classified outcomes to their respective nurturing care component, and then applied an inductive approach to organize key constructs within each nurturing care component and the specific measures and indicators used across studies. We identified 239 total articles representing more than 50 LMICs for inclusion in the review. The majority of included studies reported a measure of nutrition (N = 166), early learning (N = 140), and health (N = 102), followed by responsive caregiving (N = 78) and lastly safety and security (N = 45). For each nurturing care component, we uncovered multiple constructs relevant to children under-5: nutrition (e.g., anthropometry, complementary feeding), early learning (e.g., stimulation practices, early childhood education), health (e.g., birth outcomes, morbidity), responsive caregiving (e.g., parental responsivity, parent-child interactions), and safety and security (e.g., discipline, inadequate supervision). Particularly for outcomes of early learning and responsive caregiving, there was greater variability with regards to the measures used, reported indicators, and analytic construction of variables than the other three nurturing care components. This study provides a comprehensive review of the current state of measurement of nurturing care. Additional research is needed in order to establish the most optimal measures and indicators for assessing nurturing care, especially for early learning and responsive caregiving.