Children Under-five Years Of Age Research Articles

Fidelity of implementation of national guidelines on malaria diagnosis for children under-five years in Rivers State, Nigeria

BackgroundMalaria is still a disease of global public health importance and children under-five years of age are the most vulnerable to the disease. Nigeria adopted the “test and treat” strategy in the national malaria guidelines as one of the ways to control malaria transmission. The level of adherence to the guidelines is an important indicator for the success or failure of the country’s roadmap to malaria elimination by 2030. This study aimed to assess the fidelity of implementation of the national guidelines on malaria diagnosis for children under-five years and examine its associated moderating factors in health care facilities in Rivers State, Nigeria.MethodsThis was a descriptive, cross-sectional study conducted in Port Harcourt metropolis. Data were collected from 147 public, formal private and informal private health care facilities. The study used a questionnaire developed based on Carroll’s Conceptual Framework for Implementation Fidelity. Frequency, mean and median scores for implementation fidelity and its associated factors were calculated. Associations between fidelity and the measured predictors were examined using Mann Whitney U test, Kruskal Wallis test, and multiple linear regression modelling using robust estimation of errors. Regression results are presented in adjusted coefficient (β) and 95% confidence intervals.ResultsThe median (IQR) score fidelity score for all participants was 65% (43.3, 85). Informal private facilities (proprietary patent medicine vendors) had the lowest fidelity scores (47%) compared to formal private (69%) and public health facilities (79%). Intervention complexity had a statistically significant inverse relationship to implementation fidelity (β = − 1.89 [− 3.42, − 0.34]). Increase in participant responsiveness (β = 8.57 [4.83, 12.32]) and the type of malaria test offered at the facility (e.g., RDT vs. no test, β = 16.90 [6.78, 27.03]; microscopy vs. no test, β = 21.88 [13.60, 30.16]) were positively associated with fidelity score.ConclusionsThis study showed that core elements of the “test and treat” strategy, such as testing all suspected cases with approved diagnostic methods before treatment, are still not fully implemented by health facilities. There is a need for strategies to increase fidelity, especially in the informal private health sector, for malaria elimination programme outcomes to be achieved.

Clinical profile of children with influenza like illness during pre-monsoon at coastal Karaikal, Puducherry, India.

Influenza infections in developing countries are under reported and WHO estimates that nearly 99% of influenza deaths worldwide occur in children under-five years of age in Asian and African countries. Consequently, this study aims to analyze the use of clinical profile and easily available laboratory parameters to aid identification of the possible viral etiology in the setting of pre-monsoon ILI. A cross-sectional study was carried out for three months among children with ILI attending fever clinic of a tertiary care hospital in Karaikal, South India. In the study population the prevalence of ILI was highest in the age group four to five years followed by school aged children. Adolescents were affected the least. Influenza B was most common virus causing ILI in this region, followed by covid-19 infection. Laboratory parameters depicted a significantly high ESR in COVID-19 infected ILI children. They also exhibited leucopenia and normal platelet counts. Clinical symptoms and laboratory parameters which are easily available and cheaper can be used in resource poor settings of healthcare to identify possible influenza and COVID-19 infected children amongst cases presenting with ILI.

Co-existence of maternal overweight/obesity, child undernutrition, and anaemia among mother-child pairs in Ethiopia.

Ethiopia is currently known to be the most food-insecure country in sub-Saharan Africa, where childhood undernutrition remains endemic. While attention is increasingly being paid to childhood undernutrition in Ethiopia, a current surge of "triple burden of malnutrition" (TBM) has received less attention. The purpose of this study was to determine the prevalence of TBM and identify the associated factors in Ethiopia. Data were from the Ethiopian Demographic and Health Surveys (2005-2016) and a total of 20,994 mother-child pairs were examined in this study. The TBM was our primary outcome variable, which encompasses three types of nutritional problems-when a mother may be overweight/obese, while her child is stunted, wasted, or underweight plus has anaemia under the same roof. A multilevel logistic regression explored the individual- and community-level factors associated with TBM. Our study indicated that children under-five years of age were anaemic, stunted, wasted, and underweight [49.3% (95% CI: 48.7-49.9), 43.1% (95% CI: 42.4-43.7), 10.3% (95% CI: 9.9-10.7), and 27.6% (95% CI: 27.0-28.1)] respectively. The overall prevalence of TBM was 2.6% (95% CI: 2.39-2.83). Multilevel analyses revealed that TBM was more likely to occur among children aged 12-23 months (AOR: 2.54, 95% CI: 1.68-3.83), 24-35 months (AOR: 1.54, 95% CI: 1.03-2.29), children perceived by their mothers to be smaller than normal at birth (AOR: 1.94, 95% CI: 1.48-2.56), who experienced fever in the past 2 weeks (AOR: 1.58, 95% CI: 1.24-2.01), and lived in urban settings (AOR: 1.79, 95% CI: 1.13-2.86). Lower odds of TBM were reported among female children (AOR: 0.59, 95% CI: 0.47-0.72), and those who lived in rich households (AOR: 0.69: 95% CI: 0.49-0.98). TBM was found to be present in almost three percent of households in Ethiopia. Addressing the TBM through double-duty actions will be of critical importance in achieving malnutrition in all its forms in Ethiopia.

Assessment of Nutritional Status of Under Five Years Children in Kolati Bhumlu of Kavrepalanchok District

Background: The nutritional status of children is one of the major indicators of child survival and a proxy indicator for the general health of the population. Malnutrition is a significant public health issue in the majority of developing nations and is particularly prevalent among children under five years of age. Mortality and morbidity among children under-five years of age are influence by nutritional status. The context of Nepal, more than one-third (36%) of children under-five years of age stunted or too short for their age. 10% of children wasted (too thin for height), a sign of acute malnutrition. 27% of children underweight or too thin for their age. These children had greater risk of severe acute malnutrition and death. Objective: Study’s objective was to assess the nutritional status of under-five year’s children and factors associated with malnutrition. Method: A descriptive cross-sectional study conducted in Kolati Bhumlu of Kavrepalanchok district of Nepal. A total of 115 under-five year’schildren and their mothers were included in study. Statistical Package for the Social Sciences (SPSS) version16 was used to analyze the data. Result: The prevalence of underweight was found to be 28.7% according to the classification of malnutrition based on Z- score .Similarly, the prevalence of wasting was found to be 18.3% and the prevalence of stunting was found to be 29.6%. According to Gomez’s malnutrition classification (NCHS/WHO as standard) for Weight for age (underweight) 3.5% children were severely malnourished. According to Water-low’s classification, regarding the height for age (stunting) 9.6% children were severely malnourished. Regarding MUAC measurement 7.8% children had severe malnutrition. The Gender of the child was associated with stunting. Conclusion: In the study population, the high prevalence of malnutrition especially stunting among under-five years children. Taking weight, height, age, and mid- upper arm circumference (MUAC) measurements of malnourished children more than three-fifths of them were below -2SD and nearly one-fourths were below -3SD which needs intervention.

Factors influencing utilisation of insecticide treated nets among children under-five years of age in Kpone-On-Sea in the Kpone Katamanso District in Ghana

Children under-five years of age are among the vulnerable group mostly affected by morbidity and mortality due to malaria. Insecticide treated nets (ITNs) have proved to be effective in reducing malaria transmission and increasing child survival. Significant investment into scaling up of ITNs has been done but achieving actual utilisation among beneficiaries is still a challenge in malaria endemic regions including Ghana. The study aimed to assess factors influencing utilisation of ITNs among children under-five years in Kpone-On-Sea in Ghana. We used a cross-sectional community survey design to determine the proportion of children under-five years of age sleeping under ITNs and factors influencing utilisation of ITNs among care-givers in Kpone-On-Sea. We randomly sampled 325 care-givers of children under-five years between March and June 2017. Microsoft Excel version 2016 and SPSS were used for data entry and analysis, and further analysis was conducted using STATA version 14 software. Chi-square test was used to test for associations and multiple logistic regression to determine strength of associations. We found that the proportion of children under-five years sleeping under ITNs was 91%. Factors associated with ITN utilisation among children under-five years included caregivers’ level of education (p<0.01), their awareness that children under-five years are most at risk of malaria (P<0.05), knowledge that ITN protect against mosquito bite (P<0.02), knowledge on the importance of ITNs in preventing malaria (P<0.01), ITN ownership (P<0.03), type of ITN owned (p<0.02) and the period within which caregivers utilise ITN (P<0.00). We also found high ownership of ITNs among caregivers, and no difference between caregivers’ knowledge on malaria and its prevention. These data improved the current knowledge of ITNs utilisation among caregivers of children under-five years and offer opportunities to conduct further studies in other regions of Ghana.

Prevalence of Refractive Errors among Under Five Year Children Attending in a Tertiary Eye Care Center of Nepal

IntroductionRefractive errors are common vision problems that occur when the shape of the eye does not properly bend or refract light to focus it on the retina. The objective of this research was to estimate the prevalence among children under-five years of age in Lumbini, Nepal.MethodsA hospital-based observational study was conducted among children attending the Lumbini Eye Institute and Research Center. Participants were selected over three months using systematic random sampling. Ophthalmic examination with retinoscopy (dry and wet) was used to determine refractive errors. The proportion of children with spherical equivalent myopia ≤-0.50 diopter (D), SE hyperopia ≥+2.00 D and SE astigmatism >0.5 in both eyes were calculated. Prevalence of myopia, hyperopia and astigmatism was reported by age, gender and religion.ResultsAmong 1,561 recruited children, the prevalence of refractive errors was 15.4% (n=240, 95% CI: 13.6% to 17.3%). The prevalence was significantly higher among older children (3 to 5 years) than the younger children (OR: 4.7; 95% CI: 1.7 to 13.1). Myopia was the most common condition (n=211, 13.5%, 95% CI: 11.9% to 15.3%). Myopia and astigmatism were significantly higher among children 3 to 5 years (22.1% and 5.56% respectively). Hyperopia prevalence was significantly higher among infants (3.3%).ConclusionsThe prevalence of refractive errors increased with age that was relatively high among infants and young children.

Prevalence of asymptomatic malaria infection by microscopy and its determinants among residents of Ido-Ekiti, Southwestern Nigeria.

Asymptomatic malaria infections have received less attention than symptomatic malaria infections in major studies. Few epidemiological studies on asymptomatic malaria infections have often focused on pregnant women and children under-five years of age as the most vulnerable groups. However, there is limitation on data regarding asymptomatic infections among the old adult populations, particularly in the study area. Therefore, this study determined the prevalence of asymptomatic malaria infection by microscopy and its determinants among residents of Ido- Ekiti, Southwestern Nigeria. A hospital-based cross-sectional study was conducted between July and September 2021 among 232 consenting apparently healthy individuals aged 40 years and above who were recruited during a free health screening program using a standardised interviewer-administered questionnaire. The questionnaire sought information on respondents' socio-demographics, presence and types of co-morbidity, and the prevention methods being adopted against malaria infection. Venous blood samples were collected and processed for asymptomatic infections using Giemsa-stained blood smear microscopy. Data were analysed using SPSS version 21. Multivariate logistic regression was used to identify factors associated with asymptomatic infections. Of the total 232 respondents, 19.0% (48/232) were confirmed to be infected with Plasmodium falciparum (95% confidence interval (CI): 14.1% - 24.6%). Lack of formal education (Adjusted odds ratio (AOR): 5.298, 95% (CI): 2.184-13.997), being diabetic (AOR: 4.681, 95% CI: 1.669-16.105), and not sleeping under Long Lasting Insecticide Net (LLINs) (AOR: 4.594, 95% CI: 1.194-14.091), were the determinants of asymptomatic Plasmodium falciparum infection. The prevalence of asymptomatic Plasmodium falciparum was 19%. Lack of formal education, being diabetic, and not sleeping under LLINs were the determinants of asymptomatic infections.

A Study to Assess the Knowledge on Cause, Spread, Prevention and Management of Diarrhoeal Diseases Among Mothers of Under-five Attending SDM Paediatric OPD, Dharwad

Background and Objectives Diarrhoea is a leading cause of illness and death among children in developing countries. About 80 of deaths in the first two years of life are due to diarrhoeal diseases. To assess the knowledge of mothers on cause spread prevention and management of diarrhoeal diseases and to determine the association between the knowledge of mothers and selected socio demographic variables.Methods A descriptive survey research design was used to study the population of mothers with children under-five years of age. The sample size was 60 and the subjects were selected using non-probability purposive sampling method. The Pediatric OPD at SDM College of Medical Sciences amp Hospital in Dharwad served as the studyrsquos location. Data was collected with the help of a structured knowledge questionnaire.Results The mean knowledge score of mothers regarding diarrhoea was 9.87 with a standard deviation of 2.65 and a median of 9.50. According to the findings 50 of mothers had adequate awareness of diarrhoea 48.33 had moderate knowledge and just 1.67 had poor information. Knowledge significantly correlated with socio-demographic status family income and the number of children.Conclusion The present study concluded that mothers have adequate knowledge regarding the diarrhoeal episodes

Study of different types of refractive errors in under-five children born preterm versus full term

Background: Preterm birth potentially plays an important role in visual development. Studies have shown that frequency of myopia, astigmatism, anisometropia, strabismus, and amblyopia in children born preterm is higher than term children.Objective: The aim is to study different types of refractive errors in children under-five years of age born preterm and term.Methods: Comparative cross-sectional study was carried out among 64 children aged 5 years or less. Age, gender, and social status were noted. Children were subjected to refraction according to their age. Detailed anterior segment and posterior segment examination as per the cooperation of the child was conducted with torch light or slit-lamp examination with Ziess, Appasamy AARU 2000. Visual acuity was examined with appropriate methods suitable for age.Results: Fifty percent were preterm and 50% were term. About 50% were male and 50% were female. The most common refractive error was hypermetropia (42%). Among those with compound types of refractive errors, the most common was compound myopic astigmatism ≥2 diopters (17%). Compound types of refractive error were significantly more (62.5%) among the preterm compared to 31.2% among term; significantly more (91.7%) among those born <32 weeks of gestation compared to 45% and 45.5% among those born between 33 and 36 weeks and born >36 weeks of gestational, respectively; significantly more (88.9%) among low birth weight babies compared to 40% among normal birth weight babies. Age and gender were not significantly associated with compound types of refractive errors (P > 0.05).Conclusion: Most common refractive error was hypermetropia. Among those with compound types of refractive errors, the most common was compound myopic astigmatism ≥2 diopters. Being preterm, born at the gestational age of <32 weeks and low birth weight were significant risk factors for compound types of refractive errors.

Perfil nutricional de crianças indígenas menores de cinco anos de idade no Alto Rio Solimões, Amazonas, Brasil (2013)

Abstract Objectives: to characterize the nutritional status of indigenous children underfive years of age living in rural communities in the Upper Solimões River region, inhabited by seven ethnic groups, based on data of december 2013. Methods: weight and height data extracted from SISVAN-I (Indigenous Food and Nutritional Surveillance System) forms filled in 2013 for 7,520 children (86.0% of the estimated children in this age group). The indices height-for-age (H/A), weight-for-age (W/A), weight-for-height(W/H), and body mass index-for-age (BMI/A) were calculated. Growth reference curves proposed by the World Health Organization were used to calculate z-scores. Results: the height-for-age (H/A) index presented the lowest mean z-score values, reaching -1.95 among children between 36 and 60 months. Mean z-score values for the weight-for-age (W/A) index also remained below zero. Mean z-score values for the indices weight-for-height (W/H) and body mass index-for-age (BMI/A) remained slightly above zero, reaching a maximum value of 0.5. Of all children, 45.7% presented low H/A, 9.6% presented low W/A, 4.5% presented low W/H, and 10.7% presented overweight based on BMI/A. Conclusion: our analysis show that in 2013 poor nutritional status persisted as an important health issue among these rural indigenous children.

Nutritional Status of Under-five Children in Sokoto, Nigeria

Background: Malnutrition is the largest risk factor in the world for disability and premature mortality among young children, especially in developing countries. A myriad of socio-economic, cultural, and environmental factors have been identified to either improve or negatively affect a child's nutritional status. Objectives: To assess the nutritional status of children under-five years of age in Sokoto, Nigeria, and determine the associated factors. Methods: A cross-sectional survey of children aged 6-59 months selected through multistage random sampling. Data was obtained using pretested semi-structured questionnaire and the nutritional indices were determined using WHO anthro v3.2.2. Data was analyzed using SPSS version 25. Results: Subjects comprised a total of 353 children with a mean (±S.D) age of 26.8 ±14.9 months. Majority 214(60.6%) were females. Most 330(93.5%) of the caregivers were married majority 180(51.0%) were of low socio-economic status. Two hundred and two (57.2%) of the under-fives had normal weight for age, 144(40.8%) of them were severely stunted, most 290 (82.2%) of them had normal weight for height, and 199(56.7%) had normal mid upper arm circumference. Mother/caregiver's age (p=0.012), marital status (p= 0.007), and child's immunization status (p=0.015) were associated with weight for age, marital status (p=0.028) was associated with the weight for height/length, Child's age group category (p&lt;0.001), social class (p=0.036), and community setting (p=0.031) were associated with the height for age, Marital status (p=0.025), child's age group category (p&lt;0.001), history of recent illness (p=0.046), and community setting (p&lt;0.001) were associated with the mid-upper arm circumference. Conclusion: Under nutrition was the main form of malnutrition among the under-fives, with severe stunting predominating. The nutritional status were influenced by some maternal or caregivers' socio-demographic factors, as well as inadequate child immunization and treatment of acute illnesses.

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

Risk Factors of Nutritional Rickets among Children Under-five Years of Age

Purpose: Rickets is one of the most common diseases of childhood and is more prevalent in the developing countries. It affects the rapid growth phase of the children. Rickets is affected by different factors which are understudied in Pakistan. This study aimed to identify the risk factors that lead to rickets in children under five years of age among diagnosed cases of the nutritional rickets. This may cause reduction in the incidence of the rickets by prevention of the factors that lead to rickets in the children.&#x0D; Methodology: This descriptive cross-sectional study was performed in the pediatric outpatients department of the Holy Family Hospital, Rawalpindi, Pakistan for 1 year from June 2021 to June 2022 on 132 diagnosed cases of the nutritional rickets. Patients were enrolled via non- probability convenient sampling technique and a set developed inclusion and exclusion criteria. Data was collected through self-structured questionnaire after taking informed consent. Data analysis was done through SPSS version 25.&#x0D; Findings: Nutritional rickets was more common among children who had, age range from 1 to 3 years group (64.39%), male gender (68.94%), lower socioeconomic status (55.30%), exclusive breastfeeding (70.45%), cow’s milk use (71.96%), no sunlight exposure (66.67%), shorter duration of sunlight exposure (57.58%) fully dressed during sunlight exposure (40.90%), no oil massage during sunlight exposure (63.30%), poor nutritional status (72.73%), and mothers with poor nutritional status (69.70%). In short, age group with range 1 to 3 years, male gender, lower socioeconomic status, exclusive breastfeeding, cow’s milk use, no sunlight exposure, shorter duration of sunlight exposure, fully dressed during sunlight exposure, no oil massage during sunlight exposure, child poor nutritional status, and mothers with poor nutritional status, all raise the of the nutritional rickets in children of under five years age.&#x0D; Recommendations: Supplements should be added in the diet of children during breastfeeding. Also, there should be adequate sunlight exposure of children. Finally, malnutrition of both children and mothers should be treated.

Assessment of anemia and associated risk factors among children under-five years old in the West Guji Zone, southern Ethiopia: Hospital-based cross-sectional study.

BackgroundAnemia adversely affects children’s mental, physical and social development, particularly in Africa. In the early stages of life, it leads to severe negative consequences on the cognitive, growth and development of children.ObjectiveThis study aimed to assess anemia and associated risk factors among children under-five years old in the West Guji Zone, southern Ethiopia, from October to November 2020.MethodA hospital-based quantitative cross-sectional study was conducted at Bule Hora General Hospital, Southern Ethiopia. A convenience sampling technique was used to include 375 under-five children enrolled in the study. The pretested structure questionnaire was used to collect socioeconomic and demographic characteristics of study individuals after taking appropriate written informed consent. Then, a venous blood sample was collected from each child and analyzed for hemoglobin determination using a Midray BC 3000 Plus machine. Binary logistic regression models were used to identify associated factors of anemia. A p-value ≤ 0.05 was considered statistically significant.ResultThe overall prevalence of anemia among under-five children was 13.2% (50) [95% CI = 5.2–21.2%]. Among anemic children under-five years of age, 12% (6) had mild anemia, 32% (16) had moderate anemia and 56% (28) had severe anemia. In this study, anemia was significantly associated with a history of intestinal protozoan infection [AOR = 2.55, 95% CI = 1.28–10.42], malaria infection [AOR = 5.01, 95% CI = 0.18–11.44] and soil-transmitted helminths infection [AOR = 6.39, 95% CI = 1.75–29.08].ConclusionThe prevalence of anemia among under-five children was found to be low in the study area; however, the majority of anemic children were in a severe stage. It could be managed by preventing malaria infection, intestinal protozoa and soil-transmitted helminthic infection.

Socio-cultural barriers to the delivery and utilisation of child healthcare services in rural Ghana: a qualitative study

BackgroundOver half of global deaths among children under five years of age occur in sub-Saharan Africa. Prompt and consistent access to and utilisation of child healthcare services improves child health outcomes. However, socio-cultural barriers impede the utilisation of child healthcare services among rural dwellers in Ghana. There is a paucity of studies that explore the experiences of nurses and caregivers regarding the socio-cultural barriers to the delivery and utilisation of child healthcare services in rural areas in Ghana such as the Nkwanta South Municipality.PurposeThe purpose of this study was to explore the experiences of nurses and caregivers regarding the socio-cultural barriers that impede the delivery and utilisation of child healthcare services by caregivers for their children in the Nkwanta South Municipality, Ghana. MethodsData were collected through semi-structured interviews conducted with a purposive sample of ten nurses and nine caregivers of children under five years of age who utilised the available child healthcare services in a rural setting. The consent of all participants was sought and given before interviews were conducted. Data analysis entailed coding and the generation of themes the codes.ResultsThe exploration of experiences of nurses and caregivers of children under-five years of age revealed that certain socio-cultural beliefs and practices, language barriers and reliance of caregivers on self-medication were the main socio-cultural barriers that impeded the delivery and utilisation of child healthcare services in the Nkwanta South Municipality. Conclusion Nurses and caregivers experienced several socio-cultural barriers which either delayed care seeking by caregivers for their sick children or interfered with the smooth and prompt delivery of needed child healthcare services by nurses. Some of the barriers negatively affected the interaction between nurses and caregivers with the tendency to affect subsequent child healthcare service utilisation. It is recommended that healthcare managers and nurses should foster close collaboration with caregivers and community leaders to address these socio-cultural barriers and facilitate prompt and consistent utilisation of child healthcare service in rural areas.

Malnutrition among under-five children in St. Martin's Island, Bangladesh: A cross-sectional study on prevalence and associated factors.

Objectives:Early childhood nutrition is critical for physical and mental development, and any hindrance (malnutrition) at this stage adversely affects adulthood which makes them more susceptible to a variety of communicable and non-communicable diseases. St. Martin’s Island was the focus of this study, which examined the prevalence and risk factors for malnutrition among under-five children.Methods:In this cross-sectional study, 256 children aged under five were assessed for anthropometry, and multiple logistic regression models were fitted to identify potential predictors of malnutrition. For analysis, SPSS and WHO Anthro software were used.Results:The prevalence of stunting, wasting, underweight, and overweight were 34.4%, 17.6%, 18.9%, and 6.9% respectively among children under-five years of age in St. Martin’s Island. An increase in child’s age decreases their risk of being stunted (AOR = 0.97, p = 0.006). Males were more likely than females to be wasted (AOR = 2.03, p = 0.001). Both stunting (AOR = 2.42, p = 0.004) and wasting (AOR = 2.82, p = 0.015) rate were higher among the poorer section as compared to the richest. On the contrary, underweight was low among the poorest section (AOR = 0.37, p = 0.024). Other socio-economic factors, for example, household food insecurity, and parental occupation affect these forms of malnutrition significantly.Conclusion:Prevalence of all forms of malnutrition except underweight was higher as compared to the national perspective in St. Martin’s Island among the under-five children. Community-based approaches by the local government in collaboration with various non-government organizations should be taken to reduce and prevent malnutrition among children.

Child mortality in Bangladesh - why, when, where and how? A national survey-based analysis.

BackgroundUpdated information on the cause of childhood mortality is essential for developing policies and designing programmes targeting the major burden of disease. There is a paucity of evidence regarding the current estimates of the cause of death in Bangladesh, which is essential for reinvigorating the current policies and reshaping existing strategies to avert preventable deaths. This paper aims to address this critical evidence gap and report the cause, timing and place of death among children under-five years of age using a nationally representative sample.MethodsThe present study was undertaken to provide updated estimates of causes of death among children under-five years of age using data from the 2017-18 round of the Bangladesh Demographic and Health Survey (BDHS). The verbal autopsy (VA) questionnaire of the 2017-18 BDHS was adapted from the standardised WHO 2016 instruments. Specially trained physicians reviewed the responses of the VA questionnaire and assigned the cause of death based on the online-2016-version of the International Classification of Diseases (ICD-10). We included 456 deaths among children under-five years of age in our analysis. Descriptive statistics were used to present the causes, timing and places of death with uncertainty ranges (UR).ResultsPneumonia is the major killer (19%), accounting for approximately 24 268 (UR = 21 626-26 695) under-five deaths per-year. It is followed by birth asphyxia (16%), prematurity and low-birth-weight (11%), serious infections including sepsis (8%) causing 20 882 (UR = 18 608-22 970), 14 956 (UR = 13 327-16,452), and 10 723 (UR = 9555-11,795) deaths per-year, respectively. Drowning (8%) caused 10 441 (UR = 9304-11 485) deaths and congenital anomaly (7%) resulted in d 8748 (UR = 7795-9623) deaths per-year. Around 29% of all deaths occurred on the first day, 52% within the first week, and 66% within the first month of life. Around 70% of birth asphyxia, prematurity, and low birth weight-related deaths happen on the day of birth. Approximately 43% of pneumonia-related deaths occur in age 1-11 months, and around 51% of drowning-related deaths happen in age 12-23 months.ConclusionsPneumonia with other serious infections, birth asphyxia, prematurity and low-birth-weight are responsible for more than half of all deaths among children under-five years of age. Strengthening the existing maternal, neonatal and child health programmes may be helpful in averting the majority of these preventable deaths. A multisectoral approach is required for the prevention of childhood deaths, especially drowning-related fatalities. Special measures need to be taken to prevent and control emerging public health challenges like birth defects and congenital anomalies.

Prevalence, level and factors associated with malnutrition in children under-five years of age and their parents’ awareness about children nutrition in Quetta city

Malnutrition continues to be a major public health problem in developing countries. It is the most important risk factor for the burden of diseases. There was lack of information regarding the prevalence, level and factors associated with malnutrition among children of under-five years of age from Baluchistan, Pakistan.

Missed Opportunity for Vaccination among Children Under-five years of age: A Cross-Sectional Study at Mwananyamala Regional Hospital, Dar es Salaam, Tanzania

Background Immunization is among the most important public health interventions against common childhood diseases. However, a missed opportunity for vaccination (MOV), may hamper the progress made in reducing childhood illness through vaccination. Knowing the magnitude and contributing factors for MOV, is essential for planning and executing preventive measures; however, these factors are not well elucidated in the Tanzania context. Broad Objective To determine the magnitude and factors for MOV among children under five-years old admitted at Mwananyamala hospital. Methodology We conducted a hospital-based, cross-sectional descriptive study among children under-five year old who were admitted at Mwananyamala hospital and their respective care givers from October to November 2018. An interview-guided questionnaire was used to collect data from the caregivers. The childhood immunization history was obtained from the immunization cards. Data were analyzed using Statistical Package for Social Sciences (SPSS version 20). Results A total of 209 caretakers and their respective children were enrolled in the study. Thirty-eight (18.2%) had MOV, and among the missed vaccines, the second dose of measles and rubella was the most missed vaccine (45.5%). Identified factors for MOV were unavailability of the vaccine on the day of vaccination 12 (31.3%), the child being sick on the day of vaccination 10(26.3%), due date forgotten 8 (20.8%), not informed on when to return for vaccination 7(18.1%), and no money for transport to vaccination center 1 (2.7%). Conclusion and recommendation The magnitude of missed opportunity for vaccination is still high among hospital admitted children. Vaccine procurement and distribution as well as improved communication among caretakers and health personnel should be more strengthened to reduce the number of children who are missing vaccines. Keywords: Missed opportunity for vaccination, Children, Under-five, Dar es Salaam.

Derivation and internal validation of a data-driven prediction model to guide frontline health workers in triaging children under-five in Nairobi, Kenya.

Background: Many hospitalized children in developing countries die from infectious diseases. Early recognition of those who are critically ill coupled with timely treatment can prevent many deaths. A data-driven, electronic triage system to assist frontline health workers in categorizing illness severity is lacking. This study aimed to develop a data-driven parsimonious triage algorithm for children under five years of age. Methods: This was a prospective observational study of children under-five years of age presenting to the outpatient department of Mbagathi Hospital in Nairobi, Kenya between January and June 2018. A study nurse examined participants and recorded history and clinical signs and symptoms using a mobile device with an attached low-cost pulse oximeter sensor. The need for hospital admission was determined independently by the facility clinician and used as the primary outcome in a logistic predictive model. We focused on the selection of variables that could be quickly and easily assessed by low skilled health workers. Results: The admission rate (for more than 24 hours) was 12% (N=138/1,132). We identified an eight-predictor logistic regression model including continuous variables of weight, mid-upper arm circumference, temperature, pulse rate, and transformed oxygen saturation, combined with dichotomous signs of difficulty breathing, lethargy, and inability to drink or breastfeed. This model predicts overnight hospital admission with an area under the receiver operating characteristic curve of 0.88 (95% CI 0.82 to 0.94). Low- and high-risk thresholds of 5% and 25%, respectively were selected to categorize participants into three triage groups for implementation. Conclusion: A logistic regression model comprised of eight easily understood variables may be useful for triage of children under the age of five based on the probability of need for admission. This model could be used by frontline workers with limited skills in assessing children. External validation is needed before adoption in clinical practice.