Under-5 Years Of Age 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.

Child drowning in Indonesia: insights from parental and community perspectives and practices.

Child drowning is a significant public health issue in Indonesia, however, there is insufficient understanding of the issue and its associated risk factors within communities. This qualitative study aimed to explore parental and community perceptions and practices related to child drowning in Indonesian communities, and the perceived causes and risk factors. Seven focus group discussions (n = 62) were conducted with parents of children aged under-5 years and village community leaders in seven villages across all districts of Lombok Island, West Nusa Tenggara Province of Indonesia. Participants were recruited using purposive and snowball sampling. The thematic analysis, guided by Braun and Clarke's framework, used both deductive approaches, utilizing the Health Belief Model's constructs and inductive approaches. Most participants were unaware of the susceptibility of their children and others in their community to drowning and of the potential severe outcomes of drowning such as injury, disability and death. Participants generally associated drowning with beaches or open seas. Unprotected wells, tubs and buckets were identified as notable risk factors for child drowning in and around the home, shaped by some experience of child drowning incidents in the community. Supervision was identified as protective factor, however, mothers were often unavailable to supervise children, and supervision responsibility was often delegated to other family and community members. This study highlights the urgent need to enhance public awareness regarding children's susceptibility to drowning. Further exploration of local contexts and social determinants of drowning in Indonesian communities is crucial for ensuring effective water safety and drowning prevention strategies.

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.

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.

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.

Household drinking water E. coli contamination and its associated risk with childhood diarrhea in Bangladesh.

Faecal contamination (byEscherichia coli [E. coli]) of household drinking water can have adverse effects on child health, particularly increasing the episodes of childhood diarrhea; however, the evidence is scanty in Bangladesh. This study utilised data from the most recent nationally representative 2019 Multiple Indicator Cluster Survey to investigate the relationship between E. coli concentration in household drinking water and diarrheal episodes among children aged under-5years in Bangladesh. Childhood diarrhea was identified by asking the children's mothers or caregivers if they had a diarrheal episode in the 2weeks preceding the survey. E. coli colonies were counted as colony-forming units (CFUs)per 100ml of water and classified into three risk groups (low: < 1CFU/100ml; moderate: 1-10CFU/100ml; and high: > 10CFU/100ml). The design-adjusted logistic regression was used to estimate the association between drinking water E. coli risk groups and childhood diarrhea, adjusting for potential confounders. We observed a significant association between household drinking water E. coli contamination and diarrheal episodes among under-5 children. Compared to thechildren from households with a low risk of E. coli contamination in drinking water, children from households with a moderate risk of E. coli contamination were 1.68 times more likely to have diarrhea, which was 2.28 times among children from households with a high risk of E. coli contamination. Findings of the studyhave significant policy implications and urge to ensure safe water supplies, improve water management practices and modify hygiene behaviours to reduce episodes of childhood diarrhea.

Policy Challenges Facing the Scale Up of Integrated Community Case Management (iCCM) in Uganda.

Integrated Community Case Management (iCCM) of malaria, pneumonia and diarrhoea is an equity focused strategy, to increase access to care for febrile illness in children under-5 years of age, in rural communities. Lay community members are trained to diagnose and treat malaria, pneumonia and diarrhoea in children, and to identify and refer very ill children. Today, many low-income countries including Uganda, have a policy for iCCM which is being rolled out through public sector community health workers (CHWs). Ten years after the introduction of the iCCM strategy in Uganda, it is important to take stock and understand the barriers and facilitators affecting implementation of the iCCM policy. We conducted an iCCM policy analysis in order to identify the challenges, enablers and priorities for scale-up of the iCCM strategy in Uganda. This was a qualitative case study research which included a document review (n=52) and key informant interviews (n=15) with Ugandan stakeholders. Interviews were conducted in 2017 and the desk review included literature up to 2019. This paper highlights the iCCM policy trajectory since 2010 in Uganda and includes a policy timeline. The iCCM policy process was mainly led by international agencies from inception, with little ownership of the government. Many implementation challenges including low government funding, weak coordination and contradicting policies were identified, which could contribute to the slow scale up of the iCCM program. Despite the challenges, many enablers and opportunities also exist within the health system, which should be further harnessed to scale up iCCM in Uganda. These enabling factors include strong community commitment, existing policy instruments and the potential of utilizing also the private sector for iCCM implementation. The iCCM program in Uganda needs to be strengthen through increased domestic funding, strong coordination and a focus on monitoring, evaluation and operational research.

Exploring determinants of under-5 stunting in Malawi using a generalised linear mixed model

Background. Although several studies have examined determinants of stunting, most fail to account for unobserved heterogeneity in clustered survey data. Objective. To investigate the determinants of stunting among Malawian children under-5 years of age. Methods. The study utilised cross-sectional data on 5 686 children aged 0 - 59 months extracted from the 2015 - 2016 Malawi Demographic and Health Survey dataset. Data were analysed using a generalised linear mixed model applied to clustered data. Results. Children who were female (adjusted odds ratio (aOR) 0.83; 95% confidence interval (CI) 0.73 - 0.94), from wealthier households (aOR 0.68; CI 0.58 - 0.81), and whose mothers were overweight/obese (aOR 0.78; CI 0.65 - 0.94), aged 25 - 34 years (aOR 0.76; CI 0.62 - 0.93) or had at least a secondary level education (aOR 0.73; CI 0.56 - 0.94) were less likely to be stunted. The likelihood of stunting was higher among children who were anaemic (aOR 1.38; CI 1.20 - 1.59) and in whom respondents reported small birth size (aOR 1.61; CI 1.34 - 1.93). Age ≥12 months, being a twin or triplet and living in the Central region of Malawi also increased a child’s risk of being stunted. About 3.0% of the variance in likelihood of being stunted occurred across communities (clusters). Conclusions. Hidden community variations of child stunting in clustered-survey data need to be accounted for. Stunting strategies should be context specific.

Treatment-Seeking Behaviors of Families for under Five Children in Field Practice Area of Jawaharlal Nehru Medical College, Wardha

Context: Globally, India had the largest population of under-five (127 million), and the greatest number of under five deaths (2.1 million) in 2006. Nearly about 2 million of cases of diarrhea occur annually in India. An average Indian child below 5 years of age can have 2–3 episodes of diarrhea. It contributes to nearly 2.1 million of the global burden of 9.7 million under five deaths, which is the highest for any nation in the world. The Millennium Development Goal 4 aimed at reducing under-five mortality by two-third till year 2015 which remained unachieved and sustainable development goal 3 aims to ensure healthy lives and promote well-being for all at all ages including under-five children by the year 2030. The health and treatment-seeking behavior of parents and caregivers has direct reflection over child survival statistics of India. The present study has been conducted to study the determinants of treatment-seeking behavior of families for illness of under-five children in the field practice area of Jawaharlal Nehru Medical College (JNMC), Sawangi, Wardha, Maharashtra, India. Aims: A study on the treatment-seeking behaviors of families for illnesses of under-five children in field practice area of JNMC, Wardha, Maharashtra, India. Objectives: The objective of this study is to know the treatment-seeking behaviors of families for under-five children in rural areas. Materials and Methods: This study was carried out in the field practice area of community medicine JNMC, Sawangi Wardha, Maharashtra, India. The present study was carried out in the adopted villages from the field practice area of Wardha district by the JNMC. The present study was a community-based, cross-sectional study, and the study period was 6 months (i.e., from July 2019 to December 2019). The study participants comprised of the caregivers of children under-5 years of age and including mothers and other family members who were primarily responsible for attending the child's health. All children in the age group of 0 to 5 years from the study area were identified for the same (from Anganwadi's in the villages). The study participants, i.e., parents who were ready to participate in the study by signing the written consent were included in the study. Statistical Analysis Used: A predesigned and prestructured questionnaire was prepared and implemented for data collection. Results: The results showed that most of the under-five children were in the age group of 2–3 years. Most of the under-five children were having itching on skin followed by fever and diarrhea. Most of the parents took their under-five children to ANM's or the government hospital situated at their place. Conclusions: The present study concludes that treatment-seeking practices among parents for under-five children in the adopted villages of medical college are satisfactory in terms of qualified treatment provider and compliance to the treatment.

Malaria: Prevalence and related factors in children at Aba, Southeast Nigeria

Background: Childhood malaria has remained a major public health burden. It severely affects children aged under-5 years, particularly in Sub-Saharan Africa. Curbing the prevalence of malaria begins with determining the prevalence and related factors of the disease in the community. Objective: The objective of the study was to determine the prevalence and related factors of malaria in children at Aba, Southeast Nigeria. Materials and Methods: In this retrospective study, 275 case files of children admitted with malaria in the Department of Paediatrics of the Abia State University Teaching Hospital from January 1, 2016, to December 31, 2016, were analyzed. Results: During the study period, among the 440 overall admission, 275 children were diagnosed with malaria. The prevalence of malaria in our study was 62.5%. The male:female ratio was 1:1.2. We found, 234 (85.1%) children were &lt;5 years of age, 23 (8.2%) belonged to the age group of 5–11 years, and 18 (6.7%) were aged between &gt;11 and 16 years. The highest prevalence of malaria 40 (14.4%) occurred in September while the least 10 (3.6%) occurred in April. Around 247 (89.8%) patients were discharged home, 18 (6.5%) patients succumbed to death, and 6 (2.1%) patients were discharged against medical advice. Conclusion: The prevalence and mortality rates of malaria are high. To curb the trend of this disease, good environmental sanitation, prevention of the anophelene mosquito blood meal on humans, and early diagnosis and treatment of malaria should all be enhanced.

Evaluating the Effects of Climate and Environmental Factors on Under-5 Children Malaria Spatial Distribution Using Generalized Additive Models (GAMs)

Although malaria burden has declined globally following scale up of intervention, the disease has remained a leading cause of hospitalization and deaths among children aged under-5 years in Nigeria. Malaria is known to be related to climate and environmental conditions. Previous research has usually studied the effects of these factors, neglecting possible correlation between them, high correlation among variables is a source of multicollinearity that induces overfitting in regression modelling. In this paper, a factor analysis was first introduced to circumvent the issue of multicollinearity and a Generalized Additive Model (GAM) was subsequently explored to identify the important risk factors that might influence the prevalence of childhood malaria in Nigeria. The GAM incorporated the complexity of the survey data, while simultaneously modelling the nonlinear and spatial random effects to allow a more precise identification of the major malaria risk factors that influence the geographical distribution of the disease. From our findings, the three latent factor components (constituted by humidity, precipitation, potential evapotranspiration, and wet days/maximum and minimum temperature/proximity to permanent waters, respectively) were significantly associated with malaria prevalence. Our analysis also detected statistically significant and nonlinear effect of altitude: the risk of malaria increased with lower values but declined sharply with higher values. A significant spatial variability in under-5 malaria prevalence across the survey clusters was also observed; malaria burden was higher in the northern part of Nigeria. Investigating the impact of important risk factors and geographical location on childhood malaria is of high relevance for the sustainable development goals (SDGs) 2015–2030 Agenda on malaria eradication, and we believe that the information obtained from this study and the generated risk maps can be useful to effectively target intervention efforts to high-risk areas based on climate and environmental context.

Clinical Presentation and Factors Associated with Diabetic Ketoacidosis at the Onset of Type-1 Diabetes Mellitus in Children and Adolescent at Muhimbili National Hospital, Tanzania: A Cross Section Study

The incidence and clinical presentation of Type 1 diabetes mellitus (T1DM) varies markedly among countries with a worldwide trend of affected children under-5 years of age. The classical triad of polydipsia, polyuria and weight loss is the most common presentation. Similarly, the frequency of Diabetic Ketoacidosis (DKA) at the onset of T1DM is persistently high in Africa affecting more than two thirds of diabetic children.

Explanatory social variables of under-5 mortality caused by injury in Isfahan Province, Islamic Republic of Iran.

Injuries are a major cause of disease, long-term disability and death. Injury-related damage accounts for 12% of the burden of disease worldwide. Recently, significant improvements in child health have been achieved in the Islamic Republic of Iran: under-5 mortality was reduced substantially from 1990 to 2013. Nevertheless, injury is still a significant cause of mortality in this age group. Because of their vulnerability and the high rates of injury-related mortality among children under-5, this study aimed at investigating explanatory social variables of injury-related mortality. The study was conducted using the Commission on Social Determinants of Health conceptual framework among children aged under-5 years in Isfahan Province. Using the national child mortality surveillance system 1433 under- 5 mortalities during 2010-2015 were secondary analysed. We found 403 (28%) cases were related to injury. Most of the deaths occurred in 706 infants (49.2%), among boys (54.8%) and urban residents (78.9%). Multivariate logistic regression showed that mothers' low education level, age 1-5 years', living in a supportive centre and having financial problems increased the odds of under-5 mortality caused by injury (odds ratio > 1, P-value ≤ 0.05). Considering the importance and impacts of social factors on injury-related mortality among children, health policy-makers should initially consider the social determinants of health approach in child health programmes to inform interventions aimed at reducing injury-related mortality.

Nutrition intake and causative factor of stunting among children aged under-5 years in Lamongan city

The study aimed to analyze the nutrition intake and causative factor of stunting among children aged under 5 years in Lamongan City. This study was using the observational analytic with a cross-sectional study using a questionnaire to define the nutrition intake and causative factor of stunting among children in 4 districts. This study recruited 40 children aged under 5 years (24-59 months) which are selected using simple random sampling techniques from May to June 2019. The average intake of energy, protein, calcium, and phosphor in respondents was 77.23% RDA, protein 69.82% RDA, calcium 79.74% RDA, and phosphor 68.75% RDA, respectively. Out of 40 stunting children were suffering from infectious disease during period 3 months (67.5%). Parent's education (mothers and fathers) had low education (70% and 72.5%), and 65% of mother's from respondents has no job. Causative factor of stunting among children aged under 5 years in Lamongan City was less nutritional intake, infection disease, and parents characteristic. The evidence in this research primarily align with common The World Health Organization conceptual framework on childhood stunting.

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.

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.

Prevalence of Stunted Growth in Pakistan: A Socio-economic Phenomenon.

This study attempts to examine the relationship between the stunted growth with socioeconomic variables such as growth rate, fiscal expenditures on health and education, level female education and poverty level for the last two decades. In a developing country like Pakistan where the prevalence of stunted growth is nearly 50%, that is around fifty percent of the children under the age of five are suffering from malnutrition and the expenditures on health is approximately 2.5% of the GDP, it is expected to have a significant relationship between the expenditures on health and stunted growth. Similarly, the female education rate is expected to have significant impact on the malnutrition of a child under-5 years of age. Pearson correlation estimates will be used to investigate the relationship; along with the multivariate regression analysis will be employed to measure the association, between the variables. The study finds the female education, poor living conditions and poverty as significant variables associated with stunted growth. Managing and controlling factors such as preventative healthcare focus on female adult education, access to clean drinking water and poverty alleviation, should be used to influence levels of stunting, in light of Pakistan Key Words: Stunted growth; Poverty; Female literacy rate; Pearson correlation test DOI : 10.7176/PPAR/9-4-10 Publication date : April 30 th 2019

The efficacy of collagen based dressings for treatment of scald burns in under 5 years paediatric population: a non-comparative, prospective single centre experience

Background: One of the major challenges faced worldwide is management of burn wounds, particularly among the pediatric population. Immense research is going on to overcome the challenges associated with survival of these patients and healing of burnt areas. Newer dressing materials are being developed and one of them is collagen. The collagen is biocompatible. The aim was to achieve earlier and better healing of wounds, and to obviate the need for frequent change of dressings; which besides being painful, is quite troublesome in pediatric population.Methods: A prospective study was conducted in 38 patients of scald burns under-5 years of age, from October 2016 till July 2017. After thorough cleaning of burn wounds and thorough rinsing of collagen sheets with normal saline, the wounds were covered with sheets of collagen. Paraffin with chlorhexidine impregnated gauze dressing was applied over the sheet of collagen followed by dry gauze, cotton and bandage application. First dressing was opened after 5 days and then after 3 to 4 days.Results: The wounds healed in 10 to 14 days in most of them. Infection developed in one case, warranting removal of collagen sheet. None developed any adverse reaction to the application of collagen dressing.Conclusions: We conclude that collagen based dressing is a very good modality of treatment for the burn wounds with advantages of being cost effective, requiring lesser number of dressings and blood transfusions, and shorter duration of hospital stay.

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.

Measles &amp; Rubella Vaccination Campaign in India: Why, How, When and Where

Globally, in 2015, measles killed an estimated 1,34,200 children - mostly under-5 years of age and an estimated 49,200 deaths occurred due to measles in India. Most of these children were the ones who have not received two doses of measles vaccine. This is despite the fact that the Government of India is providing vaccines free of cost under the Universal Immunization Programme. Even today some of the children in the country are not protected against the deadly life-threatening diseases. Some of these children are left unvaccinated because their parents are hesitant to immunise, believes that vaccines are dangerous. (1)&#x0D; There are many reasons for low vaccination coverage like lack of awareness or fear of side-effects of vaccination. Some of the times children are left unvaccinated because their parents receive wrong information about vaccination from a handful of people who keep trying to sabotage the vaccination programme in the country by giving factual figures and facts. (2) With digital age, social media and WhatsApp has become a new tool to spread rumours without even disclosing their identity. (3)