Under-five Children In Nigeria Research Articles

Determinants of malaria spread among under-five children in Nigeria: results from a 2021 Nigerian malaria indicator cross-sectional survey

BackgroundMalaria is a global disease burden, especially in Africa, with Nigeria having the highest prevalence of malaria, with approximately 50% affecting children. Children under five years of age are vulnerable to the risk of malaria spread. This research aimed to identify the determinants of malaria spread among children under the age of 5 in Nigeria.MethodsThis study used national malaria indicator survey data from 2021 (2021NMIS). The NMIS was implemented by the National Malaria Elimination Programme (NMEP), and data were collected between 12 October and 4 December 2021. This study included 3678 children, and data cleaning and analysis were performed via STATA version 17 software.ResultsThere was a positive association between Child’s age in months of 13–23 (AOR = 2.97; 95% CI = 1.62–5.45), 24–35 months (AOR = 2.64; 95% CI = 1.43–4.88),36–47 months (AOR = 2.18; 95% CI = 1.17–4.08) and months of 48–59(AOR = 2.82; 95% CI = 1.53–5.23), households headed by females (AOR = 0.71; 95% CI = 0.54–0.95),households with all children slept in mosquito nets last night (AOR = 2.43; 95% CI = 1.39–4.21), some children slept in the mosquito bed net (AOR = 2.83; 95% CI = 1.50–5.35) and households with no mosquito bed nets (AOR = 2.18; 95% CI = 1.22–3.88),mothers who agreed to have heard or seen malaria messages in the last 6 months (AOR = 1.32; 95% CI = 1.62–1.74),respondents with medium level of awareness of malaria prevention messages had (AOR = 2.35; 95% CI = 1.62–3.4), Children from North East (AOR = 0.7; 95% CI = 0.54–0.9), South-South (AOR = 0.65; 95% CI = 0.5–0.85) and South West (AOR = 0.52; 95% CI = 0.37–0.73) and malaria status of children under five years of age in Nigeria.ConclusionThe government and other concerned malaria prevention organizations should emphasize maternal education programs that are vital for malaria prevention, early symptom recognition, and timely treatment, empowering families to take proactive measures. Collaboration among health, education, and community organizations is also crucial for integrated malaria control and prevention.

Acceptance of malaria vaccine among mothers of under-five children in Nigeria: Results from the M-VAN survey

Acceptance of malaria vaccine among mothers of under-five children in Nigeria: Results from the M-VAN survey

Mothers’ choice of health management services for under-five children with common illnesses: evaluating social workers’ impact in Nigerian health sector

ABSTRACT Introduction Every child deserves the right to life. In Nigeria like other African countries, a high burden of child mortality prevails. Attaining a low-mortality rate of children entails that mothers who are the primary caregivers are in the best position to provide quality healthcare management. Method With the phenomenological approach in qualitative research, the researchers sourced data using Focus Group Discussions (FGDs) and In-Depth Interviews (IDI) from 38 mothers of various categories. The participants were purposively selected from four government and mission health institutions in a semi-urban Nsukka town, Enugu State. Data were analyzed thematically. Findings Results revealed that mothers utilize health institutions including government, mission, private, pharmacies and patent medicine vendors when seeking healthcare for their children. Their inability to recognize potential life-threatening conditions is the leading factor in increasing child mortality. Findings show that because participants were concerned about financial challenges; they were ready to adopt traditional medicine as an alternative to modern medicine. The study showed evidence of unsafe strategies mothers adopt for the health management of their under-five children with common illnesses. Participants indicated little knowledge of social workers’ engagement in health institutions. Conclusion Healthy living is essential in the protection from illnesses. Since under-five children are vulnerable to illnesses, their mothers should provide them with quality healthcare management. The study recommends that social workers’ engagement with health providers and users in semi-urban societies could help propagate healthcare awareness and strategies in mothers’ choice of health management for under-five children in Nigeria. Overall, adequate health policy consideration should be given to all under-five children in Nigeria.

Spatially Weighted Multinomial Modelling of Comorbidity of Anaemia and Malaria among Under-Five Children in Nigeria

Children in sub-Saharan African countries, especially Nigeria, continue to suffer increased mortality owing to comorbidity of infections such as anaemia and malaria, which are known to epidemiologically overlap. In order to examine the risk factors and spatial patterns of comorbidity of anaemia and malaria using the 2021 Nigeria Malaria Indicator Survey (NMIS), a multinomial logit model was extended by incorporating a spatially weighted random effect. The impact of climatic variation on the childhood disease comorbidity was explored by weighting the spatial structured component based on the 2021 NMIS average cluster temperature of each state in Nigeria. A number of spatially weighted geo-additive models were fitted and compared using deviance information criterion. Inference was fully Bayesian, and an Intrinsic Conditional Autoregressive prior was used for structured random effects. Based on the map generated from the best-fitted model, which unveiled states that are more susceptible to the risk of disease comorbidity, the average temperature used as a weighting factor, however, has a strong relationship with the spatial pattern of disease comorbidity. States with low temperatures have a higher risk of comorbidity of anaemia and malaria compared to states with higher average temperatures. Area of residence, level of education of the mother, economic status of the mother, and owning mosquito-treated nets were identified as the significant risk factors associated with the disease comorbidity. Findings from this study will be helpful to policymakers and health authorities in their effort to combat the comorbidity of childhood anaemia and malaria, thereby reducing child mortality in Nigeria.

Are households with under-five children in Nigeria socioeconomically disadvantaged?

Although the sociodemographic and economic contributors to under-five mortality are well established, very little research has been done to assess the levels of disadvantage under-five children in Nigeria face along these dimensions. Nigeria has the second-highest under-five mortality rate (U5MR) in the world (111 deaths per 1000 live births) and contributed to the highest number of annual under-five deaths globally in 2020 (844,321 deaths). The country has also implemented several decades of policy interventions to reduce under-five mortality by improving sociodemographic and economic conditions at the household level. In this paper, we assess the sociodemographic and economic disadvantages that households with children under-five face compared to other households and discuss the implications for health policy. Using the Nigeria Living Standard Survey 2018-19, we conducted a bivariate analysis to compare the sociodemographic and economic characteristics of households with and without under-five children. We performed independent samples t-test and proportions test to assess whether these sociodemographic and economic factors were significantly different for both groups. We found that households with under-five children typically had larger sizes (6.6 vs. 3.6), lower mean adult age (36.5 vs. 45.3), and male household heads (91.3% vs. 71.5%) than households without under-five children. Furthermore, households with under-five children were less likely to have access to improved drinking water (77.2% vs. 86.0%) and sanitation sources (54.0% vs. 61.9%) than those without under-five children. Despite having more adult working members, 71.2% of households with under-five children lived below the poverty line compared to 37.7% of other households. Although their total consumption expenditure was lower than households without under-five children, they spent a higher proportion of their expenditure on health care and were at a higher risk of experiencing catastrophic health expenditure. Our study has shown that households with children under five are disproportionately disadvantaged than other households in Nigeria. The households with under-five children are larger, younger, and poorer than those without children. We also show a wide variation in the proportion of households with children under five by state. Any efforts to reduce under-five mortality and morbidity in Nigeria should recognize these sociodemographic and economic differences.

Factors influencing health workers' adherence to malaria treatment guidelines in under-five children in Nigeria: A scoping review.

Malaria is a leading cause of mortality in children aged 5 years and below in Nigeria. Treatment guidelines stipulate among other recommendations, testing by microscopy or a rapid diagnostic test (RDT) before treatment. Non-adherence to these guidelines portends a challenge, especially among vulnerable under-five children. This study explored the factors influencing Nigerian public health workers' (HWs) adherence to these guidelines in under-five children. A review of literature published between 2011- 2023 was conducted on Web of Science, Ovid Embase, Medline, Global Health, CAB Abstracts, Scopus, and Global Index Medicus. Data was extracted and analyzed under 4 themes: diagnosis, compliance with test results, use of recommended treatment, post-treatment counselling and severe malaria management. Nineteen (19) studies were included for review. Training and supervision, RDT and antimalarial availability, good knowledge of, and positive perception of RDTs promoted adherence to mRDT use. A lack of confidence in RDTs and age (≥ 40 years) fuelled presumptive treatment, especially among clinicians. mRDT and artemisinin-based combination therapy (ACT) stockouts dissuaded HWs from adhering to case management guidelines. Caregiver pressure for treatment was identified as a barrier to compliance with test results. It is important to design context-specific strategies to improve adherence to guidelines for malaria case management, especially in under-five children. Training on the guidelines should be tailored, needs-based, and continuous, and HWs should be supportively supervised in implementing case management. Maintaining an adequate supply of quality-assured mRDTs and antimalarials can facilitate adherence to the guidelines.

A Spatio-Temporal Mapping and Bayesian Modelling of Fever, Cough and short Rapid Breaths, as Symptoms of Pneumonia in Under-Five Children in Nigeria

Background Pneumonia remains a public health challenge in most parts of the world, with Nigeria having the highest number of pneumonia-related deaths. Understanding the geographical distribution, trends and risk factors associated with some symptoms of pneumonia can aid an appropriate preventive intervention towards abating its burden in Nigeria. Method This cross-sectional study used data from the 2008, 2013, and 2018 Nigeria Demographic Health Surveys. The outcome variables include fever, cough, and short, rapid breaths as selected symptoms of pneumonia. Optimized hotspot analysis was used to identify areas with a significantly high prevalence of fever, cough, and short rapid breaths, and a MCMC random-intercept logistic regression model was fitted to each symptom. Results The prevalence of cough was 12.1%, 10.1% and 16.9% in 2008, 2013 and 2018 respectively, 16.2%, 13.3%, and 25.7% for fever; and 41.7%, 42.5% and 6.5% for short rapid breaths respectively with variations across the states. Children aged 6-11 months had the highest higher odds (adjusted odds ratio (aOR) =1.95, 95% Credible Interval (CrI): 1.77, 2.18) of having cough, compared to children of other age groups. Similar pattern was noticed for fever and short rapid breaths. Other significantly associated factors with symptoms include the mother’s education, mother’s age, residence type, housing quality, wealth index and region. Conclusion The northern states were more characterized by short, rapid breaths while the southern states were more characterized by fever but both regions have a fair share of cough among under-five children. For cough and fever symptoms, the increased prevalence between 2013 and 2018 indicates more attention is needed. There are also higher odds of finding the symptoms amongst children aged 6-11 months compared to children of other age groups, especially in the North-eastern part of the country. Hence, government needs to strengthen immunization against diseases such as Hib, pneumococcus, measles and whooping cough (pertussis) which has been shown to be the most effective way to prevent pneumonia. Adequate nutrition is also key to improving children's natural defenses. Educated mothers needs to be adequately sensitized to understand that exclusive breastfeeding for the first 6 months of life of a child is paramount.

P24-002-23 Households’ Food Consumption Expenditure Influenced Dietary Diversity Scores and Nutritional Status of Mothers and Under-Five Children in Nigeria

P24-002-23 Households’ Food Consumption Expenditure Influenced Dietary Diversity Scores and Nutritional Status of Mothers and Under-Five Children in Nigeria

Determinants of zinc utilisation in the management of diarrhoea among under-five children in Nigeria: a population-based, cross-sectional study.

Diarrhoea remains the foremost cause of sickness and death among children aged <5 y (under-five) in low- and middle-income countries. The WHO and UNICEF recommend that any child with diarrhoea signs be given zinc tablets as part of the treatment within 24 h. Therefore, we aimed to assess the prevalence and determinants of zinc utilisation for diarrhoea among under-five children in Nigeria. The Nigeria Demographic and Health Survey 2018 was used for this study. Data were analysed using IBM SPSS version 25.0. A multilevel analysis technique employing the generalised linear mixed model was used for analysing the data of 3956 under-five children with diarrhoea. Only 29.1% of children who experienced diarrhoea received zinc combined with other forms of treatments during the diarrhoea episode. However, mothers with a secondary or higher level of education had a 40% higher likelihood of zinc utilisation during childhood diarrhoea (AOR, 1.40; 95% CI 1.05 to 2.22). Similarly, children whose mothers were exposed to media were more likely to receive zinc during diarrhoea than those whose mothers were not (AOR, 2.50; 95% CI 1.01 to 3.87). In this study, the prevalence of zinc use among under-five children with diarrhoea in Nigeria was low. Therefore, appropriate strategies to improve zinc utilisation are needed.

Spatial variations and determinants of malnutrition among under-five children in Nigeria: A population-based cross-sectional study.

Childhood undernutrition is a major public health challenge in sub-Saharan Africa, particularly Nigeria. Determinants of child malnutrition may have substantial spatial heterogeneity. Failure to account for these small area spatial variations may cause child malnutrition intervention programs and policies to exclude some sub-populations and reduce the effectiveness of such interventions. This study uses the Composite Index of Anthropometric Failure (CIAF) and a geo-additive regression model to investigate Nigeria's prevalence and risk factors of childhood undernutrition. The geo-additive model permits a flexible, joint estimation of linear, non-linear, and spatial effects of some risk factors on the nutritional status of under-five children in Nigeria. We draw on data from the most recent Nigeria Demographic and Health Survey (2018). While the socioeconomic and environmental determinants generally support literature findings, distinct spatial patterns were observed. In particular, we found CIAF hotspots in the northwestern and northeastern districts. Some child-related factors (Male gender: OR = 1.315; 95% Credible Interval (CrI): 1.205, 1.437) and having diarrhoea: OR = 1.256; 95% CrI: 1.098, 1.431) were associated with higher odds of CIAF. Regarding household and maternal characteristics, media exposure was associated with lower odds of CIAF (OR = 0.858; 95% CrI: 0.777, 0.946). Obese maternal BMI was associated with lower odds of CIAF (OR = 0.691; 95% CrI: 0.621, 0.772), whereas, mothers classified as thin were associated with higher odds of CIAF (OR = 1.216; 95% CrI: 1.055, 1.411). Anthropometric failure is highly prevalent in Nigeria and spatially distributed. Therefore, localised interventions that aim to improve the nutritional status of under-five children should be considered to avoid the under-coverage of the regions that deserve more attention.

Exposure-response relationship of residential dampness and mold damage with severe lower respiratory tract infections among under-five children in Nigeria.

In-home visits were conducted among 178 children hospitalized with LRTI matched by age (±3 months), sex, and geographical location with 180 community-based children without LRTI. Trained study staff evaluated the indoor environment using a standardized home walkthrough checklist and measured visible dampness and mold damage. Damp-moldy Index (DMI) was also estimated to quantify the level of exposure. Exposure-response relationships of dampness and mold exposure with severe LRTI were assessed using multivariable restricted cubic spline regression models adjusting for relevant child, housing, and environmental characteristics. Severe LRTI cases were more often male than female (61.8%), and the overall mean (SD) age was 7.3 (1.35) months. Children exposed to dampness <0.3 m2 (odds ratio [OR] = 2.11; 95% confidence interval [CI] = 1.05, 4.36), and between 0.3 and 1.0 m2 (OR = 2.34; 95% CI = 1.01, 7.32), had a higher odds of severe LRTI compared with children not exposed to dampness. The restricted cubic spline showed a linear exposure-response association between severe LRTI and residential dampness (P < 0.001) but a nonlinear relationship with DMI (P = 0.01). Residential dampness and DMI were exposure-dependently associated with higher odds of severe LRTI among under-five children. If observed relationships were causal, public health intervention strategies targeted at reducing residential dampness are critically important to mitigate the burden of severe LRTI among under-five children.

Prevalence, determinants, and reasons for malaria vaccine hesitancy among caregivers of under-five children in Nigeria: Results from a nationwide cross-sectional survey.

Malaria contributes to an enormous global burden of disease and mortality, especially in children. Approximately one in every four global cases and deaths from malaria occurs in Nigeria. This study aims to evaluate the prevalence and correlates of community hesitancy to the malaria vaccine, including the reasons for the hesitancy, following the approval of the RTS,S malaria vaccine by the World Health Organization (WHO). This was a nationwide cross-sectional online survey of Nigerian adults conducted from 20th October to 30th November 2021. Participants who replied 'no' or 'maybe' to a question assessing their willingness to accept the RTS,S malaria vaccine were considered "hesitant". We fit a multivariate logistic regression model to report the adjusted odds ratio (aOR) and 95% confidence interval (CI) for the factors associated with vaccine hesitancy. Among 3377 total respondents (1961 [57.86%] males; mean age [SD]: 30[9.1]), 1010 (29.91%) were hesitant. Receiving information about the RTS,S malaria vaccine initially from healthcare workers (vs. the internet) (aOR:0.55; 95% CI:0.35-0.87) was significantly associated with lower odds of hesitancy. Conversely, earning a high income of over NGN100, 000 (vs.<NGN 30,000) per month (aOR: 2.10, 95% CI: 1.36-3.24), belonging to other religious groups (vs. Islam) (aOR:3.25, 95% CI:1.18-8.98), and having a family size of more than ten (vs.<5) (aOR:1.84; 95% CI:1.08-3.13) were significantly associated with a higher odds of hesitancy. The main reasons for vaccine hesitancy included fear of vaccine adverse effects (34.95%), availability of other malaria preventive measures (33.96%) and not seeing the positive effect of the vaccine in others first (32.97%). The findings of this survey provide a valuable blueprint for the development of targeted interventions to facilitate caregiver acceptance of the RTS,S vaccine.

Health seeking behaviour among caregivers of under-five children in Edo State, Nigeria

Aim: Timely and appropriate healthcare seeking behaviours if practiced by caregivers of under-five children can have a significant impact on child survival. This study assessed the knowledge of, and general health seeking practices among mothers of under-five children in Nigeria. Methods: This descriptive cross-sectional study was carried out among caregivers of under-five children in Edo State, Nigeria, in 2013. A multi-staged sampling technique was used to recruit respondents. Data collection was done by means of a structured interviewer-administered questionnaire adapted from UNICEF/IMCI household baseline survey questionnaire. Results: A total of 370 caregivers (mean age: 31.1±5.9 years) participated in the study. Almost all of them were females 368 (99.5%), 234 (63.2%) had secondary education and 283 (76.5%) were in the unskilled social class. Over 70%, 76%, 72%, 76% and 82% of participants did not know that being unable to eat/drink, fast breathing, blood in stool and convulsion, respectively, were symptoms of a child not feeling well. The place of primary care of children by caregivers was at home 142 (38.4%), chemist shop 91 (24.6%) and health facility 80 (21.6%). Cost and long waiting time were major reasons for not seeking care in health facilities. Conclusion: This study showed poor health seeking practices among caregivers of under-five children in Edo State, Nigeria. There should be continuous education of caregivers on recognition of danger signs in children and the need to seek appropriate medical care in health facilities.

Prevalence and patterns of anthropometric failure among under-five children in Nigeria: Evidence from the National nutrition and health survey, 2018.

Globally, malnutrition among under-five children remains a public health concern. There is increasing concern at research and policy levels about anthropometric failure and the double burden of child malnutrition across different groups of children. The objective of this study was to describe the magnitude and distribution of various forms of anthropometric failure (AF) among children under age five in Nigeria. We used the 2018 National Nutrition and Health Survey data collected among 19,471 under-five children in Nigeria. The most prevalent AF was stunting only (17.7%) followed by stunting and underweight (13.9%). Wasting, stunting and underweight was found among 3.5% of the sample. Wasting, stunting and underweight was most common in age 6-11 months (7.0%) and 12-23 months (6.9%). Overall, about 1 out of 5 under-five children has multiple anthropometric failure. The peak age group for multiple AFs was between six months and 35 months. Multiple AF was less likely among females compared to males (RR=0.74, CI: 0.69, 0.80). The risk of multiple AF was higher in both North East (RR=2.15, CI: 1.78, 2.59) and North West (RR=2.98, CI: 2.51, 3.55) relative to the North Central. In contrast, the risk was lesser in the South East (RR=0.75, CI: 0.59, 0.95) and other southern regions. The study showed that multiple anthropometric failure is a common problem among children in Nigeria. Programmes that will support prevention and early identification of different types of malnutrition among under-five children across States in Nigeria are recommended.

Hierarchical modelling of factors associated with anaemia among under-five children in Nigeria.

This study used a nationally representative cross-sectional data from 2018 Nigeria Demographic Health Survey (NDHS) to investigate the prevalence and factors associated with anaemia in children aged less than five years in Nigeria. Anaemia was defined as haemoglobin level <11.0g/dl, while explanatory variables included parental profile, social and environmental factors. Descriptive analyses and multivariable Poisson regression models were fitted using Stata 15 software. Associated factors were quantified using Prevalence Ratio (PR) with 95% confidence interval (CI). Of the 5834 children aged 6-59 months, 51.9% were male. The prevalence of anaemia among under-five children was 71.6% (95% CI: 69.9-73.2). Childhood anaemia was associated with history of maternal anaemia (PR 1.06; CI 1.05-1.08); having underweight mothers (PR 1.02; CI 1.00-1.05); being a Muslim (PR 1.05; CI 1.02-1.08), Igbo (PR 1.07; CI 1.01-1.14) and Hausa (PR 1.04; CI 1.01-1.07) ethnic group. Further, children from South-South (PR 1.09; CI 1.06-1.13) and South-West (PR 1.06; CI 1.02-1.10) and those currently breastfeeding (PR 1.06; CI 1.04-1.07) had higher risk of anaemia. However, children from middle (PR 0.94; CI 0.91-0.97), or higher wealth indices were less likely to have anaemia. Maternal socio-economic and nutritional characteristics were identified as key predictors of under-five anaemia. Strategies are needed to mitigate the effect of poverty and tweak new and existing nutritional intervention programs to make them responsive to socio-cultural peculiarities across the various geo-political regions of Nigeria.

Prevalence and Determinants of Undernutrition among Under-Five Children in Nigeria: A Systematic Review

BACKGROUND: Child undernutrition is a key public health issue that both causes and contributes to disease and death. Undernutrition accounts for 45% of under-five deaths globally most of which occur in Low- and Middle-income countries (LMIC). Malnutrition has a substantial and long-lasting effect on individuals, families, communities and the entire nation. This study aimed to assess the prevalence and determinants of undernutrition in under-five children in Nigeria.&#x0D; &#x0D; METHODOLOGY: This systematic review was done following the Cochrane library guidelines. A search of literature written in English language and published between 2000 and 2022 was done using PubMed, CINAHL, MEDLINE and ProQuest databases. The initial search resulted in 760 studies. These were exported to End note version 9 to remove duplicates. Titles and abstracts were screened for studies that met the inclusion criteria. Finally, 11 studies that met the inclusion criteria were thoroughly assessed and data that were relevant to this systematic review were captured. The study findings were analyzed using descriptive statistics.&#x0D; &#x0D; RESULTS: The prevalence of undernutrition was between 1.0% and 43.3%. The highest prevalence of underweight, wasting and stunting were 43.3%, 29.3% and 41%, respectively. Factors associated with undernutrition were age, sex, birth order, recent acute diarrhoea and acute respiratory infection, maternal literacy level, maternal income &amp;lt;$20 and socio-economic class among others.&#x0D; &#x0D; CONCLUSION: Under-five undernutrition is a huge public health issue in Nigeria. Prevalence of undernutrition varies widely across geo-political zone with a myriad of associated risk factors. Multi-level and multidisciplinary interventions are required to sustainably address the determinants of under-five undernutrition.

Common childhood illnesses: a cross-sectional study of commodity stocking patterns and management knowledge among patent and proprietary medicine vendors in Nigeria

BackgroundThe trio of commonest illnesses and causes mortality among children under five (Malaria, Pneumonia and Diarrhea) are easily treatable through timely exposure to cost effective interventions at the community level. Patent and proprietary medicine vendors (PPMVs) are a leading source of care for illnesses among under-five children in Nigeria. This study was designed to explore child health services offering, particularly commodity stocking patterns and case management knowledge for common childhood illnesses among PPMVs in Ebonyi and Kaduna States.MethodsA descriptive cross-sectional study was conducted among PPMVs in four local government areas across Ebonyi and Kaduna States. Data was collected using semi-structured interviewer-administered questionnaires. Information was obtained on medicine and supplies, knowledge of common childhood illnesses management and referral practices.ResultsA total of 374 PPMVs were interviewed; the mean age was 33.7 ± 9.8 years. Among the 132 health trained respondents, 59.0% offer treatment services for sick children while 83.5% of the non-health trained respondents offer the same service. At least, 88.0% of the respondents keep stock ACTs, Amoxycilin DT, ORS and Zinc. About 38.5% reported stock-out of ACTs in the month preceding the study, 55.1% reported stock out lasting only 0 to 6 days. Only 83 (22.2%) of respondents knew the correct diagnosis of fast breathing among children aged 2 to less than 12 months old. Education and health training background were associated with a good knowledge of common childhood illnesses management (X2 = 44.88, p < 0.001; X2 = 27.14, p < 0.001).ConclusionThe relative constant availability of medicines and commodities for managing childhood illnesses positions PPMVs as a preferred source of care for these illnesses. There is a need to complement steady stock availability with provision of quality services by exposing PPMVs to trainings on integrated community case management of childhood illnesses and implementation of robust supervision mechanism to monitor them.

Nutritional status of children with epilepsy, attending the Pediatric Neurology Clinic of University of Nigeria Teaching Hospital, Enugu

Background: Malnutrition is a direct or underlying cause of 45% of all deaths of under-five children in Nigeria. Nigeria has one of the highest burden of malnourished children in the world. Certain vulnerable groups such as children with chronic diseases are often neglected in nutritional studies. Objective: This study sought to determine the prevalence of malnutrition among children with epilepsy, attending the Neurology Clinic of the University of Nigeria Teaching Hospital. Materials and Methods: This was a descriptive cross-sectional study. Study participants were epileptic children aged 6 months to 18 years. Socio-economic status was determined using the Oyedeji classification. Weight and height were measured using standard protocols. The weight for height, body mass index for age, and height for age z-scores were calculated using the WHO Anthro and Anthro Plus software. Data were analyzed using SPSS version 20.0, and significant p-values were set at less than 0.05. Results: One hundred and twenty children with epilepsy aged 6 months to 18 years who met the inclusion criteria were included in the study. Seventy-eight (65%) were males; (male: female ratio = 1: 0.5). The overall prevalence of wasting, stunting, overweight, and obesity were 5.8%, 9.2%, 10.8%, and 5.8%, respectively. There were no statistically significant differences between various forms of malnutrition and the gender, age group, and socio-economic status of study participants (p > 0.05). Conclusion: Overweight was the most common form of malnutrition, followed by stunting among the epileptic children. There is need for regular anthropometric monitoring of children with drug-naive epilepsy with targeted interventions to correct malnutrition in them during the course of epilepsy management.

Association Between Source of Treatment and Quality of Childhood Diarrhea Management Among Under-Five Children in Nigeria

Background and Objective: Despite the availability of low-cost and effective interventions, diarrhea remains one of the leading causes of under-five morbidity and mortality in Nigeria. We assessed the relationships between the source and quality of treatment for children with diarrhea in Nigeria. Methods: We analyzed cross-sectional data on 3,956 under-five children with a recent diarrheal episode, from the 2018 Nigeria Demographic and Health Survey. The outcome was quality of diarrhea management based on the administration of the following treatment recommendations: oral rehydration salt (ORS), zinc supplementation, increased oral fluids, and continued feeding. The exposure was the source of treatment (none; traditional/informal; public hospitals/health centers; private hospitals/clinics; and community-based services). Using adjusted, multivariable logistic regression, we estimated the odds ratio (OR) and 95% confidence intervals (CI) to predict the factors related to the quality of diarrhea management. Results: In all, only 1 in 5 children received all the four recommended diarrhea interventions. The odds of good quality diarrhea management were higher among children who received treatment in public hospitals/health centers, private hospitals/clinics, and community-based services compared to those of children who did not receive treatment (OR=2.52, 95% CI=1.89-3.34; OR=2.46, 95% CI=1.90-3.16; and OR=1.91, 95% CI=1.40-2.59, respectively). Compared to children whose parents did not seek treatment, the odds of receiving ORS ranged from 2.1 times (OR: 2.11, 95% CI=1.44-3.11) for seeking care in traditional/informal sources to 12.3 times (95% CI=8.81-17.15) in public hospitals/health centers. We observed similar trends for zinc supplementation. The odds of increased oral fluids were higher in public and private hospitals/clinics (OR=1.44, 95% CI=1.03-2.01 and OR=2.08, 95% CI=1.57-2.76, respectively). Across all settings, the odds of continued feeding were significantly lower among children who received treatment compared to children who did not receive treatment. Conclusion and Implications for Translation: Our findings indicate poor quality diarrhea management across various treatment settings. Policies and programs that encourage caregivers to seek treatment and improve the quality of care may contribute to reducing childhood diarrhea-related morbidity and mortality in Nigeria. Copyright © 2021 Olorunsaiye et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

A Bivariate Analysis of the Spatial Distributions of Stunting and Wasting Among Children Under-Five in Nigeria

Stunting and wasting are major malnutrition issues among children under five years of age and have continued to remain unacceptably high in Nigeria leading to high rates of child morbidity and mortality. Evidence-based strategies are required by government and non-governmental agencies to mitigate the suffering of these children, and this could be realised when the association between the determinants and the geographical distributions are fully understood. Using data from four waves of the Nigerian Demographic and Health Survey, we employed a distributional bivariate probit model to examine the geographical distributions of the levels and linear association between acute and chronic malnutrition in Nigeria after accounting for possible observed determinants. Bayesian inference was based on Markov chain Monte Carlo simulation. The findings reveal substantial spatial variations in stunting and wasting among under-five children in Nigeria, indicating a north–south divide. The findings show negative linear association between the two malnutrition indicators among children in some northern fringe states but positive for Akwa Ibom, Ebonyi and Anambra. The correlation also peaks around age 20 months indicating that during the first 2 years of life, the children have an increasing likelihood of suffering from stunting and wasting.