Under-five Children Research Articles

The Impact of Socio-Economic, Demographic, and Geographic Factors on the Mortality of Children Under the Age of Five in Kenya, 2022

Background: Reducing the under-five child mortality is vital to a nation’s development; global progress has been made in the past two decades. Nevertheless, substantial efforts in the Sub-Saharan Africa region are required to address critical risk factors to attain the Sustainable Development Goals (SDGs) by 2030. We aimed to identify the impact of socio-economic, demographic, and geographic factors on under-five child mortality in Kenya. Methods: This study utilized data from the 2022 Kenyan Demographic and Health Survey (KDHS). We extracted mortality data for children under the age of five and demographic, socio-economic, and household/geographic factors. Results: Overall, 19,530 children under the age of five yr were included, with 9,950 (50.95%) males and 9,580 (49.05%) females. Amongst children, 18,836 (96.45%) were alive and 694 (3.55%) were dead. Study findings revealed a significant association between the mother’s age and the child's death. Mothers aged between 15 and 19 yr of age indicate higher odds of child death. The odds of death of children not breastfed is 1.69 times that of other children. Mothers who had no child above five years old previously had higher odds of child mortality than those with at least three children above five years old. Conclusion: Under-five child mortality is significantly associated with breastfeeding, the mother’s age, and mothers who had a child previously in Kenya. The identified significant determinants align well with the SDG 2030 targets of improving socio-economic status, healthcare systems and reducing inequality. Therefore, the study suggests that preventing underaged women’s pregnancy, proper maternal nutrition among pregnant women, and breastfeeding should be practiced as they are more likely to reduce under-five child mortality.

Health matters: a statistical approach to understand childhood illnesses in the North-East States of India, 2019-2021.

The present study explores the prevalence and socio-economic demographic factors affecting childhood illnesses. Diarrhoea, fever and ARI among under-five children in the North -East states of India using NFHS-5 data Kids file. Results showed that diarrhoea, ARI, and fever among the northeastern states were highest in Meghalaya.For diarrhoea Sikkim has the highest prevalence for children within 6months while Meghalaya has the highest prevalence in the age groups 6- 12months and 1- 2years old children and Arunachal Pradesh has the highest rate in the age group 2- 5years old children. Meghalaya stands out with the highest prevalence of fever and ARI in all age groups. Compared to Sikkim, the state of Meghalaya had more diarrhoea, ARI and fever, and it was statistically highly significant. However, Tripura and Assam had significantly higher odds of having fever and ARI than Sikkim. There is an association between diarrhoea, fever, and ARI and factors such as the age of the child and caregiver, the wealth status of the household, the quality of sanitation facilities, methods of stool disposal, and the caregiver's educational level.

Perception of caregivers on ITNs utilisation and its effectiveness among children under 5years of age in Chikwawa district, Malawi.

In 2020, Malawi had 6.9 million malaria cases and 2551 deaths, mainly in children under five years of age. The 2017-2022 Malawi malaria control strategic plan promoted the consistent use of insecticide-treated nets through free distribution and mass campaigns. Despite widespread availability of the control strategy plan, Chikwawa District continues to suffer from high malaria burden especially among under five children, due to inconsistent insecticide-treated (ITN) net usage. For this reason, this study aimed at exploring caregivers' perceptions on insecticide-treated net utilisation and also find out about its effectiveness among those who consistently use them. This study used a sequential exploratory mixed methods design. The data used for quantitative analysis was drawn from the population of under-five children's caregivers within the catchment area of Chikwawa district hospital. The sample size was 96 participants, as determined by Cochran's formula. The data collection lasted from December 2023 to April 2024 and included four in-depth interviews and three focus group discussions to address the objectives qualitatively. The study revealed that 91.67% of households used ITNs, with 87.50% using them daily. The significant factors influencing ITN utilisation included the number of nets, user satisfaction, perceived impact, user habits, acquisition method, and usage frequency (all p values < 0.001). Under-five malaria cases were also significant (p = 0.025). The odds of the perceived net impact influencing utilisation were 4.956 times greater. Non-usage was due to heat, quality concerns, limited access, breathing difficulties, health conditions such as asthma, and misconceptions about net treatment. The study revealed a strong belief in insecticide-treated net efficacy. However, some challenges such as access, durability, and misinformation of insecticide-treated nets were discovered. These challenges affected utilisation of insecticide-treated nets in agreement with some literature reviewed. The insights found in this study will help policymakers in addressing health interventions for the reduction of malaria cases in Malawi.

The Analysis of Knowledge to the Skill of Health Cadres in Carrying Out the Early Detection of Pneumonia in Sick Children in the Working Area of Public Health Centre, Belimbing Padang City

Under-five year children death in Indonesia due to pneumonia are 32 per 1000 live birth. Data in 2018 in West Sumatra, the prevalence of ISPA was 5%, pneumonia rose to 2.5%, in the city of Padang in 2018, the number of pneumonia sufferers were 3,196 under-five year children (3.91 %). In public Health Center, Belimbing the cases of respiratory tract infection is ranked first among the ten most common diseases (53%). The aim of the research is to analyze the knowledge to the skill of cadres regarding the early detection of pneumonia in under five year children. This research design is a cross-sectional study. The population in this research were 55 respondents. Data collection used questionnaires and observation sheets. Data processing was used by editing, coding, entrying and cleaning. Univariate analysis was made in frequency distribution in percentages, and bivariate analysis used the Chi square test (CI 95%). The research results showed that there is a relationship between knowledge to health cadres’s skill, with p-value (0.004). It is hoped that cooperation will continue the program for sustainability and conduct continuous evaluation to reduce pneumonia.

Factors associated with severe malaria-related mortality among hospitalized children under five years of age in Eastern Province of Rwanda: a cross-sectional study using hospital records from 2017 to 2021.

Malaria remains a significant concern for children under five in malaria-endemic regions. Rwanda's successful efforts in malaria treatment reduced nationwide cases, but high mortality persists in the Eastern and Southern provinces. This study aimed to investigate the clinical features of severe malaria and to identify the death risk factors among under-five children in Eastern province Hospitals. This cross-sectional study assessed severe malaria-related mortality and associated factors among children aged under five years in hospitals of Eastern Province, Rwanda, from 2017 to 2021. Data were collected from hospital records, and descriptive statistics and logistic regression were used for data analysis. Factors associated with severe malaria-related mortality included coma (aOR: 10, 95% CI: 1.2-82.5, p = 0.03), Vomiting (aOR: 5.2, 95% CI: 1.0-26.0, p = 0.04), four or more days of illness before consultation (aOR: 30.9, 95% CI: 8.7-109.9, p < 0.01). On the other hand, a low parasitaemia level (aOR: 0.01, 95% CI: 0.0-0.1, p < 0.01). In conclusion, coma, vomiting, and healthcare delays increased mortality in children with severe malaria. Prompt treatment, proper assessments, protocol adherence, and caregiver education on early symptom recognition are crucial for improving outcomes.

Prevalence of anemia and its associated factors among under-five children living in Arba Minch Health and Demographic Surveillance System Sites (HDSS), Southern Ethiopia.

Childhood anemia affects around half of under five children and has impacts on physical, mental, and social development, both in the short and long term. The objective of the study was to determine the prevalence of anemia and its associated factors among under-five children living in Arba Minch Health and Demographic Surveillance System Sites (HDSS). A community-based cross-sectional study was conducted among randomly selected under-five children with their caregivers living in Arba Minch HDSS from June to August 2023. The questionnaire was developed to assess sociodemographic, nutrition, healthcare, and environmental characteristics. Hemoglobin concentration was adjusted for altitude of the village. Anemia was defined as the hemoglobin concentration below 11 g/dL. It was further categorized as mild (between 10-10.9 g/dL), moderate (7-9.9 g/dL), and severe (less than 7 g/dL). The analysis of factors associated with anemia was assessed by using logistic regression and significance was determined at p-value <0.05. A total of 332 under-five children with a mean (SD) age of 33(15) months participated. The overall prevalence of anemia among under-five children was 35.3% (95% CI: 30.4, 40.7). The magnitude of mild, moderate, and severe anemia was 12.4% (95%CI: 9.2, 16.4), 22.1% (95%CI: 17.9, 26.9), and 0.9% (95%CI: 0.3, 2.8), respectively. Anemia had a negative association with the advancing age of the children (0.95, 95%CI: 0.93, 0.97) and improvement in the family wealth score (0.86, 95%CI: 0.75, 0.99). Nearly one-third of the under-five children were anemic and childhood anemia is a moderate public health problem in the study area. The magnitude of anemia was negatively associated with the advance in child age and with the increase in the wealth status of the household. It is important to provide due attention to reduce the magnitude of anemia specifically for the youngest children and for those children from poor households.

Preserving nets, protecting children: an evaluation of factors influencing the utilization and physical integrity of long-lasting insecticidal nets among under-five children in Osun State, Nigeria.

Malaria remains a significant public health challenge in Africa where it is the most important vector-borne disease. Nigeria bears the largest burden, with pregnant women and children under 5years being more affected. Although, long lasting insecticidal nets (LLINs) remain effective for control, its use has been suboptimal. Hence this study assessed, household ownership, physical integrity and use of LLINs among children. A community-based, cross-sectional study was carried out among 1642 households using a multistage sampling technique in Osun State, Nigeria. A pretested, interviewer-administered questionnaire was used to obtain information on socio-demographic characteristics and use among under-fives. LLINs were inspected for physical integrity and cleanliness. A binary logistic regression analysis was conducted to identify factors influencing LLIN use by under-fives. The mean age of children was 32.2 ± 16.5months. Most households, 1586 (96.6%) had an LLIN while 165 (10.4%) did not hang their net. Holes were present in LLINs in 360 (22.7%) households and 196 (12.4%) had dusty or stained nets. Most households, (1259; 79.4%), had at least one LLIN for every 2 household members and survey participants reported that 1331 (83.9%) under-fives slept under an LLIN the night before the survey. Factors associated with reported LLIN use were; older parents/guardians aged 50-59years (AOR: 3.02; 95% CI 1.50-6.09), having a post-secondary education (AOR: 2.56; 95% CI 1.31-5.00), having LLIN obtained < 12months (AOR: 4.27; 95% CI 2.39-7.64), households with one LLIN for every 2 members (AOR: 1.65; 95% CI 1.15-2.37) and households with clean nets (AOR 2.75; 95% CI 1.89-4.00) had increased odds of reported LLIN utilization by under-five children. Although LLIN ownership and reported use were high in this study, gaps exist between ownership and reported use of LLINs. About one-fourth of LLINs had poor physical integrity. To maximize LLIN effectiveness in households, it is important to ensure the continued free distribution of nets and emphasize messages to parents/guardians on proper care, maintenance, and use of nets.

Directed acyclic graph helps to understand the causality of malnutrition in under-five children born small for gestational age

Directed acyclic graph helps to understand the causality of malnutrition in under-five children born small for gestational age

Rural-urban disparities in basic sanitation access among households: a multivariable decomposition analysis of Ethiopian demographic and health survey 2019

IntroductionDisparities in access to basic sanitation services between rural and urban households pose significant challenges to public health and human development. Understanding the determinants contributing to this gap is vital for advancing the Sustainable Development Goals (SDGs) and improving environmental and public health through evidence-based interventions.ObjectiveThis study aims to analyze and understand the disparities in access to basic sanitation services between rural and urban households in Ethiopia.MethodsThis study analyzed a sample of 8,663 weighted households, collected using stratified sampling techniques, utilizing the data from the 2019 Ethiopian Demographic and Health Survey (EDHS). The primary outcome was basic sanitation access, defined as access to flush or pour-flush systems, septic tanks, pit latrines, or composting toilets. A multivariable decomposition analysis was conducted to identify factors contributing to rural–urban disparities. Statistically significant variables were determined at a p-value of &amp;lt;0.05 with a 95% confidence interval.ResultsThe weighted proportion of basic sanitation access in Ethiopia was 13.78% (95% CI, 12.67–14.96), with significant disparities between rural (6.02%) and urban (27.15%) residents. Endowment factors accounted for 78.9% of this disparity, while behavioral coefficients contributed 22.1%. If the characteristics of respondents in rural and urban households had been similar, significant factors that would have narrowed the gap included the age of the household head (15–35 years), the absence of under-five children, smaller family size, and the attainment of secondary education, reducing the gap by 1.83, 2.07, 5.08, and 3.25%, respectively. Conversely, illiteracy and primary education levels widened the gap between rural and urban access to basic sanitation services by 16.85 and 0.23%, respectively. Additional factors exacerbating the rural–urban disparity included poverty (which widened the gap by 58.71%), residence in pastoralist regions (which widened the gap by 10.10%) or agrarian regions (which widened the gap by 7.03%), and access to water sources located more than 30 min away (which widened the gap by 7.91%).ConclusionSignificant disparities in access to basic sanitation services exist between rural and urban households in Ethiopia. Key factors contributing to these disparities include the age of the household head, education level, family size, region of residence, and water source proximity. Addressing these factors is essential for improving sanitation access and achieving the Sustainable Development Goals (SDGs).

Study on Weight Gain Efforts through Indigenous Technical Knowledge

Introduction: In India, under-five child malnutrition is a serious public health issue. This is demonstrated by the fact that India has one of the highest rates of underweight children worldwide. Aims: The study was carried out to assess the spatial distribution of nutritional status of children of 1-5 years through weight-for-age, height-for-age, weight-for-height data collected by the KVK. Preschoolers' dietary health was regressed on several sociodemographic factors after eliminating the effect of age. The information reveals that children's nutritional condition varies geographically and by gender in India. Methodology: A study was conducted in district Seoni of Madhya Pradesh to eliminate malnutrition via using indigenous technical knowledge (ITK). The trials were conducted in three following years viz 2020 to 2023. Primarily the training was conducted of mothers along with Anganwadi workers regarding the addition of sweet rice to kids from 1-5 years age group. Results: There was twice-daily portions of sweet rice, was prepared by using Jaggery by adding water, desi ghee, and roasted rice dry fruits added to it and then it cooked for 15-30 min and given for 45 days. The average body weight gain after evaluation and personal conversations of mothers was recorded as 9.91 kg and the proportion change against farmers practice was 13.48. Conclusion: The study concluded that rice prevalent areas and rice-based food habits for mothers and children should be adopted the sweet rice (ITK) the recommended practice against farmers’ practice.

Enteric Adenovirus Gastroenteritis in Under-Five Children, Kano-Nigeria

Abstract Context: Adenoviruses have been implicated in many outbreaks and sporadic cases of pediatric gastroenteritis. Aim: This study aimed to determine the prevalence and circulating serotype(s) of enteric adenoviruses among under-five children with diarrheal diseases in Kano, Nigeria. Settings and Designs: This was a multicentered hospital-based cross-sectional study involving 250 under-five children recruited from Murtala Muhammad Specialist Hospital, Muhammad Abdullahi Wase Teaching Hospital and Hasiya Bayero Paediatric Hospital. Materials and Methods: Enteric adenovirus F40/F41 were checked in the stools of children exhibiting symptoms of gastroenteritis, diarrhea, and/or vomiting by nested PCR amplification of the adenovirus Hexa/E1B regions and positive samples characterized by sequencing and phylogenetic analysis. Statistical Analysis Used: Data generated were analyzed using descriptive statistics, and the association between the variables was checked by the Chi-square test. A P value &lt;0.05 was considered statistically significant. Results: The nested PCR result shows that 7 (2.8%) out of the 250 stools were positive for enteric adenovirus (group F), with only serotype F41 detected within the cohort examined. The isolates were more closely related to KJ425126 from Gabon. The results highlighted that fever and vomiting are prominent features of adenovirus F41 gastroenteritis and children 1–2 years especially males were mostly affected. Conclusion: The study improved our knowledge and understanding of the role of enteric adenovirus in under-five gastroenteritis and suggests that EAdeV-F41 is an important cause of gastrointestinal infections, particularly in infants and young children in Kano, Nigeria. This may call for routine screening of the stools of children with diarrhea for future management guidelines.

Effectiveness of structured teaching programme on knowledge regarding worm infestation among mothers of under-five children

Background: Children from low and middle-income nations continue to be primarily affected by worm infections. Development and nutrition may be hampered by an intestinal worm infection. The study aimed to assess the effectiveness of structured teaching programme on knowledge regarding worm infestation among mothers of under-five children. Methods: A pre-experimental one group pre-test and post-test research design was used for the study. The sample selected were 40 mothers of under-five children in a selected area of Pulwama, Kashmir. A self-structured interview schedule was used to assess the knowledge. Results: The collected data was analysed by SPSS. The study findings revealed that the mean knowledge score of nursing students in the pre-test was 16.97 and mean knowledge score of nursing students in the post test was 29.52, with a mean difference of 12.55. In pre-test, 30 (75%) had poor knowledge, 10 (25%) had average knowledge, whereas in the post-test 8 (20%) had poor knowledge, 25 (62.5% had average knowledge and 7 (17.5%) had good knowledge. The present study revealed that there was no significant association between pre-test knowledge score with the selected socio-demographic variables. Conclusions: The study revealed that mean knowledge score of nursing students in post-test was higher than the mean knowledge score of nursing students in the pre-test. The structured teaching programme was effective in improving the knowledge regarding worm infestation among mothers of under-five children.

Longitudinal analysis of growth and nutritional disparities across socio-demographics from early childhood to adolescence: Findings from the Indian cohort of the Young Lives Survey.

Previous studies generally used cross-sectional data and focused on under-five children to assess the risk factors for malnutrition among Indian children. Some recent studies have reported that recovery from or faltering in malnutrition is possible after five years of age, but socio-demographic subgroup disparities have not been explored. This study aims to find the longitudinal disparity in height-for-age Z-scores (HAZ) and body-mass-index-for-age Z-scores (BMIAZ scores) across various sub-groups of a cohort from childhood to adolescence. This study used a cohort from the Young Lives Survey, which followed children aged of 1-15 years between 2002 and 2016-17 in the states of Andhra Pradesh and Telangana, India. Mixed-effect models were applied to find the main, time, and interaction effects of HAZ scores and BMIAZ scores. In addition, an extended Kitagawa-Oaxaca-Blinder decomposition approach to assess group-based differences over time was used. The cross-sectional prevalence of stunting reduced across all subgroups, while thinness rose during the same period. The interactions of child sex, mother's education, place of residence, wealth index, and antenatal care with time were statistically significant at p <0.05. The gender disparity in adjusted HAZ score decreased from 0.214 units at 1 year to 0.011 units at 15 years, whereas BMIAZ score differential increased from 0.106 to 0.538 units over same timeframe. Disparities in scores were also observed across rural-urban, maternal education, social group, religion, socioeconomic status, maternal age at birth, antenatal care, and premature birth status. The study sheds light on the nuanced dynamics of paediatric growth, emphasising the importance of longitudinal approaches in understanding and addressing the health disparities across different stages of childhood and adolescence.

Air pollution and under-5 child mortality: linking satellite and IPUMS-DHS data across 41 countries in South Asia and Sub-Saharan Africa

BackgroundDespite progress, under-five mortality remains high, especially in Sub-Saharan Africa and South Asia, where around 13,400 children die daily. Environmental pollutants, including PM2.5 from outdoor air and household air pollution, significantly contribute to these preventable deaths.MethodsThis cross-country study combined satellite data with 113 surveys from the IPUMS-DHS dataset (1998–2019) to examine under-five child mortality in 41 developing countries. The integration of Global Annual Particulate Matter with a diameter of 2.5 micrometres or less (PM2.5) Grids from Socioeconomic Data and Applications Center (SEDAC) and geospatial data from the DHS Program enabled a focused analysis of the association between indoor and outdoor air pollution, particularly PM2.5, and child mortality rates using both logistic and multilevel logistic regression models, as well as estimating Population Attributable Fractions (PAF) to quantify the mortality burden attributable to these pollutants.ResultsOutdoor air pollution, measured by a one standard deviation increase in PM2.5, significantly increased the risk of child mortality (Odds Ratio [OR]: 1.14; 95% Confidence Interval [CI]: 1.10–1.18; p < 0.001). Moderate and high household air pollution exposure also heightened this risk, with increases of 37% (OR: 1.37; 95% CI: 1.24–1.53; p < 0.001) and 40% (OR: 1.40; 95% CI: 1.26–1.56; p < 0.001), respectively, compared to no exposure. Multilevel models (Models 5a and 10a) produced similar estimates to standard logistic regression, indicating robust associations. Additionally, Population Attributable Fraction analysis revealed that approximately 11.9% of under-five mortality could be prevented by reducing ambient PM2.5 exposure and 12.0% by mitigating household air pollution. The interaction between indoor and outdoor pollution revealed complex dynamics, with moderate and high household exposure associated with a reduction in mortality risk when combined with PM2.5. Geographical disparities were observed, with stronger correlations between outdoor air pollution and child mortality in Africa compared to Asia, and more pronounced impacts in low-income countries. However, household air pollution had stronger association with child mortality in Africa and lower- and middle-income countries.ConclusionsOur findings could serve as a guide for policy development aimed at reducing under-five mortality, ultimately contributing to the attainment of the Sustainable Development Goal (SDGs).

Knowledge, Attitude and Practice Regarding Use of ORS in Diarrhoea by Mothers in an Island of Bangladesh

Introduction: The second leading cause of death in under-five children is diarrhea. ORS is a simple and highly effective therapy for managing diarrhea. However inappropriate knowledge of preparation and lack of use of ORS leads to health hazards including increased rate of mortality and morbidity. So aim of this study to assess the knowledge, attitude, and Practice of mothers towards the use of oral rehydration solution in the treatment of acute diarrhea in children. Methods: A cross-sectional study was carried out over eight months (1st May to 30th December 2023) among 510 mothers who had children of six months to five years and had recent episodes of diarrhea. Data were collected by using a semi-structured questionnaire in face-to-face interview. Data were analyzed by using SPSS software program.Results: Among 510 mothers, 47.05% were 20-30 years old, 29.80% were below 20 years and 23.13% were over 30 years. One fourth of them had no institutional education and 36.27% had primary, 20.78% and 18.23% had secondary and tertiary level of education respectively. 40.39% were from lower socioeconomic condition, 31.97% were from middle and 27.64% from upper socioeconomic condition. 100% of family used sanitary latrine though 73.72% use safe drinking water as a preventive part of diarrhea.89.98% of mother was aware about ORS but only 75.88% used ORS in recent episode of diarrhea, among them 63.03% prepared ORS correctly and 60.98% used adequate amount. Age of mothers was not corresponds with the correct preparation and practice of ORS but socioeconomic condition and level of education carried statistically significant value. Conclusion: Knowledge and practice of ORS preparation and used of ORS in recent episode of diarrhea among the mother was unsatisfactory. Improve the Maternal education and socioeconomic status will improve ORS correct preparation and use. Mothers should be taught the importance of optimal use and correct preparation of ORS in diarrhea. EWMCJ Vol. 12, No. 1&amp;2, January-July 2024: 43-49

Assessment of Inflammatory Markers (CBC and CRP) and their Impact on Severity and Recurrence of Pneumonia in Under-Five Children

Background: Pneumonia remains a leading cause of morbidity and mortality in children under five. This study evaluates the association between inflammatory markers complete blood count (CBC) parameters and C-reactive protein (CRP) levels and pneumonia severity and recurrence. Methods: A prospective study was conducted with 110 children diagnosed with pneumonia at Dr. Sirajul Islam Medical College &amp; Hospital and Islami Bank Hospital, Motijheel, Dhaka, from January to December 2023. Clinical assessments included demographic data, pneumonia severity classification, and inflammatory marker measurements. Results: The study population comprised 62 males (56.4%) and 48 females (43.6%), with a mean age of 24.6 months. Inflammatory marker analysis revealed significant differences in WBC count, neutrophil percentage, lymphocyte percentage, and CRP levels across mild, moderate, and severe pneumonia groups (p &lt; 0.001). Higher levels of WBC count (14,500 ± 3,500), neutrophils (72.2 ± 8.6%), and CRP (38.5 ± 11.2) were observed in patients with pneumonia recurrence compared to those without recurrence. Multivariate regression analysis identified WBC count, neutrophil count, and CRP levels as significant predictors of pneumonia recurrence. Conclusion: Elevated inflammatory markers, particularly CBC parameters and CRP levels, correlate with increased severity and recurrence of pneumonia in young children. Monitoring these markers can aid in early identification and management of at-risk pediatric patients, potentially improving clinical outcomes. Further research is needed to explore additional biomarkers and their implications in pediatric pneumonia management.

Exploring the Association Between Floods and Diarrhea among Under-five Children in Rural India.

Flood is one of the major public health concerns increasing the risk of childhood diarrhea. This study aims to explore the association of floods with diarrhea among under-five children in rural India. A cross-sectional study was carried out using large-scale nationally representative data from the National Family Health Survey-5. The Central Water Commission reports between the years 2018 and 2020 were used to group all the districts as non-flood-affected districts or flood-affected districts. Bivariate and multivariate logistic regression models were employed to assess the association of floods with childhood diarrhea. The prevalence of diarrhea was higher among children exposed to three consecutive floods during the year 2019-21 than those children not exposed to flood. Children exposed to flood three times between the year 2018-19 to 2020-21 were associated with a 34% higher likelihood of developing diarrhea than those children exposed to flood one or two times. Our study suggests that community health workers should target mothers belonging to the poor wealth quintile, young mothers, and mothers with young infants and more children to receive child health related counseling in flood-prone areas.

Hygiene practice and diarrhea prevalence among underfive children in Myanmar: a cross-sectional study

BackgroundOver 1.7 billion instances of diarrheal illness in children are reported worldwide yearly. Diarrhea was a major cause of death in children, accounting for 9% of all global under-five child deaths in 2021. The objective of this study was to identify the association between hygiene practices and childhood diarrhea among under-five children in Myanmar.MethodThis cross-sectional study was conducted in 16 townships from 8 states and regions of Myanmar. 1207 children between the ages of 6 and 59 months were recruited by multistage random sampling. Data were collected with a preformed questionnaire after participants provided consent. Multiple logistic regressions were administered to determine the factors associated with childhood diarrhea.ResultThis study found that 86 (7.13%) under-five children experienced diarrhea disease. This study identified that children receiving limited hygiene services were 2.85 times (AOR = 2.85, 95% CI: 1.31 to 6.21; p value 0.01) and children without hygiene services were 2.63 times (AOR = 2.63, 95% CI: 1.42 to 4.89; p value 0.01) more likely to have diarrhea disease than those with basic hygiene services. Other factors associated with diarrhea included: fathers who washed their hands less than four steps (AOR = 2.20, 95% CI: 1.29 to 3.74; p value 0.01), families taking more than 15 min to collect water (AOR = 1.77, 95% CI: 1.06 to 2.97; p value 0.03), families sharing toilet usage (AOR = 2.00, 95% CI: 1.15 to 3.48; p value 0.01), mother’s inadequate and problematic hygiene promotion health literacy (AOR = 2.20, 95% CI: 1.24 to 3.90; p value 0.01), houses made of bamboo or lacking floors (AOR = 2.31, 95% CI: 1.38 to 3.89; p value 0.01), families with three or more children (AOR = 1.68, 95% CI: 1.01 to 2.79; p value 0.05) and breastmilk being the primary food after 6 months of age (AOR = 2.07, 95% CI: 1.09 to 3.93; p value 0.03).ConclusionsEnsuring access to basic hygiene services, getting water at home 24 h per day, seven days per week, using private toilets, promoting hygiene health literacy, improving house flooring, family planning and introducing a variety of foods after age 6 months could significantly prevent diarrhea among under-five children in Myanmar. This study underscores the critical role of handwashing facilities in reducing the diarrhea incidence in children.

Predictors and number of antenatal care visits among reproductive age women in Sub-Saharan Africa further analysis of recent demographic and health survey from 2017-2023: Zero-inflated negative binomial regression.

Antenatal care (ANC) is an important component of maternal and child health care. To reduce perinatal mortality and improve women's experience of care, the World Health Organization (WHO) recommends pregnant women should attend at least eight ANC visits. However, in Sub-Saharan Africa (SSA), the mean number of ANC visits among reproductive-age women using Demographic and Health Surveys (DHS) data following the new WHO recommendation is so far limited. Therefore, the study aimed to determine the mean number of ANC visits and its predictors among reproductive-age women in SSA. Community-based cross-sectional study was conducted among 188,880 weighted reproductive-age women in SSA using a recent round of DHS data from 2017-2023. Zero-inflated negative binomial regression (ZINB) was conducted and statistical significance was declared at p-value <0.05 and adjusted incidence rate ratio(AIRR) for count model part and adjusted odds ratio for logit model inflated part of ZINBR with 95% confidence interval (CI) were reported. The mean number of ANC visits among reproductive-age women in SSA was 4.08 with 95%CI [4.07, 4.09]. Among reproductive-age women who gave birth in the last five years before the survey, 7.3% had eight or more ANC visits during pregnancy. Age of women, maternal and husband educational status, types of pregnancy, birth order, household size, number of under-five children, and wealth index were associated with the numbers of ANC visits among reproductive-age women in Sub-Saharan. The mean number of ANC visits among reproductive-age women in SSA is too lower than the new WHO recommendation of ANC visits for a positive pregnancy experience. This study also highlights that the proportion of at least eight ANC visits is low and there are still disparities in the mean of ANC visits across different regions of SSA. The increasing maternal age, higher maternal and husband educational status, wanted pregnancy, the number of household members, the number of under-five children, and higher wealth index increase the number of ANC visits. Unwanted pregnancy, no more fertility desire, and rural residences were contributed for zero ANC visits in SSA. Therefore, efforts should be geared towards improving maternal and husband's educational status. We strongly recommend that the governments of SSA countries should empower women economically and educationally to achieve the goals of ANC as recommended by the WHO.

Management implications of latent TB among under-five children at risk: Insights from a community study in Mumbai, India.

Latent tuberculosis infection (LTBI) management is crucial to WHO's End TB Strategy. Indian guidelines recommend treating under-five children with household TB contacts after ruling out active TB, regardless of TBI testing. However, the precise LTBI burden among children in high TB burden settings like India is unknown. A community-based study in Mumbai's urban slums screened and managed under-five children at LTBI risk to understand its epidemiology and inform TB control interventions. Total 369 eligible under-five children were enrolled for the study. LTBI screening was done using Tuberculin skin test and Interferon gamma release assay. Active TB was ruled out before initiation of TB preventive therapy among LTBI positives. Statistical tests like chi-square, logistic regression analysis and Hosmer-Lemeshow test were used. Overall, LTBI prevalence among under-five children was 12.4% by IGRA and 21.4% by TST. Undernourished children had significantly lower LTBI positivity by IGRA (p = 0.027), while those with household contacts, longer contact duration and drug-resistant tuberculosis (DR-TB) exhibited proportionally greater IGRA positivity (p = <0.001). The study found a lower LTBI prevalence among under-five children compared to adults, with key risk factors being HHC, DR-TB contact, and prolonged exposure. These findings suggest the need to revise or revisit the TPT framework for this age group in India, particularly by implementing a test-and-treat approach.