Survival analysis of time-to-death for under-five children in Somalia: Application of AFT modeling approach.

Child malnutrition is a complex disorder with long-term effects that can be traced to health outcomes, academic performance, and economic productivity. Although the problem is recognized globally, the burden of child malnutrition remains disproportionately high in Ghana. This study examined the magnitude, determinants, and socioeconomic complexities of child malnutrition in the North East Region of Ghana. Using a cross-sectional design with a quantitative approach, the study employed structured questionnaires to collect data from 1,347 mothers. The prevalence of malnutrition among under-five children in the North East Region was 14.3%. Among these, 65.6%, 13.0%, and 21.4% were underweight, stunted, and wasted, respectively. The respondents’ age (χ² = 58.227, p < 0.001), marital status (χ² = 29.600, p < 0.001), number of children (χ² = 34.620, p < 0.001), educational level (χ² = 53.165, p < 0.001), and occupation (χ² = 40.953, p < 0.001) were socio-demographic characteristics that showed significant associations with the prevalence of malnutrition. Monthly income (Fisher’s exact test = 13.203, p < 0.001), frequency of financial difficulties (Fisher’s exact test = 127.503, p < 0.001), and type of financial support received (Fisher’s exact test = 13.119, p = 0.002) were economic factors significantly associated with the prevalence of malnutrition. The study also found significant associations between the prevalence of malnutrition and respondents’ ability to provide nutritious foods (Fisher’s exact test = 122.514, p < 0.001), frequency of purchasing or receiving protein-rich foods (Fisher’s exact test = 47.276, p < 0.001), percentage of household income spent on food (χ² = 22.828, p < 0.001), age at which children were introduced to solid foods (χ² = 108.727, p < 0.001), respondents’ knowledge of nutrition (χ² = 5.718, p = 0.020), family traditions related to nutrition (χ² = 100.978, p < 0.001), availability of food (χ² = 34.810, p < 0.001), and adherence to health professionals’ advice on child feeding and nutrition (χ² = 76.023, p < 0.001). These results highlight that both structural socioeconomic constraints and behavioural practices contribute substantially to the burden of malnutrition in the region. A comprehensive, multisectoral approach should be implemented that integrates nutrition education, economic empowerment, and improved access to diverse and nutritious foods, while strengthening health system support for optimal child feeding practices, particularly among socioeconomically vulnerable households.

Severe acute malnutrition (SAM) is a disease of global public health concern, worse in developing countries, contributing to illnesses and deaths among under-five children. Diphtheria is a deadly disease with its burden alongside SAM, poorly known. This gap could impact negatively on policy formulation and interventions. In-hospital burden of under-five SAM and diphtheria with their outcome and associated factors were assessed in North-east Nigeria. A retrospective hospital-based cross-sectional study of children admitted for various illnesses at the Paediatric Emergency Unit, Paediatric Medical Ward and the Paediatric Infectious Diseases Unit of the Federal Medical Centre Nguru from 01/01/24-30/09/24. Data was analyzed using SPSS version 23. Univariate and multi-variates analyses were presented in tables and graphs, significant p was < 0.05. There were 194 (12.7%) deaths from the total 1,530 under five admissions. Males accounted for 123 (63.4%) of these deaths. SAM contributed 854 (55.8%) to the total morbidities, while acute diarrhea disease and malaria were the other lead contributors to under-five morbidities with 207 (13.5%) and 130 (8.5%) cases respectively. SAM was the highest 139 (71.6%) contributor to mortalities, followed by Diphtheria 16 (8.2%), Acute Diarrhea diseases (ADDx) 13 (6.7%) and malaria 11 (5.7%). Diphtheria and SAM have the highest case fatality rates of 22.2% and 17.0% respectively. Age, admission duration and diagnosis were major determinants of outcome of care with aOR and CI of 4.24 (2.094-5.125), 6.92 (3.54-8.10) and 2.24 (1.18-3.67) respectively. We found high mortality rate, more males and children with SAM in this study. Most of the SAM patients were infants. SAM, ADDx and Malaria were the reasons for most admissions while SAM, Diphtheria, ADDx and Malaria were the major causes of deaths. Age, duration on admission and diagnosis were the main determinants of outcome of care. Underscoring the needs for early infant feeding and optimal complimentary feeding practices. Not applicable.

Household livelihood vulnerability (HLV) remains a critical yet underexplored determinant of child health in climate-sensitive coastal regions of Bangladesh, where recurrent climate hazards disrupt livelihoods, reduce income stability, intensify food insecurity, and limit access to essential health services. Therefore, this study examines the extent and determinants of HLV and its implications for child health in southwestern coastal Bangladesh. Following the survey method, this community-based cross-sectional study was carried out in six villages of Dacope upazila in Khulna district of Bangladesh. Data were collected from 348 randomly selected caregivers of under-five children at the household level from July to October 2024. The findings demonstrated that the prevalence of HLV was 58.6% in the study area. HLV showed significant spatial and occupational variation, with the highest prevalence observed in Sutarkhali village and among households primarily dependent on Sundarbans-based natural resource extraction. Multivariate logistic regression analysis revealed that higher odds of livelihood vulnerability were examined among Muslim households, households with multiple dependents, food insecure households, those that had recently borrowed money from friends or relatives, and those relying on local government assistance. Conversely, household heads with primary, secondary, or higher education, monthly savings of BDT ≤ 1,000, and households with multiple income earners had lower odds of livelihood vulnerability. Furthermore, child health analysis revealed a significant relationship between household vulnerability and child undernutrition, indicating that children from vulnerable households were more likely to be severely underweight than peers from non-vulnerable households. This study highlights the need for integrated policy responses that simultaneously address livelihood insecurity and child health particularly, strengthening climate-resilient and diversified livelihoods, expanding education, vocational training, and financial inclusion programs (e.g., savings schemes and microcredit), and the integration of vulnerability assessments into child-nutrition programs through targeted cash transfers, supplementary feeding, growth monitoring, and nutrition counseling in coastal Bangladesh.

Acute respiratory infection (ARI) and diarrhea are major public health concerns among children under-five years of age. Somalia has one of the highest under-five mortality rates in sub-Saharan Africa, with diarrhea and ARI accounting for most deaths. No national studies have explicitly assessed the determinants of diarrhea and ARI among children in urban and rural settings. This study aimed to assess the prevalence and determinants of diarrhea and ARI among children under-five in urban and rural Somalia. We analyzed nationally representative data from the 2020 Somali Health and Demographic Survey (SHDS) of 7732 under-five-year-old children with complete responses to the variables studied. Descriptive analyses were used to summarize the respondents' characteristics. Multiple logistic regression was used to assess the determinants of diarrhea and ARI. We present our findings as adjusted odds ratios with a 95% confidence interval (95% CI), and a p-value < 0.05 was considered significant. We employed sample weights, stratification, and clustering to account for the sampling design of the SHDS. We adhered to the STROBE checklist for manuscript reporting. The prevalence of ARI was 10.7% and 12.2% in urban and rural areas, respectively, whereas that of diarrhea was 8.8% and 11.0%, respectively. Residence in the North-West, child age of 0-23 months, prelacteal feeding, maternal age of 15-24 and 25-34 years, no media exposure, and belonging to a poor wealth index were significantly associated with higher odds of diarrhea and ARI among under-fives. Being the first child in birth order, average size at birth, institutional delivery, antenatal care visits, and improved sources of drinking water and sanitation facilities were significantly associated with lower odds of diarrhea and ARI among children aged under-five years in an urban-rural setting in this study. Diarrhea and ARI morbidity in children are significant health challenges in urban and rural areas of Somalia. Public health interventions aimed at high-risk regions, young mothers, impoverished households, home deliveries, and unsanitary use of drinking water and sanitation facilities are crucial for reducing the burden of diarrhea and ARI in children under-five years of age in Somalia.

Background: Malnutrition among under-five children remains persistently high in Northern Nigeria, yet the integrated socio-demographic, environmental, and health system drivers are poorly quantified at the local level. Objective: To identify the socio-demographic, Water/Sanitation/Hygiene (WASH), Infant and Young Child Feeding (IYCF), immunization, and health access factors associated with malnutrition among under-five children in Sokoto State, Nigeria. Methods: A community-based cross-sectional study was conducted among 150 mother-child pairs attending Primary Health Centres across twelve Local Government Areas in Sokoto State between September 2024 and September 2025. Data were collected using a semi-structured questionnaire capturing geographic, demographic, socioeconomic, WASH, IYCF, immunization, and health access characteristics. Anthropometric measurements (weight, height/length, MUAC) were collected. Malnutrition was defined as underweight (Weight-for-Age Z-score &lt; -2SD). Multivariable binary logistic regression identified independent predictors of malnutrition. Model fit was assessed using Hosmer-Lemeshow test (p=0.342) and Nagelkerke R². Results: Underweight prevalence was 83.3% (95% CI: 76.5-88.6). The majority of respondents resided in rural areas (82%). Key findings included: 73.3% of households consumed low/moderate dietary diversity (≤4 food groups); 35.3% practiced open defecation; only 45.3% of children were fully immunized; 76.7% received mixed feeding (not exclusive breastfeeding); 65.3% lived &gt;5km from a health facility; and 84.7% rated external support as inadequate or absent. Only 22.7% of caregivers perceived their child as malnourished despite 83.3% objective prevalence (perception gap). Multivariable analysis identified three independent predictors of underweight: low household dietary diversity (AOR = 4.2, 95% CI: 1.8-9.8, p = 0.001); low maternal education (none/Qur'anic only) (AOR = 3.1, 95% CI: 1.3-7.4, p = 0.011); and extreme household poverty (&lt;₦20,000/month) (AOR = 2.8, 95% CI: 1.2-6.5, p = 0.018). The model explained 41% of the variance in malnutrition status (Nagelkerke R² = 0.41). Conclusion: Malnutrition in Sokoto State is driven by a synergistic interplay of dietary inadequacy, maternal educational deprivation, extreme poverty, poor WASH conditions, low immunization coverage, suboptimal IYCF practices, and geographic inaccessibility to health services. The wide perception gap indicates that malnutrition has become normalized. Addressing this crisis requires integrated, multi-sectoral interventions targeting dietary diversity, girls' education, poverty alleviation, WASH improvements, immunization coverage, and health system strengthening simultaneously.

Introduction Maternal health is a key indicator of a country's healthcare quality and overall development. Beneficiary schemes in obstetrics are designed to enhance health-seeking behavior and provide financial support to pregnant women, particularly those working in unorganized sectors, by compensating for wage loss and improving access to maternal healthcare services. Methods This study was conducted using descriptive correlational research design to assess the awareness and utilization of beneficiary schemes in obstetrics among 100 mothers of under-five children, selected using a consecutive sampling technique. Data were collected using pretested and validated tools, including a background variables proforma, obstetric variables proforma, a structured knowledge questionnaire on beneficiary schemes in obstetrics, and a checklist to assess utilization. Results &amp; Discussion The findings of the study revealed that only 14% of mothers had moderately adequate knowledge regarding beneficiary schemes, indicating generally low awareness levels. A statistically significant association was found between awareness and selected variables such as annual income and parity (p &lt; 0.05). However, no significant correlation was observed between awareness and utilization of beneficiary schemes among the participants. Conclusion The study highlights the gap between awareness and actual utilization of maternal health schemes. It emphasizes the crucial role of healthcare professionals, particularly nurses, in providing effective health education and counseling to antenatal mothers to improve awareness and promote optimal utilization of available beneficiary schemes.

This study aims to compare dietary diversity score (DDS), nutrient intakes and child feeding practices between under-five children who are provided meals by daycare (PM) or bring a lunchbox (LB) and to explore the perspective of mothers, daycare staff and management on their role in providing balanced and nutritious meals for under-five children. The cross-sectional study used mixed method. The quantitative part assessed nutrient intakes using 2-day non-consecutive dietary records and child feeding practices using Child Feeding Practices Questionnaire (CFPQ). Qualitative research employed WeValue Insitu and Perspective Exploration. The study was conducted at daycares in Ministries/Agencies in Jakarta, Indonesia, involving 138 children (6–59 months) and 124 working mothers. The qualitative sample comprised three working mothers, five daycare staff, and five daycare managers. Although DDS was higher among children aged 6–23 months in the PM group, energy and nutrient intakes were lower, with higher inadequacy of folate and calcium. Mothers in the LB had higher scores in environment, encouragement of balance and variety, and restriction subscales. Qualitative data identified role of daycare in providing meals or advice on lunchbox menus, skipping breakfast, eating environment between home and daycare, and nutrition knowledge. The higher nutrient intakes in LB were concurrent with better child feeding practices. Food provision in daycare, if not accompanied by nutrition education for parents, may lead to parents over reliance to daycare. Nutrition education is needed to enhance attitudes and awareness of working mothers and daycare staff regarding breakfast consumption, menu planning, child feeding practices, and portion sizes.

Childhood Malnutrition and its Predictors: A Comparative Cross-Sectional Study on Stunting and Wasting in Under-Five Children Along the Myanmar-China Border.

Introduction: In under-five children, the respiratory disorders contribute as a leading cause for their mortality and morbidity. The nebulization therapy has been an effective method in the treatment of respiratory problems. This study assessed mother's knowledge and practice regarding use of nebulizer among the mothers of under-five children before and after the video-assisted teaching intervention. Methodology: A pre-experimental one group pre-test and post-test design was used; sixty participants were selected using a simple random sampling technique. Prior to the video-assisted teaching, pre-test was administered that included content related to knowledge and practice on use of nebulizer. It was followed by a post-test on eighth day. A structured questionnaire was used to assess the knowledge of the mothers of under-five children with respiratory disorder and a checklist to assess practices regarding use of nebulizer. The analysis done with frequency and percentage distribution, effectiveness of the video-assisted teaching by computation of mean, standard deviation, and paired t-test and the association of pre-test knowledge scores and practice scores with the demographic variables was tested with the chi square test. Result: The results showed that the total of 63.3% mothers had average knowledge, 46.7% mothers had average practices before video-assisted teaching. There was a significant improvement in the knowledge and practice scores of participants after the intervention of video-assisted teaching. The mean of pre-test knowledge score was 10.02+2.80 and post-test knowledge score was 19.89+2.20; the t-value was 30.399 and p-value was 0.001. The mean of pre-test practice score was 9.83+3.42 and post-test practice score was 18.40+1.61; the t-value was 18.677 and p-value was 0.001. Thus, showed a significant difference between knowledge and practices regarding use of nebulizer among mothers of underfive children with respiratory disorders as calculated by paired t-test (p-value&lt;0.05). There was no significant association between with pre-interventional knowledge and practice regarding use nebulizer among the mothers and socio demographic variables at 0.05 level of significance; the hypothesis for knowledge being accepted for all variables except prior information regarding use of nebulizer and frequency of use of nebulizer and for practices except for age of mother, occupation, and information regarding use of nebulizer. Conclusion: Findings concluded an improvement in knowledge and practices of mothers of under-five children regarding use of nebulizer after the implementation of video-assisted teaching.

Human astroviruses (HAstVs) account for 2% to 9% of gastroenteritis cases in children and are occasionally associated with central nervous system complications. We report six draft HAstV genomes from Malawian children <5 years old with gastroenteritis, providing baseline information for the understanding of HAstV diversity and disease burden in sub-Saharan Africa.

Malaria infection continues to cause significant morbidity and mortality in Nigeria despite the integration of the R21/Matrix-M malaria vaccine into the National Programme on immunization. Understanding how caregivers of young children perceive this new vaccine is important for successful implementation. To assess the awareness, acceptability and factors affecting uptake of the new R21/Matrix-M malaria vaccine among caregivers of under-fives in Asaba, Southern Nigeria. A cross-sectional study was conducted between January and June 2025, among 358 consenting caregivers of under-5 children who presented at the children's outpatient and immunization clinic in three health facilities in Asaba, Delta State, Nigeria. The study utilized pretested semi-structured, self-administered questionnaires containing information on vaccine awareness, hesitancy and adverse reactions. Data was analyzed using SPSS 26, with a p-value < 0.05 considered significant. Only 36.3% of respondents were aware of the vaccine. However, most (85.8%) were willing to vaccinate their children. Reasons for reluctance to accept the vaccine were fear of adverse reactions (45.1%), lack of interest (19.6%), and spousal disagreement (13.7%). There was a statistically significant association between the type of health facility and knowledge of malaria vaccines (p = 0.038). Occupation (p = 0.018) and gender of caregivers (p = 0.006) were significant factors, female caregivers and civil servants were more willing to accept malaria vaccination for their wards. Despite a strong willingness among caregivers to vaccinate their children, awareness of the malaria vaccine was inadequate. Targeted awareness campaigns, especially addressing safety concerns and spousal engagement, are urgently needed to translate high willingness into actual uptake.

Introduction: In under-five children, the respiratory disorders contribute as a leading cause for their mortality and morbidity. The nebulization therapy has been an effective method in the treatment of respiratory problems. This study assessed mother's knowledge and practice regarding use of nebulizer among the mothers of under-five children before and after the video-assisted teaching intervention. Methodology: A pre-experimental one group pre-test and post-test design was used; sixty participants were selected using a simple random sampling technique. Prior to the video-assisted teaching, pre-test was administered that included content related to knowledge and practice on use of nebulizer. It was followed by a post-test on eighth day. A structured questionnaire was used to assess the knowledge of the mothers of under-five children with respiratory disorder and a checklist to assess practices regarding use of nebulizer. The analysis done with frequency and percentage distribution, effectiveness of the video-assisted teaching by computation of mean, standard deviation, and paired t-test and the association of pre-test knowledge scores and practice scores with the demographic variables was tested with the chi square test. Result: The results showed that the total of 63.3% mothers had average knowledge, 46.7% mothers had average practices before video-assisted teaching. There was a significant improvement in the knowledge and practice scores of participants after the intervention of video-assisted teaching. The mean of pre-test knowledge score was 10.02+2.80 and post-test knowledge score was 19.89+2.20; the t-value was 30.399 and p-value was 0.001. The mean of pre-test practice score was 9.83+3.42 and post-test practice score was 18.40+1.61; the t-value was 18.677 and p-value was 0.001. Thus, showed a significant difference between knowledge and practices regarding use of nebulizer among mothers of underfive children with respiratory disorders as calculated by paired t-test (p-value&lt;0.05). There was no significant association between with pre-interventional knowledge and practice regarding use nebulizer among the mothers and socio demographic variables at 0.05 level of significance; the hypothesis for knowledge being accepted for all variables except prior information regarding use of nebulizer and frequency of use of nebulizer and for practices except for age of mother, occupation, and information regarding use of nebulizer. Conclusion: Findings concluded an improvement in knowledge and practices of mothers of under-five children regarding use of nebulizer after the implementation of video-assisted teaching.

Malaria remains a major global health burden, with 264 million cases and 569,000 deaths in 2023. Uganda ranks third globally in malaria cases and tenth in deaths, with 95% of the country endemic and children under five most vulnerable. Despite control efforts, Mbale Regional Referral Hospital (MRRH) in Eastern Uganda reported a pediatric malaria case fatality rate of 2.7% between 2020 and 2024. This study aimed to identify factors associated with malaria-related deaths among children under five admitted to the hospital during this period. We conducted an unmatched 1:2 case-control study using retrospective data from 2020-2024. Cases were children ≤59 months with WHO-defined severe Plasmodium falciparum malaria who died during hospitalization (n = 100). Controls were similar children who recovered (n = 200), systematically sampled from about 32,400 admissions. Data were extracted from patient records, and multivariable logistic regression identified mortality predictors. Among 100 cases, 73% were aged <24 months and 61% were male. Convulsions (adjusted odds ratio [aOR]=17; 95%CI:4.2-71), loss of consciousness (aOR=14; 95%CI: 1.4-113), severe anemia (aOR=3.4; 95%CI:1.4-8.2), vomiting (aOR=3.1; 95%CI: 1.4-6.9), and delays in seeking care > 24 hours after symptom onset (aOR=8.8; 95%CI: 2.3-34) were significantly associated with mortality.Malaria deaths among under-five children was significantly associated with severe clinical features,convulsions, loss of consciousness, and severe anemia and delayed care-seeking. Early recognition of danger signs, and prompt care-seeking could reduce paediatric malaria mortality in high-burden settings like Mbale.

Malnutrition remains a major public health issue in Nigeria, particularly in the northern regions where socio-economic and healthcare barriers persist. This study assessed the burden and determinants of malnutrition among under-five children in Talata Mafara Local Government Area, Zamfara State. A community-based cross-sectional study was conducted between March and June 2024 among 200 caregiver – child pairs, selected through multistage sampling. Data were collected using structured questionnaires on socio-demographic characteristics, feeding practices, and healthcare access. Anthropometric indices were measured following WHO standards. Data were analyzed using SPSS version 25, with chi-square tests and multivariable logistic regression applied at a 95% confidence level. Overall, 40% (95% CI: 33.1 – 46.9) of children were underweight, 45% (95% CI: 38.0 – 52.0) stunted, and 30% (95% CI: 23.6 – 36.4) wasted. Malnutrition was significantly associated with caregiver education (p=0.001), household size (p=0.015), socio-economic status (p&lt;0.001), feeding practices (p=0.002), and healthcare access (p=0.045). In adjusted analysis, children from low-income households (OR=3.4, 95% CI: 1.9 – 6.0), large households (OR=2.8, 95% CI: 1.4 – 5.3), with inadequate feeding (OR=3.1, 95% CI: 1.6 – 5.9), and poor healthcare access (OR=2.1, 95% CI: 1.0 – 4.3) were at higher risk. Malnutrition among under-five children in Talata Mafara is driven by poverty, low maternal education, and weak healthcare access. Targeted interventions should strengthen maternal nutrition education, promote household economic empowerment, expand community-based nutrition programs, and improve primary healthcare services. Further research is recommended to explore cultural practices influencing child feeding.

Background: Diarrheal disease is still a major public health concern, particularly among children under-five in low-resource areas. It is responsible for high rate of illness and deaths of children mainly in developing countries.  Objectives: To determine the prevalence and associated risk factors of Diarrheal disease among children under five years of age in selected communities in Moro Local Government Area, Kwara State, Nigeria.  Methods: This descriptive cross-sectional study was conducted in three communities in Moro LGA, Kwara State, Nigeria. It included 410 caregivers of children under five years. A multi-stage sampling technique was used to select participants. Data were collected using a pretested, semi-structured, interviewer-administered questionnaire. Analysis was performed with SPSS version 26.0. Descriptive statistics and chi-square tests (p&lt;0.05) were employed.  Results: Two-week prevalence of diarrhea was 22.2% (n = 91). Among affected children, 80.2% had 2–3 episodes, with 66.3% exhibiting fever and 70.0% showing signs of dehydration. Environmental risk factors included the use of untreated well water (44.6%) and uncovered water storage (31.7%). Only 53.7% of households had hand-washing facilities. While 87.8% of caregivers sought medical care, only 34.2% did so immediately. Antibiotic use (56.1%) was more common than the use of oral rehydration solution (ORS) (34.4%) and Zinc tablet (9.4%). Households with more than three under-five children had poorer hygiene and higher diarrhea prevalence due to resource constraints and caregiver fatigue.  Conclusions: Significant associations were found with socio-demographic factors, environmental risks, and poor hygiene practices. Healthcare-seeking behavior was high (87.8%), but gaps existed in ORS use and preparation. Recommendations include improving water safety, sanitation, caregiver education, and adherence to WHO guidelines for diarrheal management.

Determinants of late malaria treatment among under-five children in West Africa.

Background: Acute Respiratory Infection (ARI) remains one of the leading causes of morbidity and mortality among children under five, especially in coastal areas with high housing density and poor ventilation. Unhealthy home environments significantly increase the risk of ARI transmission. Objective: To determine the relationship between housing density and home ventilation with the incidence of ARI among children under five in the coastal area of the Lingkar Timur Public Health Center, Bengkulu City. Methods: This study employed an analytic observational design with a cross-sectional approach. The population consisted of 283 mothers with children under five, and 74 respondents were selected using a simple random sampling technique. Data were collected through interviews and home observations using questionnaires and observation sheets. Data analysis was performed using univariate and bivariate (Chi-square test, α = 0.05). Results: There was a significant relationship between housing density and ARI incidence (χ² = 13.455; p = 0.000) and between home ventilation and ARI incidence (χ² = 29.540; p = 0.000). Children living in houses with overcrowded and poorly ventilated conditions were at a higher risk of developing ARI. Conclusion: Housing density and ventilation are significantly associated with ARI incidence among children under five. Preventive efforts should include improving housing conditions, enhancing family health education, and strengthening community-based interventions to promote healthy homes.

Almost half of under-five children in health facilities are febrile in sub-Saharan Africa. The non-specific clinical symptoms coupled with; limited diagnostics capacities, overlapping endemicity and the surveillance gaps complicates accurate cause identification of an acute febrile illnesses in resource limited settings. This challenge leads to misdiagnosis, overtreatment, and delays in appropriate management, increasing morbidity and mortality. Health systems are often overloaded, with providers attributing fevers to the most common pathogen, while other emerging infections are the cause. This study unpacked the febrile illness by testing for dengue fever in parallel to malaria. Febrile ill children below 5 years seeking health services public health facilities in Busia and Kisumu Counties were screened using an approved malaria and dengue fever rapid test kits at the outpatient department. Those who screened positive were recruited into the study. A total of 1004 children were screened, 380 met the recruitment criteria. 215 (21.4%) tested positive for P. falciparum alone, 90 (8.9%) tested positive for dengue fever alone while 75 (7.5%) had co-infections. Busia had the highest P. falciparum-only infection (23.4%) while Kisumu had the highest dengue-only infections (12.6%). Dengue fever is a re-emerging neglected tropical, climate change driven disease in malaria endemic regions. Other than creating awareness to build capacity for diagnosis, this study unmasked and confirmed dengue as a major contributor to the non malarial febrile illnesses among children. There is need to revise the screening algorithm for febrile patients to improve arboviral surveillance.

Acute malnutrition remains a critical public health challenge across East Africa, contributing substantially to under-five morbidity and mortality. Early identification of at-risk children using predictive models could enhance timely intervention. This study aimed to develop and evaluate machine learning models for predicting acute malnutrition among under-five children in East Africa. A cross-sectional analysis was conducted using the most recent DHS data from 12 East African countries. A total of 76,224 children under-five years were included. Data preprocessing involved multiple imputation for missing values, one-hot encoding for categorical variables, SMOTE to address class imbalance, and multiple feature selection. ten supervised machine learning algorithms; Logistic Regression, Random Forest, K-Nearest Neighbors, Decision Tree, Support Vector Machine, Naïve Bayes, XGBoost, LightGBM, CatBoost, and Stochastic Gradient Descent were trained and evaluated using an 80/20 train-test split and stratified five-fold cross-validation. Model performance was assessed using accuracy, AUC, precision, recall, and F1-score, and interpretability was explored using SHapley Additive exPlanations (SHAP). The overall prevalence of acute malnutrition across east Africa was 6.08% (95% CI 5.91-6.25%), ranging from 1.2% in Rwanda to 12.27% in Ethiopia. The Random Forest algorithm demonstrated the best predictive performance, achieving an AUC of 74.6% (95% CI 73.0-76.2), accuracy of 71.2%, precision of 13.1%, recall of 66.2%, specificity of 71.5%, and an F1-score of 0.218. SHAP analysis identified important predictors of acute malnutrition as rural residence, large family size (≥ 6 members), higher number of under-five children (≥ 3), small or very small birth size, inadequate antenatal care, unimproved water sources, inappropriate disposal of child feces, recent diarrheal illness, and lack of latrine facilities. Protective factors included maternal literacy, antenatal care attendance, vitamin A supplementation, longer birth intervals (≥ 2years), and maternal employment. Random Forest, demonstrate superior predictive capacity for identifying children at risk of acute malnutrition in East Africa. The integration of such models into national nutrition surveillance systems could enable early detection and targeted interventions. Strategies should prioritize rural communities, strengthen maternal education and empowerment, improve water and sanitation infrastructure, and antenatal care to mitigate risk factors and enhance child nutritional outcomes.