Under-five Death Research Articles

Determinants of Pneumonia Status in Under-five Children in Indonesia

Background: Pneumonia is a communicable disease that causes the largest under-five children death in the world. Meanwhile, Indonesia contributed 19.000 cases of under-five deaths due to pneumonia in 2018. Pneumonia can inhibit the growth and development in under-five children, cause decreased lung function or even lead to death. The pneumonia symptoms is less specific and almost the same as the flu or a common cough, makes this disease difficult to detect and difficult to treat optimally. This study was aimed to determine variables that affect the pneumonia in under-five children in Indonesia in 2018.Methods: This study used descriptive analysis and multilevel binary logistic regression. It used secondary data from the Riskesdas 2018, publication of Profil Kesehatan Indonesia 2018, and official website of Badan Pusat StatistikResult: The results indicated that in 2018, there were about 6.4 percent of under-five children who experienced pneumonia. The age of under-five children, gender, nutritional status, maternal education level, type of residence, house’s ventilation, and poverty rate per province significantly affected the status of pneumonia in under-five children in Indonesia.Conclusion : This study was expected to be able to increase public awareness about pneumonia in under-five children and can prevent under-five deaths due to pneumonia. Further research can use more up-to-date primary data and can also focus on provinces that have high rates of pneumonia in under-five children.

Predictors of time to death among under-five children in pastoral regions of Ethiopia: A retrospective follow-up study.

In Ethiopia, the mortality rate for children under five is a public health concern. Regretfully, the problem is notably underestimated and underreported, making it impossible to fully recognize how serious the situation is in the nation's developing regions. Unfortunately, no single study has been conducted to reveal the rates and predictor factors of under-five child death in Ethiopia's pastoral regions. Therefore, the purpose of this study was to determine the critical variables that led to a shorter survival time to death for children in Ethiopia's pastoral regions under the age of five. Between January 18 and June 27, 2016, a retrospective follow-up study was done among under-five children in pastoral areas of Ethiopia. The statistically significant difference between categorical predictors was shown using the log-rank test, and the Kaplan-Meier survival curve was used to determine the survival time. In order to identify the time-to-death predictor factors in children under five, Cox proportional hazards (PH) model analyses of bivariable and multivariable variables were fitted. A total 7,677 children were included in the study. The overall incidence rate of under-five mortality was 8.4% (95% CI 7.77%, 9.0%). In the multivariable Cox PH model analysis, children vaccinated (AHR: 0.72, 95% CI: 0.59, 0.88), mothers aged 35-40 (AHR: 1.27; 95% CI: 1.06, 1.52), and above 41 (AHR: 2.18, 95% CI: 1.59, 2.98), not initiating exclusively breastfeeding (AHR: 1.26, 95% CI: 1.02, 1.55), the agriculture sector of the mother's occupation (AHR: 2.57, 95% CI: 1.74, 3.31), the male sex of the household head (AHR: 0.67, 95% CI: 0.56, 0.81), non-anemic child (AHR: 0.67, 95% CI: 0.55, 0.83), and rural residence (AHR: 3.27, 95% CI: 1.45, 7.38) were identified as main predictors of time to death among under-five children. In this study, the authors found a higher rate of under-five deaths than the national figure. A child vaccinated, exclusively breastfeeding, mother's occupation, sex of household head, anemic child, mother's age, and residence were found to be the most influential predictors for time-to-death. Therefore, to lower the high incidence of under-five mortality, the government should focus on the pastoral regional states of Ethiopia.

Health impact and cost-effectiveness of expanding routine immunization coverage in India through Intensified Mission Indradhanush.

Many children do not receive a full schedule of childhood vaccines, yet there is limited evidence on the cost-effectiveness of strategies for improving vaccination coverage. Evidence is even scarcer on the cost-effectiveness of strategies for reaching 'zero-dose children', who have not received any routine vaccines. We evaluated the cost-effectiveness of periodic intensification of routine immunization (PIRI), a widely applied strategy for increasing vaccination coverage. We focused on Intensified Mission Indradhanush (IMI), a large-scale PIRI intervention implemented in India in 2017-2018. In 40 sampled districts, we measured the incremental economic cost of IMI using primary data, and used controlled interrupted time-series regression to estimate the incremental vaccination doses delivered. We estimated deaths and disability-adjusted life years (DALYs) averted using the Lives Saved Tool and reported cost-effectiveness from immunization programme and societal perspectives. We found that, in sampled districts, IMI had an estimated incremental cost of 2021US$13.7 (95% uncertainty interval: 10.6 to 17.4) million from an immunization programme perspective and increased vaccine delivery by an estimated 2.2 (-0.5 to 4.8) million doses over a 12-month period, averting an estimated 1413 (-350 to 3129) deaths. The incremental cost from a programme perspective was $6.21 per dose ($2.80 to dominated), $82.99 per zero-dose child reached ($39.85 to dominated), $327.63 ($147.65 to dominated) per DALY averted, $360.72 ($162.56 to dominated) per life-year saved and $9701.35 ($4372.01 to dominated) per under-5 death averted. At a cost-effectiveness threshold of 1× per-capita GDP per DALY averted, IMI was estimated to be cost-effective with 90% probability. This evidence suggests IMI was both impactful and cost-effective for improving vaccination coverage, though there is a high degree of uncertainty in the results. As vaccination programmes expand coverage, unit costs may increase due to the higher costs of reaching currently unvaccinated children.

Time to death and its predictors among Ethiopian under-five children: cluster-level shared frailty survival analysis using the 2019 Ethiopian mini demographic health survey

Introduction: Reducing under-five mortality to less than 25 per 1000 live births by 2030 is one of the Sustainable Development Goals introduced in 2016. However, several countries are still falling short of their targets. In Ethiopia, one out of every 19 children dies before reaching the age of five. Thus, this study aims to identify the time to death and its predictors among under-five children in Ethiopia. Methods: The data were retrieved from the 2019 Ethiopian Mini Demographic and Health Survey data set. Descriptive statistics and survival curves were applied. Shared frailty survival analysis was employed to determine the predictors of under-five mortality. Statistical significance was declared at p-value <0.05. Result: The under-five mortality rate was found to be 59 deaths per 1000 live births with an estimated mean survival time of 57.6 months (95%CI: 57.38, 57.85). A child born into a family of seven or more had an 85% lowered risk of dying (AHR = 0.15, 95% CI: 0.05, 0.44). The risk of mortality among children born in the birth order of five or above was 3 times higher (AHR = 3.00, 95%CI: 1.70, 5.21) compared to those born in the birth order of one to four. The estimated risk of death among under-five children born less than 24 months interval was 2.68 times higher (AHR=2.68, 95%CI: 1.71, 4.21). Never breastfed was also a significant predictor of under-five child death (AHR = 2.76, 95%CI: 1.46, 5.23). Conclusion: Birth order, family size, preceding birth interval, and never breastfed history were significant predictors of under-five child mortality. Health policies should focus on keeping the spirit of a continuum of care to improve the health of the child and the health of the family as a whole. Health care providers should intervene in the community to maximize optimal infant and young child feeding practices.

The effects of reproductive variables on child mortality in Ethiopia: evidence from demographic and health surveys from 2000 to 2016

BackgroundChild mortality is a crucial indicator reflecting a country's health and socioeconomic status. Despite significant global improvements in reducing early childhood deaths, Southern Asia and sub-Saharan Africa still bear the highest burden of newborn mortality. Ethiopia is one of five countries that account for half of new-born deaths worldwide.MethodsThis study examined the relationship between specific reproductive factors and under-five mortality in Ethiopia. A discrete-time survival model was applied to analyze data collected from four Ethiopian Demographic and Health Surveys (EDHS) conducted between 2000 and 2016. The study focused on investigating the individual and combined effects of three factors: preceding birth interval, maternal age at childbirth, and birth order, on child mortality.ResultsThe study found that lengthening the preceding birth interval to 18–23, 24–35, 36–47, or 48+ months reduced the risk of under-five deaths by 30%, 46%, 56%, and 60% respectively, compared to very short birth intervals (less than 18 months). Giving birth between the ages 20–34 and 35+ reduced the risk by 34% and 8% respectively, compared to giving birth below the age of 20. The risk of under-five death was higher for a 7th-born child by 17% compared to a 2nd or 3rd-born child. The combined effect analysis showed that higher birth order at a young maternal age increased the risk. In comparison, lower birth order in older maternal age groups was associated with higher risk. Lastly, very short birth intervals posed a greater risk for children with higher birth orders.ConclusionNot only does one reproductive health variable negatively affect child survival, but their combination has the strongest effect. It is therefore recommended that policies in Ethiopia should address short birth intervals, young age of childbearing, and order of birth through an integrated strategy.

Validation of CHERG'S Verbal Autopsy-Social Autopsy (VASA) tool for ascertaining determinants and causes of under-five child mortality in Pakistan.

The majority (40%) of the world's under-five mortality burden is concentrated in nations like Nigeria (16.5%), India (16%), Pakistan (8%), and the Democratic Republic of the Congo (6%), where an undetermined number of under-five deaths go unrecorded. In low-resource settings throughout the world, the Verbal Autopsy-Social Autopsy (VASA) technique may assist assess under-five mortality estimates, assigning medical and social causes of death, and identifying relevant determinants. Uncertainty regarding missing data in high-burden nations like Pakistan necessitates a valid and reliable VASA instrument. This is the first study to validate Child Health Epidemiology Reference Group-CHERG's VASA tool globally. In Pakistan, data from such a valid and reliable tool is vital for policy. This paper reports on the VASA tool in Karachi, Pakistan. Validity and reliability of the CHERG VASA tool were tested using face, content, discriminant validation, and reliability tests on one hundred randomly selected mothers who had recently experienced an under-five child death event. Data were computed on SPSS (version-21) and R software. Testing revealed high Item-content Validity Index (I-CVI) (>81.43%); high Cronbach's Alpha (0.843); the accuracy of between 75-100% of the discriminants classifying births to live and stillbirths; and I-CVI (>82.07% and 88.98% respectively) with high accuracy (92% and 97% respectively) for assigning biological and social causes of child deaths, respectively. The CHERG VASA questionnaire was found relevant to the conceptual framework and valid in Pakistan. This valid tool can assign accurate medical and non-medical causes of child mortality cases occurring in Pakistan.

Birth asphyxia and its associated factors among newborns at a tertiary hospital: evidence from Southern Ethiopia.

Globally, 45% of under-five children death occurs during the neonatal period and about 25% of all neonatal deaths are caused by birth asphyxia. In Ethiopia, in 2015, it was the first cause of neonatal deaths followed by prematurity and sepsis. The study aims to assess prevalence of Birth asphyxia and associated factors. Institution-based cross-sectional study was conducted among neonates admitted to Neonatal intensive care unit of Hawassa University Specialized comprehensive hospital from December 1 to December 30, 2020. Systematic random sampling technique was employed to select samples. Logistic regression analysis using Statistical Package for Social sciences version 24was employed. The prevalence of neonatal asphyxia in this study was17.9%. Prolonged labor [AOR (Adjusted odds ration) = 2.909; (95% CI (Confidence Interval): 1.184 - 7.151)], presence of meconium [AOR= 2.137; 95% CI 1.028 - 4.683)], premature rapture of membrane [AOR = 2.459; 95% CI: 1.021 - 6.076)] and complication during labor [AOR= 3.351; 95% CI: 2.142-5.871))], were factors associated with neonatal asphyxia. Nearly two in every ten newborns faced perinatal asphyxia in the study area. Early identification of high-risk women, intervening on delay in referral, and early and vigorous management of abnormal labor and complicated labor is essential to halt the problem.

Ukrainian paediatrics of the future: current problems and prospects for improvement

This article focuses on “Ukrainian paediatrics of the future: current problems and prospects for improvement. Aims: objectives of the research study are to identify the current problems and challenges facing paediatric healthcare in Ukraine, including issues related to healthcare professionals, infrastructure, vaccination coverage, healthcare spending and public awareness of paediatric health and prevention; areas for improvement after analyses of previous initiatives; potential for future improvements in paediatric healthcare in Ukraine, including prospects related to national vaccination programs, telemedicine and digital health, medical research, the patient-centered care, medical education and training, improved healthcare infrastructure, and public-private partnerships. Study design: Descriptive cross-sectional study Place and Duration of Study: The majority of the studies were conducted on patients, professionals’ healthcare establishment and policy maker stakeholders in the Ukraine. Methodology: In order to collect secondary data a questionnaire was used. Results: Ukraine has just 665 hospital beds per 100,000 residents in 2019 compared to 417 doctors per 100,000 in 2000. The pace of replacement for most medical equipment is sluggish. Since 2019, the rates of infant, under-five, and neonatal death have been mostly steady. The rates of BCG and measles vaccination coverage have fluctuated, although they have typically gone down. The biggest problem with paediatric healthcare in Ukraine is a lack of money, which leads to a dearth of medical personnel, supplies, and equipment, as well as a high incidence of diseases that may be prevented because of a lack of public awareness of paediatric health. Conclusion: Paediatrics faces challenges, including inadequate healthcare infrastructure and a high infant and child mortality rate. Prospects for improvement, such as the development of telemedicine and e-health services, improving maternal and child healthcare services, and increasing investment in research and development. By addressing these challenges and investing in these prospects, the country can significantly improve the health and wellbeing of its children.

Infectious diseases and health outcomes’ implications of natural resource curse in Africa

The far-reaching implications of natural resource curse on most resource-rich developing economies arguably suggests no aspect of the broader economy is spared. In light of this stark reality, this inquiry probes into causal linkages between infectious diseases, its associated health outcomes and natural resource rents on 42 African economies for which there are no missing data, over the period 2000–2019. Employing an endogenous–resistant estimator of the system generalized method of moments, the following findings are unambiguously documented. First, natural resource curse thesis is validated for curable infectious diseases such as malaria and tuberculosis but refuted for an incurable HIV prevalence. Second, the established resource curse equally affects health outcomes by shortening life expectancy, raising under-five mortality rate, increasing both birth and death rates, respectively. Third, the curse and the blessing that are often associated for owing abundant natural resources spread across other confounding variables such as per capita GDP, urbanization, control of corruption, polity, temperature, latitude, government spending on health, prevalence of HIV for females, secondary school enrolment rate, telephone per 100 subscriptions, foreign direct investment, per capita carbon emissions, trade openness, and globalization depending on which of the diseases and health outcomes’ models is estimated. Lastly, the established resource curse narrative is robust to using alternative measures of natural resource curse. In line with above findings, policy implications are drawn.

Joint distribution of child mortality and wealth across 30 sub-Saharan African countries over 2000-2019.

While reductions in child mortality have been observed across sub-Saharan African countries in the last 30 years, narrowing the gaps in under-five mortality across socioeconomic groups also requires an understanding of the multiple associations between health and welfare and socioeconomic drivers. We examined the probability density distributions in under-five mortality within countries and joint pathways of under-five mortality and wealth over time. We used 69 Demographic and Health Surveys and 19 Malaria Indicator Surveys from 30 sub-Saharan African countries, with each country having at least two surveys conducted since 2000. We constructed a cross-country wealth index and estimated under-five death prevalence. We examined the pure distribution in under-five mortality prevalence and the joint probability distribution of wealth and under-five mortality prevalence over time, including the area of confidence ellipse which spanned the two dimensions of mortality and wealth and covered 75% of the mass of the joint distribution. Most countries experienced decreases in under-five mortality along with increases in wealth over time. However, we observed great variations in the evolution of the joint distributions across countries over time. For instance, the areas of confidence ellipse ranged from 0.178 in Ethiopia (2000) to 1.119 in Angola (2006). The change (over time) in the area of confidence ellipses ranged from 0.010 in Tanzania to 0.844 in Angola between the 2000s and 2010s. The ranking of country performance on under-five mortality varied greatly, depending on whether performance summary indicators were based on disaggregation by wealth or on full non-disaggregated distributions. Our analysis points to the relevance of full distributions of health and joint distributions of health and wealth as complementary indicators of distributions of health across socioeconomic status, in assessing country performance on health.

Predictors of Time-to-Death Among Under-Five Children in Benishangul-Gumuz Regional State, Ethiopia: A Cross-Sectional Study

Background: Although Ethiopia attained the fourth-millennium development goal, it promised to decrease the under-five children's death rate in 2015. However, the under-five children death rate has still remained a major public health problem in the Benishangul-Gumuz Regional State at the country level. Therefore, this study aimed to assess the predictor factors associated with the under-five children death rate in the Benishangul-Gumuz Regional State. Methods: A community-based retrospective cross-sectional study design was used. The information gathered from 906 children born five years preceding the survey was measured. Variables such as maternal and child demographic characteristics, health, and environmental factors were measured as predictor factors of under-five children's death rate. The study used descriptive statistics, and Cox Proportional-hazard (PH) regression model to identify the major significant predictor factors associated with under-five children's death rate. Results: The overall prevalence of experiencing under-five children death rate was 9.3% [95%CI: 0.0738, 0.112] in the Benishangul-Gumuz Regional State. The Cox PH regression model analysis revealed, being multiple births (AHR = 2.17; 95% CI (1.17–4.20)), using unprotected well water (AHR = 2.13; 95% CI (1.32–3.42)), parity between 6–8 (AHR = 3.16; 95% CI (1.40–7.16)) and 9 and above (AHR = 7.86; 95% CI (2.23–27.72)), the agricultural sector of mother’s occupation (AHR = 0.39; 95% CI (0.20–0.76)) and family size (AHR = 0.74; 95% CI (0.60–0.93)) were significantly associated with a higher risk of under-five children death rate. An increment in family size and parity increases the risk of under-five children's death rate. Conclusions: The study identified the source of drinking water, family size, parity, mother’s occupation and type of childbirth were the predictor factors significantly associated with under-five children death. The prevalence of under-five children death rate shows that Benishangul-Gumuz Regional State was experiencing a higher death rate than the national level. Therefore, both government policymakers and other concerned organizations should be given special attention to the major predictor factors of the under-five children's death rate and do greater emphasis on decreasing under-five children's death rate, and health intervention policies must be studied.

Source sectors underlying PM2.5-related deaths among children under 5 years of age in 17 low- and middle-income countries

BackgroundFine particulate matter (PM2.5) from different source sectors might differ in toxicity. However, data from large-scale studies on vulnerable children in low- and middle-income countries (LMICs) are insufficient. ObjectiveTo analyze the association of under-five death (U5D) with long-term exposure to PM2.5 from different sources. MethodWe evaluated demographic and health survey data for 79,995 babies born in 2017 in 16 Asian and African LMICs (AA-LMICs) and a Latin America low-income country (i.e., Haiti). Long-term exposure to PM2.5 was assessed by a well-established product that attributed the annual concentration to 20 source sectors in 2017. The associations of survival during < 5-year periods with each source-specific concentration of PM2.5 were analyzed by Cox regression with multiple adjustments. We derived a multiple-pollutant ridge regression model to estimate the joint exposure–response function (JERF) between U5D and PM2.5 mixtures. To evaluate how sources affected PM2.5 toxicity, we evaluated the number of U5Ds attributable to PM2.5 based on the source profiles for 88 AA-LMICs. ResultsAccording to the single-pollutant model, the risk of U5D increased by 7% (95% confidence interval [CI]: 5%, 9%) for each 10 μg/m3 increment in total PM2.5 concentration. The model performance was lower than that of the multiple-pollutant ridge regression model. For each 10 μg/m3 increment in PM2.5, the excess risk of U5D ranged from 6% (95% CI: 4%, 9%) in Nepal to 10% (95% CI: 6%, 14%) in Mauritania. Based on the JERF, PM2.5 contributed to 817,647 (95% CI: 585,729, 1,050,439), i.e., 28.0% (95% CI: 20.1%, 35.8%), of all U5Ds across the 88 AA-LMICs. The PM2.5-related U5Ds were mostly attributable to PM2.5 produced by desert dust, followed by solid biofuel combustion and open fires. ConclusionThe average toxicity of PM2.5 varied by source profile, which should be taken into consideration when planning public health interventions. For some AA LMICs, natural sources of PM2.5 had the most significant health effects, and should not be ignored to ensure the protection of child health.

Using best performance machine learning algorithm to predict child death before celebrating their fifth birthday

IntroductionChild morbidity and mortality in resource-limited settings is a major public health problem. The previous studies were mainly concerned with determining the prevalence of child deaths and identifying associated factors. Extracting knowledge and discovering insights from hidden patterns in child data through supervised machine learning algorithms is limited. Therefore, this study aimed to predict the under-five death of children using a best performance-supervised machine learning algorithm. MethodsA total of 1813 samples were used from the 2019 Ethiopian Demographic and Health Survey dataset. 70% and 30% of total instances were used for training the model and measuring the performance of each algorithm with 10-fold cross-validation techniques respectively. Five supervised machine learning algorithms were considered for model building and comparison. All the included algorithms were evaluated using confusion matrix elements. Information gain value was used to select important attributes to predict child deaths. The If/then logical association was used to generate rules based on relationships among attributes using Weka version 3.8.6 software. ResultsJ48 is the second-best performance algorithm next to the random forest to predict child death, with 77.8% and 93.9% accuracy, respectively. Late initiation of breastfeeding, mothers with no formal education, short birth intervals, poor wealth status of the mother, and unexposed to media were the top five important attributes to predict child deaths. A total of six associated rules were generated that could determine the magnitude of child deaths. Of these, if children were rural residents, had a short birth interval, and if born as multiples (twins), then the probability of child death was 83.6%. ConclusionsFive machine learning algorithms were included to predict child deaths and generate rules. Hence, the random forest algorithm was the best algorithm to predict child deaths. However, the study was limited since important attributes were not included in the data source, and irrelevant values were found. So, researchers are encouraged to use machine learning algorithms for future studies including important attributes that could predict child death. The current findings would be useful for stakeholders’ preparedness, and taking proactive childcare interventions. Encouraging women in education, media access, and economic development programs are essential interventions for child death reduction.

Penanganan Gizi Buruk kepada Ibu Hamil

Abstract – The development of the fetus can be impacted by the mother's nutritional state both before and during pregnancy. fetus in the process of conception. if the mother's dietary intake is consistent before and during pregnancy, it is expected that she will have a healthy kid in a few months who will be of average weight. In other words, the mother's nutritional status affects the quality of the baby that is born. During and before pregnancy. In Indonesia, there are still many pregnant women who are undernourished. This is what prompts a research for the government to solve this as it continues to rise year after year. problem. The government is still working to lower neonatal and under-five death rates by keeping an eye on and keeping track of the decline in the nutrition's widespread use. Numerous initiatives are taken to enhance community nutrition, such as stepping up the exclusive breastfeeding program (ASI), combating micronutrient deficiencies, and providing pregnant women with iron supplements, vitamin A, taburia, salt that has been iodized, and management of malnutrition and malnourished patients. becomes essential for government initiatives.

The impact of maternal health insurance coverage and adequate healthcare services utilisation on the risk of under-five mortality in Nigeria: a cross-sectional study

BackgroundDespite the progress in reducing under-five mortality (U-5 M) in recent years, these deaths remain considerably high in Nigeria. This could be attributed to poor health policies including inequality of health insurance coverage and access to adequate healthcare services utilisations which has remained inimical to achieving sustainable development goals (SDGs). Therefore, this study examined the impact of maternal health insurance coverage and adequate healthcare services utilisation on the risk of U-5 M in Nigeria.MethodsThe data for the study were derived from the 2018 Nigeria Demographic and Health Survey and comprised a weighted sample of 127,545 birth histories of childbearing women. Descriptive and analytical analyses were carried out, including frequency tables and multivariate using Cox proportional regression. The results were presented as hazard ratios (HR) with 95% confidence intervals (CIs). Data were analyzed using Stata software version 15.1.ResultsThe results showed that 14.3% of the sampled birth histories of the childbearing women were children who died before age 5. The results further showed that 97.7% of the children were of mothers who have health insurance and over one-half (56.5%) were children whose mothers had adequate healthcare services utilisation. The risk of under-five death was significantly lower among the children of mothers who were covered by health insurance (HR: 0.66, CI: 0.42–1.02) and those whose mothers utilised adequate healthcare services (HR: 0.78, CI: 0.68–0.90). A similar result was observed among children whose mothers reported that distance to the health facility was not a problem (HR: 0.81, CI: 0.72–0.86). Some mothers’ characteristics including educational attainment, wealth quintile and region of residence significantly influenced the risk of U-5 M.ConclusionsThe study established that maternal health insurance coverage and adequate healthcare services utilisation were found to be protective factors against the risk of U-5 M. Also, the revealed low health insurance coverage of mothers calls for more pragmatic policy and intervention programmes through health insurance to achieve SDGs targets of ending preventable deaths of children under 5 years of age and ensuring quality, as well as universal access to maternal and child healthcare services.

Prevalence of pneumonia and associated factors among children aged 6–59 months in Angolela Tera district, North Shoa, Ethiopia, 2021, community-based cross-sectional study

BackgroundChildhood pneumonia is the commonest cause of suffering worldwide. Among under-five children where it accounts for more than one out of seven under-five death globally. It is the single leading cause of death in Ethiopia, accounting for 18% of all under-five mortality burdens. These deaths are easily preventable and treatable through simple and cost-effective interventions. The study aims to assess the prevalence and associated factors of pneumonia among under-five children at Angolela Tera district, North Shoa, Ethiopia, 2021. A community-based cross-sectional study was conducted on a simple random sample with a sample size of 414 registered mothers with 6–59 months of children. Semi-structured questionnaires were used to collect data. The data were entered using the EpiData version 3.1, and analysis was done by SPSS version 24. Bivariable and multivariable logistic regression analysis was used.ResultsThe prevalence of pneumonia in children under five was 5.8% (95% CI 3.6–8.2%). Based on the multivariable logistic regression analysis of this study, child male sex, have no family toilet, children having fever in the last 2 weeks, lack of maternal ANC follow-up and children with stunted were associated with pneumonia.ConclusionsThe study shows that the prevalence of under-five pneumonia was low as compared to recent EDHS 2016. Therefore, by making interventions on potential determinates such as by improving family latrine utilization, improving the nutritional status of children, and early control of respiratory tract infection and fever, we can reduce under-five pneumonia.

Determinants of Under-Five Mortality in Tach- Armachiho District, North Gondar, Ethiopia

Background: Under-five mortality rate, often known by its acronym U5MR, indicates the probability of dying between birth and five years of age, expressed per 1,000 live births. Globally, 16,000 children under-five still die every day. Especially in Sub-Saharan Africa every 1 child in 12, dying before his or her fifth birthday. This study aims to identify the determinants of under-five mortality among women in child bearing age group of Tach-Armachiho district using count regression models. Methods: For achieving the objective, a two-stage random sampling technique (simple random sampling and systematic random sampling techniques in the first and second stages respectively) was used to select women respondents. The sample survey conducted in Tach-Armachiho district considered a total of 3815 households of women aged 15 to 49 years out of which the information was collected from 446 selected women through interviewer administrated questionnaire. Results: The descriptive statistics result showed that in the district 16.6% of mothers have faced the problem of at least one under-five death. In this study, Poisson regression, negative binomial, zero-inflated Poisson and zero-inflated negative binomial regression models were applied for data analysis. Each of these count models were compared by different statistical tests. So that, zero-inflated poisson regression model was found to be the best fit for the collected data. Results of the zero-inflated Poisson regression model showed that education of husband, source of water, mother occupation, kebele of mother, prenatal care, place of delivery, place of residence, wealth of house hold, average birth interval and average breast feeding were found to be statistically significant determinants of under-five mortality. Conclusions: In this study, it was found that the factors like average birth interval and average breast feeding were found to be statistically significant factors in both groups (not always zero category and always zero category) with under-five child deathwhereas education of husband, source of water, place of delivery, mother occupation and wealth index of the household have significant effect on under-five mortality under not always zero group. Place of residence, kebele of mother and prenatal care have a significant effect on under-five mortality in TachArmachiho district on inflated group

Child Mortality prediction using Machine Learning Techniques

Abstract: Children's Mortality alludes to mortality of children younger than 5. The kid death rate, in addition under-five death rate, alludes to the probability of biting the mud among birth and exactly 5 years recent. The mortality of kids in addition happens in embryo. The purpose is to analysis AI based mostly strategies for grouping of mortality vertebrate upbeat characterization brings concerning best truth. The examination of dataset by directed AI procedure (SMLT) to catch a couple of data's like, variable characteristic proof, uni-variate investigation, bi-variate and multi-variate examination, missing value medicines and dissect the data approval, data cleaning/getting prepared and knowledge illustration are done on the entire given dataset. Our examination provides a whole manual for responsiveness investigation of model boundaries on execution within the characterization of vertebrate upbeat. To propose AN AI based mostly and moreover, to seem at and examine the presentation of various AI calculations for the given dataset.

Predictors of exceeding emergency under-five mortality thresholds using small-scale survey data from humanitarian settings (1999 – 2020): considerations for measles vaccination, malnutrition, and displacement status

BackgroundQuantifying the effect of measles containing vaccine (MCV) coverage and the prevalence of global acute malnutrition (GAM) on mortality levels in populations of displaced and crisis-affected resident children is important for intervention programming in humanitarian emergencies.MethodsA total of 1597 surveys containing data on under-five death rate, population status (internally displaced, refugee, or crisis-affected resident), measles containing vaccine coverage, and global acute malnutrition were extracted from the Complex Emergency Database (CE-DAT). Under-five mortality rates were dichotomized to those exceeding critical levels or otherwise. A Bayesian multivariable mixed-effect logistic regression model was used to assess the association between an under-five death rate (U5DR) exceeding this threshold and population status (i.e., internally displaced, refugees or residents), GAM prevalence (proxy for food security), and MCV coverage.ResultsThe prevalence of GAM, MCV and U5DR were higher in internally displaced children (IDC) with values of 14.6%, 69.9% and 2.07 deaths per 10 000 per day, respectively. Refugee populations had lower average under-five mortality rate (0.89 deaths per 10 000 per day), GAM of 12.0% and the highest measles containing vaccine coverage (80.0%). In crisis-affected residents the prevalence of GAM, MCV and average U5DR are 11.1%, 65.5% and 1.20 deaths per 10 000 per day respectively. In mixed-effect logistic model taking 2 deaths per 10 000 children less than five years old per as emergency threshold (Model III); MCV (AOR = 0.66, 95% Highest Density Interval (HDI): 0.57, 0.78), GAM (AOR = 1.79, 95% HDI: 1.52, 2.12) were associated with a reduction of the odds of U5DR exceeding critical level accounting for country-specific levels of variability. The odds of U5DR exceeding critical level (2/10000/day) in crisis-affected resident children and refugees were 0.36 (95% HDI: 0.22, 0.58) and 0.25(95% HDI: 0.11, 0.55) less than amongst IDP children adjusting for GAM and MCV. In considering country specific yearly median U5DR (model IV) the odds of U5DR exceeding twice the median U5DR were associated with MCV (AOR = 0.72, 95% HDI: 0.64, 0.82), GAM (AOR = 1.53, 95%HDI: 1.34, 1.76). The odds of U5DR exceeding critical level in crisis-affected resident children was 0.30(95% HDI: 0.20, 0.45) less than IDP children, after adjusting for MCV and GAM. We found no difference between the odds of U5DR exceeding twice the country level median U5DR in the refugee population compared to the IDPs.ConclusionsIn this study vaccination coverage and global acute malnutrition (proxy for food security) were associated with U5DR exceeding critical level. The emergency threshold for IDPs and affected residents is significantly different and consistent across the different outcomes, whereas the result is inconsistent for IDPs and refugees. Continued improvement in measles vaccination coverage and reduction of malnutrition in humanitarian emergencies have the potential to minimize the deterioration of mortality level amongst children in emergency settings. To generate a robust understanding of the critical level of child mortality in displaced and affected resident populations, studies accounting for the impact of the duration of displacement, contextual factors in humanitarian settings, and the level of humanitarian assistance provided are needed.

Causes of deaths in neonates and children aged 1–59 months in Nigeria: verbal autopsy findings of 2019 Verbal and Social Autopsy study

BackgroundNigeria has one of the highest under-five mortality rates in the world. Identifying the causes of these deaths is crucial to inform changes in policy documents, design and implementation of appropriate interventions to reduce these deaths. This study aimed to provide national and zonal-level estimates of the causes of under-five death in Nigeria in the 2013–2018 periods.MethodsWe conducted retrospective inquiries into the cause of deaths of 948 neonates and 2,127 children aged 1–59 months as identified in the 2018 Nigeria Demographic and Health Survey (NDHS). The verbal autopsy asked about signs and symptoms during the final illness. The Physician Coded Verbal Autopsy (PCVA) and Expert Algorithm Verbal Autopsy (EAVA) methods were employed to assign the immediate and underlying cause of deaths to all cases.ResultFor the analysis, sampling weights were applied to accommodate non-proportional allocation. Boys accounted for 56 percent of neonatal deaths and 51.5 percent of the 1–59-months old deaths. About one-quarter of under-5 mortality was attributed to neonatal deaths, and 50 percent of these neonatal deaths were recorded within 48 h of delivery. Overall, 84 percent of the under-5 deaths were in the northern geopolitical zones. Based on the two methods for case analysis, neonatal infections (sepsis, pneumonia, and meningitis) were responsible for 44 percent of the neonatal deaths, followed by intrapartum injury (PCVA: 21 percent vs. EAVA: 29 percent). The three main causes of death in children aged 1–59 months were malaria (PCVA: 23 percent vs. EAVA: 35 percent), diarrhoea (PCVA: 17 percent vs. EAVA: 23 percent), and pneumonia (PCVA: 10 percent vs. EAVA: 12 percent). In the North West, where the majority of under-5 (1–59 months) deaths were recorded, diarrhoea was the main cause of death (PCVA: 24.3 percent vs. EAVA: 30 percent).ConclusionThe causes of neonatal and children aged 1–59 months deaths vary across the northern and southern regions. By homing on the specific causes of mortality by region, the study provides crucial information that may be useful in planning appropriately tailored interventions to significantly reduce under-five deaths in Nigeria.