Young Children In Nigeria Research Articles

Addressing the oversight medical cases in low-middle-income countries: poor mention of shaken baby syndrome in Nigeria; reasons, challenges, and recommendations.

Shaken baby syndrome (SBS) is a severe form of child abuse that results in a triad of clinical findings: subdural hematoma, retinal hemorrhages, and encephalopathy. These injuries can lead to significant brain damage, developmental delays, disabilities, or even death. In addition to these, other indicative signs include bruises, vomiting, full fontanelles, sleepiness, seizures, and fractures. This paper reviews the existing literature on SBS in Nigeria, identifies the challenges contributing to its underrecognition, and provides evidence-based recommendations for improving diagnosis, management, and prevention strategies in the region. Despite the profound impact of SBS, its recognition and management are inadequate, particularly in low- and middle-income countries (LMICs) like Nigeria, due to limited diagnostic capabilities and documentation. Addressing these gaps is crucial for safeguarding the well-being of infants and young children in Nigeria.

A structural equation modelling approach to understanding the determinants of childhood vaccination in Nigeria, Uganda and Guinea.

Vaccines have contributed to reductions in morbidity and mortality from preventable diseases globally, but low demand for vaccination threatens to reverse these gains. Explorations of the determinants of vaccination uptake may rely on proxy variables to describe complex phenomena and construct models without reference to underlying theories of vaccine demand. This study aimed to use the results of a formative qualitative study (described elsewhere) to construct and test a model to explain the determinants of vaccination uptake. Using the results of a survey among more than 3,000 primary caregivers of young children in Nigeria, Uganda and Guinea, factor analysis produced six explanatory factors. We then estimated the effects of each of these factors on uptake of immunization using a structural equation model. The results showed that the probability that a child is fully vaccinated increases if a caregiver has support from others to vaccinate them (B = 0.33, β = 0.21, p<0.001) and if caregivers had poor experiences with the healthcare system (B = 0.09, β = 0.09, p = 0.007). Conversely, the probability of full vaccination decreases if the caregiver's husband exerts control over her decision-making ability (B = -0.29, β = -0.20, p<0.001), or if the caregiver perceives vaccines to be of low importance (B = -0.37, β = -0.27, p<0.001). Belief in religious protection (B = -0.07, β = -0.05, p = 0.118) and a belief that vaccines are harmful (B = -0.12, β = -0.04, p = 0.320) did not have an observed effect on vaccination status. This research suggests that interventions may benefit from that including entire families and communities in their design.

Effectiveness of the Eggs Make Kids demand-creation campaign at improving household availability of eggs and egg consumption by young children in Nigeria: A quasi-experimental study.

Using a quasi-experimental design, our study aimed to determine the effectiveness of the 'Eggs Make Kids Sharp & Bright and Strong & Active'demand-creation campaign in Nigeria. The intervention arm received emotionally compelling radio and television advertisements about eggs, and was exposed to promotional activities and advertising about eggs at points of purchase, schoolsand health facilities; the comparison arm received no intervention. Children 6-59 months of age (intervention: n = 1359; comparison: n = 1485) were assessed 14 months apart. Intent-to-treat analyses with analysis of covariance method assessed the impact of the intervention on caregivers' behaviour towards eggs, caregivers' willingness to pay for eggs, availability of eggs in households, and consumption of eggs by children 6-59 months of age. Analyses were adjusted for possible confounders and perceived effects of COVID-19 on finances and food consumption. Compared to the comparison arm, the intervention arm showed a greater prevalence of household egg acquisition (odds ratio = 1.34, p < 0.0001), and larger improvements in caregiver self-efficacy (β = 0.242, p = 0.004) and intent to feed eggs to children (β = 0.080, p = 0.021). No effects were found on children's egg consumption or caregivers' reported willingness to pay for eggs. The lack of impact on child egg consumption despite increased acquisition of eggs and caregiver self-efficacy suggests that other barriers to child consumption may exist. Additional research should further investigate factors that may influence intrahousehold distribution of eggs and whether these may also influence other nutritious foods.

Achieving Complete Immunization Status per Age to Reducing Risk of Acute Respiratory Infections (ARIs) among Infants in Nigeria: What should be done?

Immunization status as an outcome measure of vaccination is very critical in the prevention and control of vaccinepreventable diseases. Irrespective of several improvements in child survival strategies for over 3 decades, ARI still ranks among diseases such as malaria, diarrhea and measles responsible for majority of deaths among infants and young children in Nigeria and other developing countries. Immunity is a mechanism and process of the body system for preventing diseases by way of innate and adaptive/acquired means. This review paper, aimed at taking a critical look at how pattern of uptake of vaccination among infants according to the National Immunization Schedules under the classification of partial, complete and non-immunization status influence risk of ARI among infants. In view of this, a review of the essential literature was conducted to establish relevant concepts and evidences. It has been revealed from survey that, only 21% children had received all age-appropriate vaccinations and that 19% of children in Nigeria have not received any vaccinations. In addition, among several other studies, it was equally revealed that the Risk of ARI was higher among infants with none immunization (none and some uptake of vaccines per age) status with statistical significance (OR=1.97≈ 2, (p&lt;0.0001, 95%CI=1.495-2.604). Meaning infants with none immunization status per age are about 2 times at Risk of contracting ARI compared to infants with complete immunization status per age in Nigeria. Hence, from the principles and mechanisms of immunization responses and evidence-based reports, it is very clear that complete immunization status per age among infants is capable of reducing the Risk of ARI in that age group. Therefore, what should be done as enumerated in this publication need to be given required attention to achieving reduction in the burden of ARI among infants in Nigeria.

Effectiveness of the Eggs Make Kids Demand-Creation Campaign to Improve Household Availability of Eggs and Egg Consumption in Young Children in Nigeria

ObjectivesTo determine the effectiveness of the “Eggs Make Kids Smart & Bright and Strong & Active” demand-creation campaign on caregivers’ behavior towards eggs, caregivers’ willingness-to-pay for eggs, the availability of eggs in household, and the consumption of eggs in children 6–59 months of age in Kaduna state, Nigeria.MethodsAn egg demand-creation campaign in Kaduna state targeting families of children 6–59 months of age was implemented between October 2019 and December 2020. A quasi-experimental design was used to evaluate the impact of the campaign. The intervention arm received emotionally compelling radio and TV advertisement and promotional activities and advertising at point-of-purchase, schools, and health facilities about eggs; the comparison arm received no intervention. Children 6–59 months of age in both arms (intervention n = 1359; comparison n = 1485) were assessed 14 months apart before and after the implementation of the intervention. Intent-to-treat analyses with analysis of covariance method were used to assess impact of the intervention on caregivers’ behavior towards eggs, caregivers’ willingness-to-pay for eggs, the availability of eggs in household, and the consumption of eggs in children 6–59 months of age. Analyses were adjusted for possible confounders and perceived effects of SARS-CoV2 on household finances and food consumption.ResultsThere was improved prevalence of household egg acquisition in the intervention arm compared to the comparison arm (odds ratio = 1.34, p-value < 0.0001). The intervention arm showed larger improvements in caregiver self-efficacy (β = 0.242, p-value = 0.004) and intent to feed eggs (β = 0.080, p-value = 0.021) than the comparison arm. No effects were found on child egg consumption or caregivers’ willingness-to-pay for eggs.ConclusionsIn Nigeria, a 14-month egg demand creation campaign improved household egg acquisition and benefited caregiver self-efficacy and intent to feed eggs but did not improve child egg consumption. Further research is needed to identify how to increase child egg consumption in the context of availability of eggs in households and favorable caregiver behavior.Funding SourcesFunding for this study was provided by the Netherland's Ministry of Foreign Affairs.

Oral amoxicillin optimal choice for chest-indrawing pneumonia in young children in Nigeria

Oral amoxicillin optimal choice for chest-indrawing pneumonia in young children in Nigeria

The search for sustainable solutions: Producing a sweet potato based complementary food rich in vitamin A, zinc and iron for infants in developing countries

Deficiencies of vitamin A, zinc and iron are prevalent among infants and young children in developing countries. This is often due to consumption of unfortified cereal-based foods. Two nutritionally balanced sweet potato-based complementary foods containing locally available products were developed to help combat micronutrient deficiencies. Composite flours from orange-fleshed sweet potato (OFSP), soybean and carrots were produced by drying, milling and blending in the ratio of 64.6:34.8:0.7 and 61.3:37.7:1.0, respectively. The formulations were evaluated for nutrient composition and compared with a commercially cereal-based product (Control) and the Codex Alimentarius Commission Guidelines for complementary foods for infants and young children. The newly formulated OFSP-based complementary foods (OFSP-CFs) had higher levels of protein and fat compared to the Control. However, the latter was higher in carbohydrates and energy. The OFSP-CFs met the stipulated values for energy (≥ 400 kcal/100 g), protein (≥ 15%) and fat (10 – 25%) as specified in the Codex standards. Vitamin A (2057 – 2064 µg RAE/100 g) and zinc (8.82 – 10.38 mg/100 g) were significantly higher (p < 0.05) than levels in the Control (370 µg RAE/100 g and 2.5 mg/100 g, respectively). OFSP-CF2 was highest in iron content (9.95 mg/100 g). The newly formulated complementary foods exceeded the minimum recommended standards (at least 50% of daily recommendation in an estimated ration of 50 g) for zinc (>100%) and iron (>70%). Furthermore, the blends contained more than 200% of the requirement for daily vitamin A intake as stipulated in the Codex unlike the Control which only met about 46%. OFSP-CFs could improve the vitamin A, zinc and iron intake of infants and young children better than the Control. They may also serve as a sustainable food-based strategy for reducing vitamin A, iron and zinc deficiency as well as protein-energy malnutrition among infants and young children in Nigeria and other developing countries.

Mother's nutrition-related knowledge and child nutrition outcomes: Empirical evidence from Nigeria.

BackgroundNutrition outcomes among young children in Nigeria are among the worse globally. Mother’s limited knowledge about food choices, feeding, and health care seeking practices contributes significantly to negative nutrition outcomes for children in most developing countries. Much less is known about the relationship between mother’s nutrition-related knowledge and child nutritional outcomes in rural Nigeria. This paper investigates therefore: (i) the association of mother’s nutrition-related knowledge with nutrition outcomes of young children living in rural Nigeria, where access to education is limited, and (ii) whether mother’s education has a complementary effect on such knowledge in producing positive child nutrition outcomes in such settings.MethodsUsing the Demographic and Health Survey data for Nigeria, we employ both descriptive and regression analyses approaches in analyzing the study’s objectives. In particular, we apply ordinary least square (OLS) to investigate the association of mother’s nutrition-related knowledge with child HAZ and WHZ while controlling for maternal, child, household and regional characteristics. An index was constructed for mother’s nutrition-related knowledge using information on dietary practices, disease treatment and prevention, child immunization, and family planning.ResultsWe found that mother’s knowledge is independently and positively associated with HAZ and WHZ scores in young children. Higher levels of mother’s education, typically above primary, have a significant, positive association with child HAZ and WHZ scores. We argue that mother’s knowledge of health and nutrition may substitute for education in reducing undernutrition in young children among populations with limited access to formal education. However, the present level of mother’s education in rural Nigeria appears insufficient to reinforce knowledge in producing better nutrition outcomes for children.ConclusionsThis study suggests promotion of out-of-school (informal) education, such as adult literacy and numeracy classes where women without formal education can gain health and nutrition knowledge, and practices that could enhance child nutrition outcomes in Nigeria.

Assessing the mycotoxicological risk from consumption of complementary foods by infants and young children in Nigeria

This study assessed, for the first time, the mycotoxicological risks from consumption of complementary foods by infants and young children in Nigeria. Molds belonging to Aspergillus aculeatinus, A. flavus, A. luchuensis, A. tubingensis, A. welwitschiae and Geotrichum candidum were recovered from the complementary foods. Twenty-eight major mycotoxins and derivatives, and another 109 microbial metabolites including chloramphenicol (a bacterial metabolite), were quantified in 137 food samples by LC-MS/MS. Aflatoxins and fumonisins co-contaminated 42% of the cereal- and nut-based food samples, at mean concentrations exceeding the EU limits of 0.1 and 200 μg/kg set for processed baby foods by 300 and six times, respectively. Milk contained mainly beauvericin, chloramphenicol and zearalenone. The trichothecenes, T-2 and HT-2 toxins, were quantified only in infant formula and at levels three times above the EU indicative level of 15 μg/kg for baby food. Chronic exposure estimate to carcinogenic aflatoxin was high causing low margin of exposure (MOE). Exposures to other mycotoxins either exceeded the established reference values by several fold or revealed low MOEs, pointing to important health risks in this highly vulnerable population. The observed mycotoxin mixtures may further increase risks of adverse health outcomes of exposure; this warrants urgent advocacy and regulatory interventions.

Risk Assessment of Mycotoxins in Stored Maize Grains Consumed by Infants and Young Children in Nigeria.

Maize is a major complimentary food for infants (0–4 years) and young children (5–12 years) in Nigeria. In this study, we assessed the risk of exposure of infants and young children (IYC) to some major mycotoxins in stored maize grains from five agro-ecological zones of Nigeria. The probable daily intake approach was employed to determine exposure to five mycotoxins while the margin of exposure (MOE) and population at risk of primary hepatocellular carcinoma approaches were used to characterize the risk of consuming aflatoxin contaminated maize. Infants and young children in the Derived Savannah zone are more exposed to aflatoxins, ochratoxins, and zearalenone while those in the Northern Guinea Savanna zone are mainly exposed to deoxynivalenol and fumonisins. The mean national MOE for infants and children were 0.12 and 0.3 respectively while the risk of developing primary liver cancer was estimated at 152.7 and 61.1 cancer/year/100,000 population of infants and children, respectively. Infants and young children consuming mycotoxin contaminated maize in Nigeria are therefore vulnerable to the adverse health effects. Mycotoxin contamination of maize is still a challenge in Nigeria; mitigation efforts should target the value chain and stricter tolerable limits should be enforced.

Joint modeling of Anaemia and Malaria in children under five in Nigeria

Malaria and anaemia which jointly account for high proportion of morbidity and mortality among young children in developing countries have been individually studied using binary regression model. We adopt geoadditive latent variable model for binary/ordinal indicators to analyze the influence of variables of different types on the morbidity among young children in Nigeria. Latent variable models allow for the analysis of multidimensional response variables that reveal the indicator’s underlying relationship that are caused by the latent variables. We extend the structural model to a semi-parametric geoadditive model in order to quantify the joint spatial structure of morbidity from malaria and anaemia. Findings revealed substantial geographical variations and the generated maps can guide policy makers and donors on how to prudently utilize the scarce resources for designing more cost-effective interventions.

Enteric Adenovirus and Norovirus Gastroenteritis among Under-5 years Children in Owo, Ondo State, Nigeria

Aim: Infant mortality attributable to diarrhea continue unabated, without the precise determination of the viral etiologies. Few studies exist on enteric adenoviruses and norovirus infections in infants and young children in Nigeria. This study was aimed at the detection and determination of the Original Research Article Babalola et al.; BJMMR, 9(8): 1-9, 2015; Article no.BJMMR.14082 2 baseline prevalence of enteric adenoviruses and norovirus pathogens among under -5 years children hospitalized for acute diarrhea in Ondo state, Nigeria. Methods: In a cross sectional descriptive study conducted between November 2013 and April 2014, fifty (50) fecal specimens collected from diarrheic children below 5 years and age matched non-diarrheic controls were screened for the presence of enteric adenovirus and norovirus antigens using a 4 th generation quadruple Rapid Immunochromatographic Enzyme Immuno Assay kits. Results: Adenovirus antigen was detected in 9/50 (18%) in November 2013, and February to April 2014 while norovirus was found in 4/50 (8%) of the diarrheic children, in the months of December 2013 to February 2014. The prevalent age at infection were 0-6 months for adenovirus and 31-36 months for norovirus, while the male-to-female ratio was 1.8:1. Co-infection of adenovirus with rotavirus was detected in children between 7-12 months, while co-infection of adenovirus with norovirus was detected in children between 31-36 months old at a rate of 2% respectively. There was no significant difference in the induction of diarrhea in children by each of the two viruses (χ=1.78), and no significant difference in the rate of adenovirus (χ=0.605) and norovirus infections (χ 2 =1.09) between male and female, in the study population. Conclusion: The baseline prevalence of enteric adenovirus diarrhea was 18% (occurring in November, February to April), norovirus was 8% (occurring in December to February), dual infection by adenovirus cum rotavirus, and adenovirus cum norovirus was 2% respectively, in children below 3 years in Ondo state Nigeria. The findings suggests that human enteric adenoviruses and norovirus are becoming established etiologies of infantile diarrhea in southwest Nigeria, and vaccines should be developed and vaccination implemented alongside rotavirus.

A Bayesian multinomial modeling of spatial pattern of co-morbidity of malaria and non-malarial febrile illness among young children in Nigeria.

Children in developing countries continue to suffer mortality and morbidity from a number of illnesses, among which are malaria and non-malarial febrile illnesses, which epidemiologically overlap. We examined the spatial pattern and risk factors of co-morbidity of malaria and non-malarial febrile illness among children aged 6-59 months in Nigeria. Using data from the 2010 Nigeria Malaria Indicator Survey, we considered the co-morbidity of malaria and non-malarial febrile illness among the children as multicategorical and selected a mixed multinomial logit model capable of incorporating covariates of different types. Inference was Bayesian, based on multicategorical linear mixed-model representation. We found that the risk of co-morbidity of malaria and non-malarial febrile illness increases as a child advances in age while the risk of non-malarial fever reduces after about 32 months of age. Area of residence (urban or rural), wealth index and type of roofing material used in the dwelling are other important risk factors for the co-morbidity found in this study. Further, children from four of Nigeria's 37 states are at high risk of malaria. Disease preventive measures need to be intensified, with more focus on rural areas and the poor. Campaigns for use of insecticide-treated bed nets need be more aggressive in all Nigerian states.

Possible determinants and spatial patterns of anaemia among young children in Nigeria: a Bayesian semi-parametric modelling

Anaemia is a global public health problem affecting both developing and developed countries with major consequences for human health and socioeconomic development. This paper examines the possible relationship between Hb concentration and severity of anaemia with individual and household characteristics of children aged 6-59 months in Nigeria; and explores possible geographical variations of these outcome variables. Data on Hb concentration and severity of anaemia in children aged 6-59 months that participated in the 2010 Nigeria Malaria Indicator Survey were analysed. A semi-parametric model using a hierarchical Bayesian approach was adopted to examine the putative relationship of covariates of different types and possible spatial variation. Gaussian, binary and ordinal outcome variables were considered in modelling. Spatial analyses reveal a distinct North-South divide in Hb concentration of the children analysed and that states in Northern Nigeria possess a higher risk of anaemia. Other important risk factors include the household wealth index, sex of the child, whether or not the child had fever or malaria in the 2 weeks preceding the survey, and children under 24 months of age. There is a need for state level implementation of specific programmes that target vulnerable children as this can help in reversing the existing patterns.

A Marked Disadvantage: Rapid Urbanization and Mortality of Young Children in Nigeria

Individual-level socioeconomic position has long been recognized as a factor in childhood mortality, with lower position carrying a higher risk of death before age 5. Recent research suggests that living in a socioeconomically disadvantaged area increases a child’s risk even after adjusting for factors such as mother’s education or income. A new study using data from Nigeria shows higher rates of under-5 mortality coincided with increased urbanization and uniquely accounts for the impact of disadvantaged neighborhoods on mortality in this age group [EHP 118:877–883; Antai and Moradi]. The pace of urbanization in low- and middle-income countries, paired with inadequate economic performance and other constraints, can result in urban residents increasingly living in areas with overcrowded or deteriorating housing, few social amenities, poor environmental and sanitary conditions, and a lack of economic opportunities. Such conditions are associated with an increased risk of infectious disease and death, with under-5 mortality rates in particular reflecting the degree of socioeconomic development in specific geographic areas. Nigeria has very rapidly shifted from a mostly rural nation to a heavily urbanized one. In 1970 only 16% of the population lived in an urban area compared with an estimated 40% or more today. The current study used cross-sectional data from the 2003 Nigeria Demographic and Health Survey to assess how urbanization related to under-5 mortality rates and to evaluate the influence of area-level socioeconomics. A subsample of 1,350 mothers and 2,118 of their children, representing 165 administratively defined communities, was selected from the data, which provided demographic and socioeconomic information as well as children’s birth order and time intervals between siblings’ births. Neighborhoods were ranked by “urban area disadvantage index” scores, calculated by the percentage of children living in households without piped water, flush toilets, electricity, or nonpolluting cooking fuel; whose mothers were unemployed or uneducated; and whose households were overcrowded or among the poorest 40%. Analysis revealed that under-5 mortality increased in the periods 1979–1983 and 1999–2003. Additionally, after controlling for individual child and maternal factors, under-5 mortality rose with urban area disadvantage index score. The researchers concluded that living in a socioeconomically disadvantaged neighborhood independently increased mortality for children under 5 years old. Additionally, they confirmed other research showing that first-born status and short interval between births increased the risk of early childhood death. This study highlights a need for data to better define relationships between urban environments and health, a focus on reducing inequalities, and a promotion of longer birth intervals.

Morbidity from diarrhoea, cough and fever among young children in Nigeria

Diarrhoea, cough and fever are the leading causes of childhood morbidity and mortality in sub-Saharan Africa. Despite it being a determinant of mortality in many developing countries, geographical location has seldom been considered as an explanatory factor for the large regional variations seen in the childhood morbidity attributed to these causes in this area. The relevant data collected in two Nigerian Demographic and Health Surveys, one in 1999 and the other in 2003, have now therefore been analysed and compared. The aim was to reveal and explore inequalities in the health of Nigerian children by mapping the spatial distribution of childhood morbidity associated with recent diarrhoea, cough and fever and accounting for important risk factors, using a Bayesian geo-additive model based on Markov-chain-Monte-Carlo techniques. Although the overall prevalences of recent diarrhoea, cough and fever recorded in 1999 (among children aged <3 years) were similar to those seen in 2003 (among children aged <5 years), the mapping of residual spatial effects indicated that, in each survey, the morbidity attributable to each of these causes varied, differently, at state level. Place of birth (hospital v. other), type of feeding (breastfed only v. other), parental education, maternal visits to antenatal clinics, household economic status, marital status of mother and place of residence were each significantly associated with the childhood morbidity investigated. In both surveys, children from urban areas were found to have a significantly lower risk of fever than their rural counterparts. Most other factors affecting diarrhoea, cough and fever differed in the two surveys. The risk of developing each of these three conditions increased in the first 6-8 months after birth but then gradually declined. The analysis explained a significant share of the pronounced residual spatial effects. Maps showing the prevalences of diarrhoea, cough and fever in young children across Nigeria were generated during this study. Such maps should facilitate the development of policies to fulfil the Millennium Development Goals in Nigeria and throughout sub-Saharan Africa.

Detection of human group C rotaviruses in Nigeria and sequence analysis of their genes encoding VP4, VP6, and VP7 proteins.

In a survey on the etiology of acute gastroenteritis in infants and young children in Nigeria, group C human rotaviruses were detected in two of 112 rotavirus positive stool specimens collected between 1999 and 2000. The VP7, VP6, and VP4 genes of the two Nigerian human group C rotavirus strains (Jajeri and Moduganari) were sequenced in this study. Comparative sequence analysis with other published human group C rotaviruses showed that the genes encoding the three structural proteins were remarkably conserved in primary structure with few mutations. The VP4 and VP7 genes from the two Nigerian strains were related more closely to each other than to those of other published strains, and formed a separate cluster on the phylogenetic tree. In contrast, it was of note that VP6 gene of strain Moduganari was related more closely to the Brazilian strain Belem than to the other Nigerian strain Jajeri. This is the first report of identification of human group C rotavirus in Nigeria and constitutes the first sequence data of human group C rotaviruses in the African continent.

Onchocerciasis in pre-primary school children in Nigeria: lessons for onchocerciasis country control programme

There is limited data on the prevalence of onchocerciasis in young children in Nigeria, partly because treatment with the effective drug Ivermectin has been contra-indicated in children less than 5. As the risk of complications of onchocerciasis is related to duration and intensity of infection, it would be beneficial to know the prevalence in young children for design of control programmes. A study was therefore undertaken to determine the prevalence of onchocerciasis in 642 children 0–4 years old in a rain forest endemic community in South East Nigeria. The overall onchocerciasis prevalence (positive skin snips) for children 0–4 years old in three Local Government Areas in Enugu State, Eastern Nigeria was 15.7% with no significant difference in infection rates between male and female children. There was no detectable infection in children less than 1 year old. Characteristic onchocercal rash was identified in 11.1% of the children and presence of typical onchocercal subcutaneous palpable nodules in 4.6%. Total prevalence for adults in the same population was found to be 26.9%. This indicates that in onchocerciasis endemic communities, everybody may be at risk of infection irrespective of age.