Population modifiable risk factors associated with neonatal mortality in 35 sub-Saharan Africa countries: analysis of data from demographic and health surveys.

Background: Sub-Saharan Africa (SSA) has the highest burden of neonatal mortality in the world. Identifying the most critical modifiable risk factors is imperative for reducing neonatal mortality rates. This study is the first to calculate population-attributable fractions (PAFs) for modifiable risk factors of neonatal mortality in SSA. Methods: We analysed the most recent Demographic and Health Surveys data sets from 35 SSA countries conducted between 2010 and 2022. Generalized linear latent and mixed models were used to estimate odds ratios (ORs) along with 95% confidence intervals (CIs). PAFs adjusted for communality were calculated using ORs and prevalence estimates for key modifiable risk factors. Subregional analyses were conducted to examine variations in modifiable risk factors for neonatal mortality across Central, Eastern, Southern, and Western SSA regions. Findings: In this study, we included 255,891 live births in the five years before the survey. The highest PAFs of neonatal mortality among singleton children were attributed to delayed initiation of breastfeeding (>1 h after birth: PAF = 23.88%; 95% CI: 15.91, 24.86), uncleaned cooking fuel (PAF = 5.27%; 95% CI: 1.41, 8.73), mother's lacking formal education (PAF = 4.34%; 95% CI: 1.15, 6.31), mother's lacking tetanus vaccination (PAF = 3.54%; 95% CI: 1.55, 4.92), and infrequent antenatal care (ANC) visits (PAF = 2.45; 95% CI: 0.76, 3.63). Together, these five modifiable risk factors were associated with 39.49% (95% CI: 21.13, 48.44) of neonatal deaths among singleton children in SSA. Our subregional analyses revealed some variations in modifiable risk factors for neonatal mortality. Notably, delayed initiation of breastfeeding consistently contributed to the highest PAFs of neonatal mortality across all four regions of SSA: Central, Eastern, Southern, and Western SSA. Interpretation: The PAF estimates in the present study indicate that a considerable proportion of neonatal deaths in SSA are preventable. We identified five modifiable risk factors that accounted for approximately 40% of neonatal deaths in SSA. The findings have policy implications. Funding: None.

Delays in seeking treatment for fever in children under five years of age in Nigeria: Evidence from the National Demographic Health Survey.

BACKGROUND: In countries with high child mortality rates, such as Nigeria, early intervention for common childhood illnesses (e.g., pneumonia and malaria) is essential for improving clinical outcomes. The timely reporting and treatment of fever is therefore critical in making a differential diagnosis and choosing an appropriate course of treatment. The present study aimed to investigate the prevalence and major risk factors associated with delays in seeking treatment for fever in children under five years of age in Nigeria. METHODS: This study used a total weighted sample of 7,466 children under five years of age from the 2018 National Nigerian Demographic and Health Survey. Multivariable binary logistic regression modelling was used to investigate the association between predisposing, enabling, need, health service and community level factors, and delay in treatment-seeking for fever. RESULTS: We report the delays in seeking treatment for childhood fever that was reported by mothers in the last two weeks prior to the national survey. The prevalence for delayed treatment was 62.1% (95% confidence interval [CI]: 60.1%, 64.1%). Our findings showed that there were fewer delays in seeking treatment in children aged 24-59 months (adjusted odds ratio [aOR] = 0.79, 95% CI: 0.68, 0.93), among mothers who were formally employed (aOR = 0.84; 95% CI: 0.73, 0.96), regularly attended antenatal services (aOR = 0.76, 95%CI: 0.66, 0.88), and for those who resided in wealthier households (aOR = 0.71; 95% CI: 0.56, 0.89). Children whose mothers resided in the North-West geopolitical zone of Nigeria were less likely to delay seeking treatment for fever (aOR = 0.55; 95% CI: 0.42, 0.73). However, mothers who had an unwanted pregnancy had a higher odds of delaying treatment for childhood fever (aOR = 1.58; 95% CI: 1.05, 2.39). CONCLUSION: There were significant delays in seeking treatment for childhood fever in poorer homes found in geopolitically unstable zones of Nigeria. Mothers who were poor, unemployed, and with younger children (<12 months) often delayed seeking treatment for their febrile child. Future health promotion strategies and microenterprise schemes should target both rural and urban mothers residing in poor households. Children under 12 months of age should be a priority.

Knowledge, attitude and perception of optometrists in Trinidad and Tobago towards teleoptometry.

Background: The limited accessibility of in-person optometry services during the coronavirus disease 2019 highlighted the need for teleoptometry but no data exists to substantiate the foregoing in Trinidad & Tobago (T&T). The study assessed the knowledge, attitude and perception (KAP) of optometrists toward teleoptometry in T&T. Methods: This cross-sectional study utilized a convenient sampling technique to administer a structured, web-based survey to all registered optometrists in T&T between March and June 2021. Information on demographics and KAP of teleoptometry were collected. Descriptive statistics (mean, percentages, and standard deviations) were used to describe the characteristics of respondents. The mean scores for the main outcomes (KAP) were compared between the categorical groups of the demographic variables, using a one-way analysis of variance. A P-value of less than 0.05 was considered statistically significant. Results: Of the 116 registered optometrists in T&T, 63 responded to the survey (response rate, 54.3%), and were mostly women (44, 69.8%), aged 21-30 years (42, 66.7%), worked in urban regions (41, 65.1%), and half of them (32, 50.8%) had practiced optometry for five or more years. More than two-thirds of the optometrists (76.4%) reported that they had never provided teleoptometry services, and only a few (2, 3.2%) had training on teleoptometry. The percentage mean scores for knowledge were significantly lower than attitude (38.5 ± 17.9% vs 78.2 ± 29.9%; P = 0.002) and perception (46.2 ± 11.4%; P < 0.001) scores, all of which were significantly lower among self-employed than employed optometrists (P < 0.02, for all three variables). While men and non-professional computer users had higher mean scores for attitude than women (3.03 [95%CI: 2.14, 3.93] vs 2.31 [95%CI: 1.41, 3.21], P = 0.037) and professional users (3.15 [95%CI: 2.07, 4.24] vs 2.18 [95%CI: 1.12, 3.24], P = 0.001), knowledge and perception scores varied significantly with practitioners' years of experience (P = 0.042) and age (P = 0.041), respectively. Conclusion: The findings of the study suggest that although there was limited knowledge of teleoptometry among the participants, particularly the self-employed and the less experienced optometrists, most of them had good attitudes and perceptions toward teleoptometry. To fill the identified knowledge gap, there is a need for teleoptometry training among optometrists in T&T.

Multilevel modelling of the risk of malaria among children aged under five years in Nigeria.

BACKGROUND: Malaria is still a major cause of morbidity and mortality among children aged <5 y (U5s). This study assessed individual, household and community risk factors for malaria in Nigerian U5s. METHODS: Data from the Nigerian Malaria Health Indicator Survey 2015 were pooled for analyses. This comprised a national survey of 329 clusters. Children aged 6-59 mo who were tested for malaria using microscopy were retained. Multilevel logit model accounting for sampling design was used to assess individual, household and community factors associated with malaria parasitaemia. RESULTS: A total of 5742 children were assessed for malaria parasitaemia with an overall prevalence of 27% (95% CI 26 to 28%). Plasmodium falciparum constituted 98% of the Plasmodium species. There was no significant difference in parasitaemia between older children and those aged ≤12 mo. In adjusted analyses, rural living, northwest region, a household size of >7, dependence on river and rainwater as primary water source were associated with higher odds of parasitaemia, while higher wealth index, all U5s who slept under a bed net and dependence on packaged water were associated with lower odds of parasitaemia. CONCLUSION: Despite sustained investment in malaria control and prevention, a quarter of the overall study population of U5s have malaria. Across the six geopolitical zones, the highest burden was in children living in the poorest rural households.