Nurses' perceptions regarding their own professionalism attributes to quality neonatal, infant and under-5 childcare.

BACKGROUND: Professional nurses are trained to provide quality care. Despite the professional nurses' acquired skill and professionalism attributes, the neonate, infant, and under-5-child mortality rates are high in sub-Saharan Africa. This health care report indicates that sub-Saharan Africa countries face a challenge in reaching the Sustainable Development Goal number 3 by the year 2030 (that is, ensuring healthy lives and reducing the mortality rates of children under 5). It has been reported that professionalism in nursing can improve the quality of care and positively change the health outcomes. METHODS: This study employed a qualitative exploratory, descriptive design to explore and describe professional nurses' own professionalism attributes to provide quality care to neonates, infants, and under-5 children in the North West province in South Africa. Eight naïve sketches of an all-inclusive sample of invited professional nurses (N = 25; n = 8) were received. The naïve sketch questions were based on the Registered Nurses' Association of Ontario's professionalism attributes. Tesch's eight steps of data-analysis were used, with an independent coder's assistance. RESULTS: The categories included (1) knowledge, (2) spirit of inquiry, (3) accountability, (4) autonomy, (5) advocacy, (6) collegiality and collaboration, (7) ethics and values, and (8) professional reputation, and each category generated sub-themes. CONCLUSION: Professional nurses are aware of their own professionalism attributes in quality of care of neonates, infants and under-5 children; the 'innovation and visionary' attribute did not emerge, which should receive more attention to strengthen quality care. However, a new attribute, 'professional reputation', reflecting a South African culture-orientated attribute, emerged from the data collected.

Adherence to referral advice and its associated factors among community drug distributors and caregiver during SMC implementation in nine states.

BACKGROUND: Malaria is a global public health problem that disproportionately affects under-five children in poor resource countries. Nigeria accounted for the highest burden of malaria in Western Africa. Thus, seasonal malaria chemoprevention (SMC) programmes have been recommended and have been implemented across 9 states (Bauchi, Borno, FCT, Kebbi, Kogi, Nasarawa, Plateau, Oyo and Sokoto) in Nigeria. The study aims to measure the adherence to referral protocol and its associated factors among community drug distributors (CDs) and caregivers during SMC implementation in nine states. METHODS: The data of caregiver-child pairs that were identified with fever during the cycle one SMC implementation was extracted from the End-of-cycle (EoC) surveys carried out following cycles one SMC implementation in the study states. The surveys were completed within two weeks of the completion of SMC cycle one. Mixed-effects multivariable logistic regression models were fitted to explore the factors associated with adherence to referrals among caregivers-child pairs. RESULTS: The socio-demographic characteristics of caregiver considered in the model were not found to be significantly associated with children down with fever taking to hospital for treatment, however the caregiver whose child was referred by CDs had significantly higher odds of seeking healthcare compared to those that were not referred (OR: 1.892, 95% CI 1.081-3.310, p = 0.025). There are higher odds of children seeking treatment among those that were referred by CDs. CONCLUSION: The study's findings shed light on the adherence to referral advice and the factors influencing caregiver behaviour during SMC implementation. Referral of sick child during SMC campaign appears to ensure health-seeking for malaria case management among caregivers-child peer in target communities.

Caretaker's Knowledge, Attitudes, and Practices Regarding the Causes, Treatments, and Risks of Diarrhea Among Under-Five Children in North-Eastern Tanzania: A Cross-Sectional Study.

Background. Pediatric diarrhea remains a public health concern. This study explored caretaker's knowledge, attitudes, and practices regarding the causes, treatments, and risks of diarrhea among under-fives in Korogwe and Handeni districts, north-eastern Tanzania. Methods. We conducted a qualitative, cross-sectional study. Participants were selected through purposive sampling. Data were gathered through in-depth interviews and focus group discussions, and they were analyzed using thematic analysis. Results. Most participants had good knowledge about the risks of diarrhea among under-fives. However, most participants had poor knowledge of the causes and treatments of diarrhea. A significant proportion of participants had negative attitudes and poor practices about the treatment of diarrhea. A small percentage of participants possessed positive attitudes and appropriate practices for managing diarrhea. Conclusion. To bridge the knowledge gaps among caretakers and promote positive attitudes and behaviors about the management of diarrheal diseases, health authorities are urged to strengthen health education in the study communities.

An analysis of cause-specific under-5 mortality in Bangladesh using the demographic and health survey 2011 and 2017-2018.

BACKGROUND: As the Sustainable Development Goal 3.2.1 deadline (2030) approaches, rapidly reducing under-5 mortality (U5M) gains more prominence. However, initiatives or interventions that aided Bangladesh in achieving Millennium Development Goal 4 showed varied effectiveness in reducing certain cause-specific U5M. Therefore, this study aimed to examine the predictors of the key cause-specific mortalities. METHODS: This cross-sectional study was conducted using the Bangladesh Demographic and Health Survey 2011 and 2017-18 data. Cause-specific U5M was examined using multilevel multinomial mixed-effects analyses, and overall/all-cause U5M was examined using multilevel mixed-effects analyses. The respective estimates were compared. RESULTS: The cause-specific analysis revealed that pneumonia and prematurity-related U5M were significantly associated with antenatal care and postnatal care, respectively. However, analysis of overall/all-cause U5M did not reveal any significant association with health services. Twins or multiples had a greater risk of mortality from preterm-related conditions (adjusted Relative Risk Ratio (aRRR): 38.01, 95% CI: 19.08-75.7, p < .001), birth asphyxia (aRRR: 6.52, 95% CI: 2.51-16.91, p < .001), and possible serious infections (aRRR: 11.12, 95% CI: 4.52-27.36, p < .001) than singletons. Children born to mothers 18 years or younger also exhibited a greater risk of mortality from these three causes than children born to older mothers. This study also revealed an increase in the predicted risk of prematurity-related mortality in the 2017-18 survey among children born to mothers 18 years or younger, children born to mothers without any formal education, twins or multiples and children who did not receive postnatal care. CONCLUSIONS: This research provides valuable insights into accelerating U5M reduction; a higher risk of preterm-related death among twins underscores the importance of careful monitoring of mothers pregnant with twins or multiples through the continuum of care; elevated risk of death among children who did not receive postnatal care, or whose mothers did not receive antenatal care stresses the need to strengthen the coverage and quality of maternal and neonatal health care; furthermore, higher risks of preterm-related deaths among the children of mothers with low formal education or children born to mothers 18 years or younger highlight the importance of more comprehensive initiatives to promote maternal education and prevent adolescent pregnancy.

A Study of the Prevalence of Anemia in Children With Severe Acute Malnutrition at a Pediatric Tertiary Care Hospital in South India.

Introduction In developing countries such as India, severe acute malnutrition (SAM) has been a cause for great concern in the pediatric population. SAM is associated with significant morbidity and mortality in children less than 60 months of age and leaves them vulnerable to diseases due to a decrease in immunological response. Children with SAM are prone to infections, and due to nutritional deficiency, many have anemia which may be a direct or indirect cause of morbidity and mortality. They are affected by frequent respiratory and gastrointestinal infections. Methodology A cross-sectional study was conducted for a period of two months, from December 1, 2023, to January 31, 2024, in children with SAM aged less than 60 months. A detailed history and demographic profile were taken and recorded in a predesigned proforma. Anthropometric measurements of the study subjects were recorded, and lab investigations included complete blood picture, serum iron, serum ferritin, serum folate, and serum vitamin B12 levels. The prevalence and severity of anemia were determined by assessing the hemoglobin levels. The data collected was analyzed in Excel sheets (Microsoft Corporation, Redmond, Washington, United States) and the results were depicted in the form of graphs. Results A total of 300 children were included in the study of which 22 children were aged less than six months and 278 children were in the age group of 6-60 months. The overall gender distribution was 124 (41.4%) males and 176 (58.6%) females. In the age group of <6 months, of the 22 children, six (27.27%) were females while 16 (72.72%) were male. In the age group of 6-60 months, of the 278 children, 170 (61%) were females while 108 (39%) were males. Of the total 300 children, 232 (77.3%) were found to be anemic, of which 54 (23.2%) had mild anemia, 162 (69.8%) had moderate anemia, and 16 (6.89%) had severe anemia. Low serum iron levels were detected in 134 (44.6%) with iron deficiency being more common in females; below-normal ferritin levels were seen in 153 (51%) cases. Folate levels were found to be deficient in 97 (32.3%) children while vitamin B12 levels were deficient in 186 (62%). Conclusion Anemia is a common occurrence in children with SAM. Prevention of anemia starts from the womb by improvement of maternal nutrition and iron, and folic acid supplementation during pregnancy. Exclusive breastfeeding up to six months of age and further continuation of breastfeeding coupled with initiation of home-available complementary feeding from the age of six months onwards go a long way in maintaining healthy nutrition status in children in the vulnerable age group of less than 60 months. Healthcare professionals should utilize the well-baby and well-child visits to educate the parents and primary caretakers regarding the feeding practices to prevent, detect, and treat anemia, which will help reduce the morbidity and mortality in children with SAM.

Parents' Willingness to Vaccinate Their Children Aged From 6 Months to Under 5 Years With COVID-19 Vaccines.

Despite strides in vaccinating priority groups against COVID-19, children under 5 years in Vietnam are still under-immunized, emphasizing a significant gap in prioritization. This study aimed to assess parental willingness to vaccinate children aged 6 months to under 5 years against COVID-19 in Vietnam and identify influential factors affecting this willingness. Data were collected via a survey of 5960 parents/guardians between May and June 2022. Multinomial logistic regression was employed to analyze the impact of various factors on parents' willingness to vaccinate their children, alongside investigating reasons for reluctance or refusal and preferences for vaccine origins. Approximately 50.5%, 30.2%, and 19.3% of parents were willing, hesitant, and unwilling to vaccinate their children, respectively. Primary reasons for reluctance included concerns about vaccine safety, efficacy, and the severity of the pandemic. The most preferred vaccines originated in the United States. Factors significantly influencing willingness included parents' age, knowledge of COVID-19 and vaccines, residency, education, perception of information sufficiency, children's comorbidities, and family members' vaccination status. Promoting child vaccination habits can boost COVID-19 immunization rates. Targeting hesitancy among parents of children with comorbidities is crucial. Enhancing parental knowledge and leveraging fully vaccinated family members are effective strategies.

Health care-seeking behavior for childhood illnesses in western Kenya: Qualitative findings from the Child Health and Mortality Prevention Surveillance (CHAMPS) Study.

Background: Child mortality in Kenya is 41 per 1,000 live births, despite extensive investment in maternal, newborn, and child health interventions. Caregivers' health-seeking for childhood illness is an important determinant of child survival, and delayed healthcare is associated with high child mortality. We explore determinants of health-seeking decisions for childhood illnesses among caregivers in western Kenya. Methods: We conducted a qualitative study of 88 community members between April 2017 and February 2018 using purposive sampling in an informal urban settlement in Kisumu County, and in rural Siaya County. Key informant interviews, semi-structured interviews and focus group discussions were performed. We adopted the Partners for Applied Social Sciences model focusing on factors that influence the decision-making process to seek healthcare for sick infants and children. The discussions were audio-recorded and transcribed. Data management was completed on Nvivo® software. Iterative analysis process was utilized and themes were identified and collated. Results: Our findings reveal four thematic areas: Illness interpretation, the role of social relationship on illness recognition and response, medical pluralism and healthcare access. Participants reported some illnesses are caused by supernatural powers and some by biological factors, and that the illness etiology would determine the health-seeking pathway. It was common to seek consensus from respected community members on the diagnosis and therefore presumed cause and necessary treatment for a child's illness. Medical pluralism was commonly practiced and caregivers would alternate between biomedicine and traditional medicine. Accessibility of healthcare may determine the health seeking pathway. Caregivers unable to afford biomedical care may choose traditional medicine as a cheaper alternative. Conclusion: Health seeking behavior was driven by illness interpretation, financial cost associated with healthcare and advice from extended family and community. These findings enrich the perspectives of health education programs to develop health messages that address factors that hinder prompt health care seeking.

Shigella and ETEC have replaced rotavirus as main causes of childhood diarrhea in Rwanda after ten years of rotavirus vaccination.

The causes of diarrhea after ten years of rotavirus vaccination in Rwanda were investigated in 496 children with and 298 without diarrhea using a real-time PCR. Rotavirus was detected in 11% of children with diarrhea (OR 2.48, P=0.002). Comparison of population attributable fractions (PAF) show that Shigella (PAF=11%) and ETEC-eltB (PAF=12%) have replaced rotavirus as the main causative agents. The PAF for rotavirus had declined from 41% pre-vaccination to 6.5%, indicating that rotavirus has become one among several similarly important causes of childhood diarrhea in Rwanda. A rotavirus genotype shift to G3P[8] points at the importance of continued genotype surveillance.

Capturing growth indices on the road to health booklets in clinics in Free State, South Africa.

Background: Growth monitoring plays an essential role in the development of young children. Anthropometric indices are of utmost importance for healthcare professionals to identify children at risk of inadequate growth and malnutrition. Aim: This study aimed to assess the capturing of the growth indices in the Road to Health Booklets (RTHB) in clinics. Setting: The study was carried out in Mangaung Metropolitan municipal clinics in the Free State province, South Africa. Methods: A descriptive quantitative study was conducted using a checklist to audit 264 RTHBs. Descriptive statistics were used to analyse data. Results: The findings showed that birth weight was recorded in most 99% (n = 262) of the RTHBs. The mid-upper arm circumference (MUAC) was not recorded in 58% (n = 153) of the cases during the last visit. Weight-for-Age (WfA) was routinely plotted in 91% (n = 241) of the RTHB. The length or Height-for-Age (LHfA) was plotted in 38% (n = 99) of the RTHB and Weight-for-Length or height (WfLH) was plotted in 31% (n = 81) of the RTHB. Conclusion: The results demonstrated that certain anthropometric measures including MUAC, length, or height were absent from the records of the RTHB. Consequently, RTHB may not be effectively used as a means of evaluating nutritional status, affecting early detection of malnutrition in children. Contribution: The research makes a valuable addition to the existing body of knowledge for monitoring growth and measurement of anthropometric indices in the RTHB, as well as the appropriate execution of these practices.

The monthly trends of malaria cases in children under 5 years of age in Guinea: comparative analysis between a seasonal malaria chemoprevention (SMC) and a non-SMC health district.

BACKGROUND: The Republic of Guinea, where malaria represents the leading cause of morbidity and mortality among children, the seasonal malaria chemoprevention (SMC) is deployed only in areas with very seasonal modes of transmission. It should target children at the highest risk of serious illness. The objective of the study was to prevent uncomplicated and serious cases of malaria in the target population. This study aimed to analyse the monthly trends in malaria-related morbidity among children under the age of 5 in Guinea. METHODS: This was a quasi-experimental study with routine data from the National Health Information System (SNIS). The two districts Mamou (the SMC intervention site) and Kindia (the control site) were selected to compare the monthly trends in malaria cases among children under the age of 5, from July to October, covering the years from 2015 to 2020. The statistical analysis used interrupted time series to estimate the effects of the SMC. RESULTS: The SMC programme contributed to a significant average reduction in the number of malaria cases of 225 cases per month in the intervention district (95% CI - 362 to - 88; p = 0.002), compared to the control district. However, the study also revealed that the effect of SMC varied between cycles, presenting different monthly malaria cases. CONCLUSION: The SMC contributed to a significant reduction in malaria cases among children under the age of 5 in the health district of Mamou from 2018 to 2020. However, this reduction varied by monthly SMC cycle. This study suggests extending the SMC in other areas with high perennial seasonal transmission respecting the World Health Organization SMC eligibility criteria, as a strategy in the dynamic of reducing malaria cases in children under the age of 5 in Guinea.

Adaptive Gaussian Markov random fields for child mortality estimation.

The under-5 mortality rate (U5MR), a critical health indicator, is typically estimated from household surveys in lower and middle income countries. Spatio-temporal disaggregation of household survey data can lead to highly variable estimates of U5MR, necessitating the usage of smoothing models which borrow information across space and time. The assumptions of common smoothing models may be unrealistic when certain time periods or regions are expected to have shocks in mortality relative to their neighbors, which can lead to oversmoothing of U5MR estimates. In this paper, we develop a spatial and temporal smoothing approach based on Gaussian Markov random field models which incorporate knowledge of these expected shocks in mortality. We demonstrate the potential for these models to improve upon alternatives not incorporating knowledge of expected shocks in a simulation study. We apply these models to estimate U5MR in Rwanda at the national level from 1985 to 2019, a time period which includes the Rwandan civil war and genocide.

Detection of spatial, temporal and spatiotemporal distribution of diarrhea incidence among under-five children in Central Gondar zone, Northwest Ethiopia: a time-series study (2019-2022).

Under-five children's diarrhea is a significant public health threat and the World Health Organization (WHO) reported it as the second leading cause of children's death worldwide. In this study area, little is known about the spatiotemporal distribution of under-5 diarrhea incidence. This study was therefore, conducted among all districts in the Central Gondar zone to assess the spatial, temporal, and spatiotemporal variation in diarrhea incidence among under-five children in the Central Gondar zone. The data for children under 5 years of age with diarrhea was obtained from Central Gondar Zone Health Department diarrhea reports from January 2019 to December 2022. All districts were included and geo-coded. The spatial data were created in ArcGIS 10.8.1. Global and local spatial autocorrelation were used to detect hot spots and cold spots. The Poisson model was generated by applying the Kulldorff method in SaTScan™9.6 to analyse the the purely temporal, spatial, and space-time clusters. The study revealed spatial variation of under-5 diarrhea where Gondar City, Gondar Zuria, East Dembia, and Lay Armacho districts were the high-rate spatial clusters during the study period. A year search window for temporal scan statistic identified 01 January 2020-30 December 2021 as risk periods across all districts. Spatiotemporal scan statistics detected high-rate clusters at Gondar City, Gondar Zuria, East Dembia, Lay Armacho, and Alefa between 2019 and 2022. In conclusion, there has been a spatial, temporal, and spatiotemporal variability of under-5 children's diarrhea in the Central Gondar Zone. Interventional and preventive strategies should be developed and given priority to the areas that has been detected as a hotspot in this study to reduce the mortality and morbidity of under 5 children.

Prevalence of high-risk children and role of maternal factors on these children-findings of cross-sectional community-based study.

Background: Children, being the future of any nation, not only need special attention but also need a suiTable environment to have proper growth and development. They are also vulnerable to various diseases and disabilities. It is observed that certain maternal characteristics are helpful in the development and survival of such high-risk children. Methodology: A community-based, cross-sectional, analytic study was undertaken among children under 5 years of age in two slums. The population of both slums was 1550, out of which children under 5 years of age were 196 (12.64%), which constituted the study population. The "high-risk" children were identified based on pre-development criteria of "risk factors." Data was collected by interview technique, physical examination of the children, and checking of medical documents. The data regarding "high-risk" children were analyzed to determine the association of "high-risk" children with maternal factors like birth order, education, and occupation of the mother and child being looked after as the mother's substitute. The data obtained was subjected to standard statistical methods to achieve valid comparisons. Results: The present study revealed that out of 196 children under 5 years of age surveyed, 88 were "high-risk" children which constituted a prevalence rate of 44.89%. A significant association had been found between the prevalence of "high-risk" children and factors like birth order, education, and occupation of the mother and child being looked after by the mother's substitute. Conclusion: The study showed a significant association between various maternal factors and high-risk children. Thus maternal social and environmental factors along with enhancing pregnancy health go a long way in preventing high-risk children and betterment of child health.

Maintaining Delivery of Evidence-Based Interventions to Reduce Under-5 Mortality During COVID-19 in Rwanda: Lessons Learned through Implementation Research.

Background: The COVID-19 pandemic resulted in drops in access to and availability of a number of evidence-based interventions (EBIs) known to reduce under-5 mortality (U5M) across a wide range of countries, including Rwanda. We aimed to understand the strategies and contextual factors associated with preventing or mitigating drops nationally and subnationally, and the extent to which previous efforts to reduce U5M supported the maintenance of healthcare delivery. Methods: We used a convergent mixed methods implementation science approach, guided by hybrid implementation research and resiliency frameworks. We triangulated data from three sources: desk review of available documents, existing routine data from the health management information system, and key informant interviews (KIIs). We analyzed quantitative data through scatter plots using interrupted time series analysis to describe changes in EBI access, uptake, and delivery. We used a Poisson regression model to estimate the impact of COVID-19 on health management information system indicators, adjusting for seasonality. We used thematic analysis of coded interviews to identify emerging patterns and themes. Results: We found moderate 4% (IRR = 0.96; 95%CI: 0.93, 1.00) and 5% (IRR = 0.95; 95%CI: 0.92, 0.99) drops in pentavalent and rotavirus 2 doses vaccines administered, respectively. Nationally, there was a 5% drop in facility-based delivery (IRR = 0.95; 95%CI: 0.92, 0.99). Lockdown and movement restrictions and community and health-worker fear of COVID-19 were barriers to service delivery early in the pandemic. Key implementation strategies to prevent or respond to EBI drops included leveraging community-based healthcare delivery, data use for decision-making, mentorship and supervision, and use of digital platform. Conclusions: While Rwanda had drops in some EBIs early in the pandemic, especially during the initial lockdown, this was rapidly identified, and response implemented. The resiliency of the health system was associated with the Rwandan health system's ability to learn and adapt, encouraging a flexible response to fit the situation.

Amenable Mortality in Children under 5: An Indicator for Identifying Inequalities in Healthcare Delivery: A Review.

Universal health coverage has been proposed as a strategy to improve health in low- and middle-income countries, but this depends on a good provision of health services. Under-5 mortality (U5M) reflects the quality of health services, and its reduction has been a milestone in modern society, reducing global mortality rates by more than two-thirds between 1990 and 2020. However, despite these impressive achievements, they are still insufficient, and most deaths in children under 5 can be prevented with the provision of timely and high-quality health services. The aim of this paper is to conduct a literature review on amenable (treatable) mortality in children under 5. This indicator is based on the concept that deaths from certain causes should not occur in the presence of timely and effective medical care. A systematic and exhaustive review of available literature on amenable mortality in children under 5 was conducted using MEDLINE/PubMed, Cochrane CENTRAL, OVID medline, Scielo, Epistemonikos, ScienceDirect, and Google Scholar in both English and Spanish. Both primary sources, such as scientific articles, and secondary sources, such as bibliographic indices, websites, and databases, were used. Results: The main cause of amenable mortality in children under 5 was respiratory disease, and the highest proportion of deaths occurred in the perinatal period. Approximately 65% of avoidable deaths in children under 5 were due to amenable mortality, that is, due to insufficient quality in the provision of health services. Most deaths in all countries and around the world are preventable, primarily through effective and timely access to healthcare (amenable mortality) and the management of public health programs focused on mothers and children (preventable mortality).

Prevalence of stunting and its correlates among children under 5 in Afghanistan: the potential impact of basic and full vaccination.

BACKGROUND: Child stunting is prevalent in low and middle-income countries (LMICs), but an information gap remains regarding its current prevalence, correlates, and the impact of vaccination against this condition in Afghanistan. This study aimed to determine the prevalence and correlates of moderate and severe stunting and the potential impact of basic and full vaccination among children under five in Afghanistan. METHODS: This is a secondary analysis of the 2022-23 Afghanistan Multiple Indicators Cluster Survey (MICS) including 32,989 children under 5. Descriptive statistics were employed to describe the distribution of independent variables and the prevalence of stunting across them. Chi-square analysis was used to examine the association between each independent variable with stunting. Multinomial logistic regression was used to examine the risk of stunting across different independent variables. RESULTS: A total of 32,989 children under 5 years old were included in this study. Of those 44.7% were stunted with 21.74% being severely stunted. Children aged 24-35 and 36-47 months faced the highest risk as compared to those aged 1-5 months. The prevalence was lower in female children and they were less likely to experience severe stunting. Stunting was more prevalent in rural areas, with children there 1.16 to 1.23 times more likely to be affected than urban counterparts. Lower wealth correlated with higher stunting. Younger maternal age at birth (≤ 18) correlated with increased stunting risks, particularly in severe cases. Parental education was inversely related to stunting; higher education levels in parents, especially fathers, were associated with lower stunting rates. Households with more than seven children showed a 25% and 44% higher risk of moderate and severe stunting, respectively, compared to families with 1-4 children. Improved sanitation, but not drinking water sources, was linked to reduced stunting in the adjusted model. Vaccination had a protective effect; in the adjusted analysis, basic and full vaccinations significantly lowered the risk of severe stunting by 46% and 41%, respectively. CONCLUSION: In this nationally representative study, the prevalence of stunting was substantial (44.7%) in Afghan children. Additionally, the findings emphasize the critical factors associated with child stunting and underscore the protective role of vaccination against this condition, which provides policymakers with directions for policy efforts and intervention strategies to reduce child stunting in Afghanistan.

A Novel CPAP Device With an Integrated Oxygen Concentrator for Low Resource Countries: In Vitro Validation and Usability Test in Field.

Goal: To develop and validatea novel neonatal non-invasive respiratory support device prototype designed to operate in low-resource settings. Methods: The device integrates a blower-based ventilator and a portable oxygen concentrator. A novel control algorithm was designed to achieve the desired fraction of inspired oxygen (FiO2) while minimizing power consumption. The accuracy of the delivered FiO2 and the device power consumption were evaluated in vitro, and a formative usability test was conducted in a rural hospital in Uganda. Results: The agreement between the set and delivered FiO2 was high (limit of agreement:-5.6 ÷ 3.8%). For FiO2 below 60%, the control algorithm reduced the power drain by 50%. The device was also appreciated by intended users. Conclusion: The prototype proved effective in delivering oxygen-enriched continuous positive airway pressure in the absence of compressed air and oxygen, holding promise for a sustainable and effective implementation of neonatal respiratory support in low-resource settings.

Burden of Child Anemia Attributable to Fine Particulate Matters Brought by Sand Dusts in Low- and Middle-Income Countries.

Addressing environmental factors has recently been recommended to curb the growing trend of anemia in low- and middle-income countries (LMICs). Fine particulate matter (PM2.5) generated by dust storms were concentrated in place with a high prevalence of anemia. In a multicounty, multicenter study, we analyzed the association between anemia and life-course averaged exposure to dust PM2.5 among children aged <5 years based on 0.65 million records from 47 LMICs. In the fully adjusted mixed effects model, each 10 µg/m3 increase in life-course averaged exposure to dust PM2.5 was associated with a 9.3% increase in the odds of anemia. The estimated exposure-response association was nonlinear, with a greater effect of dust PM2.5 exposure seen at low concentrations. Applying this association, we found that, in 2017, among all children aged <5 years in the 125 LMICs, dust PM2.5 contributed to 37.98 million cases of anemia. Results indicated that dust PM2.5 contributed a heavier burden than all of the well-identified risk factors did, except for iron deficiency. Our study revealed that long-term exposure to dust PM2.5 can be a novel risk factor, pronouncedly contributed to the burden of child anemia in LMICs, affected by land degradations or arid climate.

Household food and water insecurity and its association with diarrhoea, respiratory illness, and stunting in Ecuadorian children under 5 years.

Household food and water insecurity has been previously associated with adverse health consequences in children. However, these relationships are understudied in middle-income Latin American populations such as in Ecuador, where a high prevalence of food and water insecurity has been reported. Using cross-sectional data from 2018 Ecuadorian National Health and Nutrition Survey, we examined the association of household food insecurity (HFI), household water insecurity (HWI), and concurrent HFI-HWI with diarrhoea, respiratory illness (RI), and stunting in 20,510 children aged ≤59 months. HFI was measured using the Food Insecurity Experience Scale. HWI was defined when households responded negatively to one or more of four drinking water indicators. Maternal caregivers reported on child diarrhoea and RI episodes during the previous 2 weeks. Measured length or height was used to assess stunting. We constructed log-binomial regression models to estimate the associations of HFI, HWI, and concurrent HFI-HWI with child outcomes. Moderate-severe HFI was associated with a higher prevalence of diarrhoea (PR = 1.39; 95% CI: 1.18, 1.63) and RI (PR = 1.34; 95% CI: 1.22, 1.47), HWI with a higher prevalence of RI (PR = 1.13; 95% CI: 1.04, 1.22), and concurrent HFI-HWI with a higher prevalence of diarrhoea (PR = 1.30; 95% CI: 1.05, 1.62) and RI (PR = 1.45; 95% CI: 1.29, 1.62). Stunting was not associated with HFI, HWI nor concurrent HFI-HWI. These findings suggest that HFI and HWI can independently and jointly act to negatively affect children's health. Policies and interventions aimed at alleviating both food and water insecurity are needed to bring sustained health improvements in Ecuadorian children.

Examining the paradox: increased malaria risk in children under 5 in female-headed households in Nigeria.

BACKGROUND: Nigeria is facing a severe malaria crisis, accounting for a significant proportion of global cases and deaths of malaria. This study aimed to investigate the differences between female-headed households (FHHs) and male-headed households (MHHs) and their impact on malaria risk among children under five (U5) in Nigeria. METHODS: Data from the 2021 Nigeria Malaria Indicator Survey (NMIS) were used for this cross-sectional study. A representative sample of 10,988 households was analysed, with key variables subjected to frequency calculations, descriptive statistics, and bivariate analyses using t-tests and chi-square analyses to compare the differences between FHHs and MHHs. RESULTS: Among all participants, 92.1% (N = 10,126) reported residing in male-headed households, while 7.8% (N = 862) reported living in female-headed households. MHHs were significantly more likely to own insecticide-treated bed nets (ITNs) than FHHs (64.7% vs. 53.6%, P < 0.001). U5 children in MHHs had a greater likelihood of sleeping under a bed net the night before the survey than U5 children in FHHs (35.3% vs. 30.0%, P < 0.05). The prevalence of fever in the previous two weeks among U5 children was similar in MHHs and FHHs (35.4% vs. 31.4%), and the testing rates for malaria among U5 children who experienced febrile episodes were higher in MHHs than FHHs (22.4% vs. 15.4%, P < 0.05). Although not statistically significant, FHHs exhibited a higher percentage of U5 children testing positive for malaria compared to MHHs (87.8% vs. 78.9%). On the other hand, FHHs had higher education levels, overall wealth index scores, and a larger presence in urban areas compared to MHHs (P < 0.001). Moreover, FHHs reported higher adherence to malaria prevention awareness (P < 0.001). CONCLUSION: In Nigeria, FHHs enjoy relatively better socioeconomic conditions and stronger awareness of malaria prevention compared to their male-headed counterparts. Contrary to expectations, FHHs are at an increased risk of malaria in children under 5 years old. This phenomenon is associated with entrenched gender inequality and the challenges women face in accessing critical assets. As women in FHHs bear the responsibility of income generation while caring for their children, it is crucial to prioritize interventions that address malaria management in FHHs to reduce both malaria incidence and mortality rates.