Rural-urban Disparities in Maternal Immunization Knowledge and Childhood Health-Seeking Behavior in Nigeria: a Mixed Method Study

Background: Immunization and appropriate health-seeking behavior are effective strategies to reduce child deaths. Objectives: To compare maternal knowledge about immunization; use of growth chart and childhood health-seeking behavior in rural and urban areas. Methods: A cross-sectional comparative study done in Lagos; Nigeria. Questionnaire survey and focus group discussions were done. 300 respondents were selected by multi-stage sampling while discussants were purposively selected. Results: Awareness of immunization was high but knowledge of vaccine preventable diseases (VPDs) was poor in both areas. Urban women utilized preventive services more; growth monitoring (p0.001) and immunization (p0.001) while higher proportions of rural women utilized nutritional counseling (p

National Scale-Up of Integrated Community Case Management in Rural Ethiopia: Implementation and Early Lessons Learned

Background. Although under-five mortality in Ethiopia has decreased 67in the past two decades; many children still die from preventable or treatable conditions; mainly pneumonia; newborn problems; diarrhea; malaria and malnutrition. Most of these deaths can be avoided with timely and appropriate care; but access to and use of treatment remains inadequate. Community health workers appropriately trained; supervised; and supplied with essential equipment and medicines; can deliver case management or referral to most sick children. In 2010; Ethiopia added pneumonia to diarrhea; malaria and severe acute malnutrition; targeted for treatment in the integrated community case management (iCCM) strategy. Purpose. This article describes the national scale-up of iCCM implementation and early lessons learned. Methods. We reviewed data related to iCCM program inputs and processes from reports; minutes; and related documents from January 2010 through July 2013. We describe introduction and scale-up through eight health system components. Results.The government and partners trained and supplied 27;116 of the total 32;000 Health Extension Workers and mentored 80 of them to deliver iCCM services to over one million children. The government led a strong iCCM partnership that attracted development partners inimplementation; monitoring; evaluation; and research. Service utilization and weak supply chain remain major challenges. Conclusion:Strong MOH leadership; policy support; and national partnerships helped successful national iCCM scale-up and should help settle remaining challenges

Performance of Ethiopia's Health System in Delivering Integrated Community-Based Case Management

Background. Analyzing complex health programs by their components and subcomponents serves design; documentation; evaluation; research; and gap identification and prioritization. In 2012; we developed a rapid methodology to characterize integrated community case management (iCCM) programs by assessing benchmarks for eight health system components in three program phases. Objective. To assess iCCM benchmarks in Ethiopia three years after scale-up commenced; and to compare the benchmarks across the geographical region. Methods. Six national iCCM experts scored each of 70 benchmarks (no; partial; or yes) and then were facilitated to reach consensus. Results. Overall; iCCM benchmark achievement in Ethiopia was high (87.3); highest for pre-introduction (93.0); followed by introduction (87.9) and scale-up (78.1) phases. Achievement bysystem component was highest for coordination and policy (94.2) and lowest for costing and finance (70.3). Six regional countries' benchmark assessments; including two from Ethiopia 14 months apart; were highly correlated with program duration at scale (correlation coefficient: +0.88). Conclusion. Ethiopia has a mature; broad-based iCCM program. Despite limitations; the method described here rapidly; systematically; and validly characterized a complex program and highlighted areas for attention through government or partners

Revisiting the Importance of Childhood Activity

Formalised exercise programmes for children and adolescents are becoming increasingly important. There has been a drastic increase in documented childhood morbidity and mortality relating to poor nutrition and low activity levels in recent years. Regular physical activity decreases the risk of chronic disease and is also a fundamental component in the management of illnesses. Recommendations for the paediatric population remain insufficient and ill-defined. This article revisits the risks of physical inactivity in childhood and provides the latest recommendations for exercise prescription in the paediatric population. Inactive children have a higher risk of developing chronic diseases; such as obesity; type 2 diabetes; high blood cholesterol and hypertension. Other undesirable consequences include orthopaedic problems; cardiovascular disease and various psychological complications. Both aerobic and resistance training should be incorporated into paediatric exercise programmes. The recommended guidelines for childhood activity are 60 minutes of moderate-intensity exercise every day of the week. This article highlights the importance of formalised paediatric exercise programmes in disease prevention and health promotion. A healthy and happy adolescent population ultimately contributes to an adult population with a low risk of ill health

Nurses' Monitoring of the Road to Health Chart at Primary Healthcare Level in Makhado; Limpopo Province

Background: The Road to Health Chart (RTHC) is a record chart carried by the caregiver that combines essential information on the growth monitoring of a child; immunisation; vitamin A supplementation; deworming medicine and other illnesses. It provides useful information to the parent and healthcare professional. This study sought to determine the challenges faced by professional nurses in monitoring the RTHC during consultation; the degree of implementation of the RTHC programme; and the most utilised aspect of the RTHC at Louis Trichardt Memorial Hospital and surrounding primary healthcare (PHC) clinics. Method: A cross-sectional study was conducted among 128 registered professional nurses. A self-administered questionnaire was used. Results: Ninety-six questionnaires were completed. Most of the respondents were female and aged 40-49 years. The majority of the PHC professional nurses stated that the challenges faced in monitoring the RTHC were staff shortages; lack of equipment; a work overload and unequal distribution of professional nurses on duty per shift. There was poor knowledge on how to identify malnutrition. The majority of PHC professional nurses had not completed their basic courses. Conclusion: PHC professional nurses voiced their concern that challenges encountered during consultations were direct reasons for their poor monitoring of the RTHC. The degree of implementation of the RTHC programme fell short of the norms and standards of the Department of Health and Social Development concerning child health care in South Africa. The most utilised aspect of the RTHC was the expanded programme on immunisation; vitamin A supplementation and deworming medicine

Characteristics of Children Presenting with Newly Dagnosed Type 1 Diabetes

Background. The clinical presentation of type 1 diabetes in children can be acute or insidious; and symptoms may be subtle and frequently misinterpreted. Presentation with diabetic keto-acidosis (DKA) may be associated with significant morbidity and mortality in the paediatric population. This study set out to determine the characteristics of children presenting to the paediatric endocrine service at Inkosi Albert Luthuli Central Hospital (IALCH) with DKA at the time of diagnosis; and to determine the frequency of missed diagnoses in the previous month.Methods. A retrospective study was done at IALCH; the paediatric tertiary referral centre for KwaZulu-Natal; South Africa. The study sample included all children with an initial diagnosis of type 1 diabetes between January 2008 and June 2010. Children presenting with DKA were compared with those who presented without DKA.Results. During the period under review; 63 children presented with type 1 diabetes. Of these; 44 (69.8) were misdiagnosed.Conclusion. Patients who presented with DKA had a shorter duration of symptoms than the non-DKA group. Ethnicity had no effect on characteristics at presentation. There was an unacceptable rate of missed diagnoses of type 1 diabetes in both the private and public sectors

How Effective is the 2012 Maternal; Newborn and Child Health Week (MNCHW) in River State?

Nigeria is one of the countries noted to have made insufficient progress towards the attainment of the health-related MDGs. Experience has however shown that a few cost-effective interventions that can be delivered in resource poor settings; through family/community-level action and schedulable population-oriented services; are able to rapidly attain these goals. This was the basis of the Maternal; Newborn and Child Health Week (MNCHW) in Nigeria; designed to achieve rapid population coverage of chosen interventions; within the one week period of the programme. This study assessed the effectiveness of the week held in Rivers State; in June 2012. of the LGAs; while iron and folate tablets were given to just 2.86Materials and Methods: The data for the assessment was collected through on-the- spot observations; three semi-structured questionnaires; and the final summaries of the week; provided by the State Ministry of Health. The questionnaires were administered in nine health centers; in three randomly selected LGAs. The first questionnaire was used to assess the extent of the social mobilization carried out for the week; the second was an exit interview of clients of the health facilities; and used to assess the success of the social mobilization campaign; while the third questionnaire was used to assess the availability of the intervention commodities; and the quality of care given to the clients.Results: The social mobilization campaign for the week was poorly funded and did not have much effect; as only 28.57 of the clients of the health facilities were aware of the week. Most of the commodities for the week; except the NPI vaccines and vitamin A; were not available in the required quantities. Long Lasting Insecticide-treated Nets (LLINs) and Sulphadoxine-Pyrimethamine (SP) were not available in 65.22 of the LGAs; family planning commodities were not available in 30.43 of the LGAs; family planning commodities were not available in 30.43 of the LGAs; while iron and folate tablets were given to just 2.86 of the LGAs; while iron and folate tablets were given to just 2.86 of the targeted total. The coverage rate of the vaccines ranged from 1.29 recorded with the measles vaccine; to the 14.85; for the DPT vaccine. The coverage with vitamin A of 43.41; for the DPT vaccine. The coverage with vitamin A of 43.41 was the highest of all the interventions; while the 0.36 coverage for family planning commodities was the least.Conclusions: The MNCHW in Rivers State did not meet the stated objectives. Efforts should be made to leverage on the political will of the current government of the State for health programmes

View Point: Economic Growth and Child Health in Sub Saharan Africa

After independence most African countries witnessed growth in their economies and decreases in child mortality. However both economic growth and the gains in under 5 mortality slowed dramatically in the 1980s and 1990s

Potentials of Community Pharmacists to Improve Maternal; Newborn and Child Health

Background: With the high level of pregnancy; childbirth related and under-five deaths in Nigeria; achieving optimal maternal and child health has become the responsibility of all health personnel in a task sharing approach at all levels of care. Objectives: We assessed baseline status of community pharmacists' involvement in Maternal; Newbornand Child Health [MNCH]; described training intervention for community pharmacists on MNCH and assessed its impact on maternal and child health.Methods: Semi-experimental design; using multi-stage stratified sampling method was conducted in Abuja; Kwara; Abia and Edo States of Nigeria from June - September; 2011. Pre-tested questionnaires wereused to generate data on baseline activities of pharmacists. Two of the States were selected for trainingintervention while the remaining two served as control. A post-training MNCH activity level of the study and control settings was compared based on frequency of occurrence and Chi-Square analysis with the aidof Epi Info package.Results: Over 15 of community pharmacists reported seeing 5-10 women and 10-20 children daily. Agap in MNCH knowledge was observed. The training intervention improved MNCH knowledge in the study States (P 0.05); with post-training assessment showing a 40 average increase in the number of mothers and under-five caregivers counselled on key MNCH interventions.Conclusion: The baseline status of the community pharmacists' participation in MNCH revealed aconsiderable client load of pregnant and nursing mothers with under 5 years children in contact with the community pharmacists daily. Community pharmacists in MNCH interventions indicated a knowledge gap.The training intervention showed knowledge transfer and improved community pharmacists' position as promoters; facilitators and implementers of maternal; newborn and child health in Nigeria

In What Ways Can Community Integrated Management of Neonatal and Childhood Illnesses (C-IMNCI) Improve Child Health?

Background: In addition to access to quality health services; family child care practices play a major role in improving child health and achieving reduction in childhood mortality. Objective: To assess the effect of community integrated management of neonatal and childhood illness interventions on family practices for child care. Methods: A comparative cross-sectional survey was conducted in Dabat District; northwest Ethiopia. A total of 800 mothers or caretakers of children of under two years form the Community Integrated Management of Childhood Illnesses intervention and non-intervention areas were selected using a multistage sampling procedure and interviewed in November 2007. Result: Three hundred thirty seven (84.3) of the mothers from the intervention area and 358 (89.5) from nonintervention area were illiterate. Thre vast majority (99.5) of the fathers in each of the areas were farmers. Mothers/care takers from community IMNCI intervention areas reported better child care practices in terms of time of breastfeeding initiation (OR=9.10; 95CI=5.45; 12.43); avoiding prelacteal feeding (OR=11.01; 95CI=7.98; 15.43); initiation of supplementary feeding (OR=3.63; 95CI=2.23; 5.93) compared to mothers/care takers form non intervention areas. Regarding water; personal hygiene and environmental sanitation; statistical significant differences were observed in using a safe drinking source of water (OR=6.36; 95CI=4.49; 9.01) and availability of pit latrines (OR=43.52; 95CI=25.46; 67.89) between the intervention and non-intervention areas. The likelihood of seeking care for diarrhea was about five times and that of fever is three times higher in the intervention areas compared to thenon-intervention one. Conclusion: Community IMNCI has positive effects on child feeding; disease prevention; health care seeking practices and these practices are expected to improve child health and survival. Thus the program needs to be scaled up in other areas. Further studies may assess the actual effect of the intervention on child morbidity and mortality

Breastfeeding Pattern; Anthropometry and Health Status of Infants Attending Child Welfare Clinics of a Teaching Hospital in Nigeria

Objective:To determine the breastfeeding pattern and its relationship with the physical growth and health status of infants aged 0-24 weeks.Design and setting: A prospective cohort study was carried out at three comprehensive health centres of Nnamdi Azikiwe University Teaching Hospital; Anambra State (Nigeria) from September 2006 to June 2007. The feeding pattern; body weight; length and morbidity of 228 infants were assessed at birth; 6; 10; 14; 20 and 24 weeks when they visited the child welfare clinics for routine immunisations or on appointment.The infants were recruited from the immunisation registers by a systematic random sampling method. Based on their current feeding pattern during the period under study; infants were classified into exclusive breastfeeding (EBF) and non-exclusive breastfeeding (non-EBF) groups. Data analysis was carried out using SPSS and Epi Info statistical computer software. A probability value (p-value) of less than 0.05 was considered statistically significant. Results: The EBF rate declined progressively from 64.9at birth to 37.3at 24 weeks of age. Maternal older age; multiparity and delivery at a government health facility were positively associated with higher rates of EBF (p 0.05). Only 110 (48.2) babies were put to the breast immediately (? 1 hour) after delivery. The numbers that received colostrum and prelacteal feed were 118 (82.5) and 59 (25.9); respectively. On-demand breastfeeding was more popular than timed feeding (95.5vs 7.5; p 0.05).At 24 weeks of age EBF males and females achieved a better and more rapid growth in weight and length compared to those in the non-EBF group (p

Social and Economic Consequences of HIV and AIDS on Children: Case Study of a High-Density Community in Harare; Zimbabwe

We present results from a household-based survey that was conducted in Mabvuku; a high-density community in Zimbabwe. The objective of the study was to improve understanding of social and economic consequences of HIV and AIDS on children. Children affected by HIV and AIDS (CABA) formed the treatment group while those not affected by HIV and AIDS (non-CABA) were the control group. We found that many of the differences in the socio-economic indicators that we studied between CABA and non-CABA were not significant. Therefore our results indicate a gloomy scenario for all the children. These results are consistent with existing literature which indicates that the impact of HIV and AIDS is exacerbated by poverty. Based on evidence from this paper; we conclude that programmes and interventions targeted at children should encompass both CABA and non-CABA within a framework of sustained commitment to improving the lives of these children. We hope that our findings will be used in the formulation of interventions and strategies to improve the situation of children affected by HIV and AIDS and/or living in impoverished communities

Effectiveness of Community Health Workers (CHWS) in the Provision of Basic Preventive and Curative Maternal; Newborn and Child Health (MNCH) Interventions: A Systematic Review

Due to a shortage of health workers; many low income countries rely on community health workers (CHWs) for the provision of a wide range of primary health care services; both curative and preventive; including maternal newborn and child health (MNCH) interventions. Several systematic reviews have analysed the contribution of CHWs although none has specifically focused on their role in relation to MNCH. This review was designed to find evidence of the effectiveness of CHWs in providing basic preventive and curative MNCH interventions; and to identify the factors that are crucial to their performance. It was restricted to articles published from 1998-2008 in the eng language. It included studies with qualitative and quantitative designs. Six electronic databases were searched and data was extracted using a pretested data extraction form designed basing on the Centre for Reviews and Dissemination (CRD) guidelines (2008). A narrative synthesis approach was used. The quality of included studies was assessed using pretested validity assessment tools and the applicability of interventions was evaluated using the RE-AIM framework. After the filtering; 14 studies were critically appraised; and the majority (12/14) demonstrated that CHWs were effective at reducing neonatal/child mortality rates; promoting breastfeeding practices; increasing sulfadoxine-pyrimethamine (SP) coverage for intermittent preventive treatment of malaria in pregnancy (IPTp); they provided depot medroxy-progesterone acetate (DMPA) injections as safely as qualified staff; and treated malaria in children effectively; thereby reducing workload of health professionals at peripheral health facilities. Crucial factors to their performance included training; remuneration; inadequate medical supplies; and lack of career development structure. The review shows that CHWs can be effective at providing basic curative and preventive MNCH interventions. Developing country health systems can make use of this available resource to increase access of MNCH interventions

The Use of the Road to Health Card in Monitoring Child Health

Objectives: The Road to Health Chart (RTHC) provides a simple; cheap; practical and convenient method of monitoring child health. The RTHC could assist with vaccine compliance and early identification of growth faltering; to improve general health. The purpose of the study was to assess whether the RTHCs were adequately completed and interpreted at primary; secondary and tertiary care levels in South Africa.Methods: The study was carried out at a primary; secondary and tertiary care centre. A questionnaire was administered to 100 subjects from each; seeking demographic information; whether the RTHC was brought along; and if not why it was not brought.Results: Most children were brought by their mothers. The RTHC was not brought to 48 of the consultations; of those; about 72 thought that bringing the RTHC along was not necessary. Health workers seldom asked to see the RTHC at the primary and secondary care settings; but 50 of them did so at Ga-Rankuwa Hospital (p = 0;002). In only 8 cases overall were the children below the 3rd percentile of weight-for-age. Approximately 20 had incomplete immunisations.Conclusions: Many parents believe that the RTHC is only required for Well-baby-clinic visits; not for consultations. The RTHC is not often asked for at consultations; the fact that this is more often done at the tertiary care centre may be that much of the service is supplied by paediatricians-in-training. Health workers should ask to see the RTHC; in order for mothers to understand the importance of the information. The study showed that the RTHC is not used to its full potential

ABO phenotypes and malaria related outcomes in mothers and babies in The Gambia: a role for histo-blood groups in placental malaria?

Background This study analyses the association between ABO blood group phenotypes in relation to placental malaria pathology. Methods A total of 198 mother/child pairs delivering in Banjul and the Kombo-St Mary District (The Gambia) were analysed. ABO blood group was measured by agglutination. Placental malaria parasites were enumerated and the presence of malaria pigment noted. Birth anthropometry was recorded and placental weight. Maternal and infant haemoglobin was measured. Results 89 (45) subjects were primiparae and 110 (55) multiparae. The ABO phenotype distribution was 38(A); 52(B); 6(AB) and 102(O). Placental histo-pathology showed active placental malaria in 74 (37); past infection in 42 (21) and no infection in 82 cases (41). In primiparae; blood group O was associated with a higher risk of active infection (OR= 2.99; 95CI= 1.24-7.25); and a lower risk of past infection (OR = 0.31; 0.10-1.01; p0.05). In multiparae; the O phenotype was associated with reduced prevalence of active or past placental infection (OR

Implementing Infant Hearing Screening at Maternal and Child Health Clinics : Context and Interactional Processes

Infant hearing screening has become increasingly widespread as research evidence a dramatic benefit when early identification of hearing loss occurs before six-months of age. The Health Professions Council of South Africa (HPCSA) has recently published a hearing screening position statement recommending infant hearing screening in three contexts: the well-baby nursery; at discharge from the neonatal intensive care unit (NICU); and at Maternal and Child Health (MCH) clinics. The well-baby nursery and NICUs are esta- blished and internationally recognised screening contexts abundantly reported on whilst MCH clinics have not been investigated as screening contexts previously. The objective of this study was therefore to describe the context and interactional processes during an infant hearing screening programme at MCH clinics in a South African community to ascertain whether clinics provide a suitable milieu for hearing screening programmes. An exploratory descriptive design implementing a qualitative methodology was selected to describe the context and interactional processes experienced during an infant hearing screening programme at two MCH clinics in the Hammanskraal community. Five fieldworkers conducting the screening programme at the clinics documented experiences using systematic field notes and critical reflections for a fivemonth period. The two MCH clinics investigated proved to be suitable contexts to screen infants for hearing loss despite prevailing contextual barriers that are characteristic of primary healthcare clinics in developing contexts of South Africa. Interactional processes between fieldworkers; nursing staff and caregivers revealed that collaborative partnerships fostered by consistent service delivery; maintenance of an open channel of communication and basic courteousness; facilitated an effective initial infant hearing screening at the two clinics. MCH clinics demonstrate promise as a practical contextual solution to achieve widespread screening coverage in South Africa

Progress in Implementing the Child Survival Strategy in the African Region

Under-five mortality rate in the African Region was estimated at 145/1;000 live births in 2007. These deaths were the result mainly of preventable or treatable conditions. A child survival strategy for the African Region was developed by WHO; UNICEF and World Bank and adopted by the fifty-sixth WHO Regional Committee in 2006 to address this high mortality rate.1 This report; which is a review made using reports and the results of a questionnaire sent to countries; summarizes progress in implementing the strategy as at December 2009 and proposes next steps for action. Significant achievement has been made in the areas of policy; strategy and plandevelopment; capacity building; partnerships and communication strategies; operations research; documentation and monitoring and evaluation. Also in scalingup of child survival interventions such as measles vaccination coverage; insecticidetreated nets use in children and provision of antiretroviral drugs to prevent motherto-child transmission of HIV. Currently; 21 countries are implementing the Integrated Management of Childhood Illness strategy in more than 75of the districts. Despite the achievements in some areas; coverage of some eff ective interventions remains low. Various health system challenges hamper the progress of child survival. These include inadequate country-level funding for scaling-up effective interventions; inadequate monitoring of coverage of interventions and human resource limitations. In order to increase coverage of eff ective child survival interventions and accelerate progress in implementation of the regional child survival strategy; the paper recommends several actions including the improvement of coverage of key child survival interventions and mobilization and allocation of resources to implement national child survival scale-up strategies and plans

Anaemia in Pregnancy : a Major Health Problem with Implications for Material Health Care

Women (n=2235) registering for antenatal care in two maternal and child health clinics in the Dar es Salaam area between June; 1991 and June 1992 had their haemoglobin (Hb) measured by use of a HaemoCuer haemoglobinometer. The prevalence of anaemia Hb10.5 g/dl) was 60while severe anaemia (Hb7.0 //dl) was present in 4. Young nullparous women; those who register for antenatal care late in the third trimester; and undernourished women constitute high risk groups also for severe anemia and require special attention. No single maternal characteristics or combination thereof was useful to identify a group of screening. The current national Hb level for referral to hospital (8.5 g/dl) identified 20of the pregnant population. Most of these can successfully be treated and followed at the primary care level. To comply with the available means for care in the Dar es Salaam area; it is proposed that the cutoff level for referral be changed to 7g/dl. Appropriate methods to screen for anemia at primary health care (PHC) level must be explored and instituted. Training of antenatal care (ANC) providers in clinical identification of anemia and supply of haematinics must be improved and early booking for ANC promoted. Public health measures to improve the general nutrition and iron intake of all women are necessary to reduce this serious health problem in pregnancy