Childhood Pneumonia: What’s Unchanged, and What’s New?

Childhood pneumonia is still a significant clinical and public health problem. India contributes the highest number of deaths due to pneumonia, accounts for about 20% of global mortality among under five children. Various etiologic agents including bacteria, viruses and atypical organism are responsible for childhood pneumonia. Recent studies suggest that viruses are one of the major causes of childhood pneumonia. Among viruses, respiratory syncytial virus has got great attention and several recent studies are reporting it as an important organism for pneumonia. Lack of exclusive breast feeding during first six months, improper timing of start and content of complimentary feeding, anemia, undernutrition, indoor pollution due to tobacco smoking and use of coal and wood for cooking food and lack of vaccinations are important risk factors. X-ray chest is not routinely performed to diagnose pneumonia while use of lung ultrasound is increasing to detect consolidation, pleural effusion, pneumothorax and pulmonary edema (interstitial syndrome). Role of C-reactive protein (CRP) and procalcitonin is similar, to differentiate between viral and bacterial pneumonia, however duration of antibiotics is better guided by procalcitonin. Newer biomarkers like IL-6, presepsin and triggering receptor expressed on myeloid cells 1 are needed to be evaluated for their use in children. Hypoxia is significantly associated with childhood pneumonia. Therefore, use of pulse oximetry should be encouraged for early detection and prompt treatment of hypoxia to prevent adverse outcomes. Among the available tools for risk of mortality assessment in children due to pneumonia, PREPARE score is the best but external validation will be needed.

Determinants Of Under-Nutrition Among Under Five Children in The Urban Slum of Ahmedabad, India

Introduction: In India, 6.8% of total population are under five children and 60 million are malnourished. Around 45% of deaths among children under five years are linked to under nutrition. The study aims to as-sess the nutritional status of under 5 children and associate it with various factors like age, gender, Immuniza-tion, birth weight, feeding practices, Anganwadi registration etc. Methodology: A community based cross-sectional study was conducted on 191 under five children in urban slum areas. Parents of under five children were interviewed with the help of a pre-designed questionnaire. Malnutrition was assessed using WHO recommended Z score category.Observations: Total 191 under 5 children were studied. Among them, 107 were male and 84 were female. Out of the assessed children two third were normal weight for age while one third were underweight. Nutri-tion status was significantly associated with age, birth weight, feeding practices and immunization status of children. Conclusions & Recommendations: One fourth of under-five children were under weight for age. Age, low birth weight, preterm delivery, faulty feeding practices and incomplete immunization were statistically signif-icantly associated with the underweight.

Factors Affecting Under-Five Mortality Rate (U5MR) in India- National Family Health Survey (NFHS) 5 Factsheet What It Speaks?

Introduction: In developing countries various factors lead to Under-5 Mortality and irreversible losses which can be prevented by proper measures take on factors affecting to it. Objective: This study was conducted to analyse the changing trends of Under-5 Mortality in India. The new National Family Health Survey (5th round) which was published recently came up with several new findings, which were both encouraging and disheartening and also one of the major Sustainable Development Goals.Method: A secondary data analysis was conducted of NFHS factsheets to study the U5MR in India. The indica-tors which had a correlation either positive or negative with the Under-five mortality rate were included.Result- When we look at the result, few states' performance is encouraging because they have shown some of the best declines. Correlation was found between dependant variable that is U5MR which is a dependent vari-able and several independent variables which concluded that factors like Women literacy, Men literacy, Breastfeeding, Nutritional insufficiencies, Caesarean delivery, ANC visits and IFA consumptions are negatively associated withU5MR. Conclusion: Various steps have been taken in order to improve our healthcare sector since independence, every government had their fair share of contribution, that’s the reason why we are this stage. Now it’s time to increase efforts with targeted interventions to solve this problem and complete our commitment towards the SDGs.

Antenatal care services in decreasing under-five mortality / Serviços de cuidados pré-natais na redução da mortalidade de menores de cinco anos

Abstract Objectives: the first five years of life are critical for children's physical and intellectual development. However, the under-five mortality rate in South Asia and ASEAN is relatively high, caused by complex etiologies. This paper identifies maternal high-risk fertility behaviors and healthcare services utilization and examines predictors of under-five mortality (U5M) in 7 Asian (South Asia - ASEAN) developing countries (Indonesia, Myanmar, Cambodia, Philippines, Bangladesh, Nepal, and Pakistan). Methods: a multivariate logistic regression model with a complex survey was used to examine predictors of U5M on the frequency of U5M adjusted for comorbidities. Results: according to multivariate models (model 2), U5M was 2.99 times higher in mothers with low weight at birth infants than in mothers without low weight at birth infants (aOR= 2.99; CI95%=2.49-3.58); Mothers without antenatal care contacts were 3.37 times more likely (aOR= 3.37; CI95%=2.83-4.00) to have a U5M than mothers with eight or more antenatal care contacts; U5M in Indonesia was 2.34 times higher (aOR= 2.34; CI95%= 1.89-2.89). It is investigated that antenatal care serves as a predictor in decreasing U5MR. Conclusions: in order to achieve significant U5MR reduction, intervention programs that encourage antenatal care consultations should be implemented.

Resumo Objetivos: os primeiros cinco anos de vida são críticos para o desenvolvimento físico e intelectual da criança. No entanto, a taxa de mortalidade de menores de cinco anos no sul da Ásia e na ASEAN é relativamente alta, causada por etiologias complexas. Este artigo identifica comportamentos maternos de fertilidade de alto risco e utilização de serviços de saúde e examina preditores de mortalidade abaixo de 5 anos (MM5) em 7 países em desenvolvimento da Ásia (Sul da Ásia - ASEAN) (Indonésia, Mianmar, Camboja, Filipinas, Bangladesh, Nepal e Paquistão). Métodos: um modelo de regressão logística multivariada foi usado para examinar preditores de MM5 na frequência de MM5 ajustado para comorbidades. Resultados: na análise multivariada (modelo 2), U5M foi 2,99 vezes maior em mães com bebês com baixo peso ao nascer do que em mães sem bebês com baixo peso ao nascer (aOR= 2,99; IC95%=2,49-3,58); as mães sem contatos de cuidados pré-natais tiveram 3,37 vezes mais probabilidade (aOR=3,37; IC95%=2,83-4,00) para ter MM5 do que mães com oito ou mais contatos de cuidados pré-natais; MM5 na Indonésia foi 2,34 vezes maior (aOR= 2,34; IC95%= 1,89-2,89). Investiga-se que os cuidados pré-natais funcionam como um preditor na diminuição da MM5. Conclusões: para uma redução significativa da MM5, devem ser implementados programas de intervenção que estimulem as consultas pré-natais.

Surveillance on pediatric bacterial meningitis in Gondar University Hospital, Ethiopia from 2012 to 2021: Retrospective analysis

Introduction: Acute Bacterial meningitis is still a major cause of death in under-five children. Surveillance on Pediatric Bacterial Meningitis has been set up by the World Health Organization to generate data on vaccine preventable causes of Meningitis in under-five children. Ethiopia is one of the countries conducting the surveillance and Gondar University Hospital is one of the sentinel surveillance sites. In this study we described the epidemiological data on Bacterial meningitis in under-five children at Gondar University Hospital from 2012-2021. Methods: Data were extracted directly from Gondar University Hospital surveillance database collected from under-five children admitted to the Hospital with suspected meningitis from January 1st, 2012 to December 31st , 2021. Socio-demographic and clinical characteristics were collected using standard pretested questioners. All under-five children with suspected meningitis over the 10-years period were included and descriptive statistics like frequency, percentage, mean, median and standard deviations were used for the characteristics of under-five Children with Suspected Bacterial Meningitis. Results: In this study, a total of 4311 under-five admitted with suspected bacterial meningitis from 2012 to 2021 were enrolled. The majority, 71% of suspected meningitis were reported in infants. The mortality rate in suspected meningitis during the study period was 1%. The majority (92.4 %) had fever at presentation followed by seizure (62.7 %), altered consciousness (58.9 %) and bulged fontanel in 48.3 %, respectively. The commonest bacteria identified by CSF culture and Polymerase Chain Reaction was Streptococcus pneumonia (SPN). There was a reduction of confirmed meningitis cases from 2012 to 2021 (26 cases in 2012 and 6cases in 2021). Conclusions: Streptococcus pneumoniae was the commonest cause of PBM. Bacterial detection by culture was low which showed that Polymerase Chain Reaction (PCR) test should be encouraged to improve bacterial detection.

Malaria prevalence and associated additional risk factors among children under-five years who sleep under insecticide treated nets in Zambia

Background:Insecticide Treated Nets are one of the backbones of malaria prevention in Africa where the vector mosquitos bite at night and prefer humans for feeding. Children who sleep under Insecticide Treated Nets though protected still get malaria infections. This study aimed to assess the risk factors of malaria infection among under-five childrenwhosleepunderinsecticide-treatedTreated Nets. Methodology:This was a secondary analysis of a cross-sectional survey the Malaria Indicator survey of 2021 in Zambia. Data was extracted from the database at the Ministry of Health and analysed in STATAversion 14. Data was analysed in counts and frequencies,cross-tabulations andassociationsassessed using logistic regressing using complex data analysis.Results:Atotal of 1695 children aged below five years who had slept under an Insecticide Treated Net the night before the survey were included in the study, 50.9% were female while 49.1 were male. Over a third of them (23.9%) had a fever in the previous two weeks, over half 51.9% of them had anaemia and 28.8% of them had malaria infection tested using Rapid Diagnostic tests. There was a 3.46 (95%CI 2.67 ­ 4.49) increase in the odds of having malaria ifthe under-five child was anaemic (haemoglobin less than 11mg/dl). Other factors that are usually associated with malaria infection such as younger age group, low socio-economic status, residing in rural areas and having had a fever in the previous two weeks. Conclusion:In Zambia, about a third of under-five children who slept under insecticide-treated nets still had evidence of malaria infection. Asignificant risk factor for malaria infection among the under-five children who slept under ITNs was anaemia. Other known risk factors for malaria among under-five children such as age, rural residence, wealth status, province of residence and education of guardians were not statistically significant.

Factors associated with anaemia in under-five children in Zambia: Secondary analysis of the 2021 Malaria Indicator Survey Data

Introduction:Anaemia is one of the major public health concerns in many developing countries including Zambia. Unless it is acute, the consequences of anaemia are not immediate but have long-term debilitating effects such as growth and intellectual retardation and as such it does not receive the necessary attention it deserves. This study set out to assess the prevalence and associated factors of anaemia in under-five children in Zambia. Methods:This study was a secondary analysis of the 2021 Malaria Indicator Survey. We extracted data from the data sets at the National Malaria Elimination Centre after obtaining permission from the Ministry of Health. The extracted data was analysed in STATA14, summarised in frequencies, cross-tabulations between independent variables and the outcome and multivariable logistic regression was used to assess the associations between variables and anaemia. Findings:The prevalence of anaemia was found to be 53.8%. Anaemia was found to be associated more with children below one year compared to older children, children whose household heads had no or only have primary education compared to those with secondary or tertiary education and in the northern parts of the country such as Luapula and Northern provinces compared to the southern province. Further anaemia was more common in those with malaria than those without malaria and those with febrile illnesses than those without febrile illnesses. In addition, anaemia was less common in those who slept under insecticide-treated nets. Conclusion: Anaemia in Zambia has been found to be higher than the average in Southern Africa, it is associated with younger age groups, poverty conditions and where diseases like malaria and other febrile illnesses are more common than where they are not. The use of interventions like insecticide-treated nets is associated with reduced prevalence of anaemia.

Déterminants de la supplémentation en vitamine A chez les enfants âgés de 6 à 59 mois au Sénégal en 2017: Étude transversale / NA

La supplémentation en vitamine A (SVA) est une des stratégies de prévention de la carence en vitamine A. L'objectif était d'étudier les déterminants de la SVA au Sénégal. Ils'agissait d'une analyse secondaire de l'enquête démographique et de santé conduite en 2017. Un échantillonnage en grappes à deux degrés était réalisé. La population d'étude était constituée des enfants âgés de 6 à59 mois. La régression logistique a permis l'identification des déterminants de la SVA. L'odds ratio ajusté (ORA) et son intervalle de confiance à 95% (IC95%) étaient calculés. La couverture en SVA était de 63,8%. Ses déterminants étaient le fait de résider dans les régions Sud-Est (ORA = 2,88 ; IC95%= 2,19-3,79), Centre (ORA = 2,77; IC95% = 2,14-3,59) et Nord (ORA =3,57; IC95%= 2,69-7,73), la taille du ménage ≥ 10 (ORA = 1,28 ;IC95%= 1,11-1,49), la taille de la fratrie ≥ 4 (ORA =1,23 ; IC95%= 1,07-1,43), et l'accouchement en établissement sanitaire (ORA = 1,35 ; IC95%= 1,01-1,80), l'utilisation de la radio (ORA = 1,46 ; IC95%= 1,20-1,77), l'utilisation de la télévision (ORA = 1,33; IC95%= 1,12-,157), la tranche d'âge 12-59 mois (ORA = 2,5 ; IC95%=2,14-2,92), la vaccination par le penta3 (ORA =2 ; IC95% :1,53-2,62). La couverture en SVA n'est pas optimale. La SVA à domicile dans la région Ouest, la promotion de l'accouchement institutionnel, la communication de masse, le renforcement des connaissances des vaccinateurs sur la SVA seraient nécessaires.

Vitamin A supplementation (VAS) is one of the strategies to prevent vitamin A deficiency. The objective was to study the determinants of VAS in Senegal. This was a secondary analysis of the Demographic and Health Survey conducted in 2017. Two-stage cluster sampling was used. The study population consisted of children aged 6-59 months. Logistic regression was used to identify the determinants of VAS. The adjusted odds ratio (AOR) and its 95% confidence interval (95% CI) were calculated. VAS coverage was 63.8%. Its determinants were residence in the South-East (AOR = 2.88; 95% CI= 2.19-3.79), Centre (AOR = 2.77; 95% CI= 2.14-3.59) and North (AOR =3.57; 95% CI= 2.69-7.73) regions, household size ≥ 10 (AOR = 1.28; 95% CI95= 1.11-1.49), sibling size ≥ 4 (AOR =1.23 ; CI95%= 1.07-1.43), and delivery in a health facility (AOR= 1.35; 95% CI= 1.01-1.80), radio use (ARO = 1.46; 95% CI= 1.20-1.77), television use (AOR = 1.33; 95% CI= 1.12-.157), age group 12-59 months (AOR = 2.5;95% CI=2.14-2.92), vaccination with penta3 (AOR =2; 95% CI=1,53-2,62). VAS coverage is not optimal. Home-based VAS in the western region, promotion of institutional delivery, mass communication, strengthening of vaccinators' knowledge on VAS would be necessary.

Knowledge, attitude and perception of mothers of under-five towards vaccination during supplementary immunization activities in Ibadan North-West Local Government Area, Ibadan, Oyo State, Nigeria

Supplementary immunization activities campaigns provide children with an additional dose of vaccine and deliver other interventions. However, there is dearth of information on knowledge, attitude and perception of mothers of under-five towards vaccination during supplementary immunization activities. A descriptive cross-sectional study which employed multistage sampling technique was designed to fill this gap. Four wards were randomly selected from eleven wards in Ibadan North-West Local Government Area and houses were enumerated from the selected wards, systematic random sampling was used to select houses and then respondents. A semi-structured interviewer administered questionnaire was used to elicit information on three hundred and five respondents. Knowledge scores of ≤4, 5-8, and ≥ 9 were rated poor, fair and good, respectively. Attitude scores of ≤5 and >5 was rated negative and positive attitude, respectively while perception scores ≤4 and >4 were rated negative and positive perception, respectively. Data was analyzed with SPSS version 25 using descriptive statistics and Chi-square test at 5% level of significance. The mean age of respondents was 30.6±6.1years, the highest level of education for most (68.5%) was secondary school. Their mean parity and number of under-five were 2.5±1.4 and 1.2±0.4, respectively. Knowledge was generally poor, more than half (53.1%) had poor knowledge, majority (88.2%) have positive attitude while 84.6% have a positive perception. One-fourth (24.6%) and one-fifth are of the opinion that frequent vaccination will make the vaccine ineffective and overload immune system, respectively. There was generally poor knowledge of supplementary immunizations and mothers need to be educated on the importance.

Relationship of Physical Environmental Conditions of Houses with the Incidence of Pneumonia among Children under Five

@#Introduction: In 2019, according to the World Health Organization (WHO), pneumonia is the leading infectious cause of death in children under the age of five. In 2017, pneumonia killed 808,694 children under five, accounting for 15% of all fatalities among children under the age of five. Methods: An observational analytic survey with a case control design was used as the study approach. The research samples were collected using a simple random sampling procedure with 48 children under the age of five separated into two groups, 24 samples for the case group and 24 samples for the control group. The research was carried out between February and July of 2020. This study tools used were observation sheets and rollmeters.The data was analyzed using univariate and bivariate analysis using the Chi-Square test at a significance level of 0.05. Results: The results showed that there was a relationship between incidence of pneumonia in children under five with different variables, respectively, ventilation area, floor type, wall type, presence of smoke hole. Conclusion: It implies that the community should pay attention to the overall condition of the house, one of which is by improving home ventilation, adjusting the room area to the number of occupants, quitting smoking in the house, and cleaning the floor more often.

Sociodemographic and Environmental Factors Influencing Acute Respiratory Infections among Under-five Children of Chars (riverine islands) of Tinsukia District, Assam: A Community-based Cross-Sectional Study

Acute respiratory tract infections (ARIs) are a major cause of morbidity and mortality in under?five children worldwide. Assam has around 2500 river islands (locally called Chars/Chaporis) in the Brahmaputra River with socioeconomically deprived inhabitants lacking access to basic health?care facilities. A community?based cross?sectional study was carried out among 380 under?five children living in the Char areas of Tinsukia District to estimate the prevalence of ARI and determine the associated risk factors. The prevalence of ARI among under?five children was found to be 56.32%. Prevalence was significantly higher among children living in Dibru?Saikhowa island, with families having >2 children, belonging to socioeconomic class 5 (modified BG Prasad scale), having a positive history of smoking or ARI in family members, having homes with attached kitchens or using wood for cooking, inadequate ventilation or overcrowding and residences of katcha ghars.

Nutritional Status of Tribal Under‑Five Children in a Community Development Block of Birbhum District, West Bengal: A Cross‑Sectional Study

Introduction: One of the essential components for maintaining health is having proper and adequate nutrition. The absence of this might affect majorly the physical domain of health, especially in under‑five children as it is the age of development. The present study was conducted among the tribal under‑five children in a tribal predominant block, Mohammad Bazar in Birbhum District of West Bengal to find out their nutritional status, along with the estimation of prevalence of anemia among them; and the association, if any, between the nutritional status of the study population with their demographic, socioeconomic, and environmental characteristics. Materials and Methods: This community‑based cross‑sectional study was conducted among 378 tribal under‑five children residing in 21 villages of Mohammad Bazar Block during September 2018–August 2020 using Lot Quality Assurance Sampling (LQAS) technique. A predesigned, pretested schedule was used to collect necessary information regarding background characteristics. Anthropometric measurements (height and weight) and biochemical estimation (hemoglobin level in blood) were done to evaluate nutritional status. Ethical permission was obtained from Institutional Ethics Committee, Burdwan Medical College. Data were analyzed using the Statistical Package for the Social Sciences, version 20. Results: The present study showed that 31.0% of under‑five children were underweight, 16.6% severely underweight, 31.5% stunted, 17.2% severely stunted, 21.7% wasted, and 7.7% severely wasted. Nearly one‑third of the study participants were suffering from anemia and most of them (91.5%) had mild anemia. As per LQAS, none of the villages had acceptable nutritional status as far as the weight for age and height for age was concerned. Conclusions:This research unveiled that the undernutrition in various forms still persists among the tribal under‑five children. Rigorous implementation of various schemes, missions, and programs by both state and Central Government are the need of the hour to overcome this downhearted situation

Impact of Intervention on Nutritional Status of Under-Fives in Tribal Blocks of Palghar District in Maharashtra, India

Background: There is a need to improve their nutritional status of under?five children through specific targeted interventions. The present study discusses the impact of intervention on nutritional status among under?five children in Palghar district from Maharashtra. Objective: The objective is to improve the nutritional status of under?five children by implementing multi?component health and nutrition education intervention, focusing on dietary counseling and modification keeping in view the cultural and socio?economic status of population. Methods: A prospective pre? and post?intervention study was conducted in two tribal blocks. Total 480 under?five children were included in pre? and post?intervention survey each. Results: Exclusive breastfeeding rates improved from 48.9% to 50.5% and initiation of complementary feeding at 6 months improved from 48.3% to 72.5% in post intervention survey as compared to preintervention survey. Among other Infant and Young Child Feeding indicators, Minimum Meal Frequency increased significantly to 67.03% from 5.91% and minimum acceptable diet improved from 5.37% to 47.2% in post intervention survey. The prevalence of Severe Acute Malnutrition (SAM) reduced from 5.4% to nil whereas severe stunting and underweight significantly decreased by 17% and 8% respectively in post intervention survey. Severe anemia decreased from 16.24% to nil post intervention. Conclusion: The study reveals a substantial improvement in timely initiation of complementary feeds, nil cases of SAM, stunting, and underweight along with severe anemia in postintervention phase. This highlights the impact of multicomponent health and nutrition education interventions which may be adapted at a programmatic level to reduce child mortality and morbidity in India.

Nutritional Status and its Determinants in Toddlers: A case study of Hilly region of Uttarakhand

Background: Nutrition in early childhood is of utmost importance specifically for first 1000 days. (1) If in this phase nutrition is neglected, it drags the child into the trap of malnutrition. Aims & Objectives: The objectives were: assess the nutritional status of children and identify the risk factors related to malnutrition in children (1-3) years. Methods & Material: Descriptive exploratory design- conducted in rural villages of Haldwani block, Uttarakhand. Multi stage random sampling technique was used to select 703 children of (1-3) years and their mothers. The children were screened for malnutrition and mothers were interviewed via semi – structured interview schedule. Results: It was found that, 74(11%) children were undernourished, 28 (3.9%) were wasted in mild category and 11 (1.5%) in moderate category. About 87 (12%) were found to be stunted in mild to moderate category. Children below 2.5kg at birth [(1.106, 3.817), p= 0.023], non-initiation of breast feed in one hour [(0.979, 3.344), p=0.055], delayed initiation of weaning [(1.162,4.026), p=0.013] and recurrent illness [(1.187,3.447), p=0.009] were factors associated with malnutrition in children at 95% CI. Conclusion: It is very important to follow up the identified malnourished children so that in the preschool age the nutritional status can be improved.

Assessment of Perception about Immunization Among the Mothers of Under-Five Children at Urban Slum Area of Vijayapura City

Introduction: Immunization is one of the most cost-effective health investments worldwide. The World Health Organization (WHO) launched the expanded programme on immunization (EPI) in 1974 with the aim of immunizing children throughout the world. Objective: Assessment of perception about immunization among the mothers of under-five children at urban slum area of Vijayapura city. Methods: Cross-sectional study was conducted in Urban Field practice area of Community Medicine department among the mothers of under-five children residing permanently in the area and were interviewed regarding the perception about immunization to their children by using pre-structured proforma. Results: level of knowledge & perception was found average (around 50%). Nearly 40 to 60% of the participants agreed to the statements which signifies the immunization is very important to the child’s growth and development and should not be avoided. Conclusions: Providing mothers of under-five children with information about vaccination effectively increases the immunization coverage and was highly cost-effective also

Multilevel Survival Analysis of Factors Associated with Under-Five Mortality in Manipur

Background: Child mortality is a major public health issue. The studies on under‑five mortality that ignore the hierarchical facts mislead the interpretation of the results due to observations in the same cluster sharing common cluster‑level random effects. Objectives: The present study uses a multilevel model to analyze under‑five mortality and identify the significant factors for under‑five mortality in Manipur. Methods: National Family Health Survey‑5 (2019–21) data are used in the present study. Amultilevel mixed‑effect Weibull parameter survival model was fitted to determine the factors affecting under‑five mortality. We construct three‑level data, individual levels are nested within primary sampling units (PSUs), and PSUs are nested within districts. Results: Out of the 3225 under‑five children, 85 (2.64%) died. The three‑level mixed‑effects Weibull parametric survival model with PSUs nested within the districts, the likelihood‑ratio test with Chi‑square value = 10.98 and P = 0.004 < 0.05 indicated that the model with random‑intercept effects model with PSUs nested within the districts fits the data better than the fixed effect model. The four covariates, namely the number of birth in the last 5 years, age of mother at first birth, use of contraceptive, and size of child at birth, were found as the risk factor for under‑five mortality at a 5% level of significance. Conclusions: In the random‑intercept effect model, the two estimated variances of the random‑intercept effects for district and PSU levels are 0.27 and 0.31, respectively. The values indicate variations (unobserved heterogeneities) in the risk of death of the under‑five children between districts and PSUs levels.

Mothers' perception of COVID-19 infection in their under-five children presenting in a tertiary health institution in South-East Nigeria and associated factors

Background: Maternal attitude to health-seeking behavior of their under-five children in the COVID-19 pandemic is not well-known. Objectives: This study is aimed at determining mothers' perception of COVID-19 pandemic among their under-five children and associated factors. Methodology: This is a prospective and observational study carried out in two health institutions in South-East Nigeria. Results: Most subjects, 243 (65.3%) noted that someone without showing symptoms of COVID-19 could transmit the virus. Of the mothers of children under-five, 271 (72.8%) highlighted the possibility of COVID-19 infection in the under-five. A small number of participants 53 (14.2%) showed awareness that people should cough into their elbows as a way of preventing the transmission of COVID-19. A small number of participants, 160 (43.0%) had a good perception of COVID-19. Majority of mothers who were married, 148 (44.7%) showed a good perception of COVID-19 when compared with those who were single, 12 (29.3%); however, this is not significant, (χ2 = 3.550, P = 0.060). A large number of participants who have attained tertiary education, 92 (48.9%) had a good perception of COVID-19 which is higher than that seen in mothers with secondary education 68 (37.0%) (χ2 = 5.444, P = 0.020). Participants who were 30­34 years had 1.8 times higher odds of good perception of COVID 19 compared with mothers who were more than 35 years (adjusted odds ratio = 1.803, 95% confidence interval = 1.026­3.170). Conclusion: Although most mothers affirm that a child could be infected by COVID-19, a small number of them actually had a good perception of COVID-19 infection. Good perception of COVID-19 among the under-five is enhanced by the high level of education and age of 32­34 years.

Malnutrition and its associated factors among children under 5 years old in Putrajaya: a study protocol

@#Introduction: Prevalence of malnourished children in Putrajaya was unexpectedly high in 2016. This paper describes the study protocol for a case-control study conducted to identify the associated factors of malnutrition among children under 5 years old in Putrajaya. Methods: This study involved two phases. Phase I was ‘screening’ where all children aged 6-59 months in 118 preschools and four government health clinics were measured for their weight and height. The World Health Organization Anthro software was used to determine the nutritional status of these children. Phase II was the ‘interview’ where children from screening were sampled into four pairs of case and control. The optimum sample size for the case of stunted, wasted, underweight, and overweight were 380, 335, 318, and 308, respectively. The same number of controls were recruited. Parents/caregivers of selected children were approached to obtain data on parental factors, children factors, food intake factors, and environmental factors that contributed to malnutrition. Data analysis was performed by multiple logistic regression in SPSS version 26. Results: Screening phase successfully measured 8,261 (50.1%) children from an estimated 16,500 children under 5 years old in Putrajaya. The number of children who were stunted, wasted, underweight, and overweight were 2,105 (25.5%), 512 (6.2%), 1,516 (18.4%), and 248 (3.0%), respectively. As overweight was undersampled, the number of controls for overweight was doubled to increase the power of the study. Parents/caregivers of selected cases and controls were interviewed in their household or any other venues at their convenience. Conclusion: This protocol promises beneficial outputs to stakeholders and policy makers that can be used for combating malnutrition in children.

Acceptability of height measuring equipment of different materials among community nutrition and health workers and parents in Laguna Province, Philippines

@#<p style="text-align: justify;"><strong>OBJECTIVES:</strong> This study aimed to determine the acceptability of four height/length boards as measuring equipment, (1) NNC wooden height board (HB), (2) Allen's stick, (3) aluminum-acrylic height board, and (4) stadiometer, from the perspective of the community nutrition and health workers (CNHWs) and mothers/caregivers.</p><p style="text-align: justify;"><strong>METHODS:</strong> The study was conducted in two municipalities in the province of Laguna, Philippines. Respondents were 12 CNHWs and 22 parents/guardians of randomly selected children ages 1-5 years. Focus group discussions were also conducted among CNHWs to determine their perceptions, experiences, and feedback on the use of the equipment. Parents/guardians were interviewed about their views on the acceptability of the equipment.</p><p style="text-align: justify;"><strong>RESULTS AND CONCLUSION:</strong> In the urban area, Allen's stick was most favored by end-users, while in the rural area, the NNC wooden HB was the most acceptable. Meanwhile, guardians preferred the aluminum-acrylic HB in the rural area and Allen's stick in the urban area. It was concluded that the use of height boards to measure the height or length of children was acceptable to both CHNWs and parents. CHNWs preferred the stadiometer for height measurement and Allen's stick for length measurement. In contrast parents/guardians preferred the aluminum-acrylic HB and Allen's stick as these were deemed non-threatening, culturally acceptable, safe, comfortable for the children, and the procedures were easily understood.</p>

Seroprevalence of anti-HBs antibodies and the need for booster vaccination in children under 5 years of age born to HBsAg-negative mothers

Objective: To determine the proportion of HBV surface antigen (anti-HBs) antibody positive children under five years of age born to HBsAg-negative mothers and to analyze the possible related factors following implementation of a hepatitis B vaccination program for infants in Indonesia 22 years ago. Methods: Blood samples were taken from children under five years of age born to HBsAg-negative mothers who have completed primary vaccination series. Anti-HBs antibodies were determined by using rapid test. Data of age, gender, nutritional status, vaccination timing or vaccination compliance, and booster vaccination were collected from vaccination card. Results: Ninety children were enrolled, consisting of 47 females and 43 males with a mean age of 2.3 years. Twenty two (24.4%) children received booster vaccine between 18 and 24 months and 55 (61.1%) were anti-HBs positive. Among factors of age, gender, nutritional status, compliance to vaccination and booster vaccine, only administration of booster vaccine was significantly associated with anti-HBs status (OR 5.45, 95% CI 1.45, 20.52). Children who received booster vaccine at age of 18-24 months were 5.45 times more likely to be anti-HBs positive than that of children who did not receive booster vaccine. Conclusions: Booster vaccine rate is low among children under 5 years of age but is associated with anti-HBs positivity. Booster vaccination may be required to improve anti-HBs seropositivity.