The status of research on malnutrition among children under 5 years in Southern Africa: a systematic review

Malnutrition rates remain alarming with stunting declining too slowly while wasting still impacts the lives of many young children. Globally, 5.6 million children die before their fifth birthday annually, with 80% of these deaths occurring in Sub-Saharan Africa and Asia. A total of 29 most relevant articles were included, which followed the preferred reporting items for systematic reviews and meta-analyses for protocols (PRISMA-P). The literature search was conducted in multiple electronic databases, including Google Scholar, PubMed, and Research Gate. A large proportion of the literature focused on determining factors associated with malnutrition. Similarities were found amongst various articles with findings highlighting household food insecurity as a major threat that leads to inadequate feeding practices and consequently resulting in undernutrition. This review assessed the state of knowledge on malnutrition in Southern Africa. The authors identified knowledge gaps that should be considered for future research. We did not come across any evaluation studies assessing food security interventions in response to malnutrition. Moreover, sanitation in relation to malnutrition is not broadly researched. We recommend future studies to apply a cross-sectional analytic design with mixed methods, combining survey data, geographical data, household and key informant interviews. There is a need to map the prevalence of malnutrition in children under five years and providing more knowledge on vulnerability and contexts that influence malnutrition including socio-economic, environmental and infrastructural conditions. We further recommend the use of GIS databases to generate information on spatio-temporal patterns of malnutrition.

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.

Community case management of chest indrawing pneumonia in children aged 2 to 59 months by community health workers: study protocol for a multi-country cluster randomized open label non-inferiority trial

Background:The World Health Organization (WHO) integrated management of childhood illness (IMCI) protocol recommends treatment of chest indrawing in 2-59 months old children with oral amoxicillin by trained health facility workers. Whereas, the WHO/UNICEF integrated community case management (iCCM) protocol recommends referral by community level health workers (CLHWs) to a health facility. This study aims to evaluate whether CLHWs can treat chest indrawing pneumonia effectively and safely.Methods:Thismulti-centre cluster randomized controlled open label, non-inferiority trial will be conductedin Bangladesh, Ethiopia, India and Malawi. All sites will use a common protocol with the same study design, participants, intervention, control and outcomes. CLHWs will identify 2-59 months old children with chest indrawing. Study supervisors, trained in the iCCM protocol, will confirm CLHWs’ findings. Pulse oximetry will be used to identify hypoxaemic children. In the intervention group, enrolled children will be treated with oral amoxicillin for 5 days, and in the control group they will be referred to ahealth facility, after providing first dose of oral amoxicillin. An independent outcome assessor will visit each enrolled child on days 6 and 14 of enrolment, to assess study outcomes.Conclusions:If CLHWs can effectively and safely treat chest indrawing pneumonia in 2-59 months old children, it will increase access to pneumonia treatment substantially, as in many settings, health facilities and trained health workers are not easily accessible. Moreover, this evidence will contribute towards the review of the current iCCM protocol and its harmonization with the IMCI protocol. Trial Registration:The trial is registered at AZNCTR International Trial Registry as ACTRN12617000857303

Socio-demographic determinants of diarrhoeal diseases among under five years old children in Rwanda

Background Diarrhoeal disease is a worldwide public health issue and remains a major cause of mortality and morbidity in children under five years old. Low and middle income countries (LMIC) of Africa and part of Asia are more affected by diarrhoeal diseases. Objectives To measure the prevalence of Diarrhoeal Diseases and to assess Socio-demographic determinants among Under Five Years Old Children in Rwanda. Methods A cross-sectional design was used. Secondary data analysis was carried out on a sample of 7474 drawn from Rwanda Demographic and Health Survey (RDHS). RDHS used multistage sampling technique. Results After running multiple logistic regression, Sociodemographic determinants associated with diarrhoeal included age of children, wealth index category, mother education, husband/partner education, types of place of residence (P-Value) Conclusion The results of the study showed that diarrhoeal remains an important health issue in Rwanda. Occurrence of diarrhoeal was statistically associated with child age, wealth index, education of parents, types of place of residence.

Skin problems in children under five years old at a rural hospital in Southern Ethiopia

Objective To examine the prevalence of cutaneous disorders in children under 5 years old who attended a rural hospital in Southern Ethiopia. Methods A prospective cross-sectional study was conducted from January 26 to February 20, 2015 in children under 5 years old who attended Gambo Rural Hospital in West Arsi of the Oromia Region, Ethiopia. Results A total of 324 children were included (59.6% male) whose median age was 16.4 months. In total, 147 children [45.4%; 95% confidence interval (CI): 40.0%–50.8%] under 5 years had a skin problem, of which 101 (68.7%) consulted for that reason. The other 46 (31.3%) consulted for a general health problem and the dermatological condition was a secondary finding during the physical exploration. In 93 children (28.7%; 95% CI: 20%–33.8%), it was the main disease, and in 54 children (16.5%; 95% CI: 13.0%–21.1%) it was concomitant with other diseases. The most common dermatological disease was scabies (n = 44, 13.6%; 95% CI: 10.3%–17.7%). Impetigo was diagnosed in 32 children (9.9%; 95% CI: 7.1%–13.3%), of which 23 (71.9%) had complicated impetigo. Nineteen children (5.9%; 95% CI: 3.8%–9.0%) had eczema, 10 (3.1%) had eczema associated to other conditions. The following most frequent skin problems were tinea (n = 9; 2.8%), infected wound and ulcer (n = 7; 2.2%), and burns (n = 6; 1.9%). Conclusions Skin problems, mainly scabies, impetigo, and eczema were common in young children attended at a rural hospital in Southern Ethiopia. Children under 5 years should be examined thoroughly to rule out skin diseases, especially scabies.

Skin problems in children under five years old at a rural hospital in Southern Ethiopia

Objective: To examine the prevalence of cutaneous disorders in children under 5 years old who attended a rural hospital in Southern Ethiopia. Methods: A prospective cross-sectional study was conducted from January 26 to February 20, 2015 in children under 5 years old who attended Gambo Rural Hospital in West Arsi of the Oromia Region, Ethiopia. Results: A total of 324 children were included (59.6%male) whose median age was 16.4 months. In total, 147 children [45.4%; 95% confidence interval (CI): 40.0%–50.8%] under 5 years had a skin problem, of which 101 (68.7%) consulted for that reason. The other 46 (31.3%) consulted for a general health problem and the dermatological condition was a secondary finding during the physical exploration. In 93 children (28.7%;95%CI:20%–33.8%), it was the main disease, and in 54 children (16.5%;95%CI:13.0%–21.1%) it was concomitant with other diseases. The most common dermatological disease was scabies (n=44, 13.6%;95%CI:10.3%–17.7%). Impetigo was diagnosed in 32 children (9.9%;95%CI:7.1%–13.3%), of which 23 (71.9%) had complicated impetigo. Nineteen children (5.9%;95%CI:3.8%–9.0%) had eczema, 10 (3.1%) had eczema associated to other conditions. The following most frequent skin problems were tinea (n = 9; 2.8%), infected wound and ulcer (n=7;2.2%), and burns (n=6;1.9%). Conclusions: Skin problems, mainly scabies, impetigo, and eczema were common in young children attended at a rural hospital in Southern Ethiopia. Children under 5 years should be examined thoroughly to rule out skin diseases, especially scabies.

Nasopharyngyeal Carriage and Antimicrobial Susceptibility of Streptococcus pneumoniae, in Children under Five Years at Mbarara Regional Referral Hospital, Uganda.

Background: Acute respiratory infections (ARI) are a leading cause of childhood morbidity and mortality, causing 25-30% of all deaths in developing countries. Pneumococcal disease is a significant public health problem that usually follows pneumococcal colonization of the nasopharynix. We determined the prevalence of nasopharyngeal carriage of Streptococcus pneumoniae, antimicrobial susceptibility patterns and risk factors for nasopharyngeal carriage of S. pneumoniae among under fives attending Maternal Child Health Clinic at Mbarara Regional Referral Hospital (MRRH). Methods: We performed a cross-sectional study between August and November 2012. Nasopharyngeal swabs collected from four hundred healthy children were cultured on blood agar and chocolate agar and incubated for 24 hours at 37⁰C in carbon dioxide jar. Upon growth the organisms were identified by colonial appearance and standard biochemical tests. Antimicrobial resistance to six antibiotics was performed using Kirby Bauer method on chocolate agar and interpreted according to CLSI guide lines. Results: The prevalence of S. pneumoniae in the cultured samples was reported at 19% (76/400). Of the positive isolates, 75/76 (99%) and 55/76 (77%) were shown to be resistant to cotrimoxazole and tetracycline, respectively. Among the factors assessed for nasopharyngeal carriage of S. pneumoniae none was significantly associated with carriage. Conclusion: Despite the low rate of carriers of S. pneumoniae, a remarkable resistance of these isolates to cotrimoxazole and tetracycline was detected.

Breastfeeding Practices of mothers of under five years old children in Bahir Dar City, Ethiopia: A descriptive cross sectional-community based survey.

Background: Improved breastfeeding practices can help in preventing diarrheal diseases and malnutrition. In Ethiopia, children are still suffering from diarrheal diseases and malnutrition. Aims & Objective: This study was aimed at assessing mothers’ breastfeeding practices in Bahir Dar, Ethiopia. Materials and Methods: A cross sectional survey was conducted by involving of 415 mothers. The study was conducted from April 15 to May 15, 2011. Three kebeles (the smallest administrative level) from Bahir Dar city were selected randomly. The sample was determined by using single population proportion formula and proportionally distributed to the selected kebeles according to population size. To be eligible to participate in the study, mothers had to live in households that had children under five years of age. Households were selected by systematic sampling method. Mothers were interviewed in their homes using a structured questionnaire that had been pre-tested. The data were analyzed using SPSS version 16.0. Odds ratio was calculated with 95% confidence intervals; P-values less than 0.05 were considered as statistically significant. Results: Data were collected from 415 mothers. Breast-feeding was practiced by 400(96.4%) of all respondents. Two hundred seventy eight (69.5%) mothers reported initiating breast-feeding within one hour of delivery. One hundred thirty four (33.5%) of mothers reported feeding colostrum to their infants. The main reasons for not giving colostrum included the belief that colostrum is unclean was reported by 30 (22.4%) mothers, colostrum makes the newborn sick by 58 (43.3%) mothers and that withholding colostrum initiates breast milk production by 46 (34.3%) mothers One hundred and nine (26.3%) of mothers reported giving pre lacteal feeds to their infants. About 325 (78.3%) of mothers reported that they had heard information about exclusive breastfeeding but only 172(41.4%) had appropriate knowledge. One hundred and thirty three (38.1%) mothers substituted breast milk before the child reaching six months of age. Mothers’ educational status, Antenatal care (ANC) follow up during pregnancy, availability of television in the household and place of delivery were significantly associated with feeding colostrum to the infant (P<0.05). Conclusion: This study showed that the prevalence of ever breastfeeding was almost universal but still mothers had gaps about early initiation of breastfeeding, giving the first milk for their newborns and exclusive breastfeeding. Therefore information regarding optimal breastfeeding practices should be provided for mothers and local health extension workers. An effort should also be made to increase community awareness about the importance of optimal breastfeeding for the child growth and development.

Prevalence of child malnutrition in agro-pastoral households in Afar Regional State of Ethiopia

Based on data generated from 180 randomly selected households with children age under five years old in Aysaita district of Afar region of Ethiopia, this study explored prevalence of malnutrition and scrutinized household characteristics, maternal characteristics, specifics of the child and economic variables associated with child malnutrition. The height-for-age Z-scores (HAZ), weight-for-height Z-scores (WHZ) and weight-for-age Z-scores (WAZ) were used to measure the extent of stunting, wasting and underweight, respectively. The results revealed that prevalence of long term nutritional imbalance and malnutrition status indicator (i.e. stunting) was 67.8%. The short term measure (wasting) was found to be 12.8% and underweight was found to be 46.1%. Moreover, children in households which are headed by women, and characterized by more dependency ratio, less access to assets, health services and institutions are more likely to be undernourished.

High participation in the Posyandu nutrition program improved children nutritional status

The objective of this research was to analyze nutritional status and food consumption of children participating in the Posyandu nutrition program. A total sample of 300 children under five years had been drawn. Sample was divided into two categories namely high participation and low participation in the Posyandu nutrition program. The sample was selected from two sub districts of Cianjur District, West Java. The districts were areas with a high proportion of poor people and many of them take the benefits of Posyandu nutrition program conducted by the government. The participation of children (under five years old) in visiting Posyandus was relatively good, namely, 92.4% (for the high participation group). However, for the low participation group, the number of participating children was relatively low (28.3%). The average consumption of energy for children under five years old was still below the recommended dietary allowance < 80% of RDA, whereas the protein consumption was already above the RDA. The prevalence of underweight, stunting, and wasting among children were respectively 30.0%, 43.7%, and 12.3%. The activities at Posyandus had a positive impact on the nutritional status of children under five years olds, measured in terms of weight for age (W/A) and weight for height (W/H). The more frequent the visit to Posyandus, the better the nutritional statuses would be.