Prevalence and Determinants of the use of Enema in under-five children in Akwa Ibom State

Background: Use of enema in children across clinical and community settings are associated with risks. This study seeks to determine the prevalence of enema practice in under-five children, substances used as enema and the reasons for enema practice by mothers. Materials and Methods: This was a descriptive cross sectional study among 252 consecutively recruited mothers of under-five children attending immunization/well babies clinics in 2 health centres in Akwa Ibom state using a semi-structured self and interviewer administered questionnaire for data collection. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 17.0 at a level of significance of P<0.05. Results: One hundred and sixty-nine (67.1%) respondents had ever given enema to their children. Mothers (69.2%) administered enema to their children which most often (72.8%) was recommended to them by others. Herbal enema was preferred to chemical and plain water enema. Common reasons for enema administration were in preparation for administration of antimalarial to ensure its effectiveness (60.4%), to relief constipation (49.7%) and abdominal pains (46.7%) and treatment of fevers (41.4%). Predictors of enema practice were age of the child (OR 0.4, 95% CI 0.212-0.765, p=0.005) and ethnic origin of the mothers (OR 9.4,95% CI 4.024-22.104, p<0.001). Conclusion: The practice of enema is common in the study area. Health practitioners should be aware of this practice in the communities, seek for this history during clinical consultation and make concerted effort in educating the mothers and other caregivers against this practice.

Risk factors responsible for lower respiratory tract infections in children aged under five: a hospital based study

Background: Lower respiratory tract infections (LRTI) contribute significantly in terms of hospital admission and mortality. Along with attempts to improve treatment modalities, it is imperative to identify risk factors that will aid in prevention of these infections.Methods: This was a case-control study done in tertiary care hospital, Cuttack, enrolling inpatients between 2 months to 5 years with symptoms suggestive of LRTI as cases. Those with tuberculosis, aspiration pneumonia, asthma and nosocomial infections were excluded. After obtaining consent, questionnaire was administered to parents, regarding their socio-demographic and other relevant details. Data analysis was done using statistical software Epi Info™, version 6 and association of each variable with LRTI assessed with chi-square test.Results: A total of 314 children were enrolled in the study, with 158 being cases. The case-fatality rate was 23% and 53.8% suffered from complications, the most common being respiratory failure. A significant association was seen between LRTI and social variables namely maternal literacy(p-value<0.005), socioeconomic status (p-value<0.001) and number of children (p-value<0.001), housing pattern (p-value<0.001), fuel used at home (p-value=0.003), ventilation adequacy (p-value=0.004), presence of separate kitchen at home (p-value=0.0009) and presence of overcrowding (p-value<0.001) and individual factors improper breastfeeding(p-value<0.005) and weaning(p-value=0.03), malnutrition (p-value<0.001), vitamin A deficiency(p-value=0.03) and history of respiratory infection in mother (p-value=0.025) or siblings(p-value=0.048).Conclusions: The burden of lower respiratory tract infections can be substantially reduced by prevention using the identification of risk factors such as housing patterns, education of parents and improved nutrition of the children, and measures to combat the same, at each level.

Hand washing practices amongst mothers of under-fives in an urban slum

Background: Hand washing with soap is a cost-effective tool of disease prevention, but most of the time it is overlooked. Use of contaminated hands enhances transmission of germs into body causing ill-health. Mothers clean, prepare, serve and feed the food. If this is coupled with poor knowledge and practice of hand washing it increases risk to spread of diseases to self, other family members especially to under-fives. Present study was conducted to address this issue being a critical factor in disease prevention. The objective of the present study was to determine the knowledge and practices of hand washing amongst mothers of under-fives.Methods: Present cross sectional study was conducted at UHTC, field practice area of Community Medicine, GMC, Latur amongst mothers of under-fives visiting UHTC to avail health services. The data was collected in a predesigned, pretested questionnaire by interviewing them.Results: Out of 204 mothers, 38.24% were from the age group of 24-26 and majority i.e., 69.61% were housewives. 99.02% mothers were aware that unwashed hands can transmit the diseases. Most of the mothers told that clean hands reduces food and water contamination. Maximum i.e., 97.57% mothers washed hands before eating and 71.57% washed before cooking. All the mothers washed hands after visiting toilet. Most mothers used soap and water (85.3%) for hand washing. Significant numbers of mothers, under-fives and other members suffered from diarrhea in last six months (p<0.05).Conclusions: Hand washing practices need to be followed at all critical moments for prevention of the faeco-oral infections.

Utilization of immunization services among children aged under five in Kirinyaga County, Kenya

Background: Immunization is the key strategy to curb communicable diseases which are the number one killer of children under five years of age. Immunization prevents mortalities of approximating three million children under five years annually. This study aimed to assess utilization of immunization services among children aged under five in Kirinyaga County, Kenya.Methods: This was a descriptive cross-sectional study conducted among 388 participants in the five sub-counties of Kirinyaga County through systematic random sampling. Data was collected using a structured interview and review of recorded data from the Children immunization record card. Data was analyzed using SPSS and chi-square tests used to measure the association between independent and dependent variables. Statistical significance was set at p≤0.05.Results: Immunization at birth and at 6 weeks was highly utilized at 91%. However, there was a decline during the subsequent visits. Age, gender, profession and level of income were significant factors that affected timely immunization. Health service barriers to utilization included long ques and waiting time, stock out of vaccine and rescheduling of vaccination and clinic return dates. Other identified factors were myths and misconception, side effects, parity and lack of information.Conclusions: The results showed that utilization of immunization services was not in compliance with the expanded programme on immunization schedule. There is therefore need for health education programs to be carried out to improve utilization of immunization services and a door to door campaign to trace and immunize defaulters.

Danger signs of acute respiratory tract infections in under-five children: awareness among mothers in the urban slums of Hyderabad, its relation to treatment seeking behaviour

Background: Sustainable development goals (SDGs) proposes to all countries an aim to reduce under-five mortality to 25 per 1000 live births by 2030. Acute respiratory tract infections including pneumonia are the leading cause of death among the children less than five years in India. Identification of severe respiratory infections from non-severe forms necessitates that care-givers, especially mothers are aware of danger signs. An attempt is made to study the awareness of danger signs among the Mothers and see its relation to treatment seeking behaviour.Methods: Community based cross-sectional survey was conducted involving 344 mothers of under-five children living in the urban slums of Hyderabad.Results: The awareness of mothers about the danger signs of ARI is poor. Very few knew that fast breathing (11 percent), wheezing (4.7 percent), convulsions (1 percent), lethargy (1 percent) are major danger signs of ARI requiring urgent medical attention. A majority of mothers took the child with ARI to private hospital (42 percent) while few approached Govt. Hospital or dispensary (4.7 percent). Many mothers (77 percent) were aware that vaccination against diseases might protect the children against ARIs. The prevalence of acute respiratory infections among the children in the current study (59.3 percent) is much higher that previous studies elsewhere.Conclusions: A very high proportion (44 percent) of the mothers were ignorant of any danger sign of ARI. The significant association between awareness and positive health care seeking behaviours, like consulting allopathic doctor or govt. hospital or private hospital establishes the evidence that awareness levels are the prerequisite for the positive health care behaviour.

Socioeconomic and cultural factors associated with mortality in Malaria induced anaemia among under-five children in Benin city, Nigeria.

Background: Children under the age of five years bear the brunt of malaria infection. Malaria induced anaemia (MIA) is the most prevalent presentation of malaria and a major cause of morbidity and mortality in Nigeria. Objective: To determine the socioeconomic and cultural factors associated with mortality in under-five children presenting with malaria induced anaemia. Methods: This is a cross-sectional descriptive study conducted at the Children Emergency Room of the University of Benin Teaching Hospital, Benin City, Nigeria. Questionnaires which were researcher-administered were used to collect information on the child’s age, gender, parents’ or caregiver’s education, occupation, recognition of symptoms of malaria and anaemia, cultural practices during child’s illness and patients’ outcome. Results: The case fatality rate was 3.1%. Poor parental education, low social class and lack of skilled job amongst the parents were associated with high mortality. Other factors associated with mortality include high patronage of chemists and prayer houses as well as poor recognition of pallor by mothers. Conclusion/Recommendations: Improvement in socioeconomic status especially female education and empowerment is again emphasized. This and other socioeconomic boost should be targeted alongside malaria-control programmes in order to reduce mortality associated with malaria induced anaemia. Parental enlightenment on recognition of symptoms of malaria and anaemia will improve their health-seeking behaviour, promote early diagnosis and prompt institution of effective antimalarial therapy.

Comparative Analysis of the Nutritional Status of Under-five Children and their Mothers in Rural and Urban Areas of Anambra State, Nigeria.

Aim: Malnutrition in the form of under-nutrition is still a major public health problem in developing countries of sub-Saharan Africa including Nigeria. This study compares the nutritional status of under-five children and their mothers in rural and urban areas of Anambra State Nigeria. Methodology: This was a comparative cross-sectional study carried out in one urban and two rural local government areas of Anambra State, Nigeria namely Awka South, Dunukofia and Anaocha respectively. A total of 657 mother-child pairs were selected from eligible households using the multistage sampling technique. Data on household food security was obtained from the mothers using semi-structured, interviewer-administered questionnaires while anthropometric measurements were carried out on the children and their mothers using weighing scales and height boards. Results: The overall prevalence of stunting, wasting and underweight among the under-five children in this study were 15.1%, 18.1% and 10.4% respectively, and the proportions were higher in the rural area than in the urban. The prevalence of stunting (height < 152 cm) in the mothers was 7.9% in the rural area compared to 9.1% in the urban area. Majority of the women were overweight (BMI ≥ 25.0), more in the urban (69.3%) than in the rural (59.2%). Conclusion: This study confirmed that under-five under-nutrition remains a serious public health problem in Anambra State, Nigeria. In order to reduce child morbidity and mortality to which malnutrition contributes significantly, concerted effort must be made by the government to improve child and maternal nutritional status by directing attention to improving household food security through developing and implementing policies that improve the livelihoods of the population.

Risk factors for death in under-five children presenting with acute diarrhoea in an urban teaching hospital in Nigeria

Dehydration is believed to be the primary cause of acute diarrhoea-related mortality. However, it is likely that a number of demographic and clinical risk factors may also interact to create the continued mortality due to acute diarrhoea. This study sought to explore the contributory role of some of these risk factors on diarrhoea-related mortality. This was a descriptive cross-sectional study involving 135 children between 29 days and 59 months admitted into the Diarrhoea Treatment and Training Unit during the period of July 2010 and January 2012. A range of demographic and clinical variables as well as outcome were obtained using a structured interviewer-administered questionnaire. To identify risk factors that were independently associated with mortality, a multivariate analysis was done after controlling for confounders. Fourteen (10.4%) children, nine males and five females died following admission. The odds of a child dying of an acute diarrhoea disease following admission was increased in children with co-diagnosis of pneumonia (AOR = 16.38, p = 0.03), non-usage of ORS (AOR = 16.52, p = 0.00), diarrhoea episodes > 6 times in 24 hours (AOR = 23.63, p = 0.00) and Duration of diarrhoea > 3 days before admission (AOR = 3.63, p = 0.04). Acute diarrhoea related mortality can be further reduced if awareness is created concerning these risk factors such that high risk children can easily be identified and targeted for intensive intervention.

Study of morbidity pattern of under-fives in paediatrics OPD of a tertiary care hospital in a rural area of Uttar Pradesh.

Background: Children under-five are most vulnerable for malnutrition and infection. Morbidity pattern of this age group has several determinants like socio-economic status, basic education, occupation, socio-cultural practices, living environment etc. Objectives: To study the morbidity pattern in under-five children and to find out it’s association with various factors. Methods: This was a cross-sectional study conducted in paediatrics OPD of a tertiary care level hospital in rural area of Etawah District of Uttar Pradesh for three months. We included 379 children by random sampling design. Mothers of children were interviewed using a predesigned schedule. Chi-square test was used for statistical analysis. Results: Commonest morbidity was malnutrition (70.71%), followed by ARI (63.59%), anaemia (47.76%), diarrhea (20.58%), malaria (13.33%) and worm infestation (10.03%) while around 25 percent suffered from other illnesses. Most common symptom was fever (70.71%) and cough (62.8%). A statistically significant association was found in morbidity pattern of ARI, diarrhea, malaria, malnutrition and anaemia with various factors like education, socio-economic status, and occupation. Congenital anomalies were found in around 3 percent children. 3.69 percent children were admitted in wards from OPD. Conclusion: Common childhood illnesses were prevalent though children suffered from serious illnesses on very few occasions.