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.

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.

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

Management of Acute Respiratory Infections in Children under Five by Self-medication and Prescription of Antibiotics in Bukavu

Acute respiratory infections (ARI) are one of the top 10 killer diseases in children. In developing countries, the treatment is often initiated by self-medication (SM) before going to the hospital in case of a complication. This study assessed the level ofself-medication and the adequacy of hospital prescribing patterns of antibiotics for the management of acute respiratory infections in children under five. It was a cross-sectional survey conducted in 2018, including a face-to-face interview with 227 children’s mothers for self-medication and a review of 1162 medical files available at the pediatrics wards of Panzi General Hospital and University Clinic in Bukavu. Of 227 mothers interviewed, 168(74%) self-medicated children with six antibiotics, mainly amoxicillin (67%), and Cotrimoxazole (60%), principally to avoid medical consultation fees and to mitigate the early signs of the disease. However, among them, 49.8% rushed to the hospital after a complication. Of the 1162 medical files reviewed, 248(21.34%)are ARI cases of which 53% males and 47% females. Under 2 years constitute 85%. Dominant ARIs were acute pharyngitis (19.1%), acute otitis media (15.3%), bronchial superinfection (23.3%), and pneumonia (16.3%). The mortality rate attributable to ARIs was 17.5% (14/80). The antibiotics used in hospital include gentamicin (67%) in combination with cefotaxime, ampicillin, and azithromycin. The unprofessional dispensing of antibiotics in community pharmacies encouraged the high level of self-medication.

The influence of supplementary feeding by local food and 123 milk toward increasing the nutritional status of 12-24 months children with undernutrition status in southeast Sulawesi province, Indonesia.

Background: Until now, the case of energy protein malnutrition in children is still high in Indonesia. Kendari city, one of the areas in Indonesia with high prevalent of this disease, has a significant increase which risen from 9.2% in 2006 to 15.1% in 2007. Methods: This was an experimental study that was under taken for 30 days. Sample of research was undernutrition children 12-24 months age that came from Puskesmas Puuwatu area and Perumnas in Kendari City that collected by simple random sampling technique. 16 children under five in the Puskesmas Puuwatu area received local food intervention and 16 children in the area of Puskesmas Perumnas received 123 Milk intervention. Results: There was significant difference in the Mean of body weight differences before and after intervention between children group that was given Local food and 123 Milk (p=0,032. Analysis with using paired t test indicated the differences between Z-Score value with BW/A and BW/H index before and after treatment in the children group that received local food intervention (p=0,000). In the children group that received 123 Milk intervention, the analysis result of Z-Score value with BW/A index before and after intervention indicated that there was not any significant difference (p=0,084), while the analysis of Z-Score value of BW/H index before and after intervention indicated the existence of significant different (p=0,000). The analysis that used independent t test did not indicated the significant difference of Z-Score value with BW/A and BW/H index after the intervention between children group that received Local food and 123 Milk intervention. Independent t-test analysis toward difference Mean of Z-score value with BW/A index indicated that there was significant difference between children group that received Local food and 123 Milk intervention (p=0,025). Analysis result toward difference Mean of Z-Score value with BW/H indicated the existence of significant difference between two group of intervention (p=0,028). Conclusions: Supplementary feeding by local food has better result in the increasing of body weight and Z-Score value than the giving of 123 Milk.

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.

Home Care of Under 5¬Children with Diarrhea by Caregivers Before Presenting to Central Hospitals, Vientiane Capital, Lao PDR / Lao Medical Journal

Rational and Background: Diarrhea remains an important cause of morbidity and mortality among children under five (U5) in Laos. Complications of paediatric diarrhea are not uncommonly found among the children admitted to hospitals. Incorrect home¬care practice of children with diarrhea by their guardians may be an important factor contributing to such complications. Methodology: A cross¬sectional, descriptive study was carried out at three central hospitals of Vientiane Capital (Mahosot, Mother and Child, and Setthathirat) between January and February 2010 with objectives to (1) determine the frequency of diarrhea complications among U5 children, (2) describe home care behavior of diarrhea by care¬givers, and (3) correlate such behavior with complications. Results: During the study period 3,722 U5¬children presented or were admitted to the three hospitals. Of these 880 (24%) had diarrhea. Of all children with diarrhea, 262 children and their guardians were studied. All children had been treated before presenting to the study hospitals [home¬care by guardians (52%), treated in public hospitals (34%) and in private clinic (14%)]. One hundred and seventy¬one children (65%) had at least one complication at presentation including dehydration (48.5%), malnutrition (27%) and abdominal distension (12%) with one intussusception (0.4%). Treatments given to the children before presenting to the hospitals were ORS (83%), antibiotics (46%), anti¬diarrheals (25%), herbal medicines (8.5%), and antiemetics (5%). Ninety percent of the guardians had correct knowledge of diarrhea definition and on how to prepare ORS but only 32% and 27% of the guardians increased quantity of daily fluid and food, respectively, to their children during diarrhea. The mean (95%CI) years of schooling of the guardians whose children had complications at presentation were significantly lower than those whose children did not have complications [8.5 (8.1 – 8.9) vs 9.2 (8.2 – 9.6), P = 0.04]. Children who received anti¬diarrheals and antibiotics before presentation were 5 and 3 times, respectively, likely to have complications when compared to those who did not [OR = 4.9, 95%CI = 2.2¬10.9; P < 0.001 and OR = 3.4, 95%CI = 1.9 – 5.9; P < 0.001; respectively]. Children treated with anti-diarrheals and antibiotics prior to presentation were 26 and 5 times, respectively likely to have abdominal distension compared to those without treatment [OR = 26.1, 95%CI = 9.4-72.4; P < 0.001 and OR = 4.8, 95%CI = 2.0¬11.7; P < 0.001; respectively]. Children who were given normal quantity of fluid by the guardians during diarrhea were 1.5 times likely to be dehydrated when compared to those who received increased quantity of fluids [OR = 1.6, 95%CI = 1.1¬2.2; P = 0.002]. Conclusion: Half of Lao U5¬children with diarrhea admitted or presented at central hospitals in Vientiane Capital had been treated by their caregivers and 2/3 of them had at least one complication. These complications were significantly associated with incorrect home¬care practice by the guardians especially treatments with anti¬diarrheals and antibiotics.

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.

PM10 as Predictor of Ventilation Efficiency of Houses in Relation to Health Effect.

Concerns for the high concentration of particulates in the ambient air of Jakarta had been associated with respiratory health effects. Accordingly, the high concentration of indoor air particulate in homes was also recognized as a potential health hazard to the household. This paper was based on findings in a cross-sectional study in homes of a village, Jakarta done for a dissertation of a doctoral degree in Public Health. In relation to health aspect, ventilation effectiveness was more predicted by the variation of indoor particulates concentrations (as PM10) than the physical characteristic of the houses. Besides, respiratory symptoms rates among children under-five were positively associated to PM10 concentrations. Except for the house dampness factor, no physical features of the houses such as sizes of windows, rooms, and the like, contributed to the variability of health of the occupants. This research suggested that PM10 concentration was a better indicator for a healthy house than the physical characteristics of the house. As such, the most sensitive and specific level of PM10 concentration to predict the development of respiratory symptoms was 70µg/m3. This cutoff concentration of PM10 agreed with the guideline value set on the level of 70 µg/m3 for the thoracic particles by the World Health Organization.