Assessment of the Behavioural Effects of Cartoon Viewing among Parents of Under-Five Children

Background of the Study: Cartoons are the most popular entertainment for the Children. Mostly children begin watching cartoons on television at the early age of six months, and by the age of two or three children become enthusiastic viewers. Objectives: The main objective of the study is to assess the behavioral effects of cartoon viewing among the parents of under-five children. Methodology: Descriptive study design was used to conduct the study in selected tertiary care hospital. As per the inclusion criteria 50 samples were selected by using non probability purposive sampling technique. Self structured questionnaire was used to collect data and the behavioral effects of cartoon viewing among the parents of under-five children. Results: The study findings revealed that, among 50 samples 32% of the Children had mild effects on behaviour, 66% had moderate effects on behaviour and 2% of the Children had sever effects on behaviour. The mean and standard deviation score of the study was 54.72+0.8571. There was a significant association between the behavioral effects of cartoon viewing and the age of the Children (χ2 = 7.6364 , P<0.05). Conclusion: The study concluded that, 32% of the children had mild effects on behaviour, 66% had moderate effects on behavior and 2% of the children had sever effects on behaviour. Keywords: Cartoons, behavioral effects, under five children, parents.

Prevalence and Determinants of Under-Nutrition Among Under-Five Children in Afar Region, Ethiopia: Evidence From 2016 Ethiopian Demographic and Health Survey

Background: Undernutrition is one of the major public health concerns among infants and young children in the country. Childhood under-nutrition is widespread in low and middle-income countries. This study was initiated to assess the prevalence of under-nutrition and its associated factors among under-five children in Afar Region, Ethiopia. Methods: The data for this study were extracted from the Ethiopian Demographic and Health Survey (EDHS) 2016. The information collected from 937 children born 5 years before the survey was considered in the analysis. A multivariable binary logistic regression analysis was used at a 5% level of significance to determine the individual- and community-level factors associated with childhood malnutrition.Results: The prevalence of stunting, underweight and wasting in Afar region were 41.1%, 36.2% and 17.7%, respectively. About 26.7% of children in Afar region were both stunting and underweight, 12.7% were both underweight and wasting, 7.6% were both stunting and wasting and only 7.0% of children had all the three under-nutrition conditions. Among the factors considered in this study, age of a child in months, anemia level, mothers’ BMI, household wealth index, size of child at birth, number of living children and place of residence were significantly associated with stunting, underweight and wasting in Afar Region. Conclusions: The prevalence of all stunting, underweight and wasting was relatively high. Undernutrition is one of the major public health concerns among children in Afar Region. The effect of these factors should be considered to develop strategies to reduce under-nutrition in the study area. Thus, intervention should be focused on improving the under-nutrition determinants of the children to improve the child's nutritional status and reduce child morbidity and mortality.

Characteristics of severely malnourished under-five children immunized with Bacillus Calmette-Guérin following Expanded Programme on Immunization schedule and their outcomes during hospitalization at an urban diarrheal treatment centre, Bangladesh

Background Bacillus Calmette-Guérin (BCG) vaccination has recently been found to have beneficial effects among children infected other than Mycobacterium tuberculosis. Due to the paucity of data on the outcomes of children who had successful BCG vaccination following Expanded Programme on Immunization (EPI) schedule, we aimed to investigate the characteristics of such children and their outcomes who were hospitalized for severe malnutrition. Methods A prospective observational study was conducted to determine the viral etiology of pneumonia in severely malnourished children those were admitted to the Dhaka Hospital of International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) between April 2015 and December 2017, constituted the study population. Using a case-control design for the analysis, children having BCG vaccination prior hospital admission were treated as cases (n = 611) and those without vaccination, constituted as controls (n = 83). Bi-variate analysis was conducted using socio-demographic, clinical, laboratory, and treatment characteristics on admission and outcomes during hospitalization. Finally, log-linear binomial regression analysis was done to identify independent impact of BCG vaccination. Results The cases more often presented with older age, have had lower proportion of maternal illiteracy, higher rate of breastfeeding, severe wasting and lower rate of hypoglycemia, compared to the controls. The cases were also found to have lower risk of severe sepsis and deaths, compared to the controls (for all, p<0.05). However, in log-linear binomial regression analysis, after adjusting for potential confounders, BCG vaccination following EPI schedule (RR:0.54; 95%CI = 0.33–0.89; p = 0.015) and breastfeeding (RR:0.53; 95%CI = 0.35–0.81; p = 0.003) were found to be protective for the development of severe sepsis. Conclusion BCG vaccination and breastfeeding were found to be protective for the development of severe sepsis in hospitalized severely malnourished under-five children which underscores the importance of continuation of BCG vaccination at birth and breastfeeding up to two years of age.

Time to death among HIV-infected under-five children after initiation of anti-retroviral therapy and its predictors in Oromiya liyu zone, Amhara region, Ethiopia: a retrospective cohort study

Background Human Immunodeficiency Virus (HIV) is infection which mainly attacks immune system of an individual. Its disease progress is rapid in children and if treatment is not initiated nearly half of infected children will die by the second year of infection. In Ethiopia, nearly twenty four percent of HIV related death is happen to under-five children; however studies done in this specific age group are limited are with poor evidence of predictors. Objectives To determine time to death and identify predictors of death in HIV infected under- five children on antiretroviral therapy in Amhara regional state, Oromia ‘liyu’ zone, Northeast Ethiopia, from 2014 to 2019. Methods Institution based retrospective follow up study was conducted in 376 under-five HIV- infected children on antiretroviral therapy from January 2014 to December 2019 in health institutions in Oromia Liyu Zone, Amhara region, Ethiopia. Multivariable Cox-proportional hazard regression model was used to identify independent predictors of mortality in HIV- infected under-five children on antiretroviral therapy. Result At the end of follow up, 304 (80.85%) of HIV-infected children were alive, 39 (10.95%) were lost to follow up, 12 (3.19%) were transferred out and 21 (5.59%) were reported dead due to HIV/AIDS. The cumulative survival probabilities of children after 3, 6, 12, 24 and 36 months were 0.99, 0.98, 0.97, 0.89 and 0.87 respectively. The overall mean time to death was 19.7 months (95%CI = 18.74–20.67) with incidence of 5.9 deaths per 100 child-months (95%CI: 3.89–9.09). Children with severe malnutrition at baseline (AHR = 4.9; 95 CI: 1.04, 23.50), advanced WHO clinical stage at enrolment (AHR = 3.9; CI: 1.37, 10.88), poor adherence to ART (AHR = 6.56; CI: 3.33, 10.14) and with no history of Isoniazide prophylaxis were significantly associated to higher mortality events (AHR = 3.6; CI: 1.24, 10.18). Conclusion Death of HIV-infected under-five children on ART is high within the first one year after enrolment. The risk of death increased if the child was malnourished at beginning of treatment, had poor ART adherence, with advanced WHO clinical stages and lack of Isoniazide prophylaxis during their age of infancy.

Clinical Profile and Characterization of Rotavirus Strains in Under-Five Children with Diarrhea: A Hospital-Based Study from Eastern Odisha, India

Objective Diarrheal diseases are one of the most common causes of hospitalization in children under five. Rotavirus is the most common cause of acute diarrhea in younger children, and the prevalence decreases rapidly with increasing age. The objective of the study was to estimate the burden of rotavirus infection in acute gastroenteritis among under-five children admitted to a tertiary care hospital in eastern Odisha, for the clinical profile and identity of the prevalent strains. Methods This was a prospective observational study linked to the National Rotavirus Surveillance Network (NRSN), where 720 under-five children with diarrhea were enrolled. In total, 675 stool samples of eligible candidates were sent for rotavirus isolation, and identification of strains was done by identifying VP7 (G-type) and VP4 (P-type) genes by reverse transcription polymerase chain reaction. Results Categorical variables were presented as frequency and percentage, and continuous variables were expressed as mean ± standard deviation. Rotavirus was detected in 256 (37.92%) samples. Males outnumbered females. The most common affected age group was 7 to 12 months, followed by 13 to 18 months. G3P[8] was the most prevalent strain in this study. Conclusion Children between the age of 7 and 18 months were most vulnerable to rotavirus infection. The most prevalent strain varies from one region to another and continuous surveillance is needed.

Association of Acute Respiratory Infections with Indoor Air Pollution from Biomass Fuel Exposure among Under-Five Children in Jimma Town, Southwestern Ethiopia

Background. Most of the households in developing countries burn biomass fuel in traditional stoves with incomplete combustion that leads to high indoor air pollution and acute respiratory infections. Acute respiratory infection is the most common cause of under-five morbidity and mortality accounting for 2 million deaths worldwide and responsible for 18% of deaths among under-five children in Ethiopia. Although studies were done on acute respiratory infections, the majority of studies neither clinically diagnose respiratory infections nor use instant measurement of particulate matter. Methods. The community-based cross-sectional study design was employed among under-five children in Jimma town from May 21 to June 7, 2020. A total of 265 children through systematic random sampling were included in the study. The data were collected using a pretested semistructured questionnaire and laser pm 2.5 meter for indoor particulate matter concentration. Associations among factors were assessed through correlation analysis, and binary logistic regression was done to predict childhood acute respiratory infections. Variables with p -value less than 0.25 in bivariate regression were the candidate for the final multivariate logistic regression. Two independent sample t-tests were done to compare significant mean difference between concentrations of particulate matter. Results. Among 265 under-five children who were involved in the study, 179 (67.5%) were living in households that predominantly use biomass fuel. Prevalence of acute respiratory infections in the study area was 16%. Children living in households that use biomass fuel were four times more likely to develop acute respiratory infections than their counterparts (AOR: 4.348; 95% CI: 1.632, 11.580). The size of household was significantly associated with the prevalence of acute respiratory infections. Under-five children living in households that have a family size of six and greater had odds of 1.7 increased risk of developing acute respiratory infections than their counterparts (AOR: 1.7; 95% CI: 1.299, 2.212). The other factor associated with acute respiratory infection was separate kitchen; children living in households in which there were no separate kitchen were four times at increased risk of developing acute respiratory infection than children living in households which have separate kitchen (AOR: 4.591; 95% CI: 1.849, 11.402). The concentration of indoor particulate matter was higher in households using biomass fuel than clean fuel. There was statistically higher particulate matter concentration in the kitchen than living rooms (t = 4.509, p ≤ 0.001 ). Particulate matter 2.5 concentrations (μg/m3) of the households that had parental smoking were significantly higher than their counterparts (AOR: 20.224; 95% CI: 1.72, 12.58). Conclusion. There is an association between acute respiratory infections and biomass fuel usage among under-five children. Focusing on improved energy sources is essential to reduce the burden and assure the safety of children.

Occurrence of Diarrheal diseases among under-five children and associated socio-demographic and household environmental factors: An Investigation Based on National Family Health Survey-4 in Rural India

Background: Diarrheal disease is a major population health problem that is the leading reason for mortality and morbidity among children aged 0-59 months in rural India. Therefore, the rationale of this study was to identify the socio-demographic, environmental predictors associated with diarrhea among under-five children in rural India. Methods: A total of 188,521 living children (0-59 months) were utilized from the National Family Health Survey-4, 2015–2016. Bivariate and binary logistic regression analysis was carried out from the available NFHS-4 data for selected socio-demographic and environmental predictors to identify the relationship of occurrence of diarrhea using STATA 13.1. Results: In rural India, children aged 12-23 months [AOR: 0.897, 95% CI (0.876, 0.983)], 24-35 months [AOR: 0.579, 95% CI (0.543, 0.617)], 36-47 months [AOR: 0.394, 95% CI (0.367, 0.424)], 48-59 months [AOR: 0.313, 95% CI (0.289, 0.339)] were significantly less likely to suffer diarrheal disease. Female children [AOR: 0.897, 95% CI (0.859, 0.937)], children belonged to Scheduled Tribe [AOR: 0.811, 95% CI (0.755, 0.872)], Other Backward Classes [AOR: 0.902, 95% CI (0.851, 0.956)] were less likelihood to experience diarrhea significantly. Diarrhea disease was also significantly more likely to occur among Muslim children [AOR: 1.217, 95% CI (1.128, 1.313)], other religion [AOR: 1.163, 95% CI (1.062, 1.272)] children in central region [AOR: 1.510, 95% CI (1.410, 1.617)], east region [AOR: 1.077, 95% CI (1.002, 1.157)], and west region [AOR: 1.201, 95% CI (1.095, 1.317)], children with low birth weight [AOR: 1.135, 95% CI (1.074, 1.149)], undernourished [AOR: 1.097, 95% CI (1.038, 1.197)], improper stool disposal [AOR: 1.061, 95% CI (1.002, 1.124)], and rudimentary roof materials [AOR: 1.113, 95% CI (1.048, 1.182)]. Conclusions: In the rural part of India, diarrhea has occurred frequently now. The different socio-demographic and environmental factors are influencing this disease. For reducing the vulnerability of diarrhea the socio-demographic and environmental factors should be improved or monitoring by effective community education. The government and different NGOs should focus on improved drinking water sources, sanitation facility which may reduce the vulnerability of the disease.

Assessment of Knowledge and Attitude Regarding Risk Factors of Malaria Among Caregivers of Under-Five Children in the Buea Health District, South West Region, Cameroon

Aims: The study measured the level of knowledge and attitudes towards malaria and examined associated factors among caregivers of under-five children. Study Design: The study was community-based, descriptive cross-sectional. Place and Duration of Study: The study was carried out in Buea Health District (BHD) from February to June 2020. Methodology: Data were obtained through face-to-face interviews with the caregivers of under-fives. The above mean scores were used to determine the level of knowledge. The attitude levels were measured by using 3-point Likert scales. Univariate and multivariate logistic regression analyses were performed to identify risk factors associated with knowledge and attitude. SPSS software version 20.0 was used for analysis. Results: Out of the 390 respondents, 69.5% of them had a neutral attitude. Meanwhile, 27.7 % of participants carried a favorable attitude towards malaria and only 2.8 % of them had an unfavorable attitude, Caregivers of under-five children who scored below the mean score were 25.1 % which was considered having poor knowledge and above the mean score was 74.9% which was considered good knowledge. In the multivariable logistic analysis, caregivers with a primary school level of education were 4.1 times (AOR = 4.1, CI = 1.486-11.102) times more likely of receiving a high malaria knowledge score as compared to those with no formal education. Factors associated with caregiver's attitude level towards malaria risk were educational level and marital status which showed significant associations in the univariate analysis Conclusion: Caregivers of under-fives displayed a good knowledge of malaria risk factors. However, in these endemic areas for malaria, caregiver attitude was found to be unenthusiastic and unresponsive, and this poses additional challenges in reaching the malaria elimination goal. Thus, suggesting that educational messages during the campaign should be contextual to reach out to local communities to trigger a positive behavioural change.

Determinants of Acute Respiratory Infection among Under-Five Children in Rural Ethiopia

Introduction: In low- and middle-income nations, acute respiratory infection (ARI) is the primary cause of morbidity and mortality. According to some studies, Ethiopia has a higher prevalence of childhood acute respiratory infection, ranging from 16 % to 33.5 %. The goal of this study was to determine the risk factors for acute respiratory infection in children under the age of five in rural Ethiopia. Methods: A cross-sectional study involving 7,911 children under the age of five from rural Ethiopia was carried out from January 18 to June 27, 2016. A two stage cluster sampling technique was used recruit study subjects and SPSS version 20 was used to extract and analyze data. A binary logistic regression model was used to identify factors associated with a childhood acute respiratory infection. The multivariable logistic regression analysis includes variables with a p-value less than 0.2 during the bivariate logistic regression analysis. Adjusted odds ratios were used as measures of effect with a 95% confidence interval (CI) and variables with a p-value less than 0.05 were considered as significantly associated with an acute respiratory infection. Results: The total ARI prevalence rate among 7,911 under-five children from rural Ethiopia was 7.8%, according to the findings of the study. The highest prevalence of ARI was found in Oromia (12.8 %), followed by Tigray (12.7 %), with the lowest frequency found in Benishangul Gumuz (2.4 %). A multivariable logistic regression model revealed that child from Poor household (AOR=2.170, 95% CI: 1.631-2.887), mother’s no education (AOR=2.050,95% CI: 1.017-4.133), mother’s Primary education (AOR=2.387, 95% CI:1.176-4.845), child had not received vitamin A (AOR=1.926, 95% CI:1.578-2.351), child had no diarrhea (AOR=0.257, 95% CI: 0.210-0.314), mothers not working (AOR=0.773, 95% CI:0.630-0.948), not stunted (AOR=0.663, 95% CI: 0.552-0.796), and not improved water source (AOR=1.715, 95% CI: 1.395-2.109). Similarly, among under-five children, the age of the child, the month of data collection, anemia status, and the province were all substantially linked to ARI. Conclusions: Childhood ARI morbidity is a serious health challenge in rural Ethiopia, according to this study, with demographic, socioeconomic, nutritional, health, and environmental factors all having a role. As a result, regional governments, healthcare staff, and concerned groups should place a priority on reducing ARI, and attempts to solve the issue should take these variables into account.

Anthropometric Indices of Giardia-Infected Under-Five Children Presenting with Moderate-to-Severe Diarrhea and Their Healthy Community Controls: Data from the Global Enteric Multicenter Study

Among all intestinal parasitosis, giardiasis has been reported to be associated with delayed growth in malnourished children under 5 living in low- and middle-income countries. Relevant data on the nutritional status of children aged 0–59 months presenting with moderate-to-severe diarrhea (MSD) and giardia infection were collected from sentinel health facilities of the Global Enteric Multicenter Study’s (GEMS) seven field settings, placed in diverse countries of Sub-Saharan Africa and South Asia between, December 2007 and February 2011. Then, this study analyzed a robust dataset of study participants (n = 22,569). Children having giardiasis with MSD constituted as cases (n = 1786), and those without MSD constituted as controls (n = 3470). Among the seven field sites, symptomatic giardiasis was 15% and 22% in Asian and African sites, respectively, whereas asymptomatic giardia infection (healthy without MSD) in Asian and African sites was 21.7% and 30.7%, respectively. Wasting and underweight were more frequently associated and stunting less often associated with symptomatic giardiasis (for all, p < 0.001). Symptomatic giardiasis had a significant association with worsening of nutritional status in under-five children. Improved socio-economic profile along with proper sanitation and hygienic practices are imperative to enhance child nutritional status, particularly in resource limited settings.