Under five Children

Nepal [48–50], China [51]. An increasing pattern of stunting by age is found to be undeviating with increas- ing pattern of communicable childhood diseases by age [52]. As discussed by Hong, Banta and Betancourt [23], this may partly be due to starting other foods along with breastfeeding to a child after 6 months of age, which in- creases the likelihood of taking polluted foods and mini- mizes the essential safety provided by breast milk. Moreover, children initiate crawling nearby at this age and are more probable to be carried out-of-doors, which makes them exposure to additional toxicities. Among the under five children, it is most likely to be stunted be- tween age 12–47 months. Therefore, caring at early childhood is more likely to be protective and stunting becomes more prospective as the child becomes more dependent for caloric intake from foods which should be improved. More elaborative researches are needed to demonstrate in this regard.

It has been estimated that every minute eight under-five children die in sub-Saharan Africa. Of the 46 countries in the African Region, 36 have under-five mortality rates (U5MRs) of above 100 per 1000 live births; 8 have U5MRs of at least 200 per 1000 live births; 5 countries have had static U5MRs in the past fifteen years while in 9 countries the U5MRs have reversed. Two thirds of the under-five deaths in the African Region are due to preventable causes. (Smith and Haddad, 1999; Federal Office of Statistics Nigeria Demographic and health survey, 1990) The chief causes of death are neonatal conditions and acute respiratory infections mainly pneumonia, malaria, diarrheal diseases, measles and HIV/AIDS, most of which are complicated by malnutrition that accounts for one third of all deaths in children under five years of age. Under- five deaths, most of which occur in the African Region, increased to 43% globally in 2005 from 31% in 1990. According to WHO, an estimated 10.6 million under-five children die each year, 4.6 million of whom die in the African Region.

Diarrhea is defined as the passage of three or more loose or watery stools in a 24-hour duration (1). The point- prevalence (last two weeks) of diarrhea among under-five children is about 9-20% (2). In developing countries the 4.9 children per 1000 per year die as a result of diarrheal illness in the first five years of life (1). Diarrhea causes an estimated 1.8 million deaths per year, and it is a major cause of mortality in children aged less than five years (3). In our country, diarrhea is the fourth cause of under five-year mortality. In a national survey in Iran, 10.1% of children reported to have diarrheal diseases two weeks prior to the interview (4). Young age, poor nutritional sta- tus, dehydration, and lack of breastfeeding are the major risk factors for death from diarrhea (5). Studies revealed that rotavirus is the most frequent etiological agent of diarrhea (2). Of the bacterial infectious agents, Esch- erichia coli are the major pathogens afflicting children aged less than five years (6). Most of diarrheal episodes are self-limited however the mortality is primarily due to dehydration (3). Oral rehydration therapy (ORT) with oral rehydration salt (ORS) solutions is the appropriate management of diarrheal dehydration and is the single most effective strategy in preventing diarrheal deaths in children (2). ORS has been considered as inexpensive and can be easily administered at home by the mothers as soon as a diarrhea episode begins. Its use has been wide- ly advocated by World Health Organization (WHO) (7). It seems that death from diarrhea is easily preventable by simple programs. A systematic review by Shah revealed that only 26% of children used ORT during diarrhea. Only one in ten children was given increased fluids during di- arrhea and twenty-seven percent of children were given less to drink; 10 percent were given much less to drink, and 4 percent were not given anything to drink, result- ing in 4 in 10 children

Background: Assessment of the safety profile of the new rotavirus vaccines in Africa requires base-line epidemiological data on intussusception. Hence, this study was aimed at describing the prevalence and associated factors of intussusception in under-five children in Enugu, Southeast, Nigeria. Methods: This was a retrospective descriptive study involving the sixty reported cases of intussusception in under-five children admitted in a hospital in Enugu between 2007 and 2012. Cases of intussusception were selected using the Brighton collaboration intussusception working group level I diagnostic criteria. Information sought from the patients’ folders included demo- graphic characteristics and clinical manifestations including history of previous rotavirus vac- cination, duration of illness prior to presentation, diarrhoea, vomiting, passage of red currant jel- ly- like stool, abdominal mass and distension, method of diagnosis, treatment option(s) employed and their outcomes. The data was analyzed using SPSS version 17.0. Results: The majority of the cases were aged less than one year (53; 88.3%) while the average incidence of intussusception was 0.1 per 1000. None of the cases had received rotavirus vaccinations. The common clinical presentations were vomiting, 55 (17.2%), passage of red currant stool 50 (15.6%), fever 50

Where health systems are characterized by high out-of-pocket payments and a wide range of public and private health care providers, understanding the health-seeking behaviors (HSB) of different communities and population groups is essential if adequate access to services and protection against unaffordable health costs are to be achieved. (Grundy John et al., 2010) Government of India and Himachal Pradesh has also made sincere efforts to improve the overall health of under five children using a multipronged approach under National Health Mission (NHM). The mission document of NHM also highlights this as an important issue (Chandrashekhar T Sreeramareddy et al., 2006). Governments, both at central and state level, collect information, directly or indirectly, about these diseases through various sources like NFHS, DLHS, periodic surveys etc. However, independent studies are also necessary to validate the findings of above sources. There is paucity in literature to assess the morbidity profile among 0- 5 yrs of age in Himachal Pradesh. The present study, therefore, was conducted to study the pattern of the morbidity among under five children and also to study treatment seeking behavior of the parents or guardians of these children in Kangra district of Himachal Pradesh.

Back ground: Anemia is major health problem throughout the world. The magnitude of the problem in developing countries high, since they are more exposed to various health and socioeconomic problems which are directly or indirectly related with anemia. Though all age groups can develop anemia due to various factors, under-five children and pregnant women are the most vulnerable age groups. The hemoglobin level below which anemia is considered according to WHO criteria is as follows. The children(6 months -6yrs) their level of hemoglobin were 11gm/dl and the children aged 7yrs -14yrs their hemoglobin measurement were 12gm/dl, the adult male >15yrs their level of hemoglobin were 13gm/dl ,the pregnant female were 11gm/dl those non pregnant female and her level of hemoglobin were12gm/dl. Objective: To assess the prevalence of anemia and associated factors in under five children at Bedele Hospital(BH), Ilubabor zone, Oromia regional state south west Ethiopia 2017. Methods: Institution based cross sectional survey was conducted at Bedele Hospital. All children admitted to Pediatrics ward were included in the study. Data was collected from April 1-30, 2017 by face to face interviews using pre-tested structured questionnaire. Data was processed and analyzed manually using scientific calculator. Descriptive statistics like frequency table, chi-square test of independence was used to characterize disease and associated factors. Tables were used to summarize the finding. Results: Prevalence of anemia in children admitted at BH was high (66.8%). severe anemia is constitute for 3%, moderate and mild anemia contributes 37.1% and 26.7% respectively. Characteristics most strongly associated with anemia were malaria, malnutrition and presence of helminthes. Conclusions: The prevalence of anemia was 66.8%. Mild, moderate and severe anemia was 26.7%, 37.1% and 3% respectively. Recommendation: Considering a high prevalence of anemia. Preventive strategies such as, fortification of food, iron supplementation, antimalarial prophylaxis, follow up clinics, regular screening of hemoglobin level must target all under five irrrespective of their hemoglobin level or clinical status.

Abstract: Malnutrition in all its forms is still a major public health problem in the world, especially in developing countries, including Sudan. It’s an underlying factor in over 50% of deaths in children under five years of age who die each year from preventable causes. Malnutrition prevents children from reaching their full physical and mental potential. The Specific objective of this paper was to determine the magnitude of malnutrition among children aged 6-59 months in Tawila Administrative Unit (TAU) in Tawila locality in North Darfur State at Sudan, 2017. This paper was comparative cross- sectional community-based study applied the quantitative research method. Five-hundred and ninety seven children at the age ranged between 6-59-month were studied. To assess the malnutrition status of the children under the study, anthropometric measurements for height, weight and edema examination were applied. The collected data analyzed by using Epidemiological Information (Epi-Info), emergency nutritional assessment software version 11 (ENA). The anthropometric result was classification based on WHO standard, 2006. The results showed that the prevalence rate of wasting was 14.7% (10.4 - 20.4 95% C.I.), stunting was 48.9% (44.1 - 53.8 95% C.I.) and underweight was 35.6% (30.4 - 41.1 95% C.I.). Male children and those aged between (12 -23 months) are at higher risk of acute malnutrition and those aged (12-35 month) are at higher risk to stunting and underweight. The study concluded that the malnutrition is an important major public health problem among under five children ages in Tawila locality. Under-five children in Tawila locality suffer high rates of malnutrition. Therefore, health facility-based interventions, community-based program, nutritional education programs are strongly recommended in Tawila locality. In addition to that ensuring food security including the availability and adequacy of general rations (including iodized salt and fortified grain/cereals).

The data were extracted, edited, and analyzed by using SPSS version 23 for Windows. Then a weighted analysis was conducted using the same sampling weight given for each region in Ethiopia DHS to compensate for the une- qual probability of selection between the strata [8, 12]. Bivariate logistic regression was performed and variable with P-value less than 0.25 were transported into mul- tivariable binary logistic regression analysis to identify the determinant of malnutrition of under-five children. Finally, variables with P-values < 0.05 in the multivari- able logistic regression model were taken as statistically significant.

difficulties (Patricia A. et al. 2008). Various factors influence the development of speech and use of language including sociodemographic factors such as family size, parental education, occupation and working hour, poverty, birth and family-related factors, e.g. positive family history of speech delay, deleterious oral habits, heavy TV watching or fussy temperament of the child (Ellis E. M. et al., 2008; Tomblin J. B. et al., 1997) and environmental risk factors such as living in an unsafe/stressful surroundings, poor child-parent interaction, lack of resources available for stimulation etc. All of these factors need to be taken into careful consideration to fully understand and support children's social and emotional health through a comprehensive, ecological approach. Studies have already proven that early intervention in children, aged less than six years with delays in speech development and language acquisition, will decrease the impact on their academic lives and also on social relations (Ramey &Campbell, 1984). This particular study was designed to identify the sociodemographic, personal and environmental risk factors of delayed speech development in under-five children so that it might be helpful for the professionals to look into the probable risk factors and provide an early intervention for a better outcome.

Undernutrition is still a public health problem in Tanzania despite national and global efforts in combating it. However, little availability of suitable data limits understanding of why the problem still persists. This chapter aimed at finding out the determinants of undernutrition among under-five children in Tanzania. Specifically, this paper assessed the influence of child care practices on nutritional status of under-five children focusing on local fishing communities in Pangani District. A sample of 355 under-five children was selected from households using systematic sampling method. Cross-sectional research design was employed to collect both anthropometric quantitative and qualitative data. ENA for SMART software version 2011 was used to generate indices for weight-for-height, height-for-age and weight-for-age. The findings confirm that under-nutrition is still a public health problem in Pangani as indicated by higher level of stunting (27.9%) and wasting (5.1%). Binary Logistic Regression was employed to assess the influence of individual characteristics of a child and care practices by mothers/care-takers on under-nutrition in children under-five. Place of delivery, delivery assistance, sex of a child, having siblings under-five, immunization status, essential ANC visits and exclusive breast feeding were the most important factors associated with under-nutrition. The findings call for collaborative action between Government, NGOs and the District Nutrition Officer on how to curb malnutrition in Pangani.

Education of mother and father was recorded in completed years of formal education. If a mother or father of the child were not able to read or write, they were labeled as illiterate. For analysis, ages of the mother, father and child were converted to categorical variables (mother as <25 years and >25 years, father <30 years and >30 years, children (<2 months, 2 months -1 year and >1 year). History of immunization was elicited from parents and verified by checking the written document wherever available. A child was assessed to be completely immunized if he/she had received all

The chosen area of study Jimma town is located 354 km away from Addis Ababa in south western Ethiopia and has population of 207,573 (2012 Gc). The residents of the city comprise of different ethnic groups Oromo being most common followed by Amara, SNNPR and others. The climate condition of the area is woinadega and coffee is the main cash crop of the people surrounding the city. The city has two hospitals JUSH and Shenen Gibe hospital. The data collection was done in February 2015 to December 2016, (after getting ethical Clarence from JUSH, Jimma, vide certificate reference No. was RPGC/18/2012, dated 05/03/2012) from pediatric OPD, JUSH, an super-specialty centre serving the Jimma town and its surroundings. Guardians (Mother and fathers) of children were explained about the purpose of the study and written consent was obtained prior to the data collection. Study subjects sampled from all under 5 sick children who are visiting JUSH, Pediatrics OPD. All sick children under five years of age, visited JUSH Pediatrics OPD were included in the study. The children over five years of age, history of any congenital defects, history of genetic disorder, malignancies etc were excluded from the study. The nutritional statuses of the subjects were evaluated by the measuring Mid-Upper Arm Circumference (MUAC). MUAC is the circumference of the left upper arm, measured at the mid-point between the tip of the shoulder and the tip of the elbow. MUAC is used for the assessment of nutritional status.

prevalence of anaemia in children for the year 2008, anaemia in rural areas and urban areas were 84% and 68% respectively (GSS et al, 2009). The Upper West and Upper East had the highest of prevalence rate of anaemia in children of 88% and 89% respectively while Greater Accra recorded 62% (GSS et al, 2009). Various studies have linked anaemia to a number of factors, and found that iron deficiency anaemia is a major threat to child and maternal health (GSS et al, 2009; Paliakara, 2009). Generally, there have been several studies on anaemia in Ghana, but household characteristics have not been well explored. The major gaps in the study of anaemia in Ghana, therefore, are inadequate explanations of the spatial variations that have occurred in rural-urban areas of Ghana. Furthermore, the reasons for regional differences have also not received much attention. Moreover, household characteristics such as family composition, heads of household, household size, housing and type of households in which children dwell as well as household feeding practices have not been well explored as variables that could be associated with anaemia in children (Bongaarts, 2001; Kennedy and Cogill, 1987; World Bank, 1975). The WHO (2008) is of the view that the role of other factors rather than iron deficiency in the development of anaemia is not well appreciated by public health officials because for a long time anaemia has been confused with iron deficiency anaemia and it has influenced the development of strategies and programmes designed to control the immediate causes of anaemia whereas the myriad of remote causes are left untackled (WHO, 2008). It is on the basis of the problems mentioned above that the current study seeks to find answers to household factors which constitutes the remote causes that are associated with anaemia among children in Ghana.

19. Selestine H, Seter S, Olusegun B, Peter S, Adamson SM, Emmanuel R. Demographic, cultural and environmental factors associated with frequency and severity of malnutrition among Zambian children less than fi ve years of age. J Public Health Epidemiol. 2011;3(8):362 – 370. 20. Abera L, Dejene T, Laelago T. Prevalence of malnutrition and asso- ciated factors in children aged 6 – 59 months among rural dwellers of Damot Gale district, South Ethiopia. Int J Equity Health. 2017;16:111. doi:10.1186/s12939-017-0608-9

Forty-five percent of all mortality among children less than 5 years of age is linked to malnutrition [8]. In many countries of the world, only a minority of children are growing healthily. In Nigeria, Bangladesh, Democratic Republic of Congo, Ethiopia, and Pakistan, for example, the percentage of under – 5 children who are growing normally is less than 48 percent. Nigeria has also been classified as one of the countries not meeting the world health target for reduction in obesity rate. Although the country has been classified among countries making progress, for exclusive breastfeeding, the rate of progress is relatively slow and the nation is not meeting with the world health assembly target [3].

Table 2 shows that the number of live births between the years 1997-2006 was 12,317 and the number of under-five deaths during the same period was 890 (7%). The under-five mortality was extremely high for multiple births (35%) as compared to singleton births (7%). Children with first birth order (9%) and with 7 or 7+ birth orders (9%) died more than the children with 2-3 birth orders (6%) and 4-6 birth orders (8%) before the age of five. The number of deaths among the under-five children was higher for children whose preceding birth interval were less than 18 months (15%) and also the under-five deaths were found highest among the mothers whose age at the time of birth of their dead children were less than 20 years. From table 2 it is also evident that the under-five mortality was lower among children of secondary (5%) and higher educated (2%) mothers than children of mothers with no education (9%) and with primary education (7%). Similar results also found incase of father’s education. Table 2 further shows that as compared to household with access to hygienic toilet and improved source of drinking water, the percentages of under-five mortality were higher among children living in households without access to hygienic toilet and improved sources of drinking water. It is observed from the chi-square test results that most of the covariates have statistically significant association with under-five mortality (table 2). The result shows that some child and maternal related and socio-economic variables have significant association with under-five mortality.

Malnutrition is a failure of the body to get an appro- priate amount of nutrients for healthy human organ and tissue function. Children were more vulnerable to malnutrition. Children who suffer from nutritional deprivation were at risk of developmental delays which can lead to different consequences [1]. In the year 2007, the Lancet estimated that about 200 million under-five children were failing to fulfill developmen- tal potential in developing countries due to malnutri- tion [2]. According to the MDG report in 2012 malnourished children at adulthood are estimated to earn 20% less than their counterparts [3]. The young lives survey in its 2010 report in developing countries suggests that by of age 7 or 8 years older the malnutri- tion consequence is comparable to a loss of full-term schooling and is associated with the loss of 10–15 IQ points [4, 5].

The dramatic changes in the child survival rates in south- ern central Iraq have been attributed to a variety of factors, including the declining economic well-being of the popu- lation, its effect on mother and child nutrition levels, as well as the declining access to healthcare and food security [30]. UNICEF in association with the UN's World Food Programme (WFP) reported that: "One out of every 4 Iraqi infants is malnourished. Chronic malnutrition among under-five children has reached 27.5% [31]. Historically, the Centre and South had better conditions than the North, but in the 1990s the situation reversed [29], after the implementation of the food-for-oil program in 1996. Of the oil revenues, 15% was earmarked for humanitarian supplies for the Kurdish population in northern Iraq, while ~25 cents per person per day for food and medicine was available for Central and Southern Iraq [32]. The north received 22% more per capita in dollar-value goods than the centre and south from the oil-for-food pro- gramme. The system of deductions resulted in per capita spending in the Center-South of only 61% that in the North until December, 2000 (later 69%), a very substan- tial difference. Moreover, the sanctions allowed the North to derive cash from 10% of its oil sales allocation [33]. More NGOs worked in the three governorates in Kurdis- tan (Sulaimania, Dohouk and Erbil) which contributed to improved health and nutrition of women and children in the region. All these factors acted concurrently to affect negatively under-five's health to a greater extent in the South region, while children's health in the north region benefited from the improved socio-economic conditions. The Millennium Development Goals (MDGs) represent the widest commitment in history to addressing global poverty and ill health [34]. The Millennium Development Goal for child survival (MDG-4) to reduce childhood mortality by two-thirds between 1990 and 2015 will not be met without substantial reductions in neonatal mortal- ity [35].

Background: According to UNICEF report, 19.8% children under-five years in India are wasted, 48% are stunted and 42.8% are underweight. Multisectoral initiatives by the national and state governments are yet to reduce the burden of malnutrition. Jan Swasthya Sahyog (JSS) Health Centre in Chhattisgarh, plays a vital role in improving nutritional status of tribal under- three children attending the phulwaris (or creches). Objectives of this study were to assess the nutritional status of under-five children attending the phulwaris located under Bamhni sub center and to identify the common morbidities among these children.

Results: The study indicated that prevalence of stunting, wasting and underweight among children under five years old were 45.8 %, 10.7 % and 21 % respectively. Children in rural Kebeles with Adjusted odd ratio (AOR) =2.45, 95 % CI(1.25-6.66), children who were 6 and above birth order (AOR =1.992, 95 % CI( 1.05-3.77)), and children who were used to live with households having two and more under five children (AOR = 1.81, 95 % CI( 1.19-2.7)) were more stunted than their counterparts. Children in the lowland Kebeles, (AOR = 3.29, 95 % CI( 1.2-8.8)) and children having diarrhea, (AOR = 2.48, 95 % CI(1.28-4.78)); mothers with Body mass index (BMI) < 18.5 (AOR = 2.17, 95 % CI(1.17-3.81)); mothers who did not have ANC visit during pregnancy (AOR = 3.47, 95 % CI (1.49-7.8) ) and with birth order of 4 to 5 children (AOR = 3.08, 95 % CI (1.11-8.5)), were more likely to be underweight than their counterparts. Moreover, male children (AOR = 2.37, 95 % CI (1.19-4.7)), children who were served food with family (AOR = 2.3, 95 % CI (1.14- 4.9)), children who had fever, (AOR = 2.9, 95 % CI (1.16-7.2)), were more likely to be wasted than their counterparts.