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Chikhungu, Lana. "Modelling under-nutrition in under-five children in Malawi." Thesis, University of Southampton, 2013. https://eprints.soton.ac.uk/354348/.
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Despite numerous Government efforts to tackle the problem of child under-nutrition in Malawi, the levels of child under-nutrition remain high with stunting estimated at 47% and underweight at 12.7% . This thesis investigates whether the levels and patterns of stunting and underweight in Malawi have changed between the years 2000 and 2010 and if so how. It studies how feeding patterns and child immunisation affects child’s nutritional status in Malawi and analyses the different pathways through which household and community level socio-economic factors affect a child’s nutritional status in Malawi. The Malawi Demographic and Health Survey (MDHS) data sets of 2000, 2004 and 2010 are used in the study of levels and patterns of child under-nutrition in Malawi whilst the 2004 MDHS is used to investigate how feeding patterns and child immunisation affect a child’s nutritionals status in Malawi. The 2004 Malawi Integrated Household Survey data is merged with the 2004 Community level to analyse the pathways through which household and community level socio-economic factors affect child nutritional status in Malawi. Results of this study show that children from communities that have a daily market are less likely to be stunted compared to children from communities without a daily market. Children from communities that trace their descendants through their father have a lower likelihood of stunting compared to children from communities that trace their descendants through the mother due to being of relatively higher economic status. The levels of stunting and underweight have gone down significantly from 54.1% and 21.4% respectively in the year 2000 to 47.1% and 12.7% respectively in 2010. However, the percentage of children that are stunted but not affected with other under-nutrition problems has hardly changed, estimated at 37.2% in 2000 and 36.2% in 2010. Although generally female children are less likely to be stunted and less likely to be underweight, female children are more likely to be underweight as they get older. Contrary to what one would expect, children are more likely to be stunted during harvest time compared to the hunger season. Most of the children are fed food from the local grain, whilst in fact children aged between 7 to 36 months who consume food from animal sources are less likely to be undernourished. Children whose mothers are in possession of a child health card1 are less likely to be underweight. The Malawi Government should therefore intensify its efforts of encouraging mothers to attend under-five clinics, feed children that are undergoing weaning food from animal sources and should invest more in programmes that boost socio-economic status such as education and entrepreneurship skills.
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Mikhala, Paul L. "Understanding the determinants of under five mortality in Kenya." Thesis, University of Southampton, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.327252.
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Aheto, Justice Moses Kwaku. "Modelling malnutrition among under-five-year-old children in Ghana." Thesis, Lancaster University, 2016. http://eprints.lancs.ac.uk/82143/.
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Childhood malnutrition is a real-life and a chronic problem and one of the global major public health challenges, especially in developing countries like Ghana. Several attempts from governmental and non-governmental organizations to address the problem have fallen below expectation. It is recognised that the existing studies and nutrition intervention strategies are inadequate and hence not working to expectation. This thesis examines childhood malnutrition in Ghana using appropriate and advanced statistical methods to help improve the understanding of childhood nutrition and to better inform targeted public health nutrition interventions in the country. In this thesis, we provided solutions to five main problems: (1) investigated the major risk factors for malnutrition; (2) investigated household level variations in nutritional outcomes of children; (3) explored, modelled and illustrated spatial variations in the risk of childhood malnutrition over Ghana; (4) explored, modelled, forecasted and illustrated spatio-temporal variations in the risk of childhood malnutrition over Ghana; (5) jointly modelled weight-for-age Z-score (WAZ) and height-for-age Z-score (HAZ) to improve accuracy and reliability in estimates. To answer the first and the second problems, multilevel models were considered. The results showed strong residual household-level variations in under-fives nutritional outcomes and that child’s age, type of birth, child’s experience of diarrhoeal episodes, size of child at birth and months of breast feeding, mother’s education, current age, BMI and national health insurance status, household toilet facility ownership and wealth status were predictive of under-fives nutrition. To answer the third problem, spatial models were employed. The study found substantial spatial variation in the predicted risk of under-fives malnutrition over Ghana and also showed that Normalised Difference Vegetation Index (a marker for vegetation cover), elevation and rural/urban residence status were predictive of under-fives nutritional outcomes. The study considered spatio-temporal models to answer the fourth problem. The results showed substantial spatio-temporal variation in the risk of under-fives chronic malnutrition over Ghana. Our forecasted map of chronic malnutrition showed substantial spatial variation with children from parts of Northern and Western regions being at the highest risk of malnutrition compared to children from other regions of the country. In our forecast maps, the effect of increasing the level of maternal education was shown to reduce the prevalence of malnutrition throughout Ghana. To answer the fifth problem, multivariate response multilevel models were considered. The study found that the residual household effects for WAZ and HAZ are very strongly correlated and that the correlation was stronger for the residual household effects than the residual child effects. This also suggests that after adjusting for risk factors in our model, it is the same as-yet unidentified factors at household level that influence both WAZ and HAZ. The results also showed that there was more accuracy and reliability in estimates from the multivariate response multilevel model over separate multilevel models and showed that the effect of some important risk factors differed substantially across WAZ and HAZ. The findings from this thesis are intended to help policymakers responsible for the health and nutrition of children to design efficient public health policies and targeted nutrition interventions amidst scarce public health resources available in Ghana to better understand, target and to reduce childhood malnutrition prevalence closer to the level expected in a healthy, well-fed population of children under-fives.
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Kukeba, Margaret. "Ethnography of household cultural feeding practices of children under five years in rural northern Ghana." Thesis, University of Manchester, 2017. https://www.research.manchester.ac.uk/portal/en/theses/ethnography-of-household-cultural-feeding-practices-of-children-under-five-years-in-rural-northern-ghana(cac6d660-1ac9-447d-9fc3-1970fdb56df0).html.
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Background: Appropriate child feeding prevents nutrient deficiencies, diseases, and deaths in children. However, only 13.3% of children aged 6-23 months in Ghana receive the minimum acceptable diet. Thus, undernutrition remains high in rural northern Ghana, especially among under-fives. This is showing no improvement despite economic development and implementation of globally recommended nutrition & feeding interventions. There is limited context specific evidence about child feeding in rural northern Ghana. Aim: To examine how culture might impact upon the feeding of children under five years of age in rural northern Ghana. Methods: A qualitative ethnographic study was completed between October 2014 and May 2015. Data were collected in a rural Ghanaian community via participant observation and sixty-one ethnographic interviews with mothers, fathers, and grandparents in 15 households, and spiritual leaders are known as "diviners". Themes were developed through inductive analysis of field notes and verbatim transcribed interviews using a framework approach. Results: The content of a child's diet and the pattern of feeding were found to be influenced by the community's notion of food, taboos, and beliefs which originated in a traditional African religion. Shared household responsibility for feeding children and the gendered and age related hierarchy of household decision making also influenced child feeding. Discussion: This study has shown multifaceted taken-for-granted social and cultural influences on child feeding. Whilst mothers are the main recipients of the official public health nutrition and child feeding advice, the communal structures, living arrangements and social interactions support, enhance, and reinforce the community inclined practices that limit mothers' independent decision making. Conclusion: To effect community change and promote uptake of public health nutrition recommendations, a community wide nutrition intervention approach may be more beneficial than the current approach which targets mothers. Furthermore, community and cultural influences must be understood and considered by health professionals if such interventions are to succeed.
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Al, Hosani H. A. "Mortality in infants and children under five years in Abu Dhabi Emirate." Thesis, University of Aberdeen, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.592058.
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A two stage survey was carried out in order, a) to investigate trends and differentials in infant mortality in Abu Dhabi Emirate from 1980 to 1996 and b) to investigate the influence of risk factors on the problem of mortality under five years. The first stage reviewed infant mortality by sex, ethnicity, locality and cause of death. Data about the births and deaths of children were obtained from the Departments of Preventive Medicine in the three Health Regions of Abu Dhabi, Al Ain and the Western Region; 4523 infant deaths were coded according to the 9th revision of the International Classification of Diseases. The underlying causes of death were grouped into six main categories, namely: infections; congenital anomalies; conditions originating in the perinatal period; ill-defined conditions; accidents and miscellaneous. The rates for infant, perinatal, neonatal and postneonatal mortalities decreased substantially during the study period. The values for these mortality rates (per 1000 live births or total births in the case of the perinatal mortality rate) or 21.55, 20.43, 13.42 and 8.13 respectively in 1980 contrasted with their values of 9.15, 12.12, 5.51 and 3.64 in 1996. By contrast, the stillbirth rate showed the least change, declining from 8.4 in 1980 to a minimum of 7.79 per 1000 total births in 1996. The ratio of postneonatal to neonatal mortality rates remained broadly constant during the study period. In 1996, the under-5 mortality per 1000 live births was 13.1 in Abu Dhabi Emirate. Accidents formed the leading cause of death in the 1-5 year old children in the whole population from 1980 to 1996. A multiple regression technique was used to evaluate the independent effect of the variables (sex, nationality and region) upon the infant mortality rate. The rate of decline of the infant mortality rate appeared to be changing during the study period, which made the models containing the square of the year more fitting to the data points.
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Liias, Nejla. "The possession versus use of mosquito nets for children under five in Kenya." CONNECT TO ELECTRONIC THESIS, 2007. http://dspace.wrlc.org/handle/1961/4139.
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van, Aswegen Tanya. "Factors associated with morbidity and mortality in children under-five years admitted with severe acute malnutrition to a regional paediatric hospital in Kwazulu-Natal." University of the Western Cape, 2018. http://hdl.handle.net/11394/6741.
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Magister Public Health - MPHBackground: Malnutrition is a complex condition profoundly impacting child mortality and morbidity, especially in sub-Saharan Africa. Severe acute malnutrition is of growing concern locally where unacceptable mortality rates persist, despite reasonable standards of clinical care. Aim: To determine factors associated with morbidity and mortality in children under-five years admitted with severe acute malnutrition to a regional paediatric hospital in KwaZulu-Natal. Methodology: This was a quantitative study. A retrospective observational study design was used. Medical records of all children with severe acute malnutrition, under the age of five years, admitted between April 2015 and December 2016 to the regional paediatric hospital in KwaZulu-Natal were included. Data was obtained from medical records and admission books. A trained research assistant was used to extract and record data with a piloted data extraction tool. Data was entered and cleaned using Microsoft Excel and analysed using SPSS (v 20) and STATA (v 14). Descriptive summary statistics were used to describe the characteristics of the study population and bivariate analysis using t-tests and Chi-square tests to determine significance. Kaplan Meier and Multivariate Cox regression was used to assess the association of variables with morbidity and mortality. Results: Of the 276 eligible case records included in the study, 54% were male and 90% of all cases were younger than 2 years. Even though associations did not reach significance, teenage pregnancy and unemployment was high amongst the caregivers of the study population. Most of the malnourished children admitted (74%) presented with multiple comorbidities. Diarrhoea (43%), HIV- infection (30%) and respiratory tract infections (30%) were the top three comorbidities found, followed by tuberculosis (27%). The overall mortality rate was 8.7%. Survival probability was significantly reduced in children with pneumonia and those who presented with hypoglycaemia, dehydration, dermatosis, severe pallor, altered consciousness or shock on admission (p < 0.05). There was a significantly increased risk of death in males (HR = 0.174, 95%CI = 0.05 - 0.665), and in those who presented with dehydration (HR = 4.1, 95%CI = 1.25 - 13.59), evidence of lethargy or coma (HR = 4.2, 95%CI = 1.04 - 17.12) or multiple clinical signs (HR = 4.4, 95% CI =2.56 - 7.59) on admission (p < 0.05). The comorbidities HIV-infection (HR = 9.9, 95%CI = 1.39 - 70.68) and pneumonia (HR = 3.4, 95%CI = 1.56 - 7.43) showed a significantly increased mortality risk (p < 0.05). Conclusion: This study supports the body of evidence that despite reasonable standards of hospital care, it is difficult to obtain the target for severe acute malnutrition mortality (< 5%), likely due to the presence of contextually specific factors. Local interventions at hospital, primary health care and community level is needed, as well as further research to facilitate comprehensive policy-making.
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McCartney, Damon Andrew. "Development of the AnimalSeek method to evaluate the localisation ability of children under five." Thesis, University of Nottingham, 2013. http://eprints.nottingham.ac.uk/13147/.
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This thesis describes the development of a novel game-like method, the AnimalSeek method, which can be used, along with motion tracking technology, to measure localisation ability of a child under five years of age. For the game-like task to be successful, a high number of responses (in particular correct head turn responses) was required. Previous studies, although not all looking at localisation ability, have used many different techniques to obtain the maximum number of responses from a child. The children were engaged inside a custom-built environment inside an anechoic chamber. Three large video screens onto which backgrounds and animated characters were projected and manipulated and used to engage the child in the game-like task. Behind the video screens were loudspeakers from which the auditory stimulus where presented. A correct response to the auditory stimulus i.e. a head, hand or eye movement towards the target speaker was rewarded with a animated character presented on the screens (incorrect responses were presented with a static character). The location of the reward in relation to the auditory stimulus was a point of interest and was investigated to see how it affected the number of responses. The method shows it was possible to engage the child with the visual environment and obtain responses, however, the results showed generally fewer head turn responses than expected, especially in the younger age groups. Motion tracking technology was used to measure the localisation ability of the children, as well as measuring the responses, the motion tracking data was used and programs developed which could automatically classify the responses the children made to the sounds. The thesis has shown that it is possible to devise a new method which can be used to engage the child in the task and extract and classify their responses to auditory stimuli in order to measure their localisation ability.
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Piniel, Abigail. "Factors contributing to severe acute malnutrition among the under five children in Francistown-Botswana." Thesis, University of the Western Cape, 2016. http://hdl.handle.net/11394/5253.
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Magister Artium (Child and Family Studies) - MA(CFS)Introduction: Malnutrition is the immediate result of inadequate dietary intake, the presence of disease or the interaction between these two factors. It is a complicated problem, an outcome of several etiologies. SAM is one of the leading causes of morbidity and mortality among children under the age of five in developing countries. Although studies in Botswana show some improvement in child malnutrition since the 1980s, severe acute malnutrition still remains a cause for concern in many parts of the country. There is little information on undernourishment situation of children under the age of five years in the urban areas of the country. Aim: The purpose of this study was to determine the risk factors to severe acute malnutrition among children under the age of five years in Francistown, Botswana. The UNICEF conceptual framework was used as a guide in assessing and analysing the causes of the nutrition problem in children and assisted in the identification of appropriate solutions. Methods: The study was conducted on cases who had been admitted and referred at any time between March and July 2015. A quantitative research methodology was used to conduct the study. A case-control study design was utilised. Random selection of cases and controls was done on a ratio of 1:2 case per control. Cases included children under the age of five years admitted to Nyangabgwe Referral Hospital and those referred to the Nutritional Rehabilitation Centre within the hospital in Francistown-Botswana with a diagnosis of severe acute malnutrition. Controls were children of the same age, gender and attending the same Child welfare clinic as the case and with good nutritional status. Data was collected through face-to-face standardised interviews with care-givers. Results: Data collection was done using a combination of a review of records (child welfare clinic registers, and child welfare clinic cards) and structured questionnaires. 52 cases and 104 controls were selected with the primary or secondary care-giver as the respondent. (N=156). Data was collected using a self-developed structured questionnaire and the review of documents. Of all the cases 36.5% (n=19) were diagnosed with MAM, 46.2% (n=24) with SAM, 1.9% (n=1) with moderate PEM and 7.7% (n=4) each for PEM and Severe PEM. All the cases had presented with clinical signs and symptoms of severe acute malnutrition and/or the weight-for-height Z-score of ≤ -3 SD. Following placement of the data in regression models, the factors that were found to be significantly associated with child malnutrition were low birth weight (AOR = 0.437; 95% CI = 0.155-1.231) , exclusive breastfeeding (AOR = 2.741; 95% CI = 0.955-7.866), child illness (AOR = 0.383; 95% CI = 0.137-1.075), growth chart status (AOR =7.680; 95% CI = 1.631-36.157), level of care-giver’s education (AOR = 0.953; 95% CI = 0.277-3.280), breadwinner's work status (AOR = 1.579; 95% CI = 0.293-8.511), mother’s HIV status (AOR = 0.777; 95% CI = 0.279-2.165), alcohol consumption (AOR = 0.127; 95% CI = 0.044-0.369), household having more than one child under the age of five (AOR = 0.244; 95% CI = 0.087-0.682), household food availability (AOR = 0.823; 95% CI = 0.058-11.712), living in a brick type of house (AOR = 13.649; 95% CI = 3.736-49.858), owning a tap (AOR = 1.269; 95% CI = 0.277-5.809) and refuse removed by the relevant authority (AOR= 2.095; 95% CI = 0.353-12.445) were all statistically significantly associated with severe acute malnutrition (p < 0.05). Therefore, all these variables were included in the binary stepwise regression where living in a mud house type was the most significant factor and not being breastfed for at least three months was the least significant. Conclusion: The findings of this study suggested that immediate determinants to SAM were; child born with a low birth weight, appetite and child illness. Underlying contributing factors were; the child not exclusively breastfed for at least three months, growth chart not up to date, care-givers education level, employment status, alcohol consumption, household food availability, type of housing, owning a tap and number of children under the age of five year. Therefore, increasing household food security and strengthening educational interventions for women could contribute to a reduction in the prevalence of SAM in Francistown, Botswana.
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Jroundi, Imane. "Epidemiology and aetiology of severe respiratory infections among children under five, admitted to the children hospital of Rabat, Morocco." Doctoral thesis, Universitat de Barcelona, 2015. http://hdl.handle.net/10803/396205.
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Pneumonia is one of the major public health problems threats to child survival in large parts of the world. The burden of this disease in terms of morbidity and mortality remains unacceptably high with almost one million children dying every year as a result of pneumonia episode. Over 90% of these pneumonia-associated deaths in young children occur in developing countries and are mainly secondary to bacterial infections. The availability of effective vaccines against bacterial pneumonia, coupled with adequate and efficacious antibiotic treatments, should be sufficient to reduce this burden.
In Morocco, a middle income country of North Africa, Pneumonia is the first cause of death of children under five of age. However, few data is available regarding its etiology and epidemiology.
The first article of this thesis attempts to comprehensively review what was the available knowledge regarding pediatric pneumonia in Morocco, prior to the initiation of this project. Indeed, scarcity of data often hinders the implementation of measures to prevent and better manage these infections. This review confirms the alarming lack of recent data regarding pediatric pneumonia one of the major killers of children in Morocco.
The second article of this thesis is a general overview on the epidemiology, etiology and the clinical presentation of acute respiratory infections in Moroccan children under the age of five years. Through our study, we were able to show a high prevalence of viral infections, with wheezing as the major clinical symptomatology. These findings are similar to what can be found in wealthy countries and markedly differ from the high bacterial burden that can be found in poorer settings, although overall case fatality rates remained unacceptably high in our setting.
As a result of afore mentioned high case fatality rates in our series, we decided to investigate the specific risk factors upon admission for a bad prognosis during hospitalization. The results of this analysis are presented in the third article of this thesis. The article concluded that the early identification of factors associated with a poor prognosis could improve management strategies and the survival likelihood of Moroccan children with severe pneumonia.
In the fourth article of this thesis, we chose to focus on two highly prevalent and potentially hazardous viruses causing acute respiratory infections in our setting, namely respiratory syncytial virus (RSV) and Human metapneumovirus (hMPV). In this analysis, we compared the epidemiological, clinical and laboratory features of these two infections, and concluded that despite the clinical presentation of those two pathogens was almost indistinguishable, hMPV tented to be highly more severe and significantly associated to a poor outcome. An early recognition of these viruses and good management of the cases is important to guarantee a better outcome.
The fifth article of this thesis specifically addresses the use of antibiotics to treat acute respiratory infections in Morocco. By analyzing data on pre-admission antibiotics use, and intra-hospital antibiotics utilization, we discuss whether such valuable drugs are used rationally in the country. This analysis also reflects on whether antibiotic usage may have had or not an impact on antimicrobial resistance rates.
The last article of this thesis examines data on the distribution of serotypes among streptococcus pneumoniae isolates from the nasopharynx of healthy children and compares it to those isolated among admitted children with clinical severe pneumonia. These data will be used as a baseline to help assessing the impact of the pneumococcal vaccine and to monitor any potential serotype replacement phenomena.
Altogether, this thesis tries to offer a comprehensive snapshot of the situation of pediatric pneumonia in Morocco.A pesar de los esfuerzos hechos para reducir la carga de mortalidad causada por las infecciones respiratorias agudas, estas enfermedades se mantienen como uno de los principales peligros para la salud infantil en amplias zonas del mundo. Las medidas de control existentes son claramente insuficientes a la hora de reducir globalmente el impacto de infecciones tan comunes en la infancia. De hecho, la carga de estas enfermedades en términos de morbilidad y mortalidad persiste inaceptablemente alta con, anualmente, cerca de un millón de muertes anuales, lo que es lo mismo, una muerte cada 34 segundos. Las infecciones respiratorias agudas, siendo la neumonía su forma más paradigmática, son responsables del 15% de las muertes de niños menores de 5 años en el mundo. Más del 90% de estas infecciones respiratorias agudas se producen en los países en vías de desarrollo, fundamentalmente asociadas a neumonías bacterianas. Mientras que la enfermedad clínica puede afectar a cualquier grupo de edad, la mortalidad por neumonía se ve esencialmente circunscrita a los niños menores de cinco años en los países pobres. La disponibilidad de vacunas efectivas contra las neumonías bacterianas, sumada al uso adecuado de los tratamientos antibióticos, debería ser suficiente para reducir esta carga. Sin embargo, la identificación y tratamiento precoz de los episodios clínicos y al acceso a los centros de salud parecen constituirse como barreras infranqueables en la mayoría de los países pobres. Adicionalmente, la malnutrición y el bajo nivel socio económico imperante en muchos de estos entornos dónde las neumonías son un mayor problema, contribuyen desfavorablemente al mal pronóstico de estas infecciones. El conocimiento de los determinantes locales específicos de la enfermedad respiratoria aguda pediátrica en esos entornos ayudaría a entender o mejor por qué todavía estamos muy lejos de controlar adecuadamente estas infecciones, y profundizar sobre las razones por las cuales siguen causando un impacto tan importante en la salud del niño.
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My, Phan Vu Tra. "Diarrhoeal disease in children under the age of five in Ho Chi Minh City, Vietnam." Thesis, University of Oxford, 2013. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.601170.
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The focus of the global diarrhoeal disease burden is in low and middle-income countries, where the disease epidemiology and aetiology is highly variable and not well characterised. The aim of this thesis was to challenge the knowledge gaps regard ing diarrhoeal disease in children under the age of five in Ho Chi Minh City (HCMC), Vietnam. Firstly, a pilot surveillance in southern Vietnam demonstrated a preponderance of enteric viruses in hospitalised diarrhoeal children and reported the first rotav irus GI2 in Vietnam; despite being geographically disproportional distributed, rotav irus (RoV) predom inated fo llowed by norovirus (NoV). On the basis of these data, a prospective multi-centre hospita lbased surveil!ance was conducted in HeMe to study diarrhoeal disease in detail and \ investigate the extent and the ep idemiology of the hypothes ized NoV emergence. Faecal , specimens from diarrhoea patients and diarrhoea-free chi ldren were screened for a panel of pathogens; RoV was again identified as the predominant agent, fo llowed by NoV. Enteric bacteria were found at smaller proportions, and exhibited excessive antim icrobial res istance. As NoV was found to be highly endemic and a major cause of hospita lisation, a risk factor analysis for NoV infections was performed. Ri sk facto rs in cluded young age, residential crowding and contact with symptomatic individ uals. Additional analys is on the phylogenetic structure of NoV stra ins demonstrated diverse genotypes circulating, most commonly belonging to the GIIA lineage. A spatioremporal analysis of 0 11.4 variants, GI1.4-2006b (Minerva) and the novel emergent GIL4-20 10 (New Orleans), suggested a strain replacement phenomenon and detected a cluster of 0 11.4-201 0 in the northeastern part of the city. These studies indicate prominent di sease dynam ics involved rapid evolution of vi ruses, necessitate studies on strain distribution and genomic analyses and potenti al source additi onally f contributing to genetic variations (animal reservoirs), and suggest considerable impact of RoV and NoV immunisation in Vietnam.
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Adeyemi, Emmanuel Olusola. "Predictors of Malaria-Anemia Comorbidity among Under Five Children in Nigeria: A Cross Sectional Study." Digital Commons @ East Tennessee State University, 2021. https://dc.etsu.edu/asrf/2021/presentations/71.
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Anemia is known to worsen treatment outcomes in malaria, but there are not many studies to identify the predictors of anemia in Nigerian children with malaria. The objective of this study is to identify some of those predictors. Socio-demographic variables are predictors of anemia among under five children in Nigeria was the hypothesis tested. This is a cross-sectional study that used the 2018 demographic health survey (DHS) data from Nigeria to explore some of the factors that determine the presence of malaria-anemia co-morbidity in Nigerian children less than five years (N= 265). The outcome variable was anemia status in children under five with malaria and the explored predictors include age, sex, residential type, region of residence, mother’s education status and family’s wealth index. The study analyzed unweighted and weighted frequencies of the variables and conducted comparison of the outcome groups based on the predictor variables using Chi-square. Univariable and multivariable logistic regression was used to explore the strength of relationship between the outcome variable and the significant predictor variables in bivariate analysis. SAS 9.4 was used for the statistical analysis. Analysis of weighted frequencies showed that 55% of the children were less than 2 years of age while the sex was almost equally distributed between males and females (50.9% vs 49.1%). Just over two-thirds lived in a rural area, 63.2% resided in the Northern part of the country, 59.1% had a rich family and majority (69.1%) had anemia. When cross-tabulated with the outcome variable of anemia status, there was a significant difference in the categories of age (P=0.0048), residential type (P=0.0031), mother’s education status (P=0.0210) and family’s wealth index (P=0.0010). Univariable logistic regression showed that children less than 2 years had over two times higher odds of developing anemia when infected with malaria compared to older children aged 3-4 years (OR:2.17, 95% CI:1.26-3.74, P=0.0052). Urban-dwelling children had 57% reduced odds of developing anemia compared to rural-dwelling children (OR:0.43, 95% CI:0.25-0.76, P=0.0034). Children of educated mothers had 50% reduced odds of developing anemia compared to children of uneducated mothers (OR:0.50, 95% CI:0.28-0.91, P=0.0222), while children in poor families had 165% increased odds of developing anemia compared to those born into rich families (OR:2.65, 95% CI 1.47-4.78, P=0.0012). Once adjusted for all significant variables in the bivariate analysis, only age remained significant as a predictor of anemia in children under five years with malaria (OR:2.29, 95% CI:1.31-4.02, P=0.0039). Younger age seems to be an important predictor of anemia in Nigerian children with malaria in real life settings given its significance on the multivariable model. This finding should inform clinicians on the need to pre-empt and treat anemia in Nigeria’s younger children with malaria for better treatment outcome.
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Jorosi-Tshiamo, Wananani B. "DIETARY INTAKE OF CHILDREN AGED 1 YEAR TO 5 YEARS AND THEIR ANTHROPOMETRIC MEASURES IN KWENENG DISTRICT-BOTSWANA." Case Western Reserve University School of Graduate Studies / OhioLINK, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=case1346223185.
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Taye, Mami Dorothy. "Pain assessment of children under five years in a primary health care setting / Mami Dorothy Taye." Thesis, North-West University, 2012. http://hdl.handle.net/10394/9844.
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Pain is a very common problem experienced by the general population and children in particular. It goes beyond personal suffering and affects all dimensions of the quality of life and general functioning of both adults and children, be it the physiological, psychological or financial aspects. Children may suffer from pain that may either be chronic or acute, depending on the diagnosis. Assessment of pain in children is equally important as that of adults, except that they lack the verbal fluency and cognitive development to communicate their pain. Children’s experience of pain is similar to that of adults. Pain assessment is a key aspect in the nursing management of children and delivery of care within the Primary Health Care (PHC) setting. Effective pain assessment is thus reliant on comprehensive assessment of the child and his or her pain.
The aim of this research was to explore and describe practices and perceptions of professional nurses working in a PHC facility regarding pain assessment of children under five years in the Mangaung Metropolitan Municipality and to formulate recommendations for professional nurses in PHC facilities to facilitate pain assessment in PHC settings.
A qualitative study design was used and data was collected with the use of focus groups. A purposive sampling was conducted to select participants who represent the target population. The sample used for the study included all the professional nurses working in PHC facilities registered with the South African Nursing Council and that have at least one year of experience. The practical training of the researcher to conduct an interview was done prior to the actual research. A pilot focus group was conducted and the interview schedule was finalised. Semi-structured focus groups were used to obtain data from the participants. The researcher conducted 6 focus group interviews attended by 32 professional nurses. Data was collected until data saturation was achieved. Trustworthiness was ensured in accordance with the principles of credibility, transferability, dependability and confirmability. Data was captured on a digital voice recorder and transcribed verbatim. Field notes were taken during each focus group.
Data analysis was done by means of content analysis by the researcher and an independent co-coder. After consensus and saturation, three major themes emerged.
Each theme was identified and divided into sub-themes and was consequently discussed together with the relevant data obtained from literature. The findings indicated that professional nurses perceive the assessment of pain in children under five years as a challenge. The combination of signs and symptoms to make decisions with pain assessment was identified as an area of concern. The participants further p erceived the history provided by the parent as important in the process of pain assessment.
The conclusions drawn are that the professional nurses acknowledge that they don’t take sufficient notice of pain in children under five, which means that children with pain are neglected. Professional nurses maintain that there is a need for sufficient pain assessment and the need for guidelines and tools to assess pain in children under five, especially in the PHC setting. These professional nurses support the availability of guidelines to assist them to conduct effective and comprehensive pain assessment.
The research report concluded with the researcher’s recommendations for nursing education, nursing research and nursing practice with specific formulation of guidelines for the facilitation of professional nurses to truly render effective and comprehensive pain assessment in PHC settings.Thesis (MCur)--North-West University, Potchefstroom Campus, 2013.
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PICASSO, BRENDA CELIS. "A PUBLIC HEALTH APPROACH TO UNDERNUTRITION IN CHILDREN UNDER FIVE AND INFANTS IN ETHIOPIA: AN OVERVIEW." Thesis, The University of Arizona, 2016. http://hdl.handle.net/10150/613425.
Full textAbstract:
Child malnutrition is a public health issue that concerns the entire world. Children under five and infants who are suffering from undernutrition are highly susceptible to adverse health effects such as disease, growth failure and/or micronutrient deficiencies; consequently, impeding their ability to develop and fulfil their lives to their full potential. In Ethiopia, this issue has been attributed to a set of social determinants of health which facilitates the way we address the issue. In public health, the problem of child undernutrition has been handled via various modalities: from prevention, to management, to treatment. Consequently, efforts to combat child undernutrition require integrated efforts from local, state and national organizations to continue the progress in eradicating child undernutrition in Ethiopia. The following paper discusses the issue of child undernutrition in Ethiopia using a public health approach.
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Makala, Lukuni. "The influence of maternal HIV status on mortality in children under the age of five years." Master's thesis, University of Cape Town, 2020. http://hdl.handle.net/11427/32538.
Full textAbstract:
Child mortality can be used to measure the level of social development as well as the health status of children (Hill 1991). By world regions, sub-Saharan Africa maintains the highest rates of under-five mortality. Current under-five mortality is estimated at 76 deaths per 1,000 live births (Hug, Sharrow, Zhong et al. 2018). In Zambia, under-five mortality reached a peak of 197 in 1996 and is currently estimated at 60 (Hug, Sharrow, Zhong et al. 2018). On the world health agenda, reducing child mortality has been made a priority, especially for low income countries that remain the most affected. Among the targets of the Sustainable Development Goals (SDGs) is reduction of neonatal mortality to at least 12 deaths per 1,000 live births and under-five mortality to 25 deaths by 2030 (United Nations 2015). HIV/AIDS is one of the leading causes of mortality in Zambia and has contributed to the slow decline of under-five mortality (Garenne and Gakusi 2006). Children under the age of five years get infected with HIV mainly through vertical transmission (Fishel, Ren, Barrère et al. 2014). In the absence of treatment, vertical transmission of HIV is high and can range between 15 and 45 per cent, reducing below 5 per cent with effective interventions (Barral, Oliveira, Lobato et al. 2014). Despite vertical transmission being the main pathway through which children get infected with HIV, little research has been done to determine the significance of maternal HIV status on under-five mortality in Zambia. The aim of the study was, therefore, to determine the extent to which mortality of children with HIV-positive mothers differs from that of children with HIV-negative mothers. The Zambia Demographic and Health Survey (ZDHS) data for 2007 and 2014 which contain HIV serotesting data were used. Survival analysis using Poisson regression was used to model the influence of maternal HIV status taking into account confounding factors. The results of the study indicate that maternal HIV status was significantly associated with child mortality in both survey periods but by 2013/14 the influence of maternal HIV status had reduced and was insignificant for children born within one year of the 2013/14 survey. The reduction in the risk of dying between the inter-survey period may be as a result of increased coverage of prevention of mother-to-child transmission (PMTCT) and antiretroviral therapy (ART) services over the years. In order to reach universal coverage, there is need for increased provision of PMTCT and ART treatments and support for HIV strategies such as the 90 90 90 target.
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Ekström, Josephine. "Possibilities and obstacles regarding under-five mortality : A case study in Babati district, Tanzania." Thesis, Södertörns högskola, Institutionen för livsvetenskaper, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:sh:diva-17192.
Full textAbstract:
Tanzania is close to reach one of the Millennium Development Goals; to reduce child mortality with two-thirds between 1990 until 2015. This qualitative case study focuses on under-five children’s health in Babati district, situated in the north-west of Tanzania. The empirical data used in this thesis has been collected through interviews with health personnel and mothers during three weeks in February to March 2012. The purpose of the study has been to identify direct and underlying reasons causing child mortality, and to investigate what measures are needed to improve the situation. The most prominent diseases creating death amongst children are pneumonia and malaria, and also diarrheal diseases are common. The prevalence of the diseases differs from wet and dry season, whereas there are more cases of illness and death during the wet season. Malaria and pneumonia are common causes of death during the wet season, and diarrheal diseases are more common during the dry season. Underlying reasons affecting child mortality in Babati district are the lack of infrastructure, such as few well-functioning roads to the main hospitals which affects the rural population in particular. Also the limited access to transport is a vast problem when there is acute illness or childbirth. The clinics available in Babati district are poorly equipped and have a lack of personnel, creating a stressful situation for both healthcare workers and patients. More governmental funds and infrastructure is needed in the area to be able to create a sustainable situation for future children.Tanzania är nära att nå ett av Milleniemålen; att reducera barnadödligheten med två tredjedelar mellan 1990 till 2015. Den här kvalitativa fallstudien fokuserar på barn under fem års hälsosituation i Babati distriktet, beläget i nordvästra Tanzania. De empiriska data som används i studien har samlats genom intervjuer med sjukvårdspersonal och mödrar under tre veckors tid under februari och mars 2012. Syftet med studien har varit att identifiera direkta och indirekta orsaker till barnadödlighet, samt att undersöka vilka förbättringar som krävs för att förbättra situationen. De mest framträdande orsakerna för barnadödlighet är lunginflammation och malaria, men också sjukdomar kopplade till diarré är vanligt förekommande. Förekomsten av sjukdomarna varierar beroende på om det är regnsäsong eller torrperiod. Under regnsäsongen så är det flest sjukdoms- och dödsfall, och lunginflammation och malaria är mest förekommande medans diarré är vanligast under torrperioden. Bakomliggande orsaker som påverkar barnadödlighet i Babati är bristen på infrastruktur, få välfungerande vägar till huvudsjukhusen vilket framför allt påverkar den rurala befolkningen. Den begränsade tillgången till transport är ett vidsträckt problem vid akut sjukdom eller förlossning. Klinikerna i Babati distriktet är undermåligt utrustade och har personalbrist, vilket skapar en ohållbar situation för både sjukvårdspersonalen och patienterna. Mer statliga resurser och infrastruktur behövs i området för att kunna skapa en hållbar situation för framtidens barn.
Miljö och utveckling i syd
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Linjewile-Marealle, Navoneiwa. "Oral health and nutritional status of the children under five years, Queen Elizabeth II Hospital, Maseru, Lesotho." Thesis, University of the Western Cape, 2006. http://etd.uwc.ac.za/index.php?module=etd&action=viewtitle&id=gen8Srv25Nme4_1437_1190193126.
Full textAbstract:
The aim of this study was to compare the oral health status between well and malnourished children under five years old attending Mother and Child Health clinic in Queen Elizabeth II Hospital in Maseru, Lesotho.
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Pelley, Terri Jacklyn. "The Development and Validation of the Psychosocial Adjustment to Burn Questionnaire for Children Age Five and Under." University of Dayton / OhioLINK, 2010. http://rave.ohiolink.edu/etdc/view?acc_num=dayton1291917169.
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Attique, Amer Boonyong Keiwkarnka. "Utilization of immunization services among mothers with children under five years of age in abbottabad district, Pakistan /." Abstract, 1999. http://mulinet3.li.mahidol.ac.th/thesis/2542/42E-AmerAttique.pdf.
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Carter, Yvonne Helen. "The aetiology and prevention of accidents to pre-school children : an evaluation of accidents to children under five years old in North Staffordshire." Thesis, Imperial College London, 1993. http://hdl.handle.net/10044/1/7464.
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hussein, hanaa. "Prevalence of Diarrhea and assoicated risk factors in children under five years of age in Northern Nigeria : A secondary data analysis of Nigeria and Demographic and Health Survey 2013." Thesis, Uppsala universitet, Internationell mödra- och barnhälsovård (IMCH), 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-323559.
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Mpogui, Andrea. "Consumption of Rainwater and Diarrheal Disease in Children Under Five in the Dominican Republic from 2002 to 2007." Digital Archive @ GSU, 2012. http://digitalarchive.gsu.edu/iph_theses/232.
Full textAbstract:
Background: With the MDG 7 target deadline approaching to halve the global population lacking access to improved water and sanitation by 2015, many nations find the need to explore alternative water sources. Rainwater may be a viable alternative water source. However, there have been concerns raised in recent decades as to the quality of rainwater harvested for potable use.
Methods: Data from the Demographic and Health Surveys database which included 50,579 household surveys between 2002 and 2007 from the Dominican Republic were examined. STATA 8 was used for data analysis. Descriptive statistics were computed, and logistic regression analysis was used to compare toilet type, water source, and type of place of residence with prevalence of diarrheal disease in children under five.
Results: This study found that rainwater presents less risk for diarrheal disease when compared to all other water sources (excluding bottled water). In 2002, people who consumed all other sources of water (excluding bottled) were 1.28 times more likely to have diarrhea in children under 5 (95% CI 1.05-1.57) compared to those who consumed rainwater. They were 1.33 times more likely to have diarrhea in children under 5 (95% CI 1.08-1.65) in 2007 and 1.31 times more likely in both years combined (95% CI 1.13-1.51).
Discussion: This study concluded that consuming rainwater presents a decreased risk for diarrheal disease compared to all other sources (excluding bottled water). More studies are needed to add more evidence to the existing literature regarding health risks associated with rainwater consumption.
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Del, Valle Mendoza Juana Mercedes, Oré Veronica Casabona, Helasvuo Veronica Petrozzi, Tapia Angela Cornejo, Pablo Weilg, Maria J. Pons, Mora Erico Cieza, Mayra Jorge Bazán, Pacherres Hernan Cornejo, and Joaquin Ruiz. "Bordetella pertussis diagnosis in children under five years of age in the Regional Hospital of Cajamarca, Northern Peru." The Journal of Infection in Developing Countries (JIDC), 2015. http://hdl.handle.net/10757/605267.
Full textAbstract:
Introduction: Bordetella pertussis is an important human pathogen that causes whooping cough (pertussis), an endemic illness responsible of
significant morbidity and mortality, especially in infants and children. Worldwide, there are an estimated of 16 million cases of pertussis,
resulting in about 195,000 child deaths per year. In Peru, pertussis is a major health problem that has been on the increase despite
immunization efforts. The objective of this study was to determine the prevalence of B. pertussis among children under five years of age
suspected to have whopping cough in Cajamarca, Peru.
Methodology: Children diagnosed with whooping cough admitted to the Hospital Regional de Cajamarca from August 2010 to July 2013
were included. Nasopharyngeal samples were obtained for B. pertussis culture and polymerase chain reaction (PCR) detection.
Results: In 133 children, the pertussis toxin and IS481 gene were detected in 38.35% (51/133) of the cases by PCR, while only 9.02%
(12/133) of the Bordetella cultures were positive. The most frequent symptoms in patients with positive B. pertussis were paroxysm of
coughing 68.63% (35/51), cyanosis 56.86% (29/51), respiratory distress 43.14% (22/51), and fever 39.22% (20/51). Pneumonia and acute
bronchial obstructive syndrome were present in 17.65% (9/51) and 13.72% (7/51) of the cases, respectively.
Conclusions: B. pertussis is responsible for an important proportion of whooping cough in hospitalized children in Cajamarca. Epidemiologic
surveillance programs for B. pertussis are essential in Peru, especially in children who could most benefit from the vaccine.
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Maphalala, Gugu Petunia. "Epidemiology of rotatirus diarrhoea in children under five years years of age from selected healthcare facilities in Swaziland." Thesis, University of Limpopo (Medunsa Campus), 2013. http://hdl.handle.net/10386/1154.
Full textAbstract:
Thesis (MSc (Medical science in medical virology)) -- University of LimpopoBackground: It has been established that rotaviruses are the main cause of acute gastroenteritis in children worldwide, resulting in more than 453 000 deaths, with a high mortality still occurring in African countries and Asia. In Swaziland, diarrheal diseases are a common cause of morbidity and mortality among children <5 years of age. Approximately 10% of hospitalised Swazi children die due to diarrhoea every year. Through financial assistance from the World Health Organization (WHO), many African countries have conducted a lot of rotavirus disease studies. In Swaziland, the epidemiology of rotavirus infection is unknown due to lack of data. Thus, the study’s aim was to examine the epidemiology and characterize rotavirus strains in children <5 years of age, hospitalised and attending the outpatient departments of public and private healthcare facilities in Swaziland. Materials and methods: A total of 745 diarrheal stool specimens were collected from children <5 years of age from April 2009 to December 2010. Group A rotavirus antigen was detected using a commercially available enzyme immunoassay (EIA) kit (ProSpectTM, Oxoid Ltd, UK). Polyacrylamide gel electrophoresis (PAGE) was used to determine the electrophoretic pattern of rotavirus strains. The P and G genotypes were established by reverse transcription polymerase chain reaction (RT-PCR) and multiplex hemi-nested PCR amplification of the VP4 and VP7 genes respectively, using type-specific primers. Sequencing was performed on 35 specimens to confirm the circulating genotypes. The phylogenetic tree and similarity distances between genotypes were constructed using the neighbour joining method and the Kimura two-parameter model package in the MEGA version 5.05 software program. Results: Group A rotavirus was detected at 13.3% in 2009 (based on samples collected from April to December) and 23.4% in 2010 (based on one year collection) from children <5 years of age hospitalized and attending outpatient departments. The rotavirus infection was more frequently detected in the age group 0-11 months (22.2%). Gender did not play a major role in rotavirus infection, because both male (20.8%) and female (18.8%) children were equally affected. Of the children that were admitted in the hospital, 33.3% were affected by rotavirus infection compared to those attending the outpatient departments (13.5%). The rotavirus infection was observed during the cooler, drier months of the year. The three most predominant G and P genotypes detected were G2P[4] (30.4%), followed by G1P[8] (15.5%) and G9P[8] (8.8%). A significant number of uncommon rotavirus strains (32.4%), mixed infections (8.8%) and nontypeables (4.1%) were also detected. The circulating genotypes detected were classified into lineages and sub-lineages defined by phylogenetic analysis of nucleotide sequences. The Swaziland strains were found clustering with known African and global strains from the GenBank. Conclusion: The findings of this study reveal that group A rotaviruses are the etiological agents of severe diarrhoea in children under 5 years in Swaziland. The diversity of rotavirus strains that were detected highlights the importance of introducing the rotavirus vaccine in the country. The currently licensed vaccines may confer protection against the circulating strains detected in this study. Data on the burden of rotavirus disease in Swaziland will be used to convince the Ministry of Health and policy makers in the country to advocate for the introduction of the rotavirus vaccine. This is the first data on the epidemiology and characterization of rotavirus strains in Swaziland; therefore there is a need for continuing with the surveillance of rotavirus in the existing sentinel sites to determine the impact of rotavirus infection over time. It is also essential to continuously monitor the rotavirus strains circulating among Swazi children.
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Huicho, Luis, Carlos A. Huayanay-Espinoza, Eder Herrera-Perez, Eddy R. Segura, de Guzman Jessica Niño, María Rivera-Ch, and Aluisio J. D. Barros. "Factors behind the success story of under-five stunting in Peru: a district ecological multilevel analysis." BioMed Central Ltd, 2017. http://hdl.handle.net/10757/622308.
Full textAbstract:
Background: Stunting prevalence in children less than 5 years has remained stagnated in Peru from 1992 to 2007, with a rapid reduction thereafter. We aimed to assess the role of different predictors on stunting reduction over time and across departments, from 2000 to 2012. Methods: We used various secondary data sources to describe time trends of stunting and of possible predictors that included distal to proximal determinants. We determined a ranking of departments by annual change of stunting and of different predictors. To account for variation over time and across departments, we used an ecological hierarchical approach based on a multilevel mixed-effects regression model, considering stunting as the outcome. Our unit of analysis was one department-year. Results: Stunting followed a decreasing trend in all departments, with differing slopes. The reduction pace was higher from 2007–2008 onwards. The departments with the highest annual stunting reduction were Cusco (−2.31%), Amazonas (−1.57%), Puno (−1.54%), Huanuco (−1.52%), and Ancash (−1.44). Those with the lowest reduction were Ica (−0.67%), Ucayali (−0.64%), Tumbes (−0.45%), Lima (−0.37%), and Tacna (−0.31%). Amazon and Andean departments, with the highest baseline poverty rates and concentrating the highest rural populations, showed the highest stunting reduction. In the multilevel analysis, when accounting for confounding, social determinants seemed to be the most important factors influencing annual stunting reduction, with significant variation between departments. Conclusions: Stunting reduction may be explained by the adoption of anti-poverty policies and sustained implementation of equitable crosscutting interventions, with focus on poorest areas. Inclusion of quality indicators for reproductive, maternal, neonatal and child health interventions may enable further analyses to show the influence of these factors. After a long stagnation period, Peru reduced dramatically its national and departmental stunting prevalence, thanks to a combination of social determinants and crosscutting factors. This experience offers useful lessons to other countries trying to improve their children’s nutrition.Revisión por pares
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Kangwana, Beth Bonareri Pamba. "The impact of retail sector delivery of artemether-lumefantrine on effective malaria treatment of children under five in Kenya." Thesis, Open University, 2011. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.578278.
Full textAbstract:
Background: With a low proportion of children receiving the first line treatment for suspected malaria, it has been proposed that artemisinin based combination therapy be subsidised in the private sector in order to improve affordability and access. This thesis presents an evaluation of a pilot subsidy mechanism in Western Kenya. Methods: The primary objective was to evaluate the impact of providing subsidized artemether-lumefantrine (AL) through trained retailers, on the coverage of prompt effective anti-malarial treatment for febrile children aged three to 59 months. I used a cluster-randomised, controlled design with nine control and nine intervention sublocations, equally distributed across three districts. Provider, mystery shopper and household cross- sectional surveys were conducted at baseline and one year later. Data were analysed based on cluster-level summaries, comparing control and intervention arms, while adjusting for covariates. On average details of 2,706 children and 564 retail outlets were captured per year. ., Results: Provider survey and mystery shopper data showed that at follow-up a significantly greater percentage of retailers stocked and dispensed AL, and knew that AL was the first line treatment for uncomplicated malaria in the intervention arm compared to the control. Significantly fewer retailers stocked antimalarial monotherapies. Household survey data showed that an average of 29% of children had experienced fever within the previous two weeks.
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Logie, Carol A. "Early childhood care and education in Trinidad & Tobago : an anlysis of centre-based provision for children under five." Thesis, University of Sheffield, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.387742.
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Karkuki, Osguei Nushin. "The relationship between socio-economic variation and nutritional status of under five year old Nepalese children and their mothers." Thesis, University of Cambridge, 2014. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.648724.
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Siswanto, Eddy Bhuiyan Shafi Ullah. "Knowledge and perception of pneumonia disease among mothers of children under five years attending Nakhon Pathom General Hospital, Thailand /." Abstract, 2007. http://mulinet3.li.mahidol.ac.th/thesis/2550/cd399/4937989.pdf.
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Munthali, Justice. "Food Accessibility and Nutrition Status of Tenant Women of Reproductive Age and Under-Five Children on Smallholder Tobacco Farms in the Northern Malawi." Diss., University of Pretoria, 2017. http://hdl.handle.net/2263/63282.
Full textAbstract:
Introduction: Lack of evidence-based information is an impediment to improve the food
security and nutrition status of vulnerable tobacco tenant women and their children on
smallholder farms in Malawi.
Aim: To assess and describe the food accessibility and nutrition status of the tobacco tenant
women of reproductive age and their under-five children on smallholder farms, as well as to
determine and report correlational relationships amongst demographic and socio-economic
factors, food accessibility measurements and nutrition status indicators.
Design: Quantitative cross-sectional descriptive correlational study.
Setting: Bwengu, Engucwini and Njuyu Extension Planning Areas, Mzimba North district,
Malawi.
Sample: 110 women of reproductive age sampled through a proportional systematic random
sampling technique, and their 139 under-five children. The sample size was calculated using
nQuery version 7 software based on 47% prevalence of malnutrition among under-five
children in Malawi, estimated at 95% CI to the accuracy of 10%.
Methodology: Data were captured through face-to-face interviews during the hunger season.
Food accessibility was captured using the Household Food Insecurity Access Scale (HFIAS),
Household Hunger Scale (HHS), Months of Adequate Household Food Provisioning
(MAHFP) and Individual Dietary Diversity Scale (IDDS). Nutrition status was measured
using anthropometry according to standard protocol. WHO Anthro software was used to
compute Z-scores (W/A, H/A, W/H and BMI/A) for children, based on WHO standards.
Microsoft Excel was used to calculate BMI for women, based on WHO cut-off points. Stata
software was used to compute regression analyses to establish correlational relationships
between independent and dependent variables. Ethical approval was obtained from the
University of Pretoria, Natural and Agriculture Science Committee (Number EC151215-
028), as well as from the Mzuzu Agriculture Development Division in Malawi. Results: Mean age of the women was 27.3 ± 6 years and 28.8 ± 15 months for the children.
The experience of food insecurity access was severe for 75% of the households. Nearly onefifth
of households were severely hungry, and had adequate food for only about eight months
of the year. The women and their children consumed a mean of two food groups in the
previous 24 hours. For the women, 21% were malnourished. For the children, 20% were
wasted, 31.3% were stunted and 34% were underweight. More male children were
malnourished.
For food accessibility measurements, the multivariable linear regression analysis was used.
The significant factors influencing the severity of the experience of food insecurity access
were loan access (P = 0.015) and household size (P = 0.000). For the prevalence of hunger,
the significant factors were food security and nutrition training (P = 0.046), marital status (P
= 0.045) and household size (P = 0.000). For the annual prevalence of hunger, the significant
factors were labour (P = 0.038), income (P = 0.008) and household size (P = 0.001). For the
dietary diversity, the significant factors were labour (P = 0.001), food security and nutrition
decisions (P = 0.004), mother’s age (P = 0.033) and income (P = 0.000).
Using the multivariable IV regression analysis, the significant factors influencing the BMI of
the women were their age (P = 0.054), loan access (P = 0.004), HFIAS scores (P = 0.007) and
HHS scores (P = 0.001). For the children’s weight-for-age, the significant factors were the
mother’s BMI (P = 0.014), child’s sex (P = 0.005), assets (P = 0.014), mother’s age (P =
0.001) and child’s age (P = 0.015).
Using the multivariable random-effects GLS regression analysis, the significant factors
influencing the children’s height-for-age were the mother’s age (P = 0.004), child’s sex (P =
0.005), assets (P = 0.028) and HFIAS scores (P = 0.006). For the children’s weight-forheight,
the significant factors were the mother’s BMI (P = 0.032), MAHFP scores (P =
0.029), child’s age (P = 0.008) and income (P = 0.001). For the children’s BMI-for-age, the
significant factors were the mother’s BMI (P = 0.030), mother’s age (P = 0.029), income (P =
0.002) and assets (P = 0.047).
Conclusion: The food accessibility and nutrition status of the tobacco tenant women and
their children were seriously poor. The significant factors influencing food accessibility and nutrition status were loan access, household size, food security and nutrition training, marital
status, labour, income, assets, food security and nutrition decisions, mother’s BMI, mother’s
age, child’s age, child’s sex, HFIAS scores, HHS scores and MAHFP scores. The study
findings offer clues to policy makers on where to direct interventions to improve food
accessibility and nutrition status of the tobacco tenant women and their children in Malawi.Dissertation (MSc)--University of Pretoria, 2017.
Human Nutrition
MSc
Unrestricted
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Dagvadorj, Amarjargal. "Hospitalization risk factors for children’s lower respiratory tract infection: A population-based, cross-sectional study in Mongolia." Kyoto University, 2017. http://hdl.handle.net/2433/226777.
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Senzilet, Linda Debra. "The impact of Ontario's child restraint legislation on the incidence, severity and patterns of injury in children under five years." Thesis, University of Ottawa (Canada), 1992. http://hdl.handle.net/10393/7698.
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In 1983, the Ontario government introduced legislation which mandated the restraint of all child passengers under 50 pounds in restraint systems appropriate to their weight. The efficacy of such restraint systems has been proven, and standards for their manufacture have been set by the government of Canada. The objectives of this study were to determine whether Ontario's child restraint legislation has resulted in significant and sustained reductions in the incidence and severity of injury, as well as changes in the anatomical patterns of fatal and non-fatal injury. Data sources included the Hospital Medical Records Institute (HMRI) and Transport Canada's Traffic Accident Information Data Bank (TRAID). The study used the interrupted time-series design and autoregressive integrated moving average (ARIMA) modelling to analyze a variety of rates and indicators calculated for children under 5, as well as for a control group of adults 20-44 years old. The study period encompassed five pre-law years and five post-law years, extending from 1979 to 1988. Results suggested that there were no significant changes in either the incidence, severity or anatomical patterns of injury in children covered by the legislation. Two possible explanations for the apparent lack of an intervention effect are that either the pre- to post-legislation increase in (proper) usage rates was not large enough, or that any positive effects of the law were too gradual to be detected. These conclusions are supported by evidence that there was a relatively high usage of child restraints prior to the legislation, and that rates of proper wearing of restraints did not exceed 50% in the years following implementation. Child restraint laws cannot achieve their objectives without a higher level of sustained compliance. Several means of achieving this objective are presently being implemented by the so-called "95 by 95" program, i.e., the National Occupant Restraint Program that is operating in all provinces, and whose stated goal is a 95% wearing rate of restraints in all age groups by the year 1995. (Abstract shortened by UMI.)
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Adhiambo, Oreje Joy Susan. "Assessment of prescribing patterns and availability of anti-malarial drugs to children under five years of age in a rural district in Kenya." University of Western Cape, 2013. http://hdl.handle.net/11394/3927.
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Magister Public Health - MPHAim: The aim of this study was to assess the prescribing practices and availability of antimalarial drugs to children under five years of age in primary health care facilities in Bondo district.
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Kamaranzi, Bakunda Kaakaabaale. "Factors associated with late presentation of children under five and pregnant women with malaria for treatment at health units in Bungokho Health Sub District." Thesis, University of the Western Cape, 2010. http://etd.uwc.ac.za/index.php?module=etd&action=viewtitle&id=gen8Srv25Nme4_9025_1363357146.
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Background: Malaria is the leading cause of death of Uganda&rsquo
s children under 5 years of age and the number-one cause of illness in adults in Uganda. The success of malaria treatment strategies is closely linked to the behavior of patients and caretakers of young children. In the case of malaria this includes accessing appropriate treatment for
suspected malaria in time. In Bungokho Sub County, in spite of the efforts by district health workers and the Ministry of Health to implement the malaria control, prevention and treatment strategies, pregnant women and caretakers of children under 5 years of age continue to present late for treatment in the health units resulting in possible avoidable
death or disability. Aim and objectives: The aim of this study was to explore the factors that lead to late presentation of children and pregnant women with malaria for treatment at health units. This was done by exploring the perceptions of caregivers of children under five years and pregnant women on the community&rsquo
s knowledge and understanding of the
symptoms and treatment of malaria
and describing perceptions of caregivers and pregnant women on health care provision at the health units and alternative treatment for malaria. Methods :The study was conducted in Bungokho Health sub-district, in Mbale district, Eastern Uganda over a two month period in 2009. It was a descriptive exploratory study using qualitative research methods. Four focus groups were carried out, two with caregivers of children under 5 years and two with pregnant women, with each focus group consisting of eight participants. Two caregivers and two pregnant women were identified from the focus groups for further indepth interviews. Four in-depth interviews were conducted with health unit staff from Bungokho HCVI. Notes were taken and observations made during the focus groups and interviews. The proceedings were audio-taped and recordings used to expand and clarify notes. Thematic content analysis was used to analyze the data and identify recurrent themes from the focus group discussions and
interviews of the reasons for late presentation for malaria treatment. Results: All caregivers were women, a significant majority of whom were peasants who had not gone beyond the primary education. Caregivers were aware of the general symptoms of malaria but associated more serious or dangerous symptoms with other causes including
witchcraft. Pregnant women, on the other hand, seemed to have sound knowledge of both the general and dangerous symptoms of malaria and were likely to attend the health
units timeously for reatment. Religious beliefs and practices, particularly belief in the healing ability of prayers prevented early reporting of malaria cases to health units leading
to late presentation. Alternative treatment of malaria from traditional herbalists was also sought by the communities particularly when the intensity of malaria was at its peak during the rainy season. Poverty in the community seemed to play a big role in shaping community preference for treatment sources, as well as early presentation to the health
units. It was found that the anticipated cost of laboratory tests and sundries at the health units deterred caregivers from taking children under five to health units. There was therefore a strong reliance (and preference for) community medicine distributor&rsquo
s (CMDs) because of free services and easy access. Lack of support from spouses (in particular husbands) coupled with the rude behavior of health workers towards caregivers and pregnant women discouraged visits to health units. The long waiting time and intermittent drug stock-outs also created a negative perception of service at the health units. Conclusions and recommendations: There is need for further sensitization of communities on the need to seek prompt treatment for children under five years of age at the health units (that is, within 24 hours of the onset of fever). Training and supervision of CMDs should be strengthened to ensure consistent supply of drugs, correct dosage of anti-malarial medication and improvements in the referrals to the health units. In order to improve
service delivery at the health units, there is need to review and strengthen human resource management of the health units, including staffing requirements and management
practices, such as support and supervision, patient care standards and client feedback mechanisms. It is also important that there are adequate stocks of anti-malarial drugs
and laboratory supplies at health units.
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Liow, Eric Kang-Yan. "Unregulated drug vendors' knowledge, attitudes, beliefs and practices related to malaria management of children five and under in Butaleja District, Uganda." Thesis, University of British Columbia, 2013. http://hdl.handle.net/2429/45412.
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He, Hui Sirikul Isaranurug. "Risk factors of pneumonia among children under five years of age at Queen Sirikit National Institute of Child Health, Bangkok, Thailand /." Abstract, 2000. http://mulinet3.li.mahidol.ac.th/thesis/2543/43E-HeHui.pdf.
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Angkham, Ounavong Santhat Sermsri. "Self-medication of antibiotics in mild URI among mothers with children under five years old, in Naxaithong district, Vientiane, Lao PDR /." Abstract, 2003. http://mulinet3.li.mahidol.ac.th/thesis/2546/4537458.pdf.
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Adji, Seno Charnchudhi Chanyasanha. "Factors related to mother's behavior in order to give ORS to children under five years old at Kuma Health Center, Indonesia /." Abstract, 2005. http://mulinet3.li.mahidol.ac.th/thesis/2548/cd375/4737944.pdf.
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Kalyango, Joan N., Elizeus Rutebemberwa, Charles Karamagi, Edison Mworozi, Sarah Ssali, Tobias Alfven, and Stefan Peterson. "High Adherence to Antimalarials and Antibiotics under Integrated Community Case Management of Illness in Children Less than Five Years in Eastern Uganda." Uppsala universitet, Internationell mödra- och barnhälsovård (IMCH), 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-197719.
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Background Development of resistance to first line antimalarials led to recommendation of artemisinin based combination therapies (ACTs). High adherence to ACTs provided by community health workers (CHWs) gave reassurance that community based interventions did not increase the risk of drug resistance. Integrated community case management of illnesses (ICCM) is now recommended through which children will access both antibiotics and antimalarials from CHWs. Increased number of medicines has been shown to lower adherence. Objective To compare adherence to antimalarials alone versus antimalarials combined with antibiotics under ICCM in children less than five years. Methods A cohort study was nested within a cluster randomized trial that had CHWs treating children less than five years with antimalarials and antibiotics (intervention areas) and CHWs treating children with antimalarials only (control areas). Children were consecutively sampled from the CHWs' registers in the control areas (667 children); and intervention areas (323 taking antimalarials only and 266 taking antimalarials plus antibiotics). The sampled children were visited at home on day one and four of treatment seeking. Adherence was assessed using self reports and pill counts. Results Adherence in the intervention arm to antimalarials alone and antimalarials plus antibiotics arm was similar (mean 99% in both groups) but higher than adherence in the control arm (antimalarials only) (mean 96%). Forgetfulness (38%) was the most cited reason for non-adherence. At adjusted analysis: absence of fever (OR = 3.3, 95%CI = 1.6–6.9), seeking care after two or more days (OR = 2.2, 95%CI = 1.3–3.7), not understanding instructions given (OR = 24.5, 95%CI = 2.7–224.5), vomiting (OR = 2.6, 95%CI = 1.2–5.5), and caregivers' perception that the child's illness was not severe (OR = 2.0, 95%CI = 1.1–3.8) were associated with non-adherence. Conclusions Addition of antibiotics to antimalarials did not lower adherence. However, caregivers should be adequately counseled to understand the dosing regimens; continue with medicines even when the child seems to improve; and re-administer doses that have been vomited.
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O'Brien, Kathryn. "The prevalence of urinary tract infection (UTI) in children under five years old presenting with an acute illness in UK general practice." Thesis, Cardiff University, 2013. http://orca.cf.ac.uk/47309/.
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Urinary tract infections (UTI) in young children have been associated with serious long-term complications such as renal scarring, hypertension and renal failure. The presenting symptoms of UTI in children are non-specific. If UTI is not suspected, a urine sample is not obtained, and without this, UTI cannot be diagnosed. There is evidence that the diagnosis is often missed. Most published studies have not systematically sampled urine, and those that have are largely based in US emergency departments and only include highly selected groups of children. The true prevalence of UTI in acutely ill children presenting in UK general practice is therefore unknown. My thesis consists of a literature review discussing the association of childhood UTI with long-term complications, the challenges of diagnosis and the evidence that UTIs are being missed; a systematic review of papers reporting UTI prevalence in children which highlights the need for a study in UK general practice; a pilot study to determine the feasibility of recruiting children and obtaining urine samples in UK general practice; and a prospective cohort study to determine the point prevalence of UTI in 597 presenting children, determine the predictive value of presenting symptoms, signs and risk factors, and describe the clinical outcomes for children with UTI. I found that the prevalence of UTI was 5.9% (95% confidence interval: 4.3-8.0%). This may be sufficiently high to justify increased urine sampling in general practice. A multi-variable logistic regression model identified younger age range, pain on passing urine (dysuria) and urinary frequency as being associated with UTI. I propose a urine sampling strategy for GPs assessing acutely ill children and compare this to suspicion-led sampling and current guidelines. In my discussion I discuss the limitations, generalisability and implications of these findings.
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Madondo, Andrew. "Socio-demographic characteristics of caregivers and the clinical profile of undernourished under five year old children admitted in Nyangabgwe Referral Hospital, Botswana." Thesis, University of Limpopo (Medunsa Campus), 2012. http://hdl.handle.net/10386/668.
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Thesis (MPH) -- University of Limpopo, 2012.Background: Despite Botswana being a middle income country undernutrition among children younger than five years of age continues to affect different parts of the country. Undernutrition can be attributed to a number of reasons which vary from region to region. There is little information on the socio-demographic characteristics of caregivers and the clinical profile of undernourished children in Francistown and surrounding villages. Purpose: To determine the socio-demographic characteristics of caregivers and the clinical profile of undernourished children admitted at Nyangabgwe Referral Hospital, Francistown, Botswana. Method: Data were collected from 113 caregiver-child pairs using a researcher administered questionnaire targeting caregivers and the child's hospital card and the child's anthropometric measurements were taken. Data were analysed using the WHO Anthro 2006 software and Stata 10. Descriptive statistics were derived and Chi -square tests were done at 5% level of significance to determine any associations. Results: The majority of the caregivers were single mothers (80%) younger than 30 years of age. Oedematous malnutrition was found in 50% of the children and was more common in males at 55%. The reasons given by caregivers as to why their children had been admitted did not relate to the child's nutritional state. The child's gender was associated with stunting (X2 = 4.0638, P = 0.044) at 5% level of significance. Looking at any associations between caregiver characteristics and the child's clinical profile only marital status was associated with child presenting with cough (X2 = 4.0947, P = 0.045) at 5% level of significance. There was no association between the caregiver characteristics and the severity of any of the three types of undernutrition (wasting, stunting and underweight). Conclusion: This study showed that the majority of caregivers were younger than 30 years of age and single. The child's gender was associated with stunting which may need more research on. Almost 50% of the children had oedematous malnutrition. Public health interventions should focus on providing caregivers with health education on the early signs of undernutrition so as to facilitate timely interventions and prevent severe cases of undernutrition.
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Ahmed, Ayeda. "Association of sickle cell disease with nutritional status among under-five children: a secondary analysis of Nigeria demographic and health survey 2018 data." Thesis, Uppsala universitet, Internationell mödra- och barnhälsovård (IMCH), 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-413841.
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Abstract Background Malnutrition in childhood brings lots of difficulties that hinder to lead a healthy life. Nigeria is one of the most populous country in Africa has record of largest number of children suffered from chronic malnutrition under five years age. Sickle cell disease (SCD) is one of the most common haemoglobinopathy which occurs in Nigerian children. The aim of the present study is towards recognize the nutritional status of children sufferings from SCD and findings association with other socio-economic characteristics. Method A population based cross sectional survey was performed and total 11,243 children were selected for anthropometric measurement, hemoglobin test and genotype test. A two- stage stratified cluster sampling was applied in this study and using biomarker questionnaire support to collect data. Finally, multivariable logistic regression was used to discovery association between SCD children with stunting and wasting combined with other socio-economic characteristics. Result Children with sickle cell disease had significantly higher odds (aOR =1.47;95% confidence interval (CI) : 1.13-1.91) of stunting compared children with non-sickle cell disease .Conferring to gender, female children had significantly lower odds (aOR = 0.74,95% confidence interval (CI) : 0.68-0-81) of stunting compared with male children. Children from richest group had significantly lower odds (aOR=0.34;95% confidence interval (CI): 0.28-0.41) of stunting compared with the poorest group. There was no significant association observed between wasting and children with sickle cell disease. Conclusion The results indicate that SCD places a nutritional burden on affected under five children in Nigeria. Higher number of SCD affected children were suffering from stunting compare to healthy children. However, there was no significant difference on wasting between SCD and healthy children.
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Nurhaeni, Nani. "Assessment of the feasibility of modifying risk factors for acute respiratory infection in children under five years of age in West Java, Indonesia /." St. John's, NF : [s.n.], 2001.
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Langi, Grace Kerly Lony Nate Hongkrailert. "Knowledge and perception of mothers about nutritional status of children under five years of age in Bahu Health Center, Manado city, North Sulawesi province, Indonesia /." Abstract, 2008. http://mulinet3.li.mahidol.ac.th/thesis/2551/cd415/5037990.pdf.
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Ehrich, Kathryn. "A case for dialogic practice : a reconceptualisation of ‘inappropriate’ demand for and organisation of out of hours general practice services for children under five." Thesis, Brunel University, 2000. http://bura.brunel.ac.uk/handle/2438/5270.
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The recent expansion of general practitioner (GP) out of hours cooperatives indicates that many British GPs see this as the solution to managing out of hours work, particularly the 'problem' of 'inappropriate' demand. This thesis investigates the highly contentious subject of 'inappropriateness' of demand for out of hours GP services for children under five, and develops a methodology that allows for a reconceptualisation of the issues involved based on the beliefs, assumptions and practices of all those concerned, rather than locating the 'problem' within the province of parents alone, or within the doctor-patient relationship as a bounded system. Using a predominantly sociological and anthropological conceptual framework, the thesis draws on a synthesis of views and practice, bringing those of professionals and parents together with fieldwork observations based in the primary care centre setting. It suggests that contrary to talk about management of the 'problem' in technical, bureaucratic and medical terms, this becomes a moral issue in practice. Scientific or organisational imperatives disguise largely moral proscriptions and examples illustrate ways in which moral and emotional dimensions embedded within these social relations can conflict with particular forms of rationality. The analysis shows how organisational initiatives that fail to take account of such moral frameworks can produce unexpected and unintended consequences. The thesis illustrates the value of what is described as a dialogic process, taking account of the fluidity between voices, layers of time and space, and interchange between researcher, participants, and future audiences. The play of these issues in the rapid and extensive growth of cooperatives is discussed in the wider context of the rhetoric of consumerism and shifts in interprofessional practices and relationships. Negotiation of 'appropriate' supply of and demand for out of hours services has had a major impact on government initiatives for primary care as a whole. Thus key elements in the formation of cooperatives, originally targeted at a more narrow conceptualisation of problems, can be seen as expressing a deeper impetus for change, and serving as vehicles for more fundamental and rapid development.
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Suwa, Keiko Pantyp Ramasoota. "Approaches to mobilize community participation in nutrition promotion o of children under five among village health volunteers, Wang Nam Yen district, Sakeo province, Thailand /." Abstract, 2004. http://mulinet3.li.mahidol.ac.th/thesis/2547/cd364/4637896.pdf.
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Dahl, Helena. "Mothers’ treatment seeking behavior for children with diarrhea: a cross-sectional study in Zambia." Thesis, Mittuniversitetet, Institutionen för hälsovetenskap, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:miun:diva-41720.
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According to WHO, diarrhea disease is the second leading cause of death worldwide for children under five. Around 525 000 children under five are killed every year by diarrhea. Most deaths from diarrhea occur among children less than 2 years of age living in South Asia and sub-Saharan Africa. With a comprehensive strategy that ensures all children in need receive critical prevention and treatment measures it is possible to save the lives of millions of children at risk of death from diarrhea. The aim of this study was to identify what kind of treatment has been given to under-five children with symptoms of diarrhea and what kind of care the respondent sought in Zambia, a low-income country. Method: A cross-sectional study with secondary data from Zambia Demographic and Health Survey (ZDHS). The first-born child under five with diarrhea the last two weeks was selected in this study, to analyze what kind of treatment was given when showing symptoms of diarrhea. Out of the first-born children (n=7048) we found that 1 289 children had diarrhea during the last two weeks before the survey. Result: Of children having diarrhea 80% received some kind of treatment. Thirty eight percent of the children with diarrhea symptoms was given zinc and 67% was given pre-packaged Oral Rehydration Solution (ORS). The first place to seek treatment for the child’s diarrhea was at the Government Health Center (66%)followed by 18% that sought treatment at the Government Health Post. Conclusion: This study showed that the treatment and care seeking behavior for caregivers to under-5 children with diarrhea is of public health concern. Less than half of the children receives zinc as a treatment and 67% receives prepacked ORS. There is a need for education and awareness on the efficacy of ORS and especially zinc in preventing diarrhoea mortality and contribute to the UN Sustainable Development Goals target 3.2.Betyg i Ladok 210314.
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Chinkubala, Lontia. "To investigate the extent to which under-five HIV positive children access Antiretroviral Therapy (ART) : a case of Siavonga District of Southern Province of Zambia." Thesis, Stellenbosch : Stellenbosch University, 2015. http://hdl.handle.net/10019.1/97087.
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Thesis (MPhil)--Stellenbosch University, 2015.ENGLISH ABSTRACT: The impact of HIV/AIDS has affected all categories of people in society, including children under the age of five. This segment of the population depends entirely on adults and older children in order for them to survive. This research endeavoured to investigate the extent to which under-five HIV positive children access ART in Siavonga District in the Southern Province of Zambia. The necessity of such information for all cannot be over-emphasised as this category of the population under study is among the most neglected when it comes to issues of HIV/AIDS. Under-five HIV positive children need special attention in order for them to enjoy their right to survival and development. In terms of methodology, the research took an interpretive approach as it employed the qualitative methodology in its endeavours, in order to get an in-depth understanding of people’s views on the topic under research. Different interview schedules were used to collect data from community members, Community Health Workers (CHW), Home-based Care Providers (HBCP), staff of the Ministry of Health and District AIDS Task Force (DATF). The findings of this research addressed all the objectives but one. This research revealed that almost all the community members in Siavonga District had general knowledge about HIV/AIDS and the need for under-five HIV positive children accessing antiretroviral therapy. However, their attitudes and practices varied when it came to the application of this knowledge. According to respondents, the major challenges that under-five HIV positive children were facing when it came to accessing ART were as follows: food insecurity, followed by access to health facilities and social matters. Others included stigma and discrimination, long distances to health facilities, inadequate disposable income at household level and negative attitudes by some people who think that it is a waste of time and resources to give too much attention, including ART to under-five HIV positive children whom according to them will die soon. However, the majority of respondents indicated that there was need to accept these children like any other as they too had the right to live; hence, they needed care and support which included facilitating their access to ART. This research was an eye opener to all duty bearers to recognize and acknowledge the importance of under-five HIV positive children’s access to ART. This will contribute towards enhancing the will to step up efforts for this intervention. From the findings, it is evident that there is need for income generating activities to provide disposable income to people of Siavonga District so that they give appropriate support, particularly to children who are infected or affected by HIV/AIDS. Furthermore, more resources are required from NGOs, government and other stakeholders to enhance not only sensitization on the importance of the target population’s access to ART, but also provision of these ART services. All relevant stakeholders should heed the call to aggregate information for under-five HIV positive children in question so as to specially target interventions accordingly.
AFRIKAANSE OPSOMMING: Die impak van MIV/Vigs raak alle kategoriee van mense in die samelewing, insluitende kinders jonger as vyf jaar oud. Die segment van die bevolking is heeltemal afhanklik van volwassenes en ouer kinders om te oorleef. Hierdie navorsing poog om die omvang van kinders jonger as vyf, wie MIV positief is, se toegang tot antiretrovirale terapie (ART) in die Siavonga Distrik van die suidelike provinsie van Zambia te ondersoek. Die noodsaaklikheid van sodanige inligting vir alle sektore in die samelewing kan nie oorbeklemtoon word nie, aangesien hierdie kategorie van die bevolking een van die mees verwaarloosde is wanneer dit kom by MIV/Vigs verwante kwessies. Kinders jonger as vyf wie MIV positief is, moet spesiale aandag ontvang sodat hulle reg op oorlewing en ontwikkeling kan geskied. In terme van die metodologie het die navorsing ‘n beskrywende benadering gevolg om die kwalitatiewe metode in sy poging, ten einde ‘n in-diepte begrip van mense se standpunte oor die onderwerp onder navorsing te kry. Verskillende onderhoude is gebruik om data in te samel van gemeenskapslede, gesondheidswerkers in die gemenskap, tuisversorgers, personeel van die Ministerie van Gesondheid en Distriks vigs-taakspan. Die bevindinge van hierdie navorsing het al die doelwitte, behalwe een, aangespreek. Die navorsing het getoon dat byna al die gemeenskapslede in Siavonga Distrik algemene kennis het oor MIV/Vigs en die behoefte van kinders jonger as vyf se toegang tot ART. Hul houdings en praktyke verskil egter in die toepassing van hierdie kennis. Volgens die respondente is die grootste uitdagings wat kinders jonger as vyf ondervind wanneer dit kom by toegang tot ART is voedselonsekerheid, gevolg deur toegang tot gesondheidsfasiliteite en sosiale aangeleenthede. Ander sluit in stigma, diskriminasie, lang afstande na gesondheidsfasiliteite, onvoldoende besteebare inkomste op huishoudelike vlak en negatiewe houdings van sommige mense wat dink dat dit ‘n vermorsing van tyd en hulpbronne is om aan kinders jonger as vyf te spandeer, aangesien, die kinders in elk geval (volgens hulle) binnekort sal sterf.Die meerderheid van die respondente het aangedui dat dit nodig is om hierdie kinders soos enige ander kind te aanvaar en dat hulle ook die reg het om te leef: daarom dat hulle sorg en ondersteuning benodig, wat die fasilitering van hul toegang tot ART insluit. Hierdie navorsing het weer die klem geplaas op die belangrikheid van kinders jonger as vyf se toegang tot ART. Dit is duidelik dat daar ‘n behoefte is aan inkomste-genererende aktiwiteite en om besteebare inkomste aan die mense van Siavonga Distrik te voorsien, sodat hulle toepaslike ondersteuning kan bied, veral aan kinders wat deur MIV/Vigs geraak word. Verder is meer hulpbronne nodig van nie-regeringsorganisasies, die regering en ander belanghebbendes, nie net om die belangrikheid van die teikenbevolking se toegang tot ART nie, maar ook vir voorsiening van hierdie ATR dienste.
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Rossouw, Esmari. "The molecular epidemiology and diversity of gastroenteritis viruses in HIV-infected, -exposed and -unexposed children under the age of five years in Pretoria, South Africa." Diss., University of Pretoria, 2020. http://hdl.handle.net/2263/75468.
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Viruses are common causes of both endemic and epidemic gastroenteritis, infecting millions of people per year, with norovirus, rotavirus and adenovirus-F as the main causative agents, and sapovirus and astrovirus as contributing viruses. These viruses are highly infectious and most severe in the very young, old, or individuals who are immunocompromised. The viral infection usually causes self-limited gastroenteritis, although chronic infection has been observed in highly immunocompromised patients. African and South-East Asian regions are disproportionally affected by diarrhoeal disease. These regions (especially South Africa) are also more severely affected by human immunodeficiency virus (HIV) infections. It has been suggested that immunocompromised individuals may form part of a reservoir for novel virus variants and recombinants.
It should be taken into account that not every person is equally susceptible to infection after pathogen exposure and that not all infected persons develop clinical symptoms (Ramani and Giri, 2019). One host genetic factor that can influence susceptibility to enteric infection is the expression of histo-blood group antigens (HBGAs). Histo-blood group antigens are a major group of complex carbohydrates and are determinants of both human and animal ABO blood groups and the Lewis blood group systems, which are distributed in abundance on the mucosal epithelia of the gastrointestinal tract. Histo-blood group antigens have been proven to influence susceptibility to rotavirus and norovirus infections.
Saliva, blood and stool specimens (n=205) have previously been collected from children (≤ 5 years of age) hospitalised with gastroenteritis at Kalafong Provincial Tertiary Hospital from June 2016 to December 2017. Follow up stool specimens were then collected six weeks after enrolment when possible. A descriptive questionnaire was completed by each child’s guardian, giving information on age, residential area, HIV status etc. of the participating child. The stool specimens were screened for six gastroenteritis causing viruses (norovirus GI and –GII, rotavirus, sapovirus, astrovirus and adenovirus) by multiplex PCR. Forty-seven percent (96/205) of specimens tested positive for at least one gastroenteritis causing virus. Rotavirus predominated (46/205), followed by norovirus (32/205), adenovirus (15/205), sapovirus (9/205) and astrovirus (3/205). A total of 27/32 norovirus (GI.3, GII.2, GII.3, GII.4, GII.7, GII.12 and GII.21), 44/46 rotavirus (G1P[8], G2P[4], G2P[6], G3P[4], G3P[8], G8P[4], G8P[6], G9P[6] and G9P[8]) and 8/9 sapovirus (GI.1, GI.2, GII.1, GII.4 and GII.8) strains have been genotyped, of which norovirus GII.4 and rotavirus G3P[4] predominated. A total of 46/205 children submitted a follow up stool specimen to be tested. Of the 46 children, 9 tested positive for norovirus infection with initial stool specimen testing. Follow up screening resulted in 13/46 (28%) specimens testing positive for either norovirus GI or GII, with all patients presenting as asymptomatic. After genotyping it was observed that only one of the follow up specimens were identical to the original sequence genotyped, indicating prolonged shedding. FUT2 genotyping of 205/205 children showed a 71%:29% ratio between secretors and non-secretors. Eighty percent (77/96) of the virus-infected children were secretors whereas only 20% (19/96) were non-secretors. Rotavirus (p<0.01) and norovirus GII.4 (p<0.05) specifically were found to be more prevalent in secretors. In this study, no statistical significance was observed in terms of severity of and susceptibility to gastroenteritis viruses between HIV-infected, HIV-exposed uninfected or HIV-uninfected individuals. Histo-blood group phenotyping has resulted in various combinations, with Le(b) being the most prevalent antigen found.
Next generation sequencing was unsuccessful. In future, fresh specimens should be considered for testing, with more funding and time for optimisation of this process and to give adequate results.
In summary, gastroenteritis is still a leading cause of childhood morbidity and mortality, with all advancements in understanding the disease helping to decrease the impact of it. This study again reinforced the importance of these viruses, as they are circulating in such high abundance. It also reinforced the concept that susceptibility to noro- and rotavirus infection is affected by the secretor status of a person. This could in future help with better understanding the viral infection mechanisms and in turn help with vaccine development and treatmentDissertation (MSc (Medical Virology))--University of Pretoria, 2020.
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