Search Results (128)

Background/Objectives: Children with stunting are at risk of immune function disruption and micronutrient deficiencies, leading to nutritional anemia and susceptibility to infection. This study determined the prevalence and etiology of anemia in children under five with stunting and tuberculosis (TB) and analyzed the associated factors. Methods: A cross-sectional study was conducted among children under five with stunting from 30 May to 13 June 2022. Participants were selected via the proportionate stratified random sampling of 74 community health centers in Bandung City, Indonesia. An anthropometric measurement was performed to determine stunting and conduct TB diagnosis, and hematology tests were performed to elaborate the anemia profiles. Results: In total, 138 participants were included, among which 80 (58.0%) had TB and 57 (41.3%) had anemia, mostly caused by iron deficiency anemia (IDA)—38/57 (66.7%). The coexistence of anemia in children with stunting and TB was present in 33 (23.9%) and it was associated with nutritional status (weight-for-length), p = 0.026. Conclusions: Anemia, as a part of the triple burden among children under five with stunting and TB was highly prevalent, mostly due to IDA; in this study, only nutritional status was associated with the triple burden. Full article

Childhood immunization is one of the most effective public health measures, yet inequities remain in marginalized populations across Asia, where parental adherence is essential to sustaining the Expanded Program on Immunization. This narrative review examines determinants of adherence among under-five children in disadvantaged communities. Following PRISMA guidelines, searches of PubMed, Scopus, and Google Scholar identified studies published between 2015 and 2025, with earlier key works included as relevant. Twenty-one studies from South, Southeast, and East Asia were analyzed. Five domains were associated with adherence: socioeconomic and access factors, where maternal education, household income, and possession of immunization cards were positive predictors, while remote residence was a barrier; trust, cultural beliefs, and social norms, with misinformation and vaccine controversies reducing uptake, and provider trust and supportive norms improving it; migration and mobility, as migrant, stateless, and left-behind children had lower coverage due to weak registration and disrupted caregiving; household and caregiver dynamics, where decision-making by family or community members shaped uptake, while large family size and maternal employment limited adherence; and health system capacity, with inadequate infrastructure and follow-up hindering coverage and integration with maternal–child health services facilitating it. Addressing these intersecting barriers through equity-focused strategies is critical to achieving universal immunization coverage. Full article

Background: Antenatal care (ANC) offers a valuable opportunity to reduce the risk of acute respiratory infections (ARIs) in children under five; however, its impact remains less understood and has not been comprehensively synthesised. This systematic review aimed to assess evidence on the association between ANC utilisation and ARIs in children under five. Methods: A systematic search was conducted in PubMed, CINAHL, Scopus, Web of Science, and Google Scholar for studies published between 2000 and 2025. PRISMA 2020 guidelines were followed in reporting. A qualitative synthesis was performed for all ARI outcomes, and a meta-analysis was conducted for pneumonia. Results: Eleven observational studies assessed the association between ANC utilisation and ARIs. Three ARI-related outcomes were identified: pneumonia (n = 4), pertussis (n = 2), and general ARIs (n = 5). ANC attendance was generally associated with reduced odds of respiratory infections across studies. The pooled analysis of two case–control studies (n = 2; total n = 956) showed a non-significant association between ANC attendance and pneumonia in children (pooled OR = 1.46; 95% CI: 0.91, 2.35; I² = 0%). Conclusion: Our review suggests a potential protective effect of ANC, though evidence from the pneumonia-focused meta-analysis was inconclusive. Improving access to quality ANC may reduce respiratory infections, but more studies are needed across different populations. Full article

Background: Undernutrition is a major public health concern, accounting for nearly half of global under-five mortalities and leading to serious long-term consequences for those who survive. Most nutritional screening programs give priority to acute undernutrition (wasting). The co-presence of chronic undernutrition (stunting) has been shown to have the highest risk of mortality. To date, few studies have assessed outpatient treatment outcomes of children with wasting + stunting (WaSt), with some inconsistencies in results and only one study having investigated the outcome of patients requiring hospitalization. The aim of the present study is to investigate the impact of stunting on the outcomes of severely wasted children admitted for inpatient treatment in an Ethiopian referral hospital. Methods: A retrospective cross-sectional study was conducted to compare treatment outcomes (length of hospital stay, weight gain, recovery rate, readmission rate) of wasted and WaSt children admitted to “St. Luke Catholic Hospital and College of Nursing and Midwifery” between January 2018 and February 2023. Results: The analysis comprised 616 children aged 6–60 months and stunting was diagnosed in 559 children (90.7%). Children with stunting had a longer length of stay (median difference 3 days, 95% confidence interval 0 to 5; p = 0.03) and improved weight gain (median difference 4 g/kg/day, 95% confidence interval 0 to 4; p = 0.002) compared to children without stunting. Discharge rate (p = 0.99) and readmission rate (p = 0.25) were not statistically different between children with or without stunting. Conclusions: Stunting was found to be present in most children admitted for severe wasting to the Stabilization Centers in a sub-Saharan setting. Stunting was associated with longer hospitalization and greater weight gain, but discharge and readmission rate were comparable between children with or without stunting. Full article

Aims: To investigate the global epidemiological characteristics of lower respiratory infection (LRI) burden caused by Streptococcus pneumoniae (SP) from 1990 to 2021. Methods: Using data from the Global Burden of Disease (GBD) study 2021, we systematically analyzed Streptococcus pneumoniae-related (SP-related) LRI burden, focusing on mortality, disability-adjusted life years (DALYs), and temporal trends by age, gender, geographic region, and socio-demographic index (SDI) quintiles. Decomposition analysis assessed the influence of epidemiological shifts, population growth, and aging on age-standardized mortality rates (ASMRs), while an autoregressive integrated moving average (ARIMA) model projected future trends. Results: Between 1990 and 2021, the global SP-related LRI death number decreased from 1,028,083 (95% uncertainty interval (UI): 923,782–1,146,074) to 505,268 (95% UI: 454,335–552,539), and the ASMR dropped from 19.28 (95% UI: 17.32–21.49) to 6.40 (95% UI: 5.76–7.00) per 100,000. The age distribution consistently exhibited a clear two-tiered pattern, gradually shifting from being predominantly composed of young children to being dominated by older adults. Disparities were stark across SDI quintiles, low-SDI regions exhibited up to 100-times-higher under-five mortality than high-SDI regions. Geographic distribution showed the highest ASMRs in sub-Saharan Africa and the lowest in Canada, the United States, and Australia, with Mongolia and Finland showing the largest reductions in mortality. Epidemiological changes were the most significant factor in ASMR reduction. Conclusions: The SP-related LRI burden has decreased globally but remains a major health concern, especially in low-SDI regions. Targeted public health interventions, particularly for neonates and elderly adults, are essential to address persistent disparities and further reduce mortality. Full article

Background/Objectives: The under-five mortality rate (U5MR) remains a serious health challenge in Indonesia, with low birth weight (LBW) being a key risk factor. This study aimed to identify predictors of survival among under-five children with LBW using data from the 2017 Indonesia Demographic and Health Survey (IDHS). Methods: This cross-sectional study included 625 children under five with LBW. The dependent variable was under-five mortality (children aged 0–59 months), while the independent variables include child (gender), maternal (age at delivery, education, empowerment, delivery complications, and breastfeeding history), health service (antenatal care-ANC and place of delivery), and household (wealth quintile and residence) factors. Data were obtained from the 2017 IDHS using household and women’s questionnaires and analyzed using univariate analysis, Kaplan–Meier estimation, and Cox regression. Results: 41 of 625 children born with LBW died before the age of five. The Kaplan–Meier estimation found that maternal (delivery complications and breastfeeding history), health service (ANC history and place of delivery), and household factors (residence) significantly influenced the survival of LBW children. The Cox regression results showed that LBW children who were breastfeed and whose mother had adequate antenatal care visits had a lower risk of under-five mortality. Surprisingly, children born in health facilities had a significantly higher risk of death compared to those born elsewhere. Conclusions: Exclusive breastfeeding, adequate antenatal care, and place of delivery are important determinants of survival among children born with LBW. This support targeted interventions to improve the survival chances of children born with LBW, particularly in their early years of life. Full article

Background: Anaemia and undernutrition remain a significant public health problem in low and middle-income countries (LMICs), particularly affecting under-five children. In Tanzania, the prevalence of anaemia and undernutrition in under-five children is still high; however, less is known about the prevalence and predictors of these conditions in rural areas. Therefore, the current cross-sectional study presents the prevalence and determinants of anaemia and undernutrition among 457 children aged 6–24 months in the Babati and Hanang districts of Tanzania. Method: Haemoglobin concentration was assessed through capillary blood samples. Anaemia was classified according to WHO 2011 guidelines using a cut-off of <11.0 g/dL for children under five, while the WHO 2006 growth indicators were used to classify the nutritional status (i.e., stunting, wasting and underweight). Results: The results from this study show that 32%, 32%, 20% and 4% of children aged 6–24 months were anaemic, stunted, underweight and wasted, respectively, while only 33% had an adequate minimum dietary diversity (MDD). In addition, the child’s age (13–24 months) was significantly associated with anaemia (AOR: 2.1 95% CI 1.4, 3.1), stunting (AOR:17.4 95% CI 10.3, 29.4) and underweight (AOR: 15.9 95% CI 7.9, 32.0). Moreover, male children were three times more likely to be wasted (AOR: 3.5 95% CI 1.1, 10.9) than their female counterparts. Anaemia and stunting were the most prevalent nutritional disorders among 6–24-month-old children in the Hanang and Babati districts. Moreover, age (13–24 months) was found to be the common predictor for anaemia, stunting and underweight. Conclusion: The observed association between age and anaemia, as well as undernutrition, suggest that age may be an essential factor when designing nutrition-related programs in similar rural settings. Full article

Background/Objectives: Despite ongoing national interventions, pockets of acute malnutrition persist in rural settings of South Africa, contributing to disproportionate rates of child morbidity and mortality. This study aimed to identify risk factors associated with acute malnutrition among under-five children attending primary healthcare facilities in Msinga, KwaZulu-Natal Province, with a specific focus on dietary diversity and selected infant and young child feeding indicators. Methods: A cross-sectional, facility-based study was conducted among 415 mother–child pairs attending five randomly selected PHC facilities in the Msinga sub-district. Participants were selected using a multistage sampling design from a sampling frame of 18,797 under-five children. Of the 551 mother–child pairs approached; the final analytic sample comprised 415 observations. Data were collected through structured interviews, anthropometric assessments, and dietary diversity scores (DDS). Data were analyzed using Stata 18, and Poisson regression was applied to identify risk factors. Results: The prevalence of acute malnutrition was 29% based on weight-for-height/length z-scores (WHZ/WLZ) and 27% based on mid–upper-arm circumference z-scores (MUACZ). Children aged ≥36 months had significantly higher prevalence of acute malnutrition (aPR = 1.62; 95% CI: 1.15–2.10). Children from households with five or more members had reduced risk (aPR = 0.66; 95% CI: 0.45–0.74), and those born full-term showed a strong protective association (aPR = 0.39; 95% CI: 0.23–0.64). Maternal age was associated with reduced risk, with children of mothers aged 25–34 years (aPR = 0.67; 95% CI: 0.48–0.93) and ≥35 years (aPR = 0.58; 95% CI: 0.35–0.84) experiencing significantly lower prevalence. Mixed feeding was significantly associated with reduced risk (aPR = 0.86; 95% CI: 0.55–1.17), while a DDS ≥4 was protective (aPR = 0.41; 95% CI: 0.04–0.84). Consumption of protein-rich foods was notably low, with only 21% consuming flesh foods and 10% consuming eggs. Conclusions: Acute malnutrition in under-five children was significantly associated with poor diet quality, older age, low household income, and mixed feeding practices. Protective factors included full-term pregnancy, larger households, older maternal age, and adequate dietary diversity, highlighting the importance of targeted, multisectoral interventions. Full article

Background: Nearly half of under-five deaths are linked to undernutrition. Most evidence on undernutrition relies on conventional anthropometric measures. Conventional anthropometric measures fail to capture its overlapping forms and are limited in providing the true burden and distinct disaggregated patterns of undernutrition. Using the Composite Index of Anthropometric Failure (CIAF), this study aims to provide updated regional and country-level pooled prevalence estimates of the overall burden and various single and coexisting patterns of undernutrition among children in Sub-Saharan Africa (SSA). Methods: We systematically searched Medline, CINAHL, Web of Science, Scopus, and Google Scholar for studies published between January 2006 and October 2023. Studies reporting the prevalence of aggregated CIAF or any of the disaggregated forms of CIAF (stunting only, wasting only, underweight only, stunting-underweight, wasting-underweight, and stunting-wasting-underweight) based on the 2006 World Health Organisation (WHO) growth standard were included. Data extraction was performed by two reviewers, and discrepancies were resolved by consensus. Pooled prevalences of various categories of undernutrition were estimated using a random effect model meta-analysis. Subgroup analysis and meta-regression were performed to identify possible sources of heterogeneity among the included studies. Publication bias was checked using the Asymmetry funnel plot and Egger’s test. The protocol was registered on PROSPERO (CRD42023458796). Result: This systematic review and meta-analysis identified 3898 published studies from the database search, of which 26 were included. In SSA, the overall pooled prevalence of undernutrition among children was 37.45% (95% Confidence Interval (CI): 31.97, 42.92). Of these, 10% (95% CI: 8.02, 11.98) of children experienced at least one coexisting form, and 25.5% (95% CI: 16.78, 33.72) experienced at least one single form of undernutrition. Stunting only [22.32% (95% CI: 18.26, 26.39)] was the most prevalent disaggregated pattern of undernutrition, followed by the coexistence of stunting with underweight [10.15% (95% CI: 8.17, 12.13)]. Conclusions: Over one in three children in SSA experienced at least one form of undernutrition. Nearly one-third of these undernourished children were affected by multiple forms of undernutrition. The high prevalence of coexisting undernutrition indicates the need to develop multi-indicator nutrition strategies that could simultaneously address the various dimensions of undernutrition in children. Full article

Background/Objective: Rotavirus is a major cause of acute gastroenteritis (AGE) in children <5 years. While rotavirus vaccines are effective in reducing AGE, limited data on their indirect effects exist. The aim of our narrative systematic review was to summarise the indirect effects of rotavirus vaccines on unvaccinated children and adults (PROSPERO: CRD42023418015). Methods: Peer-reviewed articles and conference abstracts were searched through Medline, Embase and PubMed on 8 December 2024. Observational studies of national/regional vaccine introduction were included. We included five outcomes: rotavirus–AGE inpatient admissions, rotavirus–AGE outpatient attendances, all-cause AGE inpatient admissions, all-cause AGE outpatient attendances, and stool rotavirus positivity. Outcome measures reported as percent reduction or individual incidence rates for the pre- and post-introduction periods were transformed to incidence rate ratios (IRRs). Median IRRs and interquartile ranges (IQRs) were calculated for each outcome by age group (<5, 5–19, and >18 years). Results: From an initial 757 articles, 44 studies including 9,327,974 participants were included. In unvaccinated children <5 years, there were reductions in rotavirus–AGE admissions (median IRR: 0.62, IQR: 0.40–0.82), rotavirus–AGE outpatient attendances (0.74, 0.16–0.98), all-cause AGE admissions (0.70, 0.56–0.86), and stool rotavirus positivity (0.42, 0.31–0.57), but not all-cause AGE outpatient attendances (0.92, 0.78–1.17). Few studies reported these outcomes for children and adolescents aged 5–19 years and adults >18 years. Indirect effects appeared to be greater in higher income and lower under-five mortality settings. Conclusions: Understanding these indirect benefits is crucial for evaluating the broader impact and cost-effectiveness of rotavirus immunisation programs. Full article

Crude oil spills create environmental hazards, leading to air pollution and respiratory health risks in under-five children due to their developing organs. This study compares ambient air quality (AAQ) and the respiratory health (RH) of under-five children in crude oil-impacted and less-impacted communities. The study involved 450 under-five children (mean age: 3 years) from three Niger Delta communities: Bodo, K-Dere, and Beeri. AAQ was measured using sensors, and RH was assessed through interviewer-administered questionnaires between July and October 2022. Mean concentrations of pollutants, including PM_2.5, PM₁₀, TVOCs, and HCHO, were consistently higher in Bodo and K-Dere (oil-impacted communities) compared to Beeri (less-impacted community), with levels frequently exceeding both WHO and national standards. These concentrations were highest near spill sites and during evening periods, highlighting localized and temporal factors influencing air pollution. Respiratory symptoms such as cough, difficulty breathing, and persistent nasal congestion were significantly more prevalent among children in oil-impacted communities. Logistic regression analysis indicated a higher likelihood of respiratory issues in these communities, with odds ratios ranging from 2.53 to 14.18 for various symptoms. Elevated air pollution from crude oil spills correlates with a higher prevalence of respiratory conditions in children from impacted communities, underscoring the need for public health interventions in these areas. Full article

Background: Malnutrition among expectant mothers in underdeveloped areas is abundant and a serious public health concern. This study examines how maternal empowerment affects nutritional outcomes among under-five children in developing Asian nations. Objective: With an emphasis on nutritional outcomes, including stunting, wasting, and underweight, the main objective of this study is to investigate the connection between mother empowerment and child malnutrition and explore how better child health in developing Asian nations can be achieved through empowering mothers. Methods: Using Demographic and Health Survey (DHS) data of ten emerging Asian countries from three regions of Asia, this study evaluates maternal empowerment using the composite maternal empowerment index (CMEI) and examines how it relates to children’s nutritional health. For the assessment of the significance of the association between maternal empowerment and child health outcomes, statistical analysis was conducted. Results: Our results indicated that maternal empowerment and child health have a statistically significant relationship, especially regarding a reduction in the prevalence of stunting, wasting, and underweight conditions in children. At the same time, maternal education showed a significant role in reducing malnutrition in children in all three regions of Asia. Conclusion: In conclusion, developing Asian nations require empowering women. Also, it is essential to initiate nutrition programs, extension education, and synergistic working models that are especially suited to rural women. By strengthening mothers’ roles in promoting their children’s health, these initiatives can help solve the widespread problem of child malnutrition. Full article

Background: Exposure to household air pollution (HAP) is one of the primary risk factors for acute lower respiratory infection (ARI) morbidity and mortality among children in low-income settings. This study aimed to examine the relative contribution of residing in deprived neighbourhoods and exposure to HAP on the occurrence of ARI among children using data from the 2014–2015 Chad Demographic and Health Survey (DHS). Methods: We applied multilevel modelling techniques to survey data of 2882 children from 372 communities to compute the odds ratio (OR) for the occurrence of ARI between children of respondents exposed to clean fuels (e.g., electricity, liquid petroleum gas, natural gas, and biogas) and respondents exposed to polluting fuel (e.g., kerosene, coal/lignite, charcoal, wood, straw/shrubs/grass, and animal dung). Results: The results showed that children exposed to household polluting fuels in Chad were 215% more likely to develop ARI than those not exposed to household air pollution (OR = 3.15; 95% CI 2.41 to 4.13). Further analysis revealed that the odds of ARI were 185% higher (OR = 2.85; 95% CI 1.73 to 4.75) among children living in rural residents and those born to teenage mothers (OR = 2.75; 95% CI 1.48 to 5.15) who were exposed to household polluting fuels compared to their counterparts who were not exposed. In summary, the results of the study show that the risk of ARI is more common among children who live in homes where household air-polluting cooking fuel is widely used, those living in rural areas, those living in socioeconomically deprived neighbourhoods and from the least wealthy households, and those born to teenage mothers in Chad. Conclusions: In this study, an independent relative contribution of variables, such as HAP from cooking fuel, neighbourhood deprivation, living in rural areas, being from a low-income household, having a mother who is a manual labourer worker, and being given birth to by a teenage mother, to the risk of ARI among children is established. Full article

Background: The composite index of anthropometric failure (CIAF) studies co-occurrences of three forms of child undernutrition: stunting (S), wasting (W), and underweight (U). This study attempts to modify it through the inclusion of a fourth form of undernutrition, that is, anaemia (A), serving as a proxy for micronutrient deficiencies among under-five children in India. Methods: Spatial and multivariate analyses were employed to analyse the co-occurrences of child undernutrition with reference to the child’s and mother’s characteristics using National Family Health Survey (NFHS) data. Results: The modified index of “CIAF + Anaemia” identified thirteen manifestations of child undernutrition in India, the most prevalent co-occurrence being “only anaemia” (30%), followed by a triple burden or co-occurrence of stunting, underweight, and anaemia (SUA) (12%). The prevalence of the quadruple burden of child undernutrition (SWUA) was found to be highest in the states of Jharkhand and Gujarat (7%). A higher likelihood of the co-occurrence of “SUA” was observed among underweight mothers (16%), whereas that of “only anaemia” was observed more among overweight mothers (35%) compared to their counterparts. The co-occurrences “SUA” and “SWUA” were found to be moderately clustered among the districts of India. Conclusions: Overall, the study reinforces the need for early identification and specialised treatment approaches for children burdened with multiple forms of undernutrition to prevent its scarring effect. Full article

Introduction: Undernutrition in low- and middle-income countries (LMICs) remains a leading public health challenge. It accounts for one-third of the under-five mortality rate in sub-Saharan Africa (SSA). This study applied the composite index of anthropometric failure (CIAF) to assess the prevalence of various standalone and coexisting forms of undernutrition and identify associated risk factors. Methods: Nationally representative demographic health survey (DHS) data from 26 SSA countries were used. A multilevel multinomial logistic regression analysis was conducted considering the hierarchical nature of DHS data and more than two categories of outcome variable. Four models were fitted and the model with the highest log-likelihood and lowest deviance was chosen as the best-fitted model. The adjusted relative risk ratio (aRRR) with its corresponding 95% confidence interval (CI) was presented as a measure of the effect. Results: The overall prevalence of undernutrition among under-five children in SSA was 34.59% (95% CI: 34.35–34.82). Additionally, 20.49% (95% CI: 20.30–20.69) and 14.09% (95% CI: 13.92–14.26) of under-five children had standalone and coexisting undernutrition, respectively. The mother’s educational level and household wealth status were the most significant shared drivers for standalone and coexisting undernutrition. On the other hand, child and health service factors were differentiating factors between standalone and coexisting undernutrition. Age of the child, sex of the child, type of birth, birth weight, adherence to age-appropriate feeding, antenatal care visit (ANC), place of delivery, and maternal educational status were the most significant determinants of various undernutrition forms in 0–23-month-old children. For 24–59-month-old children, age of the child, sex of the child, type of birth, household wealth status, and maternal education were identified as the main determinants of different forms of undernutrition. Conclusions: Our analysis revealed that distal factors were shared risk factors among standalone and coexisting forms of undernutrition. However, proximal and intermediate factors varied in the type and strength of the association between standalone and coexisting undernutrition. This implies that holistic and category-specific strategies are needed to significantly reduce undernutrition among under-five children in SSA. Full article