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Tshivhase L, Magavha TA, Moloko SM. Guardians' involvement in the management of childhood illnesses in Vhembe district, Limpopo. Health SA 2024; 29:2715. [PMID: 39229316 PMCID: PMC11369609 DOI: 10.4102/hsag.v29i0.2715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 07/18/2024] [Indexed: 09/05/2024] Open
Abstract
Background Guardians' involvement in the management of childhood illnesses plays a pivotal role in reducing mortality and morbidity among children under 5 years old. It is through the guardian's eyes that the child can be afforded timely healthcare, prevented from contracting an illness and effectively taken prescribed medication. Aim The study aimed to explore the guardians' lived experiences in their involvement in managing childhood illnesses in Vhembe district, Limpopo province, South Africa. Setting A qualitative, exploratory and descriptive study was conducted with 16 purposively sampled participants. Methods One-on-one individual interviews were conducted with participants. Data were analysed following Braun and Clarke's thematic analysis. Results Guardians reported their involvement by seeking child healthcare in healthcare facilities when ill and due for immunisations. Involvement in childhood care is performed through assessment of child illness at home, follow-up, referral of children to healthcare facilities, promotion of child health and prevention of childhood illnesses. Conclusion Children remain dependent on guardians for their well-being. Seeking care, preventing illnesses and promoting childhood health are vital in reducing child mortality and childhood morbidity. Contribution Involving and empowering guardians regarding the care of children under 5 years old are vital in achieving Sustainable Development Goal number 3 in 2030.
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Affiliation(s)
- Livhuwani Tshivhase
- Department of Nursing School of Health care Sciences, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Department of Health Studies, College of Human Sciences, University of South Africa, Pretoria, South Africa
| | - Tshifhiwa A. Magavha
- Department of Nursing School of Health care Sciences, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Sophy M. Moloko
- Department of Nursing School of Health care Sciences, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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Nwankpa OP, Ekwueme CN, Akamike I, Mbachu CO, Onwujekwe O. Do male and female heads of households have different beliefs about gender equity among young people in Nigeria? FRONTIERS IN SOCIOLOGY 2024; 9:1354991. [PMID: 39206324 PMCID: PMC11349628 DOI: 10.3389/fsoc.2024.1354991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 06/28/2024] [Indexed: 09/04/2024]
Abstract
Introduction Gender-transformative approaches (GTAs) have been successfully carried out to address harmful gender norms and power imbalances to promote more gender equitability. However, to improve the health and wellbeing of young people, it is necessary to involve household heads by positively transforming their beliefs on gender equity and norms. Methods This study was cross-sectional quantitative research undertaken in six local government areas in Ebonyi State, Nigeria. The study population consisted of household heads in households with young people aged 15-24 years. Data were collected for 15 days using paper and electronic copies of the questionnaire. Descriptive, bivariate, and logistic regression analyses were performed using Stata. Results The results showed that 46.32% of male and 62.81% of female heads of households disagreed with the statement "a good woman never questions her husband's opinions, even if she is not sure she agrees with them." Female heads of households aged 50 years and below with an odds ratio of 0.47 (p-value = 0.02) suggest they were 0.47 times more likely to have a positive attitude toward the rights and privileges of young girls. Male heads of households aged 50 years and below with an odds ratio of 1.05 (p-value = 0.84) suggest that they were 1.05 times more likely to have a positive attitude toward the rights and privileges of young girls. Conclusion This paper provides new knowledge on the gender norm attitude of male and female heads of households on the rights, privileges, and equity promotion of young boys and young girls, as well as its associated factors.
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Affiliation(s)
| | - Chinazom N. Ekwueme
- Health Policy Research Group, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Ifeyinwa Akamike
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Abakaliki, Nigeria
| | | | - Obinna Onwujekwe
- Health Policy Research Group, University of Nigeria, Enugu Campus, Enugu, Nigeria
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Eduku S, Annan E, Amponsah MA. Maternal social support and resilience in caring for preterm newborns at the neonatal intensive care unit (NICU): A qualitative study. Heliyon 2024; 10:e34731. [PMID: 39149050 PMCID: PMC11325064 DOI: 10.1016/j.heliyon.2024.e34731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 07/08/2024] [Accepted: 07/16/2024] [Indexed: 08/17/2024] Open
Abstract
Introduction Mothers with preterm babies at the NICU are at a high risk of acquiring psychological distress as a result of unexpected and upsetting experiences. While there is a strong emphasis on the infant's health, the mother's well-being, particularly her mental health, is sometimes disregarded. A qualitative exploratory descriptive design was used to explore maternal social support and resilience in caring for preterm newborns at the NICU in Municipal hospital in Ghana from May to July 2022. Methods A qualitative exploratory method was used, and a purposive sampling technique was used to select 15 postnatal women who had their preterm babies on admission to the NICU until data saturation. Data was analysed using thematic content analysis. Results The findings of the study showed that social support for their mothers as they care for their preterm infants contributed to their resilience. Three themes emerged from the analysis of the data: informational support, instrumental support and psychosocial support. Conclusion There is a need for training in communication skills and counselling for healthcare professionals working in the NICU to be able to communicate effectively with mothers and also adopt a family-centered approach in the care of preterm infants. This will support mothers to strengthen their resilience when caring for their premature babies in the NICU. The role of instrumental support for mothers specifically financial and physical care support in building maternal resilience cannot be overemphasised.
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Adamu A, Ango UM. Health-seeking Behavior among Mothers of Under-five Children in Sokoto Metropolis, Sokoto, Nigeria. Ann Afr Med 2024; 23:335-342. [PMID: 39034556 PMCID: PMC11364322 DOI: 10.4103/aam.aam_112_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 11/21/2023] [Accepted: 01/04/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND In most developing countries, the health of the children is strongly dependent on maternal health-care-seeking behavior. The ability of caregivers to recognize and seek appropriate care for childhood illnesses is instrumental in reducing childhood deaths and preventing significant number of complications. The study aimed to determine the health-care-seeking behavior and associated factors among the mothers of under-five (U5) children in Sokoto Metropolis. METHODOLOGY This was a descriptive, cross-sectional study carried out among 386 mothers of U5 children in Sokoto metropolis from August 1 to September 30, 2021. The study participants were selected using the multistage sampling technique. A structured questionnaire was used to collect the information. Data were analyzed using the SPSS version 24. The level of significance for Chi-square was set at a P < 0.05. RESULTS Majority 312 (80.8%) of the respondents U5 children had fallen sick in the last 6 months, most of which 238 (61.7%) were not taken to a health facility. The major reasons why respondents do not take their U5 children to a health facility when sick are because they bought drugs from patent medicine vendor and perceiving the illness of the U5 as not serious to warrant taking the child to a health facility in 93 (24.1%) and 63 (16.3%), respectively. There was association (P ≤ 0.05) between health-care-seeking behavior and respondents' level of education, occupation, monthly income, as well as distance taken to reach a health facility within 30 min' walk. CONCLUSIONS The health-seeking behavior of the mothers for their U5 was poor. Maternal level of education, occupation, income, and lesser number of children in the family were the factors that were significantly associated with seeking health facility care for a sick U5. This study recommends girl child education, women empowerment, and increase access to family planning by the government.
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Affiliation(s)
- Asma’u Adamu
- Department of Paediatrics, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Umar Mohammad Ango
- Department of Community Health, Usmanu Danfodiyo University, Sokoto, Nigeria
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Kawakatsu Y, Mosser JF, Adolph C, Baffoe P, Cheshi F, Aiga H, Watkins DA, Sherr KH. High-resolution mapping of essential maternal and child health service coverage in Nigeria: a machine learning approach. BMJ Open 2024; 14:e080135. [PMID: 38858137 PMCID: PMC11168136 DOI: 10.1136/bmjopen-2023-080135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 05/12/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND National-level coverage estimates of maternal and child health (MCH) services mask district-level and community-level geographical inequities. The purpose of this study is to estimate grid-level coverage of essential MCH services in Nigeria using machine learning techniques. METHODS Essential MCH services in this study included antenatal care, facility-based delivery, childhood vaccinations and treatments of childhood illnesses. We estimated generalised additive models (GAMs) and gradient boosting regressions (GB) for each essential MCH service using data from five national representative cross-sectional surveys in Nigeria from 2003 to 2018 and geospatial socioeconomic, environmental and physical characteristics. Using the best-performed model for each service, we map predicted coverage at 1 km2 and 5 km2 spatial resolutions in urban and rural areas, respectively. RESULTS GAMs consistently outperformed GB models across a range of essential MCH services, demonstrating low systematic prediction errors. High-resolution maps revealed stark geographic disparities in MCH service coverage, especially between rural and urban areas and among different states and service types. Temporal trends indicated an overall increase in MCH service coverage from 2003 to 2018, although with variations by service type and location. Priority areas with lower coverage of both maternal and vaccination services were identified, mostly located in the northern parts of Nigeria. CONCLUSION High-resolution spatial estimates can guide geographic prioritisation and help develop better strategies for implementation plans, allowing limited resources to be targeted to areas with lower coverage of essential MCH services.
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Affiliation(s)
- Yoshito Kawakatsu
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Jonathan F Mosser
- Health Metrics Sciences, University of Washington, Seattle, Washington, USA
| | - Christopher Adolph
- Department of Political Science, University of Washington, Seattle, Washington, USA
| | | | | | - Hirotsugu Aiga
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Department of Global Health, George Washington University School of Public Health and Health Services, Washington, DC, USA
| | - D A Watkins
- Department of Medicine, University of Washington, Seattle, Seattle, Washington, USA
| | - Kenneth H Sherr
- Department of Global Health, University of Washington, Seattle, Washington, USA
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Eom YJ, Chi H, Jung S, Kim J, Jeong J, Subramanian S, Kim R. Women's empowerment and child anthropometric failures across 28 sub-Saharan African countries: A cross-level interaction by Gender Inequality Index. SSM Popul Health 2024; 26:101651. [PMID: 38524893 PMCID: PMC10958109 DOI: 10.1016/j.ssmph.2024.101651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 02/01/2024] [Accepted: 03/02/2024] [Indexed: 03/26/2024] Open
Abstract
Background Child undernutrition remains a major global health issue, particularly in sub-Saharan Africa (SSA). Given the important role mothers play in early childhood health and development, we examined how individual-level women's empowerment and country-level Gender Inequality Index (GII) are jointly related with child undernutrition in SSA. Methods We pooled recent Demographic and Health Surveys from 28 SSA countries. For 137,699 children <5 years old, undernutrition was defined using anthropometric failures (stunting, underweight, wasting). Women's empowerment was assessed using three domains of Survey-based Women's EmPowERment (SWPER) index: attitude to violence, social independence, and decision-making; and country-level gender inequality was measured using GII from United Nations Development Programme. Three-level logistic regression was conducted to examine the joint associations of SWPER and GII as well as their interactions with child anthropometric failures, after adjusting for sociodemographic covariates. Results Overall, 32.85% of children were stunted, 17.63% were underweight, and 6.68% had wasting. Children of mothers with low-level of empowerment for all domains of SWPER had higher odds of stunting (attitude to violence: OR=1.15; 95% CI, 1.11-1.19; social independence: OR=1.21; 95% CI, 1.17-1.25; decision-making: OR=1.16; 95% CI, 1.12-1.20), and consistent results were found for underweight and wasting. Independent of women's empowerment, country-level GII increased the probability of underweight (ranging ORs=1.46; 95% CI, 1.15-1.85 to 1.50; 95% CI, 1.18-1.90) and wasting (ranging ORs=1.56; 95% CI, 1.24-1.97 to 1.61; 95% CI, 1.27-2.03). Significant interaction was found between women's empowerment and country-level GII for stunting and underweight (p<0.05). Conclusions In SSA countries with greater gender inequality, improving women's social independence and decision-making power in particular can reduce their children's risk of anthropometric failures. Policies and interventions targeted at strengthening women's empowerment should consider the degree of gender inequality in each country.
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Affiliation(s)
- Yun-Jung Eom
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, 145 Anam-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Hyejun Chi
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, 145 Anam-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Sohee Jung
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, 145 Anam-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Jinseo Kim
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, 145 Anam-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Joshua Jeong
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1516 Clifton Road, NE, Atlanta, GA, 30322, USA
| | - S.V. Subramanian
- Harvard Center for Population and Development Studies, Cambridge, MA, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Rockli Kim
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, 145 Anam-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
- Division of Health Policy and Management, College of Health Sciences, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
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Chi H, Eom YJ, Jung S, Kim J, Jeong J, Kim R. Maternal Decision-Making Power and Care-Seeking Behaviors for Acutely Ill Children: A Multilevel Analysis of 33 Sub-Saharan African Countries. Am J Trop Med Hyg 2024; 110:370-378. [PMID: 38190745 PMCID: PMC10859818 DOI: 10.4269/ajtmh.23-0511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/26/2023] [Indexed: 01/10/2024] Open
Abstract
Timely and appropriate healthcare seeking is crucial to reduce child mortality. However, rates of care seeking for acute childhood diseases remain low in sub-Saharan Africa (SSA). This study investigated the association between maternal decision-making power and care-seeking behaviors for children with diarrhea and acute respiratory infection (ARI) in SSA. Demographic and Health Surveys from 33 SSA countries were used in a sample of mother-child pairs (mothers aged 15-49 years; children aged 0-59 months) with a recent child episode of diarrhea (N = 41,729) and ARI (N = 71,966). Maternal decision-making power was defined as making decisions on all four familial topics alone or jointly with the husband/partner. Care-seeking behaviors were measured as seeking care from health providers, other types of providers, and any providers (including both). Multivariable three-level logistic regressions were conducted. Approximately 60% of the sample sought care from any provider (46-48% from health providers versus 13-14% from others). Approximately 28% of mothers had high decision-making power. After adjusting for sociodemographic characteristics, high maternal decision-making power was associated with higher likelihood of seeking care from a health provider for both diarrhea (adjusted odds ratio [aOR] = 1.06, 95% CI = 1.01-1.12) and ARI (aOR = 1.07, 95% CI = 1.03-1.11) and lower likelihood of seeking care from others (aOR = 0.89, 95% CI = 0.82-0.97 for diarrhea; aOR = 0.88, 95% CI = 0.82-0.94 for ARI). Maternal decision-making power was positively associated with their care-seeking behaviors from health providers for acutely ill children in SSA. Women's empowerment interventions that particularly increase women's agency in decision-making may holistically improve health and well-being of the next generation.
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Affiliation(s)
- Hyejun Chi
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
| | - Yun-Jung Eom
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
| | - Sohee Jung
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
| | - Jinseo Kim
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
| | - Joshua Jeong
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Rockli Kim
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
- Division of Health Policy and Management, College of Health Sciences, Korea University, Seoul, Republic of Korea
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Bolarinwa OA, Hajjar JM, Alawode OA, Ajayi KV, Roberts AT, Yaya S. Multiple high-risk fertility behaviours and children under five mortality survivors among ever-married women of reproductive age in Nigeria. Arch Public Health 2023; 81:175. [PMID: 37759256 PMCID: PMC10523755 DOI: 10.1186/s13690-023-01192-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Multiple high-risk fertility behaviours (MHRFBs), including maternal age < 18 or > 34 years old, a birth order 4+, and birth spacing < 24 months, can directly or indirectly affect survival outcomes among under-five children. There is a dearth of available information and data about these two phenomena in Nigeria. Thus, this study evaluates the prevalence of MHRFBs and examines the association between MHRFBs and under-five mortality survival (U5M) outcomes among ever-married women of reproductive age in Nigeria. METHODS This study used the recent secondary datasets from the Nigerian Demographic Health Surveys conducted in 2018, with a total sample size of 10,304 women of reproductive age. The outcome variable was MHRFBs. Multivariable logistic regression analysis was employed to examine the association between U5M and MHRFBs. Odds ratios with a p-value of less than 0.05 were considered significant. RESULTS It was found that among women who had MHRFBs, U5M was prevalent, particularly in young maternal age (< 18 years) and within short birth intervals (< 24 months). The adjusted odds ratio of the association between MHRFBs and U5M shows the experience of MHRFBs, in addition to other factors such as household wealth index, type of marriage, and sex of child, to be significant predictors for U5M. The odds were higher for U5M to occur among women who had experienced MHRFBs compared to those who have not had an experience of MHRFBs [aOR = 1.48; 95%CI: 1.02-2.17 ]. Similarly, the odds of U5M occurrence among women in polygamous marriages are higher compared to those in monogamous unions [aOR = 1.35; 95% CI: 1.10-1.65]. While under-five children born in the richest households (wealth quintiles) are less likely to die compared to those born in the poorest households [aOR = 0.64; 95% CI: 0.41-1.01]. CONCLUSION This study concludes that women in Nigeria who engaged in MHRFBs, particularly maternal ages < 18 years and short birth intervals (< 24 months), were more likely to experience U5M. Furthermore, children born to women who received post-natal care after delivery were more likely to survive U5M, as were children born to women with educated partners. We recommend strengthening educational opportunities and creating adaptive reproductive health education programs for ever-married women of reproductive age in Nigeria.
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Affiliation(s)
- Obasanjo Afolabi Bolarinwa
- Department of Public Health, York St. John University, London, UK.
- Department of Demography and Population Studies, University of Witwatersrand, Johannesburg, South Africa.
| | - Julia Marie Hajjar
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Oluwatobi Abel Alawode
- Department of Sociology and Criminology & Law, University of Florida, Gainesville, FL, 32611, USA
| | - Kobi V Ajayi
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, TX, USA
| | | | - Sanni Yaya
- School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, Ottawa, ON, Canada
- The George Institute for Global Health, Imperial College London, London, UK
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Bakare AA, King C, Salako J, Bakare D, Uchendu OC, Burgess RA, Shittu F, Iuliano A, Isah A, Ahmed T, Ahmar S, Valentine P, Olowookere TF, McCollum ED, Colbourn T, Falade AG, Graham HR. Pneumonia knowledge and care seeking behavior for children under-five years in Jigawa, Northwest Nigeria: a cross-sectional study. Front Public Health 2023; 11:1198225. [PMID: 37533532 PMCID: PMC10393027 DOI: 10.3389/fpubh.2023.1198225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/19/2023] [Indexed: 08/04/2023] Open
Abstract
Background Between 2013 and 2022, Nigeria did not meet globally defined targets for pneumonia control, despite some scale-up of vaccinations, oxygen and antibiotics. A deliberate focus on community-based programs is needed to improve coverage of protective, preventive and treatment interventions. We therefore aimed to describe caregiver knowledge and care seeking behaviour for childhood pneumonia, in a high child mortality setting in Nigeria, to inform the development of effective community-based interventions for pneumonia control. Methods We conducted a cross-sectional household survey in Kiyawa Local Government Area, Jigawa State, Nigeria between December 2019 and March 2020. We asked caregivers about their knowledge of pneumonia symptoms, prevention, risks, and treatment. A score of 1 was assigned for each correct response. We showed them videos of pneumonia specific symptoms and asked (1) if their child had any respiratory symptoms in the 2-weeks prior; (2) their subsequent care-seeking behaviour. Multivariate regressions explored socio-demographic and clinical factors associated with care seeking. Results We surveyed 1,661 eligible women, with 2,828 children under-five. Only 4.9% of women could name both cough and difficulty/fast breathing as pneumonia symptoms, and the composite knowledge scores for pneumonia prevention, risks and treatment were low. Overall, 19.0% (536/2828) of children had a report of pneumonia specific symptoms in the prior two-weeks, and of these 32.3% (176/536) were taken for care. The odds of care seeking was higher among children: with fever (AOR:2:45 [95% CI: 1.38-4.34]); from wealthiest homes (AOR: 2:13 [95% CI: 1.03-4.38]) and whose mother first married at 20-26 years compared to 15-19 years (AOR: 5.15 [95% CI: 1.38-19.26]). Notably, the caregiver's knowledge of pneumonia was not associated with care seeking. Conclusion While some socio-demographic factors were associated with care seeking for children with symptoms of Acute Respiratory Infection (ARI), caregiver's knowledge of the disease was not. Therefore, when designing public health interventions to address child mortality, information-giving alone is likely to be insufficient.
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Affiliation(s)
- Ayobami A. Bakare
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
- Department of Community Medicine, University College Hospital, Ibadan, Nigeria
| | - Carina King
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Julius Salako
- Department of Paediatrics, University of Ibadan, Ibadan, Nigeria
| | - Damola Bakare
- Department of Paediatrics, University of Ibadan, Ibadan, Nigeria
| | - Obioma C. Uchendu
- Department of Community Medicine, University College Hospital, Ibadan, Nigeria
- Department of Community Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Funmilayo Shittu
- Department of Paediatrics, University of Ibadan, Ibadan, Nigeria
| | - Agnese Iuliano
- Institute for Global Health, University College London, London, United Kingdom
| | - Adamu Isah
- Save the Children International, Abuja, Nigeria
| | | | - Samy Ahmar
- Save the Children UK, London, United Kingdom
| | | | | | - Eric D. McCollum
- Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Tim Colbourn
- Institute for Global Health, University College London, London, United Kingdom
| | - Adegoke G. Falade
- Department of Paediatrics, University of Ibadan, Ibadan, Nigeria
- Department of Paediatrics, University College Hospital, Ibadan, Nigeria
| | - Hamish R. Graham
- Department of Paediatrics, University College Hospital, Ibadan, Nigeria
- Centre for International Child Health, Murdoch Children’s Research Institute, University of Melbourne, Royal Children’s Hospital, Parkville, VIC, Australia
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Akinrinoye OO, Labaeka AA, Fowobaje KR, Graham H, Falade AG. Low Mortality among Under-5 Children with Severe Community-Acquired Pneumonia: A 5-Year Retrospective Analysis of 588 Admissions in Ibadan, Nigeria. J PEDIAT INF DIS-GER 2023. [DOI: 10.1055/s-0043-1767815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Abstract
Objective Community-acquired pneumonia (CAP) is the commonest cause of death in under-5 children worldwide. Although the mortality from CAP has decreased over the last decade, it is still unacceptably high in lower-middle-income countries (LMICs). We aimed to determine the case fatality rate (CFR), and factors associated with treatment failure and outcome, using recommended antimicrobials.
Methods A 5-year retrospective review of severe pediatric pneumonia admissions between August 1st, 2014 and July 31st, 2019 at the University College Hospital, Ibadan, Nigeria was conducted. Relevant clinical information including antibiotics use and outcome was analyzed using descriptive statistics, test of association, and logistic regression.
Results There were 588 children aged 2 to 59 months, male:female ratio was 1.5:1. About two-thirds were aged ≤12 months. The majority were fully immunized for age (87.2%), about 34% were malnourished and 68% were hypoxemic at presentation. Only 71% of children were commenced on the recommended first-line antibiotics following the Pediatric Association of Nigeria (PAN) antibiotic guidelines. Initial antibiotics were changed in 22.3% of the patients. The need to change intravenous (iv) amoxicillin plus iv gentamicin was necessary in 23.80% compared with 18.1% for iv cefuroxime plus iv gentamicin. Severe acute malnutrition (odds ratio [OR]: 2.8 [95% confidence interval [CI]: 1.1–7.3]) and hypoxemia (OR:2.3 [95%CI: 1.0–5.6]) were independently associated with antibiotics change. The CFR was 1.36%.
Conclusion The low CFR suggests a better outcome compared with other previous studies in LMICs. However, the high rate of antibiotics changes (22.3%) was possibly due to failure of first line antibiotics; especially among malnourished and hypoxemic children. Randomized controlled trial of iv cefuroxime plus gentamicin versus iv amoxicillin plus gentamicin is recommended.
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Affiliation(s)
| | | | | | - Hamish Graham
- Department of Pediatrics, University College Hospital, Ibadan, Nigeria
- Centre for International Child Health, The Royal Children's Hospital, Murdoch Children Research Institute, University of Melbourne, Parkville, Australia
| | - Adegoke Gbadegesin Falade
- Department of Pediatrics, University College Hospital, Ibadan, Nigeria
- Department of Pediatrics, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Tack B, Vita D, Nketo J, Wasolua N, Ndengila N, Herssens N, Ntangu E, Kasidiko G, Nkoji-Tunda G, Phoba MF, Im J, Jeon HJ, Marks F, Toelen J, Lunguya O, Jacobs J. Health itinerary-related survival of children under-five with severe malaria or bloodstream infection, DR Congo. PLoS Negl Trop Dis 2023; 17:e0011156. [PMID: 36877726 PMCID: PMC10019685 DOI: 10.1371/journal.pntd.0011156] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 03/16/2023] [Accepted: 02/09/2023] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND Prompt appropriate treatment reduces mortality of severe febrile illness in sub-Saharan Africa. We studied the health itinerary of children under-five admitted to the hospital with severe febrile illness in a setting endemic for Plasmodium falciparum (Pf) malaria and invasive non-typhoidal Salmonella infections, identified delaying factors and assessed their associations with in-hospital death. METHODOLOGY Health itinerary data of this cohort study were collected during 6 months by interviewing caretakers of children (>28 days - <5 years) admitted with suspected bloodstream infection to Kisantu district hospital, DR Congo. The cohort was followed until discharge to assess in-hospital death. PRINCIPAL FINDINGS From 784 enrolled children, 36.1% were admitted >3 days after fever onset. This long health itinerary was more frequent in children with bacterial bloodstream infection (52.9% (63/119)) than in children with severe Pf malaria (31.0% (97/313)). Long health itinerary was associated with in-hospital death (OR = 2.1, p = 0.007) and two thirds of deaths occurred during the first 3 days of admission. Case fatality was higher in bloodstream infection (22.8% (26/114)) compared to severe Pf malaria (2.6%, 8/309). Bloodstream infections were mainly (74.8% (89/119)) caused by non-typhoidal Salmonella. Bloodstream infections occurred in 20/43 children who died in-hospital before possible enrolment and non-typhoidal Salmonella caused 16 out of these 20 bloodstream infections. Delaying factors associated with in-hospital death were consulting traditional, private and/or multiple providers, rural residence, prehospital intravenous therapy, and prehospital overnight stays. Use of antibiotics reserved for hospital use, intravenous therapy and prehospital overnight stays were most frequent in the private sector. CONCLUSIONS Long health itineraries delayed appropriate treatment of bloodstream infections in children under-five and were associated with increased in-hospital mortality. Non-typhoidal Salmonella were the main cause of bloodstream infection and had high case fatality. TRIAL REGISTRATION NCT04289688.
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Affiliation(s)
- Bieke Tack
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Department of Pediatrics, University Hospitals UZ Leuven, Leuven, Belgium
- * E-mail:
| | - Daniel Vita
- Hôpital Général de Référence Saint Luc de Kisantu, Kisantu, Democratic Republic of the Congo
| | - José Nketo
- Zone de Santé Kisantu, Kisantu, Democratic Republic of the Congo
| | - Naomie Wasolua
- Hôpital Général de Référence Saint Luc de Kisantu, Kisantu, Democratic Republic of the Congo
| | - Nathalie Ndengila
- Hôpital Général de Référence Saint Luc de Kisantu, Kisantu, Democratic Republic of the Congo
| | - Natacha Herssens
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Emmanuel Ntangu
- Hôpital Général de Référence Saint Luc de Kisantu, Kisantu, Democratic Republic of the Congo
| | - Grace Kasidiko
- Hôpital Général de Référence Saint Luc de Kisantu, Kisantu, Democratic Republic of the Congo
| | - Gaëlle Nkoji-Tunda
- Department of Microbiology, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
- Department of Medical Biology, University Teaching Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Marie-France Phoba
- Department of Microbiology, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
- Department of Medical Biology, University Teaching Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Justin Im
- International Vaccine Institute, Seoul, Republic of Korea
| | - Hyon Jin Jeon
- International Vaccine Institute, Seoul, Republic of Korea
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Florian Marks
- International Vaccine Institute, Seoul, Republic of Korea
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
- Madagascar Institute for Vaccine Research, University of Antananarivo, Antananarivo, Madagascar
| | - Jaan Toelen
- Department of Pediatrics, University Hospitals UZ Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Octavie Lunguya
- Department of Microbiology, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
- Department of Medical Biology, University Teaching Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Jan Jacobs
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
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Defar A, B. Okwaraji Y, Tigabu Z, Persson LÅ, Alemu K. Spatial distribution of common childhood illnesses, healthcare utilisation and associated factors in Ethiopia: Evidence from 2016 Ethiopian Demographic and Health Survey. PLoS One 2023; 18:e0281606. [PMID: 36897920 PMCID: PMC10004611 DOI: 10.1371/journal.pone.0281606] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 01/26/2023] [Indexed: 03/11/2023] Open
Abstract
INTRODUCTION Childhood illnesses, such as acute respiratory illness, fever, and diarrhoea, continue to be public health problems in low-income countries. Detecting spatial variations of common childhood illnesses and service utilisation is essential for identifying inequities and call for targeted actions. This study aimed to assess the geographical distribution and associated factors for common childhood illnesses and service utilisation across Ethiopia based on the 2016 Demographic and Health Survey. METHODS The sample was selected using a two-stage stratified sampling process. A total of 10,417 children under five years were included in this analysis. We linked data on their common illnesses during the last two weeks and healthcare utilisation were linked to Global Positioning System (GPS) information of their local area. The spatial data were created in ArcGIS10.1 for each study cluster. We applied a spatial autocorrelation model with Moran's index to determine the spatial clustering of the prevalence of childhood illnesses and healthcare utilisation. Ordinary Least Square (OLS) analysis was done to assess the association between selected explanatory variables and sick child health services utilisation. Hot and cold spot clusters for high or low utilisation were identified using Getis-Ord Gi*. Kriging interpolation was done to predict sick child healthcare utilisation in areas where study samples were not drawn. All statistical analyses were performed using Excel, STATA, and ArcGIS. RESULTS Overall, 23% (95CI: 21, 25) of children under five years had some illness during the last two weeks before the survey. Of these, 38% (95%CI: 34, 41) sought care from an appropriate provider. Illnesses and service utilisation were not randomly distributed across the country with a Moran's index 0.111, Z-score 6.22, P<0.001, and Moran's index = 0.0804, Z-score 4.498, P< 0.001, respectively. Wealth and reported distance to health facilities were associated with service utilisation. Prevalence of common childhood illnesses was higher in the North, while service utilisation was more likely to be on a low level in the Eastern, South-western, and the Northern parts of the country. CONCLUSION Our study provided evidence of geographic clustering of common childhood illnesses and health service utilisation when the child was sick. Areas with low service utilisation for childhood illnesses need priority, including actions to counteract barriers such as poverty and long distances to services.
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Affiliation(s)
- Atkure Defar
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | - Yemisrach B. Okwaraji
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Zemene Tigabu
- Department of Paediatrics and Child Health, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Lars Åke Persson
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kassahun Alemu
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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King C, Siddle M, Adams O, Ahmar S, Ahmed T, Bakare AA, Bakare D, Burgess RA, Colbourn T, McCollum ED, Olowookere T, Salako J, Uchendu O, Graham HR, Falade AG. Prevalence of pneumonia and malnutrition among children in Jigawa state, Nigeria: a community-based clinical screening study. BMJ Paediatr Open 2022; 6:e001640. [PMID: 36645778 PMCID: PMC9577914 DOI: 10.1136/bmjpo-2022-001640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/27/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To estimate the point prevalence of pneumonia and malnutrition and explore associations with household socioeconomic factors. DESIGN Community-based cross-sectional study conducted in January-June 2021 among a random sample of households across all villages in the study area. SETTING Kiyawa Local Government Area, Jigawa state, Nigeria. PARTICIPANTS Children aged 0-59 months who were permanent residents in Kiyawa and present at home at the time of the survey. MAIN OUTCOME MEASURES Pneumonia (non-severe and severe) defined using WHO criteria (2014 revision) in children aged 0-59 months. Malnutrition (moderate and severe) defined using mid-upper arm circumference in children aged 6-59 months. RESULTS 9171 children were assessed, with a mean age of 24.8 months (SD=15.8); 48.7% were girls. Overall pneumonia (severe or non-severe) point prevalence was 1.3% (n=121/9171); 0.6% (n=55/9171) had severe pneumonia. Using an alternate definition that did not rely on caregiver-reported cough/difficult breathing revealed higher pneumonia prevalence (n=258, 2.8%, 0.6% severe, 2.2% non-severe). Access to any toilet facility was associated with lower odds of pneumonia (aOR: 0.56; 95% CI: 0.31 to 1.01). The prevalence of malnutrition (moderate or severe) was 15.6% (n=1239/7954) with 4.1% (n=329/7954) were severely malnourished. Being older (aOR: 0.22; 95% CI: 0.17 to 0.27), male (aOR: 0.77; 95% CI: 0.66 to 0.91) and having head of compound a business owner or professional (vs subsistence farmer, aOR 0.71; 95% CI: 0.56 to 0.90) were associated with lower odds of malnutrition. CONCLUSIONS In this large, representative community-based survey, there was a considerable pneumonia and malnutrition morbidity burden. We noted challenges in the diagnosis of Integrated Management of Childhood Illness-defined pneumonia in this context.
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Affiliation(s)
- Carina King
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Morgan Siddle
- Institute for Global Health, University College London, London, UK
| | - Osebi Adams
- Save the Children International, Abuja, Nigeria
| | | | | | - Ayobami Adebayo Bakare
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Community Medicine, University College Hospital Ibadan, Ibadan, Nigeria
| | - Damola Bakare
- Paediatrics, University College Hospital Ibadan, Ibadan, Nigeria
| | | | - Tim Colbourn
- Institute for Global Health, University College London, London, UK
| | - Eric D McCollum
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | - Julius Salako
- Paediatrics, University College Hospital Ibadan, Ibadan, Nigeria
| | - Obioma Uchendu
- Department of Community Medicine, University College Hospital Ibadan, Ibadan, Nigeria
- Department of Community Medicine, University of Ibadan, Ibadan, Nigeria
| | - Hamish R Graham
- Paediatrics, University College Hospital Ibadan, Ibadan, Nigeria
- International Child Health, MCRI, Royal Children's Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Adegoke Gbadegesin Falade
- Paediatrics, University College Hospital Ibadan, Ibadan, Nigeria
- College of Medicine, University of Ibadan, Ibadan, Nigeria
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Morello T, Lima AS, da Silva RG. Drivers of respiratory health care demand in Acre state, Brazilian Amazon: a cross-sectional study. BMC Public Health 2022; 22:1821. [PMID: 36153579 PMCID: PMC9509621 DOI: 10.1186/s12889-022-14171-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 07/21/2022] [Indexed: 11/28/2022] Open
Abstract
Background The scarce knowledge about the drivers of demand for respiratory health care in the Brazilian Amazon, where the gap of human and physical health care resources is wide, is expanded with two surveys conducted in the west of the region, in Acre state. Potential drivers, informed by a review of twelve recent papers, were classified into seven categories capturing the individual, household, community and macroeconomic dimensions. Methods Quantitative field surveys were conducted in 2017 and 2019 based on coupled conglomerate-quota randomization sampling. Adults responded about their own health or their children’s health. The probability of seeking physician care for the latest episode of respiratory illness or dry cough was analysed with multiple nonlinear regressions, having as covariates the potential predictors informed by the literature. Results The propensity to seek health care and to purchase medication was larger for children. Influenza-like illness (Despite the exact diagnostic stated by respondents being “influenza”, a virus detection test (such as the PCR test) is not commonly applied, as informed by the Acre state public health service. In consistency, the term “influenza-like illness” is used.) was the most frequently diagnosed disease, followed by pneumonia, suggesting that a health care-seeking rate below 40% may perpetuate health impairment and local contagion. Illnesses’ severity, including the pain experienced, was the main predictor, revealing that subjective perception was more influential than objective individual and household characteristics. Conclusions The results suggest that subjective underestimation of respiratory illnesses’ consequences for oneself and for local society could prevent health care from being sought. This is in line with some previous studies but departs from those emphasizing the role of objective factors. Social consequences, of, for instance, a macroeconomic nature, need to be highlighted based on studies detecting long-run relationships among health care demand, health and economic performance at the national level. Depending on the intensity of the trade-off between the costs imposed on the health system by increased demand and on the economy by the reduced productivity of the ill, policy could be adopted to change subjective perceptions of illnesses with nudges and educational and informational interventions. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14171-z.
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Adeoti IG, Cavallaro FL. Determinants of care-seeking behaviour for fever, acute respiratory infection and diarrhoea among children under five in Nigeria. PLoS One 2022; 17:e0273901. [PMID: 36107948 PMCID: PMC9477346 DOI: 10.1371/journal.pone.0273901] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 08/18/2022] [Indexed: 12/05/2022] Open
Abstract
Background Despite available, inexpensive and effective treatments, malaria, diarrhoea, and pneumonia still contribute the majority of the global burden of childhood morbidity and mortality. Nigeria has the highest absolute numbers of child deaths worldwide. Appropriate care-seeking is important for prompt diagnosis, appropriate and timely treatment, and prevention of complications. The objective of this cross-sectional study was to examine the prevalence of and factors associated with appropriate care-seeking for childhood illnesses. Methods We used the most recent Nigeria Demographic and Health Survey (2018) to assess the prevalence of appropriate care-seeking among mothers of children under five with symptoms of common childhood illnesses. For diarrhoea, we defined appropriate care-seeking as seeking care from a formal health provider. For fever and acute respiratory infection (ARI), appropriate care-seeking was defined as seeking care from a formal provider the day of or after symptom onset. Multivariate logistic regression was carried out to assess factors associated with optimal care-seeking for each illness. Results At least 25% of parents did not seek any care for children with fever or ARI; this figure was over one third for diarrhoea. Only 15% and 13% of caregivers showed appropriate care-seeking for their children with fever and ARI respectively, and 27% of mothers sought care from a formal provider for diarrhoea. Predictors of appropriate care-seeking varied according to childhood illness. Previous facility delivery was the only risk factor associated with increased odds of appropriate care-seeking for all three illnesses; other risk factors varied between illnesses. Conclusion Overall, care-seeking for childhood illnesses was suboptimal among caregivers in Nigeria. Interventions to increase caregivers’ awareness of the importance of appropriate care-seeking are needed alongside quality of care interventions that reinforce people’s trust in formal health facilities, to improve timely care-seeking and ultimately reduce the high burden of child deaths in Nigeria.
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Affiliation(s)
- Ifeoluwa Gbemisola Adeoti
- Children Specialist Hospital, Ilorin, Kwara State, Nigeria
- Institute of Child Health, University College London, London, United Kingdom
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Chace Dwyer S, Mathur S, Kirk K, Dadi C, Dougherty L. "When you live in good health with your husband, then your children are in good health …." A qualitative exploration of how households make healthcare decisions in Maradi and Zinder Regions, Niger. BMC Public Health 2022; 22:1350. [PMID: 35840957 PMCID: PMC9283840 DOI: 10.1186/s12889-022-13683-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 06/16/2022] [Indexed: 12/02/2022] Open
Abstract
Background Gender dynamics influence household-level decision-making about health behaviors and subsequent outcomes. Health and development programs in Niger are addressing gender norms through social and behavior change (SBC) approaches, yet not enough is known about how health care decisions are made and if gender-sensitive programs influence the decision-making process. Methods We qualitatively explored how households make decisions about family planning, child health, and nutrition in the Maradi and Zinder regions, Niger, within the context of a multi-sectoral integrated SBC program. We conducted 40 in-depth interviews with married women (n = 20) and men (n = 20) between 18 and 61 years of age. Results Male heads of household were central in health decisions, yet women were also involved and expressed the ability to discuss health issues with their husbands. Participants described three health decision-making pathways: (1st pathway) wife informs husband of health issue and husband solely decides on the solution; (2nd pathway) wife informs husband of health issue, proposes the solution, husband decides; and (3rd pathway) wife identifies the health issue and both spouses discuss and jointly identify a solution. Additionally, the role of spouses, family members, and others varied depending on the health topic: family planning was generally discussed between spouses, whereas couples sought advice from others to address common childhood illnesses. Many participants expressed feelings of shame when asked about child malnutrition. Participants said that they discussed health more frequently with their spouses’ following participation in health activities, and some men who participated in husbands’ schools (a group-based social and behavior change approach) reported that this activity influenced their approach to and involvement with household responsibilities. However, it is unclear if program activities influenced health care decision-making or women’s autonomy. Conclusions Women are involved to varying degrees in health decision-making. Program activities that focus on improving communication among spouses should be sustained to enhance women role in health decision-making. Male engagement strategies that emphasize spousal communication, provide health information, discuss household labor may enhance couple communication in Niger. Adapting the outreach strategies and messages by healthcare topic, such as couples counseling for family planning versus community-based nutrition messaging, are warranted. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13683-y.
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Affiliation(s)
| | | | - Karen Kirk
- Population Council, Washington, D.C, USA
| | - Chaibou Dadi
- Conception Etudes Suivi Evaluation Appuis Formation, Niamey, Niger
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Mueller AK, Matoba J, Schue JL, Hamapumbu H, Kobayashi T, Stevenson JC, Thuma PE, Wesolowski A, Moss WJ, _ _. The Unmeasured Burden of Febrile, Respiratory, and Diarrheal Illnesses Identified Through Active Household Surveillance in a Low Malaria Transmission Setting in Southern Zambia. Am J Trop Med Hyg 2022; 106:1791-1799. [PMID: 35895429 PMCID: PMC9209922 DOI: 10.4269/ajtmh.21-1253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/07/2022] [Indexed: 01/25/2023] Open
Abstract
Malaria incidence has declined in southern Zambia over recent decades, leading to efforts to achieve and sustain malaria elimination. Understanding the remaining disease burden is key to providing optimal health care. A longitudinal study conducted in a rural area of Choma District, Southern Province, Zambia, assessed the prevalence of and factors associated with symptoms of non-malarial illnesses and treatment-seeking behavior. We analyzed data collected monthly between October 2018 through September 2020 from 1,174 individuals from 189 households. No incident malaria cases were detected by rapid diagnostic tests among febrile participants. Mixed-effects logistic regression identified factors associated with cough, fever, diarrhea, and treatment-seeking. Incidence rates of cough (192 of 1,000 person-months), fever (87 of 1,000 person-months), and fever with cough (37 of 1,000 person-months) were highest among adults older than 65 years. Diarrhea incidence (37 of 1,000 person-months) was highest among children younger than 5 years. For every additional symptomatic household member, one's odds of experiencing symptoms increased: cough by 47% (95% CI, 40-55), fever by 31% (95% CI, 23-40), diarrhea by 31% (95% CI, 17-46), and fever with cough by 112% (95% CI, 90-137), consistent with household clustering of illnesses. However, between 35% and 75% of participants did not seek treatment for their symptoms. Treatment-seeking was most common for children 5 to 9 years old experiencing diarrhea (adjusted odds ratio, 3.61; 95% CI, 1.42-9.18). As malaria prevalence reduces, respiratory and diarrheal infections persist, particularly among young children but, notably, also among adults older than 65 years. Increasing awareness of the disease burden and treatment-seeking behavior are important for guiding resource re-allocation as malaria prevalence declines in this region.
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Affiliation(s)
- Alexandra K. Mueller
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland;,Address correspondence to Alexandra K. Mueller, Johns Hopkins School of Medicine, 5200 Eastern Ave., Baltimore, MD 21224. E-mail:
| | | | - Jessica L. Schue
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Tamaki Kobayashi
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | - Amy Wesolowski
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - William J. Moss
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;,W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Kunnuji M, Wammanda RD, Ojogun TO, Quinley J, Oguche S, Odejimi A, Weiss W, Abba BI, King R, Franca-Koh A. Health beliefs and (timely) use of facility-based care for under-five children: lessons from the qualitative component of Nigeria's 2019 VASA. BMC Public Health 2022; 22:850. [PMID: 35484514 PMCID: PMC9047270 DOI: 10.1186/s12889-022-13238-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 03/14/2022] [Indexed: 11/22/2022] Open
Abstract
Background Nigeria’s under-five health outcomes have improved over the years, but the mortality rates remain unacceptably high. The qualitative component of Nigeria’s 2019 verbal and social autopsy (VASA) showed that caregivers’ health beliefs about causes of illnesses and efficacious treatment options contribute to non-use/delay in use of facility-based healthcare for under-five children. This study explored how these health beliefs vary across zones and how they shape how caregivers seek healthcare for their under-five children. Methods Data for this study come from the qualitative component of the 2019 Nigeria VASA, comprising 69 interviews with caregivers of under-five children who died in the five-year period preceding the 2018 Nigeria Demographic and Health Survey (NDHS); and 24 key informants and 48 focus group discussions (FGDs) in 12 states, two from each of the six geo-political zones. The transcripts were coded using predetermined themes on health beliefs from the 2019 VASA (qualitative component) using NVivo. Results The study documented zonal variation in belief in traditional medicine, biomedicine, spiritual causation of illnesses, syncretism, and fatalism, with greater prevalence of beliefs discouraging use of facility-based healthcare in the southern zones. Driven by these beliefs and factors such as availability, affordability, and access to and perceived quality of care in health facilities, caregivers often choose one or a combination of traditional medicines, care from medicine vendors, and faith healing. Most use facility-based care as the last option when other methods fail. Conclusion Caregivers’ health beliefs vary by zones, and these beliefs influence when and whether they will use facility-based healthcare services for their under-five children. In Nigeria’s northern zones, health beliefs are less likely to deter caregivers from using facility-based healthcare services, but they face other barriers to accessing facility-based care. Interventions seeking to reduce under-five deaths in Nigeria need to consider subnational differences in caregivers’ health beliefs and the healthcare options they choose based on those beliefs.
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Affiliation(s)
- Michael Kunnuji
- Department of Sociology, University of Lagos, Lagos, Nigeria.
| | - Robinson Daniel Wammanda
- Department of Paediatrics, Ahmadu Bello University/Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | | | - John Quinley
- Social Solution International, CIRCLE Project, Rockville, USA
| | - Stephen Oguche
- Department of Paediatrics, Faculty of Clinical Sciences, College of Health Sciences, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - Adeyinka Odejimi
- Department of Health Planning, Research and Statistics, Federal Ministry of Health, Abuja, Nigeria
| | - William Weiss
- USAID Senior Monitoring & Evaluation Advisor, IPA Mobility Program/Johns Hopkins University, Baltimore, USA
| | | | - Rebekah King
- Social Solutions International (United States), Rockville, USA
| | - Ana Franca-Koh
- Social Solutions International (United States), Rockville, USA
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Awasthi KR, Jancey J, Clements ACA, Leavy JE. A qualitative study of knowledge, attitudes and perceptions towards malaria prevention among people living in rural upper river valleys of Nepal. PLoS One 2022; 17:e0265561. [PMID: 35303022 PMCID: PMC8932613 DOI: 10.1371/journal.pone.0265561] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 03/03/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Nepal has made significant progress in decreasing the number of malaria cases over the last two decades. Prevention and timely management of malaria are critical for the National Malaria Program in its quest for elimination. The study aimed to explore the knowledge, attitudes and behaviour towards malaria prevention and treatment among people living in rural villages of Khatyad Rural Municipality in Nepal. METHODS This qualitative study collected information through virtual in-depth interviews (N = 25) with female and male participants aged between 15 and 72 years. RESULTS More than half of the participants knew about the causes of malaria, were aware of the complications of untreated malaria and knew that anti-malarial medicines were provided for free at the public health facilities. Participants indicated that their first choice of health care were public health facilities, however limited supply of medications and diagnostics deviated patients to the private sector. While tertiary care costs were not financially viable, participants opted against traditional care for malaria. Factors such as cost of treatment, distance to the health facility and the decision making authority in households influenced health related decisions in the family. Although long-lasting insecticidal nets were distributed and indoor residual spraying was done periodically, several barriers were identified. CONCLUSION Increased awareness of malaria prevention and treatment among people living in malaria risk areas is important for the National Malaria Program in its quest for malaria elimination in Nepal.
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Affiliation(s)
- Kiran Raj Awasthi
- Curtin School of Population Health, Curtin University, Perth, WA, Australia
| | - Jonine Jancey
- Curtin School of Population Health, Curtin University, Perth, WA, Australia
| | | | - Justine E. Leavy
- Curtin School of Population Health, Curtin University, Perth, WA, Australia
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Olapeju B, Adams C, Wilson S, Simpson J, Hunter GC, Davis T, Mitchum L, Cox H, James K, Orkis J, Storey JD. Malaria care-seeking and treatment ideation among gold miners in Guyana. Malar J 2022; 21:29. [PMID: 35101036 PMCID: PMC8805325 DOI: 10.1186/s12936-022-04045-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 01/10/2022] [Indexed: 12/13/2022] Open
Abstract
Background Although miners are a priority population in malaria elimination in Guyana, scant literature exists on the drivers of malaria-related behaviour. This study explores the relationship between gold miners’ malaria-related ideation and the adoption of malaria care-seeking and treatment behaviours including prompt care-seeking, malaria testing, and self-medication. Methods Data are from a cross-sectional quantitative survey of 1685 adult miners between the ages of 18–59 years who live in mining camps in Regions 1, 7, and 8. The analysis focused on miners who reported an episode of fever in the past year (n = 745). Malaria care-seeking and treatment ideation was defined as a composite additive score consisting of the following variables: general malaria knowledge, perceived severity, perceived susceptibility, beliefs, perceived self-efficacy, perceived norms, interpersonal communication, and perceived response efficacy. Multivariable logistic regressions explored the relationship between ideation on care-seeking/treatment behaviours, controlling for confounding variables. Results Most miners with a recent episode of fever had perceived risk (92%), self-efficacy (67%), susceptibility (53%) and high malaria knowledge (53%). Overall, miners' care-seeking/treatment ideation score ranged from 0 to 8 with a mean of 4.1. Ideation scores were associated with higher odds of care-seeking for fever (aOR: 1.19; 95% CI 1.04–1.36), getting tested for malaria (aOR: 1.22; 95% CI 1.07–1.38) and lower odds of self-medication (aOR: 0.87; 95% CI 0.77–0.99). Conclusions A national community case management initiative is using study findings as part of its scale-up, using volunteers to make testing and treatment services more accessible to miners. This is complemented by a multi-channel mass media campaign to improve miners’ ideation. Communication messages focus on increasing miners’ knowledge of malaria transmission and symptoms, encourage positive beliefs about malaria testing and volunteer testers, promote evidence about the effectiveness of testing, and reminders of how quick and easy it is to get a malaria test with the community case management initiative. Study findings also have implications for efforts to eliminate malaria across the Guiana Shield.
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Koné S, Fink G, Probst-Hensch N, Essé C, Utzinger J, N’Goran EK, Tanner M, Jaeger FN. Determinants of Modern Paediatric Healthcare Seeking in Rural Côte d'Ivoire. Int J Public Health 2022; 66:1604451. [PMID: 35173568 PMCID: PMC8842662 DOI: 10.3389/ijph.2021.1604451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 12/10/2021] [Indexed: 11/16/2022] Open
Abstract
Objectives: To determine factors that influence healthcare seeking among children with fatal and non-fatal health problems. Methods: Last disease episodes of surviving children and fatal outcomes of children under 5 years of age were investigated by means of an adapted social autopsy questionnaire administered to main caregivers. Descriptive analysis and logistic models were employed to identify key determinants of modern healthcare use. Results: Overall, 736 non-fatal and 82 fatal cases were assessed. Modern healthcare was sought for 63.9% of non-fatal and 76.8% of fatal cases, respectively. In non-fatal cases, young age, caregiver being a parent, secondary or higher education, living <5 km from a health facility, and certain clinical signs (i.e., fever, severe vomiting, inability to drink, convulsion, and inability to play) were positively associated with modern healthcare seeking. In fatal cases, only signs of lower respiratory disease were positively associated with modern healthcare seeking. A lack of awareness regarding clinical danger signs was identified in both groups. Conclusion: Interventions promoting prompt healthcare seeking and the recognition of danger signs may help improve treatment seeking in rural settings of Côte d'Ivoire and can potentially help further reduce under-five mortality.
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Affiliation(s)
- Siaka Koné
- Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, Abidjan, Côte d’Ivoire
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Günther Fink
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Nicole Probst-Hensch
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Clémence Essé
- Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, Abidjan, Côte d’Ivoire
- Institut d’Ethnosociologie, Université Félix Houphouët-Boigny, Abidjan, Côte d’Ivoire
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Eliézer K. N’Goran
- Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, Abidjan, Côte d’Ivoire
- Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d’Ivoire
| | - Marcel Tanner
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Fabienne N. Jaeger
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
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22
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Kunnuji M, Eshiet I, Ahinkorah BO, Omogbemi T, Yaya S. Background predictors of time to death in infancy: evidence from a survival analysis of the 2018 Nigeria DHS data. BMC Public Health 2022; 22:15. [PMID: 34991534 PMCID: PMC8734103 DOI: 10.1186/s12889-021-12424-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/15/2021] [Indexed: 11/18/2022] Open
Abstract
Background Nigeria’s child health profile is quite concerning with an infant mortality rate of 67 deaths per 1000 live births and a significant slowing down in progress towards improving child health outcomes. Nigeria’s 2018 Demographic and Health Survey (DHS) suggests several bio-demographic risk factors for child death, including mother’s poor education, poverty, sex of child, age of mother, and location (rural vs urban) but studies are yet to explore the predictive power of these variables on infant survival in Nigeria. Methods The study extracted data for all births in the last 12 months preceding the 2018 Nigeria DHS and used the Cox proportional hazard model to predict infant survival in Nigeria. Failure in this analysis is death with two possible outcomes – dead/alive – while the survival time variable is age at death. We censored infants who were alive at the time of the study on the day of the interview. Covariates in the analysis were: age of mother, education of mother, wealth quintile, sex of child, location, region, place of delivery, and age of pregnancy. Results The study found that a higher education of a mother compared to no education (β = .429; p-value < 0.05); belonging to a household in the richer wealth quintile (β = .618; p-value < 0.05) or the highest quintile (β = .553; p-value < 0.05), compared to the lowest wealth quintile; and living in North West (β = 1.418; p-value < 0.05) or South East zone (β = 1.711; p-value < 0.05), significantly predict infant survival. Conclusion Addressing Nigeria’s infant survival problem requires interventions that give attention to the key drivers – education, socio-economic status, and socio-cultural contextual issues. We therefore recommend full implementation of the universal basic education policy, and child health education programs targeted at mothers as long- and short-term solutions to the problem of poor child health outcomes in Nigeria. We also argue in favor of better use of evidence in policy and program development in Nigeria.
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Affiliation(s)
- Michael Kunnuji
- Department of Sociology, University of Lagos, Lagos, Nigeria
| | | | | | | | - Sanni Yaya
- School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, 120 University Private, Ottawa, ON, K1N 6N5, Canada. .,The George Institute for Global Health, Imperial College London, London, UK.
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Rabbani F, Khan HA, Piryani S, Pradhan NA, Shaukat N, Feroz AS, Perveen S. Changing Perceptions of Rural Frontline Workers and Caregivers About Management of Childhood Diarrhea and Pneumonia Despite Several Inequities: The Nigraan Plus Trial in Pakistan. J Multidiscip Healthc 2021; 14:3343-3355. [PMID: 34880624 PMCID: PMC8648085 DOI: 10.2147/jmdh.s334844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/04/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose Diarrhea and pneumonia greatly contribute to high childhood mortality in Pakistan. Frontline community health workers or the Lady Health Workers (LHWs) provide care at the doorstep of over 60% of Pakistan’s rural residents. Difficult terrain, lack of supplies, and inadequate supervision put these LHWs at an added disadvantage in the timely diagnosis and delivery of known treatment options to community caregivers (CCGs). This study aims to assess whether a supportive supervision intervention through Lady Health Supervisors (LHSs) using enhanced mentorship and written feedback cards have the potential to improve case management of childhood diarrhea and pneumonia. Study Setting and Design This perception-based qualitative inquiry nested within the Nigraan Plus trial included LHSs, LHWs, and CCGs as the participants. Twenty-two in-depth interviews (IDIs) and 16 focus group discussions (FGDs) were conducted before a supportive supervision intervention in 2017, and 10 FGDs were conducted in 2019 once the intervention concluded. Data were analyzed using manual content analysis. Results The perceived ability of LHWs and LHSs to describe the danger signs of diarrhea and pneumonia, classify dehydration and relate respiratory rate to the severity of pneumonia improved over time. Appropriate prescription of zinc in diarrhea and antibiotics in pneumonia was noted. Furthermore, CCGs’ trust in LHWs increased following the intervention, and they reported a growing inclination to contact LHWs as their first point of care. LHWs in the intervention arm were more satisfied with their job due to frequent supervisory visits and continuous feedback by LHSs. Conclusion Despite geographic, social, and economic inequities, supportive supervision has the potential to improve knowledge, practice, and skills of frontline health workers related to CCM of childhood diarrhea and pneumonia in disadvantaged rural communities. Additionally, the trust of CCGs in the health workers’ ability to manage such cases is also enhanced.
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Affiliation(s)
- Fauziah Rabbani
- Office of Research and Graduate Studies, The Aga Khan University, Karachi, Sindh, Pakistan.,Department of Community Health Sciences, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Hyder Ali Khan
- Department of Community Health Sciences, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Suneel Piryani
- Department of Community Health Sciences, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Nousheen Akber Pradhan
- Department of Community Health Sciences, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Natasha Shaukat
- Department of Community Health Sciences, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Anam Shahil Feroz
- Department of Community Health Sciences, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Shagufta Perveen
- Department of Community Health Sciences, The Aga Khan University, Karachi, Sindh, Pakistan
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24
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Ariyo T, Jiang Q. Trends in the association between educational assortative mating, infant and child mortality in Nigeria. BMC Public Health 2021; 21:1493. [PMID: 34340670 PMCID: PMC8330029 DOI: 10.1186/s12889-021-11568-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 07/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Existing knowledge has established the connection between maternal education and child survival, but little is known about how educational assortative mating (EAM), relates to childhood mortality. We attempt to examine this association in the context of Nigeria. METHODS Data was obtained from the 2008, 2013, and 2018 waves of the Nigeria Demographic and Health Survey, which is a cross-sectional study. The sample includes the analysis of 72,527 newborns within the 5 years preceding each survey. The dependent variables include the risk of a newborn dying before 12 months of age (infant mortality), or between the age of 12-59 months (child mortality). From the perspective of the mother, the independent variable, EAM, includes four categories (high-education homogamy, low-education homogamy, hypergamy, and hypogamy). The Cox proportional hazard regression was employed for multivariate analyses, while the estimation of mortality rates across the spectrum of EAM was obtained through the synthetic cohort technique. RESULTS The risk of childhood mortality varied across the spectrum of EAM and was particularly lowest among those with high-education homogamy. Compared to children of mothers in low-education homogamy, children of mothers in high-education homogamy had 25, 31 to 19% significantly less likelihood of infant mortality, and 34, 41, and 57% significantly less likelihood of child mortality in 2008, 2013 and 2018 survey data, respectively. Also, compared to children of mothers in hypergamy, children of mothers in hypogamous unions had 20, 12, and 11% less likelihood of infant mortality, and 27, 36, and 1% less likelihood of child mortality across 2008, 2013 and 2018 surveys, respectively, although not significant at p < 0.05. Both infant and child mortality rates were highest in low-education homogamy, as expected, lowest in high-education homogamy, and lower in hypogamy than in hypergamy. Furthermore, the trends in the rate declined between 2008 and 2018, and were higher in 2018 than in 2013. CONCLUSION This indicates that, beyond the absolute level of education, the similarities or dissimilarities in partners' education may have consequences for child survival, alluding to the family system theory. Future studies could investigate how this association varies when marital status is put into consideration.
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Affiliation(s)
- Tolulope Ariyo
- Institute for Population and Development Studies, School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, China
| | - Quanbao Jiang
- Institute for Population and Development Studies, School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, China
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Sato M, Oshitani H, Tamaki R, Oyamada N, Sato K, Nadra AR, Landicho J, Alday PP, Lupisan SP, Tallo VL. Factors affecting mothers' intentions to visit healthcare facilities before hospitalisation of children with pneumonia in Biliran province, Philippines: a qualitative study. BMJ Open 2020; 10:e036261. [PMID: 32847907 PMCID: PMC7451295 DOI: 10.1136/bmjopen-2019-036261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Despite a substantial reduction in the mortality rate of children under 5 years in the past 25 years, pneumonia remains the single-largest infectious cause of child deaths worldwide. This study explored the chronological order of visited healthcare facilities and practitioners, and the factors affecting mothers' intention to seek care before the hospitalisation of children with pneumonia. METHODS AND ANALYSIS A qualitative research design was employed using theory of planned behaviour as a framework for the analysis. Using purposive sampling technique, 11 mothers, whose children under 5 years old were hospitalised with severe pneumonia, were recruited for individual semi-structured interviews. Their socio-demographic information was analysed using descriptive statistics. RESULTS Mothers brought their sick children to multiple facilities, and 1 to 19 days had passed before hospitalisation. We identified four major factors determining mothers' intentions: (1) doing something useful for the sick child, (2) expecting the child to receive the necessary assessment and treatment, (3) accepting advice to visit a healthcare facility and be referred to a hospital and (4) considering issues and benefits associated with hospitalisation. Mothers noticed their children's unusual symptoms and monitored them while applying home remedies. They also took their children to traditional healers despite knowing that the treatments were not necessarily effective. Mothers expected children to be checked by health professionals and listened to advice from family members regarding the facilities to visit, and from healthcare staff to be referred to a hospital. Financial issues and the double burden of housework and caring for the hospitalised child were mothers' major concerns about hospitalisation. CONCLUSION Children were hospitalised after several days because they visited multiple healthcare facilities, including traditional healers. Improving care quality at healthcare facilities and reducing financial and mothers' burden may reduce the hospitalisation delay for children with pneumonia.
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Affiliation(s)
- Mari Sato
- Department of Virology, Tohoku University, Sendai, Miyagi, Japan
| | - Hitoshi Oshitani
- Department of Virology, Tohoku University, Sendai, Miyagi, Japan
| | - Raita Tamaki
- Japan International Cooperation Agency, Nairobi, Kenya
| | - Nobuko Oyamada
- Department of Maternal Nursing, Tohoku University, Sendai, Miyagi, Japan
| | - Kineko Sato
- Department of Maternal Nursing, Tohoku University, Sendai, Miyagi, Japan
| | | | - Jhoys Landicho
- Epidemiology and Biostatics, Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Portia P Alday
- Epidemiology and Biostatics, Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Socorro P Lupisan
- Epidemiology and Biostatics, Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Veronica L Tallo
- Epidemiology and Biostatics, Research Institute for Tropical Medicine, Muntinlupa City, Philippines
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