The latest report from the Intergovernmental Panel on Climate Change (IPCC) highlighted the worsening impacts of climate change. Two climate factors-temperature and rainfall uncertainties-influence the risk of childhood diarrhea, which remains a significant cause of morbidity and mortality in low- and middle-income countries. They create a conducive environment for diarrhea-causing pathogens and overwhelm environmental prevention measures. This study aimed to produce comprehensive evidence on the association of temperature and rainfall variability with the risk of childhood diarrhea and the influence of water and sanitation conditions on those associations. We conducted a systematic review and meta-analysis using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) approach. Records published in English from 2006 to 2023 were searched on 8 January 2024 via PubMed, EMBASE, ScienceDirect, Scopus, the Cochrane Library, and Google/Google Scholar using comprehensive search terms. We assessed studies for any risk of bias using the Navigation Guide and rated the quality of the evidence using the GRADE approach. The heterogeneity among estimates was assessed using I-squared statistics (I2). The findings of the analysis were presented with forest plots using an incidence rate ratio (IRR). A meta-analysis was conducted on effect modifiers (water supply and sanitation conditions) using a random effects model with a 95% confidence interval (CI). The statistical analyses were conducted using R 4.3.2 software and Review Manager 5.3. A total of 2017 records were identified through searches, and only the 36 articles that met the inclusion criteria were included. The analysis suggests a small positive association between increased temperature and the occurrence of under-five diarrhea, with the pooled IRR = 1.04; 95% CI [1.03, 1.05], at I2 = 56% and p-value < 0.01, and increased rainfall and U5 diarrhea, with IRR = 1.14; 95% CI [1.03, 1.27], at I2 = 86% and p-value < 0.01. The meta-analysis indicated a positive association between unimproved latrine facilities and drinking water sources with a rainfall-modified effect on U5 diarrhea, with IRR = 1.21; 95% CI [0.95, 1.53], at I2 = 62% and p-value = 0.03. We found that an increase in mean temperature and rainfall was associated with an increased risk of childhood diarrhea. Where there were unimproved latrine facilities and drinking water sources, the increase in mean rainfall or temperature would increase the incidence of childhood diarrhea. The results of this review help in assessing the effectiveness of current intervention programs, making changes as needed, or creating new initiatives to lower the prevalence of childhood diarrhea.

UNASSIGNED: Every child deserves the right to life. In Nigeria like other African countries, a high burden of child mortality prevails. Attaining a low-mortality rate of children entails that mothers who are the primary caregivers are in the best position to provide quality healthcare management.
UNASSIGNED: With the phenomenological approach in qualitative research, the researchers sourced data using Focus Group Discussions (FGDs) and In-Depth Interviews (IDI) from 38 mothers of various categories. The participants were purposively selected from four government and mission health institutions in a semi-urban Nsukka town, Enugu State. Data were analyzed thematically.
UNASSIGNED: Results revealed that mothers utilize health institutions including government, mission, private, pharmacies and patent medicine vendors when seeking healthcare for their children. Their inability to recognize potential life-threatening conditions is the leading factor in increasing child mortality. Findings show that because participants were concerned about financial challenges; they were ready to adopt traditional medicine as an alternative to modern medicine. The study showed evidence of unsafe strategies mothers adopt for the health management of their under-five children with common illnesses. Participants indicated little knowledge of social workers\' engagement in health institutions.
UNASSIGNED: Healthy living is essential in the protection from illnesses. Since under-five children are vulnerable to illnesses, their mothers should provide them with quality healthcare management. The study recommends that social workers\' engagement with health providers and users in semi-urban societies could help propagate healthcare awareness and strategies in mothers\' choice of health management for under-five children in Nigeria. Overall, adequate health policy consideration should be given to all under-five children in Nigeria.

BACKGROUND: Globally, pneumonia is one of the leading causes of morbidity and mortality as well as hospitalization burden for under-five children. Despite significant initiatives implemented to reduce morbidity and mortality from pneumonia in under-five children, little is known regarding the time to recovery and its predictors among under-five children admitted with severe pneumonia in Ethiopia. Hence, this study intended to estimate the median time to recovery and its predictors among under-five children admitted with severe pneumonia in East Wallaga zone public hospitals, western Ethiopia; 2023.
METHODS: An institution-based retrospective cohort study was conducted among 383 under-five children who were admitted with severe pneumonia in East Wallaga zone public hospitals from January 2017 to December 2022. A systematic sampling method was used to select eligible medical records. EpiData Version 4.6 was used to enter the data and analyzed using STATA Version 17.0. Cox-proportional hazard assumption test and model fitness were checked. Variables with P-value ˂ 0.25 at bivariable Cox regression analysis were selected for the multivariable Cox proportional model. A multivariable Cox regression model with 95% CI and Adjusted Hazard Ratio (AHR) was used to identify a significant predictor of time to recovery from severe pneumonia at a P-value < 0.05.
RESULTS: At the end of the follow-up, 356 observations were developed an event (recovered) with the median time to recovery of 4 days with IQR of 3-5 days. The overall incidence rate of recovery was 22.26 per 100 (95% CI: 20.07-24.70) person-days observations. Being rural residency (AHR: 0.75, 95% CI: 0.60-0.93), late presenters for seeking care (AHR = 0.70, 95% CI: 0.53-0.93), presence of danger sign at admission (AHR = 1.46, 95% CI: 1.15-1.83), and presence of comorbidity (AHR = 1.63, 95% CI, 1.31-2.04) were found to have a statistically significant association with prolonged recovery time.
CONCLUSIONS: The median time to recovery from severe pneumonia was long, and factors such as Residence, co-morbidity, presence of danger signs, and duration prior to seeking care were statistically significant predictors of recovery time from severe pneumonia. Hence, due attention has to be given to increasing the community\'s health-seeking behavior to visit health facility early and especial attention should be given for children with danger signs and comorbidity.

UNASSIGNED: malnutrition continues to be a significant public health and development concern not only in the developing country but also in the world. It is a serious problem because it is causing the deaths of 3.5 million children under 5 years old per- year.
UNASSIGNED: Institution based cross-sectional study design was employed using sample of 342 children selected through systematic simple random sampling technique from May 1st -July30 /2020. Bivariate and multivariate logistic regression analysis was used. The variables which had significant association were identified on the bases of P value<0.05 and AOR 95% CI.
UNASSIGNED: The analysis this study revealed that, 42.6% of children were stunted. The main associated factors of stunting were found to be birth order of the child, maternal occupation, frequency meal per day, mother who did not wash their hand before breastfeeding, (AOR=1.636:95%CI:1.00-2.674), children who were not vitamin A, supplemented (AOR=1.901, 95%CI: 1.162-3.109), and child whose mother were not use family planning (AOR=2.916, 95%CI: 1.064-7.989 were associated with outcome variable.
UNASSIGNED: From the findings of this study, it is concluded that stunting is still an important problem among children aged 6-59 months. Especial attention should be given on intervention of malnutrition.

The emerging predictors of childhood undernutrition include household food insecurity (HFI) and inadequate diet diversity (DD). Geographical, socio-cultural, economic, and demographic factors contribute to HFI. Earlier, HFI was often considered an outcome of hunger and poverty leading to undernutrition. The increasing availability of data related to childhood DD and its direct association with undernutrition indicates that DD could mediate the relationship between HFI and undernutrition. This narrative review examined the association of HFI and/or DD with undernutrition in children younger than 5 years in the Indian subcontinent; and the current programmes and policies. The current evidence showed a possible association between HFI and DD either independently or together with childhood undernutrition. Until now, nutrition-specific interventions to address moderate and severe forms of undernutrition were focused, with a limited attention on nutrition-sensitive approaches to improve HFI and DD. Interventions which improve HFI and DD may be included in the existing programmes and would help address the undernutrition in children younger than 5 years.

Childhood stunting is a significant public health concern in Bangladesh. This study analysed the data from the Healthy Village programme, which aims to address childhood stunting in southern coastal Bangladesh. The aim was to assess childhood stunting prevalence over time and explore the risk factors in the programme areas. A cross-sectional, secondary data analysis was conducted for point-prevalence estimates of stunting from 2018 to 2021, including 132,038 anthropometric measurements of under-five children. Multivariate logistic regression analyses were conducted for risk factor analysis (n = 20,174). Stunting prevalence decreased from 51% in 2018 to 25% in 2021. The risk of stunting increased in hardcore poor (aOR: 1.46, 95% CI: 1.27, 1.68) and poor (aOR: 1.50, 95% CI: 1.33, 1.70) versus rich households, children with mothers who were illiterate (aOR: 1.25, 95% CI: 1.09, 1.44) and could read and write (aOR: 1.35, 95% CI: 1.16, 1.56) versus mothers with higher education, and children aged 1-2 years compared with children under one year (aOR: 1.32, 95% CI: 1.20, 1.45). The stunting rate was halved over three years in programme areas, which is faster than the national trend. We recommend addressing socioeconomic inequalities when tackling stunting and providing targeted interventions to mothers during the early weaning period.

BACKGROUND: Malaria remains a significant public health challenge in Sub-Saharan Africa (SSA), particularly affecting under-five (UN5) children. Despite global efforts to control the disease, its prevalence in high-risk African countries continues to be alarming, with records of substantial morbidity and mortality rates. Understanding the association of multiple childhood, maternal, and household factors with malaria prevalence, especially among vulnerable young populations, is crucial for effective intervention strategies.
OBJECTIVE: This study examines the prevalence of malaria among UN5 children in selected high-risk SSA countries and analyzes its association with various childhood, maternal, and household factors.
METHODS: Data from the Malaria Indicator Surveys (MIS) spanning from 2010 to 2023 were analyzed. A weighted sample of 35,624 UN5 children from seven countries in sub-Saharan Africa (SSA) known for high malaria prevalence was considered in the analyses. Descriptive statistics and modified Poisson regression analysis were used to assess the association of multiple factors with malaria prevalence. Stata version 15 software was used in analyzing the data and statistical significance was set at a 5% significance level.
RESULTS: The overall pooled prevalence of malaria among the studied population was 26.2%, with substantial country-specific variations observed. In terms of child factors, a child\'s age was significantly associated with malaria prevalence (APR = 1.010, 95% CI: 1.007-1.012). Children of mothers with higher education levels (APR for higher education = 0.586, 95% CI: 0.425-0.806) and Fansidar uptake during pregnancy (APR = 0.731, 95% CI: 0.666-0.802) were associated with lower malaria risk. Children from middle-wealth (APR = 0.783, 95% CI: 0.706-0.869) and rich (APR = 0.499, 95% CI: 0.426-0.584) households had considerably lower malaria prevalence compared to those from poor households. Additionally, rural residency was associated with a higher risk of malaria compared to urban residency (APR = 1.545, 95% CI: 1.255-1.903).
CONCLUSIONS: The study highlights a notable malaria prevalence among under-five (UN5) children in high-risk SSA countries, influenced significantly by factors such as maternal education, Fansidar uptake during pregnancy, socioeconomic status, and residency. These findings underscore the importance of targeted malaria prevention strategies that address these key determinants to effectively reduce the malaria burden in this vulnerable population.

UNASSIGNED: A good screening tool, such as a growth chart, should distinguish between children with normal growth and those with perturbed growth. Suitability of synthetic Indian growth references for diagnosing growth-related disorders for under-five children has not been evaluated. To assess the validity of World Health Organization (WHO) 2006 standards vs synthetic Indian references (2019) (by comparing weight, height, body mass index (BMI), standard deviation scores (SDS) and the composite index of anthropometric failure (CIAF)) in differentiating normal children and children with growth-related disorders.
UNASSIGNED: Records of 2188 children (0-60 months) attending a tertiary centre paediatric outpatient department (OPD) were retrospectively studied; 1854 children were healthy and 334 were diagnosed with growth-related disorders as per the European Society for Paediatric Endocrinology (ESPE) classification. The anthropometric parameters converted to Z-scores for weight-for-age (WAZ), height-for-age (HAZ), BMI-for-age (BAZ) and a CIAF were computed using WHO and synthetic charts; Student\'s t-test was used for assessing differences and Youden\'s index for validity.
UNASSIGNED: Disease status of children and anthropometric failure on WAZ, HAZ, BAZ and CIAF on both WHO and synthetic charts had a significant association (P-value <0.05). WAZ, HAZ on both charts and CIAF on synthetic chart had a fair to moderate agreement (Kappa statistics) with disease status as per diagnosis (P-value <0.05). The sensitivity and negative predictive value for all anthropometric parameters were higher for synthetic charts.
UNASSIGNED: Indian charts were more sensitive for diagnosing growth-related disorders from birth to 60 months of age when compared to WHO growth standards.

Objectives: This systematic review and meta-analysis aimed to: i) determine the pooled prevalence of acute diarrhea; and ii) synthesize and summarize current evidence on factors of acute diarrheal illnesses among under-five children in Ethiopia. Methods: A comprehensive systematic search was conducted in PubMed, SCOPUS, HINARI, Science Direct, Google Scholar, Global Index Medicus, Directory of Open Access Journals (DOAJ), and the Cochrane Library. This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. The methodological quality of each included article was assessed using the Joanna Briggs Institute (JBI) quality assessment tool for cross-sectional and case-control studies. A random-effect meta-analysis model was used to estimate the pooled prevalence of diarrheal illnesses. Heterogeneity and publication bias were assessed using I2 test statistics and Egger\'s test, respectively. The statistical analysis was done using STATA™ software version 14. Results: Fifty-three studies covering over 27,458 under-five children who met the inclusion criteria were included. The pooled prevalence of diarrhea among under-five children in Ethiopia was found to be 20.8% (95% CI: 18.69-22.84, n = 44, I2 = 94.9%, p < 0.001). Our analysis revealed a higher prevalence of childhood diarrhea in age groups of 12-23 months 25.42% (95%CI: 21.50-29.35, I2 = 89.4%, p < 0.001). In general, the evidence suggests that diarrheal risk factors could include: i) child level determinants (child\'s age 0-23 months, not being vaccinated against rotavirus, lack of exclusive breastfeeding, and being an under-nourished child); ii) parental level determinants {mothers poor handwashing practices [pooled odds ratio (OR) = 3.05; 95% CI:2.08-4.54] and a history of maternal recent diarrhea (pooled OR = 3.19, 95%CI: 1.94-5.25)}; and iii) Water, Sanitation and Hygiene (WASH) determinants [lack of toilet facility (pooled OR = 1.56, 95%CI: 1.05-2.33)], lack handwashing facility (pooled OR = 4.16, 95%CI: 2.49-6.95) and not treating drinking water (pooled OR = 2.28, 95% CI: 1.50-3.46). Conclusion: In Ethiopia, the prevalence of diarrhea among children under the age of five remains high and is still a public health problem. The contributing factors to acute diarrheal illnesses were child, parental, and WASH factors. A continued focus on improving access to WASH facilities, along with enhancing maternal hygiene behavior will accelerate reductions in diarrheal disease burden in Ethiopia.

UNASSIGNED: This study sought to evaluate the association between serum vitamin D levels and acute respiratory infection (ARI) in under-five children in Nnamdi Azikiwe University Teaching Hospital (NAUTH) in Nigeria.
UNASSIGNED: This study was conducted in NAUTH, Nigeria, in 2017, in 250 children with ARI, classified into those with acute upper respiratory infection (AURI) and those with acute lower respiratory infection (ALRI). and 250 children without ARI, matched for age and gender. Sociodemographic data and serum vitamin D were obtained. The data were compared between the study and the control groups. The data were compared between those with AURI and those with ALRI.
UNASSIGNED: The mean serum 25(OH)D of (52.2±25.6 ng/ml) in the study subjects was lower than the (57.0±23.9 ng/ml in the control group (t=2.20, p=0.03).The mean serum 25(OH)D levels in children with ALRI [39.8±23.8 ng/ml] was lower than in those with AURI [56.0±24.9ng/ml] (t= 14.83, p <0.001). In addition, the association between low levels of serum 25(OH)D and severity of ALRI was significant (x2 = 9.45, p = 0.002).
UNASSIGNED: In under-five children, serum vitamin D levels were low, and these low levels were associated more with ALRIs than AURIs in this study.