Under Five

The knowledge of caregivers is an important factor when it comes to the maintenance of both the nutritional status of children and protection of their nutritional needs to ensure a sound foundation and secure future of any healthy society. This research thus aimed at investigating the trends in Infant and Young Child Feeding practices for children aged 0 to 23 months to evaluate how the nutrition education and counselling received during contact with health workers have contributed to the Knowledge, Attitudes and Practices of the caregivers regarding appropriate nutrition in Ekiti State. The assessment was done using a cross-sectional survey method, and FAO's guideline for assessing nutrition related KAP5 was adopted and used. Cochran's equation was used to calculate the sample size, and three households were randomly picked in each political ward. Data was collected and analysed using EPI Info 7. 94.3% of the respondents breastfeed their children on demand, and 47.2% of the mothers had skin contact with their babies after delivery. 78.2% believed that exclusive breastfeeding is very good. 68.2% believed that their children could get diarrhoea from the use of a feeding bottle. 88.3% are aware that 5-9 months are the appropriate age for the introduction of semisolid and solid food. There is a high level of knowledge, attitude and practice among the caregivers and an improvement was observed in most of the infant and young child feeding practices in Ekiti State.

Background
Malaria accounts for about 300,000 childhood deaths and 30% of under-five year old mor- tality in Nigeria annually. We assessed the impact of intervention strategies that integrated Patent Medicines Vendors into community case management of childhood-diseases, improved access to artemisinin combination therapy (ACT) and distributed bed nets to households. We explored the influence of household socioeconomic characteristics on the impact of the interventions on fever in the under-five year olds in Bauchi State Nigeria.

Methods
A cross-sectional case-controlled, interventional study, which sampled 3077 and 2737 under-5 year olds from 1,588 and 1601 households in pre- and post-intervention periods respectively, was conducted from 2013 to 2015. Difference-in-differences and logistic regression analyses were performed to estimate the impact attributable to the interventions: integrated community case management of childhood illness which introduced trained pub- lic and private sector health providers and the possession of nets on the prevalence of fever.

Results
Two-week prevalence of fever among under-fives declined from 56.6% at pre-intervention to 42.5% at post-intervention. Fever-prevention fraction attributable to nets was statistically significant (OR = 0.217, 95% CI: 0.08–0.33). Children in the intervention group had signifi- cantly fewer incidence of fever than children in the control group had (OR = 0.765, 95% CI:0.67–0.87). Although being in the intervention group significantly provided 23.5% protection against fever (95% CI: 0.13–0.33), the post-intervention likelihood of fever was also signifi- cantly less than at pre-intervention (OR = 0.57, 95% CI: 0.50–0.65). The intervention protec- tion fraction against fever was statistically significant at 43.4% (OR = 0.434, 95% CI: 0.36– 0.50). Logistic regression showed that the odds of fever were lower in households with nets (OR = 0.72, 95% CI: 0.60–0.88), among children whose mothers had higher education, in the post-intervention period (OR = 0.39, 95% CI: 0.33–0.46) and in the intervention group (OR = 0.52, 95% CI: 0.48–0.66). The odds of fever increased with higher socio-economic status of households (17.9%-19.5%). Difference-in-differences showed that the interven- tions significantly reduced occurrence of fever in the intervention group (OR = 1.70, 95% CI: 1.36–2.14).

Conclusion
The interventions were effective in reducing the prevalence and the likelihood of childhood malaria fever. Taken to scale, these can significantly reduce the burden of malaria fever in the under-five year old children.