Associations of diarrhea episodes and seeking medical treatment among children under five years: Insights from the Zimbabwe Demographic Health Survey (2015-2016)

Treatment-seeking practices of caregivers for children aged less than five years old with diarrhoea in low- and middle-income countries: a systematic review and meta-analysis

Background

Diarrhoeal diseases in children aged <5 years require immediate medical attention. However, previous studies conducted on treatment-seeking practices of caregivers for children aged <5 years with diarrhoea in low- and middle-income countries (LMICs) were inconsistent and inconclusive. We aimed to estimate the pooled treatment-seeking practice of caregivers for children aged <5 years with diarrhoea in LMICs.

Methods

We used the 2020 PRISMA guidelines to conduct this systematic review and meta-analysis. We included both published and unpublished articles in English that reported treatment-seeking practices from health facilities in LMICs between 2010-22. We searched CINAHL, Medline/PubMed, Web of Science, Embase, and grey literature sources. We assessed the eligible articles using the Newcastle-Ottawa Scale quality appraisal checklist and Begg's test for the presence of publication bias. Further, we used the regression-based Egger test to test for a small study effect. Moreover, we used a narrative synthesis to characterise the studies. We estimated the pooled treatment-seeking practice using a random-effect model. We conducted a subgroup analysis considering the articles' publication status, residence, World Bank income category, study design and approach, and study setting. We presented the results using tables, figures, forest plots, and funnel plots.

Results

We included 76 articles in the analysis. The overall treatment-seeking practices of caregivers were 52.84% (95% confidence interval (CI) = 47.51-58.17). Healthcare-seeking practices in low-income countries (58.12%), lower-middle-income countries (48.41%), and upper-middle-income countries (51.44%) were not statistically different. The pooled treatment-seeking practice for diarrhoea varied by study site: 29.80% (95% CI = 25.00-34.60) in peri-urban, 54.20% (95% CI = 44.71-63.70) in rural, and 47.76% (95% CI = 34.47-61.06) in urban settings. A cross-sectional design was employed in 72 studies, and 71 were quantitative.

Conclusions

Treatment-seeking practice for diarrhoea among children aged <5 years in LMICs remained low. There was no statistically significant difference in treatment-seeking practice for children with diarrhoea by the country's income classification. We recommend further studies to identify factors affecting treatment-seeking practices for diarrhoea among children aged <5 years in LMICs and to act on findings and recommendations.

Registration

PROSPERO: CRD42022290180.

Multilevel analysis of healthcare utilization for childhood diarrhea in high under five mortality countries

Globally, 4.9 million under-five deaths occurred before celebrating their fifth birthday. Four in five under-five deaths were recorded in sub-Saharan Africa and Southern Asia. Childhood diarrhea is one of the leading causes of death and is accountable for killing around 443,832 children every year. Despite healthcare utilization for childhood diarrhea has a significant effect on the reduction of childhood mortality and morbidity, most children die due to delays in seeking healthcare. Therefore, this study aimed to assess healthcare utilization for childhood diarrhea in the top high under-five mortality countries. This study used secondary data from 2013/14 to 2019 demographic and health surveys of 4 top high under-five mortality countries. A total weighted sample of 7254 mothers of under-five children was included. A multilevel binary logistic regression was employed to identify the associated factors of healthcare utilization for childhood diarrhea. The statistical significance was declared at a p-value less than 0.05 with a 95% confidence interval. The overall magnitude of healthcare utilization for childhood diarrhea in the top high under-five mortality countries was 58.40% (95% CI 57.26%, 59.53%). Partner/husband educational status, household wealth index, media exposure, information about oral rehydration, and place of delivery were the positive while the number of living children were the negative predictors of healthcare utilization for childhood diarrhea in top high under-five mortality countries. Besides, living in different countries compared to Guinea was also an associated factor for healthcare utilization for childhood diarrhea. More than four in ten children didn't receive health care for childhood diarrhea in top high under-five mortality countries. Thus, to increase healthcare utilization for childhood diarrhea, health managers and policymakers should develop strategies to improve the household wealth status for those with poor household wealth index. The decision-makers and program planners should also work on media exposure and increase access to education. Further research including the perceived severity of illness and ORS knowledge-related factors of healthcare utilization for childhood diarrhea should also be considered by other researchers.

Observation on the Effect of Rehabilitative Physical Training on Sports Injuries under Ultrasound Image Examination

In order to observe the effect of rehabilitative physical training on sports injuries under ultrasound examination, this study firstly carried out experiments, induction and analysis of ultrasound examination, and evaluation-related content, especially the diagnosis of ultrasound examination in muscle and tendon injuries caused by various reasons. And the clinical application of treatment (clinical research) is reviewed, in order to provide reference data for clinical stage summary. Then, by determining the fasciculation and location of the tendon rupture injury by ultrasound, the clinic can decide whether or not to proceed with surgery. Small Achilles tendon tears only require conservative treatment to avoid the development of complete Achilles tendon rupture. Finally, 26 patients and 10 healthy adults were examined by ultrasonography, and each subject was segmented to examine 11 muscles, including the tongue muscle. The bilateral trapezius, bilateral biceps brachii, bilateral abductor pollicis brevis, bilateral quadriceps femoris, and bilateral tibialis anterior muscles were evaluated by ultrasound and statistical methods. The experimental results show that if the fasciculation of the Achilles tendon injury does not reach more than 3/11, it indicates that no surgical treatment is required; for those with a complete tear of the Achilles tendon, the distance between the broken ends should be further measured in the toe flexion state to evaluate whether surgical treatment is required. It effectively solves the problem of visual diagnosis of sports injuries.

Epidemiological surveillance of enteric viral diseases using wastewater in Africa - A rapid review

Viral enteric pathogens remain an important cause of diarrhoeal outbreaks among children in sub-Saharan Africa (SSA). Consequently, diarrhoeal illness remains a significant cause of morbidity and mortality in the under-fives in SSA. These outbreaks associated with viral pathogens tend to be seasonal and early warning systems for impending outbreaks could be very crucial for triggering preventive public health response and building public health resilience to deal with increased demand for medical services. Wastewater surveillance for pathogens is an important epidemiological component that could inform early warning systems. The objective of this rapid review was to evaluate the use of wastewater for epidemiology surveillance of enteric viral pathogens. Nine studies met the inclusion criteria. Eight viral pathogens were reviewed and analysed from 6 countries that performed wastewater analysis. Six studies explored the epidemiologic significance of viral pathogens in wastewater. The findings of this review revealed that monitoring of wastewater can provide an additional tool to determine the epidemiology of viral pathogens circulating in the community thereby providing early warning of potential outbreaks using wastewater-based epidemiology methods. Five of the included studies revealed the occurrence of viral pathogens in raw sewage and treated wastewater as an indication of inefficient elimination of viruses leading to potential release into water sources which presents a public health risk, increasing the risk of inducing gastroenteritis in the population. Six studies revealed the need for public health authorities to realise the potential benefit of environmental surveillance (ES) as an additional tool to determine the epidemiology of viral pathogens circulating in each community. Despite the significant public health challenge associated with enteric viral pathogens in sub-Saharan Africa, there remains remarkable underinvestment in potentially epidemiologically beneficial research, including wastewater-based epidemiology for these infections.