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Background Childhood stunting is the most widely prevalent among under-five children in Ethiopia. Despite the individual-level factors of childhood stunting are well documented, community-level factors have not been given much attention in the country. This study aimed to identify individual- and community-level factors associated with stunting among under-five children in Ethiopia. Methods Cross-sectional data from the 2016 Ethiopian Demographic and Health Survey was used. A total of 8855 under-five children and 640 community clusters were included in the current analysis. A multilevel logistic regression model was used at 5% level of significance to determine the individual- and community-level factors associated with childhood stunting. Results The prevalence of stunting was found to be 38.39% in Ethiopian under-five children. The study showed that the percentage change in variance of the full model accounted for about 53.6% in odds of childhood stunting across the communities. At individual-level, ages of the child above 12 months, male gender, small size of the child at birth, children from poor households, low maternal education, and being multiple birth had significantly increased the odds of childhood stunting. At community-level, children from communities of Amhara, Tigray, and Benishangul more suffer from childhood stunting as compared to Addis Ababa’s community children. Similarly, children from Muslim, Orthodox and other traditional religion followers had higher log odds of stunting relative to children of the protestant community. Conclusions This study showed individual- and community-level factors determined childhood stunting in Ethiopian children. Promotion of girl education, improving the economic status of households, improving maternal nutrition, improving age-specific child feeding practices, nutritional care of low birth weight babies, promotion of context-specific child feeding practices and narrowing rural-urban disparities are recommended.

Concurrent wasting and stunting (WaSt) is a condition where both wasting and stunting exist in a child at the same time. This study aimed to assess the prevalence of WaSt and to identify potential associated factors in Ethiopia.  A total of 33,650 children aged between 0 and 59 months were included in the analysis from the four waves of the Ethiopian Demographic and Health Survey. A mixed‐effects logistic regression model was used to identify the determinants of WaSt. The prevalence of WaSt was found to be 4.7% (95% confidence interval [CI]: (4.5–4.9)), with respectively 2.5% (95% CI: 2.1–3.1) and 4.9% (95% CI: 4.7–5.2) among children in urban and rural settings. Children: (i) in the age group 12–23 months (adjusted odds ratio [AOR]: 4.16, 95% CI: (3.20–5.42)) and 24–59 months (AOR: 3.08, 95% CI: (2.28–4.17)); (ii) who were perceived by their mothers to be smaller than normal at birth (AOR: 1.98, 95% CI: (1.57–2.50)); (iii) had diarrhoea (AOR: 1.38, 95% CI: (1.11–1.71)); and (iv) fever in the past 2 weeks (AOR: 1.38, 95% CI: (1.10–1.71)) reported higher odds of WaSt. Being a female child (AOR: 0.57, 95% CI: (0.48–0.69)), having received measles vaccination (AOR: 0.71, 95% CI: (0.55–0.89)), having a mother with a normal body mass index (18.5–24.9 kg/m2) (AOR: 0.57, 95% CI: (0.48–0.68)), having a wealthier household (AOR: 0.67, 95% CI: (0.50–0.90)), and living in rural setting (AOR: 0.49, 95% CI: (0.32–0.74)) were associated with reduced odds of WaSt. The prevalence of WaSt was high, with approximately 1 in 20 Ethiopian children suffering from the condition and needing a prompt response to minimize the poor health and developmental outcomes. Children perceived by their mother to be smaller than normal at birth, older children, and babies with diarrhoea and fever had higher odds of WaSt. In this study, we attempted to assess the prevalence of concurrent wasting and stunting (WaSt) and to identify potential associated factors in Ethiopia. The prevalence of WaSt was high, with approximately 1 in 20 Ethiopian children suffering from the condition and needing a prompt response to minimise poor health and developmental outcomes. Key messages Few studies have examined the prevalence of concurrent wasting and stunting (WaSt) and contributing factors in Sub‐Saharan African (SSA) countries including Ethiopia. WaSt was found to be a significant public health problem particularly among children aged 0–59 months in Ethiopia. Children perceived by their mother to be smaller than normal at birth, older children, and babies with diarrhoea and fever were more likely to experience WaSt. Existing nutrition‐specific and sensitive interventions that address the immediate and underlying drivers of wasting and stunting should also consider addressing both issues simultaneously.

Background The demand for herbal medicines continues to increase globally. However, community perceptions on their effectiveness and factors influencing their use have not been extensively investigated, notably in the Tanga Region, North-eastern Tanzania, where their use in treating various diseases, including paediatric diarrhoea, has flourished. According to studies, Tanga Region has a high prevalence of diarrhoea among under-five children. This study explored community perceptions on the effectiveness of herbal medicines and factors associated with their use in managing diarrhoea among under-five children in North-eastern Tanzania. Methods A qualitative approach and a narrative design were employed by the present study since they had the potential to reveal unrecognized or unreported research problems. Focus group discussions and in-depth interviews were used to facilitate data collection from June 2022 to February 2023. The methods were chosen since they are the most common sources of qualitative data in health research. Purposive sampling method was used to select 247 participants, which included 171 caretakers, 52 traditional healers, and 24 paediatric health workers. Interviews were conducted until the saturation point was reached. The purposive technique was considered since it was a method that enabled the researcher to select participants who were knowledgeable about the study topic. Data analysis was performed using thematic analysis. Results Economic hardship, culture and heritage, superstitious beliefs, failure to recover after receiving hospital medication, easy accessibility of herbal medicines, and long distance to the health facility were the factors perceived to be potentially associated with persistent use of herbal medicines among caretakers. The majority of participants believed that herbal treatments were harmless and effective in treating diarrhoea. Conclusion Superstitious beliefs, culture, and heritage were the primary justifications for using herbal medicines. It is vital for the relevant authority to educate the community on the risk of using unproven herbal medicines in order to diminish the effects that may arise from using uninvestigated herbs. As things stand, the use of herbal medications will continue owing to their relevance to the lives of people in the study setting.

Introduction Pneumonia is a leading cause of under‐five mortality, with 30 million annual cases in India. Despite national guidelines, significant barriers to timely and appropriate care‐seeking persist. Caregivers often face financial constraints, lack of awareness, mistrust in government facilities and a preference for non‐registered medical practitioners (non‐RMPs), delaying effective treatment. This study explores care‐seeking behaviours, associated socio‐demographic factors and barriers to access to appropriate healthcare for childhood pneumonia in rural India. Methods This study is part of a broader implementation research (IR) initiative and represents its formative phase. This mixed‐methods study was conducted in Palwal district, Haryana, covering 42 villages (population: 107,440). A cross‐sectional survey identified suspected pneumonia cases among 9593 under‐five children through house‐to‐house visits using a structured checklist. Data on socio‐demographic characteristics, health insurance, care‐seeking patterns and provider preferences were collected. Directed acyclic graphs (DAGs) identified potential confounders in the association between care‐seeking behaviour and key exposure variables. Additionally, qualitative in‐depth interviews explored caregivers' perceptions, decision‐making and healthcare barriers to pneumonia management. Quantitative data were analysed using logistic regression, while qualitative data were thematically analysed using the Three Delays Model. Suspected under‐five pneumonia cases' caregivers and families were actively engaged in this formative phase to inform Phase II implementation strategies of broader IR, ensuring community‐driven and contextually relevant strategies. Results Among 231 suspected pneumonia cases, 97% of caregivers sought medical care, but 71% consulted non‐RMPs, and only 3.6% visited government facilities. Seeking appropriate care was associated with higher maternal education (AOR 6.5, 95% CI: 2.7–9.7) and higher wealth index (AOR 1.7, 95% CI: 1.0–2.6). Thematic analysis revealed delays due to symptom misinterpretation, reliance on home remedies, financial constraints, gender biases, mistrust in public healthcare services and logistical barriers. Conclusion Despite high care‐seeking rates, provider preferences, socio‐cultural factors and systemic barriers delay appropriate pneumonia treatment. Addressing these challenges requires improving awareness, enhancing public healthcare trust and strengthening frontline healthworker engagement. This study underscores the role of structured beneficiary involvement in refining pneumonia management strategies to ensure sustainable, community‐driven interventions. Patient or Public Contribution This study is part of an ongoing implementation research (IR) aimed at improving the effective coverage of childhood pneumonia management in a low‐resource setting. A structured engagement with primary caregivers of under‐five children, mothers, fathers, family members, community members and local community stakeholders/representatives, for example, local leaders, village heads and so forth, has been integrated at multiple stages to ensure the relevance and applicability of its findings. The current study is part of Phase I (formative research) of the IR, where primary caregivers and family members participated in a needs assessment, providing critical insights into the barriers and facilitators influencing care‐seeking for childhood pneumonia in a rural low‐to‐middle socio‐economic setting. Their inputs have informed the refinement of study tools and the development of mitigation strategies for the logic and implementation model. As the research progresses into Phase II (model development and implementation), the community continues to play an integral role in providing feedback on the feasibility and appropriateness of proposed strategies. This ongoing feedback loop assesses how effectively these strategies strengthen linkages between the healthcare system and the community, foster an active local needs assessment mechanism among healthcare providers and enhance demand generation for appropriate pneumonia care‐seeking. These iterative refinements ensure that the implementation strategies remain responsive to the evolving needs of the community. In the forthcoming Phase III, which will focus on scaling up the finalised implementation model, strategies will be adapted to further improve care‐seeking for under‐five children. Continuous engagement with caregivers and local community representatives, including Panchayati Raj Institution (PRI) members, will be central to refining these strategies. Additionally, during the dissemination phase, key findings will be shared with caregivers, community members and PRI representatives, facilitating discussions on study implications and informing future policy and programmatic decisions. Their ongoing involvement will help contextualise findings and enhance the long‐term sustainability of strategies aimed at improving pneumonia care‐seeking behaviours and effective management in rural India.

Background and Aims When predicting the risk of childhood acute respiratory infections (ARI) among under‐five children, categorizing drinking water sources remains controversial in Bangladesh. The study aimed to assess the impact of main two drinking water sources on childhood ARI status. Methods From January to April 2023, a hospital‐based case‐control study was carried out involving 216 cases and 216 controls among under‐five children in Dhaka, Bangladesh. Children with ARI symptoms were considered as cases, while controls were without ARI symptoms. Piped water sources were categorized as improved sources, while tube well/boreholes as unimproved. Bivariate and multivariate logistic regression were performed to assess the relationship between two different water source categories and childhood ARI status. Results Around 57% of households with cases had access to improved water sources while for controls it was 68.1%. Households with improved water sources had a 51% lower risk of having under‐five children with ARIs (AOR: 0.5, 95% CI: 0.3–1.0, p = 0.039). Prematurity (AOR: 1.8, 95% CI: 1.1–3.0, p = 0.025), delayed initiation of breastfeeding (AOR: 3.0, 95% CI:1.8–4.8, p < 0.001), exposed to in‐house smoking (AOR: 3.0, 95% CI: 1.9–5.0, p < 0.001) were associated with increased risk of childhood ARI. Older children had a lower risk of having ARI than infants. Conclusion Piped drinking water sources are associated with a lower risk of ARI among under‐five children in Bangladesh. Water purification practices may act as a protective mechanism against ARI in households with piped water sources. Water supply infrastructure and behavioral strategies programs in areas with unimproved water sources could reduce the burden of ARI.

Background and Aims Worldwide, pneumonia was responsible for about 740,180 deaths in children under 5 year, accounting for 14% of all deaths in 2019. The purpose of this study was to identify associated risk factors of community acquired pneumonia among 2–59 months old children in Awi Zone, Northwest Ethiopia. Methods A community‐based cross‐sectional study was conducted from March to July 2023, using a multistage sampling method to select 1368 participants. Data were collected using a structured questionnaire. Multilevel analysis was used to identify factors associated with community‐acquired pneumonia. Variables with p‐value < 0.05 were considered as statistically significant. Results The prevalence of community acquired pneumonia among 2‐59 months old was 11.33%. Primary education (AOR = 0.34; 95% CI: 0.12, 0.95), stunting (AOR = 6.12; 95% CI: 2.41, 15.51), having diarrhea (AOR = 5.04; 95% CI: 2.41, 10.55), history of acute lower respiratory tract infection (AOR = 20.84; 95% CI: 3.95, 109.83), use of charcoal as fuel source (AOR = 130.56, 95% CI: 5.94, 2869.18), carrying of a child on mother during cooking (AOR = 2.27, 95% CI: 1.10, 4.69), and presence of separate kitchen (AOR = 0.38; 95% CI: 0.19, 0.74) were associated with community acquired pneumonia. Conclusion Mother education, age of child, stunting, presence of separate kitchen, previous respiratory tract infection, use of charcoal for fuel source, carrying of a child on mother during cooking, and history of diarrhea showed a significant association with community acquired pneumonia. Therefore, we recommend adequate health education on nutrition, diarrhea prevention and treatment, and reducing indoor air pollution to reduce the risk of community‐acquired pneumonia.

Oral rehydration therapy reduces mortality and morbidity due to diarrheal diseases. However, Oral rehydration therapy remains to be underused worldwide and particularly in low-income countries. This study aims to assess the prevalence of oral rehydration therapy use during diarrheal episode and associated factors among mothers of under-five children visiting public health facilities in North Showa zone, Oromia region, Ethiopia. Institutional based cross-sectional study design was employed for one month in June 2020. A structured interview administered questionnaire was used to collect data. Data were entered into EPI-info 3.5.2 then transported to SPSS 21 version. Descriptive statistical analysis was done, and an association between dependent variables and independent variables were examined in logistic regression models. The overall prevalence of oral rehydration therapy use during diarrheal episode was 51.5%. Maternal literacy [AOR= 2.175, 95% CI: (1.178, 4.015)], mothers occupation being farmer [AOR= 0.394, 95% CI: (0.203, 0.762)], post natal care visit [AOR= 2.565, 95% CI: (1.468, 4.480)] and good knowledge of oral rehydration therapy [AOR= 1.919, 95% CI: (1.132, 3.253)] were significantly associated with oral rehydration therapy use. In this study oral rehydration therapy use was moderate. Maternal literacy, good knowledge of oral rehydration therapy, maternal occupation being a farmer, and postnatal care visit were the independent predictors of oral rehydration therapy use. Therefore, programmers and stakeholders who are working on child health programs should design interventions that focus on factors deterring child oral rehydration therapy use during diarrheal episode morbidity and mortality.

Background Undernutrition among under five children in India is a major public health problem. Despite India’s growth in the economy, the child mortality rate due to undernutrition is still high in both urban and rural areas. Studies that focus on urban slums are scarce. Hence the present study was carried out to assess the prevalence and determinants of undernutrition in children under five in Maharashtra, India. Methods A community-based cross-sectional study was conducted in 16 randomly selected clusters in two districts of Maharashtra state, India. Data were collected through house to house survey by interviewing mothers of under five children. Total 2929 mothers and their 3671 under five children were covered. Multivariate logistic regression analysis was carried out to identify the determinants of child nutritional status seperately in urban and rural areas. Results The mean age of the children was 2.38 years (±SD 1.36) and mean age of mothers was 24.25 years (± SD 6.37). Overall prevalence of stunting among children under five was 45.9%, wasting was 17.1 and 35.4% children were underweight. Prevalence of wasting, stunting and underweight were more seen in an urban slum than a rural area. In the rural areas exclusive breast feeding ( p  < 0.001) and acute diarrhea ( p  = 0.001) were associated with wasting, children with birth order 2 or less than 2 were associated with stunting and exclusive breast feeding ( p  < 0.05) and low maternal education were associated with underweight. Whereas in the urban slums exclusive breast feeding ( p  < 0.05) was associated with wasting, sex of the child ( p  < 0.05) and type of family ( p  < 0.05) were associated with stunting,and low income of the family ( p  < 0.05) was associated with underweight. Conclusions Factors like sex of the child, birth order,exclusive breast feeding,economic status of the family, type of family,acute diarrhea and maternal education have influence on nutritional status of the child. Improvement of maternal education will improve the nutritional status of the child. Strategies are needed to improve the economic status of the community. Trial registration Trial registration number: CTRI/2017/12/010881 ; Registration date:14/12/2017. Retrospectively registered.

In addition to physical wellbeing, healthy development of a child is when social, emotional and educational needs are met. 1 Ocular diseases among children are related to prenatal-, neonatal-, or childhood-underlying causes. 2 Ocular diseases at a young age might significantly affect children's development and eventually interfere with their quality of life. 3–7 Visual defects and blindness among young children are a major concern, as they have numerous negative impacts on individuals, the community, and the country. [...]the majority of young children never get an eye examination. The majority of ocular disorders such as amblyopia, unilateral blindness, and strabismus occur at a young age and is the reason why the American Academy of Pediatrics recommends visual screening programs for children younger than 5 years to ensure early detection and appropriate interventions, which, in turn, result in a better quality of life. 12 The objective of this research was to study the epidemiological patterns of ocular morbidity among children younger than 5 years old at three tertiary eye hospitals. STUDY POPULATION AND DATA COLLECTION Patient records of all children younger than 16 years old who attended any of the three hospitals, for any complaint, in 2019 were retrieved (n = 10,886) to collect those of under 5 years of age to estimate their proportion and later to study the pattern of ocular disorder.