Under-five children

Background: Malnutrition among children under five years remains a critical public health issue in Nigeria, contributing substantially to under-five morbidity and mortality. Despite various interventions, limited evidence exists on the specific determinants of malnutrition in semi-urban settings such as Egor Local Government Area, Edo State, Nigeria. Objective: This study assessed the prevalence and determinants of malnutrition among children under five years in Egor LGA, specifically evaluating caregiver knowledge, feeding practices, sources of nutritional information, and socioeconomic factors influencing nutritional outcomes. Methods: A descriptive cross-sectional study was conducted among 400 caregiver- child pairs selected through multi-stage stratified systematic random sampling from primary healthcare centres, immunization clinics, and child welfare services in Egor LGA between January and March 2026. Data were collected using a structured interviewer-administered questionnaire covering sociodemographic characteristics, caregiver knowledge (27-point scale), child feeding practices (12-point scale), information sources, and household factors. Anthropometric measurements (weight, height/length, mid-upper arm circumference) were taken following WHO standardized protocols. Nutritional status was classified using WHO 2006 Child Growth Standards (Z-scores). Data were analysed using IBM SPSS version 25, with chi-square tests and multivariate binary logistic regression (p < 0.05 significance level). Results: The majority of caregivers were mothers (73.3%), aged 29–38 years (38.8%), with secondary (47.0%) or tertiary (41.5%) education. Good knowledge of child nutrition was demonstrated by 65.6% of caregivers, with 96.3% correctly identifying exclusive breastfeeding duration (6 months) and 91.3% knowing appropriate complementary feeding age (6 months). However, only 47.5% exhibited good feeding practices. A significant knowledge-practice gap was identified: caregivers with good knowledge were significantly less likely to have good feeding practices (AOR = 0.625, 95% CI: 0.409–0.955, p = 0.030). Health workers were the most utilized (94.5%) and trusted (44.8%) information source, yet only 13.0% had attended formal nutrition education. Overall malnutrition prevalence was 20.7% (underweight 14.5%, moderate malnutrition 4.0%, wasting 1.3%, stunting 1.0%). Recent child illness (AOR = 1.891, 95% CI: 1.101–3.250, p = 0.021) and good feeding practices (AOR = 2.042, 95% CI: 1.167–3.571, p = 0.012) were significant risk factors for malnutrition, while good caregiver knowledge (AOR = 0.419, 95% CI: 0.245–0.717, p = 0.001), male caregiver sex (AOR = 0.305, 95% CI: 0.112–0.831, p = 0.020), and household food insecurity (AOR = 0.382, 95% CI: 0.204–0.712, p = 0.002) were protective. Conclusion: Despite relatively high caregiver knowledge and lower malnutrition prevalence than national averages in Egor LGA, a substantial knowledge-practice gap persists, and child feeding practices remain suboptimal with low dietary diversity and high consumption of sugary drinks and packaged snacks. Health workers are trusted information sources but structured nutrition education is underutilized. Interventions must address economic and structural barriers limiting knowledge translation, integrate practical skills-based nutrition counselling into routine health services, and target modifiable risk factors including childhood illnesses.

Background: Malaria remains a leading cause of morbidity and mortality among under-five children in Nigeria. The introduction of malaria vaccines (RTS,S/AS01 and R21/Matrix-M) offers a promising complementary intervention. However, vaccine acceptance is critically dependent on caregivers' knowledge and perceptions—factors that remain poorly characterized in Benin City, Edo State. Objective: To assess the knowledge, perception, acceptance, and factors influencing acceptance of malaria vaccines among caregivers of under-five children in Benin City, Edo State, Nigeria. Methods: A community-based descriptive cross-sectional study was conducted from May 2024 to May 2026 among 426 caregivers of under-five children selected through a multi- stage sampling technique in Ekosodin community, Ovia North-East Local Government Area, Benin City. Data were collected using a pretested, structured, interviewer-administered questionnaire. Knowledge was assessed using a 12-point scoring system (categorized as good: ≥50%), perception using a 10-item Likert scale (positive: >60%), and acceptance as willingness to vaccinate. Data were analyzed using IBM SPSS version 27.0; bivariate and multivariate logistic regression analyses were performed with statistical significance set at p<0.05. Results: The mean age of respondents was 35.2±10.4 years; the majority were female (68.1%), married (67.1%), and had secondary education (43.7%). While awareness of malaria was universal (99.8%), only 44.1% had heard of the malaria vaccine, and overall good knowledge of the vaccine was poor (20.2%). Positive perception toward the malaria vaccine was high (84.7%). Willingness to accept the vaccine was 73.5%, although actual uptake remained low (11.5%). Fear of adverse reactions (82.3%) was the predominant reason for refusal. Significant predictors of good vaccine knowledge included tertiary education (AOR=4.84; 95% CI: 2.67–8.77; p=0.001) and ever-married status (AOR=2.40; 95% CI: 1.09–5.26; p=0.030). Positive perception was strongly associated with Christian religious affiliation (AOR=7.37; 95% CI: 3.10–17.54; p<0.001). The strongest independent predictor of willingness to accept the malaria vaccine was positive perception (AOR=7.39; 95% CI: 3.87–14.12; p<0.001), followed by good knowledge of the vaccine (AOR=2.87; 95% CI: 1.24–6.63; p=0.014). Increasing age was associated with reduced willingness (AOR=0.97; 95% CI: 0.95–1.00; p=0.046). Conclusion: Despite favorable perception and high willingness to accept malaria vaccines among caregivers in Benin City, significant gaps exist in knowledge and awareness. Perception emerged as the strongest driver of acceptance, while educational status and marital status influenced knowledge. These findings underscore the urgent need for targeted health education interventions, particularly leveraging healthcare professionals as trusted information sources, to bridge the knowledge-practice gap and optimize malaria vaccine uptake in this setting. Keywords: Malaria vaccine, knowledge, perception, acceptance, caregivers, under-five children, Benin City, Nigeria.