Causes and Risk Factors of Hospitalization among Under-five Children in Kassala, Eastern Sudan


  • Ahmed A. Hassan Department of Research, Taami for Agricultural and Animal Production, Khartoum, Sudan
  • Zainab Taha Department of Health Sciences, College of Natural and Health Sciences, Zayed University, Abu Dhabi, United Arab Emirates
  • Mohammed A. Abdulla Department of Pediatrics, Faculty of Medicine, Gadarif University, Sudan
  • AbdelAziem A. Ali Department of Obstetrics and Gynecology, Faculty of Medicine, Kassala University, Sudan
  • Ishag Adam Department of Obstetrics and Gynecology, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Kingdom of Saudi Arabia



Under-five children’s hospitalization, Birth order, Paternal education, Bottle-feeding, Sudan


BACKGROUND: According to the World Health Organization estimation, African Region deaths of all under-five deaths in 2015 were over 5 times higher in comparison to the European Region.

AIM: The study aimed to estimate the prevalence, investigate the possible causes and risk factors associated with under-five children’s hospitalization in Kassala, Eastern Sudan.

METHODS: A community-based cross-sectional study was conducted from December 2015 to March 2016. The data were collected by interviewing mothers.

RESULTS: A total of 297 mother-child pairs participated in the study. The mean (SD) of maternal age and children’s age was 27.6 (5.9) years and 16 (11.3) months, respectively. One hundred and three children were hospitalized over the past 6 months. The most common mentioned causes for the last hospitalization were gastroenteritis 28.1% (29/103), respiratory tract infections 19.4% (20/103), malaria 9.7% (10/103), and trauma 3.8% (3/103). In multivariable analysis, a high birth order (adjusted odds ratio [AOR] 1.25, 95% Confidence Interval [CI] (1.06, 1.47), low paternal education (AOR 2.89, 95% 1.32, 6.30), and bottle feeding (AOR 2.26, 95% CI 1.30, 3.80) were associated with under-five children’s hospitalization.

CONCLUSIONS: More than one-third of the children were hospitalized in Eastern Sudan. Urgent action is required to address children’s health issues (i.e., the above-mentioned causes and associated factors).


Download data is not yet available.


Metrics Loading ...

Plum Analytics Artifact Widget Block


WHO. Infant Mortality; 2017. Available from: [Last accessed on 2019 Dec 05].

Mahgoub HM, Adam I. Morbidity and mortality of severe malnutrition among Sudanese children in new halfa hospital, Eastern Sudan sign in Oxford academic account. Trans R Soc Trop Med Hyg. 2012;106(1):66-8. trstmh.2011.09.003

Monge RB. Upper airway infections related to the use of the feeding bottle in feeding the young infant. Curr Nurs Costa Rica. 2017;32:90-103.

Hanieh S, Ha TT, Simpson JA, Thuy TT, Khuong NC, Thoang DD, et al. Exclusive breast feeding in early infancy reduces the risk of inpatient admission for diarrhea and suspected pneumonia in rural Vietnam: A prospective cohort study. BMC Public Health. 2015;15:1166. PMid:26602368

Ajetunmobi OM, Whyte B, Chalmers J, Tappin DM, Uk M, Wolfson L, et al. Breastfeeding is associated with reduced childhood hospitalization: Evidence from a scottish birth cohort (1997-2009). J Pediatr. 2015;166(3):620-5.e4. https://doi. org/10.1016/j.jpeds.2014.11.013 PMid:25556021

Patel DV, Bansal SC, Nimbalkar AS, Phatak AG, Nimbalkar SM, Desai RG. Breastfeeding practices, demographic variables, and their association with morbidities in children. Adv Prev Med. 2015;2015:892825. PMid:26347823

Kaur A, Singh K, Pannu MS, Singh P, Sehgal N, Kaur R. The effect of exclusive breastfeeding on hospital stay and morbidity due to various diseases in infants under 6 months of age: A prospective observational study. Int J Pediatr. 2016;2016:7647054. https://

Gebremedhin D, Berhe H, Gebrekirstos K. Risk factors for neonatal sepsis in public hospitals of Mekelle City, North Ethiopia, 2015: Unmatched case control study. PLoS One. 2016;11(5):e0154798. PMid:27163290

Sharaf A, Ibrahim E, Nabag FO. Impact of diarrhoea on the nutritional status among children under five years old. Sudan J Sci Technol. 2016;17(2):46-56.

Hussain Z, Khan N. Assessment of the nutritional status of bottle-fed infants and the prevalence of infections, allergy and diarrhea among bottle fed infants and its comparison with exclusively breast fed infants aged 0-6 months. J Pediatr Neonatal Care Assess. 2017;6(4):2-7. jpnc.2017.06.00249

Biks GA, Berhane Y, Worku A, Gete YK. Exclusive breast feeding is the strongest predictor of infant survival in Northwest Ethiopia: A longitudinal study. J Health Popul Nutr. 2015;34:9. PMid:26825334

Awasthi A, Awasthi S. Promoting exclusive breastfeeding in India to reduce neonatal mortality. Clin Epidemiol Glob Health. 2016;4(4):151-2.

Thaver D, Zaidi AK. Burden of neonatal infections in developing countries: A review of evidence from community-based studies. Pediatr Infect Dis J. 2009;28(1):S3-9. inf.0b013e3181958755

Muoneke VU, Ibekwe RC, Nebe-Agumadu HU, Ibe BC. Factors associated with mortality in under-five children with severe anemia in Ebonyi, Nigeria. Indian Pediatr. 2012;49(2):119-23. PMid:21719933

Howidi M, Al Kaabi N, El Khoury AC, Brandtmüller A, Nagy L, Richer E. Burden of acute gastroenteritis among children younger than 5 years of age-a survey among parents in the United Arab Emirates. BMC Pediatr. 2012;12:74. https://doi. org/10.1186/1471-2431-12-74 PMid:22708988

Anteneh ZA, Andargie K, Tarekegn M. Prevalence and determinants of acute diarrhea among children younger than five years old in Jabithennan District, Northwest. BMC Public Health. 2017;17(1):99. PMid:28103908

Pernica JM, Steenhoff AP, Welch H, Mokomane M, Quaye I, Arscott-Mills T, et al. Correlation of clinical outcomes with multiplex molecular testing of stool from children admitted to hospital with gastroenteritis in Botswana. J Pediatric Infect Dis Soc. 2016;5(3):312-8. PMid:26407262

Kanan SO, Swar MO. Prevalence and outcome of severe malnutrition in children less than five-year-old in omdurman paediatric hospital, Sudan. Sudan J Paediatr. 2016;16(1):23-30. PMid:27651550

Elhassan EM, Hassan AA, Mirghani OA, Adam I. Morbidity and mortality pattern of neonates admitted into nursery unit in wad medani hospital, Sudan. Sudan J Med Sci. 2010;5(1):13-6.

Sudan National S3M. Executive Summary: Simple Spatial Surveying Method (S3M) Survey in Sudan, Khartoum; 2013. Available from: uploads/2014/12/sudan_s3m-_2013_final-endorsed-executivesummary_25nov2014.pdf. [Last accessed on 2019 Dec 10].

Ambroso G, Crisp J, Albert N. Review of UNHCR’s Response to the Protracted Refugee Situation in Eastern Sudan. United Nations High Commissioner for Refugees Policy Development and Evaluation Service (PDES); 2011. Available from: https://

Abdalla IM. Shagarab land will Change into Desert by Refugees, El-Griba Locality, Kassala State, Sudan. Int J Curr Microbiol Appl Sci. 2015;4(9):784-8.

World Food Programme. A Comprehensive Food Security Assessment in Kassala State, Sudan UN World Food Programme; 2012. Available from: http://www.documents. pdf?iframe. [Last accessed on 2019 Dec 10]. https://doi. org/10.1093/law:epil/9780199231690/e574

Kok W. Self-settled refugees and the socio-economic impact of their presence on kassala, Eastern Sudan. J Refug Stud. 2018;2(4):419-40.

Ottaway M, El-Sadany M. Sudan: From Conflict to Conflict. Washington, DC: USA; 2012. Available from: http://www. [Last accessed on 2019 Dec 11].

Sudan Integrated Food Security Phase Classification IPC. Sudan Acute Food Insecurity Situation, Khartoum, Sudan; 2017. Available from: public/documents/ena/wfp258759.pdf?iframe. [Last accessed on 2019 Dec 10].

Gubert MB, Spaniol AM, Bortolini GA, Pérez-escamilla R. Household food insecurity, nutritional status and morbidity in Brazilian children. Public Health Nutr. 2016;19(12):2240-5. PMid:26893101

Campbell AA, de Pee S, Sun K, Kraemer K, Thorne-lyman A, Moench-Pfanner R, et al. Relationship of household food insecurity to neonatal, infant, and under-five child mortality among families in rural Indonesia. Food Nutr Bull. 2009;30(2):112-9. PMid:19689089

Nnadi C, Etsano A, Uba B, Ohuabunwo C, Melton M, Nganda G, et al. Approaches to vaccination among populations in areas of conflict. J Infect Dis. 2017;216(1):S368-72. https://doi. org/10.1093/infdis/jix175 PMid:28838202

Pereira AL, Handa S, Holmqvist G. Prevalence and Correlates of Food Insecurity Among Children Across the Globe, Florence, Italy; 2017. Available from: iwp_2017_09.pdf. [Last accessed on 2019 Dec 10].

Betebo B, Ejajo T, Alemseged F, Massa D. Household food insecurity and its association with nutritional status of children 6-59 months of age in East Badawacho district, South Ethiopia. J Environ Public Health. 2017;2017:6373595. https://doi. org/10.1155/2017/6373595 PMid:28408936

Chowdhury MR, Khan MM, Islam, MR, Perera NK, Shumack MK, Kader M. Low maternal education and socio-economic status were associated with household food insecurity in children under five with diarrhoea in Bangladesh. Acta Paediatr. 2016;105(5):555-61. PMid:26719122

Brinkman H, Hendrix CS. Food Insecurity and Violent Conflict: Causes, Consequences, and Addressing the Challenges. Report No. 24. Rome, Italy; 2011. Available from: https://www. [Last accessed on 2019 Dec 10].

Footer KH, Rubenstein LS. A Human Rights Approach to Health care in conflict. Int Rev Red Cross. 2013;95(889):167-87.

Central Bureau of Statistics (CBS). Censuses, Sudan Goverment; 2018. Available from: files.php?id=7#&panel1-3. [Last accessed on 2019 Dec 10].

The Organisation for Economic Co-Operation and Development. OECD Health Statistics 2017 Definitions, Sources and Methods Hospital Average Available from: Length of Stay by Diagnostic Categories; 2017. aspx?idfile=05c5f7a0-a813-4cc1-8a83-0d77343b5b9e. [Last accessed on 2019 Dec 13].

Beser OF, Cokugras FC, Erkan T, Kutlu T, Yagci RV, TUHAMAR Study Group. Evaluation of malnutrition development risk in hospitalized children. Nutrition. 2018;48:40-7. PMid:29469018

Siziya S, Muula AS, Rudatsikira E. Correlates of diarrhoea among children below the age of 5 years in Sudan. Afr Health Sci. 2013;13(2):376-83. PMid:24235939

Wang H, Peng J, Wang B, Lu X, Zheng JZ, Wang K, et al. Inconsistency between univariate and multiple logistic regressions. Shanghai Arch Psychiatry. 2017;29(2):124-8. PMid:28765686

Lo SK, Li IT, Tsou TS, See L. Non-significant in univariate but significant in multivariate analysis: A discussion with examples. Changgeng Yi Xue Za Zhi. 1995;18(2):95-101. PMid:7641117

Li V, Davies K, Koizumi E, Paluch S, Riviere S, Summers M. Reducing child mortality in Sudan by preventing diarrheal disease. J Glob Health. 2014;4(1):1-11.

Kinyoki DK, Manda SO, Moloney GM, Odundo EO, Berkley JA, Noor AM, et al. Modelling the ecological comorbidity of acute respiratory infection, diarrhoea and stunting among children under the age of 5 years in Somalia. Int Stat Rev. 2017;85(1):164-76. PMid:28450758

Musa HA, Holi MA, Hussein ME, Shikeiri AB. Faecal contamination of feeding bottles contents, among artificially fed children. Sudan J Med Sci. 2009;4(2):1-4. https://doi. org/10.4314/sjms.v4i2.44901

Kim HY, Han Y, Pyun Y, Kim J, Ahn K, Lee SI. Asia pacific allergy respiratory symptoms in infants. Asia Pac Allergy. 2011;1(1):30-5.

Brhanu H, Negese D, Gebrehiwot M. Determinants of acute diarrheal disease among under-five children in Pawi hospital, Northwest Ethiopia, 2013/14. Am J Pediatr. 2013;314(6):68-75.

Hsu NY, Wu PC, Bornehag CG, Sundell J, Su HJ. Feeding bottles usage and the prevalence of childhood allergy and asthma. Clin Dev Immunol. 2012;2012:158248. https://doi. org/10.1155/2012/158248 PMid:22291844

Melo AM, Kassar SB, Lira PI, Coutinho SB, Eickmann SH, Lima MC. Characteristics and factors associated with health care in children younger than 1 year with very low birth weight. J Pediatr. 2013;89(1):75-82.

Sonneveldt E, Plosky WD, Stover J. Linking high parity and maternal and child mortality: What is the impact of lower health services coverage among higher order births? BMC Public Health. 2013;13 Suppl 3:S7. https://doi. org/10.1186/1471-2458-13-s3-s7 PMid:24564721

Grundy E, Kravdal Ø. Do short birth intervals have longterm implications for parental health? Results from analyses of complete cohort Norwegian register data. J Epidemiol Community Health. 2014;68(10):958-64. jech-2014-204191 PMid:25009153

Khan JR, Awan N. A comprehensive analysis on child mortality and its determinants in Bangladesh using frailty models. Arch Public Health. 2017;75(1):1-10. s13690-017-0224-6

Costello CA. Maternal and Child Health in Rural Uganda: The Role of Nutrition, Mortality and Depletion; 1986. Available from: [Last accessed on 2019 Dec 10].

Adam I, Ismail MH, Nasr AM, Prins MH, Smits LJ. Low birth weight, preterm birth and short interpregnancy interval in Sudan. J Matern Fetal Neonatal Med. 2009;22(11):1068-71. https://doi. org/10.3109/14767050903009222 PMid:19900046

Andriano L, Monden CW. Maternal education on child mortality: Evidence from a quasi-experiment in Malawi and Uganda. In: The 2017 International Population Conference, Cape Town, South Africa; 2017. p. 1-7. s13524-019-00812-3

Natarajan V. Does maternal education really improve child health? IOSR J Dent Med Sci. 2013;4(4):7-9.

Hassan AA, Abubaker MS, Radi EA, Adam I. Education, prenatal care, and poor perinatal outcome in Khartoum, Sudan. Int J Gynaecol Obstet. 2009;105(1):66-7. ijgo.2008.10.026 PMid:19062014

Ali AA, Mohammed AA, Sulaiman MA. Education, poor antenatal care coverage and teenage pregnancy at Kassala Hospital, Eastern Sudan. J Public Health Epidemiol. 2011;3(13):642-4.

Cochrane SH, Leslie J, O’Hara DJ. Parental education and child health: Intracountry evidence. Health Policy Educ. 1982;2(3-4):213-50. https://doi. org/10.1016/0165-2281(82)90011-x PMid:10298649

Rammohan A, Awofeso N, Fernandez RC. Paternal education status significantly influences infants’ measles vaccination uptake, independent of maternal education status. BMC Public Health. 2012;12(336):1-7. https://doi. org/10.1186/1471-2458-12-336

Ayoub AS. Effects of women’s schooling on contraceptive use and fertility in Tanzania. Afr Popul Stud. 2004;19(2):139-57.

das Gupta M, Engelman R, Levy J, Luchsinger G, Merrick T, Rosen JE. State of World Population 2014. New York: UNFPA; 2014. p. 1-136.

Farhadian A, Chan VS, Farhadian H, Farhadian H. Addressing household food insecurity using the household food insecurity access scale (HFIAS) in a poor rural community in Sabah, Malaysia. Int J Humanit Soc Sci Invent. 2015;4(8):89-100.

Corman H, Noonan K, Carroll A, Reichman NE, Carroll A, Reichman NE. Low-income fathers’ access to health insurance. J Health Care Poor Underserved. 2009;20(1):152-64. https:// PMid:19202254

Okwaraji YB, Cousens S, Berhane Y, Mulholland K, Edmond K. Effect of geographical access to health facilities on child mortality in rural Ethiopia: A community based cross sectional study. PLoS One. 2012;7(3):e33564. journal.pone.0033564 PMid:22428070

Abhulimhen-Iyoha BI, Omoigberale AI. Malaria comorbidities in patients seen at the children emergency room, University of Benin teaching hospital, Benin city, Nigeria. Ann Biomed Sci. 2012;11(1):16-23.

Walker CL, Perin J, Katz J, Tielsch JM, Black RE, Walker CL. Diarrhea as a risk factor for acute lower respiratory tract infections among young children in low income settings. J Glob Health. 2013;3(1):010402. PMid:23826506

Etiaba E, Onwujekwe O, Uzochukwu B, Uguru N, Okoronkwo I, Adjagba A. What co-morbidities do people with malaria have and what are their patterns of health seeking in Nigeria? Niger J Clin Pract. 2015;18(1):22-6. https://doi. org/10.4103/1119-3077.154196 PMid:25511339




How to Cite

Hassan AA, Taha Z, Abdulla MA, Ali AA, Adam I. Causes and Risk Factors of Hospitalization among Under-five Children in Kassala, Eastern Sudan. Open Access Maced J Med Sci [Internet]. 2020 Aug. 30 [cited 2021 Sep. 22];8(E):451-7. Available from:



Public Health Epidemiology


Most read articles by the same author(s)