Search results for “Children”

Prevalence and Risk Factors of Intestinal Parasitic Helminths among Primary School Children in Oru West Lga, Imo State, Nigeria

Intestinal parasitic helminths pose a significant public health burden, particularly among children. This cross-sectional study investigated the prevalence and risk factors of intestinal parasitic helminths among 550 school children aged 4-12 years in Oru-West L.G.A, Imo State, Nigeria. Stool samples were examined using parasitological techniques, and questionnaires were administered to collect data on risk factors. The overall prevalence of intestinal parasitic helminths was 49.1% (270/550), with Ascaris lumbricoides being the most prevalent (30.37%). Multivariate analysis revealed significant associations between intestinal parasitic helminths and lack of hand-washing, insufficient toilet facilities, consumption of unwashed vegetables, and poor environmental sanitation. Males had a significantly higher infection rate than females (P < 0.05). Age-related prevalence was highest among children aged 4-6 (51.85%). Occupational status and educational level of parents were also significant predictors of infection. These findings highlight the need for public health education, provision of basic sanitation facilities, and regular de-worming as preventive measures.

Assessing The Nutritional Status and Health Outcomes of Women and Children in Rajshahi, Bangladesh: A Comprehensive Study

Background Malnutrition is a significant public health issue in Bangladesh, particularly impacting women and children. Rajshahi, marked by socio-economic disparities, offers a distinctive context to explore the nutritional status and health outcomes of these vulnerable groups. Objectives This study aims to assess the nutritional status of women and children in Rajshahi and investigate associated health outcomes. Additionally, it seeks to identify socio-economic and cultural factors that influence nutrition. Methods A mixed-methods approach was utilized, incorporating a cross-sectional survey of 460 households and in-depth interviews with mothers and caregivers. Anthropometric measurements were taken to evaluate the nutritional status of women and children, while dietary assessments measured nutrient intake and diversity. Logistic regression analysis was performed to determine the likelihood of malnutrition based on socio-economic characteristics, thereby identifying key risk factors. Results The findings indicate a troubling prevalence of malnutrition, with 36% of children under five classified as stunted and 25% as underweight. The analysis highlights critical factors contributing to chronic undernutrition, including maternal education, employment, and dietary diversity. Notably, mothers aged 27-37 exhibit a lower risk of undernutrition, and urban households with secure food access demonstrate better nutritional outcomes. Discussion Maternal education and employment were positively associated with better nutritional outcomes, as educated and employed mothers had higher chances of maintaining a normal BMI. Regular ANC visits (≥4 visits) were crucial for improved maternal nutrition. Household food security emerged as a significant determinant, with food-secure households showing better maternal nutritional status. Safe water access and adequate dietary diversity were also linked to improved maternal BMI. Additionally, factors such as child birth weight, exclusive breastfeeding, and childhood diarrhea significantly influenced maternal nutrition. Moreover, frequent antenatal care visits and a diverse diet are vital in mitigating undernutrition risks among children. Conclusion This study emphasizes the urgent need for targeted interventions to combat malnutrition in Rajshahi. Recommendations include implementing community-based nutrition education programs and improving access to healthcare services. By addressing the socio-economic and cultural determinants of nutrition, stakeholders can enhance health outcomes for women and children in the region, ultimately contributing to broader public health objectives in Bangladesh.

Burden of Unintentional Childhood Injuries in Pre-School Children (2-6yrs) and Knowledge of Primary Caregivers on Early Management: A Descriptive Observational Study in Urban Slums of Bhubaneswar, Odisha

Background Injuries, particularly unintentional ones, are a neglected public health concern and are preventable or avoidable. Children in urban slums are especially vulnerable due to hazardous living conditions, inadequate supervision, and lack of safe sojourns or play areas. Since these injuries result in seeming spontaneous recovery, appropriate care being initiated by the primary care giver is questionable. Objective To assess the burden of unintentional injuries of unintentional injuries in pre-school going children aged 2-6 years in urban slums of Bhubaneswar, Odisha. To compare the knowledge of the 1st level care post-injury among the primary care givers against standardized prescribed care. Methods A cross-sectional descriptive observational study was conducted for over 2 years in urban slums under the Bhubaneswar Municipal Corporation (BMC), the capital city of Odisha. A total of 285 children aged 2-6 years, whose mothers consented to participate, were included in the study. Data regarding the type of injury and its management, as well as, associated socio-demographic factors, were collected using a pre-designed, pre-tested questionnaire. Descriptive statistics was used to derive the burden of unintentional injuries in children. The knowledge of the 1st level of care to be given after the common injuries was assessed among all the primary caregivers to detect the treatment and care gap. Results The majority of primary respondents were mothers aged 21-30 years (82.1%), The frequency of an episode of unintentional injury (occurrence in last 3 months) in the study population was found to be 58%. The most common type of injury reported was skin lacerations or tears, common site being in the upper and lower limbs. Males were more affected as compared to females (54.64 %) The reporting of unintentional injuries among the children was found to have significant association with the occupation of the father. Fathers who were unemployed or working as unskilled labor, their child’s probability of reporting an unintentional injury was found to be high, with p value coming to be statistically significant. Conclusion The study highlights the complex interplay of sociodemographic factors influencing unintentional injuries among children in urban slums and the need to create awareness among the primary caregivers, about the immediate management, so that chronic complications may be averted. It is difficult to avert injury as this age group is agile and nowadays supervision is challenging. Still, the knowledge of management would not just empower the caregiver, but also the growing child, who can attend to their younger siblings or themselves, whenever they get injured next. Further research with larger sample sizes is warranted to validate these findings and develop effective prevention strategies.

Internal Jugular Phlebectasia; A Challenging Neck Mass in Children

Cystic neck masses are uncommon in children, and a minority of them are soft. Internal jugular vein phlebectasia (IJVP) is a rare cause of soft neck cysts. It presents usually as a unilateral soft neck mass of changing size. In most cases it is unilateral, right sided and predominantly in males. Imaging study modalities are diagnostic and helpful for observation and follow up. In the vast majority of cases, it decreases in size with time requiring only conservative treatment. However, surgery might be necessary in large or complicated phlebectasia. IJVP is underdiagnosed or misdiagnosed especially in pediatrics, with few cases documented in medical literature. To improve awareness of presentation and management-plan of this rare case, the authors present an extremely rare case of huge left internal jugular phlebectasia in a 14 year-old boy worsened and complicated over years of wait and see approach that needed surgical treatment.

Genotypic Diversity among Salmonella Typhi Isolated from Children Living in Informal Settlements in Nairobi, Kenya

The persistence of multidrug-resistant (MDR) Salmonella Typhi (S. Typhi) is a challenge especially in regions where typhoid is endemic. Surveillance of circulating genotypes of MDR S. Typhi is crucial in typhoid acute cases and carriers. This study aimed to investigate genotypic diversity of S. Typhi from symptomatic and asymptomatic children in endemic settings in Nairobi, Kenya. Symptomatic and asymptomatic individuals’ ≤ 16 years were recruited at four health facilities and tested for typhoid through stool cultures. The S. Typhi isolates were subjected to antibiotic susceptibility testing to investigate multidrug resistance. The MDR S. Typhi isolates’ DNA was extracted and illumina sequenced. Raw reads were de novo assembled and analyzed by pathogen-watch. From the 90 sequenced isolates, 60 (67%) were confirmed to be S. Typhi (sequence Type 1 and genotype 4.3.1). Out of the 60 S. Typhi strains; 39 (65%) had plasmids, from these 38 (97%) had IncHI1 plasmids alone. Out of the 60, 59 (98%) S. Typhi isolates had blaTEM-1D. Point mutations conferring reduced susceptibility to quinolones were detected in 42 (70%) of S. Typhi isolates, from these; 14 (33%) had gyrA S83Y , and 28 (67%) gyrB S464F genes, respectively. This study reports 4.3.1 (H58) as the most dominant S. Typhi genotype responsible for spread of MDR phenotypes carried on IncHI1 plasmids. Presence of MDR S. Typhi with resistance genes such as blaTEM-1Dand reduced susceptibility to ciprofloxacin especially among asymptomatic individuals, reiterates the need for use of typhoid conjugate vaccine among vulnerable children as a control and prevention measure against typhoid.

Relationship between Systolic and Diastolic Blood Pressure Loads on ABPM and BMI Percentiles in Children

Ambulatory blood pressure monitoring is widely used in pediatric patients to identify hypertension and its complications. Previous studies correlating obesity and hypertension using ABPMs showed increasing blood pressure loads with increasing BMI. However, BMI percentiles are more reliable indicators of obesity in children. Our study aimed to describe the association between BMI percentiles and systolic and diastolic blood pressure load using ABPM in children and adolescents. Retrospective analysis of ABPMs (Welch Allyn) was performed on a total of 115 patients between 7 and 18 years of age who were referred for elevated BP without a diagnosis of hypertension at our institution from Jan 2011 to Oct 2013. Patients were divided into 4 groups based on BMI percentile: <94th percentile, 94–98th percentile, 98–99th percentile, and >99th percentile. Analysis between blood pressure loads and BMI percentiles revealed greater mean systolic and diastolic loads with increasing BMI percentiles, but the P value was not statistically significant. Analysis of the systolic loads between children from different racial backgrounds revealed higher values in African American children than in Hispanic and Caucasian children, but the P value was not statistically significant.

Effectiveness of Mindful Routine in Attention Deficit Hyperactive Disorder (ADHD) Children

Attention deficit hyperactive disorder is characterised by set of neurological based symptoms in children which falls into broadly two categories; inattention and hyperactive impulsive behaviour. It adversely affect child in various areas like social skill, communication, routine of daily life, academic performance and many.It not only affects the child but also other family members. ADHD often creates unproductive pattern, spouse conflict and poor quality of life. Because of executive function issue, ADHD child face difficulty in establishing and maintaining routines from morning to night which increase demands on parents. As a result parents becomes more exhausted ,emotionally triggered and breakdown.This study shows establishing consistent mindfulness routine make daily life simpler and easier for both the parent and children with ADHD.

Changes in Cellular Morphology in Bronchoalveolar Lavage Fluid of Children with Mycoplasma Pneumoniae Pneumonia

Objective To study changes of cell morphology in BALF in children with Mycoplasma pneumoniae pneumonia (MPP). Methods From December 2021 to May 2022, a group of 32 children diagnosed with Acute MPP and admitted for treatment in the Pediatrics Department and PICU of the First Affiliated Hospital of Xinxiang Medical University were selected for our study. These patients underwent bronchoalveolar lavage as part of their clinical assessment. For comparison, we included a control group comprising 10 children who were not infected but had bronchial foreign bodies. We investigated the cellular composition in the bronchoalveolar lavage fluid (BALF) using Wright-Giemsa staining and microscopic evaluation, aiming to understand the relationship between shifts in cell proportions and extra-pulmonary symptoms associated with MPP. Results In this study, a total of 42 cases were enrolled, with 32 cases in the study group and 10 cases in the control group. There were no statistically significant differences in gender, age, height, weight, and BMI between the two groups (p > 0.05). The study group exhibited significantly higher levels of neutrophil percentage (GRA%), CRP, D-dimer, and LDH in blood routine tests compared to the control group (p < 0.05). Furthermore, the proportions of neutrophils (%) and macrophages (%) in BALF were significantly higher in the study group compared to the control group (p< 0.05), while the proportion of lymphocytes (%) in BALF showed no statistically significant difference between the two groups (p> 0.05). Conclusion In the acute phase of MPP in children, BALF is predominantly composed of neutrophils. A lower proportion of lymphocytes in BALF is associated with a higher incidence of extra-pulmonary manifestations and longer hospitalization duration.

Severity Extent Of Wasting Among Children Admitted To Therapeutic Feeding Program. A Case Control Study

Introduction Children with complicated Severe Acute Malnutrtion (SAM) admitted to Therapeutic Feeding Center (TFC), and ‘uncomplicated’ SAM managed in Outpatient Therapeutic Program (OTP). Objective This study aims to examine the anthropometric differences between SAM admitted to TFC and OTP. Methods A hospital based case control study conducted in the Therapeutic Feeding Program (TFP) of Al-Sadaka General Teaching hospital, Aden, included complicated (cases) and uncomplicated (control) severely wasted 6-60 month old children admitted between July 2022 to June 2023. The WHO anthropometric calculator was used to assess every child’s weight-for-length/height SD and length/height for age SD. Results A total of 313 cases and 122 controls were admitted, mean age, weight, length/height, and MUAC among the cases were (13.04±7.34 mo., 5.41±1.33 kg, 68.32±7.10 cm, and 10.57±1.36 cm) respectively; while among the controls were (20.05±12.93 mo., 7.05±1.74 kg, 76.89±10.46 cm, and 11.28±1.11 cm) respectively. Severe wasting by WFL/H < - 3SD z- score seen more among the controls; cases vs controls were (37.0% vs 68.9%). Howevere, the other groups of severity of WFL/H z-score were seen with nearly douple frequencies among the case vs the controls (35.8% vs 18.8% < - 4SD), (14.7 vs 7.4% < - 5SD). Less than – 6SD was seen much more among the cases vs the controls (8.6% vs 1.6%). Less than – 7 SD among the cases was 1.3% and no children belong to this group in the controls.. The majority of the cases belonged to the age group 6-24 months. Conclusion Children a dmitted to TFC had severe wasting reaching up to < - 6 and < - 7 SD below the WHO cut-off, WFL/H < - 3SD z-score, and at an early age, with simultaneous presence of severe stunting and low MUAC which denotes high mortality risk.

Human Immunodeficiency Virus Drug Resistance (HIVDR) and Baseline Characteristics among Antiretroviral Therapy (ART) experienced Children and Adolescents under the care of Chidamoyo Christian Hospital in Hurungwe, Zimbabwe

Introduction Human Immunodeficiency Virus (HIV) remains a persistent global public health challenge. In 2020, approximately 37.9 million individuals were living with HIV globally, including 1.7 million children <15 years old, with a global HIV prevalence of 0.8% among adults. A larger portion of people living with HIV are found in low-and middle-income countries, and Sub-Saharan Africa (SSA) is home to about 68% of people living with HIV in the world. Strikingly, with increased uptakes in PMTCT, challenges in ART programs, and high viremia among children and adolescents in SSA, the success rate of ART might be quickly compromised, with possible HIVDR emergence, particularly after years of paediatric ART exposure. Therefore, monitoring ART response in children and adolescents in terms of HIVDR patterns and other socio-economic determinants of disease progression might help achieve better treatment outcomes at individual levels. At a programmatic level, this can guide further optimization of treatment options for SSA especially Zimbabwean rural where there is paucity of information on HIVDR prevalence in children and adolescents. Methods We enrolled 89 children and adolescents experiencing virologic failure from Chidamoyo Christian Hospital in Hurungwe. We managed to amplify all the 89 using nested PCR and 32.5% (29) had resistance to at least one ART drug and analysis was done using the 29 samples. Results Among the 89 participants with virologic failure,29 were resistant to at least one of their ART drugs. 39.2% of males and 23.07% of females had HIV-1 with resistance to at least one medication. Among 29 participants with HIVDR mutations, the prevalence of at least one HIVDR mutation to protease inhibitors (PIs), Nucleotide Reverse Transcriptase Inhibitors (NRTI), and Non-Nucleotide Reverse Transcriptase Inhibitors (NNRTI) were 6.47% ,46.76% and 46.76% respectively. Of the 29 participants who had HIVDR 19 (65.5%) had resistance to a drug they were currently taking and they needed to be switched to a better effective ART regimen Conclusion Use of HIVDR testing in guiding and monitoring development of HIVDR at the start of ART or at 1st failure can be very important in treatment options and patient management.

Epidemio-Clinical Profile of Acute Diarrhea in Children From 0 To 5 Years and Prevalence of Rotavirus Before and After the Introduction of the Rotasiil Vaccine in the Democratic Republic of Congo.

Introduction Acute diarrhea remains one of the major health problems in developing countries. According to the WHO, rotavirus contributes to approximately 40% hospitalizations and is the leading cause of severe diarrhea in children 0-5 years old. The objective was to determine the prevalence of rotavirus and the sociodemographic and clinical profile among children with diarrhea in 4 hospitals in the DRC. Methods This study is documentary, retrospective and analytical taking two periods, before and after introduction of the vaccine, i.e. January 2017 to December 2018 and January 2020 to December 2021 in 4 hospitals, i.e. 2 in Kinshasa and 2 in Lubumbashi. Results Total 1872 children, 924 (49.4%) of whom were enrolled before the introduction of the vaccine and 948 (50.6%) after. Only 1737 had performed serology, of which 875 (50.4%) were rotavirus positive and 862 (49.6%) were negative. Positive results, a reduction of 30.6% is noted since the introduction of the vaccine. The predominant age range was 6 to 11 months. The male gender was predominant at 56.7%. Diarrhea was found in 88.5%, vomiting in 73.7% and fever in 73.9%. Before vaccination, the risk was more: 11 times to have diarrhea, 9-10 times the frequency between 3-10 times a day, 9 times vomiting, 2 times fever and 2 times to have a positive result. Conclusion From this study, we note a reduction frequency due to diarrhea unlike previous years, probably attributable to the vaccine.

Context Specific Complementary Feeding Recommendations for Children in Pakistan Based on Secondary Analysis of National Complementary Feeding Assessment and Pakistan Demographic Health Survey 2018

Background In Low Middle-Income Countries (LIMCs), malnutrition, especially undernutrition is one of the leading causes of childhood mortality and morbidity. Poor complementary feeding practices are among the most notable contributors to poor nutritional indicators in children under five. This article provides an output of secondary data analysis of the Cost of Diet (CoD) and Optifood component of National Complementary Feeding Assessment conducted by UNICEF Pakistan along with Pakistan Demographic Health Survey (PDHS) 2018. Methods For correlation of Optifood data and CoD data with PDHS data of CF, GraphPad software, MS Excel was used along with manual quantifications. The analysis of DHS-2018 data was conducted using STATA software. Univariate analysis included comparison of categorical variables i.e. various individual, household and community level parameters with that of outcome variables of minimum dietary diversity (MDD), minimum meal frequency (MMF) and minimum dietary diversity (MAD) using chi-square test. Findings The overall rate of MMF was 56.6% among children of 6-23 months of age with MDD in 18.6% and MAD in 13.8% of children. Percentage of annual cost spent on nutritious diet for MDD, MMF and MAD varies from 27.86% to 43.08% across all the provinces. Children aged 6–8 months and 9–11 months often consumed infant milk and cereals, while children aged 12–23 months often consumed eggs and grain products. Consumption of dairy products was highest in Punjab, Sindh, AJK, and Islamabad, that of grains roots and tubers was highest in KPK, FATA and GB. Conclusion Considering CF practices in Pakistan are inadequate as indicated by poor MDD, MMF, and MAD, therefore it is imperative that a holistic approach using both communication and non-communication based interventions is to be employed through active stakeholder engagement.

Growth charts for children-Which ones to use in post Covid era?

A practical review compares growth chart standards and references for pediatric monitoring after the COVID era. It advises on selection, interpretation, and equity considerations in diverse populations.

Evaluation of A Nutrition Feeding Algorithm for Children and Adolescents Undergoing Haematopoietic Stem Cell Transplantation (HSCT)

Background Nutrition support during the acute phase post allogeneic haematopoietic stem cell transplantation (HSCT) is required to optimise short- and long-term outcomes for children. An algorithm was developed and evaluated to assist clinicians to make objective and consistent enteral feeding decisions. Methods The algorithm was evaluated on all patients who underwent allogeneic HSCT treatment between November 2017 - February 2019. Results Of the 48 patients, 43 had a nasogastric tube (NGT) inserted, of which 36 patients received a hydrolysed peptide-based formula, 5 patients received a whole protein formula only and 2 patients were fed an amino acid-based formula. Parenteral nutrition (PN) was used in 41 of the patients. Eleven did not have an NGT in-situ at the commencement of HSCT. Of the remaining 37 patients, 26 followed the algorithm and 11 patients did not comply. The group of patients who did not follow the algorithm had the longest median length of stay (LOS) of 49 days. Patients receiving only EN had the lowest median LOS of 30 days. The two groups that reported better weight outcomes were those who followed the algorithm and those who were fully EN fed. Conclusions Effective use of the HSCT feeding algorithm indicated improved patient outcomes for children undergoing HSCT, with better weight outcomes and reduced LOS. Recommendations to improve the efficacy and compliance of the algorithm include regular education/input to the oncology medical teams to better understand objective thresholds for EN and PN commencement.

Impact of Intestinal Helminth Infections on Malnutrition and Haematological Indices of School-Age Children in Gondar Town, Ethiopia

In Ethiopia stunting, underweight and wasting in school children are very common. The aim of this research was to evaluate the impact of intestinal helminthes and schistosomiasis on malnutrition, anaemia and haematological indices in the school age children of Azezo Elementary School in Gondar town. Kato Katz technique was performed to determine infection and intensity of intestinal helminth infections. AnthroPlus software version 1.04 was used to get malnutrition indices while fully automated haematological analyzers were used to determine haematological and biochemical parameters. A total of 384 school children were recruited in this study. The overall prevalence of helminth infection was 45.8% (178/384) with the leading Ascarislumbericoides infection (20.6%) compared to the second leading Schistosomamansoni (17.4%) and third leading hook worm infections (13.3%). The prevalences of body mass indexes for age Z-scores (BAZ) indices were 9.6% (37) very sever thin, 17.2% (66) sever thin, 38.3% (147) thin, 34.4% (132) normal and 0.5% (2) overweight. On the other hand, the prevalences of height for age Z-scores (HAZ) indices were 12.2% (47) stunt, 87% (334) normal and 0.8% (3) over height. Of the total 384 school age children, 335 (87.2%) had normal blood glucose level (70 – 110 mg/dL) while the remaining 49 (12.8%) school age children were hypoglycemic. The number of the school children with normal total protein level (6.6 – 8 g/dL) was 259 (67.4%) while the remaining 125 (32.6%) school children were hypo-proteinaemic. The prevalence of anemia in the school age children was 33.1% (127). Intestinal helminth infections were statistically significantly associated (p = 0.000) with hypo-proteinaemia, anemia and number of lymphocytes compared with non-infected school children. The likelihood of anemia in intestinal helminth infected school children, when it was compared with uninfected, was 148 times higher for both Ascaris lumbericoides-Schistosoma mansoni co-infection, 38 times for Hookworm, 20 times for Schistosoma mansoni and 3 times for Ascaris lumbericoides mono-infections. Conclusion: Intestinal helminth infections in school age children aggravate malnutrition. Prolonged malnutrition and intestinal helminth infections could result in stunting in school-age children.

Vitamin B12 Deficiency in Children Due to Lack of Intake: A Report of Two Cases at the Pediatric Department at Aristide Le Dantec Hospital

We report 2 cases of vitamin B12 deficiency in children due to deficient intake. These were 2 girls aged 4 years (case 1) and 6 years (case 2), respectively, hospitalized in December 2020 and March 2021 in the pediatric ward of Le Dantec hospital. Both patients presented with aregenative anemia, melanoderma and undernutrition. The bone marrow count in case 1 showed a dysmyelopoiesis with megablastosis. The blood vitamin B12 level was low in both cases. Folic acid blood levels were normal in both patients, but an associated martial deficiency was found in case 2. The dietary survey revealed a lack of intake of animal products rich in vitamin B12. Vitamin B12 replacement therapy was effective with rapid regression of all clinical signs observed in both children. The control of the vitamin B12 level after 1 month of treatment was normal in both patients. The disappearance of the symptoms under substitute treatment confirmed the deficiency of Vitamin B12 intake in both patients. Conclusion: Both of our patients had a profound Vitamin B12 deficiency in a context of deficiency in nutrition. The regression of the symptoms was spectacular under vitamin B12 replacement therapy, confirming the deficiency. We recommend in our context a contribution in micronutrients such as vitamins in children after weaning to avoid dietary errors.

RETRACTED: Profile of Children with Covid 19 Infection in our Set Up

This article has been retracted on July 20, 2022. VIEW THE RETRACTION NOTICE (https://doi.org/10.14302/issn.2692-1537.ijcv-25-5866) In December 2019, a novel coronavirus, now named as SARS-CoV-2, caused a series of acute atypical respiratory diseases in Wuhan, Hubei Province, China. The disease caused by this virus was termed COVID-19. The virus is transmittable between humans and has caused pandemic worldwide. The number of death tolls continues to rise and a large number of countries have been forced to do social distancing and lockdown. In humans, COVIDs mostly cause respiratory and gastrointestinal symptoms. Clinical manifestations range from a common cold to more severe disease such as bronchitis, pneumonia, severe acute respiratory distress syndrome, multi-organ failure and even death. Preliminary evidence suggests children are just as likely as adults to become infected with SARS-CoV-2 but are less likely to be symptomatic or develop severe symptoms. in our study , we consider the symptomatology , complications and mortality patterns of this disease in children.

Retraction Note: Profile of Children with Covid 19 Infection in our Set Up

Proportion of WaterBorne Diseases in Children Aged 0 To 5 Years in the Health Area of the Urban Dispensary in Ebolowa - Cameroon

Background Water-related diseases are water-related disorders of the body. They are a public health problem as they are responsible for 60% of infant mortality in our developing countries. There are few studies in South Cameroon on the subject. Overall Objective of this work was to study the explanatory behavioral factors of waterborne diseases in children aged 0 to 5 years in the health area of the urban dispensary in Ebolowa in Cameroon in 2020. Methodology This was an analytical cross-sectional study comparing two groups of children (group 1: children affected by waterborne diseases group 2: children unaffected by waterborne diseases) within the health area of the Ebolowa urban area. It lasted 21 months and the study period was from 28 December 2020 to 22 January 2021. We included children aged 0 to 5 years present in households where parents/guardians gave their informed consent. Sampling was probabilistic and cluster sampling. Using the Kelsey formula, we obtained a sample of 420 households and 566 children. Data was collected using a questionnaire and stored in the Excel spreadsheet and analyzed with CDC USA's epi info software 7.2.2.6. The calculation p value was done with Stat Calc at the significance threshold of 0.05. Bold The proportion of waterborne diseases was 97% (549/566) among the children aged 0 to 5 years surveyed. The most common reasons for using the health service for children aged 0-5 years were diarrhea 78.62% (IC75.06-81.80), and malaria 78.09% (74.09-81.30). The median age of children suffering from these pathologies was 36 months (24; 60). The gender ratio (Boys/Girls) was 2.06/1. Conclusion We propose to increase the awareness of mothers/guardians on good practices; also, to increase health promotion in the fight against waterborne diseases.

Prevalence and Factors Associated with Under Nutrition among Children Aged 6 to 59 Months in Ngoma District, Rwanda

In Rwanda, 38% children aged 6-59 months are stunted. In Ngoma District, stunting rate is estimated at 41% among the children aged below 5 years. The study objective was to evaluate the prevalence and factors contributing to under nutrition among children aged 6- 59 months in Ngoma District. Cluster sampling was used to determine the study participants for each sector within 14 sectors by considering the sample size of 442. The WHO Anthro software version 3.2.2 was used to determine the nutritional status of the children. SPSS version 24 was used for analysis. Of 442 children participated in the study 50.9% of them were females, 24.4% were aged 15-23 months and the majority of children (89.8%) born with normal birth weight. Study findings revealed that the prevalence of under nutrition was 33.7% for stunting, 3.6% for wasting and 6.6% underweighted. Poor sanitation facility (AOR: 4.1, 95%CI: 1.83-9.3, p=0.001), poor diet (AOR: 1.9, 95%CI: 1.18-3, p=0.008) were significantly associated with stunting. Factors such as lack of hand-washing facilities (AOR: 2.5, 95% CI: 1.013-6.3, p=0.047), not eat vegetables (AOR: 4.4, 95%CI: 1.7-10.96, p=0.001), and not eat fishes (AOR: 4.1, 95%CI: 1.6-10.6, p=0.003) were associated with wasting. Short breastfeeding duration (AOR: 4.5, 95%CI: 2.9-7.2, p=0.001), not eat vegetables (AOR: 1.9; 95%CI: 1.1-3.05, p=0.008), and not eat eggs (AOR: 2, 95%CI: 1.3-2.9, p=0.001) were associated with underweight. Poor families with under-five children need continuous support that will assist them to improve nutritional status of their children.

Prevalence and Risk Factors of HIV Infection among Children Born from HIV Positive Women Musanze District, Rwanda

In Rwanda the prevalence of mother-to-child HIV transmission is 1.5%, the prevalence was found to be higher in rural area. The purpose of this study was to determine the Prevalence and Risk Factors of HIV Infection among Children born from HIV Positive Women in Musanze District. The study findings help to decrease the rate of HIV infection among children born from mother HIV positive to zero. This study was conducted in Musanze District, Northern Province in Rwanda. The study targeted 420 HIV positive mothers who delivery in different health facilities located in Musanze district form January 2019 to December 2020 and their children. SPSS version 22 was used for analysis. Of 420 children born from HIV positive mothers 91.7% were aged between 18-24 months, 55.2% were female. The majority of HIV positive mothers 80.2% who participated in the study were married. The prevalence of HIV infection among children born from HIV positive women was 2.9%. Children whose mother had poor adherence to ART were 1.5 times more likely to get HIV at birth compared to those whose mother had good adherence (AOR = 1.5; 95% CI: (1.12-2.21)). Children born from mothers in WHO stage II were more likely to get HIV from their mother (AOR = 1.24; 95% CI: (1.32-2.207)). Children born from HIV positive mother with one ANC visit were 2.5 times more likely to get HIV from their mothers (AOR = 1.56; 95% CI: (2.31-5.17)).  

The Influence of Siblings on Young Children’s Understanding of Fluid Intake

Background Children need to drink enough water (1.1-1.3 litres) throughout the day to stay hydrated and for health benefits1. Wellbeing and cognitive function benefits have been identified for children who are hydrated2. Yet there is a dearth of research focusing specifically on children’s perceptions of their own fluid intake levels and who helps support them in ensuring they are drinking enough water, this is a novel area to investigate. Previous research3 identified that 44.2% of young children’s fluid intake were influenced the strongest by a family member. This paper will explore in further detail the influence of siblings on children’s fluid intake, in particular older versus younger siblings. Methods 130 children (67 girls and 63 boys, of which 45 had a younger sibling (s) and 85 having an elder sibling(s), from 4 primary schools in the South East of England, were questioned between January and April 2019 using an adapted version of Coppinger and Howells’ (2019)4 questionnaire, on their understanding of fluid intake, how much they perceived they drank and who supported them in prompting them to drink. Physical visual representations were used to aid question comprehension and to ensure the questions were appropriate for young children. The data was analysed using SPSS 24.0 using MANOVAs (P < 0.05) to consider statistical variance in gender and older sibling status. Results The most significant results were linked to elder siblings influence younger siblings in drinking too little fluids within a school day (F=0.530, p<0.05), whilst those without an elder sibling, thought they drank beyond the daily recommended guidelines and reported they drank over 2 litres. This illustrates that children misunderstand fluid intake recommendations regardless of whether they have an elder sibling or not. Children named adults, both parents and teachers as well as elder siblings as the key influencers of them drinking (F=3.67, p<0.05) and the data indicated that girls were more influenced by siblings than boys, whilst twins were not influenced by each other. Conclusion It is concluded that siblings do have an influence on the consumption of water, as siblings act as role models and other siblings follow their habits, therefore the whole family unit is important to ensure that the right fluid intake is consumed. It is recommended that further education, curriculum and community development is needed to continue to support young children’s knowledge and understanding of fluid intake.

Impact of Environmental Sanitation and Hygienic Practices on Nutritional Status of Lodha Women and Children of West Bengal, India

Aim To assess the sanitation and hygienic practices of women and its effects on the nutritional status of the mother and preschool children of the Lodha tribal community in two districts of West Bengal. Methods A cross-sectional study was conducted during November, 2014 - December, 2018 of 941 Lodha mothers and 1043 of their preschool children in Paschim Medinipur and Jhargram districts. All information was collected by using KAP questionnaire following interview and group discussion. Mother nutritional status was assessed based on body mass index (BMI) and mid upper arm circumference (MUAC). A child was classified as underweight, stunting and wasting as weight-for-age, height-for-age and weight-of -height Z-score below -2 standard deviation of WHO standard. Results This study found 35% of the households used safe drinking water. Almost 97.2% of the mother had the low hand wash score and about 67.1% of them had an average WaSH score. Overall, 41.6% and 1.6% mothers were suffered from undernutrition (BMI <18.5 kg/m2) and overweight/obesity (BMI≥25kg/m2). Whereas, 48.9% women were undernourished based on MUAC<22.0cm. Moreover, the overall prevalence of wasting, stunting and underweight of preschool children was 31.9%, 62.1% and 61.3%, respectively. The WaSH score of family was significantly associated with child stunted and underweight. Conclusion There is a good association between poor household WaSH practices with child undernutrition and morbidity. Hence, there is an urgent need to develop the comprehensive knowledge, attitude and practice (KAP) guidelines in their language to educate them about appropriate water storage, retrieval methods, sanitation and hand washing practices.

Factors Influencing Recovery among Children with Moderate Acute Malnutrition Treated at Kirehe District Health Centers

Acute malnutrition affects nearly 52 million of under five years children globally, 75% of them live in low to middle income countries. The treatment of acute malnutrition using supplement foods could help children recovering and could reduce the risk of sickness. The present study investigated the factors associated with recovery among children with moderate acute malnutrition (MAM) under a follow-up program at health facilities. A prospective study was conducted in 16 health centers of Kirehe District of Rwanda and included 200 children from 6 to 59 months. A semi-structured questionnaire was used for data collection. All children enrolled in the study spent three months in nutrition program at health centers. The results show that after 3 months in the program 77.5% recovered from MAM. Children aged above 36 to 59 months were recovered at 90% whereas children aged from 24-35 months were recovered at 73.5%. Micronutrients and deworming provided at health facility were contributed to the recovery as children who received them were recovered at 89.1% and for those who didn’t were recovery at 72.1%. The findings demonstrated that boys were 16 times more likely to recover from MAM in three months of intervention than girls (AOR=16.19, p<0.001, 95% CI: 5.39- 48.63). Children from moderate income families were 3 more likely to recover than those from very low income families (AOR=2.8, p=0.029, 95% CI: 1.11-7.51). Male gender, receiving micronutrients and deworming from health facilities and family income status were factors associated with MAM recovery status

Management of Plastıc Bronchıtıs in Chıldren: A Case Report and Lıterature Revıew

Plastic bronchitis (PB) is a rare disease characterized by the presence of mucofibrinous plugs which may occlude and conform the shape of tracheobronchial tree. These casts are exteremely cohesive. Most common presenting symptoms include cough, fever and dyspnea and if the cohesive casts occlude the airway totally life-threatening complications and even death may occur. The aim of treatment is to remove the casts and adress the symptoms. In this study a 6-year-old boy with PB is presented. In addition to medical treatment obstructing casts were removed via rigid bronchoscope. It is aimed to review the clinical and radiographic features and choices of treatment in this disease.

Clinical Landmarks of COVID-19 in Newborn, Children and Teenagers

This review catalogs clinical landmarks of COVID‑19 across newborns, children, and adolescents, including MIS‑C, risk factors, and considerations for vaccination and school policies.

Educational Needs of Mothers about using Oral Rehydration Salt (ORS) at Home During Acute Diarrhea in Children under 5 at Urmia Population Research Center

Preventable factors such as infectious diseases (pneumonia, diarrhea, and malaria), malnutrition and neonatal complications are still the leading cause of child mortality worldwide 1 In 2013, it is estimated that 6.3 million babies born worldwide died before the age of 5, and approximately 9.2% of these deaths were due to diarrheal diseases 23 in simple, accessible ways, and effective treatment can reduce diarrhea-related mortality and make hospital admissions unnecessary, and the role of mothers is the most important 4. Since the presentation of Oral Rehydration Therapy (ORT) in 1979, mortality has reduced. Diarrhea has had a steady downward trend 5. If mothers who have children under 5 years of age, used correctly ORS, they could easily resolve the problem of dehydration in acute diarrhea 6. Mothers didn’t use correctly ORS because of their Low literacy and lack of knowledge and wrong attitude about ORT7. Some health care workers provide mothers’ required equipments, regardless of their educational needs, and mothers may not use ORS. In this study, health workers identified mothers' educational needs and subsequently they trained them about using ORS at home in acute diarrhea in children under 5 years of age.

Implementation of an Elemental Diet in Five Children Diagnosed with Autism Spectrum Disorder Presenting with Gastrointestinal Disease: A Brief Report

Autism Spectrum Disorder (ASD) is a developmental disorder characterized by impaired communication and social interaction. Children with ASD are frequently diagnosed with gastrointestinal (GI) issues, including inflammatory bowel disease (IBD), gastroesophageal reflux, abdominal pain, diarrhea, and constipation, although the association between ASD and GI conditions is unclear. Underlying nutritional deficiencies are more common in children with ASD, and increase the risk of them developing medical conditions secondary to the behavioral diagnosis. This objective of this study was to examine the use of an elemental diet (ED) in the treatment of gastrointestinal disease in 5 children with ASD ages 2-21 years of age. In the study participants, the ED was well-tolerated with improvements in anthropometric measures, nutritional markers, and/or GI functioning reported after 12 weeks of intervention. Further research to advance the development of specific evidence-based guidelines in the management and treatment of gastrointestinal concerns in the ASD population is warranted.

Risk Factors of Persistent Diarrhoea in Children below Five Years of Age

Background Persistent diarrhoea is a commonly observed phenomenon both in Bangladesh and all over the developing countries. It is the single most important cause of diarrhoea related deaths in the community, accounting for over half of them. If associated factors are properly identified & treated, it is possible to prevent most cases of persistent diarrhoea. Objective This study was undertaken to find out the possible risk factors associated with persistent diarrhoea in children below 5 years of age. Methods This was a prospective analytical case control study carried out in a tertiary care hospital, Dhaka. A total of 30 consecutive cases of persistent diarrhoea and 60 consecutive acute diarrhoea controls (matched for age and sex) under 5 comprised the study subjects in this study. Children beyond the age and whose parents didn’t give written consent were excluded from the study. Data were collected using a structured questionnaire and a standered case definition of acute & persistent diarrhoeawere adopted. Data were later processed and analyzed using SPSS (Statistical Package for Social Science version 12) in the year 2012. Results were considered statistically significant when p value was <0.05. Results According to the study, 56.6% of cases and 63.3% of controls were in the ‘6 to 12 months’ age group and about two-third of the participants in both cases 20 (66.7%) and controls 39 (65.0%) were males.Strong association was found with ‘bottle feeding’ RR=2.2556; 95% CI: 1.259, ‘presence of blood/mucus’ RR=2.5038; 95% CI: 1.4129, ‘WAZ≤ 2)’ RR=2.8867; 95% CI: 1.7202 and ‘early complementary feeding [RR=4.67; 95% CI: 2.5017-8.7175 and OR=7.8858; 95% CI: 3.6791-16.9 Conclusion In the present studyfour factors showed some association with persistent diarrhoea, namely: ‘use of animal milk’; ‘antibiotic use during acute diarrhoea’; ‘history of diarrhoea in previous 3 months’ and ‘pre-lacteal feed’. Strong association was found with ‘bottle feeding practices’ ‘presence of blood &/or mucus in stool’, WAZ <-2 and ‘early complementary feeding

Young Children’s Understanding of Fluid Intake.

Background Coppinger and Howells’ (2019) previously completed an International comparison between primary schools in Ireland and England focusing on children’s understanding of fluid intake. They identified that children under 11 years did not understand the amount of fluid they need each day for good health. Within their sample there was only a limited number of children who were aged 4 – 5 years. This research focuses on this particular age phase and further questions if young children understand fluid intake. Methods 130 children (63 boys and 67 girls, of which 83 were aged 4 and 47 were aged 5) from 4 elementary schools in the South East of England were questioned between January and April 2019 using an adapted version of Coppinger and Howells’ (2019) questionnaire on their understanding of fluid intake and how much they perceived they drank and who supported them in prompting them when to drink. The adaptions were to ensure the questionnaire was age appropriate for younger age range, and included physical visual representations to aid question comprehension. Results 46.9% of children felt they consumed 500ml or under a day. Only 39.6% responded that they were supported by the teacher, also when children were thirsty, if given the option of playing or stopping rehydration and then playing 33.8% would continue to play without drinking. Conclusion Young children in England do not understand fluid recommendations, they were not supported within the school setting by their teacher and more effective resources and strategies are needed to support children’s knowledge.

The Effect of Weekends and Clock Changes on the Sleep Patterns of Children with Autism: A Study of Historical Records

Background Children with autism spectrum disorders (ASD) often have difficulties settling to sleep and maintaining asleep through the night. Sleep difficulties are linked to challenging behaviour so understanding the causes of these difficulties is vital. Possible explanations are: (1) that irregular innate cycles lead to difficulties maintaining/initiating sleep at the appropriate times; (2) that children with ASD fail to learn from the contingencies that teach neurotypical children to initiate and maintain sleep. If the cycles are innate then small externally imposed changes in routine will not affect the sleep cycle. Methods The sleep records of 46 children with autism and moderate to profound intellectual impairments attending a residential school were examined to identify the effects of spring time change and weekend leave on 1) the times children went to sleep, 2) the length of their sleep and 3) the number of sleep disruptions. Manual staff recordings of the children’s sleep were conducted and data for these variables were analysed using repeated measures analysis of variance. Results A later sleep time was found in children regarding their sleep onset on Sunday after the time change (average onset was 9:57 p.m. ((s.e. = 8.49 minutes) versus 10:17 p.m. (s.e. = 8.19 minutes), with analysis of variance of sleep onset time showing a significant effect (F (3,41) = 5.02, p = 0.005). However, only two out of three comparison groups showed statistically significant effects (March 23rd versus March 30th mean difference = 0.39, p = 0.003; March 30th April 13th mean difference = 0.36, p = 0.03). No statistical difference was found between March 30th versus April 6th or other sleep parameters in any groups (i.e., sleep duration or night time awakenings). Similarly, no change in any sleep parameters (i.e., sleep onset or awakenings) were found when Sundays sleep parameters were compared to Mondays and/or Tuesdays. Conclusions In this small pilot study, small changes of day/night cycles appear to have few effects on the sleep patterns of children with ASD attending a residential school. While no significant sleep pattern change was found in this population due to change of clock times or weekend visits, larger epidemiological studies addressing other unexamined variables to better delineate changes in ASD are needed.

MRI Study and Psychological Assessment in Children and Youth with Deviation Behaviour

Objective Antisocial behavior (ASB) in children and youth is public health problem in Georgia. Nevertheless, there has been no systematic study the risk factors for ASB that could counteract on ASB development. To prevent ASB development and acceleration the understanding of biological (assessment of Brain morphology using MRI) and psychological (assessment using Freiburg Personality Inventory) risk factors is critical. This was the aim of this study. Method The children/youth with ASB tendency (AST) were identified by the Freiburg Personality Inventory (FBI). The biological and psychosocial factors contributing to AST were evaluated using a semi-structured clinical interview. Brain anatomy and morphology was studied using magnetic resonance imaging (MRI). Results Children/youth with AST had significant abnormalities in most axial elements of the DSM multi-axial system but not in brain anatomy measured by MRI. Conclusion Early identification of ASB tendencies and a provide correlationship between specific psychiatric, medical and family stress factors will likely reduce the number of children/youth with ASB and will promote their integration into society.

Common Complementary Feeding Practices Among Under-Five Children: The Case of Zambia

Introduction In the past several decades, Zambia has suffered high levels of under nutrition particularly stunting among children below 5 years of age. Although appropriate complementary feeding practices are reported to reduce child deaths by 6%, they have not received the adequate attention from programme officers and caregivers in terms of implementation. Objectives The objective was to investigate issues surrounding the common complementary feeding practices practised by caregivers of children below five years in health facilities and areas where high rates of malnutrition admission come from. Design A cross sectional research using both qualitative and quantitative methods. The study used mostly proportions based mostly on global indicators on complementary feeding. Qualitative data was also analysed according to themes of global complementary feeding indicators Setting The study was conducted in five hospitals, namely Arthur Davison, Solwezi Central, Kabwe and Livingstone General, and University Teaching Hospital. Subjects The target populations were mothers whose children were admitted for malnutrition and those with children 0-59 months living in communities with the highest number of malnourished cases admitted to selected hospitals Results About45.2% (190) of caregivers introduced liquids before six months of age and 7.6% (32) after 6 months attributing child thirst, medication and advice from health worker as the main reasons. Slightly above half (54.2% of 224) of mothers/caregivers used cups to feed their babies. The use of feeding bottles was still common (8.2% of 34). Responsibility to feed the child is mostly left to the mother (86.4%, 362). In addition, children were being feed about 2.67 (SD 0-72) per day. Conclusions Child feeding practices were still poor. This contributes to poor child growth and health. More interventions should be planned to improve child care behaviour.

Hip Angle Behavior in Landing After Drop Jump in Children; and their Implicance in Prevention Programs

Background The Anterior Cruciate Ligament (ACL) injury is uncommon, but constitutes an important percentage of the lesions requiring more than 8 weeks of recovery in sports. Most ACL injuries do not require external contact and are associated with biomechanical risk factors that stress this ligament ACL: like an increase in knee valgus angle (KV) and hip flexion (HF) and a decreased in knee flexion (KF). The ACL requires muscle cooperation to resist the load; however, when there is fatigue, the protective capacity of the musculature would decrease. The objective of the study is to analyze the angular behavior before and after a physical load for HF in children of 14-15 years old. Hypothesis The physical load applied in a single training session is enough to change some biomechanical risk factors of ACL injury. Study Design Experimental study Level of Evidence 2b Methods The sample consisted of 50 students from different soccer schools between 14-15 years old. We analyzed the hip angular behavior of hip flexion before and after a training session. The angles where obtained from inertioal sensor while the students performed a Drop Jump test from a 30 centimeters drawer. Results Statistically significant differences were found in the differences between pre physical load HF / post-load HF (p = 0.00053), right pre physical load HF / right post- load HF (p = 0.0086) and left post- load (p = 0.0248206). Conclusions It was concluded that the angular behavior of HF increases significantly in both post-training limbs, after performing a physical load. Clinical Relevance This study analyzed the importance of using prevention injury programs since early stages, and give importance to the eccentric role of hamstring, gluteus and core exercises.

The Prevalence of Intestinal Parasite Infection in El Behara Schoolchildren.

This study was conducted to evaluate the prevalence of intestinal parasite in schoolchildren in Damanhur, Egypt and some of its villages. The pathogenic enteric protozoa have been progressively involved in bargaining the soundness of a great many individuals, for the most part in creating nations. Mediations are being set up to control the dreariness and mortality because of these protozoan contaminations. A portion of these mediations target school going kids with regards to class based wellbeing intercession. The present examination concentrated on exploring the commonness of intestinal protozoan contaminations among younger students chose networks comprising of urban, urban-poor and per urban settlements in the Damanhour and a few towns. In the present work Giardia lamblia was the second usually identified protozoan with a diseases rate 10.4% among the analyzed cases. In the present examination generally speaking level of parasitic contaminations among the kids was 57.3%. It's viewed as Enterobius vermicularis was the most usually identified protozoan as it spoke to 4.1% of the parasitic diseases in the considered cases pursued by Ascaris lumbricoides; 1.4% and Giardia lamblia contaminations as they spoke to 0.6%; separately. The protozoa like Giardia and Cryptosporidium are regularly present in surface waters and cause episodes in this manner legitimately affecting human wellbeing.

International Comparison of Children’s Knowledge, Barriers and Reported Fluid Intake Across the School Day.

Background To date, no research has explicitly examined children’s knowledge and consumption of fluids at school, particularly during times of exercise (physical education (PE)). Methods Between May and July, 2018, 322 (213 females, 104 males; mean age = 8 years 5 months, SD ± 2 years 1 month) elementary school children from Ireland (n=237) and England (n=85) completed a questionnaire on their understanding of fluid intake and how much they perceived they drank on days when they did/did not participate in PE. Results Younger (<9 years) English children were most thirsty at the end of the school (68%), compared to younger and older (≥9 years) Irish children who were most thirsty after (38% <9 years; 39% ≥9 years) or during (21% < 9 years; 21% ≥9 years) PE. In both countries for <9 year olds, similar amounts were consumed on days when they did, and did not, partake in PE with 41% of all participants reporting intakes below daily guidelines. No child, of any age, was correct at predicting what their fluid intake should be on days when they took part in PE. Conclusion Young children in England and Ireland do not understand fluid recommendations, especially the increased need for fluid on days when they partake in PE. Further objective research is needed to ascertain whether actual fluid intake in children matches perceived intakes and whether the structure of the school day, and intensity levels of PE lessons, influence these intakes. Additional research needs to gauge the importance of the teacher and how they are a key influencer in supporting children in their learning of how, why and when to drink.  

Recovery Time from Severe Acute Malnutrition and Development of Complementary Food Supplement For Affected Ethiopian Children

Background: Severe acute mal nutrition (SAM) among children still remains the major problem in Ethiopia. The shortening of the SAM recovery time by applying appropriate dietary means during treatment and also after recovery, can save huge sums of public health spending. Objectives: Determining the recovery time of SAM affected children and developing complementary food supplement (CFS). Methods: Hospital based retrospective cohort study was carried out on 401 SAM affected children. A structured and pre tested data abstraction form was used for data collection. The data were entered into Epi info and exported to SPSS for analysis. All of the nutritional properties of the developed product in three different ratios of the flours of maize, soybean and powder of moringaolifera leaves were assessed and compared to the control (100% maize). Results: The median recovery time was 16 days. There was a significant increase in protein, mineral and beta carotene content with increasing level of Moringaolifera leaf powder in the CFS. Conclusion: To increase the rate of recovery from sever acute malnutrition and also to prevent relapsing, moringa incorporated cheaper complementary fod supplements could be recommended for SAM affected children.

Evaluation of Serum Vitamin D Levels in Foster's Children Care Center

Vitamin D, the sunshine vitamin, is now recognized not only for its importance in promoting bone health in children and adults, but also for its other health benefits, including reducing the risk of chronic diseases such as autoimmune diseases, common cancer, and cardiovascular diseases. Ultraviolet radiation of the sun with wavelengths of 290-310 nm penetrates into the skin and converts 7-dehydrocholesterol to previtamin D3, which quickly transforms to vitamin D3. Vitamin D (D represents either D2 or D3) made in the skin or ingested through diet is biologically inert and requires two successive hydroxylations first in the liver on carbon 25 to form 25-hydroxyvitamin D 25(OH)D and then in the kidney for a hydroxylation on carbon 1 to form the biologically active form of vitamin D, 1,25-dihydroxyvitamin D (1,25(OH)2D) 121419. The concentration of the produced 25-hydroxy vitamin D in blood circulation is 1,000 times more than 1,25-dihydroxy vitamin D 4, and it is regarded as a standard indicator of vitamin D status in humans 3. 25-hydroxy vitamin D half-life is about 2-3 weeks and it is regulated by calcium (Ca), phosphorus (P), and serum parathyroid hormone (PTH) to some extent. 25-hydroxy vitamin D content also reflects the amount of vitamin D produced in the skin after exposure to sunlight or received through food intake 56. Guidelines for vitamin D insufficiency/deficiency defined by serum 25(OH)D concentrations have been published from many countries and regions all over the world 7891011. Vitamin D deficiency is a pandemic problem. According to global estimations, more than one billion people around the world suffer from vitamin D deficiency. Among Iranian population, the incidence of vitamin D deficiency varies from 2.5 to 98.5% based on geographic area 1213. Various factors may give rise to vitamin D deficiency, including skin pigments, low levels of vitamin D in diet (insufficient fish oil and egg yolk intake), malnutrition, genetic factors, exclusive breast feeding, vitamin D deficiency of mother during pregnancy, prematurity, chronic use of drugs (e.g., anticonvulsants, aluminum-containing anti-acids, rifampcin, isoniazid, antifungal drugs, antiviral drugs, and glucocorticoids), winter and obesity 113. Cultural habits, the need for full body coverage during outdoor activities and the lack of sunlight programs are the risk factors for low vitamin D levels in women 151617. Children enter foster care due to early childhood adverse experiences such as poor prenatal and infant health care, food insecurity, chronic stress, and the effects of abuse and neglect. As a result, they are at higher risk for poor physical, psychological, neuroendocrine and neurocognitive outcomes compared to others. Foster children are at risk for growth and nutritional deficiencies due to their poor nutritional environment prior to placement in foster care. Insufficient caloric intake results in growth deficiencies. Evidence showed that the risk of stunting and underweight is high in this population 18. The risk of developing hypovitaminosis D was significantly higher in children living in foster homes. One reason is that they are at higher risk of child abuse, emotional deprivation and physical neglect than children living with their families. Moreover, these children most likely do not spend much time outdoors and they lack adequate sun exposure. Another reason is that as children grow up in institutional care, they shift from a diet of vitamin D–fortified formula milk to cooked food, which may not be fortified with vitamin D 1. Iranian government has made some efforts to apply efficient interventions to reduce the prevalence of vitamin D deficiency, and the country’s healthcare system should be managed through accurate planning. Yet, in this country, studies on vitamin D deficiency in children living in foster homes are very limited, and given that timely diagnosis and treatment of this deficiency is vital, this research is conducted in Ali Asghar foster home in Mashhad, Iran.

Prevalence of Diarrhea and Associated Factors among Under Five Years Children in Harena Buluk Woreda Oromia Region, South East Ethiopia, 2018

Background: Acute diarrheal diseases are the leading cause of preventable childhood death, especially in developing countries. It is the second leading cause of death in under-five year children nest to pneumonia. Objectives: The aim of this study was to determine the magnitude and associated factors of diarrhea in under-five in Harena Buluk district. Methods: A community based Cross sectional study was conducted in February, 2018. A two stage stratified sampling method was done to select the eligible households. Data was collected by trained data collectors using pretested questionnaire list which was prepared based on EDHS and WHO core questionnaires related to diarrhea. Data was entered in to a computer using Epi data 3.1 and exported to SPSS V.20 for further analysis. Logistic regression was used to determine level of association with 95% CI. A p-value <0.05 in the final model were considered as significant. Result: The two weeks period magnitude of diarrhea among under-five children was 28.4% with 95% CI (14.5-20.8) which was associated with households with one under five children (AOR: 0.268, 95% CI(.08,0.90)), living in the home with single room ((AOR = 6.01, 95% CI(1.01,36.01)), clean latrine/faces not seen around the pit or on the floor of latrine(AOR: 0.298, 95% CI(0.097,0.92)), long time take to fetch water from source (AOR: 0.046,95%CI(0.01,0.22)), home based water treatment ((AOR = 0.15, 95% CI: (0.04, 0.62)), living with animal in the same house(AOR: 8.31, 95% CI(2.46,28.06)), children who took gruel type of food(AOR: 0.24, 95% CI(0.07,0.81)), hand washing practice before cooking food (AOR: 0.195(0.066, 0.574)). Conclusion: The two weeks period magnitude of acute under-five diarrhea was relatively high and number of under five children in the household, cleanness latrine, time taking from the source of water, home based water treatment, number of rooms in the home, live with animal in the same house, type of food child take, hand washing before food preparation had significant association with the occurrence of under-five diarrhea. Improve community about home and environmental sanitation and hand practices were recommended.

Drug Abuse among Street Children

In The Gambia like all nations, drug abuse is seen as a social and health problem that has many serious implications for the physical, social, psychological and intellectual development of the victims more especially, the children. Therefore, it continues to be a concern to families, community leaders, educators, social workers, health care professionals, academics, government and its development partners. Though there are some studies on drug abuse, there is none on children and drug abuse focusing on the street children the most vulnerable category. Street children are hypothesized to be more at risk of any epidemic including drug abuse. This study sought to determine the risk and prevalence of drug abuse among street children focusing on those in the car parks. The research was focused on six critical areas: level of knowledge of drug abuse, perception towards it, level of knowledge of the causes of it in the community and among street children, level of knowledge of negative impacts of it, level of knowledge of the preventive methods; and level of knowledge of the support services and treatments needed by victims. A structured questionnaire was used to collect the data from thirty five participants (i.e. one driver and six casual apprentices from each of the five car parks) were interviewed. The data was presented and analyzed using tables and percentage. The findings revealed among other things, that there is high level of awareness of drug abuse but the feelings towards it are mixed. Like other children, street children are abusing drugs mainly due to peer influence with the ultimate objective of getting high to relief stress, group recognition, desire to be trusted by peers, etc. Similarly, participants are highly aware of the negative impacts encompassing fighting, stealing, mental illness, etc. To finance the behavior, victims are engaged in all types of dangerous antisocial behavior including romantic ones exposing them to a range of diseases including STIs and HIV/AIDS. Marijuana is the most commonly abused drug. Though in the minority, some have started experimenting cocaine/coke, hashish; and heroin. While participants have good knowledge of the critical methods to fight drug abuse, the support services needed by victims, victims are mostly reluctant to seek the services not only because they are hard to find but fear societal stigmatization, exclusion and discrimination and professionals’ maltreatments.

Safety, Tolerability, Efficacy and Logistics of Administration of Three Types of Therapeutic Feeds to Children with Severe Acute Malnutrition (SAM)

Objective: To analyse safety, tolerability, efficacy and logistic issues related to administration of 3 types of therapeutic feeds to children with severe acute malnutrition (SAM) from tribal district of Nandurbar, Maharashtra. Design: A three arm open label, block randomized trial using 3 therapeutic feeds i.e. commercially available ready to use therapeutic feed (C-RUTF), locally prepared ready to use therapeutic feed ( L-RUTF) & amylase rich food(ARF) was given to 1092 tribal children of SAM in Nandurbar District, Maharashtra, India during 2014-2015. Setting: Tribal district of Nandurbar, Maharashtra. Participants: 1092 children of SAM, 766 on C-RUTF, 184 on L-RUTF & 143 on ARF followed on treatment for 8 weeks. Outcomes: The recovery rates in the three groups, any untoward effects during treatment and logistic aspects of procurement, delivery, storage & administration of therapeutic feeds. Results: Total number of children with SAM were 1092. Gr 1 – Out of 765 children of SAM, 404 (52.8%) recovered on C-RUTF. Gr 2 – 80 (43.5%) recovered out of 184 on L-RUTF. Gr 3 – 64 (44.8%) recovered on ARF at the end of 8 weeks of treatment, the difference being statistically significant between C-RUTF & others. Out of 38 children on C-RUTF, it was observed that 1 had diarrhoea, 1 had vomiting, 1 had fever, 4 children reported more activity in terms of playfulness, more speaking & smiling. 31 children had nothing specific to report. Out of 34 children on L-RUTF, 6 children reported diarrhoea, 1 had vomiting & 4 children reported fever. 3 children reported more activity. 23 children had nothing specific to report. Out of 19 children on ARF, 1 had diarrhoea, 1 had vomiting, 1 had fever, 3 reported more activity. 13 had nothing specific to report. Untoward effects were noted in 3 out of 38 (7.89%) in C-RUTF group, 11 out of 34 (32.35%) in L-RUTF group and 3 out of 19 (15.7%) in ARF group. Conclusion: C-RUTF was found to be more efficacious, with least untoward effects, easy to administer and was more palatable when compared to L-RUTF & ARF.

Health Care Providers Perception and Practice of HIV Disclosure to Sero-Positive Children and Adolescents in a Tertiary Health Facility in Abuja, Nigeria

Background: Ideally, disclosure of HIV status to infected children and adolescents should involve both health care workers and parents/caregivers. Most studies on disclosure in children have focus mainly on parents/caregivers with little information on health care workers. We conduct this study to evaluate the practice, perception of the healthcare workers in our health facility on disclosure to infected children and adolescents. It is envisaged that such information will help in the design of better strategies on disclosure in our environment. Methods: A cross sectional hospital based study was conducted among health care workers at the special treatment clinic, and heart to heart unit of the University of Abuja Teaching Hospital, Gwagwalada from January to March 2017 for the above objective. A structured questionnaire was used to collect information on disclosure among the healthcare workers, which include among others: their bio-data, knowledge, perception, and practice on disclosure in the two service areas of the hospital. Results: Of the 80 health care workers interviewed, 60(75.0%) were females, 11(13.8%) were doctors, 9(11.3%) nurses, 17(21.3%) monitoring/evaluation/record clerks, and 16(20.0%) were either voluntary counseling and testing counselors or adherence counselors. Their mean age and duration in service in the two areas were 39.70±7.10 and 7.93±4.99 years respectively. Over half 48(60.0%) of the health care workers were unaware of the hospital having guideline on disclosure, 64(80.0%) have not been trained, and 68(85.0%) does not know any key information on disclosure. While all 80(100%) felt that disclosure was a good practice for better adherence, only 16(20.0%) had actually disclosed, with 6(37.5%) not seeking any formal permission from parent/caregivers before disclosing. Ages 8-16 years was recommended by 60(75%) as the appropriate age to disclose, however 28(35.0%) recommended age 14-16 years. Over half of the respondents 58(72.5%) admitted that disclosure should be a shared responsibility between themselves and the caregivers, most however perceive their role as only preparing the parents/caregivers for disclosure, and providing ongoing counseling to both the parents/caregivers and the children and adolescents. Lack of training on disclosure, and none availability of guideline in the health institution were major setback on the ability of the healthcare providers to fully participate in disclosure process. Conclusion: While healthcare providers support the idea of disclosing at mid and late adolescent, their perceived role was that of support and provision of ongoing counseling. Lack of training and none availability of disclosure guideline affects their perceived role. There is need to train and retrain healthcare workers on disclosure guideline, and making such guideline available in the health facilities.

Feeding Problems in Children with Autism Spectrum Disorders

Background: Feeding problems are common in autism. Parents are frequently worried about the health status of their children, which may be threatened by some consequent nutritional deficiencies. Despite this, feeding behaviours remain little explored by clinicians working with children with autism spectrum disorders and researches are lacking especially in Tunisia. Aims: To evaluate the frequency and the types of feeding problems in children with autism spectrum disorders. Settings and Design: A comparison was made between 57 children with autism spectrum disorders and 57 control groups regarding the feeding problems. Parents completed the children’s eating behavior inventory (CEBI). Autism severity is evaluated using the Childhood Autism Rating Scale. The SPSS statistical package, version 20.0 was used. Results: According to the CEBI, children with autism spectrum disorders showed more feeding problems than the control group (82.4% versus 56.1%, p=0.002). In fact, the parents of these children observed more pica habits on their children compared to the control group (p=0.000). They also observed more selectivity for starchy foods compared to the control group (p=0.000). The more the autistic symptoms were severe, the more children exhibited feeding problems (p=0.02). Conclusions: Our findings suggest that feeding problems are more common in children with autism. Clinical implications trigger the need for clinicians to provide the necessary assessment and treatment.

Building Resilience among Children and Youth with ADHD through Identifying and Developing Protective Factors in Academic, Interpersonal and Cognitive Domains

Children and youth with ADHD are a vulnerable group susceptible to adversity in wide-ranging life domains. However, many children and youth, irrespective of having ADHD become successful both academically andinterpersonally, and improve their cognition. This group can be considered as being “resilient”, that is, adapting to the adversity they may face in a positive manner. The overarching goal of this paper is to highlight domains at the academic, interpersonal and cognition levels that are indicative of resiliency among children and youth with ADHD. The secondary goal is to highlight interventions that result in promoting resiliency among this group at these levels. It is necessary for future interventions to be designed and implemented with developing the resiliency of children and youth with ADHD in mind. To achieve this, research needs to begin to identify the strengths of children and youth with ADHD to provide insight into how their strengths can compensate for their weaknesses, and to promote their resiliency leading to success academically, interpersonally and cognitively.

Fractures of the Humeral Condyles in Children – A Review

The three most common elbow fractures classically reported in pediatric orthopedic literature are supracondylar (50–70%), lateral condylar (17–34%), and medial epicondylar fractures (10%). The mechanism of injury varies, but the most commonly described mechanism involves a fall on an outstretched hand with varus, valgus or rotational force or a combination thereof. The vectors of force and the degree of chondro-osseous development dictate the type of injury incurred. A review of the literature was conducted to see the most frequent injuries and complications.

Assessment of the Preferred Methods Used by Mothers to Prevent Malaria Infection among Children Under Five Years in the Hohoe Municipality Of Ghana

Background: The use of Long Lasting Insecticide Nets (LLINs) is seen as a major public health intervention and has shown to have both direct and indirect effects on the dynamics of malaria transmission. This report assessed the methods used by mothers to prevent malaria infection among their children under five years in the Hohoe Municipality. Method: A cross-sectional survey carried out in February 2017 among 418 mothers with children under five. Data were collected in the form of interviews using questionnaires on the usage of LLIN alone, LLIN with other methods (LLIN+) and use of other methods only (OMs). Chi square test and multinomial logistic regression were used to determine the association between dependent and independent variables. Results: Of the 418 mothers, 28.5% used LLIN only, 50.7% used LLIN+ and 20.8% used OMs only to prevent malaria. Mothers aged 30-39 and 40-49 years were 3.87 and 5.55 times more likely to use LLIN only rather than OMs as compared to those aged less than 20 years (AOR=3.87, p=0.019) and (AOR=5.55, p=0.029) respectively. Similarly, mothers aged 30-39 and 40-49 years were 3.08 and 4.02 times more likely to use LLIN+ rather than OMs as compared to those aged less than 20 years (AOR=3.08, p=0.023) and (AOR=4.02, p=0.050) respectively. Mothers who attained a higher level of education were 2.08 times more likely to use LLIN+ rather than OMs as compared to those with no formal education (AOR=2.08, p=0.015). Those who resided in rural areas were 2.00 times more likely to use LLIN only and LLIN+ rather than OMs only as compared to urban dwellers (AOR=2.00, p=0.002) and (AOR=2.00, p=0.013) respectively. Conclusion: More than half of the mothers preferred using LLIN+. One out of 3 mothers used only LLIN while one out of 5 used OMs only to prevent malaria. Age, educational level and place of residence were significantly associated with methods used to prevent malaria. There is the need for targeted education on LLINs in order to improve usage among younger mothers and mothers residing in urban areas. Further investigations to determine reasons for using OMs only and also determine the added value of OMs to LLINs in preventing malaria are recommended.

Mental Health Promotion for the ‘In-Betweeners’: The Rationale and Effectiveness of Community-Based Mentoring and Coaching Schemes for Primary School-Aged Children.

Background: There are relatively few research publications of mental health promotion initiatives for primary school aged children that are based in community rather than educational settings. Aims: To describe developmental frameworks and models of mentoring, coaching and mental health promotion and to summarize any evidence for the efficacy of community initiatives. Methods: An umbrella review was undertaken of publications on theories and models, and a synthesis of findings from reviews of outcomes of mentoring, mental health promotion initiatives undertaken outside of school time for children aged 5-11 years. Results: Developmental mentoring on its own or in combination with outside school activities is potentially more flexible in terms of delivery and targets than school-based programs. Pooled effect sizes (range about 0.2-0.4) suggest modest but significant gains across several key domains (cognition, emotion, physical health, and social connectedness) that equate to about 10 percentile point on the developmental evaluations employed. Mediators of benefits include the level environmental or individual risk of the child and parental involvement. It is noteworthy that poor quality, atheoretical programs can have detrimental effects. Conclusions: Children aged 5-11 years may be more accepting of, and could make significant gains from, community-based mental health promotion interventions such as developmental mentoring. However, there are some significant gaps in the knowledge-base that need to be addressed through more systematic research.

Increased Level of Lactate Dehydrogenase Correlates with Disease Growth in Algerian Children with Lymphoma

Objective: This study aimed to evaluate the relation of Lactate dehydrogenase (LDH) levels with stage of the disease and it role in monitoring tumor response to therapy in lymphoma patients. Methods. LDH levels were evaluated on 65 diagnosed Algerian children and compared to healthy control. Results: Our results revealed that LDH levels were significantly higher in untreated children with both hodgkin’s and non hodgkin’s lymphomas compared to control. Moreover, it was observed that the higher is the stage of disease, the more serum LDH level will be. However, there was a significant fall in serum LDH activity by completion of the chemotherapeutic courses. Conclusion: LDH plays an important role in tumor initiation and maintenance. The elevated serum LDH may reflect, release of the enzyme from malignant cells and suggest that they may reflect tumor burden and therefore correlate with disease progression.

Inguinal Hernia: A Probable Complication of Urinary Schistosomiasis in School Age Male Children in an Area Highly Endemic for Schistosoma Haematobium in Zambia.

Introduction Schistosoma haematobium infection is acquired early in life with the peak prevalence and intensity of infection occurring in the second decade of life in endemic areas. The aim of this study was to establish any association between S. haematobium infection and development of inguinal hernia in school age children in a S. haematobium highly endemic area in Zambia. Methodology An analytical study was conducted at St Paul’s Mission Hospital, Nchelenge, Luapula province, Zambia. Hospital operating theatre records were reviewed for inguinal hernia repair operations in school age children. Results There were 45 inguinal hernia repair operations conducted in male school age children presumed to be infected with S. haematobium between July 2010 and July 2015. The mean age of these children was 9.6 years while the age range was from 6 years to 14 years. The overall prevalence of S. haematobium in school age children in the area ranged from 89.5% to 95.5% during this period. Conclusion Inguinal hernia is a probable complication of S. haematobium infection in school age male children.

Risk Factors for Stunted Growth among Children Aged 6–59 Months in Rural Uganda

Despite the agreed global and national stunting reduction targets, Uganda has made very little progress. Understanding context-specific risk factors for stunted growth is therefore pertinent to designing programs to address the problem. A cross-sectional study was conducted in 32 randomly selected villages in Buhweju district, Southwest Uganda. Data entry, cleaning and analysis were carried out using Statistical Package for Social Sciences (SPSS) version 21. A regression analysis was conducted to examine the associations between potential risk factors and stunted growth. The survey covered 256 households and anthropometric measurements were taken for 221 children aged 6–59 months. The majority of the households (66%) in the district were food insecure and had a low socioeconomic status (84%). The prevalence of stunting in Buhweju district was 51%, which is significantly higher than the regional and national averages. Only 28% of the children were exclusively breastfed in the first 6 months of life, and only 10% of them received the minimum acceptable diet (MAD). The findings of this study demonstrate that reductions in stunted growth at national or regional levels has not necessarily translated into similar trends in rural areas of Uganda. The notable contributors to stunting in these areas include morbidity, sub-optimal infant and young child feeding (IYCF) practices, low consumption of animal-source foods, food insecurity, lack of access to high-quality drinking water, sanitation and hygiene (WASH) facilities and poverty. Increased investment in both nutrition specific and sensitive interventions is therefore crucial to address these risk factors.

A Specific Case of Non-Specificity: Longitudinal Effects of Dysfunctional Attitudes on Depressive, Eating Disorder and Aggressive Symptoms in Children and Adolescents 

An important step in the validation of disorder-specific etiological models is the examination of the predictive specificity of proposed vulnerability factors. It may advance the understanding of the emergence of comorbidity and the identification of at risk-populations for mental disorders. To enhance the currently limited evidence on the specificity of Beck´s cognitive diathesis-stress model of depression, the present study investigated longitudinal effects of dysfunctional attitudes and stressful life events on the development of depressive, eating disorder and aggressive symptoms in children and adolescents. A large sample of initially asymptomatic children and adolescents completed self-report symptom measures at study entrance and again approx. 20 months later, and reported stressful life events during the study interval. Stressful life events proved to be a risk factor to all investigated symptom domains. Dysfunctional attitudes at T1 were prospectively related to depressive symptoms, aggressive behavior and weight concerns at T2. However, types of associations varied as dysfunctional attitudes showed linear associations with weight concern, but nonlinear effects on depressive and aggressive symptomatology. Findings of the current study thus suggest that dysfunctional attitudes are not uniquely related to the development of depressive symptomatology in children and adolescents, but may contribute to adverse outcomes in various symptom domains. Thus, intervention efforts based on Beck´s vulnerability - stress model of depression may turn out to be useful in reducing vulnerability to a variety of outcomes in children and adolescents.

Trends of Diabetes in Children and Adolescents in Pediatric Endocrinology Clinic and Clinical Pediatric Diabetes Center at Al Baha Central Hospital in Saudi Arabia

Objectives This study describes and compares the epidemiological criteria of children with diabetes from 2007 to 2014. Methods A prospective study conducted with 372 children with diabetes mellitus. An access program was used for data collection, and SPSS 17 was used to analyses the results. Results A total of 372 cases with diabetes were studied and were divided into three groups according age. The first age group was between one day and six years and comprised 128 (34.4%) patients. The second group aged 7- 12 years of age comprised 174 (46.7%) patients. The third group aged 13-18 years of age comprised 58 (15.59%) patients. The average age was 8.32 years. Females constituted 52 % (194 cases) of all cases. T1DM constituted 95.4%, equal to 355 patients, T2DM constituted 1.88%, equal to seven cases. Monogenic diabetes affected three patients or 0.79%, with one case of monogenic neonatal diabetes confirmed by genetic study, and two other cases suspected to be MODY. The highest incidence was observed in the autumn months, with 105 children affected, constituting 27.8 % cases. The year 2012 had the highest incidence rate, with 59 children and adolescents affected at an incidence rate of 25.48 / 100000.Al-Baha region had the highest number of cases constituting 37.7 % of cases. Diabetic ketoacidosis was the first presentation and constituted 44.2% of cases. Conclusion. Diabetes in children is increasing significantly in recent years, requiring more detailed analysis of its epidemiological factors to find out any significant correlations which may help in its prevention.

A Longitudinal Intervention Study to Reduce Aggression by Children Ages 4-11

Our objective was the early identification, assessment and treatment of aggression by primary school children four to eleven years old, with the goal of preventing school expulsion. The children were identified by teachers and other professionals for their aggressive behavior. Children were assessed for five symptoms which are linked to the development and persistence of social and/or physical aggressive behaviors: inattention, hyperactivity, anxiety, poor social functioning, and oppositional behavior. Long term follow-up continued for up to 9 years. Conners’ Scales for parents and teachers were used to assess the severity of predisposing symptoms and emotional lability. The children were treated with psychosocial and pharmacological interventions by social workers and a physician, in addition to utilizing community and school resources. Teachers reported a reduction in some of the predisposing symptoms: hyperactivity, emotional lability, oppositionality, and improved social functioning. Parents reported improvements in all five of the children’s physically aggressive behaviors. Early intervention for children’s aggressive behaviors was found to be effective. None of the children in the study were expelled from school.

A Comparison Study of the Fitbit Activity Monitor and PSG for Assessing Sleep Patterns and Movement in Children

Background: Despite its expense, labor and intrusiveness, polysomnography (PSG) is the gold standard for diagnosing obstructive sleep apnea (OSA). Recently, commercially available electronic activity monitors, such as Fitbit, have become widely accepted and can provide an estimate of sleep patterns for screening children with possible OSA. A previous study demonstrated Fitbit to be valid compared to PSG in adults. To date, these devices have not been extensively utilized for research in children with sleep disordered breathing (SDB). Objective: To evaluate the validity of the Fitbit activity monitor compared to PSG in children and adolescents with SDB. Methods: Data was collected from 14 children, ages 3 through 11, who were scheduled for a PSG during the study period. Fitbit was worn concurrently during the night of the PSG. Analyses were performed by comparing total sleep time, number of awakenings, sleep efficiency and wake after sleep onset (WASO) Fitbit parameters with the corresponding parameters measured by PSG using Spearman’s rho. Fitbit movement epochs were also compared to PSG epochs showing movement behavior. Results: Pilot data suggest that Fitbit demonstrates a high sensitivity for sleep, a low specificity for wake and a trend suggesting good association of movement measurements. Conclusion: Although Fitbit is not as accurate as PSG for determining wakefulness, it may be a useful screening device to assess gross sleep quality in children. Further studies are indicated to validate these findings.

Vitamin A deficiency Disorders among the Rural Pre-School Children of South India

Objectives: Vitamin A deficiency (VAD) among the rural pre-school children in India is continues to be a major nutritional problem of public health significance, even after the implementation of national vitamin A prophylaxis programme for more than four decades. The aim of the study was to assess the prevalence of vitamin A deficiency among rural pre-school children of South India. Methodology: A community based cross-section study; adopting multi-stage random sampling procedure was carried out by the National Nutrition Monitoring Bureau (NNMB) among rural pre-school children of four South Indian states viz. Kerala, Tamil Nadu, Andhra Pradesh and Karnataka during 2003-05. A total of 35,480 (Boys: 18,216; Girls: 17,264) rural children of 1-5 year age group was covered for this study. Key Results: The prevalence of Bitot’s spot, an objective ocular sign of VAD among the rural pre-school children of South Indian was 0.6% (95%CI:0.5-0.7). Similarly, the proportion of children with sub-clinical VAD was 59.3%, suggestive of a severe public health problem. In general, the prevalence of VAD was significantly higher (p<0.001) among the children of socio-economically marginalized sections of the communities, labourers, illiterate mothers and those residing in the households with no sanitary latrine. Conclusion: The prevalence of clinical and sub-clinical VAD among the rural pre-school children of south India is suggestive of a public health concern. Therefore, rural communities are encouraged to consume diets rich in pre-formed and pro-vitamin A and administer periodic massive dose vitamin A solution to the children of under five for the prevention and control of VAD.

Ocular Manifestations of Vitamin A Deficiency Among the Rural Pre-School Children of North India

Purpose: Vitamin A deficiency (VAD) is still a major nutritional problem of public health importance among the rural pre-school children in India, even after the implementation national vitamin A prophylaxis programme for prevention of nutritional blindness and ICDS have been in operation for more than three decades. The purpose of this communication is to assess the prevalence of ocular manifestations of vitamin A deficiency among rural pre-school children of north India. Methods: A community based cross-section study; adopting multi-stage random sampling procedure was carried out by NNMB among rural pre-school children of four north Indian states viz. Maharashtra, Madhya Pradesh, Orissa and West Bengal. A total of 36,111 rural pre-school children of 1-5years (Boys: 18408; Girls: 17703) were covered for this study. Results: The prevalence of conjunctival xerosis (2.5%), the first ocular sign of VAD and Bitot’s spot (0.9%), an objective ocular sign of VAD was higher than the cut-off values suggestive of public health nutritional problem among the rural children. While, the prevalence of night blindness, the first symptom VAD was reported among 0.5% of rural children. Similarly, the proportion of rural pre-school children with sub-clinical VAD was 64%, suggestive of severe public health importance. Conclusion: The prevalence of ocular manifestation and sub-clinical vitamin A deficiency was high among the rural children of north India. Therefore, rural communities are encouraged to consume diets rich in vitamin A and administer massive dose vitamin A solution to the children of under five for the prevention and control of vitamin A deficiency and its adverse impact on child morbidity and mortality.

Management of Locally Advanced and Metastatic Pediatric Nasopharyngeal Carcinoma. Experience of Children Cancer Hospital – Egypt

Background. Nasopharyngeal carcinoma (NPC) is a rare disease in the pediatric age group; it represents 1% of all pediatrics malignancies, however, it is the predominant malignancy arising in the nasopharynx in this age group. Although NPC is a chemo-radiosensitive disease yet, the optimal dose of radiotherapy and optimal timing of chemotherapy is still not standardized. Methods. This is a retrospective study including all the newly diagnosed pediatric NPC who were diagnosed and treated at the Children Cancer Hospital Egypt (CCHE) during the period from July 2007 to December 2012. All imaging studies (e.g., CT or MRI scans) were reviewed by a senior head and neck radiologist for proper staging and assessment of tumor response. Patients were staged according to AJCC staging system. Modified version of the Response Evaluation Criteria in Solid Tumor (RECIST) was used to assess response. Results. Twenty-six patients were diagnosed and received treatment as NPC in CCHE. Median age was 12 years (range 7.8-17 years). There was a male predominance. Eleven patients (42.3%) were stratified as stage 4, and 11 (42.3%) as stage 3. All patients received 3 cycles of neo-adjuvant chemotherapy followed by concurrent chemo-radiotherapy. IMRT was used to deliver radiotherapy in all patients. The overall response rate (CR and PR) to induction therapy was 73%, 19.3% had SD, while 7.7% had PD. By the end of the study, 18 patients (69.2%) were alive in CR, 5 patients (19.2%) had PD, and 3 patients (10%) lost for follow up. The Mean duration of follow up was 35 months, range 5-66 months. The 3 year OS and EFS and rates were 84.6% and 69.3 % respectively. OS for M0 was 91.3% and for M1 33.3% with statistical significance (p =0.032). Conclusion. Neoadjuvant chemotherapy followed by concurrent chemoradiotherapy using IMRT lead to good clinical end results with limited toxicity. Metastatic disease at presentation was identified as the adverse prognostic factor.

New Regulations for Foods Offered to School Children in Chile: Barriers to Implementation

Objective: To prevent childhood obesity, the Chilean government has recently implemented food regulation laws that apply to schools. This paper reviews the literature regarding the challenges in successfully integrating policies to regulate foods offered in schools. In addition, to understand some of the potential implementation barriers, a survey was conducted to evaluate how well food regulation laws were understood and implemented in Chilean schools. Methodology: A narrative literature review was conducted regarding food regulation policies in Chilean schools and potential barriers to implementation. This informed a subsequent descriptive, qualitative survey which was conducted in the Valparaíso region of Chile to examine knowledge, practices, and potential barriers to implementation of the new regulations. Twelve randomly-selected school food kiosk owners completed a survey and structured interview. Visual observations were also performed at each food kiosk. Content analysis identified trends in food items sold and determined the depth of understanding kiosk owners have of a specific new food law, "La Composición Nutricional de los Alimentos y Su Publicidad (20.606)." Key Results: 7 articles in Spanish and 10 in English were reviewed. The literature review revealed that unhealthful food options are readily available to Chilean students in school kiosks. The results of the survey and interview indicated that the school kiosk owners surveyed have a general understanding of the food law. 10 out of 12, however, were unsure of the law's exact contents. Unhealthful food options, inconsistent with regulation 20.606 were observed in all 12 visited kiosks. Conclusion: Evidence from a literature review and the survey findings confirm that unhealthful foods persist in Chilean schools, despite government food regulations. Although the majority of the school kiosk owners acknowledge law 20.606, most lack an understanding of its exact contents and their role in promoting healthier foods in schools. Further education of vendors and school administrators is needed to enhance compliance with the new Chilean food regulations.

Barriers to Physical Activity and Healthy Eating in Children as Perceived by Low-Income Parents: A Case Study

During the past three decades the prevalence of childhood obesity has steadily increased in the United States. Causes of childhood obesity are complex and include numerous individual and environmental factors. The purpose of this study was to determine parent perceptions on the social-ecological barriers (community, school, and family) to physical activity and healthy eating, perceived specific to their children. Self-reported data gathered from a 50-item questionnaire and six focus groups were conducted with parents (n=43) enrolled in the Women, Infants, and Children (WIC) Program. Participants (16 to 67 years old) were predominately female (88.4%), Hispanic (67%), low income, and living in or near Lompoc in Santa Barbara County, CA. The social-ecological model (family, school, and community) was utilized to create focus group questions and provide recommendations as part of the Lompoc Community Health Improvement Project (2006-to-the-present). Popular community barriers for physical activity were: disconnected sidewalks, lack of safe bike routes to school, lack of recreational programming at an affordable cost, and language barriers (lack of marketing physical activity programs in Spanish). Two safety barriers involved parks; fear of injury (dilapidated equipment) and fear of gangs (violence). Common school barriers were: teachers do not lead-by-example, lack of healthy food in school cafeteria, and insufficient time for children to purchase food and eat. Family barriers included: grandparents sabotaging healthy eating environments (e.g., spoiling children), insufficient nutrition knowledge (both children and parents), and economics (not being able to afford healthy food and a recreation/gym membership).

Breakfast Cereal and Nutrition Education on Body Mass Index and Diet Quality in Elementary School Children: A Pilot Study

Objective: Skipping breakfast has been associated with an increased risk of obesity. This randomized controlled pilot study tested whether emphasizing breakfast consumption, in conjunction with nutrition counseling, would improve weight status and dietary quality in children. Design and Methods: Twenty children were recruited and randomized to a breakfast (BF, n=11) or control (n=9) intervention. Both groups received weekly group nutrition counseling for 12 wk but breakfast consumption was emphasized, and ready-to-eat (RTE) cereal provided, to BF only. Anthropometric measurements were taken weekly. Three-day food records were taken at baseline and endpoint. Results: Weight status did not change significantly, however, children in BF displayed an overall decrease in BMI (-1.0±5.1%) whereas children in the control group had an overall increase (1.1±7.2%) from baseline (P=0.52). Three-day food records (BF, n=6; control, n=5) revealed group x time interactions on total sugars (P=0.007), folate (P=0.05), vitamin B12 (P=0.03), sodium (P=0.05), niacin (P=0.009), and vitamin B6 (P=0.023). Except for sodium, BF had improvements in these nutrients relative to the control group. Conclusions: Preliminary data from this study show that the provision of RTE cereal with weekly nutrition counseling may positively affect intake of essential nutrients. The effects of breakfast consumption on weight status are still uncertain.

Investigating the Relationship between Children, Depression, and Pain in Black Women with Sickle Cell Disease (SCD)

Medical advances in obstetrics and hematology have encouraged researchers to investigate the reproductive risk in women with Sickle Cell Disease (SCD) attempting motherhood.  However, few hematological studies have been completed focused specifically on the reproductive mental health of Black women with SCD.  Historically women with SCD have been guided away from childbirth under the premise that they were not emotionally or physically capable of managing children. One question that remains unclear, from the limited research available in this area, is whether the presence of children serves to influence mood and pain in Black women with SCD.  The current study examined the effects of the presence of children on self-reported pain and depressive symptoms and the relationship between pain and psychological functioning in African American women with SCD.  Self-reported rates of depression, pain intensity, and pain severity were evaluated in 70 African American females with SCD.  Results of Analysis of Covariance (ANCOVA) did not find differences in reported mood or pain between women with and without children.  The current study serves as an initial observation upon which replication of the current findings and future prospective studies can be conducted. The study may ultimately mature into an area of research that guides reproductive decision-making for women with SCD and their doctors.

Prevalence and Factors Associated with Disclosure of HIV Diagnosis to Infected Children Receiving Antiretroviral Treatment in Public Health Care Facilities in Gauteng, South Africa

HIV infected children who started antiretroviral therapy (ART) in public health facilities in South Africa have survived to older age and disclosure has become an essential part of their care. Available data on HIV disclosure to children were collected much earlier in the provision of ART in South Africa. The aim of the study was to (a) determine the characteristics of caregivers of pediatric HIV patients in Gauteng, South Africa, (b) estimate the prevalence and timing of HIV disclosure among these patients, and (c) assess the factors associated with disclosure status. A cross-sectional study was conducted among 286 caregivers of paediatric ART children aged 4–17 in two centres in Gauteng, South Africa. Bivariate and multivariate logistic regression analyses were carried out. The highest proportion of care givers were biological mothers (n=140, 49.3%). The mean age of the children was 8.5 years, (range 4-17 years). More than a third (n=99, 34%) were disclosed their HIV status, and the mean age at disclosure was 9.3 years, (SD = 2.7). Child’s age older than 10 years (OR =1.63; 95% CI: 1.44–1.85), having a nonbiological caregiver (OR=1.75; 95% CI: 1.06-2.89), caregiver educational level (OR =0.64; 95% CI: 0.47–0.87), and caregiver’s age older than 60 years (OR=1.02; 95% CI: 1.01-1.04), were significantly associated with HIV disclosure to infected children. The relatively higher prevalence of disclosure is attributed to increasing access to paediatric ART. Training healthcare providers to support caregivers in disclosure will increase the rate of disclosure to HIV infected children receiving ART in public health facilities.

Relationship Between Household Economic Status and Childhood Micronutrient Deficiency in India: An Evidence from a National Level Representative Survey

The high prevalence of anemia among children and adolescents in India is still an overwhelming problem. Not only that, there is also a considerable deficiency of various micronutrients such as Vitamin A, Vitamin B12, Vitamin D, serum ferritin, Zinc and Folate etc. in children. These micronutrients have several functional roles for the normal growth and development of children. Unfortunately, recent studies on public health and nutrition intervention have so far focused less on these micronutrition and more on anemia and nutrition. Data for this study obtained from the Comprehensive National Nutrition Survey (CNNS 2016-18), a nationally representative survey covering different age group. Specifically, it includes information on 9767 children aged 1-4 years. Out of these surveyed children biomarker data for hemoglobin, serum ferritin, zinc, folate, vitamin A, vitamin B12 and Vitamin D were collected from 8242 children. Micronutrient deficiencies were identified based on WHO and other established cut-off criteria. Wealth quintiles were computed to identify household economic inequality. The prevalence of anemia at the national level was 40.7%. Among micronutrients, folate (22.9%) and zinc (18.7%) deficiencies were most commonly observed, followed by vitamins A (18.3), vitamin B12 (13.8%) and vitamin D (14.0%). Iron deficiency as measured by ferritin was present in 31.6% of children. It is alarming that nearly one in three children (32.8%) suffer from deficiencies in two or more micronutrients. Clear socioeconomic disparities were observed for all micronutrient deficiencies (MND); children in the poorest groups had significantly higher levels of micronutrient deficiencies than children in the richest groups. Among the states, Gujarat and Madhya Pradesh had the highest overall micronutrient deficiencies, while West Bengal and Kerala had the lowest. This clearly shows that a large proportion of preschool children in India suffer from anemia and MND, with the prevalence being even more alarming in lower socio-economic settings. This study suggests that there is a need to move beyond single-nutrient interventions and implement comprehensive, multi-micronutrient supplementation or food fortification strategies seamlessly into the existing national health and nutrition programs.

Menopausal Symptoms Affecting Productivity and Occupational Needs of Peri-Menopausal Women in a Private University, Philippines

Objective This study aimed to explore the respondents’ reproductive health profiles, examining the physiological and psychosocial perimenopausal symptoms affecting productivity, and identifying occupational needs. It also determined the relationship between menopausal symptoms and the productivity and occupational needs of peri-menopausal women. Methodology A descriptive cross-sectional design was used, surveying 50 women over 40 years old with a validated four-point Likert scale instrument. The instrument undergone content validation, reliability test, and ethical approval. Survey was administered personally and online using purposive sampling. Statistical treatments included weighted mean, F-test, T-test, Pearson r correlation, and ranking. Key results The majority of participants had their first menstruation between 11 to 15 years old and experienced regular menstrual cycles. Most had one child, with an equal number of cesarean and normal deliveries, and reported no pregnancy complications. The study found that participants seldom experienced physiological and psychosocial menopausal symptoms. They agreed on the occupational needs during the perimenopausal period. It was found that physiological symptoms were influenced by factors such as early menarche, cesarean delivery, and pregnancy complications. Additionally, psychosocial symptoms varied based on menstrual status, the number of children, and pregnancy complications, with those experiencing earlier menstruation or complications reporting more intense symptoms. The study revealed a significant relationship between both physiological and psychosocial perimenopausal symptoms, which negatively impacted productivity and increased occupational needs. Women with higher menopausal symptoms expressed a greater need for workplace policies that support perimenopausal women, highlighting the need for tailored workplace interventions for this demographic. Future Direction The study recommends including pap smears and mammograms in annual exams for peri-menopausal women, offering awareness seminars on managing perimenopausal symptoms to reduce workplace disruptions, and suggests future research exploring additional variables affecting perimenopausal women’s health and productivity

Review on Frequency Neurofeedback on Autism Spectrum Disorder: Overview, Efficacy and Research Direction

Frequency neurofeedback (FNF) is a biofeedback method that targets frequencies between 1 and 50 Hz. The efficacy of FNF with autism has been labeled ‘probably efficacious’ in literature reviews in the last decade, despite new research pointing towards a higher standard. The aim of this review was to analyze key features of these studies, with a goal of determining the efficacy standard of FNF on autism and establishing a research direction. Electronic databases and literature reviews were used to collect a total of ten randomized and/or matched controlled trials. FNF reaches a Level 4 efficacy standard, with an impact on a broad range of factors including core autistic traits, social communication, emotional regulation, cognitive flexibility, executive function, behaviors of concern, attention, metabolic or thermal activity, and EEG e.g. decreased absolute power, mu rhythm, coherence and hyperconnectivity. Current evidence generalizes to male children, up to 18 years, with a low-average or higher intellectual functioning, with autism as the only diagnosis. A meta-analysis suggests a large superior effect when compared to wait list controls. Current research does not meet the higher efficacy standards outlined by Arns et al. (2020). Small samples plague most studies, and the maintenance of improvements post-training are yet to be assessed adequately. Eight recommendations are made.

Prevalence of Burnout, Secondary Traumatic Stress, Anxiety, and Depression Among Maternal and Neonatal Healthcare Staff in Two Tertiary Hospitals in Zambia

Background Healthcare worker stress, anxiety, burnout, and trauma have been widely documented across global healthcare systems. Staff in maternal and neonatal units frequently encounter emotionally distressing events and work under high pressure with limited resources. In Zambia, despite some gains in reducing maternal and neonatal mortality, fatality rates remain above national targets, exposing staff to repeated occupational trauma. Objective(s) This study aimed to assess the psychological well-being of staff in maternal and neonatal intensive care units, identify specific needs and stressors, and develop practical recommendations to improve resilience and support staff mental health. Methods A mixed-methods cross-sectional study was conducted at Ndola Teaching Hospital (NTH) and Arthur Davison Children's Hospital (ADCH), two major tertiary hospitals in Zambia. Data were collected over four days in February 2025. The study included 87 (out of 161) healthcare professionals, including nurses, midwives, and doctors. The Goldberg Anxiety and Depression Scale (GADS) and the Professional Quality of Life Scale Version 5 (ProQOL 5) were used to collect quantitative data, which were analysed using descriptive statistics and 95% confidence intervals (CI). Open-ended survey questions provided qualitative data, which were analysed using thematic analysis. Ethical approval was granted by the hospital ethics committee. Results High rates of clinical symptoms were observed. The overall prevalence of symptoms in the past 30 days was: anxiety (62%), depression (68%), burnout (50%), and secondary traumatic stress (46%). Junior doctors demonstrated the highest rates of depression (83%) and burnout (67%). The obstetrics and gynaecology and labour wards had the highest rates of secondary traumatic stress symptoms. Key qualitative themes identified were professional stressors, team and leadership issues, and the emotional burden of the work. Conclusion This study highlights an urgent need for both psychological and organizational support for maternal and neonatal healthcare staff in Zambia. The findings indicate that burnout and secondary traumatic stress are highly prevalent, particularly among junior doctors and those in high-risk wards. Targeted interventions at both systemic and individual levels are necessary to protect the well-being of healthcare workers and improve patient outcomes.

The Impact of Public Financing, Economic Growth, and Corruption on Immunization Performance: Evidence from 37 Sub-Saharan African Countries

Background In sub-Saharan Africa, where many countries continue to experience high burdens of vaccine-preventable diseases, increasing immunization access have been a priority for the governments and international organizations such as Gavi, the Vaccine Alliance. Over 40 Gavi-supported African countries have been impacted, with 364 million children reached and over US$5.7 billion disbursed, averting over 8.9 million child deaths. Despite this progress, the African region has struggled with immunization coverage due to various factors. Nevertheless, some African countries are transitioning out of Gavi support due to economic growth. However, many require strong political will to increase their expenditure on immunization. This study therefore aims to understand the factors influencing immunization performance and its relationship to public expenditure. Methods Data on 37 Gavi-eligible sub-Saharan African countries between 2006 and 2019 was obtained from the World Bank’s World Development Indicators, the WHO and UNICEF Joint Reporting Form and the Transparency International’s Corruption Perception Index. Descriptive immunization and health expenditure were analyzed using a panel regression of variables. DPT3 was used as an indicator of immunization uptake. The indicator for public expenditure on immunization per child was based on government spending on immunization divided by the number of children in the birth cohort. Results The average gross national income increased from US$639 to US$1,192 per capita, while government spending on immunization increased from US$1.7 to about US$4.5 per child. The findings show that there is a correlation between improved immunization financing, increased gross national income, reduced corruption, and improved immunization coverage. However, performance declines beyond a certain threshold when gross national income per capita increases. In addition, an English-speaking country effect was observed. Conclusions While improved immunization financing increases immunization coverage and constitutes an advocacy talking point, there is a need to understand why an increase in gross national income per capita does not translate into an improved immunization coverage. Key highlights Increasing national spending on immunization drives up the uptake of childhood vaccines. There is a threshold beyond which immunization coverage falls despite increased GNI. Controlling corruption increases immunization coverage tendency. French- and English-speaking countries’ immunization coverage differs. Immunization and health system financing have separate outcomes.

Factors Influencing Dietary Diversity and Nutritional Status Among Adolescent Pregnant Women in South-Eastern Tanzania: A Hospital-Based Cross-Sectional Study

Introduction Adolescent pregnancy has become a global health concern in recent years, with maintaining dietary diversity being essential to ensure the health of both the mother and fetus. This study aimed to understand the dietary diversity and nutritional status among pregnant adolescents attending antenatal clinic and identify the factors influencing these outcomes. Methodology A hospital based cross-sectional study was done at St Francis Regional Referral Hospital at Ifakara, Tanzania. A total of 131 adolescent pregnant women consented to participate. Data was obtained using questionnaire and 24-hour dietary recall. Results The study revealed that 93.1% (n=122) of adolescent pregnant women met the minimum dietary diversity score based on 24-hour recall period. Similar proportions were observed for age group but vary significantly with the number of children born (p< 0.001), marital status (p = 0.032) and education level (p< 0.001). Additionally, 93.9% (n=123) of adolescent pregnant women had a normal Mid-Upper Arm Circumference (MUAC) and 6.1% (n=8) were undernourished. Similar proportions were observed across age, number of children born, marital status, education status, and occupation. Conclusion Most adolescent pregnant women in this study achieved adequate dietary diversity. However, socio-demographic factors such as age, marital status, and education, as well as challenges like illness and loss of appetite, influenced their dietary diversity and overall nutritional status. Future research should adopt a community-based longitudinal approach to better understand these factors and provide a more comprehensive understanding on the dietary patterns of adolescent pregnant women.

Parents and Siblings as Role Models in Dealing With Digital Screen Media. Findings from A Media Fasting Intervention

Parents' and siblings’ role model motivation and function could play an important role in positively influencing both their own media behavior and that of family members. To investigate whether parents and siblings consciously take on this role model function, their intentions were being evaluated with a standardized questionnaire before a 6-week media fasting intervention. 135 pairs of parents and 178 pairs of children were included. A major component of the parents' media fasting intention to media fast was to be a role model for their children. This was particularly related to the idea that media fasting has something cleansing about it, as well as the hope of becoming more attentive and calm as a family. These parents seem to want to strengthen family cohesion and climate and protect their children from excessive media consumption. Children who want to be role models for their parents also intend to have a positive influence within the family and want to be role models for their siblings. Regression analyses revealed several predictors of the parents' intent for role model function: the hope of becoming more attentive and calm as a family, the view that media fasting has something cleansing about it, and the perception that it is good for one's children to use less digital screen media, and, inversely, age (R2 =.35). The best predictors of the corresponding intention among the children were the desire to be a role model for their siblings, for the family to do more together again and, as for the parents, a younger age (R2=.57). The intentions of both groups are different, but the possibility of using less media is perceived as sensible. The role model function appears to be a relevant motivating and influencing factor regarding the conscious use of digital screen media and regulation of screen time. This should be taken into account when developing interventions.

Development of Municipal Decision-Making Strategies as Management Tools to Combat Waterborne Diseases

Waterborne diseases pose a significant global public health threat, particularly in sub-Saharan Africa, where frequent outbreaks occur. These diseases stemming from contaminated drinking water, poor waste management, and insufficient hygiene contribute to high morbidity and mortality in children under 5 years old. A study addressed waterborne diseases in N'Djamena, Chad's 3rd and 9th districts, through decision-making strategies. The research employed various methods, including a household survey using questionnaires, workshops, semi-structured interviews, and focus group discussions. Additionally, documentary research provided essential data for analysing the situation of diseases in the community. Epidemiological data from 2019- 2022 indicated a substantial prevalence of diseases such as diarrhoea, dysentery, skin infections, typhoid, abdominal pain, and malaria, with notable mortality, especially among children. Among surveyed households, 50% believed the consumed water was contaminated, attributing it to faecal matter, while 28% and 22% linked the diseases to inadequate hygiene and unsanitary conditions, respectively. The study advocates for comprehensive strategies, including improving water treatment efficiency, implementing safe waste management, promoting hygiene, and vaccination. Active involvement of all stakeholders, with municipal authorities leading, is crucial for effective implementation and combating waterborne diseases.

Comparative Study On ‘Dietary Education’ In Japan And Korea: From The Latest Nutritional Knowledge Perspective

According to the Japan’s National Health and Nutrition Survey, trends in the intake of vegetables and fruits (1999-2018), which are considered effective in preventing lifestyle-related diseases, are far below the target value; In the under-50 age group, less than 30% achieved the target vegetable intake of 350g, and less than 15% achieved the target fruit intake of 200g 53. Against such background, it has become a challenge to nurture children's ‘self-management ability’ that leads to spontaneous and healthy dietary habits 16. Until now, almost all research on ‘Dietary education’ has been conducted in the field of nutrition, focusing on accumulating nutritional knowledge by explaining each nutritional component and its function. However, it is difficult to nurture spontaneous and healthy dietary habits simply through repeated nutrition-based education. It can be said that the pedagogical approach of this paper has made it possible to pursue from a broader perspective that influences food choices. Research on ‘nutrition transition’ points out “worldwide obesity dynamics and their determinants” based on “a shift in the broader patterns of dietary habits (Western-style diet) and corresponding nutrition-related diseases” 42. Nutrition transition research 5040 has a broad and holistic perspective on food and health, making it easy to understand nutrition. The purpose of this paper is to pursue how to nurture the ‘self-management ability’ for spontaneous and healthy dietary habits, based on these latest nutritional knowledges. Because nutrition transition is a global phenomenon, the author choses to use broader methods of international comparative research. Comparisons lead to discoveries and value creation. This can be said to have the greatest significance in comparative research.

Antibiotic Prescribing Practices for Upper Respiratory Tract Infection Among Clinical Officers at Kiambu County

Background Antibiotics are the most prescribed medications worldwide. Global consumption rose by 65% in 76 low and middle-income countries between the years 2000 and 2015. According to the World Health Organization, improper administration of antibiotics occurs in over 60% of people with upper respiratory tract infections. Inadvertent antibiotic use has been identified as a contributor to antimicrobial resistance. Outpatient antibiotic use accounts for around 80-90% of all antibiotic use in patients. Clinical officers are non-physician healthcare workers who have received less training, have a more restricted scope of practice than physicians. Clinical officers are key service providers in this country especially at the primary healthcare level. Objective The study assessed the factors that influence antibiotic prescribing for upper respiratory tract infections by clinical officers. Method A prospective study was carried out at 20 public hospitals in Kiambu County, on 36 clinical officers and 600 patient prescriptions. The parameters measured were patient factors, prescriber factors, institutional factors and how they affected the antibiotic prescribing practices by either being rational or irrational. Rational prescribing was identified as prescribing the right drug, at the right frequency, in the right duration, right dose for the right indication. Prescriptions were considered irrational if they did not satisfy any of the rational indices. Data was collected via a questionnaire from the clinical officers while WHO prescription checklist was used to collect data from patient encounters. Data was analyzed using Statistical Package for Social Sciences version 22.0 (SPSS v22.0) with P-value, Confidence Interval and Odds Ratio. Results A total of 600 patient encounters were recorded and 79.8% of the 479 encounters had an antibiotic prescription for URTI, 91% of the antibiotics prescribed were the right dose, 98% had the right frequency, 75% had the right duration, and only 23% had the right indication. Patients above 65 years were more likely to receive an antibiotic prescription OR 3.98 CI 0.91,17.41 P=0.17 compared to children under 12 years old. Males were more likely to receive an antibiotic, but this was not significant OR 1.06 CI 0.70, 1.59 P=0.79. A total of 28 (4.6%) patients had fever, and all received antibiotics. A total of 36 clinical officers were sampled and only 5 (13.8%) were found to have rational prescriptions (P=0.63), prescriber age (P=0.92), prescriber level of education (P=0.99) and prescriber work experience (P=0.22) were not associated with antibiotic prescription. As per institutional factors, availability of antibiotics (P=0.026) and availability of prescription guidelines (P=0.012) were associated with rational prescription of antibiotics. Conclusion The study indicated that there was a high antibiotic prescription rate deviating from the WHO standard. It demonstrated that most antibiotic prescriptions were irrational.

Rheumatic Heart Disease In Chad: Clinical, Paraclinical, Therapeutic And Progressive Aspects

Introduction Rheumatic heart disease is mostly common in low-income or developing parts of the world, such as Sub-Saharan Africa, with a high morbidity and mortality rate. There are few data that are available in Chad on rheumatic heart disease. Our objective was to study the clinical, echocardiographic, therapeutic, and progressive aspects of rheumatic heart disease at the Renaissance University Hospital Center and the National Reference Teaching Hospital in N’Djamena, Chad. Patient and methods This was a prospective, multicenter and observational cohort study, covering a consecutive series of patients consulted and/or hospitalized for rheumatic heart disease, documented by an echocardiogram from January 2015 to January 2021. Results Among the 4456 patients consulted and/or hospitalized, 398 cases of rheumatic heart disease (8.9%) were collected, and 364 patients had met the inclusion criteria. The mean age was 31.2 ± 14.4 years, and 193 patients (53%) were female. On admission, heart failure was present in 214 patients (58.8%), ischemic stroke in 10 patients (2.7%) and supraventricular arrhythmias such as atrial fibrillation in 94 patients (25.8%) and atrial flutter in 6 patients (1.6%). Mitral regurgitation was observed in 49.7% (n=181) of cases, aortic regurgitation in 33.2% (n=121), mitral stenosis in 31.3% (n=114), and aortic stenosis in 7.7% (n=28). At least two valvular disorders were combined in 48.4% of cases. A surgical intervention such as a heart valve replacement and/or valvuloplasty was performed in 80 patients (22.2%). At least one rehospitalization was noted in 56.9% of patients. Forty-two of the 150 patients free of heart failure at inclusion (28%) had experienced the first episode of decompensated heart failure during follow-up. On the other hand, in 119 patients (55.6%), it was the second episode of decompensated heart failure. Other progressive complications included atrial fibrillation (13.8%), thromboembolic complications (6.3%), infective endocarditis (6.0%) and prosthetic valve dysfunction (1.4%). Altogether, the mortality rate was 10.4%. It was 9.9% in non-operated patients compared to 12.5% in operated patients (p=0.49). Conclusion The present study shows that morbidity and mortality of rheumatic heart disease remain high in our context and often affect children, young adults, and women. Treatment is essentially based on cardiac surgery which is not available in Chad.

Knowledge And Practice of Preconception Care Among Women of Reproductive-Age in Bheerkot Municipality, Nepal

Background Preconception care is a crucial aspect of maternal and child healthcare services that aims to mitigate adverse pregnancy outcomes and enhance the desired health outcomes for women, newborns, and children. Despite the continuous multi-sectoral efforts in preconception care, maternal mortality and morbidity remain significant health concerns globally. This study aimed to assess the knowledge and practice of preconception care and its associated factors among women of reproductive age in Bheerkot Municipality, Nepal.  Methodology A community-based descriptive cross-sectional study was conducted among 215 reproductive-age women to assess knowledge and practice regarding preconception care in Bheerkot Municipality, Nepal. Structured questionnaires were designed in the Nepali language and used in face-to-face interviews. We used a simple random sampling technique to collect quantitative data. In a statistical analysis, we employed the Chi-squared test and logistic regression analysis to identify possible predictors using the odds ratio and considered variables with p<0.05 statistically significant at a 95% confidence interval. Result Out of the 215 women who participated in the study, only 46.9% had a good knowledge of preconception care. Approximately half (43.7%) of the respondents had never practiced preconception care. Among respondents who had practiced preconception care before, 47.9% reported good practice, and 52.1% reported poor practice. Age of the respondent (χ2=14.2063, P=0.000823, df=1), marital status (χ2=17.9851, P=0.000022, df=1), time to reach a health facility (χ2=30.1371, P=0.00001, df=1), and age at first pregnancy (χ2=4.7975, P=0.0285, df=1) were statistically associated with knowledge about preconception care. Women who have foreign employment as a major source of family income and whose age is from 25 to 34 years were more likely to have a better practice of preconception care than their counterparts (COR 3.5000, CI 1.3343 to 9.1805, P = 0.0109) and (COR 3.4000, CI 1.1646 to 9.9265, P = 0.0252), respectively. Additionally, out of those who practiced preconception care, most respondents (93.4%) have practiced it in government health facilities. Conclusion Respondents had relatively poor knowledge and practice of preconception care. Collaboration of governmental health institutions between multiple sectors at local levels for more education and information and a specific national protocol or policy formulation would be beneficial in improving preconception care in Nepal.

Impact of Family Planning and Religious Belief upon Family Growth in Addis Ababa, Ethiopia, 2022

Introduction Family and virus programs are currently important for union and about 7 million, and unfortunately (250 million) reproduce. Above the place, it closes; it's slow, slow, causing serious injuries and women during pregnancy. In addition to friends and couples who want health and quality and quality and quality and quality. Especially in a hurry, access to FPS is valid and accessible limited, or you have the opportunity to go home safe and healthy and health plan programs. The final change is very associated with its own interests in the world. The focus agreement in women of fecund women takes advantage of the opportunity to defend themselves between women's threats. In addition, women are classified with different methods. Objectives To assess the Impact of Family Planning and Religious Belief upon Family Growth in Addis Ababa, Ethiopia. METHODS Research style was a descriptive cross-sectional survey, which assessed the employment of semi permanent strategies and effects of contraception among ladies of fruitful age, through health facilities in Addis Ababa, Ethiopia. Data are entered in to applied math software package Epinfo v 3.7 and export into SPSS to code decrypt and analysis. Outcome is gift as a variety of table, graph and bivariat and multi chance variable regression are presented. Result The magnitude of current utilization of modern contraceptive was 59 % among women in Addis Ababa public health facilities. Age (AOR =0.14(95%CI(0.03-0.68)), Educational status (AOR=0.04(95%CI (0.02- 0.63)), number of children wanted (AOR=10.8(95%CI (4.02- 18.97)) and communication with partner about modern contraceptive use (AOR=3.17(95%CI (0.89-11.27)) were statically significant factors for utilization of modern contraceptive.

A Newer Approach in the Management of Cough: A Review on Levodropropizine

Safe and effective antitussive therapy remains a significant area of unmet need for cough management. Antitussive drugs are commonly used cough suppressants and include centrally acting (opioids and non-opioids) cough suppressants and peripherally acting antitussives. Authors searched PubMed, Google Scholar and additional studies from reference lists via cross-referencing to identify studies assessing levodropropizine for the treatment of cough. Of the 748 studies identified, 13 were included. Recent clinical evidence, guideline recommendations and findings from this review suggest that levodropropizine is a peripheral antitussive which reduces cough intensity, frequency, and nocturnal awakenings in children and adults and provides better efficacy outcomes with a more favourable risk/benefit ratio compared to centrally acting antitussive agents which pose greater safety concerns and present an unacceptable risk–benefit profile. This review is aimed at Indian primary care physicians for making effective cough management decisions where the clinical evidence needs to be translated to clinical practice. Key Messages The usage of currently available centrally acting antitussive agent is greatly limited by their central depressing action and frequent side effect. The findings of this review indicate that levodropropizine is an effective antitussive agent and well tolerated in the management of cough in patients of all ages.

Spontaneous Subgaleal Hemorrhage in a Child with Autism

Severe ascorbic acid (Vitamin C) deficiency, commonly known as “scurvy,” continues to be a problem in malnourished populations across the world but is relatively rare in the United States. Early features of this condition include general weakness, fatigue, and aching limbs. An extremely rare and late feature of this condition is subgaleal hemorrhage. Scurvy has such a low prevalence in First World countries that it is often misdiagnosed or not diagnosed at all. The subject in this case report presented acutely and is one of few to involve a subgaleal hemorrhage to be documented in medical literature to date. Laboratory studies and clinical improvement through treatment established the diagnosis. Ascorbic acid deficiency should be considered when evaluating children with poor nutrition despite socioeconomic status, living conditions, or access to health care. This case also reminds us that neurodivergent children are a vulnerable population and more research will need to be conducted to determine just how detrimental the pandemic has been to patients with ongoing problems who were lost to follow up.

Statistical Study on the Impact of Computer-use on Child-health in the Arab-community

United States of America (USA), Australia, and Canada recommending children computer-use should be imperfect. It obligated a strong influence on children’s lives. The problem was for stuck in the computer-use for a long time per day. The goal was to follow child-health in the Arab-community to notice its influence on the child-health. The method was through a arithmetical study by sending Internet questionnaire and receiving the parents' advice. The results were in the 500 parent answers and 14 comments. The first was "You have a child up to 13 years old?"; 83.6%. The second was "Your child used a computer?"; 80.8%. The third was "Your child used the computer for a long time?"; 67.9%. The fourth was "The computer caused a health problem for your child?"; 70.3%. The fifth was "The computer caused your child mental disorder?"; 68.5%. The sixth was "The computer caused your child trouble seeing?"; 77.2%. The seventh was "The computer caused your child trouble sleeping?"; 72.0%. The eighth 8 was "The computer caused your child feeding problem?"; 69.5%. The ninth was "The computer caused your child family relationship problem?", 72.0%. The tenth was "Prevent your child from using the computer to protect his health?"; 79.0%. It was concluded that the extent of the harms of child computer-use from a health and psychological point. They have young and sensitive tissues. The computer-use affected them, child-health. It was recommended the parents instructions will protect children from the computer-use for long periods. That will reduce child-health and psychological problems.

Outcome of traumatic brain injury and its associated factors among pediatrics patients treated in Amhara national regional state comprehensive specialized hospitals, Ethiopia 2022.

Background Traumatic brain injury in pediatrics is one of the commonest causes of morbidity, disability and mortality worldwide. In low- and middle-income countries Study showed that death of pediatrics from traumatic brain injury was 7.3%. However, there is limited data towards the outcome of traumatic brain injury and its associated factors in Ethiopia. Objective To assess the outcome of traumatic brain injury and associated factors among pediatrics patients in Amhara National Regional State Comprehensive Specialized Hospitals, Ethiopia. Methods An institution based retrospective cross-sectional study was conducted among 423 pediatrics patients from January 1, 2019 to December 30, 2021, and data extraction period was from May 16 to June15, 2022. Systematic random sampling technique was employed to select the study participants. Data were collected from patient charts and registry books by using a data extraction tool. Data were entered into the Epi-info version 7 and analysis was done by SPSS Version 25. Both Bi-variable and multi-variable analyses were employed to identify factors associated with outcome of traumatic brain injury. Result From 423 sampled study participant charts 404 of them had complete information with response rate of 95.5% and included in the final analysis. The overall unfavorable outcome of traumatic brain injury at discharge was found that 12.13% (95% CI: 9.1% - 15.7 %). Sever traumatic brain injury (AOR: 5.11(CI :1.8-14.48), moderate traumatic brain injury (AOR:2.44(CI:1.07-5.58), Hyperglycemia (AOR: 3.01 (CI:1.1-8.04), sign of increased intracranial pressure (AOR:7.4(CI:3.5-15.26), and medical comorbidity (AOR: 2.65(CI:1.19-5.91) were predicted of unfavorable outcome of traumatic brain injury pediatrics patient. Conclusion and recommendations twelve present of traumatic brain injury results unfavorable outcome. Sever and moderate form of traumatic brain injury, hyperglycemia, signs of increased intracranial pressure, and medical comorbidity were factors associated with unfavorable outcome of traumatic brain injury in children. Therefore, it is preferable to improve accesses to acute and post-acute care services to lower the unfavorable outcome of traumatic brain injury in children.

Metallic Intrapulmonary Foreign Body by Playful Accident in A Child

Intrathoracic foreign bodies secondary to penetrating wounds are rare in children. We report the observation of a 10-year-old patient who presented an intrapulmonary metallic foreign body following a playful accident. Its migratory aspect, highlighted by imaging, required urgent extraction which was performed by thoracotomy, with good clinical outcome. The interest of the question lies in the circumstances of the incident, the type of foreign body and the terrain.

Adolescent-Parent Communication on Sexual and Reproductive Health and its Associated Factors among Higher Secondary School Students of Tokha Municipality, Kathmandu, Nepal

Introduction Physical, psychological, and emotional growth are among the changes that define the adolescent stage. As compared to other age groups, adolescents are more vulnerable to sexual and reproductive health issues. Parents can become protective and influencing factors for their children to prevent risky sexual behavior. This study aims to assess adolescent-parent communication on sexual and reproductive health and its associated factors.   Methods A descriptive cross-sectional study was conducted among 212 adolescents aged 15–19 in higher secondary schools of Tokha Municipality. A self-administered structured modified questionnaire to assess the communication used the Weighted Topics Measure of Family Sexual Communication (WTM) tool with a simple random sampling technique of data collection. We performed descriptive statistical analysis and chi-square tests to analyze data and assess the association between variables. Data quality was assured through careful questionnaire design, pretesting, and training.  Results The study found that about 75.9% of adolescents had communicated on SRH topics with their parents. Only 56.1%, 50.1%, 55.2%, and 50.5% of adolescents communicated about choosing a life partner, menstruation, physical and psychological changes during adolescence, and the physical growth and development of reproductive organs, respectively, while topics like using birth controls, when to start having sex, pregnancy, how to handle sexual pressure from a partner, STI and HIV/AIDs, about condoms, and abortion had never communicated by 61.3%, 86.6%, 69.3%, 85.8%, 72.2%, 78.8%, and 82.5% of adolescents, respectively. Adolescent-parent communication on sexual and reproductive health was significantly associated with the level of knowledge regarding sexual and reproductive health (X2 = 5.809, p = 0.01, df = 1). Similarly, there was a significant association with the perceived parenting style (X2 =3.932, p =0.04, df =1), living arrangements (X2 =6.376, p=0.01, df =1), and adolescent-parent communication. Conclusion  It concluded that adolescent-parent communication on SRH issues is not satisfactory. Creating an adolescent-friendly environment at home and conducting awareness programs with the help of the local government of the respective schools would help to increase adolescent-parent communication. 

Examining the Effects of Mobile Telephone Communication on the Utilization of Antenatal Care Services Among Expectant Mothers in Kyotera And Rakai Districts, Uganda

Uganda still grapples with a high maternal mortality rates of 336 deaths per 100,000. Expectant mothers across the country lack awareness about the availability of antenatal care services; yet attendance of antenatal care services during pregnancy is crucial in protecting the health of women and unborn children. This article describes a protocol for investigating the effectiveness of mobile telephone communication interventions on the utilization of antenatal care services among expectant mothers in the districts of Kyotera and Rakai Districts in Uganda. Under the protocol, 28 health facilities in the districts of Kyotera and Rakai will be selected using simple random sampling and allocated into the intervention and control arms at a ratio of 1:1. A total of 2224 expectant mothers receiving antenatal care from the sampled health facilities will be recruited using systematic sampling. Expectant mothers receiving antenatal care from facilities allocated into the intervention arm will receive mobile telephone voice and text messages reminders for scheduled ANC visits. The mobile telephone messages will further provide maternal health information and availability of ANC services on a fortnightly basis. On the other hand, expectant mothers receiving antenatal care from facilities allocated into the control group will not get any reminders for scheduled ANC visit and maternal health information through the mobile telephone communication platform. Expectant mothers in the control arm will receive standard maternal health care without reminders. Expectant mothers in both groups will provide baseline data, midterm data will be obtained from the ANC registers at 6 moths while end of term data will be collected after an intervention period of 12months. The data collected will include the number of antenatal care visits attended, antenatal care services obtained from the health facilities, sociodemographic factors and mobile telephone usage, ownership and knowledge. The anticipated outcomes are; increased awareness and utilization of ANC services.

Prevalence of Covid 19 in Students Attended Al-Dora Family Medical Center for Covid 19 Test

Introduction: Covid 19 pandemic affected all aspect of life, particularly schools attending. Students replaced their presentational lessons by on line distance learn. Ministry of health decisions varied between complete electronic study and attendance several days per week depending on the number of cases of the whole population. In Iraq, total cases till 15 of September, 2021, reached 1.963,264 and total death 21,631. Highest percent of confirmed cases in age group (30-39) years; 24.7%, while in children aged (0-9) years only 1.6%, and in older age group (10-19) years; 7.5%. Cases of covid19 at lower percent in small children and in school age children and tend to increase with age as it reached to 22.6% in age group (20-29). Objectives: Prevalence of covid 19 in students attending AL-dora medical center lab. Comparisons in number of cases of students before and after the school lock –down. Methods: It is a cross sectional study, included the records of schools health unit and lab records of VTM nasal or pharyngeal swab and rapid test in Al-Dora family health center from 1/10/2020 to 15/7/2021. Results: The study included 1711 students, the mean age group was 15.7 (± 4.9) years. The study showed the prevalence of covid19 in students attained the lab was 23.4%, highest percent was in age group >18 years and the lowest percent was in age group 6-12 years. The percent of vaccinated students in academic year 2020/2021 was 0.3 %( 3/1000). There is no significance difference in age group 6-12 years and age group >18 years before closing schools and colleges and after closing while age group 13-18 years showed a significant increase in positive cases after closing schools as cases increase from 18.1% to 25.9% after closing schools. Positive cases showed no significance difference with sex before and after closing. Discussions: The educational path of students in different age groups had broken down. Fear of parents could be justified but it could be exaggerated. School closures were applied almost around the world trying to decrease the potential spread of disease despite early studies suggested this would have less impact than most other non-pharmacological interventions.

Review on Public Health Effects of Aflatoxins in Milk and Milk-Based Foodstuffs of Dairy Cow

Aflatoxins are toxigenic metabolites that are definitely occurring by lethal strains of Aspergillus parasiticus and Aspergillus flavus that commonly dwell and colonize in feed components and various nutritive foodstuffs particularly milk and milk based products. This Review has three main objectives; those are causes of aflatoxin, effects and methods of control in milk and milk products. Drinking of cow milk polluted with aflatoxin may overwhelm immunity and subsidize to stunting in young children, as the young children are not immune-competent during early stage. It has been internationally assessed that aflatoxin is possibly accountable for 30% of the annual cases of liver cancer. Generally, control approaches of aflatoxin can be applied during pre-harvest, cautious management in the time of harvest and postharvest decontamination. Moreover, choosing breed for aflatoxin impervious crop diversities, prevention of aflatoxin production through biological decontamination by microorganisms and their metabolites, rejection of aflatoxin by physical means in addition to inactivation by chemicals are the typical approaches that have been described in different studies. For the reason that cow milk is the most important and principal diet of children, but the risk of exposed to the cancer are more in infants. In addition, according to various investigations it also well thought that young animals are also found to be more vulnerable to aflatoxin than adults. Thus; the contamination of cow milk and milk products by AFM1 should understood as undesirable for young human and animals.

Critical Review of Teaching and Learning Methodologies for Learners with Special Educational Needs in the 21st Century and Beyond

The number of children with SEN is continuously growing, leading to pressure on the few special schools available in the USA. Furthermore, the adoption of a special school system has been criticized on the basis that it isolates and discriminates against children with special educational needs and disabilities. Even though inclusive education can address such limitations, the application of the most appropriate pedagogical approaches for SEN learners is still a challenge. The presented study focused on critically appraising the pedagogical approaches for SEN learners in the 21st century and beyond. In order to achieve this goal, a systematic review of the literature approach was adopted. The literature search process was conducted on three databases: Education Full Text, Linguistics and Language Behavior Abstracts, and PsycINFO. The selection of these databases was influenced by their reputation of hosting high quality and up-to-date literature about special education. The initial literature search process generated 6129 hits, but only ten studies were finally selected for review after the application of inclusion and exclusion criteria. A critical review of the evidence presented in the selected studies generated eight themes describing various pedagogical approaches for special education, within both blended and mainstream learning environment. Knowledge generated in this systematic review can be used by the special education sector of the U.S to develop pedagogical approaches for SEN students, leading to improved performance and social skill development.

Complementary Food Hygiene Practice among Mothers or Caregivers in Bale Zone, Southeast Ethiopia: A Community Based Cross-Sectional Study

Introduction Foodborne diseases are a major public health problem which predominantly affects infants and young children. Appropriate complementary food hygiene practice is very important to reduce the prevalence of foodborne illnesses. However, the information regarding this practice is not available and assessed before. Thus, the study was aimed to assess complementary food hygiene practices among mothers of children aged 6-23 months. Methods A community based cross-sectional study was conducted in Robe town on a samples of 517 mother-child pairs, which were selected by using systematic sampling technique. Data was collected using pre-tested and structured questionnaire, and each variable was described in the frequency and percentage. Bivariable and multivariable logistic regression analyses were used to identify factors associated with complementary food hygiene practice. Odds ratios with 95% confidence interval were used to assess levels of significance. Result The result indicated that 55% of participated mothers scored above the mean score of food hygiene practices. Mothers of children aged 12-23 months had higher odds to practice good food hygiene measures than those of aged 6-11 months (AOR, 1.82 95% CI (1.21, 2.73)). Mothers whose children attended growth monitoring session practice good food hygiene than their counterpart (AOR, 2.74 95% CI (1.49, 5.06)). Mothers having media exposure, and having knowledge on critical times of hand washing had relatively good food hygiene measures (AOR, 0.73 95 CI (1.14, 2.62)). Among food hygiene measures; handwashing with water and soap were low before eating food (17%), before feeding children (21%) and before preparing food (32%) when compared with after visiting the toilet (81%) and touching dirt (68%). Conclusion and Recommendation The study identified that food hygiene practices in the current study were mainly associated with child age, growth monitoring follow-up, maternal awareness about critical times of hand washing, and media exposure. So, improving knowledge of mothers on critical times of handwashing, strengthening growth monitoring follow-up and media promotion are important measures to improve food hygiene practices among mothers of infants and young children.

“Happy Village” Concept Helping Villages to Face COVID-19

“Health Promoting Village” concept named as “Happy Villages” started in 2007 in Badulla District in Uva Province was a community mobilization process through which village communities have been empowered to look after their community health. The areas included were Early Childhood Care and Development (ECCD), Non-Communicable Diseases (NCD) prevention , Alcohol and drug abuse. Gender Based Violence. The programmed used many interactive tools as “Mood Chart” or “Happiness Calendar” which was giving a visualizing effect. Continuous assessments done from 2009 to 2013 showed that the Health promotion strategies used in the Happy Village concept in the Uva Province can effectively and efficiently be utilized for improvement of nutrition and achievement of milestones in children. From 2017 a National program is launched named “Happy Villages”. During the Covid 19 outbreak health promotion approaches were initiated to change in lay communities successfully. Villagers had actively engaged, collectively acted in responsible manner, and identified measures to prevent COVID-19 transmission in their households, neighbourhood and community. The use of village empowerment had become a fruitful source to face the Covid pandemic in Sri Lanka. Almost 300 “Happy Villages” around the country have made facing the Covid epidemic their chief task. Many innovative ideas and practices in facing Covid 19 pandemic at village level including a visualizing calendar to identify the risk behaviours of the family members as well as the Happiness calendar to identify the family stress levels are among them. Health promotion concept is getting rooted around the country with active participation of the villages with a multisectoral support. Continuous monitoring and evaluation and sharing best practices will show the world the effectiveness of Health Promotion and the ability of empowered people in facing pandemic situations

Investigating the level of Safety Considerations in Radiology Centers (North of Iran): Cross –Sectional Study

Background and Purpose Providing health care is the basic right of people(1). Diagnostic radiology is one of the main procedures in health care services and proper benefiting from this technology is brought only under well planning and management(1). Supervision of the available condition and its comparison with the recommended standards is a key role in assessing assurance from the benefit of these instruments (2). Data show that more than 80% of patients referring to these hospitals need radiology image (3).Improper service causes repetition of radiography and even wrong diagnosis, as a results threatening health of the patients (3) lack of protective barrier leads to the exposure of the staff to X-ray which is obviously carcinogen us (4). It happens that the instruments are not working properly, like of symmetry in X-ray field, defects in collimators, lack of adjusting ray field and X-ray, low quality or defective developing machine, lack of proper protective barrier, using low quality film and drugs, lack of protective barrier for children, all of which cause severe hazards for the patients and staff (4). Materials and Methods The crucial aim of medical services is to provide the public with their needs which are very important. The sensitivity of such services is to such an extent that in case of lack of care, the hazards are too high. In evaluation of health services, the first thing is to evaluate the device used. Methods, efficiency, profits and their combination for prevention and eradication of diseases are also important. Therefore to gain this goal, it is necessary the obtain results comparable with recommended standards. The purpose of this study was to access the conditions of radiology units at Mazandaran University hospitals and compare them with the standards of ICRU NCRP and ICRP. Radiology unit is the most expensive section of any hospital for its instruments, manpower and space provided. In a study conducted in 51centers on radiology staff, radiography room and protective barrier, ray leakage, the outcome were 89%, 82%, 77% and 37% respectively. It was found that the condition of these centers regarding the protective barriers is very unsuitable due to unawareness of the leakage (5, 6).Considering the mentioned necessities, in this study, the condition of radiography centers affiliated to the Mazandaran University of Medical Sciences was studied for the type and the rate of problem, in order to provide a proper solving method. Results Data were collected through, observation, interviewing and filling questionnaire. Results show that, the situations of the radiology units are for from international standard, to such an extent that it is matched clout 50%. Conclusion The results showed that, none of the dark rooms are standard, and do not have proper alarm signal. In 63% of these units there no tiling system about staff protection from radiation. Defects in radiography room, protective barrier and lack looking rays were 60%, 51% and 47% respectively. Referring to the obtained data, periodic supervision, and obeying of the standards are necessary.

Potential Impact of COVID-19 Outbreak on Education, Staff Development and Training in Africa

Purpose This paper assess the impact of COVID-19 pandemic on Education, Staff development and Training in Africa. Online Research Methodology/Approach The data use in this paper was generated from online survey questionnaire, in which the participants were asked about certain questions in which covid-19 affect their social-economic situation. The questionnaire was design to help Africa to understand covid-19 impacts on their social and economic live. Results The results of this study reveal that coronavirus pandemic affected Africa in a number of ways; 1) 52.2 percent of the respondents said they should open school now in Africa, while 47.8 percent fear they should not open schools 2) 81 percent said before educational institution are closed there is public or official announcement that institutions must be closed due to pandemic—may be 3 months, ……,,…,, one week it depends on the severity of how covid-19 is spreading across the regions in Africa, 10.7 percent of the respondent said it may be and only 8.3 percent said it is not official announced.3) 65.4 percent of the respondents said government implemented an education response for continue of learning in Africa while educational institutions are closed 4) 61.5 percent said use of online/digital learning platform is the method for continuity of learning is currently available for children affected by closures of educational institutes provided by government, while 50 percent said television, radio, or podcast broadcast and 17.9 percent said assigning reading and exercises for home study. 5) 45.3 percent out of 100 percent said use of online or digital learning platform are the proportion of children affected by education institution closure. 38.7 percent said the proportion of children affect are the one that concentrate of using television, radio or podcast broadcasts to get academic content. 14.7 percent of the respondents are the proportion of the children affected by educational institute closure if they are assigning reading and exercises for home study. 6) 52.6 percent of the respondents from non-government organization, private schools said use of online or digital learning platform is the method for continuity of learning is currently available for children affected by closures of educational institutes, while 61.5 percent said use of online/digital learning platform is the method for continuity of learning is currently available for children affected by closures of educational institutes provided by government. The same thing government said as well. Similar respondents from government as do the non-government or private schools and 35.9 percent respondent said television, radio and podcast broadcast are method for continuity of learning is currently available for children affected by closures of educational institutes-provided by non-governmental organization, private schools etc, whereas 50 percent of the respondents said assigning reading and exercises for home study is the method for continuity of learning is currently available for children affected by closures of educational institutes-provided by government.7) 48.1 percent of the respondents said for the impact of covid-19 pandemic on staff development and training that their enterprise or organization partially suspended operation due to the pandemic and 34.2 percent of the responded said they completely suspended operation because of coronavirus pandemic and 16.5 percent said no closures on in operation for staff development and training because of pandemic. 8)According to the results of this question of the online survey, 49.3 percent said the challenges their enterprise face in delivery staff training programmes and activities using online learning or offline learning during covid-19 was due to infrastructure issues such the problem associated with internet and the like. The survey of the study also confirmed that 32.9 percent twice said limited digital skills of trainers and cost of staff training was a major setback to train staff in their enterprise or organization or department or establishment while 30.1 percent said it is due to limited digital literacy of users are the main challenges face by their department in order to train staff. Policy Implications The implication of the results from this online survey is that it has serious impacts on education closure and staff development and training. As educations are closed due to covid-19 pandemic, it will affect already problems of human capital that are hampering the development of Africa. Due to covid-19 pandemic, the achievement of sustainable development goals on quality education will be seriously halted. The government and the ministry in Africa should work hand in hand to solve the problems of children affected by schools closure after the pandemic by either additional hours or provide more study hours for schools to catch-up with what happened during the pandemic, the study noted. Originality/value The impact of covid-19 on education, staff development and training.

Favourable Outcome in Pediatric Neurosurgery for Extra Dural Hematoma in Sub Sahara Africa: Report of Parakou University Hospital in the Benin Republic

Introduction The extra dural hematoma is a blood collection between the cranial vault and the dura mater. It is a neurosurgical emergency whose statistical data are poorly known in the Republic of Benin. Objective The aims of this study are to assess epidemiology, therapeutic and outcome of traumatic extra dural hematomas for children admitted to the surgical department of CHUD-B/A from 2012 to 2017. Methods This was a cross-sectional, descriptive and retrospective study over a period from January 1st, 2012 to December 31st, 2017. Results One hundred and seventy-eight cases of children aged between 0-15 years were examined for brain traumatic injury. Twenty-seven 27 (15.2%) cases of extra dural hematomas were retained. The most represented age group was between 11-15 years with a frequency of 42.1%. The male sex was more represented (78.9%). Road traffic accidents were the main aetiology (57.9%). 52.6% had a mild head injury, 26.3% had a moderate head injury and 21.1% had a severe head injury. On brain scan the frequently observed location was temporo-parietal (31.6%). Acute anemia was observed in 16 children. Seventeen children were operated on. The operation involved evacuation of extra dural hematoma by cranial bone flap with suspension of the dura mater. There were no deaths. Conclusion The availability of brain CT makes the diagnosis of extra dural hematoma easier. Its management is neurosurgical with a favourable post-operative evolution in all cases in this series.

Childhood Overweight, Social Media, and Osteoarthritis: Is there a Possible Emergent, yet Unrecognized Linkage?

Background Osteoarthritis, a serious and increasingly prevalent disabling global health condition found largely among older adults, has been linked to the presence of excess body weight. But what contributes to this growing health epidemic of excess weight, which is increasingly observed in children? Moreover, can a case be made for predicting a possible negative linkage between the pervasive use of social media from the earliest point in time and possible subsequent childhood overweight or obesity and late life osteoarthritis that may be amenable to intervention? Methods To examine the most probable answers to these questions, the EBSCO, Scopus and PUBMED data bases were sourced for relevant data. The extracted data were carefully reviewed, categorized and documented in narrative format. Results While one cannot readily carry out research to answer the above questions, prevailing data imply that there is more risk of being overweight in childhood, as well as acquiring possible later life disabling osteoarthritis, or a more serious manifestation of this disease, through the prolonged, unfettered and frequent use of social media in early and middle childhood. Conclusion Those in the realm of developing preventive strategies against childhood overweight or obesity as well as osteoarthritis are strongly encouraged to examine the role of the media environment and messages children are exposed early on in this regard. Alternately, children who already have disabilities, joint pain due to arthritis or other health conditions, and who may have to rely more on social media than others who are active- may suffer more readily from an energy imbalance and become overweight if due precautions against this are not taken.

Use of Fluoride and Silver Ion Compounds in Three International School Based Oral Health Programs – A Case Report

Untreated dental caries in children is one of the most common diseases and largest public health problems in the world. A novel caries management program, using 50% silver nitrate, 38% silver diamine fluoride, and 5% sodium fluoride varnish, was developed at Shoreview Dental, LLC, a private dental practice in Oregon USA, and then introduced into schools in Ecuador, Ghana, and Bolivia. Cavitated carious lesions were treated with 50% silver nitrate, followed by covering with 5% sodium fluoride varnish, three times over two weeks for 165 children in Ecuador at initial assessment, 3 months, and 6 months. This protocol was repeated for 271 children in Ghana at initial assessment and 12 months. In Bolivia, 130 children were treated with 38% silver diamine fluoride, followed by covering with 5% sodium fluoride varnish, once per visit at initial assessment, 6, 12, 18, 24, 30, and 36 months. The percentage of children with active cavitated carious lesions at initial evaluation was 92.7% (Ecuador), 55.4% (Ghana), and 92.3% (Bolivia). The final arrest rate of treated surfaces was 98.8% (Ecuador), 67.6% (Ghana), and 90.2% (Bolivia). Effectiveness of cavitated caries lesion arrest is increased when it is thoroughly cleaned and dried before the treatment protocol. Further optimization is obtained when this protocol is repeated multiple times.

Redefining Coronavirus: Update on the Impacts of COVID-19 in the Rural Areas of Abia State

Public health professionals working in rural communities are aware of the health disparities which result from lack of physicians, limited services, and income during the pandemic. Also they are aware that some populations are more vulnerable than others. People in the rural areas are experiencing problems on their physical, social and economic life styles because the pandemic is exacerbating some inequities. Individuals especially women and children in the rural areas are facing barriers in accessing health care services due to lack of resources and availability of health care providers in the communities. With COVID-19, women are less likely to seek services, including sexual and reproductive health services. Such services may be postponed to limit exposure to COVID-19 infection. This is particularly disturbing because in addition to the women maintaining their own health, they are also responsible for taking care of the mental, emotional and physical health needs of their families as well as all domestic responsibilities. As such, women in rural settings face special challenges as a result of these significant roles they play. Therefore, the impacts of COVID-19 are exacerbated on women by virtue of their sex and the roles they play in the family. This is a qualitative study that reviewed the reports of the 36 health care professionals under the aegis of members of COVID-19 committee working in partnership with state government to control, prevent and cushion the effects of COVID-19 in the society. This study is therefore, a summary of the observations of the COVID-19 committee members made up of 10(27.8%) females and 26(72.2%) males. The study focused on exploring how individual lifestyles in the rural areas have been affected in the face of COVID- 19 pandemic by identifying the vulnerabilities in social, political and economic systems which can amplify the impacts of the pandemic. Findings showed that preventive measures like lockdown and social distancing rules, wearing of face mask, hand washing with soap, and environmental cleanliness were not observed. The study noted that health seeking behaviours, sexual and marital life including income, education, employment and social interactions were all negatively affected. Most hospitals were battered and health care professionals boycotted the hospitals for fear of being infected. It was found that lack of health workers in the hospitals caused a good number of individuals to engage in self-medications. Also most pregnant women delivered their babies at home and few with traditional birth attendants. Some of the women who had deliveries at home experienced complications during and after delivery. Unfortunately, the report showed that governments’ financial supports to these women and their family members were insignificant as the government was more concerned with mitigating the spread of COVID-19 than assisting women to have safe deliveries. Therefore, the vulnerable groups especially women, children, and the elderly who experienced threats to their safety and wellbeing as a result of the services that were disrupted during the pandemic, should be assisted so as not to lose their lives to preventable diseases.

The Impact of Combining Nutrition Education with Active Choice on the Fruit and Vegetable Consumption Among Second Grade Students

Daily intake of fruits and vegetables provides the basis for healthy nutrition. Yet low consumption of fruits and vegetables (FV) persists among school-aged children. Framed by the Social Cognitive Theory, this study aimed to determine the effectiveness of nutrition lessons combined with an active choice intervention on children’s FV consumption. Using a quasi-experimental design, 89 second graders were assigned to groups. Students in the experimental group (n=46) received four nutrition lessons combined with nine active choice sessions, while those in the control group (n=43) received active choice sessions only. Responses to pre- and post-intervention surveys that inquired FV knowledge and consumption were compared within and between groups using independent and paired t-tests. Empowered by improved knowledge, self-efficacy and the positive environment created through nutrition lessons and active choice, the experimental group showed improvement in consumption behavior compared to the control group at post-intervention: bringing FV to school and finish eating (69.7 vs. 51.2, p=.05 for fruits; 43.5 vs. 39.5, p=.41 for vegetables); like choosing FV (84.8 vs. 65.1, p=.01); like to eat more FV (80.4 vs. 62.8, p=.16); FV are healthy (100 vs. 95.3, p=.14). The magnitude of improvement is small yet consistent in every aspect of outcome measures. Combining nutrition education with the active choice component showed potential for a larger impact on behavior change among study participants. Parental support and community involvement could enhance the effectiveness of nutrition education in schools.

A Review The use of Cerebrolysin in Pediatric Charcot Marie Tooth Disease

Charcot Marie Tooth disease is a is a very chronic progressive hereditarymotor and sensory neuropathy characterized by progressive weakness andloss of touch sensation across various parts of the body. There are no curative or effective medical therapies that can ameliorate the disability associated with Charcot Marie Tooth disease. The aim of this paper is to describe the safe novel use of cerebrolysin in an Iraqi patient with Charcot Marie Tooth disease. Patients and Methods A boy who was born on the seventh of November, 2009, and was first seen on 29th of January, 2018 at the Children Teaching Hospital of Baghdad Medical City and had Charcot Marie Tooth disease was observed. He had difficulty in walking and abnormal gait that made him left first grade primary school. The nerve conduction study and electromyography study supported the clinical diagnosis of chronic symmetric sensori-motor polyneuropathy of moderated severity. The boy was treated with a safe novel therapy for one month. He receivedten doses of 3 ml intra-muscular cerebrolysin every three days. Results The short term effect of the therapy was dramatic with noticeable improvement that has never been reported before with this condition. Conclusion Further studies enrolling more patients are highly recommended.

Evolution of Anthropometry in Malnutrition

The present paper describes the significance of anthropometric measurements in detecting nutritional status of individuals, specially children. It highlights evolution of anthropometry, discusses importance of various measurements & their role in determining undernutrition & obesity. There is a need to have one measurement to detect obesity & undernutrition both. An ideal such measure is yet to be established.

Nutritional Care for Patients with Ebola Virus Disease in Ebola Treatment Units – Past and Current Experiences from Practitioners

Background In November 2014, the World health Organization (WHO), in collaboration with United Nations Children's Fund (UNICEF), and the World Food Programme, produced interim guidelines (iGL) on providing nutritional support to patients in Ebola treatment units (ETUs). They have been translated into French and issued by the Ministry of Health, UNICEF and WHO in adapted versions to be used in the current outbreak in the Democratic Republic of the Congo (DRC). This paper evaluates the use and usefulness of the 2014 iGL in the West Africa and current DRC Ebola virus disease (EVD) outbreaks and identifies experiences and lessons learned from practitioners on the operational aspects of nutritional care and support in ETUs. Methods Key-informants (n=26), from 12 organizations (Non-Governmental Organizations, United Nations, Red Cross Red Crescent Movement) were interviewed who were actively engaged in the nutritional and/or clinical care of EVD patients. Results There was a consensus among key-informants that the 2014 iGL initially served a guiding purpose. However, the vast amount of learning from the 2014-2016 and current EVD outbreaks indicates that the interim guidelines need to be revised. Practitioners struggled to find operational solutions for nutritional care, and the challenges were plentiful, especially regarding 1) the different perceptions of the importance of nutritional care among ETU staff; 2) the difficulties around food preparation and distribution for EVD patients; 3) how to take into account the patients’ dietary preferences; 4) the nutritional care needed in relation to specific EVD symptoms; 5) who assumed roles in nutritional care in ETUs; 6) if and how feeding support was organized; 7) whether malnutrition needed to be addressed and how; and 8) whether the intake of specific nutrients could contribute to improved treatment outcomes.  Information from the key-informants interviews resulted in numerous lessons learned and recommendations for nutritional support during current and future outbreaks. Conclusions This investigation underscored the importance of documenting experiences of practitioners on nutritional care in emerging infectious diseases for which limited scientific evidence exists and for which interim guidelines are produced to fill in knowledge gaps. It also emphasized the importance of nutritional care in ETUs during treatment.

Severe Infantile Blount’s Disease in Kumasi, Ghana: A Case Report

Blount’s disease, also known as tibia vara, is a developmental disorder involving the posteromedial proximal tibial physis resulting in progressive varus, procurvatum and internal torsion of the affected tibia 1. The condition was first published by Blount in 1973 2. The aetiology of this disease is unkown. However, associations exist between blount’s disease and the Afro-Caribbean race, early age of walking and obesity 34. Furthermore, genetic predisposition has been postulated as well as mechanical loading of the physis 456. Affected children are usually overweight and start walking early. It is bilateral in 80% of cases 7.

Adolescents’ Perceptions of Gender Discrimination in India: Do Perceptions Differ for Boys and Girls?

Despite the gains India has made in recent decades, it remains a country with vast gender inequities. Gender sensitization and empowerment programs aimed at young people, precisely at the time when they are forming their gender attitudes, has the potential to diminish gender inequity in the long-term. This study represents data from 36 qualitative in-depth interviews conducted amongst adolescent boys and girls enrolled in grade 7 in northern India, in schools that serve under-resourced communities. The interviews asked questions related to positive youth development, gender roles, violence, and locus of control. The results of the qualitative analysis provide insights into how adolescents perceive gender discrimination in their families and communnites. The majority of expectations for boys revolved around physical labor, while, for girls, gender roles were primarily focused on stopping education early to get married and take care of the household and children. Many of the responses from both boys and girls on privileges/restrictions were related to daughters not being fully educated while sons often were. Furthermore, when comparing between boys and girls (attributes) and understanding superiority, many participants noted there is a clear preference of boys compared to girls. Girls also had higher proportion of violence codes compared to boys, perhaps because many girls felt they were hit more frequently than boys. The results of this qualitative analysis provide direction for both future research as well as the development of gender sensitization interventions specifically designed for adolescents.

Role of Religion on Knowledge, Attitude and Practices of Lactating Mothers on Infant Feeding

Infant and young child feeding (IYCF) practices directly affect the nutritional status of children under two years of age, and ultimately, impact child survival. These practices are influenced by maternal knowledge and attitudes as well as socio-demographic and cultural factors; and an understanding of such factors is important to scaling up IYCF practices. This study was designed to assess the role of religion on knowledge, attitude and infant feeding practices among Christian and Muslim lactating mothers in Ibadan North Local Government Area (LGA), Oyo State. The descriptive cross-sectional study was conducted among 320 lactating mothers in the LGA. Eight focus group discussions were carried out among Christian and Muslim lactating mothers. An adapted pre-tested questionnaire was used to collect information on socio-demographic characteristics and IYCF knowledge, attitude and practices of the respondents. Knowledge on IYCF was assessed on 14-item scale, and the scores categorised as: ˂5.60 poor, 5.60–10.88 fair, and ˃10.88 good knowledge. Attitude was assessed on 13 statements from the IOWA Infant Feeding Attitude scale with lowest and highest obtainable score of 13 and 65 respectively. A score of ˂44 was ranked as poor, and ˃44 points good. Data were analysed using descriptive statistics and one-way ANOVA. Qualitative data was analysed thematically. Mean age of respondents was 30.0±4.9 years, 55.9% were Muslims, and 63.8% had fair knowledge. There was no significant difference in fair knowledge categorisation (63.7%, 63.8%), but there existed slight difference in good (20.7%, 21.3%) and poor (15.6%, 14.9%) knowledge of the Muslim and Christian respondents respectively. Mothers with poor attitude constituted 56.0%. Muslim religion directly supports pre-lacteal feeding and duration of breastfeeding while the other indirectly supports breastfeeding. Religious practices directly and indirectly affect knowledge, attitude and practices of nursing mothers on infant feeding; hence, healthcare Professionals should pay more attention to nutrition education in religious houses using the infant and young child feeding module.