Understanding the risk from playgrounds to injuries for children in the Republic of Moldova.

Preconception Women’s Health and Pediatrics: An Opportunity to Address Infant Mortality and Family Health

Impact of hygiene of housing conditions on performance and health of two pig genetic lines divergent for residual feed intake

The age at which children enter school represents a transitional period between early childhood and adolescence that involves increasing autonomy, interaction with peers, and exposure to environments outside the home. Although mortality is generally much lower in the 5 to 9 age group compared with infancy and early childhood, there are many preventable causes of mortality, morbidity, and disability that emerge in this age group, including injuries, noncommunicable diseases, and vaccine-preventable and highly treatable infections.1 Partly because of relatively low mortality rates and less frequent contacts with the health system, school-age children and younger adolescents ages 5 to 14 have been referred to as the “missing middle,” in that there is a dearth of robust data on key health indicators, morbidity burden, and cause-specific mortality in this group.2 Many health issues that have a high burden in early childhood can persist in older children, especially in low- and middle-income countries (LMIC), resource-constrained settings, and marginalized communities worldwide. Undernutrition and infections occurring in the context of poverty remain leading causes of morbidity and mortality in school-age children living in LMIC,3 whereas those children in higher-income settings are more likely to die due to injuries or noncommunicable disease (NCD). In addition, the prevalence of overweight and obesity in children and adolescents has increased steadily over the last few decades,4 though the rate of these increases varies widely among countries.5New risk factors relating to diet, lifestyle, mental health, injuries, and NCDs also become more prominent as children approach and enter adolescence, many of which can contribute to the development of chronic NCDs over the life course. Within this period, school-age children begin to establish healthy lifestyle habits (eg, diet, physical activity, avoidance of substance use), and are learning about sexual and reproductive health and rights, as well as the measures they can take to protect themselves and others. This represents a window of opportunity for educational interventions to support good health, optimal development, and well-being. A growing body of evidence suggests that school-based and digital platforms and delivery strategies are promising tools that aid in the delivery of health interventions to older children.The methodology and reviews described herein contributed to the portion of the upcoming 2022 Lancet Optimizing Child and Adolescent Health and Development Series6 related to school-age child and adolescent health interventions. This Lancet Series is the product of an ongoing academic collaboration involving global child health researchers worldwide, including many who are authors on articles within this supplement. The aim of the specific Lancet Series article citing this supplement is to provide a comprehensive overview of systematic reviews describing the most recent evidence for effective interventions to support maternal, newborn, child, and adolescent health and development from preconception through to 20 years of age.Figure 1 provides an overview of the key child health domains, and a breakdown of the intervention review topics addressing key risk factors covered by the articles included in this journal supplement. On the basis of work done in previous comprehensive overviews of interventions for child and adolescent health (eg, Disease Control Priorities, 3rd edition7; Lancet Adolescent Health Commission8), we identified a comprehensive set of key child health domains that represented priority areas for interventions to address modifiable risks for the major causes of child mortality and morbidity. The factors that informed which domains were covered in this supplement included: conditions with a high global burden of disease, conditions with disproportionate impacts on vulnerable and marginalized populations, potential to support improved human capital development across the life course, and pragmatic considerations including whether the topic had recently been covered elsewhere. In cases where the child health domain was deemed too broad in scope for a single review (eg, infectious diseases), the subtopics for individual reviews were also chosen on the basis of these factors. The age group of specific interest for these reviews was older school-age children (ages 5–9.9), though the period of early adolescence (ages 10–14.9) was also recognized as an important area of overlap and transition. The general outcomes of interest aligned with those chosen through consensus by the Lancet Series working group. These included, but were not limited to, mortality, severe morbidity, disability, growth and development, knowledge and behavior, and indicators of improved human capital development such as academic achievement.The methodological approaches taken, and child health domains covered in this supplement of reviews, was informed by a broad initial literature-scoping and evidence-mapping process to identify key health interventions and associated evidence for their effectiveness in the form of systematic reviews. This was done across all domains, from preconception and pregnancy to ages 0 to 20 to inform the 2022 Lancet Optimizing Child and Adolescent Health and Development Series.6 This involved leveraging existing large-scale intervention overviews (eg, Disease Control Priorities 3rd edition, Lancet Series) that had already highlighted existing effective interventions and the most recent systematic reviews detailing the evidence for their effectiveness. Additional targeted searches for newer interventions and systematic reviews in each domain were also conducted. Through this evidence-mapping process, we explored coverage and extent of LMIC-specific evidence across all child health domains to identify areas where school-age evidence was lacking and determined that there were significant gaps in existing evidence for intervention effectiveness in school-age children.We funneled the reviews identified during this initial scoping process that contained studies covering school-age children and adolescents into the individual reviews for each domain of child health covered in this supplement. We elected to conduct targeted overviews of systematic reviews if there was deemed to be a large body of existing evidence syntheses. In cases where there was a lack of evidence syntheses of intervention effectiveness for a given domain of school-age child health, conventional systematic reviews of primary literature (ie, experimental studies) were conducted. The general methodology for these 2 approaches are described below. See Table 1 and Fig 1 for a summary of the review methods used for each child health domain, and Fig 2 for a breakdown of the main methodology followed in each type of review.For those child health domains that encompassed a variety of intervention types addressing a wide range of risk factors and health conditions, and for which the initial scoping process identified a variety of existing systematic reviews of intervention effectiveness, an overview of systematic reviews was undertaken. This approach was taken to ensure comprehensiveness, reduce duplication of review efforts, and make the review process feasible.In addition to incorporating those relevant reviews previously identified in the initial literature-scoping and evidence-mapping exercise, tailored searches were executed in several databases (eg, Medline, Cochrane Database of Systematic Reviews, Campbell Library) to identify literature published up until the end of 2020. Evidence derived from Cochrane reviews and other high-quality systematic reviews that synthesized evidence from randomized controlled trials and quasi-experimental studies examining the effectiveness of interventions was prioritized for inclusion. A first pass of title and abstract screening for relevance was conducted, followed by a full text screening that was done by at least 2 reviewers against inclusion criteria. Two reviewers independently filled a standardized data abstraction form to capture review characteristics, the characteristics of included studies and interventions (eg, age coverage, country representation, delivery platform), and pooled-effect estimates (eg, risk ratios, odds ratios, mean differences, 95% confidence intervals) derived from meta-analyses where they were reported. The main outcomes of interest across the reviews included measures of child morbidity, mortality, development, academic achievement, and mental and physical well-being. The extracted data were then matched among reviewers to check for errors and ensure consistency, and then consolidated into a single table for inclusion in the article. The AMSTAR 2 tool12 was used for review quality assessment, and was also conducted in duplicate, with any disagreements in ratings resolved by consensus or the involvement of a third reviewer.If for a given domain the initial evidence-mapping exercise revealed that the existing evidence-synthesis literature was lacking for the school-age group, we proceeded with a conventional systematic review of primary literature. All systematic reviews were reported in accordance with the reporting guidance provided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria.13Search strategies were developed using the population, intervention, control, and outcomes methodology, relevant medical subject headings terms, and keywords derived from the scoping search. The search terms were adapted for use in other bibliographic databases in combination with database-specific filters for controlled trials, where these were available. Searches for the individual, domain-specific reviews were conducted in a variety of databases, including but not limited to: PubMed, Embase, Medline, PsycINFO, Ovid SP, The Cochrane Library, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register, and the World Health Organization regional databases. Evidence derived from LMIC was prioritized for synthesis, though evidence from high-income countries (HIC) settings was leveraged to highlight whether effective interventions exist in cases where LMIC evidence was sparse. Gray literature searches and additional hand searching were conducted in Google Scholar and reference lists of relevant articles, book chapters, and reviews.After removal of duplicate studies, a multistage screening process was performed to select studies that met the eligibility criteria. Each title and abstract was assessed by at least 1 reviewer, who excluded those that were deemed irrelevant. At the full-text review stage, at least 2 reviewers assessed all full texts. Any disagreements in inclusion decisions were resolved by discussion and, where necessary, by consulting a third reviewer. At this stage, reasons for exclusion were documented. The methods section of each individual review in this supplement describes their selection and eligibility criteria, which differed depending on the child health domain being assessed. Data from included studies were independently extracted and coded by 2 review authors using standardized, previously piloted data extraction forms, which sought general study characteristics, details of the population, intervention, comparison groups, and quantitative outcome data. Data extraction forms were matched and checked, and if necessary, a third review author was consulted in the event of any disagreements to establish consensus.Assessment of risk of bias for included studies was conducted according to criteria and tools outlined in the Cochrane Effective Practice and Organization of Care guidelines14 for randomized trials, nonrandomized trials, controlled before–after, interrupted time series, and the Cochrane Handbook for Systematic Reviews of Interventions.15 Assessments were conducted independently by 2 review authors; scores were compared, and a final risk of bias judgement was reported for the included studies of each systematic review. Randomized trials were assessed using the Cochrane Risk of Bias tool15 across the following domains: randomization process, deviations from the intended interventions (blinding of personnel, participants, and outcome assessment), missing outcome data, outcome measurement, the selection of the reported result, disclosure of funding, and conflicts of interest. Studies were assigned an overall risk of bias judgement accordingly (low risk, high risk, or some concerns/medium risk). Quasi-experimental study designs were assessed using the Risk of Bias Tool for Nonrandomized Studies of Interventions (ROBINS-I) tool.15,16 Studies were assessed according to the following domains: bias because of confounding, bias in selection of study participants, bias in classification of interventions, bias because of deviations from intended interventions, bias because of missing data, bias in measurement of outcomes, and bias in selection of the reported result. Each study was assigned an overall risk of bias judgement (low, moderate, serious, and critical risk).Meta-analyses were conducted where possible using Review Manager 5.4 software.17 Randomized controlled trials and cluster-randomized controlled trials were analyzed separately from quasi-experimental study designs. To mitigate heterogeneity within included studies, a random-effects meta-analysis was used for pooled outcomes. For those situations where meta-analysis was not possible, data on the effect of interventions from individual studies was tabulated and reported, and a narrative synthesis was conducted for each key intervention domain.Where there were a sufficient quantity of comparable studies (in both interventions and outcome), a summary of the intervention effect and a measure of quality for key outcomes were produced using the Grading of Recommendations Assessment, Development and Evaluation approach.18 The Grading of Recommendations Assessment, Development and Evaluation approach considers 5 domains (study limitations, consistency of effect, imprecision, indirectness, and publication bias) to assess the quality of the body of evidence for each outcome. The evidence was downgraded from “high quality” by 1 level for serious (or by 2 levels for very serious) limitations, depending on assessments for risk of bias, indirectness of evidence, serious inconsistency, imprecision of effect estimates, or potential publication bias.The aim of the authors of this supplement of reviews is to comprehensively assess the available evidence for the effectiveness of interventions to improve health and well-being in school-age children and adolescents. The initial literature-scoping and evidence-mapping process, followed by the different review approaches taken, has helped to maximize the scope covered across this set of reviews, and has allowed us to provide the most comprehensive assessment of the state of the published literature covering interventions for school-age children and adolescents. The individual reviews in this supplement have also highlighted child health domain-specific gaps in the evidence for both primary literature in the school-age group, and gaps in existing evidence syntheses.It is important to note that, for the reviews within this supplement, the descriptions of intervention effects are meant to provide an overview of what is currently known in terms of evidence for effectiveness, and do not imply that other interventions were ineffective simply because there was an evidence gap. Given the limited space and large scope, it was only possible to provide the highlights of specific comparisons and outcomes in each of the results sections. Comprehensive tables of study characteristics, outcomes, and effect estimates are provided in both the main articles and appendices.Although we were specifically interested in focusing on LMIC research, this was only feasible for a few review topics (eg, sexual and reproductive health and rights, neglected tropical diseases) because of a dearth of literature. Instead of being used to attempt to generalize their effectiveness to LMIC settings, evidence from intervention effectiveness in HIC settings are included and described to establish that effective interventions do indeed exist and may differ in their impact between settings. This approach has previously been used in the context of adolescent health interventions.19 This evidence from HIC could act as a starting point for future research and implementation in various LMIC settings, with program components tailored to local contexts.In the case of those reviews taking the overview of systematic reviews approach, we were limited to including only those primary studies already included in systematic reviews and could not cover each subdomain in depth. Thus, we were unable to identify and include those primary studies that may not have been included in systematic reviews because of studies not being identified in review authors’ database searches, not meeting their inclusion criteria, or falling out of the time frame of the review. Furthermore, some systematic reviews of primary literature were unable to perform meta-analyses because of high heterogeneity or a lack of high-quality evidence from randomized trials, which makes synthesizing the existing evidence more difficult.

A variety of legislation, initiatives and organizations exist to support, encourage and even oblige schools to collaborate more effectively with parents or guardians. However, there is minimal understanding of the experiences and opinions of parents and school staff about their roles, especially in relation to children's health education. This study examined how parents of 10-11-year-old children perceive the roles of both home and school in educating children about health. A questionnaire, based partly on the Finnish national core curriculum for basic education, was administered to 348 parents; the response rate was 53%. Factor analysis was used to define sum variables, which were then used as dependent variables in an analysis of variance examining the effects of children's gender and health; parents' education, gender, work status and year of birth; and school location (urban/rural). The results suggested that parents considered that either health education was mainly their responsibility, or it was a mutual responsibility with the school. Parents living in rural areas and the youngest group of parents were more likely to consider that health education should be shared with schools than were parents living in cities, or older parents. To expand awareness about the role of home and school in children's health education and to develop further health promotion within the whole school community, it is important to gather parents' views regarding health issues. This study was conducted as part of a broader program in the health promotion network of the Schools for Health in Europe (SHE).

This study aimed to examine the association between parental incarceration and children's oral health in the United States and assess the degree to which household socioeconomic factors, children's healthcare insurance and oral healthcare utilization/preventive care explain this association. Using data from the 2016-2018 National Survey of Children's Health (NSCH; N=99962), a series of logistic regression models were used to investigate the association between parental incarceration and a variety of children's oral health conditions. The Karlson-Holm-Breen method was used to assess the degree to which household socioeconomic factors, children's healthcare insurance and oral healthcare utilization/preventive care visits reduced the association between parental incarceration and children's oral health. Results from logistic regression analyses demonstrated that net of control variables, children of incarcerated parents have significantly worse oral health including poor or fair teeth condition (OR=2.71, 95% CI=2.23-3.29), toothaches (OR=1.72, 95% CI=1.36-2.18), gum bleeding (2.12, 95% CI=1.52-2.94), cavities/tooth decay (OR=1.50, 95% CI=1.26-1.77) and are more likely to have unmet dental care needs (OR=1.78, 95% CI=1.28-2.46). Attenuation analyses demonstrated this relationship is partially explained by household material hardship and children's health insurance. Parental incarceration is associated with worse oral health and unmet dental care needs. Household material hardship and children's health insurance partially attenuate this association. Efforts to expand oral health literacy to incarceration-exposed parents, and policies that buffer against material hardship and inadequacies in children's health insurance may be useful for improving oral health of children whose parents have been incarcerated.

Background: In many African settings, infant and child care practices are dictated by long-established social norms and cultural values, some of which may be disastrous to the health of the baby. To determine how maternal education is related with child health and rearing practices in Kano. Materials and Methods: Using a descriptive cross-sectional design, 386 randomly selected mothers of under-five children and their babies were examined. Data were analyzed using IBM SPSS Statistics for Windows, version 22 (IBM Corp., Armonk, NY, USA). Children's weight-for-height, height-for-age, and weight-for-age Z-scores were obtained. Infant and child care, feeding and weaning practices were assessed and scored based on a system adapted from past study. Results: The mean ± standard deviation of the mothers was 27.3 ± 5.2 years, 69.7% had at least secondary school education. The mothers had 4 ± 2 children, and 79.3% were ≥12 months old. More than half of the children (58.2%) had suffered one or more of the common childhood diseases within the previous month, 60.3% had a form of malnutrition and less than half (42.5%) were fully immunized for age. Varying infant and child care, feeding and weaning practices were observed. Overall, half (49.2%) of the mothers had good care practices, 42.2% had good feeding practices and 57.6% had good weaning practices. Interestingly, neither the mothers' care practices nor the feeding practices were statistically associated with their educational status. However, the proportion of the mothers with good weaning practices was higher among those with no secondary education (59.7%). Conclusion: The finding suggests that cultural beliefs are specific areas of focus in campaigns for improving infant and child care and rearing practices of mothers, and eventually for reducing the high infant and child morbidity and mortality in the Northern Nigeria.

Rangeland degradation in a semi-arid South Africa—II: influence on soil quality

To study new programmes in health promotion of 6- to 36-month-old children included in the public dental service (PDS) of Vantaa and compare them with the previously used programme by assessing parents' opinions on the oral health counselling and their readiness to make changes in oral health habits. An additional aim was to study parents' readiness to change their child's health habits in relation to the child's MS colonisation, health habits and parents' education. The subjects consisted of the parents of first-born children examined at age two (n = 647). The link to the study was e-mailed to the parents (n = 586) after their child's two-year visit. The dental professionals were trained to do plaque testing, observe dental decay and control the progression of caries lesions, utilise the oral health counselling programmes and deliver client-centered counselling. Data were statistically analysed using Pearson's Chi-Square and logistic regression. The response rate was 68%. In the opinion of 91% of the respondents, the information received was at least somewhat useful. The respondents in the new programmes were more likely to report at least intending to change their own health habits (p = 0.032). There was, however, no programme-related difference in readiness for change their child's health habits. Respondents who made/intend to make changes reported a lower level of education and their children were more likely to have had positive MS scores compared to children whose parents reported having made no changes. It may be possible to promote beneficial habits by delivering oral health counselling to parents, who would thus serve as better role models for their children. The findings indicate that the changes occurred in the families who needed it most.

Child care practices have contributed immensely to decreased child mortality especially in developing nations. Investigation of child care practices and associated factors among women is necessary to provide insight into extent of adoption of maternal, newborn and child health strategies and suggest enhancement strategies where possible. This examines child care practices and associated factors among women in Dekina LGA, Kogi State. Cross-sectional survey research design was adopted for the study. The population of the study comprised 971 women of childbearing age accessing health services at health facilities in Dekina LGA, Kogi State, North-Central Nigeria. A sample of 384 women of child bearing age was selected through multi-stage sampling procedure. Well-completed 299 copies of the researcher-designed Women’s Child Care Practices and Associated Factors Questionnaire (WCCPAFQ), which comprised sections A, B and C was used for data collection. The reliability co-efficient of the instrument was determined using Split-half method and Spearman-Brown Correction Formula. The reliability co-efficient of the instrument was 0.65. Frequency and percentage, Spearman’s <i>p</i> (<i>rho</i>) rank Correlation Coefficients and logistic regressions were employed for data analyses. A logistic regression was run to investigate the relationship between the dependent and independent variables. Results showed that women moderately practised (57.5%), 51.9% of women perceived that the outlined factors affected child care practices while there was low relationship between outlined factors and child care practices among women (maternal age <i>r</i> = 0.11, p < 0.05; maternal education <i>r</i> = 0.10, p < 0.05). Independent variables of age [OR = 1.65, 95% (C. I: 0.56 - 4.88)] and maternal education [OR = 2.45, 95% (C. I: 1.01 - 5.94)] had significant influence on child health care practices. It was recommended that government; private organizations, Non-governmental Organizations (NGOs) and other stakeholders in the health sector should implement holistic programmes that will enhance women’s capacity to effectively and efficiently adopt integrated maternal, newborn child health survival strategies for quality child care practices. The general public should also be enlightened via health education programmes on the associated health risks of poor child care practices prevalent in many rural communities.

We analyzed data sets on phytomass production, basal cover, and monthly precipitation of a semiarid grassland in South Africa for good, medium, and poor rangeland condition (a) to investigate whether phytomass production per unit of basal cover differed among rangeland conditions, (b) to quantify the time scales of a carryover effect from production in previous months, and (c) to construct predictive models for monthly phytomass. Finally, we applied the best models to a 73-year data set of monthly precipitation data to study the long-term variability of grassland production. Our results showed that mean phytomass production per unit of basal cover did not vary significantly among the rangeland conditions—that is, vegetated patches in degraded grassland have approximately the same production as vegetated patches in grassland in good condition. Consequently, the stark decline in production with increasing degradation is a first-order effect of reduced basal area. Current-year precipitation accounted for 64%, 62%, and 36% of the interannual variation in phytomass production for good, medium, and poor condition, respectively. We found that 61%, 68%, and 33%, respectively, of the unexplained variation is related to a memory index that combines mean monthly temperature and a memory of past precipitations. We found a carryover effect in production from the previous 4 years for grassland in good condition and from the previous 1 or 3S month for grassland in medium and poor condition. The memory effect amplified the response of production to changes in precipitation due to alternation of prolonged periods of dry or wet years/months at the time scale of the memory. The interannual variability in phytomass production per unit basal cover (coefficient of variation [CV] = 0.42–0.50 for our 73-year prediction, CV = 0.57–0.71 for the 19-year data) was greater than the corresponding temporal variability in seasonal rainfall (CV = 0.29).

The formation of the health of adolescent children is carried out under the influence of many risk factors, including non-medical determinants: lifestyle, socio-economic, household factors and living conditions. Conducting epidemiological studies to identify the leading risk factors for the lifestyle and quality of life of adolescents is currently consistent with the basic directions of development of preventive medicine. Aim. Analysis of literature data, leading factors, the impact of social determinants on the health and well-being of children and adolescents. Material and methods. The choice of publications was made according to keywords that reflected between the indicators of the health of children and adolescents and the factors that influence them. Assessment of the influence of social determinants on the health of children and adolescents made it possible to prepare comprehensive measures to improve the health and health of children and adolescents. Conclusions. In the literature review, the social conditions studied have a decisive influence on the formation of the lifestyle, health and well-being of children and adolescents. Keywords: сhildren, adolescents, social determinant.

Children are the most vulnerable among the malnourished population of Bangladesh. Child and maternal care practices are now being considered as important complements to increasing household income or targeted food interventions to address child growth needs. In Bangladesh, as elsewhere, many children, even in poor households, do well nutritionally, whereas others do not. This study attempts to identify characteristics of the existing child and the maternal care environment that could be used as a basis for designing policies and programs to improve the nutritional status of children. For the present study, all children between 6-18 months of age were selected from a nutrition survey of a cross section of 741 households conducted by the IFPRI Bangladesh Food Policy Project in February-March 1992. Households of 111 children thus were revisited in May-June 1993 to obtain, retrospectively, information from mothers or alternative primary caregivers about selected child care practices and related indicators. Information was obtained on feeding practices of infants and mothers, indicators of psychosocial care, and health and hygiene practices. In this study, information on child care practices obtained together with information from the original nutrition survey on maternal and child nutrition, individual food consumption, and household demographic and socioeconomic status was used. Children who exhibited the best growth status, holding age and income level constant, compared to the others in the same environmental setting, are identified as positive deviants. Those with the worst growth are categorized as negative deviants. Children falling in-between positive and negative deviants are labeled as median growers. Even though an increase in income was found to be associated with improving child nutrition, on average, this association was not very evident at the two tails of the nutrition status distribution, with household income of negative deviant children higher than for both the positive deviants and median growth children, implying a limited access or allocation of household income by mothers in these households, and the relevance of non-income factors. Also, in the sample as a whole, gender differences in child nutrition were not found to be very significant. There was, however, unmistakable evidence of differential treatment of children by gender. There were three times as many male children in the positive deviants group as compared with female children. Even though there were an equal number of male and female children in the negative deviants group, there is evidence of differential child mortality by gender, with evidence of large numbers of missing female children in this group, who were, on average, only one year old. A selection of caring practices and indicators were identified for infant feeding, complementary feeding, maternal diet and health, psychosocial care, and health and hygiene practices. Descriptive and multivariate analyses were conducted to identify key caring practices and indicators associated with well and poorly growing children. The analysis supports earlier work that indicates that determinants of child nutrition are not exactly the same for different groups of children, even in the same population. Two key factors that were important across the board were hygiene practices and mothers' access to knowledge (listening to radio programs on child health and nutrition). Important factors contributing to negative deviance were found to be an early introduction of complementary food (before four months), restricting maternal diet for longer periods after the child's birth, and the absence of specially prepared food items in the child's diet. Care factors of the caretaker were also found to be important: a mother's expression of satisfaction with her family life, which was used as one of the indicators of psychosocial care, was found to be statistically significant. Many local practices were identified that programs and policies could support and build upon to facilitate the participation and empowerment of local communities, families, women, and men in Bangladesh for better child nutrition.

The dynamics of health care delivery for children and adolescents have greatly evolved over the last 5 years. The growth of managed care has been especially rapid, and has coincided with other fundamental changes—declines in private coverage, growth of Medicaid, welfare reform, and the creation of the state Child Health Insurance Program (CHIP).1 Over the past 10 years, the number of children covered through employer-sponsored plans and other private plans has dropped.2 During this same period, changes to Medicaid have begun to de-couple eligibility from welfare eligibility, theoretically enabling states to expand coverage. For children, this movement from private to public coverage has accelerated the movement to managed care systems. Between 1991 and 1997, Medicaid enrollment in managed care plans increased from 9.5% to 47.8% of total Medicaid enrollment.3 Recent estimates suggest that over half of these Medicaid managed care enrollees are children.4 However, little is known about the impact of these trends on children's access to and use of services, let alone the quality and outcomes of that care. This report is the first in what is anticipated to be an annual series of reports on access to and use of health care services by America's children and youth. The report capitalizes on the existence of 2 national datasets, the Medical Expenditure Panel Survey (MEPS) and the Healthcare Cost and Utilization Project (HCUP), which have not been widely used by the child health services research community. As background to these new sources of data, we have provided a detailed description of the datasets, and review some of the fundamental tabulations. In future years, as more data are accumulated, these reports will focus on delineation of key trends and analyses addressing policy issues. ### MEPS The MEPS is conducted to provide nationally representative estimates of health care use, …

The role of parents and the family in promoting children's oral health is increasingly acknowledged in the dental literature. This study aimed to investigate twelve-year changes in pre-schoolers' oral health and parental involvement in children's dental care using data from two repeated cross-sectional surveys. The objectives were (1) to assess the temporal changes in children's dental health status and oral health-related behaviours, (2) to examine temporal changes in parental attitudes toward their children's oral health care, and (3) to analyze the associations between observed changes. Two identical cross-sectional surveys were conducted in 2010/2011 (n = 294) and 2023 (n = 304). In both surveys, parents answered questions regarding their children's oral health care and completed the 38-item 'Parental Attitudes toward Children's Oral Health' (PACOH) scale, while the dental health of their 3-7-year-old children was clinically assessed. Changes in the examined characteristics were analyzed using general linear models. Significant positive changes (p < 0.001) were observed when comparing the surveys: the dmf-t (decayed, missing, filled teeth) score for deciduous teeth decreased from 5.56 to 3.31; the Silness-Löe Plaque Index decreased from 1.45 to 1.15; the percentage of children brushing their teeth regularly increased from 33.0% to 55.3%; the percentage of parents assisting their child with tooth brushing increased from 19.2% to 85.1%; and regular visits to a children's dentist increased from 36.4% to 85.1%. Moreover, the study revealed better parental attitudes toward their children's oral health care, as reflected by a change in the total score of the PACOH scale from 112 to 122. It was concluded that changes in parental attitudes played a crucial role in driving positive trends in oral health-related behaviours, which likely contributed to the improvement of dental health in children. Therefore, understanding and influencing parental attitudes can be essential for promoting good oral health skills and good oral health in young children.

Zimbabwe has one of the highest prevalence rates on preventable child morbidity in the world. This is mainly attributable to the absence of an effective community health mobilisation structure that reaches all targeted households with correct and consistent social behaviour change interventions for better child and maternal health.&#x0D; To address this, a cluster randomised controlled trial was conducted to assess the effectiveness of a developed integrated community intervention approach in reducing child morbidity and improving maternal health outcomes. A total of 765 mother-child pairs (413 in the intervention and 352 in the control) from 2 districts in Mashonaland East province were recruited and followed up for 12 months. Only women with children aged 0 - 48 months at the beginning of the study were selected. Participants were selected (and recruited) through stratified random sampling from 30 villages/clusters (16 in the control and 14 in the intervention) out of the total of 43 villages in the 2 districts. The intervention arm received education on maternal and child health through an Integrated Care Model mobilisation system whereas participants in the control arm were mobilized and educated using the conventional mobilisation system. Baseline and end-line surveys were done to assess and compare baseline characteristics and secondary study outcomes. The primary outcome was child morbidity in the follow-up period of 12 months.&#x0D; The mean age of participating mothers was 28 years (SD = 6.8) and that of participating children was 18.2 months (SD = 4.0). The risk of child morbidity was 37.5% in the control and 22.0% in the intervention representing a relative risk of 1.7 [95% C.I (1.4-2.1)]. The incidence rate of child morbidity was 0.043 and 0.022 episodes per child year in the control and intervention arm respectively giving an incidence rate ratio of 2.0(p&lt;0.001). This ratio meant that the chance of being a disease case in the control was double that in the intervention arm. Women in the intervention arm had statistically significant (p&lt;0.001) higher knowledge about maternal and child health and better child care practices at the end of the study.&#x0D; There was strong evidence that the Integrated Care Model did not only reduce child morbidity but also improved maternal knowledge, health-seeking behaviour and care practices. Accordingly, governments in developing countries and countries in poor resource settings could strengthen their community health delivery systems by implementing this low-cost, sustainable and high-impact approach.