Burden Of Disease In Children Research Articles

Insurance record-based analysis of the burden of disease in children, adolescents, and adults with galactosemia in the US

Insurance record-based analysis of the burden of disease in children, adolescents, and adults with galactosemia in the US

FACTORS INFLUENCING INTEGRATED MANAGEMENT OF NEWBORN CHILDHOOD ILLNESSES (IMNCI) UPTAKE AMONG CHILDREN IN CMH GILGIT, PAKISTAN

In developing countries, about 9 million children die before reaching the age of 5 every year, with 70% of these deaths attributable to five central diseases (measles, diarrhea, pneumonia, malaria, and malnutrition). The World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) have recognized the importance of early care-seeking and have developed the "integrated management of childhood illness" to promote proper healthcare practices within families and communities and decrease the mortality rate of children under five in developing countries. This study aimed to improve the health-seeking behaviour of mothers and reduce the burden of disease in children under five, with specific objectives to assess the factors affecting the uptake of integrated management of childhood illness (IMNCI) and the health-seeking behaviour of mothers. Using a structured questionnaire, a hospital-based cross-sectional study was conducted on 156 randomly selected parents of patients at CMH, Gilgit, from August to December 2016. The chi-square test determined associations between different factors and mothers' health-seeking behaviour. The results showed strong associations at p=0.05 and a 95% confidence interval with n=156. Strong associations were found between the first care given and the head of the family (p=0.02) and between health problems and the head of the family (p=0.01). The findings also indicated a strong relationship between the head of the family and restrictions when seeking care for a sick child (p=0.00). Maternal education positively impacts health outcomes, leading to fewer family restrictions, early identification of problems, and improved decision-making when seeking healthcare.

Prevalence, incidence, and trends of epilepsy among children and adolescents in Africa: a systematic review and meta-analysis

BackgroundEpilepsy contributes to a significant disease burden in children and adolescents worldwide. The incidence of childhood epilepsy is threefold higher in low and middle income countries compared in high-income countries. Epilepsy is a serious neurological condition associated with stigma and discrimination, an impaired quality of life, and other mental health related problems.ObjectiveThis study is aimed to synthesize existing evidence and estimate the pooled prevalence and incidence of epilepsy in children and adolescents in Africa.MethodsA comprehensive and systematic search of relevant databases was conducted. The quality of each study was assessed using the Newcastle-Ottawa Quality Assessment Scale adapted for meta-analysis. Two reviewers screened retrieved articles, conducted critical appraisals, and extracted the data. Heterogeneity between studies was assessed by visual inspection of forest plots and statistically using Cochran’s Q statistics and the I2 test. Publication bias was checked by visual inspection of funnel plots as well as statistically using Egger’s correlation and Begg’s regression tests. Finally, the pooled prevalence and incidence of childhood epilepsy were computed with 95% confidence intervals.ResultIn this review and meta-analysis 42 studies with 56 findings were included to compute the pooled prevalence of childhood epilepsy. On the other hand, 6 studies were included to estimate the combined incidence. The pooled prevalence of cumulative epilepsy was 17.3 per 1000 children. Whereas the pooled prevalence of active and lifetime epilepsy was 6.8 and 18.6 per 1000 children respectively. The pooled incidence of childhood epilepsy was 2.5 per 1000 children.ConclusionNearly 1 in 50 children are suffering from epilepsy in Africa. However, little attention has been paid to the prevention and treatment of childhood epilepsy. Mass epilepsy screening, scaling up treatment coverage, and designing strict treatment follow up and monitoring mechanisms are recommended.

Assessing the disease burden of air pollution on children and adolescents in China from 1990 to 2019

<p>Air pollution is a pressing concern in China, particularly its adverse effects on vulnerable populations such as children and adolescents. This study aimed to elucidate the disease burden in children and adolescents attributable to air pollution in geographical areas across China from 1990 to 2019. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 methodology to estimate disease burden attributable to air pollution in 33 areas of China, including provinces, autonomous regions, municipalities, and special administrative regions. In 2019, approximately 10,511 childhood deaths and 932,095 disability-adjusted life-years (DALYs) were attributable to air pollution in China. The DALYs was higher for boys and infants <1 year than it was for girls. Lower respiratory infections, neonatal preterm birth, and neonatal encephalopathy caused by birth asphyxia and trauma were the main air pollution-related diseases. The disease burden attributable to air pollution in children and adolescents decreased significantly from 1990 to 2019; with the average annual percent change (AAPC) of ?9.11% ([95%CI, ?9.61% to ?8.60%], P<0.001) for death rate, and ?9.09% ([?9.59% to ?8.58%], P<0.001) for DALYs rate. Disease burden attributable to air pollution in children and adolescents varied across provinces, with DALYs rate per 100,000 population ranged from 16.88 in Hong Kong to 2,152.54 in Tibet, peaking in the health area five. These findings highlight the necessity for province-specific research into the impacts of air pollution on childhood health in China, as well as improved air pollution control measures.</p>

Role of Nidana Parivarjana as a Line of Management in Pureeshaja Krimiroga

Krimi is used to denote tiny organism which reside in human body. The concept of Krimi and their relation in development of disease is mentioned by Ayurveda literature. Krimi Roga, a serious morbidity, contributes significantly to disease burden in children and causes malnourishment and stunted growth in them. Aharaja and Viharaja Nidana plays an important role in growth of Krimi. Treatment modalities mentioned for Krimiroga are Apakarshana, Prakriti Vighata and Nidana Parivarjana. Concept of Nidana Parivarjana holds important role in prevention as well as treatment of disease especially in Krimiroga.

Correlation of Body Mass Index with Blood Pressure in School Going Children Aged 6 To 14 Years in Ramdhuni Municipality of Eastern Nepal

Introduction: Children of school age groups in developing countries are facing the problem of overweight and obesity. Childhood obesity continues as obesity in adulthood. The chance of high blood pressure (BP) in overweight and obese children is more than healthy weight children. However, in Nepal, data on the relationship between hypertension and obesity, and disease burden in children at the national level are limited. To overcome these diseases and to develop effective prevention strategies, knowing the prevalence of the disease is a priority. Thus, this study aims to determine the prevalence and the relationship between overweight/obesity with BP in school going children aged 6-14 years, living in Ramdhuni municipality of eastern Nepal.
 Objective: To find prevalence and the association of BMI with blood pressure in school going children aged 6 to 14 years in Ramdhuni municipality of eastern Nepal.
 Methodology: This was a school based cross-sectional prospective study conducted at various schools in Ramdhuni municipality from February -March 2022. A total of 490 apparently healthy students of age group 6-14 years of both boys and girls were enrolled. Measurement of height and weight was done by standard procedure. The data was entered into Microsoft offices excel and analyzed using a statistical package for social sciences (SPSS 20.0).
 Results: In this present study, data of 490 students aged between 6 and 14 years were evaluated. Of them, 77.8% (n=381) were normal weight, 10.6% (n=52) were overweight and 5.9% (n=29) were obese. The prevalence of hypertension and prehypertension was 0.8% (n=4) and 0.6% (n=3), respectively. The body mass index was statistically significant as an explanatory variable of hypertension for both genders.
 Conclusion: This study concludes that overweight and obese children are at a significantly higher risk for hypertension than are normal weight children. Blood pressure measurement should be routine and frequent in children, especially overweight and obese children.

Burden of respiratory failure in pediatric patients: Analysis of a prospective multicenter cohort in Bogotá, Colombia.

The approach to the burden of disease is a demographic, economic, and a health problem, which requires the design and application of specific measures of cost of the disease, such as disability-adjusted life years (DALYs), to establish better public health policies in the pediatric population. The aim of this study is to approach the burden of disease in children with acute respiratory failure (ARF) through the calculation of DALYs. This study was conducted in the framework of a prospective, multicenter cohort in Bogotá, Colombia. Inclusion criteria were all pediatric patients admitted to the emergency department, hospitalization, and intensive care unit with respiratory distress; eligible patients were all those who developed ARF between April 2020 and December 2021. They were followed-up during hospitalization, at 30 and 60 days after admission. The Infant/Toddler Quality of Life Questionnaire and KIDSCREEN quality of life scales were applied for follow-up according to the age group. The results were used to calculate DALYs. Six hundred and eighty-five eligible patients, 296 (43.08%) developed ARF, of these 22 (6.08%) patients died (mortality rate = 7.43%). The total DALYs was 277.164 years. For younger than 9 years, the DALYs were 302.64 years, while for older than 10 years were 40.49 years. ARF is one of the main causes of preventable mortality in pediatrics, its progression to respiratory failure is a highly prevalent condition in pediatric age, a condition that has a great impact on mortality, morbidity, and disability in our patients.

Quantifying the environmental burden of disease for children and adolescents in Germany

Abstract Introduction Children and adolescents are more vulnerable to the impacts of environmental risk factors. They are in a sensitive stage of life, where the organ systems are still developing. Already minor interferences can have an effect on their future health. The UKAGEP-project aimed to estimate the Environmental Burden of Disease (EBD) for children and adolescents in Germany. Methods We tested the feasibility of applying the EBD-concept, developed by the World Health Organization, for 18 environmental risk factors. Where possible, data from the German Environmental Survey (GerES V) was used as the basis for the analyses. In addition, we performed systematic literature searches to identify adequate exposure-response-relationships. Results EBD quantifications were performed for 5 out of 18 environmental risk factors (PM2.5, bisphenol A, environmental noise, second-hand smoke and benzene). For the remaining risk factors, only particular steps of the EBD approach were realized. Taking two exemplary risk factors, about 28 % (170,000) of all obesity cases in the 7-17-year-olds were due to the exposure to bisphenol A and nearly 5 % (1,300) of the disability-adjusted life years for lower respiratory tract infections in 3-17-year-olds were attributable to PM2.5 in 2016. Conclusions Even though quantifications were performed for several risk factors, we had to conclude that for the remainder, availability and quality, especially of the exposure-response relationships and health data, were not sufficient to estimate burden of disease. Further, the exposure to some of these risk factors assessed in the GerES-V-study was too low to allow estimating the EBD. This does not mean that the identified concentrations were generally uncritical or that lifelong exposure could not lead to health impairments in the further life course. It only means that potential health outcomes have not occurred yet or the concentrations may lead to subclinical alterations in human body systems. Key messages • Environmental risk factors cause considerable burden in children and adolescents. • Estimating the environmental burden of disease for children and adolescents remains challenging.

Adrenergic and mesenchymal signatures are identifiable in cell-free DNA and correlate with metastatic disease burden in children with neuroblastoma.

Cell-free DNA (cfDNA) profiles of 5-hydroxymethylcytosine (5-hmC), an epigenetic marker of open chromatin and active gene expression, are correlated with metastatic disease burden in patients with neuroblastoma. Neuroblastoma tumors are comprised of adrenergic (ADRN) and mesenchymal (MES) cells, and the relative abundance of each in tumor biopsies has prognostic implications. We hypothesized that ADRN and MES-specific signatures could be quantified in cfDNA 5-hmC profiles and would augment the detection of metastatic burden in patients with neuroblastoma. We previously performed an integrative analysis to identify ADRN and MES-specific genes (n=373 and n=159, respectively). Purified DNA from cell lines was serial diluted with healthy donor cfDNA. Using Gene Set Variation Analysis (GSVA), ADRN and MES signatures were optimized. We then quantified signature scores, and our prior neuroblastoma signature, in cfDNA from 84 samples from 46 high-risk patients including 21 patients with serial samples. Samples from patients with higher metastatic burden had increased GSVA scores for both ADRN and MES gene signatures (p<.001). While ADRN and MES signature scores tracked together in serially collected samples, we identified instances of patients with increases in either MES or ADRN score at relapse. While it is feasible to identify ADRN and MES signatures using 5-hmC profiles of cfDNA from neuroblastoma patients and correlate these signatures to metastatic burden, additional data are needed to determine the optimal strategies for clinical implementation. Prospective evaluation in larger cohorts is ongoing.

Genomic, transcriptomic, and phenotypic differences among archetype Shigella flexneri strains of serotypes 2a, 3a, and 6.

Given the genomic diversity between S. flexneri serotypes and the paucity of data to support serotype-specific phenotypic differences, we applied in silico and in vitro functional analyses of archetype strains of 2457T (Sf2a), J17B (Sf3a), and CH060 (Sf6). These archetype strains represent the three leading S. flexneri serotypes recommended for inclusion in multivalent vaccines. Characterizing the genomic and phenotypic variation among these clinically prevalent serotypes is an important step toward understanding serotype-specific host-pathogen interactions to optimize the efficacy of multivalent vaccines and therapeutics. This study underpins the importance for further large-scale serotype-targeted analyses.

Pediatric RSV-Associated Hospitalizations Before and During the COVID-19 Pandemic.

Respiratory syncytial virus (RSV) is a leading cause of pediatric hospitalizations. To describe the epidemiology and burden of RSV-associated hospitalizations among children and adolescents in Canadian tertiary pediatric hospitals from 2017 to 2022, including changes during the COVID-19 pandemic. This cross-sectional study was conducted during 5 RSV seasons (2017-2018 to 2021-2022) at 13 pediatric tertiary care centers from the Canadian Immunization Monitoring Program Active (IMPACT) program. Hospitalized children and adolescents aged 0 to 16 years with laboratory-confirmed RSV infection were included. The proportion of all-cause admissions associated with RSV and counts and proportions of RSV hospitalizations with intensive care unit (ICU) admission, prolonged stay (≥7 days), and in-hospital mortality were calculated overall and by season, age group, and region. Seasonality was described using epidemic curves. RSV hospitalizations for 2021-2022 were compared with those in the prepandemic period of 2017-2018 through 2019-2020. Bonferroni corrections were applied to P values to adjust for multiple statistical comparisons. Among 11 014 RSV-associated hospitalizations in children and adolescents (6035 hospitalizations among male patients [54.8%]; 5488 hospitalizations among patients aged <6 months [49.8%]), 2594 hospitalizations (23.6%) had admission to the ICU, of which 1576 hospitalizations (60.8%) were among children aged less than 6 months. The median (IQR) hospital stay was 4 (2-6) days. The mean (SD) number of RSV-associated hospitalizations during prepandemic seasons was 2522 (88.8) hospitalizations. There were 58 hospitalizations reported in 2020-2021, followed by 3170 hospitalizations in 2021-2022. The proportion of all-cause hospitalizations associated with RSV increased from a mean of 3.2% (95% CI, 3.1%-3.3%) before the pandemic to 4.5% (95% CI, 4.3%-4.6%) in 2021-2022 (difference, 1.3 percentage points; 95% CI, 1.1-1.5 percentage points; corrected P < .001). A significant increase in RSV-associated hospitalizations was found in 2021-2022 for 3 provinces (difference range, 2.5 percentage points; 95% CI, 1.4-3.6 percentage points for Quebec to 2.9 percentage points; 95% CI, 1.4-3.5 percentage points for Alberta; all corrected P < .001). Age, sex, ICU admission, prolonged length of stay, and case fatality rate did not change in 2021-2022 compared with the prepandemic period. Interregional differences in RSV seasonality were accentuated in 2021-2022, with peaks for 1 province in October, 4 provinces in December, and 3 provinces in April, or May. This study found that the burden of RSV-associated hospitalizations in Canadian pediatric hospitals was substantial, particularly among infants aged less than 6 months, and RSV hospitalizations increased in 2021-2022 compared with the prepandemic period, while severity of illness remained similar. These findings suggest that RSV preventive strategies for infants aged less than 6 months would be associated with decreased RSV disease burden in children.

Otolaryngological burden of disease in children with primary ciliary dyskinesia in Victoria, Australia.

The aim of this study was to summarize the otolaryngological manifestations amongst children with primary ciliary dyskinesia (cwPCD) to improve diagnosis, investigations and management amongst otolaryngologists. A retrospective review of primary ciliary dyskinesia (PCD) diagnoses at our institution over an 8-year period between January 2014 and October 2022 was conducted. Patient characteristics, diagnosis, otolaryngological symptomatology, treatment and outcomes were recorded. 24 patients were identified. Thirteen patients (54%) had documented conductive hearing loss on audiological evaluation; with 11 (85%) requiring hearing aids. Six patients (25%) underwent middle ear ventilation tube (MEVT) insertion with 67% experiencing post-MEVT otorrhoea. Twenty children (83%) reported chronic nasal discharge however only 3 (13%) reported nasal obstruction. Nine patients (38%) had symptoms consistent with sleep disordered breathing with 79% of them requiring operative management with adenotonsillectomy. Middle ear effusion is common amongst cwPCD and should be managed with conservative measures due to the significant burden of post-MEVT otorrhoea. Sinonasal symptoms rarely need surgical intervention. Many otolaryngological symptoms of PCD are often underreported, particularly sleep-disordered breathing. Paediatric PCD patients should be managed in a multidisciplinary team with routine and tailored therapies to manage all aspects of the condition.

Understanding the patient experience of Classic Galactosemia in pediatric and adult patients: increased disease burden, challenges with daily living, and how they evolve over time

BackgroundClassic Galactosemia (CG) is a rare, autosomal recessive condition. Newborn screening and a timely galactose-restricted diet can resolve acute symptoms and decrease fatalities, but significant chronic, progressive morbidities remain and significantly impact daily life. The objective of this study was to better understand the burden of disease in children and adults with CGs and describe how morbidities evolve over time.MethodsA total of 49 individuals with CG from the United States (US) were included in the qualitative surveys (13 adults [9 self-reported] and 36 pediatric patients). Fifteen follow-up interviews were conducted with 5 adults and 10 caregivers, discussing 17 individuals with CG overall (2 caregivers each discussed 2 children).ResultsQualitative survey and interview data demonstrated the substantial burden of CG. Difficulties in a wide range of functions were experienced, which included: speech articulation; language and communication; cognition, memory and learning; emotions; and social interactions. Most difficulties appeared in childhood and persisted or worsened with age. Most adults did not live independently. Others lived semi-independently and experienced many daily challenges and required support. Caregivers also described the burden of caring for someone with CG and spoke about the impact this has on their day-to-day life, work, and relationships.ConclusionsThese findings demonstrate the pronounced and persistent burden of disease encountered by individuals with CG, and that the condition has a significant impact on the quality of life of caregivers.

Challenges when estimating the environmental burden of disease for children in Germany

Challenges when estimating the environmental burden of disease for children in Germany

Growth and disease burden in children with hypophosphatasia

Growth and disease burden in children with hypophosphatasia

Strengthening Mental Health and Resilience Through Schools: Protocol for a Participatory Design Project.

Mental health problems are a main contributor to the global burden of disease in children and young people within urban environments. In response, the potential of both school- and sport-based mental health promotion interventions has been advocated. However, there exists limited insights into how sport-based interventions can be integrated within school environment. Moreover, there is a need to consider children and young people's specific needs, challenges, and motivations when designing novel mental health promotion interventions. The Strengthening Mental Health and Resilience Through Schools (SMARTS) project aims to co-design an evidence-informed school-sport-based mental health promotion program. Specific objectives include (1) co-designing a multicomponent program, integrating sport sessions with class-based sessions, and complementing with educational modules for teachers and parents; (2) exploring how the mental health program can be implemented most effectively within the Brussels school system; and (3) conducting preliminary process and outcome testing of the program. A participatory design framework will be adopted to develop the program. This framework involves end users throughout the entire study process, from problem identification to intervention delivery and evaluation, while at the same time ensuring program development remains directly informed by the available scientific evidence. Participant recruitment will commence in September 2023. The full project will be completed by March 2027. With this intervention, we aim to provide a direct contribution to the promotion of children and young people's mental health within the Brussels school context. At a broader level, conducting and documenting this large participatory design project can, hopefully, inspire other researchers to tailor their mental health programs to specific populations. PRR1-10.2196/49670.

Infant antibody and B-cell responses following confirmed pediatric GII.17 norovirus infections functionally distinguish GII.17 genetic clusters.

Genogroup II (GII) noroviruses are a major cause of diarrheal disease burden in children in both high- and low-income countries. GII.17 noroviruses are composed of distinct genetic clusters (I, II, IIIa, and IIIb) and have shown potential for replacing historically more prevalent GII.4 strains, but the serological basis for GII.17 antigenic diversity has not been studied in children. Utilizing samples from a birth cohort, we investigated antibody and B-cell responses to GII.17 cluster variants in confirmed GII.17 infections in young children as well as demonstrated that the distinct genetic clusters co-circulate. Polyclonal serum antibodies bound multiple clusters but showed cluster-specific blockade activity in a surrogate virus neutralization assay. Antibodies secreted by immortalized memory B cells (MBCs) from an infant GII.17 case were highly specific to GII.17 and exhibited blockade activity against this genotype. We isolated an MBC-derived GII.17-specific Immunoglobulin A (IgA) monoclonal antibody called NVA.1 that potently and selectively blocked GII.17 cluster IIIb and recognized an epitope targeted in serum from cluster IIIb-infected children. These data indicate that multiple antigenically distinct GII.17 variants co-circulate in young children, suggesting retention of cluster diversity alongside potential for immune escape given the existence of antibody-defined cluster-specific epitopes elicited during infection.

The burden of disease for children born alive with Turner syndrome-A European cohort study.

Turner syndrome is a rare congenital anomaly caused by complete or partial X chromosome monosomy that may affect mortality and morbidity in childhood. This population-based data-linkage cohort study, as part of the EUROlinkCAT project, investigated mortality and morbidity for the first 5 years of life for liveborn European children diagnosed with Turner syndrome. Thirteen population-based registries in 10 countries from the European surveillance of congenital anomalies (EUROCAT) network participated. Data on children born 1995-2014 and diagnosed with Turner syndrome were linked to mortality, hospital and prescription records. Children with any congenital anomaly and children without a congenital anomaly were included for comparison on morbidity. Out of a population of 5.8 million livebirths 404 were diagnosed with Turner syndrome prenatally or in infancy and 95.5% survived to their fifth birthday. During the first year of life 72.3% (95% CI 59.5;81.6) of children with Turner syndrome were hospitalized, the median length of stay was 5.6 days (95% CI 3.5;7.7) and 18.7% (95% CI 13.9;23.9) underwent surgery. After the first year of life hospitalizations and length of stay decreased but more children underwent surgery (30.8% [95% CI 17.6;44.7]). In the first 5 years the percentage of children with Turner syndrome having a prescription for antibiotics was 12%-20% per year and increased with the age of child. In the first year of life, the burden of disease was relatively high for children with Turner syndrome. The outlook is more positive beyond the first year, though overall morbidity still exceeded that of children without congenital anomalies.

The unfinished agenda of communicable diseases among children and adolescents before the COVID-19 pandemic, 1990–2019: a systematic analysis of the Global Burden of Disease Study 2019

Communicable disease control has long been a focus of global health policy. There have been substantial reductions in the burden and mortality of communicable diseases among children younger than 5 years, but we know less about this burden in older children and adolescents, and it is unclear whether current programmes and policies remain aligned with targets for intervention. This knowledge is especially important for policy and programmes in the context of the COVID-19 pandemic. We aimed to use the Global Burden of Disease (GBD) Study 2019 to systematically characterise the burden of communicable diseases across childhood and adolescence. In this systematic analysis of the GBD study from 1990 to 2019, all communicable diseases and their manifestations as modelled within GBD 2019 were included, categorised as 16 subgroups of common diseases or presentations. Data were reported for absolute count, prevalence, and incidence across measures of cause-specific mortality (deaths and years of life lost), disability (years lived with disability [YLDs]), and disease burden (disability-adjusted life-years [DALYs]) for children and adolescents aged 0-24 years. Data were reported across the Socio-demographic Index (SDI) and across time (1990-2019), and for 204 countries and territories. For HIV, we reported the mortality-to-incidence ratio (MIR) as a measure of health system performance. In 2019, there were 3·0 million deaths and 30·0 million years of healthy life lost to disability (as measured by YLDs), corresponding to 288·4 million DALYs from communicable diseases among children and adolescents globally (57·3% of total communicable disease burden across all ages). Over time, there has been a shift in communicable disease burden from young children to older children and adolescents (largely driven by the considerable reductions in children younger than 5 years and slower progress elsewhere), although children younger than 5 years still accounted for most of the communicable disease burden in 2019. Disease burden and mortality were predominantly in low-SDI settings, with high and high-middle SDI settings also having an appreciable burden of communicable disease morbidity (4·0 million YLDs in 2019 alone). Three cause groups (enteric infections, lower-respiratory-tract infections, and malaria) accounted for 59·8% of the global communicable disease burden in children and adolescents, with tuberculosis and HIV both emerging as important causes during adolescence. HIV was the only cause for which disease burden increased over time, particularly in children and adolescents older than 5 years, and especially in females. Excess MIRs for HIV were observed for males aged 15-19 years in low-SDI settings. Our analysis supports continued policy focus on enteric infections and lower-respiratory-tract infections, with orientation to children younger than 5 years in settings of low socioeconomic development. However, efforts should also be targeted to other conditions, particularly HIV, given its increased burden in older children and adolescents. Older children and adolescents also experience a large burden of communicable disease, further highlighting the need for efforts to extend beyond the first 5 years of life. Our analysis also identified substantial morbidity caused by communicable diseases affecting child and adolescent health across the world. The Australian National Health and Medical Research Council Centre for Research Excellence for Driving Investment in Global Adolescent Health and the Bill & Melinda Gates Foundation.

Prevalence, risk factors, impact and management of pneumonia among preschool children in Chinese seven cities: a cross-sectional study with interrupted time series analysis

BackgroundPneumonia is a common disease worldwide in preschool children. Despite its large population size, China has had no comprehensive study of the national prevalence, risk factors, and management of pneumonia among preschool children. We therefore investigated the prevalence of pneumonia among preschool children in Chinese seven representative cities, and explore the possible risk factors of pneumonia on children, with a view to calling the world's attention to childhood pneumonia to reduce the prevalence of childhood pneumonia.MethodsTwo group samples of 63,663 and 52,812 preschool children were recruited from 2011 and 2019 surveys, respectively. Which were derived from the cross-sectional China, Children, Homes, Health (CCHH) study using a multi-stage stratified sampling method. This survey was conducted in kindergartens in seven representative cities. Exclusion criteria were younger than 2 years old or older than 8 years old, non-permanent population, basic information such as gender, date of birth and breast feeding is incomplete. Pneumonia was determined on the basis of parents reported history of clearly diagnosed by the physician. All participants were assessed with a standard questionnaire. Risk factors for pneumonia, and association between pneumonia and other respiratory diseases were examined by multivariable-adjusted analyses done in all participants for whom data on the variables of interest were available. Disease management was evaluated by the parents’ reported history of physician diagnosis, longitudinal comparison of risk factors in 2011 and 2019.ResultsIn 2011 and 2019, 31,277 (16,152 boys and 15,125 girls) and 32,016 (16,621 boys and 15,395 girls) preschool children aged at 2–8 of permanent population completed the questionnaire, respectively, and were thus included in the final analysis. The findings showed that the age-adjusted prevalence of pneumonia in children was 32.7% in 2011 and 26.4% in 2019. In 2011, girls (odds ratio [OR] 0.91, 95%CI [confidence interval]0.87–0.96; p = 0.0002), rural (0.85, 0.73–0.99; p = 0.0387), duration of breastfeeding ≥ 6 months(0.83, 0.79–0.88; p < 0.0001), birth weight (g) ≥ 4000 (0.88, 0.80–0.97; p = 0.0125), frequency of putting bedding to sunshine (Often) (0.82, 0.71–0.94; p = 0.0049), cooking fuel type (electricity) (0.87, 0.80–0.94; p = 0.0005), indoor use air-conditioning (0.85, 0.80–0.90; p < 0.0001) were associated with a reduced risk of childhood pneumonia. Age (4–6) (1.11, 1.03–1.20; p = 0.0052), parental smoking (one) (1.12, 1.07–1.18; p < 0.0001), used antibiotics (2.71, 2.52–2.90; p < 0.0001), history of parental allergy (one and two) (1.21, 1.12–1.32; p < 0.0001 and 1.33, 1.04–1.69; p = 0.0203), indoor dampness (1.24, 1.15–1.33; p < 0.0001), home interior decoration (1.11, 1.04–1.19; p = 0.0013), Wall painting materials (Paint) (1.16, 1.04–1.29; p = 0.0084), flooring materials (Laminate / Composite wood) (1.08, 1.02–1.16; p = 0.0126), indoor heating mode(Central heating)(1.18, 1.07–1.30, p = 0.0090), asthma (2.38, 2.17–2.61; p < 0.0001), allergic rhinitis (1.36, 1.25–1.47; p < 0.0001), wheezing (1.64, 1.55–1.74; p < 0.0001) were associated with an elevated risk of childhood pneumonia; pneumonia was associated with an elevated risk of childhood asthma (2.53, 2.31–2.78; p < 0.0001), allergic rhinitis (1.41, 1.29–1.53; p < 0.0001) and wheezing (1.64, 1.55–1.74; p < 0.0001). In 2019, girls (0.92, 0.87–0.97; p = 0.0019), duration of breastfeeding ≥ 6 months (0.92, 0.87–0.97; p = 0.0031), used antibiotics (0.22, 0.21–0.24; p < 0.0001), cooking fuel type (Other) (0.40, 0.23–0.63; p = 0.0003), indoor use air-conditioning (0.89, 0.83–0.95; p = 0.0009) were associated with a reduced risk of childhood pneumonia. Urbanisation (Suburb) (1.10, 1.02–1.18; p = 0.0093), premature birth (1.29, 1.08–1.55; p = 0.0051), birth weight (g) < 2500 (1.17, 1.02–1.35; p = 0.0284), parental smoking (1.30, 1.23–1.38; p < 0.0001), history of parental asthma (One) (1.23, 1.03–1.46; p = 0.0202), history of parental allergy (one and two) (1.20, 1.13–1.27; p < 0.0001 and 1.22, 1.08–1.37; p = 0.0014), cooking fuel type (Coal) (1.58, 1.02–2.52; p = 0.0356), indoor dampness (1.16, 1.08–1.24; p < 0.0001), asthma (1.88, 1.64–2.15; p < 0.0001), allergic rhinitis (1.57, 1.45–1.69; p < 0.0001), wheezing (2.43, 2.20–2.68; p < 0.0001) were associated with an elevated risk of childhood pneumonia; pneumonia was associated with an elevated risk of childhood asthma (1.96, 1.72–2.25; p < 0.0001), allergic rhinitis (1.60, 1.48–1.73; p < 0.0001) and wheezing (2.49, 2.25–2.75; p < 0.0001).ConclusionsPneumonia is prevalent among preschool children in China, and it affects other childhood respiratory diseases. Although the prevalence of pneumonia in Chinese children shows a decreasing trend in 2019 compared to 2011, a well-established management system is still needed to further reduce the prevalence of pneumonia and reduce the burden of disease in children.