To screen 2-5-year-old children from two districts in rural Bengal, India, using the Early Childhood Development Index 2030 (ECDI2030) tool and to compare the profiles of those developmentally 'on-track' and 'not-on-track' in terms of availability of fourteen important socio-cultural, economic and environmental factors. The study included children aged 2-5years from Purulia and South 24 Parganas districts of West Bengal, India, using 'simple-random-sampling-without-replacement' (SRSWOR) design for selection. Each participant underwent a three-step enquiry comprising demographic data collection, assessment of 14 socio-cultural, economic and environmental factors using Multiple Indicator Cluster Survey (MICS)-6, and administration of the ECDI2030 questionnaire. Trained community workers conducted the survey. Out of 2170 children aged 2-5years, 85.25% were developmentally 'on-track' and 14.75% were not. Children 'on-track' more often had higher maternal education, greater parental engagement (play, storytelling, singing and reading), appropriate toys and fathers' involvement and had more toys and picture books at home. Maternal depression and tiredness, preschool attendance and family income showed minimal differences between the groups. The ECDI2030 tool is useful for identifying children whose development is 'not-on-track' and the influencing factors they lack. These insights can guide targeted early childhood development interventions. Caregiver awareness should be strengthened, with emphasis on active play, talking and interaction at home.

Why primary caregivers fail to report pediatric pain: A qualitative study.

Intellectual developmental disability and risk of developing depression in type 2 diabetes.

Evaluating the effect of a family-centered empowerment model on the caring power and life satisfaction of family caregivers of older adults with cancer.

This study summarised the global epidemiology, prevention policies, and public health communication strategies related to infant botulism and exposure to honey. A narrative review of epidemiological data was carried out from 1976 to 2024, using surveillance reports, national health agency documents, and peer-reviewed literature. Cases were rare, but honey was the only consistently confirmed dietary source of infant botulism. The median age at onset was 3-4 months, and mortality was below 1% if the infants received intensive care support and specific therapy with human botulism immune globulin. A global review from 2007 to 2021 reported that the USA had approximately 130 cases of infant botulism per year, while Europe, Canada, Japan, and Australia reported markedly lower incidences. Italy had 36 cases between 2001-2020, which represented 8% of all confirmed botulism cases in the country during that period. We found that health authorities uniformly advised against consuming honey before 12 months of age, but warning labels remained voluntary in many regions, and caregiver awareness varied. Strengthened paediatric counselling, harmonised labelling policies, and culturally tailored communication strategies are needed to reduce infant botulism by preventing infants under 12 months of age from consuming honey.

Introduction: Ensuring proper children drug utilization is essential for successful treatment. Several studies have reported various problems including dosing errors and drug misuse, including use without prescription. There is a lack of data regarding this issue in Sudan where a large portion of the population is under 16 years. Objectives: We aimed to assess knowledge, attitude, and practice regarding pediatric medications among caregivers of children admitted to the largest paediatric hospital in Sudan. Methods: We conducted a hospital-based cross-sectional survey in Mohamed Alamin Hamid Pediatric Hospital between 1 April to 30 September 2021. We randomly invited caregivers of admitted children and interviewed consenting particiapnts using avalidated structured questionnaire. Results: 385 caregivers participated in the study (82% response rate) with a mean age of 32.6 years (SD 7.2). The majority of respondents were mothers (75.3%), with a mean age of 32.6 years. Over a third (37.4%) were primary school graduates, while 23.1% were university graduates. Mothers were primarily responsible for giving medication at home in 88.1% of cases. 38% of participants reported the treatment process failed due to children’s refusal to take medication. A significant finding was that 61% of parents reported using drugs without a prescription; of these, antipyretics (56.4%) and antibiotics (36.3%) were the most common. While 87.3% of parents recorded the time of medication administration, only 59.7% administered drugs at regular 8-hour intervals when prescribed three times daily. A concerning 52.7% of parents stated they would keep leftover liquid medication for later use. The study also found that parents with higher education levels were more likely to use medical leaflets as a source of information (p=.000) and to record medication administration times (p=.008). Conclusion: This study reveals a high rate of self-medication, particularly with antibiotics, which poses a serious risk for antimicrobial resistance. While practices like recording administration times were common, storing leftover medication was a frequent, potentially harmful practice. The educational level, income, and residence of caregivers were significant factors influencing their knowledge and practice . Efforts should focus on simplifying pediatric medication formulations to reduce errors. Further research in assessing factors associated with self-medications are recommended in Sudan.

As populations age, dementia is becoming increasingly prevalent, posing major public health challenges. Aging in place (AIP) is an important policy and personal objective for older adults, including those experiencing cognitive impairment. We investigated whether specific environmental features influence AIP of older adults with cognitive impairment and how cognitive impairments or dementia diagnoses affect caregivers' environmental perceptions and decision-making. This convergent mixed-methods study surveyed 95 caregivers of older adults with cognitive impairment. Logistic regression was used to identify neighborhood features that predicted the AIP outcome, while thematic analysis examined caregivers' qualitative narratives on how neighborhood features shape AIP. Neighborhood features had limited direct effects on the AIP outcome, regardless of dementia severity. However, a significant interaction emerged between formal diagnosis and perceived safety (p < .01). This indicates an important moderating role of diagnosis status, with each additional point on the safety scale associated with a 10% increase in the AIP odds among those with a formal dementia diagnosis. Qualitative findings reinforced the importance of perceived safety, while also highlighting accessible destinations/services and community support as additional facilitators of AIP. These findings suggest environmental features and diagnostic status jointly shape AIP decisions. A timely dementia diagnosis may heighten caregiver awareness of environmental supports and barriers, enabling informed adjustments. To create inclusive neighborhoods that support AIP, coordinated approaches integrating early diagnosis, dementia-friendly design, and community support are needed. Such approaches can contribute to reducing institutional transitions and caregiver burdens.

Double awareness, the ability to live meaningfully while preparing for the end of life, is central to serious illness conversations. In hematology, prognostic uncertainty and expectations of novel therapies often delay prognostic dialogue, limiting opportunities to cultivate double awareness in patients and caregivers. To explore how patients, caregivers, and hematology clinicians trained in serious illness conversations navigate prognostic dialogue and how this may facilitate double awareness. This qualitative study analyzed audio-recorded transcripts of serious illness conversations conducted between November 1, 2022, and January 31, 2025, among patients, caregivers, and clinicians treating hematologic malignant neoplasms in the intervention arm of a nationwide, Danish cluster randomized trial (ACT study; planned follow-up of 18 months), using reflexive thematic analysis. Twenty-five of seventy-five eligible audio recordings were selected for variation in patient demographics (age, sex, and diagnosis), caregiver relationship, treating clinicians, and perceived goals of treatment among patients with limited treatment options from 5 Danish hematology departments. The Danish Serious Illness Care Program includes clinician training, communication tools, preparatory materials, documentation, and scheduled conversation slots. Communicative dynamics of how patients, caregivers, and clinicians navigate prognostic dialogue in serious illness conversations in hematology. A total of 25 patient-caregiver dyads (50 individuals; median [IQR] patient age, 73 [67-79] years; 11 [44%] female and 14 [56%] male patients; median [IQR] caregiver age, 66 [52-72] years; 20 [80%] female and 5 [20%] male caregivers) and 16 physician-nurse teams (32 clinicians; median [IQR] physician age, 46 [41-48] years; 11 [69%] female and 5 [31%] male; median [IQR] nurse age, 38 [32-46] years; 16 [100%] female) were studied. Patients had multiple myeloma (8 [32%]), lymphoma (8 [32%]), myelodysplastic syndrome (6 [24%]), or acute leukemia (3 [12%]). A total of 18 (72%) were enrolled during treatment of relapsed disease. Preparatory materials and clinicians' conversation opening laid the foundation for prognostic dialogue. Clinicians followed patients' verbal and emotional cues of readiness or hesitation for prognostic dialogue and adjusted the depth and timing of prognostic information accordingly. Prognostic uncertainty was used to acknowledge both realistic concerns and hopes. In this qualitative study of serious illness conversations among patients with hematologic malignant neoplasms, their caregivers, and clinicians, clinicians' attentiveness to patients' and caregivers' oscillating readiness enabled prognostic dialogue. Prognostic uncertainty served as a constructive element and resource rather than a barrier, supporting patients' preparation for the end of life while continuing to live meaningfully.

Atopic dermatitis (AD) is a chronic, relapsing inflammatory dermatosis characterized by epidermal barrier dysfunction, immune dysregulation, and significant impairment in quality of life, particularly among pediatric populations. Although topical anti-inflammatory therapies remain central to acute flare control, growing evidence supports barrier-directed skincare as a fundamental component of long-term disease management. This narrative review synthesizes current evidence on cleansing, moisturization, photoprotection, and preventive strategies in AD, with specific consideration of pediatric care and real-world challenges within the Indian healthcare context. Clinical studies consistently demonstrate that regular emollient use enhances skin hydration, accelerates barrier recovery, alleviates symptom burden, and improves quality of life, with additive benefits when combined with topical corticosteroids. National guidance further emphasizes age-appropriate bathing practices, including delayed bathing in low-birth-weight infants and gentle cleansing followed by prompt emollient application. Despite these recommendations, Indian surveys reveal persistent gaps in caregiver awareness, delayed diagnosis, intermittent moisturizer use, and suboptimal adherence driven by cost constraints, loss to follow-up, and preference for alternative therapies. While emerging modalities, including biomimetic formulations, digital health platforms, and personalized skincare, offer potential future directions, current evidence remains largely exploratory, with limited data on cost-effectiveness and real-world implementation. Overall, barrier-focused skincare represents an important adjunct to pharmacologic therapy in AD; however, effective integration into Indian clinical practice will require strengthened caregiver education, context-specific guidance, and system-level strategies addressing accessibility and adherence, supported by future pragmatic trials and epidemiological studies to enable scalable, evidence-based care.

BackgroundPublished evidence on patient experiences, perceptions, and challenges related to early breast cancer (eBC) in Italy is limited. Understanding these aspects is critical for improving diagnosis, treatment outcomes, and quality of life (QoL).ObjectiveThis study used social media listening (SML) to explore the patient journey, treatment perceptions, QoL, and unmet needs of patients with eBC, caregivers, and health care professionals (HCPs) in Italy.MethodsThis retrospective noninterventional SML study analyzed publicly available posts from December 2021 to November 2023 using breast cancer–related keywords in English and Italian through Sprinklr, a web-based aggregator tool. Posts sourced from social media platforms, such as X (formerly known as Twitter), blogs, forums, Facebook, Instagram, and YouTube, were filtered by geographic location to include only users in Italy. Posts were filtered using natural language processing (NLP) for relevance and duplicates, followed by manual review and stakeholder identification (patients, caregivers, and HCPs). Key themes of discussion were identified through thematic analysis of posts across the stages of the patient journey (symptoms, diagnosis, treatment, etc). Ethical guidelines were followed by using anonymized, publicly available data. Descriptive statistics were used to analyze the data, and posts with missing data were excluded. Consequently, denominators varied across analyses and were adjusted based on data availability for specific variables.ResultsOf the 20,008 posts initially extracted, 1580 posts were retained following NLP filtering, and 530 posts were included after manual screening. The majority (493/518, 95%) of the posts were sharing information about diagnosis and treatment journeys, emotional challenges, QoL concerns, and symptoms (eg, lumps, breast pain), while 27% (141/518) of the posts sought information on diagnostic dilemmas, treatment options, and second opinions. Patients contributed 60% (318/530) of the posts, and caregivers contributed 21% (111/530) of the posts, with over half (57/107, 53%) discussing their mothers’ diagnosis and treatment struggles. HCPs contributed 16% (85/530) of the posts, primarily sharing clinical trial updates, drug approvals, and disease awareness efforts. A total of 88 posts included discussions on QoL, and eBC significantly impacted patients’ emotional, physical, functional, and social well-being. Discussions revealed key unmet needs, including limited awareness of adjuvant therapy options, lack of peer support groups, suboptimal patient-HCP communication, and insufficient access to specialty care facilities.ConclusionsThis study highlights gaps in eBC management related to patient education, HCP communication, and access to specialty care and describes an associated worsening of QoL for patients as reflected in social media posts. Within the limitations of an observational SML design, increasing patient and caregiver awareness of available adjuvant therapies to improve adherence and reduce recurrence risk, alongside expanding access to regional breast cancer centers, may help optimize patient experiences and outcomes. Further research using complementary data sources is needed to confirm and extend these findings.

Previous trials in Africa and Asia, including Bangladesh, showed that community health workers can effectively treat young infants (7-59 days) with fast breathing and children (2-59 months) with chest indrawing pneumonia at home with oral amoxicillin using enhanced integrated community case management (iCCM) protocols. However, the Enhanced Management of Pneumonia in Community (EMPIC), its pneumonia-specific component, has not yet been applied in routine government health systems. Here, we developed a protocol for a feasibility study on the integration of EMPIC into community clinics in Bangladesh through existing government health systems. This study will adopt an implementation research approach that integrates quantitative and qualitative methods. A delivery package will be co-developed with stakeholders to introduce enhanced pneumonia management through government systems in three phases within community clinics of selected upazilas in Kushtia and Dinajpur districts. We will use the plan-do-check-act cycle framework to evaluate implementation, track progress, identify gaps, and test potential solutions. Data collection methods will include health facility assessments, data extractions from routine registers and monthly reports, household surveys, and community follow-ups of under-five children with pneumonia on days 7 and 14 post-treatment. The primary outcome is high (i.e. ≥80%) and effective coverage (i.e. patients receiving the full course of pneumonia treatment) of pneumonia treatment in under-five children. Secondary outcomes include treatment failure rates among under-five children with pneumonia; availability of commodities and supplies for pneumonia management; health worker knowledge, caregiver awareness and care-seeking practices regarding childhood pneumonia; pneumonia prevalence among under-five children; community clinic utilisation for pneumonia-related symptoms by under-five children; and treatment compliance. Our findings may inform the evidence-based scale-up of enhanced pneumonia management in Bangladesh and other low- and middle-income countries, contributing to improved community-level management of childhood pneumonia.

Since 2009, informal caregivers (CGs) have been able to obtain information on support options and receive initial relief through consultation as part of informal caregiver counselling (ICC) in accordance with § 7a SGB XI. However, this offer has been used infrequently, and scientific evidence on non-users is lacking.The data were obtained from the cross-sectional study 'Progress in Home Care (ProCare)' and constituted a representative sample of CGs caring for care receivers (CRs) who were covered by statutory insurance in Bavaria (n=2,824). The analysis of use was based on Bradshaw's taxonomy of social need. The characteristics of (non-)users of ICC were identified descriptively (expressed need), and difference and regression analyses were computed (comparative need). For non-users of ICC, the reasons for non-use were evaluated (felt need), and the subjective and objective need for using ICC were compared (felt vs. normative need). Furthermore, information sources on care-related topics were analysed for CGs who were not aware that they were entitled to ICC.ICC was used by 20.97% (n=593) of CGs in the previous three months, of whom 85.91% stated that they benefited from the ICC. Multivariate binary logistic regression revealed that CGs of CRs who were older (OR=1.01) or had a higher level of care (OR=1.33) or dementia (OR=1.30) used ICC more frequently. Functional coping was also associated with more frequent use (OR=1.10). 53.99% of non-users stated that they had no need for ICC to date. However, only 36.73% of this group demonstrated no normative need. CGs who were not yet aware of ICC can be reached in the future via the Internet and social media (55.92%), doctors (53.13%), and their immediate environment (49.65%).The high level of satisfaction with ICC highlights its potential, underscoring the necessity for its utilisation to be augmented. In order to prevent high burden at an early stage, preventative, ongoing use should be achieved instead of the current late utilisation and functional coping strategies of CGs should be strengthened. Additionally, there is a large discrepancy between objective and subjective perceptions of CGs burden and associated needs, as well as a lack of knowledge about ICC. In order to raise awareness in CGs, a wider range of targeted information sources should be used.

Adverse childhood experiences (ACEs) are potentially traumatic events, such as abuse, neglect, and household stress, that occur before the age of 18. ACEs are common: Almost two-thirds of U.S. adults report at least one ACE, and nearly one-fifth report four or more. ACEs can have wide-ranging effects on mental and physical health and social relationships. These negative health outcomes come about through a process known as toxic stress, a condition characterized by heightened and prolonged physiological and psychological changes that can persist into adulthood. Given the substantial cost of ACEs to society and their potential to affect future generations, broad population-level interventions are needed. For this study, the authors evaluated Live Beyond, a public awareness campaign funded by the Office of the California Surgeon General and carried out by Civilian, a social marketing and communications agency. Civilian used social marketing to reach two priority populations: youth and young adults ages 16 to 25, and caregivers of youth ages 8 to 16 in California. The study presents findings of a process evaluation that used document review to detail the planning, development, and implementation of the campaign, and an outcome evaluation that used surveys precampaign and ten months postimplementation to examine the campaign's impact on transition-age youth's and caregivers' ACE-related knowledge and awareness, attitudes and beliefs, skills and actions, and well-being. The authors concluded that, if continued for a longer time, Live Beyond could make headway in addressing the high prevalence and cost of ACEs and toxic stress in California.

Adverse childhood experiences (ACEs) are associated with poor mental health outcomes, yet little is known about discrepancies between adolescent and caregiver reports of ACE exposure. This study examines differences between adolescent self-reported and caregiver-reported ACEs and evaluates how reporting discrepancies are associated with depressive and anxiety symptoms among hospitalized adolescents. We recruited 250 adolescent-caregiver dyads from an inpatient adolescent unit in Bronx County, New York. Adolescents and caregivers independently completed ACE questionnaires, assessing traditional (e.g., abuse, neglect) and non-traditional (e.g., community violence, discrimination) ACEs experienced by the adolescent. Adolescent self-reported depression and anxiety was measured using the Patient Health Questionnaire Modified for Adolescents (PHQ-9A) and Generalized Anxiety Disorder-7 (GAD-7), respectively. Descriptive statistics and Pearson correlations were used to analyze the data. Adolescents reported higher mean ACE scores than caregivers for both traditional (1.66 vs. 1.24, p < 0.001) and non-traditional (1.36 vs. 0.89, p < 0.001) ACEs. Discrepancies in reporting were positively correlated with adolescent depression (r = 0.357, p < 0.001) and anxiety (r = 0.241, p < 0.001). Gender-diverse adolescents reported the highest ACE scores, and larger score differences were noted among Hispanic and mixed-race dyads. These findings highlight discrepancies between adolescent and caregiver reports of adolescent adversity and underscore the importance of adolescent self-report in clinical assessment. Future research should focus on evaluating interventions that support caregiver awareness, particularly in diverse populations.

Family caregiving is a core challenge in modern society, and social awareness of young caregivers has heightened since the 2021 caregiving tragedy incident. While institutional frameworks are being established, such as the recent enactment of the “Crisis Children and Youth Support Act” and the nationwide expansion of ‘Youth Future Centers’, research on ‘self-care’ remains insufficient. Therefore, this study conducted in-depth interviews with six young caregivers who are only children to explore their self-care experiences. Qualitative content analysis yielded four core themes: Daily Life as Responsibility, Time of Losing Myself, Reconnecting with Myself, and Life Beyond Caregiving. The findings reveal that young caregivers perceive an essential act for maintaining their existence. This study suggests the need to establish a delivery system, such as integrated case management through the Youth Future Center and strategic linkage with existing mental health voucher programs. It emphasizes tailored support measures to strengthen young caregivers' self-care capabilities.

In low- and middle-income countries (LMICs), close cohabitation with animals and limited access to water, sanitation, and hygiene (WASH) infrastructure increase the risk of zoonotic enteric pathogen transmission to young children. This mixed-methods study combined (A) microbiological analysis of 120 animal fecal samples, and (B) go-along, semi-structured interviews with 35 mothers of children under two years across urban (n = 10), intermediate (n = 15), and rural (n = 10) communities in Ecuador to investigate: (Q1) What zoonotic enteric pathogens are present in animal feces and at what concentrations? (Q2) How are children exposed to animals and their feces? and (Q3) Which animals may serve as key sources of child exposure? Microbiological analysis revealed high prevalence and concentrations of zoonotic pathogens, most commonly E. coli aEPEC (57%), Salmonella sp. (36%), and E. coli STEC (25%), with frequent co-infections (33%) and concentrations (4.97-9.29 log10 gc/g) often exceeding infectious dose thresholds. Qualitative findings showed risks from free-roaming animals, poor feces management, and frequent child-animal contact, often indirectly through caregivers and siblings. Triangulation identified chickens and dogs as the most likely potential exposure sources due to their behaviors, proximity to children, and pathogen carriage. These findings highlight the need for targeted interventions to limit animal roaming, improve animal feces management, and increase caregiver awareness, while underscoring how mixed-methods approaches can help identify context-specific exposure pathways that should be considered when designing interventions.

Background: Vitamin A supplementation coverage has been inconsistent, as only slightly more than half of children aged 6–59 months receive the supplement. This study aimed to assess the determinants of Uptake of Vitamin A supplements among children aged 6 to 59 months attending Kirumandagi Health Centre II, Luweero district. Methodology: A descriptive cross-sectional study design employing quantitative methods was used to collect data among caregivers of children aged 6 to 59 Months attending Kirumandagi Health Centre II. Data collection was done within a period of 4 days by a convenience sampling technique using researcher-administered questionnaires, and data were analyzed using the Microsoft Excel (2019) program. Findings were presented in the form of tables, graphs, and pie-charts. Results: Out of 40 participants: (62.5%) were aged between 29 and 39 years, and (50%) of the respondents had attained secondary education. With caregiver-related factors (50%), the respondents did not know the benefits of Vitamin A for children, (65%) family needs made it hard to take their children, (75%) forgot, and (50%) families did not support them in taking their children for Vitamin A supplementation. Health facility–related determinants showed that (62%) reported inadequate staffing level, (70%) Vitamin A supplements were not always available at the health Centre and (65%) stated that health workers did not explain during Vitamin A visits. Conclusion: Forgetfulness, poor family support, and limited awareness were major barriers to the uptake of Vitamin A supplements. Many caregivers lacked knowledge about the benefits of Vitamin A, and some had mixed beliefs about its importance. Recommendation: The health facility management should improve health worker communication by encouraging brief but effective health education during child health visits. They should conduct regular community sensitization sessions to improve caregiver knowledge and awareness.

Heat stroke (HS) is a life-threatening condition exacerbated by rising global temperatures, with children identified as a particularly vulnerable population. Despite this, basic research on age-related differences in thermotolerance remains limited. In this study, we established a high-temperature and high-humidity exposure model with real-time core body temperature (CBT) monitoring to investigate thermotolerance in young versus adult rats. The results showed that young rats exhibited prolonged CBT plateau phases and delayed HS onset, indicating enhanced thermotolerance compared to adult rats. This was accompanied by significantly milder multi-organ injury and reduced intestinal barrier damage. Young rats displayed lower serum levels of D-lactate and intestinal fatty acid-binding protein, better-preserved intestinal epithelial ultrastructure, and higher expression of tight junction proteins such as ZO-1, Occludin, and E-cadherin. Moreover, young rats showed elevated expression of heat shock proteins (HSP40 and HSP70) in intestinal tissues, which likely contributed to improved barrier integrity and cellular protection. These findings suggest that enhanced intestinal barrier stability and robust HSP responses underlie the superior thermotolerance observed in young rats. However, despite their physiological advantages, infants and young children often suffer poor HS outcomes due to behavioral limitations and caregiver negligence, especially in enclosed environments such as parked vehicles. This highlights the critical need for enhanced caregiver awareness, improved pediatric emergency response training, and preventive strategies to mitigate pediatric HS risk.

Background: Diarrhea, especially among the under-fives, is a matter of public health importance globally, given the annual morbidity and mortality it causes to this vulnerable age group. This study assessed awareness of caregivers towards home management of diarrhea among children under five years at Dr. Ronald Batta Memorial Hospital, Entebbe Municipality, Wakiso District. Methods: A cross-sectional descriptive study involving 30 respondents who were caregivers of children under five years who presented at the health facility for medical attention was recruited. A simple random sampling procedure was used to select the respondents, and a researcher-administered questionnaire was used for collecting data. Collected data was sorted, coded, entered into Epidata, and then exported to SPSS for analysis. The analysed data were presented in figures and tables reflecting frequencies and percentages. Results: The study involved 30 caregivers, the majority female (70%) and aged 20–30 years (57%). Most were married (67%) and had secondary education (67%), with half employed as casual workers. Regarding knowledge of diarrhea, 87% recognized predisposing factors, mainly contaminated food and water (69%). Only 43% had received information, primarily from media (46%) and health facilities (31%). All children had experienced diarrhea, but 57% were not managed at home; those managed received ORS (77%), zinc (77%), and fruits (69%). Caregivers largely knew to seek medical care when conditions worsened (67%) and identified hygiene and handwashing as preventive measures (80%). Treatment knowledge included herbal remedies (31.2%), anti-diarrheals (26.2%), and ORS (21.3%), yet 53% did not know ORS preparation, and 57% were unaware of administration frequency. Conclusion: The Majority of caregivers had inadequate knowledge of home management of diarrhea among children under five years. Recommendation: The government should support community sensitization programs on diarrheal infection and their home management among children under five years.

BackgroundDespite progress in childhood vaccination, many children in low- and middle-income countries, including Ethiopia, remain unvaccinated, presenting a significant public health challenge. The Immunization Agenda 2030 (IA2030) seeks to halve the number of unvaccinated children by identifying at-risk populations, but effective strategies are limited. This study leverages machine learning (ML) to identify Ethiopian children aged 12-35 months who are at higher risk of being zero dose (ZD). By analyzing demographic, socioeconomic, and health care access data, the study developed predictive models using different algorithms. The findings aim to inform targeted interventions, ultimately improving vaccination coverage and health outcomes.ObjectiveThis study aimed to develop an ML model to predict ZD children and to identify the most influential predictors of ZD in Ethiopia.MethodsWe examined how well the predictive algorithms can characterize a child at risk of being ZD based on predictor variables sourced from the recent National Immunization Evaluation Survey data. We applied supervised ML algorithms with the survey datasets, which included 13,666 children aged 12-35 months. Model performance was assessed using accuracy, area under the curve, precision, recall, and F1-score. We applied Shapley Additive analysis to identify the most important predictors.ResultsThe Light Gradient Boosting Machine (LGBM), Random Forest, Extreme Gradient Boosting (XGBoost), and AdaBoost classifiers effectively identified most ZD children as being at high risk. Among these, LGBM demonstrated the best performance, achieving an accuracy of 93%, an area under the curve of 97%, a precision of 94%, and a recall of 91%. The most significant features impacting the model included poor perception of vaccination benefits, lack of antenatal care utilization, distance from immunization services, and absence of maternal tetanus toxoid vaccinations.ConclusionsThe developed ML models effectively predict children at risk of being ZD, with the LGBM model showing the best performance. This model can guide targeted interventions to reduce ZD prevalence and address vaccination inequities. Key predictors include access to immunization sites, maternal health service utilization, and perceptions of immunization benefits. By focusing on these vulnerable groups, public health efforts can tackle disparities in vaccination coverage. Enhancing maternal care, raising caregiver awareness, and improving immunization access through outreach can significantly reduce the number of ZD children.