Cause Of Death In Children Research Articles

KARYOLOGICAL CHANGES OF BUCCAL EPITHELIOCYTES IN CHILDREN WITH ACUTE RESPIRATORY PATHOLOGY CAUSED BY SARS-COV-2

Pneumonia is one of the leading causes of death in children under 5 years of age in lowincome countries worldwide. This problem became especially acute with the onset ofthe new coronaviral infection caused by SARS-CoV-2. Community- acquired pneumoniais also one of the most common diseases in children, which requires extensive use ofantibiotics and admission to pediatric clinics. That is why diagnosis of the infectiousinflammatory process activity and prediction of the disease severity is the main factorin optimizing the treatment of children who suffer from infectious respiratory pathology.Objective – to improve the prediction of the severe course of acute respiratory pathologycaused by the SARS-CoV-2 virus by analyzing the results of kariological indicators ofexfoliative cells of the buccal epithelium in children of different ages. Materials and methods. 63 children with acute respiratory pathology caused by theSARS-CoV-2 virus (average age – 10.6±0.5 years) were comprehensively examinedby the method of simple random sampling using the «experiment- control» method.The verification of the etiological factor of inflammation of the respiratory tract wascarried out by the method of polymerase chain reaction with reverse transcriptase(a set of COVID-19 Multiplex RT-PCR in real time from Labsystems Diagnostics Oy) ina nasopharyngeal swab and/or lung expiratory tissue.Fixed smears- imprints of exfoliative cells of the buccal epithelium were stained with azureeosin according to Romanovsky- Giemsa. By light microscopy of cytological samples,changed cells with nuclear abnormalities were evaluated and the number of cells withmicronuclei and karyological indicators of exfoliative cells of the buccal epithelium per100 cells in the preparation were determined.Results.Pathological changes of buccal epithelium exfoliative cells as protrusion, karyopyknosis,karyorrhexis and apoptosis are directly proportional to the disease severity and reflect exclusivelytoxic effects. Identification of the morphological changes expressiveness in the buccal epitheliumcells can be used as a diagnostic factor in prediction of the severe disease, and accordingly,serves as an impetus in optimization of the conducted treatment strategy.Conclusions. A greater number of pathological cells in smears- imprints of the buccalepithelium, and, accordingly, slightly higher cytogenetic indices are determined in patientswith pneumonia and multisystem inflammatory syndrome associated with SARS-CoV-2, whohad a severe and extremely severe course of the disease. Significantly fewer pathologicallychanged cells are found in patients with acute respiratory tract infection of multiplelocalization and bronchitis, who mostly had a medium- severe course of the disease, whichcan be used to predict the severity of the infectious- inflammatory process in children.

Assessment of severity of community acquired pneumonia by paediatric infectious diseases society and clinical and radiological profile in 0-5 year age group

Background: The WHO estimates that ARI, mostly in the form of CAP, is the leading cause of death in children under five, killing over 2 million children annually. The present study's PEWS score and PIDS severity criteria were undertaken to know the clinical and radiological profile of patients with Pneumonia and to categorize these patients with PEWS score and PIDS criteria to redefine their severity and assess the management and outcomes. Methods: Patients aged between 0 to 5 years who presented with cough complaints and respiration difficulty were assessed. The criteria for ICU admission is the presence of more than 2 minor criteria or one of the major criteria. PIDS criteria for CAP recommends ICU admission or continuous monitoring for children in ED. Results: A prospective observational study of 104 children with CAP was included, and their pneumonia was evaluated using PIDS criteria. The patients were categorized for pneumonia according to PIDS criteria. 32.69% of children were classified as severe CAP (p value=0.02). This difference between non-severe and severe Pneumonia is considered to be statistically significant in which patients classified as severe CAP. Conclusions: The patients were categorized for Pneumonia according to PIDS criteria. 32.69% of children were classified as severe CAP (p value=0.02). This difference between non-severe and severe Pneumonia is considered to be statistically significant in which patients classified as severe CAP needed vigorous management in emergency department followed by ICU management.

Post-mortem investigation of deaths due to pneumonia in children aged 1–59 months in sub-Saharan Africa and South Asia from 2016 to 2022: an observational study

The Child Health and Mortality Prevention Surveillance (CHAMPS) Network programme undertakes post-mortem minimally invasive tissue sampling (MITS), together with collection of ante-mortem clinical information, to investigate causes of childhood deaths across multiple countries. We aimed to evaluate the overall contribution of pneumonia in the causal pathway to death and the causative pathogens of fatal pneumonia in children aged 1-59 months enrolled in the CHAMPS Network. In this observational study we analysed deaths occurring between Dec 16, 2016, and Dec 31, 2022, in the CHAMPS Network across six countries in sub-Saharan Africa (Ethiopia, Kenya, Mali, Mozambique, Sierra Leone, and South Africa) and one in South Asia (Bangladesh). A standardised approach of MITS was undertaken on decedents within 24-72 h of death. Diagnostic tests included blood culture, multi-organism targeted nucleic acid amplifications tests (NAATs) of blood and lung tissue, and histopathology examination of various organ tissue samples. An interdisciplinary expert panel at each site reviewed case data to attribute the cause of death and pathogenesis thereof on the basis of WHO-recommended reporting standards. Pneumonia was attributed in the causal pathway of death in 455 (40·6%) of 1120 decedents, with a median age at death of 9 (IQR 4-19) months. Causative pathogens were identified in 377 (82·9%) of 455 pneumonia deaths, and multiple pathogens were implicated in 218 (57·8%) of 377 deaths. 306 (67·3%) of 455 deaths occurred in the community or within 72 h of hospital admission (presumed to be community-acquired pneumonia), with the leading bacterial pathogens being Streptococcus pneumoniae (108 [35·3%]), Klebsiella pneumoniae (78 [25·5%]), and non-typeable Haemophilus influenzae (37 [12·1%]). 149 (32·7%) deaths occurred 72 h or more after hospital admission (presumed to be hospital-acquired pneumonia), with the most common pathogens being K pneumoniae (64 [43·0%]), Acinetobacter baumannii (19 [12·8%]), S pneumoniae (15 [10·1%]), and Pseudomonas aeruginosa (15 [10·1%]). Overall, viruses were implicated in 145 (31·9%) of 455 pneumonia-related deaths, including 54 (11·9%) of 455 attributed to cytomegalovirus and 29 (6·4%) of 455 attributed to respiratory syncytial virus. Pneumonia contributed to 40·6% of all childhood deaths in this analysis. The use of post-mortem MITS enabled biological ascertainment of the cause of death in the majority (82·9%) of childhood deaths attributed to pneumonia, with more than one pathogen being commonly implicated in the same case. The prominent role of K pneumoniae, non-typable H influenzae, and S pneumoniae highlight the need to review empirical management guidelines for management of very severe pneumonia in low-income and middle-income settings, and the need for research into new or improved vaccines against these pathogens. Bill & Melinda Gates Foundation.

Child opportunity index is associated with pediatric firearm injury in Philadelphia, Pennsylvania.

Firearm injury is the leading cause of death in children. This study uses geospatial mapping to illustrate the burden of pediatric firearm injury in Philadelphia and assesses the relationship between Child Opportunity Index (COI) and injury, hypothesizing that lower COI zip codes would have higher injury and mortality rates. Pediatric firearm injury data for children aged 0-19 years in Philadelphia, from 2015 to February 2023, was visualized by race/ethnicity, fatal versus non-fatal status, and COI for zip code. COI was then dichotomized as "High" or "Low" based on nationally normed scores and used to compare incidence and odds of mortality. Injury incidence rates by COI were calculated using weighted Poisson regression, to adjust for the total number of children in each COI category. Odds of mortality by COI, adjusted for age, sex and race/ethnicity, were calculated using multivariable logistic regression. Of 2,339 total pediatric firearm injuries, 366 (16%) were fatal. Males (89%), adolescents (95%) and Black children (88%) were predominately affected. Geospatial mapping showed highest burden in North and West Philadelphia, which corresponded with areas of low COI. The incidence rate ratio (IRR) of injury in low COI zip codes was 2.5 times greater than high COI (IRR 2.5 [1.93-3.22]; p < 0.01). After adjusting for age, sex, and race/ethnicity, odds of mortality in low COI zip codes was nearly twice that of high COI zip codes (aOR 1.95 [0.77-4.92]), though did not demonstrate statistical significance (p = 0.16). Child opportunity index is associated with pediatric firearm injury in Philadelphia, Pennsylvania.

Infant diarrheal disease in rhesus macaques impedes microbiome maturation and is linked to uncultured Campylobacter species

Diarrheal diseases remain one of the leading causes of death for children under 5 globally, disproportionately impacting those living in low- and middle-income countries (LMIC). Campylobacter spp., a zoonotic pathogen, is one of the leading causes of food-borne infection in humans. Yet to be cultured Campylobacter spp. contribute to the total burden in diarrheal disease in children living in LMIC thus hampering interventions. We performed microbiome profiling and metagenomic genome assembly on samples collected from over 100 infant rhesus macaques longitudinally and during cases of clinical diarrhea within the first year of life. Acute diarrhea was associated with long-lasting taxonomic and functional shifts of the infant gut microbiome indicative of microbiome immaturity. We constructed 36 Campylobacter metagenomic assembled genomes (MAGs), many of which fell within 4 yet to be cultured species. Finally, we compared the uncultured Campylobacter MAGs assembled from infant macaques with publicly available human metagenomes to show that these uncultured species are also found in human fecal samples from LMIC. These data highlight the importance of unculturable Campylobacter spp. as an important target for reducing disease burden in LMIC children.

Knowledge and Practices of Home Diarrhoea Management among Adolescent Mothers with under Five Children in Nyando SubCounty, Kisumu, Kenya

Background: Globally, diarrhea is the primary cause of death for children under the age of five. In Kenya, it continues to be a significant source of illness and mortality in this age range. Mothers play crucial roles in the prevention and control of diarrhea among these children by practicing easy home management. Aim: This study aimed to assess adolescent mothers’ knowledge, and practice in the prevention and home management of diarrhoeal diseases among children under five years old in Nyando sub-county, Kenya Setting: This study was conducted in Nyando sub-county, Kisumu County, Kenya. Methods: A mixed method descriptive cross-sectional study design was conducted using a Proportionate sampling technique. Data were collected using a structured interviewer-administered questionnaire and interview guides and analysed using STATA version 16 to generate the tables and bar graphs. NVivo version 12 was used to analyse the qualitative data adopting thematic analysis approach. Results: Boiling of drinking water was a common practice as reported by majority (75.8%, n= 216) of the participants. A total of 94 mothers (33.0%) expressed knowledge of exclusive breastfeeding while 10.5% (n=30) indicated maintenance of cleanliness as methods. These adolescent mothers practiced continued feeding and breastfeeding during diarrhoea episodes. In addition, the use suboptimal diarrhoea management practices such as food restriction and use of traditional herbs was practiced among the study participants. Conclusion: Continued feeding and breastfeeding during diarrhoea episodes were identified as appropriate management practices and were significant in preventing dehydration as well as increased vulnerability to malnutrition. There is also need of creating awareness of other diarrhoea management practices such as the use of banana and yoghurt as well as demystifying the use of traditional herbs in diarrhoea management.

Program eliminacije morbila u Evropi

The use of a safe and effective measles vaccine in national immunization programs has resulted in a reduction in the number of deaths from the disease, although measles remains one of the leading causes of death in children under 5 years of age in underdeveloped and developing countries. After the successful eradication of smallpox, as well as the results achieved in the eradication of poliomyelitis at the global level, the process of measles elimination was initiated using the previously known strategies. In both American regions of the World Health Organization (WHO), the elimination of measles has been successfully verified, while in the WHO European Region, up to 2020, elimination has been verified in 29 out of 53 countries. The main challenges in the process of measles elimination are reaching and maintaining high immunization coverage, reaching and maintaining the values of surveillance indicators, implementing additional immunization of unvaccinated and incompletely vaccinated persons, solving serious problems such as the occurrence of measles epidemics in vulnerable groups, endemic maintenance of the disease, re-establishment virus transmission, determination of chains of transmission, genotyping of agents, impact of measures to control the COVID-19 pandemic. Bearing in mind the mentioned problems, the WHO has decided to postpone the elimination of measles in the WHO European Region to the year 2030.

A Call to Arms: On Complacency in Times of a Public Health Crisis

Gun violence is the leading cause of death in children under the age of 17, yet it is free of public health regulations because of the American public and political divide on gun control rights. However, this lack of regulations amount for almost 50,000 preventable deaths annually. This commentary urges public health officials, research intuitions, and medical practitioners to recognize gun violence as a public health crisis and call for regulations, research funding, and patient and provider education resources.

Анализ изменений структуры насильственной смерти детей и подростков в Саратовской области за период 2018–2022 гг.

Abstract. The analysis of violent child mortality is important in developing preventive measures to reduce this indicator. Aims and Tasks. The research purpose is to analyze the structure of violent death among children in the Saratov Region in 2018–2022. Materials and Methods. The research materials include the results of forensic medical examinations of the corpses of 314 children under the age of 18 who died from external causes. Results/Discussion. We establish decrease in the rate of violent death among children from 17.7 to 12.2 per 100 thousand of the population. There is a prevalence of blunt trauma (35.7 %), asphyxia (34.7 %) and poisoning (22 %) in violent death causes among children. The dynamics showed a tendency towards an increase in the proportion of blunt trauma. We note the peak of deaths from asphyxia in 2020 (45.8 %), reveal an increase in the proportion of hangings. Asphyxia is the leading cause of death in children under 1 year old, asphyxia and blunt trauma with a high percentage of falls from high altitude (40 %) – in the 1–3 year old group. In the 4–6 years old group the main types of death are blunt trauma (38.6 %) and poisoning (36.4 %). In the 7–11 years old group asphyxia is in the lead (40.4 %), followed by blunt trauma (36.5 %) with a high percentage of traffic accidents. In 12–17 years old group blunt trauma is in the first place (38.5 %), asphyxia with a predominance of hangings is in the second place. Conclusions. As we note a decrease in the violent death of children in general, we establish a tendency of increasing the proportion of blunt trauma and a change in the structure of asphyxia with a significant increase in the proportion of hangings. Differences in the structure of causes of death in different age groups were revealed.

Acute Diarrhea in Children

Background: Acute diarrhea is the most frequent gastrointestinal disorder and the main cause of dehydration in childhood. Diarrhoea is the fifth leading cause of death in children under the age of five years and rotavirus is the leading aetiology in this age group. Six risk factors (childhood wasting, unsafe water, oral rehydration, unsafe sanitation, handwashing, and therapeutic zinc) can cause diarrhea death in sub-Saharan Africa. Case: a 7-month-old baby came to the hospital complaining of fever and diarrhea one day before. The patient was hospitalized because the baby’s condition required observation. 16 days after hospitalization, the patient came back with complaints of diarrhea that had persisted for more than 2 weeks. Conclusion: Diarrhea in children requires special attention because even though it sounds trivial, if it is not handled properly it can cause serious problems, even death.

Respiratory Syncytial Virus-related Lower Respiratory Tract Infections in Neonatal and Post-neonatal Babies: A Series of Four Cases

Respiratory Syncytial Virus (RSV) is a highly contagious seasonal virus that is the leading cause of acute Lower Respiratory Tract Infections (LRTI) in the paediatric age group and is one of the leading causes of death in children under five in developing countries. There is evidence that severe RSV infection and hospitalisation in early life increase the risk of recurrent wheezing, childhood asthma, and allergic sensitisation. Even though RSV being a major global health concern, very few papers concentrate on the neonatal period in India. The present case series presents four cases (three females and one male baby) highlighting the impact of RSV in neonatal and post-neonatal infants in India. The cases highlight the diversity of presentation; one infant required prolonged High-flow Nasal Cannula (HFNC) support, while two needed just symptomatic care. The importance of Polymerase Chain Reaction (PCR) in resource-constrained situations is highlighted as diagnostic issues are examined. Treatment focuses on supportive care; oxygen and respiratory support are provided in more severe cases. The present study emphasises the need for early detection and preventative measures, such as using novel treatments like nirsevimab. The present case series advocates for focused therapies and additional research in the Indian paediatric environment, adding insightful perspectives to the expanding body of knowledge on RSV.

Automated Cough Sound Analysis for Detecting Childhood Pneumonia.

Pneumonia is one of the leading causes of death in children. Prompt diagnosis and treatment can help prevent these deaths, particularly in resource poor regions where deaths due to pneumonia are highest. Clinical symptom-based screening of childhood pneumonia yields excessive false positives, highlighting the necessity for additional rapid diagnostic tests. Cough is a prevalent symptom of acute respiratory illnesses and the sound of a cough can indicate the underlying pathological changes resulting from respiratory infections. In this study, we propose a fully automated approach to evaluate cough sounds to distinguish pneumonia from other acute respiratory diseases in children. The proposed method involves cough sound denoising, cough sound segmentation, and cough sound classification. The denoising algorithm utilizes multi-conditional spectral mapping with a multilayer perceptron network while the segmentation algorithm detects cough sounds directly from the denoised audio waveform. From the segmented cough signal, we extract various handcrafted features and feature embeddings from a pretrained deep learning network. A multilayer perceptron is trained on the combined feature set for detecting pneumonia. The method we propose is evaluated using a dataset comprising cough sounds from 173 children diagnosed with either pneumonia or other acute respiratory diseases. On average, the denoising algorithm improved the signal-to-noise ratio by 44%. Furthermore, a sensitivity and specificity of 91% and 86%, respectively, is achieved in cough segmentation and 82% and 71%, respectively, in detecting childhood pneumonia using cough sounds alone. This demonstrates its potential as a rapid diagnostic tool, such as using smartphone technology.

The longitudinal effect of disseminating handwashing public health education to children in India via co-created, culturally relevant resources.

Infectious diseases are a leading cause of death for children from low- and middle-income countries (LMICs), often due to inadequate hand-hygiene. This study evaluates culturally relevant educational resources as a vehicle to disseminate the importance of handwashing amongst children in India. Employing a participatory action research (PAR) model and mixed methods, this follow-up longitudinal study evaluates a set of innovate educational handwashing resources and workshops specifically co-created for use in the State of Gujarat, and how they aid teachers in the teaching of hand-hygiene over a 3 year period. Working alongside local NGOs on-the-ground, teacher questionnaires (n=58) and focus groups including a brief questionnaire with teachers (n=35) were conducted to assess the impact of trainer workshops. In addition, pre- and post-workshop worksheets were conducted with children (n=98). Percentage change was calculated between children's pre-and post-worksheet scores and a cumulative frequency of responses to each questionnaire criterion was measured. Data from the focus group found that the resources had been used in over 200 schools by more than 5000 children. In addition, 92.28 % of teachers said they would use the resources within their classrooms in India, with 58.16 % of pupils having an increased understanding of germs/handwashing directly after the workshop. Teachers reported that they are able to teach microbiology and handwashing more effectively. Furthermore, following a focus group, 100 % of teachers noted a reduction in childhood vomiting and diarrhoeal illnesses linked with insufficient hand-hygiene across 46 schools in the State of Gujarat since using the Germ's Journey resources.

Respiratory Syncytial Virus: Transmission and Treatment

Respiratory Syncytial Virus (RSV), a respiratory tract infection-causing virus with a global distribution and seasonal occurrence, is the second leading cause of death in children under one year old, after malaria. The Respiratory Syncytial virus is an enveloped negative-strand RNA virus from the Paramyxoviridae family primarily transmitted by droplets of a cough or sneeze. However, kisses between infected and healthy individuals can also rapidly spread the virus, especially among children. Typically, the virus causes symptoms such as coughing, sneezing, or a fever making it visibly like other infections or conditions. Young children may have apnea and overall be irritable. Confirmation of RSV diagnosis can be done through available RSV-card tests or through RT-PCR tests. Though there is no standard treatment for RSV infection, drugs such as Ribavirin and Synagis (Palivizumab) are currently used for managing symptoms of RSV infection in areas that have access to such medications. Palivizumab is used to treat prophylaxis, the prevention of serious lower respiratory tract disease brought on by RSV in children at high risk of RSV disease, is the greatest preventative approach. Numerous clinical studies are being conducted right now to treat and prevent RSV infection. Most of the study focuses on children below the age of 5 years because they are the most vulnerable, but there is also research on the prevalence of RSV in older adults and the effects of maternal vaccination on infants through the antibodies made to fight against RSV infection. G protein, F protein, and SH protein are three crucial membrane proteins that make up the RSV structure. A vaccine containing both the F and G RSV proteins would offer more protection against RSV. The F and G protein stimulates antibody formation, which neutralizes the virus. The RSV treatment plans and vaccine trials within India, South Africa, the United States of America, and the United Kingdom show similarities and differences that could be utilized to develop a treatment plan for RSV. In the upcoming years, further research is required to produce a cheaper alternative that is accessible to all countries. This will help to establish a set, effective protocol for RSV to be used worldwide.

Detection of human bocavirus (HBoV) in children with acute respiratory infection (ARI) during the covid-19 transition period

Acute respiratory infections (ARIs) are the highest cause of death in children in the world. Based on the 2018 Riset Kesehatan Dasar Nasional, ARI cases in Indonesia showed a prevalence of 4.4%, with the highest cases occurring in children. One of the new viruses first identified in 2005 in human nasopharyngeal samples is the human bocavirus (HBoV). HBoV is a single-strand DNA virus belonging to the Parvoviridae family. This study aimed to assess the prevalence of HBoV in children presenting with ARI during the transitional period of the Covid-19 era. HBoV detection was conducted using multiplex PCR and reverse hybridization methods on nasopharyngeal and oropharyngeal swab samples collected from symptomatic children. This study reported a prevalence rate of 4.94% for HBoV in 2022 and 5.04% in 2023. Furthermore, the study identified favorable detection rates for HBoV in children with ARIs as 14.81% in 2022 and 8.45% in 2023. These rates ranked 2nd and 5th highest among other pathogens detected in ARIs. Additionally, there was an increase in positive HBoV samples from 4 samples in 2022 to 6 samples in 2023, which was attributed to the relaxation of nonpharmaceutical Covid-19 interventions by mid-2022. HBoV was identified at a significant rate among children with ARI in Jakarta during the transitional phase of the Covid-19 era (2022-2023). Given its potential to induce severe ARI, HBoV necessitates heightened attention as an etiological agent.

Analysis of Knowledge and Attitudes of Mothers with Toddlers at Risk of Diarrhea in the Moramo Health Center Working Area South Konawe Regency

Background: The incidence of diarrhea in Indonesia is the second leading cause of death in children under 5 (five) years of age. Data on the number of cases of diarrhea in children in 15 districts and 2 (two) cities in Southeast Sulawesi Province. South Konawe Regency is in second place with the most cases of diarrhea in toddlers, totaling 77 cases. South Konawe Regency has 24 Community Health Center working areas. In the Moramo Community Health Center area, there were 41 cases of diarrhea in 2021.&#x0D; Method: The type of research used in this research is quantitative with an observational method with a Case Control Study Design approach. This research was carried out in August 2022. This research will be carried out in the Moramo Health Center Work Area, South Konawe Regency, Southeast Sulawesi Province. With a sample of 76 respondents. The sampling technique used in this research was Simple Random Sampling.&#x0D; Result: The results of the research are known from the results of the analysis X2Hit 15.221 &gt; Hit 10,344&gt; df=1), ϕ = 0.504.&#x0D; Conclusion: It is hoped that parents, especially mothers who have toddlers, can increase their knowledge about the causes of diarrhea, improve their attitudes to avoid diarrheal disease, especially in toddlers.

Environmental Determinants to Pneumonia among Toddler in Depok City in 2013-2022

ABSTRACT Pneumonia is inflammation of the lung which is the main cause of child death in the world, including in Indonesia. Pneumonia may be triggered by host and environmental factors. To date, a few studies have examined the relationship between toddler characteristics, environmental, and demographic factors with the incidence of toddler pneumonia, with inconsistent results. Therefore, we aimed to determine the relationship between the coverage of exclusive breastfeeding, LBW, healthy house, and population density to pneumonia among toddlers in Depok City in 2013-2022. The data such as Incidence of pneumonia, coverage of exclusive breastfeeding, coverage of LBW, coverage of healthy house, and population density were obtained from Depok City Government. The data is secondary data from 2013-2022. The study design used was an ecological study design and the population was all toddlers diagnosed with pneumonia in Depok City. The coverage of pneumonia cases found in toddlers in Depok City has increased in 2022 to reach 55.28%. Our results demonstrated a significant relationship between the coverage of exclusive breastfeeding (p=0.000, r=-0.497), the coverage of LBW (p=0.011, r=0.242), and the coverage of healthy house (p=0.026, r=0.212). While the population density did not show a significant relationship with the incidence of pneumonia (p=0.099, r=0.158). Exclusive breastfeeding, LBW, healthy house are the underlying relationship for pneumonia among toddlers in Depok City. The results indicate to be an input for planning pneumonia prevention and control programs in Depok City in the future. Keywords: Exclusive Breastfeeding, Healthy House, Low Birth Weight, Population Density, Toddler’s Pneumonia

Incidence and pattern of childhood cancer in Addis Ababa, Ethiopia (2012–2017)

BackgroundCancer is becoming a major public health problem globally and a leading cause of death in children in developed countries. However, little is known about the epidemiology of childhood cancer in Ethiopia. This study, therefore, assessed childhood cancer incidence patterns in Addis Ababa using the Addis Ababa city population-based cancer registry data from 2012 to 2017.MethodsInvasive cancer cases diagnosed in ages 0–14 years from 2012 to 2017 were obtained from the Addis Ababa City population-based Cancer Registry. Cases were grouped according to the International Classification of Childhood Cancer, 3rd edition (ICCC-3) based on morphology and primary anatomic site. Age-standardized incidence rates (ASR) were calculated by the direct method using the world standard population.ResultsThe overall average annual incidence rate during 2012–2017 in children was 84.6 cases per million, with rates higher in boys (98.97 per million) than in girls (69.7 per million). By age, incidence rates per million increased from 70.8 cases in ages 0–4 years to 88.4 cases in ages 5–9 years to 110.0 cases 10–14 years. Leukaemia was the most common childhood cancer in both boys (29.1%) and girls (26.8%), followed by lymphoma in boys (24.7%) and renal tumours (13.1%) in girls. The overall cancer incidence rate decreased from 87.02 per million in 2012 to 51.07 per million in 2017.ConclusionThe burden of childhood cancer is considerably high in Addis Ababa. The observed distribution of childhood cancer in Addis Ababa differs from other African countries. This study highlights the need for further research and understanding of the variations in cancer patterns and risk factors across the region.

Validation of CHERG'S Verbal Autopsy-Social Autopsy (VASA) tool for ascertaining determinants and causes of under-five child mortality in Pakistan.

The majority (40%) of the world's under-five mortality burden is concentrated in nations like Nigeria (16.5%), India (16%), Pakistan (8%), and the Democratic Republic of the Congo (6%), where an undetermined number of under-five deaths go unrecorded. In low-resource settings throughout the world, the Verbal Autopsy-Social Autopsy (VASA) technique may assist assess under-five mortality estimates, assigning medical and social causes of death, and identifying relevant determinants. Uncertainty regarding missing data in high-burden nations like Pakistan necessitates a valid and reliable VASA instrument. This is the first study to validate Child Health Epidemiology Reference Group-CHERG's VASA tool globally. In Pakistan, data from such a valid and reliable tool is vital for policy. This paper reports on the VASA tool in Karachi, Pakistan. Validity and reliability of the CHERG VASA tool were tested using face, content, discriminant validation, and reliability tests on one hundred randomly selected mothers who had recently experienced an under-five child death event. Data were computed on SPSS (version-21) and R software. Testing revealed high Item-content Validity Index (I-CVI) (>81.43%); high Cronbach's Alpha (0.843); the accuracy of between 75-100% of the discriminants classifying births to live and stillbirths; and I-CVI (>82.07% and 88.98% respectively) with high accuracy (92% and 97% respectively) for assigning biological and social causes of child deaths, respectively. The CHERG VASA questionnaire was found relevant to the conceptual framework and valid in Pakistan. This valid tool can assign accurate medical and non-medical causes of child mortality cases occurring in Pakistan.

A multicenter evaluation of pediatric emergency department injury visits during the COVID-19 pandemic

BackgroundInjuries, the leading cause of death in children 1–17 years old, are often preventable. Injury patterns are impacted by changes in the child’s environment, shifts in supervision, and caregiver stressors. The objective of this study was to evaluate the incidence and proportion of injuries, mechanisms, and severity seen in Pediatric Emergency Departments (PEDs) during the COVID-19 pandemic.MethodsThis multicenter, cross-sectional study from January 2019 through December 2020 examined visits to 40 PEDs for children < 18 years old. Injury was defined by at least one International Classification of Disease-10th revision (ICD-10) code for bodily injury (S00–T78). The main study outcomes were total and proportion of PED injury-related visits compared to all visits in March through December 2020 and to the same months in 2019. Weekly injury visits as a percentage of total PED visits were calculated for all weeks between January 2019 and December 2020.ResultsThe study included 741,418 PED visits for injuries pre-COVID-19 pandemic (2019) and during the COVID-19 pandemic (2020). Overall PED visits from all causes decreased 27.4% in March to December 2020 compared to the same time frame in 2019; however, the proportion of injury-related PED visits in 2020 increased by 37.7%. In 2020, injured children were younger (median age 6.31 years vs 7.31 in 2019), more commonly White (54% vs 50%, p < 0.001), non-Hispanic (72% vs 69%, p < 0.001) and had private insurance (35% vs 32%, p < 0.001). Injury hospitalizations increased 2.2% (p < 0.001) and deaths increased 0.03% (p < 0.001) in 2020 compared to 2019. Mean injury severity score increased (2.2 to 2.4, p < 0.001) between 2019 and 2020. Injuries declined for struck by/against (− 4.9%) and overexertion (− 1.2%) mechanisms. Injuries proportionally increased for pedal cycles (2.8%), cut/pierce (1.5%), motor vehicle occupant (0.9%), other transportation (0.6%), fire/burn (0.5%) and firearms (0.3%) compared to all injuries in 2020 versus 2019.ConclusionsThe proportion of PED injury-related visits in March through December 2020 increased compared to the same months in 2019. Racial and payor differences were noted. Mechanisms of injury seen in the PED during 2020 changed compared to 2019, and this can inform injury prevention initiatives.