Cent CI Research Articles

Tenecteplase versus Alteplase in Acute Ischemic Stroke: A Systematic Review and Meta-analysis.

A number of clinical trials have compared tenecteplase (TNK) and alteplase for the management of acute ischemic stroke (AIS) and the results are inconsistent. Present systematic review and meta-analysis is undertaken to analyse the efficacy and safety of TNK in AIS compared to alteplase. A thorough literature search was performed through the databases Embase, Cochrane Library, PubMed, and clinicaltrials.gov, for a period from inception to September 2022, with the keywords i.e., "tenecteplase" and "alteplase" and "acute ischemic stroke." Clinical trials published in English that compared the efficacy and safety of TNK to alteplase in AIS were included. The major outcomes of this meta-analysis were proportion of patients free from disability and functional independence at 90 days, early neurological improvement at 24 hours, all-cause mortality at 90 days, patients with intra cranial hemorrhage (ICH), and patients with severe disability at 90 days. A total of nine studies with 3,573 patients were included in the analysis. The proportion of patients with freedom from disability was comparable in both groups (relative risk [RR] = 1.04, 95 per cent CI = 0.92-1.17; p = .53). Similarly, proportion of patients with functional independence was comparable (RR = 1.12, 95 per cent CI = 0.96-1.31; p = .14). TNK group had a higher rate of early neurological recovery (RR = 1.56, 95 per cent CI = 0.96-2.54; p = .07). All-cause mortality at 90 days was comparable in both groups (RR = 0.97; 95 per cent CI = 0.72-1.29; p = .82). The proportion of patients with ICH was higher in TNK group (RR = 1.14, 95 per cent CI = 0.77-1.68; p = .52). The proportion of patients with severe disability was less in TNK group (RR =0.84, 95 per cent CI = 0.53-1.32; p = .44). TNK was similar to alteplase in terms of efficacy and safety. The patients in TNK group showed early neurological improvement but were simultaneously at higher risk of ICH. The TNK can be an alternative to alteplase if the benefits outweigh the risks.

Assessment of tympanic membrane perforation size using ImageJ software by ENT clinicians of different grades.

To compare visual estimation versus ImageJ calculation of tympanic membrane perforation size in the paediatric population between clinicians of different experience. Five images of tympanic membrane perforations in children, captured using an otoendoscope, were selected. The gold standard was the ImageJ results by one consultant otologist. Consultants, registrars and Senior House Officers or equivalent were asked to visually estimate and calculate the perforation size using ImageJ software. The mean difference in variation from gold standard between visual estimation and ImageJ calculation was 12.16 per cent, 95 per cent CI (10.55, 13.78) p < 0.05, with ImageJ providing a more accurate estimation of perforation. Registrars were significantly more accurate at visual estimation than senior house officers. There was no statistically significant difference in ImageJ results between the different grades. Using ImageJ software is more accurate at estimating tympanic membrane perforation size than visual assessment for all ENT clinicians regardless of experience.

University Students’ Internet Addiction and the Relationship Between Online Gaming and Family Function in Karachi, Pakistan

Internet addiction in the student population is a chronic social issue in Pakistan. Parental supervision is required to counter the issue. This study identifies an association between online gaming disorder and family functions by studying university students in Karachi, Pakistan. It is a cross-sectional study and 350 university students were selected through a multi-stage stratified sampling technique. A validated and structured questionnaire assessed family functioning and internet addiction. Data was analyzed using a multivariate logistic regression to identify associations between family function and online gaming disorders. In total, 66 per cent of students were found to be addicted to videogames and 39 per cent of students were deficient in their role in the family. The decreased problem solving skills (Adjusted Odd Ratio AOR 2.02, 95 per cent CI 1.35-5.96, p-value 0.002), decreased roles in the family (AOR 2.99, 95 per cent CI 1.23-5.75, p-value 0.004) and bad communication skills (AOR 0.91, 95 per cent CI 0.59-2.94, p-value 0.567) were associated with severe online gaming disorder. This study reveals a strong association between disrupted family functions and internet addiction and provides new evidence on the complex interaction between individuals and interpersonal risk factors involved in addiction among young adults. Keywords: Games, Family, Internet Addiction, Students, University

P196 Major variance in scoring of endoscopic recurrence after ileocolic resection for Crohns Disease – a systematic review and meta-analysis

Abstract Background Adequate scoring of endoscopic recurrence in Crohn’s disease patients is of utmost importance, as it is used to diagnose recurrent disease, to predict disease outcomes, to (re-)initiate or change therapy and to monitor its effect. This study aims to assess the variance in endoscopic recurrence in patients after ileocolic resection for Crohn's disease using the most common classification systems, the Rutgeerts (RS) and modified Rutgeerts (mRS) classification. Methods A systematic literature search using MEDLINE, Embase and the Cochrane Library was performed. All RCTs and cohort studies describing endoscopic recurrence after an ileocolic resection for Crohn's disease were included. Main outcome was the range of endoscopic recurrence rates within twelve months postoperatively, defined as RS≥i2 and/or mRS≥i2b. A proportional meta-analysis was performed. Results Seventy-six studies comprising 7751 patients were included. The weighted mean of the endoscopic recurrence rates, defined as either RS≥i2 and/or mRS≥i2b, was 43.99% (95 per cent CI 43.56 – 44.43), ranging from 5.0% – 93.0%, fig 1. For studies reporting endoscopic recurrence defined as ≥i2 and for studies reporting recurrence defined as ≥i2b the weighted means were 44.0% (range 5.0% – 93.0%) and 41.1% (range 19.8% – 62.9%) respectively. Within studies reporting both RS and mRS the weighted means for endoscopic recurrence were 61.3% (range 39.1% – 84.7%) and 40.6% (range 19.8% – 62.0%) respectively. Conclusion This study demonstrates a major variance in scoring endoscopic recurrence after ileocolic resection for Crohn's disease, with the greatest variance when using the original Rutgeerts classification. This suggests a high likelihood of inadequate diagnosis of disease recurrence, with major implications for quality of life and health care consumption. Therefore, there is an important need to improve endoscopic scoring of recurrent disease.

The impact of hospital volume on survival in patients with locally advanced colonic cancer.

High hospital volume has been shown associated with improved survival in patients with several cancers. The aim of this nationwide cohort study was to investigate whether hospital volume affects survival in patients with locally advanced colonic cancer. All patients with non-metastatic locally advanced colonic cancer diagnosed between 2007 and 2017 in Sweden were included. Tertiles of annual hospital volume of locally advanced colonic cancer were analysed and 5-year overall and colonic cancer-specific survival were calculated with the Kaplan-Meier method. HRs comparing all-cause and colonic cancer-specific mortality rates were estimated using Cox models adjusted for potential confounders (age, sex, year of diagnosis, co-morbidity, elective/emergency resection, and university hospital) and mediators (preoperative multidisciplinary team assessment, neoadjuvant chemotherapy, radical resection, and surgical experience). A total of 5241 patients were included with a mean follow-up of 2.7-2.8 years for low- and high-volume hospitals. The number of patients older than 79 years were 569 (32.3 per cent), 495 (29.9 per cent), and 482 (26.4 per cent) for low-, medium- and high-volume hospitals respectively. The 3-year overall survival was 68 per cent, 60 per cent and 58 per cent for high-, medium- and low-volume hospitals, respectively (P < 0.001 from log rank test). High volume hospitals were associated with reduced all-cause and colon cancer-specific mortality after adjustments for potential confounders (HR 0.76, 95 per cent CI 0.62 to 0.93 and HR 0.73, 95 per cent CI 0.59 to 0.91, respectively). The effect remained after inclusion of potential mediators. High hospital volume is associated with reduced mortality in patients with locally advanced colonic cancer.

Effects produced by the facemask with and without skeletal anchorage for the orthopaedic treatment of Class III malocclusion in growing patients: a systematic review and meta-analysis of RCTs.

Skeletally anchored facemask has been proposed to maximize skeletal effects and minimize dental effects in the treatment of Class III malocclusion in growing patients. To compare the dento-skeletal effects produced by the facemask with or without skeletal anchorage for the treatment of Class III malocclusion in growing patients. PubMed, Cochrane Library, Scopus, Embase, Web of Science, and OpenGrey were used for the electronic search without language, publication status, and year restrictions. Only RCTs were included. Inclusion criteria were: growing patients (age under 18 years) with Class III malocclusion, with indications for treatment with the facemask. Data were extracted by two independent reviewers. GRADE statement was executed. The mean of differences (MD) and the risk ratio (RR) were used. Three articles with a total of 123 patients were included. One article was at low risk of bias while two were at high risk of bias. There were no significant differences between the two groups in ANB angle, Wits appraisal, SNB angle, and SN-MP angle. SNA angle was significantly increased in the skeletally anchored facemask (pooled MD = 0.80 favouring skeletal anchorage, 95% CI from 0.29 to 1.31, P = 0.002, I2 = 12 per cent, three studies, GRADE moderate). The U1-SN angle was significantly reduced in the skeletally anchored facemask (pooled MD = -5.91 favouring skeletal anchorage, 95% CI from -7.64 to -4.27, P < 0.00001, I2 = 0 per cent, two studies, GRADE moderate). There were significantly less complications in tooth-anchored facemask (pooled RR = 7.98 favouring dental anchorage, 95 per cent CI from 1.04 to 61.27, P = 0.05, I2 = 0 per cent, two studies, GRADE low). Few RCTs (three) were included, and two studies were at high risk of bias. There were no long-term RCTs comparing skeletally anchored facemask with dental-anchored facemask. Only Asiatic patients were included in this systematic review. Skeletally anchored facemask was associated to a greater increase of SNA angle at the end of treatment though clinically not significant. Facemask with skeletal anchorage determined a reduced inclination of maxillary incisors compared to dental-anchored facemask with greater risks of complications. PROSPERO register (CRD42020221982).

Factors Associated with Preventive Care Utilisation among Chinese Older Adults: Evidence from the 2018 Chinese Longitudinal Healthy Longevity Survey

This research examined the sociodemographic factors associated with preventive care utilisation among Chinese older adults. Using the latest 2018 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), preventive care utilisation was defined as an annual physical examination. In the final study sample, approximately 69 per cent of the older adults had a physical examination annually. Older adults who had received a high level of formal education (eleven years or above) were more likely to use preventive care (all p &lt; 0.01). Participants with a rural social health scheme and residing in rural areas were also more likely to use preventive care (all p &lt; 0.05). For the interaction effect, rural older adults who could not afford healthcare expenses were less likely to use preventive care (AOR = 0.37, 95 per cent CI: 0.16, 0.84). More reforms should be directed toward reducing social disparities regarding preventive care utilisation.

Contraceptive method use among women in India: Does the family type matter?

ABSTRACT The use of contraceptive methods and their correlates continues to be a subject of scientific interest in developing countries, including India, for its contribution to reducing fertility and improving maternal and child health. This study explores the family type and contraceptive use by analyzing the National Family Health Survey-4 data (2015–16). Multinomial logistic regression was used to check the adjusted effects of the predictor variables on contraceptive use. STATA (version 13) was used for the analysis with a significance level of 5 per cent. Adjusting the effects of socio-demographic and economic characteristics, women from nuclear family had 6 per cent lower odds of using modern limiting method (OR = 0.94, 95 per cent CI = 0.92–0.96) and 5 per cent lower odds of using any traditional method of contraception (OR = 0.95, 95 per cent CI = 0.91–0.99) than their counterparts from non-nuclear family with mother-in-law (MIL). Family type, especially the presence of MIL, was associated with daughter-in-law’s (DIL) contraceptive behavior. The results based on a nationally representative recent survey contribute to the existing scanty evidence on the association between the MIL and DIL’s contraceptive behavior in the Indian context. Results suggest more awareness about the benefits of modern spacing methods among the mothers-in-law, leading to their enhanced use.

Austerity, Poverty, and Children’s Services Quality in England: Consequences for Child Welfare and Public Services

In England, the dominant policy narrative recognises no association between spending on children’s services and quality and a limited association between quality and deprivation. We combined 374 inspection outcomes between 2011 and 2019 with data on preventative and safeguarding expenditure and Indices of Multiple Deprivation (IMD) scores. A multilevel logistic regression model predicting ‘good’ or ‘outstanding’ judgements suggests each £100 increase in preventative spending per child was associated with a 69 per cent increase (95 per cent CI: 27.5 per cent, 124 per cent) in the odds of a positive inspection. A one-decile increase in deprivation was associated with a 16 per cent (95 per cent CI: −25 per cent, −5.7 per cent) decrease. Safeguarding expenditure was not associated with outcomes. Deprived communities have worse access to good-quality children’s services and government policies that have increased poverty and retrenched preventative services have likely exacerbated this inequality. Further, inattention to socioeconomic context in inspections raises concerns about their use in ‘take over’ policies.

Impact of atorvastatin on erectile dysfunction: A meta-analysis and systematic review.

Atorvastatin may be an effective treatment for erectile dysfunction (ED). The purpose of this meta-analysis was to determine whether atorvastatin therapy is effective in the treatment of ED. All published research on atorvastatin in the treatment of ED patients in EMBASE, PubMed, Web of Science and Cochrane were investigated till 30 October 2021. A meta-analysis of randomized controlled trials (RCTs) was done to investigate the efficacy of atorvastatin and placebo in the treatment of ED. Moreover, we also performed a meta-analysis based on single-arm trials (SATs) to explore the atorvastatin treatment on the efficacy of ED. In a meta-analysis based on RCTs, the weighted mean difference of the change of International Index for Erectile Function-5 (IIEF-5) score in the atorvastatin treatment group with or without treatment was 4.53 (95 per cent confidence interval [CI] of 3.28-5.79) higher than in the control group. In an SAT-based meta-analysis, the ES of the change in IIEF-5 score in the atorvastatin treatment group before and after treatment was 3.22 (95 per cent CI of 1.32-5.12). Atorvastatin is an effective therapeutic drug for patients with ED. However, we expect that more multicentre clinical trials will be conducted to support this assertion.

Rice varietal preference of farmers in rice bowl region of bihar: A polychotomous logistic regression analysis

Rice is the principal crop of Bihar in terms of area so Rice Bowl district of Bihar was selected purposively. Through random sampling farmers were selected from each of the four selected villages in two blocks constituting a sample of 160 respondents. The study revealed that the most preferred variety of rice was Nata Mahsuri. Apropos rice varietal preference viz., least preferred (0), less preferred (1), preferred (2) and most preferred (3) Quadripartite Polychotomous Logistic Regression was applied having Nagelkerke pseudo-R-Square value of 0.719. One unit increase in average yield will increase the probability to maneuver from least preferred to most preferred variety by 343.70 per cent [odds ratio (OR), 4.437; 95 per cent CI of Estimate (E) = 1.720 to 11.445]. The research concluded that early sowing and high yielding varieties should be promoted in the study local along with that awareness should be given to the large farmers for the improved variety.

Age-related hearing loss and mild cognitive impairment: a meta-analysis and systematic review of population-based studies.

The aim of this study was to identify any relationship between hearing loss and mild cognitive impairment. This was a systematic review and meta-analysis of randomised controlled trials conducted using Medline and the Cochrane Library up to 24 June 2020. Prospective, cohort and cross-sectional, and observational studies that reported on the relationship between mild cognitive impairment and hearing loss were included. A total of 34 studies reporting data on 48 017 participants were included. Twenty-three studies observed a significant association between hearing loss and mild cognitive impairment. The pooled risk ratio across all studies of prevalence of mild cognitive impairment in people with hearing loss was 1.44 (random-effects; 95 per cent CI = 1.27-1.64; p < 0.00001; I2 = 0 per cent). Significantly more people with mild cognitive impairment had peripheral hearing loss compared with those without (risk ratio, 1.40 random-effects; 95 per cent CI = 1.10-1.77; p = 0.005; I2 = 0 per cent). When the incidence was studied, significantly more people with peripheral hearing loss had mild cognitive impairment compared with those without (risk ratio = 2.06 random-effects; 95 per cent CI = 1.35-3.15; p = 0.0008; I2 = 97 per cent); however; a high level of statistical heterogeneity was evident. Most of the studies included in this systematic review observed a significant association between hearing loss and mild cognitive impairment.

6 - Children at Risk: A Study of the Psychosocial Impact of HIV on Orphans and other Vulnerable Children in Benin

This paper describes the effect of parental HIV on the life of children in Benin. A total of 2,043 children aged from 10 to 16 were surveyed on health, diet, violence, school attendance and psychosocial state. The results indicate that, while Beninese children who have had a parent living with HIV are not necessarily subjected to different economic and material conditions than those who have not, they do experience a much greater lack of psychosocial support. In contrast to children whose parents are not known to have HIV, these affected children are less prone to general illness (OR=0.69, 95 per cent CI 0.55-0.86). However, when they are sick, HIV-affected children are significantly more likely to undertake self-treatment (OR=1.38; 95 per cent CI 1.04-1.86) and more likely to work (OR=1.65, 95 per cent CI 1.04-2.60). They are also offered fewer meals than unaffected children (OR=1.94; 95 per cent CI 1.52-2.47). With respect to psychosocial fac- tors, the data suggest that children who have had a parent with HIV have signifi- cantly higher levels of psychological distress than those who have not. Govern- ments and civil society organisations need to address not only the material deprivation, especially hunger, of children thus affected by HIV, but also their need for social services.

The presence and characteristics of 'spin' among randomized controlled trial abstracts in orthodontics.

To identify the presence and characteristics of spin (using reporting strategies to distort study results and mislead readers) within randomized controlled trial (RCT) abstracts published in orthodontic journals, and to explore the association between spin and potentially related factors. A manual search was conducted to identify abstracts of RCTs with statistically non-significant primary outcomes published in five leading orthodontic journals between 2015 and 2020. Spin in the Results and Conclusions sections of each included abstract was evaluated and categorized according to pre-determined spin strategies. Logistic regression analyses were employed to explore the association between spin and relevant factors. A total of 111 RCT abstracts were included, of which 69 (62.2 per cent) were identified with spin. In the Results section, 47 (42.3 per cent) abstracts had spin, and 'focusing on significant within-group comparison for primary outcomes' was the most frequent spin strategy. In the Conclusions section, 57 (51.4 per cent) abstracts presented spin, with the most common strategy being 'claiming equivalence or non-inferiority for statistically nonsignificant results'. According to multivariable logistic regression analysis, a significantly lower presence of spin was found in studies with international collaboration (odds ratio [OR]: 0.331, 95 per cent confidence interval [CI]: 0.120-0.912, P = 0.033) and trial registration (OR: 0.336, 95 per cent CI: 0.117-0.962, P = 0.042). The prevalence of spin is high among RCT abstracts in orthodontics. Clinicians need to be aware of the definition and presence of spin. Concerted efforts are needed from researchers and other stakeholders to address this issue.

Small animal disease surveillance 2020/21: SARS-CoV-2, syndromic surveillance and an outbreak of acute vomiting in UK dogs.

Small animal disease surveillance 2020/21: SARS-CoV-2, syndromic surveillance and an outbreak of acute vomiting in UK dogs.

Determinants of Cellphone Usage among Sea Fisher’s During Marine Fishing in Selected Coastal Villages of Bangladesh

The cell phone can provide numerous benefits to sea fishers who risk their lives and resources for making livelihoods. This article is based on the firm assumption that the use of the cell phone during marine fishing can contribute to income, security and risk reduction. This study adds to the empirical evidence of determinants of cell phone use by fishers during marine fishing. For the purpose of reaching objectives, the study has drawn quantitative data generated through structured face-to-face interviews with 200 randomly selected fishers from three selected villages adjacent to the Bay of Bengal in the mid coastal area of Bangladesh during the period January to February 2016. Descriptive statistics, inferential statistics and binary logistic regression model is used to analyze the data. The study concludes that fishers own cell phone (odds ratio[OR]=6.56, 95 per cent confidence interval [CI]: 1.69,25.44), enjoying the availability of cell phone network (OR=166.20, 95 per cent CI:38.35, 720.28), earned low (OR=20.35, 95 per cent CI:4.24, 97.28) to medium income (OR=9.53, 95 per cent CI:0.99, 91.12) form sea fishing have a greater tendency to use cell phones, while fishers had low information need (OR=0.11, 95 per cent CI:0.01, 1.13) represented lower use of cell phone during marine fishing. Thus, it is essential to build cell phone infrastructure bases in the potential fishing zones of Bangladesh and supplying cell phone devices at subsidised cost.

Linkage between water, sanitation, hygiene, and child health in Bugesera District, Rwanda: a cross-sectional study

Rwanda met the Millennium Development Goal targets for access to drinking water and sanitation. However, the WASH practices of high-risk communities are undocumented. Lack of information may hide disparities that correlate with disease. The purpose of this study was to assess WASH and childhood diarrhoea in Bugesera District. A survey was administered to caregivers. Water and stool samples were collected to assess physical and biological characteristics. Focus groups provided information on community context. Analysis included descriptive statistics, Chi-square, logistic regression, and thematic analysis. Piped water and unimproved sanitation were used by 45.28 per cent and 88.38 per cent of respondents. Most respondents (51.47 per cent) travelled 30–60 minutes per trip for water and 70 per cent lacked access to hand-washing near the latrine. Diarrhoea was less prevalent in children who used a toilet facility (p = 0.009). Disposal of faeces anywhere other than the toilet increased the odds of having diarrhoea (OR = 3.1, 95 per cent CI = 1.2–8.2). Use of a narrow mouth container for storage was associated with decreased intestinal parasites (p = 0.011). The presence of a hand-washing station within 10 metres of the toilet was associated with lower odds of intestinal parasites (OR = 0.54, 95 per cent CI: 0.29–0.99). Water and sanitation access, water handling and storage, and unsanitary household environment underlie high diarrhoeal disease prevalence.

Comparison between two screws for maxillary expansion: a multicenter randomized controlled trial on patient's reported outcome measures.

The objective of this study was to compare an expansion screw of the maxilla that generates moderate and continuous forces versus a conventional screw for rapid maxillary expansion (RME) on patient-reported outcome measure during the first 12 weeks of treatment. This is a superiority, multicenter, two-arm parallel balanced randomization trial. Patients in the mixed dentition were included with a transverse discrepancy between the two arches of at least 3 mm. An expansion screw using moderate continuous forces (Leaf group, treated with an expansion screw with Ni-Ti springs) was compared to a conventional RME screw that generates intermittent heavy forces (RME group). The primary response variable was the visual analogue scale (VAS) on pain calculated in the first 12 weeks of therapy. The VAS on difficulty on speaking and oral hygiene, patient satisfaction, and complications were also evaluated. A computer-generated block randomization was used with allocation concealed in sequentially numbered opaque-sealed envelopes. Blinding was not applicable. Linear models were used for statistical analysis. Twenty-eight patients in the Leaf group and 28 patients in the RME group were randomized and included in the study. There were no dropouts. The mean of the VAS for pain was 0.3 ± 0.4 in the Leaf group and 0.6 ± 0.5 in the RME group. The difference was -0.3 (95 per cent CI from -0.5 to -0.0; P = 0.017) in favour of the Leaf group. The difference in pain was marked in the first week (Leaf group 2.2 ± 2.3; RME group 3.7 ± 2.6; difference -1.5; 95 per cent CI from -2.7 to -0.3; P = 0.019). Patients in the Leaf group experienced a lower degree of pain, especially during the first week following the application of the expander. For the other variables, no significant differences were reported between the two treatments. The study was registered in the ISRCTN register on 8 November 2016 with the number ISRCTN18263886.

Effect of a high-intensity one-week training programme and student-level variables on the bovine transrectal palpation and pregnancy diagnosis skills of final-year veterinary students

BackgroundTo improve bovine transrectal palpation (TRP) and pregnancy diagnosis (PD) training, the effect of a high-intensity one-week training programme for veterinary elective students (N=59) with an interest in production animal...

Association between Health Insurance and Incidence of Death in Stateless Children in Tak Province, Thailand

This study assesses the association between health insurance and incidence of death in stateless children compared with uninsured children in Tak Province in Thailand. The study used electronic medical records of children aged between 0 and 15 who registered with selected health facilities between 01 January 2013 and 31 December 2017. The required data was obtained from ‘43-files database’ through the Provincial Public Health Office. The death case was used as a binary outcome variable while the exposure was three types of insurance: uninsured, stateless and the Universal Coverage Scheme (UCS). The age, sex and domicile of the children were used as covariates in the multivariate logistic regression. Of 164,435 registered children, 824 death cases were found during the study period. The study results suggest that insurance is associated with the reduced risk of deaths in stateless children. The odds of death is 86 per cent lower in the stateless insurees than in the uninsured children (adjusted odds ratio [AOR] = 0.242, 95% confidence interval [CI] = [0.136,0.403]; p &lt; 0.001). The death is 69 per cent lower in the UCS beneficiaries than in the uninsured children (AOR = 0.385,95 per cent CI = [0.308,0.489]; p &lt; 0.001). Age, sex and domicile of the children were independently associated with a varying risk of death.