Child Health Booklet Research Articles

Fetal and Infancy Exposure to Phenols, Parabens, and Phthalates and Anthropometric Measurements up to 36 Months, in the Longitudinal SEPAGES Cohort.

Endocrine-disrupting chemicals may play a role in adiposity development during childhood. Until now literature in this scope suffers from methodologic limitations in exposure assessment using one or few urine samples and missing assessment during the infancy period. We investigated the associations between early-life exposure to quickly metabolized chemicals and post-natal growth, relying on repeated within-subject urine collections over pregnancy and infancy. We studied the associations of four phenols, four parabens, seven phthalates, and one nonphthalate plasticizer from weekly pooled urine samples collected from the mother during second and third trimesters (median 18 and 34 gestational weeks, respectively) and infant at 2 and 12 months of age, and child growth until 36 months. We relied on repeated measures of height, weight and head circumference from study visits and the child health booklet to predict growth outcomes at 3 and 36 months using the Jenss-Bayley nonlinear mixed model. We assessed associations with individual chemicals using adjusted linear regression and mixtures of chemicals using a Bayesian kernel machine regression model. The unipollutant analysis revealed few associations. Bisphenol S (BPS) at second trimester was positively associated with all infant growth parameters at 3 and 36 months, with similar patterns between exposure at third trimester and all infant growth parameters at 3 months. Mono-n-butyl phthalate (MnBP) at 12 months was positively associated with body mass index (BMI), weight, and head circumference at 36 months. Mixture analysis revealed positive associations between exposure at 12 months and BMI and weight at 36 months, with MnBP showing the highest effect size within the mixture. This study suggests that exposure in early infancy may be associated with increased weight and BMI in early childhood, which are risk factors of obesity in later life. Furthermore, this study highlighted the impact of BPS, a compound replacing bisphenol A, which has never been studied in this context. https://doi.org/10.1289/EHP13644.

Infant feeding practices and body mass index up to 7.5 years in the French nationwide ELFE study.

The infant diet represents one of the main modifiable determinants of early growth. This study aimed to investigate the associations of infant feeding practices with body mass index (BMI) until 7.5 years. Analyses were based on data from the French nationwide ELFE birth cohort. Data on breastfeeding (BF) and complementary feeding (CF) were collected monthly from 2 to 10 months. Infant feeding practices were characterized using principal component analyses (PCA) and hierarchical ascendant classification. BMI z-score was computed at 1, 2, 3, 5 and 7.5 years, from data collected in the child's health booklet; 7.5-year overweight was defined according to IOTF references. Associations between infant feeding practices and BMI were investigated by linear regression models adjusted for main confounders. Ever breastfeeding was not associated with BMI up to 7.5 years. Compared to intermediate breastfeeding duration (1 to <3 months), longer breastfeeding duration (≥6 months) was related to lower 1-year BMI, but not at older ages. Compared to the recommended age at CF introduction (4-6 months), early CF (<4 months) was related to higher BMI up to 5 years with a similar trend at 7.5 years, but not to the risk of overweight. The PCA patterns characterized by early baby cereal introduction and late food pieces introduction or by frequent intake of main food groups were related to a lower BMI up to 7.5 years. Breastfeeding was related with a lower BMI in infancy but not thereafter, whereas an early CF initiation (<4 months) was associated with a higher BMI in childhood.

Use and filling out of the child health booklet among beneficiaries of the Bolsa Família Program in Salvador-Bahia, Brazil: a cross-sectional study, 2023.

To compare child health booklet (CHB) use and filling out among mothers who were or were not Bolsa Família Program (BFP) beneficiaries. Cross-sectional study with mothers of children <6years attending health centers in Salvador, Bahia, Brazil, between January-February/2023. The CHB was evaluated regarding its use (having a CHB, having it in hand, and having read it) and filling out (growth curves, development monitoring forms, and vaccination completeness). Descriptive statistics and the chi-square test were used. Of the 411 study participants, 66% were BFP beneficiaries. Significant differences were found between the groups regarding CHB use: having a CHB (p < 0.001), having it in hand (p = 0.037), and having read it (p < 0.001). Significant difference in vaccination completeness was found (p = 0.005). There was a significant difference in CHB use and vaccination completeness when comparing mothers who were BFP beneficiaries and those who were not.

Use and filling out of the child health booklet among beneficiaries of the Bolsa Família Program in Salvador-Bahia, Brazil: a cross-sectional study, 2023

Resumo Objetivo: Comparar uso e preenchimento da caderneta da criança entre mães beneficiárias ou não do Programa Bolsa Família. Métodos: Estudo transversal com mães de crianças menores de 6 anos em unidades de saúde de Salvador-BA, entre janeiro e fevereiro de 2023. A caderneta da criança foi avaliada quanto ao uso (ter a caderneta, estar com ela em mãos e tê-la lido) e preenchimento (curvas de crescimento, fichas de avaliação do desenvolvimento e completude vacinal). Utilizaram-se estatística descritiva e teste qui-quadrado, com nível de significância de 5%. Resultados: Das 411 participantes do estudo, 66% eram beneficiárias do programa. Houve diferença significativa entre os grupos quanto ao uso da caderneta: ter a caderneta (p &lt; 0,001), estar com ela em mãos (p = 0,037) e tê-la lido (p &lt; 0,001). Quanto ao preenchimento, houve diferença significativa apenas na completude vacinal (p = 0,005). Conclusão: Houve diferença significativa quanto ao uso e à completude vacinal, comparando-se mães beneficiárias e não beneficiárias do Programa Bolsa Família.

Consulta de puericultura na Estratégia Saúde da Família em municípios do interior do estado da Paraíba, Brasil

Abstract This article aims to evaluate the childcare appointments by health professionals working at the Family Health Strategy in municipalities in the State of Paraíba, compare the performance by health team type (The Mais Médicos Program or conventional), and analyze the association of client satisfaction with the developed actions. This cross-sectional study evaluated the structural conditions of health units, the work process of health professionals, and client satisfaction, observing childcare appointments in 22 health teams. Poor employment relationships and professionals’ knowledge about child growth curves were highlighted in the structure. In the 175 appointments observed, we detected neglect in completing the Child Health Booklet (CHB), obtaining data on food consumption, and guidance practices. Only 36% of the appointments were classified with adequate duration. There was greater satisfaction for appointments developed in health teams of the Mais Médicos Program, with longer duration and better performance in guidance practices. The implementation of childcare appointments reveals significant gaps that can influence maternal satisfaction.

Childcare appointment at the Family Health Strategy in municipalities in the inland region of the State of Paraíba, Brazil.

This article aims to evaluate the childcare appointments by health professionals working at the Family Health Strategy in municipalities in the State of Paraíba, compare the performance by health team type (The Mais Médicos Program or conventional), and analyze the association of client satisfaction with the developed actions. This cross-sectional study evaluated the structural conditions of health units, the work process of health professionals, and client satisfaction, observing childcare appointments in 22 health teams. Poor employment relationships and professionals' knowledge about child growth curves were highlighted in the structure. In the 175 appointments observed, we detected neglect in completing the Child Health Booklet (CHB), obtaining data on food consumption, and guidance practices. Only 36% of the appointments were classified with adequate duration. There was greater satisfaction for appointments developed in health teams of the Mais Médicos Program, with longer duration and better performance in guidance practices. The implementation of childcare appointments reveals significant gaps that can influence maternal satisfaction.

Toward a digital child health booklet

Abstract Public health, paediatrics as well as other health professionals share the interest in providing services and improving conditions to ensure life-long health and well-being of children and adolescents. In this interprofessional setting and aim, parents are central partners, as are adolescents when they take over the responsibility of their own health. Ensuring the availability of health data for parents and adolescents at any given time and place is a key factor to empower and improve health management and literacy, providing continuity of health information along the care chain, and analysing health data of healthy and sick children is of high importance. The digital booklet will have a positive impact on sharing of health information among care professionals, thus ensuring continuity of care and limiting redundancy of investigation, and in addition provide data for public health research and monitoring of health and determinants. The Swiss Society of Paediatrics, the ZHAW/Institute of Public Health and the Kollegium of Hausarztmedizin (general practices) founded an association to digitalize the current paper child and adolescent health booklet with the aims: 1. Empower parents as ‘owners’ of health data to take responsibility and have greater autonomy in managing their child's health and illness 2. Provide a digital infrastructure for – low-threshold and reliable source of advice – easy update of data/information, digital communication with parents – sharing of data with professionals and non-professionals involved in care of child. 3. Monitoring of children's health data (parental consent provided) The speakers with present their collaboration and project, its current status, as well challenges and solutions found.

9.N. Workshop: It Takes Two To Improve European Child Health (Care)

Abstract Many societal developments have an impact on health care in general and on child health care, in particular. Internationally challenges include an aging population, more cultural diversity and a rising prevalence of chronic diseases among children and adolescents, revealing potential risks for child health care. A strong focus must be placed on prevention strategies that are effective, sustainable and equitable. Planning and implementing prevention strategies may require shifts in the organization of care, such as the forging and strengthening of interdisciplinary and intersectoral partnerships within a country. A promising example of such partnerships is the collaboration of public health with paediatrics. Both professional groups acknowledge the call for greater integration since prevention strategies can only be achieved and sustained by working together. The objectives of this workshop are to: • Provide a selective overview of three partnerships and plans for cooperation between public health and paediatrics. • To exchange experiences and possibilities with the audience to pave the way for further successful partnerships. In this workshop, we outline the partnership and plans for cooperation between public health and paediatrics in three European countries: Netherlands, Finland and Switzerland. In the first presentation, Danielle Jansen and Károly Illy will share the new vision towards the year 2030 of the Dutch Paediatric Society in which building blocks are presented to guarantee accessible, high-quality, timely and effective care for every child. One of the building blocks to be highlighted is the interprofessional collaboration between paediatricians and public health professionals. In the second presentation, Julia Dratva and Susanne Stronski from Switzerland will present a shared paediatric and public health vision of a digital child health booklet. The digital booklet will empower parents and adolescents, provide access to personal health irrespective of place or time, improve sharing health information among care professionals, thus ensuring continuity of care and limiting redundancy of investigations and in addition, and provide data for public health research and monitoring. Challenges and solutions will be shared with the audience. In the third presentation, Silja Kosola from Finland will present a Finnish vision for school health care where professionals trained in public health and medicine collaborate with each other as well as with teachers for the benefit of children and adolescents. This multidisciplinary collaboration across governing bodies is especially important as Finland undergoes a national reform of social and health care services. After the three presentations, we engage the audience by asking for their experiences and sharing the examples of collaborations between public health and paediatrics, as well as barriers and facilitators. At the end of the workshop, we would like to summarize the results of the workshop in an overview of preliminary best practices. Key messages • Global climatic, societal and politic developments reveal potential risks for child health cand health care, which must be countered effectively, sustainably and equitably. • Greater integration of prevention across sectors is elemental and can be achieved through interprofessional partnerships.

Vaccination Coverage during Childhood and Adolescence among Undergraduate Health Science Students in Greece.

High rates of vaccination coverage in childhood represent one of the most important cost-effective tools of primary prevention and have substantially reduced the incidence of and mortality from vaccine-preventable diseases globally. Vaccination coverage of young people has not been well estimated in Greece. Anonymous self-completed questionnaires and the participants’ Child Health Booklet were used to estimate complete vaccination coverage of mandatory vaccinations against vaccine-preventable diseases of undergraduate students at the University of West Attica during the academic year 2020–2021. Student’s t-tests were used to estimate mean values. Overall, 79% (95% CI: 78–81%) of study participants were fully vaccinated. This coverage was lower in males especially for vaccines that should be done during childhood (p = 0.045). High vaccination percentage (>90%) was observed for the meningococcus group A, C, W135, Y, measles-mumps-rubella, hepatitis B and meningitis C vaccine. Nevertheless, suboptimal coverage was assessed for the booster dose of tetanus, diphtheria, pertussis, for the human papillomavirus vaccine among girls, for the tuberculosis, for the meningococcus group B, for the pneumococcal, and for the seasonal influenza vaccines. In conclusion, the promotion of routine vaccination programs for young adults needs to be strengthened. An identification system for under-vaccinated students, an efficient reminder system and university campus vaccine program practices should be established, particularly among males.

Infant feeding practices associated with adiposity peak and rebound in the EDEN mother-child cohort.

High magnitude of adiposity peak and early adiposity rebound are early risk markers of later obesity. Infant diet represents one of the main modifiable determinants of early growth. This study aimed to investigate the association between infant feeding practices and age and magnitude of adiposity peak and rebound. Analyses were based on data from the French EDEN mother-child cohort. Data on breastfeeding and complementary feeding were collected at birth and 4, 8, and 12 months. From clinical examinations and measurements collected in the child's health booklet up to 12 years, individual growth curves were modeled, and ages and magnitudes of adiposity peak and rebound were estimated. Associations between infant feeding practices and growth were investigated by multivariable linear regression in children after testing a child-sex interaction. In the studied population (n = 1225), adiposity peak occurred at a mean of 9.9 ± 2 months and adiposity rebound at 5.5 ± 1.4 years. Associations between infant feeding practices and adiposity peak or rebound were moderated by child sex. For girls, each additional month of breastfeeding was related to a 2-day increase in the age at adiposity peak (p < 0.001), and an 18-day increase in the age at adiposity peak (p = 0.004). Whereas for boys, each additional month for the age at complementary food introduction was associated with a 29-day increase in the age at adiposity rebound (p = 0.02). For boys, long breastfeeding duration was only related to reduced body mass index at adiposity peak. Child sex has a moderating effect on the association between infant feeding practices and adiposity peak or rebound. The well-known association between breastfeeding duration and early growth seems stronger in girls than boys. The association found for complementary feeding in boys may give new insights into preventing obesity.

State of Play of the Use of Children’s Health Booklets in Cameroon according to Child Health Professionals

Introduction: The Child health booklet has been shown to be an essential tool for monitoring the implementation of interventions with a high impact on reducing infant and child mortality. Objective: To describe the opinion of child health providers about child health records. Methodology: Cross-sectional survey of health professionals on content, ease of use and recommendations for a health record of the ideal child. Results: About 3/4 (75%) of participants considered medical follow-up useful and 91.5% wanted it to be conducted at all levels of health care. According to 93% of them, all health care providers should be involved. However, almost two-thirds (65.5%) had never been trained to use the child’s health record. About half (54.2%) of them had already seen the national manual and only 43.7% had ever filled it out, 82.2% of whom found it very difficult. With regards to the assessment of the content, 44.4% to 57.7% of respondents were dissatisfied with 12 of the 16 subheadings of the handbook. As for an ideal child health record, the majority recommended that it should contain indicators related to: childbirth, growth, monitoring of preventive activities and advice to parents. Conclusion: Child health booklets available in health facilities in Cameroon are not optimally used to reduce infant and child morbidity and mortality. It is important to review the content of the child’s health booklets in order to adapt it to the Cameroonian context.

Evaluation of child health booklet usage in primary healthcare centres in Duhok Province, Iraq

ObjectivesA child health booklet (CHB) is a record of a child's health, growth and development that is kept by the child's parent or guardian, with contributions from various health professionals. Documentation of a child's growth and development started in the 20th century. This study was carried out to evaluate the usage of CHBs in primary healthcare centres (PHCCs) in Duhok Province, through studying the attitude and practices of parents and healthcare providers (HCPs). Study designA cross-sectional design was adopted to achieve the objectives of the study, using a stratified sampling procedure. MethodsAn interviewer-administered questionnaire was used to collect data from 403 parents and 62 HCPs. Participants came from 20 PHCCs that were widely distributed within seven administrative districts of Duhok Province. Data collection started on 18th of April 2016 and ended on 25th of July 2016. ResultsThe study revealed that 362 (89.8%) parents received a copy of the CHB and 98.9% retained it. Most CHB retainers regularly brought it with them whenever they attend the PHCCs. For those who retained and brought the CHB, vaccination records were documented in 100% of booklets, followed by the documentation of anthropometric measurements (22.1%), child developmental checking (17.9%) and growth chart updates (10.6%). ConclusionMost parents received a copy of the CHB with high retention rate; however, booklet usage was often limited to documentation of vaccinations. The study findings clearly indicated the need for enhancing cooperation between all departments and staff in healthcare facilities through the distribution of CHBs to all parents of age-appropriate children, proper usage of the booklets by regular requesting of CHBs from parents when attending health facilities and proper documentation of all health services attended.

Awareness and Utilization of Mother Child Health Booklet by Health Workers and Mothers in Western Kenya

Awareness and Utilization of Mother Child Health Booklet by Health Workers and Mothers in Western Kenya

Adherence to pneumococcal conjugate vaccination schedule and uptake rate as compared to the established diphtheria-tetanus-acellular pertussis vaccination in Cyprus

BackgroundPneumococcus is a common cause of invasive and non-invasive infections in children. In areas with high vaccination coverage, universal infant vaccination with conjugated pneumococcal vaccine (PCV) has significantly decreased the incidence of vaccine type nasopharyngeal carriage and invasive pneumococcal disease. The aim of this study is to examine immunization coverage rate and timely administration of the recently introduced PCV and compare to the established diphtheria-tetanus-acellular pertussis vaccine (DTaP) with similar schedule. MethodsA stratified random sample of healthy infants and children 6–36 months of age were recruited. Demographic data were collected from parents. Among enrolled children, immunization status for DTaP and PCV was noted from the child's health booklet. ResultsOf 1105 children enrolled in the study, 586 (53%) were vaccinated in the private sector and the rest in the public sector. A significant higher proportion of children vaccinated at the private sector were fully vaccinated for PCV (71% versus 58%, p < 0.05) while no difference in the DTaP coverage was observed. Conversely, the compliance to the recommended vaccination schedule was much higher in the public sector for the first and second dose of PCV and second dose of DTaP.The overall, timely administration was higher for the DTaP vaccine when compared to PCV (p < 0.05).Moreover, adherence to the program was higher for the firstborn child of the family while significant differences were observed between different geographic regions. Interestingly, co-administration of DTaP and PCV was observed in only 2% of the children. ConclusionIn children residing in Cyprus, vaccination coverage and adherence to PCV vaccination schedule are significantly lower compared to the established DTaP vaccine. There is an urgent need for increasing the overall vaccination coverage as well as improving the adherence to vaccination schedule. Possible interventions are proposed.

Assessment of select electronic health information systems that support immunization data capture \u2013 Kenya, 2017

BackgroundAlthough electronic health information systems (EHIS) with immunization components exist in Kenya, questions and concerns remain about their use and alignment with the Kenya Ministry of Health’s (MOH) National Vaccine and Immunization Program (NVIP). This article reports on the findings of an assessment of select EHIS with immunization components in Kenya, specifically related to system design, development, and implementation.MethodsWe conducted a rapid assessment of select EHIS with immunization components in Kenya from January to May 2017 to understand the design, development, implementation of the EHIS including the lessons learned from their use. We also assessed how the data elements in the EHIS compared to the data elements in the Maternal and Child Health Booklet used in the existing paper based system in Kenya.ResultsThe EHIS reviewed varied in purpose, content, and population covered. Only one system was built to focus specifically on immunization data. Substantial differences in system functionality and immunization-related data elements included in the EHIS were identified. None of the EHIS had all the data elements necessary to fully replace or operate independently from the standardized paper-based system for recording immunization data in Kenya.ConclusionsOverall, the findings of this assessment highlighted substantial variation in the EHIS with immunization components. The findings provide insights and lessons learned for the Kenya MOH NVIP, immunization partners, vendors of EHIS, and users of EHIS to consider as Kenya transitions from paper-based to electronic immunization information systems.

Factors associated with hospitalization during neonatal period

ObjectiveNeonatal mortality rate remains high in Brazil. The aim of the study was to evaluate the factors associated with hospitalization during the neonatal period. MethodsCross‐sectional study conducted in ten randomly‐selected Brazilian municipalities. Mothers of children under the age of 6 who were carrying the child's health booklet were interviewed in basic health units. Hierarchical modeling of sociodemographic factors (distal level), maternal variables (intermediate level), and features of the newborns (proximal level) was performed. The variables that presented a value of p≤0.20 in the univariate analysis were included in the multivariate hierarchical modeling process, with block input according to their hierarchical level. The variables with a value of p≤0.05 were considered statistically significant. Results2022 mothers were included, allowing 258 (12.8%) cases of hospitalization during the neonatal period to be identified, of which 49.7% were male, 8.9% were premature, and 8.4% had low birth weight (<2500g). After analysis by hierarchical approach, factors associated with neonatal hospitalization (prevalence ratio [95% CI]) included: history of prematurity (2.03 [1.25–3.30], p=0.004), gestational risk (2.02 [1.46–2.79], p<0.001); intrapartum risk (3.73 [2.33–5.99], p<0.001); gestational age (32–37 weeks: 13.83 [1.74–110.09], p=0.01; and<32 weeks: 25.03 [3.03–207.12], p=0.003); low birth weight (3.95 [2.56–6.09], p<0.001), and male gender (1.44 [1.09–1.98], p=0.01). ConclusionFactors associated with maternal and neonatal history are associated with neonatal hospitalization.

Scaling up Pediatric HIV Testing by Incorporating Provider-Initiated HIV Testing Into all Child Health Services in Hurungwe District, Zimbabwe.

Practical ways are needed to scale-up pediatric HIV testing in sub-Saharan Africa, where testing is usually limited to HIV-exposed children in maternal and child health clinics. We implemented an enhanced pediatric HIV testing program in 33 health facilities in Zimbabwe by integrating HIV testing into all pediatric health services. We collected individual data on children tested by having health care workers complete a program-specific child health booklet. We compared numbers of children tested before and during the program using routinely collected aggregate program data reported by health facilities. A total of 12,556 children aged 0-5 years were recorded in child health booklets; 9431 (75.1%) had information on HIV testing, of whom 7326 (77.7%) were tested; 7167 had test results of whom 122 (1.7%) were HIV-infected. Among children seen in outpatient clinics, 82.1% were tested compared with 66.5% tested among children seen in maternal/child health clinics. Of the 122 HIV-infected children identified, 77 (63.1%) could be missed under existing pediatric testing guidelines. The number of HIV-infected children identified during the 6-month program increased by 55% compared with the prior 6-month period (RR = 1.55, 95% CI: 1.22 to 1.96). Factors independently associated with HIV infection included being malnourished (adjusted odds ratio [AOR] = 7.7, 95% CI: 2.1 to 28.6), being exposed to TB (AOR = 8.1, 95% CI: 2.0 to 32.2), and having an HIV-infected mother (AOR = 41.6, 95% CI: 15.9 to 108.8). Integrating HIV testing into all pediatric health services is feasible and can assist in identifying HIV-infected children who could be missed in current testing guidelines.

Factors associated with hospitalization during neonatal period

ObjectiveNeonatal mortality rate remains high in Brazil. The aim of the study was to evaluate the factors associated with hospitalization during the neonatal period. MethodsCross-sectional study conducted in ten randomly-selected Brazilian municipalities. Mothers of children under the age of 6 who were carrying the child's health booklet were interviewed in basic health units. Hierarchical modeling of sociodemographic factors (distal level), maternal variables (intermediate level), and features of the newborns (proximal level) was performed. The variables that presented a value of p≤0.20 in the univariate analysis were included in the multivariate hierarchical modeling process, with block input according to their hierarchical level. The variables with a value of p≤0.05 were considered statistically significant. Results2022 mothers were included, allowing 258 (12.8%) cases of hospitalization during the neonatal period to be identified, of which 49.7% were male, 8.9% were premature, and 8.4% had low birth weight (<2500g). After analysis by hierarchical approach, factors associated with neonatal hospitalization (prevalence ratio [95% CI]) included: history of prematurity (2.03 [1.25–3.30], p=0.004), gestational risk (2.02 [1.46–2.79], p<0.001); intrapartum risk (3.73 [2.33–5.99], p<0.001); gestational age (32–37 weeks: 13.83 [1.74–110.09], p=0.01; and<32 weeks: 25.03 [3.03–207.12], p=0.003); low birth weight (3.95 [2.56–6.09], p<0.001), and male gender (1.44 [1.09–1.98], p=0.01). ConclusionFactors associated with maternal and neonatal history are associated with neonatal hospitalization.

Neonatal Hearing Screening in primary health care and family health care.

The Universal Newborn Hearing Screening (UNHS) looks for early diagnosis and rehabilitation of newborns at risk or not of hearing impairment. The purpose is analyze the flow of Universal Newborn Hearing Screening in the family health care strategy unit through the tracking and monitoring of children. This is a quantitative and retrospective study. The trace begins with the third copy of the Live Newborn Declaration, filled in at the maternity ward. An interview with parents and guardians was made by a community agent at the Health Unit or at the home of the newborn. Monitoring was conducted by live birth declaration and the information collected by the interviewer from maternal and child health booklet and the follow-up at high complexity services. The sample was made up of 50 neonates. 52% were between 30 and 89 days and 54% were male. 12% of newborns presented a risk factor for hearing loss and the neonatal screening was performed in 86% of cases. Hearing health measures show integrality in hearing impairment care at the basic health unit to high complexity hospital. The flow of care for newborn hearing screening is in agreement with the child health care guidelines in Curitiba, however, it is not yet universal. In conclusion, the participation of the family health strategy unit in the tracking and monitoring of children submitted to the Universal newborn hearing screening program is feasible and recommended.

The Mobile Solutions for Immunization (M-SIMU) Trial: A Protocol for a Cluster Randomized Controlled Trial That Assesses the Impact of Mobile Phone Delivered Reminders and Travel Subsidies to Improve Childhood Immunization Coverage Rates and Timeliness in Western Kenya.

BackgroundText message (short message service, SMS) reminders and incentives are two demand-side interventions that have been shown to improve health care–seeking behaviors by targeting participant characteristics such as forgetfulness, lack of knowledge, and transport costs. Applying these interventions to routine pediatric immunizations may improve vaccination coverage and timeliness.ObjectiveThe Mobile Solutions for Immunization (M-SIMU) trial aims to determine if text message reminders, either with or without mobile phone–based incentives, sent to infant’s parents can improve immunization coverage and timeliness of routine pediatric vaccines in rural western Kenya.MethodsThis is a four-arm, cluster, randomized controlled trial. Villages are randomized to one of four study arms prior to enrollment of participants. The study arms are: (1) no intervention (a general health-related text message will be texted to this group at the time of enrollment), (2) text message reminders only, (3) text message reminders and a 75 Kenyan Shilling (KES) incentive, or (4) text message reminders and a KES200 incentive. Participants assigned to study arms 2-4 will receive two text message reminders; sent 3 days before and one day before the scheduled immunization visit at 6, 10, and 14 weeks for polio and pentavalent (containing diphtheria, tetanus, pertussis, hepatitis B, and Haemophilus influenza type b antigens) type b antigens) vaccines, and at 9 months for measles vaccine. Participants in incentive arms will, in addition to text message reminders as above, receive mobile phone–based incentives after each timely vaccination, where timely is defined as vaccination within 2 weeks of the scheduled date for each of the four routine expanded program immunization (EPI) vaccination visits. Mother-infant pairs will be followed to 12 months of age where the primary outcome, a fully immunized child, will be ascertained. A fully immunized child is defined as a child receiving vaccines for bacille Calmette-Guerin, three doses of pentavalent and polio, and measles by 12 months of age. General estimating equation (GEE) models that account for clustering will be employed for primary outcome analyses.ResultsEnrollment was completed in October 2014. Twelve month follow-up visits to ascertain immunization status from the maternal and child health booklet were completed in February 2016.ConclusionsThis is one of the first studies to examine the effect of text message reminders on immunization coverage and timeliness in a lower income country and is the first study to assess the effect of mobile money-based incentives to improve immunization coverage.Trial RegistrationClinicaltrials.gov NCT01878435; https://clinicaltrials.gov/ct2/show/NCT01878435 (Archived by WebCite at http://www.webcitation.org/6hQlwGYJR)