Child Health Care Research Articles

Self protective health care in childhood cancer survivors from the perspective of survivors, parents, and professionals: a qualitative study.

Childhood cancer survivors experience many health problems that they must protect themselves from their destructive physical and psychological effects. Understanding experiences of children about self-protective care will help health care providers manage long-term care plans. Therefore, this study was conducted with the aim of exploring self-protection care in childhood cancer survivors. This is a phenomenological study that was conducted in the clinics and cancer care centers of Urmia and Khoy in Iran. 27 participants were selected by purposive sampling until data saturation. The data was collected using a semi-structured and in-depth face to face interview. Content analysis approach used for data analysis and MAXQUDA 10 software used for data management. Data analysis led to the emergence of "self-protection health care" as a main category, two categories "maintaining physical health" and "keeping a strong mindset" and 9 sub-categories including "abstain activities that may cause harm", "refusing contact with others for possible infection", "monitoring symptoms and side-effects of cancer coming back", "avoiding unhealthy diet", "knowing about cancer from similar others", "keep away negative thoughts and emotions", "drawing on spiritual resources", "creating a bridge to life again" and "being healthy for the sake of one's family". According to the results of this study, self-protection is one of the most important cares for childhood cancer survivors. Over time, the influence of the clinical team and parents on children's health care diminishes. Therefore, they should promote their health and well-being behaviors and use a variety of protective approaches to self-care.

A "silent storm": uncovering the escalating crisis in mental healthcare for children and adolescents in Slovenia during and after the COVID-19 pandemic.

Our aim was to assess the burden of children and adolescents' mental health problems on the Slovenian outpatient healthcare system before, during and after the pandemic. In a retrospective analysis of healthcare indicators from 2008 to 2023, we analysed data from the National Institute of Public Health. Key domains included initial visits for mental and behavioural disorders (MBDs) to primary care for the population aged 0-19; the number of referrals to an initial assessment with a child and adolescent psychiatrist (CAP) at the secondary level for the population aged 0-17 along with the corresponding waiting times; and the number of urgent referrals for the population aged 0-17 to emergency mental health centres at the tertiary level. The calculations included rates per 1000 people. Descriptive statistics and diagrams were used to compare the data. Segmented linear regression analysis (SLR) was conducted on the primary healthcare data to identify the distinct temporal point indicating an increase. Comparing the average rates of the 2020-2022 period to those of the 2018-2019 period, there was a 20% increase in initial visits to primary care, a 23% increase in the referral rate to a CAP at the secondary level, and a 41% increase to the tertiary level of care. In secondary care, a four- to sevenfold increase in waiting times for the initial CAP assessment was observed between 2019 and 2023. The incidence of initial visits to primary healthcare services for MBD increased from 2008 to 2019 (average annual growth rate of 4.5%). The average annual growth rate for the 2020-2022 period tripled to 13.9%. The SLR showed that the trend of accelerating growth could have begun in 2017 for the 0-5 age group and possibly for the 15-19 age group as well. After the initial decline in 2020, all levels of the Slovenian healthcare system faced an increased burden of MBD in children and adolescents from 2021 to 2022 compared to pre-pandemic levels. Nevertheless, a portion of this increase aligns with longitudinal growing trends from 2008 onwards. Tackling the crisis requires urgent national action, significant improvement in organization, and investments in mental health.

Regional Disparities, Economic Development, and Neonatal Mortality and Hospital Delivery in China.

A negative association between neonatal mortality and hospital delivery has been found in some low- and lower-middle-income countries but not in rural settings characterized by poor quality of maternal and child health care. To examine the association between neonatal mortality and hospital delivery in China across urban and rural regions, regional disparities, and varying levels of economic development. This retrospective cohort study used county-level data from 2008 to 2020 from the National Maternal & Child Health Statistics across mainland China. Statistical analysis was conducted from March to December 2023. Since 2008, China has strategically leveraged hospital deliveries with national subsidies to diminish neonatal mortality, particularly in rural areas. Neonatal mortality and hospital delivery rates were calculated, and their association was estimated using multivariable fixed-effects linear models of county-level cohort data to adjust for time-invariant differences across counties and controls for gross domestic product (GDP) per capita, women's years of education, hospital beds, and health workers. The analysis included data from 2930 counties, with 198.7 million live births across 36 255 county-year records between 2008 and 2020. The mean (SD) neonatal mortality rate per 1000 live births decreased in rural areas from 12.3 (7.5) in 2008 to 3.9 (2.7) in 2020 and decreased in urban areas from 5.0 (3.1) in 2008 to 2.0 (1.3) in 2020. Hospital delivery rates increased in rural areas from a mean (SD) of 93.4% (11.8%) in 2008 to 99.9% (0.6%) in 2020 and increased in urban areas from 97.7% (6.1%) in 2008 to 100.0% (0.1%) in 2020. In rural areas, an increase of 10 percentage points in hospital deliveries was associated with a neonatal mortality rate of -1.4 (95% CI, -1.9 to -1.0; P < .001) per 1000 live births, whereas this negative association was not observed in urban areas. When the analysis was stratified by regions and incomes, the negative association became considerably stronger in the western and central regions of China, as well as in counties with lower GDP per capita. This cohort study of more than 2900 counties in China suggests that an increase in hospital deliveries was associated with reduced neonatal mortality in rural and economically underdeveloped areas in China. To further reduce neonatal mortality and improve newborn health, it is imperative to increase the accessibility of hospital delivery services.

Effectiveness of pharmacological procedural sedation in children with autism spectrum disorder: A systematic review and meta-analysis.

Management of primary healthcare and routine minor procedures for children with autism spectrum disorder (ASD) can be challenging; therefore, when behavioural strategies fail, sedative medications are often employed. We evaluated the effectiveness of the current pharmacological strategies for managing children with ASD. We performed a systematic review and meta-analysis of the current approaches for procedural sedation in children with ASD. Twenty studies met inclusion criteria. Dexmedetomidine, midazolam, propofol and chloral hydrate were the most efficient agents for successful procedures, while propofol had the highest number of adverse events. The most frequently used agents were dexmedetomidine and midazolam or a combination of the two, and the effectiveness of dexmedetomidine plus midazolam was superior to dexmedetomidine alone. Multiple effective drug regimens exist for procedural sedation in children with ASD. These results could support the development of specific guidelines for procedural sedation in children with ASD.

Concurrent predictors of behavioral inflexibility in minimally verbal and verbal autistic children.

Behavioral inflexibility (BI) refers to the rigid and inflexible patterns of behaviors that are a core aspect of autism. Few studies have investigated BI in autism separately from other restricted and repetitive behaviors (RRBs). The present study used a relatively new measure, the behavioral inflexibility scale (BIS; Lecavalier, L., Bodfish, J., Harrop, C., Whitten, A., Jones, D., Pritchett, J., Faldowski, R., & Boyd, B. (2020). Autism Research, 13(3), 489-499), to examine the relationship of BI and variables that are both core symptoms in autism as well as symptoms associated with cooccurring mental health conditions, atypical sensory experiences, and adaptive functioning in a sample of 87 children with autism. Additionally, we aimed to understand how these relationships may be related to autistic individuals' verbal status: minimally verbal (MV) or verbal. Results revealed that anxiety, attention deficit/hyperactive, depressive, oppositional defiance problems, and sensory differences were all significantly correlated with BI in the MV group. In contrast, only anxiety, depressive, and oppositional defiance problems were significantly correlated with BI in the verbal group. Linear regression analyses showed that oppositional defiance problems and atypical sensory experiences explained a significant proportion of the variance of BI in the MV group, whereas only depressive problems were significant in the verbal group after accounting for other mental health conditions. Overall, our findings demonstrate that multiple aspects of psychopathology are significantly related to BI and can have broader implications for interventions and mental health care in autistic children.

Fifteen years of training courses and implementation of child and adolescent psychiatry in Jimma, South-West Ethiopia: a single site case study

In Ethiopia, as in many other low-and middle-income countries, health professionals, particularly mental health workers, are scarce. The purpose of this case study is to describe the process of establishing training child psychiatry and capacity building to implement clinical care for child and adolescent mental health. We present a case study on training of child and adolescent psychiatry embedded within the master’s degree program in integrated clinical and community mental health at the department of psychiatry in Jimma University, Ethiopia. This program is jointly developed in collaboration between Jimma University and Ludwig-Maximilian-University, Germany. The core elements of the training were to train mental state description, making decisions on possible disorders, perform occupational activities, and design psychosocial interventions. The WHOmhGAP guide is considered as appropriate knowledgebase for our teaching program. Each course was evaluated bidirectional with multiple methods. From 2010 to 2024, twelve trainings were organized. We structured the program in three phases. The initial phase (2010–2014) was to establish collaboration with guest lecturers and to develop, implement, and evaluate the training. The second phase (2015–2019) changed to mentorship and transition from guest lecturers to local trainers and included a refresher course. Phase three (2020–2024) was independent work. An outpatient clinical service for children was implemented by the lead author and now is running at Jimma University. The implementation of the training took place in small steps. A long-term commitment of local and guest lecturers enabled to develop culturally appropriate solutions for the local context. A similar approach can be applied to effectively start and expand child and adolescent mental health care in other resource limited settings.

ASARA-A technology-driven maternal and child healthcare model of Araku

Tribal populations form 8.6% of total India’s population. The health indicators of tribal populations lag behind their non-tribal counterparts. Limited access to healthcare services, poor transportation facilities, increased out-of-pocket expenditures for health, distinct cultural practices and remote settlement among many others contribute to the poor health status of the tribal populations. However, to achieve sustainable development goals by 2030, it is extremely important to address the healthcare needs of the tribal population. The current paper is the first part of the model of care working paper series that discusses the components of the ASARA project to highlight the impacts of the decade long efforts towards improving maternal and child care in the region.

Debuting an innovative model for integrated child health care in the Southeast region, Bulgaria

Abstract Background Demographic indicators are fundamental drivers for health policy action. The Southeast Region (SER) is the largest statistical region (NUTS 2) in Bulgaria (BG), distinguished by the highest Infant mortality rates (IMR) and teenage crude fertility rates across the European Union (EU). For instance, the 2022 statistics reveal an IMR of 8.2 per 1000 live births in SER, notably higher than Bulgaria’s average of 4.8 and the EU’s average of 3.3. This disparity highlights the critical need for region-specific health initiatives aimed at curtailing IMR and harmonizing health outcomes throughout the EU territories. This report outlines such an initiative under the project code BG16FFPR003-2.001-012, recently funded by the EU. The novel SER initiative: This is the first presentation of the concept of integrated territory investments (CITI) and the innovative model for integrated child health care in SER, BG. The project impacts child health care across the four districts of SER - Burgas, Sliven, Yambol, Stara Zagora. The municipalities have collaboratively submitted 24 project proposals with educational bodies, NGOs, public institutions, and the Ministry of Health. The theoretical frame of the project’s model is underpinned by three foundational pillars: 1) Prevention in primary healthcare; 2) Child health care in hospitals; 3) Development of human resources, providers of health care. The forthcoming infrastructural, organisational, and capacity-building interventions will remain adaptable yet aligned with the overarching CITI framework. Conclusions A current phase of public discourse on the CITI concept and the innovative integrated model in SER is underway. Stakeholders are actively encouraged to provide input either through discussions or by participating in designated online surveys. Community engagement is instrumental in evaluating and prioritizing these initiatives, which aim to fundamentally transform the SER by leveraging its unique territorial potential. Key messages • Demographic indicators drive health policy. Project BG16FFPR003-2.001-012 targets EU disparities, lowering IMR and balancing fertility rates. • This is the first presentation of the “Innovative model for integrated child health care in SER”. The EPH Conference provides an ideal platform for sharing and discussion.

Declining trends of overweight and obesity in 4-year-olds during 2007-2022 in Northern Sweden

Abstract Background Overweight among preschool children is a huge public health issue. The prevalence of both childhood overweight and obesity increased during the COVID-19-pandemic. Our aim was to study the development of overweight and obesity among 4-year-olds in Västerbotten, Sweden, from 2007 until 2022 with special focus on the COVID-19-pandemic and the year after. Methods This is a repeated cross-sectional study that utilized individual data from most 4-year-old children living in Västerbotten County, Sweden in 2007-2022, implying that the children were born 2003-2108. We included encrypted and anonymized individual anthropometrical data from the routine 4-year-old Child Health Care visit. There were 47 004 4-year-old children living in the county and we included data from 42 584 children, 21 966 boys and 20 618 girls at the age of 46-51 months. Results Overweight and obesity decreased over the study period. In 2007 the prevalence of overweight was 13.4% for boys and 14.9% for girls and obesity 3.7% for boys and 2.7% for girls. In 2022 the prevalence of overweight had declined to 9.5% for boys and 12.1% for girls and the prevalence of obesity to 1.8% and 2.1%, respectively. During the COVID-19-pandemic the prevalence of overweight and obesity for both boys and girls increased and then rapidly returned to the pre-pandemic level in 2022. Conclusions In a setting with free standardized Child Health Care, we present a clear decline in the prevalence of overweight and obesity among Swedish preschool children over time. As in other settings the prevalence of overweight and obesity increased during the COVID-19-pandemic, but we also report a rapid decline in overweight and obesity after the pandemic. It is essential to understand the underlying mechanisms responsible for this favorable trend. Key messages • We present clear decline in the prevalence of overweight and obesity in preschool children over time in a setting with free standardized Child Health Care. • It is important to understand the possible mechanisms of the favorable trend of decrease of the prevalence of overweight and obesity in children pre- and post-pandemic.

4.N. Scientific session: Equity in Child Health: Leveraging Universal Health Promotion Services for Families Amid Uncertainty

Abstract This workshop addresses the urgent need to foster resilience and equity in child health within the context of an increasingly uncertain Europe. Rapid societal changes, exacerbated by events such as the COVID-19 pandemic and heightened risks of conflict, climate change and economic instability, underscore the importance of nurturing environments where children can thrive despite challenging circumstances. The workshop aims to explore strategies for promoting well-being and addressing social inequalities in child health within the context of universal health promotion services, such as school health services and child health clinics. Objectives are to 1) Elucidate the importance and impact of universal health promotion services in addressing social inequalities and promoting equitable opportunities for all children, regardless of background or circumstance; 2) Identify actionable steps for interventions mitigating social inequalities and promoting equitable opportunities focusing on health literacy among parents with immigrant backgrounds; 3) Showcase successful models and initiatives in universal healthcare and health promotion services for children and families, emphasizing early intervention and standardized evaluation tools; and 4) Facilitate dialogue and knowledge exchange among professionals, policymakers, and stakeholders involved in child and adolescent health promotion. This workshop’s added value lies in its multidisciplinary approach, fostering collaboration for innovative solutions in child health resilience and equity. The coherence between presentations lies in their joint focus on addressing social inequalities in the context of universal health promotion services for children and families. Each presentation offers a unique perspective on these themes, contributing to a comprehensive understanding of the challenges and opportunities in child health promotion. • Hanne Nissen Bjørnsen’s presentation on the role of universal services in public health and addressing social inequality sets the stage by examining the structural factors contributing to disparities in child health outcomes. • Kirsti Riiseŕs presentation conveys the importance of user, stakeholder, and community involvement in creating culturally sensitive strategies for effective health promotion services in the context of health literacy among parents with immigrant backgrounds • Kristin Haraldstad’s presentation on Starting Right, an evidence-based assessment of children in municipalities healthcare centers, highlights the importance of early intervention and targeted support in mitigating health inequalities and promoting well-being. Format of the workshop: Three 10-minute presentations followed by a 20-minute moderated discussion to delve into empowerment and equity in child health, encouraging rich idea exchanges. Key messages • Leveraging universal health promotion services effectively empowers children and families while addressing social inequalities amidst periods of uncertainty. • Collaborative, user-centered approaches and evidence-based working strategies are key to promoting equity and building resilience in child health.

Intersectional inequalities in child social-emotional health: a case for proportionate universalism

Abstract Background Social-emotional difficulties in early childhood are associated with a range of outcomes across the life course and are related to socioeconomic factors. The aim of this study was to examine intersectional inequalities in social-emotional problems in preschool children relating to their parents’ income, education and country of birth in addition to investigating the public health implications. Methods This population-based study with a repeated cross-sectional design in the Västerbotten County of Sweden used the Ages and Stages Questionnaires: Social-Emotional (ASQ:SE) for children aged 3 in child health care services over the years of 2014-2018 and socio-economic information from national population registers. The effective sample of 8,823 individuals was analyzed using additive binomial regression in combination with an analysis of individual heterogeneity and discriminatory accuracy (AIHDA) approach to estimate risk differences for social-emotional problems across 27 intersectional groups and discriminatory accuracy. Results Average risk differences generally increased in the groups where multiple dimensions of social inequality intersected, with risk differences as high as 18% (95% CI 8 to 28%) and 25% (95% CI 14 to 37%) compared to the most advantaged category. The discriminatory accuracy of all three included regression models was estimated as moderate, but improved in a slight but statistically significant way with the addition of social inequalities. Conclusions This study increases our understanding of intersectional and social inequalities in social-emotional problems in preschool children. It supports the need for universal public health policies in addition to policies targeting more vulnerable groups when addressing this issue, consistent with the concept of proportionate universalism. An intersectional research perspective including discriminatory accuracy could increase our knowledge of health inequities and improve public health effectiveness. Key messages • Intersecting dimensions of social inequalities are associated with an increased risk of social-emotional problems in children aged 3. • Universal public health policies are needed in addition to policies targeting vulnerable population groups with regards to social-emotional problems in young children.

Associations between maternal origin, breastfeeding and health service use: a mediation analysis

Abstract Background The influence of maternal health utilization on breastfeeding practices is well established. However, research shows that immigrant women tend to face challenges in accessing maternal health services. Our aim was to examine any variation in maternal and child health service utilization between immigrant and native-born mothers as well as to examine potential mediation roles of service utilization on the association between maternal origin and breastfeeding practices. Methods We used a nationwide FinChildren (2020) survey on parents with infants focusing on Somali (n = 29), Arabic (n = 81) and Russian speaking (n = 181) parents and their infants. We compared them with native Finnish speakers (n = 7508). We used Process Macro to conduct mediation analysis. Results Almost 25%/ of Somali-/Arabic-speaking mothers reported not taking their infants to routine child health clinic visits. The proportion was 0.4% for native-born mothers and 1.6% for Russian-speaking mothers (p &amp;lt; 0.001). Around 18% of Somali-/Arabic-speaking mothers and only 0.6% of the native-born mothers reported not utilizing child health clinic services in the past year (p &amp;lt; 0.001). Somali-/Arabic speaking mothers were more likely to receive breastfeeding support from maternity clinics and native-born mothers from maternity hospital or peer support groups. Russian-speaking mothers were most satisfied with the received child healthcare services while Somali/Arabic-speaking mothers were least satisfied with these services (p &amp;lt; 0.001). Only participating in breastfeeding peer support groups had mediation effects on association between maternal origin and breastfeeding practices. Conclusions This study shows that immigrants mothers, particularly Somali/Arabic speaking mothers use less the maternal health services particularly routine health visits. It is essential to encourage them to use the services to be able to monitor the health of both mother and the child. Key messages • Somali-/Arabic-speaking mothers are in a vulnerable position when it comes to utilizing healthcare services. • This study call for more research exploring factors contributing to this.

The Interaction of Race and Pregnancy Intentions on Breastfeeding Initiation Rates and Duration in the United States.

Background: Unintended pregnancy increases adverse perinatal health outcomes. Limited studies exist on the influence of pregnancy intention on breastfeeding. This study examines the interaction of Race and couples' pregnancy intention on breastfeeding initiation and duration. Methods: Using the National Survey of Family Growth (2017-2019), we categorized breastfeeding into three categories (never breastfed, breastfed for 6 months or less, and breastfed for more than 6 months). Multinomial logistic regression and probability marginal effects were estimated across racial categories (Hispanics, non-Hispanic [NH] White, Black, and NH-others or multiracial). Results: The probability (Pr.) of never breastfeeding was the greatest among NH-Black women for all pregnancy intentions-both intended (Pr.: 0.34), mother-only (Pr.: 0.27), father-only (Pr.: 0.45), ambivalent (Pr.: 0.55), and neither intended (Pr.: 0.37). The probability of breastfeeding for 6 months or less is highest for Hispanics for both intended (Pr.: 0.41), NH-White for mother-only intended (Pr.: 0.49), Hispanics for father-only intended (Pr.: 0.56), ambivalent pregnancy intentions (Pr.: 0.60), and NH-others or multiracial for neither intended pregnancies (Pr.: 0.48). The probability of breastfeeding for more than 6 months is highest for NH-others or multiracial for both intended (Pr.: 0.50), ambivalent (Pr.: 0.49), and neither intended (Pr.: 0.36), while highest for NH-Black for mother-only intended (Pr.: 0.43). Conclusions: Our study demonstrates the interaction of Race and couples' pregnancy intention on breastfeeding initiation and duration. Owing to the high volume of unintended pregnancies in the United States, the current study might help maternal and child healthcare providers understand the interaction between race and pregnancy intentions on breastfeeding initiation and duration in the United States.

The WHO health system performance assessment applied to child healthcare in Luxembourg, 2011-2022

Abstract Background Health System Performance Assessments (HSPAs) evaluate health systems in terms of their objectives and their overall goals, such as access to quality services and health improvement. Beyond the overall health system assessment, HSPA can evaluate performance in providing care to specific populations. We assessed the response of the Luxembourg health system to children’s particular health needs, by populating the WHO HSPA framework for universal healthcare with child-specific indicators. Methods We searched international databases, guidelines, policy documents, and the scientific literature to identify child-specific indicators suitable for assessing the health system objectives as defined by the WHO HSPA framework. To select the most relevant indicators, we conducted expert appraisal regarding feasibility, validity and actionability. Those indicators were calculated based on available national data. To explore inequities within the system, we performed socioeconomic stratifications. Results Twenty-nine indicators were used to populate the framework, sourced from social security databases (n = 15), monitoring and surveillance (n = 11), and surveys (n = 2). For effectiveness assessment, we used 11 indicators and found that preventive services performed best for children under two years. Five indicators showed good accessibility to primary and secondary care. Another five indicators assessed safety indicating a recent increase in the relative use of broad-spectrum antimicrobials and an overuse of caesarean sections. Additional disaggregation of three indicators didn’t expose socioeconomic inequities in service delivery. Data gaps exist to assess children’s user-experience and financing of child health services. Conclusions The WHO HSPA framework proved valuable for evaluating the Luxembourg health system’s performance for children. We identified good performance in accessibility and effectiveness for young children, alongside data gaps to assess user-experience. Key messages • The application of national child-specific indicators to the WHO health system performance assessment, highlighted strengths in accessibility and effectiveness while also pointing to key data gaps. • We used the WHO health system performance assessment (HSPA) to evaluate the health system for children in Luxembourg. This exercise enhances the development of a tailored national HSPA framework.

Advancing Children’s Participation Rights in Healthcare Through Play

Abstract Within the vulnerable clinical context, children’s participation rights are easily compromised in relation to their protection and service provision. Unfortunately, failure to engage children in medical conversations can make this stressful context even more acute. In response to this problem, this Article presents the legal, philosophical and evidence-based arguments for incorporating play as a child-friendly intervention to engage young patients in meaningful participation in clinical settings. Play as the natural language of children can make them receive and assimilate medical information without fear. Play is also a well-recognised mechanism of child agency and their most natural form of participation, and as such can become a springboard for engaging and empowering children in healthcare.

Folk Wisdom and Traditional Knowledge: A Study of Mother and Child Healthcare Practices of Maram Nagas in India

Indigenous knowledge and healthcare practices are deeply embedded in the cultural fabric of tribal communities, influencing every aspect of life and ensuring the well-being of individuals. This paper delves into the Indigenous knowledge systems of the Maram Naga community in Manipur, India, mainly focusing on practices related to mother and child healthcare. The study is based on qualitative data gathered from 225 households across 12 Maram Naga villages through in-depth personal interviews and focus group discussions. It explains the beliefs, rituals, and other traditional cultural practices integral to the Maram Nagas in promoting the health and wellness of the mother and child in pre-natal and post-natal care.

New Age Parenting and Its Impact on Child’s Oral Health: Cross-sectional Questionnaire Study

Abstract Background: With increased globalization, East culture is meeting West culture and parenting style has been completely changed. Children depend significantly on their parents for provision, instruction, and supervision of crucial preventive oral hygiene habits. The education level and awareness of parents regarding preventive oral health measures play a pivotal role in this aspect. Therefore, it becomes imperative to evaluate and educate parents about proper oral hygiene care for their children, ultimately contributing to the overall well-being of the child. Aim: The aim of this study was to assess an impact of new age parenting on oral health of their children. Methodology: A cross-sectional questionnaire study was conducted among 204 parents of children aged 5–10 years, consisting of 27-item questionnaires containing four domains of demographic data, knowledge, attitude, and practice, which was distributed among the participants. A descriptive analysis was done using IBM SPSS software (version 22.0 Chicago, IL, USA). Results: It was surprising to note that 32.84% of parents were unaware about the specialist dentist is available for children. About 65.69% of parents had low level of knowledge regarding oral health of their children. The correlation among knowledge, attitude, and practice was determined to be highly statistically significant (P = 0.0001). Conclusion: Our study concluded that knowledge, attitude, and practice of oral health care of children are low among new age parents and there is a need to educate these parents regarding the same.

25 Genomic medicine in paediatric care for neurodevelopmental disorders: An assessment of practices, attitudes and education needs of Ontario paediatricians

Abstract Background Non-geneticist healthcare professionals are increasingly responsible for delivering genetics-informed care to individuals and their families affected by neurodevelopmental disorders (NDDs). Developing education tools to support their continuing education will require an understanding of physicians’ current approaches, attitudes and desired resources regarding genomic medicine, in the context of their specialty and healthcare system. Objectives Our goal was to assess paediatricians’ current practices, attitudes, and education needs regarding the provision of genomic medicine to individuals with NDDs in Ontario. Design/Methods We distributed an anonymous electronic questionnaire between April 2023 and June 2023 using online dissemination strategies. Inclusion criteria were paediatricians who self-identify as providing care to patients with NDDs. A multi-disciplinary team of genetic and non-genetic experts and a family partner developed the questionnaire. It had four sections: 1) demographic and clinical practice information, 2) experience with providing genomic medicine, 3) attitudes about providing genomic medicine, 4) education needs. Results One hundred and thirty paediatricians completed the questionnaire (estimated response rate of 10%, based on estimated 1300 Ontario paediatricians with varied practices). General paediatricians comprised 76% of responders; 50% of responders practiced outside a large urban centre. In terms of experience with genomic medicine: 58% of responders always/often discuss genetic testing options with families. Barriers to ordering genetic testing included lack of knowledge, confidence, access to lab services and time. Rates of ordering genetic testing varied by NDD and genetic test. Some paediatricians endorsed outdated testing practices (e.g., 9% order karyotype for patients with autism). Paediatricians also order genetic tests outside of standard clinical guidelines (e.g., 38% order a genetic test for patients with isolated language delay). In terms of attitudes regarding genomic medicine: majority believe that it is important to become educated about delivering genetic services to patients with NDDs. Over 60% strongly agree/agree that a genetic diagnosis may offer improved health management and research access, and about 50% strongly agree/agree that it may offer improved access to medical services and positive psychological impact for families. Commonest barriers to integrating genomic medicine in paediatric care were concerns about unanticipated genetic results, lack of local resources/logistical challenges, and competing psychosocial considerations. In terms of genetic education needs: paediatricians expressed strongest interest in learning about genetic testing (e.g. utility, interpretation, management) and advances in genomic technologies. Conclusion Ontario paediatricians integrate aspects of genomic medicine in the care of individuals with NDDs, though sometimes outside of clinically recommended contexts. They desire more support in optimizing this integration as genomic technologies and information evolve. Our study provides valuable information to guide the creation of genetic education tools to enhance collaborative healthcare for children and youth with NDDs.

67 A population-based cohort study of endocrine outcomes within the first 5 years of life in children born preterm

Abstract Background Preterm birth (&amp;lt;37 weeks’ gestational age [GA]) occurs in 8% of live births in Canada. While advancements in neonatal medicine have led to increased survival in preterm births, infants born preterm continue to sustain short- and long-term health sequelae. There is paucity of large population studies evaluating childhood health care outcomes, including endocrine-related outcomes, in recent birth cohorts. Objectives To evaluate the rates of endocrine conditions during the first 5 years of life in children born preterm and term. Design/Methods The study cohort included liveborn infants at 22-44 weeks’ GA in British Columbia, Canada between 2004-2014. Follow-up data to December 2019 included linked health services use information from four BC provincial databases (perinatal database, hospitalizations, outpatient services, and outpatient prescriptions). Rates of outcomes were compared by GA at birth (37-44 weeks reference category) using robust Poisson regression. Results There were 455,960 children included in this study with 42,820 (9.4%) born at &amp;lt;37 weeks GA. Results are summarized in Table 1 and Table 2. Compared to children born at 37-44 weeks’ gestations, infants born at 36 weeks’ gestation or younger have an increased rate of thyroid disorders between 0 months and 5 years (rate ratio [RR]: 1.45, 95% confidence interval [CI]: 0.78-2.43; RR: 1.83, 95% CI 1.51-2.20; RR: 1.41 95% CI 1.26-1.57 for 22-27 weeks, 28-33 weeks and 34-36 weeks GA, respectively). Similarly, infants born at 36 weeks’ gestation or younger have a higher rate of conditions in growth and development (RR: 3.05, 95% CI: 0.76-7.96; RR: 3.20, 95% CI 2.04-4.76; RR: 1.42 95% CI 1.02-1.94 for 22-27 weeks, 28-33 weeks and 34-36 weeks gestations, respectively) and bone health conditions (RR: 1.38, 95% CI: 1.27-1.49; RR: 1.04, 95% CI 1.00-1.08; RR: 1.05 95% CI 1.03-1.07 for 22-27 weeks, 28-33 weeks and 34-36 weeks gestations, respectively). There was no difference in rates of conditions related to glucose metabolism such as diabetes mellitus or hypoglycemia. Conclusion Children born preterm have increased rates of endocrine conditions by age 5. Disorders of thyroid, growth and development are increased in infants born preterm. Children born preterm have an increase rate of bone-related disorders, including those born late-preterm. These results provide useful prognostic information for follow-up care for preterm children and for healthcare resource planning. Furthermore, these results highlight areas of future research in endocrine health among preterm infants.

Predictors and number of antenatal care visits among reproductive age women in Sub-Saharan Africa further analysis of recent demographic and health survey from 2017-2023: Zero-inflated negative binomial regression.

Antenatal care (ANC) is an important component of maternal and child health care. To reduce perinatal mortality and improve women's experience of care, the World Health Organization (WHO) recommends pregnant women should attend at least eight ANC visits. However, in Sub-Saharan Africa (SSA), the mean number of ANC visits among reproductive-age women using Demographic and Health Surveys (DHS) data following the new WHO recommendation is so far limited. Therefore, the study aimed to determine the mean number of ANC visits and its predictors among reproductive-age women in SSA. Community-based cross-sectional study was conducted among 188,880 weighted reproductive-age women in SSA using a recent round of DHS data from 2017-2023. Zero-inflated negative binomial regression (ZINB) was conducted and statistical significance was declared at p-value <0.05 and adjusted incidence rate ratio(AIRR) for count model part and adjusted odds ratio for logit model inflated part of ZINBR with 95% confidence interval (CI) were reported. The mean number of ANC visits among reproductive-age women in SSA was 4.08 with 95%CI [4.07, 4.09]. Among reproductive-age women who gave birth in the last five years before the survey, 7.3% had eight or more ANC visits during pregnancy. Age of women, maternal and husband educational status, types of pregnancy, birth order, household size, number of under-five children, and wealth index were associated with the numbers of ANC visits among reproductive-age women in Sub-Saharan. The mean number of ANC visits among reproductive-age women in SSA is too lower than the new WHO recommendation of ANC visits for a positive pregnancy experience. This study also highlights that the proportion of at least eight ANC visits is low and there are still disparities in the mean of ANC visits across different regions of SSA. The increasing maternal age, higher maternal and husband educational status, wanted pregnancy, the number of household members, the number of under-five children, and higher wealth index increase the number of ANC visits. Unwanted pregnancy, no more fertility desire, and rural residences were contributed for zero ANC visits in SSA. Therefore, efforts should be geared towards improving maternal and husband's educational status. We strongly recommend that the governments of SSA countries should empower women economically and educationally to achieve the goals of ANC as recommended by the WHO.