Child Health Indicators Research Articles

Parental visual dysfunction and its associations with early childhood development in a community sample of families in Beijing, China

While research has associated parental visual functions with child vision, little is known about whether parental visual dysfunction is related to early childhood development (ECD) outcomes other than vision. Considering that parents with visual dysfunction conditions may encounter difficulties in engaging in some daily activities, the children of these parents possibly have fewer opportunities to acquire and refine certain ECD skills. This research explores associations between parental visual dysfunction conditions and different ECD outcomes in a community sample of families from Beijing, China. Participants were parents of 2140 young children (44.4% girls; age range = 0.75–63.25 months). Parents reported concerns about their visual dysfunction and responded to the Chinese version of the Ages and Stages Questionnaires, Third Edition (ASQ-C). Family demographics and child health indicators were controlled for as covariates. Analysis of variance (ANOVA) and analysis of covariance (ANCOVA) tests were used to compare group differences in the ASQ-C scores. Logistic regressions were conducted to examine the relative risk of suspected developmental delays in the ECD domains for children with parents with different visual function conditions. Results showed that children whose parents had visual dysfunction scored lower on the gross motor domain. Specifically, children whose parents had visual dysfunction conditions other than myopia had lower scores on the gross-motor and problem-solving domains relative to their counterparts. This group of children was prone to suspected developmental delays in the problem-solving domain. In conclusion, our findings suggest that having parents with visual dysfunction conditions other than myopia may be a risk, potentially compromising ECD in China.

The status of reproductive Health Indicators in Iran, Compared to the Sustainable Development Goals of the World Health Organization

Background and Objectives: Health indicators such maternal and child mortality rates are social indicators that are used to measure the development of each country. This study aims to investigate the status of maternal and child health indicators and total fertility rate in the last 10 years in Iran compared to the sustainable development goals (SDG) of the World Health Organization (WHO). Methods: This is a systematic review study. A search was first conducted to find studies related to the study objectives in Iran from 2012 to 2022 in online databases of SID, IranDoc, Web of Science, PubMed, Scopus and Google Scholar, using the keywords: Health, fertility, mothers, children. The results of the studies were compared with the SDG indicators of the WHO. Results: The initial search yielded 162 articles. After removing duplicates and screening the studies based on the inclusion criteria, finally 20 articles were selected for the review. The status of SDG indicators in Iran, except for neonatal mortality rate and low birth weight, was in accordance with the SDGs of the WHO until 2030. Conclusion: In the last ten years, the status of most SDG indicators in Iran has been favorable. However, the attention should be paid to the factors affecting neonatal mortality rate and low birth weight to reduce their rates and improve the country’s health status.

Early life health adversity and internalizing disorders in the transition from adolescence to adulthood.

Early life adversity (ELA) and youth chronic health conditions have been examined as separate contributors to psychopathology. However, little work has specifically examined early life health adversity (ELHA) and its association with risk for internalizing disorders. This study seeks to examine the relationship between ELHA and internalizing disorders across adolescence. A sample of 705 Australian mother-youth dyads participated in a prospective longitudinal study. Mothers reported child health indicators at youth ages three-to-four days, six months, and five years and completed a psychiatric interview at 15 years. Youth completed a psychiatric interview, as well as measures of current health status, at age 20. ELHA was positively associated with both youth anxiety and depressive disorders from ages 15 to 20. When independently accounting for the role of (a) current health status and (b) exposure to traditionally conceptualized forms of ELA, these findings remained statistically significant for anxiety but not depressive disorders. ELHA interacted with maternal depression, such that ELHA was only associated with youth depressive disorders in cases where mothers themselves had experienced depression. Routine mental health screenings may be warranted for youth who experience ELHA and their mothers. Pediatric primary care may be an ideal setting for implementing prevention and intervention efforts.

Determination of Health Concepts in β-Propeller Protein-Associated Neurodegeneration.

β-Propeller protein-associated neurodegeneration (BPAN) is a rare, X-linked condition caused by pathogenic variants in the WDR45 gene that result in a defect of autophagy. Classified as a disorder of neurodegeneration with brain iron accumulation, β-propeller protein-associated neurodegeneration is associated with severe neurologic impairments. With the anticipation of future therapeutic trials, this project characterizes the family's perspective of the impact of disease and defines Health Concepts (HC).Children with a molecularly confirmed diagnosis of β-propeller protein-associated neurodegeneration were enrolled in a prospective natural history study. We administered the Vineland Adaptive Behavior Scales-Third Edition and provided health-related quality of life questionnaires to 42 caregivers. Questionnaires included Pediatric Quality of Life Inventory-Generic Core and Pediatric Quality of Life Inventory-Family Impact modules, Caregiver Priorities and Child Health Index of Life with Disabilities, and Caregiver TBI-CareQoL.The Vineland Adaptive Behavior Scales-Third Edition (n = 42) captured the family's perspective that communication was more affected compared with socialization, activities of daily living (ADL), and motor skills (P < .0001, P < .0001, P = .0053, respectively). Similarly, on the Caregiver Priorities and Child Health Index of Life with Disabilities (n = 26), Pediatric Quality of Life Inventory-Generic Core (n = 27), CareQol (n = 26), and Pediatric Quality of Life Inventory-Family Impact (n = 27), communication abilities, as well as social functioning and activities of daily living, were noted to be most impacted.Through the use of standardized surveys and outcome assessments, we establish the effects of β-propeller protein-associated neurodegeneration on caregiver quality of life. Key health concepts identified by families included overall health, comfort, and communication. The identified HC will inform the future identification of concept of interest and selection of appropriate clinical outcome assessments through the administration of patient-reported outcomes.

Improving Accessibility and Delivery of Healthcare Services to Underserved Children through Technology: A Comprehensive Approach of Literature Review

This study investigates the use of technology to improve healthcare accessibility and delivery for children in underprivileged communities through article review comprehensively. A literature review with qualitative method that involved four distinct steps. In the initial stage, the search was conducted using Google Scholar (GS) and Scopus website. The second stage was filtering, which entails selecting the journals that will be examined. The last stage was analysis the articles, this analysis uses a 4-step PRISMA process to identify 123 articles published from 2019 to 2024 in Scopus journal. The review was evaluated the efficacy of telemedicine, mobile health applications, and wearable devices in monitoring and addressing children's health, while considering genetic predispositions and underlying medical issues that influence growth patterns. The research emphasizes the importance of a comprehensive strategy in evaluating child growth and development, utilizing health data to tailor interventions. Online systems, such as mobile phones and PDAs, can support healthcare workers in underserved rural areas. The integration of technology is essential for addressing unique challenges in underserved areas and ensuring access to high-quality healthcare services for all children. Current monitoring methods include regular check-ups, growth charts, and developmental screenings, with advancements in technology providing new tools like mobile health apps and wearable devices. Involving various stakeholders in the evaluation process is crucial, with participatory research focusing on community empowerment, ownership, and capacity building. Online systems offer efficient and accessible ways to track health data but may come with privacy concerns and data breach risks. The study focuses on the effectiveness of online systems for monitoring child health indicators, discussing data collection methods, sampling strategies, and ethical considerations. Findings reveal the need to address areas such as limited social interaction and incorporate interactive activities and group projects into online curriculum. Understanding the impact of online learning on students' health and well-being is crucial for tailoring approaches to ensure comprehensive support. The research findings have significant implications for child health policy and practice, emphasizing the importance of social connection and mental well-being in online learning environments.

Rib-on-pelvis deformity: a modifiable driver of pain and poor health-related quality of life in cerebral palsy.

Cerebral Palsy (CP) often presents with a sweeping thoracolumbar scoliosis and pelvic obliquity. With severe pelvic obliquity, the ribs come into contact with the high side of the oblique pelvis, termed rib-on-pelvis deformity (ROP). ROP can result in costo-iliac impingement, or pain associated with ROP, and can also adversely affect breathing and sitting balance. The goal of this study was to evaluate whether CP patients with ROP have worse health-related quality of life (HRQOL) before surgery and a greater improvement in HRQOL after surgery. A retrospective analysis of a prospectively collected, multicenter, international registry was performed for all nonambulatory patients with CP treated with spinal fusion with at least two-year follow-up. HRQOL was measured via the Caregiver Priorities & Child Health Index of Life with Disabilities (CPCHILD) questionnaire domains (0 = most disability, 100 = least disability). ROP was defined as having a rib distal to the superior portion of the iliac crest on preop upright radiographs. The ROP group and control group without ROP were compared regarding six domain scores and total score of CPCHILD. Multiple linear regression was used to control for curve apex location, major coronal Cobb angle, type of tone, and pelvic obliquity. 340 patients met inclusion criteria (52% female, mean age 14.0years). The mean major coronal Cobb angle was 81 degrees and mean pelvic obliquity was 22 degrees. 176 patients (51.8%) had ROP while 164 patients (48.2%) did not. ROP was independently associated with worse preoperative Positioning/Transfers/Mobility (PTM), Comfort & Emotions (C&E), and total CPCHILD score via the CPCHILD questionnaire (p < 0.05). Patients with preoperative ROP experienced a greater improvement in the C&E and PTM domains as well as total CPCHILD score than patients without ROP (p < 0.05). CP patients with rib-on-pelvis deformity experience more pain and worse HRQOL than patients without this deformity. These patients experienced a greater improvement in HRQOL after spinal fusion measured via the CPCHILD questionnaire.

Exploring the association between individual, family, and program characteristics and change in health outcomes 12 months after enrollment into the CANadian Pediatric Weight management Registry (CANPWR).

To examine individual, family, and program characteristics associated with changes in anthropometric and cardiometabolic health indicators in children with overweight or obesity after participating in multidisciplinary obesity management for 12 months. Participants included children 2-17 years old with overweight or obesity enrolled in the CANadian Pediatric Weight Management Registry (CANPWR). Multiple linear regression analyses were conducted to investigate the associations between individual, family, and program characteristics and changes in anthropometry (WHO BMI z-score) and cardiometabolic health indicators (systolic and diastolic blood pressure; fasting and 2-h glucose post-oral glucose tolerance test (OGTT); high density lipoprotein- (HDL) and non-HDL cholesterol and fasting triglycerides). BMI z-score data were available from 1065/1286 (82.8%) at 6-months post-baseline and 893/1286 (69.4%) at 12-months post-baseline. At 6-months, BMI z-score decreased relative to baseline (mean difference (MD) [95% confidence interval (CI)] = -0.08 [-0.10 to -0.06]; p < 0.001). BMI z-score (MD [95% CI] = -0.08 [-0.13 to -0.04); p = 0.001) and fasting triglycerides (MD [95% CI] = -0.07 [-0.13 to -0.02); p = 0.011) decreased at 12 months from baseline. Older age at baseline (estimated β = 0.025; 95% CI [0.006, 0.042], p = 0.007) and female sex (estimated β = 0.241; 95% CI [0.108, 0.329], p < 0.001) were associated with a worsened Δ BMI z-score at 12 months, while total hours with mental health provider (estimated β = -0.015; 95% CI [-0.030, -0.001], p = 0.049) was associated with an improved Δ BMI z-score at 12 months. Hours with an exercise counselor (estimated β = 0.023; 95% CI [0.008, 0.039], p = 0.003) were associated with improved HDL, while hours with a registered dietitian (estimated β = -0.026; 95% CI [-0.051, -0.001], p = 0.044) were associated with improved non-HDL cholesterol. Male sex and hours spent with a mental health provider, exercise counselor, and registered dietitian were related to significant improvements in several anthropometric and cardiometabolic health indicators at 12 months post-baseline.

The relationship between kinship and foster placement on mental health indicators in children and youth seeking treatment

BackgroundChildren living in both kinship and foster care placements often face considerable adversity. It is possible that these placements can have differential impacts on children’s socioemotional, psychological, and educational outcomes and well-being. ObjectiveThis study examined the similarities and differences between children and youth who reside in kinship placements and those who reside in foster placements. Specifically, similarities and differences in children's mental health care and service requirements, as well as their family's strengths and resources were explored to better understand the needs of children placed in out-of-home care. ParticipantsThe final sample included assessments from 5356 treatment-seeking children, ages three to 18 years old, from across 66 select mental health agencies in Ontario. MethodsChildren were assessed using the interRAI ChYMH, the ChYMH-S, or the ChYMH-DD. These assessments include a variety of embedded evidence-informed scales and algorithms to examine the mental health needs, preferences and strengths of these vulnerable children. ResultsCompared to children in kinship placements, children in foster care were more likely to: (a) exhibit greater externalizing symptoms, (b) display concerns regarding sexual behaviour, (c) encounter trauma, and (d) experience more polyvictimization. No differences were found in terms of spirituality and cultural connectedness. Additionally, kinship caregivers tended to experience greater distress, compared to foster caregivers. ConclusionsFindings from this study highlight important areas where children residing in out-of-home care, particularly those in foster care, require increased access to mental health resources and support. Furthermore, trauma-informed care should always be at the forefront when working with foster and kinship care children and their families.

Effectiveness of a game-based high-intensity interval training on executive function and other health indicators of children with ADHD: A three-arm partially-blinded randomized controlled trial

BackgroundChildren with ADHD demand for effective intervention with minimum side effect to improve executive function (EF) and health well-being. MethodThis study used a three-arm partially-blinded randomized controlled trial to test the effects of two different kinds of 8-week game-based training programs (game-based HIIT program, GameHIIT; and game-based structured aerobic exercise program, GameSAE) on EF and other health indicators of children with ADHD, which was compared with a non-treatment control group. ResultsA total of 49 children with ADHD completed the program. Analyses of EF tests and parental survey indicated that (i) there is no significant intragroup difference among all measures between pre-/post-intervention tests for two game-based intervention groups. The only significant intergroup difference was observed in self-monitor score of parent-reported child's EF between GameSAE group and the control (large effect). Similarly, cerebral hemodynamic responses also found no significant group effect for all EF tests. However, the time effects were observed in several channels in the GameHIIT group in two EF tests (Color Words Stroop Test and Tower of London Test). No significant change of participants' overall ADHD symptoms was found in the pre-/post-tests for three groups. Nonetheless, further analyses revealed that both of two game-based training programs exhibited the significant positive effects on child's PA levels and the large effects on levels of physical fitness, when they were compared to the control. ConclusionBy this study, a significant enhancement in physical fitness and PA levels were found in both game-based PA interventions when they were compared with control group. However, the effectiveness of game-based PA interventions on improving EF or reducing ADHD symptoms remains unclear. This implies that a larger intervention dosage or a tailored intervention design may be warranted to improve the EF of children with ADHD.

Possible determinants of physical fitness in Japanese school children: Across-sectional study.

Physical fitness is one of the most important health indicators in children. Although appropriate body composition or certain lifestyle factors such as frequent physical activity are thought to improve physical fitness, results of previous studies are inconsistent, and most studies were from Western countries. We investigated associations of body composition and modifiable lifestyle factors such as physical activity, screen time, diet and sleep duration with physical fitness in Japanese primary school children. 2308 children (age 10-12 years old) in 12 primary schools were analysed in this cross-sectional study. Physical fitness was evaluated by sports battery tests conducted routinely and annually at schools. The total score of sports battery tests, 20-m shuttle run (laps) and grip strength (kg) were selected as outcomes. Information about lifestyle factors was collected by two questionnaires. Associations between lifestyle factors and physical fitness were assessed by multivariable linear mixed models by sex. Frequent exercise was related to better overall physical fitness. Regarding the 20-m shuttle run, many unfavourable lifestyle factors such as higher BMI in boys (β -7.37, 95% confidence interval [CI] -8.39, -6.35) and girls (β -3.54, 95% CI -4.50,-2.58), longer screen time (β -4.31, 95% CI -7.29, -1.34) in boys and girls (β -5.65, 95% CI -9.01, -2.30); shortest (reference) versus longest, breakfast skipping in boys (β -5.24, 95% CI -8.71, -1.77) and girls (β -3.57, 95% CI -6.84, -0.30); consumers (reference) versus skippers were associated with worse performance. Better quality of diet was associated with better results in the 20-m shuttle run only in girls (β 2.58, 95% CI 0.24, 4.93); lowest (reference) versus highest. Frequent exercise was related to better physical fitness. Higher BMI and unfavourable lifestyle factors such as longer screen time and breakfast skipping were associated with worse results of the 20-m shuttle run.

Determinants of Undernutrition among Under-Five Children: A Community-Based Study from Eastern India

Backgrounds: Children are prone to undernutrition which adversely affects their health status. Nutritional status of under-five children is a sensitive indicator of nutrition and child health. Hence, the present study is undertaken to assess the prevalence and determinants of undernutrition among under-five children in a rural area of West Bengal, India. Methods: A community-based cross-sectional study was conducted among 1680 under-five children who were selected by 30 cluster sampling technique to assess the prevalence and determinants of undernutrition. Nutritional status was assessed by means of weight-for-age, height-for-age, weight-for-height and mid-upper arm circumference-for-age criteria based on World Health Organization’s child growth standards. Results: The prevalence of underweight, stunting, and wasting among under-five children was found to be 33.7%, 34.8%, and 21.6%, respectively. Moreover, 39.4% of the studied children had low mid-upper arm circumference-for-age. After adjustment for possible confounders, maternal illiteracy, lower socio-economic status, presence of anemia and any childhood morbidity were found significant determinants of undernutrition. Conclusions: Widespread prevalence of undernutrition among under-five children with anemia and childhood morbidity as important determinants highlights a need for multi-disciplinary integrated approach towards improving the child health and nutrition. Long term measures like improvement of maternal education and poverty alleviation should also be considered in future plans.

Socioeconomic inequality in child health outcomes in India: analyzing trends between 1993 and 2021

BackgroundThe health of India’s children has improved over the past thirty years. Rates of morbidity and anthropometric failure have decreased. What remains unknown, however, is how those patterns have changed when examined by socioeconomic status. We examine changes in 11 indicators of child health by household wealth and maternal education between 1993 and 2021 to fill this critical gap in knowledge. Doing so could lead to policies that better target the most vulnerable children.MethodsWe used data from five rounds of India’s National Family Health Survey conducted in 1993, 1999, 2006, 2016, and 2021 for this repeated cross-sectional analysis. We studied mother-reported cases of acute respiratory illness and diarrhea, hemoglobin measurements for anemia, and height and weight measurements for anthropometric failure. We examined how the prevalence rates of each outcome changed between 1993 and 2021 by household wealth and maternal education. We repeated this analysis for urban and rural communities. ResultsThe socioeconomic gradient in 11 indicators of child health flattened between 1993 and 2021. This was in large part due to large reductions in the prevalence among children in the lowest socioeconomic groups. For most outcomes, the largest reductions occurred before 2016. Yet as of 2021, except for mild anemia, outcome prevalence remained the highest among children in the lowest socioeconomic groups. Furthermore, we show that increases in the prevalence of stunting and wasting between 2016 and 2021 are largely driven by increases in the severe forms of these outcomes among children in the highest socioeconomic groups. This finding underscores the importance of examining child health outcomes by severity.ConclusionsDespite substantial reductions in the socioeconomic gradient in 11 indicators of child health between 1993 and 2021, outcome prevalence remained the highest among children in the lowest socioeconomic groups in most cases. Thus, our findings emphasize the need for a continued focus on India’s most vulnerable children.

Determinants of wealth-related inequalities in full vaccination coverage among children in Nepal: a decomposition analysis of nationally representative household survey data

BackgroundOver the past two decades, child health indicators in Nepal have improved significantly at the national level. Yet, this progress hasn’t been uniform across various population subsets. This study identified the determinants associated with childhood full vaccination, assessed wealth-related inequalities, and delved into the key factors driving this inequality.MethodsData for this study were taken from the most recent nationally representative Nepal Demographic and Health Survey 2022. A total of 959 children aged 12–23 months who had received routine childhood basic antigens as per the national immunisation program were considered for analysis. Binary logistic regression models were conducted to identify the associated factors with outcome variable (uptake of full vaccination). The concentration curve and Erreygers normalized concentration index were used to assess inequality in full vaccination. Household wealth quintile index scores were used to measure wealth-related inequality and decomposition analysis was conducted to identify determinants explaining wealth-related inequality in the uptake of childhood vaccination.ResultsThe coverage of full vaccination among children was 79.8% at national level. Several factors, including maternal health service utilisation variables (e.g., antenatal care, institutional delivery), financial challenges related to visiting health facilities, and mothers’ awareness of health mother group meetings within their ward, were associated with the uptake of full vaccination coverage among children. The concentration curve was below the line of equality, and the relative Erreygers normalized concentration index was 0.090, indicating that full vaccination was disproportionately higher among children from wealthy groups. The decomposition analysis identified institutional delivery (20.21%), the money needed to visit health facilities (14.25%), maternal education (16.79%), maternal age (8.53%), and caste (3.03%) were important contributors to wealth related inequalities in childhood full vaccination uptake.ConclusionsThere was notable wealth-related inequality in full vaccine uptake among children in Nepal. Multisectoral actions involving responsible stakeholders are pivotal in reducing the inequalities, including promoting access to maternal health services and improving educational attainment among mothers from socioeconomically disadvantaged communities.

Arabic Translation of The Caregiver Priorities and Child Health Index of Life with Disabilities CPCHILD Scale

Abstract Background Children with cerebral palsy have difficulties in daily life activities (feeding, toilet training, dressing), communication, and mobility. The children’s independence and quality of life decrease when their performance in activities of daily living is reduced. Evaluation of motor function for affected children with cerebral palsy (CP), individual needs and goals of these patients and their parents is still lacking and needs to be further addressed. The CPCHILD is a multidimensional patient centered assessment tool. Aim of the Work Our aim is to translate and provide an Arabic version of the CPCHILD for assessing the caregivers’ perceptions of the health status, comfort, wellbeing, functional abilities, and quality of life for their children with cerebral palsy. Patient and Methods This study was a cross sectional study, conducted at Pediatric Neurology Clinic at Children’s Hospital, and Physical Medicine Outpatient Clinic at Ain Shams University Hospitals. The CPCHILD was translated from English to Arabic with the agreement of the scale's owner. The Arabic version was provided through translation and back translation process, which was then presented to the caregivers of CP children for evaluation of the perspectives and quality of life for their children. Results An Arabic version of the CPCHILD scale was created. The enrolled caregivers for children with CP were the biological mothers. The mothers of the CP children were able to understand and respond to the translated scale and reported poor mean total CPCHILD score 26.45 (0-58.3). Conclusion The Arabic version of the scale was provided through translation and back translation process and the version was prepared for subsequent validation tests. The translated version will help in applying the scale in the caregivers' language in a culture proper setting and can be helpful in the assessment of health-related quality of life of children with CP.

The sleep and activity database for the early years (SADEY) study: design and methods

BackgroundCanada, Australia, the World Health Organization and other countries have released 24-hour movement guidelines for the early years which integrate physical activity, sedentary behaviour, and sleep, focusing on supporting children to achieve a healthy 24-hour day. The guideline evidence synthesis, however, highlighted the dearth of high-quality evidence, particularly from large-scale studies. The Sleep and Activity Database for the Early Years (SADEY) project aims to assemble a large, pooled database of 24-hour movement behaviours and health indicators in young children (birth to 5.99 years), to advance knowledge in these areas. This paper describes the SADEY design and methods.MethodsData sets were identified with > 100 children and device-measured (hip-worn ActiGraph accelerometers) physical activity and sedentary behaviour, parent-reported or device-measured sleep, and at least one health outcome: physical (BMI, waist circumference, blood pressure), social-emotional (Strength and Difficulties Questionnaire), cognitive (Early Years Toolbox), or motor development (Test of Gross Motor Development 2). Led by the University of Wollongong co-ordinating centre, the SADEY project collates the datasets to create a pooled database.FindingsTo date, 13 studies from 7 countries have been included in the database. Ethics clearance and data sharing agreements have been secured for all studies and the SADEY 1.0 database is being assembled including ~ 8,000 participants.DiscussionSADEY will be used to address questions of global importance to public health policy and practice, for example – Is the mix of movement behaviours across the 24-hour day associated with healthy development?, What is the optimal mix of these behaviours?, and; What factors can be targeted to support young children in achieving the optimal mix of 24-hour movement behaviours? Additionally, SADEY seeks to develop and disseminate protocols, develop capacity on the device-based measurement of movement behaviours, and seeks partnerships with stakeholders that promote knowledge translation on movement behaviours to support healthy development among young children.

Changes in reproductive, maternal, and child health in Haiti during the pre- and peri-COVID-19 pandemic.

To assess changes in reproductive, maternal, newborn, child, and adolescent health (RMNCAH) in Haiti from August 2018 to September 2021, before and during the COVID-19 pandemic. A retrospective study using surveillance data from the Haitian Unique Health Information System, examining two periods: pre- and peri-COVID-19 pandemic. Health indicators at the national level in the two periods were compared using two-sample t-tests for proportions, and average absolute monthly changes were calculated using variance-weighted regression. There was a statistically significant decline in the proportion of most of the indicators assessed from the pre- to the peri-COVID-19 pandemic period. However, the most affected indicators were the proportions of pregnant women with four antenatal care visits, with five antenatal care visits or more, and those who received a second dose of tetanus vaccine, which decreased by over 4 percentage points during the two periods. Likewise, the proportions of children who received diphtheria, tetanus, and pertussis (DTaP), BCG, polio, pentavalent, and rotavirus vaccines also all declined by over 8 percentage points. In contrast, pneumococcal conjugate vaccine increased by over 4 percentage points. A statistically significant decrease was also observed in the average absolute monthly changes of several reproductive and child health indicators assessed. The COVID-19 pandemic may have contributed to the decline observed in several RMNCAH indicators in Haiti. However, the role played by the sociopolitical crisis and control exercised by armed groups over the population in the last three years cannot be ruled out.

The impact of mode of birth delivery on child health in India

Background: A skilled birth attendant and the place of delivery have significant effects on child growth. Aims: The present paper aims to examine the mode of delivery and its impact on child health among children (0 – 59 months) in India. Methods: The life table estimation of mortality and both bivariate and multivariate logistic regressions were used to identify the association between child health and mode of delivery using data from the National Family Health Survey conducted in 2015 – 2016. Results: After adjusting for socioeconomic and biodemographic factors, poor child growth (measured through Z-scores for stunting, wasting, and underweight categories) was more significant in cesarean delivery compared to normal delivery. In contrast, live birth for different groups of women was reportedly higher in normal vaginal delivery than in cesarean delivery. Neonatal and infant mortality rates were lower for normal delivery than cesarean delivery, particularly in public hospitals. The risk of child death was also higher in cesarean delivery, particularly in the neonatal period. Conclusion: The findings from this study could inform the development of health-care policies and the implementation of strategies aimed at improving the quality of painless labor and prompt delivery in health-care facilities, particularly public hospitals. Relevance for Patients: The present study may help pregnant women and their providers decide whether a cesarean delivery is appropriate.

Association between Child Mortality and Healthcare Facility Level Factors: Evidence from Nationally Representative Survey

Child mortality is an important indicator of child health and overall national development. Under-five mortality is unacceptably high in Low- and Middle-Income Countries (LMICs) including Bangladesh. Increased availability and access to the healthcare services can play a significant role to reduce under-five mortality. The aim of this study was to explore the associations of several forms of child mortality with health facility level factors. Data were extracted from the 2017-18 Bangladesh Demographic and Health Survey data and 2017 Bangladesh Health Facility Survey data. Three outcome variables were considered: neonatal mortality, infant mortality, and under-five mortality in this study. Health facility level factors were considered as major explanatory variables. They were the availability of the child healthcare services at the nearest healthcare facility, readiness of the nearest healthcare facility to provide child healthcare services and the average distance of the nearest healthcare facility providing child healthcare services. Multilevel mixed-effect logistic regression model was used to determine the associations between the outcome variables and explanatory variables adjusted for covariates. We reported under-five, infant and neonatal mortality were 40, 37, and 30 per 1000 live births, respectively. The likelihood of neonatal and infant mortality was found to be declined for one-unit increase on the availability and readiness of the mothers’ homes nearest healthcare facilities to provide child healthcare services. On contrary, for every kilometre increased distance between mothers’ homes and their nearest healthcare facility was found to be associated with increased in the likelihoods of neonatal, infant and under-five mortality. The availability of health facilities providing child healthcare services close to residence and their improved management, infrastructure, and readiness to provide child healthcare services play a significant role in reducing under-five mortality in Bangladesh. Policies and programs should prioritize to increase the availability and accessibility of health facilities that provide child healthcare services.

Impact of COVID-19 pandemic on physical health amongst children: Difference-in-differences analyses of nationwide school health checkup database.

The COVID-19 pandemic posed tremendous challenges for children. However, the long-term effects of the pandemic on various aspects of physical health at a national level remain unclear. In this retrospective cohort study, we analysed data from nationwide health checkup records amongst children aged 7-15 years. The dataset comprised 3 544 146 records from 393 794 individuals who graduated from junior high school during fiscal years 2007 to 2022. Difference-in-differences (DID) analyses with multiple time periods were used to examine the impact of COVID-19 on physical health outcomes. Compared with the pre-pandemic period, the COVID-19 pandemic was associated with excess increases in obesity for boys and girls, persisting over the 3 years (+0.42%; [95% CI, 0.23-0.61]). Also, it was associated with excess increases in underweight (+0.28% [0.25-0.32]) and poor visual acuity amongst boys in the 3rd year (+1.80% [1.30-2.30]). There were excess reductions in dental caries (-1.48% [-2.01 to -0.95]), glucosuria (-0.55 [-0.88 to -0.23]) and hematuria (-0.43% [-0.73 to -0.13]) during the 3rd year of the pandemic. These findings underscore the multifaceted impact of the pandemic on various health indicators for school-aged children. This information could be valuable for public health policy and paediatric healthcare planning in the post-pandemic era.

Does health voucher intervention increase antenatal consultations and skilled birth attendances in Cameroon? Results from an interrupted time series analysis

BackgroundLimited access to health services during the antenatal period and during childbirth, due to financial barriers, is an obstacle to reducing maternal and child mortality. To improve the use of health services in the three regions of Cameroon, which have the worst reproductive, maternal, neonatal, child and adolescent health indicators, a health voucher project aiming to reduce financial barriers has been progressively implemented since 2015 in these three regions. Our research aimed to assess the impact of the voucher scheme on first antenatal consultation (ANC) and skilled birth attendance (SBA).MethodsRoutine aggregated data by month over the period January 2013 to May 2018 for each of the 33 and 37 health facilities included in the study sample were used to measure the effect of the voucher project on the first ANC and SBA, respectively. We estimated changes attributable to the intervention in terms of the levels of outcome indicators immediately after the start of the project and over time using an interrupted time series regression. A meta-analysis was used to obtain the overall estimates.ResultsOverall, the voucher project contributed to an immediate and statistically significant increase, one month after the start of the project, in the monthly number of ANCs (by 26%) and the monthly number of SBAs (by 57%). Compared to the period before the start of the project, a statistically significant monthly increase was observed during the project implementation for SBAs but not for the first ANCs. The results at the level of health facilities (HFs) were mixed. Some HFs experienced an improvement, while others were faced with the status quo or a decrease.ConclusionsUnlike SBAs, the voucher project in Cameroon had mixed results in improving first ANCs. These limited effects were likely the consequence of poor design and implementation challenges.