Child Health Research Articles

A Digital Cognitive-Physical Intervention for Attention-Deficit/Hyperactivity Disorder: Randomized Controlled Trial.

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders among children. Pharmacotherapy has been the primary treatment for ADHD, supplemented by behavioral interventions. Digital and exercise interventions are promising nonpharmacologic approaches for enhancing the physical and psychological health of children with ADHD. However, the combined impact of digital and exercise therapies remains unclear. The aim of this study was to determine whether BrainFit, a novel digital intervention combining gamified cognitive and exercise training, is efficacious in reducing ADHD symptoms and executive function (EF) among school-aged children with ADHD. This 4-week prospective randomized controlled trial included 90 children (6-12 years old) who visited the ADHD outpatient clinic and met the diagnostic criteria for ADHD. The participants were randomized (1:1) to the BrainFit intervention (n=44) or a waitlist control (n=46) between March and August 2022. The intervention consisted of 12 30-minute sessions delivered on an iPad over 4 weeks with 3 sessions per week (Monday, Wednesday, and Friday after school) under the supervision of trained staff. The primary outcomes were parent-rated symptoms of attention and hyperactivity assessed according to the Swanson, Nolan, and Pelham questionnaire (SNAP-IV) rating scale and EF skills assessed by the Behavior Rating Inventory of Executive Function (BRIEF) scale, evaluated pre and post intervention. Intention-to-treat analysis was performed on 80 children after attrition. A nonparametric resampling-based permutation test was used for hypothesis testing of intervention effects. Among the 145 children who met the inclusion criteria, 90 consented and were randomized; ultimately, 80 (88.9%) children completed the study and were included in the analysis. The participants' average age was 8.4 (SD 1.3) years, including 63 (78.8%) male participants. The most common ADHD subtype was hyperactive/impulsive (54/80, 68%) and 23 (29%) children had severe symptoms. At the endpoint of the study, the BrainFit intervention group had a significantly larger improvement in total ADHD symptoms (SNAP-IV total score) as compared to those in the control group (β=-12.203, 95% CI -17.882 to -6.523; P<.001), owing to lower scores on the subscales Inattention (β=-3.966, 95% CI -6.285 to -1.647; P<.001), Hyperactivity/Impulsivity (β=-5.735, 95% CI -8.334 to -3.137; P<.001), and Oppositional Defiant Disorder (β=-2.995, 95% CI -4.857 to -1.132; P=.002). The intervention was associated with significant reduction in the Metacognition Index (β=-6.312, 95% CI -10.973 to -1.650; P=.006) and Global Executive Composite (β=-5.952, 95% CI -10.214 to -1.690; P=.003) on the BRIEF. No severe intervention-related adverse events were reported. This novel digital cognitive-physical intervention was efficacious in school-age children with ADHD. A larger multicenter effectiveness trial with longer follow-up is warranted to confirm these findings and to assess the durability of treatment effects. Chinese Clinical Trial Register ChiCTR2300070521; https://www.chictr.org.cn/showproj.html?proj=177806.

Prenatal opioid exposure by likelihood of exposure and risk to prenatal development: Medicaid-covered births in Wisconsin, 2010-2019.

Prenatal opioid exposure is an established public health problem, in particular among Medicaid-covered births. Yet, existing prevalence rates are plausibly underestimated. We leverage extensive linked longitudinal administrative data for all Medicaid-covered live births in Wisconsin from 2010 to 2019 to estimate a range of prevalence rates using an innovative strategy that jointly accounts for both likelihood of exposure and potential risk to prenatal development. We find that 20.8% of infants may have been prenatally exposed to opioids, with 1.7% diagnosed with neonatal abstinence syndrome and an additional 1.2% having a high combined likelihood of exposure and potential risk to prenatal development, 2.6% a moderate combined likelihood and risk, and 15.3% a low or uncertain combined likelihood and risk. We assess improvements in prevalence estimates based on our nuanced classification relative to those of prior studies. Our strategy could be broadly used to quantify the scope of the opioid crisis for pregnant populations, target interventions, and promote child health and development.

Status (in)consistency in education and violent parenting practices towards children

Violent childrearing practices represent an invisible threat for global health and human development. Leveraging underused information on child discipline methods, this study explores the relationship between parental educational similarity and violent childrearing practices, testing a new potential pathway through which parental educational similarity may relate to child health and wellbeing over the life course. The study uses data from Multiple Indicator Cluster Surveys (MICS) and Demographic and Health Surveys (DHS) covering 27 sub-Saharan African (SSA) countries. Results suggest that couples where partners share the same level of education (homogamy) are less likely to adopt violent childrearing practices relative to couples where partners face status inconsistency in education (heterogamy), with differences by age of the child, yet less so by sex and birth order. Homogamous couples where both partners share high levels of education are also less (more) likely to adopt physically violent (non-violent) practices relative to homogamous couples with low levels of education. Relationships are stronger in countries characterized by higher GDP per capita, Human Development Index, and female education, yet also in countries with higher income and gender inequalities. Besides stressing the importance of female education, these findings underscore the key role of status concordance vs discordance in SSA partnerships. Tested micro-level mechanisms and country-level moderators only weakly explain result heterogeneity, calling for more research on the topic.

Clinical and molecular genetic analysis of a child with comorbid 16p11.2 microdeletion syndrome and Rett syndrome

To explore the genetic characteristics of a child with comorbid 16p11.2 microdeletion syndrome and Rett syndrome (RTT). A male infant who was admitted to Gansu Provincial Maternity and Child Health Care Hospital in May 2020 was selected as the study subject. Clinical data of the infant was collected. Genomic DNA was extracted from peripheral blood samples from the infant and his parents, and subjected to whole exome sequencing (WES). Candidate variant was verified by Sanger sequencing. The patient, a 4-day-old male infant, had presented with poor response, poor intake, feeding difficulties, and deceased at 8 months after birth. WES revealed that he has harbored a 0.643 Mb deletion in the 16p11.2 region, which encompassed key genes of the 16p11.2 microdeletion syndrome such as ALDOA, CORO1A, KIFF22, PRRT2 and TBX6. His father has carried the same deletion, but was phenotypically normal. The deletion was predicted to be pathogenic. The child was also found to harbor a maternally derived c.763C>T (p.R255X) hemizygous variant of the MECP2 gene, which was also predicted to be pathogenic (PVS1+PS4+PM2_Supporting). The 16p11.2 deletion and the MECP2: c.763C>T (p.R255X) variant probably underlay the pathogenesis in this infant.

Bone health and awareness of osteoporosis in women aged 40 to 60 years in Jiaxing City, China.

The objective of this study is to evaluate the pattern of bone mineral density (BMD) in native Jiaxing women, and to investigate their awareness of osteoporosis. A total of 538 native Jiaxing women aged 40 to 60 years were recruited from January 2022 to December 2023 when they had routine examinations in the physical examination center of Jiaxing Maternal and Child Health Hospital. The Chinese version of Osteoporosis Prevention and Cognition Tool was used to evaluate participants' cognitive level of osteoporosis. BMD of participants' lumbar spine (L1-L4) and left hip (Neck/Troch/Ward) was measured by dual-energy X-ray absorptiometry. The mean total score of the awareness about osteoporosis (general knowledge, complications, and prevention) was 22.08 ± 2.74, which was suboptimal. The higher the education level, the higher the score of awareness (P < .01). Medical staff had the highest awareness rate of osteoporosis and the farmer had the lowest. Lumber spine and hip BMD of all sites was significantly decreased with increasing age (P < .001). Premenopausal women had higher BMD than postmenopausal women at all lumbar spine and hip sites (P < .01). The overall frequency of osteoporosis was 10.8% in the lumbar spine, 8.6% in the total hip, and 17.7% in either site. Osteoporosis and osteopenia are highly prevalent among native Jiaxing women but their awareness of osteoporosis is inadequate. To reduce the prevalence of osteoporosis, especially among the unemployed, we should carry out effective health education through multimedia to raise their awareness of osteoporosis. In addition, menopausal hormone therapy should also be considered in menopausal women.

Barriers to equitable healthcare services for under-five children in Ethiopia: a qualitative exploratory study

BackgroundDisparities in child healthcare service utilization are unacceptably high in Ethiopia. Nevertheless, little is known about underlying barriers to accessing child health services, especially among low socioeconomic subgroups and in remote areas. This study aims to identify barriers to equity in the use of child healthcare services in Ethiopia.MethodsData were obtained from 20 key- informant interviews (KII) and 6 focus group discussions (FGD) with mothers and care givers. This study was conducted in Oromia Region, Arsi Zone, Zuway Dugda District from June 1–30, 2023. The study participants for this research were selected purposively. The information was collected based on the principle of saturation after sixteen consecutives interview were conducted. Both KII and FGD were audio-recorded and complementary notes were taken to record observations about the participants’ comments and their interactions. Each interview and FGD data were transcribed word-for-word in the local Afaan Oromo and Amaharic languages and then translated to English language. Finally, the data were analyzed thematically using NVivo 14 software and narrated in the linked pattern of child health service utilization.ResultsThis study identified six major themes which emerged as barriers to healthcare utilization equity for caregivers and their -under-five children. Barriers related to equity in low level of awareness regarding need, low socioeconomic status, geographical inaccessibility, barriers related to deficient healthcare system, community perception and cultural restrictions, and barriers of equity related to political instability and conflict. The most commonly recognized barriers of equity at the community level were political instability, conflict, and a tremendous distance to a health facility. Transportation challenges, poor functional services, closure of the health facility in working hours, and lack of proper planning to address the marginalized populations were identified barriers of equity at organizational or policy level.ConclusionThis study showed that inequity in child healthcare utilization is an important challenge confronting Ethiopia. To achieve equity, policy makers and planners need to change health policy and structure to be pro-poor. It is also necessary to improve the healthcare system to increase service utilization and access for impoverished women, individuals with lower levels of education, and residents of isolated rural areas. Furthermore, context specific information pertaining to cultural barriers and political ecology are required.

Clinical and genetic analysis of a patient with short stature due to variant of RPL13 gene

To analyze the clinical phenotype and genetic characteristics of a patient with Isidor-Toutain spinal epiphyseal dysplasia (SEMD) due to variant of RPL13 gene. A pregnant woman at 18 weeks of gestation who had presented at Quzhou Maternal and Child Health Care Hospital on January 14, 2023 was selected as the study subject. Whole exome sequencing (WES) was carried out for the patient, and candidate variant was validated by Sanger sequencing and bioinformatic analysis. The woman was 37 years old with extremely short stature (135 cm) and "O" shaped legs. WES revealed that she has harbored a c.548G>C (p.Arg183Pro) missense variant of the RPL13 gene (NM_000977.4). The same variant was not found in her fetus. Based on the guidelines from the American College of Medical Genetics and Genomics (ACMG), the variant was predicted to be likely pathogenic (PS4+PM2_Supporting+PP3+PP4). Isidor-Toutain type SEMD due to variants of the RPL13 gene may have variable expressivity and diverse clinical phenotypes. Above finding has facilitated the differential diagnosis and genetic counseling for this family.

Associations between parental socioeconomic status and mental health in Chinese children: the mediating roles of parenting practices.

The significance of socioeconomic status (SES) in child mental health is well-established in Western populations; however, there is little evidence on this topic in Chinese populations. The possibility that Chinese families with different SES elicit different parenting practices that cause positive or negative child mental health outcomes warrants further investigation. This study examined the associations of SES, parenting practices, and child mental health among 1401 Chinese school children and their parents residing in Shanghai. SES was measured by a composed index of parental education levels, occupations, and household incomes. The Alabama parenting questionnaire (APQ; child version) and the strengths and difficulties questionnaire (SDQ; parent version) were used to assess parenting practices and child mental health. We also explored the underlying mechanisms between parental SES and the mental health of children by testing different parenting practices as mediators of the relationships. The results showed that a higher SES is positively associated with better mental health in children. Positive involvement and deficient monitoring can mediate the relationship between SES and child mental health outcomes. Negative discipline did not significantly mediate the above relationship. The results highlight the significance of positive involvement and sufficient monitoring in promoting children's mental health and provide evidence for designing effective programs to improve parenting skills.

The Translation of Recovery-Oriented Social Work Practice in Child and Youth Mental Health: A Scoping Review

Abstract Recovery-oriented practice has become taken for granted and seen as the most ideal way of working for social workers alongside other allied health practitioners in the mental health field. Recovery-oriented practice is defined as a person-centred and strengths-based approach, providing interventions, as well as facilitating environmental and multidisciplinary resources to support the individual’s independence. The applicability of recovery in a child and youth mental health (CYMH) context, however, continues to be questioned. Although some research has explored what recovery means for young people, there is scant literature that examines how recovery-oriented practice is enacted when working with children and their families. This scoping review, guided by the Arksey and O’Malley’s framework explores how recovery is conceptualised and translated into practice with children aged two to twelve years who have identified ‘mental health concerns’ and their families. Qualitative and grey literature from the last twenty years was thematically analysed. The findings highlight the primacy placed on global recovery-oriented principles and expose the superficial articulation of the application of recovery-oriented practice with children. Findings underscore the need to critically investigate how social workers enact recovery approaches when working in a clinical CYMH setting, dominated by the medical model which prioritises evidence-based intervention and marginalises children’s knowledge.

Cultural food practices and sources of nutrition information among pregnant and postpartum migrant women from low- and middle-income countries residing in high income countries: A systematic review.

Women in low- and middle-income countries (LMICs) may engage in a range of cultural food practices during pregnancy, including restricting or avoiding foods high in protein and iron, and foods rich in vitamins and minerals. While research has explored the cultural food practices of pregnant women in LMICs, there is less understanding of the continued cultural food practices of women who migrate to high-income countries and then become pregnant. This systematic review explores the existing research on cultural food practices and sources of nutrition information among pregnant and postpartum migrant women from LMICs, residing in high-income countries. A systematic search was conducted in April 2024 across Global Health, CINAHL, and MEDLINE, published in English, with no date restrictions. Eligible studies included those focused on pregnant and postpartum women who had migrated from LMICs to high-income countries. Studies were excluded if they comprised of non-immigrant women or did not involve LMIC participants. Screened were studies for eligibility, data were extracted, and study quality was assessed. In total, 17 studies comprising qualitative (n = 10) and quantitative (n = 7) approaches were included. In 14 studies participants adhered to cultural food practices, wherein certain nutritious foods were restricted during pregnancy or the postpartum period; three studies noted limited adherence due to support, acculturation, and access to traditional foods. Most studies (n = 10) reported traditional "hot" and "cold" food beliefs during pregnancy and postpartum, aiming to maintain humoral balance for maternal and child health and to prevent miscarriage. Nutrition advice was sought from family members, friends, relatives, healthcare providers, and media sources, with a preference for advice from family members in their home countries. There is a need for culturally appropriate nutrition education resources to guide pregnant migrants through healthy and harmful cultural food practices and overall nutrition during this crucial period. (PROSPERO Registration: CRD42023409990).

Use of Digital Technologies: Family Perspectives on Children's Health

The increasing use of digital technologies among children and adolescents prompts concerns about their impact on development and necessitates family mediation. This study explored primary caregivers’ views on the effects of screen exposure on child health through a focus group with 20 caregivers (17 mothers and 3 grandmothers, aged 20 to 40) from an elementary school in Irecê, Bahia. Findings indicate that children’s screen time, including TV and mobile phones, often lacks proper time and content control due to caregivers’ extensive responsibilities such as remote work and household chores. Major concerns were exposure to violent games, deceptive online profiles, and potential interactions with abusers. Notable behavioral issues in children included irritability, aggression, and sleep problems. Caregivers implemented mediation strategies like setting rules, time restrictions, content filters, and discussing digital self-care. The discussion also addressed addiction mechanisms, family screen habits, gender differences in electronic device usage, and their health impacts on children. An agreement was made to limit screen use across the family, especially an hour before bedtime, aiming to enhance children’s sleep quality and thereby improve their mood and academic performance. This condensed study underscores the challenges caregivers face with children’s digital access and stresses the importance of effective mediation strategies. Enhanced parental engagement and school collaboration are crucial for fostering healthier digital habits that benefit children’s health and family well-being.

Interactions of Nutrition and Infection: The Role of Micronutrient Deficiencies in the Immune Response to Pathogens and Implications for Child Health.

Approximately five million children die each year from preventable causes, including respiratory infections, diarrhea, and malaria. Roughly half of those deaths are attributable to undernutrition, including micronutrient deficiencies (MNDs). The influence of infection on micronutrient status is well established: The inflammatory response to pathogens triggers anorexia, while pathogens and the immune response can both alter nutrient absorption and cause nutrient losses. We review the roles of vitamin A, vitamin D, iron, zinc, and selenium in the immune system, which act in the regulation of molecular- or cellular-level host defenses, directly affecting pathogens or protecting against oxidative stress or inflammation. We further summarize high-quality evidence regarding the synergistic or antagonistic interactions between MNDs, pathogens, and morbidity or mortality relevant to child health in low- and middle-income countries. We conclude with a discussion of gaps in the literature and future directions for multidisciplinary research on the interactions of MNDs, infection, and inflammation.

Preschool and child health: Evidence from China's universal child care reform

Early childhood education programs have been found to effectively promote children's social and cognitive development. However, the health impact of these programs is less understood. Using a quasi-experiment of the first universal child care reform in China from 2010, this paper aims to identify whether the preschool reform produces any short-term effects on health-related outcomes of preschoolers (3-6 years old). Specifically, this reform expands access to affordable preschools that provide full-day center-based education, with school meals and essential health services on campus. I exploit the variation in the number of newly established preschools across provinces and implement difference-in-differences and triple-difference strategies. Results confirm the effectiveness of this reform by showing a strong and positive impact on preschool attendance. This paper then documents the benefits to alleviating underweight among preschoolers. Estimates show a larger effect in rural areas, suggesting that the reform narrows rural-urban disparities in education access and undernutrition prevention. I also explore the impact on caregivers’ health consciousness and find improved health-seeking behavior when children get sick.

Factors Related to Maternal-fetal Attachment in Pregnant Mothers: An Analytical Cross-sectional Study

Aim:: The study investigated the relationship between Determining the Factors Related to Maternal-Fetal Attachment in Pregnant Mothers with Maternal-Fetal Attachment. Background:: Demographic policies in Iran emphasize population, fertility, and maternal health. Maternal-fetal attachment (MFA) is a term used to describe conditions that help the mother cope with the physiological changes during pregnancy. MFA contributes significantly to the future health of mother and child. Thus, it is essential to identify the nature of maternal-fetal attachment during pregnancy, when women need to prepare for and adapt to childbirth. The present study was conducted to determine the factors related to maternal-fetal attachment in pregnant mothers of Arak City. Objectives:: The study investigated the relationship between obstetric-demographic factors, emotional intelligence, marital satisfaction, and domestic violence with maternal-fetal attachment. Methods:: The present cross-sectional study was conducted on 177 pregnant mothers with a gestational age of 37-40 who were referred to health centers in Arak, Iran, for pregnancy care in 2022. Five questionnaires, including an obstetric-demographic questionnaire, Cranley's Standard Mother-Fetal Attachment Scale, Schutte Self-Report Emotional Intelligence Test, ENRICH marital satisfaction scale, and HITS domestic violence questionnaire, were used to measure the factors related to maternal-fetal attachment. Data were analyzed using SPSS21 software and descriptive and analytical statistics, including frequency distribution, Pearson correlation, t-test, Chi-square, Analysis of variance (ANOVA), and Multiple Logistic Regression model. Results:: The mean of age women and age of husbands was 29.07± 5.88 years and 32.93± 5.28 years, respectively. The mean maternal-fetal attachment score was 88.12± 15.76. The mean of the emotional intelligence, the marital satisfaction and, the domestic violence was 4.71± 2.81, 121.88± 17.30, 37.86± 7.25, 6.54± 3.35, respectively. The interval between the current and the previous pregnancy had a range of 1-7 years and a mean of 4.71± 2.8 years. : There was a positive significant correlation between the maternal-fetal attachment score and the interval between the current and the previous pregnancy (r=0.22, p=0.02), : There was a positive significant correlation between the maternal-fetal attachment score and the emotional intelligence (r=0.31, p=0.001) the marital satisfaction (r=0.25, P=0.001). There was a negative significant correlation between the maternal-fetal attachment score and the domestic violence (r=-0.26, p=0.001 Conclusion:: Identifying attachment-related factors helps the health staff carry out the necessary training and preventive measures to increase maternal-fetal attachment, especially in high-risk parents who need more care.

Post-Pandemic Evolution of Suicide Risk in Children and Adolescents Attending a General Hospital Accident and Emergency Department.

Lockdowns and other health protective measures, such as social distancing, imposed during the COVID-19 pandemic nurtured unprecedented levels of stress and social isolation around the world. This scenario triggered an increase in suicide thoughts and self-harm behaviours among children and young people. However, the longer-term impact of the pandemic on children's and adolescents' mental health, especially with regard to self-harm, is still to be fully discovered. We carried out a retrospective study where we collected data related to suicide ideation and self-harm behaviours in all patients aged under 18 that required on-call psychiatric services at the General Hospital Accident and Emergency (A&E) department in Salamanca, Spain, during 2019 (pre-pandemic) and in both 2021 and 2022 to capture possible variation at different time points during the post-pandemic period. A total of 316 patients aged under 18 were seen by on-call psychiatric services at the A&E department during the three time periods: 78 in 2019, 98 in 2021 and 140 in 2022. The mean age was 15.12 (SD 2.25) and females represented more than twice the number of males each year. More than half of all patients assessed during 2022 disclosed suicide thoughts, whilst in 2019, it was near 25%. This increase in suicide ideation rates was more marked among females (X2 = 15.127; p = 0.001), those aged over 15 (X2 = 16.437; p < 0.001) and/or those with a previous history of mental health problems (X2 = 17.823; p < 0.001). We identified an increase in the proportion of males with suicide ideas, especially between 2021 and 2022 (X2 = 8.396; p = 0.015). Our study suggests that children's and adolescents' demand for urgent mental healthcare and their clinical presentations in A&E departments with suicide thoughts and/or self-injuries do not seem to be declining after the pandemic but increasing over time. More research is warranted to understand possible factors involved in this sustained upward trend.

Call for Action-Crisis Recovery and Preparedness in Child and Adolescent Public Health.

Call for Action-Crisis Recovery and Preparedness in Child and Adolescent Public Health.

'I'm still su!c!dal when you're done with the paperwork': an inductive framework thematic analysis of #camhs on TikTok.

Young people are sharing their experiences of Child and Adolescent Mental Health Services (CAMHS) in the United Kingdom on TikTok. Little is known about the content of these videos and their influence on young people's attitudes towards seeking professional mental health support. This study explored how CAMHS is represented in a sample of 100 #camhs TikTok videos using participatory inductive framework thematic analysis. Four themes were developed alongside young people as co-researchers: (a) CAMHS can be frustrating and unhelpful, but sometimes life-saving, (b) Young people can feel their distress is invalidated by CAMHS, (c) CAMHS makes young people feel responsible for their distress, and (d) Young people may not feel CAMHS professionals are trustworthy. Video content described dismissive responses to expressions of suicidal ideation, professional knowledge being privileged over lived experience, and breaches of confidentiality. Some shared positive experiences of CAMHS helping to keep them safe. Together, the themes reflect a representation of CAMHS as a service where adults are powerful and young people occupy a subjugated position. This may influence young people's professional help-seeking behaviour. Recommendations for clinical practice and future research are presented.

Adverse Childhood events of individuals and its relationship with resilience

ObjectiveThe aim of this study is to examine the relationship between childhood trauma and psychological resilience in the Turkish Cypriot community and to identify the predictors of psychological resilience. MethodThe research was conducted with 354 individuals in a web-based online environment in Northern Cyprus. Data were collected using a “Personal Information Form”, the “Adverse Childhood Events Scale”, and the “Resilience Scale for Adults”. Percentage, mean, standard deviation, and Pearson's correlation analysis were used in the data analysis. ResultsIn the study, 16.67 % of the participants were exposed to war or conflict when they were young and 10.17 % had a mental illness. In addition, it was determined that there were statistically significant and negative correlations between the Adverse Childhood Events Scale scores and the scores they got from the Adult Resilience Scale and the sub-dimensions of the scale. Female gender and education level predicted the scores on the Resilience Scale for Adults positively, and the presence of mental disease and the scores on the Adverse Childhood Events Scale negatively predicted the scores on the Resilience Scale for Adults. Conclusionİn this study, gender, educational status, presence of mental illness, and the total score on the Adverse Childhood Events Scale were determined to be predictive variables affecting resilience. Considering the research findings, it is recommended that nurses plan studies for the protection of the mental health of children and adolescents and the groups exposed to trauma should be psychologically supported to raise individuals with high resilience.

Contextual factors associated with diarrhea among under-five children in the Gambia: a multi-level analysis of population-based data

BackgroundDiarrhea poses a significant threat to the lives of children in The Gambia, accounting for approximately 9% of all deaths among children under the age of five. Addressing and reducing child mortality from diarrhea diseases is crucial for achieving the Sustainable Development Goal (SDG) 3, specifically target 3.2, which aims to eliminate preventable deaths in newborns and children under the age of five by 2030. Thus, this research aims to assess the prevalence and contextual factors associated with diarrhea among under-five children in The Gambia.MethodsThis research employed secondary data from the 2019/20 Gambia Demographic Health Survey (GDHS). The study initially involved 8,362 women aged between 15 and 49 years. Of these, 6,929 women with children under five were included in this analysis. Data were analyzed using STATA with cross-tabulation and model fitting. Multilevel logistic regression was applied to accommodate the hierarchical structure of the demographic health survey data. The model comparison parameters were BIC, AIC, deviance, and LLR. Variables with a p-value less than 0.05 were selected for multivariable analysis. The statistical significance of the factors was determined using an adjusted odds ratio with a 95% confidence interval (CI) and a p-value of less than 0.05.ResultsThe prevalence of diarrhea in under-five children was 53.2% in males and 46.8% in females. In the final model, Kerewan (aOR = 0.58; 95% CI = 0.33–0.98) and Basse (aOR = 0.59; 95% CI = 0.35–0.98) have significantly lower odds of childhood diarrhea compared to Banjul, female children show slightly lower, yet significant, odds of diarrhea compared to males (aOR = 0.96; 95% CI = 0.86–0.98), deliveries at government health centers are associated with higher odds of childhood diarrhea compared to home births (aOR = 1.24; 95% CI = 1.01–1.52). Mothers with post-secondary education had significantly lower odds of having children with diarrhea than those without any education (aOR = 0.50; 95% CI = 0.26–0.99) after controlling for confounders.ConclusionThe study findings indicate that several factors significantly impact the risk of childhood diarrhea in The Gambia. These factors include region of residence, sex of the child, place of delivery, and education level of the mother. The study suggests that existing interventions aimed at improving child health outcomes in the country should take into consideration these influential factors. Addressing these modifiable factors can enhance the effectiveness of interventions and promote better health outcomes for children in Gambia.

Subjective Poverty, Family Support and Health-Related Well-Being of School-Aged Children in Single-Parent Households in Ghana: The Role of Health Literacy and Duration of Parental Separation

This study expands ongoing inquiry and debates on the influence of single-parent households on child health outcomes, particularly in low- and middle-income countries (LMICs), where the phenomenon is rapidly increasing. It examines how conventional (i.e., access to money for children—conceived as experience of poverty—, family support, and experience of social isolation) and contemporary (i.e., health literacy) factors shape the health-related well-being of children in single-parent homes in Ghana in the short-, medium- (five years or less) and long-term (6 years +). It also investigates the extent to which health literacy explains how other factors influence their health-related well-being. Data was gathered through a cross-sectional survey conducted in Kumasi in the Ashanti region of Ghana (n = 337). Based on binary logistic regression and structural equation modelling analysis, health literacy (Odds Ratio, OR, = 1.086, p < 0.05) and social isolation (OR, = 0.584, p < 0.05) were associated with the health-related well-being of children who had been separated from a parent for five years or less while family support (OR = 1.592, p < 0.05) was associated with the health-related well-being of children separated from a parent for more than five years. Health literacy explained the association of experience of poverty (β = -0.012, p < 0.05) and experience of social isolation (β = -0.010, p < 0.10) with their health-related well-being. However, these significant relationships did not differ according to the duration of separation. The results underscore the need to invest in policies and programmes that can reduce exposure to health risks and empower children in single-parent households to contribute to protecting their health-related well-being.