Child Health Care Research Articles

Genetic analysis of a child with pachygyria due to variant of ADGRG1 gen

To explore the genetic basis for a child with pachygyria. A proband who had visited Qinzhou Maternal and Child Health Care Hospital for pachygyria and mental retardation in June 2020 was selected as the study subject. Clinical data was collected. The child was subjected to whole exome sequencing (WES), and candidate variant was verified by Sanger sequencing. The proband, a 4-year-and-6-month-old female, was clinically diagnosed with megagyrus deformity. WES revealed that she has harbored compound heterozygous variants of the ADGRG1 gene, namely c.781G>T (p.E261*) in exon 6 and c.1369A>C (p.S457R) in exon 11, which were verified by Sanger sequencing to be derived from her mother and father, respectively. Her younger sister was also heterozygous for the c.1369A>C (p.S457R) variant. Based on the guidelines from the American College of Medical Genetics and Genomics (ACMG), both variants were rated as likely pathogenic (PVS1+PM2_ Supporting; PM1+PM2_Supporting+PM3+PP3). The c.781G>T (p.E261*) and c.1369A>C (p.S457R) compound heterozygous variants of the ADGRG1 gene probably underlay the pachygyria malformation in this child.

Unmasking the complexities of healthcare access in low-resource settings: a health systems approach to obstetric and under-5 healthcare in rural settings of Eastern Uganda

ABSTRACT Background Access to appropriate obstetric and under-5 healthcare services in low-resource settings is a challenge in countries with high mortality rates. However, the interplay of multiple factors within an ecological system affects the effectiveness of the health system in reaching those in need. Objective This study examined how multiple factors concurrently affect access to obstetric and child healthcare services in resource-poor settings Methods The research used social autopsies [in-depth interview] with mothers who experienced newborn death [n = 29], focus group discussions [n = 8] with mothers [n = 32], and fathers [n = 28] of children aged 6–59 months, and the author’s field observations in Eastern Uganda’s rural settings. The research employed narrative and inductive thematic analysis, guided by concepts of social interactions, behaviour, and health institutional systems drawn from system theory. Results The study unmasked multiple concurrent barriers to healthcare access at distinct levels. Within families, the influence of mothers-in-law and gender dynamics constrains women’s healthcare-seeking autonomy and agency. At the community level, poor transport system, characterised by long distances and challenging road conditions, consistently impede healthcare access. At the facility level, attitudes, responsiveness, and service delivery of health workers critically affect healthcare access. Negative experiences at health facilities profoundly discourage the community from seeking future health services. Conclusion The findings emphasise the persistent influence of structural and social factors that, although well documented, are often overlooked and continue to limit women’s agency and autonomy in healthcare access. Enhancing universal access to appropriate healthcare services requires comprehensive health systems interventions that concurrently address the healthcare access barriers.

Job satisfaction and associated factors among rural health extension workers in Buno Bedele Zone South West Ethiopia

Job satisfactions have impacts on productivity and essentials provision of care for maternal and child health in the rural area. Despite Health extension workers (HEWs) have pivotal role towards improvement of maternal and child health outcome, there is scarcity of data regarding their job satisfaction, hence this study was employed to assess the level of job satisfaction and associated factors among rural HEW in Buno Bedele Zone, Southwest Ethiopia. A Facility based cross-sectional study design was conducted among 393 randomly selected HEW from May to June, 2023. A pretested; questionnaire was used to collect the data. SPSS version 25 was used for statistical analysis. Logistic regression analysis with odds ratio (OR), a 95% CI and P < 0.05 were used to declare statistical significance. The overall satisfaction of health extension workers was 45.5%, [95% Confidence interval CI 44.0–46.09]. Availability of residence [AOR = 2.349, 95% CI 1.352, 4.083], transfer between kebeles [AOR = 0.267, 95% CI 0.132, 0.540], availability of medical supply [AOR = 2.853, 95% CI 1.474, 5.523], Good working environment [AOR = 3.395, 95% CI 2.017, 5.717], Getting technical support during work from their supervisor [AOR = 3.656, 95% CI 1.851, 7.219] were significantly associated factors with HEW job satisfaction. More than half of the health extension workers were dissatisfied with their jobs. Availability of living home, Transfer, medical supply, Environment, Support was predictor of job satisfaction. It is crucial to encourage intervention mode that may enhance their satisfaction and motivation of HEWs to improve service provision.

Introducing a self-managed early communication resource for parents – A mixed methods feasibility study of the Swedish “ComAlong online”

Background Web-based programmes offer parents of children with communication difficulties promising access to parent-mediated, early interventions. However, empirical evaluations of such programmes are limited. This study focused on parents and used mixed methods to examine the feasibility of ComAlong online. Methods ComAlong online is a Swedish, self-managed web-resource teaching parents supportive strategies to promote child communication. Data of different types were collected from a total of 71 parents: ten individual parent interviews, 21 pre-questionnaires and 10 post-questionnaires, and finally 50 anonymous digital evaluation surveys. Descriptive statistics and deductive qualitative content analysis were used. Results Findings indicate that parents perceived improved child communication and own competence after using the ComAlong online. The most valued parts included podcasts with experts and videos of parent-child interaction. Parents reported that the resource was easy to use, but they wanted to have gained access to the resource when the child was younger. Suggestions for changes included adding a chat function with experts, a parent net forum, and the possibility of creating personalised playlists of videos and podcasts. Evaluation of the research process revealed difficulties in recruiting parents from local child healthcare services and parents of children not yet with a diagnosis. Conclusions This study supports the potential for self-managed, web-based resources to disseminate evidence-based parent training for supporting early communication development. Importantly, parents lack individual guidance from experts and contact with other parents. Also, measures need to be made to disseminate the resources within local child healthcare services.

Exploring maternal and child healthcare projects in South African communities through Ubuntu lens: an appreciative inquiry

BackgroundUbuntu, a Nguni Bantu term meaning “humanity towards other”, embodies a philosophy of collectivism, interconnectedness and mutual respect, which is deeply ingrained in South African culture. Ubuntu led community-based collaborative projects enhance community engagement of several stakeholders to ensure improved health outcomes for the mothers and children in the region. Similarly, collaborations between universities are required to co-create evidence-based interventions with healthcare systems and communities to achieve healthcare objectives. This paper explores maternal and child healthcare (MCH) projects in South African communities through the Ubuntu lens, using an appreciative inquiry approach.MethodsA Qualitative approach based on the 5-cycle of Appreciative Inquiry (AI) as proposed by Cooperrider and Srivastava were applied. A purposive sampling method was used to select participants (n = 14) who are members of the Ubuntu MCH project. Data was gathered through workshop group discussions. The interviews were audiotaped and transcribed verbatim. Data analysis followed the six steps of narrative analysis.ResultsThree main themes were identified: Academic growth of personnel; professional empowerment and Ubuntu mentorship.ConclusionThis study confirms that the Ubuntu principles emphasises solidarity, cohesion, and collaboration. The study recommends leveraging on Ubuntu principles to strengthen maternal and child healthcare services, suggesting that such this approach can lead to more sustainable and impactful health improvements in South African communities.

Child health outcomes and associated factors among under five years children in Ethiopia: a population attributable fractions analysis of Ethiopia demographic and health survey (2005–2016)

IntroductionIn Ethiopia, more than half (57%) of children aged 6–59 months were estimated to be anemic in 2016 alone. The country had about 37% of under-five children suffering from stunting and under-five mortality rate of 59 deaths per 1000 live births in 2019. The main purpose of this paper was to estimate the proportion of under-five children prevented from childhood undernutrition, anemia, and under-five mortality by removing the risk factors or inequalities.MethodThis cross-sectional study was based on a pooled total sample of 29,831 children aged 0–59 months drawn from three rounds of the Ethiopian Demography and Health Surveys (2005–2016). We employed multiple logistic regression analysis to identify the modifiable risk factors associated with childhood anemia, undernutrition, and under-five mortality among under-five children. We also used Population Attributable Fractions (PAFs) to estimate the proportion of under-five children that could be prevented from childhood undernutrition, anemia, and under-five mortality by removing inequalities.ResultPAF analyses of risk factors of childhood anemia confirmed that 38.5% of occurrence of childhood anemia was attributed to five selected risk factors, which include having a large household size (5+), being in a poor household, being born from anemic and unemployed mothers, and being breastfed for less than six months. About 45.6% of occurrences of childhood undernutrition were attributed to unimproved toilet facility, solid cooking fuel, and home delivery. About 72% of the reported under-five mortality could possibly be averted by removing the use of unimproved toilet facilities, early age childbirth (< 18 years old mothers), and a large number of children ever born to mothers and less than six months breastfeeding practice at the population level.ConclusionThe present study suggests that a substantial reduction in the prevalence of childhood anemia, undernutrition, and under-five mortality in the country is attainable if child survival-focused program interventions and policies target households and mothers with low socioeconomic status and those who have low awareness of child healthcare, including breastfeeding practice and use of safe sanitation facilities.

A Comparative Analysis of the Regulatory Framework and Collaborative Environment for Pediatric Medical Device Development in Japan and the United States: Identifying Challenges, Support Mechanisms, and Emerging Opportunities.

There are specific obstacles to designing medical devices for children, such as commercial distortions and regulatory hurdles. This study compares the regulatory frameworks and collaborative ecosystems of the United States (US) and Japan, enabling the development of pediatric medical devices. The study illustrates the differences as well as parallels between the two countries by outlining their primary obstacles, channels of assistance, and prospects. The regulatory regimes of the US and Japan pose substantial challenges due to their intricate approval procedures and the dearth of pediatric-specific guidelines. However, while Japan's ecosystem is more dispersed, the US offers more well-established support mechanisms, such as funding initiatives and research alliances. Despite these difficulties, there are still prospects for innovative thinking and collaborative work. The article demonstrates successful partnerships between business, academia, and government in both countries, which have helped propel the advancement of pediatric devices. For stakeholders endeavoring to maneuver through thecomplex terrain of pediatric medical device development, this study offers valuable insights. With a comprehensive understanding of the regulatory and collaborative frameworks in Japan and the US, developers can more effectively leverage resources, overcome obstacles, and bring vital technology to market. The study's findings have implications for researchers, industry leaders, and policy regulators, providing recommendations for strategies aimed at stimulating innovation and enhancing children's healthcare outcomes internationally.

The Function of Cadres in Putting Child Development Stimulation, Detection, and Early Intervention Programs into Practice

The East Java province's child health care coverage in 2020 was 83.3%, a decrease from 2019. In Surabaya, the coverage in 2019 was 91.59%, but it still did not meet the 2020 Minimum Service Standards (MSS) target of 100%. The inadequate implementation of programs for early detection, stimulation, and intervention in child growth and development (SDIDTK) is one factor contributing to the failure to meet this objective. For these initiatives to be successful at the Posyandu level, community health workers, or cadres, must be involved. The objective of this research is to look at how the SDIDTK programs use cadres. There were 71 respondents in the cross-sectional research, which used an observational analytic methodology. Out of the seven roles, only two were performed by all cadres (71 individuals): determining head circumference, weight, height, and upper arm circumference; providing the information into the early detection form for assessing newborn growth and creating a visual representation of the results. In the mother and child health book, two roles were not performed by any of the cadres. The first responsibility was to complete the Early Detection of Child Growth and Development form by providing the child's identity. The second role was to use the child development checklist to observe and mark the child's developmental abilities as appropriate (√) or not appropriate (-).

Utilization of maternal health care services among pastoralist communities in Marsabit County, Kenya: a cross-sectional survey

BackgroundImproving maternal healthcare services is crucial to achieving the Sustainable Development Goal (SDG-3), which aims to reduce maternal mortality and morbidity. There is a consensus among different researchers that proper utilization of maternal healthcare services can improve the reproductive health of women, and this can be achieved by providing Antenatal Care (ANC) during pregnancy, Health Facility Delivery (HFD), and Postnatal Care (PNC) to all pregnant women. The main aim of this study was to investigate the utilization and factors associated with maternal and child healthcare services among women of reproductive age in the pastoralist communities in Kenya.MethodsA cross-sectional survey was conducted among 180 pastoralist women who gave birth in the past two years across ten mobile villages in Marsabit County between 2nd January and 29th February 2019. Three key outcomes were analyzed, whether they attended ANC 4+ visits, delivered at HF, and received PNC. Pearson χ2 test and multivariate logistic regression analysis were conducted by IBM SPSS27.0 following Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. The significance level was set at p < 0.05.ResultsOf the 180 eligible pastoralist women (mean age 27.44 ± 5.13 years), 92.2% were illiterate, 93.9% were married, 33.3% were in polygamy, and 14.4% had mobile phones. The median commuting distance was 15.00 (10–74) km, 41.7% attended ANC 4+, 33.3% HFD, and 42.8% PNC. Those women residing close (≤ 15 km) to a health facility had a threefold higher ANC 4+ (OR 3.10, 95% CI 1.47–6.53), 2.8-fold higher HFD (OR 2.80, 95% CI 1.34–5.84), and 2.5-fold higher PNC (OR 2.49, 95% CI 1.19–5.22) probability. The likelihood was 30-fold higher for ANC 4+ (OR 29.88, 95% CI 6.68–133.62), 2.5-fold higher for HFD (OR 2.56, 95% CI 0.99–6.63), and 60-fold higher for PNC (OR 60.46, 95% CI 10.43–350.55) in women with mobile phones. A monogamous marriage meant a fivefold higher ANC 4+ (OR 5.17, 95% CI 1.88–14.23), 1.6-fold higher HFD (OR 1.67, 95% CI 0.77–3.62), and a sevenfold higher PNC (OR 7.05, 95% CI 2.35–21.19) likelihood. Hosmer Lemeshow test indicated a good-fitting model for ANC 4+, HFD, and PNC (p = 0.790, p = 0.441, p = 0.937, respectively).ConclusionIn conclusion, the utilization of three essential maternal health services is low. Geographic proximity, monogamous marriage, and possession of mobile phones were significant predictors. Therefore, it is recommended that stakeholders take the initiative to bring this service closer to the pastoralist community by providing mobile health outreach and health education.

Machine-learning diagnostic models for ovarian tumors

PurposeTo create a diagnostic framework for clinical behavior and pathological tissue prognosis in ovarian cancer by using machine-learning (ML) methods based on multiple biomarkers. Experimental designOverall, 713 patients with ovarian tumors at Sun Yat Sen Memorial Hospital were randomized into training and test cohorts. Four supervised ML classifiers, namely Support Vector Machine, Random Forest, k-nearest neighbor, and logistic regression were used to derive diagnostic and prognostic information from 10 parameters commonly available from pretreatment peripheral blood tests and age. The best prediction model was selected and validated by comparing the accuracy and the area under the ROC curve of each prediction model and by applying the external data of Guangdong Maternal and Child Health Center. ResultsML techniques were superior to conventional regression-based analyses in predicting multiple clinical parameters pertaining to ovarian tumor. Ensemble methods combining weak decision trees and RF showed the best reference in diagnosis, especially for malignant ovarian cancer. The values for the highest accuracy and area under the ROC curve for malignant ovarian cancer from benign or borderline ovarian tumors with RF were 99.82 % and 0.86 (micro-average ROC curve), respectively. The greatest accuracy and AUC for the diagnosis of pathological tissue with logistic regression curve were 78.0 % and 0.95 (micro-average ROC curve), respectively. In external validation, the random forest prediction model had an accuracy of 0.789 for applying data from external centers to verify tumor benignity and malignancy, and the logistic regression model had an accuracy of 0.719 for predicting the nature of the tumor. ConclusionsAn ovarian tumor can be diagnosed and characterized before initial treatment via ML systems to provide critical diagnostic and prognostic information. The use of predictive algorithms can facilitate customized treatment options with patient preprocessing stratification.

Health policies and guidelines to promote, protect and support early childhood development: A narrative review.

This comprehensive review examines the pivotal role of health policies and guidelines in promoting, protecting, and supporting early childhood development (ECD). Recognizing the multifaceted nature of ECD, the study explores key elements commonly found in policies that span health, education, social services, and community support. The focus is on creating an integrated approach that ensures the optimal well-being and growth of children during their formative years. The review highlights the significance of maternal and child health care, emphasizing contact toward prenatal and postnatal care for pregnant women and newborns. Nutritional policies center around supporting breastfeeding and ensuring access to nutritious food, laying the foundation for a healthy start in life. Early childhood education programs and parental education initiatives are crucial components, emphasizing cognitive, social, and emotional development from the earliest stages. The review underscores the importance of a holistic perspective, urging the integration of services across sectors to provide a comprehensive framework for ECD. Research-based policies, continuous monitoring, and evaluation mechanisms ensure evidence-driven decision-making and ongoing refinement of strategies. Additionally, the role of legislation and advocacy is highlighted in protecting the rights and well-being of children and advocating for ECD at various levels. In the end, this review highlights the importance of ECD guidelines and health policies as investments that not only help individual children but also enhance societal productivity and general well-being. By prioritizing the early years, policymakers can lay a strong foundation for future health, learning, and success.

Promoting successful health care transitions for young people aging out of foster care.

Improving adolescent to adult health care transitions (HCTs) would benefit all young people in the United States but has particular importance for the more than 120,000 adolescents and young adults (AYA) placed in foster care. Leveraging clinical guidelines and evidence-based interventions, HCT efforts inclusive of and specific to AYA placed in foster care can be strengthened through greater collaboration between child welfare, health care, and other AYA-serving systems. This Health Policy Brief advances the importance of structured Health Care Transition services for adolescents and young adults placed in foster care. Additionally, it highlights opportunities for health care providers, youth-serving systems, and health policy stakeholders to collaborate with child-welfare involved young people in order to prioritize evidence-based health care transition interventions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Effect of a subanesthetic dose of esketamine combined with propofol on postoperative fatigue syndrome in patients undergoing gastroenterological endoscopy under anaesthesia: A retrospective study.

To assess the effect of subanesthetic dose of esketamine in combination with propofol on the incidence of postoperative fatigue syndrome (POFS) in patients who underwent gastroenterological endoscopy under anaesthesia. Clinical data of 160 patients who underwent gastroenterological endoscopy under anaesthesia in Huzhou Maternity & Child Health Care Hospital from January to December 2022, ASA Grade- I and II, were retrospectively selected. According to the records, patients were grouped based on the administered anesthetic. Patients who received 0.2 mg/kg of esketamine and 2~2.5mg/kg of propofol comprised Group-E, and patients who were administered one μg/kg of fentanyl and 2 - 2.5mg/kg of propofol comprised Group-F. Mean arterial pressure (MAP), oxygen saturation (SpO2) and heart rate (HR) were recorded before the operation (T0), after anesthesia (T1), three minutes after the gastroscope was inserted (T2), five minutes after the colonoscope was inserted (T3) and at the end of the operation (T4). Operating time, recovery time, propofol dosage and incidence of adverse reactions in the two groups were recorded. The Christensen scores and the incidence of POFS of all patients on Day-I before operation and 1st, 3rd, and 5th days after the operation were recorded. Compared with T0, MAP, SpO2 and HR in both groups of patients decreased at T1, T2, T3 and T4 (P<0.05). MAP, SpO2 and HR of patients in Group-E were significantly higher compared to Group-F at T1, T2, T3 and T4 (P<0.05). Compared with Group-F, the recovery time, intraoperative bradycardia and respiratory depression in Group-E were significantly lower (P<0.05), and Christensen scores and the incidence of POFS decreased significantly on the 1st, 3rd, and 5th day after the operation (P<0.05). Subanesthetic dose of esketamine combined with propofol can reduce POFS and postoperative adverse reactions in patients undergoing gastroenterological endoscopy.

Performance evaluation of noninvasive prenatal testing on 24 chromosomes in a cohort of 118,969 pregnant women in Sichuan, China.

This study aimed to comprehensively analyze the detection capacity of non-invasive prenatal testing (NIPT) for chromosomal abnormalities of all 24 chromosomes, as well as high-risk indications for pregnancy and the fetal fraction, in a large cohort. We retrospectively enrolled 118,969 pregnant women who underwent NIPT at Sichuan Provincial Maternity and Child Health Care Hospital from March 2019 to June 2022. The sensitivity, specificity, positive predictive value, negative predictive value, and positive chromosomal abnormality rate were calculated. The fetal fraction based on gestational age, maternal body mass index, and number was examined. NIPT demonstrated > 99% sensitivity and specificity for almost all of the common trisomies (T21, T18, and T13), sex chromosomal aneuploidies, rare autosomal trisomies, and microdeletion/microduplication syndromes. Positive predictive values varied from 12.0% to 89.6%. Advanced maternal age was associated with an increased risk of three major aneuploidies. The fetal fraction was positively correlated with gestational age and negatively correlated with the maternal body mass index. NIPT can be used to effectively screen for chromosomal abnormalities across all 24 chromosomes. Advanced maternal age is a risk factor for high-risk pregnancy, and careful consideration of the fetal fraction is essential during NIPT.

Digital Beacons of Hope? The Challenges and Potentials of Digital Health Applications for Children and Adolescents with Mental Disorders in Germany

Digital Beacons of Hope? The Challenges and Potentials of Digital Health Applications for Children and Adolescents with Mental Disorders in Germany Abstract: With the Digital Healthcare Act, Germany has taken a decisive step toward promoting high-quality, evidence-based digital health applications (DiHAs). Presently, there is a significant gap in the provision of mental health services throughout Germany, particularly regarding children and adolescents and especially in the aftermath of the COVID-19 pandemic. DiHAs as low-threshold, location- and time-independent additional mental health services - may offer a way to address this situation. Particularly in the emerging generation of digital natives, there is a high demand for digital mental health services. However, despite the rapidly growing supply of DiHAs for adults, there is a lack of approved DiHAs for children and adolescents with mental disorders. Rather, the demand for care is left to the unregulated market of diverse internet- and mobile-based interventions; early studies have questioned the evidence base, safety, and quality. This discrepancy arises from various specific challenges and risks that reduce incentives to develop DiHAs for this particularly vulnerable target group, including (1) limited evidence, (2) high complexity in study execution, (3) high complexity in the development of applications, (4) poorly researched specific risks, and (5) high regulatory requirements. This article discusses these challenges and risks and outlines the perspectives for a high-quality, safe, and evidence-based digital mental healthcare for children and adolescents.

Perspectives of Caregivers on Access to Health Care for Children with CKD

BackgroundInequitable access to health care based upon demographic factors such as ethnicity, socioeconomic status (SES) and geographical location has been consistently found in children with chronic kidney disease (CKD). However, little is known about the perspectives of caregivers on accessing healthcare. We described caregivers’ perspectives on accessing healthcare for children with CKD from socioeconomically disadvantaged backgrounds and/or rural or remote areas. MethodsCaregivers of Australian children aged 0-16 years, across all CKD stages, from low SES backgrounds, and/or residing in rural or remote areas, purposively sampled from five centers, participated in semi-structured interviews on accessing healthcare. Transcripts were analyzed thematically. ResultsFrom 32 interviews, we identified 6 themes: lack of agency undermining ability to seek care (obscurity of symptoms, uncertain and confused about care processes, vulnerable and unable to advocate), losing trust in clinicians (confused by inconsistencies and ambiguities in advice, distressed by lack of collaborative care), exasperated by organizational rigidity (frustrated by bureaucratic roadblocks, lack of access to specialist care in rural and remote settings, inadequacies of support programs), compounding burden of caregiving (unsustainable financial pressure, debilitating exhaustion, asymmetry of responsibility), intensifying strain on family (uprooting to relocate, sibling stress and neglect, depending on family support), building resilience and stability (empowerment through education, confidence in technical and medical support). ConclusionsCaregivers of children with CKD from disadvantaged backgrounds feel disempowered and vulnerable when accessing care for their child. Strategies are needed to improve access to healthcare for families who are socioeconomically or geographically disadvantaged.

Newborn community health advancements among Ethiopian Orthodox Christian women in North Gondar, Ethiopia: community-based randomised trial protocol

IntroductionDespite significant progress over past decades, neonatal and infant morbidity and mortality remain unacceptably high in Ethiopia. Simple interventions have been shown to improve the health of children and reduce...

Women’s Perception of a Midwife-Led Clinic: A Qualitative Study

Background: While maternal and child health care is a crucial component of every healthcare system, the burden on medical staff in caring for low-risk pregnant patients could be significantly alleviated by recruiting and maintaining a substantial number of midwives. Objectives: This study aims to understand the perceptions of women recipients of antenatal services provided by midwife-led clinics (MLC). Method: The study utilised a phenomenological approach with semi-structured interviews to gather information from participants regarding their perceptions of the MLC. Results: Participants in the survey were women (n=13) who attended the MLC, the majority being over 30 years of age and graduates. The participants believed that the clinic was essential, and felt at ease with the midwife and the services. Most expressed satisfaction with the health education offered by the clinic on the subject of prenatal care, nutrition, exercise, and breastfeeding. Conclusion: The participants in this study preferred midwife-led clinics because they allowed for better communication, answered queries, and provided significant emotional support. The participants felt comfortable with the midwife, who created a forum for discussion and clarification of doubts.

Inequalities and Trends in Under-Five Mortality Between Formal and Informal Areas in Ouagadougou, Burkina Faso.

The physical expansion of the city of Ouagadougou, the capital and largest city of Burkina Faso, subsided in 2015 after the government banned land speculation that contributed to the growth and entrenchment of informal areas. The government subsequently implemented social policies such as free health care for pregnant women and children under 5years of age. Against this background, we tested the convergence of under-5 mortality trends between formal and informal areas in the city between 2010 and 2019; data covering that period came from the Ouagadougou Health and Demographic Surveillance System (HDSS). The analyses included the calculation of all-cause and cause-specific mortality rates, the implementation of a Poisson regression model, and competing risk models. Over the study period, children in formal areas had lower mortality than those in informal areas. However, the inequality gap decreased over time due to a faster mortality decline in informal areas. This decline was explained by a rapid decline in deaths from malaria and other causes including sepsis, HIV/AIDS, measles, meningitis, and encephalitis. The pursuit of upgrading informal areas and the implementation of social policies targeting the poorest are likely to accelerate the mortality decline in Ouagadougou overall.

Parental decision-making in taking care of child health in Indonesia: Findings from a national survey

Background: The decision-making process to search for child health services involves interaction among the mother, partner, and other family members. Parental decision-making is highly complex since it involves an emotional consideration between the benefit and the child's future. The common problem in deciding the service is the lack of capabilities, such as facility, knowledge, and skill.Objective: The purpose of this study is to analyze the influence of socio-demographic factors on parents' decision-making in obtaining health services for their children Methods: This study design was cross-sectional data from the Indonesia Demographic and Health Survey (IDHS) of 2017, which was applied in this study. The respondents involved were 8,838 women aged 15-49 who had given birth in the last five years. This study employed descriptive, chi-square, and regression statistics analysis. The results were provided as adjusted odds ratios (AORs) with 95 percent confidence intervals. The statistical analysis utilized SPSS version 21.0 software (SPSS Inc., Chicago, IL, USA).Results: Bivariate analysis revealed a significant relationship between decision-making and age, living place, educational background, and wealth index (p-values 0.030, &lt;0.001, 0.002, and 0.006), but not with health insurance ownership (p=0.242). After multivariate analysis, only age-related decisions were associated with a significant risk. It explained that younger group (15-29) has a 0.325 times chance of making a joint decision than the 40 to 49-year-old group (AOR: 0.325; 95%CI: 0.144-0.733). Conclusion: Parental decision-making regarding childcare is related to several factors, namely age, living place, educational background, and socioeconomic status. Health education is a strategy to promote child health in Indonesia by facilitating proper decision-making.