Childhood Illness Research Articles

A potential platform for future vaccine trials identifies high incidence of symptomatic and asymptomatic influenza infection among children aged 6-23 months in South Africa.

Approaches for determining whether influenza vaccination prevents infection, attenuates illness, or both, are important for developing improved vaccines. We estimated influenza infection incidence, and evaluated symptom ascertainment methodologies in children to inform future vaccine trial design. We conducted a prospective cohort study among children aged 6-23 months from May-October 2022. Study nurses collected symptom and temperature data and mid-turbinate nasal swabs twice-weekly irrespective of symptoms; caregivers entered symptom data daily and collected nasal swabs weekly. Samples were tested for influenza using PCR. Of 230 healthy, screened children, 93 were enrolled of whom 87 (94%) completed 6-months follow-up. 95% (4245/4476) of scheduled nurse, 90% (2045/2276) of caregiver swabs, 99% (92/93) of baseline blood collections and 67% (9245/13768) of scheduled symptom diaries were completed. PCR-confirmed influenza incidence was 65% (60/93) for ≥1 infection; 11 (18%) individuals had 2 and 1 (2%) had 3 episodes. Of 73 episodes, 55 (75%) had ≥1 symptom and 37 (51%) had fever (measured and/or reported). Median infection duration was 7 days (interquartile range 4-9). Human RNase P gene was detected in 99% (2032/2045) of caregiver-collected swabs, through which 5 additional episodes were identified. Per episode, caregiver's diaries of reported and measured fever were 19%(25/73,34%) and 11%(15/73,21%) higher than nurse-reported (11/73,15%) and -measured fevers (7/73,10%), respectively. The incidence of influenza infection was high and mainly symptomatic suggesting that this platform could be suitable for future trials of vaccine efficacy and correlates of protection against infection and illness in children.

Trends in the Prevalence and Factors Associated with Undernutrition in Tunisian Children Aged 0–23 Months

Background: In recent years, undernutrition has remained a significant public health issue in Tunisia, increasing the risk of illness and mortality in young children. Therefore, this study aims to analyse the prevalence and factors contributing to undernutrition among Tunisian children aged 0–23 months. Methods: The study included 3265 children aged 0–23 months from the 2011–2023 Tunisia Multiple Indicator Cluster Surveys (MICS). Trends and logistic regression analyses were used to determine the prevalence and predictors of undernutrition. Results: The prevalence of stunting, wasting, and underweight in infants and children aged 0–23 months has increased by 3.3%, 0.5%, and 2.1%, respectively. Stunting and underweight were more common among infants aged 0–5 months (11.8% for stunting, 8.9% for underweight, p < 0.01), and first-time mothers (8.3% for stunting, 4.1% for underweight, p < 0.01). In 2023, compared to 2011, the odds of stunting, wasting, and being underweight had increased by 22%, 16%, and 70%, respectively. Infants aged 0–5 months had higher odds of undernutrition in all three indices. Children of obese or overweight mothers, and those who started breastfeeding late, were more likely to be stunted. Boys had significantly higher odds of wasting and underweight. Children with low birth weight, and duration of breastfeeding > 12 months, had significantly higher odds of being underweight. Conclusions: This study shows that infants aged 0–5 months, first-time mothers, boys, and children from poor households in Tunisia are at a higher risk of undernutrition. To address the growing issue of undernutrition in Tunisian children, enhancing maternal and child health and nutrition services, improving parental education, and implementing community-based programs that provide breastfeeding and nutritional education to infants born to new mothers and mothers with high/low BMI is recommended.

Association between sick child facility readiness and quality of care at the individual and facility level in five low- and middle-income countries.

Raising the quality of health services is key to continued progress in improving child health, however, data on service quality are limited and difficult to interpret. The relationship between facility readiness and the quality of care is complex. Using publicly available data sets from five low- and middle-income countries (LMICs), we assessed the relationship between structural factors and the clinical quality of care for managing sick children. We developed indices for readiness and quality accounting for available indicators, expert opinion, and alignment with integrated management of childhood illness (IMCI) guidelines. In each country, we assessed the association between readiness and quality, with and without adjusting for other factors. We considered associations overall, by domain, and by provider type, explored non-linear associations, and compared associations at the individual and facility-level. The analysis included data from 3,149 health facilities and 11,159 sick child observations. In four of the five countries included in the analysis, we observed for every 10%-point increase in readiness, quality increased by about 1% point after adjusting for facility type and managing authority. There was little evidence of a non-linear relationship or a threshold effect altering the relationship between readiness and quality of care. Beyond readiness, younger child age, higher cost of care, and having a respiratory, digestive, or febrile diagnosis were most often associated with a higher quality of care. Higher "human resources" readiness domain scores were most consistently associated with better quality of care, while the quality of care domain of "treatment" was the least influenced by readiness. Facility-level associations did not vary greatly from individual-level associations. The weak correlation observed suggests readiness plays an important role in quality but as currently measured cannot be used to characterize clinical quality of care. Data for assessing quality of health services are limited, presenting challenges for understanding impediments, assessing interventions, and gauging changes in the quality of care over time. We need better data to assess the quality of care being delivered in LMICs to understand what factors drive quality, with the goal of improving the management of sick children.

Reactive arthritis in children

One of the common childhood illnesses is reactive arthritis, which develops during or soon after an infection.Purpose. The aim of the study was to study the etiology, clinical and laboratory manifestations of arthritis in children.Material and methods. The study included 37 children with arthritis aged 1 year 10 months to 15 years who were hospitalized at Kazan City Children’s Hospital № 1.Results. Reactive arthritis was diagnosed in 26 children, and juvenile idiopathic arthritis in 11. In 20 patients, reactive arthritis manifested itself as monoarthritis with predominant damage to the hip or knee joints – in 11 and 9 cases, respectively. Two children had ankle arthritis. In 4 cases there was oligoarthritis. Markers of infectious diseases were identified in 10 out of 26 children with reactive arthritis (38%). In 5 children (19%) IgM to Mycoplasma pneumonia was detected, in two (8%) – IgM to capsid antigen of Epstein–Barr virus, in one child (4%) – IgM to Chlamydia pneumonia. Two children had elevated ASLO values (more than 400 IU/ml). Inflammatory in the blood in 33 cases (89%) were characterized by increased erythrocyte sedimentation rate, the median of which was 22 mm/hour. Increased level of C-reactive protein and leukocytes in the blood were observed only in 9 (24%) and 7 (19%) children, respectively.Conclusion. Reactive arthritis in children mainly manifests as monoarthritis, with predominant damage to the hip or knee joints and in most cases was associated with Mycoplasma pneumonia.

Health matters: a statistical approach to understand childhood illnesses in the North-East States of India, 2019-2021.

The present study explores the prevalence and socio-economic demographic factors affecting childhood illnesses. Diarrhoea, fever and ARI among under-five children in the North -East states of India using NFHS-5 data Kids file. Results showed that diarrhoea, ARI, and fever among the northeastern states were highest in Meghalaya.For diarrhoea Sikkim has the highest prevalence for children within 6months while Meghalaya has the highest prevalence in the age groups 6- 12months and 1- 2years old children and Arunachal Pradesh has the highest rate in the age group 2- 5years old children. Meghalaya stands out with the highest prevalence of fever and ARI in all age groups. Compared to Sikkim, the state of Meghalaya had more diarrhoea, ARI and fever, and it was statistically highly significant. However, Tripura and Assam had significantly higher odds of having fever and ARI than Sikkim. There is an association between diarrhoea, fever, and ARI and factors such as the age of the child and caregiver, the wealth status of the household, the quality of sanitation facilities, methods of stool disposal, and the caregiver's educational level.

Critical risk factors analysis of infection-associated hemophagocytic lymphohistiocytosis in children.

To analyze the critical factors of infection-associated Hemophagocytic lymphohistiocytosis (HLH) in children, so as to provide theoretical basis for clinicians to evaluate the disease condition, formulate treatment plan and improve prognosis.This study is a retrospective analysis. 60 cases of children with infection-associated HLH were divided into critical and non-critical groups based on the presence of multiple organ dysfunction syndrome (MODS), and the clinical characteristics and laboratory data of the two groups of children were analyzed. A multifactor logistic regression analysis model was used to assess the independent risk factors affecting critical illness in children with infection-associated HLH, and the Receiver Operating Characteristic (ROC) curve analysis was used to evaluate the predictive value of risk factors for critical illness in children with infection-associated HLH. Children in the critical group with HLH had a younger age at onset. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), gamma-glutamyl transferase (GGT), D-dimer (DD), and triglycerides (TG) were significantly higher in the critical group, while albumin (ALB) was significantly lower, showing statistical significance (P < 0.05). Multifactorial logistic regression analysis of age, ALB, and TG showed that younger age and lower ALB were associated with a higher risk of MODS in children with infection-associated HLH, with age and ALB being independent risk factors for critical illness. ALB predicted the ROC area under the curve for critical children with infection-associated HLH was 0.765 (95% CI: 0.643-0.888, P = 0.011), with the optimal cut-off value being 32.50g/L (sensitivity = 68.3%, specificity = 84.2%); age predicted the ROC area under the curve for critical children with infection-associated HLH was 0.711 (95% CI: 0.570-0.851, P = 0.009), with the optimal cut-off value being 1.50 years (sensitivity = 70.7%, specificity = 68.4%). This study suggests that younger patients and those with hypoalbuminemia among infection-related HLH patients are more likely to develop MODS. In the future, verification will be required through large-scale, multi-center studies.

Caring Under Pressure: Investigating Parental Attitudes in Mother–Child Chronic Illness Dynamics

Background: The presence of chronic illnesses in both a mother and a child poses a significant challenge for mothers in managing these conditions, yet how maternal attitudes adapt to dual illness remains poorly understood. This study aims to explore parenting styles in families dealing with mother–child chronic illnesses. Methods: Mothers of children aged 2–6 were recruited from three pediatric clinics and categorized based on the health status of both the mother and the child. Data collection included case files and the Parental Attitude Scale (PAS), which assessed democratic, authoritarian, overprotective, and permissive attitudes. The interaction between mother–child health status and higher levels of parental subscales was analyzed using the chi-square test. Multiple logistic regression analysis was then performed to evaluate this interaction, controlling for confounding baseline characteristics. Results: In total, 878 mother–child pairs were included. Mothers exhibited varying attitudes based on education, employment, and the child’s age. Chronic illness in both mother and child and only the child having an illness were significantly associated with higher overprotective scores (p &lt; 0.001). The percentage of mothers with high permissive scores was higher when only the mother had an illness and when both were healthy, compared to the case of both mother and child having an illness (p = 0.018). After adjusting for confounding factors, having a sick child showed a 1.6-fold increase in the likelihood of a high overprotective score, and both the mother and child having an illness showed a 2.94-fold increase. Similarly, after adjusting for the same confounding factors, the likelihood of a high permissive score was 2.56 times lower when both were ill compared to when both were healthy. Conclusions: This study reveals that when a child is affected by a chronic illness—whether or not the mother is also ill—mothers tend to exhibit higher levels of overprotection and lower levels of permissiveness, while their levels of authoritarianism and democratic attitudes in parenting remain relatively stable.

Evaluating the Economic and Epidemiological Impact of RSV Hospitalizations in Southern Austria [Southern Austria Respiratory Syncytial Virus INpatient Investigation (ARNI Study)

RSV bronchiolitis is a leading cause of hospitalization in infants and young children. We aimed to document the economic burden and epidemiology of RSV over seven seasons in Southern Austria. All RSV-associated hospitalized (PCR-proven) children ≤ 5 years of age between 1 October 2015 and 30 April 2022 were collected retrospectively. Demographic and epidemiologic data, along with hospitalization costs (direct and indirect), were calculated. Among 976 children hospitalized due to RSV infection, 87% were healthy term infants, and 79% were < 12 months old. Prematurity (13%) and pre-existing conditions (11%) significantly impacted older children-59% of cases in the 2nd compared with 68% in the 1st year of live. RSV-related hospital costs were approximately €2.0 millions per year (of a total of 60 millions per year). RSV accounted for 19% of hospitalizations due to acute respiratory illness (ARI) in children ≤ 5 years, 37% of all ARI < 6 months, 28% of all ARI < 12 and 6.3% of all-cause hospitalizations < 12 months of age, respectively. Every 5th hospitalization due to respiratory illness in children ≤ 5 years of age was associated with RSV, representing 7.9% of all hospitalizations and 3.3% of all paediatric hospitalization costs.

Erythema Infectiosum: A Narrative Review.

Erythema infectiosum occurs worldwide. School-aged children are most often affected. Since the diagnosis is mainly clinical, physicians should be well-versed in the clinical manifestations of erythema infectiosum to avoid misdiagnosis, unnecessary investigations, and mismanagement of the disease. The purpose of this article is to familiarize physicians with the wide spectrum of clinical manifestations and complications of erythema infectiosum associated with parvovirus B19 infection. A search was conducted in July 2022 in PubMed Clinical Queries using the key terms "Erythema infectiosum" OR "Fifth disease" OR "Slapped cheek disease" OR "Parvovirus B19". The search strategy included all clinical trials, observational studies, and reviews published within the past 10 years. Only papers published in the English literature were included in this review. The information retrieved from the above search was used in the compilation of the present article. Erythema infectiosum is a common exanthematous illness of childhood caused by parvovirus B19. Parvovirus B19 spreads mainly by respiratory tract secretions and, to a lesser extent, the saliva of infected individuals. Children between 4 and 10 years of age are most often affected. The incubation period is usually 4 to 14 days. Prodromal symptoms are usually mild and consist of lowgrade fever, headache, malaise, and myalgia. The rash typically evolves in 3 stages. The initial stage is an erythematous rash on the cheeks, with a characteristic "slapped cheek" appearance. In the second stage, the rash spreads concurrently or quickly to the trunk, extremities, and buttocks as diffuse macular erythema. The rash tends to be more intense on extensor surfaces. The palms and soles are typically spared. Central clearing of the rash results in a characteristic lacy or reticulated appearance. The rash usually resolves spontaneously within three weeks without sequelae. The third stage is characterized by evanescence and recrudescence. In adults, the rash is less pronounced than that in children and is often atypical. Only approximately 20% of affected adults have an erythematous rash on the face. In adults, the rash is more frequently found on the legs, followed by the trunk, and arms. A reticulated or lacy erythema is noted in 80% of cases which helps to distinguish erythema infectiosum from other exanthems. Pruritus is noted in approximately 50% of cases. The diagnosis is mainly clinical. The many manifestations of parvovirus B19 infection can pose a diagnostic challenge even to the best diagnostician. Complications include arthritis, arthralgia, and transient aplastic crisis. In most cases, treatment is symptomatic and supportive. When parvovirus B19 infection occurs in pregnant women, hydrops fetalis becomes a real concern. Erythema infectiosum, the most common clinical manifestation of parvovirus B19 infection, is characterized by a "slapped cheek" appearance on the face and lacy exanthem on the trunk and extremities. Parvovirus B19 infection is associated with a wide spectrum of clinical manifestations. Physicians should be aware of potential complications and conditions associated with parvovirus B19 infection, especially in individuals who are immunocompromised, chronically anemic, or pregnant.

Associations of childhood socioeconomic position and health with trajectories of grip strength from middle to older ages in populations from China and from England

BackgroundWe investigated associations of childhood socioeconomic position and health with trajectories of grip strength from middle to older ages in two distinct populations. MethodsWe used data from the China Health and Retirement Longitudinal Study (CHARLS, n = 16,701) and English Longitudinal Study of Ageing (ELSA, n = 12,695). Hand grip strength was measured at three timepoints in CHARLS (2011–2015) and four in ELSA (2001−2020). Random-effects growth models were applied to assess associations between each childhood factor and age trajectories of grip strength. FindingsLower parental education was associated with weaker grip strength, by 0·36 kg(95 % CI:0·17,0·56) for participants of illiterate (vs literate) parents in CHARLS and 1·88 kg(0·43,3·33) for participants of parents without education (vs ≥ high school) in ELSA, after adjusting for parental occupation and own adult socioeconomic position. Low parental occupation was associated with weaker grip strength, although the difference diminished after adjustment for adult socioeconomic position. Financial hardship was associated with weaker grip strength only in CHARLS, by 0·19 kg(0·01,0·38) after adjustment. Self-rated poor childhood health and school absenteeism were associated with weaker grip strength (both studies). Being confined to bed and hospitalised for more than a month due to health were associated with weaker grip strength only in CHARLS. Each additional childhood illness (only reported in ELSA) was associated with 0·52 kg(0·28,0·81) lower mean grip strength. Reported poor childhood health (CHARLS), low parental education and school absenteeism (ELSA) were associated with grip strength decline. InterpretationLower socioeconomic position and poor health in childhood were associated with weaker grip strength in later life in both Chinese and English populations. Addressing socioeconomic disparities and promoting health of children may enhance life-course physical capacity, promote healthy ageing and reduce age-related adversities.

Exposure to household air pollution and childhood multimorbidity risk in Jimma, Ethiopia

BackgroundChildhood multimorbidity, characterized by the simultaneous occurrence of multiple medical conditions in children, is a global concern. Notably, exposure to household air pollution has been linked to various health issues, particularly affecting vulnerable segments of the population residing in poorly ventilated homes. However, evidence regarding the impact of household air pollution on the risk of multimorbidity in low-income settings remains scarce. Therefore, this study aims to investigate the association between household air pollution and childhood multimorbidity in Jimma, Ethiopia.MethodsA comparative cross-sectional study was conducted to collect data from 280 children under the age of five who lived in households using solid fuel (n = 140) and clean fuel (n = 140). The Demographic Health Survey morbidity questionnaire was used to collect information from mothers about common childhood illnesses. Multiple logistic regression analysis was employed to explore the relationship between the use of solid fuel for cooking in households and the likelihood of childhood multimorbidity. In addition, Poisson regression estimation was used to determine if exposure to solid fuel could increase the number of morbidities.ResultsThe overall prevalence of childhood multimorbidity was 34.3% [95% CI: 0.29–0.40]. Among these cases, 23.9% were among children from solid fuel user households, whereas about 10.4% were from clean fuel user households. Adjusted for all possible socioeconomic, demographic, water, sanitation, hygiene, and health care covariates, children living in solid fuel user households had more than three times the odds of childhood multimorbidity compared to children living in clean fuel user households (AOR = 3.14, 95% CI [1.42–6.95], p &amp;lt; 0.001). Moreover, household air pollution from solid fuel use was positively associated with an increased number of individual morbidity conditions, with an adjusted β coefficient of 0.46 (IRR = 1.58, 95% CI [1.17–2.13], p = 0.003).ConclusionSolid fuel use was an independent predictor of childhood morbidity risk. Efficient policies and strategies, such as the integration of environmental regulation policies into the healthcare system aimed at the reduction of harmful air pollutants and their adverse health effects on children, need to be implemented.

Long-term outcomes of childhood otitis media and hearing loss: a systematic review

ABSTRACT Otitis media (OM) is a common childhood illness which can cause hearing loss and developmental delays. This is the first systematic review to investigate the long-term, longitudinal health and social outcomes of OM and hearing loss in childhood. The study was registered in PROSPERO (CRD42023396318). A structured search strategy identified literature in the following databases: CINAHL, Scopus, Medline, PsychInfo, and EmCare. Articles were independently dual-screened and extracted data were synthesised. From 2825 potential studies, 25 were selected for inclusion. These assessed broad outcomes: physical health, audiological health academic, behavioural, social function, service use, and housing. Overall, 28% of papers found no difference between those with a childhood history of OM and those without, 40% found poorer outcomes for those with a history of OM, and 32% found mixed results. This is the first study of its kind to explore the long-term effects of otitis media and resultant hearing loss in children. Trends of poor academic, behavioural, and audiological outcomes were identified in children with OM and hearing loss. Multiple gaps in the literature were identified including a paucity of recent research, studies extending into adulthood, and studies focusing on high-risk populations.

Public health prevention programmes for mental illness in school-age children and adolescents

Abstract Background Psychiatrists, psychotherapists and other mental health professionals have long stated the importance of adequate social groups and early intervention for the prevention of severe mental diseases. With psychiatric illness incidence increasing most in the adolescent and young adult populations, we propose the use of school-age directed public mental health initiatives to combat remaining social stigma and promote mental wellbeing, as well as educate children and adolescents in how to recognise symptoms and ask for help. Methods We conducted a systematic review on PubMed as well as government and NGO websites to identify public health initiatives in the prevention and early identification of mental illness among young individuals. Results Preliminary results show that, while certain countries have delineated guidelines on how to support students’ mental health, very few have implemented nation-wide, or even region-wide programmes that directly target prevention and education. A particular note should be made regarding substance abuse and addiction, one of the few illnesses for which many countries have already enacted in-school programmes, that however often overlook the medical aspect of such diseases. Of further note are certain local programmes aimed at offering quality and accessible care to adolescents struggling with mental diseases. Conclusions With psychiatric diseases projected to become one of the greatest contributors to the global burden of disease by 2030, and the importance of early intervention in preventing severe psychiatric illness, we advocated for European public health initiatives implemented in schools, which could be crucial in curbing the spread of mental illness. Key messages • Adolescent and young adults are those most affected by the rising prevalence of mental illness. Consequently, we advocate for in-school programmes to aid in early identification and intervention. • Early identification of mental diseases is crucial in the prevention of severe psychiatric illness, but little has been done so far in terms of public health interventions to tackle such problems.

Maternal factors associated with early-onset neonatal sepsis among caesarean-delivered babies at Mbarara Regional Referral Hospital, Uganda: a case-control study

BackgroundBabies born via caesarean section in low-income settings face a higher risk of early-onset neonatal sepsis (EONS), which has greater mortality than late-onset sepsis. However, maternal factors contributing to EONS among caesarean-delivered babies in these settings, including Uganda, are not well documented. We determined maternal factors associated with EONS among term babies delivered by caesarian section at Mbarara Regional Referral Hospital (MRRH), southwestern Uganda.MethodsWe conducted an unmatched case-control study at MRRH from December 2019 to March 2020. Cases were caesarean section-delivered term babies with EONS (within 72 h). Controls were caesarean section-delivered term babies without EONS. We enrolled mother-baby pairs for both groups, obtaining maternal data via structured questionnaires The diagnosis of EONS was made using the WHO Young Infant Integrated Management of Childhood Illnesses algorithm. Cases were consecutively recruited while controls were recruited by simple random sampling in a ratio of 1:2. We excluded newborns whose mothers were too ill to consent. We used multivariable logistic regression analysis to identify maternal factors associated with EONS.ResultsWe enrolled 52 cases and 104 controls. The mean age for the mothers was 27 (± 5.5) years. Neonates born to referred mothers had higher odds of EONS than those born to non-referred mothers (AOR = 6.2, 95% CI: 1.8–21). Additionally, decision-to-delivery time > 1 h for emergency caesarean section (AOR = 16, 95% CI: 4.2–65), antepartum hemorrhage (AOR = 8.0, 95% CI: 1.6–40), primiparity (AOR = 4.8, 95% CI: 1.1–21), and > 3 vaginal examinations after membrane rupture (AOR = 4.3, 95% CI: 1.5–12) were associated with EONS.ConclusionsPrime gravidity, antepartum hemorrhage, multiple vaginal examinations after membrane rupture, long decision-to-delivery time, and referral status were associated with EONS among term babies delivered by caesarean section at MRRH. To reduce EONS risk, clinicians should limit post-membrane rupture vaginal exams or consider prophylactic antibiotics if multiple exams are needed. Screening babies born to primiparous women, those referred, those with antepartum hemorrhage, multiple vaginal exams after membranes rupture, and long decision-to-delivery times, could aid prompt recognition of EONS and timely interventions. Implementing standard procedures to reduce caesarean decision-to-delivery time could reduce risk for EONS in this setting.

Hygiene practice and diarrhea prevalence among underfive children in Myanmar: a cross-sectional study

BackgroundOver 1.7 billion instances of diarrheal illness in children are reported worldwide yearly. Diarrhea was a major cause of death in children, accounting for 9% of all global under-five child deaths in 2021. The objective of this study was to identify the association between hygiene practices and childhood diarrhea among under-five children in Myanmar.MethodThis cross-sectional study was conducted in 16 townships from 8 states and regions of Myanmar. 1207 children between the ages of 6 and 59 months were recruited by multistage random sampling. Data were collected with a preformed questionnaire after participants provided consent. Multiple logistic regressions were administered to determine the factors associated with childhood diarrhea.ResultThis study found that 86 (7.13%) under-five children experienced diarrhea disease. This study identified that children receiving limited hygiene services were 2.85 times (AOR = 2.85, 95% CI: 1.31 to 6.21; p value 0.01) and children without hygiene services were 2.63 times (AOR = 2.63, 95% CI: 1.42 to 4.89; p value 0.01) more likely to have diarrhea disease than those with basic hygiene services. Other factors associated with diarrhea included: fathers who washed their hands less than four steps (AOR = 2.20, 95% CI: 1.29 to 3.74; p value 0.01), families taking more than 15 min to collect water (AOR = 1.77, 95% CI: 1.06 to 2.97; p value 0.03), families sharing toilet usage (AOR = 2.00, 95% CI: 1.15 to 3.48; p value 0.01), mother’s inadequate and problematic hygiene promotion health literacy (AOR = 2.20, 95% CI: 1.24 to 3.90; p value 0.01), houses made of bamboo or lacking floors (AOR = 2.31, 95% CI: 1.38 to 3.89; p value 0.01), families with three or more children (AOR = 1.68, 95% CI: 1.01 to 2.79; p value 0.05) and breastmilk being the primary food after 6 months of age (AOR = 2.07, 95% CI: 1.09 to 3.93; p value 0.03).ConclusionsEnsuring access to basic hygiene services, getting water at home 24 h per day, seven days per week, using private toilets, promoting hygiene health literacy, improving house flooring, family planning and introducing a variety of foods after age 6 months could significantly prevent diarrhea among under-five children in Myanmar. This study underscores the critical role of handwashing facilities in reducing the diarrhea incidence in children.

Adult mental healthcare professionals' experiences of family centred conversations with patients who are parents: a qualitative study.

Many parents with a mental illness report a desire for both recognition of their parental role and support for themselves and their children. However, parents are often fearful of negative judgements from professionals about their ability to be a parent, which inhibits raising concerns about their children with clinical teams. Consequently, an essential first step to supporting families is for professionals to proactively identify which patients are parents, although evidence indicates this is not consistently part of services. Professionals could play a pivotal role in guiding parents about how to talk to their children about their mental illness; this in turn can facilitate family functioning and enable children to access evidence-based interventions. This approach is crucial for mitigating the well-documented intergenerational risk of poorer outcomes and mental illness in children of affected parents. This study aimed to explore adult mental healthcare professionals' beliefs and experiences of talking with patients about: i) their role as parents ii) communication with their children about mental illness. Semi-structured qualitative interviews were conducted with 19 adult mental healthcare professionals with 4-30 years' experience of working with adult patients under the care of NHS adult mental healthcare services in England. Audio recordings were transcribed verbatim and analysed using an inductive coding approach following the principles of thematic analysis. All participants recognised their responsibility to identify patients' children through routine safeguarding protocols, but supporting patients around telling their children the diagnosis was less common. Many participants expressed concerns that raising the topic of children with patients could conflict with other parts of their professional role or would not be welcomed. Obstacles to these conversations were identified, across individual, environmental and organisational factors. Potential facilitators included specific staff training and resources for clinical teams and families around how to tell children about mental illness. Adult mental healthcare professionals would benefit from enhanced training on the importance and methods of guiding parents to communicate with their children about mental illness. This should include routine identification of which patients are parents and recognition of the impact of an adult's mental illness on the wider family system.

Travel-associated illness in children in pre-pandemic Western Sydney, 2018-2020.

Observational cohort study. In the 18 months immediately before the COVID-19 pandemic (2018-2020), we prospectively collected demographic, travel and clinical data from children with travel-acquired illness or injury identified by active surveillance of CHW Emergency Department attendees and referrals to the infectious diseases service. We identified 587 returned child travellers with an illness or injury associated with overseas travel. Most were aged younger than 5 (62.8%) and had travelled within the Asia-Pacific region (84.6%). The main reason for travel, where recorded (50.3%), was visiting friends and relatives (VFR)(65.4%). Most travellers (90.1%) had a common childhood infection, illness or injury coincidentally acquired during travel, including respiratory infection (37.5%), acute diarrhoea (15.7%) and nonspecific febrile illness (13.1%). Exotic/nonendemic infections were uncommon (9.9%, including potential rabies exposure) but were associated with much higher admission rates than 'cosmopolitan' (globally distributed) diseases (74.2% vs 21.9%). Most of these occurred in VFR travellers (86.3%); enteric fever, largely acquired in South Asia, predominated (51.7%). One in five admitted patients had a disease for which specific pretravel vaccination is available. Receipt of pretravel vaccines was infrequently recorded. Returned child travellers in Western Sydney frequently presented with respiratory infections and may be a key population for surveillance of imported respiratory viruses. The burden of exotic disease was small and borne by VFR travellers. Travel-related illness in Western Sydney could be reduced by health education of travellers and targeted pretravel vaccination, especially typhoid vaccination for VFR travellers to South Asia. Universal, systematic screening of emergency department attendees for recent overseas travel would improve surveillance of travel-related illness.

Mother-Led Science: Rethinking Science-Based Social Movements Through Temporality and Care

This article explores the subjective and temporal modes of organizing underlying science-based social movements through an analysis of two mother-led movements in Argentina. The Abuelas de Plaza de Mayo appropriated forensic anthropology and nascent DNA technologies to identify their disappeared grandchildren during the 1976–83 dictatorship. The Madres de Ituzaingó Anexo developed community-led epidemiology studies and agrochemical contamination mapping to argue for a causal relation between intensive pesticide use and high rates of childhood illnesses. We focus on how these movements delineate visions of time, responsibility, and collective action by closely examining the underlying histories and practices of each social movement as they politicized motherhood and appropriated scientific practice. We offer the concept of mother-led science through the temporal registers of constancy, desgaste, and durability to illuminate the iterative relationship between care work, creating sustainable communities and institutions, and the fragile processes of stabilizing facts. Mother-led science, with its dual claims to scientific authority in an epistemic register and maternal authority in an affective register, articulates a potent form of scientific organizing. We suggest that these affective temporalities may be present across all science-based social movements but can be obscured by narratives of linear progress toward objective truths.

Parental Illness Shocks and Child Health in Bangladesh

Parental Illness Shocks and Child Health in Bangladesh

Homoeopathy vs. conventional primary care in children during the first 24 months of life—a pragmatic randomised controlled trial

To compare the difference between primary homoeopathic and conventional paediatric care in treating acute illnesses in children in their first 24 months of life. One hundred eight Indian singleton newborns delivered at 37 to 42 weeks gestation were randomised at birth (1:1) to receive either homoeopathic or conventional primary care for any acute illness over the study period. In the homoeopathic group, conventional medical treatment was added when medically indicated. Clinicians and parents were unblinded. Children in the homoeopathic group experienced significantly fewer sick days than those in the conventional group (RR: 0.37, 95% CI: 0.24–0.58; p < 0.001), with correspondingly fewer sickness episodes (RR: 0.53, 95% CI: 0.32–0.87; p = .013), as well as fewer respiratory illnesses over the 24-month period. They were taller (F (1, 97) = 8.92, p = .004, partial eta squared = 0.84) but not heavier than their conventionally treated counterparts. They required fewer antibiotics, and their treatment cost was lower.Conclusion: Homoeopathy, using conventional medicine as a safety backdrop, was more effective than conventional treatment in preventing sick days, sickness episodes, and respiratory illnesses in the first 24 months of life. It necessitated fewer antibiotics and its overall cost was lower. This study supports homoeopathy, using conventional medicine as a safety backdrop, as a safe and cost-effective primary care modality during the first 2 years of life.Trial registration: Clinical Trial Registry-India (2018/09/015641). https://ctri.nic.in/Clinicaltrials/login.phpWhat is Known:• Due to their holistic nature, many Complementary and Alternative Medical (CAM) modalities are not readily amenable to assessment by head-to-head RCT for a given Indication.• We propose a pragmatic, RCT comparing homoeopathic with conventional medicine as a system.What is New:• Homoeopathic was apparently superior to conventional primary care in preventing sick days, sickness episodes, and respiratory illness episodes and was significantly associated with growth in height but not weight and required fewer antibiotics in children from birth to 24 months of age.