Fatigue negatively affects quality of life. We aimed to compare the prevalence of fatigue in survivors of childhood cancer with the Swiss general population, describe longitudinal patterns of fatigue, and identify characteristics associated with persistent fatigue in survivors. In this cohort study, we used data from the Swiss Childhood Cancer Registry and the Swiss Childhood Cancer Survivor Study, including survivors (≥5years since diagnosis; diagnosed between 1976 and 2015 at <20years of age) aged ≥20years at study entry, using data from the baseline and follow-up survey. A representative sample of the general population was used as a comparison group. Fatigue prevalence and fatigue severity were measured using the SF-36 vitality scale, from which we derived longitudinal patterns (no/low fatigue, late onset, improving, persistent). We used multivariable logistic regression to identify clinical, psychosocial and demographic characteristics associated with persistent fatigue. Overall, 1846 survivors participated at baseline (52% male), and 684 survivors also participated at follow-up (median 9years from baseline; 52% male). From the general population, 863 persons participated (42% male). Survivors had similar fatigue prevalence at baseline/follow-up (26%/29%) as the general population (26%). No/Low fatigue was experienced by 64%, late onset by 14%, improving by 7%, and persistent fatigue by 15% of survivors. More late effects, psychological distress, pain, and less time spent on moderate-intensity physical activity were associated with persistent fatigue. This study provides data on longitudinal patterns of fatigue in survivors and identifies factors associated with persistent fatigue that can be used to identify survivors at risk and as a target for interventions aimed at improving fatigue.

Role of endoscopic third ventriculostomy in children in a high-burden resource-limited setting: A prospective study.

ResumenLa leucemia aguda (LA) representa la principal neoplasia en niños en México y América Latina, donde se observan tasas de incidencia y mortalidad elevadas, particularmente en poblaciones con ascendencia indígena y condiciones socioeconómicas desfavorables. Este artículo analiza los determinantes sociales y biológicos que influyen en la aparición y evolución de la leucemia linfoblástica aguda (LLA), y destaca las hipótesis de Greaves y Kinlen, así como su posible adecuación en contextos latinoamericanos. La evidencia sugiere que factores como la pobreza, el rezago educativo, el hacinamiento y el acceso limitado a servicios de salud impactan directamente en la mortalidad infantil por LA. En el análisis realizado específicamente para este trabajo, con la utilización de bases de datos públicas y de acceso abierto, se identificó un gradiente pobreza-mortalidad, en el que los municipios más pobres presentan un mayor riesgo de muerte por leucemia en menores de 20 años de edad. Se concluye que la epidemiología, al integrarse con principios de justicia social, es clave para diseñar y dar seguimiento a intervenciones de política pública que se implementen para reducir las desigualdades y mejoren la supervivencia infantil en México.

This study analysed the relationship between rural sanitation and survival rates of children less than five years in China. The data from the World Bank for the period 2000 to 2020 were obtained via the World Development Indicators (WDI). The central theme was to determine the correlation between access to basic rural sanitation and two essential child survival indicators: stunting heights and under-five mortality. The study used graphical trend analysis and statistical correlation to determine trends and correlations across time. Findings showed a high negative correlation between under-five mortality, and rural sanitation and between stunting and rural sanitation. The results indicate that with improved access to sanitation, there is reduced stunted growth and mortality among the children. Reduction in stunting growth was attributed to limited exposure to sanitation-related diseases such as diarrhoea, the common culprits of malnutrition and mortality among under five children. We conclude that increased access to rural sanitation is associated with increased child survival and should receive priority in health and development policy. Integration of sanitation efforts into maternal and child health programs and further investments in rural sanitation infrastructure can also improve health outcomes and support the attainment of global development targets.

This study aimed to evaluate the clinical characteristics and identify prognostic variables affecting overall survival (OS) in children with undifferentiated embryonal sarcoma of the liver (UESL) using data from the SEER database. We performed a retrospective cohort analysis of 101 patients aged ≤19 years diagnosed with UESL between 2000 and 2022 from the SEER database. Kaplan - Meier survival analysis and Cox proportional hazards regression were applied to determine independent prognostic factors. A nomogram was constructed based on significant predictors. Tumor size, surgical resection, and chemotherapy emerged as independent prognostic factors. Patients with tumors larger than 15 cm had a markedly increased risk of mortality. Surgical resection and chemotherapy were associated with improved survival outcomes. A nomogram incorporating these factors was developed to predict OS. Larger tumor size was linked to higher mortality, whereas chemotherapy significantly reduced death risk. Tumor size, surgery, and chemotherapy are crucial determinants of survival in pediatric UESL. Surgical intervention combined with chemotherapy appears essential for improving prognosis. Further external validation is warranted to refine treatment strategies.

Despite significant progress in reducing child mortality, Nepal’s under-five mortality rate remains above the Sustainable Development Goal (SDG) target of 20 deaths per 1000 live births. This study examines the heterogeneity in under-five mortality by household generations and household structure using pooled data from six rounds of the Nepal Demographic and Health Survey (1996–2022). Multivariable logistic regression models reveal that children in one- or two-generation households face higher mortality risks compared to those in three- or more-generation households. Additionally, nuclear households exhibit slightly elevated mortality risks compared to extended households. A nonlinear multivariate decomposition analysis identifies birth cohort, household wealth and maternal education as key contributors to widening mortality disparities, while maternal age at birth and preceding birth interval help to narrow these gaps. The findings underscore the role of family structure in shaping child survival outcomes and highlight the need for targeted interventions to address persistent inequalities in under-five mortality in Nepal.

The health and survival of children under five years of age is a public health priority, particularly in sub-Saharan African countries. Senegal, like other sub-Saharan African countries, is characterized by a high mortality rate. In this context, CEA-SAMEF contributes to the fight against morbidity and mortality through community support activities in the form of free medical consultations in various regions of Senegal. The main objective of our work was to assess these activities. This was a retrospective and descriptive study covering all consultations carried out in the period from January 2021 to December 2022. The parameters studied were sociodemographic, clinical and therapeutic characteristics. During the study period, 1116 children were seen. Males predominated at 59.5%, representing a male-to-female ratio of 1.47. Children under 5 years of age accounted for 52.2%. The majority of children resided in the Diourbel region. The reasons for consultation were primarily respiratory problems (35.12%), digestive problems (24.21%), and fever (21.2%). Respiratory illnesses (37.65%) were the most common, followed by infectious diseases (27.1%) and digestive problems (24.7%). Treatment generally consisted of antipyretics (paracetamol), antiparasitics (albendazole and mebendazole), salbutamol ( a 2-agonist), and antibiotics (amoxicillin and amoxicillin-clavulanic acid). Community support activities contribute effectively to the fight against morbidity and mortality, which are a public health priority, especially in sub-Saharan African countries. Keywords: Child, Community support, Morbidity, Senegal.

Pneumonia remains a leading cause of under-five morbidity and mortality worldwide, with the burden particularly high in low- and middle-income countries, including Ethiopia. While most studies emphasize prevalence, limited evidence exists on recovery time and its predictors, despite their critical role in guiding clinical management and reducing hospital burden. Recovery duration reflects illness severity, treatment effectiveness, and resource utilization, and may be influenced by comorbidities, nutritional status, and timely initiation of treatment. Determining time to recovery and its predictors is therefore essential to improve child survival and optimize health system performance. This study aimed to assess the time to recovery from severe pneumonia and its predictors among under-five children admitted to West Gojjam Zone public hospitals in 2023. An institutional-based prospective follow-up study was conducted among 394 under-5 children in West Gojjam-selected public hospitals from April 2023 to July 2023. A systematic random sampling technique was used to select the study participants. Data were collected from mothers/caregivers using structured questionnaires. The data were entered into Epi data version 4.6 and analyzed using Stata version 17. After identifying predictor variables with P-value ≤ 0.25 during the bivariable analysis and by checking model assumption, Weibull regression was performed. A hazard ratio with a 95% confidence interval was used and a P-value < 0.05 was considered a statistically significant. The median time to recovery from severe pneumonia was 4 days with the interquartile range (3–6), and the overall recovery rate from severe pneumonia was 19.75 per 100 person-days (95% CI: 18% − 22%). The recovery from severe pneumonia was found among children with total visits for severe pneumonia ((4–5 times (AHR: 0.47, 95% CI: 0.34–0.66)), Educational level ((diploma and above) (AHR: 1.75, 95% CI: 1.26–2.44)), Maternal body mass index ((malnutrition) (AHR: 0.4, 95% CI: 0.21–0.74)), Cooking place ((Separate Kitchen) (AHR: 1.63, 95% CI: 1.25–2.13)), previous acute upper respiratory tract infection ((No) (AHR: 1.48, 95% CI: 1.12–1.95)), danger sign ((No) (AHR: 1.96, 95% CI: 1.53 2.45 )) and Residence ((urban) (AHR: 1.52, 95% CI: 1.16–2.00)). The findings of this study showed that the median time to recovery was 4 days. The main predictors of time to recovery from severe pneumonia were 4–5 times visiting with severe pneumonia, Educational level, Mother’s body mass index, Cooking place, a danger sign, previous acute upper respiratory tract infection and Residence. Hence, it should be better to give attention to children with identified predictors.

Ghana faces persistent maternal health challenges. This study examined Pregnancy Schools in eight Northern districts, analyzing how Model Mother selection approaches shape program effectiveness and maternal health outcomes through culturally grounded, community-based intervention strategies. Existing literature emphasizes peer credibility and cultural embeddedness as critical to maternal health success. Earlier studies highlighted literacy as a determinant of peer education. This study interrogates that assumption, revealing that trust and cultural acceptance exert stronger influence on health-seeking behavior and service uptake. A mixed-methods design was employed, combining quantitative surveys and qualitative interviews to evaluate 200 Model Mothers across eight districts. Stratified sampling ensured representation, and multivariate regression analysis assessed the impact of selection criteria on maternal health outcomes. Districts prioritizing trust and maternal experience Talensi, Kasena Nankana, East Mamprusi, and Gushegu recorded significantly higher antenatal care attendance (β = 0.32, p &lt; 0.01) and skilled delivery uptake (β = 0.28, p &lt; 0.05). In contrast, Mamprugu-Moaduri, Zabzugu, West Gonja, and Sawla-Tuuna-Kalba emphasized literacy, yielding weaker outcomes in antenatal care (β = 0.05, p = 0.42) and skilled delivery (β = 0.07, p = 0.36), both statistically insignificant. These findings indicate that technical knowledge alone does not predict influence, while trust-based social capital enhances program effectiveness. Trust and maternal experience emerged as key determinants of MM selection, surpassing literacy. The results validate community mobilization theories, challenge literacy-centered approaches, and provide evidence to guide maternal health programming in Ghana.

Gross motor development of children is very important for the survival of children because if it is disturbed, the child will experience inhibition of the child's movement which is influenced by the nerve muscles themselves, for example walking, running, jumping and others. Gross motor development can develop well and optimally if the food intake we eat is balanced and fulfilled, therefore the importance of providing nutritional intake. This study aims to determine the impact of a healthy and nutritious food program on the gross motor skills of children aged 2-3 years at Abdurrahman Bin Auf Kindergarten, East Jakarta. Gross motor development in early childhood is an important aspect that is closely related to physical readiness, health, and the child's ability to carry out daily activities. The results of the study indicate that a healthy and nutritious food program has a significant positive impact on children's gross motor skills, including balance, coordination, and specific abilities such as walking, running, and jumping. This study uses a qualitative method with a case study approach. This study involved interviews with the principal, teachers, and parents, as well as direct observation of children's gross motor skills. The study results showed that children who participated in a healthy and nutritious food program had better gross motor skills than those who did not. This study recommends that healthy and nutritious food programs be continued and enhanced to improve gross motor skills in children aged 2-3 years.

Optimal infant and young child feeding (IYCF) early initiation of breastfeeding, exclusive breastfeeding for 6 months, and appropriate complementary feeding with continued breastfeeding to 2 years and beyond is among the highest-impact, lowest-cost strategies for improving child survival, growth, and neurodevelopment in India. Despite notable gains in early initiation and exclusive breastfeeding in the past decade, complementary feeding remains weak, with persistent inequities by geography, socioeconomic status, maternal education, and social group. This review synthesizes recent evidence on IYCF practices in India, identifies implementation barriers across health systems, communities, and markets, and proposes pragmatic solutions. It integrates insights on frontline worker performance, mobile health (mHealth) and mass media, regulatory environments, social norms, urbanization, and vulnerable sub-populations such as adolescents, urban poor, tribal communities, and draw on global evidence to inform program design. It concludes that with an implementation agenda for India focused on service delivery quality, rights-based regulation and maternity protection, context-specific behaviour change, workforce strengthening, and routine measurement to accelerate progress.

The phenotype of autosomal recessive polycystic kidney disease (ARPKD) can be quite variable: some patients progress to end-stage kidney disease (ESKD) in infancy, while others may not require kidney replacement therapy (KRT) until later childhood or adolescence. This study aimed to evaluate clinical, biochemical, imaging, and genetic findings that may influence kidney prognosis in pediatric patients with ARPKD. The patients diagnosed before birth or in the first month were classified as perinatal presenters and later than 1month as non-perinatal presenters. Additionally, groups were formed based on estimated glomerular filtration rate (eGFR) at the last visit and variant types. Seventeen patients (8 male, 9 female) were enrolled in the study. Kidney survival rates at 5years was 71.4% in the perinatal group, whereas it was 100% in the non-perinatal group. The early height-adjusted kidney dimension (haKD) was positively correlated with perinatal presentation and antenatal diagnosis. At the last follow-up, the mean eGFR was significantly lower in the truncating group with four patients (23.5%) progressing to stage-5 chronic kidney disease (CKD). The kidney survival rate is lower in patients with early presentation. Initial low eGFR and severe variants are important predictors of kidney survival. Additionally, early high haKD may be associated with poor kidney outcome. Further studies with larger patient populations and long-term follow-up are necessary to better understand the prognosis of pediatric patients with ARPKD.

Abstract Background Sexual violence against children (SVAC) is an acknowledged concern in humanitarian settings; yet, effective, tested interventions to support disclosure and access to care remain limited. This study assessed the feasibility of implementing SVAC screening, referral protocols, and service provision, in a bid to rectify these limitations within two primary schools in Uganda’s Kiryandongo Refugee Settlement. Methods A mixed-methods concurrent triangulation design was used to implement and assess the feasibility of a seven-month intervention (April–October 2024) in two primary schools. Para-Social Workers, trained under Uganda’s Ministry of Gender, Labour and Social Development, screened Primary 6 and 7 pupils, aged 11 to 35 years old, for SVAC. Older pupils (Primary 6–7) were selected for their perceived capacity to engage on the topic. Survivors received school-based psychological first aid and were referred to additional services as needed. Results The intervention demonstrated strong demand and acceptability among the target populations. All 831 eligible pupils assented to intervention participation, and the majority (96%, n = 794) ended up actually participating in the screening exercise. Of these, 82% ( n = 653) disclosed experiencing SVAC, with 100% receiving care. In contrast, in the absence of screening in the 12-month period before the intervention, only 16 pupils in the same primary schools disclosed experiencing SVAC and obtained care. Stakeholders – including parents, teachers, government, and humanitarian actors – expressed strong support for expanding the model, while pupils reported high levels of satisfaction with the intervention. Conclusions Proactive SVAC screening in schools within humanitarian settings is both feasible and holds promise for effectively identifying and supporting child and adolescent survivors of sexual violence. The intervention significantly increased disclosure and service uptake and was well received by all stakeholders. Findings support the adaptation and cautious scale-up of this model in similar, carefully selected and adequately resourced, crisis-affected contexts.

BackgroundSustainable Development Goal (SDG) 3.2, which aims to reduce under-five mortality rate (UFMR) below 25 deaths per 1000 live births by 2030, is still a crucial target for improved child survival in sub-Saharan Africa because UFMRs are still high and progress has stalled in recent years.ObjectiveThis study aimed to model the possibility of reaching the SDG 3.2 target by 2030 and evaluate trends in under-five mortality in Kenya.MethodThree models: autoregressive integrated moving average (ARIMA), autoregressive fractionally integrated moving average (ARFIMA) and hybrid were fitted to annual national under-five mortality data from 1995 to 2022. Automated model selection showed ARIMA (0,2,1) as the best fitting model from information criteria, predictive accuracy and residual diagnostics. The model was tested with mean absolute error, root mean square error, mean absolute percentage error and tested against the 80/20 train–test split.ResultsKenya’s UFMR has been slightly declining over the course of the study, but the ARIMA projection indicates that the rate of fall is slowing. By 2030, the UFMR is expected to be 27.8 deaths per 1000 live births (95% prediction interval (PI) 25.2 to 30.3), over the SDG 3.2 goal level (signifying an increase in predicted uncertainty). The upper bound of humanity’s real 95% PI still far exceeds the aim, even as the lower bound has started to move closer. Kenya would require an accelerated annual decline in roughly 2.43 fatalities per 1000 starting in 2023 much higher than trends seen in the recent past to meet SDG 3.2.ConclusionKenya’s UFMR has significantly decreased; however, the SDG 3.2 target might not be met by 2030 without more initiatives. To accelerate progress, it will be essential to improve mother and child health services, increase community-level interventions, address social injustices and employ more focused county-specific strategies. Using additional high-quality data and improved modelling tools could enhance child mortality monitoring and prediction in the future.

Background: Optimal breastfeeding and complementary feeding practices are crucial for child survival, growth, and development. Despite national progress, gaps persist in rural and peri-urban regions of Bangladesh, where cultural beliefs and limited awareness influence infant and young child feeding (IYCF) behaviors. Objective: To assess breastfeeding and complementary feeding practices among mothers of children aged 0–23 months in selected villages of Gazipur district, Bangladesh. Methodology: A cross-sectional descriptive study was conducted between November 2024 and March 2025 among 247 mothers from different villages in Gazipur district. Participants were selected through convenience sampling and interviewed face-to-face using a pre-tested, semi-structured questionnaire. Data were analyzed using SPSS (version 26); descriptive statistics such as frequency, percentage, and mean ± SD were applied. Results: Early initiation of breastfeeding within 1 hour was practiced by 24.2% of mothers, while 58.2% initiated between 1–3 hours after delivery. Colostrum was fed to 73% of infants. Prelacteal feeding was observed among 27% of mothers, with honey (61.25%) and sugar water (35.63%) being the most common. Additional foods were introduced after breastfeeding initiation by 64.7% of mothers, predominantly sugar water or honey (75.8%). Complementary feeding was initiated after 6 months by 81.6% of mothers, with khichuri (51.9%) and suji (34.9%) being the primary foods. Most children (60.8%) received complementary foods ≤3 times per day. Dietary diversity remained limited, with high reliance on rice (89.5%) and other milk (89.5%). Conclusion: Although most mothers practiced timely complementary feeding and provided colostrum, suboptimal behaviors such as prelacteal feeding, delayed initiation of breastfeeding, and inadequate dietary diversity persist. Strengthened community counseling, behavior change communication, and support from health workers are essential to promote appropriate IYCF practices in rural Bangladesh.

Background: Childhood cancer survival in low- and middle-income countries (LMICs) is low, and data are limited. Aim: We investigated 1-year and 2-year overall survival (OS) of children diagnosed with cancer in Zimbabwe between 2015 and 2021. Setting: Retrospective childhood cancer data from 2015 to 2022 were collected from KidzCan’s database. Methods: Demographic data, cancer diagnosis and performance status were collected to determine OS 2 years post-cancer diagnosis. Data were analysed using Kaplan-Meier survival curves and Cox regression analysis. Results: A total of 514 from 1090 childhood cancer cases were analysed (576 cases were excluded because of missing data). The mean age at diagnosis was 5.0 years (standard deviation 3.8), with a male-to-female ratio of 1:1.25. One-year OS was 38% (mean 7.5 months; 95% confidence interval [CI] [7.1–8.0]) and 2-year OS was 17.3% (mean 10 months; 95% CI [9.7–11.4]). Male cases (21.9%) had a better 2-year OS compared to female cases (10%) (p = 0.012). Lymphoma and retinoblastoma had the best 2-year OS (29% and 28%, respectively) (p = 0.002). Children active at diagnosis (28%) had an improved 2-year OS than those who were frail (11.5%) and bedridden (13%) (p &lt; 0.001). Conclusion: Sex, cancer diagnosis and performance status were associated with OS. Long-term follow-up is essential to determine long-term outcomes for all children treated with cancer. This study highlights the vital role of civil society organisations in supporting the establishment of a local childhood cancer registry. Contribution: This study will significantly contribute to understanding childhood cancer survival in LMICs like Zimbabwe and provide a baseline for future research.

Despite global declines in under-five mortality, African countries continue to experience high rates, with socioeconomic disparities undermining progress toward Sustainable Development Goal 3.2. While wealth gradients in child survival are well documented, the proportion of deaths directly attributable to inequality remains poorly quantified across national contexts. We conducted a cross-national secondary analysis using the WHO Health Equity Assessment Toolkit (HEAT) v.6.0. Data from ten African countries for the 2022 reference year were included, comprising a total study population of over 6.5million live births. Under-five mortality rates were obtained from United Nations Inter-agency Group for Child Mortality Estimation (UN IGME) datasets, disaggregated by wealth quintile and sex. Inequality was assessed using Difference, Ratio, Population Attributable Risk, Population Attributable Fraction, Slope Index of Inequality, and Relative Index of Inequality. National under-five mortality ranged from 38.0 per 1,000 live births in Rwanda to 117.3 in Niger, with all countries exceeding the SDG target of ≤ 25. Wealth gradients were present in all settings: the absolute difference between poorest and richest quintiles ranged from 11.3 (South Sudan) to 67.0 (Mali). Inequality-attributable burdens were highest in Mali (PAR - 41.9; PAF - 44.7%), Togo (PAR - 25.6; PAF - 42.5%), and Madagascar (PAR - 22.7; PAF - 34.5%). Gradient measures confirmed steep inequities in Mali and Togo (SII ≤ -56.3; RII 2.3). Male children had higher mortality, but sex-attributable fractions were negligible. Up to 45% of under-five deaths in high-burden African countries are attributable to economic inequality. Embedding equity metrics into child survival strategies and targeting the poorest households are essential to accelerate progress toward ending preventable child deaths. Precision public health targeting the poorest quintiles is crucial to reducing preventable child deaths in Africa.

Lasting sequelae are identified in 50% of child survivors of cerebral malaria (CM). Rehabilitation options in malaria-endemic regions are scarce and largely focused on physical deficits, leaving children without support for cognitive recovery. Effective and accessible interventions are vital for improving outcomes. Furthermore, the assessment of brain function and recovery after CM is dependent on behavior-based tests that are time-consuming and require substantial training to administer. Objective, easy-to-use alternatives may be impactful. Children aged 3–12 years who had survived CM were recruited. Participants underwent a 6-month in-home, tablet-based neurorehabilitation program called Dino Island (DI). Participants also underwent serial assessments of brain health that were conducted by measuring event-related potentials (ERPs) using the Brain Vital Signs system. The feasibility, fidelity, acceptability, appropriateness, and affordability of the interventions were evaluated through interviews with the study nurses and the participants’ families. Both programs were feasible and easy to implement. Acceptability was demonstrated by low attrition rates (5%) and positive family ratings (100%). Appropriateness for DI was confirmed by parent reports of positive behavioral changes in their children (60%). For Brain Vital Signs, appropriateness was confirmed by adequate data acquisition for most participants. Finally, positive indicators of affordability from a healthcare perspective were identified. Neurorehabilitation using a home tablet-based program and objective brain health assessment using ERPs was feasible, well accepted, and appropriate in child CM survivors in sub-Saharan Africa. Further development and research into the program’s ability to improve and measure cognitive recovery is justified.

Understanding how the gut microbiome confers immune protection in early life remains a fundamental challenge, particularly in high-infection-burden, underrepresented populations. Here, we analyse longitudinal stool microbiome and illness data from 633 Gambian children aged 7–37 months enroled in a randomised, double-blind iron supplementation trial (NCT02941081). The primary endpoint was correction of iron deficiency anaemia, and the secondary endpoint was diarrhoea incidence and other adverse events; IHAT was non-inferior to ferrous sulphate for iron correction and showed fewer moderate-to-severe diarrhoea episodes. Using 16S rRNA sequencing at three timepoints (Days 1, 15, and 85), we find that children who remained infection-free harboured a consistently higher relative abundance of Prevotella stercorea, a keystone taxon of non-industrialised gut ecologies. In contrast, Escherichia coli and other opportunistic pathogens were enriched in children who developed infections. These taxonomic signatures were temporally stable and embedded within distinct, co-occurring microbial networks. Strikingly, higher P. stercorea abundance was inversely associated with both infection frequency and duration, with the greatest differences observed in children aged 1–2 years, potentially explaining their increased infectious risk. Our findings reveal a Prevotella-dominated enterotype associated with reduced infection risk, with implications for vaccine responsiveness, child survival, and microbiota-targeted interventions in global child health.

Introduction: Paediatric mortality is a pressing public health concern in South Sudan, particularly in tertiary care settings where systemic challenges constrain access to timely and quality healthcare. In response to this, the Momentum Integrated Health Resilience (MIHR), in collaboration with the Association of Gynaecologists and Obstetricians of South Sudan, undertook a paediatric death audit (PDA) at Al-Sabbah Children’s Hospital in Juba. This study aimed to describe the experience and the status of PDA implementations and provide recommendations for improvement. Method: This was a cross-sectional, descriptive study conducted in September 2024. Data were collected using a standardised tool adapted from the United States Agency for International Development Maternal and Child Survival Programme. To obtain the information, focal group discussions were conducted with 13 members from the PDA hospital committee and officials from the Ministry of Health of Central Equatoria State. Another group obtained retrospective data from the available PDA review forms and guidelines. Results: Based on this assessment, the PDA committee at Al-Sabbah Children’s Hospital is functional. The hospital has verifiable PDA guidelines, mainly from the World Health Organisation, standardised death notification and death review forms that capture paediatric death information, and job aids like the International Classification of Diseases-Perinatal Mortality and the International Classification of Diseases-Paediatric Death to support cause-of-death classification. However, it lacked standardised death certificates with a designated section to record the cause of death. The assessment revealed that only a few deaths were reviewed as sampled by the committee chair. Conclusion: PDA is well implemented in Al-Sabbah Children’s Hospital. The assessment recommends replicating the PDA in other national and state hospitals, as well as forming and training PDA committees on the standardised classification of causes of neonatal and paediatric deaths.