Child Survival Research Articles

The Food and Nutrition Policy Environment and Drivers of Changes in Key Food System Outcomes in Ethiopia

Background: There seems to be huge gap in our understanding of the changes over time in food system outcomes and their drivers in Ethiopia. The main aim of this study is to examine the food and nutrition programs and policies and their corresponding key food system outcomes in Ethiopia. Methods: The bulk of the information was generated using scooping review of relevant articles and policy documents. About 67 full text records were used for the review. In addition, data were collected using Key Informant Interview (KIIs) purposefully selected from sectoral offices from two major cities (Hawassa and Dire Dawa), of two regions. The analytical framework used in this paper was adopted from previous studies on related subjects and addressed three key components of food system: review of food and nutrition policy environment, key food system outcomes and key drivers. Results: Despite improvement in some food system outcomes (such as child nutrition and survival), food security crises in Ethiopia are still becoming more frequent and more acute, affecting the poor disproportionately. Most food and nutrition policies are constrained by lack of implementation capacities. Indicating the presence of various barriers (socioeconomic, demographic, and environmental). Poor human capital (such as knowledge and attitude), food taboos and tradition, cultural practices such as gender-based norms, poor education, poor delivery/supply chain, demographic pressure and other environmental drivers play critical role in food and nutrition security of most vulnerable population groups in Ethiopia. Conclusion and implications: Given the challenges confronting Ethiopia today, it is imperative to assume that meeting Sustainable Development Goal (SDG) 2 (i.e., attaining zero hunger by 2030) becomes challenging. This calls for continuous capacity building to help implement, learn, and adapt a systems approach; and access to education and skill training on food production and consumption and narrowing down the gender differential in food access and consumption.

Preservation of Pancreatic Function Should Not Be Disregarded When Performing Pancreatectomies for Pancreatoblastoma in Children.

Complete surgical resection in the context of a multimodal approach has been associated with excellent long-term survival in children diagnosed with pancreatoblastoma (PB). Traditionally, curative intent surgery for PB implies standard pancreatic resections such as pancreaticoduodenectomies and distal pancreatectomies with splenectomies, surgical procedures that may lead to significant long-term pancreatic functional deficiencies. Postoperative pancreatic functional deficiencies are particularly interesting to children because they may interfere with their development, considering their long life expectancy and the significant role of pancreatic functions in their nutritional status and growth. Thus, organ-sparing pancreatectomies, such as spleen-preserving distal pancreatectomies and central pancreatectomies, are emerging in specific tumoral pathologies in children. However, data about organ-sparing pancreatectomies' potential role in curative-intent PB surgery in children are scarce. Based on the literature data, the current review aims to present the early and late outcomes of pancreatectomies in children (including long-term deficiencies and their potential impact on the development and quality of life), particularly for PB, and further explore the potential role of organ-sparing pancreatectomies for PB. Organ-sparing pancreatectomies are associated with better long-term pancreatic functional outcomes, particularly central pancreatectomies, and have a reduced impact on children's development and quality of life without jeopardizing their oncological safety. The long-term preservation of pancreatic functions should not be disregarded when performing pancreatectomies for PB in children. A subset of patients with PB might benefit from organ-sparing pancreatectomies, particularly from central pancreatectomies, with the same oncological results as standard pancreatectomies but with significantly less impact on long-term functional outcomes.

Assessment of spillover of antimicrobial resistance to untreated children 7 to 12 years old after mass drug administration of azithromycin for child survival in Niger: a secondary analysis of the MORDOR cluster-randomized trial.

The risk of antibiotic resistance is complicated by the potential for spillover effects from one treated population to another. Azithromycin mass drug administration programs report higher rates of antibiotic resistance among treatment arms in targeted groups. This study aims to understand the risk of spillover of antibiotic resistance to non-target groups in these programs. Data was used from a cluster-randomized trial comparing the effect of biannual azithromycin and placebo distribution to children 1-59 months on child mortality. Nasopharyngeal samples from untreated children 7-12 years old were tested for genetic determinants of macrolide resistance (primary outcome) and resistance to other antibiotic classes (secondary outcomes). Linear regression was used to compare the community-level mean difference in prevalence by arm at the 24-month timepoint adjusting for baseline prevalence. 1,103 children 7-12 years old in 30 communities were included in the analysis (15 azithromycin, 15 placebo). Adjusted mean differences in prevalence of resistance determinants for macrolides, beta-lactams and tetracyclines were 3.4% (95% CI -4.1% to 10.8%, P-value 0.37), -1.2% (95% CI -7.9% to 5.5%, P-value 0.72), and -3.3% (95% CI -9.5% to 2.8%, P-value 0.61), respectively. We were unable to demonstrate a statistically significant increase in macrolide resistance determinants in untreated groups in an azithromycin mass drug administration program. While the result might be consistent with a small spillover effect, this study was not powered to detect such a small difference. Larger studies are warranted to better understand the potential for spillover effects within these programs.

Early-Neonatal, Late-Neonatal, Postneonatal, and Child Mortality Rates Across India, 1993-2021

The global success of the child survival agenda depends on how rapidly mortality at early ages after birth declines in India, and changes need to be monitored to evaluate the status. To understand the disaggregated patterns of decrease in early-life mortality across states and union territories (UTs) of India. Repeated cross-sectional data from the 5 rounds of the National Family Health Survey conducted in 1992-1993, 1998-1999, 2005-2006, 2015-2016, and 2019-2021 were used in a representative population-based study. The study was based on data of children born in the past 5 years with complete information on date of birth and age at death. The analysis was conducted in February 2024. Time and geographic units. Mortality rates were computed for 4 early-life periods: early-neonatal (first 7 days), late-neonatal (8-28 days), postneonatal (29 days to 11 months), and child (12-59 months). For early and late neonatal periods, the rates are expressed as deaths per 1000 live births, for postneonatal, as deaths per 1000 children aged at least 29 days and for child, deaths per 1000 children aged at least 1 year. These are collectively mentioned as deaths per 1000 for all mortalities. The relative burden of each of the age-specific mortalities to total mortality in children younger than 5 years was also computed. The final analytical sample included 33 667 (1993), 29 549 (1999), 23 020 (2006), 82 294 (2016), and 64 242 (2021) children who died before their fifth birthday in the past 5 years of each survey. Mortality rates were lowest for the late-neonatal and child periods; early-neonatal was the highest in 2021. Child mortality experienced the most substantial decrease between 1993 and 2021, from 33.5 to 6.9 deaths per 1000, accompanied by a substantial reduction in interstate inequalities. While early-neonatal (from 33.5 to 20.3 deaths per 1000), late-neonatal (from 14.1 to 4.1 deaths per 1000), and postneonatal (from 31.0 to 10.8 deaths per 1000) mortality also decreased, interstate inequalities remained notable. The mortality burden shifted over time and is now concentrated during the early-neonatal (48.3% of total deaths in children younger than 5 years) and postneonatal (25.6%) periods. A stagnation or worsening for certain states and UTs was observed from 2016 to 2021 for early-neonatal, late-neonatal, and postneonatal mortality. If this pattern continues, these states and UTs will not meet the United Nations Sustainable Development Goal targets related to child survival. In this repeated cross-sectional study of 5 time periods, the decrease in mortality during early-neonatal and postneonatal phases of mortality was relatively slower, with notable variations across states and UTs. The findings suggest that policies pertaining to early-neonatal and postneonatal mortalities need to be prioritized and targeting of policies and interventions needs to be context-specific.

Evolution of Exclusive Breastfeeding Practices According to Continuous Demographic and Health Surveys (DHS-C) from 2010-2011 to 2019 and Associated Factors in Senegal

Introduction: The first two years of a child's life are particularly important. Inadequate breastfeeding practices during this period considerably compromise the health, development and survival of infants, children and mothers. Several studies have assessed the impact of breastfeeding on infant mortality. The objectives of our study were to investigate changes in exclusive breastfeeding practices during the first six months of life according to DHS data from 2010-2011 to 2019 and to identify the various associated factors. Methodology: This is a quantitative analysis of secondary data based on cross-sectional data from the DHS from 2010-2011 to 2019 on changes in exclusive breastfeeding practices for infants under six months of age. Our study focused on women aged 15 to 49 years interviewed during the DHS and residing in Senegal at the time of the various surveys who had children under two years of age. Data were collected on exclusive breastfeeding rates in different years, the socio-demographic and gyneco-obstetric characteristics of mothers, and the characteristics of newborn children. A multivariate analysis was performed to identify factors associated with exclusive breastfeeding. Results: showed that exclusive breastfeeding rates remained below 50% from 2010-11 to 2019. Analysis by region showed a disparity between the different regions. The associated factors were: ethnic group: Wolof are less likely to practice EBF with an adjusted AOR of 0.59 with a CI<sub>95</sub>: [0.38, 0. 90], maternal literacy: mothers who could not read were less likely to perform EBF with an adjusted AOR of 0.71 and a CI<sub>95</sub>: [0.53-095], birth order: mothers with 6 or more children were more likely to perform EBF, with an AOR of 3.20 and a CI<sub>95</sub>: [1.68-6.17], maternal occupation: Working mothers were less likely to practice EBF than non-working mothers, with an AOR of 0.60 and a CI<sub>95</sub> [0.46-0.79], access to the media: Mothers with access to the media were less likely to practice assisted fertilization, with an AOR of 0.57 and a CI<sub>95</sub>: [0.37-0.90] and use of modern contraception: Mothers using modern contraception were less likely to practice exclusive breastfeeding, with an AOR of 0.53 and a CI<sub>95</sub>: [0.38-0.72]. Conclusion: Despite all the efforts made by the Senegalese government and its technical and financial partners, rates are still low. To strengthen the practice of exclusive breastfeeding, it is important and urgent to design and implement innovative evidence-based interventions covering the different levels of the socio-ecological model (individuals, families, communities and public policies).

Determination of birth prevalence of sickle cell disease using point of care test HemotypeSC™ at Rundu Hospital, Namibia

BackgroundSickle cell disease (SCD), a noncommunicable disease, has the greatest burden in sub-Saharan Africa. The majority of children (50–90%) with SCD die before their 5th birthday, with approximately 150,000–300,000 annual SCD child deaths in Africa. In developed countries, newborn screening (NBS) has been shown to improve the survival of children with sickle cell disease, with under5 childhood mortality reduced tenfold due to interventions performed before the development of complications. Point –of-care tests have been developed for resource limited settings to expand NBS. The aim of this study was to determine the birth prevalence of sickle cell disease in Namibia using the HemoTypeSC™ point-of-care test.MethodsA cross-sectional descriptive study was carried out at Rundu Intermediate Hospital in the Kavango East Region. Two hundred and two (202) well newborns within 72 h of birth were recruited for the study from 22 February to the 23th March 2023. Descriptive statistics were used to compute the haemoglobin types of the study participants.ResultsThe majority of the participants (n = 105, 52%) were females, and (n = 97,48%) were males. The median age of the participants was 23 h (Q1, Q3; 11; 33),) with an age range of 2–98 h. Sickle cell trait was present in 9.4% of the screened newborns, no homozygous disease was detected, and 90.6% had Hb AA.ConclusionsThis study is the first to measure HbS gene carriage at birth using HemotypeSC point-of-care testing in Namibia. There was a moderate prevalence of sickle cell traits but no SCD. This baseline study may provide the foundation for larger epidemiological surveys to map HbS gene carriage in Namibia to provide evidence for policy makers to fashion appropriate SCD newborn screening services.

Renal thrombotic microangiopathy is associated with poor renal survival in children with immunoglobulin A nephropathy.

The aim of this study was to examine the clinical and pathological characteristics as well as the prognosis of immunoglobulin A nephropathy (IgAN) accompanied by renal thrombotic microangiopathy (rTMA) in paediatric patients. After balancing epidemiological characteristics and pathological types between groups, 427 patients (rTMA group: 23, non-rTMA group: 46) were included. The clinical and pathological features, prognosis and clinical risk factors of the two groups were analysed. IgAN-rTMA children showed more severe clinical and pathological manifestations. The findings from the logistic regression analysis indicated that hypercellularity 1 (E1) (HR: 0.805, 95% CI: 0.763 ~ 1.452, P = .016), endocapillary proliferation (HR: 1.214, 95% CI: 0.093 ~ 4.815, P = .025) and C3 staining (HR: 7.554, 95% CI: 2.563 ~ 15.729, P = .037) were the risk factors for rTMA in children with IgAN. The renal survival in rTMA group was lower than non-rTMA group (χ2 = 18.467, P = .000). Cox regression analysis showed that E1 (HR: 7.441, 95% CI: 1.095 ~ 10.768, P = .037), C3 disposition (HR: 3.414, 95% CI: 0.834 ~ 11.578, P = .027) and rTMA (HR: 8.918, 95% CI: 1.032 ~ 16.754, P = .041) were identified as independent risk factors for the development of end-stage renal disease (ESRD). The presence of rTMA had a significant impact on the severity and prognosis of IgAN. And rTMA has been identified as an independent risk factor for the development of renal failure in children diagnosed with IgAN.

Major surgical conditions of childhood and their lifelong implications: comprehensive review.

In recent decades, the survival of children with congenital anomalies and paediatric cancer has improved dramatically such that there has been a steady shift towards understanding their lifelong health outcomes. Paediatric surgeons will actively manage such conditions in childhood and adolescence, however, adult surgeons must later care for these 'grown-ups' in adulthood. This article aims to highlight some of those rare disorders encountered by paediatric surgeons requiring long-term follow-up, their management in childhood and their survivorship impact, in order that the adult specialist may be better equipped with skills and knowledge to manage these patients into adulthood. A comprehensive literature review was performed to identify relevant publications. Research studies, review articles and guidelines were sought, focusing on the paediatric management and long-term outcomes of surgical conditions of childhood. The article has been written for adult surgeon readership. This article describes the aforementioned conditions, their management in childhood and their lifelong implications, including: oesophageal atresia, tracheo-oesophageal fistula, malrotation, short bowel syndrome, duodenal atresia, gastroschisis, exomphalos, choledochal malformations, biliary atresia, Hirschsprung disease, anorectal malformations, congenital diaphragmatic hernia, congenital lung lesions and paediatric cancer. The increasing survivorship of children affected by surgical conditions will translate into a growing population of adults with lifelong conditions and specialist healthcare needs. The importance of transition from childhood to adulthood is becoming realized. It is hoped that this timely review will enthuse the readership to offer care for such vulnerable patients, and to collaborate with paediatric surgeons in providing successful and seamless transitional care.

Treatment-related mortality among children with cancer in Denmark during 2001-2021.

Survival of children with cancer has markedly improved over recent decades, largely due to intensified treatment regimes. The intensive treatment may, however, result in fatal complications. In this retrospective cohort study, we assessed temporal variation in the incidence of treatment-related death and associated risk factors among children diagnosed with cancer in Denmark during 2001-2021. Among all children diagnosed with first incident cancer before age 15 years recorded in the Danish Childhood Cancer Register (n = 3,255), we estimated cumulative incidence of treatment-related death (death in the absence of progressive cancer) within 5 years from diagnosis using Aalen-Johansen estimators and assessed associated risk factors using Cox regression. Among all 3,255 children with cancer, 93 (20% of all 459 deaths) died from treatment. Of these treatment-related deaths, 39 (42%) occurred within 3 months of diagnosis. The 5-year cumulative incidences of treatment-related death were 3.3% during 2001-2010 and 2.5% during 2011-2021 (p = 0.20). During 2011-2021, treatment-related deaths accounted for more than half of all deaths among children with haematological cancers. Risk factors varied according to cancer group and included female sex, age below 1 year at diagnosis, disease relapse, stem cell transplantation, central nervous system involvement, and metastasis at diagnosis. Despite increasing treatment intensities, the incidence of treatment-related death has remained stable during the past 20 years in Denmark. Still, clinical attention is warranted to prevent treatment-related deaths, particularly among children with haematological cancers. Patient characteristics associated with increased treatment-related death risk support patient-specific treatment approaches to avoid these fatalities.

Preconceptional and Antenatal Care through Life Style with special reference to Sadvritta: A Scoping Review

Sadvritta is a group of good conducts indicated to practice throughout life for everyone. Sadvritta plays significant role in prevention of all kind of diseases and in promotion of health. Female reproductive health is responsible for proper outcomes related to maternal and child health. There are guidelines in Ayurveda which consists of concepts of preconceptional, antenatal and post-natal health care of a mother and child. Wholesome life style with physical, psychological and verbal acts along with required medication and Panchakarma are mentioned. Special guidelines are mentioned for a couple as a Garbhadhan Vidhi (method of impregnation) which is supposed to follow at the time of preconception. Wholesome regimens at physical, mental and verbal level in life style of pregnant woman and a father at the time of conception is advised to maintain. Many factors described in Garbhini Paricharya and Sadvritta other than nutrition and medication are important for prevention. Emotional health of a mother is associated with the health of a child. Sadvritta and Ayurvedic life style consists guidelines which can reduce health issues due to stress. Many countries have developed national level health programmes for mother and child health. Goals of mother and child health programme emphases on antenatal, intra-natal and post- natal health care. Objectives of MCH programme are reduction of mortality and morbidity rates of mother and child. For it, care can be started at preconceptional phase. There may be a scope to advise Sadvritta guidelines to currently established MCH with Ayurveda health care. This article is an effort to view scope in MCH through Ayurveda and Sadvritta.

Mortality and its predictors among human immunodeficiency virus-infected children younger than 15 years receiving antiretroviral therapy in Ethiopia: a systematic review and meta-analysis

BackgroundDespite antiretroviral treatment (ART), the human immunodeficiency virus (HIV) continues to pose a considerable health burden in resource-poor countries. This systematic review and meta-analysis aimed to determine the pooled incidence density of mortality and identify potential predictors among HIV-infected children receiving ART, from studies conducted in various parts of Ethiopia.MethodsA comprehensive database search was made in Excerpta Medica, PubMed, Web of Science, African Journals Online, Google Scholar, and Scopus. We reported results following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020. Excel Spreadsheet and STATA Version 14 software were used for data abstraction and meta-analysis, respectively. Statistical heterogeneity among studies was assessed using I2 statistics. Meta-regression and subgroup analysis were performed to further explore the sources of statistical heterogeneity. Moreover, publication bias and a leave-out-one sensitivity analysis were performed.ResultsTwenty-two articles involving 8,731 participants met inclusion criteria and were included. The pooled incidence density of mortality was 3.08 (95% confidence interval (CI), 2.52 to 3.64) per 100 child years. Predictors of mortality were living in rural areas (hazard ratio (HR), 2.18 [95% CI, 1.20 to 3.98]), poor adherence to ART (HR, 2.85 [ 95% CI, 1.39 to 5.88]), failure to initiate co-trimoxazole preventive therapy (HR, 2.16 [95% CI, 1.52 to 3.07]), anemia (HR, 2.28 [95% CI, 1.51 to 3.45]), opportunistic infections (HR, 1.52 [ 95% CI, 1.15 to 2.00]), underweight (HR, 1.74 [95% CI, 1.26 to 2.41]), wasting (HR, 2.54 [95% CI, 1.56 to 4.16]), stunting (HR, 2.02 [95% CI, 1.63 to 2.51]), World Health Organization classified HIV clinical stages III and IV (HR, 1.71 [95% CI, 1.42 to 2.05]), and Nevirapine-based regimens (HR, 3.91 [95% CI, 3.09 to 4.95]).ConclusionsThis study found that the overall mortality rate among HIV-infected children after ART initiation was high. Therefore, high-level commitment and involvement of responsible caregivers, healthcare providers, social workers, and program managers are of paramount importance to identify these risk factors and thus enhance the survival of HIV-infected children receiving ART.

Impact of treatment and clinical characteristics on the survival of children with medulloblastoma in Mexico.

Data on medulloblastoma outcomes and experiences in low- and middle-income countries, especially in Latin America, is limited. This study examines challenges in Mexico's healthcare system, focusing on assessing outcomes for children with medulloblastoma in a tertiary care setting. A retrospective analysis was conducted, involving 284 patients treated at 21 pediatric oncology centers in Mexico. High-risk patients exhibited markedly lower event-free survival than standard-risk patients (43.5% vs. 78.3%, p<0.001). Influential factors on survival included anaplastic subtype (HR 2.4, p=0.003), metastatic disease (HR 1.9, p=0.001); residual tumor >1.5cm², and lower radiotherapy doses significantly impacted event-free survival (EFS) and overall survival (OS). Platinum-based chemotherapy showed better results compared to the ICE protocol in terms of OS and EFS, which was associated with higher toxicity. Patients under 3 years old displayed notably lower OS and EFS compared to older children (36.1% vs. 55.9%, p=0.01).

The impact of welfare on maternal investment and sibling competition: evidence from Serbian Roma communities.

Siblings compete for limited parental resources, which can result in a trade-off between family size and child growth outcomes. Welfare incentives may improve parental circumstances in large families by compensating for the additional costs of an extra child and increasing the resources available to a family. The improvements in conditions may influence parents to increase their investment, expecting greater returns from the investment in child survival and development, while in turn increase sibling competition for the investment. This study assessed whether welfare benefits have influenced parental investment trade-offs and competition between siblings among Serbian Roma, a population largely dependent on welfare. Using data from the UNICEF Multiple Indicator Cluster Survey 6, this study assessed the associations between maternal investment, child cash benefits, sibship size, and child anthropometry, as an indicator of health, among 1096 Serbian Roma children aged 0 to 59 months. Living in a small family benefited Roma children, while the incentives increased competition between siblings. Maternal investment was negatively associated with incentives, as the improvements brought about were insufficient to influence a change in maternal perceptions about the local setting uncertainty and thus promote an increase in investment.

Contribution of vaccination to improved survival and health: modelling 50 years of the Expanded Programme on Immunization

WHO, as requested by its member states, launched the Expanded Programme on Immunization (EPI) in 1974 to make life-saving vaccines available to all globally. To mark the 50-year anniversary of EPI, we sought to quantify the public health impact of vaccination globally since the programme's inception. In this modelling study, we used a suite of mathematical and statistical models to estimate the global and regional public health impact of 50 years of vaccination against 14 pathogens in EPI. For the modelled pathogens, we considered coverage of all routine and supplementary vaccines delivered since 1974 and estimated the mortality and morbidity averted for each age cohort relative to a hypothetical scenario of no historical vaccination. We then used these modelled outcomes to estimate the contribution of vaccination to globally declining infant and child mortality rates over this period. Since 1974, vaccination has averted 154 million deaths, including 146 million among children younger than 5 years of whom 101 million were infants younger than 1 year. For every death averted, 66 years of full health were gained on average, translating to 10·2 billion years of full health gained. We estimate that vaccination has accounted for 40% of the observed decline in global infant mortality, 52% in the African region. In 2024, a child younger than 10 years is 40% more likely to survive to their next birthday relative to a hypothetical scenario of no historical vaccination. Increased survival probability is observed even well into late adulthood. Since 1974 substantial gains in childhood survival have occurred in every global region. We estimate that EPI has provided the single greatest contribution to improved infant survival over the past 50 years. In the context of strengthening primary health care, our results show that equitable universal access to immunisation remains crucial to sustain health gains and continue to save future lives from preventable infectious mortality. WHO.

Surgical Melody Mitral Valve: A Paradigm Shift for Infants With Unrepairable Mitral Valve Disease

BackgroundThe Melody valve (Medtronic, Minneapolis, MN) for mitral valve replacement (MVR) (MelodyMVR) has been an effective strategy to treat unrepairable mitral valve disease in small children. This study analyzed survival, durability, and complications of the MelodyMVR strategy. MethodsPatients who underwent MelodyMVR between 2014 and 2023 were included. Transplant-free survival was analyzed with Kaplan-Meier analysis. The Fine and Gray subdistribution method was applied to quantify the cumulative incidence. ResultsTwenty-five patients underwent MelodyMVR. Median age and weight were 6.3 months (interquartile range, 4.4-15.2 months) and 6.36 kg (interquartile range, 4.41-7.57 kg). Fifteen patients (60%) had congenital mitral valve disease and 13 (52%) had dominant mitral regurgitation. The median diameter of the implanted Melody was 16 mm (interquartile range, 14-18 mm). Mortality at 6 months, 1 year, and 5 years was 8.3% (95% CI, 2.2%-29.4%), 12.5% (95% CI, 4.2%-33.9%), and 17.6% (95% CI, 7.0%-40.7%), respectively. Two hospital survivors (8%) required early Melody replacement. Competing risk analysis showed that ∼50% of patients underwent mechanical MVR by 3.5 years after MelodyMVR. Freedom from bleeding and thrombosis at 4 years was 87.5% (95% CI, 74.2%-100%). Eleven patients underwent subsequent mechanical MVR with no deaths. One (9%) required pacemaker implantation after mechanical MVR. ConclusionsMelodyMVR provides reasonable early and medium-term survival in small children and a high rate of successful bridge to mechanical MVR. MelodyMVR is associated with minimal pacemaker requirement, bleeding, and thrombosis. Early Melody functional deterioration necessitates early repeat MVR, which can be achieved with minimal morbidity and mortality.

FEMALE GENDER: AN INDEPENDENT PREDICTOR OF HIGH NORMAL BLOOD PRESSURE IN LONG -TERM ADULT SURVIVORS OF CHILDHOOD, ADOLESCENT AND YOUNG ADULT CANCER

Objective: Determine the blood pressure profile in longterm adult survivors of childhood, adolescent and young adult cancer. Determine predictive factors for abnormal blood pressure figures in these patients. Design and method: 104 patients aged over 18, who had received chemotherapy with or without mediastinal radiotherapy for the treatment of neoplasia diagnosed and treated before the age of 21. High blood pressure was defined by a SBP &gt; = 140 mmHg and/or DBP &gt; = 90 mmHg or by the use of antihypertensive drugs. High normal blood pressure corresponded to a SBP between 130 mmHg and 139 mmHg and/or a DBP between 85 and 89 mmHg. Results: Male predominance (56.7%) with a sex ratio of 1.3. Mean current age 25.12 +/-5.40 years, age at diagnosis 13.4 ±5.13 years, duration since end of treatment of cancer 10.67 +/-5.80 years, BMI 22.77 ±4.66 kg/m2, male waist circumference (WC) 82.7 ±12.6 cm, female (WC) 78.6 ± 10.4 cm, SBP 114.5 ±11.7 mmHg, DBP 74.2 ±7.4 mmHg. Chemotherapy alone 80.8%, chemotherapy + mediastinal radiotherapy 19.2%, anthracyclines 100%, platinum salts 32%, corticoids 9%. Low HDL-cholesterol 44.7%, high normal blood pressure 24.3%, abdominal obesity 15.8%, hypertriglyceridemia 9.7%, obesity 8.7%, prediabetes 6.9%, fasting plasma glucose &gt; = 110 mg/dl 6.9%, metabolic syndrome (MS) 3.8%. Multivariate study: Gender (OR = 3.32 95% CI 1.11 - 9.92 p=0.03) - MS (OR = 0.07 95% CI 0.06 - 0.81 p=0.03). Conclusions: Nearly a quarter of the patients in our study (24%) had a high normal blood pressure, which was associated with female gender and the presence of metabolic syndrome. These results confirm the need for early screening of cardiovascular risk factors, particularly hypertension, in long-term adult survivors of childhood, adolescent and young adult cancer.

Highlights from the first-ever violence against children and youth survey conducted exclusively in a humanitarian setting

BackgroundViolence against children (VAC) has garnered attention as a priority issue, in part, due to the Violence Against Children and Youth Surveys (VACS). Although children are disproportionately represented among forcibly displaced people, VACS are a novelty in humanitarian settings. ObjectiveThis paper presents the approach to the first-ever VACS conducted exclusively in a humanitarian setting (HVACS) in Uganda, in addition to providing an overview of the results of this novel survey, along with their implications. Participants and settingParticipants included 1338 females and 927 males aged 13–24 years living in refugee settlements in Uganda. MethodsThis was a cross-sectional representative household survey conducted in all 13 refugee settlements in Uganda between March and April 2022. A three-stage sampling process was used to identify participants. Descriptive analysis was conducted, involving the application of sample weights to obtain estimates that are representative of the study population. ResultsVAC in refugee settings is pervasive, with females being more likely than males to experience sexual violence and males being more likely than females to experience physical violence. VAC perpetrators were mostly people who were known to child survivors. Whereas knowledge of where to seek help for violence was relatively high (more so for males compared to females), the levels of disclosure and help-seeking were very low for both groups. ConclusionRobust surveys that have traditionally excluded humanitarian settings can be conducted in these contexts. Data emanating from such surveys are critical for developing relevant guidance on interventions to appropriately address major public health issues, such as VAC.

Assessment of the acceptance and implementation of child survival strategies among mothers in some selected communities in south-south Nigeria

Objective: The aim of this study was to assess the acceptance and implementation of child survival strategies through knowledge and practices among mothers in some selected communities in south-south Nigeria. Method: A descriptive survey method was used for the study and Rivers state which is in South-South Nigeria was randomly selected for the pilot study. The study was conducted between September 2021 and August 2023 and a sample size of Six Hundred respondents were randomly selected from the three senatorial districts of Rivers State. The instrument used for data collection was researchers’ constructed questionnaire with 17 items grouped into A and B. Section A contained information on demographic data of the respondents while section B focused on the Knowledge, practices and factors that influenced the acceptance and implementation of child survival strategies among mothers in some selected Local Government Areas in Rivers state. Data was analysed using descriptive statistics of percentages in frequency and tables. Results: The results of the findings showed a high level of knowledge (100%) and its components like skilled child birth attendance (92%), exclusive breastfeeding (83%), immunization (96%) and family planning (78.5%). Also majority of the mothers actually practiced the components of child survival strategies in this study, except family planning services (16%) despite being in the peak of their reproductive years and already having between four to six children. Other factors such as the attitude of the health workers and educational background of mothers were also identified as barriers to the practice of child survival strategies. Conclusion: It was therefore recommended amongst others that government at all levels should embark on aggressive health enlightenment campaign to further sustain these practices and also improve the acceptance and implementation of the practices of other child survival strategies yet to be accepted by mothers.

Impact of scaling up of kangaroo mother care on neonatal mortality among babies born with birth weight

ObjectiveTo assess the impact of scaling up of kangaroo mother care (KMC) on neonatal mortality among babies born with birth weight <2000 g across an entire district in southern India.Design,...

Differences in Gross Motor Skills of Preschool Children Aged 5-6 Years Before and After Playing the Traditional Engklek Game

Background: Gross motor skills are important for a child's survival because they are stimulated during childhood, which is a long time to practice everything that will be carried into adulthood. According to national data, in Indonesia, 11% of children below the age of 5 experience growth and development disorders. The purpose of this research was to analyze the differences on the child's gross motor skills before and after the traditional engklek game at Dharma Wanita Tisnogambar Kindergarten, Jember Regency. Methods: Pre-experimental is the method used in this research with a one-group pre-post test approach. With a total population of 30 Dharma Wanita Tisnogambar Kindergarten children and a sample of 16, the SOP for playing crank and gross motor observation sheets, the intervention was carried out for 2 weeks with 4 meetings, the Wilcoxon Match Pairs Test is the analysis used by the researchers. Results: The results of the gross motoric research before the game were carried out in the BB category of as many as 11 children (68.8%) and in the MB category of as many as 5 children (31.3%). Meanwhile, after the game was played, the results were in the BSB category, namely 10 people (62.5%), in the BSH category, namely 4 people (25%), and 2 other people were in the MB category (12.5%). The results of the analysis show that there are differences on the child's gross motor skills before and after the traditional engklek game, the p-value is 0.03 - 0.05. Conclusions: The conclusion is that before and after the traditional engklek game, there are differences in the gross motor skills of children in kindergarten.