Vulnerable Children Research Articles

Adverse Childhood Experiences and Mental Distress Among Adolescents and Youth in Zimbabwe.

Adverse childhood experiences (ACEs) are a global public health crisis associated with physical and poor mental health outcomes. The current study examined the prevalence and association between individual and cumulative ACEs with mental distress among adolescents and youth in Zimbabwe. Data from the 2017 Violence Against Children and Youth Survey were utilized (13-25 years old, n = 8,715). Bivariate analysis was conducted using chi-square tests to obtain the prevalence estimates. Two sets of logistic regression models were conducted to determine significant associations between independent variables (i.e., experiencing childhood physical, emotional, and sexual violence; witnessing intimate partner violence (IPV) and community violence; orphan status; and cumulative ACE exposure) and the dependent variable (i.e., mental distress in the past 30 days as measured by Kelser 6). 28.4% of the adolescents and youth reported experiencing mental distress in the past 30 days. Regarding ACEs, cumulative ACE exposure (34.7%; adjusted odds ratio [AOR] = 2.13) and individual ACEs (i.e., experiencing childhood physical violence [39.3%; AOR = 1.41], emotional violence [55.8%; AOR = 2.67], sexual violence [50.8%; AOR = 2.00], witnessing community violence [47.3%; AOR = 1.52], witnessing IPV [43.1%; AOR = 1.47], and being orphaned during childhood [33.6%; AOR = 1.24]) were significantly associated with higher prevalence rates and odds of experiencing mental distress in the past 30 days among adolescents and youth in Zimbabwe. These findings show that ACEs are highly prevalent and increases the risk of mental distress for vulnerable adolescents and youth in Zimbabwe. Effective interventions to reduce violence exposure in families, schools, and communities are essential to mitigate the negative consequences of ACEs and mental distress of adolescents and youth in Zimbabwe. Strengthening child protection policies and involving social workers, psychologists, and mental health workers are also crucial for safeguarding vulnerable children who might be impacted by ACEs in Zimbabwe. Implications for future research are further discussed.

Psychosocial Impact of a True-Positive, False-Positive, or Inconclusive Newborn Bloodspot Screening Result: A Questionnaire Study among Parents.

Expansion of newborn bloodspot screening (NBS) can increase health gain for more children but also increases the number of false-positive and uncertain results. The impact of abnormal and inconclusive NBS results on parental well-being and healthcare utilization was investigated. A questionnaire was sent to Dutch parents receiving an abnormal or inconclusive NBS result five weeks (T1) and four months (T2) post-NBS and compared to parents with a normal result (controls). In total, 35 true-positive (TP), 20 false-positive (FP), and 57 inconclusive (IC) participants and 268 controls filled out T1; 19 TP, 14 FP, 27 IC, and 116 controls filled out T2. Participants showed positive attitudes towards NBS. FP participants more often considered NBS less reliable. TP and FP participants experienced more negative emotions regarding the test result compared to controls at both T1 and T2, and IC only at T1. Parent-reported child vulnerability and perceptions of the newborn's health status and of parenthood showed no differences. TP and FP participants reported more healthcare utilization at T1, and mainly TP at T2. TP and IC participants showed more emergency department visits at T1. The findings can be used to improve NBS programs and optimize support for families with various NBS results.

Improving agencies' response to tackling serious youth violence

Review of cases in the London borough of Croydon highlights how safeguarding organisations need to work with vulnerable children as early as possible to reduce the risk of them getting involved in violent incidents

A New Blueprint for Secure Care

A shortage of secure placements is affecting the wellbeing of some of the UK's most vulnerable children. A new research partnership is working with the sector to find out what needs to change

Trends in council spending on services for vulnerable children

Latest figures show that the amount spent by local authorities on children's services has accelerated over the past year. Andrew Rome summarises the key drivers of change and offers advice on how commissioners can respond to spending trends

Reflecting on the Present through the Past: Children's Displacement from Ukraine

Abstract: Friederike Kind Kovács and Anna Oksiutovych argue that the displacement of children is one of the major, but generally overlooked, consequences of the war in Ukraine. The authors find valuable insights in studying previous examples of children's forced displacement and migration to safe countries that help identify the possible long- and short-term consequences for the children who have left Ukraine following the Russia's invasion that began February 24, 2022. Specifically, the history of Hungarian children's displacement during and after World War I offers important parallels. Kind-Kovács and Oksiutovych identify two kinds of displacements—those that take place by families leaving for safe countries in anticipation of the crisis created by the war and children's forced displacement under Russian policies. In regard to the latter, the article examines the Russian government's possible motivations behind the forced abduction of 700,000 Ukrainian minors taken to Russia, actions that are contrary to international law. These abductions target the most vulnerable children, especially orphans and disabled children residing in institutions. The authors conducted oral histories with Ukrainian mothers who relocated with their children to safe countries, and their testimonies offers insights into the difficulties faced by these refugee children even in these "better" circumstances. The authors underscore the urgent need for comprehensive international measures to protect children's rights in conflict zones such as Ukraine, finding support for their conclusions in historical evidence.

Socio-Cultural Discourses of Children Engaged in Child Labor in India: A Macro-Ethnographic Study.

Child labor is considered one of the main social problems that affect the community and has a physical and psychosocial impact on a child's health, growth, and development. The study aimed to describe the sociocultural discourses of children involved in child labor. A macroethnographic approach was used to collect the data from the selected community areas of Punjab, India. A community-based qualitative study using purposive sampling was carried out among children engaged in child labor (n = 8). The data were gathered through in-depth or semi-structured interviews and non-participant observation under four phases: community context assessment, egocentric network analysis, validation, and dissemination of study findings. The guide for consolidated criteria for reporting qualitative research (COREQ) was followed. Ongoing analysis was conducted using Spradley's analysis approach to identify the themes. Thematic analysis resulted in the emergence of various themes related to child labor, namely, adaptability, money-centric attitude, sense of being underserved, social deprivation, work burden, reduced emotional expression, workaholism, abuse, family shoulder, family cohesion, and sense of industry. Apart from that, inhuman living and working conditions, as well as school deprivation among study subjects, were observed. Poverty emerged as the single most compelling factor for child labor in India. The study concluded that child labor had a negative impact on children's overall development. An effective intervention to stop child labor is if vulnerable children are identified through primary healthcare, and a relationship of trust is built that allows for the provision of health care, education, support, and referral to additional services outside the health sector.

Socio-Economic-Driven Disparities in Chronic Illness and Disability Among the South African Children: Exploring Variations Within the Urban and Rural Areas

ABSTRACT: Existing literature on health inequalities often overlooks the nuanced dynamics, particularly among vulnerable children with chronic diseases and disabilities and fails to consider regional disparities within countries like South Africa. This paper asserts the necessity for a more granular analysis in South Africa, recognizing the varied health outcomes for children across different economic segments and geographical settings. Specifically, the health trajectories for children differ markedly between rural formal areas, regions under traditional authorities, formal urban areas, and informal urban settlements. Addressing the generalizations common in prior research, this study takes a precise, regionally focused approach to socio-economic-driven disparities in chronic illness or disability. It distinguishes between rural formal areas, traditional authority areas, formal urban areas, and informal urban areas, unveiling the intricate layers of health disparities. Using data from the National Income Dynamics Study, concentration indices, and the Oaxaca-Blinder Decomposition method, the paper analyzed health inequality trends from 2008 to 2017. The results uncover significant inequalities, with alarming trends, particularly among children with chronic illnesses and disabilities in traditional authority regions and informal urban environments. The paper's evidence shows that rural formal areas have experienced a decline in health disparities as opposed to the deepening divide in traditional authority-led regions. The urban analysis reveals a split: while formal urban settings often favour the wealthier, informal urban areas indicate a shift towards lower socioeconomic brackets. The decomposition analysis highlights the evolving socioeconomic elements influencing each region over time. These insights emphasize the urgent necessity for geographically tailored policy interventions. By understanding the distinct socioeconomic landscapes across various regions, we can formulate policies that resonate with each area's specific realities and challenges. Such targeted strategies are essential in reducing health inequalities and enhancing the life quality of children with chronic health conditions and disabilities, playing a critical role in South Africa's journey toward comprehensive health equity.

A Descriptive Analysis of Access to Assistive Technology in Children With Acquired Brain Injury: The Right to Assistive Devices.

Pediatric clinicians caring for children with acquired brain injury have noted that many individuals requiring assistive technology (AT) go unserved or face delays until devices are obtained, with potential adverse implications for recovery and development. In this article we map the pathways by which AT is prescribed and assess delays and barriers to access. We conducted a retrospective chart review of patients with moderate to severe brain injury admitted to Blythedale Children's Hospital over a 2-year period using a database drawn from the medical record. We identified 72 children diagnosed with brain injury requiring at least 1 device. Devices were used to improve mobility and positioning, self-care, safety, and communication, and enable access to other technologies and foster social integration. We found that 55% of devices were delivered, with most deliveries to home or the hospital's outpatient department for fitting, training, and instruction. Time to delivery ranged from 12 to 250 days with an average of 69.4 days. Twenty percent of nondeliveries were attributable to change in medical status, transfer to a skilled nursing facility, or continued inpatient status, while 31% were canceled by the family. Other nondeliveries were attributed to insurance coverage. We also found that the medical record is not designed for the longitudinal tracking of devices, indicating the need for a prospective process to document the AT trajectory. Instead of tolerating delays and denials, there should be a normative expectation that children have a right to medically necessary devices, consistent with disability law. This analysis was undertaken as a step toward formulating a prospective means of tracking AT recommendations, approvals, denials, and/or deliveries. Our findings should be understood as a promissory note toward structural reforms that are reflective of society's responsibility to better meet the needs of vulnerable children and their families.

Missed Lessons from The Holocaust: Avoiding Complexities and Darker Aspects of Jewish Child Survivors' Life Experiences

Abstract: Joanna Beata Michlic sees how much of the attention to child survivor histories can be traced to the experiences of Jewish children after the Holocaust. She criticizes the continuing attempts to draw a narrative of redemption and renewal from this history—and its uses as a paradigm—as simplistic and harmful. Instead, Michlic argues it is important to understand the many vulnerabilities of child survivors, not simply celebrate their success. Accepting the complexities and painful truths pertaining to the Jewish child survivors' biographies uncovers valuable lessons that may be applied to policies directed at today's vulnerable child refugees. Fully examining the experience of young Jewish refugees recognizes that reaching a peaceful Western country to start life anew did not mean that the children instantly transformed themselves into happy individuals. Michlic argues that the multiple scars incurred by war, loss, separation, and the imperative to adapt to a new life are not simply left behind. In the case of Jewish child survivors, these wounds lingered, shaping their identities and memories throughout their lives. It is essential to listen to child survivors' testimonies about the emotional price of losing their families and communities. Invoking the past to understand the present includes being willing to accept history's uneasy, painful, and complex personal realities.

Assessing Child Health Disparities: Evidence from a Household-Based Health Index in Punjab, Pakistan

Around the world, undernutrition causes more than half of all deaths in children under 5 years of age. It also increases children's vulnerability to common diseases, impairs recovery, and stunts their physical and mental development. This paper investigates the state of child health and the assessment of health inequalities in children under 5 years, utilising Multiple Indicators Cluster Surveys across 36 districts in Punjab, Pakistan. We suggest a new household-based health index to identify health disparities and to help policymakers implement more successful domestic policies to offset inequalities. Additionally, this study estimates the health disparities for robustness checks applying the Palma ratio and Gini coefficient. The study's findings revealed that every second child in Punjab is malnourished and that 51% of children in Punjab had not received all of their recommended vaccinations. The results also show that health disparities in low-income districts are worse than in high-income districts. The findings further demonstrate that important contributors to health disparities include parental illiteracy, poverty, and political backwardness. This study recommends a multifaceted policy intervention to address child immunization, undernutrition, and infectious disease legislation, as well as income inequality, to reduce health disparities.

Development of PD in lower-income countries: a rational solution for the management of AKI and ESKD

It is estimated that more than 50% of patients with end stage kidney disease (ESKD) in low-resource countries are unable to access dialysis. When hemodialysis is available, it often has high out of pocket expenditure and is seldom delivered to the standard recommended by international guidelines. Haemodialysis is a high cost intervention with significant negative effects on environmental sustainability, especially in resource poor countries (the ones most likely to be impacted by resultant climate change). This review discusses the rationale for peritoneal dialysis (PD) as a more resource and environmentally efficient treatment with the potential to improve dialysis access, especially to vulnerable populations, including women and children, in lower resource countries. Successful initiatives, such as the Saving Young Lives program, have demonstrated the benefit of PD for acute kidney injury. This can then serve as a foundation for later development of PD services for ESKD programs in these countries. Expansion of PD programs in resource poor countries has proven to be challenging for a variety of reasons. Hopefully, if some of these issues can addressed, PD will be able to permit an expansion of ESKD care in these countries.

Spatial Spread of Diphtheria and Public Health Engagement in Nigeria

Diphtheria is a potentially fatal and highly contagious vaccine-preventable disease that spreads between people mainly by direct contact or through the air via respiratory droplets. The disease can affect all age groups; however, unimmunized children are particularly at risk. This article examines the spatial spread of diphtheria in Nigeria. The paper examines community awareness and public health actions taken by various actors and stakeholders to alleviate the diphtheria outbreak. The risks of spreading diphtheria and the vulnerability of children due to poor immunisation are frightening. Consistency in data collection and good quality (quantitative) data provides a basis for timely intervention and future response to the treatment of diphtheria. Curtailing crowding, reducing multidimensional poverty and social inequalities, and enhancing hygienic practices (WASH) are practical measures to reduce spread, infection, and death arising from the diphtheria outbreak in Nigeria and other countries.

Impacts of Deforestation on Childhood Malaria Depend on Wealth and Vector Biology.

Ecosystem change can profoundly affect human well-being and health, including through changes in exposure to vector-borne diseases. Deforestation has increased human exposure to mosquito vectors and malaria risk in Africa, but there is little understanding of how socioeconomic and ecological factors influence the relationship between deforestation and malaria risk. We examined these interrelationships in six sub-Saharan African countries using demographic and health survey data linked to remotely sensed environmental variables for 11,746 children under 5years old. We found that the relationship between deforestation and malaria prevalence varies by wealth levels. Deforestation is associated with increased malaria prevalence in the poorest households, but there was not significantly increased malaria prevalence in the richest households, suggesting that deforestation has disproportionate negative health impacts on the poor. In poorer households, malaria prevalence was 27%-33% larger for one standard deviation increase in deforestation across urban and rural populations. Deforestation is also associated with increased malaria prevalence in regions where Anopheles gambiae and Anopheles funestus are dominant vectors, but not in areas of Anopheles arabiensis. These findings indicate that deforestation is an important driver of malaria risk among the world's most vulnerable children, and its impact depends critically on often-overlooked social and biological factors. An in-depth understanding of the links between ecosystems and human health is crucial in designing conservation policies that benefit people and the environment.

Childhood Health Risks and Vulnerabilities Associated with Climate Change in the Philippines: Basis for Child Health Vulnerability Framework

Rising temperatures and intensifying storms have characterized the past decade in Iligan City, Philippines, demonstrably increasing the frequency and intensity of extreme weather events. This poses a growing threat to children's health and well-being. To gain an in-depth understanding of local experiences, a qualitative study was employed using purposive sampling of 15 parents and barangay health workers. Extreme heat, heavy rain, flooding and landslides were identified as the most frequent climate-related disasters, leading to injuries, displacement, and outbreaks of waterborne diseases among children. Vulnerabilities stem from living in flood-prone areas, children's underdeveloped immune systems, and existing health issues, amplifying their risks. The proposed framework emphasizes early warning systems and climate-resilient infrastructure (e.g., flood protection measures) to address geographic vulnerabilities. It also incorporates nutrition programs, child-friendly health services, and Mental Health and Psychosocial Support (MHPSS) to tackle children's physical and mental health needs. By implementing these interventions based on local needs and vulnerabilities identified in this study, the Local Government Unit (LGU) can effectively mitigate the impact of climate change on children's health in Iligan City.

Asthma Academy for Family Caregivers: A Quality Improvement Project.

Background: Asthma affects one in every 12 children in United States with significant prevalence in underserved groups. Family caregiver education is essential to improve childhood asthma control. The literature suggests that family caregivers' lack of knowledge about asthma management affects their children's health outcomes. An evidence-based education program that improves caregivers' asthma knowledge may improve the family's well-being. Objectives: The goal of the Asthma Academy project is to improve the disease management of children with asthma by providing an in-person family caregiver education program. The main objectives are to (a) improve family caregivers' asthma knowledge, (b) enhance their confidence in asthma management, and (c) evaluate caregivers' satisfaction with the education program. Method: This quality improvement project used an in-person educational program with an asthma education video resource for caregivers of children with asthma. Results: The family caregivers' asthma knowledge improved significantly after the education. The confidence levels in caring for children with asthma increased. Caregivers' satisfaction with the Asthma Academy education session was favorable. Conclusions: The Asthma Academy was an acceptable and effective delivery method of education for family caregivers of children with asthma in the in-patient setting. Empowering family caregivers of vulnerable children through asthma education may improve child health outcomes and mitigate complications from asthma. Implications for Nursing Nurses and clinicians are steward of providing patient education. Individualized, patient-tailored education is recommended.

Cultural Ramifications on the Educability of Pregnant and Parenting Learners at Four South African High Schools

The study investigated how the socio-cultural and traditional practices of school-based education duty-bearers influenced the educational access and participation of pregnant and parenting learners (PPLs) who chose to continue with schooling after falling pregnant. Using a qualitative case study research design, four high schools with high rates of girl pregnancy from one South African education district were purposively selected. The participants included 8 school governing body (SGB), 8 school management team (SMT), 8 pregnant-monitoring teachers (PMT), 8 class teachers, 8 PPLs and 8 mainstream learners who schooled with PPLs. Data were collected through individual interviews for PPLs for their confidentiality, and focus group interviews for all the other participants. Study results indicated that due to cultural, traditional perceptions and practices, the South African national education policy measures on the prevention and management of learner pregnancy which allows schoolgirls to return to school after giving birth was loosely observed and implemented at the schools. The reasons for these are; a) Negative attitudes of teachers and mainstream to PPLs; b) Domestication of motherhood and childrearing by community; c) Mythological discernment of PPLs by mainstream learners; d) Character contamination; and e) Femininity as a negative label on PPLs in a formal school setting. Thus, from the findings, it is recommended that school-based duty bearers be trained on democratic education policy frameworks and their implementation strategies, to benefit the vulnerable children such as PPLs, among others.

Language brain responses and neurodevelopmental outcome in preschoolers with congenital heart disease: A fNIRS study

Neurodevelopmental disabilities affect up to 50% of survivors of congenital heart disease (CHD). Language difficulties are frequently identified during preschool period and can lead to academic, social, behavioral, and emotional difficulties. Structural brain alterations are associated with poorer neurodevelopmental outcomes in patients with CHD during infancy, childhood, and adolescence. However, evidence is lacking about the functional brain activity in children with CHD and its relationship with neurodevelopment. This study therefore aimed to characterize brain responses during a passive story-listening task in 3-year-old children with CHD, and to investigate the relationship between functional brain patterns of language processing and neurodevelopmental outcomes. To do so, we assessed hemodynamic concentration changes, using functional near-infrared spectroscopy (fNIRS), and neurodevelopmental outcomes, using the Wechsler Preschool and Primary Scale of Intelligence – 4th Edition (WPPSI-IV), in children with CHD (n = 19) and healthy controls (n = 23). Compared to their healthy peers, children with CHD had significantly lower scores on the Verbal comprehension index (VCI), the Vocabulary acquisition index (VAI), the General ability index (GAI), and the Information and the Picture Naming subtests of the WPPSI-IV. During the passive story-listening task, healthy controls showed significant hemodynamic brain responses in the temporal and the temporal posterior regions, with stronger activation in the temporal posterior than in the temporal regions. In contrast, children with CHD showed reduced activation in the temporal posterior regions compared to controls, with no difference of activation between regions. Reduced brain responses in the temporal posterior regions were also correlated with lower neurodevelopmental outcomes in both groups. This is the first study that reveals reduced brain functional responses in preschoolers with CHD during a receptive language task. It also suggests that the temporal posterior activation could be a potential brain marker of cognitive development. These findings provide support for the feasibility of identifying brain correlates of neurodevelopmental vulnerabilities in children with CHD.

HIDDEN HORRORS: HUMAN TRAFFICKING IN IRAQ - A NATION IN NEED OF ANTI-TRAFFICKING LAWS

Human trafficking and settler trafficking are universal and general offence that use men, women and children for interest. Many parts of the world witness these kinds of trafficking, here we are discussing trafficking in Iraq. Forced nuptials, household subjugation within the community, family and tribe as well as strained labor and strained prostitution, are all forms of human trafficking that have been recorded in Iraq for a prolonged duration. Since the 2003 invasion and ensuing civil war, Iraq has flattered a more perennial harbor for external hirelings who are at a higher danger of being trafficked and majority migrates from the Philippines, Nepal, Bangladesh, and other countries with elevated degree of penury. In consonance to reliable accounts, the Iraqi military trafficked Kurdish women into commercial sex labor during the Anfal campaign in the late 1980s, and women who were displaced during the revolt in southern Iraq in 1991 have been detained for prostitution in the KRG. Increased risks for the most vulnerable women, children, minorities, displaced persons, and other vulnerable groups have also been brought on by the conflict with ISIS in Iraq. However, the Iraqi government officials are yet to bring laws that could prevent these offenders and punish them. Iraq has never brought any anti-trafficking codifications, aiding traffickers to advance to function with indemnity. KEYWORDS: Human Trafficking, Iraq, Migrants, Kurdish, Women, Traffickers.

Co-production of health and social science research with vulnerable children and young people: A rapid review.

The term 'care-experienced' refers to anyone who is currently in care or has been in care at any stage in their life. A complex interplay of factors leads to care-experienced children and young people (CECYP) experiencing poorer oral health and access to dental care than their peers. A rapid review of the co-production of health and social care research with vulnerable children and young people (CYP) was carried out to inform the development of a co-produced research project exploring the oral health behaviours and access to dental services of CECYP. Here, 'co-production' refers to the involvement of CYP in the planning or conduct of research with explicit roles in which they generate ideas, evidence and research outputs. To learn how to meaningfully involve vulnerable CYP in the co-production of health and social science research. To identify: Different approaches to facilitating the engagement of vulnerable CYP in co-production of health and social science research; different activities carried out in such approaches, challenges to engaging vulnerable CYP in co-production of health and social science research and ways to overcome them and areas of best practice in relation to research co-production with vulnerable CYP. A rapid review of peer-reviewed articles was conducted in six databases (MEDLINE, Embase, SocINDEX, CINAHL, PsycINFO and Web of Science) and grey literature to identify studies that engaged vulnerable CYP in co-approaches to health and social research. Of 1394 documents identified in the search, 40 were included and analysed. A number of different approaches to co-production were used in the studies. The CYP was involved in a range of activities, chiefly the development of data collection tools, data collection and dissemination. Individual challenges for CYP and researchers, practical and institutional factors and ethical considerations impacted the success of co-production. Co-production of health and social science with vulnerable CYP presents challenges to researchers and CYP calling for all to demonstrate reflexivity and awareness of biases, strengths and limitations. Used appropriately and well, co-production offers benefits to researchers and CYP and can contribute to research that reflects the needs of vulnerable CYP. Adherence to the key principles of inclusion, safeguarding, respect and well-being facilitates this approach. Members of our patient and public involvement and stakeholder groups contributed to the interpretation of the review findings. This manuscript was written together with a young care leaver, Skye Boswell, who is one of the authors. She contributed to the preparation of the manuscript, reviewing the findings and their interpretation.