Childhood Illness Research Articles

Managing Expectations: Understanding Parents' Perceptions of Their Child's Serious Illness.

Parenting a seriously ill child is complex and emotionally intense. To further develop Hinds and colleagues' Good Parent themes: "Keeping a Positive Outlook" and "Keeping a Realistic Outlook," we reviewed grounded theories published in English language journals from January 2006 to April 2021 identifying 18 studies with relevant results. Parents' efforts to keep a positive outlook included cognitive (e.g., remain hopeful, avoid negative thinking) and behavioral (e.g., monitoring child for signs of improvement, information seeking) actions. To keep a realistic outlook, parents acknowledged the serious nature of the condition, negative treatment effects, and limitations to treating the child normally. Parents holding both positive and realistic outlooks recognized the seriousness of their child's illness and remained hopeful while preparing for their child's death. Our analysis extends the understanding of how parents' expectations regarding the course and outcome of their child's illness shape cognitive and behavioral aspects of their parenting.

The Impact of Heating Methods on Respiratory and Allergic Diseases in Preschool Children: A Repeated Cross-Sectional Survey Across Northern and Southern China

Indoor heating methods may influence the prevalence of respiratory and allergic diseases among preschool children. However, limited research has explored the relationship between indoor heating methods and childhood illnesses over time or on a large urban scale, and particularly the relationship between heating methods and asthma or allergic rhinitis among preschoolers from 2010 to 2019. This study conducted cross-sectional investigations in two northern cities (Taiyuan and Urumqi) and two southern cities (Chongqing and Changsha) in China during two periods: Period I (2010) and Period II (2019). Using Pearson’s chi-squared tests, we analyzed the associations between four indoor heating methods—convective heating (CH), convective and radiant heating (CH&RH), radiant heating (RH), and polluting heating (PH)—and nine respiratory and allergic diseases. Logistic regression models were employed to explore the relationships between heating methods and disease prevalence. The results revealed substantial differences in heating method choices between northern and southern Chinese cities (p < 0.001). These differences were significantly associated with the prevalence of respiratory and allergic diseases in preschoolers. Heating behaviors may have contributed to a decrease in the lifetime prevalence of asthma, pneumonia, rhinitis, and the 12-month prevalence of eczema in preschool children. In southern households, CH was linked to a lower risk of lifetime asthma (AOR: 0.63) and 12-month wheezing (AOR: 0.53). However, RH in southern households increased disease risks (AOR: 0.53). This study provides insights into the associations between heating methods and the prevalence of diseases among preschoolers across two periods in China. The findings offer new perspectives and guidance for families in selecting appropriate heating methods.

Impact of zinc supplementation on cellular and molecular biomechanical alterations and critical outcomes in pediatric patients with sepsis: A randomized controlled trial

Background: Sepsis remains a significant contributor to illness and death in children. Studies suggests that potential benefits of zinc supplementation in patients with sepsis, such as reduced inflammation and mortality rates. Zinc is involved in maintaining the structural integrity and function of cell membranes, which is essential for proper cell signaling and biomechanical responses. It can also influence the activity of key enzymes and proteins that regulate intracellular and extracellular forces, thereby affecting cell adhesion, migration, and overall tissue mechanics. Therefore, this study aimed to evaluate the occurrence of Acute Respiratory Distress Syndrome (ARDS), Septic Shock, Acute Kidney Injury (AKI), and Mortality in Pediatric Sepsis receiving Zinc supplementation, with a focus on the underlying cellular and molecular biomechanical mechanisms. Methods: This study was a Randomized Control Trial (RCT) conducted using a parallel-group, double-blind design and prospective cohort approach. Participants were selected through consecutive sampling and then randomized into two groups: one receiving standard therapy plus zinc supplementation and the other receiving standard therapy plus a placebo. Results: Among pediatric patients with sepsis, the incidence of septic shock was significantly lower in the group receiving standard therapy with zinc supplementation (34.4%) compared to the placebo group (65.6%) (p = 0.00, OR 2.29, 95% CI: 1.28–4.11). The incidence of ARDS was 66.7% in the placebo group, versus 33.3% in the zinc group (p = 0.00, OR 0.37, 95% CI: 0.22–0.64). For acute kidney injury (AKI), 65.7% occurred in the placebo group compared to 34.3% in the zinc group (p = 0.04, OR 2.09, 95% CI: 0.99–4.40). Mortality in the placebo group was 64.3%, while in the zinc group it was 35.7% (p = 0.01, OR 0.48, 95% CI: 0.26–0.88). Conclusion: Zinc supplementation significantly reduces the incidence of acute respiratory distress syndrome, acute kidney injury, septic shock, and mortality in pediatric patients with sepsis. These outcomes may be attributed to zinc’s role in modulating cellular signaling pathways, enhancing cellular integrity under stress, and improving the biomechanical properties of cell membranes, thereby promoting better physiological responses in the context of sepsis.

Community health worker and caregiver experiences and perceptions of a multimodal handheld pulse oximeter used in sick child consultations in rural Burundi: A qualitative evaluation.

Community Health Workers (CHWs) in low- and middle-income countries are essential in providing primary health care to remote communities. However, due to limited diagnostic tools, CHWs often struggle to correctly identify childhood illnesses, especially pneumonia. We conducted a prospective pilot study and used qualitative research methods to evaluate acceptability and feasibility of a multimodal pulse oximeter used by CHWs during their integrated community case management (iCCM) of childhood illness consultations in rural Burundi. We used purposive sampling to recruit CHWs and trained them to use the oximeters during household iCCM consultations for children 6-59 months of age. After eight weeks of using the devices, we conducted eight focus group discussions to evaluate experiences and perceptions of the device among CHWs and caregivers. Our thematic analysis, based upon deductive and inductive reasoning, identified the following themes: durability, storability, trust, self-efficacy, child agitation, ease of using the device, and interpretation of parameters. CHWs deemed the devices highly acceptable and took pride in safely storing them but reported challenges in utilizing respiration rate, pulse, and oxygen saturation (though temperature was understood). Child agitation was a barrier to oximeter use, especially among children 6-12 months. Additional CHW capacity-building on interpreting parameters is needed when using oximeters during household iCCM consultations in Burundi, including an iCCM job aid (decision-making tree) with oxygen saturation and respiratory rate cut-offs for treatment and/or referral. Training and using child-calming techniques could be an important strategy for obtaining quality measurements. While CHWs and caregivers highly valued the oximeters during sick child visits, the devices may be better utilized and scalable at the health facility level.

Wealth-related inequality in women healthcare-seeking behaviour for under-five children illness in Afghanistan: evidence from 2022 Afghanistan Multiple Indicator Cluster Survey

BackgroundThis study examined the wealth-related inequality in women healthcare seeking behaviour for under-five children illness in Afghanistan and its determinants.MethodsData of 32409 mothers/caregivers of children under-five were extracted from Afghanistan Multiple Indicator Cluster Survey conducted in 2022. Wealth-related inequalities in women healthcare seeking behaviour for under-five children illness was investigated using Erreygers and Wagstaff concentration indices and curve. Contributions of selected factors to the total inequality were estimated using the Erreygers decomposition technique.ResultsThe Erreygers and Wagstaff normalized concentration indices for women healthcare seeking behaviour for under-five children illness was 0.040; p < 0.000 and 0.042; p < 0.000 respectively. Hence, women healthcare seeking behaviour for children under-five illness was heavily concentrated among women from richer households and disfavoured women from poorer households. The decomposition findings revealed that household wealth (265%), residency in rural areas (-125%), access to mobile phone (-83%), access to internet (67%) and mothers’ education (26%) were the major determinants of pro-rich inequalities.ConclusionPolicy makers, the private and development actors in Afghanistan should promote inclusive income generation interventions and healthcare awareness programmes, including women from poor households to eliminate wealth-related inequalities in women healthcare seeking behaviour. There is need for decentralizing health facilities in both rural and urban areas to improve equitable access to healthcare services. There is scope for disseminating health education through mobile phones and internet, reaching out to all areas to improve knowledge on children’s illnesses and subsequently reduce inequalities in women health seeking behaviours.

Interpretation of Neonatal Adrenal Function Results and Adrenal Function Results in Critical Illness

Adrenal insufficiency (AI) is a life-threatening disorder. Defects at any level of the hypothalamic-pituitary-adrenal axis can impair adrenal function. It is difficult to make a diagnosis of AI in the newborn because during the neonatal period clinical findings are not specific and range from insidious, nonspecific complaints to circulatorycollapse due to hypovolemic shock. Another condition when is difficult to make a diagnosis of AI is in critically ill patients. There is no consensus on which patients to test for AI, which tests to use and how to interpret them. In this evidence-based review we aim to provideinformation for the evaluation of adrenal function results and findings in both the neonatal period and critical illness in childhood and adolescence.

The effectiveness of play therapy on depression and anxiety in hospitalized children with cancer: a systematic review.

The presence of cancer and its treatment will induce anxiety and various effects, not only on a physical level but also on a psychological level. Play therapy can be used by children to articulate their emotions and foster proficient communication with healthcare professionals and caregivers. Play therapy emerges as a highly effective method for the management of illness in children diagnosed with cancer. A thorough search was conducted across multiple databases including PubMed, Web of Science, Scopus, Google Scholar, and Cochrane Library. Our review included only interventional studies published from inception to 1 March 2024 that investigated the impact of play therapy on depression and anxiety in hospitalized children with cancer. For each study, information was gathered regarding the study's objective, participant characteristics, conditions, intervention details, comparisons made, study duration, and outcome measures. Following the retrieval of 2158 records, 12 studies were found to meet the eligibility criteria and were thus selected to include in the synthesis. Play therapy has been explored in several studies using interventions like cognitive-behavioral-based play therapy, family-based play therapy, group-based play therapy, virtual reality-based play therapy, and play therapy combined with other therapeutic approaches. Specifically, six studies investigated the effects of play therapy on anxiety, two studies on depression, and four studies on anxiety and depression. Play therapy is highly recommended due to its simplicity, minimal requirement of tools and materials, ease of implementation, affordability, and suitability for hospitalized preschool and school-age children with cancer.

Human bocavirus infections in paediatric patients in a tertiary care hospital in Kerala, India.

Human bocaviruses (HBoVs) can cause respiratory illness in young children. Although the first HBoV infection in India was reported in 2010, very little information is available about its prevalence, clinical features, or geographic distribution in this country. This study was conducted using 136 respiratory samples from paediatric patients in a tertiary care hospital in Kerala, 21 of which tested positive for HBoV1 and were further characterized through VP1/VP2 gene sequencing. We found that different strains of HBoV1 are co-circulating in the region and that HBoV1 can be detected in children with severe acute respiratory infections, either alone or coinfections with other pathogens, without any significant differences in their clinical characteristics.

Burden of RSV infections among young children in primary care: a prospective cohort study in five European countries (2021-23).

The majority of respiratory syncytial virus (RSV) infections in young children are managed in primary care, however, the disease burden in this setting remains poorly defined. We did a prospective cohort study in primary care settings in Belgium, Italy, Spain, the Netherlands, and the UK during the RSV seasons of 2020-21 (UK only; from Jan 1, 2021), 2021-22, and 2022-23. Children aged younger than 5 years presenting to their general practitioner or primary care paediatrician with symptoms of an acute respiratory tract infection were eligible for RSV testing. Children who tested positive for RSV were consented and followed up for 30 days via a physician clinical report (initial primary care visit on day 1) and two parent-report questionnaires (days 14 and 30). We assessed the burden of RSV in terms of clinical course (symptoms, illness duration, and complications), health-care resource utilisation (primary care visits, emergency department visits, hospitalisation rate, and medication use), and societal impact (daycare or school absence and parental work absence) for the 30-day follow-up period. Among 3414 tested children, 1124 (32·9%; 95% CI 31·3-34·5) tested positive for RSV. Among children with data on age, RSV positivity rate was 38·9% (36·1-41·7; n=466 of 1198) in children younger than 1 year and 25·9% (24·0-27·9; n=513 of 1979) in those aged 1 to <5 years. Of the 1124 RSV-positive children, 878 (78·1%) were enrolled and had day 1 data collected (median age 11·1 months [IQR 6·0-22·0]; 446 [50·9%] boys and 431 [49·1%] girls [N=877]). RSV illness lasted a mean of 11·7 days (95% CI 11·2-12·2; n=794). At day 14 and day 30, any remaining symptoms were reported in 451 of 804 (56·1% [95% CI 52·6-59·6]) and 261 of 724 (36·0% [32·6-39·7]) children. The mean number of primary care visits per child ranged from 1·4 (95% CI 1·2-1·6; the Netherlands) to 3·0 (2·8-3·3; Spain), and was higher in children younger than 1 year (2·7 visits [2·4-2·9]) than in those aged 1 to <5 years (2·1 [1·9-2·2]). Prescribed medication use varied, from 25 of 96 children (26·0% [95% CI 17·6-36·0]; the UK) to 228 of 297 children (76·8% [71·5-81·5]; Italy), with bronchodilators and antibiotics being the most commonly prescribed medicines across all countries. Prescribed medication use was reported in 258 of 418 children aged 1 to <5 years (61·7% [56·9-66·4]) and 196 of 394 children younger than 1 year (49·7% [44·7-54·8]). Missed working days by parents due to their child's RSV illness were reported in 340 of 744 cases (45·7% [42·1-49·4]); the mean number of missed workdays ranged from 1·3 days (95% CI 0·5-2·2) in Spain to 4·1 days (3·3-5·0) in Belgium. RSV infections in children younger than 5 years in primary care are associated with substantial symptomatology, health-care utilisation, and parental work absence. Notable differences in RSV burden existed across countries, likely due to differences in primary health-care systems, clinical practice, and health-care-seeking behaviour. This study emphasises the importance of considering country-specific primary care burden estimates when considering the implementation of RSV immunisations programmes. Sanofi and AstraZeneca.

The Prevalence and Determinants of Undernutrition Among Infants and Children Aged 6 Months to 5 Years in Sub-Saharan African Countries: A Systematic Scoping Review.

To explore the prevalence and determinants of undernutrition among infants and children aged 6 months to 5 years in sub-Saharan African countries. Despite substantial progress over the past 20 years, undernutrition has remained an alarming global challenge. Sub-Saharan Africa is the only region where the prevalence of stunting in children younger than 5 years has significantly increased. This study seeks to update the evidence on the prevalence and determinants of childhood undernutrition in this vulnerable region. This systematic scoping review was conducted following the 2018 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews. Five electronic databases were searched on December 14, 2022, with no date or language restrictions. Primary studies presenting evidence on the prevalence and determinants of childhood undernutrition among infants and children aged 6 months to 5 years were included. Data on the prevalence of stunting, wasting, and underweight, and on determinants of undernutrition were extracted, described, and compared with national survey data. A total of 59 publications from 11 countries were included, with most studies conducted in Ethiopia (n = 38) and Tanzania (n = 7). Stunting prevalence ranged from 8% to 64%, wasting prevalence ranged from 1% to 58%, and the prevalence of underweight ranged from 2% to 63%. The most frequently reported determinants of undernutrition were the child's age (>24 months), male sex, maternal illiteracy, diarrhea or illness in the past 2 weeks, low household socioeconomic status, or living in a larger household (n > 4 members). Overall, 56% of the included studies reported higher stunting prevalence, 60% reported higher wasting prevalence, and 57% reported a higher prevalence of underweight than reported by relevant national surveys. The prevalence of childhood undernutrition reported by primary studies is often higher than that reported by national surveys. Several immediate and underlying determinants influence childhood undernutrition. Future research should incorporate the findings from primary research to develop holistic, multistrategy approaches to address childhood undernutrition in sub-Saharan African countries.

FAMILY PLANNING EFFECTS ON MATERNAL AND CHILD HEALTH IN PAKISTAN- A NARRATIVE REVIEW

Background: Family planning is a cornerstone of reproductive health, contributing significantly to improved maternal and child health outcomes. In Pakistan, where high population growth, limited healthcare infrastructure, and socio-cultural barriers persist, the role of family planning is pivotal in reducing maternal and infant mortality, enhancing birth spacing, and improving overall health indicators. Despite its importance, challenges such as gender inequality, socio-religious norms, and inadequate healthcare services limit its adoption and effectiveness. Objective: To evaluate the impact of family planning on maternal and child health outcomes in Pakistan, including contraceptive use, maternal and infant mortality, birth spacing, and childhood illnesses. Methods: A narrative review was conducted using electronic databases, including PubMed, Embase, Web of Science, and Scopus, alongside manual reference searches. Studies conducted in Pakistan, published in English, and focusing on family planning's impact on maternal and child health outcomes were included. Data extraction encompassed study characteristics, family planning interventions, maternal and child health outcomes, and key findings. Quality assessment tools such as the Newcastle-Ottawa Scale and Cochrane Risk of Bias Tool were employed to evaluate methodological rigor. Data synthesis was performed narratively, and meta-analysis was conducted where feasible to summarize quantitative findings. Results: Family planning interventions demonstrated significant benefits, including reductions in maternal and infant mortality, healthier birth spacing, and lower rates of childhood illnesses. Contraceptive use improved maternal health outcomes by preventing high-risk pregnancies and reducing complications. However, socio-cultural barriers, limited healthcare access, and unmet contraceptive needs were identified as persistent challenges. Conclusion: Family planning has a transformative impact on maternal and child health outcomes in Pakistan. Addressing socio-cultural and healthcare system barriers through integrated strategies and evidence-based policies can enhance its adoption, contributing to improved health and well-being for families nationwide.

Burden and pattern of diseases among tribes of South-West Rajasthan

ABSTRACT Introduction: Policymakers can better grasp regional health challenges by investigating the disease profile in a specific area. It is challenging to understand the burden and pattern of diseases in the aspirational district of Sirohi, Rajasthan, which is also a partially tribal district, due to the lack of studies on disease profiling among the tribals in the state. Aim: To determine the prevalent diseases among the people of district Sirohi through secondary data analysis of data collected from government healthcare facilities. Materials and Methods: We conducted a retrospective analysis of health data from the records of the government health system in the district Sirohi, Rajasthan, for the last three years, from 2020 to 2022. Our analysis specifically examined illnesses that affected pregnant women, children, and patients attending outpatient and inpatient departments. Results: Over three consecutive years, tribal blocks had a higher load of diseases compared to the non-tribal blocks of the Sirohi district. Diarrhoea contributed 67.9% of childhood illnesses, followed by pneumonia (14.4%). The occurrence of maternal anaemia among pregnant women was 81%, with a noticeable upward trajectory. The most common reasons for admission to the in-patient department were respiratory illnesses (n = 6,145), diarrhea with dehydration (n = 4,339), snake bites (n = 687), and typhoid (n = 539). Pindwara had the highest number of respiratory illness (n = 2897, 47.1%) compared to all other blocks. Conclusion: This study emphasizes the necessity of addressing the health challenges encountered by tribes in district Sirohi. To tackle these issues, it is imperative to execute a targeted and precise strategy. There is a lack of data within tribal communities, which necessitates additional research to formulate a targeted strategy for tribal health.

The promises and limits of standardisation through paper-based technologies: An ethnographic exploration of integrated management of childhood illness (IMCI) in Bangladesh.

Integrated Management of Childhood Illness (IMCI) is a strategy that aims to standardise clinical assessment and treatment of sick children. In this article, we examine the aspirations and unfolding of introducing a revised IMCI strategy in Bangladesh. We carried out ethnographic fieldwork among project implementors and in IMCI health service delivery settings in Kushtia district, including 36 semi-structured interviews with policymakers, programmers and IMCI service providers. We focused on the IMCI register, a paper-based technology designed to guide health service providers to enact standardised treatment and decision-making during healthcare encounters. During its design, policymakers and programmers aspired to produce a register that would be simple to use and guide health service providers to enact care uniformly. However, simplicity was muddled by the range of agendas and negotiations around what should be standardised and how. In health facility settings, despite national approval, the register's legitimacy was ambiguous as it was perceived as a materialisation of an external project, and its introduction did little to reconfigure how providers enacted health care. However, it operated as a powerful material to make claims about the types of care that matter, as providers saw the work of completing the register as compromising their ability to do the highly valued work of interfacing with patients. Moreover, the register became a tool to negotiate and index intra-institutional hierarchies. Rather than pointing to project failure, these findings reflect the nature of technologies, which are always reconfigured within the systems and social worlds in which they are embedded.

MFSD6 is an entry receptor for respiratory enterovirus D68.

Enterovirus D68 (EV-D68) is a leading non-polio enterovirus that causes severe respiratory diseases and poliomyelitis-like illness in children. Viral entry represents a potential multifaceted target for antiviral intervention; however, there are no approved inhibitors to block EV-D68. Here, we identify the functionally undescribed membrane protein major facilitator superfamily-domain-containing protein 6 (MFSD6) as an EV-D68 entry factor amenable to therapeutic intervention. Specifically, MFSD6 expression is crucial for EV-D68 replication. MFSD6 binds to EV-D68 particles and is necessary for virus attachment to cells. The second extracellular domain of the MFSD6 molecule is involved in the recognition of EV-D68. On the basis of these findings, we engineered a recombinant protein complex comprising the MFSD6 ectodomain fused to Fc (MFSD6-Fc(CH3)), which potently inhibited EV-D68 uptake. MFSD6-Fc(CH3) effectively blocked EV-D68 infection invitro and prevented lethality in newborn mice. In conclusion, our study not only identifies MFSD6 as an EV-D68 entry factor but also reveals a potential antiviral target and therapeutic agent.

Evaluation of skill-based training program on Integrated Management of Neonatal and Childhood Illnesses (IMNCI)

Objectives: To assess student reactions to the skill-based training program on IMNCI. To assess student learning in the skill-based training program on IMNCI by OSCE and retro-pre feedback. To assess the reaction of students to OSCE as an assessment tool. Material and Methods: It was a mixed method interventional educational research. Students were assessed by using OSCE stations, retro pre feedback, and open ended questions about the training program and OSCE. Results: Retro?pre feedback of self?assessment of the 75 students shows that, after the training program, there is a significant increase in the self perceived post-test scores of Knowledge of Importance of IMNCI (2–4), Chart booklet (1.5–3.9), Skills of assessing the child for danger signs (1.7–3.9), cough (1.9–3.9), diarrhoea (2.1–4.2), anemia (2.2 –4.1), malnutrition (2.2 –4.2), counseling the care giver of the child (2-4.2). The students liked the skills taught interactively through videos, case scenarios, and role plays. Student liked the OSCE because of the clinical scenarios, photos, diverse cases were evaluated. Conclusions: Overall, the training program was taken well by the students and their IMNCI skills were improved.

AI-assisted diagnostic approach for the influenza-like illness in children: decision support system for patients and clinicians

Abstract Influenza-like illnesses (ILI), such as influenza and RSV, pose significant global health burdens, especially in febrile children under 6 years old. Differentiating these from bacterial infections based solely on clinical symptoms is challenging. While PCR tests are reliable, they are costly and time-consuming. An effective predictive tool would help doctors prioritize tests and guide parents on seeking emergency care for their febrile children. We collected data from 2,559 children who visited the hospital for ILI inspections. We developed XGBoost models, comparing nine different machine learning algorithms. Our AI-assisted diagnostic pipeline consists of two stages: Decision Support System for patients (DSS-P): An in-house model using sex, age, symptoms, and medical history to decide on hospital visits. Decision Support System for clinicians (DSS-C): An in-hospital model incorporating breath sound types and Chest X-ray results to determine the necessity of clinical tests. We tested various experimental settings, including the addition of RAT-tested samples and the combined consideration of influenza and RSV. The performance for influenza achieved an Area Under the Curve of 0.749 and 0.776, while RSV achieved 0.907 and 0.924 in DSS-P and DSS-C, respectively. We identified biomarkers, noting that most biomarkers had opposite effects for influenza and RSV. This study developed predictive models for influenza and RSV and explored their underlying mechanisms. An expectation tool to guide doctors in prioritizing tests or assisting parents in deciding on emergency care for their febrile child would be invaluable. Biomarker analysis performed can provide insight on clinical fields.

Obraz dziecka w XV‑wiecznej hagiografii krakowskiej

The aim of this article is to present how the hagiographic context influenced the image of the child and to demonstrate the ways in which the experiences of young children were portrayed in the late medieval period. The fifteenth century miracles of the Krakow saints are analyzed in terms of the child’s relationship with its parents, the immediate environment, other children, as well as the ways in which young children experienced pain, suffering, and illness. Miracle arratives fulfilled important functions for the socjety of the time, shaping and depicting the socio‑cultural attitudes of the adult world towards children in a social, moral, and religious context.

Pulse oximetry and oxygen services for under-five children with community-acquired pneumonia attending primary and secondary level health facilities in Lagos, Nigeria (INSPIRING-Lagos): a pre-implementation and post implementation study

IntroductionChildhood pneumonia is a leading cause of child mortality in Nigeria and poor quality of care is a persistent issue. We aimed to understand whether introducing primary care stabilisation rooms...

Prevalence and associated factors of psychiatric problems in children aged 6–18 years with type-1 diabetes mellitus in Gondar, Ethiopia: a cross-sectional study

BackgroundDiabetes mellitus is one of the most common chronic illnesses in children with multiple psychosocial, economic and developmental effects. Psychiatric disorders such as depression, anxiety, psychological distress, and eating disorders are more common in diabetic patients than the non-diabetic once. The main objective of our study was to assess Prevalence and associated factors of psychiatric problems in children aged 6–18 years with type 1 diabetes mellitus in Gondar, Ethiopia.MethodsAn institution-based cross-sectional study was conducted among 206 children aged 6–18 years with type-1 diabetes mellitus having regular follow-ups at the University of Gondar comprehensive and Specialized Hospital (UoGCSH) over three three-month period. Data was collected by trained physicians using interviewer-administered structured questionnaires. Convenient sampling technique was applied and Participants were selected sequentially until the sample size was achieved. Both bivariate and multivariate logistic regression analyses were used for Model fitness and the strength of association was determined using an OR, p-value of < 0.05 and 95% CI.ResultsThe prevalence of psychiatric problems was 11.7% and those children living with only either of the parent (AOR = 8.39, 95%: 1.5–46), living with other relatives (AOR = 11.3, 95% CI: 1.97–64.7), more than 5 family size (AOR = 0.3, 95%CI: 0.1–1.2), fathers attended formal education (AOR = 0.3, 95%: 0.04–1.73), a patient having good glycemic control (AOR = 0.2, 95%: 0.04–0.67) and those with a family history of diabetes mellitus(AOR = 5.2, 95% CI: 1.2–22.1) were significantly associated with a psychiatric problem in diabetic aged 6–18 years with p-value < 0.05.ConclusionThe prevalence of psychiatric problems in diabetic children was significantly high and children living with single parent, paternal educational status, glycemic control, family history of diabetes, and family size were found to have significant association with the occurrence of psychiatric problems in diabetic children.

A cluster randomized trial assessing the effect of a digital health algorithm on quality of care in Tanzania (DYNAMIC study)

Digital clinical decision support tools have contributed to improved quality of care at primary care level health facilities. However, data from real-world randomized trials are lacking. We conducted a cluster randomized, open-label trial in Tanzania evaluating the use of a digital clinical decision support algorithm (CDSA), enhanced by point-of-care tests, training and mentorship, compared with usual care, among sick children 2 to 59 months old presenting to primary care facilities for an acute illness in Tanzania (ClinicalTrials.gov NCT05144763). The primary outcome was the mean proportion of 14 major Integrated Management of Childhood Illness (IMCI) symptoms and signs assessed by clinicians. Secondary outcomes included antibiotic prescription, counseling provided, and the appropriateness of antimalarial and antibiotic prescriptions. A total of 450 consultations were observed in 9 intervention and 9 control health facilities. The mean proportion of major symptoms and signs assessed in intervention health facilities was 46.4% (range 7.7% to 91.7%) compared to 26.3% (range 0% to 66.7%) in control health facilities, an adjusted difference of 15.1% (95% confidence interval [CI] 4.8% to 25.4%). Only weight, height, and pallor were assessed statistically more often when using the digital CDSA compared to controls. Observed antibiotic prescription was 37.3% in intervention facilities, and 76.4% in control facilities (adjusted risk ratio 0.5; 95% CI 0.4 to 0.7; p&lt;0.001). Appropriate antibiotic prescription was 81.9% in intervention facilities and 51.4% in control facilities (adjusted risk ratio 1.5; 95% CI 1.2 to 1.8; p = 0.003). The implementation of a digital CDSA improved the mean proportion of IMCI symptoms and signs assessed in consultations with sick children, however most symptoms and signs were assessed infrequently. Nonetheless, antibiotics were prescribed less often, and more appropriately. Innovative approaches to overcome barriers related to clinicians’ motivation and work environment are needed.