Childhood Illness Research Articles

Challenges experienced by nurses regarding the involvement of guardians in integrated management of childhood illnesses in Vhembe District

The involvement of families and communities in healthcare services by healthcare providers enhances accountability towards the community they serve. Guardians need to be involved in the integrated management of childhood illnesses (IMCI) to improve child health outcomes. The study aimed to explore challenges experienced by nurses regarding the involvement of guardians in the management of childhood illnesses in the Vhembe district. A qualitative, exploratory-descriptive design was followed in this study. Fifteen participants were purposefully selected for the study. One-on-one interviews following a semi-structured interview guide were conducted face-to-face with the participants. A voice recorder was used to record the interviews. Data analysis was done following Tesch's eight steps. Trustworthiness was ensured throughout the study. The study yielded two themes, namely: guardians-related challenges, which are lack of knowledge and understanding of IMCI, language barrier and lack of continuity of care and healthcare service-related challenges, which are lack of human resource, staff attitude towards the IMCI strategy, shortage of material resource and erratic water supply. For the strategy to be effective in reducing the complications of childhood illnesses and child mortality, the government needs to avail the required resources and develop measures to empower guardians in child health management.

EHealth Literacy and the Use of NHS 111 Online Urgent Care Service in England: Cross-Sectional Survey.

Many health care systems have used digital technologies to support care delivery, a trend amplified by the COVID-19 pandemic. "Digital first" may exacerbate health inequalities due to variations in eHealth literacy. The relationship between eHealth literacy and web-based urgent care service use is unknown. This study aims to measure the association between eHealth literacy and the use of NHS (National Health Service) 111 online urgent care service. A cross-sectional sequential convenience sample survey was conducted with 2754 adults (October 2020-July 2021) from primary, urgent, or emergency care; third sector organizations; and the NHS 111 online website. The survey included the eHealth Literacy Questionnaire (eHLQ), questions about use, preferences for using NHS 111 online, and sociodemographic characteristics. Across almost all dimensions of the eHLQ, NHS 111 online users had higher mean digital literacy scores than nonusers (P<.001). Four eHLQ dimensions were significant predictors of use, and the most highly significant dimensions were eHLQ1 (using technology to process health information) and eHLQ3 (ability to actively engage with digital services), with odds ratios (ORs) of 1.86 (95% CI 1.46-2.38) and 1.51 (95% CI 1.22-1.88), respectively. Respondents reporting a long-term health condition had lower eHLQ scores. People younger than 25 years (OR 3.24, 95% CI 1.87-5.62) and those with formal qualifications (OR 0.74, 95% CI 0.55-0.99) were more likely to use NHS 111 online. Users and nonusers were likely to use NHS 111 online for a range of symptoms, including chest pain symptoms (n=1743, 70.4%) or for illness in children (n=1117, 79%). The users of NHS 111 online were more likely to have also used other health services, particularly the 111 telephone service (χ12=138.57; P<.001). These differences in eHealth literacy scores amplify perennial concerns about digital exclusion and access to care for those impacted by intersecting forms of disadvantage, including long-term illness. Although many appear willing to use NHS 111 online for a range of health scenarios, indicating broad acceptability, not all are able or likely to do this. Despite a policy ambition for NHS 111 online to substitute for other services, it appears to be used alongside other urgent care services and thus may not reduce demand.

Gastroenteritis: When Your Child Needs Hospital Care

Patient Education| 2021 Gastroenteritis: When Your Child Needs Hospital Care Connected Content Translation: La gastroenteritis: En qué casos su hijo necesita cuidado hospitalario: (Gastroenteritis: When Your Child Needs Hospital Care) Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Share Icon Share Facebook Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Gastroenteritis: When Your Child Needs Hospital Care. Pediatric Patient Education 2021; 10.1542/peo_document218 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All AAP SitesAll PublicationsPediatric Patient Education Search Advanced Search Gastroenteritis is a common childhood illness that causes diarrhea and vomiting that can lead to dehydration. It is usually caused by a virus but can also be caused by bacteria or a parasite. Most of the time mild diarrhea and vomiting last for just a few days. However, if symptoms don't go away or they get worse, your child may need to be treated in the hospital. Call your child's doctor if your child is younger than 6 months and has any of the following: Blood in the stoolFrequent vomitingStomach painUrinates less often (Wets fewer than 6 diapers per day.)No tears when cryingLoss of appetite for liquidsHigh fever (over 102°F or 39°C)Frequent diarrheaDry, sticky mouthWeight lossExtreme thirst The biggest concern with gastroenteritis is dehydration, which occurs when a child loses too much... Copyright © 20082008 American Academy of Pediatrics You do not currently have access to this content.

High-resolution mapping of essential maternal and child health service coverage in Nigeria: a machine learning approach

BackgroundNational-level coverage estimates of maternal and child health (MCH) services mask district-level and community-level geographical inequities. The purpose of this study is to estimate grid-level coverage of essential MCH services...

Non-thyroidal Illness in Children with Congestive Heart Failure

To estimate the proportion and risk factors of non-thyroidal illness (NTI) in children with congenital heart disease (CHD) with congestive heart failure (CHF). This study enrolled children (6 weeks to 60 months age) with CHD and CHF. The clinical profile and disease severity, derived from the Pediatric Early Warning Score (PEWS) was recorded. Baseline blood samples were taken within 24 hours of hospitalization and evaluated for free tri-iodothyronine (fT3), free thyroxine (fT4), thyroid stimulating hormone (TSH), N-terminal pro-brain natriuretic peptide (NT pro-BNP) and reverse T3. A total of 80 (64 acyanotic CHD) children of median (interquartile range) age 5 (2.5, 8.0) months were enrolled. NTI was seen in 37 (46%) of whom 27 had low fT3 levels. The proportion of NTI was highest in children with severe disease (20/30), than moderate (4/9) or mild disease (13/41) (p=0.018). Ten (27%) patients with NTI died compared to 2 (4.7%) without NTI with unadjusted odds ratio (OR) [95% confidence interval (CI)] 7.593 (1.54, 37.38); p=0.006. After adjusting for NTI, shock and NT-pro-BNP levels, PEWS was the only significant predictor of mortality (OR: 1.41, 95% CI: 1.03, 1.92; p=0.032). Linear regression for fT3 identified a significant relationship with log NT-BNP [beta -3.541, (95% CI: -1.387, -0.388)] and with TSH [beta 2.652 (95% CI: 0.054, 0.383)]. The cutoff (area under the curve, 95% CI) that predicted mortality were fT4 <14.5 pmol/L (0.737, 0.60, 0.88), fT3/rT3 index <1.86 pg/ng (0.284, 0.129, 0.438) and NT pro-BNP >3725 pg/mL (0.702; 0.53, 0.88). NTI was present in a significant proportion of children with CHD and CHF. fT3 level was significantly associated with NTBNP levels and thus severity of CHF.

Common Childhood Illnesses: Diagnosis and Treatment of Asthma, Allergies, and Ear Infections

Common Childhood Illnesses: Diagnosis and Treatment of Asthma, Allergies, and Ear Infections

Pharmacogenomics of coronary artery response to intravenous gamma globulin in kawasaki disease

Kawasaki disease (KD) is a multisystem inflammatory illness of infants and young children that can result in acute vasculitis. The mechanism of coronary artery aneurysms (CAA) in KD despite intravenous gamma globulin (IVIG) treatment is not known. We performed a Whole Genome Sequencing (WGS) association analysis in a racially diverse cohort of KD patients treated with IVIG, both using AHA guidelines. We defined coronary aneurysm (CAA) (N = 234) as coronary z ≥ 2.5 and large coronary aneurysm (CAA/L) (N = 92) as z ≥ 5.0. We conducted logistic regression models to examine the association of genetic variants with CAA/L during acute KD and with persistence >6 weeks using an additive model between cases and 238 controls with no CAA. We adjusted for age, gender and three principal components of genetic ancestry. The top significant variants associated with CAA/L were in the intergenic regions (rs62154092 p < 6.32E–08 most significant). Variants in SMAT4, LOC100127, PTPRD, TCAF2 and KLRC2 were the most significant non-intergenic SNPs. Functional mapping and annotation (FUMA) analysis identified 12 genomic risk loci with eQTL or chromatin interactions mapped to 48 genes. Of these NDUFA5 has been implicated in KD CAA and MICU and ZMAT4 has potential functional implications. Genetic risk score using these 12 genomic risk loci yielded an area under the receiver operating characteristic curve (AUC) of 0.86. This pharmacogenomics study provides insights into the pathogenesis of CAA/L in IVIG-treated KD and shows that genomics can help define the cause of CAA/L to guide management and improve risk stratification of KD patients.

Umbilical hernia in pediatric patients attending outpatient department in tertiary care centre

Background: Umbilical hernias are estimated to affect 15% of children. Age, race, gestational age, and coexisting disorders are some of the variables that affect it. In comparison to the general population, there are greater incidences of connective tissue illnesses in children, premature delivery, low birth weight, syndromic newborns, black children, and children with pathologies that raise intraabdominal pressure. To determine the prevalence and to assess the risk factors of umbilical hernia in pediatric patients attending outpatient department (OPD) in tertiary care centre. Methods: The present observational study was conducted in paediatric OPD, of a tertiary care centre over a period of one year. A total of 100 study subjects were enrolled with suspected umbilical hernia. The data was collected with the help of a structured clinical proforma and analysed with SPSS version 20.0. Results: In our study the most prevalent age group involved being 0-1 years (6%) followed by 8-10 years (3%) and 2-4 years (2%). Umbilical hernia was seen more in males (64%) than females. Low birth weight (81%), premature delivery (54.54%), and undernutrition (90.9%) were the risk factors that were observed to be associated with the development of umbilical hernia. Conclusions: The study concluded that the overall prevalence of umbilical hernia was 11% and the associated risk factors were premature delivery, low birth weight and poor nutrition.

Medical Students' Clinical Knowledge of Integrated Management of Childhood Illness: A cross-sectional comparative study.

This study aimed to investigate and compare the clinical knowledge implications of the integrated management of childhood illness (IMCI) preservice education between pre-clerkship and junior clerkship medical students. This observational comparative cross-sectional study was conducted between June and August 2022 at Sultan Qaboos University, Muscat, Oman. A self-administered questionnaire was utilised and included questions on sociodemographic data, duration of IMCI preservice training, knowledge of the participants concerning the IMCI objectives and information on a range of childhood conditions. A total of 97 medical students were included in the study. The majority of students (42.3%) had received 2 lectures in IMCI preservice training. The role of the IMCI approach in reducing childhood morbidity and mortality was advocated by the majority of students (80.8% in the junior-clerkship [JCR] group and 73.3% in the pre-clerkship group). The awareness of the IMCI component of improving the health system was higher in JCR compared to pre-clerkship participants (P = 0.044). When compared to pre-clerkship students, the JCR participants demonstrated a slightly higher awareness of skin pinch (P = 0.038), chest indrawing (P = 0.008), anaemia assessment based on nail bed examination (P = 0.002), diagnostic assessment of malnutrition based on palm examination (P = 0.018), sucking capacity in breastfeeding (P = 0.025), and vaccines such as those for tuberculosis (P = 0.001), pneumococcal (P = 0.018) and rotavirus (P = 0.007). The majority of students displayed good IMCI knowledge and JCR students showed better knowledge compared to pre-clerkship candidates.

Supporting parents with acutely ill children: Environment scan and user evaluation of mobile applications (the SuPa kids project)

BackgroundChildren are one of the biggest users of emergency departments in the UK, sometimes utilising services when experiencing acute illnesses that can be managed at home. mHealth can be an efficacious way for parents/guardians to manage acute illnesses. It has also become a ubiquitous resource to promote public health interests within a resource constrained health system. However, to be effective, co-design is necessary with concepts such as usefulness, ease of use, trustworthiness and security underpinning the utility of mHealth interventions for acute childhood illness. ObjectiveThe objective of this study was to conduct an environmental scan of mHealth apps for parental assessment and management of acute childhood illnesses in 0- to 5-year-olds, review the content and functionality of each identified app against the list of desired attributes identified in previous research and synthesise publicly available reviews from end users to demonstrate the quality of current apps in the marketplace and identify areas for improvement. MethodApp characteristics were mapped to an a priori defined list of desirable attributes. End user reviews were mapped to a modified Technology Acceptance Model framework that included overarching themes of: Perceived Usefulness (PU), Perceived Ease of Use (PEU), Perceived Trustworthiness (PT) and Perceived Security (PS) using reflexive thematic analysis. ResultsOverall, 15 apps were included in the analysis (Table 2). Fourteen of the 15 apps were available on both the iOS and Android platforms. ‘Baby Illness, Prevention, Cure’ was only available on the Android store. All apps were free to download and did not restrict access to information or features via in-app purchases. Baby and child first aid (British Red Cross) was the earliest app to be released (2014). This app was updated annually, with the most recent update being 2022. The most recent apps to be released (2018) were ‘AskFirst’ (formerly Ask NHS), ‘Essex Child Health’ and ‘The Lullaby Trust Baby Check’, updated in 2022, 2020 and 2019, respectively. No individual app met all the desirable attributes highlighted by parents in previous research. Both ‘Healthier Together’, and ‘The Lullaby Trust Baby Check’ included all but one desirable attributes (video), as did the ‘’CATCH (Common Approach to Children’s Health), which did not utilise a traffic light system. Apps that were locality specific were not rated by users (Berkshire Child Health, Cheshire Child Health, Child Health Guide Newham, Child Health HMR, Oldham Child Illness and Walsall Healthy Child). All other apps were rated from 2/5 to 5/5 stars. When considering localities, the ‘CATCH’ app was only supported in Halton, Cheshire, Knowsley, Liverpool, St Helens and Vale Royal. Further investigation evidenced no correlation between inclusion of the desirable attributes and app rating. ConclusionOverall, this research has highlighted several aspects of best practise when developing mHealth apps for the management of acute childhood illnesses, for increasing PU, PEU, PT and PS; and also, places importance on co-design.

Family Participation in The Integrated Management of Childhood Illness Implementation Process: Systematic Literature Review

This study aims to analyze the role and contribution of families in the implementation of Integrated Management of Childhood Illness (IMCI) and the impact of family participation on child health outcomes. In addition, this study also identified factors that support or hinder family participation in the IMCI program. The method used was a systematic literature review of various published studies. The method used is a systematic literature review with the main data source of 15 previous studies on the theme to be examined in this study so that the data makes a new finding. The main findings of this study show that family education, social and community support, health policies, and family experiences and perceptions of IMCI are important themes that influence the successful implementation of IMCI. Effective education of families improves their understanding and skills in managing childhood illnesses, while support from health workers and the community can increase family participation in IMCI programs. Supportive health policies and appropriate interventions also play an important role in ensuring the program's effectiveness. However, lack of motivation and adequate information from health workers can be barriers to family participation. This study confirms the importance of active family participation in IMCI implementation to improve child health outcomes. Recommendations for further research include evaluation of the most effective educational methods, the influence of technology in supporting IMCI, and longitudinal studies to monitor the long-term impact of family participation. From a health policy perspective, improved training for health workers, strengthened social and community support networks, and improved accessibility of health information through various media are suggested to support better implementation of IMCI programs.

Levelling up health in the early years: A cost-analysis of infant feeding and healthcare.

Although breastfeeding is recommended as the optimal form of nutrition in the first six months, it is not sustained as the predominant mode of feeding infants in Scotland. This study estimated the impact of infant feeding choices on primary and secondary healthcare service costs in a 13-year birth cohort. Using linked administrative datasets, in a retrospective cohort design of 502,948 singletons born in Scotland between 1997 and 2009, we estimated the cost of GP consultations and hospital admissions by area deprivation and mode of infant feeding up to 6-8 weeks for ten common childhood conditions from birth to 27 months. Additionally, we calculated the potential healthcare savings if all infants in the cohort had been exclusively breastfed at 6-8 weeks. Discounting of 1.5% was applied following current health economic conventions and 2009/10 used as the base year. Over the study period, the estimated cost of hospital admissions in the cohort was £111 million and £2 million for the 2% subset of the cohort with primary care records. Within each quintile of deprivation, exclusively breastfed infants used fewer healthcare services and incurred lower costs compared to infants fed (any) formula milk. At least £10 million of healthcare costs may have been avoided if formula-fed infants had been exclusively breastfed within the first 6-8 weeks of birth. This study using a representative birth cohort demonstrates how breastmilk can promote equitable child health by reducing childhood illness and healthcare utilisation in the early years.

Current use of medicinal plants for children's diseases among mothers in Southern Romania.

There is a limited number of studies focusing on ethnomedical practices in children, particularly in Eastern Europe. Romania has a rich history of using medicinal plants in ethnopediatric care, and our objective was to identify the medicinal plants currently employed in treating childhood illnesses in the southern region of the country. Material and methods Our investigation used structured interviews, focusing on respondent demographics, local names of therapeutically employed herbs, the specific plant part(s) utilized, methods of preparation and administration, and local folk indications of taxa. A total of 326 mothers with children aged 0 to 18, hospitalized in the "Grigore Alexandrescu" Children Emergency Hospital Bucharest and residing in Southern Romania, were enrolled in the study. Use Value Citation Index (UVc), Informant Consensus Factor (Fic), and Fidelity Level (FL) were calculated. Results Twenty-five plants were identified for treating children's diseases in Southern Romania. The majority of informants resided in urban areas, and mothers primarily acquired knowledge from family members and healthcare professionals. The herbs most frequently employed were Mentha spp. (UV = 0.509) for diarrhea, Matricaria spp. (UV = 0.301) for skin infections (Fic = 0.99) and digestive diseases (Fic = 0.98), and Calendula officinalis L. (UV = 0.365) for skin diseases (Fic = 0.99). Less utilized were Raphanus raphanistrum subsp. sativus (L.) Domin in respiratory diseases, Prunus avium (L.) L. stalks in urinary tract ailments, Helianthus annuus L. in ear infections, Allium sativum L. in intestinal parasitosis, Viola tricolor L. in hives, Triticum aestivum L. in dermatitis and Allium ursinum L. as a tonic. In 184 cases herbal treatment was used in conjunction with conventional medications. Education level correlated with the number of employed plants and the variety of treated ailments, while residency (rural vs. urban) did not. Both residency and education influenced plant procurement methods: rural background and, surprisingly, higher education were linked to a preference for harvesting rather than purchasing plants. Conclusion Botanical remedies are still commonly used in the treatment of pediatric diseases in Southern Romania, although the variety of taxa seems reduced compared to the past. Further exploration is essential to unlock the maximum benefits of ethnopediatric practices.

Investigating the Relationship between Religiosity and Post-Traumatic Stress Disorder in Mothers of Children with Cancer Admitted to t Pediatric Oncology Department of Shahid Sadoughi Hospital , Yazd , 2019

Introduction: Religiosity can help in adapting to difficult situations and provide better care. Therefore, this study was conducted to determine the relationship between religiosity and post-traumatic stress disorder in mothers of children with cancer. Methods: This was a cross-sectional and descriptive-correlational study conducted on 115 mothers of children with cancer who were admitted to Shahid Sadoughi Hospital, in Yazd, in 2019. Sampling was done through convenience sampling method. Data collection tools were the demographic information questionnaire, and Mississippi PTSD and Glock and Stark questionnaires. . Descriptive (mean and standard deviation) and analytical (Pearson's correlation, chi-square) statistical tests and indicators were used; data were investigated and statistically analyzed using SPSS 21 software with a confidence level of 95%. Results: The findings showed that in the post-traumatic stress disorder questionnaire, the average score was 97/61±36/78 and the average score of the religiosity questionnaire was 26/77±61/85. Pearson's correlation coefficient showed a negative relationship between religiosity and PTSD (p= 0/160, r= -0/132). The average score of PTSD and religiosity among mothers was not significantly different according to various variables such as mother's occupation, child's gender, and education level. The difference in the average score of PTSD in mothers was different according to the characteristics such as education level and occupation. The average score of religiosity was more different when comparing working mothers with housewives. The average stress score after the accident showed a greater difference in mothers according to the type of child's illness. The average PTSD score was 83/87±25/79 for neuroblastoma and 92/33±24/98 for solid tumor disease. Conclusion: PTSD among mothers was close to the cut-off point for the disorder. Although there was no significant relationship between PTSD and mothers' religiosity, it can be said that the severity of mental situation of mothers with severe cancer was effective in the study.

Underweight and Predictors Among Children Aged 6-59 Months in South Ethiopia.

Underweight remains the primary public health concern among under-five-year-old children in Ethiopia, despite numerous government-implemented nutrition-specific and sensitive interventions. Therefore, this study aimed to assess underweight and associated factors among children in South Ethiopia. Between March and April 2021, 717 children in the South Ari district who were between the ages of 6 and 59months participated in a cross-sectional study. To choose a sample of households containing a minimum of one child between the ages of 6 and 59months, a multi-stage sampling procedure was used. Data were collected by interviewer-administered structured questionnaires from the mothers of the children. To determine the factors associated with being underweight, a binary logistic regression analysis was built. All variables with a p-value <0.25 in the bivariable analysis were entered into a multivariable logistic regression analysis. To assess the strength of the association, an adjusted odds ratio (AOR) with a 95% confidence interval was used. With a p-value below 0.05, statistical significance was declared. The prevalence of underweight was determined to be 29.7% (95% CI: 26.5%, 33.2%). Child age 6-23months [adjusted odds ratio (AOR) = 0.28; 95% confidence interval (CI): 0.18, 0.44], food insecurity (AOR = 1.48; 95% CI: 1.04, 2.10), sub-optimal child dietary diversity (AOR = 1.44; 95% CI: 1.01, 2.03), birth interval <24months (AOR = 2.49; 95% CI: 1.75, 3.54), and common childhood illness (AOR = 2.21; 95% CI: 1.52, 3.21) were associated with being underweight. Underweight among children is predicted by household food insecurity, suboptimal dietary diversity, and common childhood illnesses, necessitating further efforts to improve food security and manage common illnesses.

Agreement between quality of life assessed using family proxy and child self-reports among children with hematologic malignancy.

Evidence-based literature recognizes that the different degrees of agreement between a child self-report and a proxy-report depend on the characteristics of the domains, the child's age and illness, the proxy's own perspective on QoL, and family attendance during the child's hospitalization. This study aims to determine the degree of agreement between proxy-reports and child self-reports on quality of life (QoL) for children with hematologic malignancy ranging in age from 5 to 18 years who are undergoing treatment.We retrieved clinical QoL data from a study titled "Dynamic change in QoL for Vietnamese children with hematologic malignancy" from April 2021 to December 2022. To evaluate the magnitude of agreement between self-reports and proxy-reports, intraclass correlation coefficients (ICCs) for 259 pairs of measurements were quantified. Using independent t tests, the mean differences between self-reports and proxy-reports were tested.Moderate agreement was consistent through all age groups for five subscales, including physical, psychosocial, pain, nausea, and procedural anxiety (ICCs ranged from 0.53 to 0.74). The weakest agreement appeared in two groups, subjects aged 5-7 years and 13-18 years on six domains (school, treatment anxiety, worry, cognitive problems, perceived physical appearance, and communication) (-0.01 to 0.49). Child self-rating was consistently higher than that of proxies for the physical, emotional, and nausea domains among children aged 5-7 years and for procedural anxiety, treatment anxiety, and cognitive problems among children aged 8-12 years. Conclusion: The agreement level of self-reports and proxy-reports was differently distributed by child age and the PedsQL domains. The proxy children agreement on QoL among children with hematologic malignancy was divergent according to the different age groups, which could potentially be explained by proxy-child bonding at different stages of childhood development. Our recommendation for future studies is to explore children's age as a potential factor influencing proxy agreement on QoL among children with cancer. What is Known: • Children and their proxies may think differently about quality of life (QoL). • Comparing two sources of data (i.e., child and proxy) on aspects of QoL can help identify the discrepancies between children's perceptions of their QoL and their parents' perceptions. This can be useful in terms of identifying potential areas for improvement or concern and may also be helpful in making decisions about treatment and care. What is New: • Our study results demonstrated that proxies who comprised children aged 5-7 years or 13-18 years reported differently among domains that cannot be expressed verbally or with body language, including cognitive problems, perceived physical appearance, and communication. • Children generally perceived their QoL to be better than their proxies. Therefore, a more comprehensive understanding of children's QoL may require the consideration of multiple sources of data from various perspectives.

“It Would Be All-Consuming”: Community Parents' Perceptions of the Pediatric Intensive Care Unit

AbstractParents of children hospitalized in the pediatric intensive care unit (PICU) may have expectations which could contribute to their emotional experiences both during and after hospitalization. This study aimed to evaluate community parents' knowledge and perceptions of the PICU to enhance understanding of preexisting concerns that may influence PICU experiences. English-speaking parents who had a child between the ages of 6 and 12 years old participated. Participants (n = 211) were mostly female (77%), white (72%), and married (72%). Participants completed an online survey regarding demographics and PICU knowledge. Participants were randomized to read a vignette in which a friend disclosed their child's PICU hospitalization either due to surgery, an accident, or chronic health condition. After reading the vignette, participants reported on the expected length of stay (LOS), survival expectations, and expected level of distress. Parents responded to open-ended questions regarding anticipated stressors, parent needs, and PICU resources. Parents overestimated the LOS and underestimated the survival rate. They expected PICU hospitalization to be highly distressing, primarily due to concerns about their hospitalized child, and that parents would need and have emotional support available to them. Parents may come into the PICU with preexisting concerns regarding medical outcomes. It is important that PICU providers assess for and address any parent misperceptions about their child's illness immediately upon admission and frequently throughout hospitalization. It is important to offer and encourage the use of psychosocial support services.

Cost-effectiveness of village health worker-led integrated community case management (iCCM) versus health facility based management for childhood illnesses in rural southwestern Uganda

BackgroundIn Uganda, village health workers (VHWs) manage childhood illness under the integrated community case management (iCCM) strategy. Care is provided for malaria, pneumonia, and diarrhoea in a community setting. Currently, there is limited evidence on the cost-effectiveness of iCCM in comparison to health facility-based management for childhood illnesses. This study examined the cost-effectiveness of the management of childhood illness using the VHW-led iCCM against health facility-based services in rural south-western Uganda.MethodsData on the costs and effectiveness of VHW-led iCCM versus health facility-based services for the management of childhood illness was collected in one sub-county in rural southwestern Uganda. Costing was performed using the ingredients approach. Effectiveness was measured as the number of under-five children appropriately treated. The Incremental Cost-Effectiveness Ratio (ICER) was calculated from the provider perspective.ResultsBased on the decision model for this study, the cost for 100 children treated was US$628.27 under the VHW led iCCM and US$87.19 for the health facility based services, while the effectiveness was 77 and 71 children treated for VHW led iCCM and health facility-based services, respectively. An ICER of US$6.67 per under five-year child treated appropriately for malaria, pneumonia and diarrhoea was derived for the provider perspective.ConclusionThe health facility based services are less costly when compared to the VHW led iCCM per child treated appropriately. The VHW led iCCM was however more effective with regard to the number of children treated appropriately for malaria, pneumonia and diarrhoea. Considering the public health expenditure per capita for Uganda as the willingness to pay threshold, VHW led iCCM is a cost-effective strategy. VHW led iCCM should, therefore, be enhanced and sustained as an option to complement the health facility-based services for treatment of childhood illness in rural contexts.

Safety and Immunogenicity of an mRNA-Based hMPV/PIV3 Combination Vaccine in Seropositive Children.

Human metapneumovirus (hMPV) and parainfluenza virus type 3 (PIV3) are common respiratory illnesses in children. The safety and immunogenicity of an investigational mRNA-based vaccine, mRNA-1653, encoding membrane-anchored fusion proteins of hMPV and PIV3, was evaluated in hMPV/PIV3-seropositive children. In this phase 1b randomized, observer-blind, placebo-controlled, dose-ranging study, hMPV/PIV3-seropositive children were enrolled sequentially into 2 dose levels of mRNA-1653 administered 2 months apart; children aged 12 to 36 months were randomized (1:1) to receive 10-μg of mRNA-1653 or placebo and children aged 12 to 59 months were randomized (3:1) to receive 30-μg of mRNA-1653 or placebo. Overall, 27 participants aged 18 to 55 months were randomized; 15 participants received 10-μg of mRNA-1653 (n = 8) or placebo (n = 7), whereas 12 participants received 30-μg of mRNA-1653 (n = 9) or placebo (n = 3). mRNA-1653 was well-tolerated at both dose levels. The only reported solicited local adverse reaction was tenderness at injection site; solicited systemic adverse reactions included grade 1 or 2 chills, irritability, loss of appetite, and sleepiness. A single 10-μg or 30-μg mRNA-1653 injection increased hMPV and PIV3 neutralizing antibody titers (geometric mean fold-rise ratio over baseline: hMPV-A = 2.9-6.1; hMPV-B = 6.2-13.2; PIV3 = 2.8-3.0) and preF and postF binding antibody concentrations (geometric mean fold-rise ratio: hMPV preF = 5.3-6.1; postF = 4.6-6.5 and PIV3 preF = 13.9-14.2; postF = 11.0-12.1); a second injection did not further increase antibody levels in these seropositive children. Binding antibody responses were generally preF biased. mRNA-1653 was well-tolerated and boosted hMPV and PIV3 antibody levels in seropositive children aged 12 to 59 months, supporting the continued development of mRNA-1653 or its components for the prevention of hMPV and PIV3.

Determinants of low birth weight and its effect on childhood health and nutritional outcomes in Bangladesh

BackgroundThe high incidence of low birth weight (LBW) is associated with an increased risk of infant mortality, adverse pregnancy outcomes for mothers, and a decline in overall health and well-being. The current study aimed to identify the various determinants of LBW and its effect on adverse health and nutritional outcomes of children aged 0–23 months in Bangladesh.MethodsBangladesh Demography and Health Survey (BDHS) 2017-18 data was used. A chi-square test and multivariable logistic regression analysis were used to find out the associations between independent variables and outcomes (e.g., LBW, child illness and undernutrition).ResultsThe overall prevalence of LBW among was 16.3%. Mother with no formal education (AOR = 2.64, 95% CI = 0.55–3.30, p = 0.01), female child (AOR = 1.31, 95% CI = 1.04–1.65, p = 0.023); and poorest economic status (AOR = 1.69, 95% CI = 1.13–2.51, p = 0.010), were identified significant determinants of LBW. Of home environment and hygiene factors, unimproved toilet facilities (AOR = 1.38, 95% CI = 1.03–1.84, p = 0.030) had a significant effect on LBW. In addition, children born with LBW were more likely to suffer fever (AOR = 1.26, 95% CI = 1.05–1.60, p = 0.050), stunting (AOR = 2.42, 95% CI = 1.86–3.15, p = < 0.001), wasting (AOR = 1.47, 95% CI = 1.02–2.25 p = 0.049), and underweight (AOR = 3.19, 95% CI = 2.40–4.23, p = < 0.001).ConclusionOne out of five children was LBW in Bangladesh. Maternal education, sex of child, wealth index, and toilet facilities had significant effects on LBW. In addition, LWB contributed to children’s poor health and nutritional outcomes. Enhancing maternal pregnancy, and child health outcomes necessitates policies addressing poverty, gender inequality, and social disparities. Key strategies include promoting regular prenatal care, early medical intervention, reproductive health education, and safe hygiene practices. To combat the negative impacts of LBW, a comprehensive strategy is vital, encompassing exclusive breastfeeding, nutritional support, growth monitoring, accessible healthcare, and caregiver education.