Childhood Illness Research Articles

School refusal profiles maintained by negative reinforcement and their relationship with self-perceived health.

Health alterations and school refusal behavior may significantly affect student evolution in all areas of student lives. The objective of this study was to use latent profile analysis to identify school refusal profiles sustained by negative reinforcement and to determine their relationship with distinct self-perceived health variables (Satisfaction, Well-being, Resilience, Performance, and Risk-Taking). The School Refusal Assessment Scale-Revised (SRAS-R) and the Child Health and Illness Profile (CHIP-CE/CRF) were administered to 737 students (60.9% male) aged between 8 and 10 (M = 8.76, SD = 0.74). Three profiles of school refusal maintained by negative reinforcement were obtained: no risk, moderate risk, and high risk. It was confirmed that school refusal through negative reinforcement correlates negatively with health dimensions, also finding that a higher risk profile for school refusal is associated with lower levels of self-perceived health. Similarly, it was determined that the high-risk profile is the most maladaptive, with significantly lower data in four of the five self-perceived health dimensions that were evaluated. In conclusion, remaining in situations with no or moderate risk of school refusal due to negative reinforcement encourages higher levels of self-perceived health, while being at high risk of school refusal due to negative reinforcement is associated with worse self-perceived health.

Clinical and socio-demographic profile of pneumonia in children aged 2 months to 5 years

Among the common childhood illnesses, pneumonia is a substantial cause of morbidity and mortality in children throughout the world. Approximately, 150 million episodes of childhood pneumonia are reported every year, out of which 95% are from developing countries. In addition, socioeconomic and environmental factors like overcrowding, air pollution, passive smoking, practice of bottle feeding etc., contribute to the significant rise in incidence of pneumonia during recent years. The known factors affecting mortality are malnutrition, inadequate vaccination, illiteracy and lack of exclusive breast feeding.Pneumonia is one of the most prevalent Pediatric infections, and it is a leading cause of morbidity and mortality in children all over the world. Every year, approximately 150 million cases of childhood pneumonia are reported, with 95 percent of cases coming from underdeveloped nations. Furthermore, socioeconomic and environmental variables like as overcrowding, air pollution, passive smoking, and the practice of bottle feeding, among others, have contributed to the large increase in pneumonia incidence in recent years. Malnutrition, inadequate immunization, illiteracy, and a lack of exclusive breast feeding are all documented variables that contribute to mortality.A total of 120 children in the age group of 2 months to 5 years, diagnosed with Pneumonia as per standard definition were enrolled in the study. Detailed history was taken including socio demographic factors and physical examination was done in all children. Appropriate investigations were done. : Children aged between 2 and 12 months constituted 60% of cases. The male to female ratio was 1.5:1. 27.5% children had low birth weight, 63.3% were exclusively breast fed up to 6 months of age. Severe and very severe pneumonia was seen in 90% of children between age group 2 months and 2 years, 63.6% with low birth weight, and 66.6% with partial immunization status. Significant association was found between early weaning and severity of pneumonia (45.45% vs 26.3%).Children less than 2 years are more prone for developing pneumonia. Low birth weight, partial immunization status of the children, early weaning, history of bottle feeding, lower socioeconomic status, overcrowding, malnutrition and lack of maternal literacy were shown to have an increased risk for severe and very severe pneumonia in children. As most of the above stated factors are modifiable, the implementation of various preventive and educational programs in our society has a likelihood to reduce the occurrence and severity of pneumonia in children

Regional determinants of quality of care for sick children: A multilevel analysis in four countries.

The limited impact of increased access to care on improvements in health outcomes during the Millennium Development Goal era has been attributed, in part, to inadequate quality of care. We identified regional factors associated with health service quality for sick child care in low-income countries and examined whether provider factors interact with regional factors to affect the quality of care. We conducted cross-sectional random intercept four-level linear regression using the most recent Service Provision Assessment and Demographic Health Survey data from four countries (467 from the Democratic Republic of Congo 2018, 2425 from Afghanistan 2018, 2072 from Nepal 2015, and 813 from Senegal 2017). The outcome variable was the service quality score for sick child care, which was measured as the percentage of clinically recommended tasks completed in the integrated management of childhood illness (ranging from 0 to 100). Regional factors were selected based on the High-Quality Health System Framework. The service quality score was found to be positively associated with the proportion of large facilities (β = 8.61; P = 0.004) and the proportion of providers ranked in the top fifth for service quality score (β = 30.15; P < 0.001) in the region. We identified significant cross-level interactions between provider qualifications (β = -16.6; P < 0.001) or job descriptions (β = 12.01; P = 0.002) and the proportion of providers in the top fifth for service quality scores within the region. As the proportion of top-performing providers in a region increased, the increase in the service quality score was more pronounced among providers who were nonmedical doctors or did not have job descriptions than among their counterparts. Our findings indicate that the quality of care for sick children in a region improves with a greater proportion of high-performing providers or larger facilities. Providers who are not medical doctors, or those who have specific job descriptions, tend to benefit more from the presence of these top-performing providers.

Childhood growth during recovery from acute illness in Africa and South Asia: a secondary analysis of the childhood acute illness and nutrition (CHAIN) prospective cohort

Growth faltering is well-recognized during acute childhood illness and growth acceleration during convalescence, with or without nutritional therapy, may occur. However, there are limited recent data on growth after hospitalization in low- and middle-income countries. We evaluated growth following hospitalization among children aged 2-23 months in sub-Saharan Africa and South Asia. Between November 2016 and January 2019, children were recruited at hospital admission and classified as: not-wasted (NW), moderately-wasted (MW), severely-wasted (SW), or having nutritional oedema (NO). We describe earlier (discharge to 45-days) and later (45- to 180-days) changes in length-for-age [LAZ], weight-for-age [WAZ], mid-upper arm circumference [MUACZ], weight-for-length [WLZ] z-scores, and clinical, nutritional, and socioeconomic correlates. We included 2472 children who survived to 180-days post-discharge: NW, 960 (39%); MW, 572 (23%); SW, 682 (28%); and NO, 258 (10%). During 180-days, LAZ decreased in NW (-0.27 [-0.36,-0.19]) and MW (-0.23 [-0.34,-0.11]). However, all groups increased WAZ (NW, 0.21 [95% CI: 0.11, 0.32]; MW, 0.57 [0.44, 0.71]; SW, 1.0 [0.88, 1.1] and NO, 1.3 [1.1, 1.5]) with greatest gains in the first 45-days. Of children underweight (<-2 WAZ) at discharge, 66% remained underweight at 180-days. Lower WAZ post-discharge was associated with age-inappropriate nutrition, adverse caregiver characteristics, small size at birth, severe or moderate anaemia, and chronic conditions, while lower LAZ was additionally associated with household-level exposures but not with chronic medical conditions. Underweight and poor linear growth mostly persisted after an acute illness. Beyond short-term nutritional supplementation, improving linear growth post-discharge may require broader individual and family support. Bill & Melinda Gates FoundationOPP1131320; National Institute for Health ResearchNIHR201813.

Perspectives of healthcare workers on integrated management of childhood illness in Pakistan: A phenomenological approach.

In 2019, an estimated 5.2 million deaths were reported among children less than 5years of age. At primary healthcare level, healthcare workers (HCWs) mostly rely on history and clinical findings and less on inadequate diagnostic facilities. To enhance case management skills of HCWs, World Health Organization devised an integrated management of childhood illnesses (IMCI) strategy in 1995, modified to distance learning IMCI in 2014. A qualitative phenomenological study was conducted to explore perceptions of HCWs about standard and distance IMCI. Four focus group discussions were conducted with purposively selected 26 HCWs (IMCI trained) from 26 basic health units of Abbottabad district in Pakistan. Gadamer's philosophical hermeneutics were adopted during the inductive thematic analysis. Five themes that emerged are inexorable health seeking behaviors, IMCI being a comprehensive algorithm for consultation, a tedious protocol, scaling up protocol to specialists and private practitioners, and administrative insufficiency by the department of health. Improvement in case management skills of HCWs was reported as a result of IMCI trainings. It needs administrative support, regulations to control poly-pharmacy and provision of drugs without prescription, and a curb on political and bureaucratic interference.

Deep learning autism classification and prediction

One of the most prevalent illnesses in children is autism spectrum disorder (ASD) (1 in 44). According to some estimates, 53% of kids with ASD engage in one or more challenging behaviors (CB; aggression, self-injury, property destruction, elopement, etc.), which is significantly higher than the prevalence among their peers who are typically developing or who have other developmental disorders. Numerous, significant negative effects of CB on the person exist, and they are linked to a worse long-term outlook. For caregivers of children with ASD, the presence of CB is a better indicator of stress than the severity of the child's core ASD symptoms. The validity of fixed features extracted from autistic children’s face photographs as a biomarker to demarcate them from healthy children is investigated in this study paper. The proposed paper aims to use deep learning models (CNN) to classify autism spectrum disorders based on facial expression images. By leveraging the power of deep convolutional neural networks, based on the Kaggle dataset. We used and prepared data input to CNN models where the split image in two parts horizontally and vertically as feature extractor’s model as a binary classifier to identify autism in children accurately. Our results reveal that the proposed model achieved an accuracy of 94%, Sensitivity of 93% and Specificity of 95% this indicator is considered important and can be built or relied on.

A Comparative Clinical Study of Mridweekadi Churna and Yavagrajadi Vati in Tundikeri (Tonsillitis) in Children

Tonsillitis is one of the common diseases in pediatric age group. In Ayurveda it can be correlated with Tundikeri, Which has been described under the Mukharoga. Description of Mridweekadi Churna is mentioned in Charaka Samhita in Trimarmiya Aadhyay under Mukha Rogas Chikitsa, and description of Yavagrajadi Vati is mentioned in Yoga Ratnakar in Mukha Roga Chikitsa Aadhyay. According to Acharya Vagbhata the main Dosha involved in Tundikeri is Kapha Dosha. Majority of ingredients of Mridweekadi Churna and Yavagrajadi Vati have Tikta, Kashaya, Laghu, Ruksha Guna, due to this it subsides Kapha Dosha. Therefore, a study was planned to compare the effect of both drug in Tundikeri (tonsillitis). Methods: Children, aged 5 to 16 years, suffering from tonsillitis were registered and categorized under two groups: group- A and group-B. Group A- Patients were treated with Mridweekadi Churna, and Group B- Patients were treated with Yavagrajadi Vati for 10 days and 7 days follow up also done by drug free period. Results: In Group-A, 55% patients were moderately improved and 45% patients showed mild improvements. In Group-B, 15% patients showed marked improvement, 75% patients were moderately improved and 10% patients showed mild improvement. Conclusion: Tonsillitis is an inflammation of the tonsils and it is a common childhood illness. During childhood period there is a natural dominancy of Kapha dosha and Tundikeri- a Kapha Pradhana disease (according to Acharya Vagbhata), hence children are more prone to it. To treat this, drugs should have the Kaphahar properties like Tikta, Kashaya ras and Laghu, Ruksha Guna. In this comparative clinical study both the chosen drugs, Mridweekadi Churna and Yavagrajadi Vati possesses all these properties and also are markedly effective in Tundikeri, but group B Yavagrajadi Vati display better results than Mridweekadi Churna. This study will also help future researchers to evaluate further in this research work.

Optimizing integration of community-based management of possible serious bacterial infection (PSBI) in young infants into primary healthcare systems in Ethiopia and Kenya: successes and challenges

BackgroundEthiopia and Kenya have adopted the community-based integrated community case management (iCCM) of common childhood illnesses and newborn care strategy to improve access to treatment of infections in newborns and young infants since 2012 and 2018, respectively. However, the iCCM strategy implementation has not been fully integrated into the health system in both countries. This paper describes the extent of integration of iCCM program at the district/county health system level, related barriers to optimal integration and implementation of strategies.MethodsFrom November 2020 to August 2021, Ethiopia and Kenya implemented the community-based treatment of possible serious bacterial infection (PSBI) when referral to a higher facility is not possible using embedded implementation research (eIR) to mitigate the impact of COVID-19 on the delivery of this life-saving intervention. Both projects conducted mixed methods research from April-May 2021 to identify barriers and facilitators and inform strategies and summative evaluations from June-July 2022 to monitor the effectiveness of implementation outcomes including integration of strategies.ResultsStrategies identified as needed for successful implementation and sustainability of the management of PSBI integrated at the primary care level included continued coaching and support systems for frontline health workers, technical oversight from the district/county health system, and ensuring adequate supply of commodities. As a result, support and technical oversight capacity and collaborative learning were strengthened between primary care facilities and community health workers, resulting in improved bidirectional linkages. Improvement of PSBI treatment was seen with over 85% and 81% of estimated sick young infants identified and treated in Ethiopia and Kenya, respectively. However, perceived low quality of service, lack of community trust, and shortage of supplies remained barriers impeding optimal PSBI services access and delivery.ConclusionPragmatic eIR identified shared and unique contextual challenges between and across the two countries which informed the design and implementation of strategies to optimize the integration of PSBI management into the health system during the COVID-19 pandemic. The eIR participatory design also strengthened ownership to operationalize the implementation of identified strategies needed to improve the health system’s capacity for PSBI treatment.

Development and Validation of an Automated Classifier to Diagnose Acute Otitis Media in Children

Acute otitis media (AOM) is a frequently diagnosed illness in children, yet the accuracy of diagnosis has been consistently low. Multiple neural networks have been developed to recognize the presence of AOM with limited clinical application. To develop and internally validate an artificial intelligence decision-support tool to interpret videos of the tympanic membrane and enhance accuracy in the diagnosis of AOM. This diagnostic study analyzed otoscopic videos of the tympanic membrane captured using a smartphone during outpatient clinic visits at 2 sites in Pennsylvania between 2018 and 2023. Eligible participants included children who presented for sick visits or wellness visits. Otoscopic examination. Using the otoscopic videos that were annotated by validated otoscopists, a deep residual-recurrent neural network was trained to predict both features of the tympanic membrane and the diagnosis of AOM vs no AOM. The accuracy of this network was compared with a second network trained using a decision tree approach. A noise quality filter was also trained to prompt users that the video segment acquired may not be adequate for diagnostic purposes. Using 1151 videos from 635 children (majority younger than 3 years of age), the deep residual-recurrent neural network had almost identical diagnostic accuracy as the decision tree network. The finalized deep residual-recurrent neural network algorithm classified tympanic membrane videos into AOM vs no AOM categories with a sensitivity of 93.8% (95% CI, 92.6%-95.0%) and specificity of 93.5% (95% CI, 92.8%-94.3%) and the decision tree model had a sensitivity of 93.7% (95% CI, 92.4%-94.9%) and specificity of 93.3% (92.5%-94.1%). Of the tympanic membrane features outputted, bulging of the TM most closely aligned with the predicted diagnosis; bulging was present in 230 of 230 cases (100%) in which the diagnosis was predicted to be AOM in the test set. These findings suggest that given its high accuracy, the algorithm and medical-grade application that facilitates image acquisition and quality filtering could reasonably be used in primary care or acute care settings to aid with automated diagnosis of AOM and decisions regarding treatment.

Hospital-based Home Care for Children with Cancer from the Parents̓ Point of View - A Qualitative Exploration of Family Members

About 2,200 children and adolescents in Germany per year are diagnosed with oncological diseases. Through now, there are almost no offers for home care services for these patients. There is a pilot program offering hospital-based home care for children and adolescents with cancer in Germany. The perspective of the parents will be researched by a qualitative exploring study. In this interview study parents from children with cancer will be interviewed. A qualitative exploring interview study, seeking the subjective perspective from parents on the hospital-based home care for children with cancer. The sample was drawn criterion-guided. The interviews were transcribed verbatim and analysed using qualitative content analysis. For socio- demographic characteristics the participants respond to an online questionnaire. Eleven women and three men aged between 30 and 60 years participated in the interviews. The average age of the ill children was 8.43 years. Five parents state that the children's illness did not lead to a reduction in working hours or to the termination of the employment relationship. Hospital-based home care results in subjectively perceived relief in everyday family life, especially in terms of time. Furthermore, a reduction in the psychological perception of stress is described. Due to the study design, the results presented here are to be regarded as indicative. In future studies the presented results should be supplemented by quantitative representative studies.

Impact of respiratory viral infections on nasopharyngeal pneumococcal colonization dynamics in children.

Prevention of acute respiratory illnesses (ARI) in children is a global health priority, as these remain a leading cause of pediatric morbidity and mortality throughout the world. As new products and strategies to prevent respiratory infections caused by important pathogens such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), influenza, respiratory syncytial virus and pneumococcus are advancing, increasing evidence suggests that these and other respiratory viruses and pneumococci may exhibit interactions that are associated with altered colonization and disease dynamics. We aim to review recent data evaluating interactions between respiratory viruses and pneumococci in the upper respiratory tract and their potential impact on pneumococcal colonization patterns and disease outcomes. While interactions between influenza infection and subsequent increased susceptibility and transmissibility of colonizing pneumococci have been widely reported in the literature, emerging evidence suggests that human rhinovirus, SARS-CoV-2, and other viruses may also exhibit interactions with pneumococci and alter pneumococcal colonization patterns. Additionally, colonizing pneumococci may play a role in modifying outcomes associated with respiratory viral infections. Recent evidence suggests that vaccination with pneumococcal conjugate vaccines, and prevention of colonization with pneumococcal serotypes included in these vaccines, may be associated with reducing the risk of subsequent viral infection and the severity of the associated illnesses. Understanding the direction and dynamics of viral-pneumococcal interactions may elucidate the potential effects of existing and emerging viral and bacterial vaccines and other preventive strategies on the health impact of these important respiratory pathogens.

Trajectories of illness perceptions in paediatric cancer patients and their parents and associations with health-related quality of life: Results of a prospective-longitudinal study.

In paediatric oncology, little is known about trajectories of illness perceptions and their longitudinal associations with health-related quality of life (HRQoL). Therefore, the aim of this study was to investigate changes in illness perceptions in children and parents over a one-year-period and to investigate predictive value of child's and parent's illness perceptions during acute treatment for child's HRQoL 1year later. N=65 child-parent-dyads participated in a longitudinal study (retention rate: 80.2%). Children were 4-18years of age and underwent acute cancer treatment at baseline. Children and parents reported on their own illness perceptions (Illness-Perception-Questionnaire-Revised), as well as on the child's HRQoL (KINDL-R) at baseline and one-year-follow-up. Paired-samples t-tests were calculated to investigate changes over time. A hierarchical multiple regression analysis was performed to investigate predictive value of child's and parent's illness perceptions for child's HRQoL. Child's HRQoL t(63)=-6.73, p<0.001, their perceptions of coherence (i.e. understanding; t(54)=-2.36, p=0.022) and consequences of their illness (t(54)=2.86, p=0.006), and parent's perception of cyclical trajectory (t(61)=2.06, p=0.044) improved from baseline to 1-year-follow-up. All other illness perceptions remained stable. Exploratory post-hoc analyses showed differences in the pattern of change in age-, gender-, and diagnosis-specific subgroups. After controlling for baseline levels of HRQoL, child's perceptions of symptoms and consequences were independent predictors of their HRQoL 1year later (R2=0.396, F(2,52)=10.782, p<0.001), whereas no parent's illness perceptions added predictive value. In paediatrics, child's and parent's illness perceptions should be assessed. Our findings highlight the importance of illness perceptions as potential modifiable variables in interventions to improve child's HRQoL.

Prevalence and correlates of paediatric guideline non-adherence for initial empirical care in six low and middle-income settings: a hospital-based cross-sectional study

ObjectivesThis study evaluated the prevalence and correlates of guideline non-adherence for common childhood illnesses in low-resource settings.Design and settingWe used secondary cross-sectional data from eight healthcare facilities in six Asian...

Integrated management of childhood illness in Rwanda: Impact of mentorship on the quality of care in Nyanza and Huye districts

AbstractBackgroundIn Rwanda, health posts (HPs) are intermediary primary care facilities that provide comprehensive primary care services to communities and are located at a reasonable walking distance from people's homes. We assessed the readiness of HPs for Integrated Management of Childhood Illness (IMCI) services and examined changes in the quality of care for IMCI services between districts that implemented IMCI mentorship program (Nyanza district) and Huye district which it did not.MethodsWe conducted a prospective cohort study to assess whether there was change in the quality of IMCI care provided at 17 Nyanza HPs 1‐year after IMCI mentorship implementation. The readiness of HPs for IMCI was assessed across nine factors, resulting in essential (all factors) and desirable (less than seven factors) composite scores. Unpaired t‐tests were used to measure changes in IMCI quality.ResultsThe HPs with IMCI mentorship had an increase in mean desirable (0.7–0.89) and essential (0.61–0.78) composite scores compared to non‐mentored HPs in Huye. The nurses who received mentorship program had improved scores in factors like IMCI training, service package availability, register availability, supportive supervision, and basic equipment availability. Quality improvements in IMCI assessments were observed in vital sign registration, danger sign detection, cough identification, malnutrition screening, and tuberculosis sign identification in the mentored HPs.ConclusionMentorship of nurses in HPs holds promise for enhancing facility readiness and IMCI service quality. Before expanding clinical mentorship, identified gaps such as staffing, supply chains, and health financing need to be addressed.

Influence of feeding practices on Childhood illness

Background: The phase between a child's birth and the age of two years is crucial for ensuring the child’s growth and development through optimal feeding habits. Breastfeeding is considered one of the most effective methods for ensuring the health and survival of children. Aim &amp; Objective: This study aims to access the influence of feeding practices on childhood illness. Methodology: A cross-sectional study was done among 280 mothers having children less than 2 years of age attending primary health centres adopted by the Department of Community Medicine JSS medical college, Mysuru. Data regarding feeding practices and childhood illnesses were collected using a pre-tested questionnaire prepared based in Infant and Young Child Feeding guidelines by interviewing the mothers. Result: Among the study population, 75.4% of children in urban and 75.7% of children in rural suffered from childhood illness. It was observed that childhood illness was more common among children with poor feeding practices (75.7% in rural and 93.5% in urban) and the association was found to be statistically significant. Conclusion: The study sheds light on the importance of appropriate feeding practices, which have a higher influence on a child's health.

Race, Ethnicity, and Intensive Care Utilization for Common Pediatric Diagnoses: U.S. Pediatric Health Information System 2019 Database Study.

Racial and ethnic disparities in healthcare delivery for acutely ill children are pervasive in the United States; it is unknown whether differential critical care utilization exists. Retrospective study of the Pediatric Health Information System (PHIS) database. Multicenter database of academic children's hospitals in the United States. Children discharged from a PHIS hospital in 2019 with one of the top ten medical conditions where PICU utilization was present in greater than or equal to 5% of hospitalizations. None. Race and ethnicity categories included Asian, Black, Hispanic, White, and other. Primary outcomes of interest were differences in rate of PICU admission, and for children requiring PICU care, total hospital length of stay (LOS). One-quarter ( n = 44,200) of the 178,134 hospital discharges included a PICU admission. In adjusted models, Black children had greater adjusted odds ratio (aOR [95% CI]) of PICU admission in bronchiolitis (aOR, 1.08 [95% CI, 1.02-1.14]; p = 0.01), respiratory failure (aOR, 1.18 [95% CI, 1.10-1.28]; p < 0.001), seizure (aOR, 1.28 [95% CI, 1.08-1.51]; p = 0.004), and diabetic ketoacidosis (DKA) (aOR, 1.18 [95% CI, 1.05-1.32]; p = 0.006). Together, Hispanic, Asian, and other race children had greater aOR of PICU admission in five of the diagnostic categories, compared with White children. The geometric mean (± sd ) hospital LOS ranged from 47.7 hours (± 2.1 hr) in croup to 206.6 hours (± 2.8 hr) in sepsis. After adjusting for demographics and illness severity, children from families of color had longer LOS in respiratory failure, pneumonia, DKA, and sepsis. The need for critical care to treat acute illness in children may be inequitable. Additional studies are needed to understand and eradicate differences in PICU utilization based on race and ethnicity.

Application of DOHaD hypothesis to the Effect of Stress Levels in Pregnant Women on the Fetus and Baby’s Mental Health: A Literature Review

Introduction: According to the research of Cadzow et al., on antepartum and postpartum mental health, weak attachment bonding between the fetus and mother during pregnancy was associated with postpartum depression and anxiety. Sugishita et al. found that postpartum depression decreased when attachment to the fetus was higher during the antepartum period. Attachment to the fetus during pregnancy was associated with maternal mental health and was associated not only during pregnancy but with postpartum depression and blood cortisol levels, which are stress indicators, cross over the placenta and have been correlated with maternal and fetal levels. It has been afraied that strong psychological stress during pregnancy has some effect on the fetus and causes mental development in children, and the fetal programming hypothesis is pointed out in the background. However, there has been no previous research on the relationship between mental health such as stress in pregnant women and the fetal programming hypothesis. The purpose of this study is to examine the relationship between stress in pregnant women and the fetal programming hypothesis through literature. Methods: The databases used in the literature search are Pubmed, CINAHL, Cochrane Library, and Google Scholar. The search range is from 2000 to 2020. The criteria for adopting the document are 'DoHaD' x 'Mental Health', 'DoHaD' x 'Stress', and 'DoHaD' x 'Depression' in the English original article registered in the retrieved database. Among the retrieved articles, duplicate documents were excluded as a result of animal experiments and genome analysis. As a result, 13 articles were selected. Results &amp; Conclusion: As a result of conducting a literature review, it was found that when the stress of the pregnant woman is physically and psychologically high, the stress of the child is high. In particular, fetal dysfunction is likely to occur during labor if you spend pregnancy period when pregnancy complications and anxiety are strong. It is still necessary to examine the relationship between the child's growth and mental illness and the stress she received as a mother at the time of the fetus.

Integrated Management of Childhood Illness implementation in Nepal: understanding strategies, context, and outcomes

BackgroundHealth system-delivered evidence-based interventions (EBIs) are important to reducing amenable under-5 mortality (U5M). Implementation research (IR) can reduce knowledge gaps and decrease lags between new knowledge and its implementation in real world settings. IR can also help understand contextual factors and strategies useful to adapting EBIs and their implementation to local settings. Nepal has been a leader in dropping U5M including through adopting EBIs such as integrated management of childhood illness (IMCI). We use IR to identify strategies used in Nepal’s adaptation and implementation of IMCI.MethodsWe conducted a mixed methods case study using an implementation research framework developed to understand how Nepal outperformed its peers between 2000–2015 in implementing health system-delivered EBIs known to reduce amenable U5M. We combined review of existing literature and data supplemented by 21 key informant interviews with policymakers and implementers, to understand implementation strategies and contextual factors that affected implementation outcomes. We extracted relevant results from the case study and used explanatory mixed methods to understand how and why Nepal had successes and challenges in adapting and implementing one EBI, IMCI.ResultsStrategies chosen and adapted to meet Nepal’s specific context included leveraging local research to inform national decision-makers, pilot testing, partner engagement, and building on and integrating with the existing community health system. These cross-cutting strategies benefited from facilitating factors included community health system and structure, culture of data use, and local research capacity. Geography was a critical barrier and while substantial drops in U5M were seen in both the highest and lowest wealth quintiles, with the wealth equity gap decreasing from 73 to 39 per 1,000 live births from 2001 to 2016, substantial geographic inequities remained.ConclusionsNepal’s story shows that implementation strategies that are available across contexts were key to adopting and adapting IMCI and achieving outcomes including acceptability, effectiveness, and reach. The value of choosing strategies that leverage facilitating factors such as investments in community-based and facility-based approaches as well as addressing barriers such as geography are useful lessons for countries working to accelerate adaptation and implementation of strategies to implement EBIs to continue achieving child health targets.

Examining the implementation of facility-based integrated management of childhood illness and insecticide treated nets in Bangladesh: lessons learned through implementation research

BackgroundBangladesh significantly reduced under-5 mortality (U5M) between 2000 and 2015, despite its low economic development and projected high mortality rates in children aged under 5 years. A portion of this success was due to implementation of health systems-delivered evidence-based interventions (EBIs) known to reduce U5M. This study aims to understand how Bangladesh was able to achieve this success between 2000 and 2015. Implementation science studies such as this one provide insights on the implementation process that are not sufficiently documented in existing literature.MethodsBetween 2017 and 2020, we conducted mixed methods implementation research case studies to examine how six countries including Bangladesh outperformed their regional and economic peers in reducing U5M. Using existing data and reports supplemented by key informant interviews, we studied key implementation strategies and associated implementation outcomes for selected EBIs and contextual factors which facilitated or hindered this work. We used facility-based integrated management of childhood illnesses and insecticide treated nets as examples of two EBIs that were implemented successfully and with wide reach across the country to understand the strategies put in place as well as the facilitating and challenging contextual factors.ResultsStrategies which contributed to the successful implementation and wide coverage of the selected EBIs included community engagement, data use, and small-scale testing, important to achieving implementation outcomes such as effectiveness, reach and fidelity, although gaps persisted including in quality of care. Key contextual factors including a strong community-based health system, accountable leadership, and female empowerment facilitated implementation of these EBIs. Challenges included human resources for health, dependence on donor funding and poor service quality in the private sector.ConclusionAs countries work to reduce U5M, they should build strong community health systems, follow global guidance, adapt their implementation using local evidence as well as build sustainability into their programs. Strategies need to leverage facilitating contextual factors while addressing challenging ones.

The Planetary Child Health & Enterics Observatory (Plan-EO): A protocol for an interdisciplinary research initiative and web-based dashboard for mapping enteric infectious diseases and their risk factors and interventions in LMICs.

Diarrhea remains a leading cause of childhood illness throughout the world that is increasing due to climate change and is caused by various species of ecologically sensitive pathogens. The emerging Planetary Health movement emphasizes the interdependence of human health with natural systems, and much of its focus has been on infectious diseases and their interactions with environmental and human processes. Meanwhile, the era of big data has engendered a public appetite for interactive web-based dashboards for infectious diseases. However, enteric infectious diseases have been largely overlooked by these developments. The Planetary Child Health & Enterics Observatory (Plan-EO) is a new initiative that builds on existing partnerships between epidemiologists, climatologists, bioinformaticians, and hydrologists as well as investigators in numerous low- and middle-income countries. Its objective is to provide the research and stakeholder community with an evidence base for the geographical targeting of enteropathogen-specific child health interventions such as novel vaccines. The initiative will produce, curate, and disseminate spatial data products relating to the distribution of enteric pathogens and their environmental and sociodemographic determinants. As climate change accelerates there is an urgent need for etiology-specific estimates of diarrheal disease burden at high spatiotemporal resolution. Plan-EO aims to address key challenges and knowledge gaps by making and disseminating rigorously obtained, generalizable disease burden estimates. Pre-processed environmental and EO-derived spatial data products will be housed, continually updated, and made publicly available for download to the research and stakeholder communities. These can then be used as inputs to identify and target priority populations living in transmission hotspots and for decision-making, scenario-planning, and disease burden projection. PROSPERO protocol #CRD42023384709.