Child Survival Research Articles

INTERNATIONAL AND NATIONAL LEGAL ASPECTS OF THE PRINCIPLE OF CHILDREN'S SURVIVAL AND DEVELOPMENT

The formation of the need for the special protection of children and the recognition of their rights came to the fore as a result of the historical processes taking place in the world. In the article, the factors determining the international and national legal protection of the principle of children's survival and development have been studied from various aspects. As a result of the comparative analysis, the article clarified the problems encountered during the application of international and national legal norms in the field of the principle of children's survival and development, and presented suggestions and recommendations. As a result of the conducted research, in addition to presenting proposals for the elimination of existing practical and legal problems, analyses of the norms of domestic regulation were also conducted.

Effects of Combination Antiretroviral Therapy and Nutritional Rehabilitation on Growth in Children Aged 6-36 Months with Severe Acute Malnutrition in IMPAACT Protocol P1092.

Antiretroviral therapy (ART) is known to improve child survival and growth in children living with HIV (CLHIV). We investigated growth outcomes in children with severe nonedematous acute malnutrition (SAM) and without SAM (mild malnutrition and normal nutrition) after initiation of ART in both groups and nutritional support. IMPAACT P1092 enrolled CLHIV aged 6 to <36 months with World Health Organization (WHO)-defined SAM or without SAM across 5 sites in Sub-Saharan Africa and followed them for 48 weeks. The enrollment was conducted in four countries: Malawi, Tanzania, Uganda, and Zimbabwe between October 2015 and September 2017. Weight, height, and mid-upper arm circumference (MUAC) were measured at baseline through 48 weeks. WHO weight-for-length/height Z-scores (WFL/H Z-score) were calculated. SAM children received readily available therapeutic food per WHO guidelines. All participants were initiated on a triple-ART regimen. SAM children entered the study after initial nutritional rehabilitation. Fifty-two CLHIV, 25 in the SAM cohort and 27 in the without SAM cohort, were enrolled. WFL/H Z-scores and MUAC in the SAM cohort increased significantly at weeks 24 and 48 [WFL/H Z-scores: mean change (95% CI) 2.34 (1.77, 2.91) and 2.73 (2.09, 3.37), both P < .001; MUAC: mean change (95% CI) 2.63 (1.98, 3.28) and 3.53 (2.83, 4.24) cm, P < .001]. At week 48, mean SAM height was 4 cm shorter and mean weight 1 kg lighter than without SAM [post hoc mean differences -4.11 (95% CI -8.60, 0.38) cm and -0.92 (95% CI -2.22, 0.39) kg]. CLHIV with SAM who undergo WHO nutritional rehabilitation can achieve significant growth and WFL/H Z-score improvements but continued intensive anthropometric monitoring is needed as SAM may still be behind those without SAM.

Childhood Cancer Incidence and Survival in South Australia and the Northern Territory, 1990-2017, with Emphasis on Indigenous Peoples.

Reports of a rise in childhood cancer incidence in Australia and globally prompted the investigation of cancer incidence and survival in South Australia (SA) and the Northern Territory (NT) over a 28-year period, with emphasis on Indigenous peoples. This cross-sectional analysis of two prospective longitudinal databases, the SA and NT Cancer Registries (1990-2017), included all reported cases of childhood cancers. Poisson regression provided estimates of incidence rate ratios and survival was modelled using Cox proportional hazard models for children aged <5 and ≥5 years. A total of 895 patients across SA (N = 753) and the NT (N = 142) were ascertained. Overall and in the NT, childhood cancer incidence was higher in males compared with females (IRR 1.19 [1.04-1.35] and 1.43 [1.02-2.01], respectively). Lymphocytic leukemia was the most reported cancer type across all locations. With reference to the 1990-1999 era (181.67/100,000), cancer incidence remained unchanged across subsequent eras in the combined cohort (SA and NT) (2000-2009: 190.55/100,000; 1.06 [0.91-1.25]; 2010-2017: 210.00/100,000; 1.15 [0.98-1.35]); similar outcomes were reflected in SA and NT cohorts. Cancer incidence amongst non-Indigenous children significantly decreased from the 1990-1999 era (278.32/100,000) to the 2000-2009 era (162.92/100,000; 0.58 [0.35-0.97]). Amongst 39 Indigenous children in the NT, incidence rates remained unchanged across eras (p > 0.05). With reference to the 1990-1999 era, overall survival improved in subsequent eras in SA (2000-2009: HR 0.53 [0.38-0.73]; 2010-2017: 0.44 [0.28-0.68]); however, remained unchanged in the NT (2000-2009: 0.78 [0.40-1.51]; 2010-2017: 0.50 [0.24-1.05]). In the NT, overall survival of Indigenous patients was significantly lower compared with the non-Indigenous cohort (3.42 [1.92-6.10]). While the survival of Indigenous children with cancer significantly improved in the last two eras (p < 0.05), compared to the 1990-1999 era, no change was noted amongst non-Indigenous children in the NT (p > 0.05). The incidence of childhood cancers has remained unchanged over 28-years in SA and the NT. Encouragingly, improved survival rates over time were observed in SA and amongst Indigenous children of the NT. Nevertheless, survival rates in Indigenous children remain lower than non-Indigenous children.

Nutritional Support Best Practices in Pediatric Blood and Marrow Transplant Patients: An Integrative Review.

Nutrition is vital to the long-term survival of children undergoing blood and marrow transplantation (BMT), but there is no standardization on how to optimize the nutritional status of these patients. A literature search was performed to evaluate nutritional support approaches currently in practice for pediatric patients who are undergoing BMT. CINAHL, Embase, and Cochrane databases were searched for peer-reviewed articles evaluating nutritional interventions for BMT recipients aged 20 or younger. Nine articles published between 2019 and 2023 were found and reviewed. The nutritional support varied between enteral nutrition, parenteral nutrition, a combination of both, and prophylactic feeding tube placement. The post-transplant outcomes identified as associated with alterations in nutritional regimens included length of stay, date of platelet engraftment, incidence of acute graft-versus-host disease, infection rate, and overall survival. The use of any amount of enteral nutrition compared to parenteral alone was beneficial. Complications during BMT can potentially be decreased via prioritizing enteral nutrition over parenteral. The paucity of literature on this topic highlights an unmet need in the field. Future research should focus on ways to optimize the nutritional support of transplant recipients, including increasing the likelihood of enteral feeding tube placement and utilization.

Reintegrated online sexual abuse and exploitation of children (OSAEC) survivors: A phenomenology of how they regained their morale and confidence

Reintegrated online sexual abuse and exploitation of children (OSAEC) survivors: A phenomenology of how they regained their morale and confidence

Erosion of the Capital City Advantage in Child Survival and Reproductive, Maternal, Newborn, and Child Health Intervention Coverage in Sub-Saharan Africa.

The place of residence is a major determinant of RMNCH outcomes, with rural areas often lagging in sub-Saharan Africa. This long-held pattern may be changing given differential progress across areas and increasing urbanization. We assessed inequalities in child mortality and RMNCH coverage across capital cities and other urban and rural areas. We analyzed mortality data from 163 DHS and MICS in 39 countries with the most recent survey conducted between 1990 and 2020 and RMNCH coverage data from 39 countries. We assessed inequality trends in neonatal and under-five mortality and in RMNCH coverage using multilevel linear regression models. Under-five mortality rates and RMNCH service coverage inequalities by place of residence have reduced substantially in sub-Saharan Africa, with rural areas experiencing faster progress than other areas. The absolute gap in child mortality between rural areas and capital cities and that between rural and other urban areas reduced respectively from 41 and 26 deaths per 1000 live births in 2000 to 23 and 15 by 2015. Capital cities are losing their primacy in child survival and RMNCH coverage over other urban areas and rural areas, especially in Eastern Africa where under-five mortality gap between capital cities and rural areas closed almost completely by 2015. While child mortality and RMNCH coverage inequalities are closing rapidly by place of residence, slower trends in capital cities and urban areas suggest gradual erosion of capital city and urban health advantage. Monitoring child mortality and RMNCH coverage trends in urban areas, especially among the urban poor, and addressing factors of within urban inequalities are urgently needed.

Childhood immunization in Ghana: Tracing the history and projecting the future

AbstractChildhood immunization has contributed significantly to child survival globally. Ghana adopted the Expanded Program on Immunization (EPI) in the year 1972, and since then Ghana's immunization program has chalked huge successes in disease prevention, particularly the drastic reduction in the incidence of the six childhood killer diseases. Despite these successes, there are shortfalls that affect childhood vaccinations in Ghana. Here, we look at the evolution of childhood vaccine adoption in Ghana, the disease burden in the pre‐vaccination era and the vaccination era, the benefits of the immunization program, and the identified shortfalls. More importantly, the impact of childhood immunization on the current state of vaccine‐preventable diseases and the prospects the future holds for vaccine development and disease prevention in Ghana were discussed. Undoubtedly, Ghana has made significant progress in vaccine adoption and expansion of immunization program, resulting in a significant reduction in vaccine‐preventable deaths particularly in children. However, challenges pertaining to vaccine coverage, periodic shortages of vaccine, untimely immunization, and logistics constraints persist, which need redress. Moreover, there is currently no continuous post‐vaccine surveillance to evaluate long‐term vaccine impact. Additionally, Ghana lacks the technology and skill to manufacture its own vaccines. Following the establishment of the National Vaccine Institute, Ghana should be in the position to start the production of established vaccines such as those covered under EPI, whereas collaborative research is needed to discover new vaccines. Finally, it is critical to network childhood immunization records across the nation to ensure enhanced data for planning.

The prognostic role of 18F-FDG PET/CT-based response evaluation in children with stage 4 neuroblastoma.

To evaluate the association between metabolic response on 18F-FDG PET/CT and long-term survival in children with neuroblastoma (NB). A total of 39 consecutive children with newly diagnosed stage 4 NB undergoing both 18F-FDG PET/CT imaging at baseline and after chemotherapy were retrospectively analyzed. The associations between metabolic parameters, including SUVmax of the lesion with the most intense 18F-FDG uptake at baseline (SUVb), after chemotherapy (SUVe), and the percentage change between SUVb and SUVe, and long-term survival were evaluated. With a median follow-up of 56 months, 22 patients who had achieved complete resolution on PET (no residual 18F-FDG uptake higher than the surrounding backgrounds) after chemotherapy had superior 5-year overall survival (OS) (73.6% vs. 39.0%, p = 0.044). SUVb > 6.9 indicated significantly poorer 5-year event-free survival (EFS) (12.5% vs. 59.3%, p = 0.005), as did SUVe > 1.2 (18.8% vs. 41.7%, p = 0.041). Children with SUVe > 1.2 had shorter 5-year OS (33.9% vs. 75.0%, p = 0.018). Multivariate analysis identified SUVe > 1.2 as an independent predictor for both EFS [hazard ratio (HR), 3.479, 95% CI, 1.381-8.761, p = 0.008] and OS (HR, 6.948, 95% CI, 1.663-29.025, p = 0.008), while SUVb > 6.9 was a predictor for EFS (HR, 2.889, 95% CI, 1.064-7.842, p = 0.037). Among 11 children with both SUVb > 6.9 and SUVe > 1.2, all experienced disease progression or relapse within 2 years since diagnosis. 18F-FDG PET/CT could be of useful to evaluate treatment response in children with stage 4 NB. 18F-FDG PET/CT after chemotherapy exhibits prognostic significance in neuroblastoma and holds potential as an alternative imaging modality for response evaluation, especially in cases with metaiodobenzylguanidine-nonavid or persistent avid disease. The prognostic value of chemotherapy response on 18F-FDG PET/CT in advanced neuroblastoma is unknown. Higher 18F-FDG uptake after chemotherapy was associated with worse long-term event-free survival and overall survival. 18F-FDG PET/CT after chemotherapy holds prognostic significance in children with stage 4 neuroblastoma.

Stakeholder engagement to introduce a standardised register for improved inpatient care of newborns and sick children in Bangladesh.

Despite a global decrease of 59% in under-five mortality rates from 1990 to 2021, child survival remains a pressing issue. This holds true for Bangladesh, as well. In response, the Government of Bangladesh introduced a standardised register for strengthening the inpatient management of newborns and sick children in 2021. We employed a comprehensive four-phase stakeholder engagement process to implement an inpatient register for newborns and sick children. The first stage included identifying and prioritising potential stakeholders at the national and district levels. We identified eight organisations involved in newborn and child health and selected 24 participants from various other sectors for workshops aimed at raising awareness about the register's introduction. These stakeholders also participated in the register's design, development strategies planning, and implementation phases. These phases were led by the 'National Newborn Health and IMCI programme' with support from various partners. A technical working group reviewed existing registers and helped prepare training materials. Feedback from each workshop was crucial in finalising the register. The Government of Bangladesh has recognised the need for an indoor register for newborns and sick children, which was to be established in collaboration with development partners. This initiative can enhance the quality of care for sick children and increase service provider accountability. Due to its successful implementation, it will continue to be used in the Kushtia and Dinajpur districts, with plans for a nationwide scale-up. The Government has allocated funds in the next health sector programme for orientation and register printing. A strengths, weaknesses, opportunities, and threats (SWOT) analysis of the stakeholder engagement process highlighted strengths such as a context-specific approach and collaborative engagement, as well as challenges such as time resource requirements. Implementing an inpatient register for newborns and sick children through stakeholder engagement can effectively improve child health care services. Aside from challenges such as resource intensiveness and stakeholder commitments, success depended on the organising authority's expertise in relationship building, budget allocation, time management, and workforce dedication. Therefore, strategic planning, staff recruitment, networking, and budgeting are crucial for successful stakeholder engagement and health care initiatives.

From long-term follow-up Recommendations for clinical practice to plain language summaries for childhood, adolescent, and young adult cancer survivors

BackgroundHaving sufficient knowledge of cancer diagnosis, treatment and late effects in survivors of childhood, adolescent, and young adult (CAYA) cancer is important for effective self-management and optimising health outcomes. Therefore, in collaboration with different stakeholders, the PanCare PLAIN Information Group converted the PanCareFollowUp Recommendations for late effects surveillance into information summaries that are Person-centred, written in Lay language, Accessible, Internationally relevant, and Navigable (PLAIN). MethodsThe PanCare PLAIN Information Group, comprising 21 stakeholders from seven European countries, collaborated to provide concise information for survivors and their families. The aim was to deliver PLAIN summaries that are clear and accessible for the majority of survivors, while providing links to additional sources of information. The PLAIN summaries were drafted by the PanCare PLAIN Information Group and subjected to two internal and one external consultation round, the latter involving experts, CAYA cancer survivors and parents/caregivers. ResultsIn total, 45 PLAIN summaries were developed, each corresponding to one of the PanCareFollowUp Recommendations for late effects surveillance. The summaries provide information about late effects, personal health risks, important symptoms and signs, recommended surveillance strategies, possible referral and treatment options, and self-care. ConclusionsThe PLAIN summaries are meant to increase knowledge in survivors and their families, while they may also inform healthcare professionals. Along with their translations, the PLAIN summaries will be made freely available on the PanCare website, with a link provided on the European Network of Youth Cancer Survivors information platform. In addition, they will become and integral part of the Survivorship Passport.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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