Children Attending Childcare Centres Research Articles

Prevalence and determinants of insufficient vitamin D status in young Canadian Inuit children from Nunavik.

Background: Vitamin D deficiency has reached pandemic levels affecting over one billion people worldwide. However, limited data is available on the prevalence and determinants of vitamin D status of Canadian Indigenous children and no study has been reported in Inuit children from Nunavik. Aim: Therefore, using data collected between 2006 and 2010, we aimed to investigate the prevalence and main determinants of insufficient serum 25-hydroxyvitamin D (s25(OH)D) concentrations in Inuit children attending childcare centres in Nunavik. Methods: This study included 245 Inuit children aged 11 to 54 months. s25(OH)D concentrations were measured by radioimmunoassay. Dietary intakes were assessed using 24-hour recalls. Usual dietary intakes were estimated using the National Cancer Institute method. We used a multiple imputation technique to replace missing values when performing regression analysis. Results: Our findings revealed that 64.5% of children had a s25(OH)D concentration < 75 nmol/L, while 78.1% did not meet the estimated average requirement (EAR) for vitamin D. Vitamin D intake and fluid milk consumption were positively associated with s25(OH)D concentrations, while negative associations were observed with children' energy intake, non-alcoholic beverage consumption, body weight, breastfeeding duration and, biological/adoptive/foster parents' educational level. Conclusion: Vitamin D inadequacy was highly prevalent and closely aligned with levels observed over the years in non-Indigenous children. Breastfed children who do not receive vitamin D supplementation, overweight and obese children, and children with inadequate milk consumption were at high risk of vitamin D insufficiency. Eating vitamin D rich foods such as fluid milk and seafood along with vitamin D supplementation when needed are recommended.

Risk Analysis and Risk Perception among Malaysian Caregivers: A Qualitative Study

Children attending childcare centres have been linked to increasing child health and safety risks due to uncalibrated risk analysis by caregivers. The qualitative risk analysis, which is more convenient and applicable, is heavily influenced by the risk perceptions of the risk perceivers. Therefore, this study explores how Malaysian caregivers analyse risks that could occur to children attending childcare centres. Six Malaysian caregivers selected using the purposive sampling technique were interviewed individually. The interviews are transcribed and analysed using thematic analysis. The findings show that experience, knowledge sharing, and common-sense shape caregivers’ risk perception. Thus, child health and safety risks could be reduced by providing evidence-based information related to injuries and illnesses of children attending childcare centres to caregivers.

The influence of probiotics on gastrointestinal tract infections among children attending childcare: Asystematic review and meta-analysis.

Current literature related to the impact of probiotics on the incidence of gastrointestinal tract infections (GITIs) has shown mixed results and no systematic review available with pooled analysis exists. Thus, the aim of this systematic review was to provide contemporary evidence regarding the overall and strain-specific influence of probiotics in preventing GITIs among infants and children attending childcare centres. The review shortlisted 18 RCTs after screening through the initial search results of 779 articles. However, only 15 trials were deemed eligible, addressing at least one outcome in the pooled analysis. It is concluded that the supplementation of probiotics (overall effect) may reduce the risk of GITI episode by 26%, with Lacticaseibacillus paracasei, Limosilactobacillus reuteri and Lacticaseibacillus rhamnosus GG being specifically potent probiotic strains in reducing GITI episode, duration of infection and absence from childcare respectively. There is insufficient evidence to determine the effect of Bifidobacterium animalissubsp.lactisBB-12 based on the findings of the trials included in this review.

PBI-015 - Pulsed-field gel electrophoresis of Haemophilus influenzae isolated from children attending childcare centres in Kuala Lumpur

PBI-015 - Pulsed-field gel electrophoresis of Haemophilus influenzae isolated from children attending childcare centres in Kuala Lumpur

Serotypes and beta-lactamase-producing Haemophilus influenzae isolated from children attending childcare centres in Kuala Lumpur post vaccination era

Serotypes and beta-lactamase-producing Haemophilus influenzae isolated from children attending childcare centres in Kuala Lumpur post vaccination era

Carriage of Haemophilus influenzae among children attending childcare centres in Kuala Lumpur, Malaysia in the post vaccination era: A cross-sectional study

BackgroundHaemophilus influenzae (H. influenzae) is a human upper respiratory tract colonizer which causes wide range of disease especially in children<5 years old and in the elderly. Although worldwide incidence in industrialised countries where Hib vaccination is commonly used has dropped sharply since implementation of H. influenzae type b (Hib) vaccination, there is limited data on the disease burden caused by H. influenzae in Malaysia post vaccination era. A change in predominant serotype from type b to non-b serotypes of H. influenzae in invasive diseases was reported worldwide. We investigated the carriage of H. influenzae post vaccination era among 2–4 years old. MethodologyRandomly, we collected 436 oropharyngeal swabs from healthy children aged 2–4 years in 30 registered childcare centres in Kuala Lumpur (August 2018-May 2019). Informed consent and written questionnaires were obtained from parents. H. influenzae was identified by standard microbiological methods. Univariable analysis was carried out to describe variables associated with colonization. All variables with p < 0.25 were included in multivariable logistic regression model. A p value < 0.05 was considered significant. ResultsA higher carriage rate was noted among the unvaccinated children (4/28; 14.3%) compared to vaccinated children (16/326; 4.9%) but were not statistically significant. The serotypes were type a (9; 37.5%), type b (5; 20.8%), type c (3; 12.5%), type d (2; 8%), type e (1; 4.2%) and type f (4; 16.7%). Variables like age, basic sanitation, immunization status, body mass index were included in multivariable logistic regression test since p values in univariate analysis were<0.25. Planned sewage system was found to be significant (Adjusted OR, 0.06; 95% CI, 0.01–0.46; p = 0.006). ConclusionFewer carriage rates were observed among children post Hib vaccination era. Hib carriage is still possible after vaccination. The presence non-b serotypes may imply emerging replacement serotypes.

Parental disease prevention health beliefs and triggers for keeping children home from childcare-a qualitative study in Sydney, Australia.

Infectious diseases cause considerable morbidity and mortality in children less than 5years of age. Children attending childcare centres are at increased risk of contracting infections. It is of public health interest to understand what triggers and underpins parental decisions to send an unwell child to childcare, with the obvious attendant risks to other children and childcare staff as well as the affected child. This study aimed to examine parents' disease prevention health beliefs and practices with a particular focus on how these factors influence childcare attendance decisions. Semistructured, in-depth interviews were conducted between June 2009 and May 2011 with parents who had at least one child under 5years of age enrolled in a childcare centre. Six centres in the metropolitan area of Sydney, Australia, were selected to include parents from a range of demographic and socio-economic backgrounds. Forty-two interviews were conducted, recorded, and transcribed. Themes emerging from the data included "vitamin dirt," contagion, and contagion prevention and control. These interacted with parents' decision-making about childcare attendance, and parents made choices in a complex context of obligations to their child, social contract obligations to others, peer expectations, and the need to work. Vaccination received only scant mention as a preventive health measure. Decision-making by parents concerning childcare attendance was made without reference to any external guidelines. This study provides insights into parental disease prevention beliefs, behaviours, and decision-making. It reveals a need for policies to support parents with unwell children. In addition, resources and educative efforts to raise awareness of vaccination as a preventive health measure, and awareness of infectious disease contagion more broadly, would assist in providing parents with a greater evidence base for making decisions about childcare attendance when their child is unwell.

The impact of a vaccine scare on parental views, trust and information needs: a qualitative study in Sydney, Australia

BackgroundVaccine safety scares can undermine public confidence in vaccines and decrease immunisation rates. Understanding and addressing parental concerns arising during such scares can assist in lessening their impact. In Australia in April 2010 there was a temporary suspension of influenza vaccine for children under 5 years of age after reports of an increase in the rate of adverse events following vaccination. This qualitative study aimed to explore the impact of the vaccine suspension on parental knowledge, attitudes, trust, information needs, and intent related to influenza vaccination and broader immunisation programs.MethodsSemi-structured interviews were conducted with 25 parents of children attending childcare centres in Sydney, Australia, between June 2010 and May 2011. Centres were selected to include parents from a range of socioeconomic backgrounds. Interview transcripts were coded and analysed using an approach informed by grounded theory.ResultsFindings indicated that, for those who recalled the vaccine suspension, there was a lasting sense of uncertainty and confusion and a perceived lack of information. Parents had distinct information needs following the vaccine suspension, especially in regards to vaccine safety, testing and recommendations. For many, influenza vaccination intent was conditional on receipt of information from a trusted, authoritative source allaying safety concerns. Importantly, the impact of the scare was contained to influenza vaccines only, and not other vaccine programs.ConclusionsParental concerns and information gaps following a vaccine safety scare need to be actively addressed. We provide policy and practice suggestions for proactively managing such incidents, particularly in relation to communication of timely, targeted information to parents and immunisation providers.

Infectious morbidity and resource use in children under 2 years old at childcare centres.

To analyse the associations between childcare centres and infectious morbidity and resource consumption. Cohort study from birth to 2 years. number and types of infections, drug consumption and medical visits. Exposure variable: attending or not attending a childcare centre. School age: 6-12, >12-18, >18-24 months. The initial cohort comprised 445 children, and the final cohort comprised 419 children. The mean number of recurrent infections and wheezing was higher in children attending childcare centres in all age groups with significant differences. Recurrent acute otitis media was observed in the 12- to 18-month group with an odds ratio of 6.04 (95% confidence interval, 1.3-27.6; P = 0.001) in the children attending childcare centres. In children older than 6 months, there was greater consumption of antibiotics, inhaled bronchodilators, oral and inhaled corticosteroids and montelukast. Attending a childcare is associated with an increased frequency of recurrent infections and wheezing, as well as the consumption of antibiotics, bronchodilators, corticosteroids and montelukast.

A comparison of physical activity levels in childcare contexts among Finnish and Dutch three-year-olds

The aim of the current study was to determine Finnish and Dutch three-year-old preschool children’s physical activity (PA) levels and how levels vary across gender, location, time of day and social contexts in both countries. A modified version of the Observational System for Recording Physical Activity in Children-Preschool (OSRAC-P) was used to measure children’s PA levels and contextual variables (e.g. group composition, prompts) of children attending childcare centres in Finland and the Netherlands. In total, 90 Finnish children (46 boys and 44 girls) and 97 Dutch children (46 boys and 51 girls) were observed. Three-level linear regression analyses with cross level interactions were used to assess differences between the countries in the association between the context variables and PA. During the observations, the present sample of children was mostly sedentary in nature. Outdoor location and prompts (both positive and negative) were associated with higher levels of activity in both countries. Non-solitary playing was associated with higher activity levels in the Netherlands, but not in Finland, whereas child-initiated play was positively associated with Finnish but not Dutch children’s PA levels. Finnish children were more active in the morning compared to the afternoon, while in the Dutch children PA was unaffected by time. The present findings indicate that better understanding of the contextual factors and interactions in children’s PA behaviours across the two countries could help in planning childcare interventions to increase the PA levels of preschool children.

The effects of school holidays on transmission of varicella zoster virus, England and Wales, 1967-2008.

BackgroundChanges in children’s contact patterns between termtime and school holidays affect the transmission of several respiratory-spread infections. Transmission of varicella zoster virus (VZV), the causative agent of chickenpox, has also been linked to the school calendar in several settings, but temporal changes in the proportion of young children attending childcare centres may have influenced this relationship.MethodsWe used two modelling methods (a simple difference equations model and a Time series Susceptible Infectious Recovered (TSIR) model) to estimate fortnightly values of a contact parameter (the per capita rate of effective contact between two specific individuals), using GP consultation data for chickenpox in England and Wales from 1967–2008.ResultsThe estimated contact parameters were 22–31% lower during the summer holiday than during termtime. The relationship between the contact parameter and the school calendar did not change markedly over the years analysed.ConclusionsIn England and Wales, reductions in contact between children during the school summer holiday lead to a reduction in the transmission of VZV. These estimates are relevant for predicting how closing schools and nurseries may affect an outbreak of an emerging respiratory-spread pathogen.

Directly Observed Physical Activity among 3-Year-Olds in Finnish Childcare

The main purpose of the study was to determine 3-year-olds’ physical activity levels and how these vary across season, gender, time of day, location, and the physical and social environment in childcare settings in Finland. A modified version of the Observational System for Recording Physical Activity in Children-Preschool (OSRAC-P) was used to measure physical activity levels and contextual variables (e.g., group composition, prompts) of children attending childcare centres. In total, 81 children (42 boys and 39 girls) were observed in autumn and in winter. Three-level linear regression analyses were used to assess differences between the seasons in the association between the context variables and physical activity. During the observations, the present sample of children was mostly sedentary in nature, engaging in moderate to vigorous physical activity in only 2 % of all observations. The results further showed a significant difference between season and the children’s physical activity levels: in winter, the children spent significantly more time in sedentary-level activities and less time in moderate to vigorous physical activity than in autumn. The present sample of children was physically more active outdoors than indoors. Boys showed significantly higher physical activity levels than girls. The majority of the observations did not include any oral prompting. We conclude that childcare centres offer good opportunities to increase children’s physical activity. Interventions should focus on enhancing children’s outdoor time, free play, and positive prompting and encouragement by teachers.

Prevalence of iron deficiency among Inuit preschool children attending childcare centres in Nunavik (632.8)

In infants and children, iron deficiency (ID) can have several adverse effects on health including lethargy, alterations of immune defense mechanisms and impaired growth and cognitive development. The purpose of this study was to determine the prevalence of ID in a group of preschool Inuit children attending childcare centres in Nunavik using conventional measurements of iron status and a relatively new parameter, soluble transferrin receptor (sTfR). sTfR is especially useful in the presence of inflammation or infection. Two hundred forty‐five Inuit children aged between 11 and 54 months (mean (SD) = 25.0 (9.6) months) were recruited between 2006 and 2010 in 10 of the 14 Nunavik communities. About half of the children were male and 52.3% (n=128) were less than 24 months old at the time of the study. Sixty‐five children were excluded because they lacked one or more of the parameters under analysis, leaving 180 subjects for the assessment of iron status. ID defined either as serum ferritin &lt;15 mg/L, sTfR &gt;1.55 or sTfR‐ferritin index (sTfR/log ferritin) &gt;1.5 was found in 73.2% of subjects. Anemia (hemoglobin (Hb) &lt;110 g/L (12‐35 months old) or &lt;112 g/L (36‐59 months old)) was present in 15% of children, while 7.2% suffered from iron deficiency anemia (IDA) (ID and C‐reactive protein (CRP) &lt;6 mg/L), and 5% from IDA and coexisting anemia of inflammation (ID and CRP 蠅6 mg/L). Iron deficiency constitutes a significant public health problem in these Canadian Aboriginal children. Measures to improve iron intake and bioavailability are required and consumption of traditional foods rich in iron must be encouraged.Grant Funding Source: Supported by Aboriginal Affairs and Northern Development Canada &amp; Kativik Regional Government

Effect of dietary calcium intake on lead exposure in Inuit children attending childcare centres in Nunavik

High blood lead levels (BLLs) can be found in Inuit from Nunavik. At the same time, various nutrients such as calcium could lower lead absorption and toxicity. We examined the effect of dietary calcium intakes on BLLs in 245 preschool Inuit children attending childcare centres in Nunavik. Calcium intake was assessed with one 24-h dietary recall and BLLs were determined by inductively coupled plasma mass spectrometry in whole blood samples. Multiple imputation was performed to deal with missing data. Median blood lead concentration was 0.08 μmol/L. A high proportion of children did not meet the Estimated Average Requirement for vitamin D intake (73 %) and, to a lower extent, for calcium (20 %). Calcium intake was negatively associated with BLLs ( p = 0.0001) while child’s age and energy intake were positively associated with BLLs ( p = 0.015 and p = 0.024, respectively). Consuming traditional foods rich in calcium as well as milk and alternatives may protect against lead exposure.

P049: High rate of MRSA respiratory tract colonisation in HIV-positive children in Cambodia during 2004-2012

Children attending child care centres are at increased risk of infections, including those caused by MRSA (methicillin-resistant S. aureus).

Traditional food consumption is associated with higher nutrient intakes in Inuit children attending childcare centres in Nunavik

Objectives. To describe traditional food (TF) consumption and to evaluate its impact on nutrient intakes of preschool Inuit children from Nunavik.Design. A cross-sectional study.Methods. Dietary intakes of children were assessed with a single 24-hour recall (n=217). TF consumption at home and at the childcare centres was compared. Differences in children's nutrient intakes when consuming or not consuming at least 1 TF item were examined using ANCOVA.Results. A total of 245 children attending childcare centres in 10 communities of Nunavik were recruited between 2006 and 2010. The children's mean age was 25.0±9.6 months (11–54 months). Thirty-six percent of children had consumed at least 1 TF item on the day of the recall. TF contributed to 2.6% of total energy intake. Caribou and Arctic char were the most reported TF species. Land animals and fish/shellfish were the main contributors to energy intake from TF (38 and 33%, respectively). In spite of a low TF intake, children who consumed TF had significantly (p<0.05) higher intakes of protein, omega-3 fatty acids, iron, phosphorus, zinc, copper, selenium, niacin, pantothenic acid, riboflavin, and vitamin B12, and lower intakes of energy and carbohydrate compared with non-consumers. There was no significant difference in any of the socio-economic variables between children who consumed TF and those who did not.Conclusion. Although TF was not eaten much, it contributed significantly to the nutrient intakes of children. Consumption of TF should be encouraged as it provides many nutritional, economic, and sociocultural benefits.

Community resilience, quality childcare, and preschoolers’ mental health: A three-city comparison

Many studies suggest that quality childcare can positively influence children’s outcomes in a wide range of domains, including mental health. While an extensive literature on the effects of childcare on individual children exists, how quality childcare programs contribute to trends at the population-level is yet to be established. In this study, we examine community differences in the quality of childcare and the mental health of children attending childcare centres in three communities in British Columbia, Canada. Previous research on Kindergarten children conducted in these communities indicated that two exhibited expected outcomes (based on socioeconomic criteria, these communities were classified as “better off” and “worse off”), and one exhibited better than expected outcomes and was therefore labeled “resilient.” We hypothesized that the better than expected child outcomes in the resilient community were due to better quality childcare in this community. To test this hypothesis, we assessed 621 children and their 24 respective childcare centres, and conducted extensive observations of the three study communities. As expected, teachers (but not parents) from the resilient community reported fewer children’s mental health problems and childcare quality was found to be higher in the resilient community than in the comparison communities. However, city differences were lost in the hierarchical linear regressions suggesting that the community effects were mediated through childcare quality. To interpret these findings we turned to our observations that indicated that the resilient community was markedly different from the other two in terms of the social capital and developmental assets that it possessed.

Haemophilus influenzae type b carriage in Indigenous children and children attending childcare centers in the Northern Territory, Australia, spanning pre- and post-vaccine eras

This paper investigates Haemophilus influenzae type b (Hib) carriage in Indigenous children and children attending childcare centres in the Northern Territory of Australia, 1992–2005. More than 10 years after the introduction of the Hib conjugate vaccine, Hib carriage persists in Indigenous children (3.4%, 2003–2005) and children attending childcare centres (0.2%, 2004). This is the first Australian study to examine Hib carriage spanning the pre- and post-vaccination eras. Increasing carriage rates contribute to Hib disease resurgence especially in those with higher disease burdens, such as remote Indigenous Australians, ongoing carriage surveillance provides a sentinel warning system for invasive disease. Background Following the introduction of H. influenzae type b (Hib) conjugate vaccine to Australia in 1993 as a three dose (2, 4, 12 month) schedule, the incidence of Hib disease decreased dramatically in children, especially in those aged under 5 years. We investigate Hib carriage in Indigenous children and children attending childcare centres from the Northern Territory (NT) of Australia between 1992 and 2005. We report Hib carriage rates in this well vaccinated population, with previously documented high rates of invasive disease. Methods Hib carriage was reviewed in nasopharyngeal or nasal swabs collected between 1992 and 2005; from over 2000 children (61% Indigenous) aged 0–6 years enrolled in 7 otitis media or carriage surveillance studies in the NT. Results More than 10 years after the introduction of the Hib conjugate vaccine, Hib carriage persists at low levels, but at a higher rate in Indigenous children (3.4%, 2003–2005) than children attending childcare centres (0.2%, 2004), in the NT of Australia. Conclusions This is the first Australian study to examine Hib carriage spanning the pre- and post-vaccination eras. Ongoing carriage surveillance provides a sentinel warning system for invasive disease. This notifies public health professionals of potential invasive disease, creating early warning systems for intervention if Australian Indigenous children or children attending childcare centres are to follow current international trends associated with high rates of carriage preceding invasive disease—despite high vaccination rates. Internationally there is growing concern that increasing carriage rates are the driving force behind Hib disease resurgence especially in those with higher disease burdens, such as remote Indigenous Australians. Changes to the vaccination schedule from PRP-OMPC (PedvaxHIB ®), to PRP-T (2, 4, 6, 12 months) from January 2010—may affect carriage and in time, invasive disease rates. This work is important for national and International comparisons as well as feeding back information to vaccine policy makers of the Hib carriage environment throughout this period.

The CUPDAY Study: prebiotic‐probiotic milk product in 1–3‐year‐old children attending childcare centres

The aim of the study was to evaluate the efficacy of a milk product containing probiotics and prebiotics (CUPDAY Milk) on the incidence of diarrhoea in children attending daycare centres. The study was undertaken in a randomized controlled trial with 496 children aged 1-3 years attending 29 childcare centres in Perth, Australia. The endpoint for the study was the number of days in which children were recorded as having four or more stools. The diarrhoeal rates were analyzed by Poisson regression using 'intention to treat' (all children) and 'reduced' (children enrolled for more than 10 days) data sets. There was no difference in demographic characteristics between the case and control groups. In the 'intention to treat' analysis, a total of 41 745 child-days were included in the study. The adjusted risk ratio for those consuming the 'Cupday' milk drink was 0.82 (95% CI 0.73-0.94) for the intention to treat sample (n = 496) and 0.80 (95% CI 0.70-0.91) for the reduced sample (n = 315). The children consuming the 'Cupday' drink had a 20% reduction in the number of days experiencing four or more stools per day. A milk containing probiotics and prebiotics reduced the number of days children attending child care who had four or more stools by 20%.

An evaluation of a nutrition intervention at childcare centres in South Australia

Research has shown that childcare menus in South Australia, Australia and overseas lack key nutrients recommended for children. This paper describes an incentive initiative that aimed to improve the nutrition provided to children attending childcare centres in the southern metropolitan area of South Australia between 2001 and 2003. To attain the 'Start Right Eat Right' award, aimed at childcare centres, directors and cooks from 50 centres were required to attend training, analyse a current menu for quality and quantity against various tools, review their food policy for essential criteria, have two site visits and have all staff trained in a recognised food safety and hygiene program. Forty-four (88%) of the centres completed training. Qualitative feedback from 10 awarded centres reported substantial changes and their food policy analysis showed an increase of essential points from an average score of 8.4 to 17.1 (max. score 18). More than 300 staff completed food hygiene training. Fifty per cent of the eligible centres had completed the award at program evaluation. This multi-strategic intervention was effective in improving the food provided and nutrition practices in childcare settings. Strategies attributed to its success were an inter-sectoral approach and the creation of supportive environments.