Poor Child Health Research Articles

Model of Fulfilling the Rights of Displaced Children with Special Needs with Mental Disabilities in North Aceh

Model of Fulfillment of The Rights of Abandoned Children with Special Needs with Mental Disabilities in North Aceh, Because Children as the nation's buds are expected to be the next generation that has the potential to build a state so that it must be protected from all forms of inhumane treatment in order to be able to be responsible for the sustainability of the nation and state. However, if an abandoned child has a mental disability it is feared that the creation of a generation that is not intellectually and sensorily qualified due to lack of education and poor mental health, the protection and rights of children with mental disabilities are regulated in Law No. 23 of 2002 on Child Protection. This research aims to know and analyze and to see the duties and functions of the government in fulfilling the rights of displaced children with special needs with mental disabilities by the Government of North Aceh Regency, and to identify the model of fulfilling the rights of children with special needs with mental disabilities in North Aceh. Keywords: Model of Protection, Child With Disabilities, North Aceh DOI: 10.7176/JLPG/118-12 Publication date: February 28 th 2022

Potential indirect impacts of the COVID‐19 pandemic on children: a narrative review using a community child health lens

▪In this narrative review, we summarise the vast and burgeoning research on the potential and established indirect impacts on children of the COVID-19 pandemic. We used a community child health lens to organise our findings and to consider how Australia might best respond to the needs of children (aged 0-12 years). ▪We synthesised the literature on previous pandemics, epidemics and natural disasters, and the current COVID-19 pandemic. We found clear evidence of adverse impacts of the COVID-19 pandemic on children that either repeated or extended the findings from previous pandemics. ▪We identified 11 impact areas, under three broad categories: child-level factors (poorer mental health, poorer child health and development, poorer academic achievement); family-level factors that affect children (poorer parent mental health, reduced family income and job losses, increased household stress, increased abuse and neglect, poorer maternal and newborn health); and service-level factors that affect children (school closures, reduced access to health care, increased use of technology for learning, connection and health care). ▪There is increasing global concern about the likely disproportionate impact of the current pandemic on children experiencing adversity, widening existing disparities in child health and developmental outcomes. ▪We suggest five potential strategy areas that could begin to address these inequities: addressing financial instability through parent financial supplements; expanding the role of schools to address learning gaps and wellbeing; rethinking health care delivery to address reduced access; focusing on prevention and early intervention for mental health; and using digital solutions to address inequitable service delivery.

Comparing the timeliness and adequacy of antenatal care uptake between women who married as child brides and adult brides in 20 sub-Saharan African countries.

Considering the persistent poor maternal and child health outcomes in sub-Saharan Africa (SSA), this study undertook a comparative analysis of the timing and adequacy of antenatal care uptake between women (aged 20-24 years) who married before age 18 and those who married at age 18 or above. Data came from Demographic and Health Surveys of 20 SSA countries. We performed binary logistic regression analysis on pooled data of women aged 20-24 (n = 33,630). Overall, the percentage of child brides in selected countries was 57.1%, with the lowest prevalence found in Rwanda (19.1%) and the highest rate in Chad (80.9%). Central and West African countries had the highest prevalence of child marriage compared to other sub-regions. Bivariate results indicate that a lower proportion of child brides (50.0%) had 4+ ANC visits compared to the adult brides (60.9%) and a lower percentage of them (34.0%) initiated ANC visits early compared to the adult brides (37.5%). After controlling for country of residence and selected socio-economic and demographic characteristics, multivariable results established significantly lower odds of having an adequate/prescribed number of ANC visits among women who married before age 15 (OR: 0.63, CI: 0.57-0.67, p<0.001), and women who married at ages 15-17 (OR: 0.81, CI: 0.75-0.84, p<0.001) compared to those who married at age 18+. Similar results were established between age at first marriage and timing of first ANC visit. Other interesting results emerged that young women who married earlier than age 18 and those who married at age 18+ differ significantly by several socio-economic and demographic characteristics. Efforts to improve maternal and child health outcomes in SSA must give attention to address the underutilization and late start of antenatal care uptake among child brides.

Adolescent Women with Congenital Heart Disease: Self-Reported Reproductive Health Discussions with Health Care Providers

Study ObjectiveThis study evaluated self-reported discussions with health care providers (HCPs) among adolescent and young adult (AYA) women with congenital heart disease (CHD). DesignData were collected through a one-time survey of AYA women. SettingParticipants were recruited from pediatric cardiology clinics. ParticipantsAYA women with CHD, ages 14-21 (N = 107) InterventionsNone Main Outcome MeasuresQuestionnaires assessed adolescent characteristics and specific HCP discussions regarding transmissibility of a cardiac condition to the infant, risk of pregnancy, and hormonal contraception. Outcome measures were self-reported discussions with HCPs about these reproductive health topics. ResultsMean age was 16.8 years (SD = 2.1). Self-reported reproductive health discussions were infrequent, including discussions on transmissibility of a heart condition to their offspring (37%), risk of pregnancy to their offspring (34%), risks of pregnancy to their health (46%), and risks of hormonal contraception given their heart condition (21%). Reported discussions were most commonly with a cardiologist. ConclusionsAYA women with CHD reported limited discussions about reproductive health topics important to those with CHD. Lack of appropriate and timely counseling could lead to poor maternal and child health outcomes. Targeted interventions that improve reproductive health discussions between HCPs and AYA women with CHD are needed to close critical information and service gaps.

Background predictors of time to death in infancy: evidence from a survival analysis of the 2018 Nigeria DHS data

BackgroundNigeria’s child health profile is quite concerning with an infant mortality rate of 67 deaths per 1000 live births and a significant slowing down in progress towards improving child health outcomes. Nigeria’s 2018 Demographic and Health Survey (DHS) suggests several bio-demographic risk factors for child death, including mother’s poor education, poverty, sex of child, age of mother, and location (rural vs urban) but studies are yet to explore the predictive power of these variables on infant survival in Nigeria.MethodsThe study extracted data for all births in the last 12 months preceding the 2018 Nigeria DHS and used the Cox proportional hazard model to predict infant survival in Nigeria. Failure in this analysis is death with two possible outcomes – dead/alive – while the survival time variable is age at death. We censored infants who were alive at the time of the study on the day of the interview. Covariates in the analysis were: age of mother, education of mother, wealth quintile, sex of child, location, region, place of delivery, and age of pregnancy.ResultsThe study found that a higher education of a mother compared to no education (β = .429; p-value < 0.05); belonging to a household in the richer wealth quintile (β = .618; p-value < 0.05) or the highest quintile (β = .553; p-value < 0.05), compared to the lowest wealth quintile; and living in North West (β = 1.418; p-value < 0.05) or South East zone (β = 1.711; p-value < 0.05), significantly predict infant survival.ConclusionAddressing Nigeria’s infant survival problem requires interventions that give attention to the key drivers – education, socio-economic status, and socio-cultural contextual issues. We therefore recommend full implementation of the universal basic education policy, and child health education programs targeted at mothers as long- and short-term solutions to the problem of poor child health outcomes in Nigeria. We also argue in favor of better use of evidence in policy and program development in Nigeria.

Prevalence and correlates of major depressive disorder among a national sample of middle-aged and older adults in India

Objectives: This study aimed to assess the prevalence and correlates of major depressive disorder (MDD) among middle-age and older adults in India. Methods: The cross-sectional sample consisted of 72,262 persons (45 years and older) from the 2017 to 2018 Longitudinal Ageing Study in India (LASI) Wave 1. MDD is defined using DSM-5 criteria and measured with the CIDI-SF. Logistic regression was used to evaluate the associations with MDD. Results: The prevalence of past 12-month MDD was 7.6%, 8.1% among women and 7.0% among men, and 8.2% in persons 60 years and older. In the final adjusted model, food insecurity, having 3–6 discrimination experiences, ill-treatment, victim of violent crime, disaster exposure, unsafe home/neighbourhood, poor childhood health, hypertension, stroke, tobacco use, and physical pain were positively associated with MDD. Being male, married, high socioeconomic status, living in urban areas, high spirituality/religiosity, health insurance and medium social network were negatively associated with MDD. Conclusion: Almost one in ten middle-aged and older adults in India had MDD and several associated factors were identified.

Disorders Presenting as Anaemia among Paediatric Population at a Tertiary Care Centre, Kerala, India: A Cross-sectional Study

Introduction: Anaemia is a condition marked by low Haemoglobin (Hb) concentration and is an important risk factor for the poor health and development of children and adolescents. Anaemia is not a diagnosis, but merely an objective sign of disease. The correct treatment requires an understanding of the pathogenesis of the condition. Aim: To identify disorders presenting as anaemia in paediatric population. Also to analyse the data by grading of anaemia and to calculate the proportion of anaemia in various paediatric age groups. Materials and Methods: This cross-sectional study was conducted at Government Medical College, Ernakulum, Kerala, India, from September 2017 to February 2018, on 211 paediatric patients of age groups from newborn upto 18 years. After a detailed clinical history and examination, Complete Blood Count (CBC), peripheral smear preparation, reticulocyte count, renal function tests, liver function tests, and if necessary, radiological and bone marrow examination were done. The mean haemoglobin in the categories were compared with Comprehensive National Nutritional Survey Data. The data obtained were entered in Microsoft excel 365 and further analysed. Categorical variables were analyzed by Fisher’s- exact test and continuous variables by Analysis of Variance (ANOVA) and Kruskal-Wallis test and the significance level was set at p-value ≤ 0.05. Results: Of the 211 patients, 120 (56.87%) were males and 91 (43.13%) were females. The average haemoglobin level varies across age groups and sex. In the case of newborns, average Hb was 9.31 g/dL in males and 10.4 g/dL in females. A total of 211 patients presented with 339 disease conditions, with respiratory disorders in 98, followed by 83 nutritional diseases, 49 infections and 35 systemic diseases. Total of 132 patients in age group of 6 months to 4 years, presented with maximum disorders (206). A total of 186 (54.8%) cases presented with Microcytic Hypochromic Anaemia (MHA), 149 (43.95%) with Normocytic Normochromic Anaemia (NNA) and only 4 (1.18%) with Haemolytic Anaemia (HA). No cases of macrocytic anaemia were noted. Conclusion: Total of 76.8% cases of MHA (42.1% of total anaemia cases) are associated with Nutritional, Respiratory and Infectious conditions which can be managed by public health measures. The haemoglobin levels in neonates and less than 6 months age group were significantly less than population mean which needs to be addressed. In similar manner, girls in school going age group had significantly lower Hb than boys.

Determinants of interpregnancy intervals among women in rural communities in Delta State, Southern Nigeria

Aim: To guarantee safe motherhood, women are advised to adequately space their deliveries. The World Health Organization advocated for a birth interval between 3 and 5 years, yet closed birth spacing continues to be a problem in Nigeria, resulting in poor infant, child, and maternal health. This study explored the determinants of three classes of birth interval (too short, adequate, and too long) among 534 women drawn from three rural communities in Delta State, Southern Nigeria. Methods: The study is an analytical cross-sectional household survey which used a pretested structured questionnaire to elicit information from 534 women in their homes. Extracted data were analyzed with Stata version 13.0. Frequency and simple proportion were used to describe the characteristics of the women. Bivariate analysis was undertaken to show the association between birth intervals and various sociodemographic factors. Determinants of birth interval were measured by multivariate logistic regression. Statistical significance was set at P &lt; 0.05. Results: The mean maternal age is 35.3 years (standard deviation = 7.3 years). According to the results, 74.2% (396/354) of the women reported short birth interval (&lt;24 months), 13.7% (73/534) reported adequate birth interval, and 12.2% (65/534) reported too long birth interval. According to the multivariate logistic regression, short birth interval is significantly influenced by education, media exposure, use of contraceptive, unmet need of contraceptive, and age at marriage. Adequate birth interval is determined by education and unmet need of contraceptive. Long birth interval is predicted by education and ideal birth spacing. Conclusion: In order to encourage adequate birth spacing, education and employment opportunities should be expanded for women in the study area, and the use of modern contraceptive should be encouraged.

Surviving versus thriving: The wellbeing of primary school aged children in Tonga.

To enable improvements in global child health, the focus must move beyond child survival to child wellbeing. In the Pacific Islands, the wellbeing of children has received little attention. This study aimed to investigate the wellbeing of children from three primary schools in Tonga. A cross-sectional survey was completed in three primary schools in Nuku'alofa with children aged 5-15 years. The study participants (256 children, 143 caregivers) completed the Child Health and Illness Profile - Child Edition, CHIP-CE (Version 1.0). On average, >70% of children and caregivers described home and school environments as positive. From the children's reports, boys had significantly lower scores for risk avoidance than girls (3.40 vs. 3.73, P< 0.001). Children aged 5-7 versus 8-15 years had significantly lower scores for satisfaction (3.63 vs. 3.92, P= 0.002), resilience (3.34 vs. 3.56, P= 0.016) and achievement (3.25 vs. 3.62, P= 0.002). From the caregivers' report, girls had significantly lower scores for academic performance than boys (3.60 vs. 3.81, P= 0.04). Boys had significantly lower scores for individual risk association compared to girls (3.93 vs. 4.29, P= 0.01). Overall CHIP-CE scores were lower than those of comparable populations in the West, while at the same time protective factors were documented. Understanding child wellbeing in the Pacific is critical for strengthening protective factors known to mitigate poor child health outcomes. Continuing to base global child health success on child survival alone misses opportunities for improving the wellbeing of nations.

Screen Use and Mental Health Symptoms in Canadian Children and Youth During the COVID-19 Pandemic

Longitudinal research on specific forms of electronic screen use and mental health symptoms in children and youth during COVID-19 is minimal. Understanding the association may help develop policies and interventions targeting specific screen activities to promote healthful screen use and mental health in children and youth. To determine whether specific forms of screen use (television [TV] or digital media, video games, electronic learning, and video-chatting time) were associated with symptoms of depression, anxiety, conduct problems, irritability, hyperactivity, and inattention in children and youth during COVID-19. A longitudinal cohort study with repeated measures of exposures and outcomes was conducted in children and youth aged 2 to 18 years in Ontario, Canada, between May 2020 and April 2021 across 4 cohorts of children or youth: 2 community cohorts and 2 clinically referred cohorts. Parents were asked to complete repeated questionnaires about their children's health behaviors and mental health symptoms during COVID-19. The exposure variables were children's daily TV or digital media time, video game time, electronic-learning time, and video-chatting time. The mental health outcomes were parent-reported symptoms of child depression, anxiety, conduct problems and irritability, and hyperactivity/inattention using validated standardized tools. This study included 2026 children with 6648 observations. In younger children (mean [SD] age, 5.9 [2.5] years; 275 male participants [51.7%]), higher TV or digital media time was associated with higher levels of conduct problems (age 2-4 years: β, 0.22 [95% CI, 0.10-0.35]; P < .001; age ≥4 years: β, 0.07 [95% CI, 0.02-0.11]; P = .007) and hyperactivity/inattention (β, 0.07 [95% CI, 0.006-0.14]; P = .04). In older children and youth (mean [SD] age, 11.3 [3.3] years; 844 male participants [56.5%]), higher levels of TV or digital media time were associated with higher levels of depression, anxiety, and inattention; higher levels of video game time were associated with higher levels of depression, irritability, inattention, and hyperactivity. Higher levels of electronic learning time were associated with higher levels of depression and anxiety. In this cohort study, higher levels of screen use were associated poor mental health of children and youth during the COVID-19 pandemic. These findings suggest that policy intervention as well as evidence-informed social supports are needed to promote healthful screen use and mental health in children and youth during the pandemic and beyond.

New Issues in Life Course Research: Which Early-Life Factors Matter for Late-Life Outcomes?

The increased availability of retrospective information about the lives of participants in population panel studies has expanded the range of precursors to include in life course research. However, this also challenges researchers to select among many potential precursors to a late-life outcome and to determine the relative role of factors from different periods in the life course. Each paper in this symposium uses life course information from the Health and Retirement Study (HRS) to examine different late-life outcomes. Speakers will discuss what guided the particular selection of factors and outcome to examine in their study. Sonnega, Helppie-McFall, and Lee focus on indicators of childhood financial and social adversity as potential predictors of early retirement due to poor health. Park, Larkina, and Smith ask if decisions taken in early adulthood about how to balance work-and family-life by individuals and their partners are related to the categories of important life accomplishments older adults report in their life review. Two papers examine precursors of late-life health outcomes. Williams-Farrelly and Smith identified different profiles of physical activity in early- and mid-adulthood. They discuss associations between these profiles and cognitive aging. Whereas social losses, relocation, and multimorbidity are well-documented precursors of Major Depression in old age, Bergmans and Smith asked if poor health in childhood played a distal role. The session concludes with an integrative discussion of issues by Walsemann.

Associations of Mental Health and Chronic Physical Illness During Childhood With Major Depression in Later Life

While poor health in childhood has implications for mental health years later, less is known regarding its long-term impact. We determined whether childhood chronic physical illness burden was associated with major depression (MD) in later life (i.e., >50 years), and tested mediation by childhood mental health status using path analysis. Data came from the 2016 U.S. Health and Retirement Study (n=18,047). One standard deviation increase in childhood chronic physical illness burden was associated with 1.21 (95% CI = 1.12, 1.30) times higher odds of MD in later life. Childhood mental health status explained 57.8% (95% CI: 35.2, 80.4) of this association. Results indicated that the relationship of chronic physical illness burden in childhood with MD in later life was mediated by childhood mental health status. Whether greater screening for psychiatric-related symptoms in childhood or review of health histories in later life can reduce the burden of MD requires further study.

Do Life Course Physical Activity Profiles Reduce the Effects of Childhood Exposures on Cognition?

Although physical activity throughout life is one of the most reliable predictors of healthy aging, can less consistent or favorable trajectories also improve cognition trajectories among older adults? Drawing from accumulation theories, we use longitudinal data from the Health and Retirement Study and Life History Mail Survey (N=9,309) to examine the early antecedents of cognitive decline and the extent to which different life course physical activity profiles can slow such a decline. Results from latent class analysis reveal seven distinct profiles: consistently low, consistently high, consistently average (reference), improvers, decliners, midlife motivators, and previously athletic “couch potatoes.” Growth curve modeling analyses show that membership in the consistently high class and midlife motivators were associated with better cognition initially and over time, with no difference between the two classes. Additionally, though poor health and learning problems in childhood were associated with worse initial cognition, physical activity does not mediate the relationship.

Relationships Between Childhood Health Experience and Depression Among Older People: Evidence From China.

The assessment of childhood health experience helps to identify the risk of depression among older people. Poor childhood experience is generally associated with depression in adulthood. However, whether such association can be extended to older people’ life remains unclear. The history of parental mental health was obtained from 2014 CHARLS Wave 3 (Life History Survey) data while other data from 2011 CHARLS Wave 1 baseline data. The study involves 4,306 respondents. The depression was assessed by the Chinese version of Center for Epidemiologic Studies Depression scales (CES-D) using logistic regression model. More than 40% of older people suffered from depression, 25% of whom experienced poor childhood self-reported health. Nearly 20% of their mothers and more than 10% of their fathers had a history of poor mental health. Poor childhood health experiences have shown to be associated with higher odds of depression (good self-reported health OR: 0.732, p = 0.000, 95% CI: 0.633–0.847; poor mother’s mental health OR: 1.391, p = 0.001, 95% CI: 1.138–1.699; poor father’s mental health OR: 1.457, p = 0.003, 95% CI: 1.141–1.862). There is a high rate of depression among the older adults in China. In China, older people with poor childhood health experiences are more likely to suffer from depression.

Prenatal and postnatal exposure to PFAS and cardiometabolic factors and inflammation status in children from six European cohorts.

Developing children are particularly vulnerable to the effects of exposure to per- and polyfluoroalkyl substances (PFAS), a group of endocrine disrupting chemicals. We hypothesized that early life exposure to PFASs is associated with poor metabolic health in children. We studied the association between prenatal and postnatal PFASs mixture exposure and cardiometabolic health in children, and the role of inflammatory proteins. In 1,101 mothers-child pairs from the Human Early Life Exposome project, we measured the concentrations of PFAS in blood collected in pregnancy and at 8years (range=6-12years). We applied Bayesian Kernel Machine regression (BKMR) to estimate the associations between exposure to PFAS mixture and the cardiometabolic factors as age and sex- specific z-scores of waist circumference (WC), systolic and diastolic blood pressures (BP), and concentrations of triglycerides (TG), high-density lipoprotein (HDL-C) and low-density lipoprotein (LDL-C) cholesterol. We measured thirty six inflammatory biomarkers in child plasma and examined the underlying role of inflammatory status for the exposure-outcome association by integrating the three panels into a network. Exposure to the PFAS mixture was positively associated with HDL-C and systolic BP, and negatively associated with WC, LDL-C and TG. When we examined the independent effects of the individual chemicals in the mixture, prenatal PFHxS was negatively associated with HDL-C and prenatal PFNA was positively associated with WC and these were opposing directions from the overall mixture. Further, the network consisted of five distinct communities connected with positive and negative correlations. The selected inflammatory biomarkers were positively, while the postnatal PFAS were negatively related with the included cardiometabolic factors, and only prenatal PFOA was positively related with the pro-inflammatory cytokine IL-1beta and WC. Our study supports that prenatal, rather than postnatal, PFAS exposure might contribute to an unfavorable lipidemic profile and adiposity in childhood.

ASSESSMENT OF NEONATAL OUTCOME IN BOOKED AND UNBOOKED PREGNANCY CASES IN A TERTIARY CARE CENTRE

Majority of neonatal deaths occurs in low and middle income countries indicating poor quality of health services provided by the government of the respective countries.In a developing country like India , a high morbidity and mortality serves as an sensitive indicator reecting the poor maternal and child health care services of the country.Most of the neonatal deaths can be attributed to avoidable factors which can be minimized by the effective utilization of antenatal services , early detection of high risk pregnancy and timely referral of these cases.The current study was conducted to determine the neonatal outcomes in booked and unbooked pregnancy cases in the tertiary care centre ,Assam Medical College and Hospital, Dibrugarh. METHODS: Close ended structured questionnaires were used to collect information from the parents (150 booked and 150 unbooked).Neonatal outcomes were categorised under groups of term and preterm ,live birth and stillbirts, birthweight, Gestational age, iugr, large for gestational age APGAR score ,NICU admissions and clinical course during hospital stay,course during rst 28 days of life along with complications,if any are all taken into consideration. RESULTS: During the study period 28.67% had low birth weight in booked cases and 41.33% had low birth weight in unbooked cases.The incidence of stillbirth and early neonatal deaths were 2%,4% respectively in booked cases and 4.67% , 6% respectively in unbooked cases.Higher incidence of MSL,prematurity ,birth asphyxia ,respiratory problems ,birth injuries,congenital malformations,infections and hyperbilirubinemia were seen in unbooked cases. CONCLUSIONS: The inference derived from the study ,showed that availability of antenatal care is directly proportional to the neonatal outcome .Thus unavailbility or lack of proper medical attention during the pregnancy results in unfavourable neonatal outcomes which can be prevented by increasing the range of availability , utilization and effectiveness of maternal and child health services alongwith ensuring booking of all the pregnancy cases in our country.

Determinants of preconception care among pregnant women in an urban and a rural health facility in Kenya: a qualitative study

BackgroundPreconception care (PCC) is a form of preventive health care that is offered to women and couples before conception, with the aim of improving their health status and mitigating various risk factors that could contribute to poor maternal and child health outcomes. The levels of PCC utilization are still low globally, especially in developing countries and in rural areas. Little is known regarding PCC use in Kenya that could help in addressing this shortfall. This study aimed to qualitatively assess the determinants of PCC in urban and rural settings in Kenya.MethodsA qualitative approach was employed to assess determinants of PCC using a semi-structured interview guide. The study was conducted from May to October 2017. Selected pregnant women seeking antenatal care (ANC) were recruited by quota sampling, at the Mother and Child Health (MCH) clinics in Aga Khan University Hospital, Nairobi (AKUH, N-urban) and Maragua Level Four Hospital (MLFH-rural). The interviews were thereafter transcribed verbatim and analyzed thematically.FindingsA total of 26 women were invited, of whom 21 accepted to participate in in-depth interviews (IDIs). Saturation of themes occurred with 13 interviews (7 at AKUH and 6 at MLFH).Transcription, coding and thematic analysis of the IDIs yielded 12 themes. Eleven of these themes were identified as determinants of PCC. The twelfth theme contained suggested strategies of increasing PCC awareness and utilization, such as using the media, setting up PCC clinics and integrating PCC into other clinics. The dominant themes were awareness about PCC and attitudes towards PCC and pregnancy.The broad determinants of PCC were similar in urban and rural settings – with a few notable exceptions. For example, in the rural setting, women’s level of education and a pervasive history of poor interactions with healthcare providers were major determinants of PCC.ConclusionFrom this study we conclude that women’s lack of awareness about PCC, in conjunction with attitudes towards PCC and pregnancy impact strongly on its utilization. This lack of awareness could be addressed through health education programs for both the public and for healthcare providers, as well as integrating PCC in the curricula of the later.

Legal Protection Against The Exploitation of Child Labor in Indonesia

This paper discusses the causes and impacts of exploitation of child labour in Indonesia, protection and legal sanctions for perpetrators of exploitation of child labour in Indonesia. This normative juridical research uses a statutory, conceptual and case approach. The analysis technique uses prescriptive analysis with logic and legal reasoning. The results of the study indicate that the cause of child labour exploitation is poverty; low education of parents and children; social environment; and culture. The impacts of child labour exploitation include: a) not having time to play b) children's growth and development, poor physical and mental health of children c) low self-esteem; d) Vulnerable to discriminatory treatment and work accidents; e) vulnerable to acts of violence, exploitation and abuse. Legal protection for exploited children is carried out by 1) disseminating relevant laws and regulations; 2) monitoring, reporting, and providing witnesses, and; 3) involvement of companies, trade unions, non-governmental organizations, and the community. Sanctions against the exploitation of child labour are a form of government concern for the protection of children's rights which aim to achieve justice, legal certainty and benefit for children. The provisions for these sanctions are regulated in Law Number 35 of 2014 concerning Child Protection.

A comparative analysis of the influence of contraceptive use and fertility desire on the duration of second birth interval in four sub-Saharan African countries

BackgroundFertility decline characterised by inter-birth intervals remains rather slow or stall in many countries of sub-Saharan African (SSA). Non-adherence to optimal inter-birth intervals often occasioned by low prevalence of contraceptive use and high fertility desires often lead to poor maternal and child health outcomes. Additionally, information on the influence of contraception and fertility desire on interval between first and second births (SBI) is rarely available. This study therefore aimed to examine the influence of fertility desire and contraception on SBI among women in four SSA countries.MethodsWe analysed cross-sectional data on women aged 15–49 years who participated in the recent Demographic and Health Surveys in DR Congo, Ethiopia, Nigeria and South Africa. Semi-parametric Cox proportional hazards regression was employed for the analysis at 5% significance level.ResultsThe median time to second birth was 34 months in DR Congo; 35 months, Nigeria; 42 months, Ethiopia; and 71 months, South Africa. About 70% of the women desired additional child(ren) and two-thirds have never used contraceptive in both Nigeria and DR Congo. The hazard of second birth was significantly lower among women who desired additional child(ren) compared to desired for no more child in DR Congo (aHR = 0.93; CI: 0.89–0.97), Ethiopia (aHR = 0.64; CI: 0.61–0.67) and South Africa (aHR = 0.51; CI: 0.47–0.55). Women who had never used contraceptive were 12%, 20% and 24% more likely to lengthen SBI than those who were current users in DR Congo, Nigeria and South Africa respectively. DR Congo and Nigerian women were about two times more likely to shorten SBI compared with their South African counterparts. Other significant determinants of SBI include ethnicity, rural residential, age and marital status at first birth, wealth and employment status.ConclusionFindings showed differentials in the linkage between second birth interval and the desired fertility and contraception by country, demonstrating the importance of context. The contribution of these factors to second birth interval requires country context-specific attention if further decline in fertility and poor health outcomes associated with sub-optimal inter-birth interval is to be attained in SSA.

Measuring the effects of prenatal care on child birth weight in Cameroon.

Low birth weight continues to be a significant public health problem worldwide with a range of short- and long-term consequences. However, the analysis of its determinants remains a less addressed issue in sub-Saharan African countries despite the poor child health indicators observed there. The objective of this study is to examine the effects of prenatal care on child birth weight in Cameroon, using data from the fifth Demographic and Health Survey. For this purpose, we use a system of simultaneous equations that takes into account potential endogeneity and sample selection bias. Two measures of prenatal care are used in this study, namely, adequacy and quality. Estimation of the birth weight production function using the instrumental variable two-stage least square approach reveals that adequate prenatal care increases the child's birth weight by 882.84 g. Also an increase in the quality of prenatal care by one unit improves the child's birth weight by 147.79 g. Thus, despite the fact that prenatal care in Cameroon suffers from some shortcomings as regards to the standards recommended by the World Health Organization, it remains a key factor for the improvement of neonatal health outcomes in this country.