Caretakers Of Children Research Articles

Burnout and Stressor-Related Factors among Caretaker of Children with Chronic Neurological Illness

Objective: Caring for children with neurological conditions is challenging. This study aimed to determine the prevalence of burnout and its associated factors among caretakers of children with chronic neurological illness. Method: This cross-sectional study involved 18 years or older caretakers of children with neurological illness for more than 3 months duration. They were recruited from Paediatric Neurology outpatient clinics over a period of 3 months from July to October 2019 at a general hospital in the state of Kelantan, Malaysia. Each caretaker was given a set of questionnaires that included General Stressor Questionnaire (GSQ) which was translated into Malay version ‘Soal Selidik Umum (SSU)’, Copenhagen Burnout Inventory-Malay version (CBI-M) and Demographic Information Form. Results: Overall, only 20 caretakers had mean score of 50 or higher in all component in CBI-M, making the prevalence of total burnout among the caretakers of 8.3% (95% CI = 5.2%, 12.6%). Personal burnout involved 78 caretakers (32.5%, 95% CI = 26.6%, 38.8%), 42 caretakers with client-related burnout (17.5%, 95% CI = 12.9%, 22.9%) and 11 caretakers had work-related burnout (4.6%, 95% CI = 2.3%, 8.1%). Most common stressors were performance pressure, work-family conflict and poor job prospects. Multiple logistic regression analyses showed that family stressors, types of children’s neurological illness and number of household occupants were associated with personal burnout, client-related burnout and total burnout in their caretakers. Conclusions: Prevalence of total burnout among the caretakers was low, but personal burnout was prominent. Caretakers of children with genetic illness, cerebral palsy and autism had higher prevalence of burnout compared to other chronic neurological illness.

Teaching literature following loss: teachers’ adherence to emotional rules

PurposeThis study aims to explore how teachers changed literature instruction in English language arts (ELA) classrooms following personal loss, and identifies factors influencing those changes. The author argues teachers regulated their responses to literature according to emotional rules they perceived to be associated with the teaching profession. Understanding teachers’ responses helps educators, teacher educators and educational researchers consider what conditions and supports may be required for teachers and students to share emotions related to loss in authentic ways in ELA classrooms.Design/methodology/approachTo examine changes teachers made in literature instruction following personal loss, the author conducted a thematic analysis of 80 questionnaire responses.FindingsThe author found teachers changed literature instruction related to three areas: teachers’ relationship to students, teachers’ instruction surrounding texts and teachers’ reader responses. Responses highlighted how teachers adhered to emotional rules, including a perception of teachers as authorities and caretakers of children. Teachers considered literature instruction to require maintaining focus on texts, and avoided emotional response unless it aided textual comprehension.Originality/valueScholars have argued for literature instruction inclusive of both loss experiences and also emotional response, with particular focus on students’ loss experiences. This study focuses on teachers’ experiences and responses to literature following loss, highlighting factors that influence, and at times inhibit, teachers’ authentic sharing of experiences and emotions. The author argues teachers require support to bring loss experiences into literature instruction as they navigate emotional response within the relational dynamics of the classroom.

‘Unfocused groups’: lessons learnt amid remote focus groups in the Philippines

The ongoing COVID-19 pandemic has required tremendous shifts in data collection techniques. While an emerging body of research has described experiences conducting remote interviews, less attention has been paid to...

The Experience of Parenting Children with Autism Spectrum Disorder: A Qualitative Content Analysis

ABSTRACT Objective The aim of this study was to explore the range of experiences encountered by parents and caretakers of children with autism spectrum disorder. Materials and methods An inductive conventional content analysis approach was utilized for this study. Twenty-four (N = 24) parent responses to open-ended questions about their experience parenting a child with autism spectrum disorder were analyzed. Results Based on content analysis of responses, five main categories emerged: emotional distress, growth and role change, perspective change, support or the need for support, and family strain. Within the main categories, 20 subcategories were identified. Conclusion Findings from this study show that families and caretakers of children with autism spectrum disorder endorse many emotions and complex experiences, both positive and negative. The implications from these data are great and include the need for support and resources for families impacted by autism spectrum disorder.

Use of herbal medicine by caregivers in the management of children with sickle cell disease in Mulago National Referral Hospital - Uganda.

IntroductionSickle Cell Disease (SCD) is the leading genetic disease in sub-Saharan Africa and therefore remains a global public health threat. Use of complementary and alternative medicines (CAM) most especially herbal medicine (HM) in chronic diseases such as sickle cell disease has widely been reported in Africa where advanced technologies are greatly lacking. Despite a large presence of the sickle cell disease in Uganda, the extent to which herbal medicines are used in management of children with sickle cell disease has not been documented. This study purposed to determine the prevalence of herbal medicine (HM) use and associated factors among caregivers of children with SCD at Mulago National Referral Hospital.Methodsa total of 384 child caretakers were interviewed in a descriptive cross-sectional quantitative study conducted at the Mulago Sickle cell clinic in March 2019. Enrolment was done consecutively and a structured interviewer administered questionnaire administered to collect data from the caretakers which was managed using SPSS version 23. Multivariate logistic regression was used to identify the factors associated with herbal medicine (HM) use. Factors with p-value <0.05 were regarded significant.Resultsthe rate of herbal use was 77.6% (298 of 384 caregivers). At multivariate analysis, the odds of a caregiver who agreed that; HM cures symptoms faster than conventional medicine (CM) were 3 times those who disagreed with this statement (AOR =3.439, 95% CI: 1.447 - 8.176). The odds that a caregiver who agreed that HM has fewer side effects than CM were almost 4 times those that disagreed with this statement (AOR = 3.528, 95% CI: 1.917 -6.494). The odds that a caregiver who agreed that marketing HM through televisions adverts encourages HM use were 4 times those who disagreed with this statement (AOR = 4.185, 95% CI: 2.036 -8.603).Conclusionthis study reports a high prevalence of HM use among caregivers of children with SCD at Mulago Hospital, in Uganda. The practice is significantly influenced by caretakers´ perception that HM cures symptoms faster than CM, has fewer side effects and that telemarketing has greatly facilitated its use over CM. More effort is therefore needed to encourage clinic attendances and CM use and limit the unfounded TV adverts on HM. There is also need for studies to identify the common HM used so that their efficacy and safety are well studied.

Gender differences in child nutrition status of Bangladesh: a multinomial modeling approach

PurposeMalnutrition is one of the serious public health problems especially for children and pregnant women in developing countries such as Bangladesh. This study aims to identify the risk factors associated with child nutrition for both male and female children in Bangladesh.Design/methodology/approachThis study was conducted among 23,099 mothers or caretakers of children under five years of age from a nationally representative survey named Bangladesh Multiple Indicator Cluster Survey, 2019. This study used chi-square test statistic for bivariate analysis and multinomial logistic regression was used to evaluate the adjusted effects of those covariates on child nutritional status.FindingsThe prevalence of severely malnourished, nourishment was higher for males than females (5.3% vs 5.1%, 77.4% vs 76.8%) while moderately malnourished were higher for females (18.1% vs 17.4%). The findings from the multinomial model insinuated that the mother’s education level, wealth index, region, early child development, mother’s functional difficulties, child disability, reading children's books and diarrhea had a highly significant effect on moderate and severe malnutrition for male children. For the female children model, factors such as mother’s education level, wealth index, fever, child disability, rural, diarrhea, early child development and reading less than three books were significant for moderate and severe malnutrition.Originality/valueThere is a solution to any kind of problem and malnutrition is not an exceptional health problem. So, to overcome this problem, policymakers should take effective measures to improve maternal education level, wealth status, child health.

Time Domain Analysis of Heart Rate Variability Signals in Valence Recognition for Children with Autism Spectrum Disorder (ASD)

BackgroundAutism Spectrum Disorder (ASD) is a neurodevelopmental condition that is characterized by various social impairments. Children with ASD have major difficulties in expressing themselves, resulting in stress and meltdowns. Understanding their hidden feelings and needs may help in tackling and avoiding such strenuous behaviors. ObjectiveThis research aims to aid the parents and caretakers of children with ASD to understand the hidden and unexpressed emotional state by using physiological signals obtained from wearable devices. MethodsHere, electrocardiogram (ECG) signals pertaining to two valence states (‘like’ and ‘dislike’) were recorded from twenty children (10 Control and 10 children with ASD). The heart rate variability (HRV) signals were then obtained from the ECG signals using the Pan-Tompkins's algorithm. The statistical, higher order statistics (HOS) and geometrical features which were statistically significant were trained using the K Nearest Neighbor (KNN) and Ensemble Classifier algorithms. ResultsThe findings of our analysis indicate that the integration of major statistical features resulted in an overall average accuracy of 84.8% and 75.3% using HRV data for the control and test population, respectively. Similarly, geometrical features resulted in a maximum average accuracy of 84.8% and 74.2% for control and test population respectively. The decreased HRV in the test population indicates the presence of autonomic dysregulation in children with ASD when compared to their control peers.

Parental Responsibility Toward Child as Criminal Offender in Indonesian Criminal Reform

Parents as the first guardian of the child make their role irreplaceable for children. The negligence of parents in interpreting their role as caretakers of children can have an impact on children's development. True children do not have the ability to plan a crime. ABH is more accurately seen as a victim. This study reveals the responsibility of parents to child offenders of criminal offenses in Indonesian law today and its reforms in the future. This study uses a qualitative approach and normative juridical research methods. Code No. 11 of 2012 concerning the Juvenile Criminal Justice System implies the use of Restorative Justice in every settlement of juvenile crime. There is no formal legality of parents' responsibility for criminal acts committed by children, however, the Law on the Criminal Justice System for Children only regulates the responsibility of parents in the form of compensation in terms of diversion. The principle of Vicarious Liability can be applied to child crimes in the future. The principle of Vicarious Liability can be clearly stated in the regulations relating to juvenile punishment. The principle of vicarious liability can be applied to parents for criminal acts committed by children in the context of the transfer of criminal acts, based on legal objectives, namely justice, certainty and legal usefulness in the application of criminal law in Indonesia.

Readability of Online Patient Information Relating to Cleft Palate Surgery

It is important for health care education materials to be easily understood by caretakers of children requiring craniofacial surgery. This study aimed to analyze the readability of Google search results as they pertain to "Cleft Palate Surgery" and "Palatoplasty." Additionally, the study included a search from several locations globally to identify possible geographic differences. Google searches of the terms "Cleft Palate Surgery" and "Palatoplasty" were performed. Additionally, searches of only "Cleft Palate Surgery" were run from several internet protocol addresses globally. Flesch-Kincaid Grade Level and Readability Ease, Gunning Fog Index, Simple Measure of Gobbledygook (SMOG) index, and Coleman-Liau Index. Search results for "Cleft Palate Surgery" were easier to read and comprehend compared to search results for "Palatoplasty." Mean Flesch-Kincaid Grade Level scores were 7.0 and 10.11, respectively (P = .0018). Mean Flesch-Kincaid Reading Ease scores were 61.29 and 40.71, respectively (P = .0003). Mean Gunning Fog Index scores were 8.370 and 10.34, respectively (P = .0458). Mean SMOG Index scores were 6.84 and 8.47, respectively (P = .0260). Mean Coleman-Liau Index scores were 12.95 and 15.33, respectively (P = .0281). No significant differences were found in any of the readability measures based on global location. Although some improvement can be made, craniofacial surgeons can be confident in the online information pertaining to cleft palate repair, regardless of where the search is performed from. The average readability of the top search results for "Cleft Palate Surgery" is around the seventh-grade reading level (US educational system) and compares favorably to other health care readability analyses.

The ongoing indirect effect of the COVID-19 pandemic on a pediatric emergency department.

IntroductionThe SARS-CoV-2 coronavirus pandemic may cause significant morbidity and mortality in adults, yet severe cases are rare among children. The indirect impact of the pandemic on health care delivery in general and pediatric emergency department (PED) visits in particular has been widely reported.AimsTo assess the impact of the pandemic and the social restrictions imposed in its wake on PED visits and hospitalization rates in our Israeli medical center. We also sought to track these data in relation to the variation in pandemic severity and social restrictions over time. A comparison of this data with that of the adult emergency department was also performed.MethodsData for this study were drawn from the Shaare Zedek Medical Center (SZMC), Jerusalem, Israel computerized databank. The daily number of PED and adult ER visits as well as hospitalizations resulting from these visits during the months January-July during the years 2018, 2019, 2020 were recorded. We compared the risk ratio for hospitalization in 2019 and 2020, as well as the incidence rate ratio.ResultsDuring March and April there was a decrease in PED visits from 4,588 visits in 2019 to 2,527 visits in 2020 (ratio = .551, 95%CI [.52,.58]. Despite the drop in PED visits, the rate of hospitalizations rose with respect to 2019 (Risk Ratio = 1.31, p < .001, 95%CI [1.17,1.47]). Similar but more moderate trends were seen in the adult ED. From May-July 2020, after the lockdown was lifted, PED visits remained 30% below the same time period from 2018 and 2019, while the hospitalization rate returned to its pre-pandemic level.ConclusionsA significant drop in PED visits is seen to extend well beyond the peak of the pandemic and the lockdown period. This highlights the potential risk of children with serious emergencies becoming casualties of the pandemic by their not being brought to medical attention. Efforts should be made to raise public awareness among parents and other caretakers of children regarding this matter.

The impact of backyard gardening on livelihoods of households in Sedibeng District Municipality in Gauteng Province, South Africa

The study was conducted to evaluate the impact of backyard gardening on the livelihoods of households in Sedibeng District Municipality in Gauteng Province, South Africa. Data were drawn from 60 household vegetable producers. A structured questionnaire was used to conduct one-on-one interviews to gather data which were then analysed to compare variables and the level of livelihoods of household vegetable production. The results suggested that variables such as gender, household size, marital status and household income influence vegetable production. Women, as the primary caretakers of children, were found to be more involved in vegetable production than men. The vegetable production increased when households were headed by females. Households indicated that the implementation and evaluation of the programme under study, which was successfully undertaken with the assistance of Agricultural Advisors from Gauteng’s Department of Agriculture and Rural Development (GDARD), did impact their livelihoods positively. In conclusion, the study found that household vegetable projects can assist in alleviating poverty, create job opportunities and improve livelihoods of the community of Sedibeng District Municipality.

Urdu-1 The Role of Women in the Formation and Stability of a just Social System: A Research Study

Women have ever played their central role in society development. Even they are primary caretakers of family children and elders along with prime initiator for outside assistance .It is notable that women as mothers play a key role family decisions and. History tells that whenever the economical and political system of a country changes, they provide leading helping hands to family members to adjust according to the new realities and challenges. So, the role of women in society transition pre-literate to literate is undeniable .The women have played a vital role to support their households and communities in achieving perfection in society. At present, it is need of the hour to provide women equal chances to their part in society progress and sustainability. This article will try to highlight women key role in establishment and existence of a just social system.

Graphic Design for Children with Learning Disabilities Based on the Isaan Mural Painting

The study of 'Graphic design for children with learning disabilities' is a study that delves into learning-disabled children in the Isaan region. The author used the survey to formulate a graphic and media design model to enhance LD children's learning. This paper is a qualitative study of the data retrieved from the literature review and field data. Target groups include experts, practitioners, and stakeholders. Research instruments are structured and non-structured interviews, observation forms, and tests. The collected data were then analyzed using the 'information processing theory,' 'structural-functional theory,' product design principle, and graphic design element principle. The paper presents the result using descriptive analysis. Based on the study, it was found that the cause for learning disabilities in children living in Isaan mostly concerns with environmental learning disabilities. The best period for children with learning disabilities to effectively receive help is during their early primary or elementary education. The types of learning disabilities that can be found in children in the Isaan region are mostly reading and writing disabilities. Further, it was also revealed that Nakhonratchasima Primary Education Service Area 2 has the highest rate of learning-disabled children in Isaan. Most of the children with learning disabilities did not receive proper care from their caretakers. To identifying children with learning disabilities, the author collaborated with the children's caretakers, schools, Special Education Bureau, and hospitals. Common classroom behaviors among these children are their inability to read and write; this includes difficulties in social interactions and activity participation. As for the learning materials, it is clear that the materials used did not correspond with their special needs due to their disabilities. It is clear that these children need materials made for individual use that does not require participation in front of the class or learning through multimedia. The discovery can be used as a guideline in formulating graphic design. The graphic design should make insignificant information less distinct while reinforcing the main contents with bold lines, complementary colors, page distance, pictures used in representing alphabets, and the adoption of fun and creative characters. As for the material design guideline, the media should focus on one story for individual use. Students should also learn through playing, repeated reading, writing practice, using materials repeatedly without being bored, and can memorize the lessons when participating in hands-on activities.&#x0D; &#x0D; Received: 23 December 2020 / Accepted: 11 February 2021 / Published: 5 March 2021

Folate fortification and supplementation in prevention of folate-sensitive neural tube defects: a systematic review of policy.

Neural tube defects (NTDs) are common congenital neurological defects, resulting in mortality, morbidity, and impaired quality of life for patients and caregivers. While public health interventions that increase folate consumption among women who are or plan to become pregnant are shown to reduce folate-sensitive NTDs, public health policy reflecting the scientific evidence lags behind. The authors aimed to identify the types of policies applied, associated outcomes, and impact of folate fortification and supplementation on NTDs worldwide. By identifying effective legislation, the authors aim to focus advocacy efforts to more broadly effect change, reducing the burden of NTDs in neurosurgery. A systematic review was conducted exploring folate fortification and supplementation policies using the PubMed and Scopus databases. Titles and abstracts from articles identified were read and selected for full-text review. Studies meeting inclusion criteria were reviewed in full and analyzed for study design, aim, population, interventions, and outcomes. Of 1637 resultant articles, 54 were included. Mandatory folate fortification was effective at reducing folate-sensitive NTDs. Mandatory fortification also decreased hospitalization rates and deaths after discharge and increased 1st-year survival for infants with NTDs. Recommended folate supplementation also resulted in decreased NTDs; however, issues with compliance and adherence were a concern and impacted effectiveness. Folate fortification and/or supplementation resulted in decreased NTD prevalence, although more change was attributed to fortification. Dual policies may hold the most promise. Furthermore, reductions in NTDs were associated with significant cost savings over time. Both mandatory folate fortification and recommended supplementation policies were found to effectively decrease folate-sensitive NTD rates when applied. A comprehensive approach incorporating mandatory folate fortification, appropriate folate supplementation, and improved infrastructure and access to prenatal care may lead to decreased NTDs worldwide. This approach should be context-specific, emphasize education, and account for regional access to healthcare and social determinants of health. With wide implications for NTDs, associated health outcomes, quality of life of patients and caregivers, and economic impacts, policy changes can drastically improve global NTD outcomes. As caretakers of children with NTDs, the authors as neurosurgeons advocate for a comprehensive policy, the engagement of stakeholders, and a broader global impact.

Gender-related influences on adherence to advice and treatment-seeking guidance for infants and young children post-hospital discharge in Bangladesh

BackgroundPost-hospital discharge mortality risk is high among young children in many low and middle-income countries (LMICs). The available literature suggests that child, caregiver and health care provider gender all play important roles in post-discharge adherence to medical advice, treatment-seeking and recovery for ill children in LMICs, including those with undernutrition.MethodsA qualitative study was embedded within a larger multi-country multi-disciplinary observational cohort study involving children aged less than 2 years conducted by the Childhood Acute Illness and Nutrition (CHAIN) Network. Primary data were collected from family members of 22 purposively selected cohort children. Family members were interviewed several times in their homes over the 6 months following hospital discharge (total n = 78 visits to homes). These in-depth interviews were complemented by semi-structured individual interviews with 6 community representatives, 11 community health workers and 12 facility-based health workers, and three group discussions with a total of 24 community representatives. Data were analysed using NVivo11 software, using both narrative and thematic approaches.ResultsWe identified gender-related influences at health service/system and household/community levels. These influences interplayed to family members’ adherence to medical advice and treatment-seeking after hospital discharge, with potentially important implications for children’s recovery. Health service/system level influences included: fewer female medical practitioners in healthcare facilities, which influenced mothers’ interest and ability to consult them promptly for their child’s illnesses; gender-related challenges for community health workers in supporting mothers with counselling and advice; and male caregivers’ being largely absent from the paediatric wards where information sessions to support post-discharge care are offered. Gendered household/community level influences included: women’s role as primary caretakers for children and available levels of support; male family members having a dominant role in decision-making related to food and treatment-seeking behaviour; and greater reluctance among parents to invest money and time in the treatment of female children, as compared to male children.ConclusionsA complex web of gender related influences at health systems/services and household/community levels have important implications for young children’s recovery post-discharge. Immediate interventions with potential for positive impact include awareness-raising among all stakeholders – including male family members - on how gender influences child health and recovery, and how to reduce adverse consequences of gender-based discrimination. Specific interventions could include communication interventions in facilities and homes, and changes in routine practices such as who is present in facility interactions. To maximise and sustain the impact of immediate actions and interventions, the structural drivers of women’s position in society and gender inequity must also be tackled. This requires interventions to ensure equal equitable opportunities for men and women in all aspects of life, including access to education and income generation activities. Given patriarchal norms locally and globally, men will likely need special targeting and support in achieving these objectives.

Presentation, treatment and outcomes of pediatric anterior urethral strictures: 28 years’ experience from a referral center

Pediatric urethral strictures are an uncommon entity, with the anterior urethra being the most common affected location, similar to adults. The, literature on outcomes in these strictures is limited, especially in the non-traumatic group, as most of the studies have included hypospadias related "neourethral" strictures and posterior strictures, thereby making interpretation difficult. It is for these reasons we decided to search our database to identify the different surgical procedures used and analyze the outcomes of interventions in these children and adolescents with anterior urethral strictures. To report the treatment strategies and outcomes in a series of 119 pediatric anterior urethral strictures, identified in a 28-year period in a high-volume tertiary center. A retrospective case-note review of all cases of pediatric anterior urethral strictures was done. Data on the clinical presentation including age at presentation, characteristics of strictures identified, primary intervention and additional secondary procedures and outcomes were collected. We identified 119 boys with anterior urethral strictures with commonest location being the bulbar urethra (60.5%). Sixty patients (50.4%) in this cohort underwent minimally invasive intervention in the form of dilatation or direct visual internal urethrotomy (DVIU) with the rest undergoing open intervention. The primary success rate was 87.1% (101/116) at a median follow-up of 29 (IQR 21-38) months. Idiopathic urethral stricture and iatrogenic strictures had better success rate of 92.5% and 82.1% than traumatic strictures (78.9%) and it was lowest for those traumatic strictures that were treated with DVIU (66.7%). Multifocal strictures had comparatively poorer outcomes (62.5%) compared with penile or bulbar strictures, with worst outcomes (44.4%) in those treated with substitution urethroplasty. Length >1cm, multifocality and treatment with substitution urethroplasty were significantly associated with recurrence. Three boys with strictures associated with anorectal malformations were a particularly difficult group and needed multiple intervention and had poor outcomes. Based on our study, we recommend a minimally invasive approach for short segment, bulbar strictures, especially of idiopathic etiology. For other locations and longer strictures, we recommend urethroplasty. Caution must be exercised to avoid underestimation of the actual pathology of the stricture. Caretakers of children with complete bulbar level blockage associated with anorectal malformations undergoing urethroplasty should be explained about the need for multiple interventions and possibility of poor voiding outcomes.

Proportion of children aged 9-59 months reached by the 2017 measles supplementary immunization activity among the children with or without history of measles vaccination in Lilongwe district, Malawi.

The measles Supplementary Immunization Activity (SIA) was implemented in June, 2017 to close immunity gaps by providing an additional opportunity to vaccinate children aged between 9 months and up to 14 years in Lilongwe District, Malawi. This study was conducted to determine the proportion of eligible children that were reached by the 2017 measles SIA among those children with or without history of measles vaccination, and possible reasons for non-vaccination. A cross-sectional survey using mixed methods was conducted. Caretakers of children who were eligible for the 2017 measles SIA were sampled from 19 households from each of the 25 clusters (villages) that were randomly selected in Lilongwe District. A child was taken to have been vaccinated if the caretaker was able to explain when and where the child was vaccinated. Eight Key Informant Interviews (KIIs) were conducted with planners and health care workers who were involved in the implementation of the 2017 measles SIA. Modified Poisson regression was used to examine the association between non-vaccination and child, caretaker and household related factors. A thematic analysis of transcripts from KIIs was also conducted to explore health system factors associated with non-vaccination of eligible children in this study. A total of 476 children and their caretakers were surveyed. The median age of the children was 52.0 months. Overall, 41.2% [95% CI 36.8-45.7] of the children included in the study were not vaccinated during the SIA. Only 59.6% of children with previous measles doses received SIA dose; while 77% of those without previous measles vaccination were reached by the SIA. Low birth order, vaccination history under routine services, low level of education among caretakers, unemployment of the household head, younger household head, provision of insufficient information by health authorities about the SIA were significantly associated with non-vaccination among eligible children during the 2017 measles SIA. Qualitative findings revealed strong beliefs against vaccinations, wrong perceptions about the SIA (from caretakers' perspectives), poor delivery of health education, logistical and human resource challenges as possible reasons for non-vaccination. Many children (41%) were left unvaccinated during the SIA and several factors were found to be associated with this finding. The Lilongwe District Health Team should endeavor to optimize routine immunization program; and community mobilization should be intensified as part of SIA activities.

Caretaker knowledge, attitudes, and practices (KAP) and carriage of extended-spectrum beta-lactamase-producing E. coli (ESBL-EC) in children in Quito, Ecuador

BackgroundThe rapid spread of extended-spectrum beta-lactamase-producing E. coli (ESBL-EC) is an urgent global health threat. We examined child caretaker knowledge, attitudes, and practices (KAP) towards proper antimicrobial agent use and whether certain KAP were associated with ESBL-EC colonization of their children.MethodsChild caretakers living in semi-rural neighborhoods in peri-urban Quito, Ecuador were visited and surveyed about their KAP towards antibiotics. Fecal samples from one child (less than 5 years of age) per household were collected at two time points between July 2018 and May 2019 and screened for ESBL-EC. A repeated measures analysis with logistic regression was used to assess the relationship between KAP levels and child colonization with ESBL-EC.ResultsWe analyzed 740 stool samples from 444 children living in households representing a range of environmental conditions. Of 374 children who provided fecal samples at the first household visit, 44 children were colonized with ESBL-EC (11.8%) and 161 were colonized with multidrug-resistant E. coli (43%). The prevalences of ESBL-EC and multidrug-resistant E. coli were similar at the second visit (11.2% and 41.3%, respectively; N = 366). Only 8% of caretakers knew that antibiotics killed bacteria but not viruses, and over a third reported that they “always” give their children antibiotics when the child’s throat hurts (35%). Few associations were observed between KAP variables and ESBL-EC carriage among children. The odds of ESBL-EC carriage were 2.17 times greater (95% CI: 1.18–3.99) among children whose caregivers incorrectly stated that antibiotics do not kill bacteria compared to children whose caregivers correctly stated that antibiotics kill bacteria. Children from households where the caretaker answered the question “When your child’s throat hurts, do you give them antibiotics?” with “sometimes” had lower odds of ESBL-EC carriage than those with a caretaker response of “never” (OR 0.48, 95% CI 0.27–0.87).ConclusionCaregivers in our study population generally demonstrated low knowledge regarding appropriate use of antibiotics. Our findings suggest that misinformation about the types of infections (i.e. bacterial or viral) antibiotics should be used for may be associated with elevated odds of carriage of ESBL-EC. Understanding that using antibiotics is appropriate to treat infections some of the time may reduce the odds of ESBL-EC carriage. Overall, however, KAP measures of appropriate use of antibiotics were not strongly associated with ESBL-EC carriage. Other individual- and community-level environmental factors may overshadow the effect of KAP on ESBL-EC colonization. Intervention studies are needed to assess the true effect of improving KAP on laboratory-confirmed carriage of antimicrobial resistant bacteria, and should consider community-level studies for more effective management.

Classification and Diagnosis of Schizophrenia or Other Primary Psychotic Disorders: Changes from ICD-10 to ICD-11 and Implementation in Clinical Practice.

From January 2022, the WHO member countries shall start implementing the mortality and morbidity statistics (MMS) version of the eleventh revision of the International Classification of Diseases (ICD-11). Regarding mental, behavioural or neurodevelopmental disorders, there are substantial changes from ICD-10 to ICD-11. The subchapter for schizophrenia or other primary psychotic disorders has changed due to a revised structure, new diagnostic criteria, and the introduction of dimensional elements (i.e., course and symptom qualifiers). The aim of this manuscript is twofold. First, we review changes from ICD-10 to ICD-11 in the classification and diagnosis of schizophrenia or other primary psychotic disorders, including findings from recent field studies. Second, we provide an overview of approaches to the implementation of ICD-11 in clinical practice. Critical elements for transition from ICD-10 to ICD-11 include the use of digital tools, education and training, stakeholder involvement, national adaptations, and continuous evaluation.

A study of dog bites among children in the rural area of Goa, India

Objective: 1. To study the prevalence of dog bites in children; 2. To study knowledge and practices followed regarding prevention and control of rabies among caretakers. Materials and Methods: Study Design: Cross sectional study; Study Participants: Children below 16 years of age; Study Instrument: A predesigned questionnaire was used to ask questions to parents or caretakers of children. Ethical Considerations: Ethical approval was obtained from Institutional Ethics Committee. Statistical Analysis: Data was entered in excel and analysed using SPSS version 22. Frequencies, X 2 tests and odds ratios were calculated. Results: The incidence of dog bites in children was 3.36 %. Most of the bites were in children between 6 – 10 years (2.4%) and among males (2.1%). Almost 55.6 % of the bites were unprovoked. Most common site was lower limbs (66.7%). 66.6% of the victims received anti rabies vaccine (ARV). Out of those who received ARV, only 66.7% received all doses completely. Knowledge of rabies and ARV was present in 83% and 74% of the parents respectively. Conclusion: Most of the bites happen in and around the house, which can be easily prevented. Even though free health services are so easily accessible, services are not availed. Health education regarding prevention of dog bites, correct methods of local bite management and compliance of ARV treatment is needed. Keywords: Dog bites, Children, Rural, Goa.