Child Health Research Research Articles

Outcomes of Extremely Preterm Infants Exposed to Prolonged Prelabor Rupture of Membranes before 24 Weeks of Gestation.

Preterm prelabor rupture of membranes (PPROM) before or around the limit of fetal viability is associated with serious maternal and neonatal complications including chorioamnionitis, extremely preterm birth, and pulmonary hypoplasia. To describe contemporary outcomes of extremely preterm infants born after prolonged periviable PPROM, and to identify perinatal factors associated with survival and survival without severe neurodevelopmental impairment (NDI). Among actively treated infants born alive at <27 weeks' gestational age (GA) in centers of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network from 2012 to 2018, the outcomes of survival and survival without severe NDI at 22-26 months' corrected age were compared between infants exposed to prolonged (≥120 hours) periviable (<24 weeks' GA) PPROM and unexposed infants born after rupture of membranes ≤18 hours before delivery or at delivery, adjusting for birth GA, sex, multiple gestation, antenatal steroids, small for gestational age (SGA), insurance, and center. Regression models were used to identify perinatal factors associated with survival and survival without severe NDI among the infants exposed to prolonged periviable PPROM. The analysis included 609 infants exposed to prolonged periviable PPROM and 4,489 unexposed infants. In the prolonged periviable PPROM group, 444/608 (73%) infants survived and 298/533 (56%) infants survived without severe NDI. Odds of survival (OR, 0.84; 95% CI, 0.68-1.05) and survival without severe NDI (OR, 0.91; 95% CI, 0.75-1.12) were not significantly different between prolonged periviable PPROM and unexposed groups. Variables associated with higher odds of survival without severe NDI were later GA at birth (OR, 1.37; 95% CI, 1.13-1.67), later GA at PPROM (OR 1.44; 95% CI, 1.26-1.63), and female sex (OR, 1.57; 95% CI, 1.06-2.34), while SGA infants had lower odds of survival without severe NDI (OR, 0.14; 95% CI, 0.04-0.51). Odds of survival and survival without severe NDI among infants exposed to prolonged periviable PPROM were not significantly different from unexposed infants, but decreased with earlier GA at birth and PPROM.

Prevalence, management, health-care burden, and 90-day outcomes of prolonged mechanical ventilation in the paediatric intensive care unit (LongVentKids): an international, prospective, cross-sectional cohort study.

The number of children requiring prolonged mechanical ventilation (PMV) has increased with the advancement of medical care. We aimed to estimate the prevalence of PMV worldwide, document demographic and clinical characteristics of children requiring PMV in paediatric intensive care units (PICUs), and to understand variation in clinical practice and health-care burden. This international, multicentre, cross-sectional cohort study screened participating PICUs in 28 countries for children aged >37 postgestational weeks to 17 years who had been receiving mechanical ventilation (MV; invasive or non-invasive) for at least 14 consecutive days. Screening days took place every 90 days for 3 years. Patients were eligible for inclusion in the analysis if they had been receiving MV (invasive or non-invasive) for at least 14 consecutive days by their first day of screening. Eligible patients were followed up on the subsequent screening day 90 days later or at time of hospital discharge, whichever came first. Outcome data were recorded in a validated web-based case report file. The primary outcome was the prevalence of PMV. Secondary outcomes were mortality, duration of MV, tracheostomy, and number of complications. All outcomes were assessed at 90 days post-screening. The study was registered with ClinicalTrials.gov, NCT04112459. Between Sept 4, 2019 and Dec 7, 2022, 14 595 children were screened on four separate screening days in 158 PICUs, and 2773 patients had been receiving MV for at least 14 days and were included in the analysis. The point prevalence of PMV was 25·8% (IQR 24·1-28·5). Median age was 0·4 years (IQR 0·2-5·3) and median weight was 8·1 kg (IQR 4·7-19·1). 625 (24·0%) of 2610 patients had a history of prematurity (<37 weeks gestational age at birth). 90-day outcome data were collected for 2430 patients. 441 (18·2%) of 2430 patients had died within 90 days. 649 (29·8%) of 2176 patients who initiated ventilation support upon hospital admission had a tracheostomy placed after the first 14 days of MV. The median time to tracheostomy placement after MV initiation was 26 days (IQR 18-52). 462 (21·2%) of 2176 patients had at least one failed extubation between MV initiation and their first screening date. 556 (25·6%) of 2174 patients who started MV upon hospital admission required MV for 21 days or less, whereas 1618 (74·4%) patients required MV for 22 days or more; 90-day mortality did not differ between these groups (18·2% vs 20·30%, p=0·288). Complications were recorded for 810 (38·4%) 2109 patients who initiated MV upon hospital admission; of these 539 (67%) had ventilator-associated pneumonia, and 212 (39%) of 539 patients had multiple episodes of ventilator-associated pneumonia. Timing of tracheostomy was variable, and duration of MV was longer than previously reported. The large variability in patients requiring MV and the associated health-care burden and outcomes across PICUs suggest that further investigation of the factors influencing the care of children with MV is warranted. Réseau en Santé Respiratoire du Québec (Respiratory Research Network of Quebec), Fonds de la recherche en santé du Québec, Women and Children Health Research Institute-Clinical/Community Research Integration and Support Program, Réseau mère-enfant de la francophonie. For the French and Spanish translations of the abstract see Supplementary Materials section.

Implementing Findable, Accessible, Interoperable, Reusable (FAIR) Principles in Child and Adolescent Mental Health Research: Mixed Methods Approach.

The FAIR (Findable, Accessible, Interoperable, Reusable) data principles are a guideline to improve the reusability of data. However, properly implementing these principles is challenging due to a wide range of barriers. To further the field of FAIR data, this study aimed to systematically identify barriers regarding implementing the FAIR principles in the area of child and adolescent mental health research, define the most challenging barriers, and provide recommendations for these barriers. Three sources were used as input to identify barriers: (1) evaluation of the implementation process of the Observational Medical Outcomes Partnership Common Data Model by 3 data managers; (2) interviews with experts on mental health research, reusable health data, and data quality; and (3) a rapid literature review. All barriers were categorized according to type as described previously, the affected FAIR principle, a category to add detail about the origin of the barrier, and whether a barrier was mental health specific. The barriers were assessed and ranked on impact with the data managers using the Delphi method. Thirteen barriers were identified by the data managers, 7 were identified by the experts, and 30 barriers were extracted from the literature. This resulted in 45 unique barriers. The characteristics that were most assigned to the barriers were, respectively, external type (n=32/45; eg, organizational policy preventing the use of required software), tooling category (n=19/45; ie, software and databases), all FAIR principles (n=15/45), and not mental health specific (n=43/45). Consensus on ranking the scores of the barriers was reached after 2 rounds of the Delphi method. The most important recommendations to overcome the barriers are adding a FAIR data steward to the research team, accessible step-by-step guides, and ensuring sustainable funding for the implementation and long-term use of FAIR data. By systematically listing these barriers and providing recommendations, we intend to enhance the awareness of researchers and grant providers that making data FAIR demands specific expertise, available tooling, and proper investments.

Engaging Red River Métis families in Manitoba in the development of child health resources – findings from a qualitative study

BackgroundMost research that includes Red River Métis tends to be pan-Indigenous. Grouping Métis with First Nations and Inuit can diminish their unique and diverse experiences, as well as distinctions-based approaches. Taking a step toward addressing this problem, the Manitoba Métis Federation (MMF; the national government of the Red River Métis) invited researchers within the Canadian network Translating Emergency Knowledge for Kids to partner in this research, which focuses on understanding engagement strategies that can help expose Red River Métis parents to child health research opportunities and build trust and transparency amongst research partners and participants.MethodsA qualitative descriptive approach underpinned by a participatory paradigm guided this study. Semi-structured interviews were conducted with 19 Red River Métis parents and Elders via Zoom or telephone. An inductive thematic analysis approach was used to explore patterns and themes across the data.ResultsAnalysis generated four themes: (a) show me why you are here; (b) make it easier for me to take part; (c) create welcoming spaces; and (d) it should be a give and take experience. Parents emphasized the importance of kinship and personal connections, and said they want to hear about child health study opportunities from trusted organizations. They want researchers to be transparent about their research motivations and to offer multiple ways to participate to help them fit research into their busy lives. Relational approaches within the research process (e.g., creating informal/welcoming environments, gathering over food, fostering shared learning/creative opportunities) are prominent in the findings.ConclusionThere is a dearth of research focused on the distinct experiences of Red River Métis families. Engaging Red River Métis parents early in the research process will help incorporate their preferences and perspectives into the design of a larger project to adapt child health resources. More training is needed to help researchers improve their abilities to engage in self-reflection, listen, recognize power relationships, and demonstrate trust and transparency in each research interaction. It is only through respectful and successful engagement that child health research can be relevant, applicable and positively impact Red River Métis children, families and communities.

Building a research agenda on preventing and addressing sexual assault and intimate partner violence against trans people: a two-stage priority-setting exercise

BackgroundTransgender (trans) people experience high rates of sexual assault (SA) and intimate partner violence (IPV) and seldom receive the care and supports they need post-victimization. However, there is little to no research that aids in the development or improvement of related interventions. We undertook a study to build a novel Canadian research agenda on SA/IPV against trans people to guide future work and address these profound gaps in knowledge.MethodsGuided by the Child Health and Nutrition Research Initiative (CHNRI) method for research priority-setting, we developed and circulated two consecutive surveys to a multi-stakeholder group of government decision makers; mental health, health and social service providers, researchers and trans communities, among others, who proposed research questions related to preventing and addressing SA/IPV against trans persons. The initial survey launched March 2021 garnered responses from 213 stakeholders. These items were cleaned and collated into 20 final questions that fell within seven thematic areas. The refined research questions were evaluated in August 2021 on predefined criteria for answerability, feasibility, impact and equity by 79 of 95 survey 1 respondents who agreed to participate in the second survey (response rate = 83.2%). The questions were ranked using a research priority score calculated by dividing the sum of all the answers for each question across the four criteria by the number of answers received.ResultsAll questions were highly rated on each individual criterion and each had an overall research priority score of above 80%, with the most highly ranked question falling within the theme, “improving quality and implementation of education and training: How can training (e.g., for university/college students, educators, nurses, physicians, social workers, police, lawyers, security guards) be improved to better support trans survivors of sexual assault and intimate partner violence?”.ConclusionsThese questions form Canada’s first research agenda on SA/IPV against trans people. Together, they reflect the insights of stakeholder groups who have been historically excluded from research priority-setting processes and will guide future and much-needed work on the topic. Actionable information on preventing and addressing SA/IPV against trans persons will help reduce negative outcomes associated with being victimized.

Addressing barriers to global multidisciplinary stakeholder inclusivity: Lessons from global orofacial cleft research priority setting.

Inclusivity in research priority setting is fundamental to capturing the opinion of all stakeholders in a research area. Globally, experienced healthcare workers often have deep insights that could impactfully shape future research, and a lack of their involvement in formal research and publications could mean that their voices are insufficiently represented. We aimed to modify the well-established Child Health and Nutrition Research Initiative (CHNRI) methodology to address barriers to inclusivity, which are particularly relevant in healthcare that requires highly multidisciplinary care. This global research priority-setting exercise for orofacial clefts adapted the CHNRI methodology to include research experts, clinicians from multiple disciplines, and non-technical stakeholders (i.e. patients and parents and non-governmental organisations (NGOs)) on a global basis. A multidisciplinary international steering group proposed and discussed methodological changes to improve inclusivity, including survey edits, subgroups for research questions, a demographics section, translation in French and Spanish, phrasing adaptation, and alternative dissemination techniques. We received 412 responses and 1420 questions, spanning 78 different countries and 18 different specialties/groups. Challenges remain to improve representation of all groups, with the vast majority of answers (30%) being from surgeons and a comparatively small proportion from patient/parent groups (9%). This also includes managing responses in three languages, effective dissemination, and responses that were not worded as research questions. This is one of the first CHNRI exercises to involve patients and parents, clinicians, and researchers in its first question submission stage, and the first ever to do so on a global scale. We describe our approach to addressing inclusivity challenges and report related demographic data to serve as a benchmark upon which we hope future CHNRI exercises will improve.

The Effect of Iron Deficiency Anemia on Emergency Department Admission in Asthmatic Children.

Iron deficiency (ID) is the most common nutritional deficiency and cause of anemia in childhood. Iron deficiency anemia (IDA) is a common public health problem in Turkey as in the rest of the World. Asthma is a chronic inflammatory disease of the respiratory tract, affecting approximately 10% of the population in developing countries. There are very few reports available in the medical literature regarding the association of childhood asthma and anemia, as well as the effects of anemia on asthma. This study was designed to investigate the possible relationship between serum iron levels of asthmatic patients and their frequency of emergency admission for asthma exacerbation treatment. The patients who were followed up with a diagnosis of asthma for at least 12 months at the Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, whose current age is below 21, and whose serum iron, total iron binding capacity, and ferritin levels were checked between 2017 and 2019, were included in the study. In the assessment of 612 patients diagnosed with asthma, 105 individuals, constituting 18.4% of those under asthma follow-up, were identified as having anemia. Additionally, ID not progressing to anemia was observed in 120 patients, accounting for 21.1% of the total. Individuals with IDA and/or ID alone experienced a significantly higher frequency of emergency admissions for asthma exacerbations. Moreover, ID and/or IDA were established as independent risk factors linked to emergency admissions for asthma exacerbations. odds ratio = 1.56, confidence interval = 1.06-2.30 p = 0.022. In conclusion, it may be recommended to follow up the hemoglobin and iron parameters of asthmatic patients and to take nutritional and/or supportive preparations to keep them at a high level.

Birth cohorts and their current status and prospects in China

In the context of delayed marriage and parenthood, decreased willingness in having children, and population aging in China, maternal and child health has become an important and urgent issue. Being essential platforms for research in maternal and child health, the importance of birth cohorts has been widely recognized. In the past 20 years, tens of birth cohorts have been established in major cities and regions of China, with cohorts ranging from thousands to hundreds of thousands. These cohorts, particularly those large ones launched in recent years, have collected a wide spectrum of data and biological samples from mothers and children. Although they have made considerable preliminary achievements, there remain difficulties and challenges. The significant challenges include small and medium-sized cohorts' lacking of clear research themes; insufficient recognition of and emphasis on behavioral and social determinants of health while emphasizing biological determinants of health; variations in types of variables and quality of data collected, which make it difficult for cohorts to be merged and shared; lack of and difficulties in long-term follow-up; significant uncertainties in resources for long-term sustention of the cohorts, and so on. So, we argue that birth cohorts should focus on essential and urgent issues in maternal and child health in the country and seek recognition and support from the government and the entire society. Last but not least, the overall success of birth cohorts in the country requires scientists to be not only academically capable, but also realistic, persistent, altruistic, and collaborative.

Editor's view: Is the brain's perception of ideas an underappreciated human sense?

Humans have developed sensory organs for their 'major' senses and specific neuronal receptors for a number of additional senses. Although information from sensors is integrated and processed in the brain, the brain itself has not been proposed as a sensory organ associated with a particular sense - at least not in Western culture or scientific literature. Perception of ideas has many elements of a separate sense, with the brain being a primary sensory organ. I support this notion based on 17 years of experience in the application of the Child Health and Nutrition Research Initiative (CHNRI) method for setting research priorities, which resulted in more than 150 publications involving thousands of experts who prioritised more than 20 000 research ideas. This body of work allows for the generalisation of the following key concepts: defining an idea in the context of the brain's sensory perception; defining the point of origin, sensory qualities, and common types of ideas; considering responses of the body to the brain's sensory exposure to ideas; and defining the key criteria that the brain uses to discriminate between and prioritise ideas. The human brain is continuously being exposed to ideas, which can be self-generated, triggered by information from other sensors, or introduced from the external world. From the brain's sensory perspective, ideas are competing possibilities of purposeful activities that, if followed, would be expected to result in an alternative version of the future. Pursuing ideas tends to drive most of human activity. It requires prioritising between short-, mid-, and long-term investment of energy and time. The brain's sensory role is to continuously assess many competing ideas and prioritise between them based on motivational/emotional ('attractiveness'), operational/rational ('feasibility') and outcome-related perspective ('impact'). Exposure to new ideas may instigate physiological and psychological responses, ranging from enthusiasm and excitement to feeling a threat or fear. Ideas can be used to mobilise large groups of people whose brains respond with excessive enthusiasm that can sometimes be fanatical. The judgment on the attractiveness, feasibility, and potential impact of ideas is affected by education, experience, and cognitive abilities. This sense may be sharpened through an increased level of expert knowledge and experience. Misinformation and disinformation are dangerous because they affect the brain's perception of ideas. Impairment of this inherent sense may perhaps contribute to some mental health issues. The proposed view of the brain as the sensor of ideas could lead to many qualitative or quantitative experiments to further explore the properties of this sense in both individuals and populations, establishing 'the science of ideas'.

Antimicrobial utilisation patterns between 2013 and 2022 in Canadian neonates born at less than 33 weeks gestation: a retrospective cohort study

Excessive antimicrobial exposure is associated with an increase in neonatal mortality, morbidities and adverse neurodevelopment. Canadian Neonatal Network has been promoting judicious antimicrobial use through the Evidence-based Practice for Improving Quality processes. Our objective was to evaluate the antimicrobial consumption among neonates in tertiary neonatal intensive care units (NICU) in Canada in the recent decade. This is a retrospective cohort study including data from very preterm infants (born at <33 weeks gestational age) admitted to all NICUs in Canada between January 1, 2013, and December 31, 2022. Nationwide antimicrobial utilization rate (AUR) benchmarking started in 2016, and quality improvement initiatives were continued in the subsequent years to promote judicious use of antimicrobials across the network. AUR is defined as the number of days with ≥1 antimicrobial divided by the total patient days (PD). Culture-proven sepsis refers to a neonate with positive culture of pathogens in blood and/or cerebrospinal fluid. The outcomes were evaluated during pre- (2013-2017) and post-intervention periods (2018-2022). Interrupted time-series analysis was used, and comparison of AUR calculated per each 3-month time block and the slope changes were conducted across the pre- and post-intervention periods regarding total patients and subgroups. A total of 41,253 infants were included, with 22,644 (55%) being male. The AUR was significantly lower among infants from the post- vs. those from the pre-intervention periods (152 vs. 184, p<0.0001). Among 35,670 infants without culture-proven sepsis or necrotizing enterocolitis≥Stage 2, AUR was significantly lower in the post-intervention group vs. the pre-intervention group (110 vs. 136, p<0.0001). Interrupted time-series showed significant reduction in AUR during both pre- and post-intervention periods among all infants with and without culture proven sepsis or necrotizing enterocolitis≥Stage 2 (all p<0.0001), as well as those born at <29 weeks gestational age. A comprehensive, network-wide quality improvement initiatives led to a significant and sustained reduction in antimicrobial use among preterm infants born at <33 weeks gestational age with and without culture-proven sepsis or necrotizing enterocolitis≥Stage2. This study was supported by the Canadian Institutes of Health Research Project Grant 2019 (201903PJT-420294-CA2-CAAA-245530), matched funding from the British Columbia Women's Health Foundation and start-up funding from the Women and Children's Health Research Institute, University of Alberta. The coordinating center in Toronto is funded by the Canadian Institutes of Health Research grant for the Canadian Preterm Birth Network (PBN 150642).

Auckland University of Technology (AUT), Faculty of Health and Environmental Sciences Research Roadshow 2024

AUT’s Faculty of Health and Environmental Sciences Research Roadshow is an annual event showcasing the diversity of research undertaken by faculty researchers, and postgraduate students. The 2024 faculty research roadshow was held on Thursday 12 September at AUT’s North Campus. The AUT Child and Youth Health Research Centre investigates the impact of illness and disability, home and family, health services, nutrition, physical activity and the wider environment on young people. We are committed to providing a space for young people’s voices. CYHRC presented members’ research abstracts. The theme of the roadshow was ‘Partnerships for Impact’ which for CYHRC projects incorporates – Youth as participants and coresearchers – Researchers in this field aim for meaningful youth engagement throughout the research process, from design, through recruitment and fieldwork, to dissemination. All important are efforts to create inclusive environments, provide appropriate support for youth, and demonstrate willingness to share decision-making power. For example, in two projects refugee youth were coresearchers helping to shape decision-making related to their health. Increasing the visibility of youth and the challenges they face - By focusing on a range of tools and activities, young participants and researchers, including postgraduate students, can significantly enhance their impact, visibility, and contributions to their fields. Building a strong research profile takes time and persistence, but ongoing effort will yield long-term benefits for research careers and the wider society. Partnering with organizations and actors interested in youth health – Such partnerships can contribute to youth health and empowerment and significantly increase the impact of research on youth voicelessness by application of key strategies and ensuring that organisations foster appropriate cultures and mindsets within their own and other organisations. By fostering partnerships, researchers can create a more robust ecosystem for addressing youth voicelessness. This collaborative approach ensures that research is not only more comprehensive and relevant but also more likely to lead to tangible improvements in young people's lives and opportunities for their voices to be heard. Challenges of partnering with youth given issues of voicelessness These include adult-centric perspectives and organisations, power imbalances, and communications difficulties. While there are many challenges, the potential for improved research impact makes youth engagement a valuable indeed imperative approach, especially for those focused on youth issues, such as youth health and wellbeing.

Evaluation of a point-of-care immunochromatographic assay for enteric fever in Dhaka, Bangladesh: a prospective diagnostic accuracy study

There is a shortage of rapid, accurate, and low-cost assays for diagnosing enteric fever. The dual-path platform for typhoid (DPPT) assay had high accuracy in retrospective studies with banked plasma samples. We aimed to evaluate the diagnostic accuracy of the DPPT assay in a prospective study using fingerstick capillary blood. For this prospective diagnostic accuracy study, we enrolled children younger than 18years, who presented at the Bangladesh Shishu Hospital and Institute (Dhaka, Bangladesh) with at least 3days of fever. We collected blood and nasal swabs, and did the following assays to assess the accuracy of DPPT: blood culture, serological assays for typhoid fever (DPPT assay, Widal, and Test-it), and molecular assays to identify alternative aetiologies (eg, respiratory syncytial virus [RSV], influenza, dengue virus, and Rickettsia spp). The primary outcomes of the study were the sensitivity and specificity of the DPPT assay for diagnosis of enteric fever. We evaluated the accuracy of combined anti-haemolysin Eand anti-lipopolysaccharide IgA readings using the DPPT assay in distinguishing culture-confirmed enteric fever from alternative aetiologies using receiver operating characteristic area under the curve (AUC). Given the imperfect reference standard diagnostics for enteric fever, we used Bayesian latent class models, incorporating results from the typhoid and alternative aetiology diagnostics, to estimate the sensitivity and specificity of the DPPT assay. We also did subgroup analyses for the assay across multiple biological variables. Between Aug 17, 2021, and July 16, 2022, we enrolled 501participants who presented with at least 3days of fever. 223 (45%) of 501participants were female and 278 (55%) were male. 77participants had culture-confirmed enteric fever (62 Salmonella entericaserotype Typhi and 15 Salmonella entericaserotype Paratyphi A) and 70were culture-negative with PCR-confirmed alternative aetiology (34 influenza Aor B, 22dengue virus, seven Rickettsia spp, six RSV, and one participant co-infected with RSV and dengue virus). The AUC for DPPT on fingerstick capillary blood in distinguishing typhoid from alternative aetiologies was 0·969 (95% CI 0·943-0·994). In latent class analysis, the sensitivity of DPPT was 93%(95% credible interval [CrI] 87-97) and specificity was 89% (85-93). The balanced accuracy was higher for DPPT (91%, 95% CrI 87-94) than blood culture (81%, 78-85), Test-it (77%,74-79), or Widal (70%, 67-73). Assay performance did not vary by sex, age, duration of fever at presentation, antibiotic use before presentation, Salmonella serotype, or sample type. The point-of-care DPPT assay achieved high diagnostic accuracy for enteric fever in a highly endemic community. This assay has the potential to improve clinical outcomes for enteric fever, allowing rapid diagnosis and treatment, and could facilitate more appropriate antimicrobial use. National Institute of Health, Bill & Melinda Gates Foundation, and Child Health Research Foundation.

Building capacity for maternal, newborn and child health research in low-income country settings: A research fellowship experience in Ethiopia.

There is a need to build research capacity to improve maternal, newborn, and child health (MNCH) in low- and middle-income countries (LMICs). To address this gap, we co-designed the HaSET (meaning 'happiness' in Amharic) MNCH Research Fellowship programme for academics and policymakers in collaboration with the Ministry of Health (MOH) and academic institutions in Ethiopia. Based on interviews and focus group discussions regarding a landscape analysis of the MNCH research environment, we developed an innovative 'learning by doing' model in which fellows identified research questions, developed proposals, obtained institutional review board (IRB) approvals, conducted research, analysed data, disseminated their findings, and developed policy briefs. Postdoctoral fellows were paired with policymakers and health professionals at the MoH to facilitate the translation of research findings into policy and programmes. Each pair received mentorship from a member of the HaSET's scientific advisory group (SAG) who had expertise in research methods, data analysis, dissemination, and translation of evidence into policy. The HaSET MNCH Research Fellowship curriculum included 10 modules covering topics from biostatistics to study operations and professional development. From March 2021 to July 2023, five postdoctoral fellows from local universities and four policymakers from the MoH and government research institutes underwent the HaSET programme, where they learned to gather high-quality evidence on priority research questions and guide the implementation of national policies and programmes. Leveraging existing data, the fellows produced 15 manuscripts and 11 policy briefs. The programme established a functional research link between the MoH, regional health bureaus, and local universities, while utilising the SAG's expertise in mentorship. This robust and comprehensive HaSET MNCH Research Fellowship produced the first cohort of dedicated fellows trained in evidence-based medicine and mentored them to become effective public health professionals. They conducted high-quality studies to inform policy decisions on MNCH interventions in Ethiopia. Given its sustainability and scalability, researchers and academic institutions can further adapt the fellowship curriculum within capacity-building programmes to educate the next generation of research leaders in LMICs.

Addressing social norms for adolescent timing and spacing of pregnancy in low and middle-income countries: Developing a global research agenda.

Social norms shape adolescent sexual and reproductive health behaviours contributing to contraceptive and pregnancy outcomes. No global research agendas exist to guide research on adolescent social norms shifting in low- and middle-income countries (LMICs). We developed a social norms research agenda to improve adolescent healthy timing and spacing of pregnancy in LMICs. We adapted and applied the Child Health and Nutrition Research Initiative (CHNRI) method. A group of researchers guided the process, and consulted with diverse experts to develop a list of 21 research questions for global stakeholders to score via an online survey. Survey participants scored each research question according to four criteria (fills key gap, feasible, impactful, equitable). Research priority scores (RPS) and average expert agreement (AEA) statistics were calculated for each question and analysed overall and by stakeholder region and profession. We received 185 survey responses. Participants were, on average, 44 years old, 64% were women, 70% were from LMICs and 47% were implementers. The RPS ranged from 52 to 81% (74% median) and the AEA ranged from 49 to 70% (58% median). Nearly 70% of stakeholders gave the same score to each of the top five research questions. The top five research priorities focused on effective norm-shifting interventions (NSIs) strategies, processes and indicators to NSIs, and NSI adaptation and scale-up. Using a collaborative and rigorous process with diverse representation from LMICs and implementers, we reached consensus on five priority research questions to guide future adolescent social norms research to improve healthy timing and spacing of pregnancy in LMICs.

Research agenda for ending preventable maternal deaths from postpartum haemorrhage: a WHO research prioritisation exercise

IntroductionPostpartum haemorrhage (PPH) remains the leading cause of maternal death. Yet there is a lack of clarity around what research is needed to determine what works and how best to...

Health Implications of Black Identity Among Latinos: A Call for Afro-Latina Representation in Maternal Child Health Research.

Health Implications of Black Identity Among Latinos: A Call for Afro-Latina Representation in Maternal Child Health Research.

1.K. Scientific session: Health literacy of children and adolescents across Europe

Abstract Health literacy is developed throughout the life course. Enhancing health literacy at an early age is especially important since it may impact both current and future health skills and outcomes. Low health literacy in child and adolescent populations has been linked to worse health outcomes and health disparities in Europe, making health literacy of children and adolescents an important public health topic. Developing and delivering targeted interventions and services for these age groups requires insight and data on the development and state of health literacy in early age. However, child and adolescent health literacy is still an under-researched topic. This is partly due to a lack of appropriate measurement instruments and methods to involve children in research. In the past years, new studies on child and adolescent health literacy have emerged in several European countries. In this workshop, innovative studies from Germany, the Netherlands and the UK on HL in childhood and adolescence are introduced and discussed. Both methodological findings as well as empirical data will be presented. In Germany, an instrument to measure child health literacy was developed and validated for primary school children. This instrument, the HLS-Child-Q15, has been used both in Germany and in the Netherlands to study the relationship between children’s health literacy and their health behaviors and outcomes. In the UK, methods of involving primary school children in health literacy research were studied. Experiences with a Children’s Advisory Group will be shared. Another study in the Netherland focuses on the health literacy profiles and needs of adolescent patients with rheumatic diseases. The format of this workshop will be 4x10-minute presentations (including questions) followed by a 20-minute interactive discussion, reflecting on the relevance of these results to further research, health promotion and health services. which will be followed by Q&amp;A and an open discussion with the audiences. This workshop offers a forum for researchers, health educators, practitioners and policy-makers interested in health literacy measurement and research in children and adolescents. Key messages • Child and adolescent health literacy is an important, yet under-researched public health topic. • Child health literacy is an important predictor of their health behavior and outcomes.

The Living Lab at Home: Feasibility and Acceptability of Multimodal In-Home Data Collection Among Youth Across the Developmental Spectrum.

Dynamic, real-time, in-home methods of data collection are increasingly common in child health research. However, these methods are rarely cocreated or used with families of youth with developmental disabilities. We aimed to determine the feasibility of codesigned methods for in-home data collection for youth across the developmental spectrum. Sixteen youth (14-18 years) with autism spectrum disorder, cerebral palsy, and/or chronic pain completed 14 days of data collection, wearing an accelerometer, answering Ecological Momentary Assessment (EMA) questionnaires, and collecting salivary cortisol samples. Participants completed a poststudy interview regarding their experiences. Data were analyzed for feasibility, quantity, and quality. At least 1 EMA response was provided on 73% of days, with 54% of the total number of administered prompts answered before the next prompt arrived. In total, 77% of participants wore the accelerometer ≥10 hours for at least 7 days. Adherence to 8-day saliva sampling after accounting for protocol violations and dry samples was 28%. No significant adverse events were reported aside from mild emotional distress (25%). Families reported generally high satisfaction, willingness to participate again, and acceptability, with moderate burden and interference. Qualitative interviews described: (1) the research question's value to the family as a motivator of engagement; (2) in-home data collection is not a passive or neutral experience; (3) personalized approaches and context are important to families; and (4) a clear need for continued iteration and engagement. In-home multimodal data collection is potentially feasible for families across the developmental spectrum but requires iteration based on family feedback to increase adherence.

What aspects of outcome measurement instruments are important to parents and caregivers in child health trials: Survey protocol

Background Trials of interventions to prevent illness and/or improve health outcomes in children play a crucial role in the advancement of paediatric healthcare, research, and policy. It is important for researchers and trialists involved in such trials to understand factors which are important to parents/caregivers when deciding to participate and provide data about their child. There is little evidence to date surrounding the impact of outcome measurement instruments (OMIs) on parents/caregivers’ decisions about participation and provision of data in trials. The aim of this project is to examine what characteristics of OMIs are important in parents/caregivers’ decisions to engage with and participate in trials of interventions to prevent childhood illness and/or improve child health outcomes. Methods An online cross-sectional survey is being conducted. Survey recruitment began July 2024 and will be completed in October 2024. Parents/caregivers are eligible to participate if they have at least one child up to 12 years of age; there are no restrictions based on factors such as gender or nationality. Survey participants are being recruited using convenience sampling via social media, parenting websites, and online forums. This survey includes questions about parents/caregivers’ preferences for how, when, where, and with whom data is collected in child health research, as well as the types of OMIs parents/caregivers would be most comfortable using. Data will be analysed using descriptive statistics. Conclusions Findings from this study will address the current gap in knowledge related to preferences of parents/caregivers in how data are collected in trials of interventions to improve health outcomes in children. Study findings will inform trialists in the design and conduct of child health research in the future. Implementation of study findings in future trials can also improve experiences of children and their caregivers engaged in research and enhance the quality and quantity of data being collected.

Health research priorities in Pakistan: A Child Health and Nutrition Research Initiative (CHNRI) exercise.

The National Health Vision of Pakistan 2016-2025 is to provide affordable health services through a resilient and responsive health system for achieving health-related Sustainable Development Goals (SDGs) and universal health coverage (UHC) targets. Through this study, we wanted to identify the research priorities at the national level that would help to provide the necessary evidence for achieving this vision through essential package of health services (EPHS). We followed World Health Organization (WHO) guidance for undertaking research priority-setting exercises and the Child Health and Nutrition Research Initiative (CHNRI) methodology in conducting this national exercise. The proposed research options for the next three to five years were identified in five thematic research areas: communicable diseases; non-communicable diseases (NCDs) and injuries; reproductive, maternal, newborn, child, and adolescent health (RMNCAH); mental health; and health systems and services. We assessed these research options against five priority-setting criteria: feasibility, public health importance, sustainability, equity, and community involvement. Forty-three experts proposed 272 research ideas, which were consolidated into a list of 155 research options and sent back to the experts for scoring. The top 10 research priorities in each of the five research areas were identified based on the weighted research priority scores (wRPS) rankings. Tuberculosis and antimicrobial resistance; NCD screening and prevention; maternal and neonatal mortality; mental health of children, adolescents, and youth; and human resource management were the issues that were most frequently reflected in the list of research priorities. Most research priorities aimed to identify barriers to the implementation of interventions. Through this exercise, we identified the top 50 national health research priorities, which also have a strong correlation with EPHS interventions. To realise the findings of this exercise, funding agencies should establish funding mechanisms to support the undertaking of the identified research priorities, and academic researchers should actually utilise them in future studies. Such activities could hopefully contribute to achieving the national health goals.