Country Child Research Articles

The deinstitutionalization of children and adolescents in El Salvador's child protection system

BackgroundIn 2010, El Salvador introduced legislation aimed at reforming the country's Child Protective System (CPS), with a focus on promoting deinstitutionalization. ObjectiveThe study aim was to explore the impact of deinstitutionalization on the Salvadoran CPS. Participants and settingThe study was conducted in El Salvador, granting authors unique access to key informants with extensive experience in the country's CPS. Unlike the United States, which is divided into states, El Salvador is divided into departments, and CPS providers were recruited from all 14 departments. Focus groups were facilitated in the East, West, and Central zones to ensure representation from all regions. MethodsQualitative semi-structured interviews (n = 26) were conducted in June/July of 2019, which were then followed by focus groups (n = 4) in August 2019. The analysis of the data employed a combination of deductive and inductive thematic coding methods. ResultsCPS providers offered valuable insights, categorized into five main themes: (1) Strengths of El Salvador's CPS, (2) Deinstitutionalization policy encompassing socioenvironmental contextual factors, (3) Challenges in the deinstitutionalization process, including insufficient follow-up on deinstitutionalized children, (4) Recommendations from participants, highlighting the importance of enhancing stakeholder coordination/collaboration, and (5) The necessity for a paradigm shift, emphasizing the need to redefine the social contract on protecting children from child maltreatment. ConclusionsThe Salvadoran CPS requires substantial systemic changes. Encouragingly, key informants have demonstrated a commitment to reform not only the deinstitutionalization process but also the broader CPS system in El Salvador including case management and quality of care in institutional settings.

Weak State as a Security Threat: Study Case of El Salvador (2014-2019)

Weak State as a Security Threat: Study Case of El Salvador (2014-2019)

The Pediatrician Workforce in the United States and China.

From 2019 to 2022, the For Our Children project gathered a team of Chinese and American pediatricians to explore the readiness of the pediatric workforce in each country to address pressing child health concerns. The teams compared existing data on child health outcomes, the pediatric workforce, and education and combined qualitative and quantitative comparisons centered on themes of effective health care delivery outlined in the World Health Organization Workforce 2030 Report. This article describes key findings about pediatric workload, career satisfaction, and systems to assure competency. We discuss pediatrician accessibility, including geographic distribution, practice locations, trends in pediatric hospitalizations, and payment mechanisms. Pediatric roles differed in the context of each country's child health systems and varied teams. We identified strengths we could learn from one another, such as the US Medical Home Model with continuity of care and robust numbers of skilled clinicians working alongside pediatricians, as well as China's Maternal Child Health system with broad community accessibility and health workers who provide preventive care.In both countries, notable inequities in child health outcomes, evolving epidemiology, and increasing complexity of care require new approaches to the pediatric workforce and education. Although child health systems in the United States and China have significant differences, in both countries, a way forward is to develop a more inclusive and broad view of the child health team to provide truly integrated care that reaches every child. Training competencies must evolve with changing epidemiology as well as changing health system structures and pediatrician roles.

A COMPARATIVE STUDY ON CHILDHOOD VACCINATION POLICY IN THE UNITED STATES, AUSTRALIA, EUROPE AND MALAYSIA

Vaccination from an early in life is one of the most effective medical strategies for reducing infant mortality and morbidity while also ensuring the well-being of society. Following World Health Organization (WHO) recommendations, vaccination is provided free of charge to children worldwide as part of the country's maternal and child health programmes. Nevertheless, many people believe vaccines are harmful and unnecessary, even though they are widely accepted as an effective preventive measure in public health. Many previously eradicated infectious diseases have reappeared because of vaccine hesitancy. Due to vaccine rejection, vaccine avoidance is becoming increasingly common around the world. As a result, the WHO has identified vaccine hesitancy as one of the top ten global health threats for 2019. However, policies that encourage parents to vaccinate their children, on the other hand, may increase their willingness to do so. Government policy instruments such as mandatory regulation, incentives, promotion, and education can be used to influence parental intentions. Policy measures can encourage parents' intentions to vaccinate their children. Consequently, governments can use policy instruments like required regulation, incentives and promotion to control parents' intentions. This paper examines relevant literature on childhood vaccination policies in several countries, including Malaysia, using academic journals and observations from various articles. It is hoped that this study will add to existing knowledge about childhood vaccination policies around the world.

Determining the Maternal Risk Factors Contributing to the Birth of Low Birth Weight Newborn: A Case-Control Study

Aim:To determine the maternal risk factors contributing to the birth of low birth weight newborn Study design: A case-control study Place and Duration:This study was conducted at ChildLife Foundation (CLF), Paediatric Emergency NICH Karachi Pakistan from August 2021 to January 2022. Methodology:A total of 920 mothers were included in the study that delivered the baby during the mentioned time frame, out of which 460 were cases and 460 controlled mothers for the comparative analysis of risk factors. All the newborns weighing less than 2500 grams of weight were considered as respective cases for the study. Newborns that weight more than 2500 grams were included in the control groups Results:The mean weight of newborn cases was 2.07 ± 0.45 kilograms and 3.14 ± 0.36 kilograms in the newborn control group. However, the mean gestational age of the cases was 37.2 ± 1.48, and the control was 38.3 ± 1.23 weeks. Whereas mothers of 37.2% of cases and 38.7% of control had no education background, 76% of cases had low HB levels, and 68.7% of cases had less than 24 months of the birth interval were relatedto low birth weight. There was no direct associationbetweenmaternal hypertension and low birth weight among newborns observed in the present study. Conclusion:The present study concluded that maternal low HB levels, poor socioeconomic status, low BMI, poor educational background and close birth spacing have a strong association with LBW among newborns. The country's child and maternal health care services should be prioritized to address these issues. Keywords: Childbirth, Infant mortality, Low birth weight, Neonatal mortality, Parental risk factors.

Assessment of Nutritional Status Using Anthropometric Methods and Assessment of Knowledge and Attitude of Nursing Mothers towards Breast Feeding Practices

"Your well-being will be determined by the type of food you eat," according to a popular adage. In any case, a powerful eating regimen consists of really important upgrades in the appropriate degree. It inhibits the onset of illnesses such as obesity, diabetes, heart disease, illness, and stroke, to name a few examples. Infants and small children dealing with practices are crucial in maintaining nutritional status of children aged 0 to 2 years, who are frequently influenced by daily practices. There is a correlation between children's apparent lack of solid meals and the country's child persistence rates. It is vital for children's growth and success to focus on further improving these behaviours. During the peak period of development in the first two years of life, illness and poor health have an impact on children's advancement potential. Breastfeeding is a basic human behaviour that benefits the infant and the mother's health, as well as providing a considerable financial incentive for families and social orders. The goal of the current study was to acquire a deeper grasp of the promising findings and perspectives on breast milk among rural nursing moms. A total of 200 nursing women from the city and 200 from the rural would be included in the research. A purposeful random sampling approach was used to acquire data. The information was acquired from nursing mothers using a coordinated overview to look at their food habits and attitudes. Following data collection, processing, analysis, and the post-intervention included substantial information on breastfeeding practices and their relevance. Then, under numerous areas, their nutritional knowledge and attitude, as well as nutritional health anthropometric parameters, were examined again. To code, information and attitude were employed. The content and measurable investigation was then completed, and the operating frequency was determined.

Errors and mistakes in child protection: International discourses, approaches and strategies By KayBiesel, JudithMasson, NigelParton and TarjaPösö (eds.). Bristol: Policy Press, 2020. ISBN 978‐1‐4473‐5070‐5, 296 pp., 26.99 GBP (pb), 40 GBP (hb)

Reading this engaging book, I was reminded of an incident in which I, as a social work practitioner and academic, presented a case study to the head of child protection services in Israel. The case involved a high-risk crisis situation that ended with the children remaining at home with their mother. When I completed my presentation, the senior social worker remarked, ‘that's a piece of good practice, but in the current era, if something had happened to one of the children, you would have been grilled (i.e., interrogated intensely)’. This incident exemplifies one of the main underlying assumptions of the book: that errors and mistakes in child protection are socially (and, I would add, politicly) constructed concepts rather than objective or universal ones. Hence, what is considered an error or mistake in a specific context may not be seen in such a way in another. Moreover, the same action or inaction may be judged very differently depending on the outcomes. Considering that in the context of child protection systems mistakes and errors can have life-altering consequences, the importance of understanding and conceptualising policies, practices and public perceptions regarding them is clear. The book addresses this complexity from a cross-national perspective, employing a constructivist approach. Its first two chapters contextualise different perceptions and explanations of errors and mistakes and provide a framework for defining and analysing them. These chapters are important in differentiating between errors—i.e., deviations from legal or professional duties and standards—and mistakes, i.e., actions or inactions based on misbeliefs and misunderstanding. The following 11 chapters present a critical analysis of the construction of errors and mistakes in child protection systems across various countries (England, Ireland, the Netherlands, Finland, Norway, Sweden, Switzerland, Germany, France, Italy and the USA). Each of these chapters begins with a valuable and informative general overview of the child protection system in the country under discussion and continues with an analysis of the construction of errors and mistakes in that country. Although all the chapters revolve around errors and mistakes and share a constructionist approach, their structures and foci vary, and the different authors of the chapters employ a variety of analytical and conceptual frameworks. The authors of the final chapter did not settle for a summary of the various insights, findings, and concepts presented in the different chapters. Rather, they present a comparative analysis that provides readers with a new conceptual framework for understanding different aspects of the issue at hand. These include: (a) an outline of the triggers for national discussions about errors and mistakes in child protection—mainly serious or fatal cases (e.g., the Baby P. inquiry in England and the case of Savanna in the Netherlands) and public inquiries of institutional abuse (e.g., the Kilkenny incest investigation in Ireland); (b) six kinds of key responses to errors and mistakes, including, e.g., a scandalisation response that involves media outrage and the blaming of individuals or a regulation response that focusses on limiting social workers' discretion and developing procedures and standard guidelines; (c) three strategies countries employ to avoid or handle errors and mistakes. Here the authors emphasise the importance of responding in an ethical way that supports practitioners' use of effective tools and guidelines while considering service users' perspectives to learn from mistakes and improve practice; (d) an analysis of the relationship between a country's child protection orientation (Gilbert et al., 2011) and its responses to errors and mistakes. I found this section especially important because it makes it possible to link many of the difficulties and complexities workers face in their everyday work to the wider and more political context of social policy. In this context, it is worth noting that with a few minor exceptions, the book largely overlooks the ways in which the social inequality that permeates various child protection systems across the world (Bywaters et al., 2019) is manifested in relation to error and mistakes. In sum, this book provides a comprehensive and insightful discussion and analysis of errors and mistakes in child protection. Its rich and informative content inspires reflection on the social and political mechanisms that construct not only errors and mistakes, but many other dimensions of child protection policy and practice across the world.

Первичный центр детского инсульта на базе многопрофильного педиатрического стационара. Новая реальность в педиатрии

Background. The increase in the number of diagnosed strokes in children, significant distinctive features and complexity of diagnosis, treatment and prevention of cerebrovascular diseases in children compared with adults, the impossibility of direct extrapolation of therapeutic recommendations from adult practice to pediatrics required the creation of specialized primary centers of pediatric stroke in Russia. Purpose. The purpose of this article is to describe the experience of organizing a Center for the treatment of children and adolescents with cerebrovascular diseases (hereinafter referred to as the Center) on the basis of the multidisciplinary pediatric hospital of the Morozovskaya Children's City Clinical Hospital of Moscow Healthcare Department, the introduction of modern methods of diagnosis and treatment of strokes in pediatrics, the organization of preventive measures, maintaining the city register of children's stroke, coordinating the provision of medical care to children with cerebrovascular diseases at various levels in the city of Moscow. Materials and methods. The presented experience of organizing and operating the Center covers the period from 2014 to 2019. Researchers used descriptive, statistical, and comparative analysis to demonstrate the Center's performance and justify proposed improvements in diagnostics, management of pediatric patients with cerebrovascular disease, and relapse prevention. Results. In the course of the organization and operation of the Center, there was assessed the frequency of children's strokes in the city: in 2015 - 6.59 cases per 100 thousand of the child population of Moscow; in 2016 - 6.51 per 100 thousand; in 2017 - 6.43 per 100 thousand and in 2018 - 5.86 per 100 thousand. There were improved: the diagnostics of cerebrovascular pathology and its algorithm, modern reperfusion methods of treatment (thrombolysis, thromboextraction) were introduced into practice, outpatient observation. The equipment and trained specialists concentration on the basis of the Center allowed the creation of the Center "full cycle". Maintaining the city register of pediatric stroke made it possible to compare Russian data with those available in the literature and to establish international cooperation with the International Pediatric Stroke Organization. Conclusion. The establishment of the Center is an important example of interdisciplinary interaction in pediatrics. The City Register of Pediatric Stroke will make it possible to assess the problem of childhood stroke in Moscow. The accumulated organizational, medical and diagnostic, scientific, international and educational experience of the Center can be introduced in other regions of the Russian Federation to improve the provision of medical care to children and to solve the most important problem - preserving the health of the country's child population.

Review of benefits and risks for children in open adoption arrangements

AbstractFollowing changes to our country's child protection legislation in 2015, adoptees in Spain have the possibility of post‐adoption contact with their birth families. This review aims to provide social workers with a resource to guide their decision‐making by evaluating both the benefits and risks associated with open adoption. Of the 26 studies reviewed, 22 reported benefits and 8 discussed risks. Overall, contact with birth families is more commonly associated with positive than with negative outcomes for the adoptee, especially when the adoptive family is capable of communicative openness. The results support current policy on open adoptions, but in line with previous research, we emphasize the need for contact arrangements to be decided on a case‐by‐case basis and to be monitored.

Efficacy of a Digital Health Tool on Contraceptive Ideation and Use in Nigeria: Results of a Cluster-Randomized Control Trial.

Contraceptive prevalence in Nigeria remains among the lowest in the world, which substantially contributes to the country's high maternal and child mortality. Mobile phone technology penetration has increased considerably in Nigeria, opening opportunities for programs to use this medium for reaching their intended audience with health-protective information. In 2017, the Health Communication Capacity Collaborative conducted a cluster-randomized control trial in Kaduna City to assess the efficacy of the digital health tool Smart Client on ideational and behavioral variables related to family planning. Twelve wards in the city were randomly assigned to intervention (6 wards) and control (6 wards) arms of the study. A total of 565 women aged 18-35 years were randomly selected from study wards and consented to participate in the study. At recruitment, the women completed a baseline survey. The women in the intervention group were registered to receive 1 welcome call, 13 program calls, and 3 quiz calls on their mobile phones. Each of the program calls had several segments, including introduction, drama episode, and friend-to-friend chat. The last quiz call included evaluation questions. Women in the control arm received no intervention. The efficacy of the intervention was assessed using both per-protocol and intent-to-treat differences-in-differences techniques. The intervention and control arms were equivalent in terms of key sociodemographic characteristics, with the exception of religion. Attrition was a major challenge in the study. On average, participants receiving the intervention listened to 7.2 drama episodes but only 2.6 personal stories and 1.1 sample dialogues. The results of both per-protocol and intent-to-treat analyses show that the intervention was efficacious in improving relevant ideational and behavioral outcomes. For example, the intent-to-treat results show that the intervention increased women's perceived level of confidence to discuss family planning with a provider by 27.7 percentage points and modern contraceptive prevalence by 14.8 percentage points. This efficacy assessment showed that using an interactive voice response-based digital tool that includes drama is a viable option for promoting positive ideation about family planning and increasing contraceptive use in Nigeria. Significant lessons learned from this efficacy trial include informing participants at the time of recruitment of what the opening segment of the calls will sound like to avoid the calls being mistaken for telemarketing calls and intensive testing prior to scale-up to avoid potential attrition due to technical issues.

Implementation of deinstitutionalization of child care institutions in post-soviet countries: The case of Azerbaijan

Institutional care has proven to be detrimental for child development. This study examined the status of the State Program on Deinstitutionalization and Alternative Care (SPDAC), a public policy aimed at transforming 55 institutions covering 14,500 children during 2006–2016 in Azerbaijan. The success of this public policy was crucial for the country's entire child welfare system. The study used a crosssectional, descriptive, exploratory, and qualitative method. Data were collected through in-depth, semistructured interviews and archival resources. Twenty key informants were selected through a purposive sampling strategy. They led projects or were heads of departments related to implementing the SPDAC at government agencies, national or international nongovernmental organizations, UNICEF, or as social workers in newly established alternative services. Interviews were analyzed in TAMSAnalyzer. Themes supporting possible explanations such as lack of political will, weak child protection systems, weak civil society, illequipped human resources, absence of alternative services, and low levels of knowledge of children's rights emerged in the analysis. The findings could contribute to research on child welfare reform and reflect hidden factors behind policies to guide practice in former Soviet Union states and countries rich in natural resources such oil, gas, and minerals. The primary finding of a lack of political will raises the question of how to create political will and how to motivate government officials to invest in the welfare of children.

Entrenched geographical and socioeconomic disparities in child mortality: trends in absolute and relative inequalities in Cambodia.

BackgroundCambodia has made considerable improvements in mortality rates for children under the age of five and neonates. These improvements may, however, mask considerable disparities between subnational populations. In this paper, we examine the extent of the country's child mortality inequalities.MethodsMortality rates for children under-five and neonates were directly estimated using the 2000, 2005 and 2010 waves of the Cambodian Demographic Health Survey. Disparities were measured on both absolute and relative scales using rate differences and ratios, and where applicable, slope and relative indices of inequality by levels of rural/urban location, regions and household wealth.FindingsSince 2000, considerable reductions in under-five and to a lesser extent in neonatal mortality rates have been observed. This mortality decline has, however, been accompanied by an increase in relative inequality in both rates of child mortality for geography-related stratifying markers. For absolute inequality amongst regions, most trends are increasing, particularly for neonatal mortality, but are not statistically significant. The only exception to this general pattern is the statistically significant positive trend in absolute inequality for under-five mortality in the Coastal region. For wealth, some evidence for increases in both relative and absolute inequality for neonates is observed.ConclusionDespite considerable gains in reducing under-five and neonatal mortality at a national level, entrenched and increased geographical and wealth-based inequality in mortality, at least on a relative scale, remain. As expected, national progress seems to be associated with the period of political and macroeconomic stability that started in the early 2000s. However, issues of quality of care and potential non-inclusive economic growth might explain remaining disparities, particularly across wealth and geography markers. A focus on further addressing key supply and demand side barriers to accessing maternal and child health care and on the social determinants of health will be essential in narrowing inequalities.

Determinants of childhood mortality in slums of Karachi, Pakistan.

Pakistan has an infant mortality rate (IMR) of 90.5/1000 live births, and the country's child mortality level of 117.5 is worse than in other South Asian countries. Rapid population growth combined with rural-to-urban migration has led to the creation of urban slums in which morbidity levels are usually higher than in rural populations. A study was conducted in January 1993 in 6 slums of Karachi where the Aga Khan University has operated primary health care programs since 1985. Researchers recorded the deaths of 347 children under age 5 years old due to diarrhea and acute respiratory infections (ARI) during 1989-93. 235 mothers of these children were interviewed. The following are discussed as risk factors for under-5 child mortality: the use of traditional healers, poor nutritional status, incomplete or no immunization, the quick change of healers, inappropriate child care arrangements, mother's literacy, who decides about outside treatment, short birth interval, bottle feeding, and nuclear family structure. Maternal autonomy, appropriate health-seeking behavior, and child-rearing processes identified in the study point to the need for intervention strategies which go beyond the usual primary health care initiatives and involve communities in developing social support systems for mothers.

Causes of Health Inequalities in Uganda: Evidence from the Demographic and Health Surveys

Abstract: Despite sustained macroeconomic growth and impressive income poverty reduction in Uganda, the country's total child nutrition status remains poor. More so, wide within country disparities in stunting and underweight rates exist across the country. This study explored the determinants of child nutrition status and in Uganda using three rounds of the Uganda demographic and health surveys undertaken during 1995–2006. The surveys are nationally representative and capture anthropometric indicators for children aged below 5 years. The study investigated the determinants of health inequalities focusing on child health status through a combination of decomposition and regression analysis. Our results show that household welfare status remains a key determinant of child health status and inequalities in health. Furthermore, the results show that individual maternal education matters more in enhancing child health than does community knowledge about health.

Child and adolescent injury report card: New Zealand 2009

Injury is the leading cause of death of children and adolescents. Among the Organisation for Economic Co-operation and Development nations, New Zealand has the highest rate of child and adolescent injury death. This study aimed to evaluate the status of New Zealand's child and adolescent unintentional injury prevention. The methodology of the European Child Safety Alliance Child Safety Report Card (completed for 24 countries in Europe, generating a standardised assessment of child and adolescent injury prevention) was applied to New Zealand's injury prevention position. New Zealand's position with regard to 102 questions (spanning 12 injury topics) was investigated. This information was systematically presented to a panel of child and adolescent injury experts, and agreed scores for each item were derived. New Zealand's overall score was 33/60. Deficiencies were identified across many injury prevention topics including passenger and driver safety, pedestrian safety, water safety, falls, poisoning, burns/scalds and choking/strangulation. New Zealand lacks a robust home visiting programme and injury prevention strategies with specific child and adolescent targets. New Zealand has not implemented a number of evidence-based injury prevention policies. The information from this study should be interpreted in conjunction with the epidemiology of child and adolescent injury in New Zealand. The Child Safety Report Card provides a useful methodology to guide a country's child and adolescent injury prevention policy direction.

Public expenditure, locality characteristics and child outcomes

The study explored whether locality characteristics are related to the proportion of local public expenditures on education and welfare and to a set of child outcomes (reported maltreatment rates; juvenile delinquency; success in matriculation exams; and rate of children known to social services). Specifically, we checked whether the proportion of public expenditures aligned with local needs, and whether they played a role in child outcomes. Data was collected for 172 localities in Israel that were home to approximately 34% of the country's child population. Findings show a clear relationship between the proportion of public expenditures on education and welfare and the socioeconomic characteristics of the locality. Further, the study established an association between child outcomes and the localities' socioeconomic characteristics. Findings show that Arab children are disadvantaged when compared to their Jewish counterparts. The study further supports the belief that locality matters, and that by changing locales, one can improve children's well being. The study only partially supported the notion that proportions of public expenditures on education and welfare are related to child outcomes.

The Rise and Fall of Court Prerogatives in Paternity Establishment

Much of the policy analysis literature takes the institutional structure in which a program operates?bureaucratic agencies or the courts?as given. Policy inputs proceed through the "black boxes" of institutions to produce a given set of outcomes. In this model, insti tutions are merely the channels by which policy goals are measured by either qualitative or quantitative impacts on a target population. What is missing from that paradigm, however, is the recognition that the mediating institutions themselves are the result of a particular constellation of determining forces and that these forces can have very real consequences on individuals' lives. One increasingly contentious area of debate surrounding institutional choice is paternity establishment in child support cases. Paternity establishment is a fundamental component of effective child support collection, especially as the number of out-of-wed lock births has risen from 400,000, or 10 percent of all births, in 1970 to 1.3 million, or 33 percent of all births, in 1999.1 The central question is, where should it be conducted, in the state courts or in the state administrative agencies that run the child support pro gram? Most recently, the states have answered that paternity establishment should take place under the direction of the variety of administrative agencies that run the country's child support programs. These agencies run the gamut from public welfare agencies in most states to attorney general offices and departments of revenue in others. These child support agencies, in turn, also supervise paternity establishment procedures in numerous local units, such as hospitals and town halls. This choice represents a dramatic break with past practices of deciding all such cases in the court system. How has such a mon umental change in public policy taken place? What factors mobilized such a change, and what does the current system look like? In describing this process of institutional evolution, the first section of this analysis will present the ways in which paternity cases were routinely determined under the state

Trans-Manche Partnerships

What makes one country's child protection system different from another? Rachael Hetherington describes a pilot project which looks at the different approaches adopted by English and French social workers in their child protection work, and in particular to how they work ‘in partnership’ with parents.