Global Child Health Research Articles

Scale-up of Global Child and Youth Mental Health Services: A Scoping Review

Numerous influential policy and scientific bodies are calling for more rapid advances in the scale-up of child and youth mental health services (CYMHS). A number of CYMHS innovations hold promise for advancing scale-up but little is known about how real-world efforts are progressing. We conducted a scoping review to identify promising approaches to CYMHS scale-up across the globe. Searches were completed in six databases (Academic Search Complete, CINAHL, MEDLINE, PsychInfo, PubMed, and Web of Science). Article selection and synthesis were conducted in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) checklist. A second search focused on low-and-middle-income countries (LMIC) was conducted based on the Cochrane Library recommended search filters of the World Bank listed LMIC countries. Authors used a double coding strategy during the title/abstract and full-text review. Twenty-eight articles meeting the eligibility criteria were identified that described 22 initiatives (in 11 different countries). Our review found the majority of published scale-up studies in CYMHS were not informed by scale-up frameworks in design or reporting. The methods and outcomes used in the identified articles were highly variable and limited our ability to draw conclusions about comparative effectiveness although promising approaches emerged. Successes and failures identified in our review largely reflect consensus in the broader literature regarding the need for strategies to better navigate the complexities of system and policy implementation while ensuring CYMHS interventions fit local contexts.

Applied artificial intelligence for global child health: Addressing biases and barriers.

Given the potential benefits of artificial intelligence and machine learning (AI/ML) within healthcare, it is critical to consider how these technologies can be deployed in pediatric research and practice. Currently, healthcare AI/ML has not yet adapted to the specific technical considerations related to pediatric data nor adequately addressed the specific vulnerabilities of children and young people (CYP) in relation to AI. While the greatest burden of disease in CYP is firmly concentrated in lower and middle-income countries (LMICs), existing applied pediatric AI/ML efforts are concentrated in a small number of high-income countries (HICs). In LMICs, use-cases remain primarily in the proof-of-concept stage. This narrative review identifies a number of intersecting challenges that pose barriers to effective AI/ML for CYP globally and explores the shifts needed to make progress across multiple domains. Child-specific technical considerations throughout the AI/ML lifecycle have been largely overlooked thus far, yet these can be critical to model effectiveness. Governance concerns are paramount, with suitable national and international frameworks and guidance required to enable the safe and responsible deployment of advanced technologies impacting the care of CYP and using their data. An ambitious vision for child health demands that the potential benefits of AI/Ml are realized universally through greater international collaboration, capacity building, strong oversight, and ultimately diffusing the AI/ML locus of power to empower researchers and clinicians globally. In order that AI/ML systems that do not exacerbate inequalities in pediatric care, teams researching and developing these technologies in LMICs must ensure that AI/ML research is inclusive of the needs and concerns of CYP and their caregivers. A broad, interdisciplinary, and human-centered approach to AI/ML is essential for developing tools for healthcare workers delivering care, such that the creation and deployment of ML is grounded in local systems, cultures, and clinical practice. Decisions to invest in developing and testing pediatric AI/ML in resource-constrained settings must always be part of a broader evaluation of the overall needs of a healthcare system, considering the critical building blocks underpinning effective, sustainable, and cost-efficient healthcare delivery for CYP.

Etiology of hospital mortality in children living in low- and middle-income countries: a systematic review and meta-analysis.

In 2019, 80% of the 7.4 million global child deaths occurred in low- and middle-income countries (LMICs). Global and regional estimates of cause of hospital death and admission in LMIC children are needed to guide global and local priority setting and resource allocation but are currently lacking. The study objective was to estimate global and regional prevalence for common causes of pediatric hospital mortality and admission in LMICs. We performed a systematic review and meta-analysis to identify LMIC observational studies published January 1, 2005-February 26, 2021. Eligible studies included: a general pediatric admission population, a cause of admission or death, and total admissions. We excluded studies with data before 2,000 or without a full text. Two authors independently screened and extracted data. We performed methodological assessment using domains adapted from the Quality in Prognosis Studies tool. Data were pooled using random-effects models where possible. We reported prevalence as a proportion of cause of death or admission per 1,000 admissions with 95% confidence intervals (95% CI). Our search identified 29,637 texts. After duplicate removal and screening, we analyzed 253 studies representing 21.8 million pediatric hospitalizations in 59 LMICs. All-cause pediatric hospital mortality was 4.1% [95% CI 3.4%-4.7%]. The most common causes of mortality (deaths/1,000 admissions) were infectious [12 (95% CI 9-14)]; respiratory [9 (95% CI 5-13)]; and gastrointestinal [9 (95% CI 6-11)]. Common causes of admission (cases/1,000 admissions) were respiratory [255 (95% CI 231-280)]; infectious [214 (95% CI 193-234)]; and gastrointestinal [166 (95% CI 143-190)]. We observed regional variation in estimates. Pediatric hospital mortality remains high in LMICs. Global child health efforts must include measures to reduce hospital mortality including basic emergency and critical care services tailored to the local disease burden. Resources are urgently needed to promote equity in child health research, support researchers, and collect high-quality data in LMICs to further guide priority setting and resource allocation.

Internet of things-based digital scale to detect stunting symptoms in babies under two years of age

Given the ongoing global challenge of stunting, characterized primarily by chronic underweight in infants under two years of age, a new approach leveraging digital scale and the internet of things (IoT) has been developed. This innovative system was designed to facilitate the early detection and continual monitoring of stunting symptoms caused by malnourishment. Key features include an IoT-enabled digital scale for precise weight measurement, a robust cloud platform for reliable data storage and comprehensive analysis, and an easy-to-use mobile app for user engagement. This system demonstrates its potential to simplify tracking fluctuations in baby weight and development progress related to stunting over time. Early trials demonstrated an impressive accuracy rate of 99.4% in body weight measurements and provided excellent conclusions in determining the body weight status of the infants. Overall, this IoT-based solution catalyzes the improvement of stunting detection methodologies and early intervention strategies, thus promising a better solution and a significant positive impact on global child health.

World health assembly resolution for preventing micronutrient deficiencies and associated neural tube defects-A case study of global partnerships for a successful resolution adoption.

On May 29, 2023, the 76th World Health Assembly (WHA) unanimously adopted the resolution entitled, "Accelerating efforts for preventing micronutrient deficiencies and their consequences, including spina bifida and other neural tube defects, through safe and effective food fortification."The Society for Birth Defects Research and Prevention published their resolution in 2015 supporting mandatory fortification of staple foods with folic acid and recommendations aiming to achieve global total prevention of folate-sensitive spina bifida and anencephaly, setting a goal to achieve by the year 2024.The WHA resolution provides another global push for the cause, with recommendations to member nations for food fortification to be achieved by the year 2030. This short communication documents the steps, from inception up to the passage, of the 76th WHA resolution on food fortification, with a narrative on the nature of strategic advocacy efforts by multiple governmental and nongovernmental organizations. WHA resolutions can take many years to be introduced and passed by the assembly; however, this is a case study of the swiftness of the process enabled by powerful global partnership. The documentation of this process serves as an example for developing and processing future WHA resolutions aiming to improve global maternal and child health.

POLICY AND GUIDELINE ON BREAST MILK BANK: A SYSTEMATIC REVIEW

This systematic review delves into global breast milk policies, addressing their impact on maternal and child health. Recognizing the pivotal role of breastfeeding in public health, the introduction underscores the need for a nuanced examination of existing policies. The problem statement highlights gaps in current approaches, prompting the systematic review to inform evidence-based improvements. Employing a rigorous methodology, we provided a systemically review analysis based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) technique for virtual reality implementation. The advanced searching into two powerful databases which are Scopus and Web of Science (WoS). Based on searching, final main data, n = 63 and will be analysis using synthesis approach. The five main themes, which are decided: (1) Acceptance and Perception (2), Operational Aspects and Guidelines and (3) Impact and Practices (4) Cultural Perspectives and Historical Context, and (5) Research and Innovation. Results reveal diverse policies and guidelines available across regions, influencing human milk bank initiation, duration, and associated health outcomes. The review identifies key determinants shaping human milk bank practices, assessing their alignment with global guidelines. The conclusion synthesizes findings, emphasizing the need for context-specific policies. This systematic review offers crucial insights for policymakers, healthcare professionals, and researchers dedicated to advancing global maternal and child health through informed breast milk bank policies.

Strengthening implementation of the Maternal and Child Health Handbook for global maternal, newborn, and child health

Strengthening implementation of the Maternal and Child Health Handbook for global maternal, newborn, and child health

Child and adolescent mental health services in Khartoum State, Sudan: a desktop situational analysis.

Sudan is a Northeast African country, with 61.7% of its population under 24 years. With a large youth population and significant cultural and linguistic diversity, Sudan, like most low-income countries, has contributed minimal data to global child and adolescent mental health (CAMH) research. This study aimed to perform the first ever situational analysis of CAMH services and systems in Khartoum State, Sudan. The study focused on Khartoum state and covered the calendar years 2019 and 2020. Using the World Health Organization Assessment Instrument for Mental Health Systems (WHO-AIMS) version 2.2 adapted for CAMH, the study focused on the publically available data sources. Findings were described and presented in tables and figures using the WHO-AIMS template. The situational analysis found no CAMH-specific policies, no separate budget for CAMH, and no supervising body for CAMH services in Khartoum. Three tertiary mental health hospitals provided CAMH services, all combined with adult mental health services. Essential medicines were available in all facilities, except methylphenidate available only in 3 central pharmacies. There was no free access to essential psychotropic drugs for children and adolescents except in emergency settings. Data about training to primary healthcare providers and the process of referral to specialized services were limited. A school mental health programme existed which provided early identification and management of CAMH problems in schools. The workforce was small and variable across all levels of care. No formal public health awareness campaigns and little evidence of formal intersectoral collaboration on CAMH were identified. A health information system existed, but no CAMH-specific items were reported. Among a handful of publications on CAMH, no national studies on CAMH were identified. This situational analysis represented the first systematic collation of data and information about CAMH in Sudan. Findings highlighted some areas of strength, but also many gaps in CAMH services and systems. We acknowledge the need to complement the desktop analysis with in-depth data collection with stakeholders across multiple levels, but hope that this will serve as a first step towards strengthening CAMH services in Sudan and other low-income countries.

Overview of the Most Prevalent Pediatric Congenital Heart Diseases: A Literature Review

Like every other prevalent disease process, cardiovascular diseases pose a great risk for the morbidity and mortality of human beings. Pediatric cardiovascular disease (CVD) represents a broad spectrum of disorders that affect both the heart and blood vessels in the pediatric population. There have been several epidemiological studies done to highlight the prevalence and incidence of various pediatric CVDs, emphasizing the impact on global child health. Notably, congenital heart defects, acquired heart diseases, and cardiomyopathies contribute to the majority of pediatric CVDs. Understanding the prevalence and distribution of these conditions is important for resource allocation and healthcare planning.
 Similarly, several risk factors contribute to the development and progression of pediatric CVD. Genetic predisposition, prenatal exposures, environmental factors, and lifestyle choices all play pivotal roles. Identifying and addressing these risk factors is essential for early intervention and preventive strategies.
 However, advances in diagnostic modalities have revolutionized the assessment of pediatric CVD. Non-invasive imaging techniques, genetic testing, and biomarker analyses enable earlier and more accurate detection, facilitating timely intervention and personalized treatment plans. Additionally, emerging therapeutic approaches, including innovative medical interventions and surgical techniques, are transforming the landscape of pediatric CVD management. This abstract aims to serve as a concise resource for clinicians, researchers, and physicians interested in pediatric cardiovascular health. By understanding the epidemiology, recognizing key risk factors, and staying aware of the emerging trends in diagnosis and management, people can contribute to improved outcomes and enhanced quality of life for children affected by cardiovascular diseases.

Global child health in a changing world.

Global child health in a changing world.

Response: Global Child Health Education: A Philippine Experience.

Response: Global Child Health Education: A Philippine Experience.

Family MUAC supported by a two-way SMS platform for identifying children with wasting: the Mama Aweza randomised controlled trial

Effective methods of preventing and identifying childhood wasting are required to achieve global child health goals. Family mid-upper arm circumference (MUAC) programs train caregivers to screen their child for wasting with MUAC tapes. We assessed the effectiveness of a two-way short message service (SMS) platform (referred to as the Maternally Administered Malnutrition Monitoring System [MAMMS]) in western Kenya. In this individual-level randomised controlled trial in two rural countries in western Kenya, children (aged 5-12 months) were randomly allocated (1:1) to receive either standard care (SOC) or MAMMS. Randomisation method was permuted-block randomisation with a block size of 10. Eligible participants were children attending maternal child health clinics in the two counties whom had a MUAC between 12.5 and 14.0cm. The MAMMS group received two MUAC tapes and weekly SMS reminders to screen their child's MUAC. The SOC group received routine community health volunteer services and additional quarterly visits from the study team. The primary analysis used a cox proportional hazards model to compare SOC and MAMMS time-to-diagnosis of wasting (MUAC <12.5cm) confirmed by a health professional during 6-months follow-up. Secondary outcomes were days from enrolment to treatment initiation among children with wasting, proportion of all children with wasting who were identified by the two approaches (treatment coverage), mean MUAC at treatment initiation, and duration of wasting treatment. This trial was registered on ClinicalTrials.gov, NCT03967015. Between August 1, 2019 and January 31, 2022, 1200 children were enrolled, among whom the incidence of confirmed wasting was 37% lower in the MAMMS group (hazard ratio: 0.63, 95% CI: 0.42-0.94, p=0.022). Among children with wasting, the median number of days-to-diagnosis was similar between study groups (MAMMS: 63 days [interquartile range (IQR): 23-92], SOC: 58 days [IQR: 22-94]). Treatment coverage in the MAMMS group was 83.3% (95% CI: 39.9-100.0) while coverage in the SOC group was 55.6% (95% CI: 22.3-88.9%, p=0.300). Treatment duration and mean MUAC at treatment initiation were similar between groups. Family MUAC supported by SMS was associated with a 37% reduction in wasting among young children. Empowering caregivers to monitor their child's nutritional status at home may prevent a substantial proportion of moderate wasting. Thrasher Research Foundation and Pamela and Evan Fowler.

Decolonizing Global Child Health Education for More Equitable and Culturally Safe Collaborations.

Global health (GH) as an academic field is fraught with both historical and present systemic injustice, including unilateral partnerships; power asymmetry in grant funding and research agenda setting; lack of acknowledgment of contributions from low- and middle-income country collaborators; and disadvantageous bias toward low- and middle-income country institutions. Reflecting on the legacies of colonialism and White supremacy is vital for training pediatricians to actively work to improve the health of all children worldwide, within bidirectional and culturally safe partnerships in which power dynamics and ethnocentrism are dismantled. In this article, we discuss the present challenges within academic GH education (GHE) and offer four key action steps to decolonize GHE: (1) reflecting on the history of global child health; (2) creating a new language framework on pertinent concepts in GHE; (3) developing cultural humility, antiracism, and decolonization curricula; and (4) intentional institutional action steps to decolonize and sustain culturally safe global child health education. [Pediatr Ann. 2023;52(9):e344-e350.].

Malaria in Pregnancy: Key Points for the Neonatologist.

In malaria-endemic regions, infection with the malaria parasite Plasmodium during pregnancy has been identified as a key modifiable factor in preterm birth, the delivery of low-birthweight infants, and stillbirth. Compared with their nonpregnant peers, pregnant persons are at higher risk for malaria infection. Malaria infection can occur at any time during pregnancy, with negative effects for the pregnant person and the fetus, depending on the trimester in which the infection is contracted. Pregnant patients who are younger, in their first or second pregnancy, and those coinfected with human immunodeficiency virus are at increased risk for malaria. Common infection prevention measures during pregnancy include the use of insecticide-treated bed nets and the use of intermittent preventive treatment with monthly doses of antimalarials, beginning in the second trimester in pregnant patients in endemic areas. In all trimesters, artemisinin-combination therapies are the first-line treatment for uncomplicated falciparum malaria, similar to treatment in nonpregnant adults. The World Health Organization recently revised its recommendations, now listing the specific medication artemether-lumefantrine as first-line treatment for uncomplicated malaria in the first trimester. While strong prevention and detection methods exist, use of these techniques remains below global targets. Ongoing work on approaches to treatment and prevention of malaria during pregnancy remains at the forefront of global maternal child health research.

The Changing Landscape of Global Child Health Education in the United States and the Effects of the COVID-19 Pandemic and Civil Unrest.

The events of recent years have affected the landscape of global child health education (GCHE) in the United States. War, racism, forced displacement, and the coronavirus disease 2019 (COVID-19) pandemic had global repercussions that reached US GCHE. The aim of this article is to examine the effect of these events on the landscape of GCHE in the US. Key areas of GCHE have been reframed, reshaped, and accelerated by these events. Travel restrictions accelerated virtual learning opportunities. Core curriculum needed to be reconsidered to address antiracism, equity, and decolonization. Expansion of GCHE activities, including local-global electives, was needed to meet increased resident demand and help address local community needs. Inequities in international partnerships were further highlighted, requiring new approaches. Global research education and practices were also affected with a rapid expansion in virtual opportunities and further development of education in equitable research practices. [Pediatr Ann. 2023;52(9):e324-e329.].

Craving Sweet Success: A Recipe for Developing a Global Health Education Consortium (or Any Consortium, for That Matter).

More than a decade ago, two faculty met at a conference. Each talked about how they were charged with leading global health education efforts at their institutions and longed to have an opportunity to share resources and learn from each other. After reaching out to a few other Midwestern colleagues and finding a date, the first Midwest Consortium of Global Child Health Educators meeting was held in Madison, WI. Now, after a dozen annual meetings, more than 30 articles, chapters, abstracts, and workshops, as well as the creating, piloting, and sharing of several widely used curricula in global health education, the founding consortium members share the practical steps for faculty looking to form similar regional consortia around shared interests. In this article, the authors provide a recipe for the successful formation of an academic consortium based on the lessons learned from their experience. [Pediatr Ann. 2023;52(9):e351-e356.].

Gender differences in the acceptance of wife-beating: evidence from 30 countries in Sub-Saharan Africa

BackgroundThe World Health Organization (WHO) has cited domestic violence as an urgent global maternal and child health priority. Gender differences in the acceptance of wife-beating have not been explored at the multi-country level in sub-Saharan Africa (SSA) where the occurrence of wife-beating (36%) is greater than the global average (30%). It is against this backdrop that we examine the gender differences in the acceptance of wife beating in SSA.MethodsWe used Demographic and Health Survey data from 30 SSA countries. Acceptance of wife beating among women and men was the principal outcome variable of interest. We employed Multiple correspondence analysis and logistic regression model as the primary estimation methods for this study. The descriptive statistics show that women had a higher acceptance rate (44%) of wife beating than men (25%). For the women sample, Mali, Democratic Republic of Congo, Chad, and Guinea had higher rates of acceptance of the wife beating (80.6%, 78.4%, 77.1% and 70.3% respectively) For the men, only Guinea had an acceptance rate above 50 percent.ResultsWe found that all else equal, women’s acceptance of wife beating is higher for male-headed households than for female-headed households. Women without formal education were 3.1 times more likely to accept wife beating than those with higher education. Men with no formal education were 2.3 times more likely to accept wife beating than men with higher education. We found that polygamous women were comparable to polygamous men. Polygamous women were 1.2 times more likely to accept wife beating than those in monogamous marriages. Women were 1.2 times more likely to accept wives beating if they had extramarital relationships. Contrarily, men who engaged in extramarital affairs were 1.5 times more likely to justify wife beating. We also found that women’s acceptance of wife beating decreases as they age. Men who decide on major household purchases and spending decisions on their earnings are more likely to accept wife beating. Corollary, women with similar gender and employment roles also accept wife beating. Finally, exposure to mass media is significantly associated with lower acceptance of wife beating for women and men.ConclusionWe conclude that women have a higher acceptance rate of wife beating than men in SSA. Acceptance of wife beating differs significantly by country. Given the same level of education, women are more likely to accept wife beating than men. If women and men have similar levels of employment and gender roles, acceptance of wife beating is higher when men make major household purchasing decisions and and it is still higher even when the woman makes these decisions. Acceptance of wife beating is higher among young women and men, the uneducated, those in polygamous marriages, women, and men who engage in extra marital affairs, poor households and in rural areas. The findings indicate the need for policies and programs by SSA countries to truncate the high acceptance rate of wife beating, especially among women.

Improving healthcare for children in rural China: commentary on WeChat-based self-assessment with tailored feedback

Improving healthcare for children in rural China: commentary on WeChat-based self-assessment with tailored feedback

Empowering underprivileged families in oral health through the Global Child Dental Fund's maternal and child health guides

Oral health is the result of physical, mental, and social well-being and it is in this context, the oral cavity becomes an organ to be preserved due to its importance in the most varied functions that the mouth performs. This is an observational and descriptive study of a quantitative nature. The sample consisted of families assisted by the Non-Governmental Organization (NGO) Saúde Criança. Two meetings were held where a questionnaire on oral health knowledge prepared by the team was used, after completing it, a lecture on oral health was held along with the handling of the maternal and child oral health guide of the Global Child Dental Fund. The results showed that oral health lectures associated with oral health guides showed an improvement in the acquisition and retention of knowledge about oral health. Concluding that with a certain frequency and consistency in the knowledge passed on to the groups, knowledge is fixed and, through them, health education is multiplied for the family, spreading prevention and in the long term, avoiding new illnesses.

Key considerations for developing patient management tools for small and nutritionally at-risk infants: A scoping review

Background: To improve global child health, efficacious interventions are important but real-world effectiveness is crucial; this requires translating technical guidance into frontline clinical and patient care practices. Patient management ‘tools’ are frequently used for this purpose, guiding healthcare workers to deliver quality care. Ahead of an update to a patient management tool for small and nutritionally at-risk infants under six months of age (C-MAMI Tool, V2), we reviewed how others have done this in the past. Our aim was to ensure an evidence-based development process to optimise future success and impact.&#x0D; Methods: We investigated five patient management tools: Integrated Care Pathways (ICPs), Integrated Management of Childhood Illness (IMCI), Paediatric Early Warning Systems (PEWS), Growth Monitoring (GM), and Emergency Triage Assessment and Treatment (ETAT). Searches were run in PubMed and examined evidence on the development, uptake, and effectiveness of these tools.&#x0D; Results: The tools were developed between approximately 1960-2005, with ongoing development of electronic patient management tools (e-tools). IMCI and ETAT were the most widely used in low- and middle-income countries (LMICs), but low coverage remains a major barrier to effectiveness. Growth monitoring is also widely used in LMICs but lacks strong evidence of effectiveness. Evidence on the use of e-tools for patient management in LMICs is growing. Whilst overall evidence for all these approaches was limited, the strongest evidence of effectiveness was for ICPs. Though evidence was sparse, formative work developing the tools prior to implementation seems important to their future success.&#x0D; Conclusions: Informed by this review, the C-MAMI Tool was updated to the MAMI Care Pathway Package, using an ICP approach and modelled on IMCI. This living resource continues to evolve: aligning with and accounting for existing pathways and systems; baseline formative user-experience research; formal effectiveness research to actively plan for future scale up; collecting information on variance from and adaptations to the care pathway; possible future e-tools. An ICP approach is relevant to other child health and nutrition topics.