Child Health Care Delivery Research Articles

Assessment of the availability of infrastructure, manpower, materials and knowledge of health care providers regarding child health care services in the sub centers of a block of Dibrugarh district, Assam

Background: The SCs are under constant criticism for their inability to deliver quality services. Every year some 12 million children of developing countries die before they reach their fifth birthday. Around 90% of mortality rate can be prevented by the improvement of health care quality.Methods: Cross-sectional study conducted among health care providers of sub-centers in a randomly selected block of Dibrugarh district of Assam.Results: All SCs had two health worker (female)/ANMs and a multipurpose health worker male (MPW Male). Only 20% SCs adhered to scheduled opening but 100% adhered to scheduled closing time of the health facilities. 100% of SCs were housed in government building. 70% of the SCs had motorable roads. All the SCs had a regular and good supply of BCG, OPV, measles, TT, pentavalent (90% SCs) vaccines.Conclusions: SCs play a crucial role to decrease the morbidity and mortality of under five children in the rural areas. Full-fledged SCs with sufficient manpower, good infrastructure and good knowledge of delivery of child health care among health care providers would definitely improve the level of child health care provided to the community.

Examining the unresolved conundrum of Traditional Birth Attendants’ involvement in maternal and child health care delivery in Ghana

Traditional Birth Attendants (TBAs) have been a critical human resource in maternal health care delivery in Ghana. However, following the World Health Organization’s directive for countries to discontinue using TBAs, the government of Ghana has since emphasized the use of skilled birth attendants. This policy shift created tensions between TBAs and Community Health Nurses. We examine this conundrum in this paper. We find that despite the ban, TBAs still attend a significant number of births – a situation which has produced intense contestations and continuous jostling for “functioning space” and clients between TBAs and nurses. We recommend a consensus-based partnership approach that promotes cultural competence and is sensitive to contextual cultural practices that underpin pregnancy and childbirth.

A Comparative Study on the Levels of Anxiety of Pediatric Oncology Patients With and Without Exposure to the Kythe Child Life Program

Background: In the Philippines, there is a growing number of young children diagnosed with life-limiting illnesses. A survey conducted by the Philippine Cancer facts and estimates (2006) found out that some 3500 Filipino children are diagnosed with cancer yearly. However, there is a dearth of hospital-based programs that aim at addressing the psychosocial needs of pediatric chronically ill patients and their families. Aim: The study looked at the level of anxiety of school-aged children with hematologic and oncologic illnesses exposed to a hospital-based child life program for at least six months, as well as, those of school-aged children with hematologic and oncologic illnesses who have not had any exposure to a hospital-based child life program. A comparison was made between the levels of anxiety of the two groups. The study aims to show the value of a hospital-based psychosocial program and hypothesized that chronically ill children exposed to the services of a hospital-based child life program have lower levels of anxiety compared with the children who have not had any exposure to such. Methods: This quantitative, quasi-experimental study employing a posttest only group design, compared the levels of anxiety of 80 children ages 5-11 years old diagnosed with hematologic and oncologic illnesses who were exposed to a hospital-based child life program for at least six months against those of children with hematologic and oncologic illnesses who have not had any exposure to such a program. The Child Drawing: Hospital, a validated and reliable tool used to provide a measure of the anxiety level of the hospitalized child as expressed by the child himself was used. Results: Using independent t-test to analyze the data, the levels of anxiety between the two groups show a significant difference. Results show that children who have been exposed to a hospital-based child life program had low levels of anxiety while those who have not had exposure to the such a program had average to high levels of anxiety. Conclusion: Children who have access to the services of a hospital-based child life program experienced significantly lower levels of anxiety as compared with their counterparts who are not exposed to such a program. The results support the value of child life services and, as such, should be considered an integral part of quality pediatric health care and essential in family-centered care and best-practice models of health care delivery for children.

Creating an integrated behavioral/developmental care partnership: financing and measuring effective change

A new template for improved behavioral healthcare delivery for children in areas with limited resources will be presented. The Center for Advancement of Youth (CAY) was created at the University of Mississippi Medical Center in partnership with the Division of Medicaid (a jointly funded state-federal health insurance program for the needy) in response to the overwhelming need for services for children with developmental and behavioral disorders in our region. Mississippi has more than 30,000 children with developmental and behavioral disorders and has traditionally been a desert for behavioral healthcare, with limited services and qualified providers. Increasing numbers of children have been placed on medication for developmental/behavioral difficulties without adequate monitoring or behavioral intervention services. As developmental and behavioral disorders are on the rise, the resources for parents and children in many areas remain insufficient. The lack of resources ultimately puts pressure on the primary care provider to manage and treat intricate disorders with pharmaceutical interventions. In our state, rate of diagnosis for conditions such as ADHD is very high (http://www.cdc.gov/ncbddd/adhd/prevalence.html), as well as the rate of medication use (http://www.pharmacytimes.com/news/State-ADHD-Medication-Rates-Vary-Widely). Medicaid provided funding to help remake behavioral care for children in our state in order achieve better, more efficient care while improving patient and caregiver satisfaction. The CAY model provides integrative child and adolescent behavioral health services across the state of Mississippi, a geographically large and predominately rural state, through a centralized location. Children referred by their medical home enter into an intensive triage and screening protocol with case management designed for efficiency. Telehealth and onsite visits are used. The majority of children receive services near their home town. Results have shown a diminished wait time, robust behavioral improvement and fewer medications dispensed. The goal of the CAY Center is to give children in our region access to appropriate services quickly, while avoiding redundant or unnecessary services through coordinated care and continuing to encourage the medical home concept. In this session, we will discuss the problem of providing ease of access into the behavioral care system for children and their families. We will also discuss the building process that is required, by describing the partnerships that lead to better results. Finally, we will discuss the positive outcomes that can be achieved by examining and restructuring healthcare delivery to these children. The learner will be provided a template for improved behavioral healthcare delivery in areas with limited resources.

Is the role of Health Extension Workers in the delivery of maternal and child health care services a significant attribute? The case of Dale district, southern Ethiopia

BackgroundThe Health Extension Program (HEP) is one of the most innovative community based health program launched by the Ethiopian Federal Ministry of Health to make health services accessible to rural communities by setting-out women Health Extension Workers (HEWs) in rural Health Posts. The HEWs are premised to provide basic, largely preventive, primary health services to rural villages and the program gives special attention to children and mothers. The objective of the study was to assess the contribution made by the Health Extension Workers in maternal and child health care service delivery in Dale district, southern Ethiopia.MethodsUsing a community based cross-sectional data; the study assessed the status of mother’s health service utilization and estimated the role of HEWs in maternal and child health care delivery. Mothers of reproductive age (15–49), having at least one under-five age child, were eligible for the study. The total sample size was 617 and systemic random sampling method was used to select the study subjects from each randomly selected kebeles (lower administrative units). Structured questionnaire was applied to collect data through interviewing of the selected mothers and the data were analysed using SPSS version 16 statistical software.ResultsHealth Posts are important health care delivery settings and their share from the overall service delivery of ANC, Family planning and child treatment services were pivotal. However, overall service coverage of ANC (four and more visits), delivery and PNC services were low in the district as compared to the national status; and the input from the HEWs, in this regard, was unsatisfactory. The number of home visits was also inadequate for the necessary support of the mothers. The results of the multiple logistic regression indicated that mothers who listen to the radio (AOR 4.62; CI 1.66–12.85) and who had received information about the MCH services by HEWs (AOR 2.09; CI 1.06–4.14) were significantly associated with good MCH service utilization status.ConclusionHealth Extension Workers can improve their role in the MCH service delivery in the district by delivering appropriate information about the different available services to the mothers at the community and household level. All concerned bodies, including federal, regional and local governments should support the efforts of HEWs and need to address the challenges for poor performance areas of the HEWs in MCH service delivery.

A system approach to improving maternal and child health care delivery in Kenya: innovations at the community and primary care facilities (a protocol)

BackgroundMaternal, fetal and neonatal mortality are higher in low-income compared to high-income countries due to weak health systems including poor access and utilization of health services. Despite enormous recent improvements in maternal, neonatal and under 5 health indicators, more rapid progress is needed to meet the targets including the Development Goal 3(SDG). In Kenya these indicators are still high and comprehensive systems are needed to attain the targets of the SDG 3 by 2030. We describe the structure and methods of a study to assess the impact of an innovative system approach on maternal, neonatal and under-five children outcomes.This will be implemented in two clusters in the Counties of Busia and Bungoma in Kenya. There will be 4 control clusters in Kakamega, UasinGishu, Trans Nzoia and Elgeyo Marakwet Counties in Kenya. The study population will be pregnant women, newborns and under-five children identified over the study period. The objective of the study is to improve access, utilization and quality of Maternal and Child Health care through a predesigned Enhanced Health Care System (EHC) that embodies six WHO pillars of the health system and community owned initiatives including Community Based Organisations and Income Generating Activities.Methods/DesignA five year quasi-experimental design will be used to compare the outcomes of the implementation of the EHC using the Find Link Treat and retain (FLTR) strategy in one cluster, community owned initiatives in one cluster and four control clusters at baseline and at the end of the study. A Baseline survey will be conducted in year one and an endline in the fifth year in which maternal, neonatal and underfive childhood outcomes will be compared.DiscussionThe expected findings from the study include showing trends in improvement in the intervention clusters for morbidity, mortality, health service utilization and access indicators. Use of the health systems approach in health care provision is expected to provide a holistic improvement in the quality of care in the study populations in the intervention clusters that will lead to improved health indicators including morbidity and mortality. It is expected that the findings will inform health policy of the national and county governments in Kenya and worldwide.

The delivery of value-based healthcare for children with osteosarcoma at Children’s Cancer Hospital Egypt.

e18310 Background: Aim of the study was to develop a system to measure the value of health care services delivered to osteosarcoma patients, through developing a standardized set of patient-centered outcomes for Osteosarcoma and using a consistent approach to measure the costs of Osteosarcoma care throughout all care cycles. Methods: The Porter’s Outcomes Measurement Hierarchy was used to define the domains of outcomes reporting for Osteosarcoma, which included three levels of measuring outcomes; health status achieved or retained, process of recovery, and sustainability of health. Time-driven activity-based costing (TDABC) approach was used a guide to determine the actual costs of healthcare services delivered to Osteosarcoma patients throughout their journey of cure. Results: Osteosarcoma outcome measurement tools and questionnaires were standardized based on the following domains: survival, degree of health or recovery, time to recovery and return to normal activities, disutility of care and treatment processes, sustainability of health and nature of recurrences, and the long-term consequences of therapy. The standardized outcome reporting tools under each domain included: toxicity reporting using NCI-Common Toxicity Criteria version 4.0, Pediatric Quality of Life Inventory (PedsQL) Cancer module, Musculoskeletal Tumour Society Score (MSTS) for functional outcome assessment, Palliative Care Outcomes Scale (POS). Process mapping was done for each step involved in the delivery of health care services to children with Osteosarcoma at Children’s Cancer hospital Egypt (57357 Hospital). Conclusions: Developing a standardized system for measuring the health outcomes of Osteosarcoma and the total costs for delivering the health care services is fundamental to measure and improve the value of health care delivered to Osteosarcoma patients.

Modern Approaches to the Diagnosis and Management of Children With Primary Ciliary Dyskinesia

The article presents the most modern positions of healthcare delivery for children with primary ciliary dyskinesia. Symptoms of this pathology in clinical practice vary that is conditioned by genetic heterogeneity of the disease. The most common disease manifestation in children is frequent inflammatory diseases of the upper and lower respiratory tract. They are recorded in most patients, especially in young children, and the diagnosis is often determined untimely due to a low awareness of specialists about this nosology. Differential diagnostic approach is described in detail, peculiarities of treatment and management of children with this nosology are specified. The material is based on clinical guidelines developed and approved by the professional association «Union of Pediatricians of Russia».

Progresses and challenges of utilizing traditional birth attendants in maternal and child health in Nigeria.

Background and Introduction:Emigration of healthcare workers from developing countries is on the rise and there is an urgent need for policies that increase access to and continuity of healthcare. In this commentary, we highlight some of the negative impacts of emigration on maternal and child health and discuss whether team-based healthcare delivery could possibly mitigate the shortfall of maternal and child health professionals in developing countries.Methodology:We cross-examine the availability of supporting structures to implement team-based maternal and child healthcare delivery in developing countries. We briefly discuss three key supporting structures: culture of sharing, telecommunication, and inter-professional education. Supporting structures are examined at system, organizational and individual levels. We argue that the culture of sharing, limited barriers to inter-professional education and increasing access to telecommunication will be advantageous to implementing team-based healthcare delivery in developing countries.Conclusion and Global Health Implications:Although most developing countries may have notable supporting structures to implement team-based healthcare delivery, the effectiveness of such models in terms of cost, time and infrastructure in resource limited settings is still to be evaluated. Hence, we call on usual stakeholders, government, regulatory colleges and professional associations in countries with longstanding emigration of maternal and child healthcare workers to invest in establishing comprehensive models needed to guide the development, implementation and evaluation of team-based maternal and child healthcare delivery.

Child Health Care Delivery Is Improving and So Is Pediatrics.

* Abbreviation: AAP — : American Academy of Pediatrics Over the past 9 years, we have focused on publishing studies that capture ongoing changes and innovations that could improve the care that we provide to children and their families. At the same time, we have also changed and improved the format and organization of Pediatrics to keep up with what you, our readers, have asked us to do to make the information we provide relevant, practical, up-to-date, and easily accessible across a broad range of formats. We have made substantial changes to Pediatrics , including altering the overall look, expanding our online presence, changing the print edition to include 1-page synopses of all studies published in our official online edition, and adding article types to expand our coverage of the field of pediatrics. These changes are aligned with our overall mission to provide useful and timely information to you. We will continue making changes in 2017 based on suggestions you have shared with us through our biannual readers’ survey and through e-mail, social media, and even traditional mailed letters. By continuously implementing and evaluating changes, we have used the quality-improvement methods of “plan, do, study, act” to increase the journal’s value when it comes to providing information to improve all aspects of child health and well-being. This is what our journal’s mission is all about. What changes are planned for … Address correspondence to Lewis R. First, MD, MS, Editor-in-Chief, Pediatrics Editorial Office, University of Vermont College of Medicine, 89 Beaumont Ave, Given Courtyard S250, Burlington, VT 05405. E-mail: lewis.first{at}uvm.edu.

Household income determines access to specialized pediatric chronic pain treatment in Germany.

BackgroundFamilies with lower socioeconomic status (SES) often face problems with gaining access to health care services. Information is scarce on the relationship between SES and health care delivery for children suffering from chronic pain.MethodsFamilies presenting to a specialized pain center (N = 1,001) provided information on ‘household income, ‘parental education’ and ‘occupation’ to aid the evaluation of their SES. To assess whether the SES of the clinical sample is representative of the general population, it was compared to data from a community sample (N = 14,558). For the clinical sample, travel distance to the clinic was described in relation to the 75 % catchment area. Multiple logistic regression was used to analyze the association between SES and the journey from outside the catchment area.ResultsThe SES was significantly higher in the clinical sample than in the community sample. Within the clinical sample, the distance traveled to the pain center increased with increasing SES. The 75 % catchment area was 143 miles for families with the highest SES and 78 miles for the lowest SES. ‘Household income’ predicted travel distance (OR 1.32 (1.12–1.56)). Education and occupational status were not significant predictors of travel from outside the catchment area.ConclusionsIn Germany, specialized care for children with chronic pain is subject to disparities in access. Future activities should focus on identifying barriers to access and seeking to prevent inequalities in specialized pediatric health care delivery. Increasing the number of specialized treatment facilities could improve access to specialized pediatric pain treatment, regardless of socioeconomic determinants.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1403-9) contains supplementary material, which is available to authorized users.

Deficiency of Lysosomic Acid Lipase: Clinical Recommendations for Child Health Care Delivery

The deficiency of lysosomic acid lipase is a rare hereditary enzymopathy. The focus of this article is the present condition of this issue. The authors demonstrate epidemiological data and etiopathogenetic features of two phenotypic forms of lysosomic acid lipase deficiency — Wolman disease and cholesterol ester storage disease. Clinical features of both — the rapidly progressing form and the slowly developing cholesterol ester storage disease — are described in detail in this article. The algorithm and crucial steps of differential diagnosis are described in detail. Also, indications to pathogenetic therapy are carefully formulated, and the tactic of enzyme replacing therapy is given. The modern approaches to the management of child patients are described.

Child health Care delivery system in Rewa District: A critical analysis

Background : In developing countries like India, a very high proportion of the population especially in rural areas of Madhya Pradesh does not have ready access to neonatal and child health care services. There is an urgent need for removal of obstacles to pediatric health to improve health indicators. Aims & Objectives: To assess the infrastructure and quality of child health care delivery system in Rewa district of Madhya Pradesh. Material & Method: A cross-sectional observation study carried out at tertiary care hospital. 84 Auxiliary nurse midwives (ANMs), 16 Medical officers posted at primary health centres (PHCs) and 10 medical officers in-charge of Community health centres (CHCs) were interviewed through a predesigned questionnaire over a period of one year to assess neonatal and child health care services at sub centre, PHCs and CHCs respectively. Results: 91.66% subcentres had male workers and 90.4% had ANMs. 53.5% subcentres are covering 5-10 villages and 20.2% were covering even more than 10 villages. 42.9% of studied subcentres did not have their buildings. 31.2% of studied PHCs did not have doctor. 81.2% PHCs are not having staff nurses, 43.7% of studied PHCs are not having their own buildings. Marked lack of specialists in CHCs was found affecting newborn care. Conclusion: Improvement in infrastructure and specialist facilities is needed to improve neonatal and child health care services as well as health indicators in Rewa district. Background : In developing countries like India, a very high proportion of the population especially in rural areas of Madhya Pradesh does not have ready access to neonatal and child health care services. There is an urgent need for removal of obstacles to pediatric health to improve health indicators. Aims & Objectives : To assess the infrastructure and quality of child health care delivery system in Rewa district of Madhya Pradesh. Material & Method: A cross-sectional observation study carried out at tertiary care hospital. 84 Auxiliary nurse midwives (ANMs), 16 Medical officers posted at primary health centres (PHCs) and 10 medical officers in-charge of Community health centres (CHCs) were interviewed through a predesigned questionnaire over a period of one year to assess neonatal and child health care services at sub centre, PHCs and CHCs respectively. Results : 91.66% subcentres had male workers and 90.4% had ANMs. 53.5% subcentres are covering 5-10 villages and 20.2% were covering even more than 10 villages. 42.9% of studied subcentres did not have their buildings. 31.2% of studied PHCs did not have doctor. 81.2% PHCs are not having staff nurses, 43.7% of studied PHCs are not having their own buildings. Marked lack of specialists in CHCs was found affecting newborn care. Conclusion : Improvement in infrastructure and specialist facilities is needed to improve neonatal and child health care services as well as health indicators in Rewa district. Normal 0 false false false EN-IN X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:Table Normal; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin-top:0cm; mso-para-margin-right:0cm; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0cm; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:Calibri,sans-serif; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin;}

Physical Health Problems and Barriers to Optimal Health Care Among Children in Foster Care

Children and adolescents in foster care placement represent a unique population with special health care needs, often resulting from pre-placement early adversity and neglected, unaddressed health care needs. High rates of all health problems, including acute and/or chronic physical, mental, and developmental issues prevail. Disparities in health status and access to health care are observed. This article summarizes the physical health problems of children in foster care, who are predisposed to poor health outcomes when complex care needs are unaddressed. Despite recognition of the significant burden of health care need among this unique population, barriers to effective and optimal health care delivery remain. Legislative solutions to overcome obstacles to health care delivery for children in foster care are discussed.

A “Child’s Rights Perspective”: The “Right” of Children and Young People to Participate in Health Care Research

As all human beings are consumers of health care provision across the life span and in receipt of care delivered by accountable health care professionals, all should have the right to be involved in shaping the future of their own health care. Rights-based participation, when applied successfully, has the potential to inform and influence the delivery of child health care, the child’s experience of health care, plus children’s nursing education (Coyne & Gallagher, 2011). The “right” of every child and young person to participate in research that relates to their own health care is also sustained by the author’s lead position as a Senior Lecturer in Higher Education for pre-registration children’s nursing in Northern Ireland and the appreciation of their voice when practicing as a registered children’s nurse and ward sister. The report provides an insight into seminal work on human and child rights; the historical context of children in Western society, and the evolution of children’s nursing amid the child’s right to participate in shaping their own health care.

Strengthening the home-to-facility continuum of newborn and child health care through mHealth: Evidence from an intervention in rural Malawi

This paper assesses the impact of a mobile health (mHealth) project on uptake of home-based care for newborn and child health, and investigates the extent to which uptake of home-based care resulted in lessened pressure on health facilities for conditions that can be handled at the household level. It uses mixed methods consisting of cross-sectional household surveys data from a quasi-experimental pre-test post-test design as well as qualitative data. The results show a large, positive effect of the project on the aggregate home-based care for child health, and a sharp, negative impact on facility-based care seeking for fever among children whose mothers/caretakers used the services offered by the intervention. Reasons for using the services mainly relate to the potential of avoiding unnecessary trips to the health facility for care that could be provided at home. The project provides insights on mHealth and community-based programming to improve newborn and child health care delivery.

Three Principles to Promote Quality Child Healthcare Globally

The MDGs have pointed out the large unfinished agenda of improving child health services. This short communication shows simple ways to expand and improve child health programs by improving prevention, education and early detection. The article presents a simple checklist to start improving the consistency, quality and efficiency of child healthcare delivery.

Pediatric aspects of inpatient health information technology systems.

In the past 3 years, the Health Information Technology for Economic and Clinical Health Act accelerated the adoption of electronic health records (EHRs) with providers and hospitals, who can claim incentive monies related to meaningful use. Despite the increase in adoption of commercial EHRs in pediatric settings, there has been little support for EHR tools and functionalities that promote pediatric quality improvement and patient safety, and children remain at higher risk than adults for medical errors in inpatient environments. Health information technology (HIT) tailored to the needs of pediatric health care providers can improve care by reducing the likelihood of errors through information assurance and minimizing the harm that results from errors. This technical report outlines pediatric-specific concepts, child health needs and their data elements, and required functionalities in inpatient clinical information systems that may be missing in adult-oriented HIT systems with negative consequences for pediatric inpatient care. It is imperative that inpatient (and outpatient) HIT systems be adapted to improve their ability to properly support safe health care delivery for children.

Paediatric research environment in the UK

Clinical research is essential in order to ensure that children receive the best possible treatment in the most appropriate manner. Paediatric research in the UK is mainly focussed on clinical trials. These are facilitated by networks such as the Medicines for Children Research Network. Child mortality rates in the UK are significantly higher than many other European countries. There is insufficient research in the UK into healthcare delivery for children. The most important outcomes in relation to research in children should be a reduction in child mortality rates and a reduction in child morbidity.

Effect of multiple chronic diseases on health care expenditures in childhood.

To examine multiple chronic conditions and related health care expenditures in children. Retrospective cohort study of all dependents of Mayo Clinic employees aged 0-17 on Jan 1, 2004 with continuous health benefits coverage for 4 years (N=14,727). Chronic conditions, health care utilization, and associated expenditures were obtained from medical and pharmacy claims. The most prevalent chronic conditions were asthma/chronic obstructive pulmonary disease (12%), allergic rhinitis (11%), and behavior problems (9%). The most costly conditions were congenital anomalies, asthma/chronic obstructive pulmonary disease, and behavior problems ($9602, $4335, and $5378 annual cost per child, respectively). Annual health care expenditures increased substantially with the number of chronic conditions, and a small proportion of children with multiple chronic conditions accounted for a large proportion of health care costs. In addition, those with multiple chronic conditions were more likely to persist in the top 10th percentile spender group in year-to-year spending. Children with multiple chronic conditions accounted for a large proportion of health care expenditures. These children were also likely to persist as high spenders in the 4-year time frame. Further research into effective ways to manage the health care delivery for children with multiple chronic conditions is needed.