Child Health Indicators Research Articles

Mixed Signals in Child and Adolescent Mental Health and Well-Being Indicators in the United States: A Call for Improvements to Population Health Monitoring.

Policy Points Social indicators of young peoples' conditions and circumstances, such as high school graduation, food insecurity, and smoking, are improving even as subjective indicators of mental health and well-being have been worsening. This divergence suggests policies targeting the social indicators may not have improved overall mental health and well-being. There are several plausible reasons for this seeming contradiction. Available data suggest the culpability of one or several common exposures poorly captured by existing social indicators. Resolving this disconnect requires significant investments in population-level data systems to support a more holistic, child-centric, and up-to-date understanding of young people's lives.

SISTEMA ACGEST PARA ASSISTÊNCIA À SAÚDE DE GESTANTES E PUÉRPERAS NA ATENÇÃO PRIMÁRIA

Ensuring quality prenatal and puerperal care is one of the public health policies in Brazil aimed at women and developed by nurses and community health agents (CHA) in primary care. Technology can improve the work process of these teams by making scheduling, tracking, and reporting easier. The objective was to create an integrated system between the routines of the CHA, the pregnant/postpartum women and the management carried out in the health services for this public. Then, through experimental research, field observations and knowledge of the great need to implement information technology (IT) in the public health environment, AcGest was modeled and developed. For this, IT needs were considered for use by the CHA, pregnant/postpartum women and health units. The system was divided into three modules: two applications for Android smartphones (pregnant and CHA modules) and one for the Web as a management module, which will be used on computers in health units. The system was tested in a simulated environment by the researchers and a health team in the city of Parnamirim-RN. The first version is ready, but it needs to be tested with pregnant/postpartum women, which will only be possible after submission to the ethics committee, for functionality improvements and usability evaluation. The application has great potential to improve routine care for this public, maternal and child health indicators, and serves as a model for further research in the area, as will be seen throughout this article.

Growth Monitoring and Promotion and Index Development for Improved Child Health: A Scoping Review Using Rodgers Concept Analysis Framework

Purpose: The purpose of this scoping literature review is to explore the breadth of the available literature, and identify knowledge gaps to inform future research through the use of Rodgers evolutionary concept analysis framework. The literature review also seeks to describe the key child indices developed and their characteristics so as to guide the development of a GMP index for improved child health in Zimbabwe. Methods: The keywords growth monitoring and promotion, community health workers, caregivers of children under five years, child health indices, and index development were used to search for relevant literature from Science Direct, Google Scholar, EBSCO, and PUBMED databases in English. The initial electronic database search yielded 535 research articles, and 316 were further assessed for their relevance to the study. An additional 140 articles were excluded from the search as they did not contain adequate evidence as per the Rodgers Evolutionary Framework. After the full-text review, 80 articles out of 220 articles met the inclusion criteria. Those found to be suitable were 25 articles and were thus included in the final analysis. Results: Key Antecedents: distance and socio-cultural constraints, CHW activeness, participation of fathers in GMP activities, poor understanding and interpretation of growth charts, poor communication between caregivers and CHWs, full vaccination status and complacency; Attributes: education status of parents, knowledge, attitude, and practices of caregivers and Consequences: timely health interventions, improved child health outcomes, a platform to promote optimal child health practices of GMP activities were identified. Conclusion: More research needs to be explored to form indices that incorporate behaviour change metrics. This will lead to an increased evidence base to guide the health system, funders, and policy makers conclusively.

Exploring the feasibility of establishing a core set of sexual, reproductive, maternal, newborn, child, and adolescent health indicators in humanitarian settings: results from a multi-methods assessment in Jordan

BackgroundReliable and rigorously collected sexual, reproductive, maternal, newborn, child, and adolescent health (SRMNCAH) data in humanitarian settings is often sparse and variable in quality across different humanitarian settings. To address this gap in data quality, the World Health Organization (WHO) developed a core set of indicators for monitoring and evaluating SRMNCAH services and outcomes in humanitarian settings, and assessed their feasibility in the field in Jordan, in addition to three other countries; with the goal of aggregating information from global consultations and field-level assessments to reach consensus on a set of core SRMNCAH indicators for services and outcome evaluation in humanitarian settings among WHO global partners.MethodsThe feasibility assessment in Jordan focused on the following constructs: relevance/usefulness, feasibility of measurement, systems and resources, and ethical issues. The multi-methods assessment included five components; a desk review, key informant interviews, focus group discussions, facility assessments, and observational sessions.ResultsFindings suggest that there is widespread support among regional, national, as well as global stakeholders for developing a core list of SRMNCAH indicators for monitoring and evaluation of services and outcomes in humanitarian settings in Jordan. There are numerous resources and data collection systems that could be leveraged, built upon, and improved to ensure the feasibility of collecting this proposed set of indicators. However, the data collection load requested from donors, the national government, international and UN agencies, coordination/cluster systems must be better harmonized, standardized, and less burdensome.ConclusionsDespite stakeholder support in developing a core set of indicators, this would only be useful if it has the buy-in from the international community. Greater harmonization and coordination, alongside increased resource allocation, would improve data collection efforts and allow stakeholders to meet indicators’ reporting requirements.

Analysis of Maternal Health in Local Area Monitoring-Maternal and Child Health (LAM-MCH) Indicators in Pagerageung Health Center

Objective: The purpose of this research is to know the description of the results of the analysis of maternal health in the indicators of LAM-MCH in Sukamaju Village, the Working Area of ​​the Pagerageung Health Center, Tasikmalaya Regency, in 2022. Methods: The research method used is a descriptive method. Data analysis used with univariate analysis. Results: The results showed that the coverage indicator for K1 visits was 87.08%, the coverage indicator for K4 visits was 78.20%, the coverage indicator for delivery by health personnel was 87.51%, the coverage indicator for postpartum visits was 87.51%, the achievement coverage indicator Early detection of risk factors and complications of obstetrics by health workers and the public at 26.66% Conclusion: The conclusion of this study is that indicators of maternal health have not been achieved, especially coverage of K1, K4, delivery of health workers, postpartum visits and handling of obstetric complications cases. Suggestions for this research are the need for mutually supportive cooperation between pregnant women, midwives (health workers), and also the community or regional cadres.

Understanding factors associated with rural-urban disparities of stunting among under-five children in Rwanda: A decomposition analysis approach.

Childhood stunting in its moderate and severe forms is a major global problem and an important indicator of child health. Rwanda has made progress in reducing the prevalence of stunting. However, the burden of stunting and its geographical disparities have precipitated the need to investigate its spatial clusters and attributable factors. Here, we assessed the determinants of under-5 stunting and mapped its prevalence to identify areas where interventions can be directed. Using three combined rounds of the nationally representative Rwanda Demographic and Health Surveys of 2010, 2015and 2020, we employed the Blinder-Oaxaca decomposition analysis and the hotspot and cluster analyses to quantify the contributions of key determinants of stunting. Overall, there was a 7.9% and 10.3% points reduction in moderate stunting among urban and rural areas, respectively, and a 2.8% and 8.3% points reduction in severe stunting in urban and rural areas, respectively. Child age, wealth index, maternal educationand the number of antenatal care visits were key determinants for the reduction of moderate and severe stunting. Over time, persistent statistically significant hotspots for moderate and severe stunting were observed in Northern and Western parts of the country. There is a need for an adaptive scaling approach when implementing national nutritional interventions by targeting high-burden regions. Stunting hotspots in Western and Northern provinces underscore the need for coordinated subnational initiatives and strategies such as empowering the rural poor, enhancing antenatal health care, and improving maternal health and education levels to sustain the gains made in reducing childhood stunting.

The effect of extreme weather events on child nutrition and health

This study traces the causal effects of extreme weather events on nutritional and health outcomes among rural children in Uganda using four waves of individual child survey data (2009–2014). A simultaneous regression model was applied for causal inference while also accounting for households’ adaptive responses. The study finds the evidence of a significant negative relationship between extreme weather events and availability of calories and nutrients for children. In particular, droughts reduced calorie, protein and zinc supply, and overall diet diversity by 67%, 37%, 28% and 30%, respectively. We further traced the effects of this reduced calorie and nutrient availability on child health indicators. A 10% decrease in zinc supply decreased height-for-age z-scores (HAZ) by around 0.139 - 0.164 standard deviations (SD), and increased probability of stunting ranging from 3.1 to 3.5 percentage points. Both boys and girls HAZ and stunting rates were sensitive to nutrient inadequacies. Different coping and adaptation strategies significantly influenced rural households’ ability to safeguard children’s nutrition and health against the effects of extreme weather. The findings of this study provide specific insights for building ex-ante resilience against extreme weather events, particularly when compared to ex-post, unsustainable, and often costlier relief actions.

Hospital-based case–control study of risk factors of early neonatal mortality in the Gaza Strip

Background: Early neonatal death is an essential epidemiological indicator of maternal and child health. Aims: To identify risk factors for early neonatal deaths in the Gaza Strip. Methods: This was a hospital-based case–control study. We included 132 women with neonatal deaths recorded from January to September 2018. The control group comprised 264 women who were selected using systematic random sampling and gave birth to live newborns at the time of the data collection. Results: The controls who had no history of neonatal death or still birth were less likely to have an early neonatal death compared with women who did have such a history. The controls who did not have meconium aspiration syndrome or amniotic fluid complications were less likely to have an early neonatal death compared with women who did experience these complications during delivery. The controls who had a singleton birth outcome were less likely to have an early neonatal death compared with women who had multiple births. Conclusion: It is important to establish intervention programmes to provide preconception care, improve the quality of intrapartum and postnatal care, provide high-quality health education, and improve the quality of care provided within neonatal intensive care units.

Maternal mental well-being and recent child illnesses-A cross-sectional survey analysis from Jigawa State, Nigeria.

Child health indicators in Northern Nigeria remain low. The bidirectional association between child health and maternal well-being is also poorly understood. We aim to describe the association between recent child illness, socio-demographic factors and maternal mental well-being in Jigawa State, Nigeria. We analysed a cross-sectional household survey conducted in Kiyawa local government area, Jigawa State, from January 2020 to March 2020 amongst women aged 16-49 with at least one child under-5 years. We used two-stage random sampling. First, we used systematic random sampling of compounds, with the number of compounds based on the size of the community. The second stage used simple random sampling to select one eligible woman per compound. Mental well-being was assessed using the Short Warwick-Edinburgh Mental Wellbeing Score (SWEMWBS). We used linear regression to estimate associations between recent child illness, care-seeking and socio-demographic factors, and mental well-being. Overall 1,661 eligible women were surveyed, and 8.5% had high mental well-being (metric score of 25.0-35.0) and 29.5% had low mental well-being (metric score of 7.0-17.9). Increasing wealth quintile (adj coeff: 1.53; 95% CI: 0.91-2.15) not being a subsistence farmer (highest adj coeff: 3.23; 95% CI: 2.31-4.15) and having a sick child in the last 2-weeks (adj coeff: 1.25; 95% CI: 0.73-1.77) were significantly associated with higher mental well-being. Higher levels of education and increasing woman's age were significantly associated with lower mental well-being. Findings contradicted our working hypothesis that a recently sick child would be associated with lower mental well-being. We were surprised that education and late marriage, which are commonly attributed to women's empowerment and autonomy, were not linked to better well-being here. Future work could focus on locally defined tools to measure well-being reflecting the norms and values of communities, ensuring solutions that are culturally acceptable and desirable to women with low mental well-being are initiated.

An Equity Analysis of Zero-Dose Children in India Using the National Family Health Survey Data: Status, Challenges, and Next Steps.

Background While immunization programs across the world have made considerable progress, children and communities continue to be beyond the reach of healthcare services. Globally, they are now referred to as zero-dose (ZD) children (those who have not received a single dose of diphtheria, pertussis, and tetanus-containing vaccine). Pre-COVID-19 pandemic analyses suggest that nearly 50% of vaccine-preventable deaths occur among ZD children. Two-thirds of these children live in extremely poor households suffering from multiple deprivations including lack of access to reproductive health services, water, and sanitation. Hence, ZD childrenhave now been prioritized as a key cohort for identification and integration with the health systems as we build back from the pandemic. Methodology Extracting data from the last two National Family Health Survey (NFHS) rounds (NFHS 4, 2015-2016 and NFHS 5, 2019-2021), this study aims to ascertain the status of ZD children aged 12-23 months in India, the challenges, and the necessary action agenda going forward. Data were analyzed for equity determinants such as gender, place of residence, religion, birth order, caste, and mother's schooling. Key determinants included the change in ZD prevalence at the national, state, and district levels; variations across equity parameters and states with maximum improvements; and disparity across these indicators. A correlation analysis was also conducted to understand the nature of the association between ZD prevalence and critical maternal and child health indicators. Results The overall ZD prevalence between the two rounds was reduced by 4.1% (10.5-6.4%). A total of 26 states in the country reported a ZD prevalence of <10% in NFHS 5 compared to 18 in NFHS 4. In total, 324 districts reported a ZD prevalence of <5%, and 145 districts reported a prevalence of >10%. The equity parameters reflected a slow-footed reduction among ZD for girl children, across urban geographies, firstborn children, mothers with 12 or more years of schooling, and children in families with the highest wealth quintiles. A negative correlation accentuated between the two NFHS rounds was established between first-trimester registration, four or more antenatal visits, institutional deliveries, and ZD prevalence. Conclusions The findings point toward sustained improvement across key equity parameters, however, challenges do exist. Moreover, the impact of the pandemic on immunization programs across the globe and in India is bound to halt and reverse the progress and potentiate further inequities. It is thus imperative that continued and augmented efforts are continued to identify, integrate, and immunize ZD children, families, and communities.

A subnational reproductive, maternal, newborn, child, and adolescent health and development atlas of India

Understanding the fine scale and subnational spatial distribution of reproductive, maternal, newborn, child, and adolescent health and development indicators is crucial for targeting and increasing the efficiency of resources for public health and development planning. National governments are committed to improve the lives of their people, lift the population out of poverty and to achieve the Sustainable Development Goals. We created an open access collection of high resolution gridded and district level health and development datasets of India using mainly the 2015–16 National Family Health Survey (NFHS-4) data, and provide estimates at higher granularity than what is available in NFHS-4, to support policies with spatially detailed data. Bayesian methods for the construction of 5 km × 5 km high resolution maps were applied for a set of indicators where the data allowed (36 datasets), while for some other indicators, only district level data were produced. All data were summarised using the India district administrative boundaries. In total, 138 high resolution and district level datasets for 28 indicators were produced and made openly available.

Effectiveness of the maternal and child health handbook for improving continuum of care and other maternal and child health indicators: A cluster randomized controlled trial in Angola

The maternal and child health (MCH) handbook is promoted as a tool for strengthening continuum of care. We assessed the effect of a MCH handbook intervention package on continuum of maternal and child health care and health outcomes for mother and child. We conducted an open-label, parallel two-arm cluster randomized controlled trial in Angola. We randomly assigned municipalities in Benguela province through block randomization to a group using a package of enhanced maternity care service (which included the MCH handbook distribution and its supplementary intervention) and another using usual care (two stand-alone home-based records). We included women who were pregnant at the beginning of the trial period and attended a public health care facility for maternity care services. Neither health care providers, study participants nor data assessors were masked, but the statistician was. The primary outcome was a measure of service utilization assessed via achievement of maternal behavior-based continuum of care at three months postpartum. We conducted an intention-to-treat analysis in women with available data. We randomized 10 municipalities to either the intervention (five clusters) or control (five clusters) group. Of the 11 530 women approached between June 8, 2019, and September 30, 2020, 11 006 were recruited and 9039 included in the final analysis (82%; 3774 in the intervention group and 5265 in the control group). The odds for achievement of maternal behavior-based continuum of care in the intervention group was not significantly different from that in the control group (adjusted odds ratio (aOR) = 1.18, 95% confidence interval (CI) = 0.46-2.93) at three months postpartum. However, the odds of initiating antenatal care clinic use were significantly higher in the intervention group (odds ratio (OR) = 5.16, 95% CI = 2.50-10.67). No harms associated with the intervention were reported. Distribution of the MCH handbook and its supplementary interventions promoted initiation of antenatal care service use, but did not increase service utilization sufficiently enough for attainment of study defined maternal behavior-based continuum of care. ISRCTN20510127.

Temporal trends and factors associated with preterm birth in Chile, 1992-2018.

An analytical study based on Chilean birth records obtained from the Department of Statistics and Health Information (DEIS) was conducted. This study aimed to evaluate temporal trends in preterm births by maternal age in Chile from 1990 to 2018. Results show that the preterm birth rate in 1992 was 5.0% and increased to 7.2% in 2018. The average annual percent change (AAPC) was 1.44. Age groups at the extremes (19 and under and 35 and over) presented the highest rates of preterm birth, both at the beginning and at the end of the study period. The latter group showed a smaller decrease at the beginning (1992 to 1995), with an annual percentage change (APC) of -3.00. The probability of preterm birth in both groups was higher compared to the 20-34 year old group. Although Chile boasts some of the best maternal and child health indicators in the region, repercussions associated with the current postponement of maternity - including preterm birth - must be monitored.

Rural child health in India: the persistent nature of deprivation, undernutrition and the 2030 Agenda.

The 2030 Agenda for sustainable development was launched to achieve Sustainable Development Goals (SDGs) across the globe. This paper is based on the primary database to assess the nutritional status of 5-10years children and the incidence of deprivation in their households of a backward district (Purulia), India in the context of the first two SDGs, e.g., no poverty and zero hunger. We conclude that around 74% of children are undernourished. The proportion of households multidimensionally deprived is 90%, and the majority of them live on less than $1.25 a day. Results reveal that the BMI of mother and the education of father are the two most statistically significant predictors of child malnutrition. Purulia has long been witnessing the persistent nature of deprivation, which is well reflected in the child's health. The district is quite far from the national targets in achieving the SDGs. Government, private sector, and civil society must come together to accelerate the progress of SDGs.

Socio-Demographic Determinants of Non-Utilisation of Antenatal Care Services by Women in the Northern Region of Nigeria

Background: A large proportion of women in the northern region of Nigeria do not utilise antenatal care (ANC) services. As a result, the region has the worst maternal and child health indicators. This study aims to identify the socio-demographic determinants of the non-utilisation of ANC services by pregnant women to provide evidence for policymakers to base decisions towards addressing the problem.

Cumulative Risk and Mental Health of Left-behind Children in China: A Moderated Mediation Model

Based on the dual-factor model of mental health (DFM) and the cumulative risk (CR) model, this study aimed to investigate the impact of CR on left-behind children's mental health and the underlying mechanism involved, specifically the mediating role of coping style and the moderating role of gratitude in the relationship between CR and mental health. The random cluster sampling method was applied to collect data on CR, coping style, gratitude, life satisfaction, and depression from 705 left-behind children (374 boys, Mage = 12.20 ± 1.25). The moderated mediation analyses indicated that: (1) the moderated mediation model of CR and depression was significant: coping style mediated the relationship between CR and depression, and gratitude moderated this mediating effect with gratitude strengthening the negative association between CR and coping style; and (2) gratitude moderated the relationship between CR and life satisfaction and it also strengthened the negative association between CR and life satisfaction. The findings suggest that the mechanisms of coping style may differ in the relationships between CR and positive and negative indicators of mental health in left-behind children and that gratitude as a protective factor has limited capacity to buffer the negative effect of accumulated risk. These findings provide evidence for differentiated intervention approaches to promote disadvantaged children's life satisfaction and depression.

Ülke Gelir Gruplarına Göre Anne ve Çocuk Sağlığının Değerlendirilmesi: Tanımlayıcı Bir Çalışma

Objective: The economic situation of countries is one of the important determinants of health. The aim of this study is to evaluate the socioeconomic inequalities in maternal and child health using the indicators of maternal and child health of countries by World Bank's income classification. Material and Methods: In the research, 166 countries were included. The data were analyzed using IBM SPSS Statistics (Ver. 20). The Kruskal-Wallis H test was used to analyze whether variables about maternal and child health differ according to country income groups. The significance level was accepted as p<0.05. Mann-Whitney U test was used to understand from which groups the difference originated. Results: As a result of this study, it was determined that maternal and child health variables differed statistically significantly between country groups according to the World Bank income classification. Conclusion: Using the World Bank's income classification, this study highlights socioeconomic inequalities in maternal and child health. Although very serious risks in maternal and child health are not observed in high-income and upper-middle-income countries, there remain problems, particularly in low-income and lower-middleincome countries. The results show that children in low-income countries have more limited access to important health interventions such as vaccines and medical care. Eliminating inequalities in maternal and child health should be seen as a necessity for achieving the Sustainable Development Goals. Global cooperation is considered necessary to reduce socioeconomic inequalities in maternal and child health. International organizations are expected to support these countries with seriously aid.

Sociodemographic and economic characteristics of families and health and education conditions of children in the BRISA cohort during the COVID-19 pandemic.

To describe changes in sociodemographic, economic and variables related to the characterization of family, health and education during the COVID-19 pandemic in a birth cohort evaluated at 10-11 years of age. Cross-sectional study involving 1,033 children from a cohort of children born in 2010/2011, in the city of Ribeirão Preto, SP, Brazil. Data were collected from July to October 2021 by telephone or video interview held with the person responsible for the child. The questionnaires discussed family organization, child behavior and health, school attendance, socioeconomic assessment and occurrence of COVID-19 during the period of social isolation due to the pandemic. Descriptive statistics were used to describe the data. The chi-square test was used to verify group differences by minimum wages (MW). Of the respondents, 47.6% reported worsening of their financial situation during the pandemic, which was more frequent in the group with a household income <3 MW compared to the group with >6 MW (59.1 vs. 15.7%; p<0.001). According to the respondents, 62% of the children exhibited behavioral changes during the period and anxiety was the most frequently reported condition. In addition, 61.4% of the children had learning difficulties and these problems were more prevalent among children from households with lower incomes compared to those with higher incomes (74.7 vs. 45.1%; p<0.001). The COVID-19 pandemic has changed different economic aspects of families, as well as educational, health and behavioral indicators of children. Lower-income families were the most affected both economically and in terms of other indicators.

Oral health status and indicators in children of Armenia based on the national surveys.

The aim of this study was to determine the dynamics and the structure of dental morbidity of the children population of the Republic of Armenia, in order to improve the system of methods of therapeutic and preventive measures. In recommended children's key age groups, 5879 WHO assessment forms (1997) were analyzed. Calculated prevalence and intensity of dental caries, the Significant Index of Caries (SiC) and European dental health indicators, and the condition of periodontal tissues were determined with the help of the community periodontal index (CPI) and oral hygiene by OHI-S. The statistical analysis was performed within the SPSS 19 (SPSS Inc., Chicago, IL, USA). The obtained data were statistically processed in the STATISTICA 6.0 (StataCorp LLC, College Station, TX, USA) for Excel program (Microsoft Corp., Redmond, WA, USA). The prevalence of caries of temporary teeth was 91.7% on the average. In 12-year-old schoolchildren the average prevalence of caries of permanent teeth rate was 87.5%. The prevalence of periodontal lesions in children was 47.8% on the average. In Armenia there was an increase in dental morbidity during the 2009-2019 period, which presumably would be continued unless the factors affecting the development of diseases will be changed. To improve dental health at the population level not only specialists but also health authorities should make efforts introducing appropriate prevention programs.

Qualidade de vida relacionada à saúde em crianças com paralisia cerebral associada a síndrome da Zika congênita

To describe the health-related quality of life (QOL) in children with cerebral palsy (CP) associated with congenital Zika infection. Cross-sectional study of a consecutive series of children, followed in a referral multicentric rehabilitation network in Brazil. We invited the caregivers to respond to the Brazilian version of the Caregiver Priorities & Child Health Index of Life with Disabilities (CPCHILDTM) questionnaire. Statistical analysis was performed with the Statistical Package for the Social Sciences (SPSS) 26.0™. We used absolute and relative frequencies for categorical variables and mean and standard deviation for continuous variables. The sample consisted of 193 children, at mean age of 50.3±7.6 months. We observed a predominance of children with cerebral palsy (CP) with Gross Motor Function Classification System (GMFCS) level V (93.7%). Epilepsy (88.4%) was the most common comorbidity. CPCHILDTM mean scores were activities of daily living (ADL)/personal care 43.2±12.6; positioning, transferring and mobility 33.7±16.5; comfort and emotions 84.4±15.2; communication and social interaction (CoSI) 48.2±24.3; health 70.9±17.1; and overall quality of life (OQOL) 72.1±17.1. Total score was 54.8±11.3. Among children with cerebral palsy (CP) related to congenital Zika syndrome, the quality of life (QOL) scores were very similar to other populations with cerebral palsy (CP). The activities of positioning, transferring and mobility had the greatest impact on health-related quality of life (QOL). Rehabilitation strategies and public policies should prioritize aspects related to mobility for this population.