Child Health Research Articles

Morphological and clinical findings in placentas and newborns with a history of tobacco, alcohol, and other substance abuse during pregnancy.

Exposure to toxins during pregnancy is the main modifiable behavior that affects the placenta and, consequently, the fetus. In particular, smoking is a recognized risk factor for negative outcomes. Our study pretended to examine gross and microscopic placental features in women who reported exposure to tobacco, alcohol, or other psychoactive substances. In this observational case-control study, we collected 706 placentas to assess precise substance exposure histological-interaction features of in the placenta. We examined gross and microscopic placental features, and then recorded maternal and newborn clinical conditions. We found that 4.8% of mothers admitted to consumption of some type of (harmful) substance. The most common pre-existing maternal condition was obesity (20.3%); predominant complications included amniotic infection (32.3%), urinary tract infection (14.5%) and hypertensive disorders of pregnancy (14.5%). In newborns, we discovered positive associations as respiratory distress syndrome. Macroscopically, exposed mothers had heavier placentas, more true knots, and single umbilical artery; microscopically, they were more likely to exhibit fetal vascular malperfusion (FVM). Until our present study, no research linked umbilical cord defects to toxic substance exposure; our study results do confirm association with adverse outcomes in neonates and alterations in the neuro-cardio-placental circuit through FVM. The results are confirming the importance of this modifiable risk factor and how its presence may potentially affect the course of pregnancy, as well as the health of both mother and child.

Mental Health Care for Children with Heart Disease and Their Families: Practical Approaches and Considerations for the Pediatric and Pediatric Cardiology Clinician.

Mental health conditions are a common comorbidity among children living with heart disease. Children with congenital heart disease are more likely to have a mental health condition than their unaffected peers or peers with other chronic illnesses, and mental health risk persists across their lifetime. While poorer mental health in adults with congenital heart disease is associated with worse overall health outcomes, the association between mental health and cardiac outcomes for children with heart disease remains unknown. Despite this, it is suspected that mental health conditions go undiagnosed in children with heart disease and that many affected children and adolescents do not receive optimal mental health care. In this article, we review mental health in congenital heart disease across the lifespan, across domains of care, and across diagnoses. Further directions to support mental health care for children and adolescents with heart disease include practical screening and access to timely referral and mental health resources.

Early emotional and behavioural problems predict use of habilitation services among children: Findings from a longitudinal follow-up study.

To explore the association between early emotional and behavioural problems and use of habilitation services among children in Sweden. In this longitudinal cohort study, we used data on children, 3-5 years of age, whose mothers (n = 7343) and fathers (n = 6322) had responded to the Strengths and Difficulties Questionnaire (SDQ) for assessment of emotional and behavioural problems, and who were followed for approximately 6.5 years with regard to use of habilitation services. The relations between emotional and behavioural problems and use of habilitation services were explored through cox regression models. In unadjusted models, children with identified emotional and behavioural problems were more likely to utilise habilitation services compared to those with no identified problems. These associations were shown for both mothers' (HR: 5.02) and fathers' (HR: 4.25) SDQ ratings. In adjusted cox-regression models, the associations remained significant for both mothers' (AHR: 4.24) and fathers' (AHR: 4.03) ratings. Early emotional and behavioural problems predict later habilitation service use among children in Sweden. Assessment of these problems in all children at child health services could facilitate early identification and timely interventions. Habilitation centres in Sweden could integrate mental health care into the standard treatment for children using these services.

Center for Maternal and Child Health Medicaid Partnerships (HRSA)

Center for Maternal and Child Health Medicaid Partnerships (HRSA)

Maternal and Child Health Policy Innovation Program (HRSA)

Maternal and Child Health Policy Innovation Program (HRSA)

PREVALENCE AND MANAGEMENT OF IRON DEFICIENCY ANEMIA IN CHILDREN: A SYSTEMATIC REVIEW

Background: Even in affluent nations, IDA is still a significant public health issue, particularly for young children and women who are ready to have children. Aims: This systematic review is to review the treatment and prevalence of iron deficiency anemia in children. Methods: This study demonstrated compliance with all requirements by means of a comparison with the standards established by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020. Thus, the specialists were able to guarantee that the research was as current as feasible. Publications released between 2014 and 2024 were considered for this search strategy. This was accomplished by utilizing a number of distinct online reference sites, including Pubmed, ScienceDirect, and SagePub. It was determined that reviews, previously published works, and partially completed works would not be included. Result: In the PubMed database, the results of our search brought up 353 articles, whereas the results of our search on SCIENCE DIRECT brought up 8.865 articles, our search on SAGEPUB brought up 3.269 articles. The results of the search conducted for the last year of 2014 yielded a total 184 articles for PubMed, 4.071 articles for SCIENCE DIRECT and 1.144 articles for SAGEPUB. In the end, we compiled a total of 5 papers, 3 of which came from PubMed, 1 of which came from SCIENCE DIRECT and 1 of which came from SAGEPUB. We included five research that met the criteria. Conclusion: In summary, with its haematological repercussions of anemia, IDA is a prevalent and significant children health concern. To assess the effects of IDA on immunity and neurocognition, additional research is necessary. The key to successfully treating children with IDA is early identification and diagnosis of the condition together with competent interpretation of laboratory tests.

Prompt treatment of fever and its associated factors among under-five children in sub-Saharan Africa: A multilevel analysis of evidence from 36 countries.

Despite the decrease in the global under-five mortality rate, the highest rates of mortality are reported in sub-Saharan Africa. More than one-third of all deaths among under-five children are either from lower respiratory tract infections, diarrhea, or malaria. Poor treatment-seeking behavior for fever among mothers of under-five children is a big concern in sub-Saharan Africa. However, the pooled prevalence of prompt treatment of fever and its associated factors among under-five children in the region using nationally representative data is not known. Therefore, the findings of this study will inform policymakers and program managers who work on child health to design interventions to improve the timely and appropriate treatment of fever among under-five children. Data from the recent demographic and health surveys of 36 countries in sub-Saharan Africa conducted between 2006 and 2022 were used. A total weighted sample of 71,503 living children aged under five years with a fever was included in the study. Data extracted from DHS data sets were cleaned, recorded, and analyzed using STATA/SE version 14.0 statistical software. Multilevel mixed-effects logistic regression was used to determine the factors associated with the outcome variable. Intra-class correlation coefficient, likelihood ratio test, median odds ratio, and deviance (-2LLR) values were used for model comparison and fitness. Finally, variables with a p-value <0.05 and an adjusted odds ratio with a 95% confidence interval were declared statistically significant. The pooled prevalence of prompt treatment of fever among under-five children in sub-Saharan African countries was 26.11% (95% CI: 25.79%, 26.44%). Factors like maternal education [AOR = 1.18; 95% CI (1.13, 1.25)], maternal working status [AOR = 1.34; 95% CI (1.27, 1.41)], media exposure [AOR = 1.05; 95% CI (1.01, 1.10)], household wealth index [AOR = 1.13; 95% CI (1.06, 1.19)], distance to a health facility [AOR = 1.18; 95% CI (1.13, 1.23)], healthcare decisions [AOR = 1.34; 95% CI (1.01, 1.77)], visited healthcare facility last 12 months [AOR = 1.45; 95% CI (1.38, 1.52)], antenatal care attendance [AOR = 1.79; 95% CI (1.61, 1.99)], place of delivery [AOR = 1.55; 95% CI (1.47, 1.63)], and community-level antenatal care utilization [AOR = 1.08; 95% CI (1.02,1.14)] were significantly associated with prompt treatment of fever among under-five children. The pooled prevalence of prompt treatment of fever among under-five children in sub-Saharan African countries was low. Educated women, working mothers, having media exposure, rich household wealth status, perceiving distance to a health facility was not a big problem, making healthcare decisions with husband or partner, visiting healthcare facility in the last 12 months, antenatal care attendance, health facility delivery, and high community-level antenatal care utilization increase the odds of prompt treatment of fever. Therefore, women's empowerment, information dissemination through mass media, maintaining regular visits to healthcare facilities, and strengthening health facility delivery and antenatal care services are strongly recommended.

Tobacco control policies and respiratory conditions among children presenting in primary care

Tobacco control policies can protect child health. We hypothesised that the parallel introduction in 2008 of smoke-free restaurants and bars in the Netherlands, a tobacco tax increase and mass media campaign, would be associated with decreases in childhood wheezing/asthma, respiratory tract infections (RTIs), and otitis media with effusion (OME) presenting in primary care. We conducted an interrupted time series study using electronic medical records from the Dutch Integrated Primary Care Information database (2000–2016). We estimated step and slope changes in the incidence of each outcome with negative binomial regression analyses, adjusting for underlying time-trends, seasonality, age, sex, electronic medical record system, urbanisation, and social deprivation. Analysing 1,295,124 person-years among children aged 0–12 years, we found positive step changes immediately after the policies (incidence rate ratio (IRR): 1.07, 95% CI: 1.01–1.14 for wheezing/asthma; IRR: 1.16, 95% CI: 1.13–1.19 for RTIs; and IRR: 1.24, 95% CI: 1.14–1.36 for OME). These were followed by slope decreases for wheezing/asthma (IRR: 0.95/year, 95% CI: 0.93–0.97) and RTIs (IRR: 0.97/year, 95% CI: 0.96–0.98), but a slope increase in OME (IRR: 1.05/year, 95% CI: 1.01–1.09). We found no clear evidence of benefit of changes in tobacco control policies in the Netherlands for the outcomes of interest. Our findings need to be interpreted with caution due to substantial uncertainty in the pre-legislation outcome trends.

Exploring the relationship between school-supervised asthma therapy and social determinants of health in pediatric asthma care.

Social determinants of health (SDoH), including access to care, economic stability, neighborhood factors, and social context, strongly influence pediatric asthma outcomes. School-supervised asthma therapy (SST) is an evidence-based strategy that improves asthma outcomes, particularly for historically marginalized children, by providing support for daily medication adherence in school. However, little is known about the relationship between these programs and the adverse SDoH commonly affecting underrepresented minority and marginalized children with asthma. We examined qualitative data from interviews (n = 52) conducted between 2017 and 2020 with diverse multi-level partners involved in Asthma Link, a SST intervention. Participants included end-users (children and their parents), deliverers (school nurses and pediatric providers), and systems-level partners (e.g., insurers, legislators, and state officials). We used inductive coding to determine themes and subthemes and deductive coding using the Healthy People 2030 SDoH framework. Three themes emerged: (1) SST mitigates adverse SDoH (improves access to preventive healthcare and asthma health literacy), (2) SST benefits children experiencing specific adverse SDoH (provides a consistent medication routine to children with unstable family/housing situations) and (3) specific adverse SDoH impede SST implementation (economic instability, culture and language barriers). This study suggests an important relationship between SDoH and SST that warrants further evaluation in our future work on this community-based asthma intervention. Moreover, our findings underscore the importance of measuring SDoH in the implementation and evaluation of pediatric asthma interventions, particularly given the strong influence of these social factors on child health outcomes.

Health System-Related Factors that Influence Retention in Care among HIV Infected Pregnant Women in Narok County, Kenya

Purpose: The aim of the study was to establish the health system-related factors that influence retention in care among HIV infected pregnant women in Narok County, Kenya. Methodology: The study adopted a cross-sectional mixed method design. Purposive sampling method was used to sample the required sample size of 117 HIV infected pregnant women, the participants of the Focus Group Discussions (FGD) and Key Informant Interviews (KII). The study was carried out at Narok County Referral and all the sub-county hospitals in Narok County. A structured questionnaire was used to collect quantitative data. Focus group discussion and KII guides were used to collect qualitative data. Quantitative and qualitative data was analyzed using SPSS version 21 and Nvivo version 14 respectively. Chi square test and logistic regression analysis were used to determine the health system-related factors that influence retention in HIV care. Thematic content analysis was done for qualitative data. The mean age of participants was 30 years (SD=6.48). The study results generated were presented in bar graphs and tables for quantitative data. Results were presented as narrations and triangulated with qualitative data. Findings: This study established that health system-related factors (waiting time, health care workers services and ARV availability) influenced retention in care among HIV infected pregnant women. However, only ARV availability had a significant association with retention in care (P&lt;0.001, OR=0.19). The multiple logistic regression was used to predict the influence of grouped variables. Overall, the model was a significant predictor of retention in care. Health system related factors was found to increase the likelihood of being retained in care (OR=5.14), though not significant predictors of retention in care (P&lt;0.34). Unique Contribution to Theory, Practice and Policy: Health system-related factors particularly ARV drug stocks, healthcare workers staffing and timely access of services should be strengthened in order to avert stock outs, minimize waiting time and follow up patients who miss clinic appointments to increase retention among pregnant women in HIV care. Advocate for policy reforms aimed at addressing structural barriers to retention in care, including increased investment in healthcare infrastructure, workforce capacity building, and integration of HIV services within maternal and child health programs. By aligning policy initiatives with the unique needs of HIV-infected pregnant women, policymakers can foster an enabling environment for retention in care, ultimately contributing to the achievement of national and global HIV/AIDS targets.

How does intergenerational coresidence affect the physical health of middle-aged children? Evidence from China

ABSTRACT Due to increasing longevity and decreasing fertility, the middle-aged generation has emerged as the primary caregivers for their elderly parents in China. Using the China Health and Retirement Longitudinal Survey, this study employs an endogenous treatment effect model to estimate the causal impact of intergenerational coresidence on the physical health of middle-aged children. The findings reveal that coresidence significantly deteriorates the physical health of middle-aged children. Notably, this effect is more pronounced in employed individuals compared to unemployed ones. Marginal effect analysis uncovers that coresidence has adverse effects on middle-aged children who are either particularly healthy or particularly unhealthy, while the marginal impact of coresidence on children in average health conditions is insignificant.

Interpretation of the UK screening and treatment of retinopathy of prematurity updated 2022 guidelines

The UK screening and treatment of retinopathy of prematurity (ROP) updated 2022 guidelines were developed by a multidisciplinary guideline development group from the Royal College of Paediatrics and Child Health and the Royal College of Ophthalmologists, following the standards of the National Institute for Health and Care Excellence. They were published on the websites of the Royal College of Paediatrics and Child Health and the Royal College of Ophthalmologists in March 2022, and formally published in Early Human Development in March 2023. The guidelines provide evidence-based recommendations for the screening and treatment of ROP. The most significant change in the 2022 updated version compared to the previous guidelines is the lowering of the gestational age screening criterion to below 31 weeks. The treatment section covers treatment indications, timing, methods, and follow-up visits of ROP. This article interprets the guidelines and compares them with ROP guidelines/consensus in China, providing a reference for domestic peers.

Unveiling school community perceptions of nutrition-friendly school initiatives in preschool settings in rural Sindh province, Pakistan: an exploratory study.

In 1995, the World Health Organization launched its Global School Health Initiative to expand the Health Promoting School (HPS). The objective of this study was to explore the perception of the school community in implementing nutrition-friendly school initiatives in preschool settings. This paper delineates the exploratory phase of a mixed-method study, which broadly aims to assess the adoption of the Nutrition Friendly School Initiative (NFSI) through a preschool preparedness intervention package in rural Sindh province, Pakistan. The study sites include three campuses of the Aga Khan School (Mirpur Sakro, Junior Campus Vur, and a community-based school in Sujawal). Participants were selected purposively from these campuses and constituted a committee named 'school community,' which was responsible for implementing all activities outlined in the intervention package. Data was gathered through in-depth interviews and consultative meeting with the school community. Thematic analysis was employed for data analysis. The analysis established five major themes that represent the participants' perception of school-based nutrition interventions in preschool settings. These five themes include (i) Challenges in health and nutrition for pre-school age children, (ii) Clarity in roles and responsibilities for school-based nutrition intervention, (iii) Advancing school-based nutrition activities and interventions, (iv) Recognizing resources requirements, (v) Opportunities and challenges for the way forward in school-based nutrition. Findings also suggest sustainability and scalability measures that include the aligning School Nutrition Policy with the school handbook, ways to engage with parents, a nutrition theme corner, the inclusion of a parenting component in the nutrition manual, and capacity building of the school community. Qualitative findings have guided the refinement of the intervention package, proposing additional measures for sustainability and scalability across AKES, P. The school community is hopeful that the implementation of the refined intervention package will enhance preschool preparedness toward achieving nutrition-friendly school checklist items. This study holds strong potential for replication in a public school setting and presents an opportunity to launch a school accreditation program to certify schools as Nutrition-friendly.

Family Stress Processes Underlying COVID‐19–Related Economic Insecurity for Mothers and Fathers and Children's Internalizing Behaviour Problems

ABSTRACTCOVID‐19 and its economic fallout have resulted in unprecedented financial insecurity and material hardship for many American families, with a disproportionately negative impact on children and families from socioeconomically disadvantaged contexts. The current study applied the family stress model to examine the family processes underlying pandemic‐related economic insecurity and children's internalizing behaviours. Online survey data from an economically diverse sample of mothers and fathers, who experienced at least one type of pandemic‐related economic insecurity in the United States (N = 259), were collected across two longitudinal time points in the early weeks of COVID‐19: (1) 14 April and (2) 30 April of 2020. Parental depressive symptoms, negative partner relationship quality and harsh parenting were tested as mediators. Results from the path model showed that pandemic‐related economic insecurity was associated with higher levels of parental depressive symptoms, which were then associated with higher levels of negative partner relationship quality. Negative partner relationship quality was subsequently associated with more harsh parenting, which was then associated with increased child internalizing behaviours. Indirect effects were found for all hypothesized mediators. The family stress model can be applied and extended to the early COVID‐19 period. Child and family social work implications include targeting parents' mental health, relationship quality and parenting behaviours, as well as directly addressing financial and material hardship, to mitigate the adverse effects of pandemic‐related economic insecurity on children's mental health.

Association between Child Mortality and Healthcare Facility Level Factors: Evidence from Nationally Representative Survey

Child mortality is an important indicator of child health and overall national development. Under-five mortality is unacceptably high in Low- and Middle-Income Countries (LMICs) including Bangladesh. Increased availability and access to the healthcare services can play a significant role to reduce under-five mortality. The aim of this study was to explore the associations of several forms of child mortality with health facility level factors. Data were extracted from the 2017-18 Bangladesh Demographic and Health Survey data and 2017 Bangladesh Health Facility Survey data. Three outcome variables were considered: neonatal mortality, infant mortality, and under-five mortality in this study. Health facility level factors were considered as major explanatory variables. They were the availability of the child healthcare services at the nearest healthcare facility, readiness of the nearest healthcare facility to provide child healthcare services and the average distance of the nearest healthcare facility providing child healthcare services. Multilevel mixed-effect logistic regression model was used to determine the associations between the outcome variables and explanatory variables adjusted for covariates. We reported under-five, infant and neonatal mortality were 40, 37, and 30 per 1000 live births, respectively. The likelihood of neonatal and infant mortality was found to be declined for one-unit increase on the availability and readiness of the mothers’ homes nearest healthcare facilities to provide child healthcare services. On contrary, for every kilometre increased distance between mothers’ homes and their nearest healthcare facility was found to be associated with increased in the likelihoods of neonatal, infant and under-five mortality. The availability of health facilities providing child healthcare services close to residence and their improved management, infrastructure, and readiness to provide child healthcare services play a significant role in reducing under-five mortality in Bangladesh. Policies and programs should prioritize to increase the availability and accessibility of health facilities that provide child healthcare services.

Clinical diagnostic practices for Chinese developmental dyslexia

Objective: To explore the optimization of the standardized assessment tool for clinical diagnosis of Chinese developmental dyslexia (DD). Methods: A cross-sectional study was conducted from May to December 2023, in which 130 primary school children in grades 1 to 3 with clinical signs of literacy lag and positive screening results on the screening scales were recruited from the outpatient clinic of Child Health Care Medical Division, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine. Chinese dyslexia screening behavior checklist for primary students (CDSBC) was used as the screening scales, and supplemented by dyslexia checklist for Chinese children. Referring to the standard procedure of the"expert advice on diagnosis and intervention of chinese developmental dyslexia", the developmental dyslexia scale for standard mandarin (DDSSM) was used to evaluate the children's literacy-related cognitive abilities and conduct the diagnostic assessment, and divided the children into learning backward group and the DD group. The t-test and χ2 test were used to compare the differences in the distribution of intelligence, literacy and attention deficit hyperactivity disorder between the two groups. Spearman's correlation was used to analyze the correlation between the scores for each cognitive ability in the DDSSM and the CDSBC. Results: Of the 130 children, 90 were male, aged (8.3±1.0) years; 40 were female, aged (8.1±0.9) years. A final diagnosis of DD was made in 59 cases, of which 41 were males. There was no statistically significant difference in operational intelligence quotient (101±15 vs.100±15, t=0.53, P>0.05) and statistically significant difference in literacy of DDSSM (32±5 vs.21±4, t=11.56, P<0.001) between the learning backward group and the DD group. Eighteen cases (25.4%) of the learning backward group were children with attention deficit subtype attention deficit hyperactivity disorder (ADHD-I), and 16 cases (27.1%) in DD group, the difference in incidence between the two groups was not statistically significant (χ2=0.05, P>0.05). There were correlations between the DDSSM (for oral vocabulary, morphological awareness and orthographic awareness) and the CDSBC total score (r=-0.42, -0.32, -0.35, all P<0.01), but the correlations for visuospatial perception and rapid automatized naming with CDSBC total score were not statistically significant (r=-0.09 and -0.20,both P>0.05). Conclusions: For literacy-related cognitive abilities, screening scales CDSBC are not sufficiently useful for assessment, so the introduction of standardized assessment tools DDSSM is an optimization of the clinical diagnosis of Chinese DD, which is crucial for achieving accurate diagnosis and intervention.

A comparative study on knowledge, awareness and perception of contraception among rural and urban population in Punjab

In developing countries like India, a lack of awareness about contraceptive methods often leads to misconceptions, limited choices, and improper family planning. This knowledge gap not only disrupts maternal and child health complications but also disrupts the economy of society and the nation. Therefore, the purpose of this study was to investigate the knowledge, awareness and perception of contraception among the rural and urban population in Punjab.This observational study conducted in the Department of Obstetrics and Gynecology at a tertiary health care centre, in Punjab, India. A total of 500 women were evaluated with the help of a pre-designed questionnaire to address knowledge, awareness, and perception of contraception among the rural and urban population in Punjab. The statistical analysis was performed by using SPSS Windows, version 28. In the present study, a total of 492 participants were included, of whom 387 were from rural areas and 105 were from urban areas. This study revealed, 100% of participants were aware of contraception. In terms of the source of information, social circles were identified as the primary channel (46.34%), followed by the media (33.94%), health workers (16.87%), and educational institutes (2.85%).This study highlights contraceptive methods, including condoms, oral contraceptives, and intrauterine devices (IUDs), as primary choices. Therefore, it's important to bridge the gap between awareness and action. Hence, this study, advocate the awareness program on interventions to ensure everyone can access effective family planning resources without barriers.

Development of new hormonal male contraception for the couple.

Current options for male contraception are limited to condoms, the withdrawal method, or a vasectomy. Studies indicate that men have expressed growing interest in bearing responsibility for family planning. To review prior studies investigating the role of an androgen-only or androgen with progestin regimen for hormonal male contraception and to provide an update of a promising new hormonal agent, a transdermal gel. Thus far, there have been six studies conducted in couples evaluating the contraceptive efficacy of an androgen-only or androgen co-administered with a progestin regimen for hormonal male contraception. The only ongoing study is by the National Institute of Child Health and Human Development, in collaboration with the Population Council. They have developed a novel transdermal gel containing testosterone and segesterone acetate (Nestorone), a progestin. An ongoing phase II study enrolling more than 460 couples has shown great potential with respect to the product's efficacy, safety, reversibility, and acceptability. As this agent advances in development, a rapid at-home test for sperm concentration will provide couples with immediate feedback regarding their potential for pregnancy. There is promise for the first-of-its-kind hormonal male contraceptive, a transdermal gel, to achieve market approval for distribution in the United States and elsewhere. Its safety, efficacy, reversibility, and user-control are all appealing qualities that make it readily adoptable for clinical practice.

Family Medicine Implementation to Maternal and Child Health in Rural Japan: A Narrative Review.

This research provides a critical narrative review of maternal and child health (MCH) in rural Japan, reflecting broader challenges faced by aging societies globally. The study explores the intertwined roles of professional and lay care in sustaining rural communities, emphasizing the unique position of family medicine and primary care in enhancing MCH services. The scarcity of healthcare resources, particularly the shortage of obstetricians and the weakening of traditional community support systems, underscores the challenges in these areas. Our review method involved a comprehensive search of PubMed for articles published from April 2000 to August 2024, focusing on MCH issues in rural Japan. This study highlights several critical gaps in rural MCH provision: the migration of medical professionals to urban centers, the transformation of social structures affecting traditional caregiving, and the lack of specialized MCH training among primary care physicians. We discuss potential solutions such as incentivizing obstetric care in rural areas, integrating MCH education within family medicine curricula, and revitalizing community-based support systems. By addressing these issues, the research aims to formulate actionable strategies to bolster MCH services, thus ensuring better health outcomes and sustainability of rural communities in Japan and similar settings worldwide.

Integration of cervical cancer screening into healthcare facilities in low- and middle-income countries: A scoping review.

Cervical cancer is a prevalent disease among women, especially in low- and middle-income countries (LMICs), where most deaths occur. Integrating cervical cancer screening services into healthcare facilities is essential in combating the disease. Thus, this review aims to map evidence related to integrating cervical cancer screening into existing primary care services and identify associated barriers and facilitators in LMICs. The scoping review employed a five-step framework as proposed by Arksey and O'Malley. Five databases (MEDLINE, Maternity Infant Care, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science) were systematically searched. Data were extracted, charted, synthesized, and summarised. A total of 28 original articles conducted in LMICs from 2000 to 2023 were included. Thirty-nine percent of the reviewed studies showed that cervical cancer screening (CCS) was integrated into HIV clinics. The rest of the papers revealed that CCS was integrated into existing reproductive and sexual health clinics, maternal and child health, family planning, well-baby clinics, maternal health clinics, gynecology outpatient departments, and sexually transmitted infections clinics. The cost-effectiveness of integrated services, promotion, and international initiatives were identified as facilitators while resource scarcity, lack of skilled staff, high client loads, lack of preventive oncology policy, territorial disputes, and lack of national guidelines were identified as barriers to the services. The evidence suggests that CCS can be integrated into healthcare facilities in LMICs, in various primary care services, including HIV clinics, reproductive and sexual health clinics, well-baby clinics, maternal health clinics, and gynecology OPDs. However, barriers include limited health system capacity, workload, waiting times, and lack of coordination. Addressing these gaps could strengthen the successful integration of CCS into primary care services and improve cervical cancer prevention and treatment outcomes.