Child Health Outcomes Research Articles

Prenatal maternal diabetes, comorbidities, and risk for neurodevelopmental impairment in the first two years.

Maternal diabetes is a known risk for neurodevelopmental delay in offspring, and often presents with comorbid metabolic conditions, such as obesity and hypertension. However, their combined effects on neurodevelopmental outcomes remain unclear. We investigated the independent and combined associations of maternal diabetes and comorbidities with the risk of neurodevelopmental delay in children aged 12 and 24 months. A prospective longitudinal cohort of children from Pregnancy during the COVID-19 Pandemic study. Neurodevelopmental screening at 12 and 24 months was conducted using the Ages and Stages Questionnaire, which assesses domain-specific development. Maternal diabetes was not associated with neurodevelopmental risks either at 12 or 24 months. However, in combined analyses, maternal diabetes and pre-pregnancy overweight were associated with an increased risk of neurodevelopmental delay in personal-social skills (odds ratio [OR], 1.75 [95%CI,1.01-3.01]) at 24 months, though not at 12 months. Maternal diabetes and pre-pregnancy obesity were also associated with an increased risk for neurodevelopmental delay in communication (OR, 1.71 [95%CI,1.01-2.82]) and personal-social skills (OR, 2.01 [95%CI,1.03-3.73]) at 24 months. Furthermore, maternal diabetes and hypertensive disorders of pregnancy (HDP) had higher rates of positive screening for delay in fine-motor skills (OR, 3.54 [95%CI, 1.28-8.41]) at 12 months but not at 24 months. Post-hoc analysis revealed an independent association of maternal pre-pregnancy obesity, but not overweight, with an increased risk of neurodevelopmental delay in communication, fine-motor, and personal-social skills (ORs ranging from 1.44 to 1.71) at 24 months but not 12 months. Similarly, there was an independent association of maternal HDP with an increased risk of neurodevelopmental delay in fine-motor and and personal-social skills (ORs ranging from 2.01 to 2.19) at 24 months. Maternal diabetes with comorbid conditions is likely to increase the risk of neurodevelopmental delay during infancy than individual exposure, suggesting the persistent influence of prenatal exposure on offspring neurodevelopment. 1. Identifying modifiable prenatal risk factors for neurodevelopmental impairment in offspring is crucial for targeted interventions and providing support to mothers during pregnancy, which can lead to improved child health outcomes. 2. Maternal diabetes was not associated with neurodevelopmental delays in children at 12 or 24 months. 3. Maternal diabetes in combination with pre-pregnancy overweight or obesity increased the risk of cognitive delay at 24 months. 4. Maternal pre-pregnancy obesity but not overweight, and hypertensive disorders of pregnancy independently increased risks of cognitive and motor delays at 24 months.

Point-of-care biochemistry for primary healthcare in low-middle income countries: a qualitative inquiry

BackgroundAccess to essential diagnostics is crucial for primary healthcare (PHC) in low-and-middle income countries (LMICs). Many LMICs have invested in equipping PHC with point-of-care (PoC) diagnostics for infectious diseases, however there has been no similar investment to improve PHC capacities for clinical chemistry. The biochemistry gap is among the deterrents to universal health coverage.MethodsA social sciences project was conducted with the aim to understand the key PHC stakeholders’ insights on the pertinence of PoC biochemistry for PHC in LMICs. Data generation was conducted between July-November 2023 in Mongolia, Nigeria and Peru. Decision-makers in healthcare delivery, healthcare professionals, and patient and community advocates were engaged using a combination of sampling techniques. Unstructured individual and group conversations, and non-participant observation were conducted. Analysis involved an inductive line-by-line coding on printed transcripts, followed by a deductive coding and theme-by-theme analysis on digitized transcripts.ResultsFifteen, 51 and 20 informants from Mongolia, Nigeria and Peru, respectively, participated. Fifty-five of the 94 informants were female. Most informants considered that PoC biochemistry in PHC would be pertinent, from a clinical and a resources-saving perspective. Those households that currently bear the burden of referrals (i.e., the poor, the bedridden, the older adults) would benefit the most from the deployment of PoC biochemistry for essential biochemistry parameters. Improved access to PoC glycated hemoglobin (HbA1c), lipid, liver and kidney profile was perceived as helpful to inform clinicians’ decision-taking. The value of PoC biochemistry for the management of noncommunicable diseases (diabetes, hypertension) and infectious conditions (dengue, malaria, tuberculosis), to improve child health outcomes (severe dehydration in children with diarrhea and/or malnutrition) and to reduce preventable causes of death (dengue-related renal failure) was highlighted.ConclusionsPoC biochemistry holds potential to revert the impact that the biochemistry gap has for patient care in some LMICs’ PHC settings. PoC equipment for parameters such as HbA1c, urea, creatinine or electrolytes could enhance community-level management of preventable causes of mortality, improve service delivery for patients affected by locally-prevalent infectious conditions, and improve the psychosocial and economic wellbeing of patients facing the burden of referrals to remote biochemistry-equipped centers.Trial RegistrationNot applicable.

Association between maternal stress and child sleep quality: a nationwide ECHO prospective cohort study.

Childhood sleep quality is associated with physical, cognitive, and behavioral health and predicts later sleep quality; it has many determinants, including developmental exposures. To examine associations between maternal stress during pregnancy and childhood sleep quality and determine whether postnatal stress mediates the association. Data from the Environmental Influences on Child Health Outcomes cohort were used. Perceived Stress Scale (PSS) T-scores were the exposure measure. Outcome measures were preschool Child Behavior Checklist (CBCL) sleep syndrome scale and Patient-Reported Outcomes Measurement Information System Sleep Disturbance Parent Proxy short form 4a (PSD4a) T-scores at ages 4-8 years. Linear mixed-effects regression modeling was performed for each sleep outcome, adjusting for maternal age at delivery and education and child sex, gestational age at birth, and age at outcome ascertainment, with random intercepts for cohorts. Prenatal PSS score was associated with both CBCL (B = 0.09, 95% confidence interval [CI]: 0.06, 0.11; p < 0.01) and PSD4a (B = 0.07, 95% CI: 0.03, 0.12; p < 0.01) scores. Postnatal perceived stress mediated a proportion of the total effect of prenatal stress in both CBCL (66.3%) and PSD4a (95.9%) samples. Both pre- and postnatal maternal perceived stress appear to influence sleep quality during early life. Prenatal stress significantly associates with child sleep problems and disturbances at ages 4-8 years; postnatal maternal stress is a significant mediator of these associations. Research suggests a range of prenatal affective/distress exposures associated with child sleep problems, but the conclusions remain in doubt due to the mixture of exposures and outcomes employed. Ours is the first US-based effort to explore associations between perceived maternal stress during pregnancy and child sleep problems and disturbance in early and middle childhood. Even a small effect of a prevalent issue like psychosocial stress may have important public health implications at the population level.

Exploring Screen Time and Its Effects on Children's Mental Health: A Cross-Sectional Study.

Background The increasing prevalence of screen-based activities among children has raised concerns about potential mental health effects. This study investigates the relationship between screen time and mental health outcomes in children aged 6 to 14 years in Saudi Arabia and Bahrain, focusing on emotional symptoms, conduct problems, hyperactivity, peer problems, and depressive symptoms. Methods A cross-sectional study was conducted with 670 children recruited through stratified random sampling. Data were collected using self-reported questionnaires and parental surveys from January to June 2024. Screen time was assessed across four activities: TV viewing, smartphone usage, computer/tablet use, and video game playing, recorded separately for weekdays and weekends. Mental health was evaluated using the Strengths and Difficulties Questionnaire (SDQ) and the Children's Depression Inventory (CDI). Descriptive statistics and Pearson correlation coefficients were used to analyze the data. Results Participants reported a mean total screen time of 7.25 ± 2.4 hours on weekdays and 8.4 ± 2.65 hours on weekends. Smartphone usage (2.75 ± 1.3 hours/day) was the most common activity. Emotional symptoms, conduct problems and depressive symptoms were significantly correlated with both weekday and weekend total screen time (weekday r = 0.43, r = 0.31, and r = 0.49, respectively, p < 0.001; weekend r = 0.47, r = 0.33, and r = 0.54, respectively, p < 0.001). Smartphone usage had the strongest association with depressive symptoms (r = 0.46, p < 0.001). Conclusion This study identifies a significant positive correlation between increased screen time and adverse mental health outcomes in children, particularly emotional symptoms and depressive symptoms. The findings emphasize the need for public health strategies to manage screen time and promote healthier digital habits to mitigate the potential negative effects on children's mental health.

Integrating health and child protection systems: towards collaboratively improving health outcomes for children in kinship care in rural Australia

PurposeThere is a growing recognition that the integration of health systems will benefit children in out-of-home care (OOHC), especially those who have experienced trauma. This paper examines the adaptation of existing health systems and the persistent barriers between rural health and child protection programs. It focuses on health systems integration for children aged 0–6 years in kinship care and their siblings.Design/methodology/approachThe study applied a multi-methods qualitative approach involving individual interviews and focus groups with project members from operational or strategic reference groups, child protection personnel and the kinship carer program. We also reviewed documentary evidence.FindingsWe found evidence that health clinicians and child protection practitioners adapted and adjusted services as they collaboratively worked together to improve care delivery to children in kinship care. Yet, despite successful adaptations to systems and the appointment of a health navigator, systemic barriers remain. These include service and staff shortages in rural Australia, complications around information sharing, authority and power dynamics and siloed operations. Such barriers prevent better-integrated health systems and ultimately impair health outcomes for children in kinship care.Originality/valueThis paper contributes to knowledge and practice to improve the integration of child protection and healthcare services in Australian OOHC. It provides valuable insights into the challenges and successes of health systems integration, highlighting the need for continued collaborative effort to create effective, place-based models of care that benefit these children and their carers.

The Effect of Screen Time and Positive School Factors in the Pathway to Child and Youth Mental Health Outcomes.

Beyond achievement, educational settings offer informal supports that may be critical for child and youth mental health. However, children's educational environments have experienced significant disruption with the coronavirus pandemic. School settings offer unique opportunities to support children's mental health, but research must identify powerful points of intervention. This study examined school factors (aspirations, perceived competence, sense of belonging, and emotional engagement) as predictors of children's mental health, and the potential consequences of increasing screen time in and outside of school. Participants (N = 707) were parents and their children (6-18 years) from community and clinical settings who completed prospective surveys about children's school experiences and mental health symptoms (November 2020-May 2022). Standardized measures of depression, anxiety, irritability, inattention, and hyperactivity were collected. Structural equation modelling tested longitudinal associations between screen time, school factors, and mental health outcomes. Positive associations between each of the school factors (B = 0.14 [SE = 0.04] to B = 0.43 [SE = 0.04]) suggested they may reinforce one another. Longitudinally, sense of belonging and emotional engagement at school predicted lower severity for symptoms of depression, anxiety, irritability, and inattention (B=-0.14 [SE = 0.07] to B =-0.33 [SE = 0.10]). Greater screen time was associated with lower aspirations and perceived competence (B = - 0.08 [SE = 0.04] to B = - 0.13 [SE = 0.06]). Results suggest that school factors beyond achievement may be key correlates of child and youth mental health. While curriculum expectations emphasize academic achievement, an investment in supporting positive attitudes and aspirations at school is also warranted.

Estradiol and progesterone from pregnancy to postpartum: a longitudinal latent class analysis.

During the peripartum, women undergo significant hormonal changes that are crucial for fetal development and a healthy pregnancy and postpartum period for mother and infant. Although several studies have determined healthy norm ranges of estradiol and progesterone, there are discrepancies among the reports, rendering it unclear which hormone levels are linked to adverse health outcomes. To account for the impact of sex steroid patterns on health outcomes in mothers and children, a longitudinal assessment of different parameters is needed. We longitudinally assessed a cohort of 130 women over five months during pregnancy and postpartum. The women provided saliva samples and completed psychosocial questionnaires. Hormone analyses were conducted using enzyme-linked immunosorbent assay (ELISA). Different parameters of estradiol and progesterone were analyzed and evaluated in relation to psychometric variables. To examine the presence of heterogenous hormonal trajectories in the peripartum, we applied group-based trajectory modelling as a special case of latent-class group analysis. Estradiol and progesterone levels rose towards the end of pregnancy and dropped sharply after birth, with considerable individual variation, particularly during pregnancy. However, their ratio remained stable. We identified three estradiol trajectory subgroups and two progesterone subgroups. Age influenced progesterone levels, with older pregnant women having higher levels than younger women. Anxiety and depressive symptoms had a predictive value for trajectories of specific subgroups of women. The study also revealed two distinct subgroups regarding the course of estradiol and progesterone fluctuations as well as their ratio. This study provides insights into the course and fluctuation of salivary estradiol and progesterone levels among healthy women during the peripartum period, highlighting significant variations in hormone levels but stability in their ratio during this time. The finding of distinct sex steroid courses in the peripartum is new and suggests the need for further research to explore their impact on health outcomes. Our preliminary results suggest that hormonal fluctuations at the end of pregnancy appear to be a normal occurrence and might even be a protective factor for associated psychological symptoms and sleep disturbances in women.

Effects of school closure on lifestyle behaviours and health outcomes in children during the COVID-19 pandemic in Chile: A time-matched analysis.

The COVID-19 pandemic led to school closures, potentially impairing children's behaviours and health. We aimed to explore the effects of school closure on lifestyle behaviours (dietary habits, physical activity) and health outcomes (adiposity, fitness, self-esteem, self-concept) in children. We measured 247 children before school closure (October-November 2019) and after school reopening (October-November 2021) (COVID-19 group). To distinguish the changes due to school closure from changes due to growth, we included 655 age-matched children with cross-sectional measurements in October-November 2019 (control group). The response of this group (i.e., differences between children with 2 years of difference) was considered the expected response to growth. Two-way ANOVA was used to test age-by-group interactions, indicating an effect of school closure. In 7-to-9-year-old children, the COVID-19 group had larger-than-expected decreases in physical activity (by 0.4 points), resulting in higher physical inactivity prevalence (by 19 percent points) at 9 years. This was accompanied by larger-than-expected increases in fat percentage (by 6.1 percent point). In 8-to-10-year-old children, the COVID-19 group had higher physical inactivity prevalence at 10 years (by 20 percent points). This was accompanied by larger-than-expected increases in fat percentage (by 8.3 percent points), z-score BMI (by 0.90 units), and waist circumference (by 6.1 cm). In 9-to-11-year-old children, the COVID-19 group had larger-than-expected decreases in physical activity (by 0.3 points) and increases in self-concept (by 0.2 points). The response in dietary habits, fitness, or self-esteem was not different between groups. Overall, school closure negatively impacted physical activity and adiposity, particularly in the youngest children.

Factors associated with essential newborn care practices among non-institutional births in urban Bangladesh: evidence from Bangladesh Urban Health Survey 2021

ABSTRACT Background Non-institutional births remain prevalent in low- and middle-income countries, associated with a majority of adverse maternal and child health outcomes, including maternal and child mortality. Ensuring essential newborn care (ENC) practices for these non-institutional births is crucial for reducing these adverse outcomes. This study aimed to identify the prevalence, and factors associated with the adoption of ENC practices among non-institutional births in urban Bangladesh. Methods A total of 2,165 children’s data were analyzed, extracted from the 35,186 ever-married women interviewed in the 2021 Bangladesh Urban Health Survey. Six ENC components and their level (lowest/none, moderate, and highest) were considered as the outcome variables. Several socio-demographic factors were considered as the explanatory variables. Multivariate binary and multinomial logistic regression model were used to explore the association between outcome and explanatory variables. Results Approximately 49% of all mothers reported practicing the highest level of ENC. Among the individual components, the highest adherence was observed for the use of a disinfected instrument to cut the umbilical cord (90%). The likelihood of adopting the highest level of ENC practices was higher among mothers with relatively higher education and wealth quintiles and lower among those residing in slum and other urban areas of city corporations compared to non-slum areas. Mothers living in the Khulna and Sylhet divisions had a lower likelihood of adopting the highest level of ENC practices. Conclusion Awareness building programs are needed to educate the population, particularly mothers, about the importance of practicing ENC for improving maternal and child health outcomes.

Intimate Partner Violence and Its Effects on Maternal and Child Health: A Longitudinal Study in Bener Meriah Regency, Aceh, Indonesia

Intimate partner violence (IPV) is a significant public health issue with devastating consequences for maternal and child health. This study investigates the prevalence and impact of IPV on pregnant women and their children in Bener Meriah Regency, Aceh, Indonesia, a region with limited research on this topic. A longitudinal study was conducted with 250 pregnant women recruited from antenatal clinics in Bener Meriah Regency. Data were collected through questionnaires and interviews at three time points: during pregnancy, six months postpartum, and one year postpartum. The questionnaires assessed IPV experiences, maternal mental health (depression, anxiety, and stress), and child health outcomes (birth weight, growth, and development). The prevalence of IPV during pregnancy was 32%. Women who experienced IPV were significantly more likely to suffer from depression, anxiety, and stress during pregnancy and postpartum. IPV was also associated with lower birth weight and an increased risk of developmental delays in children. In conclusion, this study highlights the serious consequences of IPV for maternal and child health in Bener Meriah Regency. The findings underscore the urgent need for IPV screening and intervention programs in antenatal and postnatal care settings. Midwives play a critical role in identifying and supporting women experiencing IPV.

Early Initiation of Breastfeeding (EIBF) Practices in Bener Meriah Regency, Aceh, Indonesia: A Cross-Sectional Study on the Role of Midwives in Reducing Infant Mortality

Early initiation of breastfeeding (EIBF) is critical for reducing infant mortality and improving child health outcomes. Midwives play a crucial role in promoting and supporting EIBF. This study investigated EIBF practices in Bener Meriah Regency, Aceh, Indonesia, focusing on the factors associated with midwives' knowledge, attitudes, and practices regarding EIBF. A cross-sectional study was conducted among 150 midwives in Bener Meriah Regency. Data were collected using a structured questionnaire that included items on sociodemographic characteristics, knowledge, attitudes, and practices related to EIBF. Descriptive statistics, chi-square tests, and logistic regression were used to analyze the data. The majority of midwives (87.3%) had good knowledge about EIBF. However, only 62.7% of midwives reported always assisting mothers with EIBF within one hour of birth. Factors significantly associated with midwives' EIBF practices included their age, years of experience, and place of work (urban vs. rural). While midwives in Bener Meriah Regency generally possess adequate knowledge about EIBF, there is a need to improve their practices in assisting mothers with EIBF, especially in rural areas. Targeted interventions, such as training programs and supportive supervision, are necessary to enhance midwives' skills and confidence in promoting and supporting EIBF.

What aspects of outcome measurement instruments are important to parents and caregivers in child health trials: Survey protocol

Background Trials of interventions to prevent illness and/or improve health outcomes in children play a crucial role in the advancement of paediatric healthcare, research, and policy. It is important for researchers and trialists involved in such trials to understand factors which are important to parents/caregivers when deciding to participate and provide data about their child. There is little evidence to date surrounding the impact of outcome measurement instruments (OMIs) on parents/caregivers’ decisions about participation and provision of data in trials. The aim of this project is to examine what characteristics of OMIs are important in parents/caregivers’ decisions to engage with and participate in trials of interventions to prevent childhood illness and/or improve child health outcomes. Methods An online cross-sectional survey is being conducted. Survey recruitment began July 2024 and will be completed in October 2024. Parents/caregivers are eligible to participate if they have at least one child up to 12 years of age; there are no restrictions based on factors such as gender or nationality. Survey participants are being recruited using convenience sampling via social media, parenting websites, and online forums. This survey includes questions about parents/caregivers’ preferences for how, when, where, and with whom data is collected in child health research, as well as the types of OMIs parents/caregivers would be most comfortable using. Data will be analysed using descriptive statistics. Conclusions Findings from this study will address the current gap in knowledge related to preferences of parents/caregivers in how data are collected in trials of interventions to improve health outcomes in children. Study findings will inform trialists in the design and conduct of child health research in the future. Implementation of study findings in future trials can also improve experiences of children and their caregivers engaged in research and enhance the quality and quantity of data being collected.

Patient-provider communication about cigarette and e-cigarette use during pregnancy: Adaptation and validation of frequency and quality of communication measures among a sample of pregnant patients.

Quality of patient-provider communication regarding tobacco use may encourage cessation that could lead to improved health outcomes for mothers and children. However, currently there are no validated measures of frequency and quality of patient-provider communication about cigarettes and e-cigarettes. The objective of this study was to adapt and validate measures of frequency and quality of patient-provider communication about smoking and e-cigarette use among a sample of pregnant mothers who currently smoked. An online sample of US pregnant women who reported past 30-day smoking were recruited to complete a cross-sectional, online survey (n=267). An exploratory factor analysis examined the factor structure of four measures of frequency and quality of patient-provider communication about cigarettes and e-cigarettes among those who reported prior communication with their provider about cigarettes and e-cigarettes (n=170). Relationships between measures were explored, and a logistic regression explored each measure's association with intention to switch from cigarettes to e-cigarettes. Items measuring the frequency of communication loaded onto one factor for both cigarettes and e-cigarettes (α=0.88). Quality of communication loaded onto two factors for both cigarettes and e-cigarettes, termed active communication and internalized perception. Internalized perceptions of communication quality about cigarettes (β= -0.32, p<0.002), active communication (β=0.46, p<0.02), and internalized perceptions of communication about e-cigarettes (β= -0.36, p<0.001) were related to intention to switch, in separated models. Quality conversations between healthcare providers and pregnant patients is likely more important for behavioral decision-making than the frequency of communication.

Optimization of timing for maternal immunization to protect newborns from influenza infection

Objectives The primary objective of this systematic review was to identify the optimal timing for immunizing pregnant women to confer the most protection by reducing the incidence of laboratory-confirmed influenza or influenza-like illness in infants less than 6 months of age. Currently, there are gaps in research regarding the timing of administration during the gestational period to provide maximum immunogenicity to the infant. The research question being addressed is: ‘When considering immunization of pregnant mothers with the influenza vaccine, implementing a vaccination program during which trimester in pregnancy would optimize benefits for infants less than 6 months of age in terms of the incidence of laboratory-confirmed influenza and influenza-like illness?’ Design Systematic review/Meta-analysis Methods Randomized controlled trials (RCT’s) and observational studies comparing health outcomes of infants and children up to 6 months of age born to women who received inactivated influenza vaccine during pregnancy with mothers who did not receive the vaccine or received a control vaccine. The primary outcome was laboratory-confirmed influenza infection in infants. Secondary outcome measures included influenza –like illness diagnosed by a clinician and acute respiratory illness. Results 7 studies were included: 2 primary RCT’s and 5 observational studies (prospective and retrospective cohort studies).5 of the 7 studies were suitable to be included in the quantitative synthesis part and and were compared. Forrest plot analysis revealed that vaccinating pregnant mothers in the second and third trimester when compared with any trimester (1,2 and 3) (OR 0.18 vs. 0.65) conferred less protection, promoting vaccination in the first trimester. Conclusions Vaccinating pregnant mothers in the first trimester conferred greater protection to infants than any other trimester.

Balancing nutrition and budgets: Socio-ecological impacts on nutritional environments of families with low incomes

BackgroundResearch on childhood nutritional environments, which are predictive of a variety of child and family health and wellbeing outcomes, has primarily focused on parenting behaviors and the home food environment. However, broader social and community factors play an important role in shaping nutritional environments during early childhood. Food security is a key example that is closely linked to nutrition-related health disparities, which can arise from constrained financial resources and material deprivations. Understanding parent and caregiver lived experiences related to social and community components of family nutritional environments in the context of economic constraints could help to support multi-level nutritional practices that are optimal for healthy child development. MethodSemi-structured in-depth interviews were conducted using a narrative approach with parents (n = 21) of pre-school aged children living near or below the poverty line. Participants were recruited from social and community service sites pertinent to maternal and child health in Philadelphia where health disparities are highly concentrated. Analysis was conducted using MAX QDA analytic software following a systematic approach for thematic analysis in narrative research. ResultsThree themes describe the feeding and eating environments in the home and community context: 1) Food Procurement and Meal Planning; 2) Family Togetherness; 3) Creativity, Variety, and Flexibility. Creative decision making and food procurement strategies responsive to child preferences were balanced by shopping to save and visiting multiple stores for the best foods and savings. Logistical (e.g., transportation, childcare) and emotional supports facilitated food shopping habits and routines, while lack of trusted childcare, reliable transportation, and social support barriers challenged feeding and eating decisions. ConclusionStrategies for improving cost and time-efficiencies could help support health-promoting nutritional environments of families with food insecurity. Building social and community capacity and facilitating connections to practical supports that include trustworthy childcare and peer support may be particularly important for this population.

Inadequate Sunlight Exposure as A Risk Factor for Nutritional Rickets: A Systematic Review

Insufficient sunlight exposure significantly contributes to the development of nutritional rickets, highlighting the critical importance of sunlight in maintaining optimal bone health and preventing this debilitating condition. Nutritional rickets, a preventable skeletal disorder, has significant implications for child health and development, particularly where there is limited sunlight exposure. Adequate sunlight exposure, especially in the form of ultraviolet B (UVB) radiation, is essential for synthesizing and maintaining optimal vitamin D levels, which are key in preventing nutritional rickets. This systematic review aims to comprehensively analyze the relationship between inadequate sunlight exposure and the development of nutritional rickets among children. The review could inform effective preventive strategies by identifying the precise levels of sunlight exposure needed for healthy development and the factors contributing to inadequate exposure. Literature was searched through Google scholar, PubMed (Medline), Cochrane, and Elsevier using the following key terms; Nutritional rickets, Sunlight exposure, and vitamin D deficiency. Only peer-reviewed articles and research theses were included. Additionally, only literature reporting on nutritional rickets as a result of inadequate sunlight exposure practices were included. A total of 9 papers were included in the review. Findings such as Limited Sunlight Exposure with factors such as closed housing environments, urbanization, and cultural practices contributing to this phenomenon, Misconceptions and Fear regarding potential harms associated with sunlight exposure, such as skin cancer, sterility, and blindness, Disparities in Knowledge and Practices about sunlight exposure, Environmental Influences such as housing conditions and access to outdoor spaces significantly influence sunlight exposure opportunities for children. Interventions aimed at enhancing sunlight accessibility and creating sun-safe environments are crucial for optimizing exposure and preventing rickets. Comprehensive strategies are necessary to address sunlight exposure practices' complexities, including education, cultural sensitivity, policy reforms, and environmental modifications. Integrating these interventions is essential for promoting optimal sunlight exposure and improving child health outcomes.

Wasserstein regression with empirical measures and density estimation for sparse data.

The problem of modeling the relationship between univariate distributions and one or more explanatory variables lately has found increasing interest. Existing approaches proceed by substituting proxy estimated distributions for the typically unknown response distributions. These estimates are obtained from available data but are problematic when for some of the distributions only few data are available. Such situations are common in practice and cannot be addressed with currently available approaches, especially when one aims at density estimates. We show how this and other problems associated with density estimation such as tuning parameter selection and bias issues can be side-stepped when covariates are available. We also introduce a novel version of distribution-response regression that is based on empirical measures. By avoiding the preprocessing step of recovering complete individual response distributions, the proposed approach is applicable when the sample size available for each distribution varies and especially when it is small for some of the distributions but large for others. In this case, one can still obtain consistent distribution estimates even for distributions with only few data by gaining strength across the entire sample of distributions, while traditional approaches where distributions or densities are estimated individually fail, since sparsely sampled densities cannot be consistently estimated. The proposed model is demonstrated to outperform existing approaches through simulations and Environmental Influences on Child Health Outcomes data.

Financial Inclusion, Household Decision-making and Child Health Outcome in Nigeria

Financial Inclusion, Household Decision-making and Child Health Outcome in Nigeria

Sex differences in DNA methylation variations according to ART conception-evidence from the Norwegian mother, father, and child cohort study

Previous studies have shown cord-blood DNA methylation differences in newborns conceived using assisted reproductive technologies (ART) compared to those conceived naturally. However, whether these ART-related DNA methylation differences vary with children’s sex is unknown. We hypothesize that the DNA methylation differences in cord blood between ART-conceived and naturally conceived newborns also varies by the sex of the child, with distinct patterns of differential methylation present in males and females. We investigated sex differences in cord-blood DNA methylation variation according to conception by ART using the Illumina MethylationEPIC platform, comparing 456 ART-conceived versus 507 naturally-conceived girls, and 503 ART-conceived and 473 naturally-conceived boys. We identified 37 differentially methylated CpGs according to ART-conception among girls, and 70 differentially methylated CpGs according to ART-conception among boys, when we used a 1% false discovery rate to account for multiple testing. Ten CpGs were differentially methylated according to conception by ART in both sexes. Among the genes that were associated with these CpGs, we found the BRCA1; NBR2 gene (two CpGs) was hypermethylated in girls while the APC2 (two CpGs) and NECAB3;ACTL10, (four CpGs) related to cellular signaling were hypomethylated in boys. These findings confirm the presence of sex-specific epigenetic differences, illustrating the nuanced impact of ART on the fetal epigenome. There is a need for further explorations into the implications for sex-specific developmental trajectories and health outcomes in ART-conceived children.

Empowering Mothers: Self-efficacy Strategies and Fluoride Varnish Therapy Behavior in Preschool Children

Background: Oral health poses significant challenges, particularly among preschool children, emphasizing the critical role of mothers in preventive care. Self-efficacy, as a determinant of behavior, holds promise in shaping oral health practices. Objectives: The present study was conducted to determine the effect of Bandura's self-efficacy strategies on the fluoride varnish therapy behavior of mothers of preschool children. Methods: This intervention study, conducted from 2021 to 2023, involved 88 mothers with children aged 3 to 6 years. Participants were randomly divided into intervention and control groups. Data collection included a demographic questionnaire, a researcher-developed self-efficacy assessment tool, and an observational checklist of mothers' fluoride varnish therapy behavior. The intervention comprised educational sessions focusing on self-efficacy strategies. Data were analyzed with descriptive and inferential statistics in SPSS software version 20. Results: Before the intervention, there were no significant differences in self-efficacy scores between the intervention and control groups (Cohen's d = 0.18). Similarly, there were no significant differences between the two groups in the varnish therapy behavior score of the mother before the intervention (Cohen's d = 0.05). However, two months later, significant improvements were observed in both self-efficacy scores (Cohen's d = 2.28) and fluoride varnish therapy behavior (Cohen's d = 3/32) among mothers in the intervention group compared to controls. Conclusions: This study underscores the pivotal role of self-efficacy strategies in empowering mothers to effectively engage in fluoride varnish therapy behavior, and highlights the significant improvements observed in both self-efficacy and varnish therapy behavior that emphasize the educational interventions aimed at enhancing mothers' self-efficacy, ultimately contributing to improved oral health outcomes for children.