Home-based Record Research Articles

Post-campaign coverage evaluation of a measles and rubella supplementary immunization activity in five districts in India, 2019-2020.

In alignment with the Measles and Rubella (MR) Strategic Elimination plan, India conducted a mass measles and rubella vaccination campaign across the country between 2017 and 2020 to provide a dose of MR containing vaccine to all children aged 9 months to 15 years. We estimated campaign vaccination coverage in five districts in India and assessed campaign awareness and factors associated with vaccination during the campaign to better understand reasons for not receiving the dose. Community-based cross-sectional serosurveys were conducted in five districts of India among children aged 9 months to 15 years after the vaccination campaign. Campaign coverage was estimated based on home-based immunization record or caregiver recall. Campaign coverage was stratified by child- and household-level risk factors and descriptive analyses were performed to assess reasons for not receiving the campaign dose. Three thousand three hundred and fifty-seven children aged 9 months to 15 years at the time of the campaign were enrolled. Campaign coverage among children aged 9 months to 5 years documented or by recall ranged from 74.2% in Kanpur Nagar District to 90.4% in Dibrugarh District, Assam. Similar coverage was observed for older children. Caregiver awareness of the campaign varied from 88.3% in Hoshiarpur District, Punjab to 97.6% in Dibrugarh District, Assam, although 8% of children whose caregivers were aware of the campaign were not vaccinated during the campaign. Failure to receive the campaign dose was associated with urban settings, low maternal education, and lack of school attendance although the associations varied by district. Awareness of the MR vaccination campaign was high; however, campaign coverage varied by district and did not reach the elimination target of 95% coverage in any of the districts studied. Areas with lower coverage among younger children must be prioritized by strengthening the routine immunization programme and implementing strategies to identify and reach under-vaccinated children.

Digitalization of home-based records for maternal, newborn, and child health: a scoping review

BackgroundAt least 163 countries use a form of home-based record, a document to record health information kept at home. These are predominantly paper-based, although some countries are digitalizing home-based records for improved access and use. This scoping review aimed to identify efforts already undertaken for the digitalization of home-based records for maternal, newborn, and child health (MNCH) and lessons learned moving forward, by mapping the available peer-reviewed and grey literature.MethodsThe scoping review was guided by Arskey and O’Malley’s framework. A literature search of references published from 2000 until 2021 was conducted in Medline, Embase, CINAHL, EBM reviews, Google Scholar, IEEE Xplore as well as a grey literature search. Title and abstract and full texts were screened in Covidence. A final data extraction sheet was generated in Excel.ResultsThe scoping review includes 107 references that cover 120 unique digital interventions. Most of the included references are peer-reviewed articles in English language published after 2015. Of the 120 unique digital interventions, 80 (66.7%) are used in 31 different countries and 40 (33.3%) are globally available pregnancy applications. Out of the 80 digitalization efforts from countries, most are concentrated in high-income countries (n=68, 85%). Maternal health (n=73; 61%) and child health (n=60; 50%) are the main health domains covered; the main users are pregnant women (n=57; 48%) and parents/caregivers (n=43; 36%).ConclusionsMost digital home-based records for MNCH are centered in high-income countries and revolve around pregnancy applications or portals for home access to health records covering MNCH. Lessons learned indicate that the success of digital home-based records correlates with the usability of the intervention, digital literacy, language skills, ownership of required digital devices, and reliable electricity and internet access. The digitalization of home-based records needs to be considered together with digitizing patient health records.

The Benefits and Challenges of Paper Handheld Maternal Record in Southeast Asia: A Systematic Review

Background: Home-based maternal records were first designed for better monitoring during pregnancy, delivery, and the postpartum period. There are various studies that reported on the benefits of paper handheld record for mothers in across regions. However, majority of the studies on paper handheld record or home-based record were mainly addressing the benefit and very scare on the challenges faced by the users. This study aims to evaluate the benefits and challenges of the maternal paper handheld to users particularly to mothers and healthcare providers in Southeast Asia (SEA) region. Methods: Articles were searched from Scopus, Web of Science, and PubMed using relevant keywords based on the review topic. Based on PRISMA guidelines, the search results were then screened based on inclusion criteria: published between 2012 and 2021in English language, available in full text, open access, and conducted in Southeast Asia. Six articles were included in the final analysis, which were also appraised for their quality. Results: There are six articles included in this review. Majority of the studies highlighted the benefits of paper handheld records to mothers. Upon further analysis, there are three major themes emerged from the outcome namely mother’s knowledge, maternal health service utilization and breastfeeding practice. Only one study reported on the challenges faced by mothers and care provider while utilising the paper handheld record. Conclusions: The paper handheld maternal record implementation in SEA exhibited great positive impact to the mothers in terms of knowledge, maternal health service utilization and breastfeeding practice. Nonetheless, it is quite difficult to find studies that addressed the challenges faced by the users in SEA region. It would be best to understand the challenges faced regionally or even locally to make improvement of the maternal health service as it needs to be comprehensive and suited with the local context.

A global perspective of the role of the maternal and child health handbook in health promotion: Narrative synthesis

Little is known about the impact of "home-based records'' on the health promotion of mothers and children. Considering this, we compiled and analysed existing evidence on the effectiveness of a specific home-based record, the Maternal and Child Health Handbook (MCHHB), in enhancing the health of mothers and their children. A systematic search of PubMed, Google Scholar, Maternity, and Infant Care, CINHAL, and Ovid was conducted. All types of original research articles published in English were considered. A narrative synthesis was used due to the heterogeneity of findings among the included studies. Out of a total of 1351 papers, 45 studies were included. Breastfeeding, immunisation, family planning, antenatal care, maternal nutrition, maternal Tetanus Toxoid (TT) immunisation, vitamin A and iron supplements, smoking and alcohol consumption during pregnancy, healthy and safe delivery, awareness of pregnancy complications, and healthy child development are all areas where MCHHB has been implemented and evaluated. Although one study found no effect, our findings indicate a positive impact. The results emphasised the effectiveness and value of MCHHB in enhancing maternal and infant health. However, given that only a small number of studies were available for each outcome group, we suggest more research be conducted on the MCHHB's positive effects on mothers’ and children’s health.

0956 Evaluation of a novel automated oxygen desaturation analysis

Abstract Introduction The oxygen desaturation index (ODI) quantifies the number of desaturations per hour of sleep and is a valuable parameter in diagnosing sleep-related breathing disorders. While oximetry alone is insufficient for an accurate diagnosis, it provides meaningful insights for Obstructive Sleep Apnea (OSA) and the ODI has been shown to correlate with the Apnea-Hypopnea Index (AHI). The close relationship between the ODI and other parameters is especially interesting for home-based sleep studies and/or screening, which typically use a limited set of sensors (but almost always include oximetry) and are becoming increasingly more prevalent. An accurate and automated tool for oximetry analysis will thus be paramount for the sleep clinician. Methods The current study aims to evaluate a novel automated solution for oxygen desaturation scoring, provided by Somnilog. We selected 20 overnight recordings, a mix of hospital- and home-based recordings from a dataset from the Antwerp University hospital and an internal database collected from several French sleep centers. The analyzed population (10 females, age 53.0±16.7 years old, BMI of 28.8±4.8 kg/m²) had a variety of diagnoses, including non-apneic snoring and central and obstructive sleep apnea. Each recording was also scored for oxygen desaturations by a sleep expert, using the AASM guidelines and a 3% drop criterion. Results The automated solution accurately detected desaturation events with a precision and recall of 0.97 and 0.96, respectively. The reported ODI had an intraclass correlation (ICC) of 0.99 with the index found by the expert. The difference in the number of events reported by the automated solution and the expert was not significant between the lab- and home-recorded patients (p=0.23). We furthermore validated the novel solution with another well-used commercial package and obtained similar performance metrics: precision and recall of 0.96 and ICC of 0.99. Conclusion The current study demonstrates the validity of the novel commercial package for oxygen desaturation scoring. The automated tool achieved near-perfect agreement with the sleep experts, and a similar performance to another existing solution in the market. The tool is robust for home-based recordings which are typically more artifact-prone, thereby supporting the increasing demand for out-of-centre overnight studies. Support (if any) n/a

0335 Persistence of Sleep Duration Phenotypes Across Nights of Laboratory and Home Sleep Recording

Abstract Introduction Vgontzas and colleagues have proposed dividing the population of persons with insomnia disorder into short (< 6 hours/night) and normal (> 6 hours/night) sleep duration phenotypes based on their objective sleep duration as measured by one or more nights of polysomnography (PSG). However, first night effects, homeostatic recovery mechanisms and the site where PSG is conducted may all affect the sleep duration observed on individual PSG nights. The current study evaluated the stability of objective sleep duration phenotyping across multiple laboratory and home-based PSG recordings. Methods Seventy-six adults (Mage = 51.8±16.5 yrs.; 50% women) with an insomnia disorder underwent a series of three PSG recordings in the sleep lab and three in their homes in a counterbalanced order. Participants chose their own bed and rising times each night to produce results representative of their usual sleep patterns. Participants were classified into short (ISS: TST < 6 hours) and normal (INS: TST > 6 hours) duration phenotypes using the mean sleep times across all nights. Results Twenty-eight participants were classified as the ISS phenotype and 48 were classified as the INS phenotype with equal numbers of men and women in each group. A linear mixed models analysis showed only significant main effects for phenotype classification (F = 119.72; p < .0001) and recording night (F = 4.29; p < .025). The ISS mean TST was 326.8 minutes whereas the INS mean TST was 396.8 minutes. Mean TST across both groups was significantly shorter on the first PSG night (Mean = 353.0 min.) across settings than on night 2 (Mean = 372.4 min.). The majority of the ISS group (78.6%) and INS group (77.1%) had TST < 6 hours and TST > 6 hours, respectively, on 4 or more nights of sleep recordings. Conclusion ISS and INS sleep duration phenotypes have relative stability in their objective sleep times across nights and recording sites. These findings support the growing literature suggesting the distinctiveness of these subtypes of insomnia disorder. Support (if any) Funding support from the Department of Veterans Affairs Merit Review Grant Program

Cluster Analysis of Home Polygraphic Recordings in Symptomatic Habitually-Snoring Children: A Precision Medicine Perspective.

(1) Background: Sleep-disordered breathing (SDB) is a frequent problem in children. Cluster analyses offer the possibility of identifying homogeneous groups within a large clinical database. The application of cluster analysis to anthropometric and polysomnographic measures in snoring children would enable the detection of distinctive clinically-relevant phenotypes; (2) Methods: We retrospectively collected the results of nocturnal home-based cardiorespiratory polygraphic recordings and anthropometric measurements in 326 habitually-snoring otherwise healthy children. K-medoids clustering was applied to standardized respiratory and anthropometric measures, followed by Silhouette-based statistics. Respiratory Disturbance Index (RDI) and oxygen desaturation index (≤3%) were included in determining the optimal number of clusters; (3) Results: Mean age of subjects was 8.1 ± 4.1 years, and 57% were males. Cluster analyses uncovered an optimal number of three clusters. Cluster 1 comprised 59.5% of the cohort (mean age 8.69 ± 4.14 years) with a mean RDI of 3.71 ± 3.23 events/hour of estimated sleep (e/ehSleep). Cluster 2 included 28.5% of the children (mean age 6.92 ± 3.43 years) with an RDI of 6.38 ± 3.92 e/ehSleep. Cluster 3 included 12% of the cohort (mean age 7.58 ± 4.73 years) with a mean RDI of 25.5 ± 19.4 e/ehSleep. Weight z-score was significantly lower in cluster 3 [−0.14 ± 1.65] than in cluster 2 [0.86 ± 1.78; p = 0.015] and cluster 1 [1.04 ± 1.78; p = 0.002]. Similar findings emerged for BMI z scores. However, the height z-score was not significantly different among the 3 clusters; (4) Conclusions: Cluster analysis of children who are symptomatic habitual snorers and are referred for clinical polygraphic evaluation identified three major clusters that differed in age, RDI, and anthropometric measures. An increased number of children in the cluster with the highest RDI had reduced body weight. We propose that the implementation of these approaches to a multicenter-derived database of home-based polygraphic recordings may enable the delineation of objective unbiased severity categories of pediatric SDB. Our findings could be useful for clinical implementation, formulation of therapeutic decision guidelines, clinical management, prevision of complications, and long-term follow-up.

Benchmarking Real-Time Algorithms for In-Phase Auditory Stimulation of Low Amplitude Slow Waves With Wearable EEG Devices During Sleep.

In-phase stimulation of EEG slow waves (SW) during deep sleep has shown to improve cognitive function. SW enhancement is particularly desirable in subjects with low-amplitude SW such as older adults or patients suffering from neurodegeneration. However, existing algorithms to estimate the up-phase of EEG suffer from a poor phase accuracy at low amplitudes and when SW frequencies are not constant. We introduce two novel algorithms for real-time EEG phase estimation on autonomous wearable devices, a phase-locked loop (PLL) and, for the first time, a phase vocoder (PV). We compared these phase tracking algorithms with a simple amplitude threshold approach. The optimized algorithms were benchmarked for phase accuracy, the capacity to estimate phase at SW amplitudes between 20 and 60 μV, and SW frequencies above 1 Hz on 324 home-based recordings from healthy older adults and Parkinson disease (PD) patients. Furthermore, the algorithms were implemented on a wearable device and the computational efficiency and the performance was evaluated in simulation and with a PD patient. All three algorithms delivered more than 70% of the stimulation triggers during the SW up-phase. The PV showed the highest capacity on targeting low-amplitude SW and SW with frequencies above 1 Hz. The hardware testing revealed that both PV and PLL have marginal impact on microcontroller load, while the efficiency of the PV was 4% lower. Active stimulation did not influence the phase tracking. This work demonstrated that phase-accurate auditory stimulation can also be delivered during fully remote sleep interventions in populations with low-amplitude SW.

Comparative analysis of pre-Covid19 child immunization rates across 30 European countries and identification of underlying positive societal and system influences.

This study provides a macro-level societal and health system focused analysis of child vaccination rates in 30 European countries, exploring the effect of context on coverage. The importance of demography and health system attributes on health care delivery are recognized in other fields, but generally overlooked in vaccination. The analysis is based on correlating systematic data built up by the Models of Child Health Appraised (MOCHA) Project with data from international sources, so as to exploit a one-off opportunity to set the analysis within an overall integrated study of primary care services for children, and the learning opportunities of the 'natural European laboratory'. The descriptive analysis shows an overall persistent variation of coverage across vaccines with no specific vaccination having a low rate in all the EU and EEA countries. However, contrasting with this, variation between total uptake per vaccine across Europe suggests that the challenge of low rates is related to country contexts of either policy, delivery, or public perceptions. Econometric analysis aiming to explore whether some population, policy and/or health system characteristics may influence vaccination uptake provides important results-GDP per capita and the level of the population's higher education engagement are positively linked with higher vaccination coverage, whereas mandatory vaccination policy is related to lower uptake rates. The health system characteristics that have a significant positive effect are a cohesive management structure; a high nurse/doctor ratio; and use of practical care delivery reinforcements such as the home-based record and the presence of child components of e-health strategies.

Neuroscience from the comfort of your home: Repeated, self-administered wireless dry EEG measures brain function with high fidelity.

Recent advances have enabled the creation of wireless, “dry” electroencephalography (EEG) recording systems, and easy-to-use engaging tasks, that can be operated repeatedly by naïve users, unsupervised in the home. Here, we evaluated the validity of dry-EEG, cognitive task gamification, and unsupervised home-based recordings used in combination. Two separate cohorts of participants—older and younger adults—collected data at home over several weeks using a wireless dry EEG system interfaced with a tablet for task presentation. Older adults (n = 50; 25 females; mean age = 67.8 years) collected data over a 6-week period. Younger male adults (n = 30; mean age = 25.6 years) collected data over a 4-week period. All participants were asked to complete gamified versions of a visual Oddball task and Flanker task 5–7 days per week. Usability of the EEG system was evaluated via participant adherence, percentage of sessions successfully completed, and quantitative feedback using the System Usability Scale. In total, 1,449 EEG sessions from older adults (mean = 28.9; SD = 6.64) and 684 sessions from younger adults (mean = 22.87; SD = 1.92) were collected. Older adults successfully completed 93% of sessions requested and reported a mean usability score of 84.5. Younger adults successfully completed 96% of sessions and reported a mean usability score of 88.3. Characteristic event-related potential (ERP) components—the P300 and error-related negativity—were observed in the Oddball and Flanker tasks, respectively. Using a conservative threshold for inclusion of artifact-free data, 50% of trials were rejected per at-home session. Aggregation of ERPs across sessions (2–4, depending on task) resulted in grand average signal quality with similar Standard Measurement Error values to those of single-session wet EEG data collected by experts in a laboratory setting from a young adult sample. Our results indicate that easy-to-use task-driven EEG can enable large-scale investigations in cognitive neuroscience. In future, this approach may be useful in clinical applications such as screening and tracking of treatment response.

The Role of the Maternal and Child Health Handbook in Developmental Surveillance: The Exploration of Milestone Attainment Trajectories

Despite the pivotal role of developmental surveillance in pediatric practice for the early detection of neurodevelopmental disorders (NDDs), there are several barriers, including scarcity of time and staff availability, to its implementation. Additionally, inadequate parental knowledge on what to expect about their child's development contributes to potential delays in the early identification of NDDs. Home-based records (HBRs) are widely used in both high-income and low- and middle-income countries, allowing caregivers to prospectively chart the child's development, including milestone attainment, and thus can be a useful tool for developmental surveillance. Therefore, we analyzed data on milestone attainment from birth to 5 years of age obtained through the home-based records (the Maternal Child Health Handbook: MCHH) in 720 children who attended the Hirosaki Five-year-old children Developmental Health Check-up Study in Hirosaki, Japan to identify trajectory patterns of milestone attainment. Parallel process latent class growth analysis on four milestone domains (motor, social interaction, communication, and self-care) revealed three different trajectories (Class 1: “Consistent milestone attainment” group; 42%, Class 2: “subtle initial delay and catch-up” group; 45%, Class 3: “Consistent failure to attain expected milestones” group; 13%). In Class 3, 90% of children were diagnosed with at least one NDDs at age 5 and approximately 65% of children had autism spectrum disorder and/or intellectual disability, the rate of which was higher than that in the other two classes. Boys and preterm-born children were more likely to be assigned to classes with less favorable trajectories of milestone attainment. Although the use of the MCHH alone does not substitute diagnostic evaluation for NDDs, our study findings suggest the potential utility of the MCHH as a tool to educate parents on what longitudinal patterns of milestone attainment are concerning and require prompt visits to professionals.

Policy and practice of checking vaccination status at school in 2018, a global overview

BackgroundChecking vaccination status at school is widely recommended as a strategy to strengthen routine childhood vaccination coverage. Documentation of approaches, challenges, strengths, and impact of this strategy in a variety of contexts is key to enhancing adoption and implementation. However, there is limited information about the prevalence of policies and the implementation of checking vaccination status at school globally. MethodsA one-time supplementary survey was circulated with the annual World Health Organization (WHO) and United Nations International Children’s Emergency Fund (UNICEF) Joint Reporting Form in 2019 to all WHO member states and non-member state reporting entities. Additional publicly available country-level data, including primary school enrollment, home-based record (HBR) ownership, and World Bank income classification were linked to the supplementary survey responses, which were descriptively analyzed. ResultsWe received survey responses from 130 of the 194 (67%) WHO member states and 15 non-member state reporting entities. Almost half (46%) of the respondents reported having a law requiring proof of vaccination to enter at least one level of education, and 60% of the respondents reported having a law that requires checking vaccination status at school in 2018. Three-quarters of the respondents (77%) reported the practice of routinely checking vaccination status at school. Both laws and the practice of checking were more common in the WHO Region of the Americas and the WHO European Region, and in high- and upper-middle-income countries. Individual HBR was the document most frequently checked. Catch-up vaccination occurred most frequently at health centers. Evaluation of checking vaccination status at school to determine what has worked and its effect was infrequently reported. ConclusionDespite widespread implementation of checking vaccination status at school in 2018, documentation of the experiences in planning and implementing this strategy, and its effects remains sparse, particularly in low- and middle-income countries.

Vaccination against tuberculosis, polio and hepatitis B at birth in Podor health district, Northern Senegal: cross-sectional study of vaccination coverage and its associated factors

BackgroundIn Senegal, studies focusing specifically on vaccination coverage with the Bacille de Calmette et Guérin (BCG) vaccine, the birth dose of oral polio vaccine (OPV zero dose) and the birth dose of hepatitis B (HepB-BD) vaccine are insufficient. This study aimed to highlight vaccination coverages with birth doses and factors associated with timely vaccination in Podor health district.MethodsA cross-sectional study was carried out from June 19 to 22, 2020. The study population consisted of children aged 12 to 23 months of which 832 were included. A stratified two-stage cluster survey was carried out. The sources of data were home-based records (HBR), health facility registries (HFR) and parental recalls. Timely vaccination refers to any vaccination that has taken place within 24 h after birth. Descriptive analyzes, the chi-square test and logistic regression were performed.ResultsThe crude vaccination coverages with BCG, OPV zero dose and HepB-BD were 95.2%, 88.3% and 88.1%, respectively. Vaccination coverages within 24 h after birth were estimated at 13.9%, 30% and 42.1%, respectively. The factors associated with timely HepB-BD are delivery in a health facility (AOR = 1.55; 95% CI = 1.02–2.40), access to television (AOR = 1.63; 95% CI = 1.16–2.29), weighing (AOR = 3.92; 95% CI = 1.97–8.53) and hospitalization of the newborn immediately after birth (AOR = 0.42; 95% CI = 0.28–0.62).ConclusionTimely administration of birth doses is a challenge in the Podor health district. The solutions would be improving geographic access to health facilities, involving community health workers, raising awareness and integrating health services.

Missed Opportunities for Vaccination and Associated Factors among Children Aged 12 - 23 Months in Cameroon: Further Analyses of 2018 Cameroon Demographic and Health Survey

Background: Low vaccination coverage has been attributed to missed opportunities for vaccination (MOV). This study examines the prevalence of MOV, and its associated factors among children in Cameroon. Methods: Data from the 2018 Demographic and Health Survey (DHS) was analyzed for children with at least one vaccination date in the home-based record (HBR). Immunization performances such as accessibility, drop-out, and timeliness, were assessed. Service quality was assessed using MOV. Multiple logistic regression examined the effect of DHS variables on MOV outcomes, and a decision tree approach was used to study their interaction. Results: Overall, 1824 children aged 12 to 23 months were surveyed; 1285 (70.45%) had cards seen with vaccination dates leading to 85.03% of immunization activities. A proportion of 46.5% of children were not completely vaccinated. There was 27% of drop-out between BCG and MCV1, and less than 10% with the specific antigens. Vaccination timeliness proportions ranged from 42.18% for BGC to less than 70% for PENTA1-3. The national prevalence of MOV for simultaneous vaccines was 75.1% (95% confidence interval (CI) = 72; 79). Among those who experienced MOV, 67.4% (95% CI = 60 - 73) were uncorrected MOV. MOV was an issue in all regions and comparable in rural areas that urban areas (p = 0.2). Dose-specific MOV ranged from 2.66% (for the third dose of the pneumococcal conjugate vaccine) to 91.12 (for the yellow fever vaccine). Second birth order children experienced more MOV than first born children (adjusted odds ratio (aOR) = 1.67, 95% CI: 1.11 - 2.47). Children born to non-educated/primary level mothers had increased odds of experiencing a MOV than those born to educated mothers (aOR = 1.48, 95% CI = 1.007 - 2.19/aOR = 1.55, 95% CI = 1.12 - 2.09). Children from poorest households were at high risk of experiencing MOV for any vaccine than richest households (aOR = 2.04, 95% CI = 1.11 - 3.76). Conclusion: There is a burden of MOV and under immunized children in the population. Direct interventions that target rural poor and focus on equity gaps that relate to maternal education, socio-economic status, and family planning, should be implemented. Such strategies should aim at reducing MOV for the achievement of the immunization agenda 2030 goals.

P029 Home video sleep recording as a screening tool for paediatric obstructive sleep apnoea

Abstract Introduction Polysomnography (PSG) remains gold standard for assessment of paediatric OSA, despite limitations. Home-based video sleep recordings offer a promising screening tool that would be relatively simple and inexpensive but have been minimally investigated. This study aims to assess the ability of short home-based video sleep recordings to predict PSG-diagnosed OSA in a population of healthy children. Methods Healthy children aged 1–18 years undergoing PSG to assess for OSA were recruited. Those with comorbidities likely to cause/exacerbate OSA, aside from adenotonsillar hypertrophy and obesity, were excluded. Thirty-minute video recordings of sleep shortly after sleep onset capturing the face and exposed torso were obtained. A previously validated scoring system was modified to include six parameters: snore, inspiratory noise, respiratory events, respiratory effort, mouth breathing and neck extension. Results We report interim results of this ongoing study. Of the 51 children meeting inclusion criteria, videos for 44 (28M, mean (SD) age 8.58 (2.96) years) were deemed satisfactory and analysed. Four (9%) children had OAHI >5 episodes/h on PSG and median Total Video Score (TVS) was 0 (IQR 0–1). TVS and OAHI >5 episodes/h on PSG showed a statistically significant association (OR 2.782, p=0.006) with area under the curve of 0.847. TVS ≥4 showed sensitivity of 75% and specificity of 100% for OAHI >5 episodes/h. Discussion This video scoring system, when applied to short home-based video sleep recordings, showed acceptable diagnostic accuracy for PSG-diagnosed OSA. Full data analysis will further clarify the role of this modality as a screening tool for paediatric OSA.

Roles of the Maternal and Child Health Handbook and Other Home-Based Records on Newborn and Child Health: A Systematic Review.

Home-based records are paper or electronic records retained and used by mothers or caregivers to document the health services received for maternal, newborn, and child health. Little has been studied about the roles of these records on newborn and child health outcomes. Hence, we collated and summarized evidence concerning the roles of home-based records in improving newborn and child health. We conducted a systematic search in several databases: MEDLINE, Web of Science, CINAHL, PsycINFO, PsycARTICLES, Academic Search Complete, SocINDEX, CENTRAL, DARE, NHS EED, HTA, J-STAGE, Ichushi, and gray literature. We included original research articles of all study designs published in English or Japanese until January 2020. Owing to heterogeneity across the outcomes of included studies, we conducted a narrative synthesis. We included 55 studies (23 in Japanese) among 14,017 identified articles. We identified the following roles of home-based records on newborn and child health: promoted newborn/childcare seeking, improved knowledge and practices of newborn/childcare, encouraged home care for childhood illnesses, reduced child mortality and morbidity, and facilitated continuum of care. We observed a mixed effect on age-appropriate immunization (e.g., DTP3 completion) and no effect on the practice of immediate breastfeeding and prevention of perinatal mortality and morbidity. The findings highlighted the effectiveness and usefulness of home-based records to improve newborn and child health outcomes. However, only a few studies were available for each outcome category, limiting the certainty of evidence provided in this review. Therefore, we recommend further studies to explore the benefits of home-based records on improving newborn and child health.

Parent engagement with the New South Wales child health home-based record: A cross-sectional survey and a retrospective chart review.

In 2018, World Health Organization endorsed universal use of home-based records to improve care for mothers, pregnant women, newborns and children. New South Wales (NSW), Australia has had universal use of a child health home-based record since 1988, with the first major update in 2013. Since the update, limitedbelief is sufficient for constituting evidence has been collected about factors influencing parent use of the record. This study aims to examine parent engagement with the record and whether it is influenced by child's first-born status and Parent Evaluation of Development Status (PEDS) outcome. A survey of 202 parent-child pairs and a review of 20 record books were conducted in NSW, Australia. Odds ratio (OR) at 95% confidence interval (CI) and .05 level of significance, bivariate and multivariate logistic regressions were conducted to examine the influence of first-born status, child's PEDS outcome and other parent-child characteristics on parent engagement with the record. Parents engaged with the home-based record by taking it for routine checks (80.7%), writing (74.8%) or reading (75.8%) information. Parents of first-born children were more than three times likely to take the record book for routine checks compared with parent of later-born children (adjusted OR [AOR] = 3.70, 95% CI 1.12-12.20). Similarly, parents of children with low PEDS level of risk were significantly less likely to read information in the record book compared with parents of children with high risk (AOR = 0.28, 95% CI 0.08-0.98). Parent record input through direct observation significantly decreased from 85% at 1-month to 60% at 12-month postnatal. Data about at least one vaccination event were recorded in all the record books examined, while 85% had all recommended vaccinations recorded. Parents valued/engaged regularly with a child health home-based record, and the record may be a useful tool for early detection and monitoring of child developmental concerns. Therefore, continued promotion of the use of child health home-based record appears to play an important role in improving child health and development.

The Maternal and Child Health Handbook for Improving the Continuum of Care and Other Maternal and Child Health Indicators in Angola: An Implementation Study Protocol.

Background: Reducing maternal, neonatal, and infant mortality tops the health targets of sustainable development goals. Many lifesaving interventions are being introduced in antenatal, delivery, and postnatal care. However, many low- and middle-income countries (LMICs) have not reached maternal and child health targets. The Maternal and Child Health Handbook (MCH-HB) is recommended as a home-based record to promote a continuum of care from pregnancy to early childhood, and is gaining increasing attention among LMICs. Several countries have adopted it as national health policy. To effectively utilize the MCH-HB in LMICs, implementation needs to be considered. Angola is an LIMC in Sub-Saharan Africa, where maternal and child health indicators are among the poorest. The Angolan Ministry of Health adopted the MCH-HB program in its national health policy and is currently conducting a cluster randomized controlled trial (MCH-HB RCT) to evaluate its impact on the continuum of care. This study aimed to evaluate implementation status, and barriers and facilitators of MCH-HB program implementation in Angola.Methods: To evaluate implementation status comprehensively, the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework will be used. Four components other than effectiveness will be investigated. A cross-sectional survey will be conducted targeting all health facilities and officers in charge of the MCH-HB at the municipality health office in the intervention group after the MCH-HB RCT. Data from the cross-sectional survey, secondary MCH-HB RCT data, and operational MCH-HB RCT records will be analyzed. Health facilities will be classified into good-implementation and poor-implementation groups using RE-AIM indicators. To identify barriers to and facilitators of MCH-HB implementation, semi-structured interviews/focus group discussions will be conducted among health workers at a sub-sample of health facilities and all municipality health officers in charge of MCH-HB in the intervention group. The Consolidated Framework for Implementation Research will be adopted to develop interview items. Thematic analysis will be performed. By comparing good-implementation and poor-implementation health facilities, factors that differ between groups that contribute to successful implementation can be identified.Discussion: This study's findings are expected to inform MCH-HB implementation policy and guidelines in Angola and in other countries that plan to adopt the MCH-HB program.

Reasons why children miss vaccinations in Western Kenya; A step in a five-point plan to improve routine immunization

Global childhood vaccination coverage has stagnated over the past decade and raising coverage will require a collection of approaches since no single approach has been suitable for all countries or situations. The American Red Cross has developed a 5-Point Plana to geolocate under-vaccinated children and determine the reasons why they miss vaccination by capitalizing on the Red Cross Movement’s large cadres of trusted community volunteers. The Plan was piloted in Bobasi sub-county in Western Kenya, with volunteers seeking to conduct a face-to-face interview in all households, visiting over 60,000 over 7 days. Six pockets of 233 children without a home-based vaccination record or missing an age-appropriate dose of Penta1, Penta3 or measles-containing vaccine were identified. Three activities were carried out to learn why these children were not vaccinated: 1) one-on-one interviews and 2) focus group discussions with the caregivers of the under-vaccinated children and 3) interviews with healthcare workers who vaccinate in Bobasi. Complacency was commonly reported by caregivers during one-on-one interviews while bad staff attitude or practice was most frequently reported in focus group discussions; health staff reported caregiver hesitency, not knowing vaccination due date and vaccine stock-outs as the most common reasons for caregivers to not have their child vaccinated. As reasons varied across the three different activities, the different perspectives and approaches helped characterize vaccination barriers. Civil society organizations working together with the Ministry of Health can provide valuable information for immunization managers to act on.

In-Motion-App for remote General Movement Assessment: a multi-site observational study

ObjectivesTo determine whether videos taken by parents of their infants’ spontaneous movements were in accordance with required standards in the In-Motion-App, and whether the videos could be remotely scored by...