Impact Child Health Research Articles

Assessing the association between household air pollution exposure and child heath in Mongolia: a birth-cohort study

Children in Mongolia are exposed to harmful levels of household air pollution (HAP) due to a high reliance on coal for indoor cooking and heating. This study aims to assess the association between HAP and child health outcomes, in a birth cohort from Ulaanbaatar, Mongolia. A composite HAP measure was created using information on cooking and heating fuels and behaviours collected as part of a randomised control trial assessing the impact of swaddling on child health. Child health outcomes (Bayley Scales of Infant Development scores [BSID-II], pneumonia, height and weight) were collected at 7, 13, and 36 months. Linear and Cox proportional hazard model were used to assess the association between HAP and child health outcomes at each time point, adjusting for child, maternal and environmental confounding factors. An increased risk of pneumonia was observed with an increasing HAP score (adjusted hazard ratio: 1.02 [1.01, 1.04]) at 7 months). An increase in HAP exposure was associated with a decrease in the BSID mental score at 13 months (β: − 0.09 [− 0.17, − 0.01]), BSID psychomotor score at 36 months (β: − 0.12 [− 0.23, − 0.02]). A decrease in height-for-age z-score (HAZ) and weight-for-age z-score (WAZ) were associated with increased HAP exposure at 7 (HAZ β: − 0.019 [− 0.030, − 0.010] and 13 months (HAZ β: − 0.020 [− 0.030, − 0.011], and WAZ β: − 0.012 [− 0.019, − 0.005]), however only HAZ was associated with HAP at 36 months (β: − 0.011 [− 0.020, − 0.002]). An increasing HAP score was associated with an increase in the health outcome composite score at 7 months only (β: 0.019; 95% CI 0.003–0.035). HAP exposure was shown to negatively impact child health sustainably over 3 years. There are implications for development of appropriate public health policies to mitigate HAP exposure throughout Mongolia and similar Central Asia settings.

The relationship between the early life gastrointestinal microbiome and childhood nocturnal cough.

Nocturnal cough affects approximately 1 in 3 children, can negatively impact child health, and is often attributable to asthma. The association of the gut microbiome with nocturnal cough has not been investigated. To investigate the association between early-life gut microbiome composition and nocturnal cough overall and in the context of asthma. Gut microbiota 1-month (neonate) and 6-month (infant) specimens from 512 children in the Wayne County, Health, Environment, Allergy, and Asthma Longitudinal Study were profiled using 16S rRNA V4 sequencing. Nocturnal cough (parental-report) and asthma (parental-reported doctor diagnosis) were assessed at age 4 years. Microbiome Regression-Based Kernel Association Tests were used to assess the relationship between gut microbiota composition and nocturnal cough overall and in the context of asthma. Operational taxonomic unit (OTU) associations were conducted using negative binomial regression, adjusting for multiple comparisons using the false discovery rate (FDR). Stool microbial composition differences during infancy were associated with nocturnal cough (Weighted Unifrac p=0.045). 78 OTUs were significantly associated with nocturnal cough overall (FDR<0.05). 110 OTUs were significantly associated with nocturnal cough and differed by asthma status (interaction FDR<0.05), with predominance of Lachnospiraceae Blautia and Dorea. 32 OTU were identified as having both overall effects and differences by asthma status. Among OTUs with significant nocturnal cough-by-asthma interactions, 84 retained significance in children with asthma, with 45 exclusive to those with asthma (predominance of Bacteroidaceae Bacteroides and Lachnospiraceae Dorea). Infantile gut microbiome development is associated with nocturnal cough and differed by asthma status by age 4 years. Further studies are needed to determine if the gut microbiome may provide additional information for the early identification of children at risk for nocturnal cough, with and without asthma.

The influence of access to care on the health literacy of families in Mexico.

Health literacy (HL) is essential to understanding health information and achieving health goals. Unfortunately, limited information is available on how parent HL impact child health outcomes. This is critical to understand in areas of the world where access to healthcare services is limited or unavailable. Thus, the purpose of this study was to assess the moderating influence of access to care on the relationship between parent HL and child health outcomes in Mexico. Using a geographically stratified convenience sample survey design, we gathered a sample of 373 parent-child dyads throughout Mexico in August of 2021. Using the HLS-Q12, the Warwick-Edinburgh Mental Wellbeing Scale, healthcare access questions developed by Levy and Janke, a single-item self-report overall health measure, and questions about substance use frequency, we found that parent HL was positively associated with youth mental wellbeing and overall health. Limited healthcare access was associated with increased youth cigarette, marijuana and alcohol use. Our results indicate that efforts to increase parent HL may be effective in improving youth health behaviors and outcomes.

Debuting an innovative model for integrated child health care in the Southeast region, Bulgaria

Abstract Background Demographic indicators are fundamental drivers for health policy action. The Southeast Region (SER) is the largest statistical region (NUTS 2) in Bulgaria (BG), distinguished by the highest Infant mortality rates (IMR) and teenage crude fertility rates across the European Union (EU). For instance, the 2022 statistics reveal an IMR of 8.2 per 1000 live births in SER, notably higher than Bulgaria’s average of 4.8 and the EU’s average of 3.3. This disparity highlights the critical need for region-specific health initiatives aimed at curtailing IMR and harmonizing health outcomes throughout the EU territories. This report outlines such an initiative under the project code BG16FFPR003-2.001-012, recently funded by the EU. The novel SER initiative: This is the first presentation of the concept of integrated territory investments (CITI) and the innovative model for integrated child health care in SER, BG. The project impacts child health care across the four districts of SER - Burgas, Sliven, Yambol, Stara Zagora. The municipalities have collaboratively submitted 24 project proposals with educational bodies, NGOs, public institutions, and the Ministry of Health. The theoretical frame of the project’s model is underpinned by three foundational pillars: 1) Prevention in primary healthcare; 2) Child health care in hospitals; 3) Development of human resources, providers of health care. The forthcoming infrastructural, organisational, and capacity-building interventions will remain adaptable yet aligned with the overarching CITI framework. Conclusions A current phase of public discourse on the CITI concept and the innovative integrated model in SER is underway. Stakeholders are actively encouraged to provide input either through discussions or by participating in designated online surveys. Community engagement is instrumental in evaluating and prioritizing these initiatives, which aim to fundamentally transform the SER by leveraging its unique territorial potential. Key messages • Demographic indicators drive health policy. Project BG16FFPR003-2.001-012 targets EU disparities, lowering IMR and balancing fertility rates. • This is the first presentation of the “Innovative model for integrated child health care in SER”. The EPH Conference provides an ideal platform for sharing and discussion.

Change in Child Opportunity Index in Early Childhood Is Associated with Youth BMI Growth.

Background: The neighborhood-level child opportunity index (COI) has been used in policy-based initiatives to identify and improve low-resource neighborhoods in order to impact child health. Understanding of how changes in COI can impact child growth, however, is lacking. Methods: Participants were 1124 children from the Family Life Project, a longitudinal birth cohort of families in rural, high-poverty areas. Youth anthropometrics were measured at eight assessments (ages 2 months through 12 years). Neighborhood COI was obtained at seven assessments (ages 2 months through 5 years) and used to create seven trajectory groups representing a change in COI: stayed low on all seven assessments, stayed moderate, stayed high, left low, declined from moderate, declined from high, and bounced around. Results: As hypothesized, moving from high COI neighborhoods into lower COI neighborhoods was associated with greater BMI growth and increased risk for obesity and severe obesity at 12 years. As hypothesized, the opposite effect, which approached significance at p = 0.056, was found among children who moved from low COI neighborhoods into higher COI neighborhoods. Specifically, moving into higher COI neighborhoods was associated with reduced BMI growth, and lower risk for severe obesity at 12 years. Conclusions: Moving into higher COI neighborhoods may be associated with healthier BMI growth, while the opposite effect may occur when moving into lower COI neighborhoods. Given the use of the COI in public health initiatives and growing evidence for its potential positive impact on child growth, future work is needed to replicate our findings among larger diverse samples.

Determination of Health Concepts in β-Propeller Protein-Associated Neurodegeneration.

β-Propeller protein-associated neurodegeneration (BPAN) is a rare, X-linked condition caused by pathogenic variants in the WDR45 gene that result in a defect of autophagy. Classified as a disorder of neurodegeneration with brain iron accumulation, β-propeller protein-associated neurodegeneration is associated with severe neurologic impairments. With the anticipation of future therapeutic trials, this project characterizes the family's perspective of the impact of disease and defines Health Concepts (HC).Children with a molecularly confirmed diagnosis of β-propeller protein-associated neurodegeneration were enrolled in a prospective natural history study. We administered the Vineland Adaptive Behavior Scales-Third Edition and provided health-related quality of life questionnaires to 42 caregivers. Questionnaires included Pediatric Quality of Life Inventory-Generic Core and Pediatric Quality of Life Inventory-Family Impact modules, Caregiver Priorities and Child Health Index of Life with Disabilities, and Caregiver TBI-CareQoL.The Vineland Adaptive Behavior Scales-Third Edition (n = 42) captured the family's perspective that communication was more affected compared with socialization, activities of daily living (ADL), and motor skills (P < .0001, P < .0001, P = .0053, respectively). Similarly, on the Caregiver Priorities and Child Health Index of Life with Disabilities (n = 26), Pediatric Quality of Life Inventory-Generic Core (n = 27), CareQol (n = 26), and Pediatric Quality of Life Inventory-Family Impact (n = 27), communication abilities, as well as social functioning and activities of daily living, were noted to be most impacted.Through the use of standardized surveys and outcome assessments, we establish the effects of β-propeller protein-associated neurodegeneration on caregiver quality of life. Key health concepts identified by families included overall health, comfort, and communication. The identified HC will inform the future identification of concept of interest and selection of appropriate clinical outcome assessments through the administration of patient-reported outcomes.

The Impact of Breastfeeding, Complementary Feeding, Immunization History, and Maternal and Child Health on Child Growth

The Impact of Breastfeeding, Complementary Feeding, Immunization History, and Maternal and Child Health on Child Growth

Parents' comprehensive health literacy and child health after attending extended home visiting in Swedish multicultural settings-A case-comparison study.

Parents' low health literacy (HL) has negative impacts on child health. Parental interventions may improve parents' HL and thus impact child health positively. This study aimed to gain knowledge about associations between parents' comprehensive HL (CHL) and child health after an extended postnatal home visiting program in Swedish multicultural, disadvantaged settings compared to parents receiving regular child healthcare (CHC). This quasi-experimental study used a case-control sampling method to recruit first-time parents through two CHC centres in Stockholm (2017-2020). Participants (N = 151) were interviewed twice through structured questionnaires when their child was <2 months and 15-18 months old. HLS-EU-Q16 assessed parents' CHL. Children's medical records (0-18 months) were reviewed regarding breastfeeding, children's exposure to smoking, language development and healthcare utilisation. Data were analysed with regression models and non-parametric tests. No significant association was found between parents' CHL and child health. However, significantly fewer unplanned visits to the CHC centre were observed among children (0-18 months) in the intervention group irrespective of CHL, compared with children to parents with improved CHL in the comparison group (F = 3.856, p = 0.011). Postnatal home visiting interventions practicing proportional universalism and family-centred care may reduce unplanned visits within CHC in disadvantaged settings despite parents' CHL. Further studies with long-term follow-up are suggested to explore associations between parents' CHL and child health. As a clinical study (not a clinical trial) with appropriate ethical permission with participants' consents, this study was retrospectively registered (18 February 2020) in the ISRCTN registry (ISRCTN10336603).

Infant and early childhood physical health assessments in the HEALthy Brain and Child Development (HBCD) Study

The HEALthy Brain and Child Development (HBCD) Study, a multi-site prospective longitudinal cohort study, will examine human brain, cognitive, behavioral, social and emotional development beginning prenatally and planned through early childhood. Many prenatal and early childhood exposures impact both later physical health and development. Moreover, early deficits in physical health, such as growth and vision, are associated with differences in brain development, language and cognitive functioning. For these reasons, the HBCD Study includes measures of early childhood physical health, many of which have clinical relevance, and are applicable for use as both predictors and outcomes. Study measures assess a broad range of physical health domains and include both objective measurement of child growth and health and subjective caregiver report of behaviors and attitudes about constructs known to influence growth and physical development. Lastly, we obtain caregiver report of the child’s routine medical care as well as acute and chronic medical issues. We anticipate that these data will contextualize the impact of child physical growth and health on child brain development and function. In this report we present the rationale for each domain and an overview of the physical health measures included in the current HBCD Study protocol.

Impact of COVID-19 pandemic on children overweight in Japan in 2020.

This study aimed to explore the association between the coronavirus disease (COVID-19) pandemic and overweight incidence among preadolescent elementary school children in Japan. A population-based longitudinal study was conducted in Adachi City, Tokyo, Japan, using data from the Adachi Child Health Impact of Living Difficulty (A-CHILD) study. The control group (2016-2018) comprised 434 children, and the COVID-19 exposure group (2018-2020) included 3500 children. Overweight was defined as a body mass index (BMI) z-score of 1 SD or more according to the World Health Organization standards. The study design involved comparing BMI z-scores before and after exposure to the pandemic, considering the associated lifestyle changes and potential consequences on physical activity, parental employment status and income. By 6th grade, the prevalence of overweight increased from 17.7% to 19.2% in the control group and 22.5% to 29.5% in the COVID-19 exposure group. Difference-in-differences analysis revealed that children's exposure to COVID-19 significantly increased BMI z-scores (coefficient 0.22, 95% confidence interval (CI) 0.14-0.29) and a higher odds ratio of overweight (odds ratio 2.51, 95% CI 1.12-5.62), even after adjusting for time-varying covariates. The COVID-19 pandemic has been associated with an increased prevalence of overweight among elementary school children in Japan.

The biological embedding of social adversity: How adolescent housing insecurity impacts inflammation over time

Background & PurposeAdolescent housing insecurity is a dynamic form of social adversity that impacts child health outcomes worldwide. However, the means by which adolescent housing insecurity may become biologically embedded to influence health outcomes over the life course remain unclear. Therefore, we aimed to utilize life course perspectives and advanced causal inference methods to evaluate the potential for inflammation to contribute to the biological embedding of adolescent housing insecurity. Materials and methodsUsing prospective data from the Great Smoky Mountains Study, we investigated the relationship between adolescent housing insecurity and whole-blood spot samples assayed for C-reactive protein (CRP). Adolescent housing insecurity was created based on annual measures of frequent residential moves, reduced standard of living, forced separation from the home, and foster care. Annual measures of CRP ranged from 0.001 mg/L to 13.6 mg/L (median = 0.427 mg/L) and were log10 transformed to account for positively skewed values. We used g-estimation of structural nested mean models to estimate a series of conditional average causal effects of adolescent housing insecurity on CRP levels from ages 11 to 16 years and interpreted the results within life course frameworks of accumulation, recency, and sensitive periods. Principal ResultsOf the 1,334 participants, 427 [44.3 %] were female. Based on the conditional average causal effect, one exposure to adolescent housing insecurity from ages 11 to 16 years led to a 6.4 % (95 % CI = 0.69 – 12.4) increase in later CRP levels. Exposure at 14 years of age led to a 27.9 % increase in CRP levels at age 15 (95 % CI = 6.5 – 53.5). Recent exposures to adolescent housing insecurity (<3 years) suggested stronger associations with CRP levels than distant exposures (>3 years), but limited statistical power prevented causal conclusions regarding recency effects at the risk of a Type II Error. Major ConclusionsThese findings highlight inflammation—as indicated by increased CRP levels—as one potential mechanism for the biological embedding of adolescent housing insecurity. The results also suggest that adolescent housing insecurity—particularly recent, repeated, and mid-adolescent exposures—may increase the risk of poor health outcomes and should be considered a key intervention target.

Knowledge on Use of Diaper and Its Impact on Child Health among Mothers of Infants

The present study aims to assess the knowledge on use of diaper and its impact on child health among mothers of infants. The objectives of the study was to assess the knowledge on use of diaper and its impact on child health among mothers of infants and to find out the association between the knowledge onuse of diaper and its impact of child health among the mothers of infants and selected socio personal variables. Non experimental descriptive study design was used in the study. The data was collected by using a semi structured questionnaire. The collected data was analysed using descriptive and inferential statistics. The result shows that out of 50 samples majority of the children are of age range 0-2 months, 52% were male children and was first born (54%). Majority of the sample are at age group 26-30 years ( 36%) , 58% samples are educated upto graduate level, 42% of samples were housewives and 48% have family income above 30,000, 94% of children were using disposable diapers ,42% of children using diapers for 3-4 hours and 80% children had no exposure to diaper rash.Among the samples, 56% of mother had moderate knowledge, 34% of mothers had poor knowledge and, 10% of mothers had good knowledge. There is significant association between the age of mother and occupation of mother and there is no association between age of child, sex of child, birth order of child, education of mother, income of family, type of diaper used, duration of diaper used, previous exposure to diaper rash.

Income and Household Material Hardship in Children With Medical Complexity.

Household economic hardship negatively impacts child health but may not be adequately captured by income. We sought to determine the prevalence of household material hardship (HMH), a measure of household economic hardship, and to examine the relationship between household poverty and material hardship in a population of children with medical complexity. We conducted a cross-sectional survey study of parents of children with medical complexity receiving primary care at a tertiary children's hospital. Our main predictor was household income as a percentage of the federal poverty limit (FPL): <50% FPL, 51% to 100% FPL, and >100% FPL. Our outcome was HMH measured as food, housing, and energy insecurity. We performed logistic regression models to calculate adjusted odds ratios of having ≥1 HMH, adjusted for patient and clinical characteristics from surveys and the Pediatric Health Information System. At least 1 material hardship was present in 40.9% of participants and 28.2% of the highest FPL group. Families with incomes <50% FPL and 51% to 100% FPL had ∼75% higher odds of having ≥1 material hardship compared with those with >100% FPL (<50% FPL: odds ratio 1.74 [95% confidence interval: 1.11-2.73], P = .02; 51% to 100% FPL: 1.73 [95% confidence interval: 1.09-2.73], P = .02). Poverty underestimated household economic hardship. Although households with incomes <100% FPL had higher odds of having ≥1 material hardship, one-quarter of families in the highest FPL group also had ≥1 material hardship.

Health Expenditure, Institutional Quality, and Under-Five Mortality in Sub-Saharan African Countries.

The aim of this study is to examine the relationship between health expenditure, institutional quality, and under-five mortality rates in sub-Saharan African countries. Specifically, the study seeks to explore the mediating role of institutional quality in this relationship, focusing on understanding how variations in healthcare spending and institutional frameworks impact child health outcomes. By examining these dynamics, the study aims to provide valuable insights that can inform evidence-based policy interventions to reduce under-five mortality and improve child health outcomes in the region. Utilizing data spanning the years 2000 to 2021 from 46 sub-Saharan African countries, this study employs a systems GMM model to explore the intricate relationship between health expenditure and under-five mortality rates (U5MRs), with a particular focus on the mediating role of institutional quality. The findings reveal that the quality of institutions significantly influences the impact of health expenditures on the U5MR. Strong institutional quality enhances the effectiveness of health expenditure in improving child health outcomes, particularly concerning the allocation of external health funds. Conversely, poor institutional quality amplifies the positive impact of domestic private and out-of-pocket health expenditures on the U5MR, as these serve as coping mechanisms in the absence of robust public healthcare systems. This research emphasizes the need for strategies that increase health expenditure and prioritize institutional strengthening to ensure efficient resource allocation and healthcare system management, thereby reducing under-five mortality rates. Furthermore, it underscores the importance of policies that minimize reliance on private and out-of-pocket health expenditures, which can lead to financial burdens and worsened health outcomes. Sub-Saharan African countries can make significant strides toward improving child survival and overall public health by addressing these issues.

Identifying critical windows of prenatal phenol, paraben, and pesticide exposure and child neurodevelopment: Findings from a prospective cohort study

BackgroundThis study aimed to investigate how exposure to a mixture of endocrine disrupting chemicals (EDCs) during two points in pregnancy affects early childhood neurodevelopment. MethodsWe analyzed publicly-available data from a high-risk cohort of mothers and their children (2007–2014) that measured six EDCs including methyl-, ethyl- and propyl parabens (MEPB, ETPB, PRPB), Bisphenol-A (BPA), 3,5,6-trichloro-2-pyridinol (TCPy), 3-phenoxybenzoic acid (3-PBA) in prenatal urine samples during the second and third trimesters. Neurodevelopmental scores were assessed using Mullen Scales of Early Learning (MSEL) at age 3. We used mean field variational Bayes for lagged kernel machine regression (MFVB-LKMR) to investigate the association between trimester-specific co-exposure to the six EDCs and MSEL scores at age 3, stratified by sex. ResultsThe analysis included 130 children. For females, the relationship between BPA and 3PBA with MSEL score varied between the two trimesters. In the second trimester, effect estimates for BPA were null but inversely correlated with MSEL score in the third trimester. 3PBA had a negative relationship with MSEL in the second trimester and positive correlation in the third trimester. For males, effect estimates for all EDCs were in opposing directions across trimesters. MFVB-LKMR analysis identified significant two-way interaction between EDCs for MSEL scores in both trimesters. For example, in females, the MSEL scores associated with increased exposure to TCPy were 1.75 units (95%credible interval −0.04, −3.47) lower in the 2nd trimester and 4.61 (95%CI −3.39, −5.84) lower in the third trimester when PRPB was fixed at the 75th percentile compared to when PRPB was fixed at the 25th percentile. ConclusionOur study provides evidence that timing of EDC exposure within the prenatal period may impact neurodevelopmental outcomes in children. More of these varying effects were identified among females. Future research is needed to explore EDC mixtures and the timing of exposure during pregnancy to enhance our understanding of how these chemicals impact child health.

Association between gestational weight gain and behavioral problems of the offspring aged 6-7 years: A population-based study in Japan.

To identify the optimal gestational weight gain (GWG) thresholds for behavioral problems and prosocial behavior in 6- to 7-year-old children. A retrospective cohort study was conducted using data from the Adachi Child Health Impact of Living Difficulty study, including all first-graders in public schools in Adachi, Tokyo, in 2017, 2019, and 2021 (n = 11 048, response rate = 80.1%). GWG was based on clinical records in the Mother and Child Health Handbook. Total difficulties and prosocial behavior were assessed using the Strength and Difficulties Questionnaire. Logistic regression models with restricted cubic splines, and quintile categories were employed to examine the association of GWG with the clinical range of total difficulties and prosocial behavior, controlling for covariates. The association between GWG and total difficulties exhibited a reverse J-shaped pattern, with low GWG, but not high GWG, increasing the risk (odds ratio [OR] 1.20, 95% confidence interval [CI] 1.01-1.42, P = 0.039 for GWG < 7 kg; OR 1.03, 95% CI 0.85-1.24, P = 0.786 for GWG > 14 kg), referencing the median (10 kg). High GWG was associated with a lower risk of problems in prosocial behavior (OR = 0.77, 95% CI 0.62-0.95, P = 0.017 for GWG > 14 kg; OR 1.06, 95% CI 0.88-1.27, P = 0.532 for GWG <7 kg). GWG less than 7 kg may increase the risk of total difficulties, whereas GWG over 14 kg may serve as a protective factor for prosocial behavior in 6- to 7-year-old children.

Caregiver and family functioning after pediatric disorder of consciousness: telephone-based outcome assessment

ABSTRACT Objective Examine initial feasibility/utility of a telephone-administered measure in describing impact of child health on caregiver/family functioning in patients with a history of a disorder of consciousness (DoC) due to severe-acquired brain injury (ABI). Method Caregivers of patients admitted at least 1 year prior for inpatient rehabilitation with DoC completed a battery of measures administered via telephone examining the impact of child health on caregiver/family functioning (Pediatric Quality of Life Family Impact Module; PedsQL-FIM) and child functioning. Results Forty-one caregivers of unique patients (age = 5–22 years; M = 14.9, SD = 5.1; 63% male; time since injury = 1–18 years; M = 5.3; SD = 4.2) completed the telephone measures. PedsQL-FIM floor and ceiling effects were minimal (administration time = 5–16 min, M = 7.4; SD = 2.8). Family functioning was lowest in Daily Activities and highest in Family Relationships. Relative to caregivers of patients with mild-severe ABI, caregivers reported lower caregiver/family functioning. Correlations were moderate between child functioning and caregiver/family functioning on some PedsQL-FIM scales. Conclusions Within this relatively small convenience sample, results indicate the PedsQL-FIM administered via telephone is feasible and useful in describing the impact of child health on caregiver/family functioning long after DoC associated with ABI. Future studies are needed to understand factors contributing to caregiver/family functioning to inform targeted interventions.

Children's and young people's experiences of expressing their views and having them heard in health care: A deductive qualitative content analysis.

To gain an understanding of children's experiences of expressing their views and having them heard in Australian healthcare settings. Child-centred qualitative research. A deductive qualitative content analysis was undertaken. Data were collected from 20 Australian children and young people between the ages of 7 and 18 years old using the 'draw, write and tell' method. Children's experiences of 'space' and 'voice', and therefore the opportunity to express their views in health care were, in the main, positive. At the same time, their experiences of 'audience' and 'influence', the situations in which those views are given due weight, were overwhelmingly described as negative. Australian paediatric health services appear to have responded to calls to provide children with the opportunity to express their views and thus are delivering on the elements of 'space' and 'voice', whereas the realisation of 'audience' and 'influence' has some way to go. Due weight is not always given to children's views. The Lundy model can be used to facilitate a better understanding of the concept of voice, and the responsibility of health organisations in implementing the rights of children and young people, as articulated in Article 12. Children and young people have a right to express their views and have them heard in health care, but their experiences in Australian health care are unknown. While children's experiences of expressing their views in health care were mostly positive, their views are not always taken seriously or given due weight. This research impacts child health professionals in Australia and internationally. The study is reported using the Standards for Reporting Qualitative Research (SRQR). Members of the Youth Advisory Council of two tertiary children's hospitals were consulted and invited to become members of the research team.

Empowered mothers and co-resident grandmothers: Two fundamental roles of women impacting child health outcomes in Punjab, Pakistan.

We show that i) empowered mothers and ii) coresident grandmothers each benefit children's nutritional health measured by height-for-age z-scores (HAZ) and weight-for-age z-scores (WAZ) for age groups 5 years and less. First, using cross-sectional data from the Pakistan Demographic and Health Survey (PDHS) for the year 2017-18, we estimate the impact of empowered mothers on child health outcomes using an instrumental variable approach to correct for endogeneity. Empowerment is measured by two indices: as a sum of the questions that gauge both attitudinal and behavioral dimensions of female agency and also and using multiple correspondence analysis (MCA) for these same questions. Second, we use a fuzzy regression discontinuity design (FRDD) to measure the causal impact of coresident grandmothers on the health outcomes of the children using multiple rounds of the Multiple Indicator Cluster Survey (MICS) from the years 2008, 2011, 2014 and 2018. The difference between the actual ages of the grandmother from the Potential Retirement Eligibility Criteria (PREC) has been used to correct for potential endogeneity. The results show that on average, the weight for age z-scores (WFA) for children under five increases by 0.28 SD with a one-index point increase in mother's empowerment. Similarly, on average, WFA increases by 0.098 SD when grandmothers are present in a household. Finally, we explore heterogeneity in the average effects stated above based upon the gender of the child as well as the wealth and geographic location of the household. The benefits of mothers' empowerment are largely driven by improvements in girls' nutrition as well as children living in rural areas while the presence of grandmothers primarily improves the nutrition of boys, children in rural areas, and children belonging to poor families.

The impact of socio-economic status on infant deaths: a case-control study from Istanbul

Abstract Background Socioeconomic disparities continue to impact child health. This study aimed to determine the association between socioeconomic status (SES) and infant mortality (IM) in a district in Istanbul. Methods This is a case-control study conducted in a district of Istanbul. The cases were all infants born alive who died before reaching the age of one between January 1, 2021, and December 31, 2022. The controls were randomly selected children who were born and survived their first year. The sample size was calculated as 83 cases and 166 controls assuming low SES doubled IM, with 80% power and an alpha error of 0.05. Data were obtained through health records and telephone interviews. SES was evaluated through a validated index that used parents’ education and occupation, households’ vehicles and ownership of electrical devices, house ownership, and the land value of the living area. SES was categorized into three groups: low, middle, and high. Logistic regression was used in the analysis. Results The response rate was 51.8%, with 42 cases and 87 controls. The multivariate model included mothers’ age, smoking status, presence of maternal chronic diseases and anemia, multiple gestations, antenatal visits (≥4 vs. &amp;lt;4), premature membrane rupture, mode of delivery, parental consanguinity, baby's gender, and the SES index. When high SES was the reference category, low (OR:4.34, 95%CI:1.18-15.92) and middle SES (OR:1.59, 95%CI:0.49-5.13) increased the risk of IM. Having &amp;lt;4 antenatal visits (OR:80.84, 95%CI:8.84-738.98), presence of maternal chronic diseases (OR:4.03, 95%CI:1.25-12.94), and anemia (OR:2.39 (95%CI: 0,86-6,64) also increased IM. Conclusions Low SES continues to be the root cause of IM. Infants of mothers who had &amp;lt;4 antenatal visits, anemia, and chronic diseases were at increased risk for mortality. To address IM, it is essential to highlight why pregnant women underutilize antenatal care since these services are free. Key messages • Achieving equity should be the main target for decreasing infant mortality. • There is a need to address underutilization of antenatal services for decreasing infant mortality.