Illness In Infants Research Articles

P-1986. COVID-19 Surveillance in Infants, Minnesota, October 2023–January 2024

Abstract Background The impact of COVID-19 in infants is incompletely understood. We conducted active surveillance, including interviews of parents of infants with COVID-19. Methods We attempted phone interviews of parents of infants aged < 12 months with lab-confirmed COVID-19 reported to the Minnesota Department of Health from 10/1/2023–1/31/2024 using a standardized form. Analyses were performed using SAS 9.4. Results Parents of 1161 (35%) infants were interviewed. There were no differences among those interviewed vs. not by white/non-white, urban/rural residence, or age. Median age was 6 months (IQR 3–8 months), 65% white, non-Hispanic, 53% male, 46% received federal assistance (WIC), and 38% attended childcare. 25% had an ill household member prior to, and 55% after, infant illness. 95% reported symptoms with fever (84%) and coryza (82%) most common. Co-pathogen detections were reported in 16% (68% RSV). 70% reported emergency (ED) or urgent care (UC) visits; 8% were hospitalized. Having a codetection (OR=4.14, p< 0.01) or underlying condition (OR=2.12, p=0.03) was associated with hospitalization. 16% of illnesses were considered severe by parents. Codetections (OR=2.46, p< 0.01), being non-white (OR=2.46, p< 0.01), receiving WIC (OR=1.99, p< 0.01), or having household income < $30,000 (OR=2.28, p< 0.01) were associated with severe illness. 80% of households had ≥ 1 adult vaccinated, but only 29% were vaccinated < 6 months prior to infant infection; 34% of households with other children had ≥ 1 child vaccinated. 10% of cases remained unrecovered at 30 days after positive test. Factors linked to non-recovery included codetections (OR=2.30, p< 0.01), prematurity (OR=2.19, p< 0.01), being non-white (OR=1.62, p=0.02), receiving WIC (OR=1.56, p=0.03), and low household income (OR=2.09, p< 0.01). Conclusion Among MN infants reported with COVID-19 with interview data, most visited ED/UC, and 16% were considered severely ill by parents. We found medical conditions, race, socioeconomic disparities, and codetections associated with severe and/or longer lasting illness. Improved understanding of the role of codetections and other risk factors, and encouraging up to date vaccination in households, may help mitigate the impact of severe COVID-19 in infants. Disclosures All Authors: No reported disclosures

Efficacy, Safety, and Immunogenicity of the MATISSE (Maternal Immunization Study for Safety and Efficacy) Maternal Respiratory Syncytial Virus Prefusion F Protein Vaccine Trial.

To evaluate descriptive efficacy data, exploratory immunogenicity data, and safety follow-up through study completion from the global, phase 3 MATISSE (Maternal Immunization Study for Safety and Efficacy) maternal vaccination trial of bivalent respiratory syncytial virus (RSV) prefusion F protein vaccine (RSVpreF). MATISSE was a phase 3, randomized, double-blinded, placebo-controlled trial. Healthy pregnant participants aged 49 years or younger at 24-36 weeks of gestation were randomized (1:1) to receive a single RSVpreF 120 micrograms or placebo dose. Primary efficacy endpoints included newborn and infant severe RSV-associated medically attended lower respiratory tract illness within 180 days after birth. The RSV-A and RSV-B serum neutralizing antibody titers were determined in a subset of pregnant participants and their newborns. In this final analysis, 7,420 pregnant participants were randomized, and 7,307 children were born (RSVpreF n=3,660, placebo n=3,647). Vaccine efficacy, defined as protection against newborn and infant severe RSV-associated medically attended lower respiratory tract illness, was 82.4% (95% CI, 57.5-93.9) and 70.0% (95% CI, 50.6-82.5) within 90 and 180 days of birth, respectively. The RSVpreF induced robust immune responses in pregnant participants and resulted in highly efficient transfer of maternal antibodies to their newborns across subgroups (by gestational age at delivery and at vaccination, number of days from vaccination to delivery, country, maternal age). Final RSVpreF safety results in pregnant and newborn and infant participants were consistent with the primary analysis with no new safety concerns identified. This final analysis of MATISSE trial data confirms the primary analysis conclusions: Maternal vaccination with RSVpreF has a favorable safety profile in both pregnant and newborn and infant participants and demonstrates efficacy against RSV-associated lower respiratory tract illness in infants through age 6 months. The RSVpreF induces robust immune responses in pregnant individuals, with corresponding high RSV-neutralizing titers in their newborns. ClinicalTrials.gov, NCT04424316.

A framework for monitoring RSV prevention product effectiveness in the United States.

During 2023, the Centers for Disease Control and Prevention (CDC) recommended the first respiratory syncytial virus (RSV) immunizations intended for widespread use in the United States to prevent severe RSV illness in infants and older adults. CDC, in collaboration with federal, public health, and academic partners, is conducting evaluations of real-world effectiveness of recommended RSV immunization products in the United States. Similar frameworks for evaluation are being applied to RSV vaccines and nirsevimab, a long-acting preventative monoclonal antibody, to estimate product effectiveness. The overall goal of CDC's RSV immunization effectiveness program is to generate timely and robust evidence through observational studies to inform immunization product policy decisions and other measures related to RSV prevention and control. CDC is evaluating effectiveness through high-quality, well-controlled observational studies leveraging a variety of platforms that provide robust data to inform policy decisions.

Postpartum depression in mothers of infants under 12 months at Hai Duong Pediatric Hospital and its association on infant health

Postpartum depression (PPD) is one of the current priorities in the national program on maternal and child health. The study aims to provide a comprehensive database on the prevalence of PPD among mothers in 12 months of post-delivery and to examine its relationship with the health status of their offspring in the first 12 months. This hospital-based cross-sectional study involved 180 mothers whose children were admitted at Hai Duong Pediatric Hospital in September 2022. The mothers in the study were classified by the PPD, which was determined using the Edinburgh Postnatal Depression Scale (EPDS) with the cut-off score of 12/13. Infant health indicators include the gestational age at birth, birthweight, congenital abnormality at birth, infant illness within the first 12 months, hospitalization frequency, crying behavior, and the mother’s concerns regarding the infant’s health status. PPD is significantly associated with the frequency of infants admitted for inpatient treatment (p=0.038) and the occurrence of prolonged infant crying episodes exceeding 15 minutes per day (p=0.004). Additionally, frequent maternal worry about the infant’s health also showed a strong relationship with PPD status (p<0.001). Strengthening targeted strategies to screen for and reduce the rate of PPD, especially among mothers who are often in a state of concern for their offspring’s health, should be prioritized.

A new chromosome-level genome assembly and annotation of Cryptosporidium meleagridis

Cryptosporidium spp. are medically and scientifically relevant protozoan parasites that cause severe diarrheal illness in infants, immunosuppressed populations and many animals. Although most human Cryptosporidium infections are caused by C. parvum and C. hominis, there are several other human-infecting species including C. meleagridis, which are commonly observed in developing countries. Here, we annotated a hybrid long-read Oxford Nanopore Technologies and short-read Illumina genome assembly for C. meleagridis (CmTU1867) with DNA generated using multiple displacement amplification. The assembly was then compared to the previous C. meleagridis (CmUKMEL1) assembly and annotation and a recent telomere-to-telomere C. parvum genome assembly. The chromosome-level assembly is 9.2 Mb with a contig N50 of 1.1 Mb. Annotation revealed 3,919 protein-encoding genes. A BUSCO analysis indicates a completeness of 96.6%. The new annotation contains 166 additional protein-encoding genes and reveals high synteny to C. parvum IOWA II (CpBGF). The new C. meleagridis genome assembly is nearly gap-free and provides a valuable new resource for the Cryptosporidium community and future studies on evolution and host-specificity.

NEONATAL JAUNDICE- KNOWLEDGE ATTITUDE PRACTICE AMONG WOMEN

Background:Neonatal jaundice which is also referred as hyperbilirubinemia is yellow discoloration of the skin and other organs due to accumulation of bilirubine.During the first week of delivery about 60 % term and 80 % preterm newborns suffer with this condition which needs medical consultation, it has been seen that breastfeeding neonates still have jaundice with in 1 month.Neonatal jaundice has a direct correlation with mortality and death in under developed countries. It is treatable illness in infants. Strategies to prevent complication of jaundice and early detection mass communication is important.To reduce morbidity and mortality due to severe NNJ, women of childbearing age and pregnant women should be educated on early recognition of NNJ, prompt and appropriate intervention. Methods:Relavant literature was scrutinize through a search on Medline and Pubmed. Results:Women more that 60% didnt knew about neonatal jaundice and have misconceptions for treatment modalities. Conclusions:Despite of spreading awareness womens have deficit knowledge and various myths regarding Neonatal Jaundice and there is need to spread awareness in community based for the same.

Etiology of Severely Dehydrating Diarrheal Illness in Infants and Young Children Residing in Low- and Middle-Income Countries.

Severe dehydration due to acute infectious diarrhea remains a leading cause of death among young children worldwide. Diarrhea with severe dehydration is a clinical syndrome with distinct management per the World Health Organization (WHO) Integrated Management of Childhood Illness (IMCI) and the WHO Global Task Force on Cholera Control (GTFCC) guidelines. We sought to characterize the pathogens causing severe dehydration using data from the Global Enteric Multicenter Study. We used the IMCI and GTFCC guidelines to define severe dehydration and quantitative polymerase chain reaction-based attribution models to assign the etiology of diarrhea associated with severe dehydration. The IMCI or GTFCC guidelines classified 2284 of the 5304 (43%) cases with moderate-to-severe diarrhea as having severe dehydration. In one-third of the cases with severe dehydration, no pathogens were attributed. The top pathogens attributed to children with guidelines-classified severe dehydration varied by age and were similar among those requiring intravenous hydration and hospitalization. Rotavirus (30.9%), Cryptosporidium (12.0%), and heat-stable (ST) enterotoxigenic Escherichia coli (ETEC) (10.3%) were the most common pathogens for ages 0-11 months, while Shigella/enteroinvasive E coli (EIEC) (25.8%), rotavirus (19.3%), and ST-ETEC (10.9%) were the most common for ages 12-23 months. Shigella/EIEC (25.9%), Vibrio cholerae (10.4%), and rotavirus (9.2%) were the most common among ages 24-59 months. The findings inform prioritization of pathogens, in addition to V cholerae, that cause severe dehydration for future preventive and treatment efforts. The schema for prioritization is driven primarily by age stratifications.

Correlation between the nucleic acid load of Bordetella pertussis and clinical features and severity of illness in infants and young children with wooping cough

To study the correlation between the level of Bordetella pertussis nucleic acid and clinical features of the disease in infants and young children and to investigate the risk factors for the development of severe pertussis. Using retrospective research methods, children aged 1 month-3 years who came to Hunan Children's Hospital from August 2023 to February 2024 and were diagnosed with pertussis for analysis. According to the logarithmic value of BP-DNA (log10 copies/ml), 35 cases were divided into the low load group, 78 cases were divided into the medium load group and 94 cases were divided into the high load group; 54 cases were divided into the severe whooping cough group and 153 cases were divided into the general group according to the severity of the disease; the clinical characteristics and laboratory data of the groups were compared, and the risk factors for the occurrence of severe whooping cough were analyzed at the same time. The ROC was used to evaluate the predictive efficacy of BP-DNA and WBC count for the development of severe pertussis. The results showed that in the high-dose group, the WBC count(22.59×109/L), L/N ratio(3.31), and hospitalization days(9.0 d) were significantly higher than those in the medium-dose group and low-dose group (F=6.309, 2.825, 15.149, all P<0.05). The hospitalization rate (100%), combined infection rate (64.96%), incidence of severe whooping cough (31.9%), pyrexia rate (29.8%), and corticosteroid use rate (57.4%) were also significantly higher than the other two groups (χ²=25.977, 9.163, 9.371, 8.299, 20.332, all P<0.05), and the complete immunity rate (9.6%) was significantly lower than the other two groups (χ²=11.632, P<0.05). Compared with the group of common whooping cough, the proportion of children under 1 year old (100%, χ²=9.581), the BP-DNA load (6.56 log10 copies/ml, Z=4.004), the WBC count(31.34×109/L, t=7.513), the PCT level(0.07 ng/ml, Z=2.626), the IL-6 level (6.65 ng/ml, Z=4.336), the combined infection rate (88.9%, χ²=36.536), the incidence of wheezing or dyspnea (55.6%, χ²=42.972), the rate of no improvement of symptoms with macrolides prior to the visit (77.8%, χ²=26.266), and the incidence of fever (55.6%, χ²=42.972) were all significantly higher;the complete immunity rate was significantly lower (5.6%, χ²=9.581) in the severe whooping cough group, the differences were all statistically significant(all P<0.05).The result of logistic regression analysis showed severe elevation of BP-DNA, high leukocyte count, co-infection, wheezing or shortness of breath, pyrexia and no improvement of symptoms with macrolides before the treatment were the risk factors for the development of severe pertussis and the logistic regressive model predicts a sensitivity and specificity of 0.83 and 0.90 for severe whooping cough, respectively. The sensitivity of BP-DNA>1.91×106 copies/ml, WBC count >19.97×109/L and the binominal combined test to predict the occurrence of severe pertussis were 0.87, 0.61 and 0.80, and the specificity were 0.43, 0.86 and 0.73, respectively. In conclusion, nucleic acid load in infants with pertussis correlated with clinical characteristics such as the active immunity status, fever, co-infections and hospitalisation and days in hospital. Children with high nucleic acid load, high white blood cell counts, co-infections, fever and no improvement of symptoms with macrolides prior to seeing a doctor were more likely to develop the severe pertussis. When BP-DNA >1.91×106 copies/ml or WBC counts>19.97×109/L, they have the highest predictive efficacy for severe pertussis respectively, and combined detection is better.

Neonatal Jaundice Risk Factors and Multidirectional Intensive Phototherapy Management at Azadi Teaching Hospital in Kirkuk City

Background: A common illness in infants, neonatal jaundice is caused by high bilirubin levels in the first few days of life, which results in yellowing of the skin and eyes. Aim: This study aims to explore neonatal jaundice risk factors and assess the efficacy of multidirectional intensive phototherapy management at Azadi Teaching Hospital in Kirkuk City. Patients and Methods: In this retrospective cross-sectional study spanning from April 1st, 2021, to October 1st, 2021, a total of 497 newborns were examined. Jaundiced neonates underwent intensive phototherapy utilizing the Bilisphere 360 system, which featured a chamber with 16 cylindrical, blue TL 20W/52 fluorescent tubes. The newborns were positioned on a gauze hammock suspended at the chamber's center, illuminated on all sides. Results: A study found that neonatal jaundice affects 50.70% of studied neonates, primarily in the 16-21-day age group, with males accounting for 57.95% of the sample. 94.84% of neonates experience jaundice due to ABO blood group incompatibility and 88.10% due to Rh incompatibility. Additionally, 77.78% of term deliveries are associated with jaundice. Infants with jaundice have higher Thyroid Stimulating Hormone (TSB) and Thyroid Stimulating Hormone (TSH) levels and a younger mean age compared to non-jaundiced infants. Bilisphere 360 proves significantly more effective in the critical 12 to 48 hours after admission, with a mean total bilirubin of 10.71 ± 1.01 mg/dl compared to 14.65 ± 1.71 mg/dl for Neonatal Exchange Transfusions (P-Value: 0.001). Factors like blood group incompatibility, labor duration, and birth weight influence TSB levels in jaundiced neonates. The Bilisphere 360 method is found to be more effective in managing neonatal jaundice than Neonatal Exchange Transfusions in reducing total bilirubin levels.

Breastfeeding Competency among Expectant Women

Breast milk serves as a vital source of nutrition for infants during the initial six months of life, offering a comprehensive array of essential nutrients.Breast milk serves as the optimal source of nutrition for infants, contributing to enhanced health outcomes throughout their lifespan and offering significant advantages to both families and society as a whole. The advocacy for breastfeeding can lead to a rise in family income through the preservation of infants' growth and development, as well as aiding in the recovery of women following childbirth. Consequently, this could result in increased labor force participation and demographic benefits for society.Moreover, it can contribute to the reduction of family and social medical costs by lowering the likelihood of short-term and long-term illnesses in women and infants. Results: The study results display that total effect of breastfeeding motivation on breastfeeding competency is .4419, p &lt; 0.05. The direct effect of breastfeeding motivation on breastfeeding competency is .4608, p &lt; 0.001. Conclusions: The student’s researcher concluded the following: The older the woman, the better the breastfeeding competency she exhibits. The better the socioeconomic status the family has, the better the breastfeeding competency the woman mirrors. The more perceived valuable breastfeeding to mothers and babies, the better the breastfeeding competency the woman reflects.

Ziresovir in Hospitalized Infants with Respiratory Syncytial Virus Infection

BackgroundRespiratory syncytial virus (RSV) is a leading cause of severe illness in infants, with no effective treatment. Results of a phase 2 trial suggested that ziresovir may have efficacy in the treatment of infants hospitalized with RSV infection.MethodsIn a phase 3, multicenter, double-blind, randomized, placebo-controlled trial conducted in China, we enrolled participants 1 to 24 months of age who were hospitalized with RSV infection. Participants were randomly assigned, in a 2:1 ratio, to receive ziresovir (at a dose of 10 to 40 mg, according to body weight) or placebo, administered twice daily, for 5 days. The primary end point was the change from baseline to day 3 (defined as 48 hours after the first administration) in the Wang bronchiolitis clinical score (total scores range from 0 to 12, with higher scores indicating greater severity of signs and symptoms). The intention-to-treat population included all the participants with RSV-confirmed infection who received at least one dose of ziresovir or placebo; the safety population included all the participants who received at least one dose of ziresovir or placebo.ResultsThe intention-to-treat population included 244 participants, and the safety population included 302. The reduction from baseline in the Wang bronchiolitis clinical score at day 3 was significantly greater with ziresovir than with placebo (−3.4 points [95% confidence interval {CI}, −3.7 to −3.1] vs. −2.7 points [95% CI, −3.1 to −2.2]; difference, −0.8 points [95% CI, −1.3 to −0.3]; P=0.002). The reduction in the RSV viral load at day 5 was greater in the ziresovir group than in the placebo group (−2.5 vs. −1.9 log10 copies per milliliter; difference, −0.6 log10 copies per milliliter [95% CI, −1.1 to −0.2]). Improvements were observed in prespecified subgroups, including in participants with a baseline bronchiolitis score of at least 8 and in those 6 months of age or younger. The incidence of adverse events related to the drug or placebo was 16% with ziresovir and 13% with placebo. The most common adverse events that were assessed by the investigator as being related to the drug or placebo were diarrhea (in 4% and 2% of the participants, respectively), an elevated liver-enzyme level (in 3% and 3%, respectively), and rash (in 2% and 1%). Resistance-associated mutations were identified in 15 participants (9%) in the ziresovir group.ConclusionsZiresovir treatment reduced signs and symptoms of bronchiolitis in infants and young children hospitalized with RSV infection. No safety concerns were identified. (Funded by Shanghai Ark Biopharmaceutical; AIRFLO ClinicalTrials.gov number, NCT04231968.)

Coparenting Patterns of Parents of an Infant With Complex Congenital Heart Disease: Qualitative Identification and Network Analysis of Effects of Infant Illness Severity and Guided Participation Intervention

Coparenting Patterns of Parents of an Infant With Complex Congenital Heart Disease: Qualitative Identification and Network Analysis of Effects of Infant Illness Severity and Guided Participation Intervention

Exploring the role of inhaled corticosteroid/betamethasone for managing recurrent respiratory illness in infants and young children

Background: Recurrent respiratory illnesses (RRIs) are frequent respiratory tract infections, particularly common in fall-winter and during seasonal changes. RRIs primarily affect children aged 2-7 years and the elderly, with respiratory viruses causing about 80% of cases. They interfere significantly with children's well-being and incur substantial medical and social costs. The study aim was to assess the effectiveness of inhaled corticosteroids (ICS) in infants and young children with recurrent respiratory symptoms. Methods: This prospective observational study took place over one year at the department of pediatrics, Cox’s Bazar medical college, Bangladesh, from June 1, 2014, to May 31, 2015. Results: The study involved 210 children with recurrent respiratory symptoms, mostly males (57.62%) and predominantly aged 1-3 years (55.71%). Atopy was present in 16.67%, and eczema in 30.48%. Only 2.38% of mothers smoked during pregnancy, and 20.48% of children were exposed to passive smoke. Salbutamol use was high (80.48%), and 32.86% used ICS. Symptoms ranged from mild (13.81%) to severe (23.81%). After six months, daytime cough reduced from 52.38% to 1.43%, and nighttime cough from 66.19% to 0%. Symptom-free days increased, and hospital admissions decreased from 90.95% to 9.05%. Common adverse events included worsening symptoms (13.81%) and fever (13.33%). Conclusions: Inhaled corticosteroid/betamethasone therapy significantly improved symptoms in infants and young children with RRIs over six months, reducing coughing, wheezing, shortness of breath, and hospital admissions, while increasing symptom-free days. Adverse events were mild and infrequent, suggesting ICS is effective and safe. Further research is needed to optimize treatment.

Impact of postpartum maternal fever or hypothermia on newborn and early infant illness and death in Southwestern Uganda

BackgroundDeaths occurring during the neonatal period contribute close to half of under-five mortality rate (U5MR); over 80% of these deaths occur in low- and middle-income countries (LMICs). Poor maternal antepartum and perinatal health predisposes newborns to low birth weight (LBW), birth asphyxia, and infections which increase the newborn’s risk of death.MethodsThe objective of the study was to assess the association between abnormal postpartum maternal temperature and early infant outcomes, specifically illness requiring hospitalisation or leading to death between birth and six weeks’ age. We prospectively studied a cohort of neonates born at Mbarara Regional Referral Hospital in Uganda to mothers with abnormal postpartum temperature and followed them longitudinally through early infancy. We performed a logistic regression of the relationship between maternal abnormal temperature and six-week infant hospitalization, adjusting for gestational age and 10-minute APGAR score at birth.ResultsOf the 648 postpartum participants from the parent study who agreed to enrol their neonates in the sub-study, 100 (15%) mothers had abnormal temperature. The mean maternal age was 24.6 (SD 5.3) years, and the mean parity was 2.3 (SD 1.5). There were more preterm babies born to mothers with abnormal maternal temperature (10%) compared to 1.1% to mothers with normal temperature (p=˂0.001). While the majority of newborns (92%) had a 10-minute APGAR score > 7, 14% of newborns whose mothers had abnormal temperatures had APGAR score ˂7 compared to 7% of those born to mothers with normal postpartum temperatures (P = 0.02). Six-week outcome data was available for 545 women and their infants. In the logistic regression model adjusted for gestational age at birth and 10-minute APGAR score, maternal abnormal temperature was not significantly associated with the composite adverse infant health outcome (being unwell or dead) between birth and six weeks’ age (aOR = 0.35, 95% CI 0.07–1.79, P = 0.21). The 10-minute APGAR score was significantly associated with adverse six-week outcome (P < 0.01).ConclusionsWhile our results do not demonstrate an association between abnormal maternal temperature and newborn and early infant outcomes, good routine neonate care should be emphasized, and the infants should be observed for any abnormal findings that may warrant further assessment.Target journalBMC Pregnancy and Childbirth (https://bmcpregnancychildbirth.biomedcentral.com/).

Rapid safety assessment of reconstituted infant formula using electrical impedance analysis

A rapid method to assess freshness is crucial for the safe handling of reconstituted infant formula (RIF) and prevention of food-borne illnesses in infants. This study explored the use of electrical impedance measurement (EIM) at a constant frequency for real-time freshness evaluation of RIF. Initial electrical impedance of 89.16 ± 0.47 Ω decreased to 74.29 ± 0.23 Ω within 48 h at room temperature (20 °C) storage. Under temperature abuse conditions (30 °C), the electrical impedance rapidly dropped from 75.48 ± 0.52 Ω to 60.15 ± 4.76 Ω within 18 h, indicating more rapid spoilage. Notable changes in the electrical impedance were observed during temperature abuse. Empirical model analysis revealed a strong positive correlation between electrical impedance and conventional freshness parameters such as pH, protein, and microbial growth. This study demonstrates the potential of EIM for the rapid detection of freshness changes in RIF, offering valuable insights into the prevention of food-borne illnesses in infants.

The Development and Effectiveness of Interactive Multimedia-Based Nutrition Education Module (IMNEM): A Concept Paper

Globally, malnutrition is an issue that has never been overcome, even after a series of efforts by experts, which have never been impressive. The world’s malnutrition burden remains unsatisfactory since malnutrition is solely responsible for more illnesses than other reasons. Malnutrition continues to be a significant problem in Malaysia. The most common manifestation of chronic malnutrition in children is stunting, a lifetime problem for a child in Malaysia. Stunting is an irreversible condition in which a child cannot regain their height in the same way that they can regain weight. Notably, various factors have been identified associated with the risk of stunting among Malaysian children. This includes socio-demographic background, gestational characteristics, maternal and infant diet, feeding practice, illness, and infection. As discovered through the literature review, stunted children face many disabilities, such as learning deficiencies, which affect their productivity for economic prosperity, mostly falling sick more often, losing opportunities to learn, performing poorly in school and growing up to be backward, and more likely to suffer from diet-related Non-Communicable Diseases (NCDs). Therefore, this study will develop and evaluate the effectiveness of interactive multimedia-based nutrition education on Knowledge, Attitude, and Practice (KAP) about nutrition, growth monitoring, breastfeeding, and child-feeding practices among mothers with stunted children using the ADDIE model. This study will employ a quasi-experimental research method consisting of control and treatment groups. The study will be conducted in maternal child health clinics in the Seberang Perai district in Pulau Pinang. The population of this study consists of mothers with stunted children under five years old. In this study, convenience sampling will be used to recruit the target population, and the sample size was determined using G*power.

Maternal Immunization Decision-Making Among Pregnant and Lactating People in Kenya: A Qualitative Exploration of Peer Influences on Vaccine Decision-Making for a Future RSV Vaccine

IntroductionRespiratory syncytial virus (RSV) is a leading cause of respiratory illness in infants globally, with new maternal RSV vaccines on the horizon. Vaccine decision-making during pregnancy is shaped by individual, interpersonal, community, and societal factors. This study explored key interpersonal influences on maternal vaccine decision-making among pregnant and lactating people (PLP) and community members in Kenya.MethodsThis qualitative study conducted in-depth interviews with six pregnant people, 18 lactating people, and 10 community members in one rural and one urban county in Kenya. Data were analyzed using a grounded theory approach.ResultsParticipants identified the pregnant person themself, male partners, other family members, peers, and healthcare providers (HCPs) as key influences on the maternal immunization decision-making process. The majority of interviewed PLP believed that decision-making during pregnancy should be left to themselves due to autonomy and their role as the primary caregiver. Community members, including male partners, also identified pregnant people as the key decision-maker. While some PLP said they deferred to male partners to make vaccine decisions, more felt that men were not as informed on maternal and child issues as themselves or other female peers and relatives. HCPs emerged as important influences and information sources for PLP during decision-making.DiscussionUnderstanding who influences vaccine-decision making during pregnancy will help inform demand generation strategies, and in turn, uptake of future maternal vaccines, including RSV vaccines. Given the strong role HCPs and peers have in the decision-making process, targeting key potential influences is essential to improve vaccine acceptance.

Cost-benefit analysis of a multicomponent breastfeeding promotion and support intervention in a developing country.

Studies on breastfeeding promotion and support interventions suggest some economic benefits. This study assessed the direct and indirect costs of a multicomponent breastfeeding promotion and support intervention during the first two years of the infant's life. This is a cost-benefit analysis of data generated from a randomized controlled trial that investigated whether provision of a multicomponent breastfeeding promotion and support intervention to Lebanese mothers in the first six months postpartum would improve breastfeeding rates compared to standard obstetric and pediatric care. Data of 339 participants on sociodemographics, mother and infant health, infant nutrition, direct and indirect costs of the intervention were used to assess the benefit-cost ratio (BCR) of the intervention at one, six, 12, and 24 months as primary outcome. Secondary outcomes included overall costs of infant nutrition and infant-mother dyad health costs during the first two years. Multiple linear regression models explored the effect of the intervention on the overall infant nutrition cost and mother-infant health costs. Similar regression models investigated the association between cost variables and infant nutrition types (exclusive breastfeeding, mixed feeding, artificial milk). Intention to treat analyses were conducted using SPSS (version 24). Statistical significance was set at a p-value below 0.05. The prevalence of Exclusive/Predominant breastfeeding among participants declined from 51.6% in the first month to 6.6% at the end of second year. The multicomponent breastfeeding intervention incurred 485 USD more in costs than the control group during the first six months but was cost-efficient at one year (incremental net benefits of 374 USD; BCR = 2.44), and two years (incremental net benefits of 472 USD; BCR = 2.82). In adjusted analyses, the intervention was significantly associated with fewer infant illness visits in the first year (p = 0.045). Stratified analyses by the infant nutrition type revealed that infants who were on Exclusive/Predominant, or Any Breastfeeding had significantly more favorable health outcomes at different time points during the first two years (p<0.05) compared to infants receiving Artificial Milk only, with health benefits being highest in the Exclusive/Predominant breastfeeding group. Moreover, Exclusive/Predominant and Any Breastfeeding had significantly lower costs of infant illness visits, hospitalizations, and infant medications during the two years (p<0.05) but had additional cost for maternal non-routine doctor visits due to breastfeeding (all p values <0.05). Whereas the overall cost (direct and indirect) during the first six months was significantly lower for the Exclusive/Predominant breastfeeding infants (p = 0.001), they were similar in infants on Mixed Feeding or Artificial Milk. Breastfeeding is associated with significant economic and infant health benefits in the first two years. In the context of the current economic crisis in Lebanon, this study provides further evidence to policymakers on the need to invest in national breastfeeding promotion and support interventions.

Factors Related to Postpartum Depression in People Living With HIV: A Systematic Review.

Postpartum depression (PPD) affects one in eight women in the United States. Women with HIV may be at higher risk for PPD. This systematic review examined factors related to PPD in those with HIV. Using three databases, articles published between 2017 and 2022 were screened for eligibility, with 19 full texts reviewed and critically appraised. Ten studies from eight countries were ultimately included in the analysis. Using Engel's biopsychosocial model, common themes emerged within the theoretical framework: (a) biological (e.g., HIV diagnosis in pregnancy, impact on HIV adherence); (b) psychological (e.g., pregnancy intention, intimate partner violence, fear of HIV transmission, infant illness, behavior); and (c) social (e.g., socioeconomic status, lack of social support, disclosure, stigma). Living with HIV carries additional stressors for new parents that may impact mental health in the postpartum period. Nurses are in a unique position to screen for PPD early using established screening tools while paying particular attention to associated factors impacting those with HIV. [Journal of Psychosocial Nursing and Mental Health Services, 62(11), 19-26.].

Impact of Infancy Conditions on Physical Growth of Children Under-five

Children under five years old is the age group most vulnerable to several health problems. It is important to evaluate the impact of infancy condition on their physical growth. This research aimed to examine the impact of infancy condition on the physical growth of children under-five years old. The unmatched case-control study was conducted in Puskesmas Griya Antapani areas, Bandung from May to July, 2023. A total of 112 children aged under 5 years were included in this study (56 cases and 56 control). The analysis used multivariate logistic regression to determine adjusted odds ratios (OR). The results showed that the variables associated with the children growth are infection or illness in infancy (OR is 0,138 95 percent CI 0,51 until 0,375), feeding patterns in infancy (OR is 11,000 95 percent CI 4,566 until 26,503), birth weight (OR is 0,170 95 percent CI 0,036 until 0,818) and economic status (OR is 0,062 95 percent CI 0,14 until 0,280). Multivariate logistic regression showed that economic status was the most dominant factor for children physical growth (OR is 6.701 95 percent CI 1,323 until 33,944). Education for families is needed in choosing food that is rich in nutrition and economical by utilizing alternative sources of protein, the amount of food, and the schedule of meals according to the needs of children according to their age.