Higher Maternal Education Research Articles

Nature, prevalence and determinants of mental health problems experienced by adolescents in south Asia: a systematic review.

Adolescence is a sensitive phase of human development where individuals, aged 10-19 years, are particularly vulnerable to developing mental health problems (MHPs). South Asia, home to 24% of the world's population, is mostly comprised of low- and middle-income countries (LMIC). Most of the world's young people live in LMICs. This systematic review aims to assess the available evidence on the nature, prevalence and determinants of MHPs experienced by adolescents in south Asia. Following PRISMA guidelines, searches were conducted in four online databases (Ovid Medline, Ovid EMBASE, Ovid Global Health, Ovid PsycInfo), titles, abstracts, and full-texts were screened, data extracted and quality assessed. Extracted data were categorised into school-based studies (SBS) and non-school-based studies (NSBS). Data were further stratified according to country, MHPs and narratively synthesised. Of the 5847 records identified in the searches, 117 met inclusion criteria. Most (n=87) were SBS. Key MHPs reported across countries include anxiety disorders and depression. Wide ranges of prevalence rates were reported for anxiety in Indian SBS (1.5-81.6%) and NSBS (1.8-88.1%), and for depression, Pakistani SBS (21-79%) and Indian NSBS (0.4-98.5%). Determinants include individual characteristics; violent victimisation; poor family/home/school environment/peer relationships; already experiencing MHPs and substance use/abuse. Increased physical activity, adequate nutrition, safe/positive homes/family environment, being unmarried females, higher maternal education, peer support/friendship, higher education level and engaging in extra-curricular activities were protective of mental well-being. Prevalence of MHPs among south Asian adolescents appears high. Determinants include social, cultural, environmental and socioeconomic factors often beyond individual control. Mental health policies and programs and research appropriate to the cultural context, that address social determinants of MHPs and evidence gaps, are needed to tackle the significant mental health burden among south Asian adolescents. Authors CM and MW are supported by a Monash University Research Training Program Scholarship. JF is supported by the Finkel Professorial Fellowship funded by the Finkel Family Foundation.

Determinants of infants and young children feeding practices among mothers living in Saudi Arabia: a cross-sectional study.

The WHO sets evidence-based guidelines for infant feeding. Adhering to the WHO guidelines ensures that infants receive the proper nutrition and thus is associated with healthy growth and development. To describe breastfeeding and complementary feeding practices (CFPs) for infants and young children and identify determinants of appropriate feeding practices. This cross-sectional study was performed via structured interviews with mothers living in Saudi Arabia's Eastern Province who had children aged 6-24 months. To evaluate their adherence to the recommended WHO practices, a scoring method was applied (0-9). 395 mothers were interviewed. The rate of breastfeeding within the first hour, and exclusively breastfeeding for six months was both 25%. Multivariate analysis showed that exclusive breastfeeding for at least six months was less likely in middle-income mothers were less likely to exclusively breastfeed for six months than high-income mothers (OR = 0.32; 95% CI: 0.18-0.57; p < 0.001). Mothers without domestic help were also less likely to exclusively breastfeed (OR = 3.0; p < 0.001), as were those not living with their husbands (OR = 2.1; p = 0.007). Multiparous mothers and those with higher education were more likely to breastfeed than high school graduates (OR = 2.3, p = 0.02; OR = 4.4, p = 0.015, respectively). Timely breastfeeding initiation within the first hour was more common in term infants than preterm infants (OR = 5.3; p = 0.033), and infants born through normal delivery were four times more likely to initiate breastfeeding early (OR = 4.0; p < 0.001). For CFPs, 42% of participants introduced solid food at six months. 55% of mothers reported poor CFPs, primarily due to inappropriate timing of solid food introduction, choking hazards, and delayed introduction of family meals. Good CFPs were positively associated with higher maternal education, increased income, and living with a husband. Partial compliance with WHO CFP standards need improvement. Interventions should raise awareness of factors leading to poor compliance and support early breastfeeding initiation and continuation. Low-income and less educated families appear to be most in need of support.

Involvement of Maternal and Socioeconomic Risk Factors in the Incidence of Fetal Growth Restriction in a Large Maternity Hospital in Romania

Background: Fetal growth restriction (FGR) refers to a condition in which a fetus does not reach its genetically predetermined growth potential due to various pathological factors of maternal or fetal origin, with potential long-life consequences, such as elevated blood pressure, type 2 diabetes mellitus, obesity, dyslipidemia, atherosclerosis. Aim: The purpose of our research is to delve into the intricate relationship between economic and social factors and the occurrence of FGR. Methods: We analyzed risk factors previously associated with FGR and aimed to compare them between two cohorts of infants with FGR: a historical cohort of infants born from 2010 to 2012 and a contemporary cohort of infants born from 2020 to 2022. Results: The global incidence of FGR in our study was 5.13%, with non-significant differences between the two time periods: 5.03% in the historical cohort and 5.25% in the contemporary cohort. More mothers of FGR infants receive formal education and are employed in the contemporary group and thus have a more stable income. There was a major decrease in the number of preterm infants with FGR, from 23.9% in the historical cohort to 5.9% in the contemporary cohort (p &lt; 0.001). Compared to the historical cohort, we found significant increases in the incidence of pregnancy-induced hypertension, Cesarean sections, and prenatal follow-up in the contemporary cohort (8.3% vs. 3.8%, p &lt; 0.001; 59.2% vs. 49.9%, p &lt; 0.001; 67.7% vs. 49.6%, p &lt; 0.001, respectively) and we also found significant correlations between prenatal care on one side and maternal smoking, urban residence, higher maternal education, and prematurity on the other. Conclusions: Certain socioeconomic factors show definite improvements over the ten-year timespan, which results in an increase in prenatal care and a decrease in the rate of prematurity. However, the incidence of FGR remains constant over the considered period, meaning that other factors, apart from socioeconomic factors, play a substantial role. Recognizing these risk factors is crucial for developing effective public health strategies aimed at reducing the incidence of FGR and improving maternal and child outcomes.

Demographic Correlates of Autism: How Do Associations Compare Between Diagnosis and a Quantitative Trait Measure?

Prevalence of autism diagnosis has historically differed by demographic factors. Using data from 8224 participants drawn from the Environmental influences on Child Health Outcomes (ECHO) Program, we examined relationships between demographic factors and parent-reported autism-related traits as captured by the Social Responsiveness Scale (SRS; T score > 65) and compared these to relations with parent-reported clinician diagnosis of ASD, in generalized linear mixed effects regression analyses. Results suggested lower odds of autism diagnosis, but not of SRS T > 65, for non-Hispanic Black children (adjusted odds ratio [OR] = 0.76, 95% CI 0.55, 1.06) relative to non-Hispanic White children. Higher maternal education was associated with reduced odds of both outcomes (OR = 0.73, 95% CI 0.51, 1.05 for ASD autism diagnosis and 0.4, 95% CI 0.29, 0.55 for SRS score). In addition, results suggested a lower likelihood of autism diagnosis but a higher likelihood of an SRS score > 65 in Black girls. Findings suggest lower diagnostic recognition of autism in non-Hispanic Black children, despite a similar degree of SRS-assessed autism-related traits falling in the clinically elevated range. Further work is needed to address this disparity.

Knowledge of Mothers about Febrile Convulsion in Children, Children Welfare Teaching Hospital, Medical City Complex, Baghdad, 2024

Abstract Background: Febrile convulsion (FC) is the most common seizure in children worldwide. Between 1% and 4% of children develop FCs. It is also a leading reason for pediatric hospital admissions. Aim of the Study: The study aimed to assess the level of mothers’ knowledge regarding FC in children and to identify the factors affecting mothers’ knowledge about FC. Methodology: A descriptive cross-sectional study was conducted in Children Welfare Teaching Hospital, Medical City Complex (outpatient clinic and emergency unit), during the period between November 2023 and August 2024. The study involved 426 mothers with children aged &lt;7 years who attended the outpatient clinic and emergency unit. A dedicated knowledge score was established based on 20 questions, dividing the mother’s knowledge into three categories (high, moderate/fair, and poor knowledge). Results: Mothers’ knowledge scores revealed that their scores ranged from 6 to 20 with a mean of 13.4 ± 2.4 standard deviation; 24 (5.6%) got poor knowledge, 317 (74.4%) got fair knowledge, and 85 (19.9%) got high knowledge. The associations were statistically significant between mothers’ knowledge level and their residency (P = 0.018) and between mothers’ knowledge level and their education (P = 0.001). Conclusion: The majority of mothers (74.4%) had a fair knowledge of FC. Their knowledge is significantly associated with higher maternal education and urban residence.

Association between elementary and middle school children with mixed/foreign parents and influenza vaccination in Japan.

The number of children with foreign parents is increasing in Japan; however, the percentage of these children receiving the recommended annual influenza vaccination, which must be paid for voluntarily, may be quite low. Socioeconomic status may influence voluntary vaccination decisions. This study explored the association between elementary and middle school children with mixed (either of the parents was non-Japanese) /foreign parents (both parents were non-Japanese) and influenza vaccination in Japan, stratified by household income and maternal education. We used combined data from eight cities in the Greater Tokyo area for the period from 2016 to 2019, which included 16,368 elementary and middle school students and their caregivers. Caregivers responded to questions about whether their children received influenza vaccination in the previous year and their foreign-born status. Multilevel Poisson regression was applied and further stratified by income status and maternal education. Three hundred ninety-one children (2.4%) had mixed parents, and 91 (0.6%) had foreign parents. When compared with Japanese children, children with mixed (incidence risk ratio, IRR: 0.80, confidence Interval, CI: 0.71, 0.90) and foreign parents (IRR: 0.70, CI: 0.56, 0.88) were less likely to receive influenza vaccination. After stratification, children with mixed/foreign parents were less likely to receive influenza vaccination than Japanese children only in households with high income and maternal education. Children with mixed and foreign parents, especially in households with high socioeconomic status, had lower influenza vaccine coverage than Japanese children.

The Relationship Between the Prevalence of Depression Caused by Antiphospholipid Syndrome Abortion and Related Factors in Pregnant Women

Background: Psychological pathologies diagnosed during pregnancy are among the risk factors affecting adverse pregnancy outcomes. Objectives: This study aimed to determine the relationship between the prevalence of depression caused by antiphospholipid syndrome (APS) abortion and related factors in pregnant women. Methods: This research is a descriptive-analytical epidemiological study. Its target population includes all patients with abortions due to APS who referred to medical centers in Ahvaz city during the academic year from October 2022 to February 2023. Forty women with a history of at least two successful births and no history of fetal death or recurrent miscarriage, similar to the studied samples, were analyzed as a control group. Two demographic questionnaires—Midwifery and Beck's Depression—were used, and the data were analyzed using SPSS24 software. Results: The linear regression test showed a significant relationship between increasing maternal age, pregnancy rate, gestational age, history of depression, and increased depression caused by abortion (P &lt; 0.05). There was a significant relationship between higher maternal education, higher husband's education, wife's occupation, mother's employment, number of living children, history of abortions, increased family well-being, and decreased depression caused by abortion (P &lt; 0.05). Conclusions: It is recommended to implement a new consultation-based midwifery care method in maternity centers. Additionally, by enhancing follow-up and referral systems, individuals suspected of having mood disorders after abortion can be identified and referred to specialized centers.

Early family socioeconomic status and asthma-related outcomes in school-aged children: Results from seven birth cohort studies

ObjectiveTo examine the associations between maternal education and household income during early childhood with asthma-related outcomes in children aged 9–12 years in the UK, the Netherlands, Sweden, Australia, the USA...

Sociodemographic and maternal health-related factors associated with mortality among children under three in Bangladesh: an analysis of data from Bangladesh Demographic and Health Survey 2017-18

BackgroundChild mortality remains remarkably high in many low- and middle-income countries (LMICs), including Bangladesh. This study aimed to identify the sociodemographic and maternal health-related factors associated with under three (U3) child mortality in Bangladesh.MethodsWe extracted data of 5299 U3 children from Bangladesh Demographic and Health Survey (BDHS) 2017-18. We used descriptive statistics to summarize the data. The chi-square (χ2) test, simple and multiple Firth logistic regression were performed to test the associations between priori-defined factors and U3 mortality.ResultsIn Bangladesh, the U3 child mortality rate was 35 deaths per 1,000 live births, with a median age at death of less than one month. The adjusted model revealed that the odds of U3 child mortality were higher among children born to mothers aged between 30 and 39 years [adjusted odds ratio (AOR) = 2.01, 95% confidence interval (CI): 1.30–3.11; p-value (p) = 0.002], those who did not use any contraceptive [AOR = 2.57, 95% CI: 1.90–3.47; p < 0.001], with first pregnancy [AOR = 14.91, CI: 4.60–48.30; p < 0.001], had birth interval less than 24 months [AOR = 2.10, CI: 1.23–3.60; p = 0.007], children born to mothers who delivered vaginally [AOR = 3.18, 95% CI: 2.07–4.87; p < 0.001]. However, lower odds of mortality were observed among children of mothers with higher education levels [AOR = 0.50, 95% CI: 0.28–0.90; p = 0.021] and families with more than five members [AOR = 0.61, 95% CI: 0.45–0.83; p < 0.01]. In addition, religion, birth attendant during delivery, and the child’s birth order were significantly associated with U3 child mortality, whereas mortality did not vary significantly across the divisions.ConclusionsHigher odds of U3 child mortality were associated with mothers who did not use contraceptives, delivered vaginally, and were aged 30–39 years in Bangladesh. Conversely, higher maternal education and larger family size were associated with lower odds of U3 child mortality. The findings suggest that community-based family planning awareness programs focused on contraceptive use, as it prevents childbirth and is also a marker of health service usage.

Social determinants and socioeconomic inequalities in adherence to antenatal iron-folic acid supplementation in urban and rural Indonesia.

Adherence to iron-folic acid supplementation (IFAS) has been linked with maternal anaemia. While findings about determinants of IFAS adherence have been mixed across different research, there is inadequate evidence in relation to socioeconomic inequalities. This study aims to examine social determinants and socioeconomic inequalities of adherence to IFAS in urban and rural Indonesia. We conducted a secondary analysis of the 2017 Indonesia Demographic and Health Survey by including a total of 12 455 women aged 15-49 years. The outcome was adherence to IFAS for at least 90 days. We used multiple logistic regression analysis adjusted for the survey design to analyse factors associated with IFAS adherence. We estimated socioeconomic inequalities using the Wagstaff normalized concentration index and plotted them using the concentration curve. About half of women consumed IFAS for at least 90 days, with a higher proportion in urban areas (59.0%) than in rural areas (47.8%). Social determinants of adherence to IFAS were similar for urban and rural women. Overall, being an older woman, having weekly internet access, antenatal care for at least four visits, and residing in Java and Bali were significantly linked to IFAS adherence. Higher maternal education was significantly linked to IFAS adherence in urban settings, but not in rural settings. There were interactions between place of residence and woman's education (p<0.001) and household wealth (p<0.001). Concentration indices by woman's education and household wealth were 0.102 (p<0.001) and 0.133 (p<0.001), respectively, indicating pro-educated and pro-rich inequalities. However, no significant education-related disparity was found among rural women (p=0.126). Women (age, education, occupation, birth number, internet access, involvement in decision-making), household (husband's education, household wealth), health care (antenatal care visit) and community (place of residence, geographic region) factors are associated with overall adherence to IFAS. These factors influence the adherence to IFAS in a complex web of deep-seated socioeconomic inequalities. Thus, programs and interventions to improve adherence to IFAS should target women of reproductive age and their families, particularly those from socioeconomically disadvantaged groups residing in rural areas.

Factors associated with the dietary patterns of Brazilian adolescents: analysis of the National Survey of School Health

ObjectivesTo identify the dietary patterns of Brazilian adolescents and to verify their associated factors. MethodsCross-sectional study with data from the 2019 National Survey of School Health. Students aged 13 to 17 participated in the survey, totaling a sample of 125,123 adolescents. The variables were divided into two groups: healthy and unhealthy diet. Principal component analysis was used to identify the dietary patterns. To evaluate the association, logistic regression was used, estimated by the Odds Ratio, with the respective 95 % confidence intervals. ResultsTwo main components were identified: first related to regular consumption of fruits, vegetables, and beans; the second related to non-regular consumption of sweet treats, soft drinks, and fast food. The highest likelihood of regularly consuming the first was observed among adolescents residing in the Central-West and Southeast regions, with higher maternal education, who abstained from alcohol, engaged in physical activity, were not sedentary, ate breakfast, had lunch or dinner with their parents, refrained from eating while engaging in other activities, and participated in school meal programs. The lowest likelihood of not regularly consuming the second was found among male adolescents aged 16 to 17, attending public schools, who abstained from alcohol, and were not sedentary. ConclusionsThis study identified two dietary patterns, both linked to socioeconomic factors and healthy lifestyle habits. Recognizing these patterns among adolescents enables health surveillance efforts aimed at reducing diseases and health problems.

What factors are associated with early childhood development in Thailand? A cross-sectional analysis using the 2022 Multiple Indicator Cluster Survey.

Early childhood development is essential for lifelong health and well-being. This study aims to assess the proportion of children aged 24-59 months in Thailand who are developmentally on track using the Early Childhood Development Index 2030 (ECDI2030) and to explore associations with household socioeconomic characteristics and environments. A cross-sectional analysis was conducted using data from the 2022 Multiple Indicator Cluster Survey by the Thailand National Statistical Office. The developmental progress of 6557 children was evaluated across health, learning and psychosocial domains using ECDI2030 criteria. Multivariable logistic regression was used to assess associations between developmental status and household and participant characteristics. The study found that 81.3% of children were developmentally on track. Factors positively associated with being on track included being female (adjusted OR (AOR)=1.49), higher maternal education (AOR=2.02 for above secondary education), more books at home (AOR=1.59 for 3-9 books; AOR=2.40 for 10+ books) and increased screen time (AOR=1.68). Living in the Northern (AOR=0.45) and Northeastern (AOR=0.56) regions decreased the likelihood of being on track. Around 20% of children did not meet ECDI2030 milestones, highlighting the need for targeted policy interventions. Gender, region, maternal education, access to books and screen time were significant factors for developmental outcomes. Policies should prioritise support for parents, nurturing care and educational resources, particularly for socioeconomically disadvantaged groups.

Cultural Perceptions of Language Development in a Population Sample of 54-Month-Old Children From Aotearoa New Zealand.

There is a dearth of information on cultural perceptions of children's language development for ethnic minorities in New Zealand to guide service provision. The current study explored differences across ethnicities in mothers' report of language concern and child language scores within a complex cultural, social, educational, and political context. Data from the antenatal and 54-month waves of Growing Up in New Zealand were utilized. At the 54-month wave interviews, 5,053 mothers were asked if language concerns had been raised and to rate their child's main language proficiency along with other measures. Logistic regression models (including influencing variables) indicated Chinese, Indian, and other Asian mothers were less likely to report language concern, whereas Māori, Pacific, other Asian, and Middle Eastern, Latin American, and African children were more likely to score low on the language measure. Higher maternal education was associated with higher child main language scores, but not with language concerns. Child multilingualism was not associated with low language scores, and these mothers were less likely to raise concern. This study demonstrated differences by ethnicity in mothers' language concern and child main language scores, which are likely to affect access to speech-language pathology services, as these typically rely on parent concern being expressed. Cultural bias in the language measure may also be present. Further research is needed to ask ethnic communities their views on culturally appropriate ways to identify children with communication needs and to develop culturally safe services.

The Knowledge, Concerns, and Beliefs of Mothers Towards Febrile Convulsions and Its Management in Aseer, Saudi Arabia.

Introduction Febrile convulsions are common in children aged six months to five years, causing significant parental distress despite being generally harmless. Various beliefs about their causes exist, including high fever and supernatural factors. Previous studies indicate that mothers' education levels and occupations influence their knowledge and attitudes toward febrile convulsions. This study in Aseer, Saudi Arabia, aimed to assess mothers' knowledge, concerns, and beliefs about febrile convulsions to identify educational needs. Methodology This cross-sectional study was conducted in Aseer, Saudi Arabia, and performed from October 2023 to July 2024. Data were collected via an online questionnaire. The collected data were cleaned in MS Excel (Redmond, WA: Microsoft Corp.) and analyzed in IBM SPSS version 29 (Armonk, NY: IBM Corp.). Results This study surveyed 538 mothers with 25.7% (n=138) aged 36-45 years, and 77.0% (n=414) were married. Regarding the number of children, 25.5% of participants (n=137) had none, 18.6%(n=100) had one child, 14.1% (n=76) had two, and 41.8% (n=225) had three or more children. Education levels showed 56.9% (n=306) had university degrees or higher. Among 401 participants, 30.9% (n=124) reported febrile convulsions in their children. The first convulsion was beforeone year of age in 14.0% (n=56), and between one and five years in 29.2% (n=117) participants. Misconceptions were common, with 73.3% (n=294) mistakenly believing that febrile convulsions are a form of epilepsy. Higher maternal education was significantly associated with lower knowledge about febrile convulsions (p=0.040), and mothers with children who hadexperienced febrile convulsions demonstrated significantly lower knowledge (p=0.003). Conclusion This study provides valuable insights into the knowledge, concerns, and beliefs of mothers in Aseer, Saudi Arabia, regarding febrile convulsions. While there is a high level of awareness about some aspects, significant misconceptions persist. Higher education and children with febrile convulsions are negative predictors of high awareness and knowledge about febrile convulsions.

Breastfeeding Status and Infectious Diseases among Children Aged 6–23 Months in Indonesia

Introduction: Infectious diseases remain public health issues in Indonesia. However, there remains a knowledge gap on whether breastfeeding can prevent infectious diseases in young children. This study examined the relationship between current breastfeeding and child infections in Indonesia. Methods: Data were derived from the 2017 Indonesia Demographic and Health Survey by including 5158 children aged 6–23 months. The dependent variables were diarrhea, fever, and acute respiratory infection (ARI). The main exposure of interest was the current breastfeeding status. Covariates included factors at the child, maternal, household, health care, and community levels. Results: Around 20%, 38%, and 4% of children experienced diarrhea, fever, and ARI, respectively. Current breastfeeding status was protective against diarrhea (adjusted odds ratio [AOR] = 0.74, 95% confidence interval [CI] = 0.61–0.89) but not related to fever (AOR = 0.95, 95% CI = 0.82–1.11) and ARI (AOR = 1.01, 95% CI = 0.70–1.47). Other factors related to diarrhea included female children, older maternal age, maternal higher education, improved drinking water source, and living in Sulawesi. Living in Sumatera and Sulawesi were linked to fever. Higher birth orders and improved toilet facilities were associated with ARI. Conclusion: The findings indicate different levels of factors affecting child infections. Thus, integrating breastfeeding promotions with water, hygiene, and sanitation interventions may help prevent infectious diseases in young children.

Does maternal education moderate the relationship between adolescent cannabis use and mental health in early adulthood?

Socioeconomic disadvantage has been associated with cannabis use and poor mental health. It is therefore hypothesised that lower maternal education, a proxy for socioeconomic disadvantage, may increase the risk of cannabis-related mental health and substance use consequences. A total of 5099 participants from the Avon Longitudinal Study of Parents and Children reported cannabis use via questionnaires at 16 or 18. Logistic regression was used to examine the relationship between any and regular (weekly or more) adolescent cannabis use with depression, anxiety, psychotic experiences, and problematic cannabis use at age 24. Maternal education was included as an effect modifier. Missing data were addressed through multiple imputation using chained equations. In total, 36.5% of participants reported adolescent cannabis use and, of these, 14% reported regular use. Adolescent cannabis use was associated with an increased likelihood of anxiety and problematic cannabis use; however, there was little evidence of moderation by maternal education. Regular cannabis use was associated with an increased likelihood of problematic cannabis use, with little evidence of moderation by maternal education. There was weak evidence that the association between regular cannabis use and depression (interaction p-value = 0.024) and anxiety (interaction p-value = 0.056) was stronger in people with high maternal education. Adolescent cannabis use is associated with increased risk of anxiety and cannabis use disorder, but there was insufficient evidence that childhood socioeconomic position (proxied by maternal education) modifies this relationship. Improved public health messages for all adolescents about these risks may be warranted.

Receipt of antimalarials among children aged 6–59 months in Nigeria from 2010 to 2021

BackgroundNigeria has the highest malaria burden globally, and anti-malarials have been commonly used to treat malaria without parasitological confirmation. In 2012, Nigeria implemented rapid diagnostic tests (RDTs) to reduce the use of anti-malarials for those without malaria and to increase the use of artemisinin-based combination therapy (ACT) for malaria treatment. This study examined changes in anti-malarial receipt among children aged 6–59 months during a 12-year period of increasing RDT availability.MethodsA cross-sectional analysis was conducted using the Nigeria Malaria Indicator Survey (NMIS) data from 2010 (before RDT implementation in 2012), 2015, and 2021. The analysis assessed trends in prevalence of malaria by survey RDT result, and fever and anti-malarial/ACT receipt in the 2 weeks prior to the survey. A multivariable logistic regression was used to account for the complex survey design and to examine factors associated with anti-malarial receipt, stratified by survey RDT result, a proxy for recent/current malaria infection.ResultsIn a nationally-representative, weighted sample of 22,802 children aged 6–59 months, fever prevalence remained stable over time, while confirmed malaria prevalence decreased from 51.2% in 2010 to 44.3% in 2015 and 38.5% in 2021 (trend test p < 0.0001). Anti-malarial use among these children decreased from 19% in 2010 to 10% in 2021 (trend test p < 0.0001), accompanied by an increase in ACT use (2% in 2010 to 8% in 2021; trend test p < 0.0001). Overall, among children who had experienced fever, 30.6% of survey RDT-positive and 36.1% of survey RDT-negative children had received anti-malarials. The proportion of anti-malarials obtained from the private sector increased from 61.8% in 2010 to 80.1% in 2021 for RDT-positive children; most of the anti-malarials received in 2021 were artemisinin-based combinations. Factors associated with anti-malarial receipt for both RDT-positive and RDT-negative children included geographic region, greater household wealth, higher maternal education, and older children.ConclusionFrom 2010 to 2021 in Nigeria, both malaria prevalence and anti-malarial treatments among children aged 6–59 months decreased, as RDT availability increased. Among children who had fever in the prior 2 weeks, anti-malarial receipt was similar between children with either positive or negative survey RDT results, indicative of persistent challenges in reducing inappropriate anti-malarials uptake.

Medication Adherence of Children with Congenital Hypothyroidism in Iran: A National Cross-Sectional Study

Background: Congenital hypothyroidism is the most common preventable and treatable cause of intellectual disability in children. A key component of the surveillance system for congenital hypothyroidism is ensuring a regular treatment program for affected children. Despite nearly 20 years since the successful implementation of the newborn screening program for hypothyroidism in Iran, a comprehensive evaluation of patients' adherence to treatment has not been conducted. Objectives: The aim of this study was to investigate the adherence to treatment among patients with congenital hypothyroidism in Iran. Methods: In this national cross-sectional study conducted in 2024, the adherence to treatment of 400 children with congenital hypothyroidism born between 2019 and 2023 in Iran was examined using the Morisky Medication Adherence Scale. The patients were randomly selected from national registry data. Data were analyzed using chi-squared tests, Fisher's exact test, and logistic regression in Stata software version 16. Results: The mean and standard deviation of medication adherence was 6.35 ± 1.41. Overall, adherence was good (≥ 6) in 284 (71.0%) of the study participants. In the univariate analysis, the most significant factors influencing adherence were place of residence, higher maternal education, lower paternal education, and type of congenital hypothyroidism (CH). In the multivariate analysis, children with permanent CH had good adherence, and parental education was not statistically significant (P &gt; 0.05). Conclusions: The results of this study showed that medication compliance in more than two-thirds of hypothyroid children diagnosed by national newborn screening is good. Given the importance of treatment in these patients, it is recommended that intervention plans be implemented, including educational programs and active follow-up of patients to increase compliance.

Quality of life in children at different stages of chronic kidney disease in a developing country

BackgroundChildren with chronic kidney disease (CKD) require comprehensive assessments, including medical and quality of life (QoL) evaluations. Few studies have been conducted in developing countries.MethodsThis cross-sectional study included 2–18-year-old patients who were categorized into 4 groups: the CKD stage 2–3, stage 4–5, stage 5 with dialysis (D), and kidney transplantation (KT) groups. QoL was measured using the Pediatric Quality of Life Inventory™ (PedsQL™) version 4.0; relationships between different factors and QoL were determined using multivariable linear regression analysis.ResultsEighty-seven patients (mean age: 13.3 (4.1) years) were included. The self-reported total scores were 77.5 (12.5), 78.9 (11.2), 77.4 (16.2), and 76.1 (10.9) in the stage 2–3, stage 4–5, stage 5D and KT groups, respectively. Parent-reported scores showed a weak-to-moderate correlation with self-reported scores (r = 0.12–0.42), with total scores of 71.8 (12.7), 69.5 (14.9), 63.4 (14.8), and 70.8 (18.1) in the stage 2–3, 4–5, 5D and KT groups, respectively. Multivariable linear regression revealed that the parent-reported score in the stage 5D group was 15.92 points lower than that in the stage 2–3 group (p = 0.02); the score in the low maternal education group was 10.13 points lower than that in the high maternal education group (p = 0.04).ConclusionsParent-reported scores showed weak-to-moderate correlation with self-reported scores. Patients with CKD stage 5D and patients with low maternal education had lower QoL. Regular QoL assessment is recommended for patients with advanced CKD and those with socioeconomic vulnerabilities.Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary information

Factors related to complementary feeding practices during the COVID-19 pandemic in Indonesia

Introduction: Complementary feeding practice is critical for adequate growth and development in children. Appropriate practices should be maintained, especially during the COVID-19 pandemic. Methods: This cross-sectional study aimed to analyse complementary feeding practices and their related factors, including the impact of the COVID-19 pandemic on household economic aspects. Data were collected via online questionnaires involving 574 mothers of children aged 6–23 months in Indonesia from April to May 2022. Results: In total, 63.6%, 64.6%, 86.6%, and 57.7% of children met the criteria for timely introduction of complementary feeding (INTRO), minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD), respectively. Households that had no impact on their ability to provide food during the pandemic had higher odds of meeting MDD and MAD. Having a high household income level, high maternal education, and being a housewife increased the odds of INTRO. The odds of MDD increased in children who lived in Java, had older age, and whose mother had high education level. Older children had higher odds of having appropriate MMF. MAD was associated with mother’s high education level and being a housewife. Conclusion: Several factors during the pandemic, including economic aspects, influenced complementary feeding practices. To prevent child malnutrition, besides ensuring household food security, other strategies to increase complementary feeding quality are also needed.