Child Health Monitoring Research Articles

Assessment of health facility capacity to provide newborn care in Bangladesh, Haiti, Malawi, Senegal, and Tanzania.

BackgroundDespite the importance of health facility capacity to provide comprehensive care, the most widely used indicators for global monitoring of maternal and child health remain contact measures which assess women’s use of services only and not the capacity of health facilities to provide those services; there is a gap in monitoring health facilities’ capacity to provide newborn care services in low and middle income countries.MethodsIn this study we demonstrate a measurable framework for assessing health facility capacity to provide newborn care using open access, nationally–representative Service Provision Assessment (SPA) data from the Demographic Health Surveys Program. In particular, we examine whether key newborn–related services are available at the facility (ie, service availability, measured by the availability of basic emergency obstetric care (BEmOC) signal functions, newborn signal functions, and routine perinatal services), and whether the facility has the equipment, medications, training and knowledge necessary to provide those services (ie, service readiness, measured by general facility requirements, equipment, medicines and commodities, and guidelines and staffing) in five countries with high levels of neonatal mortality and recent SPA data: Bangladesh, Haiti, Malawi, Senegal, and Tanzania.FindingsIn each country, we find that key services and commodities needed for comprehensive delivery and newborn care are missing from a large percentage of facilities with delivery services. Of three domains of service availability examined, scores for routine care availability are highest, while scores for newborn signal function availability are lowest. Of four domains of service readiness examined, scores for general requirements and equipment are highest, while scores for guidelines and staffing are lowest.ConclusionsBoth service availability and readiness tend to be highest in hospitals and facilities in urban areas, pointing to substantial equity gaps in the availability of essential newborn care services for rural areas and for people accessing lower–level facilities. Together, the low levels of both service availability and readiness across the five countries reinforce the vital importance of monitoring health facility capacity to provide care. In order to save newborn lives and improve equity in child survival, not only does women’s use of services need to increase, but facility capacity to provide those services must also be enhanced.

Effectivenessof Child Health Monitoring System in Simomulyo PHC Surabaya

Infant mortality rate in Surabaya was increased in 2015. Simomulyo is a region with the highest infant mortality rate with the number of 16 deaths in 2015 and 12 deaths in 2016. Despite the high infant mortality rate, programs that related to child health indicators have been surpassed the percentage of service coverage. The purpose of this research is to evaluate the effectiveness of Child Health Monitoring System in Primary Health Care of Simomulyo with system approach consisting of input, process, and output variables. The method of this research is evaluative-descriptive with Village Midwifes, Midwife Coordinator, and program officer as research informant. The result of this study emphasized that input variables for data types and data sources have been implemented effectively. Evaluation of process variables for data compilation is indicated as effective, data collection, individual data tracking, and planning of action is indicated as fair, and data analysis is less effective. Evaluation of output variable for service coverage calculation is indicated as less effective. The conclusion of this research is the effectiveness of process and output variables are less effective. Researchers proposed several alternative solutions such as socialization and workshop for all officers and village midwifes, Constructing standardized report form for the use of data analyzing, individual data tracking, and planning of action.Keywords: Infant Mortality Rate, child health monitoring, surveillance system

Using health-facility data to assess subnational coverage of maternal and child health indicators, Kenya.

ObjectiveTo develop a systematic approach to obtain the best possible national and subnational statistics for maternal and child health coverage indicators from routine health-facility data.MethodsOur approach aimed to obtain improved numerators and denominators for calculating coverage at the subnational level from health-facility data. This involved assessing data quality and determining adjustment factors for incomplete reporting by facilities, then estimating local target populations based on interventions with near-universal coverage (first antenatal visit and first dose of pentavalent vaccine). We applied the method to Kenya at the county level, where routine electronic reporting by facilities is in place via the district health information software system.FindingsReporting completeness for facility data were well above 80% in all 47 counties and the consistency of data over time was good. Coverage of the first dose of pentavalent vaccine, adjusted for facility reporting completeness, was used to obtain estimates of the county target populations for maternal and child health indicators. The country and national statistics for the four-year period 2012/13 to 2015/16 showed good consistency with results of the 2014 Kenya demographic and health survey. Our results indicated a stagnation of immunization coverage in almost all counties, a rapid increase of facility-based deliveries and caesarean sections and limited progress in antenatal care coverage.ConclusionWhile surveys will continue to be necessary to provide population-based data, web-based information systems for health facility reporting provide an opportunity for more frequent, local monitoring of progress, in maternal and child health.

Analysis of inequality in maternal and child health outcomes and mortality from 2000 to 2013 in China

BackgroundInequality in maternal and child health seriously hinders the overall improvement of health, which is a concern in both the United Nations Sustainable Development Goals (SDGs) and Healthy China 2030. However, research on the equality of maternal and child health is scarce. This study longitudinally assessed the equality trends in China’s maternal and child health outcomes from 2000 to 2013 based on place of residence and gender to improve the fairness of domestic maternal and child health.MethodsData on China’s maternal and child health monitoring reports were collected from 2000 to 2013. Horizontal and vertical monitoring were performed on the following maternal and child health outcome indicators: incidence of birth defects (IBD), maternal mortality rate (MMR), under 5 mortality rate (U5MR) and neonatal mortality rate (NMR). The newly developed HD*Calc software by the World Health Organization (WHO) was employed as a tool for the health inequality assessment. The between group variance (BGV) and the Theil index (T) were used to measure disparity between different population groups, and the Slope index was used to analyse the BGV and T trends.ResultsThe disparity in the MMR, U5MR and NMR for the different places of residence (urban and rural) improved over time. The BGV (Slope BGV = -32.24) and T (Slope T = -7.87) of MMR declined the fastest. The gender differences in the U5MR (Slope BGV = -0.06, Slope T = -0.21) and the NMR (Slope BGV = -0.01, Slope T = 0.23) were relatively stable, but the IBD disparity still showed an upward trend in both the place of residence and gender strata. A decline in urban-rural differences in the cause of maternal death was found for obstetric bleeding (Slope BGV = -14.61, Slope T = -20.84). Improvements were seen in the urban-rural disparity in premature birth and being underweight (PBU) in children under 5 years of age. Although diarrhoea and pneumonia decreased in the U5MR, no obvious gender-based trend in the causes of death was observed.ConclusionWe found improvement in the disparity of maternal and child health outcomes in China. However, the improvements still do not meet the requirements proposed by the Healthy China 2030 strategy, particularly regarding the rise in the IBD levels and the decline in equality. This study suggests starting with maternal and child health services and focusing on the disparity in the causes of death in both the place of residence and gender strata. Placing an emphasis on health services may encourage the recovery of the premarital check and measures such as prenatal and postnatal examinations to improve equality.

Child Health Monitoring Description in MCTS at Ranuyoso PHC Lumajang

Infant Mortality Rate in Lumajang was always higher than the infant mortality rate in East Java Province. Ranuyoso is a region with the highest infant mortality rate and AKABA in 2013 and 2014, with 33 and 22 deaths. The Government had implemented a program to improve the health and the consolidation scope is monitored by the Pemantauan Wilayah Setempat Kesehatan Ibu dan Anak (PWS KIA). PWS KIA had not been going well according to its purpose as a tool for monitoring the KIA service coverage to increase the range and quality of KIA services. The purpose of this research was to describe the implementation of PWS KIA for indicators of child in Health Center of Ranuyoso which based on attributes of simplicity, acceptability, sensitivity, representativeness, data quality, timeliness and stability. This research used descriptive method evaluative with coordinator midwife, midwives health center and eight village midwives as the respondent. Description based on the attributes of surveillance system showed that PWS KIA indicator of child in Health Center of Ranuyoso was not simple, sensitive but not supported well by the midwives, the data were less quality, not timely and unstable. Alternative solutions to problems that had been found were to performing the advanced analysis to determine the causality amount variables by midwives, holding routine supervision from the senior midwives, procurement of SOP or guidebook for midwives, and computerizing the recording until reporting start from village midwives, also the making of the attendance and expeditions book to record the reporting date of midwives. Keywords: MCTS, attributes surveillance, child health monitoring

Child Health Monitoring Description in MCTS at Ranuyoso PHC Lumajang

Infant Mortality Rate in Lumajang was always higher than the infant mortality rate in East Java Province. Ranuyoso is a region with the highest infant mortality rate and AKABA in 2013 and 2014, with 33 and 22 deaths. The Government had implemented a program to improve the health and the consolidation scope is monitored by the Pemantauan Wilayah Setempat Kesehatan Ibu dan Anak (PWS KIA). PWS KIA had not been going well according to its purpose as a tool for monitoring the KIA service coverage to increase the range and quality of KIA services. The purpose of this research was to describe the implementation of PWS KIA for indicators of child in Health Center of Ranuyoso which based on attributes of simplicity, acceptability, sensitivity, representativeness, data quality, timeliness and stability. This research used descriptive method evaluative with coordinator midwife, midwives health center and eight village midwives as the respondent. Description based on the attributes of surveillance system showed that PWS KIA indicator of child in Health Center of Ranuyoso was not simple, sensitive but not supported well by the midwives, the data were less quality, not timely and unstable. Alternative solutions to problems that had been found were to performing the advanced analysis to determine the causality amount variables by midwives, holding routine supervision from the senior midwives, procurement of SOP or guidebook for midwives, and computerizing the recording until reporting start from village midwives, also the making of the attendance and expeditions book to record the reporting date of midwives. Keywords: MCTS, attributes surveillance, child health monitoring

The Role of Community Health Workers in Maternal and Child Health Surveillance to Optimize Maternal and Child Health in Pasuruan District, East Java

Background : Maternal mortality ratio, infant mortality rate, and underfive mortality rate are still high in Indonesia. Pasuruan is one of the districts in East Java with the highest infant mortality rate. One of the public health interventions that has been undertaken to address this issue is maternal and child health surveillance program with community health workers being the leading implementers. This study aimed to describe the role of community health workers in maternal and child health surveillance to optimize maternal and child health care services in Pasuruan District, East Java. Subje cts and Method: This was a qualitative study using case study approach. It was conducted in Pasuruan, East Java. Key informants were selected by criterion sampling. The data were collected by in-depth interview, focus group discussion, observation, and document review. Data validity was checked by triangulation. Results : Community based maternal and child health surveillance program has been implemented for 4 years. However, only some of all community health workes have been trained in this program. The tasks of these community health workers included advocacy and monitoring of maternal and child health in the areas of posyandu. The implementation of these surveillance program had some obstacles, including low insentive of community health worker, inactive community health worker, lack of awareness among community members on maternal and child health issues, and medical factors of pregnant mothers that caused mortality. Conclusion : Community health workers help improve the quality of maternal and child health care by surveillance program, although their performances have yet to be enhanced. Keyword : maternal mortality rate, infant mortality rate, community health workers Correspondence: Ninil Dwi Pangestu. Masters Program in Public Health, Sebelas Maret University, Jl. Ir. Sutami No. 36A Surakarta 57126, Jawa Tengah. E-mail: pangestu.ninil@gmail.com. Mobile +62856553737. Journal of Health Policy and Management (2017), 2(2): 128-136 https://doi.org/10.26911/thejhpm.2017.02.02.04

Path Analysis on Life Course Factors Affecting Overweight and Obesity in Children Aged 2 to 5 Years Old in Surakarta

Background: Globally, prevalence of obesity in children under 5 years old has been increasing from 32 million in 1990 to 42 million in 2014. Indonesia ranks highest in the number of obesity cases in South East Asia with prevalence of 11.5% in 2013. However, child overweight and obesity have not been the focus of health problems in Indonesia. Early intervention and prevention of child obesity can reduce long-term risk of chronic diseases in adulthood. This study aimed to analyze the life course factors affecting overweight and obesity in children aged 2 to 5 years old in Surakarta.Subjects and Method: This was an analytic observational study with case control design. The study was conducted in 5 community health centers, Surakarta, from September to October, 2017. A total sample of 150 children aged 2 to 5 years old was selected using fixed disease sampling. The dependent variable was overweight or obesity. The independent variables were nutrition intake, exclusive breastfeeding, starting age of complementary feeding, physical activity, birthweight, age of gestation, sectio cesarea labor, maternal body mass index, and maternal job. Physical activity data was measured using Pre PAQ questionnaire. Other data were collected using a set of questionnaire and maternal and child health monitoring book. The data were analyzed by path analysis.Results: Overweight and obesity in children aged 2 to 5 years old were positively affected by over nutrition intake (b= 1.9; 95% CI= 0.15 to 3.60; p=0.033), high maternal body mass index (b= 2.0; 95% CI= 0.51 to 3.42; p=0.008), and sectio cesarean birth (b= 2.1; 95% CI= 0.56 to 3.73; p=0.008). Overweight and obesity in children aged 2 to 5 years old were negatively affected by normal birthweight (b= -2.2; 95% CI= -4.28 to -0.19; p=0.032), exclusive breastfeeding (b= -2.0; 95% CI= -3.60 to -0.39; p=0.015), timely starting age of complementary feeding (b= -1.3; 95% CI= -2.80 to 0.11; p=0.072), and high physical activity (b= -3.0; 95% CI= -4.63 to -1.37; p=0.001). Birthweight was positively affected by age of gestation (b= 4.2; 95% CI= 1.99 to 6.32; p=0.001) and was negatively affected by maternal body mass index (b= -1.1; 95% CI= -2.11 to -0.13; p=0.025). Exclusive breastfeeding was negatively affected by working outside the house (b= -1.4; 95% CI= -2.10 to -0.72; p= 0.001).Conclusion: Overweight and obesity in children aged 2 to 5 years old are positively affected by over nutrition intake, high maternal body mass index, and sectio cesarean birth. Overweight and obesity in children aged 2 to 5 years old are negatively affected by normal birthweight, exclusive breastfeeding, timely starting age of complementary feeding, and high physical activity.Keyword: life course factors, overweight, obesity, path analysis.Correspondence: Uyunun Nudhira. Masters Program in Public Health, Sebelas Maret University, Jl. Ir. Sutami 36 A, Surakarta 57126, Central Java. Email: uyununnudhira14@gmail.com. Mobile: +6285253781714Journal of Epidemiology and Public Health (2017), 2(3): 267-283https://doi.org/10.26911/jepublichealth.2017.02.03.08

Mobile-Based Nutrition and Child Health Monitoring to Inform Program Development: An Experience From Liberia.

Implementing complex nutrition and other public health projects and tracking nutrition interventions, such as women's diet and supplementation and infant and young child feeding practices, requires reliable routine data to identify potential program gaps and to monitor trends in behaviors in real time. However, current monitoring and evaluation practices generally do not create an environment for this real-time tracking. This article describes the development and application of a mobile-based nutrition and health monitoring system, which collected monitoring data on project activities, women's nutrition, and infant and young child feeding practices in real time. The Liberia Agricultural Upgrading Nutrition and Child Health (LAUNCH) project implemented a nutrition and health monitoring system between April 2012 and June 2014. The LAUNCH project analyzed project monitoring and outcome data from the system and shared selected behavioral and programmatic indicators with program managers through a short report, which later evolved into a visual data dashboard, during program-update meetings. The project designed protocols to ensure representativeness of program participants. LAUNCH made programmatic adjustments in response to findings from the monitoring system; these changes were then reflected in subsequent quarterly trends, indicating that the availability of timely data allowed for the project to react quickly to issues and adapt the program appropriately. Such issues included lack of participation in community groups and insufficient numbers of food distribution points. Likewise, the system captured trends in key outcome indicators such as breastfeeding and complementary feeding practices, linking them to project activities and external factors including seasonal changes and national health campaigns. Digital data collection platforms can play a vital role in improving routine programmatic functions. Fixed gathering locations such as food distribution points represent an opportunity to easily access program participants and enable managers to identify strengths and weaknesses in project implementation. For programs that track individuals over time, a mobile tool combined with a strong database can greatly improve efficiency and data visibility and reduce resource leakages.

Health for all: Monitoring of Roma children health in Bulgaria

Health for all: Monitoring of Roma children health in Bulgaria

Creating a Child and Youth Health Monitoring Framework to Inform Health Sector Prioritisation and Planning: Reflections on Ten Years Experience in New Zealand

In New Zealand during the early 2000s, an emerging disquiet about social inequalities in health led to calls for better information for public health monitoring. Health needs assessments (HNA) had been built into the planning cycles of the country’s newly formed District Health Boards (DHBs), which were tasked with “improving, promoting and protecting” the health of their populations. In child and youth health, a lack of data was seen as a significant barrier to effective DHB planning, with the needs of this age group often being lost amongst the concerns of an ageing adult community. This led to calls for a single national entity to select, collate and disseminate accurate information on the health of children and young people. This paper describes the origins of the NZ Child and Youth Epidemiology Service (NZCYES) and its 10 year journey to build a monitoring infrastructure to inform health service prioritisation and planning. Central to this work has been a theoretical framework, which arranges indicators into four hierarchical domains, reflecting key steps in the causal pathways linking the political, economic and social environment with child and youth health outcomes. These are cross-cut by a horizontal lifecourse dimension. Ten years on, while the available information has improved considerably, child and youth health inequalities remain high. The early hopes that HNA would show the links between socioeconomic conditions and health inequalities and that prioritisation, planning and policy would respond accordingly, have failed to materialise. Government agencies have not fully utilised the scientific evidence; and even when they have wanted to, a range of other factors (political, institutional, budgetary, inertia) have aligned to crowd out the changes that could make a real difference. Overcoming these barriers remains the challenge for the health sector over the next 10 years.

Barriers to access to treatment for mothers with postpartum depression in primary health care centers: a predictive model.

Objectiveto develop a predictive model to evaluate the factors that modify the access to treatment for Postpartum Depression (PPD). Methodsprospective study with mothers who participated in the monitoring of child health in primary care centers. For the initial assessment and during 3 months, it was considered: sociodemographic data, gyneco-obstetric data, data on the services provided, depressive symptoms according to the Edinburgh Postpartum Depression Scale (EPDS) and quality of life according to the Short Form-36 Health Status Questionnaire (SF-36). The diagnosis of depression was made based on MINI. Mothers diagnosed with PPD in the initial evaluation, were followed-up. Resultsa statistical model was constructed to determine the factors that prevented access to treatment, which consisted of: item 2 of EPDS (OR 0.43, 95%CI: 0.20-0.93) and item 5 (OR 0.48, 95%CI: 0.21-1.09), and previous history of depression treatment (OR 0.26, 95%CI: 0.61-1.06). Area under the ROC curve for the model=0.79; p-value for the Hosmer-Lemershow=0.73. Conclusionit was elaborated a simple, well standardized and accurate profile, which advises that nurses should pay attention to those mothers diagnosed with PPD, presenting low/no anhedonia (item 2 of EPDS), scarce/no panic/fear (item 5 of EPDS), and no history of depression, as it is likely that these women do not initiate treatment.

Use of a monitoring tool for growth and development in Brazilian children – systematic review

ObjectiveTo assess the use of a health monitoring tool in Brazilian children, with emphasis on the variables related to growth and development, which are crucial aspects of child health care. Data sourceA systematic review of the literature was carried out in studies performed in Brazil, using the Cochrane Brazil, Lilacs, SciELO and Medline databases. The descriptors and keywords used were “growth and development”, “child development”, “child health record”, “child health handbook”, “health record and child” and “child handbook”, as well as the equivalent terms in Portuguese. Studies were screened by title and summary and those considered eligible were read in full. Data synthesisSixty-eight articles were identified and eight articles were included in the review, as they carried out a quantitative analysis of the filling out of information. Five studies assessed the completion of the Child's Health Record and three of the Child's Health Handbook. All articles concluded that the information was not properly recorded. Growth monitoring charts were rarely filled out, reaching 96.3% in the case of weight for age. The use of the BMI chart was not reported, despite the growing rates of childhood obesity. Only two studies reported the completion of development milestones and, in these, the milestones were recorded in approximately 20% of the verified tools. ConclusionsThe results of the assessed articles disclosed underutilization of the tool and reflect low awareness by health professionals regarding the recording of information in the child's health monitoring document.

Uso de instrumento de acompanhamento do crescimento e desenvolvimento da criança no Brasil – Revisão sistemática de literatura

ObjectiveTo assess the use of a health monitoring tool in Brazilian children, with emphasis on the variables related to growth and development, which are crucial aspects of child health care. Data sourceA systematic review of the literature was carried out in studies performed in Brazil, using the Cochrane Brazil, Lilacs, SciELO and Medline databases. The descriptors and keywords used were “growth and development”, “child development”, “child health record”, “child health handbook”, “health record and child” and “child handbook”, as well as the equivalent terms in Portuguese. Studies were screened by title and summary and those considered eligible were read in full. Data synthesisSixty‐eight articles were identified and eight articles were included in the review, as they carried out a quantitative analysis of the filling out of information. Five studies assessed the completion of the Child's Health Record and three of the Child's Health Handbook. All articles concluded that the information was not properly recorded. Growth monitoring charts were rarely filled out, reaching 96.3% in the case of weight for age. The use of the BMI chart was not reported, despite the growing rates of childhood obesity. Only two studies reported the completion of development milestones and, in these, the milestones were recorded in approximately 20% of the verified tools. ConclusionsThe results of the assessed articles disclosed underutilization of the tool and reflect low awareness by health professionals regarding the recording of information in the child's health monitoring document.

Childcare use and overweight in Finland: cross-sectional and retrospective associations among 3- and 5-year-old children.

Different types of non-parental childcare have been found to associate with childhood overweight in several, but not all studies. Studies on the matter are mainly North American. The objective of our study was to examine associations between childcare use and overweight in Finland. The cross-sectional and partly retrospective data consists of 1683 3- and 5-year-old children participating in the Child Health Monitoring Development project (LATE-project) conducted in 2007-2009 in Finland. Children were measured at health check-ups and information on child's age when entering childcare, the number of childcare places the child has had, current type of childcare (parental, informal, [group] family childcare, childcare centre) and the current amount of childcare (hours) were gathered. Parents' body mass indices, family educational level, family structure, maternal smoking during pregnancy and child's birth weight were treated as covariates. Beginning childcare before age 1 (adjusted model: odds ratio [OR] 2.53, 95% confidence interval [CI] 1.41-4.52) and, for girls only, number of childcare places (adjusted model: OR 1.33, 95% CI 1.11-1.60), were associated with an increased risk of overweight. The current type of childcare or the time currently spent in childcare was not associated with overweight. Beginning childcare before age 1, which is quite rare in Finland, and having attended several childcare places were associated with overweight even when adjusting for family socioeconomic status and other family background variables. The significance of these findings needs to be further studied.

The gas cylinder, the motorcycle and the village health team member: a proof-of-concept study for the use of the Microsystems Quality Improvement Approach to strengthen the routine immunization system in Uganda.

BackgroundAlthough global efforts to support routine immunization (RI) system strengthening have resulted in higher immunization rates, the World Health Organization (WHO) estimates that the proportion of children receiving recommended DPT3 vaccines has stagnated at 80% for the past 3 years (WHO Fact sheet—Immunization coverage 2014, WHO, 2014). Meeting the WHO goal of 90% national DPT3 coverage may require locally based strategies to support conventional approaches. The Africa Routine Immunization Systems Essentials-System Innovation (ARISE-SI) initiative is a proof-of-concept study to assess the application of the Microsystems Quality Improvement Approach for generating local solutions to strengthen RI systems and reach those unreached by current efforts in Masaka District, Uganda.MethodsThe ARISE-SI intervention had three components: health unit (HU) advance preparations, an action learning collaborative, and coaching of improvement teams. The intervention was informed and assessed using qualitative and quantitative methods. Data collection focused on changes and outcomes of improvement efforts among five HUs and one district-level team during the intervention (June 2011–February 2012) and five follow-up months.ResultsWorkshops and team meetings had a 95% attendance rate. All teams gained RI system knowledge and implemented changes to address locally identified problems. Specific changes included: RI register implementation and expanded use, Child Health Card provision and monitoring, staff cross-training, staffing pattern changes, predictable outreach schedules, and health system leader—community leader meetings. Several RI system barriers prevalent across Masaka District (e.g., lack of backup HU gas cylinders, inadequate outreach transportation, and village health team underutilization) were successfully addressed. Three of five HUs significantly increased the vaccines administered. All improvements were sustained 5 months post-intervention. External evaluation validated the findings of high levels of participant engagement, empowerment to make change, and willingness to sustain improvements.ConclusionsThe Microsystems Quality Improvement Approach is a comprehensive approach, grounded in systems thinking, and coupled with intensive coaching. It provides a robust framework for engaging teams in the development of unique local solutions that strengthen RI systems in resource poor settings. The sustained improvements in local RI systems from this study provide evidence that this approach may be an effective framework for enhancing the WHO’s Reaching Every District (RED) immunization strategy.

Locally Grown Fruit and Vegetable Purchasing Habits and the Association With Children’s Diet

This study explores whether the frequency of parents’ local fruits and vegetables (F&V) purchasing is associated with children’s F&V intake. Questions from the 2008 Child Health Assessment and Monitoring Program survey assessed parental habits and perceived barriers to purchasing and preparing local food. Multivariable logistic regression was used to assess the independent association between frequency of purchasing local food and children’s F&V consumption. The study showed that 43.3% of parents report that their child consumes 5 or more servings of F&V/day. In addition, 49.7% of those who purchase locally grown F&V regularly had a child who consumed 5 or more servings of F&V/day. Compared to those parents who purchased locally grown F&V regularly, those in the less frequent purchasing categories were less likely to report that their child consumed 5 or more servings of F&V/day, pointing to the potential role that purchasing locally grown F&V may have in influencing children’s intake.

Forgone vaccination during childhood and adolescence: Findings of a statewide survey of parents

ObjectiveWidespread immunization confers both individual- and community-level protection against vaccine-preventable diseases. To better understand vaccine hesitancy, we assessed correlates of forgone vaccination for children and adolescents. MethodWe analyzed weighted data from the 2010 Child Health Assessment and Monitoring Program survey of North Carolina parents (n=1,847) of children ages 1–17. ResultsOverall, 12% of parents reported having refused or delayed a vaccine for their child. Forgone vaccination was more common for young children than for teenagers (16% versus 8%) and for children born before rather than on/after their due dates (16% versus 10%). Parents with high (versus low) scores on an index of healthy feeding practices were also more likely to report forgone vaccination (17% versus 5%). The most common reason for forgoing vaccines was concern about safety (34%). Other reasons included believing the child did not need (18%) or was too young (13%) for the vaccine, or that the child was sick (10%). ConclusionForgoing vaccines is more common among parents who are socially advantaged and highly attentive to their children's health in other areas such as nutrition. Providers should reassure parents of premature or sick children that such circumstances are not typically contraindications to vaccination.

Source of Parental Reports of Child Height and Weight during Phone Interviews and Influence on Obesity Prevalence Estimates among Children Aged 3–17 Years

We compared parental reports of children's height and weight when the values were estimated vs. parent-measured to determine how these reports influence the estimated prevalence of childhood obesity. In the 2007 and 2008 North Carolina Child Health Assessment and Monitoring Program surveys, parents reported height and weight for children aged 3-17 years. When parents reported the values were not measured (by doctor, school, or home), they were asked to measure their child and were later called back. We categorized body mass index status using standard CDC definitions, and we used Chi-square tests and the Stuart-Maxwell test of marginal homogeneity to examine reporting differences. About 80% (n=509) of the 638 parents who reported an unmeasured height and/or weight participated in a callback and provided updated measures. Children originally classified as obese were subsequently classified as obese (67%), overweight (13%), and healthy weight (19%). An estimated 28% of younger children (<10 years of age) vs. 6% of older children (aged ≥10 years) were reclassified on callback. Having parents who guessed the height and weight of their children and then reported updated values did not significantly change the overall population estimates of obesity. Our findings demonstrate that using parent-reported height and weight values may be sufficient to provide reasonable estimates of obesity prevalence. Systematically asking the source of height and weight information may help improve how it is applied to research of the prevalence of childhood obesity when gold-standard measurements are not available.

Trends in HPV vaccine initiation among adolescent females in North Carolina, 2008-2010.

To better target future immunization efforts, we assessed trends and disparities in human papillomavirus (HPV) vaccine initiation among female adolescents in North Carolina over 3 years. We analyzed data from a stratified random sample of 1,427 parents who, between 2008 and 2010, completed two linked telephone surveys: the Behavioral Risk Factor Surveillance System and the Child Health Assessment and Monitoring Program surveys. Weighted analyses examined HPV vaccine initiation for girls ages 11 to 17 years. HPV vaccine initiation increased modestly over time (2008, 34%; 2009, 41%; 2010, 44%). This upward trend was present within 11 subpopulations of girls, including those who lived in rural areas, were of minority (non-black/non-white) race, or had not recently received a preventive check-up. Looking at differences between groups, HPV vaccine initiation was less common among girls who attended private versus public school, were younger, or lacked a recent check-up. However, the latter difference narrowed over time. The low level of initiation among girls without recent check-ups increased substantially (from 11% to 41%), whereas initiation among girls with recent visits improved little (from 39% to 44%, P(interaction) = 0.007). Although HPV vaccine initiation improved among several groups typically at higher risk for cervical cancer, the lack of progress among girls with recent check-ups suggests that missed opportunities for administration have hampered broader improvements. Achieving widespread coverage of HPV vaccine will require redoubled efforts to vaccinate adolescents during routine care.