Morbidity In Children Research Articles

Child vulnerable road user crash injury severity

Road traffic crashes (RTC) are the main cause of mortality, morbidity, and disability for children globally as well as in the United Arab Emirates (UAE). Although vehicle occupants usually account for the majority of children involved in RTC in developed countries and in the UAE, injuries sustained by child vulnerable road users (VRUs) are usually more severe due to their lack of protection compared to child occupants. Such injuries are known to result in long-term suffering for children including disabilities in some cases, thereby posing a severe public health burden and economic losses to the population. However, despite the severity of injuries to child VRUs involved in RTC, studies in the UAE have mostly focused on vehicle occupants for both children and adults. To the best of our knowledge, this is the first dedicated study on child VRU RTC injuries in the UAE. Additionally, the UAE government is promoting an active transportation policy among children in a bid to curb childhood obesity. Hence, this study examined the factors contributing to RTC injury severity for child VRUs in the UAE. The results of this study will help in enhancing the safety outcomes of child VRU RTC injuries as well as providing policy recommendations for safe active transport among children in the country.

Nursing Care to An. A with a Medical Diagnosis of Acute Gastroenteritis (GEA) in the Carnation Room of Waled Hospital, Cirebon Regency: A Case Study

Gastroenteritis is one of the most common diseases in children worldwide. This disease is the third contributor to the morbidity and mortality of children in various countries, including Indonesia. Acute gastroenteritis is characterized by watery stools that come up abnormally frequently three or more times per day and may contain mucus or blood. Find out comprehensive nursing care for children with a medical diagnosis of Acute gastroenteritis. This research uses a case study method with female respondents with a medical diagnosis of acute gastroenteritis. Data collection techniques were carried out by interview (the results of the interview contained client identity, main complaints, and history of current and past illnesses), observation and physical examination. This research was carried out in the Anyelir Room at Waled Hospital, Cirebon Regency, for three days (January 22nd—24th, 2024). The results of case studies in children with acute gastroenteritis obtained diagnoses that are diarrhea, hyperthermia and hypovolemia. After carrying out nursing care for three days, it was found that the three problems were resolved, so the intervention was stopped. Based on the evaluation results, the problems of diarrhea, hyperthermia and hypovolemia in children can be resolved.

Sex differences in pediatric sepsis—a systematic review protocol

BackgroundPediatric sepsis remains a leading cause of childhood morbidity and mortality worldwide. Despite advancements in modern medicine, it accounts for more than 3 million childhood deaths per year. Multiple studies have emphasized that sex and gender have an impact on the treatment and outcome of various diseases. Adult studies have revealed sex differences in pathophysiological responses to septic shock, as well as a possible protective effect of estrogens on critical illness. Sex-specific maturational and developmental differences in host immunology have been previously demonstrated for neonatal and pediatric age groups. At present, there are no studies assessing the impact of sex on outcomes of children with sepsis.MethodsThe goal of this study is to assess sex-specific differences in childhood sepsis survival outcomes. We will systematically assess associations of sex and gender with outcomes in pediatric sepsis in the literature by performing a systematic search of MEDLINE and Embase databases. We will include all English language randomized trials and cohort studies. The study population will include children > 37 weeks gestational age and < 18 years of age. Exposure will be sepsis, severe sepsis, and septic shock and the main comparison will be between male and female sex. The primary outcome will be hospital mortality. Secondary outcomes will be the pediatric intensive care unit and hospital length of stay.DiscussionResults from this review are expected to provide important information on the association of sex with the outcomes of pediatric sepsis. If an association is noted, this study may serve as a foundation for further research evaluating the pathophysiological aspects as well as potential socioeconomic factors responsible for the clinically detected sex differences.Systematic review registrationPROSPERO CRD42022315753.

Prevalence and Pattern of Ocular Diseases Among Children Aged 7-14 Years Visiting a Tertiary Care Teaching Hospital in Central India.

Ocular morbidity in children hinders their overall development.The prevalence and pattern vary amongst countries as well as within a country. Many ocular diseases if diagnosed and treated on time can prevent ocular morbidity in children to a large extent. The aim of this study is to determine the prevalence and pattern of ocular diseases in children (7-14 years) presenting tothe All India Institute of Medical Sciences, Bhopal, a tertiary care teaching hospital in central India. This is a single-center, hospital-based cross-sectional study conducted from June 2018 to August 2019.A total of 1276 children between 7and 14 years of age were included. A thorough ocular examination was done and a diagnosis was noted. Statistical analysis was performed using Microsoft Excel, Version 2013 (Microsoft Corp., Redmond, WA) and IBM SPSS Statistics for Windows, Version 23 (IBM Corp., Armonk, NY).A p-value of <0.05 was considered significant. Results: Out of 1276 children, 505 (39.6%) were of 7-10 years while 771 (60.4%) were of 11-14 years. There were 563 females (44.1%) and 713 males (55.9%). The most common ocular morbidity was a refractive error, (653; 51.1%), it was significantly higher in the age group 11 to 14 years than in children of 7 to 10 years of age (p<0.03). The second most prevalent ocular morbidity was infection/inflammation of the adnexa (18.8%) of which males were affected more than females (p<0.0005). The other morbidities were squint and neuro-ophthalmological-related diseases (8.3%), followed by trauma (3%), congenital diseases (2.6%), amblyopia (2.4%), degenerative diseases (0.7%), neoplastic (< 0.01%), and miscellaneous disorders (1.6%). The majority of ocular disorders are preventable and treatable. The most common ocular morbidity in our study is refractive error. We recommend school-based screening programs for timely detection and correction of refractive error and to prevent amblyopia.

Vitamin A supplementation status and associated factors among children aged 6-59 months in Tanzania: a multi-level analysis.

Vitamin A supplementation every 4-6 months is an economical, rapid, and effective strategy to enhance vitamin A status and minimize child morbidity and mortality due to vitamin A deficiency in the long run. Therefore, this study was aimed at investigating the level as well as the factors influencing VAS status among children aged 6-59 months in Tanzania. This analysis relied on data from the 2022 Tanzania Demographic and Health Survey (TDHS). The study used a weighted sample of 9,382 children aged 6-59 months. Given the effect of clustering and the binary character of the outcome variable, we employed a multilevel binary logistic regression model. The adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to determine statistical significance, considering the model with the lowest deviation that best fits the data. In this study, vitamin A supplementation among children aged 6-59 months was found to be 53.18% [95% CI: 52.17, 54.19]. Mother's/caregiver's working status; Working [AOR = 1.59, 95% CI: 1.34, 1.89], ANC follow-up [AOR = 1.71, 95%CI: 1.34, 2.2], and health facility delivery [AOR = 1.55, 95%CI: 1.25, 1.91] were individual-level factors associated with vitamin A supplementation. Whereas administrative zones of Western [AOR = 2.02, 95% CI: 1.16, 3.52], Southern highlands [AOR = 3.83, 95% CI: 2.02, 7.24], Southern administrative zone [AOR = 2.69, 95% CI: 1.37, 5.3], and South West highlands [AOR = 0.56, 95% CI: 0.33, 0.95] were community-level factors associated with vitamin A supplementation. The proportion of VAS among children in Tanzania is low compared to UNICEF's target of 80. Mother's/caregiver's working status, antenatal care, place of delivery, community-level media exposure, and administrative zones were significantly associated factors with vitamin A supplementation. Therefore, interventions should be designed to improve the uptake of VAS. Provision and promotion of ANC and institutional delivery and strengthening of routine supplementation are recommended to increase coverage of childhood vitamin A supplementation. Moreover, special focus should be given to regions in the south-western highlands.

Preparation and Rationale for a Patient-Centered Clinical Outcome Assessment Set of Fluid Overload for Drug Development in Nephrotic Syndrome

Introduction: Fluid overload is a source of substantial morbidity for adults and children with nephrotic syndrome (NS). Preparation and Rationale for a Fluid Overload in Nephrotic Syndrome Clinical Outcomes Assessment Set for Drug Development (Prepare-NS, 5UG3FD007308) was funded by the US Food and Drug Administration to develop a core set of patient-reported and observer-reported (for young children) outcome measures of fluid overload for use in pharmaceutical trials across the lifespan. Methods: The Prepare-NS study team developed the proposed context of use with input from stakeholders. We conducted a scoping review to assess the available literature on relevant patient- and observer-reported measures and performed secondary analyses of existing qualitative and quantitative data. Results: The outcome set will aim to serve individuals 2 years of age and older with primary NS conditions (specifically focal segmental glomerulosclerosis, minimal change disease, IgM nephropathy, membranous nephropathy, and childhood-onset NS not biopsied). The existing literature describing patient-reported outcomes in NS largely relies on nonspecific measures of health-related quality of life; fluid overload has been associated with lower scores on these measures. Conclusion: To address the gap in measure availability and fluid overload content, the Prepare-NS team has launched a set of qualitative studies for concept elicitation from the population of interest to inform development of new measures. The resulting measures subsequently will undergo psychometric evaluation and validation in a survey study.

Comparison of Risk-Scoring Systems in Predicting Kawasaki Disease Associated Coronary Artery Dilation in a North American Cohort.

Scoring systems used to predict morbidity in children with Kawasaki disease (KD) have been developed and validated in Asian populations. The objective of this study was to assess their utility in predicting the development of coronary artery dilation in children with KD in North America. This was a secondary analysis of a National Institutes of Health / National Heart, Lung, and Blood Institute (NIH/NHLBI) Pediatric Heart Network public use dataset from a multicenter, randomized controlled trial of pulse steroid therapy in KD in a North American cohort. The primary outcome of interest was development of coronary artery dilation. The Harada, Kobayashi, Egami, and Sano scoring systems, originally developed to predict risk of intravenous immunoglobulin (IVIG) resistance in Kawasaki patients in Japan, were applied to this cohort. Subjects were kept in the analysis only if there were complete data for every element of each scoring system-Harada (n = 132), Kobayashi (n = 88), Egami (n = 139), and Sano (n = 82). Patients classified as high-risk by the Harada score were more likely to have significant coronary artery dilation (p = 0.042), were more likely to require IVIG retreatment (p = 0.002), and were more likely to require hospital readmission (p < 0.001). The Egami, Kobayashi, and Sano scores were not predictive for any measured outcome. The Harada score can be useful in identifying KD patients at risk for developing coronary artery dilation and IVIG resistance. The Harada score has demonstrated higher sensitivity but lower specificity, making it a valuable screening tool that may benefit from supplementary diagnostic methods.

Determinants of Undernutrition among Under-Five Children: A Community-Based Study from Eastern India

Backgrounds: Children are prone to undernutrition which adversely affects their health status. Nutritional status of under-five children is a sensitive indicator of nutrition and child health. Hence, the present study is undertaken to assess the prevalence and determinants of undernutrition among under-five children in a rural area of West Bengal, India. Methods: A community-based cross-sectional study was conducted among 1680 under-five children who were selected by 30 cluster sampling technique to assess the prevalence and determinants of undernutrition. Nutritional status was assessed by means of weight-for-age, height-for-age, weight-for-height and mid-upper arm circumference-for-age criteria based on World Health Organization’s child growth standards. Results: The prevalence of underweight, stunting, and wasting among under-five children was found to be 33.7%, 34.8%, and 21.6%, respectively. Moreover, 39.4% of the studied children had low mid-upper arm circumference-for-age. After adjustment for possible confounders, maternal illiteracy, lower socio-economic status, presence of anemia and any childhood morbidity were found significant determinants of undernutrition. Conclusions: Widespread prevalence of undernutrition among under-five children with anemia and childhood morbidity as important determinants highlights a need for multi-disciplinary integrated approach towards improving the child health and nutrition. Long term measures like improvement of maternal education and poverty alleviation should also be considered in future plans.

Effectiveness of intracuff alkalinized lidocaine associated with intravenous dexamethasone in reducing laryngotracheal morbidity in children undergoing general anesthesia for tonsillectomy: a randomized controlled trial

BackgroundPostoperative sore throat is one of the main postoperative complaints in patients undergoing tonsillectomy. As the primary outcome, we aimed to determine whether endotracheal tube cuffs filled with alkalinized lidocaine are associated with a lower incidence of postoperative sore throat and anesthesia emergence phenomena in children undergoing tonsillectomy or adenotonsillectomy. We also assessed the potential additional benefits of IV dexamethasone in reducing postoperative laryngotracheal morbidity. MethodsThis is a clinical prospective, randomized, controlled trial. Patients were randomly allocated to one of four groups, as follows: air – endotracheal tube cuff filled with air; air/dex – endotracheal tube cuff filled with air and intravenous dexamethasone; lido – endotracheal tube cuff filled with alkalinized lidocaine; and lido/dex – endotracheal tube cuff filled with alkalinized lidocaine and intravenous dexamethasone. Perioperative hemodynamic parameters and the incidence of postoperative nausea and vomiting, coughing and hoarseness were recorded. Postoperative sore throat was assessed in the postanesthetic care unit and 24 hours post tracheal extubation. ResultsIn total, 154 children aged 4–12 years, ASA physical status I or II, undergoing general anesthesia for elective tonsillectomy and adenotonsillectomy, were assessed for postoperative sore throat in this study. The incidence of postoperative sore throat 24 hours after tracheal extubation was significantly lower in the lido/dex group compared to groups air and air/dex (p = 0.01). However, no additional reduction in these symptoms was observed from the intravenous administration of dexamethasone when comparing the lido and lido/dex groups. Similarly, there were no differences among groups regarding perioperative hemodynamic variables or postoperative nausea and vomiting, coughing, and hoarseness during the study period. ConclusionIntracuff alkalinized lidocaine, associated with intravenous dexamethasone, might be effective in reducing sore throat 24 hours post-tonsillectomy or adenotonsillectomy in children when compared to the use of air as the cuff insufflation media.

A fascinating case of complex congenital heart disease

Complex congenital heart disease (CHD) constitutes a significant non-infectious contributor to childhood morbidity and mortality, particularly prevalent in developing countries with an estimated incidence of nearly 1/100 births. The spectrum of CHD spans from isolated atrial septal defects that necessitate no immediate intervention to intricate structural cardiovascular abnormalities demanding multiple interventions early in the neonatal period. Patients afflicted with complex CHD often manifest symptoms such as respiratory distress, cyanosis of the skin, feeding difficulties, and failure to thrive, becoming evident within the initial 48 h post-birth. In this context, we present an intriguing case of a male child with complex CHD. This case study is accompanied by a concise exploration of the embryology of the heart, shedding light on the intricate developmental processes that may underlie such congenital anomalies.

Abstract We086: Identifying Gene Regulatory Subnetwork Drivers of Cardiomyocyte Chamber Specification

Introduction: Fetal heart development is a highly coordinated process directed by complex gene regulatory networks (GRN). Imbalances in such networks can lead to congenital heart defects, a leading cause of morbidity and mortality in children. Many of these defects are related to the improper specification of cardiac progenitor cells to chamber-specific (i.e., atrial, or ventricular) cardiomyocytes, but the GRNs involved in this process are not well characterized. Hypothesis: We hypothesize that cardiomyocyte chamber specification depends on discordant atrial and ventricular regulatory subnetworks within heart field cardiac progenitor cells. Approach: We used CellOracle, a GRN inference software, and publicly available fetal mouse heart single cell RNA and ATAC sequencing data to infer cell type specific GRNs during cardiomyocyte differentiation. Each of the first heart field and two second heart field networks included 4,000 directed interactions and more than 600 genes. We performed a systematic in silico knockdown study with these networks to identify TFs that differentially modulate atrial and ventricular gene expression. Correlations in the downstream responses to TF perturbations were used to extract chamber specification subnetworks. Results: The most central genes within the heart field networks included several previously identified cardiac developmental TFs (Nkx2-5, Mef2c, Tbx5). Perturbations of these heart field GRNs identified 12 TFs that increased ventricular gene expression while also decreasing atrial gene expression (ventricular program), as well as 20 genes with the opposite effect (atrial program). Previous in vitro knockdown studies during iPSC-CM differentiation validated one of the ventricular (Hey2) and two of the atrial programming TF (Nr2f2, Tead2) predictions. Discordant atrial and ventricular regulatory subnetworks were identified, including one network with opposing effects on the expression of Wnt2 by ventricular (repressing) and atrial (activating) TFs. Conclusions: We identified a set of TFs organized within regulatory subnetworks that drive discord specification of ventricular vs. atrial cardiomyocyte gene expression within cardiac progenitor cells in mouse development. These predictions will be validated through in vitro and in vivo studies.

The many faces of sickle cell disease in children: complications in the appendicular skeleton.

Sickle cell disease (SCD) is a hereditary red cell disorder with clinical manifestations secondary to sickling or crescent-shaped distortion of the red blood cells. Musculoskeletal complications of SCD are often the main causes for acute and chronic morbidities in children with manifestations including osteomyelitis, osteoporosis and osteonecrosis. This article aims to familiarise the paediatric radiologist with appendicular skeletal complications of SCD in the paediatric population and their imaging appearance.

A Study of the Prevalence of Anemia in Children With Severe Acute Malnutrition at a Pediatric Tertiary Care Hospital in South India.

Introduction In developing countries such as India, severe acute malnutrition (SAM) has been a cause for great concern in the pediatric population. SAM is associated with significant morbidity and mortality in children less than 60 months of age and leaves them vulnerable to diseases due to a decrease in immunological response. Children with SAM are prone to infections, and due to nutritional deficiency, many have anemia whichmay be a direct or indirect cause of morbidity and mortality. They are affected by frequent respiratory and gastrointestinal infections. Methodology A cross-sectional study was conducted for a period of two months, from December 1,2023, to January 31, 2024, in children with SAM aged less than 60 months. A detailed history and demographic profile were taken and recorded in a predesigned proforma. Anthropometric measurements of the study subjects were recorded, and lab investigations included complete blood picture, serum iron, serum ferritin, serum folate, and serum vitamin B12 levels. The prevalence and severity of anemia were determined by assessing the hemoglobin levels. The data collected was analyzed in Excel sheets (Microsoft Corporation, Redmond, Washington, United States) and the results were depicted in the form of graphs. Results A total of 300 children were included in the study of which 22 children were aged less than six months and 278 children were in the age group of 6-60 months. The overall gender distribution was 124 (41.4%) males and 176 (58.6%) females. In the age group of <6 months, of the 22 children, six (27.27%) were females while 16 (72.72%) were male. In the age group of 6-60 months, of the 278 children, 170 (61%) were females while 108 (39%) were males. Of the total 300 children, 232 (77.3%) were found to be anemic, of which 54 (23.2%) had mild anemia, 162 (69.8%) had moderate anemia, and 16 (6.89%) had severe anemia. Low serum iron levels were detected in 134 (44.6%) with iron deficiency being more common in females; below-normal ferritin levels were seen in 153 (51%) cases. Folate levels were found to be deficient in 97 (32.3%) children while vitamin B12 levels were deficient in 186 (62%). Conclusion Anemia is a common occurrence in children with SAM. Prevention of anemia starts from the womb by improvement of maternal nutrition and iron, and folic acid supplementation during pregnancy. Exclusive breastfeeding up to six months of age and further continuation of breastfeeding coupled with initiation of home-available complementary feeding from the age of six months onwards go a long way in maintaining healthy nutrition status inchildren in the vulnerable age group of less than 60 months. Healthcare professionals should utilize thewell-baby and well-child visits to educate the parents and primary caretakers regarding the feeding practicesto prevent, detect, and treatanemia, which will help reduce the morbidity and mortality in children with SAM.

Epidemiological changes of invasive fungal disease in children with cancer: Prospective study of the National Child Program of Antineoplastic Drugs network, Chile.

Invasive fungal diseases (IFD) are high morbidity and mortality infections in children with cancer suffering episodes of high-risk febrile neutropenia (HRFN). IFD epidemiology has changed in the last two decades, with an increasing incidence in recent years due to the growing number of immunocompromised children at risk for IFD. The aim of this study was to evaluate the incidence of IFD in children with cancer in the period 2016-2020 compared to 2004-2006 in six hospitals in Chile. Prospective, multicentre study, carried out between 2016 and 2020 in six hospitals in Chile. The defined cohort corresponds to a dynamic group of HRFN episodes in patients <18 years old with cancer, who at the fourth day of evolution still presented fever and neutropenia (persistent HRFN). Each episode was followed until resolution of FN. The incidence of IFD was calculated between 2016 and 2020 and compared with data obtained in the period 2004-2006. The incidence rate was estimated. A total of 777 episodes of HRFN were analysed; 257 (33.1%) were considered as persistent-HRFN occurring in 174 patients. The median age was 7 years (IQR: 3-12 years) and 52.3% (N = 91) were male. Fifty-three episodes of IFD were detected: 21 proven, 14 probable and 18 possible. Possible IFD were excluded, leaving 239 episodes of persistent-HRFN with an IFD incidence of 14.6% (95% CI 10.5-19.9) and an incidence rate of 13.6 IFD cases per 1000 days of neutropenia (95% CI 9.5-20.0). Compared to 2004-2006 cohort (incidence: 8.5% (95% CI 5.2-13.5)), a significant increase in incidence of 6.1% (95% CI 0.2-12.1, p = .047) was detected in cohorts between 2016 and 2020. We observed a significant increase in IFD in 2016-2020, compared to 2004-2006 period.

The short fiber knobs of human adenovirus in species F elicit cross-neutralizing antibody responses

Human adenovirus (HAdV) type 40 in species F (HAdV-F40) and HAdV-F41 represent the third most prevalent causative agents of non-bacterial acute gastroenteritis in infants and young children, following norovirus and rotavirus. Despite their significant contribution to global child morbidity, vaccines to preemptively combat these viruses remain elusive. In this study, we investigate the potential for cross-neutralization between HAdV-F40 and HAdV-F41 using immune sera with the short fiber knob (SFK). We implemented a series of assays to evaluate the responses, including enzyme-linked immunosorbent, micro-neutralization, immunofluorescence, and quantitative polymerase chain reaction. Our results demonstrate that immune sera with HAdV-F40 SFK or HAdV-F41 SFK could effectively neutralize both HAdV-F40 and HAdV-F41, indicating a mutual cross-neutralizing effect. Notably, the immune sera with HAdV-F40 SFK demonstrated a stronger neutralization effect, suggesting the potential to develop a subunit vaccine that can simultaneously counteract both viruses. These findings underscore the potential of SFK immunization in evoking a cross-neutralizing antibody response between HAdV-F40 and HAdV-F41. This suggests a promising avenue for developing subunit vaccines against HAdV-F40 and HAdV-F41 and provides a novel perspective on the potential of neutralizing antibodies to protect against these two types of HAdV.

Quantifying the increased risk of illness in malnourished children: a global meta-analysis and propensity score matching approach

BackgroundChildhood morbidity and mortality continue to be major public health challenges. Malnutrition increases the risk of morbidity and mortality from illnesses such as acute respiratory infections, diarrhoea, fever, and perinatal conditions in children. This study explored and estimated the magnitude of the associations between childhood malnutrition forms and child morbidity.MethodsWe performed an individual participant data (IPD) meta-analysis and employed propensity score matching to examine crude (unadjusted) and adjusted associations. Our analysis utilized demographic and health datasets from surveys conducted between 2015 and 2020 in 27 low- and middle-income countries. Our objective was to quantify the risk of morbidity in malnourished children and estimate the population-attributable fraction (PAF) using a natural experimental design with a propensity score-matched cohort.ResultsThe IPD meta-analysis of child morbidity across three childhood malnutrition forms presented nuanced results. Children with double-burden malnutrition had a 5% greater risk of morbidity, which was not statistically significant. In contrast, wasted children had a 28% greater risk of morbidity. Overweight children exhibited a 29% lower risk of morbidity. Using the matched sample, children with double-burden malnutrition and overweight children had lower morbidity risks (1.7%, RR: 0.983 (95% CI, 0.95 to 1.02) and 20%, RR: 0.80 (95% CI, 0.76 to 0.85), respectively), while wasting was associated with a 1.1 times (RR: 1.094 (95% CI, 1.05 to 1.14)) greater risk of morbidity. Eliminating double-burden malnutrition and wasting in the four and seven countries with significant positive risk differences could reduce the child morbidity burden by an estimated average of 2.8% and 3.7%, respectively.ConclusionsOur study revealed a correlation between specific childhood malnutrition subtypes—double-burden malnutrition and wasting—and increased risks of morbidity. Conversely, overweight children exhibited a lower risk of immediate morbidity, yet they may face potential long-term health challenges, indicating the necessity for nuanced approaches to childhood nutrition.

Food supplementation policy for pregnant women: analysis of coverage in Brazilian regions in the light of COVID-19

Objective: in the context of Brazil, a peripheral country, pregnant women are a vulnerable class. Proper nutrition and fetal health depend directly on maternal nutrition, which is often precarious. Thus, the food supplement, which has already changed the health scenario of malnutrition in children, is big important in the best Prenatal Care. The objective is to analyze the quality and supply of food supplementation for pregnant women in Brazil, before and during the COVID-19 pandemic. Methods: analysis of public domain data, from pregnant women registered in the E-manager primary care system, between 2019 and 2021. Results: the micronutrients offered in Brazil in the public policy of supplementation for pregnant women are iron and folic acid, since 2005 until the present date. Data analysis showed that the offer of those both in the pre-pandemic year and in the pandemic was inadequate, reaching less than 20% of pregnant women in the five regions of the country, with only one state in the northeast region, of the 27 national states, having an adequate supply to 100% of pregnant women. Conclusion: supplementation rich in several micronutrients, used preventively during pregnancy, reduces maternal and fetal diseases. However, in Brazil, the supplementation policy during pregnancy is poor in quality, offering only folic acid and iron for years, as well as inadequate distribution of these. This fact proved to be unrelated to the health crisis of the pandemic, as it occurred since the pre-pandemic and worse in numbers before than during it. Therefore, a set of “poor quality and low supply” was identified in the supplementation of pregnant women in Brazil, which contributes to maintaining greater maternal-fetal and child morbidity and mortality.

Impact of Nadi Shuddhi Pranayama on Apnea Hypopnea Index, Respiratory Distress Index, and Oxygen Desaturation Index Among Adolescents With Sleep Apnea Syndrome.

Background Sleep apnea syndrome has gained significant recognition over the last decade as a potential cause of substantial childhood morbidity. This study aimed to evaluate the impact of the Apnea Hypopnea Index (AHI), Respiratory Distress Index (RDI), and Oxygen Desaturation Index (ODI) among adolescents with sleep apnea syndrome. Objectives The objective of this study is to compare the impact of Nadi Shuddhi Pranayama with routine treatment modalities on the AHI, RDI, and ODIamong adolescents with sleep apnea syndrome. Specifically, the study aims to evaluate the effectiveness of Nadi Shuddhi Pranayama in improving AHI, RDI, and ODIin this population. Methods This study was an interventional case-control studyand enrolled 34 adolescents aged 10 to 18 years who were diagnosed with sleep apnea syndrome. The participants were divided into two groups: the Nadi Shuddhi Pranayama group (n=17) and the control group (n=17). Baseline assessments included the collection of demographic information, medical history, and polysomnography results to determine the AHI, RDI, and ODI. Follow-up assessments were conducted post-intervention to measure changes in the AHI, RDI, and ODI. Results There were no significant differences between groups in terms of age (p = 0.176) or gender distribution (p = 0.300). After the intervention period, participants in the Nadi Shuddhi Pranayama group showed significant improvements in the Apnea Hypopnea Indexcompared to the standard care group (p = 0.007). However, there were no significant differences in the Respiratory Distress Index (p = 0.547) or Oxygen Desaturation Index (p = 0.304) between the groups post-intervention. Subgroup analysis based on severity categories (Mild, Normal) for the Apnea Hypopnea Index showed a significant difference between the Nadi Shuddhi Pranayama and standard care groups (p = 0.037). However, there were no significant differences in the Respiratory Distress Index (p = 0.300) and Oxygen Desaturation Index (p = 0.169) between the groups in this subgroup. Conclusion These findings suggest that Nadi Shuddhi Pranayama may improve the Apnea Hypopnea Index in adolescents with sleep apnea, particularly in those with mild symptoms, but did not significantly affect the Respiratory Distress Index or Oxygen Desaturation Index.

Determinants of childhood anaemia in India from 2005 to 2021: insights from the last three rounds of India National Family Health Surveys

Anaemia is a global public health problem affecting 800 million women and children globally. Anaemia is associated with perinatal mortality, child morbidity and mortality, mental development, immune competence, susceptibility to lead poisoning, and performance at work. This paper used data from India National Family Health Surveys (INFHS) carried out in 2005-06, 2015-16 and 2019-21 to identify the factors associated with childhood anaemia among children, adjusting for a range of covariates. In NFHS rounds of 3 and 4 after adjusting for standard covariates, in the probit model, it was found according to marginal effects, the probability of children being anaemic in urban areas is lower. Those belonging to the scheduled tribes have a higher probability of being anaemic in the two survey rounds of NFHS-3 and NFHS-4. Literate mothers were found to have a lower probability of anaemia in their children. In NFHS-5, in the binary logit model after adjusting for standard covariates, it was found that those belonging to the scheduled tribes were 1.348 times more likely to be anaemic compared to the scheduled castes. Maternal education was another significant factor determining the likelihood of being anaemic. Literate mothers were less likely to have anaemic children. This study provides crucial insights into the dynamic nature of childhood anaemia in India, utilizing data from three decades of NFHS surveys. It highlights the need for comprehensive interventions addressing socio-economic determinants, education of women, and behaviour change interventions to mitigate the burden of childhood anaemia in India.

Factors influencing compliance with multiple injection immunization among mothers of toddlers at The Public Health Center Porong Integrated Health Service Post, Sidoarjo, East Java, Indonesia: A Descriptive Study

Introduction: Immunization significantly reduces infant and child morbidity and mortality rates globally. However, basic immunization coverage in 65 countries must catch up to the 90% global target. Multiple injection immunization involves administering multiple immunizations in one visit, enhancing early protection during vulnerable periods. This approach reduces the need for multiple health visits, which is particularly beneficial for children facing access barriers. It also improves healthcare efficiency, minimizes missed opportunities, and lessens the burden on parents needing frequent facility visits. Objective: The objective of this study was to explore the factors influencing compliance with multiple injection immunization among mothers of toddlers at the Public Health Center Porong Integrated Health Service Post, Sidoarjo, East Java, Indonesia Method: Conducted in March 2024 at Public Health Centre Porong, Indonesia, this study employed a consecutive sampling method. It involved 100 mothers with infants aged 13 to 24 months who had received immunizations at the Post. Data were collected through structured interviews and analyzed to determine compliance rates and associated factors. Result: Among the participants, 91% of mothers were aged between 20 to 35 years, indicating a productive age group. The compliance rate for multiple injection immunization was 61%. Additionally, 74% of mothers had completed high school, suggesting a positive association between higher education and enhanced health decision-making capabilities. A significant proportion of mothers (75%) were not employed, highlighting the influence of occupation on health-related knowledge and practices. Conclusion: The study underscores the necessity for targeted health education initiatives tailored to the diverse demographic and occupational characteristics of mothers. Such interventions should improve maternal knowledge and promote adherence to essential childhood immunizations, leveraging the cognitive advantages associated with higher education and non-working status. This approach aims to foster informed decision-making and proactive health behaviours among mothers in community health settings.