Child Mortality Research Articles

Joint Spatial Analysis of Low Birth Weight and Stunting in West African Countries

Introduction: The burden of childhood morbidity and mortality are still huge in most sub-Saharan African countries with West African sub-region contributing largely to the burden. Previous findings have demonstrated strong link between early life events such as low birth weight (LBW) with later events particularly malnutrition. We aim at estimating the specific and shared spatial patterns of LBW and stunting among under-five children in multiple West African countries. Methods: Data set for the study was sourced from the Demographic and Health Surveys conducted in fourteen West African countries. We used a Bayesian shared component model allows us to split the spatial surface into those specific to each of the outcomes and one shared by the two, with inference based on a Bayesian approximation procedure through the integrated nested Laplace approximation. Results: The findings show spatial clustering in the shared and specific effects of the health outcomes, demonstrating high likelihood in northern Nigeria spanning through Niger and that the spatial pattern for the shared effects are similar to those of the specific effects of stunting. Furthermore, mother’s level of education, attendance in antenatal care and household wealth index are strongly associated with the shared health outcomes. Conclusion: The study provides insight into the spatial pattern of LBW and stunting among West African children and can be useful in targeted interventions in regions with high burden of LBW and malnutrition which may include more advocacy that promote the use of antenatal care services during pregnancy.

Mortality Patterns in Pediatric Pulmonary Vein Stenosis: Insights Into Right Ventricular Systolic Pressure Associations.

Pulmonary vein stenosis in children is associated with a poor prognosis. However, the cause and risk factors for mortality remain uncertain. This retrospective, single-center study identified children with primary and secondary pulmonary vein stenosis through a cardiac catheterization database. Kaplan-Meier analysis, log-rank tests, and Cox regression analysis were performed to assess outcome and identify significant predictors of mortality. Among 56 children with pulmonary vein stenosis (33 male children, 59%), 20 (36%) died at a median age of 10 months (interquartile range,4-24 months). All patients underwent cardiac catheterization, with 45 (80%) undergoing at least 1 interventional procedure. Causes of death included multiorgan failure (35%), progressive respiratory failure (20%), and sudden cardiac death (15%). Prematurity, chronic lung disease, a genetic syndrome, or the number of affected pulmonary veins did not significantly correlate with mortality. However, right ventricular (RV) systolic pressure greater than half systemic pressure was associated with mortality (hazard ratio [HR], 5.5 [95% CI, 2.2-14.1]; P<0.001). The final predictive model for mortality included RV systolic pressure greater than half systemic pressure (HR, 4.0 [95% CI, 1.6-10.4]; P=0.004), moderately or severely diminished RV systolic function (HR, 3.6 [95% CI, 1.1-11.5]; P=0.032), and the presence of congenital heart disease (HR, 2.4 [95% CI, 0.9-6.7]; P=0.084). This report is the first to indicate that RV systolic pressure and RV dysfunction are significant independent predictors of mortality in children with pulmonary vein stenosis. A greater understanding of mortality in this population is necessary, particularly in those with RV systolic pressure less than half systemic.

A quality improvement initiative to improve growth monitoring of children attending immunization clinic in an urban primary health centre in Delhi

BackgroundImmunization clinics present an opportunity for passive screening for malnutrition among young children through plotting of growth charts. Passive screening for malnutrition can enable timely interventions and improve morbidity and mortality of under-five children. Therefore, we aimed to increase the plotting of growth charts (weight-for-age) to 90%, among under-five children attending immunization clinics in an Urban Health Centre (UHC) in south Delhi over three months.MethodologyA Quality Improvement (QI) initiative was undertaken in the immunization clinic of an urban primary health centre in southern Delhi, from January to March 2024. A multi-faceted QI team was formed. The baseline coverage of weight-for-age growth chart plotting in the immunization clinic was 31%. The process flow was mapped, and critical gaps identified by root cause analysis (Fish Bone technique). Change ideas were discussed and prioritized using a prioritization matrix to implement these through sequential PDSA cycles. The main change ideas implemented were training of health workers, allotting regular supervisors for the session, and appending a stamp for quick identification of underweight children. Run chart was used to assess the changes over time. We considered the outcome achieved if the plotting coverage was more than 90% sustained for at least six consecutive immunization sessions.ResultsMultiple change ideas were implemented over a period of three months. The coverage of growth chart plotting increased to more than 90%. Lack of motivation among stakeholders was a challenge for some change ideas. Monitoring of immunization sessions for plotting of growth chart was continued post the implementation of all change ideas to assess sustainability which showed positive results. Post-implementation of the change ideas, a meeting was held with the members of the QI team to get feedback on this activity.ConclusionThere is potential for improving growth monitoring at immunization clinics, which can be beneficial in strengthening passive screening for malnutrition in primary care settings.Clinical trial numberNot applicable.

Population attributable fractions for modifiable risk factors of neonatal, infant, and under-five mortality in 48 low- and middle-income countries.

Identifying the modifiable risk factors for childhood mortality using population-attributable fractions (PAFs) estimates can inform public health planning and resource allocation in low- and middle-income countries (LMICs). We estimated PAFs for key population-level modifiable risk factors of neonatal, infant, and under-five mortality in LMICs. We used the most recent Demographic and Health Survey data sets (2010-22) from 48 LMICs, encompassing 35 sub-Saharan African countries and 13 countries from South and Southeast Asia (n = 506 989). We used generalised linear latent mixed models to compute odds ratios (ORs), and we calculated the PAFs adjusted for commonality using ORs and prevalence estimates for key modifiable risk factors. The highest PAFs of neonatal mortality were attributed to delayed initiation of breastfeeding (>1 hour of birth) (PAF = 23.9; 95% confidence interval (CI) = 23.1, 24.8), uncleaned cooking fuel (PAF = 6.2; 95% CI = 6.4, 7.8), infrequent antenatal care (ANC) visits (PAF = 4.3; 95% CI = 3.3, 5.9), maternal lack of formal education (PAF = 3.9; 95% CI = 2.7, 5.3), and mother's lacking two doses of tetanus injections (PAF = 3.0; 95% CI = 1.9, 3.9). These five modifiable risk factors contributed to 41.4% (95% CI = 35.6, 47.0) of neonatal deaths in the 48 LMICs. Similarly, a combination of these five risk factors contributed to 40.5% of infant deaths. Further, delayed initiation of breastfeeding (PAF = 15.8; 95% CI = 15.2, 16.2), unclean cooking fuel (PAF = 9.6; 95% CI = 8.4, 10.7), mothers lacking formal education (PAF = 7.9; 95% CI = 7.0, 8.9), infrequent ANC visits (PAF = 4.0; 95% CI = 3.3, 4.7), and poor toilet facilities (PAF = 3.4; 95% CI = 2.6, 4.3) were attributed to 40.8% (95% CI = 36.4, 45.2) of under-five deaths. Given the current global economic climate, policymakers should prioritise these modifiable risk factors. Key recommendations include ensuring that women enter pregnancy in optimal health, prioritising the presence of skilled newborn attendants for timely and proper breastfeeding initiation, and enhancing home-based care during the postnatal period and beyond.

Exploring health outcome disparities in African regional economics communities: a multilevel linear mixed-effect analysis

BackgroundIn African Regional Economic Communities (RECs), notable and enduring disparities exist in health outcomes. This study investigates the impact of macro-level characteristics of countries on health outcomes disparities within the African Regional Economic groupings. The study used panel data from the World Bank Development Indicators (WDI) and the Worldwide Governance Indicators (WGI), spanning 37 African countries, grouped into eight RECs between 2000 and 2019. We employed infant and under-five mortality rates and life expectancy at birth as indicators of health outcomes.MethodThe study used a multilevel linear (ML) mixed-effect approach to examine the influence of country-level factors on health outcome disparities within the eight African RECs recognized by the African Union.ResultsThe findings show that higher unemployment rates and HIV incidence exacerbate these disparities, while a growing elderly population and improved access to basic drinking water can mitigate them. Increased internet usage correlates with higher within-regional inequalities in child mortality rates but reduces disparities in life expectant at birth. Urbanization trends contribute to lower-intra-regional inequality in infant mortality rates and life expectancy at birth. Higher domestic government health expenditure as a share of general government spending is linked to reduced disparities in under-five and infant mortality rates. Still, it increases inequalities in life expectancy at birth within the regional groupings. Moreover, a higher proportion of the population below 15 years old and trade gains positively influence regional disparities in life expectancy. Conversely, DTP immunization coverage among children aged 12–23 months is associated with higher within-regional inequality in infant mortality rates.ConclusionsPolices aimed at reducing unemployment rates and HIV incidence should be prioritized. In addition, governments should invest in elderly care programs and infrastructure development for water supply. Efforts to promote internet access should be complemented by interventions to enhance child health and healthcare accessibility. Encouraging urban planning policies that prioritize developing healthcare infrastructure and facilitating healthcare access in urban areas is crucial. Furthermore, Governments should increase their health expenditure allocation in general government spending. Promoting strategies to enhance healthcare access and quality for specific demographics, alongside leveraging trade gains to invest in healthcare infrastructure and services, is imperative. Targeted interventions ensuring equitable access to immunization services should also be emphasized.

Gender differentials in infant and under-five mortality in India

Perspective vista of child-health in India reclaim within the framework of Sustainable Development Goals to ensure healthy living and well-being for all at all ages. With significant young populace in India, health status of children becomes paramount undoubtedly. Study precisely traces gender differential in child mortality, highlighting role of pointers like IMR and UMR in the context of parental, socio-economic, and environmental settings. Commissioning a comprehensive approach, study evaluates data from National Family Health Survey (NFHS-4) alongside Demographic Health Survey (DHS), USAID spanning over 2015-2016. Risk of mortality was higher among male infants and under-five children compared to female. Birth order, birth spacing, mother’s age at birth, maternal and parental education were observed valuable for child survival. Birth order higher than four with birth-spacing less than two years for mothers bearing child at 35 years of age and above were deleterious for child survival. Certain socioeconomic and environmental factors appeared significantly contributory in gender differences in child mortality. High-risk zone of Central India need critical and incisive surveillance to control child mortality due to preventable causes. Planning and implementation of health programs need to consider gender gap in child mortality for maternal and child health related policies and interventions. Study emphasizes attention of policymakers and public health entrepreneurs to foresee rewarding interventions targeting the cohort of children at risk.

Nearby armed conflict affects girls' education in Africa.

Female education is a crucial input to women's agency and empowerment, and has wide-ranging impacts, from improved labor market outcomes to reducing child mortality. Existing gender-specific evidence on the effect of armed conflict on education is conflict-specific and mixed. We link granular data on conflict events to georeferenced survey data on educational attainment from 28 countries in Africa, and use a regression-based approach to estimate the local effect of conflict exposure on female years of schooling. We find that conflict events occurring within 25 kilometers during a female child's primary school years reduces years of schooling by 0.4 years by adolescence. We do not find the same effect for males. Exposure to only low intensity conflict events with at most two casualties has persistent negative and significant effects. Consecutive years of conflict, however, can have positive effects in later years, which offset earlier negative effects, suggesting a habituation to violence. In the past two decades, we estimate excess child mortality in Africa associated with the indirect channel of women's education to be similar in magnitude to the number of direct child casualties due to conflict.

Time to neonatal mortality and its predictors among preterm neonates admitted to the neonatal intensive care unit in northern Ethiopia, 2023/2024: a retrospective cohort study

BackgroundA preterm neonate is defined by the World Health Organization as a child delivered before 37 weeks of gestation. In low- and middle-income countries, including Ethiopia, preterm-related complications are serious health problems due to increases in the mortality and morbidity of newborns and children under 5 years of age. The aim of this study was to assess the time to neonatal mortality and its predictors among preterm neonates admitted to the neonatal intensive care unit in northern Ethiopia, 2023/2024.MethodsAn institution-based retrospective cohort study was conducted among 495 randomly selected preterm neonates in six out of the fourteen general hospitals of Tigray, Ethiopia from October 2023 to June 2024. Epi Data version 4.6 and STATA version 14 were used for data entry and analysis, respectively. Descriptive statistics were carried out to determine the distribution. Kaplan-Meier analysis, life table, and log rank were computed. Cox proportional hazards models were fitted to identify independent predictors of preterm mortality.ResultsThe proportion of preterm neonatal mortality was 109 (22.7%). The overall median survival time was 21 (95% CI: 20, 28) days. Initiation of breast milk (AHR = 0.38 (95% CI: 0.24, 0.61)), respiratory distress syndrome (AHR = 1.9 (95% CI: 1.07,3.63)), perinatal asphyxia (AHR = 2.05 (95% CI: 1.05, 4.00)), receiving kangaroo mother care practice (AHR = 0.5 (95% CI: 0.34, 0.83)), and gestational age (AHR = 1.6 (95% CI 1.07, 2.59) were the predictors of time to death.ConclusionRespiratory distress syndrome, gestational age less than 32 weeks, and perinatal asphyxia at admission were found to be independent risk factors for preterm neonatal mortality. Breastfeeding and receiving kangaroo-mother care were independent preventive predictors of preterm neonatal mortality. It is better to give full emphasis and close follow-up to preterm neonates, especially during the early neonatal period.

ZooCNN: A Zero-Order Optimized Convolutional Neural Network for Pneumonia Classification Using Chest Radiographs

Pneumonia, a leading cause of mortality in children under five, is usually diagnosed through chest X-ray (CXR) images due to its efficiency and cost-effectiveness. However, the shortage of radiologists in the Least Developed Countries (LDCs) emphasizes the need for automated pneumonia diagnostic systems. This article presents a Deep Learning model, Zero-Order Optimized Convolutional Neural Network (ZooCNN), a Zero-Order Optimization (Zoo)-based CNN model for classifying CXR images into three classes, Normal Lungs (NL), Bacterial Pneumonia (BP), and Viral Pneumonia (VP); this model utilizes the Adaptive Synthetic Sampling (ADASYN) approach to ensure class balance in the Kaggle CXR Images (Pneumonia) dataset. Conventional CNN models, though promising, face challenges such as overfitting and have high computational costs. The use of ZooPlatform (ZooPT), a hyperparameter finetuning strategy, on a baseline CNN model finetunes the hyperparameters and provides a modified architecture, ZooCNN, with a 72% reduction in weights. The model was trained, tested, and validated on the Kaggle CXR Images (Pneumonia) dataset. The ZooCNN achieved an accuracy of 97.27%, a sensitivity of 97.00%, a specificity of 98.60%, and an F1 score of 97.03%. The results were compared with contemporary models to highlight the efficacy of the ZooCNN in pneumonia classification (PC), offering a potential tool to aid physicians in clinical settings.

Life and death under son preference: Economic stress, fertility, and early-life mortality in rural Spain, 1800–1910

Abstract Based on longitudinal micro data from 13 Spanish rural villages between 1800 and 1910, this paper assesses whether discriminatory practices affected fertility and sex-specific mortality in infancy and childhood during economic crises. Our contribution is twofold. On the one hand, there is a connection between short-term economic stress, fertility, and sex ratios at baptism: high-price years were followed by a decline in the number of registered baptisms and by an increase in sex ratios at baptism. These results, therefore, suggest that families mortally neglected a significant fraction of their female babies during economic crises. On the other hand, there is a connection between short-term economic stress, mortality, and sex ratios at death. Using death registers further supports this interpretation, since our evidence shows that the female biological advantage was not visible after an economic shock.

Sociodemographic Factors and Maternal Knowledge of Childhood Vaccination in Nigeria

Childhood vaccination is globally recognized as one of the most cost-effective public health interventions to reduce child mortality, particularly in regions burdened by vaccine-preventable diseases (VPDs) such as measles, polio, and tuberculosis. Despite the availability of free routine vaccination services in Nigeria, suboptimal vaccination coverage persists, and maternal knowledge plays a critical role in this challenge. While much attention has been focused on the role of attitudes and practices in influencing vaccine uptake, less is known about the specific impact of socio-demographic factors on maternal knowledge of the vaccination schedule, particularly in urban areas like Ughelli, Nigeria. This study seeks to fill this gap by examining the socio-demographic determinants of maternal knowledge about childhood vaccination in Ughelli North Local Government Area (LGA) of Delta, Nigeria. A cross-sectional descriptive study was conducted among 321 mothers residing in Ughelli North LGA, utilizing a structured and pre-tested questionnaire designed to assess maternal knowledge of vaccination schedules and key vaccines for children. The study explored the association between socio-demographic factors such as age, educational level, employment status, ethnicity, and the level of maternal knowledge about childhood vaccination. Data were collected using an online survey and analysed with descriptive and inferential statistics to identify patterns and associations. The study revealed that, despite high levels of educational attainment among participants (88.8% had tertiary education), 87.5% of the respondents demonstrated poor knowledge of the full vaccination schedule, especially concerning vaccines required beyond the age of two. Socio-demographic variables, including ethnicity, employment status, and education, were not significantly associated with vaccination knowledge (p&gt;0.05), indicating that even mothers with higher education levels exhibited gaps in specific vaccination knowledge. These results suggest that maternal education alone is not a sufficient predictor of comprehensive vaccination knowledge in this context. This study makes an original contribution to the body of knowledge by highlighting the disconnect between general education and specific health knowledge regarding childhood vaccination. While many studies have established positive links between socio-demographic factors and overall vaccine attitudes or practices, this research uniquely focuses on knowledge of the vaccination schedule, identifying critical gaps that exist independently of attitudes or socio-economic status. The findings emphasize the need for tailored health education interventions that go beyond general literacy and target the specifics of vaccine schedules and timing, particularly for vaccines administered after infancy.

Clinical manifestations of COVID-19 infection and its impact on the outcome in children and adolescents with benign and malignant hematological disease in Egypt: a single-center experience

BackgroundIt is known that viral infections are associated with increased morbidity and mortality in immunocompromised children. Few reports describe the clinical manifestations and outcomes of COVID-19 infection in children and adolescents with benign and malignant hematological disease with a large sample size from our Egyptian population.AimAs a preliminary step in developing a national registry for children and adolescents with hemato-oncological disease who were diagnosed with COVID-19 infection, in this study we aimed to determine (a) the frequency of COVID-19 infection in children with hematological disease, (b) the presenting clinical manifestations, and (c) the associated underlying disease outcome and its clinical determinants.MethodsWe collected data from medical records of a retrospective cohort including all children and adolescent patients who were known to have a benign or malignant hematological disease attending the hematology and oncology outpatient clinic or were hospitalized between February 2022 and March 2023 in a university hospital in Cairo, Egypt, for tertiary care. All patients (n = 620) were tested for SARS-CoV-2 reverse transcription polymerase chain reaction (RT-PCR) test by nasopharyngeal swab. For all patients, the collected data included the demographic data, diagnosis, cause of hospital visit, cause and duration of admission if needed, presence of symptoms suggestive of COVID-19 infection, and concurrent medications. Baseline laboratory investigation were collected included complete blood count (CBC), liver and kidney functions, C-reactive protein (CRP), serum ferritin, lactate dehydrogenase, and coagulation test. For COVID-19-positive patients, the additional data collected included the duration of COVID-19 infection, its course, full examination during this illness, its severity, and the outcome of COVID-19 infection and the underlying disease.ResultsOut of the 620 children and adolescents with benign (n = 271) and malignant (n = 349) hematological diseases in in-patients and out-patients’ settings, 86 patients (13.8%) tested positive for SARS-CoV-2. COVID-19 infection was more common in patients with hematological malignancy (n = 56, 65.1%) than those with benign hematological disease (27 patients, 31.4%). Among COVID-19-positive patients, 20 patients (23.3%) required intensive care unit admission compared to 30 (5.6%) COVID-19-negative patients (p-value < 0.000). Death was reported in 5 COVID-19-positive patients (5.8%) compared to 19 in COVID-19-negative patients (3.6%) (p-value = 0.314). The factors associated with mortality in COVID-19-positive patients (3 patients with hematological malignancy and 2 patients with aplastic anemia) was abnormal neurological examination [OR = 17.3; p-value = 0.009].ConclusionThe current study showed that COVID-19 was higher among patients with hematological malignancies than those with benign hematological disease. COVID-19 was tolerable among the studied patients with underlying hematological disease where 94.1% of the COVID-19-positive patients survived. Mortality was associated with abnormal neurological examination in COVID-19-positive patients with underlying hematological disease.

The effect of an interactive mobile health intervention to improve community-based essential neonatal care practices among postpartum women in northeast Ethiopia: a cluster randomized controlled trial.

Despite global declines in child mortality rates, Africa's reduction is lagging behind other regions. Neonatal survival remains a key priority in the sustainable development agenda. Promoting neonatal care practices at the individual and community levels is essential, and technology-based interventions can effectively reach potential future mothers. This study aimed to evaluate the effect of an interactive mobile health intervention on improving community-based essential neonatal care practices among postpartum women in northeast Ethiopia. This study was conducted in Dessie and Kombolcha city zones, in northeast Ethiopia. A cluster randomized controlled trial was implemented among 743 participants (376 intervention and 367 control) from 2 January to 15 June 2023. Pregnant women at 30-weeks' gestation in selected clusters were enrolled and followed up to 45days after childbirth. Data were collected using Open Data Kit and analysed with Stata version 17. Structural equation modelling through confirmatory factor analysis was employed. Model fitness was evaluated using the χ2:degree of freedom ratio, root mean square error of approximation and standardized root mean square residual, indicating a good model fit. Statistical significance was declared at a level <0.05 with a 95% confidence interval. The study revealed high narrow birth-to-pregnancy intervals of <24 months in both groups (48.5% control, 49.5% intervention). Awareness of neonatal care increased markedly in the intervention group, increasing from 62.0% to 85.9%, compared with an increase from 57.8% to 67.6% in the control group. Disagreement regarding immediate newborn bathing was more prevalent in the intervention group (73.9%) than in the control group (58.9%). Initiating breastfeeding within 1h after birth was higher in the intervention group (85.4%) compared with the control group (74.4%). Postnatal visits to health facilities were more frequent in the intervention group (79.6%) than in the control group (54.8%). Mobile health intervention (β=0.393, p=0.007) and knowledge of neonatal care (β=0.347, p=0.012) had a significant positive effect on neonatal care practices. There were no significant indirect pathways between the variables analysed. Mobile health intervention and knowledge of neonatal care remain significant predictors with a total effect of β=0.382, p=0.009 and β=0.347, p=0.012, respectively, in enhancing neonatal care practices. This study underscores the significant role of mobile health interventions and maternal knowledge in enhancing neonatal care practices. These findings should inform the design and implementation of maternal and child health programs, emphasizing the integration of technology and education to improve neonatal outcomes in resource-limited settings. Protocol Registration and Results System Clinical Trial Registry, www.ClinicalTrials.gov, NCT05666050. Registered on 23 December 2022.

Patriarchy, Fertility and Excess Female Child Mortality in India

Research investigating association between patriarchy and demographic behavior is limited in India. The only study on this subject utilized 1981 Indian Census data to examine associations between patriarchy and fertility. We examined the association of patriarchy, measured using India Patriarchy Index (IPI), with total fertility rate (TFR) and excess female child mortality in India. Additionally, we examined independent associations of the 5 dimensions included in the IPI with the two outcomes. We used univariate and bivariate Local Indicators of Spatial Autocorrelation, multivariable ordinary least squares and spatial error- regressions to examine the associations. Spatial heterogeneity beyond the north–south divide was evident in the spatial association of IPI with TFR and excess female child mortality. Results show positive association of IPI with TFR and excess female child mortality. While son preference and socio-economic domination were positively associated with TFR, domination of men over women and son preference were positively associated with excess female child mortality. This study is the first of its kind to examine the association of a novel measure of patriarchy with TFR and excess female child mortality. As patriarchy is deep-rooted in Indian society, a great deal of effort is needed to shift these traditionally held social norms and practices.

Geographic disparities impacting oral vaccine performance: Observations and future directions.

Oral vaccines have several advantages compared with parenteral administration: they can be relatively cheap to produce in high quantities, easier to administer, and induce intestinal mucosal immunity that can protect against infection. These characteristics have led to successful use of oral vaccines against rotavirus, polio, and cholera. Unfortunately, oral vaccines for all three diseases have demonstrated lower performance in the highest-burden settings where they are most needed. Rotavirus vaccines are estimated to have >85% effectiveness against hospitalization in children <12 months in countries with low child mortality, but only ~65% effectiveness in countries with high child mortality. Similarly, oral polio vaccines have lower immunogenicity in developing country settings compared with high-resource settings. Data are more limited for oral cholera vaccines, but suggest lower titers among children compared with adults, and, for some vaccines, lower efficacy in endemic settings compared with non-endemic settings. These disparities are likely multifactorial, and available evidence suggests a role for maternal factors (e.g., transplacental antibodies, breastmilk), host factors (e.g., genetic polymorphisms-with the best evidence for rotavirus-or previous infection), and environmental factors (e.g., gut microbiome, coinfections). Overall, these data highlight the rather ambiguous and often contradictory nature of evidence on factors affecting oral vaccine response, cautioning against broad extrapolation of outcomes based on one population or one vaccine type. Meaningful impact on performance of oral vaccines will likely only be possible with a suite of interventions, given the complex and multifactorial nature of the problem and the degree to which contributing factors are intertwined.

The relationship between maternal age, obesity, and child mortality: A cross-sectional study using 2013-2014 Demographic and Health Survey in Democratic Republic of the Congo

Abstract Objective: To investigate the relationship between maternal age and nutritional status, and test associations between maternal nutritional status and child mortality with a focus on maternal obesity. Design: Secondary analysis of data from nationally representative cross-sectional sample of women of reproductive ages (15—49 years) and their children under five years. The outcome variable for maternal nutritional status was Body Mass Index (BMI), classified into underweight (BMI &lt; 18.50 kg/m2), normal weight (18.50—24.99 kg/m2), overweight (25.0—29.9 kg/m2) and obesity (&gt;=30.0 kg/m2). Child mortality was captured with five binary variables measuring the risk of dying in specific age intervals (neonatal, post-neonatal, infant, childhood, and under-five mortality). Setting: The most recent Demographic and Health Surveys from Democratic Republic of Congo (DRC). Participants: The final samples consisted of 7,892 women of reproductive ages (15—49 years) and 19,003 children aged 0—59 months. Results: The prevalence of obesity was estimated at 3.4%; it increased with maternal age. Furthermore, obesity unevenly affected provinces in the Democratic Republic of the Congo: Kinshasa, South Kivu, North Kivu and Maniema were most affected. Finally, maternal obesity showed mixed effects on child mortality. Conclusion: The prevalence of obesity is still low; however, provinces are unevenly affected. Therefore, interventions and programs to improve nutrition should incorporate geographical disparities to tackle adverse child outcomes associated with maternal obesity, to limit negative consequences of maternal obesity, including non-communicable diseases (NCD) which might be a strong impediment to reach Sustainable Development Goals (SDG) 2 and 3.

Factors contributing to under-5 child mortality in Nigeria: A narrative review

Despite repeated efforts by the Nigerian government and the international community, under-5 child mortality remains alarmingly high in Nigeria. This narrative review aims to reassess the key factors contributing to this persistent public health challenge. A comprehensive search of peer-reviewed articles and reports published in English was conducted to identify and synthesize data on the factors predisposing Nigerian children under 5 to mortality. The review identifies multiple interrelated contributors, including socioeconomic, sociocultural, and demographic factors, inadequate access to healthcare services, an under-resourced healthcare system, and a shortage of qualified healthcare professionals. The high burden of communicable and preventable diseases also plays a significant role in under-5 mortality. To address these issues, targeted interventions such as improving healthcare access, strengthening the health system, and reducing poverty are essential. The findings underscore the urgent need for a coordinated, multi-sectoral approach to effectively reduce under-5 mortality in Nigeria and improve the health outcomes of vulnerable children. Government, healthcare providers, and communities must work together to address these concerns so that all children can access the care they need to live and flourish.

Prevalence and determinants of full vaccination coverage according to the national schedule among children aged 12–35 months in Ghana

Universal immunization of children against common vaccine-preventable diseases is crucial in reducing infant and child morbidity and mortality. Assessing the vaccination coverage is a key step to improve utilization and coverage of vaccines for under-five children. Accordingly, vaccination coverage according to the national schedule assesses the vaccination coverage of children aged 12–35 months. However, there is a scarcity of information on the full vaccination coverage according to the national schedule and its determinants in Ghana. Therefore, this study aimed to assess the prevalence and predictors of vaccination coverage according to the national schedule among children aged 12–35 months in Ghana. A cross-sectional study design using the most recent demographic and health survey data from the Ghana Demographic and Health Survey was used. We included a total weighted sample of 1,823 children aged 12–35 months in the five years preceding the survey. We used a multilevel logistic regression model to identify associated factors for vaccination coverage according to the national schedule in Ghana. The adjusted odds ratio at 95% Cl was computed to assess the strength and significance of the association between explanatory and outcome variables. Factors with a p-value of < 0.05 are declared statistically significant. In this study, the full coverage of vaccination according to the national schedule among children aged 12–35 months in Ghana was 56.45% (95% CI 51.77–56.17). Women having an ANC visit were 40% more likely (AOR = 1.40, 95% CI 1.07–1.83), women involved in healthcare decision-making were 35% more likely (AOR = 1.35, 95% CI 1.05–1.75), Women who deliver in a health facility were 1.91 times more likely (AOR = 1.91, 95% CI 1.36–2.66), and communities with high media exposure were 47% more likely (AOR = 1.47, 95% CI 1.06–2.05) to achieve full vaccination coverage as compared to their counterparts. On the other hand, being in the Western (AOR = 0.4, 95% CI 0.18–0.88) and Northern (AOR = 0.33, 95% CI 0.15–0.74) regions decreased the odds of attaining full vaccination coverage according to the national schedule in Ghana. The full vaccination coverage according to the national schedule in Ghana was lower as compared to 90% coverage recommendation by World Health organization, and there is also in-equality among regions. Maternal optimal ANC contact, health facility delivery, women involved in health care decision-making, community media exposure, and region were significantly associated with full vaccination coverage according to the national schedule in Ghana. To improve child immunization coverage, relevant authorities and stakeholders should work together to improve ANC visits, media exposure, facility delivery, and women’s empowerment, and attention should be given to deviant regions.

FilmArray® Effectively Detects All Clades of F41 but Encounters Challenges with Other Adenovirus Species.

The BioFire FilmArray® Gastrointestinal (GI) Panel, a widely used diagnostic tool, is designed to detect the genetic material of 22 common pathogens responsible for gastroenteritis, including viruses, bacteria, and parasites. It can detect human adenovirus (HAdV) species F, particularly serotypes F40 and F41, which are the major causes of diarrhea and mortality in children. However, its potential shortcomings in detecting other HAdV species limit its effectiveness in broader HAdV detection in clinical settings and outbreak investigations. The aim of this study was to evaluate the ability of the GI Panel to detect three clades of HAdV-F41 and other HAdV species (viz., A31, B3, C1, C2, C5, C2/6, and D56) in Japan. Eighteen stool samples were analyzed, five of which contained HAdV-F41, and 13 contained other HAdV species, as confirmed via PCR and sequencing. Although the GI Panel reliably detected all clades of HAdV-F41, it failed to detect any other species, highlighting its limited diagnostic utility beyond F40/41 serotypes. Considering the high false-negative rate for non-F40/41 species, integrating complementary diagnostic methods such as PCR is crucial for comprehensive HAdV detection. These findings underscore the limitations of the GI Panel in detecting non-F40/41 species, such as HAdV-C (commonly associated with pediatric gastroenteritis) and other species that are important in immunocompromised patients. Complementary diagnostic methods, such as PCR or immunochromatographic assays, are essential to ensure accurate HAdV detection, especially in vulnerable populations.

PROGNOSTIC ACCURACY OF MACHINE LEARNING MODELS FOR IN-HOSPITAL MORTALITY AMONG CHILDREN WITH PHOENIX SEPSIS ADMITTED TO THE PEDIATRIC INTENSIVE CARE UNIT.

Objective: The Phoenix sepsis criteria define sepsis in children with suspected or confirmed infection who have ≥2 in the Phoenix Sepsis Score. The adoption of the Phoenix sepsis criteria eliminated the Systemic Inflammatory Response Syndrome criteria from the definition of pediatric sepsis. The objective of this study is to derive and validate machine learning models predicting in-hospital mortality for children with suspected or confirmed infection or who met the Phoenix sepsis criteria for sepsis and septic shock. Materials and Methods: Retrospective cohort analysis of 63,824 patients with suspected or confirmed infection admission diagnosis in two pediatric intensive care units (PICUs) in Atlanta, Georgia, from January 1, 2010, through May 10, 2022. The Phoenix Sepsis Score criteria were applied to data collected within 24 h of PICU admission. The primary outcome was in-hospital mortality. The composite secondary outcome was in-hospital mortality or PICU length of stay (LOS) ≥ 72 h. Model-based score performance measures were the area under the precision-recall curve (AUPRC) and the area under the receiver operating characteristic curve (AUROC). Results: Among 18,389/63,824 (29%) children with suspected infection (median age [25th - 75th interquartile range [IQR]): 3.9 [1.1,10.9]; female, 45%, a total of 5,355 met Phoenix sepsis criteria within 24 h of PICU admission. Of the children with Phoenix sepsis, a total of 514 (9.6%) died in the hospital, and 2,848 (53.2%) died or had a PICU stay of ≥72 h. Children with Phoenix septic shock had an in-hospital mortality of 386 (16.4%) and 1,294 (54.9%) had in-hospital mortality or PICU stay of ≥72 h. For children with Phoenix sepsis and Phoenix septic shock, the multivariable logistic regression, light gradient boosting machine, random forest, eXtreme Gradient Boosting, support vector machine, multilayer perceptron, and decision tree models predicting in-hospital mortality had AUPRCs of 0.48-0.65 (95% CI range: 0.42-0.66), 0.50-0.70 (95% CI range: 0.44-0.70), 0.52-0.70 (95% CI range: 0.47-0.71), 0.50-0.70 (95% CI range: 0.44-0.70), 0.49-0.67 (95% CI range: 0.43-0.68), 0.49-0.66 (95% CI range: 0.45-0.67), and 0.30-0.38 (95% CI range: 0.28-0.40) and AUROCs of 0.82-0.88 (95% CI range: 0.82-0.90), 0.84-0.88 (95% CI range: 0.84-0.90), 0.81-0.88 (95% CI range: 0.81-0.90), 0.84-0.88 (95% CI range: 0.83-0.90), 0.82-0.87 (95% CI range: 0.82-0.90), 0.80-0.86 (95% CI range: 0.79-0.89), and 0.76-0.82 (95% CI range: 0.75-0.85), respectively. Conclusion: Among children with Phoenix sepsis admitted to a PICU, the random forest model had the best AUPRC for in-hospital mortality compared to the light gradient boosting machine, eXtreme Gradient Boosting, logistic regression, multilayer perceptron, support vector machine, and decision tree models or a Phoenix Sepsis Score ≥ 2. These findings suggest that machine learning methods to predict in-hospital mortality in children with suspected infection predict mortality in a PICU setting with more accuracy than application of the Phoenix sepsis criteria.