Child Mortality Research Articles

EXTH-17. THERAPEUTIC EFFICACY OF B7-H3 CAR T CELLS IN PEDIATRIC HIGH-GRADE GLIOMAS WITH H3G34R/V MUTATION

Abstract Pediatric high-grade gliomas (pHGGs) are aggressive brain tumors responsible for significant childhood mortality. These tumors often carry mutations in the H3F3A gene, which encodes histone H3.3 proteins. However, current treatment options are limited, underscoring the need for innovative approaches. Chimeric antigen receptor (CAR) therapy, which was successful in treating certain childhood cancers, holds promise for pHGGs with H3G34R/V mutation. In this study, we examined the expression of B7-H3 in patient tumor specimens and various pHGG cell lines with H3G34R/V mutation. Data revealed substantial B7-H3 expression, confirming its potential as a therapeutic target. Co-culturing B7-H3 CAR T cells with H3G34R/V mutated KNS42 and SJ-HGG-X42 cells led to significant increase in the expression of markers associated with T cell activation (IL2, IL6, IF-γ, TNF-α) and immune responses involving cytolytic cells (Granzyme A, B, Perforin) and elevated levels of exhaustion markers (2B4, PD1, Tim3, Lag3) in comparison to mock-treated cells. We evaluated the capability of B7-H3 CAR T cells for cytolytic activity against KNS-42 and SJ-HGG-X42 cells through in vitro testing. Our results after 72 hours of co-culture revealed a strong killing potential of B7-H3 CARs against B7-H3 positive KNS-42 and SJ-HGG-X42 cells, while minimal or no killing was observed on B7-H3KO KNS-42 and B7-H3 negative MDA MD 453 cells. In vivo efficacy of B7-H3 CAR T cells in an orthotopic mouse xenograft model implanted with KNS-42 cells. B7-H3 CAR T cell treated mice showed a marked reduction in tumor burden and a substantial improvement in survival in contrast of CD19-CAR T cell treated control group. Lastly, we have developed a novel In-Utero Electroporation (IUE) immune-competent mouse model of pHGGs with H3G34R/V mutation, that enables exploration of the impact of immune suppressive tumor microenvironment on CAR T cells efficacy. In conclusion, B7-H3 emerges as a promising therapeutic target, and CAR T cells display encouraging functionality within the context of pHGGs with H3G34R/V model.

Factors Influencing Parental Practices Regarding Childhood Immunization in Lahore, Pakistan

Background: Childhood immunization is a key strategy of the World Health Organization (WHO) to reduce child mortality. The vaccine is intended to protect about 2 million and 3 million survivors per year. Despite this, Pakistan continues to struggle with vaccine-preventable diseases due to a significant number of unvaccinated children and is one of two states where the prevalence of poliovirus persists. This study aims to investigate the factors influencing parents’ decisions regarding childhood immunization in Pakistan, with a focus on understanding parental practices and perceptions surrounding vaccination Methods: A cross-sectional study was conducted to assess parent’s practices toward vaccination of their children in Lahore, Pakistan. Validated questionnaires was used to evaluate parent’s practices of childhood vaccination. The research population was 353 parents living in urban and rural areas of Lahore with children of different ages. The data collected through a questionnaire entered and analyzed by using SPSS program v21, IBM. P-values less than 0.05 were considered as statistically significant values. Results: Out of 353 parents surveyed, majority of the study subject were mothers (56.1%) with age 25-29 years with percentage 30.0%, stating that majority of the parents have poor practice (75.4%) and a few presented good practices i.e., 24.6%. Variables like occupation, number of children, residency, living class and health care providers in respondent family shows highly significant statistical association (p<0.001) with patient’s practice regarding their child immunization. Conclusion: The poor practice towards child immunization indicates a concerning gap in immunization adherence. The study revealed that a significant majority of parents demonstrated poor practices highlighting critical public health issues despite awareness campaigns. Factors such as limited access to healthcare facilities, socioeconomics challenges and cultural beliefs contribute to poor practice. The findings emphasize the need for improved support system and educational initiatives to bridge the gap between knowledge and practice, to enhance vaccination rates and improving public health outcomes.

Clinical relevance of lung microbiota composition in critically ill children with acute lower respiratory tract infections: insights from a retrospective analysis of metagenomic sequencing.

Acute lower respiratory tract infections (ALRIs) is a leading cause of child mortality worldwide. Metagenomic next-generation sequencing (mNGS) identifies ALRIs pathogens and explores the lung microbiota's role in disease severity and clinical outcomes. This study examines the association between lung microbiota and ALRIs outcomes in children, exploring its potential as a prognostic biomarker. We retrospectively analyzed mNGS data from the bronchoalveolar lavage fluid (BALF) of 83 pediatric ALRIs patients from 2019 to 2023. Microbial diversity and relative abundances of specific taxa were compared between survivor and non-survivor groups, as well as between varying severity levels. LEfSe was employed to identify key biomarkers related to survival and disease severity. Among the 83 patients, 68 survived and 15 died. Patients were also divided into a low severity group (n = 38) and a moderate-to-very-high severity group (n = 45) according to mPIRO score at admission. Significant differences in beta diversity were observed between the survival groups and across different severity levels. Prevotella, Haemophilus and Veillonella exhibited higher abundances in both the survivor and low severity groups, suggesting their potential as predictors of better outcomes. Conversely, Enterococcus and Acinetobacter baumannii were more prevalent in the non-survivor and moderate-to-very-high severity groups. Additionally, Streptococcus pneumoniae and Streptococcus mitis showed increased abundances in survivors. LEfSe further revealed that these microorganisms may predict outcomes and severity in ALRIs. Our findings underscore the complex relationship between lung microbiota and ALRIs, with specific microbial profiles associated with disease severity and clinical outcomes. This underscores the need for further research to explore and validate its prognostic predictive capacity. Not applicable.

Completion of maternal and child health continuum of care and associated factors in West Gondar Zone, North West Ethiopia, 2023: a community based cross sectional study

BackgroundThe maternal and child health continuum of care integrates services from pre-pregnancy through childhood to enhance maternal and child outcomes. It is crucial for reducing maternal and child mortality by focusing on comprehensive health interventions. Despite its significance, comprehensive studies on the continuum remain limited. This study aimed to assess the completion of the maternal and child health continuum of care and associated factors among mothers with index children aged 12–23 months in the West Gondar Zone, Northwest Ethiopia, in 2023.MethodsA community-based cross-sectional study was conducted from May 1–30, 2023, by interviewing mothers of 12-23-month-old children in West Gondar zone. A simple random sampling method was used to select 1,019 mothers. Data were collected via KoboCollect and analyzed in Stata version 14.0. Binary logistic regression was used to examine associations between independent variables and the continuum of care. Variables with a p value < 0.2 in bi-variable analysis were included in the multivariable model. Finally, adjusted odds ratios (AOR) with 95% confidence intervals (CI) and p values < 0.05 were used to determine statistical significance. The Hosmer and Lemeshow goodness-of-fit test was computed.ResultsThe overall rate of completion of the maternal and child health continuum of care was 6.19% (95% CI: 4.69–7.68). The factors associated were having the first ANC visit before 16 weeks of pregnancy [AOR: 4.25 (CI: 2.14–8.47)], birth preparedness and complication readiness [AOR: 3.02 (CI: 1.41–6.46)], history of modern contraceptive use [AOR: 2.34 (CI: 1.16–4.73)], intended pregnancy [AOR: 3.25 (CI: 1.63–6.48)], receiving maternal services during ANC visits [AOR: 2.69 (CI: 1.07–6.80)], and the health facility being less than an hour away from home [AOR: 2.53 (CI: 1.06–6.03)].ConclusionsThe maternal and child health (MCH) continuum of care in West Gondar was low. Key factors affecting completion included birth preparedness and complication readiness, early ANC initiation, planned pregnancy, family planning use, proximity to health facilities, and maternal health services provided during ANC. Efforts should target these factors and ensure services at each stage of the continuum to stay mothers along the path of the MCH continuum of care.

Trends in Twin Births and Survival in Rural Spain: Evidence from 18th to 20th Century.

This study examines the changes over time of the twinning rate and infant and child mortality across 17 rural villages in the province of Zaragoza (Spain) over a span of 200 years. The aim is to understand how the twinning rate evolved in conjunction with the processes of economic and social modernization, as well as the demographic transition. During the period analyzed, the twinning rate increased by 10%, rising from 1.26 per 1000 births in the second half of the 18th century to 1.38 per 1000 births in the first half of the 20th century. This rate varied due to hereditary issues, biological factors such as the mother's age and parity, and socioeconomic features like family occupation and the mother's education level. In terms of child mortality, twins historically faced a significantly higher mortality rate. However, they benefited greatly from the mortality transition, at least in absolute numbers. While nearly 60% of twins did not survive beyond 5 years of age in earlier periods, the mortality rate for twins decreased to 40% by the first half of the 20th century. The excess mortality was particularly severe for girls, driven by a widespread preference for sons, which led to higher mortality rates for girls in the first 5 years of life, especially in the earliest months. These findings help us understand the improvements in uterine and childhood survival rates for contemporary twins, which can be attributed to the socioeconomic and medical advancements of the 20th century.

Evaluating Treatment and Management Strategies for Diarrhea and Typhoid Fever in Uganda

Diarrhea and typhoid fever remain significant public health challenges in Uganda, contributing to high morbidity and mortality, particularly among vulnerable populations. This review evaluates current treatment and management strategies for these diseases, focusing on standard protocols, rehydration therapy, and the escalating issue of antibiotic resistance. Diarrhea, primarily caused by infectious agents, accounts for a substantial portion of childhood morbidity and mortality, while typhoid fever, caused by Salmonella enterica serotype Typhi, poses severe health risks, particularly in urban areas with poor sanitation. Effective management relies on timely interventions, including rehydration therapy, which significantly reduces the risk of dehydration-related complications. However, the emergence of antibiotic resistance complicates treatment efficacy, necessitating ongoing evaluation and adaptation of management strategies. This review highlights the importance of integrated public health approaches that combine treatment, prevention, and community education to address the interplay of these diseases in Uganda. Key recommendations include the exploration of novel treatment modalities, robust surveillance of resistance patterns, and understanding the impact of climate change on disease incidence. Keywords: Diarrhea, Typhoid fever, Uganda, Public health, Rehydration therapy, Antibiotic resistance.

Prevalence of diarrhea and its associated factors among children under five years in Awi Zone, Northwest Ethiopia

BackgroundGlobally, diarrhea continues to be the leading cause of morbidity and mortality for children under five, with an annual rate of 149 million cases of illness and 760,000 deaths. This study aimed to assess prevalence and contributing factors of diarrhea among children under-five years in Awi Zone, Northwest Ethiopia.MethodsA community based cross-sectional study was conducted on 1387 participants from February to June 2023. A multistage sampling method was conducted. Structured and pretested questionnaires were used to collect the data. Data were entered in to Epi data and exported to STATA for analysis. A multivariable logistic regression was performed to determine factors associated with diarrhea with p-value < 0.05.ResultsThe prevalence of diarrheal disease among children under five was 17.16%. Child’s age 12 to 23 months [AOR = 16.642; 95% CI: (3.119, 88.805)], protected drinking water [AOR: 0.629; 95% CI: (0.840, 0.928)], health insurance [AOR = 0.571;95% CI: (0.386, 0.844)], institutional delivery [AOR = 0.426, 95% CI: (0.256, 0.707)], water shortage [AOR = 1.570, 95% CI: (1.083, 2.277)], and vaccinated for measles [AOR = 0.124, 95% CI: (0.065, 0.236)] were associated with diarrhea.ConclusionAge of children, source of drinking water, health insurance, place of delivery, family size, water shortage, liquid waste disposal, and measles vaccination were significantly associated with diarrhea among under five children. Interventions targeting improvements in drinking water sources, health insurance coverage, sanitation practices, and vaccination rates are crucial for mitigating the impact of diarrheal disease among children under five years in Awi Zone.

Epidemiology of Emergency Department Visits for Children With Clinically Significant Cardiovascular Disease.

The aim of the study is to determine the epidemiology, cost, and factors associated with hospital admission, deterioration if hospitalized, and mortality for children with a history of clinically significant cardiovascular disease (CVD) presenting to pediatric emergency departments (EDs). Using the Pediatric Health Information System, we performed a retrospective analysis of ED encounters of children ≤17 years old with clinically significant CVD between 2016 and 2021. Patients were included if they had a cardiovascular complex chronic condition, defined by ICD diagnosis, and procedure codes. We assessed the primary diagnosis, admission rate, ICU transfer rate (as a marker of disease progression), mortality, resource utilization, and costs. We conducted multivariable analyses to identify risk factors for admission, ICU transfer, and mortality. There were 201,551 ED visits (mean 33,592 ± 3354 per year) among 129,938 children with clinically significant CVD. Most ED encounters had a primary diagnosis of a circulatory (21.1%) or respiratory (19.7%) illness. Seventy-six percent of visits had at least one blood test or imaging study conducted. The overall admission rate was 59.7%, with 28.7% admitted to the ICU, and 6.2% transferred to the ICU after the first 24 hours. The median costs for encounters resulting in admission were $13,605 in US 2023 dollars. In multivariable analyses, younger age, a greater number of noncardiac complex chronic conditions, and CVD type were associated with increased odds of admission, ICU transfer after 24 hours, and mortality (all P < 0.05). ED visits for children with clinically significant CVD lead to substantial resource utilization, including frequent hospitalization, ICU level of care, and costs. This baseline data aids in the development of prospective studies to inform the appropriate ED management for children with clinically significant CVD.

Prevalence and factors associated with cerebral malaria among children aged 6 to 59 months with severe malaria in Western Uganda: a hospital-based cross-sectional study

IntroductionCerebral malaria, caused by Plasmodium falciparum, represents the most severe neurologic complication of malaria. Its association with high morbidity and mortality rates, especially among young children, underscores its clinical significance. In sub-Saharan Africa, including Uganda, cerebral malaria remains a major health challenge, contributing significantly to the high child mortality rate. Despite advances in malaria control, the burden of cerebral malaria among children under five is substantial, reflecting the need for targeted interventions and improved management strategies. This study aimed to determine the prevalence of cerebral malaria and identify associated factors among children admitted with severe malaria at a tertiary hospital in western Uganda.MethodsThis was a cross-sectional, descriptive, and analytical study involving children aged 6 to 59 months admitted with severe malaria. The study was conducted from January to March 2023 at Fort Portal Regional Referral Hospital. Severe and cerebral malaria were defined as per the WHO criteria. Sociodemographic, clinical, and laboratory data were collected and analyzed using IBM SPSS version 27. Logistic regression analysis was used to evaluate the factors associated with cerebral malaria. A p-value < 0.05 indicated statistical significance.ResultsA total of 250 children were recruited (mean age 33.1 ± 17.3 months). The prevalence of cerebral malaria was 12.8% (95% CI: 8.9–17.6). Cerebral malaria was independently associated with male sex (aOR: 3.05, 95% CI: 1.20–7.77, p = 0.02), abnormal bleeding (aOR: 13.22, 95% CI: 11.54–15.16, p = 0.001), history of convulsions (aOR 12.20, 95% CI: 10.7–21.69, p = 0.010), acute kidney injury (aOR: 4.50, 95% CI: 1.30–15.53, p = 0.02), and hyponatremia (aOR: 3.47, 95% CI: 1.34–8.96, p = 0.010).Conclusions and recommendationsThe prevalence of cerebral malaria was high among children with severe malaria. Factors associated with cerebral malaria included male gender, history of convulsions, abnormal bleeding, acute kidney injury, and hyponatremia. Targeted interventions and early management are essential to improve clinical outcomes.

Aortic Rupture in a Pediatric Patient With Influenza.

Influenza can lead to significant morbidity and mortality in children. Aortopathy tends to occur in adults during influenza season; however, aortic pathology in children with influenza is exceedingly rare. This report describes a child who experienced an aortic rupture during an influenza infection without evidence of secondary bacterial infection or connective tissue disorder.

COVID-19 infection in children with blood cancer: A systematic review.

Blood cancer is the most common type of cancer and the leading cause of death by disease past infancy among children. Children with blood cancer are vulnerable population to viral infections such as coronavirus disease 2019 (COVID-19). To estimate the incidence of COVID-19 in children with blood cancer and analyse the demographic parameters, clinical characteristics and treatment outcomes in children with blood cancer with COVID-19 illness. We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline and searched ProQuest, Medline, Embase, PubMed, CINAHL, Wiley online library, Scopus and Nature for studies on the development of COVID-19 in children with blood cancer, published from December 1, 2019 to April 30, 2023, with English language restriction. Of the 3077 papers that were identified, 155 articles were included in the systematic review (83 case report, 54 cohort and 18 case-series studies). Studies involving 1289 children with blood cancer with confirmed COVID-19 were analysed. Leukaemias (1141 cases) were the most frequent types of blood cancer observed in children who developed COVID-19, followed by non-Hodgkin's lymphomas (59 cases), Hodgkin's lymphomas (36 cases), Langerhans cell histiocytosis (7 cases), myelodysplastic syndrome (7 cases) and myeloid neoplasm (1 case). Among all 1289 blood cancer paediatric cases who transmitted severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), some children were documented to be admitted to the intensive care unit (ICU) (n = 175, 13.6%), intubated and placed on mechanical ventilation (MV) (n = 111, 8.6%), suffered acute respiratory distress syndrome (ARDS) (n = 144, 11.2%) or died (n = 111, 8.6%). Overall, COVID-19 in children with different types of blood cancer resulted in no or low severity of disease in 78.6% of all included cases (COVID-19 severity: asymptomatic = 238, mild = 601, or moderate = 171). Treatment for COVID-19 was not necessary in a small number of children with blood cancer (n = 94, 7.3%). Fatality in children with blood cancer with COVID-19 was reported in any of the included blood cancer categories for leukaemias (n = 99/1141, 8.7%), non-Hodgkin's lymphomas (n = 7/59, 11.9%), Hodgkin's lymphomas (n = 2/36, 5.5%), myelodysplastic syndrome (n = 1/7, 14.3%) or myeloid neoplasm (n = 1/1, 100%). Fatality rate in children with blood cancer infected with SARS-CoV-2 was the highest in patients with Hispanic ethnicity (n = 44/111, 39.6%) and COVID-19-related fatality was highest in male patients (76.5% of deceased patients). Most studies reported to alter the intensity and regimen of anticancer treatment in children with blood cancer during course of SARS-CoV-2 infection, however, many studies have reported to successfully treat COVID-19 without any changes to the anticancer treatment. Globally, leukaemias were the most prevalent and myeloid neoplasms were the least prevalent blood cancer types in children who developed SARS-CoV-2 infection. Children with blood cancer infected with SARS-CoV-2 may experience higher rates of ICU admission and mortality in comparison with the healthy pediatric populations. Mortality in children with blood cancer and infected with SARS-CoV-2 was highest in cases belonging to male gender and Hispanic ethnicity. However, children with blood cancer tend to have milder COVID-19 symptoms and are less likely to be hospitalized and have better prognosis when compared to adults. Continuation of anticancer treatment in individual paediatric blood cancer patients with COVID-19 seems to be possible.

THE IMPACT OF PAEDIATRIC EMERGENCY MANAGEMENT SKILLS ON PATIENT OUTCOMES IN ZARIA

Paediatric emergencies represent a critical challenge in Nigeria, where approximately 2,300 children under the age of five die daily, predominantly from preventable and treatable conditions such as pneumonia, malaria, and diarrheal diseases. Mortality rates are disproportionately higher in rural areas, where primary health care (PHC) centers often serve as the only point of access to medical services. The effectiveness of these centers is largely dependent on the emergency management skills of their healthcare workers. Despite their importance, there has been limited research on how the skills of PHC workers in managing paediatric emergencies impact patient outcomes. This study aimed to assess the proficiency of healthcare workers in primary healthcare centers in Zaria in managing common paediatric emergencies. A cross-sectional descriptive study was conducted among 139 health workers selected through a multi-stage sampling technique in Sabon Gari and Zaria Local Government Areas. Data collection was carried out using a pre-tested semi-structured self-administered questionnaire. The data were analyzed using SPSS version 21, and associations were tested using the chi-square test, with results presented in tables and charts. The findings revealed a significant deficiency in the emergency management skills of healthcare workers. A majority of respondents demonstrated inadequate skills in handling paediatric emergencies, with 66 (48.5%) exhibiting very poor competency in the management of common paediatric emergencies, and 32 (23.5%) displaying poor competency. Only a small fraction, 4 (2.9%) of respondents, demonstrated excellent skills in emergency management. Similarly, 46.7% of the respondents had very poor skills in the treatment of common paediatric emergencies, while only 3.0% exhibited excellent treatment skills. A statistically significant relationship was observed between the level of academic qualification and emergency management skills (p &lt; 0.05). The results underscore the critical need to enhance the skill levels of healthcare workers in PHCs through continuous professional development. This could be achieved through collaborative efforts between the Department of Paediatrics at Ahmadu Bello University Teaching Hospital and the Primary Health Care Departments of Zaria and Sabon Gari local governments, focusing on regular training and workshops. Improving the skills of healthcare workers in managing paediatric emergencies is essential for reducing child mortality and improving health outcomes in the region.

Time Trends in the Burden of Environmental Heat and Cold Exposure Among Children and Adolescents

Environmental heat and cold exposure (EHCE) remains the principal preventable cause of morbidity and mortality in children and adolescents globally. To report EHCE-related burden and analyze its temporal trends among children and adolescents from 1990 to 2019. This repeated cross-sectional study used data from the Global Burden of Disease Study 2019, which encompassed 204 countries and territories from 1990 to 2019. Children and adolescents aged 0 to 19 years were included in the study. Data analysis occurred from December 2023 to March 2024. EHCE in children and adolescents from January 1990 to December 2019. The primary outcomes were cases and rates of EHCE incidence, prevalence, mortality, disability-adjusted life-years (DALYs), and average annual percentage changes (AAPCs). Global trends in these metrics were also analyzed by sex, age, and sociodemographic index (SDI), which is a comprehensive indicator of the socioeconomic status of a country or region. A linear regression model was used to calculate AAPCs and a joinpoint regression model was used to identify the years in which trends changed significantly. From 1990 to 2019, EHCE-related incidence, prevalence, mortality, and DALYs showed a downward trend globally. However, an upward trend in EHCE incidence and prevalence was detected between 2010 and 2019 (incidence AAPC, 1.46; 95% CI, 1.05-1.87; prevalence AAPC, 1.25; 95% CI, 1.01-1.50). Regionally, although EHCE-related incidence showed a decreasing trend in most regions from 1990 to 2019, there were still some regions with an increasing trend (Southern sub-Saharan Africa AAPC, 0.23; 95% CI, 0.01-0.44). In 2019, the mortality and DALYs of EHCE were higher among children and adolescents in countries with low SDI levels. Additionally, the burden of EHCE among children and adolescents varied according to sex and age. In this cross-sectional study, a global increase was observed in EHCE incidence and prevalence since 2010. Furthermore, children and adolescents in low-SDI regions, which bear the brunt of the climate crisis, were disproportionately impacted. This suggests that future responses to climate change crises should emphasize health equity, which implies that vulnerable populations, such as children and adolescents, should be given priority in the allocation of resources to address climate change.

Corticosteroids in Pediatric Bacterial Meningitis: A Meta-Analysis of Randomized Controlled Trials Comparing Dexamethasone and Adjunctive Therapies

Introduction: Bacterial meningitis remains a significant cause of morbidity and mortality in children. Adjunctive corticosteroid therapy, particularly dexamethasone, has shown promise in reducing inflammation and improving outcomes. This meta-analysis aimed to evaluate the efficacy and safety of dexamethasone compared to placebo or other adjunctive therapies in pediatric bacterial meningitis. Methods: A systematic search of PubMed, Embase, and the Cochrane Central Register of Controlled Trials was conducted from January 2013 to October 2024. Randomized controlled trials (RCTs) comparing dexamethasone with placebo or other adjunctive therapies in children with bacterial meningitis were included. Primary outcomes were hearing loss, neurological sequelae, and mortality. Secondary outcomes included adverse events. Data were pooled using a random-effects model, and the risk ratio (RR) with 95% confidence intervals (CI) was calculated. Results: Six RCTs met the inclusion criteria, comprising 2,840 children. Dexamethasone was associated with a significant reduction in hearing loss (RR 0.57, 95% CI 0.45-0.71, p=0.005) and neurological sequelae (RR 0.66, 95% CI 0.56-0.78, p=0.006) compared to placebo. No significant difference in mortality was observed (RR 0.78, 95% CI 0.49-1.27, p=0.32). The incidence of adverse events, including gastrointestinal bleeding and hyperglycemia, was similar between the dexamethasone and placebo groups. Conclusion: Adjunctive dexamethasone therapy in pediatric bacterial meningitis significantly reduces hearing loss and neurological sequelae without increasing mortality or the risk of serious adverse events.

Spatiotemporal patterns and factors contributing to neonatal mortality in Ethiopia: Data from EDHS 2000 to 2019.

Although Ethiopia has substantial improvements in various health indicators such as maternal and child mortality, the burden of neonatal mortality remains high. Between 2016 and 2019, neonatal mortality increased from 29 deaths per 1,000 live births to 33 deaths per 1,000 live births. This study aimed to explore the spatial patterns and factors contributing to neonatal mortality in Ethiopia. Data from the Ethiopian Demographic and Health Surveys (EDHS) for the years 2000, 2005, 2011, 2016, and 2019 were analyzed. The EDHS sampling design uses a two-stage cluster sampling technique, considering census enumeration areas as primary sampling units and households as secondary sampling units. We used the Spatial Scan analysis in SaTScan and Getis-Ord Gi* statistic in Geographic Information System (GIS), to analyse the spatiotemporal patterns of neonatal mortality. Maternal, newborn and health service-related factors contributing to neonatal mortality were also analyzed using a multilevel logistic regression model. Adjusted Odds Rios (AOR) with corresponding 95% CI were presented as a measure of association and a P-value of 0.05 was used to declare statistical significance. During the initial three consecutive surveys, there was a consistent pattern of hot spot clusters in the Amhara and Benshangul Gumuz regions, along with certain parts of the Oromia region. However, in later surveys, these clusters shifted to the eastern parts of the country, notably including the Somali region. Early initiation of breast feeding was associated with reduced chances of neonatal death (Adjusted Odds Ratio [AOR]) = 0.27; 95% Confidence Interval [CI]: 0.23, 0.32). Neonates born at home (AOR = 1.46; 95% CI: 1.16, 1.82) and male babies had a higher likelihood of mortality during the neonatal period compared to their counterparts (AOR = 1.36; 95% CI: 1.24, 1.51). The odds of neonatal mortality increased with the number of children a mother had ever given birth to (AOR = 1.36; 95% CI: 1.24, 1.51). In contrast, longer birth intervals were associated with a reduced risk of neonatal mortality (AOR = 0.76; 95% CI: 0.68, 0.83). The central southern, central-western, north-western, and northern parts of Ethiopia had most of the neonatal death clusters in the first three rounds of DHS while eastern Ethiopia had the highest neonatal mortality clusters in the latest two surveys. Our results underscore the importance for policymakers and health administrators to reassess intervention approaches and reallocate resources to regions identified as hot spots for neonatal mortality. Enhancing the initiation of breastfeeding within the first hour of birth would improve newborn survival rates. Special attention and care need to be given to babies born of smaller sizes.

Novel coenzyme Q6 genetic variant increases susceptibility to pneumococcal disease.

Acute lower respiratory tract infection (ALRI) remains a major worldwide cause of childhood mortality, compelling innovation in prevention and treatment. Children in Papua New Guinea (PNG) experience profound morbidity from ALRI caused by Streptococcus pneumoniae. As a result of evolutionary divergence, the human PNG population exhibits profound genetic variation and diversity. To address unmet health needs of children in PNG, we tested whether genetic variants increased ALRI morbidity. Whole-exome sequencing of a pilot child cohort identified homozygosity for a novel single-nucleotide variant (SNV) in coenzyme Q6 (COQ6) in cases with ALRI. COQ6 encodes a mitochondrial enzyme essential for biosynthesis of ubiquinone, an electron acceptor in the electron transport chain. A significant association of SNV homozygosity with ALRI was replicated in an independent ALRI cohort (P = 0.036). Mice homozygous for homologous mouse variant Coq6 exhibited increased mortality after pneumococcal lung infection, confirming causality. Bone marrow chimeric mice further revealed that expression of variant Coq6 in recipient (that is, nonhematopoietic) tissues conferred increased mortality. Variant Coq6 maintained ubiquinone biosynthesis, while accelerating metabolic remodeling after pneumococcal challenge. Identification of this COQ6 variant provides a genetic basis for increased pneumonia susceptibility in PNG and establishes a previously unrecognized role for the enzyme COQ6 in regulating inflammatory-mediated metabolic remodeling.

Risk factors for occurrence and death of sepsis-associated acute kidney injury in children with sepsis

IntroductionThe 28th Acute Disease Quality Initiative (ADQI) Workgroup proposed the first international consensus on definition of SA-AKI in June 2023. The incidence and mortality of ADQI-defined SA-AKI in septic children is unknown, and the risk factors for the occurrence and death of SA-AKI is unexplored. MethodsWe conducted a retrospective study of septic children between January 1, 2018 and December 31, 2022. Logistic regression analysis was used to identify risk factors for SA-AKI. COX proportional hazards regression analysis was utilized for analyzing the risk factors for 30-day mortality in SA-AKI and septic children. Results221 children were included, of which 81 (36.7 %) developed SA-AKI, with 25.9 % developed into acute kidney disease. Older age, lower baseline eGFR and mechanical ventilation were independently associated with SA-AKI (P < 0.001, P < 0.01 and P < 0.05 respectively). Among the 81 SA-AKI children, 32.1 % died within 30 days from sepsis diagnosis, with higher mortality in children with late SA-AKI than early SA-AKI (72.2 % versus 20.6 %, P < 0.001). Septic shock was independently associated with 30-day death in SA-AKI children (P < 0.05). The overall 30-day mortality of septic children was 19.0 %, with mechanical ventilation, SA-AKI, and septic shock identified as independently associated with 30-day death (P < 0.001, P < 0.05 and P < 0.001 respectively). ConclusionsSA-AKI is of high incidence and mortality in septic children. Older age, lower baseline eGFR and mechanical ventilation were independent risk factors for SA-AKI. SA-AKI was independently associated with 30-day mortality in septic children.

The impact of conditional cash transfer (CCT) on health and education in a coastal community: A randomized control trial (RCT) and regression discontinuity design (RDD)

This study evaluates the impact of the Pantawid Pamilyang Pilipino Program (4Ps), a national conditional cash transfer (CCT) on the health and education of beneficiaries in the coastal community of Maangas, Presentacion, Camarines Sur. It compares households receiving 4Ps benefits to a control group of non-recipients with similar sociodemographic characteristics to establish counterfactuals. Using a Randomized Control Trial (RCT) approach, data were collected from 157 participants in each treatment and control group through structured questionnaires. Descriptive statistics were utilized to analyze the economic profiles of respondents, revealing diverse representations. Logistic regression models unveiled significant correlations between attendance, dropout rates, and various predictor variables, notably the 4Ps program and eligibility, location, household size, and perceptions. Regarding health outcomes, the analysis demonstrates the positive impact of 4Ps membership on reducing child mortality, improving child growth, and promoting healthcare-seeking behaviors. Factors such as clinic visits, health insurance, and health beliefs also significantly influence health outcomes. RDD underscores the effectiveness of the 4Ps program in poverty alleviation, with eligibility playing a key role in enhancing income outcomes among beneficiaries. Prioritizing access to healthcare services, reinforcing the importance of regular clinic visits, and optimizing child health outcomes are crucial steps towards sustainability of the program. Tailored interventions based on enrollment status and academic performance can help prevent student attrition. Providing aid to coastal communities and embedding livelihood support programs in 4Ps can break the cycle of poverty by integrating these initiatives into the current structure of the program.

The Modified History of Juvenile Rheumatic Mitral Stenosis Following Percutaneous Transmitral Commissurotomy: Intermediate-Term Outcomes From a Decadal Follow-Up Study

There are few studies that have looked at the long-term outcomes of juvenile mitral stenosis (JMS) following percutaneous transmitral commissurotomy (PTMC). This study sought to analyse the modified history of JMS in children following PTMC. We describe a longitudinal, observational follow-up study of all children and young adults aged <20 years who underwent PTMC at Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India from 2012 to 2021. Children were followed up for progression of mitral stenosis (MS), development of mitral regurgitation (MR), need for repeat interventions (percutaneous or surgical), and mortality. A total of 114 children and adolescents underwent the procedure. The mean age of children in the study was 15.1±2.5 years. After immediate procedural success, there was a tendency towards restenosis with respect to valve areas and transmitral gradients at follow-up. Severe MR after the procedure was noted in 2.6%. Compliance with penicillin prophylaxis was noted in 42.5%. The Kaplan-Meier survival estimate over 10 years showed a mortality rate of 1.98/100 patient-years and a re-intervention rate (re-do PTMC or surgery) of 5.50/100 patient-years. Additional valvular lesions were noted in 13.1% of children during follow-up. Severe symptomatic status at presentation (New York Heart Association class 4) was predictive of mortality, and children aged <15 years often needed re-intervention. With a mortality rate of 6.1% and re-do intervention rate of 15.8% during extended follow-up, JMS has considerable healthcare implications in terms of morbidity and mortality in children and young adults.

Prevalence of diarrhoea and treatment-seeking practices among children

Estimating the proportion of children with diarrhoea and those who are taken in as inpatients or outpatients is important for policy planning, resource allocation, and to evaluate the effectiveness of diarrhoea prevention and control interventions. We aimed to estimate the proportion of children <2 years of age with diarrhoea, explore their treatment-seeking practices, and identify factors associated with both diarrhoea and treatment seeking. We designed a longitudinal study based on a sample of children <2 years of age in the Birhan field site from September 2018 to September 2019. The study site collected data on child mortality and morbidity and treatment-seeking practice for those with a history of illness every three months. Mothers/caregivers were asked about signs or symptoms of illnesses for a two-week period prior to each study visit. We estimated the proportion of children <2 years of age with diarrhoea and treatment-seeking practices for each of the four rounds of data collection and identified associated factors through bivariable and multivariable logistic regression. We enrolled 4678 children <2 years of age. The proportion of children with diarrhoea was the highest from 11 September 2018 to 9 December 2018 (4.47%; 95% confidence interval (CI) = 3.70-5.35) and the lowest from 10 December 2018 to 9 March 2019 (2.48%; 95% CI = 1.90-3.19). Children from households with chlorinated drinking water had a 50% (adjusted odds ratio (aOR) = 0.50; 95% CI = 0.28-0.88) lower odds of developing diarrhoea compared to those who did not. Among 339 children with diarrhoea, 275 (81.12%; 95% CI = 76.54-85.15) were taken to health facilities for treatment. Female children had lower odds of being taken to health facilities for treatment (aOR = 0.37; 95% CI = 0.17-0.80) compared to males. While the proportion of children with diarrhoea in our study was lower than that observed in prior research conducted in Ethiopia, treatment-seeking practices were higher. Female children and children from the poorest families had lower odds of treatment. We recommend more studies to explore gender-based and socioeconomic differences affecting treatment-seeking practices.