National Child Health Research Articles

Developing Collaborative Maternal and Child Health Leaders: A Descriptive Study of the National Maternal and Child Health Workforce Development Center.

Purpose An assessment of the National Maternal and Child Health Workforce Development Center (the Center) was conducted to describe (1) effects of the Center's training on the use of collaborative leadership practices by MCH leaders, and (2) perceived barriers to collaboration for MCH leaders. The Center provides services to strengthen MCH professionals' skills in three core areas: Change Management/Adaptive Leadership, Evidence-Based Decision Making, and Systems Integration. Description This descriptive qualitative study compares eight interview responses from a sample of the Center's participants and findings from a document review of the training curriculum against an existing framework of collaborative leadership themes. Assessment Systems thinking tools and related training were highly referenced, and the interviewees often related process-based leadership practices with their applied learning health transformation projects. Perceived barriers to sustaining collaborative work included: (1) a tendency for state agencies to have siloed priorities, (2) difficulty achieving a consensus to move a project forward without individual partners disengaging, (3) strained organizational partnerships when the individual representative leaves that partnering organization, and (4) difficulty in sustaining project-based partnerships past the short term. Conclusion The findings in this study suggest that investments in leadership development training for MCH professionals, such as the Center, can provide opportunities for participants to utilize collaborative leadership practices.

Development of a framework for the delivery of integrated child healthcare: a commissioning support tool

Introduction : Designing a new model of healthcare for children is complex. There is a tendency to take a top-down ‘one-size-fits-all’ approach. At Connecting Care for Children (CC4C, an inner London integrated child healthcare scheme), we like to do something different and be the leaders of change! We offer an integrated approach to the care of children and young people based on a ‘whole population framework’ consisting of patient segments, covering the healthy child, the acutely unwell child and the child with long term illness1. It deviates away from pathways for specific conditions and redirects focus to the experience of the child with the condition, rather than just the medical aspects2. Policy context and objective : There is a need to improve outcomes and patient experience, without increasing costs. In order to build upon current services effectively, it is imperative to (i) understand the services already on offer, and (ii) identify areas where attention is needed. As such, CC4C devised a framework using a six patient segment model, to extend knowledge of services available across the sectors and act as an aid to strategic planning and commissioning. The framework lists the access points and services available to children and their families, across a population footprint. It also identifies important gaps in provision and issues relating to child health, with reference to the Child and Young People Joint Strategic Needs Assessments for the geographical area, as well as CHiMAT (National Child and Maternal Health Intelligence Network) data. Current initiatives that are underway or planned, are presented alongside the key issues, as an aid to ‘place-based’ commissioning. Targeted population : With new interest into commissioning in the form of accountable care organisations and partnerships3, this working document is especially helpful, and can be used as a tool in the planning of such partnerships and to allocate funding. The framework can be populated and grown with ideas generated from multi-agency input as well as patients themselves. Highlights : This easy to use, manageable framework aims to promote and deliver integrated care by identifying child health issues at a grassroots level. By identifying the issues at the ‘point-of-healthcare’, by both providing and receiving parties, we can define ‘never been seen before’ issues that have not previously been highlighted at the commissioning level, but that, when addressed, would have a real impact on patient experience. Transferability : Currently developed for child health, such a framework can be modified to be applicable across all age groups, populations and healthcare settings. It has already been adopted for use by three clinical commissioning groups for child health, and interest has been shown by the ‘care of the elderly’ sector. Conclusions : We believe this framework can be used as a building block for integrated care to allow all stakeholders to view current services, areas of need and thus offer solutions that really work. Through such an approach, we can truly connect with our patients and improve the patient healthcare experience. (Word count excluding references: 486) References : 1- Klaber B, Watson M. ‘A whole population approach: patient segments in child health. Connecting Care for Children North West London. Slideshow. 2014. Available from: www.londonpaediatrics.co.uk/wp/wp-content/uploads/2014/02/A-WholePopulation-Approach-Segments-in-Child-Health-Dec-13.pdf [Accessed 14th December 2016] 2- Klaber RE, Blair M, Lemer C, Watson M. Whole population integrated child health: moving beyond pathways. Arch Dis Child 2017;102:5-7. Published Online First: 23 May 2016. doi:10.1136/archdischild-2016-310485. Available from: http://adc.bmj.com/content/102/1/5 [Accessed 14th December 2016] 3- The King’s Fund. Accountable Care Organisations Explained. Available from: https://www.kingsfund.org.uk/topics/integrated-care/accountable-care-organisations-explained [Accessed 14th December 2016]

Disease burden on drowning in the Chinese population, in 1990 and 2013

Objective: To comprehensively analyze the disease burden of drowning in the Chinese population both at the national and provincial levels in 1990 and 2013, to provide reference for the development of strategies regarding drowning prevention. Methods: Both methods related to unified measurement framework and standardized estimation on Global Burden of Disease in 2013, were used. Data on deaths caused by injuries were from the following sources which include: Disease Surveillance Points, the National Maternal and Child Health Surveillance Network, the Death Registration Reporting System of Chinese Center for Disease Control and Prevention, Death Registration System and death information from Macau and Hong Kong areas of China. Injury-related incidence data was from the National Injury Surveillance System and literature review. Parameters as death/death rate, years of life lost due to premature mortality (YLL)/standardized YLL rate, years living with disability (YLD)/standardized YLD rate and disability-adjusted of life years (DALY)/standardized DALY were used to analyze the disease burden and changing trend on drowning at both the national and all the provincial levels. Results: In 2013, the number of deaths due to drowning was63 619 in China, with the standardized mortality rate as 5.29 per 100 000, accounting for 8.0% of the total injury deaths. Drowning was the fourth leading cause of injury death in the whole population and the first leading cause of injury death among children aged <5 and 5-14 years old in 2013, with YLL of drowning as 3.49 million person years, YLD as 0.04 million person years, and DALY as 3.53 million person years. Compared with data from 1990, the rates on standardized mortality, standardized YLL, standardized YLD and standardized DALY of drowning all declined in 2013. The five provinces/districts/cities with the highest rates of drowning were Xinjiang (10.08 per 100 000), Jiangxi (8.44 per 100 000), Anhui (7.92 per 100 000), Guizhou (7.77 per 100 000) and Sichuan (7.68 per 100 000). Standardized mortality of drowning reduced in all provinces in 2013. Conclusions: Disease burden of drowning in the Chinese population, especially in children, declined significantly in 2013, comparing to 1990. However, drowning remains a serious proble, with children and males in particular, in China. Research regarding prevention on drowning is in great need in the western and central areas where drowning mortalities appeared high.

Assessment of policy makers' individual and organizational capacity to acquire, assess, adapt and apply research evidence for maternal and child health policy making in Nigeria: a cross-sectional quantitative survey.

Throughout the world, there is increasing awareness and acknowledgement of the value of research evidence in the development of effective health policy and in quality health care practice and administration. Among the major challenges associated with the lack of uptake of research evidence into policy and practice in Nigeria is the capacity constraints of policymakers to use research evidence in policy making. To assess the capacity of maternal and child health policy makers to acquire, access, adapt and apply available research evidence. This cross-sectional quantitative survey was conducted at a national maternal, newborn and child health (MNCH) stakeholders' engagement event. An evidence to policy self-assessment questionnaire was used to assess the capacity of forty MNCH policy makers to acquire, assess, adapt and apply research evidence for policy making. Low mean ratings were observed ranging from 2.68-3.53 on a scale of 5 for knowledge about initiating/conducting research and capacity to assess authenticity, validity, reliability, relevance and applicability of research evidence and for organizational capacity for promoting and using of research for policy making. There is need to institute policy makers' capacity development programmes to improve evidence-informed policymaking.

Title V Workforce Development in the Era of Health Transformation.

Purpose The National Maternal and Child Health Workforce Development Center at UNC Chapel Hill (the Center), funded by the Maternal and Child Health Bureau, provides Title V state/jurisdiction leaders and staff and partners from other sectors with opportunities to develop skills in quality improvement, systems mapping and analysis, change management, and strategies to enhance access to care to leverage and implement health transformation opportunities to improve the health of women and children. Description Since 2013, the Center has utilized a variety of learning platforms to reach state and jurisdiction Title V leaders. In the intensive training program, new skills and knowledge are applied to a state-driven health transformation project and include distance-based learning opportunities, multi-day, in-person training and/or onsite consultation, as well as individualized coaching to develop workforce skills. Assessment The first intensive cohort of eight states reported enhanced skills in the core areas of quality improvement, systems mapping and analysis, change management, and strategies to enhance access to care which guided changes at state system and policy levels. In addition, teams reported new and/or enhanced partnerships with many sectors, thereby leveraging Title V resources to increase its impact. Conclusion The Center's provision of core workforce skills and application to state-defined goals has enabled states to undertake projects and challenges that not only have a positive impact on population health, but also encourage collaborative, productive partnerships that were once found to be challenging-creating a workforce capable of advancing the health and wellbeing of women and children.

National Child Health Information Programme

Pinnacle Midlands Health Network (the lead Primary Healthcare Organisation in the Midland region known as PMHN) partnered with Orion Health and the New Zealand Ministry of Health to implement a ground-breaking initiative that enables the digital tracking of key health milestones for every child in the Midlands region. The National Child Health Information Platform (NCHIP) was rolled out across the Waikato region in November 2014, connecting 32,626 (and growing) children with their health providers and ensuring that they receive all their childhood milestone checks. Children are registered at birth on a universal schedule of 28 (and growing) child health milestones; including new born checks, immunisations, well child checks, hearing and vision checks, and B4school checks to ensure that every child’s early development is monitored. The result is an information platform that gives each health provider involved in a child’s care a shared view of a child’s milestone achievements - the National Child Health Information Platform (NCHIP). Data received from six different types of healthcare provider is combined, resulting in a shared milestone history where providers are able to see when, where and with whom children have accessed services. The platform also enables electronic referrals from the midwife to general practice and other well child providers. This has been demonstrated to be both more efficient and effective than the previous system of faxing referrals to numerous providers. NCHIP has enabled the Midland region to: • Streamline, automate and assist the birth registration process • Share health milestone and demographic information across the spectrum of healthcare settings • Provide secure access for providers • Find children who were not registered with a provider and help them get connected. For example, NCHIP identified more than 6,000 children who were previously unknown to Waikato DHB’s Community Oral Health service • Find children that providers were struggling to locate and help them receive their (overdue) health milestones Nationally, in the 12 months ending December 2013, 37,518 immunisation milestones were missed and 20 per cent of children eligible for their six-week immunisations did not receive them. With the implementation of this solution more than 6,000 children who were previously unknown to Waikato DHB’s Community Oral Health service were identified. The solution ties well into the conference theme of “Promoting the health of children and families” as it engages providers, children, families and communities in the monitoring of health milestones, and encourages communication between all parties. The intention is for this pilot solution to be scaled into a national platform to help enable better health outcomes for all the children of New Zealand.

Architecture and functioning of child and adolescent mental health services: a 28-country survey in Europe

The WHO Child and Adolescent Mental Health Atlas, published in 2005, reported that child and adolescent mental health services (CAMHS) in Europe differed substantially in their architecture and functioning. We assessed the characteristics of national CAMHS across the European Union (EU), including legal aspects of adolescent care. Using an online mapping survey aimed at expert(s) in each country, we obtained data for all 28 countries in the EU. The characteristics and activities of CAMHS (ie, availability of services, inpatient beds, and clinicians and organisations, and delivery of specific CAMHS services and treatments) varied considerably between countries, as did funding sources and user access. Neurodevelopmental disorders were the most frequent diagnostic group (up to 81%) for people seen at CAMHS (data available from only 13 [46%] countries). 20 (70%) countries reported having an official national child and adolescent mental health policy, covering young people until their official age of transition to adulthood. The heterogeneity in resource allocation did not seem to match epidemiological burden. Substantial improvements in the planning, monitoring, and delivery of mental health services for children and adolescents are needed.

Secular trends of institutional delivery rate in China from 1996 to 2015

Objective: To describe the secular trends of institutional delivery (ID) rate in China from 1996 to 2015, and to assess the impacts of national health policies on the ID rate. Methods: Data on the number of live births and IDs for districts/counties in 31 provinces of China was annually collected by the Office for National Maternal & Child Health Statistics of China. Information concerning the relevant policies was from official governmental websites, including the programme to reduce maternal mortality and eliminate neonatal tetanus (2000 to 2008), and ID subsidy programme in rural China (2009 to present). According to the programme to reduce maternal mortality and eliminate neonatal tetanus, the calendar years were categorized into three periods: pre-programme period (1996 to 1999), programme implementation period (2000 to 2008) and post-programme period (2009 to 2015). Results: A total of 244 398 010 live births were included in the analysis, in which 211 605 727 were delivered in institutions. During the 20 years, the ID rate steadily increased from 58.7% (6 309 255/10 739 816) in 1996 to 99.7% (13 583 658/13 626 948) in 2015, with a compound annual growth rate of 2.8%. Analyses stratified by economic regions or urban-rural areas showed notably consistent increases in ID rates, and the regional and urban-rural differences became nearly disappeared by 2015. The largest regional difference between East (71.6%, 2 540 896/3 547 423) and West (44.6%, 1 675 305/3 752 873) was 27% in 1996 and <1% in 2015 (East 99.9%[5 177 865/5 180 636]and West 99.0%[3 925 766/3 964 622]). The urban-rural difference was 22.7% in 1996 (urban 73.5%[2 756 531/3 748 703], rural 50.8%[3 552 724/6 991 113]) and 0.4% in 2015(urban 99.9%[6 257 853/6 262 763], rural 99.5%[7 325 805/7 364 185]). During the programme implementation period and the post-programme period, the ID rates in rural area increased faster than those in urban area, and the corresponding compound annual growth rates in rural area were 2.4 and 2.8 times of those in urban area; the ID rates in Middle and West regions increased faster than those in East region, and the corresponding compound annual growth rates in West region were 3.6 and 6.3 times of those in East region. By 2015, the ID rates in all provinces other than Tibet (90.5%[48 445/53 505]) and Qinghai (97.2%[60 836/62 600]) reached or were close to 100%. However, there were still 112 districts/counties with ID rates <96%, of which 39 with ID rates <80%; the 39 districts/counties were all located in four western provinces (Tibet 19, Sichuan 15, Qinghai 3, and Xinjiang 2). Conclusions: During the past 20 years, the ID rate in China has steadily increased and achieved the goal of the year 2020 ahead of schedule; the regional and urban-rural inequality in ID has nearly disappeared. Given universal two-child policy, it is of significance to strengthen existing achievements, focus on complicated pregnancies and comprehensively improve the capability and quality of ID services; meanwhile, it is also of significance to develop particular policies and explore the medical-aid model for the minority-inhabited western regions with lower ID rates.

Foremost Prenatal Physician, Scientist Tapped to Lead National Child Health Agency: Diana Bianchi, MD, is focused on fostering more genomics research, enabling greater data-sharing collaboration among agencies in new role at NICHD.

American Journal of Medical Genetics Part AVolume 173, Issue 5 p. 1138-1139 THE AJMG SEQUENCE: DECODING NEWS AND TRENDS FOR THE MEDICAL GENETICS COMMUNITY BY DEBORAH LEVENSON Foremost Prenatal Physician, Scientist Tapped to Lead National Child Health Agency Diana Bianchi, MD, is focused on fostering more genomics research, enabling greater data-sharing collaboration among agencies in new role at NICHD First published: 19 April 2017 https://doi.org/10.1002/ajmg.a.38264Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume173, Issue5May 2017Pages 1138-1139 RelatedInformation

Progress and challenges in maternal health in western China: a Countdown to 2015 national case study.

SummaryBackgroundChina is one of the few Countdown countries to have achieved Millennium Development Goal 5 (75% reduction in maternal mortality ratio between 1990 and 2015). We aimed to examine the health systems and contextual factors that might have contributed to the substantial decline in maternal mortality between 1997 and 2014. We chose to focus on western China because poverty, ethnic diversity, and geographical access represent particular challenges to ensuring universal access to maternal care in the region.MethodsIn this systematic assessment, we used data from national census reports, National Statistical Yearbooks, the National Maternal and Child Health Routine Reporting System, the China National Health Accounts report, and National Health Statistical Yearbooks to describe changes in policies, health financing, health workforce, health infrastructure, coverage of maternal care, and maternal mortality by region between 1997 and 2014. We used a multivariate linear regression model to examine which contextual and health systems factors contributed to the regional variation in maternal mortality ratio in the same period. Using data from a cross-sectional survey in 2011, we also examined equity in access to maternity care in 42 poor counties in western China.FindingsMaternal mortality declined by 8·9% per year between 1997 and 2014 (geometric mean ratio for each year 0·91, 95% CI 0·91–0·92). After adjusting for GDP per capita, length of highways, female illiteracy, the number of licensed doctors per 1000 population, and the proportion of ethnic minorities, the maternal mortality ratio was 118% higher in the western region (2·18, 1·44–3·28) and 41% higher in the central region (1·41, 0·99–2·01) than in the eastern region. In the rural western region, the proportion of births in health facilities rose from 41·9% in 1997 to 98·4% in 2014. Underpinning such progress was the Government's strong commitment to long-term strategies to ensure access to delivery care in health facilities—eg, professionalisation of maternity care in large hospitals, effective referral systems for women medically or socially at high risk, and financial subsidies for antenatal and delivery care. However, in the poor western counties, substantial disparity by education level of the mother existed in access to health facility births (44% of illiterate women vs 100% of those with college or higher education), antenatal care (17% vs 69%) had at least four visits), and caesarean section (8% vs 44%).InterpretationDespite remarkable progress in maternal survival in China, substantial disparities remain, especially for the poor, less educated, and ethnic minority groups in remote areas in western China. Whether China's highly medicalised model of maternity care will be an answer for these populations is uncertain. A strategy modelled after China's immunisation programme, whereby care is provided close to the women's homes, might need to be explored, with township hospitals taking a more prominent role.FundingGovernment of Canada, UNICEF, and the Bill & Melinda Gates Foundation.

Geographic Variations and Temporal Trends in Cesarean Delivery Rates in China, 2008-2014

The increasing use of cesarean delivery is an emerging global health issue. Prior estimates of China's cesarean rate have been based on surveys with limited geographic coverage. To provide updated information about cesarean rates and geographic variation in cesarean use in China. Descriptive study, covering every county (n = 2865) in mainland China's 31 provinces, using county-level aggregated information on the number of live births, cesarean deliveries, maternal deaths, and perinatal deaths, collected by the Office for National Maternal & Child Health Statistics of China, from 2008 through 2014. Live births. Annual rate of cesarean deliveries. Over the study period, there were 100 873 051 live births, of which 32 947 229 (32.7%) were by cesarean delivery. In 2008, there were 13 160 634 live births, of which 3 788 029 (28.8%) were by cesarean delivery and in 2014 there were 15 123 276 live births, of which 5 280 124 (34.9%) were by cesarean delivery. Rates varied markedly by province, from 4.0% to 62.5% in 2014. Despite the overall increase, by 2014 rates of cesarean delieries in 14 of the nation's 17 "super cities" had declined by 4.1 to 17.5 percentage points from their earlier peak values (median, 11.4; interquartile range, 6.3-15.4). In 4 super cities with the largest decreases, there was no increase in maternal or perinatal mortality. Between 2008 and 2014, the overall annual rate of cesarean deliveries increased in China, reaching 34.9%. There was major geographic variation in rates and trends over time, with rates declining in some of the largest urban areas.

Pobreza infantil no Brasil: aplicação da metodologia Alkire-Foster de mensuração de pobreza multidimensional

O presente estudo propõe exercício de medição inédita da incidência e intensidade da pobreza infantil no Brasil a partir dos dados da PNDS 2006, utilizando a metodologia elaborada por Alkire &amp; Foster (2009, 2011) para mensuração de pobreza multidimensional e sua especificação para pobreza infantil proposta por Alkire &amp; Roche (2012). Conclui-se que, apesar da dificuldade de obtenção de dados primários e da arbitrariedade intrínseca à escolha de dimensões em medidas multidimensionais, os benefícios da metodologia adotada superam essas adversidades em função de sua formulação robusta e intuitiva. Medidas de incidência e intensidade da pobreza são apresentadas para os estratos rural e urbano das cinco macrorregiões do Brasil, esboçando os diferentes perfis de pobreza no Sudeste urbano e Nordeste rural

An Assessment of National Maternal and Child Health Policy-Makers’ Knowledge and Capacity for Evidence-Informed Policy-Making in Nigeria

Background: There is increasing interest globally in the use of more rigorous processes to ensure that maternal, newborn, and child health (MNCH) care recommendations are informed by the best available research evidence use. The purpose of this study was to engage Nigerian MNCH policy-makers and other stakeholders to consider issues around research to policy and practice interface and to assess their existing knowledge and capacity on the use of research evidence for policy-making and practice. Methods: The study design is a cross-sectional evaluation of MNCH stakeholders’ knowledge as it pertains different dimensions of research to practice. This was undertaken during a national MNCH stakeholders’ engagement event convened under the auspices of the West African Health Organization (WAHO) and the Federal Ministry of Health (FMoH) in Abuja, Nigeria. A questionnaire was administered to participants, which was designed to assess participants’ knowledge, capacity and organizational process of generation, synthesis and utilization of research evidence in policy-making regarding MNCH. Results: A total of 40 participants signed the informed consent form and completed the questionnaire. The mean ratings (MNRs) of participants’ knowledge of electronic databases and capacity to identify and obtain relevant research evidence from electronic databases ranged from 3.62-3.68 on the scale of 5. The MNRs of participants’ level of understanding of a policy brief, a policy dialogue and the role of researchers in policy-making ranged from 3.50-3.86. The MNRs of participants’ level of understanding of evidence in policy-making context, types and sources of evidence, capacity to identify, select, adapt, and transform relevant evidence into policy ranged from 3.63-4.08. The MNRs of the participants’ organization’s capacity to cover their geographical areas of operation were generally low ranging from 3.32-3.38 in terms of manpower, logistics, facilities, and external support. The lowest MNR of 2.66 was recorded in funding. Conclusion: The outcomes of this study suggest that a stakeholders’ engagement event can serve as an important platform to assess policy-makers’ knowledge and capacity for evidence-informed policy-making and for the promotion of evidence use in the policy process.

Preventive Child Health Care within the Framework of the Dutch Health Care System

The Netherlands has established a high quality system of child health care based on a unique standardized digital preventive child health program underpinned by legislation. Stringent assessment of the implementation of the new Youth Act is needed to fulfill the United Nations' child rights to health. The impact of national child health care systems on the well-being of children with long-term conditions should be evaluated by using international (World Health Organization) comparable coding to document the benefit of preventive child health care programs and their outcomes.

Changes in Optimal Childcare Practices in Kenya: Insights from the 2003, 2008-9 and 2014 Demographic and Health Surveys.

Objective(s)Using nationally representative surveys conducted in Kenya, this study examined optimal health promoting childcare practices in 2003, 2008–9 and 2014. This was undertaken in the context of continuous child health promotion activities conducted by government and non-government organizations throughout Kenya. It was the aim of such activities to increase the prevalence of health promoting childcare practices; to what extent have there been changes in optimal childcare practices in Kenya during the 11-year period under study?MethodsCross-sectional data were obtained from the Kenya Demographic and Health Surveys conducted in 2003, 2008–9 and 2014. Women 15–49 years old with children 0–59 months were interviewed about a range of childcare practices. Logistic regression analysis was used to examine changes in, and correlates of, optimal childcare practices using the 2003, 2008–9 and 2014 data. Samples of 5949, 6079 and 20964 women interviewed in 2003, 2008–9 and 2014 respectively were used in the analysis.ResultsBetween 2003 and 2014, there were increases in all health facility-based childcare practices with major increases observed in seeking medical treatment for diarrhoea and complete child vaccination. Mixed results were observed in home-based care where increases were noted in the use of insecticide treated bed nets, sanitary stool disposal and use of oral rehydration solutions, while decreases were observed in the prevalence of urging more fluid/food during diarrhoea and consumption of a minimum acceptable diet. Logit models showed that area of residence (region), household wealth, maternal education, parity, mother's age, child’s age and pregnancy history were significant determinants of optimal childcare practices across the three surveys.ConclusionsThe study observed variation in the uptake of the recommended optimal childcare practices in Kenya. National, regional and local child health promotion activities, coupled with changes in society and in living conditions between 2003 and 2014, could have influenced uptake of certain recommended childcare practices in Kenya. Decreases in the prevalence of children who were offered same/more fluid/food when they had diarrhea and children who consumed the minimum acceptable diet is alarming and perhaps a red flag to stakeholders who may have focused more on health facility-based care at the expense of home-based care. Concerted efforts are needed to address the consistent inequities in the uptake of the recommended childcare practices. Such efforts should be cognizant of the underlying factors that affect childcare in Kenya, herein defined as region, household wealth, maternal education, parity, mother's age, child’s age and pregnancy history.

The ethics of dental treatment during pregnancy

The ethics of dental treatment during pregnancy

State-Level Immunization Information Systems: Potential for Childhood Immunization Data Linkages.

Objectives Sources of immunization data include state registries or immunization information systems (IIS), medical records, and surveys. Little is known about the quality of these data sources or the feasibility of using IIS data for research. We assessed the feasibility of collecting immunization information for a national children's health study by accessing existing IIS data and comparing the completeness of these data against medical record abstractions (MRA) and parent report. Staff time needed to obtain IIS and MRA data was assessed. Methods We administered a questionnaire to state-level IIS representatives to ascertain availability and completeness of their data for research and gather information about data formats. We evaluated quality of data from IIS, medical records, and reports from parents of 119 National Children's Study participants at three locations. Results IIS data were comparable to MRA data and both were more complete than parental report. Agreement between IIS and MRA data was greater than between parental report and MRA, suggesting IIS and MRA are better sources than parental report. Obtaining IIS data took less staff time than chart review, making IIS data linkage for research a preferred choice. Conclusions IIS survey results indicate data can be obtained by researchers using data linkages. IIS are an accessible and feasible child immunization information source and these registries reduce reliance on parental report or medical record abstraction. Researchers seeking to link IIS data with large multi-site studies should consider acquiring IIS data, but may need strategies to overcome barriers to data completeness and linkage.

Inequality of Paediatric Workforce Distribution in China.

Child health has been addressed as a priority at both global and national levels for many decades. In China, difficulty of accessing paediatricians has been of debate for a long time, however, there is limited evidence to assess the population- and geography-related inequality of paediatric workforce distribution. This study aimed to analyse the inequality of the distributions of the paediatric workforce (including paediatricians and paediatric nurses) in China by using Lorenz curve, Gini coefficient, and Theil L index, data were obtained from the national maternal and child health human resource sampling survey conducted in 2010. In this study, we found that the paediatric workforce was the most inequitable regarding the distribution of children <7 years, the geographic distribution of the paediatric workforce highlighted very severe inequality across the nation, except the Central region. For different professional types, we found that, except the Central region, the level of inequality of paediatric nurses was higher than that of the paediatricians regarding both the demographic and geographic distributions. The inner-regional inequalities were the main sources of the paediatric workforce distribution inequality. To conclude, this study revealed the inadequate distribution of the paediatric workforce in China for the first time, substantial inequality of paediatric workforce distribution still existed across the nation in 2010, more research is still needed to explore the in-depth sources of inequality, especially the urban-rural variance and the inner- and inter-provincial differences, and to guide national and local health policy-making and resource allocation.

Effect of pregnancy intention, postnatal depressive symptoms and social support on early childhood stunting: findings from India

BackgroundAccording to United Nation Children’s Fund, it has been estimated that worldwide about 165 million children were stunted in 2012 and India alone accounts for 38 % of global burden of stunting. This study aims to examine the effect of pregnancy intention and maternal postnatal depressive symptoms on early childhood stunting in India. We hypothesized that effect of pregnancy intention and postnatal depressive symptoms were mediated by social support.MethodsWe used data from the first wave of Young Lives Study India. Multivariate logistic regression models (using generalized estimation equation) were used to examine the effect of pregnancy intention and postnatal depressive symptoms on early childhood stunting among children aged 5–21 months. The analysis included 1833 children (out of 2011 sample children) that had complete information on pregnancy intention, maternal depression and other variables.ResultsBivariate results indicate that a higher percent of children born after unintended pregnancy (40 %) were stunted than children of intended pregnancy (26 %). Likewise, the proportion of stunted children was also higher among women with high postnatal depressive symptoms (35 %) than the low level of depression (24 %). Results of multivariate logistic regression model indicate that children born after unintended pregnancy were significantly more likely to be stunted than children born after intended pregnancy (AOR: 1.76, CI: 1.25, 2.48). Similarly, early childhood stunting was also associated with maternal postnatal depressive symptoms (AOR: 1.53, CI: 1.21, 1.92). Moreover, the effect of pregnancy intention and postnatal depressive symptoms on early childhood stunting were not mediated by social support.ConclusionsThe findings of this study provide conclusive evidence regarding consequences of pregnancy intention and postnatal depressive symptoms on early childhood stunting in India. Therefore, there is a need to identify the women with unintended pregnancy and incorporate the promotion of mental health into their national reproductive and child health programme.

It's Not Just Postpartum, It's Not Just Depression [30B

INTRODUCTION:Approximately 800,000 women are diagnosed with postpartum depression (PPD) each year, although many women are undiagnosed. The National Child and Maternal Health Education Program (NCMHEP), led by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, is a