Pediatric Outpatient Department Research Articles

Maternal knowledge, perception, and attitude regarding the management of childhood febrile illness

Background:Maternal knowledge, perception, and attitude play a crucial role in the effective management of childhood febrile illnesses, as mothers are often the primary caregivers. Understanding how mothers recognize, interpret, and respond to fever can influence the timely administration of appropriate care. This highlights the importance of educating mothers on fever management practices to improve health outcomes for children. Objective:The aim is to assess maternal perceptions on the home management of childhood fever, focusing on their understanding and practices in addressing febrile illness in children. This insight can guide strategies to improve care and health outcomes. Materials and Methods: This cross-sectional study was conducted at the Pediatric Outpatient Department (OPD) of CMH Ramu, Ramu Cantonment, from April 2024 to July 2024 on 350 mothers attending with a feverish child under twelve years. Results:In our study, 60% of mothers used their hands to measure their child's body temperature, with the armpit being the preferred site. The definition of fever varied among mothers, ranging from ≥98°F to 102°F. A large proportion, 86%, were unaware of the proper dosing and frequency of Paracetamol, while 90% consulted a doctor before administering any antipyretic. The oral route was favored by 89% of mothers for antipyretic administration, and 14% relied on traditional methods. Paracetamol was the most commonly used antipyretic in 91% of cases, while 51% of mothers preferred antibiotics at the onset of fever to prevent its progression. Cefixime was the most frequently selected antibiotic (44.4%), followed by Azithromycin (30.6%) and other options. Conclusions: Misconceptions about the management of febrile children are widespread among mothers in Bangladesh, leading to unnecessary concern and an increased burden on healthcare facilities. There is a pressing need to enhance their knowledge and perception to improve care and reduce this strain. J Bangladesh Coll Phys Surg 2025; 43: 39-45

P-635. “Exploring Knowledge and Barriers to HPV Vaccination among Mothers of 9-14 Years Olds - a Descriptive Study in a Tertiary Care Hospital”

Abstract Background Human Papillomavirus (HPV) vaccination is pivotal in preventing cervical cancer and other HPV-related diseases. However, uptake remains suboptimal, partly due to parental knowledge gaps and barriers Association between Knowledge Level & Factors Hindering Vaccination Methods This prospective descriptive study was conducted in a tertiary care hospital in Trivandrum, Kerala. A structured preformed questionnaire was administered to total of 268 participants who were mothers of girl children aged 9-14 years attending outpatient pediatric department. The questionnaire assessed knowledge about HPV, the vaccine available for HPV, and factors influencing vaccinations. Results Among the 268 study subjects, a significant majority, comprising 91.4%, demonstrated a commendable level of understanding regarding the HPV vaccine. Various factors were identified as barriers to vaccination uptake, with safety concerns being the most prevalent, cited by 91% of respondents. Additionally, a notable percentage (36.9%) expressed uncertainty regarding potential future infertility concerns linked to the vaccine, while 67.2% cited the high costs associated with it as a deterrent. Nevertheless, an overwhelming majority (99.6%) acknowledged the indispensable role of vaccines in disease prevention. Conclusion The substantial knowledge observed within our study cohort can be credited to the state's commendable literacy rates and the concerted efforts of governmental and non-governmental entities to fortify healthcare awareness. This study provides valuable insights the gaps in knowledge and measures to augment HPV vaccination rates among adolescents. Disclosures All Authors: No reported disclosures

Pattern of skin diseases in patients attending pediatric outdoor patient of a Tertiary Care Hospital of Bahawalpur, Pakistan.

Objective: To determine the pattern of skin diseases among patients visiting the Pediatric outpatient department of tertiary care hospital. Study Design: Cross-sectional study. Setting: Department of Pediatric Outpatient, Combined Military Hospital, Bahawalpur, Pakistan. Period: August 2023 to February 2024. Methods: Children up to age of 12 years, attending the outpatient department for skin disorders were included in the study. Consultants with Postgraduate qualifications in Pediatrics made the diagnosis & consultations from Dermatology department were also obtained. Results: A total of 300 patients were included in the study, consisting of 60% males and 40% females, with a mean age of 2.29 years (± 1.19 years). The age group distribution indicated that 34% of participants (n=102) were under 1 year of age, while 27.3% (n=82) were between the ages of 6 to 10 years. Infectious diseases and infestations were the most prevalent skin conditions, affecting 66.36% of participants. This was followed by eczema (n=46,15.33%), hypersensitivity (n=22,7.33%), and disorders of sweat and sebaceous glands (n=23,7.66). Among the infections, bacterial infections were the most common (23%), followed by fungal infections (18.33%) and viral infections (6.3%). Conclusion: Infections and infestations together constituted 66.36% of the cases. Bacterial infections, along with scabies and fungal infections were the most common disorders observed followed by eczematous disorders. Education regarding good hygiene and proper care can eventually help.

Exclusive breastfeeding practices and factors affecting them in urban areas of Uttar Pradesh

ABSTRACT Background: Exclusive breastfeeding for the first 6 months is the recommended infant feeding practice, with established benefits. In India, exclusive breastfeeding rates have seen some improvement, but Uttar Pradesh has experienced a decline. Various factors influence breastfeeding practices, such as socio-cultural beliefs, maternal knowledge, and support. Considering urbanization, industrialization, and a significant migrant population, it is crucial to understand the determinants of breastfeeding practices in urban Uttar Pradesh. This study aimed to fill these knowledge gaps by examining factors influencing breastfeeding practices in the region. Methods: This cross-sectional study was conducted at Sharda Hospital’s Pediatrics Outpatient Department (OPD) in Uttar Pradesh over 1.5 years from January 1, 2019 to June 30, 2020. The minimum sample size of 96 was determined for the study. Study participants included 200 mothers with children aged 6 months to 2 years attending the Pediatrics OPD. Data were collected through a 42-item questionnaire administered by trained interviewers who ensured privacy and comfort. Data analysis was performed using Statistical Package for Social Sciences, including descriptive statistics and the Chi-square test for categorical variables (P < 0.05). Results: The study involved 200 mothers with children aged 6 months to 2 years attending a Pediatrics OPD in Uttar Pradesh. Mothers aged 21–30 years (78%) were predominant. Among the children, 62.5% were male. Colostrum was given by 86% of mothers, and 40% introduced pre-lacteal feeds. Exclusive breastfeeding was practiced by 60% of mothers. The analysis did not show statistically significant differences based on socio-economic status, maternal education, or occupation (P > 0.05). Conclusion: In conclusion, the findings from this study provide a comprehensive understanding of feeding practices among mothers in urban areas of Uttar Pradesh. While many mothers adhere to recommended practices, there is room for improvement in reducing pre-lacteal feeding and promoting exclusive breastfeeding.

Serum Antidiuretic Hormone Level in Nocturnal Enuretic School Children in a Tertiary Care Hospital in Bangladesh: A Cross-Sectional Study.

Primary nocturnal enuresis (PNE) is a common pediatric condition characterized by involuntary nighttime bed wetting. Primary monosymptomatic nocturnal enuresis (PMNE) is associated with altered antidiuretic hormone (ADH) secretion and lacks lower urinary tract symptoms. This study aimed to compare serum ADH levels between children with PMNE and a comparison group to explore its potential role in the pathophysiology of PMNE. This cross-sectional study included 40 children aged 6-15 years with PMNE and 40 age-matched children without enuresis (comparison group) attending the Pediatric Nephrology Outpatient Department at the National Institute of Kidney Diseases and Urology (NIKDU) from January 2022 to July 2023. Blood samples and other clinical information along with laboratory investigation are done to ensure inclusion and exclusion criteria. Fasting serum ADH level, a competitive immunoassay was done with the Arg- Vasopressin ELISA kit. Relevant clinical and demographic data were analyzed using Student's t-test for continuous variables and Chi-square/Fisher's exact tests for categorical variables. The mean age of participants was 8.82 ± 2.71 years in the PMNE group and 9.01 ± 2.54 years in the comparison group (p = 0.760). There was no significant association between sex and PMNE (p = 0.370). Children with PMNE exhibited significantly lower serum ADH levels compared to the comparison group (p < 0.05). Additionally, children with more frequent enuretic episodes demonstrated a trend of lower ADH levels (p < 0.05). This study provides evidence of a significant association between decreased diurnal serum ADH levels and PNE in children. These findings contribute to a better understanding of the pathophysiology of PNE and suggest potential avenues for novel treatment strategies, emphasizing the importance of evaluating ADH levels in PNE management.

Prevalence of depression and its associated risk factors among children and adolescent screened at a tertiary care hospital

Background: Depression in children and adolescents has been increasing worldwide especially in the adolescence. Despite its high prevalence and its substantial impact, the detection and its treatment in primary care setting have been suboptimal. To estimate the prevalence of depression among 8-17 years attending OPD at a tertiary care hospital and the risk factors associated with it. Methods: A cross-sectional study done among 400 participants of 08 to 17 years of age presenting to Pediatric and Medicine Outpatient departments of a Tertiary Care Hospital at Puducherry. A three-step process on diagnosis was involved. Step 1 included screening for psychiatric morbidities using Tamil and English version of Strengths and Difficulties Standardized Questionnaire. Those scoring above 19 were subjected to a second screening test for depression using Centre for Epidemiological Studies Depression scale for Children. All these participants were referred for psychiatric assessment irrespective of their CES-DC score for diagnosis. The data was analysed by descriptive statistics. Results: Among the study population, 49 (12.25%) participants had depression. Among the participants with 8 to 12 years of age, 10 (5%) participants had depression. Among the participants with aged 13 to 17 years, 39 (19.5%) participants had depression. The risk factors significantly associated with depression include age group, friends, sickness, constant fidgeting/squirming, temper tantrum, bullying, addiction in parents, parent education. Conclusion: Owing to the prevalence of depression in our study especially in the late adolescent, the importance is to be given for early diagnosis and appropriate management.

Steroid-Induced Psychosis in a Child With Nephrotic Syndrome Secondary to Focal Segmental Glomerulosclerosis: A Case Report.

Corticosteroid-induced psychosis is rare and less reported in children compared to adults. However, psychosis is considered a severe adverse effect of corticosteroids in pediatric nephrotic syndrome. Steroid-induced psychosis is dose-dependent and should be treated by tapering the dose of steroids and usually initiating an atypical antipsychotic. A 13-year-old male child presented to the pediatrics outpatient department with complaints of anxiety, fearfulness, and seeing images of an old man crawling into his room and threatening to strangle him with a red rope, which led to decreased sleep. He was initiated on oral prednisolone 3 weeks ago after being diagnosed with nephrotic syndrome. A diagnosis of steroid-induced psychosis was made, and he was tapered on steroids over 6 weeks. He was then initiated on tacrolimus, quetiapine, and lorazepam and was discharged after a week. At follow-up in 4 weeks, his psychosis had resolved, and nephrotic syndrome was found to improve. Children on steroids should be closely monitored for psychotic symptoms over a prolonged duration. Although tapering the dose of steroids is the gold standard treatment of steroid-induced psychosis, cases like nephrotic syndrome demand the continuous use of an immunosuppressant. In such cases, tacrolimus has been found to be an effective alternative, although continuous monitoring for nephrotoxicity is necessary. Similarly, atypical antipsychotics (like quetiapine) are preferred for psychosis because of their lesser risk for extrapyramidal side effects compared to typicals. Parental counseling and informed consent are utmost for children on steroids or tacrolimus.

Asymptomatic nasopharyngeal carriage of multidrug resistant bacteria among children at University of Gondar Hospital Northwest Ethiopia Revealing Hidden Health Risks

Gram-negative bacteria in the nasopharynx can eventually invade bacteria-limited sites and cause serious illnesses such as meningitis, otitis media, and pneumonia. However, data related to the carriage of these bacteria in children attending outpatient departments in the study area are limited. To assess nasopharyngeal carriage, antibiotic susceptibility patterns, and associated factors of gram-negative bacteria among children attending the outpatient department at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. A hospital-based cross-sectional study was conducted from September 1, 2023, to December 30, 2023. A total of 385 children aged 3 to 14 years were enrolled using a systematic random sampling technique. Sociodemographic and clinical data were collected using a semistructured questionnaire. A total of 385 nasopharyngeal samples were collected using a sterile specimen collection nasopharyngeal swab, transported using Amie’s transport medium, and subsequently inoculated on chocolate agar, blood agar, modified thayer martin agar, and MacConkey agar plates. Bacterial species were identified by colony morphology, Gram staining, and biochemical tests such as oxidase tests, satellitism tests, and carbohydrate utilization tests. An antibiotic susceptibility test was performed using the Kirby–Bauer and modified Kirby–Bauer methods on Mueller–Hinton agar plates. The data were entered into Epi-Data version 4.6.0.6 and exported to SPSS version 25 for analysis. The adjusted odds ratio at a 95% confidence interval with a P value of < 0.05 in the binary logistic regression model was considered to indicate statistical significance. The overall nasopharyngeal carriage of gram-negative bacteria was 146 (37.9%) (95% CI: 33.2–42.9). Among these, nonfastidious gram-negative bacteria represented 45 (11.7%), followed by M. catarrhalis 41 (10.6%), N. meningitidis 34 (8.8%), and H. influenzae 26 (6.8%). The isolates exhibited high resistance to tetracycline (85; 75.9%), trimethoprim-sulfamethoxazole (105; 71.9%), ampicillin (76; 67.9%), and amoxicillin/clavulanic acid (60; 69.8%) but high susceptibility to meropenem (122; 83.6%), gentamicin (73; 84.9%), and minocycline (87; 72.5%). There were 99 total multidrug-resistant strains (67.8%, 95% CI: 59.7–75.0). Male sex (AOR = 1.785, 95% CI: 1.102–2.892, P = 0.019), smoking (AOR = 2.675, 95% CI: 1.149–6.230, P = 0.022), and large family size (≥ 5) (AOR = 1.857, 95% CI: 1.140–3.023, P = 0.013) were risk factors for nasopharyngeal colonization. Increased nasopharyngeal colonization of multidrug-resistant gram-negative isolates was observed in this study. Gentamicin, minocycline, and meropenem were the most effective antibiotics for the tested isolates. Bacterial colonization increased with increasing family size, smoking status, and male sex. Therefore, a definitive diagnosis in the outpatient pediatric department should be based on culture and susceptibility test results.

Charting the Path: Psychological Factors and Diet Adherence in Adolescents With Celiac Disease.

Introduction Adolescence is a pivotal time for individuals with celiac disease (CD), presenting a host of psychosocial challenges. Managing a strict gluten-free diet (GFD) while forming self-identity, striving for autonomy, and navigating social relationships significantly impacts adolescents with CD.The present pilot study investigates the impact of psychological factors on behavioral and dietary responses in adolescents with CD, utilizing repeated measures over time. Methods Thirty-one adolescents aged 11-18 from a pediatric outpatient CD department were recruited. Participants completed the Resilience Youth Development Module (RYDM), the Child and Adolescent Mindfulness Measure (CAMM), the Strengths and Difficulties Questionnaire (SDQ), and Celiac Dietary Adherence Test (CDAT) over four phases spanning four months. Twenty-seven parents also agreed to participate in completing the SDQ parents' version. Results The results revealed moderate levels of mindfulness and resilience, accompanied by inadequate adherence to a GFD. Baseline assessments revealed difficulties in peer relationships and psychosocial functioning, which parents corroborated. Over time, reductions in mindfulness and resilience were observed, along with modest improvements in dietary adherence and decreases in psychosocial difficulties. Discussion This study underscores the importance of psychological traits, suggesting that enhancing mindfulness and resilience may improve both dietary adherence and overall well-being. However, given the dynamic nature of adolescents' coping strategies through developmental changes and social environments, tailored interventions are essential for effective disease management and social integration.

Estimation of HbA1c Levels in Transfusion-Dependent Thalassemia Patients in Comparison With Normal Healthy Individuals.

Introduction HbA1c values used for diagnosing and treating diabetes can be affected by factors such as red blood cell lifespan, hemolysis, red cell transfusion, and the presence of minor Hb species like HbA2 and HBF inhemoglobinopathies like sickle cell disease, homozygous HbC disease, HbSC disease, and β-thalassemia. This study aims to compare HbA1c levels in transfusion-dependent thalassemia (TDT) patients and healthy individuals. Materials and methods This is a cross-sectional comparative study. This study comprisestwopopulation groups. The first group includes 35 TDTpatients and the second group consists of 35 non-thalassemicindividuals who were matched for age (±1 year), gender, and BMI (±1 kg/m2). The patients were selected from the pediatric outpatient department (OPD), thalassemia ward in the pediatric department, and medicine OPD. Written informed consent/assent was obtained from the participants. A 3 ml fasting venous blood sample for fasting blood sugar(FBS), HbA1c, and complete blood count (CBC) values was obtained in ethylenediaminetetraacetic acid(EDTA) vials on the scheduled blood transfusion day (pretransfusion samples). Samples were then sent to an in-house accredited lab for testing and analysis. HbA1c was performed using the high-performance liquid chromatography (HPLC) technique. Data was compared using a t-test. Qualitative parameters were compared between groups by X2 square analyses. A multivariate linear regression model was used to explore the independent contribution of an individual predictor to HbA1c variability. Results In the study, 85.7% of patients with TDThad HbA1c levels in the diabetic range (>6.4%). In comparison, none of the control group patients had HbA1c values in the diabetic range. The mean HbA1c level was 6.94% in TDT cases and 5.3% in the control group, which was statistically significant (p < 0.001). Elevated FBS levels in the prediabetic range (>100 mg/dl, <126mg/dl) were observed in 25.7% TDT cases. All 35 controls had normal FBS levels(<100 mg/dl). No significant difference was found in FBS levels between cases (92.97 (±9.141) mg/dL) and controls (89.20 (±7.584) mg/dL) (p = 0.065). However moderately positive correlation exists between FBS and HbA1C (r =.470, p = 0.004) and between age and HbA1C (r = 0.335, p = 0.049). Conclusions The use of HbA1c as a screening tool for diabetes mellitus (DM) or assessment of glycemic control is inappropriate in TDT patients. The levels could be falsely elevated, as we found out in our study. In conditions where there is a mismatch between HbA1c and FBS levels, as seen in TDT patients, plasma glucose criteria should be used to diagnose diabetes. It is advised to use alternative indices such as fructosamine levels, glycated albumin, and continuous glucose monitoring.

Growth Status of Bangladeshi Children in Functional Constipation: Experience From A Tertiary Care Hospital

Background: Constipation is one of the common complaints of children with long-term hazardous consequences. It is a frequent cause of hospital visit in both primary and specialized care which needs proper evaluation and management. Recently in few studies, impairment of growth status has been reported as a result of functional constipation. But the relation is not well evaluated, especially in the pediatric population of our country. Aim: To assess the growth status of Bangladeshi children in functional constipation. Methods: This analytical study was conducted at the department of Pediatric Gastroenterology and Nutrition, BSMMU, Dhaka. A total 150 children aged 2-18 years were enrolled in this study. Children were divided into two groups, 75 having functional constipation (FC) and 75 healthy children with no constipation. Samples were collected randomly from pediatric out-patient department of BSMMU with consent of parents and child’s approval. Diagnosis of functional constipation was made by Rome IV criteria. Children with any red flag sign, chronic disease and on treatment of constipation were excluded from the study. Growth status (weight, height &amp; BMI) was evaluated by using growth charts. Data collected in semi-structured questionnaire and analyzed by SPSS 23.0. Results: We evaluated 75 constipated children with the mean age of 7.61±3.50 years and 75 healthy children with the mean age of 7.40±3.88 years. The mean weight of children with functional constipation was 22.8±10.01 kg, mean height 117.7 ±18.4 cm and BMI 15.6±2.3 kg/m2. The mean weight of children with no constipation was 28.6± 13.72 kg, mean height 124.49±23.3 cm and BMI 18.11±2.9 kg/m2,demonstrated significant difference between two sets. In functional constipation group, on weight for age and height for age chart, 28% and 24% children were below the 3rd centile respectively and 18.6% children had BMI below 5th centile. All these parameters (weight, height, BMI) were statistically significant in compare to children without constipation and p value is &lt;.05. Presenting features of functional constipation were anorexia (64%), abdominal pain (73.3%), hard stool (84%), blood mixed hard stool (13.3%) and nausea (34%). Conclusion: Growth impairment occurs in children with functional constipation in comparison to children without constipation. Children aged 2 to 18 years with functional constipation may have decelerated weight, height and BMI growth. And this observation needs further large-scale multicenter study for ensuring optimal growth of children with constipation. J Shaheed Suhrawardy Med Coll 2023; 15(1): 73-77

Clinico-Demographic Profile of Children Attending Pediatric Outpatient Department in Tertiary Care Center in Gandaki Province, Nepal: A Prospective, Descriptive Cross-Sectional Study

Introduction: Pediatric outpatient departments (OPDs) in tertiary care centers provide a vital connection for the early diagnosis and treatment of childhood illnesses. Understanding the clinico-demographic profile of pediatric patients attending these centers provides insight into the healthcare needs and challenges faced by children in specific regions. This study aimed to evaluate the clinico-demographic characteristics of children attending the pediatric OPD.  Methods: A prospective, descriptive cross-sectional study was conducted from April 12 to December 17, 2023 at pediatric OPD at GP Koirala National Centre for Respiratory Diseases and Hospital, Tanahun, Gandaki Province, Nepal. Data were collected from the pediatric OPD during clinical history taking and examination, including 7,020 children aged 0–14 years. Verbal consent was obtained from legal guardians for using clinical history and diagnostic data. Data on age, sex, socioeconomic status, parental education, and disease distribution were analyzed using SPSS version 23.  Results: Out of 7,020 children, 42.89% were aged 1–5 years, and 28.67% were aged 6–10 years. Males (50.7%) slightly outnumbered females (49.3%). Socioeconomic analysis showed that 57.3% of children were from low-income families. Regarding parental(either father or mother or any legal gurdian who brought child at hospital OPD) education, 31.19% had secondary education, and 28.3% had primary education. Respiratory infections (19.97%) were the most common diagnosis, followed by gastroenteritis (11%), pain abdomen (9%), and malnutrition, especially undernutrition (8%). Other notable conditions included enteric fever (7.4%) and acute conjunctivitis (7.3%).  Conclusion: The study highlights a high prevalence of respiratory and gastrointestinal conditions among children, particularly from low-income families. The findings emphasize the need for targeted healthcare interventions and improved parental education to reduce the burden of childhood illnesses in Gandaki Province.

Prevalence of Nocturnal Enuresis among Egyptian Children Presenting at the Pediatric Outpatient Department of Ain Shams University Hospital

Abstract Background Enuresis is a common problem among children and adolescents, and can lead to important social and psychological disturbances to them and their caregivers. Objectives To determine the prevalence of primary and secondary enuresis in the children and adolescent presenting at outpatient clinic. Furthermore, we aimed to determine associated risk factors of nocturnal enuresis among enuretic children. Patients and Methods A cross- sectional study was done among 1587 Arabic fluent mothers or caregivers of children aging 6-16 years recruited from outpatient clinic, Ain Shams University, Children’s Hospital from November 2022 to July 2023. Structured questionnaires were used to assess socio-demographic characteristics, risk factors of enuretic childrens, the association between enuresis and sleep disorders by using Children Sleep Habit Questionnaire (CSHQ) and the impact of enuresis on quality of their life by using Pediatric incontinence Questionnaire (PinQ). Results This study included 1587 children in Egypt, the overall prevalence of enuresis among children age group 6 to 16 years was 21%, that consisted of 209 (62.8%) boys and 124 (37.2%) girls. This study focused on risk factors that had significant difference between enuretic and non enuretic children as family history of nocturnal enuresis (p value &amp;lt;0.001), change living place (p value = 0.001) and habitual use of caffeinated drinks 9.9%and sweaty drinks 22.8% were significant risk factors (p value&amp;lt;0.001). There was a significant difference in sleep disorder grades between two groups (p value= 0.016), Enuretic participants exhibited a slightly higher prevalence of high sleep disorder grades compared to non- enuretic individuals. There was a positive significant correlation between age and PinQ score (parents’ report) (rho= 0.177, p value&amp;lt;0.001). Conclusion this study conducted among 1587 children in Egypt sheds light on the prevalence of enuresis, risk factors, and impact of nocturnal enuresis on children's quality of life. Revealed that nocturnal enuresis is a significant concern, affecting 21% of the studied children, with risk factors including gender, birth order, socioeconomic status, and family history. Furthermore, there was a significant association between sleep disorders and enuresis. Notably, nocturnal enuresis was found to negatively impact children’s quality of life.

Assessment of Awareness and Attitude Regarding Early Childhood Caries among Parents of Preschool Children Attending Pediatric Outpatient Department: A Cross-sectional Study

Background: Early childhood caries (ECC) is a common chronic disease in young children, negatively impacting their health and development. The family environment, particularly parental knowledge, significantly influences children’s oral health. This study aims to evaluate ECC awareness and attitudes among parents of preschool children in Lucknow. Materials and Methods: A cross-sectional study with 400 participants was conducted using simple random sampling. Parents visiting the pediatrics department at a tertiary hospital in Lucknow were included. Data were collected through a self-structured questionnaire, validated through a pilot study (Cronbach’s α = 0.85, face validity 84%, content validity ratio 0.78). Awareness scores were analyzed using SPSS version 24, employing Chi-square, t-tests, ANOVA, and multivariate linear regression. Results: The sample consisted of 38.3% females and 61.8% males, with 35.5% from urban areas and 64.5% from rural areas. Awareness scores were higher in females (Mean = 8.65) than in males (Mean = 6.93) and higher in urban (Mean = 9.86) than rural areas (Mean = 6.45). Education level positively correlated with awareness (F = 10.797, P &lt; 0.001), while income showed a complex relationship. Multivariate regression indicated that gender and education positively influenced awareness scores, whereas area and income had negative impacts, warranting further investigation. Conclusion: Parental awareness of ECC is significantly influenced by gender, education, and area. Educational interventions should target rural areas and parents with lower education levels to enhance oral health knowledge and practices.

Misuse of Antibiotics in Pediatric Patients – A Comprehensive Review .

To identify and assess the likely causes of antibiotic overuse in the Pediatric outpatient department (OPD) of a busy teaching hospital. Overuse of antibiotics has emerged as a significant global pediatric concern. Specifically, the sale of drugs without a prescription from a doctor and other circumstances may have an impact on the abuse of antibiotics. Antibiotic resistance is encouraged by the misuse of antibiotics, particularly when antibiotics are used, even when they are not the recommended course of therapy. The Centers for Disease Control and Prevention estimate that between one-third and half of all antibiotic usage in humans is unwarranted or improper. Viral pathogens are the primary cause of respiratory tract infections (RTI) in children compared to adults. Interestingly, compared to adults with RTI, very little is known regarding the usage of antibiotics in children.

Prevalence and Associated Factors of exclusive breast-feeding practice among Mothers with Infants Under Six Months of Age attending pediatrics OPD and EPI in Asella Referral and Teaching Hospital, East Arsi, Oromia, Ethiopia

Introduction: Exclusive breastfeeding is a highly effective and cost-efficient intervention for preventing childhood morbidities and mortalities. It can prevent approximately 13% of childhood deaths, which equates to saving at least 1.2 million children worldwide each year. However, globally, only about 35% of infants are exclusively breastfed. In developing countries, the rate is 38% for infants under six months, while in Ethiopia, approximately 52% of infants in this age group are exclusively breastfed. Objective: This study aims to assess the prevalence of exclusive breastfeeding practices and identify the associated factors among mothers of infants under six months old who are attending the pediatric outpatient department (OPD) and immunization clinics (EPI) at ARTH. Methodology: An institutional-based cross-sectional study design was employed. Data were collected using a structured questionnaire administered by six graduating Public Health students from Asella Health Science College, who received a two-day training. The collected data were coded, cleaned, and entered into Epi Info, then exported to SPSS version 26 for analysis. Descriptive statistics were used to present the respondents' characteristics through frequencies, percentages, summary measures, tables, and graphs. Bivariate and multivariate analyses were conducted to identify factors associated with exclusive breastfeeding, using odds ratios with 95% confidence intervals. A significance level was set at a p-value &lt; 0.05. Result: Around (40.4%) of mothers Out of 384 eligible mothers, all 384 agreed to participate in the study, resulting in a response rate of 100%. Approximately one-third (36.2%) of the mothers were aged between 25 and 29 years. Regarding the reasons mothers cited for not breastfeeding, 36.5% reported that they believed breast milk was insufficient, 13% mentioned that the infant was thirsty, and 8% cited a lack of time Among the various socio-demographic, health service, maternal, and infant-related factors assessed, several determinants were identified for higher chances of EBF practice. These factors include: Age of the infant: Younger infants (0-3 months) are more likely to be exclusively breastfed compared to older infants (4-5 months). Maternal occupation: Unemployed mothers are more likely to practice EBF than employed mothers. Household income: Mothers with lower monthly incomes are more likely to practice EBF. Conclusion and recommendation: The study revealed a high participation rate of 100% among the 384 eligible mothers, with a significant portion (36.2%) aged between 25 and 29 years. Despite the positive response, barriers to breastfeeding were identified, with 36.5% of mothers believing that breast milk was insufficient, 13% indicating their infants were thirsty, and 8% citing time constraints as reasons for not breastfeeding. Several socio-demographic and health-related factors significantly influence the practice of exclusive breastfeeding (EBF). Younger infants (0-3 months) are more likely to be exclusively breastfed compared to those aged 4-5 months. Additionally, unemployed mothers and those with lower household incomes demonstrate higher rates of EBF practice. Recommendations: 1. Education and Support: Implement educational programs aimed at addressing misconceptions about breast milk sufficiency and providing practical support for breastfeeding mothers, especially those returning to work. 2. Targeted Interventions: Focus on supporting employed mothers with resources and strategies to facilitate EBF, such as flexible work policies and access to breastfeeding-friendly environments. 3. Income-Based Initiatives: Develop targeted initiatives to support lower-income families in their breastfeeding efforts, ensuring access to necessary resources and information.

Ichthammol-induced maculopapular rash and itching in a pediatric patient

Ichthammol ointment is a sulfur-containing ointment which is used for the treatment of lower limb leg ulcerations and skin conditions such as atopic eczema and dermatitis. It has been in use for centuries as a topical ointment. The most common adverse drug reaction (ADR) associated with ichthammol use is skin irritation. This case was collected from the pediatric outpatient department as a part of the Pharmacovigilance elective under the Department of Pharmacology, Christian Medical College, Ludhiana, which is an ADR Monitoring Centre. The patient developed skin rashes and itching as adverse reactions to ichthammol and the medication was promptly discontinued to address the symptoms. The Naranjo’s score was 5 (probable) and the causality assessment showed a probable correlation of the current ADR with the suspect product. There are very few studies from India that have shown such reactions. Hence, this case study is rare and worth reporting to raise awareness of the same.

Contributing Risk Factors to Pneumonia in Children Under Five Years in Madhesh Province of Nepal

Introduction: Pneumonia is the significant cause of morbidity and mortality in under five year children worldwide. In Nepal, pneumonia is the second most common cause of childhood mortality. Exclusive breastfeeding and basic immunization in preventing pneumonia cannot be underestimated. This study aims to assess the contributing risk factors associated with childhood pneumonia among children aged 16 months to under-5 year.  Methods: A case-control study was conducted from January to July 2022 including children under 5 years visiting the pediatric out-patient department of JMCTH. A total of 200 subjects aged 16–59 months were enrolled, in which ‘cases’ included 100 patients diagnosed with pneumonia and ‘controls’ included 100 patients with non-pneumonia illnesses, matched by age and setting. The WHO guideline was followed for the diagnosis of pneumonia. The data on contributing risk factors were collected from both cases and controls via interview method from their parents.  Results: The study showed non-exclusive breastfeeding [odds ratio (OR) =7.82 in 95% confidence interval (CI)], indoor air pollution [OR=7.47 in 95% CI], incomplete basic immunization [OR= 4.44 in 95% CI], low birth weight [OR=3.11 in 95% CI] and severe acute malnutrition i.e. high degree of wasting [OR=2.70 in 95% CI] were the major contributing factors of pneumonia in children under age five in the Madhesh Province of Nepal. However, nutritional status (height-for-age z score), age, sex, and educational status of mother did not appear to be contributing risk factors for pneumonia.  Conclusion: This study highlights non-exclusive breastfeeding, indoor air pollution, incomplete basic immunizations, low birth weight, and severe acute malnutrition significantly increase the risk of childhood pneumonia. Exclusive breastfeeding plays a vital role, while gender seems to influence the relationship between exclusive breastfeeding and pneumonia incidence.

Effectiveness of the Buzzy Bee device on pain perception during invasive pricks among school age children: An interventional study.

Children often develop phobia toward needle pricks and invasive procedures. It is difficult for medical personnel to manage children's pain when they are in the hospital. When it comes to assessing and treating children's discomfort, nurses interact with them the most. The main objective of the study was to evaluate the effectiveness of the Buzzy Bee device on pain perception among children undergoing invasive needle pricks as part of their treatment. The study used a quantitative approach with a quasi-experimental design employing simple random sampling. A post-test-only design was used. After obtaining ethical clearance, data collection was done in the pediatric outpatient department and pediatric wards of Sultan Qaboos University Hospital, Muscat, Oman, between February 2020 and August 2021. Faces Pain Rating Scale for children was used to rate the pain during the procedure, which is a standardized tool. Data were analyzed using SPSS version 23. Descriptive and inferential statistical tests were done to analyze the data. Totally, 120 children along with their parents were interested in the study. After taking appropriate parental consent and children's assent, the participants were recruited by simple random sampling. They were equally divided into 60 in the experimental group and 60 in the control group. The mean age was 8.14 (+/-2.3) in both groups. Among the 120 samples, 63 (52.5%) of them were males and 57 (47.5%) were females. The majority of them had diagnoses like thalassemia, leukemia, and sickle cell and were getting cannulated for blood transfusion therapy. t-test shows that 51.7% (31 samples) reported no pain in the experimental group and 33.3% (20 samples) reported only mild pain, whereas in the control group, only 5.0% (3 samples) reported no pain and 21.7% (13 samples) reported mild pain. About 26.7% of the samples reported very much pain as against the 7% who reported very much pain in the interventional group. There was a statistically significant difference in the pain scores between the control group and the experimental group (likelihood ratio test, P = 0.0001). The Buzzy Bee method significantly reduced the pain. The introduction of a toy-like, child-friendly device, which works on the mechanism of vibrations and cold application, lessened the pain intensity during the procedure and acted as a good distractive therapy for children.

Knowledge, Attitude and Practice of Parents of Children with Childhood Asthma in a Tertiary Care Hospital

Back ground: Asthma is one of the most common reasons that children visit doctors, miss days at school or are admitted to hospital. If asthma is well managed, child should be able to lead a healthy and active life. Methods: The study aims to investigate parental knowledge, attitudes about childhood asthma, and practices regarding the management of their children’s asthma. An observational cross-sectional study was conducted among parents of children aged between 2 and 12 years with asthma who had visited the outpatient or inpatient department of Pediatrics at Dhaka Medical College Hospital over a period of approximately 6 months. Data were collected using a preformed Knowledge, Attitude, and Practice (KAP) questionnaire. Results: Total 110 parents of children with childhood asthma were interviewed in this study. There were 63 (57.3%) male and 47 (42.7%) female with M:F ratio 1.34:1 (Slightly male predominance). Most of the patients 57(87.6%) visited in out-patient department (OPD). Almost half of the parents (52.7%) knew their children had asthma. Most of the parents (80.9%) thought oral form of drug (syrup/ tablet) is better than inhaler. Almost two-third parents believed asthma can be cured and they did not know the importance of adherence with asthma medications. The overall parental knowledge was poor (49.09%). Nearly half of them (49.09%) had negative attitude about childhood asthma &amp; 50.9% parents had poor practice about avoidance of allergens, use of asthma medications and regular follow up of their children. Knowledge, attitude and practice are significantly associated with education, socioeconomic condition and living area. Statistically significant positive correlation has been found between knowledge and practice, but knowledge and attitude has not showed significant positive correlation. J Dhaka Med Coll. 2022; 31(2) : 194-200