Reduce Child Mortality Research Articles

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.

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 < 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.

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.

Waterborne Gastrointestinal Diseases and Child Mortality: A Study of Socioeconomic Inequality in Mexico

In Mexico, 1.9% of child mortality among children aged 3 to 15 years is attributed to waterborne gastrointestinal diseases (WGD). This study employs a generalized bivariate logit econometric model to simulate the relationships between mortality risks and seven explanatory variables. Based on the model results and sensitivity analysis of the estimated parameters, a set of policies was designed to reduce the likelihood of child mortality. The proposed strategy involves implementing the following public policies, primarily targeting communities with extreme and high marginalization: increasing access to drinking water, improving housing conditions, expanding parental basic education coverage, and providing nutrition and healthcare to children from an early age. The findings reveal that children who speak an indigenous language face a mortality risk from WGD that is three times higher than those who do not, while children who receive medical services have a 29% lower risk of mortality compared to those who do not have access to them. It is recommended to offer free medical care in indigenous languages within high-marginalization communities. The combined impact of these policies is expected to significantly reduce child mortality due to WGD.

Study of the Evolution of a Cohort Of Low-Birth-Weight Newborns at Neonatal Discharge: A Perspective on Health and Sustainable Development Goals

Aims: This study aims to analyze the evolution of a cohort of low-birth-weight newborns at neonatal discharge, identifying key health outcomes and socio-economic factors. The goal is to inform strategies aligned with Sustainable Development Goal 3 (SDG 3), focusing on improving neonatal health, reducing child mortality, and promoting equitable access to healthcare. Method: A 12-month prospective cohort study was conducted from June 2020 to July 2021 at the neonatal and nutrition referral center of the Rabat children's hospital. The study included all newborns admitted with a birth weight under 2500g, regardless of the cause of hospitalization. Results: Among 200 low-birth-weight newborns, 42.5% showed extra-uterine growth retardation at discharge. Of these, 50.6% were full-term newborns and 36% were premature infants. Full-term newborns regained birth weight in an average of 5.96±4.07 days, with a median of 4 days. For premature infants, weight recovery averaged 11±8.09 days, with a median of 8 days. Conclusions: The study assessed the progress of low-birth-weight full-term and premature babies at discharge. Tailored nutritional management is crucial, requiring an adaptable strategy from the start and continued adjustments based on clinical progress. Of the cohort, 36.03% were hypotrophic premature infants, and 50.6% were full-term low-birth-weight babies. Enhancing neonatal care quality remains a key challenge, emphasizing the need for collaboration among healthcare professionals to ensure growth monitoring and meet the specific needs of this vulnerable group.

The Impact of Ecological Footprint, Urbanization, Education, Health Expenditure, and Industrialization on Child Mortality: Insights for Environment and Public Health in Eastern Europe.

The purpose of this study is to examine the connection between child mortality in Eastern Europe and ecological footprint, urbanization, education, health expenditure, and industrialization. The study acknowledges the significance of understanding how these factors influence the infant mortality rates in this region from 1993 to 2022. The Grossman Health Outcome (H-O) model investigates the theoretical framework. For the existence of the cross-sectional dependency, mixed-order unit root, and cointegration problem, the famous Cross-Sectional Autoregressive Distributed Lag (CS-ARDL) approach is applied. The research also used the Augmented Mean Group (AMG) and Common Correlated Effects Mean Group (CCEMG) to check robustness. The findings illustrated that health expenditure and education lessen the infant mortality rate in Eastern European countries. But ecological footprint, industrialization and unemployment raise the infant mortality rate. According to the CS-ARDL findings, expenditure on healthcare significantly reduces child mortality. Still, the ecological footprint significantly impacts increasing child mortality. However, the AMG and CCEMG models demonstrate that investing in education is the most effective strategy for reducing child mortality. Therefore, the government of Eastern European countries should provide more priorities in the sustainable urbanization, health expenditure, and education sectors. The robustness of the AMG and CCEMG also demonstrated the strength of the CS-ARDL findings. This research paper contributes to SDG 3 by examining the environmental and health factors that influence child mortality in Eastern Europe. Policymakers, public health professionals, and other stakeholders can use the findings to inform the development and implementation of programs that specifically target the identified causes of child mortality.

Strengthening health-care systems to reduce child mortality

Strengthening health-care systems to reduce child mortality

Intergenerational effects of education on child mortality: Evidence from the compulsory primary schooling law in Vietnam

We leverage the introduction of Vietnam’s primary compulsory schooling law as a natural experiment to provide new evidence on the effects of parents’ education on child mortality. Employing data from the 2009 Vietnam Population and Housing Census and a regression discontinuity design, we show that the reform increased average schooling duration by approximately half a year. Our key findings reveal that one additional year of maternal schooling induced by the law reduced child mortality by 29.4%, with the majority of improvements concentrated among women residing in rural areas, minor ethnicities, and female children. While increased paternal education also exhibited a negative impact on child mortality, the effect diminished in magnitude and became statistically insignificant when controlling for maternal education. This suggests that neglecting to account for spousal education does not introduce substantial biases in estimates of maternal education’s effect on child mortality but may lead to an upward bias in estimates for fathers’ education. Further, our results indicate that increased maternal education was associated with increasing age at marriage and first birth, reducing total fertility, and engaging more in paid work, all of which could serve as potential pathways for child mortality reduction.

Africa struggles to reduce child mortality

Africa struggles to reduce child mortality

Social Policy and Early Childhood Development: A Field Study in Baghdad City

Social policy includes many aspects, some of which are related to welfare, as well as many social responsibilities and rights that are considered the basis of the early childhood stage, as social policy aims to secure a kind of stimulating, safe and equal environment for children, especially in the first years of their lives, as these early stages greatly affect their growth, development and future capabilities. It aims to study the current facts related to a phenomenon, situation or group of individuals. This study relied on the social survey method by sample and used the questionnaire tool to identify the extent of the impact of social legislation to protect early childhood. A field study in the city of Baghdad, where the study sample amounted to (200) individuals, males and females. The results of the study showed that the highest percentage of the research community are females at 54.4%. The results of the study showed that providing health care to mothers before and after birth is the health system for child health by 60.4%. The results of the study indicate that the early childhood care policy contributed to reducing child mortality rates by 63.2%. The results of the study indicate that one of the most important ways is the contribution of the social care policy to correcting some wrong practices by holding educational courses for workers in health centers by 43.6%. The results of the study concluded that there are educational programs provided for early childhood with cognitive and cognitive stimulation by 58.4%. And the contribution of government efforts to provide development programs for the early childhood stage by encouraging enrollment in education by 55.2%. One of the most important difficulties facing the implementation of policies and strategies for sustainable development for early childhood is the absence of activation of the national strategy by 36%. Therefore, we recommend the establishment of a higher council for childhood that takes on the responsibility of drawing up policies related to children and following up on strategies and programs related to them.

The Fertility Transition in Sub-Saharan Africa: The Role of Structural Change.

Despite recent economic growth and reductions in child mortality in many African countries, the region has experienced a slow fertility transition. In this study, we explore whether the slow structural economic change on the continent can explain this discrepancy. We construct a unique panel dataset combining Demographic and Health Surveys and nighttime light intensity data (an indicator of industrialization) from 57 countries at the subnational region level over three decades to analyze the drivers of fertility transitions across low- and middle-income countries. Our results confirm that household wealth, reduced child mortality, and female primary education are crucial for fertility declines. However, our analysis also highlights the importance of indicators of structural economic change, including the share of labor in nonagricultural occupations, industrialization, the share of women with higher education, and the formalization of the economy. Our simulations suggest that if high-fertility countries in sub-Saharan Africa underwent structural economic transformations comparable to those of other low- and middle-income countries with low fertility rates, their fertility levels could fall by 1 to 1.6 children.

Audio Visual and Its Impact on Pain During Immunization

Background: Immunization is an effort to increase the body's immunity to a disease and makes a significant contribution to reducing child mortality, when children are immunized, it will cause pain and the provision of audio visuals given to children is expected to reduce or divert pain during immunization. Purpose: To determine the effect of audio visual on pain during immunization in toddler children (12-36 months) in the intervention group and control group. Method: This research method is experimental which is a study by looking for the effect of audio visual on immunization pain between the intervention group and the group using a two-group posttest design involving 64 respondents who meet the inclusion criteria. Sampling using random sampling with research instruments using SOPs and FLACC. Results: The results obtained were that in the intervention group there were 56.3% of respondents who experienced mild pain and the control group there were 75.1% of respondents who experienced severe pain. Subsequent analysis using the Mann Whitney test obtained a p value of 0.001. Conclusion: Providing audio visuals is proven to have an effect on the pain scale during immunization in toddler.

Unraveling under-five mortality causes in Iran: a comprehensive systematic review and meta-analysis

BackgroundThis study systematically reviewed the causes of child death across different age groups based on the International Classification of Diseases, 10th Revision (ICD-10) criteria.MethodsA comprehensive search was conducted in seven electronic databases and two search engines to identify all studies examining child mortality in any part of Iran or the entire country. Hand searching, gray literature, and bibliographies were also utilized. Data were synthesized descriptively and through meta-analysis.ResultsA total of 35 studies were included, encompassing 58,519 death cases across various age groups. According to the ICD-10 classification, the most common causes of Neonatal Mortality Rates (NMR) were pregnancy, childbirth, and puerperium-related conditions (41.1%), congenital malformations (19.2%), and certain conditions originating in the perinatal period (14.5%). For Infant Mortality Rates (IMR), the leading causes were congenital malformations (44.0%), pregnancy, childbirth, and related conditions (14.5%), and respiratory and cardiovascular diseases (8.7%). In the age group of 28 days to 5 years, the primary causes of death were pregnancy, childbirth, and puerperium-related issues (27.5%), congenital malformations and chromosomal abnormalities (21.6%), and respiratory and cardiovascular disease (9.3%). For children aged 1 to 5 years, congenital malformations (29.1%), external causes (19.6%), and respiratory and cardiovascular disorders (7.2%) were the most significant causes of death. The meta-analysis revealed that immaturity [0.171 (PI: 0.032–0.561)] in infants aged 0–28 days, and congenital malformations in the age groups of 28 to 1 year [0.261 (PI: 0.166–0.385)] and 28 to 5 years [0.173 (PI: 0.078–0.342)] were the leading causes of death.ConclusionsThe findings of this study provide valuable insights for priority-setting interventions aimed at reducing child mortality according to the prevalence rate of specific causes in different age groups.

Validity of medical exemptions from vaccination in persons with allergic disorders

Despite the enormous successes that have been achieved in the fight against infectious diseases thanks to mass preventive vaccination, primarily the reduction of child mortality, оutbreaks of vaccine-preventable diseases sometimes occur. One of the reasons is unjustified medical exemptions from vaccinations, which were widely used in the past, the shortcomings of taking into account adverse events after immunization as well as parental refusals (complete or partial) from preventive vaccinations. The article presents data from a retrospective analysis of medical records of patients sent for consultation with an allergist-immunologist to decide on the possibility of vaccination against the new coronavirus infection (COVID-19), including to confirm previously issued medical exemptions. The study included 87 patients (39 men and 48 women), most of them were of working age. Sixty-eight patients (78.2%) had previously received medical exemptions from vaccination, including 14 (20.6%) based on information about adverse events after immunization, and 32 (47.1%) based on adverse reactions for the administration of other medications, and in 22 (32.3%) only on the basis of a diagnosis of any allergic disease. At the same time, medical documentation confirming the facts of adverse events after immunization or adverse reactions to medications was absent in the vast majority of cases. In addition, 3 patients were not vaccinated in childhood due to parental refusal, and another 16 patients were contacted to assess the potential risk of developing side effects after vaccination due to the presence of allergic diseases (bronchial asthma, allergic rhinitis, atopic dermatitis, chronic urticaria, recurrent angioedema). Based on clinical and anamnestic data and, if necessary, laboratory and instrumental studies, temporary contraindications for vaccination were identified in only 6 (27.2%) patients. There were no absolute contraindications. In other cases, stable remission was observed or the disease was fully or partially controlled with medication, which was not a contraindication for vaccination at the time of treatment. Thus, in most cases, medical exemptions from vaccinations are unfounded or become irrelevant over time. At the same time, the lack of medical documentation seriously makes it difficult to objectively assess the risk of developing adverse events after immunization in patients with allergic diseases.

Cause-Specific Mortality among Infants in a Randomized Controlled Trial of Azithromycin Compared to Placebo for Prevention of Mortality.

Although community randomized trials have found a reduction in all-cause child mortality in communities receiving mass azithromycin distribution compared with placebo, individually randomized trials have not found similar protective effects. If a direct effect of azithromycin for prevention of child mortality exists, it is likely due to reduction in infectious mortality. Here, we assessed cause-specific mortality in a large randomized controlled trial of azithromycin administered during well-infant visits in Burkina Faso for prevention of mortality. Among 32,877 enrolled infants, the most common causes of death by 6 months of age were malaria, acute respiratory infections, and diarrheal disease. We found no evidence of a difference in the distribution of cause of death by randomized treatment assignment (P = 0.42) or in any infectious-specific cause of death. The results of this analysis are consistent with no direct effect of azithromycin on infant mortality when administered during well-infant visits.

Malaria Rapid Tests, Febrile Illness Management, and Child Mortality Across Sub-Saharan African Countries

A prompt malaria diagnosis is crucial for the management of children with febrile illness in sub-Saharan African countries, where malaria remains a leading cause of mortality among children younger than 5 years of age. The development and distribution of point-of-care rapid diagnostic tests (RDTs) for malaria has transformed practice, but limited systematic evidence exists on how malaria RDTs have affected the management of febrile illness and mortality for children younger than 5 years of age across sub-Saharan Africa countries. To evaluate the association between the distribution of malaria RDTs and the management of febrile illness and mortality among children younger than 5 years of age in sub-Saharan African countries. This quasi-experimental study used a novel dataset linking malaria RDT distribution to 165 nationally representative household surveys across 35 sub-Saharan African countries with mortality data. The sample comprised approximately 3.9 million child-year observations and approximately 260 000 febrile illness episodes in children younger than 5 years of age between 2000 and 2019. Fixed-effects linear probability models were used to analyze the association between variation in malaria RDTs distributed per child younger than 5 years of age (by country per year) and blood testing, antimalarial drug use, antibiotic use, use of symptomatic treatments, and mortality rates. Variation in the effects of testing and treatment was also assessed across the sub-Saharan African countries that had varying prevalence of malaria. The mortality sample included 1 317 866 children and the fever sample included 256 292 children. The mean age of the children with febrile illness was 2.4 years (SD, 1.3 years) and 49% were female. Each additional malaria RDT distributed per child younger than 5 years of age was associated with an increase of 3.5 percentage points (95% CI, 3.2-3.8 percentage points) in blood testing, an increase of 1.5 percentage points (95% CI, 1.2-1.8 percentage points) in the use of antimalarial drugs, an increase of 0.4 percentage points (95% CI, 0.1-0.6 percentage points) in antibiotic use, and a decrease of 0.4 percentage points (95% CI, 0.1-0.8 percentage points) in the use of treatments for symptoms. Each additional malaria RDT distributed per child younger than 5 years of age was associated with a reduction in child mortality of 0.34 deaths per 1000 child-years (95% CI, 0.15-0.52 deaths per 1000 child-years). The effects of malaria RDT distribution on medication use and child mortality varied across prevalence settings (low vs high) for malaria; there were survival improvements only in areas that had a high prevalence of malaria. Increasing distribution of malaria RDTs was associated with increased blood testing, increased use of antimalarial drugs, and modestly improved survival in children younger than 5 years of age in sub-Saharan African countries. However, malaria RDTs were associated with increases in the rates of antibiotic use that were already high, suggesting that more comprehensive approaches to case management of febrile illness are needed.

Causes of Pediatric Deaths in Lusaka, Zambia: A Quantitative Geographic Information Systems Approach.

While childhood mortality has been declining in Zambia, it remains high at 58 per 1000 live births. Importantly, many leading causes of mortality in Zambia are preventable. This study was conducted to identify clusters of childhood mortality, causes of death of recently deceased children, barriers to care, and risk factors for mortality in Lusaka, Zambia. This study was conducted as a prospective cohort study. Family members or lawfully authorized representatives (LARs) were interviewed when they came to pick up death certificates for recently deceased children from Lusaka Children's Hospital. Each interview included a verbal autopsy, determination of the child's location of residence, and collection of demographic information. Demographic data was also collected from a healthy control group. Quantitative Geographic Information Systems was used to visualize mortality and evaluate for clustering. Leading primary causes of death included malnutrition (21%), complications of chronic illnesses (16%), and central nervous system infections (13%), while the leading barriers to care were cost (58%) and difficulties with travel (53%). Compared to controls, recently deceased children came from families with significantly lower incomes (1905 Kwacha vs. 2412 Kwacha, p = 0.03) and were significantly more likely to have a history of malnutrition (16.7% vs. 1.4%, p = 0.005). Mortality was clustered in two high-population density, low-income neighborhoods in Lusaka. Systems to reduce financial barriers to care and improve access to transportation could reduce childhood mortality in Lusaka. The aforementioned neighborhoods are ideal locations for public health interventions or improved healthcare services.

Toilet construction under the Swachh Bharat Mission and infant mortality in India

Improvement of water and sanitation conditions may reduce infant mortality, particularly in countries like India where open defecation is highly prevalent. We conducted a quasi-experimental study to investigate the association between the Swachh Bharat Mission (SBM)—a national sanitation program initiated in 2014—and infant (IMR) and under five mortality rates (U5MR) in India. We analyzed data from thirty-five Indian states and 640 districts spanning 10 years (2011–2020), with IMR and U5MR per thousand live births as the outcomes. Our main exposure was the district-level annual percentage of households that received a constructed toilet under SBM. We mapped changes in IMR and U5MR and toilet access at the district level over time. We fit two-way fixed effects regression models controlling for sociodemographic, wealth, and healthcare-related confounders at the district-level to estimate the association between toilets constructed and child mortality. Toilet access and child mortality have a historically robust inverse association in India. Toilets constructed increased dramatically across India following the implementation of SBM in 2014. Results from panel data regression models show that districts with > 30% toilets constructed under SBM corresponds with 5.3 lower IMR (p < 0.05), and 6.8 lower U5MR (p < 0.05). Placebo, falsification tests and robustness checks support our main findings. The post-SBM period in India exhibited accelerated reductions in infant and child mortality compared to the pre-SBM years. Based on our regression estimates, the provision of toilets at-scale may have contributed to averting approximately 60,000–70,000 infant deaths annually. Our findings show that the implementation of transformative sanitation programs can deliver population health benefits in low- and middle-income countries.

Knowledge, Attitude, and Practice of Breastfeeding among South Indians: A Cross-sectional Study

Introduction: Research shows that exclusively breastfed infants have a 13% lower mortality risk. However, only 37% of infants in Low and middle income country (LMIC) are exclusively breastfed. Materials and Methods: This cross-sectional study was conducted in a Chennai hospital’s outpatient department, focusing on pediatrics. The study commenced after obtaining ethical clearance (99/IEC-SMMCHRI). Breastfeeding knowledge, attitude, and practice (KAP) scales were developed by modifying existing KAP tools. The KAP questionnaire was based on the World Health Organization. The same was applied to 250 consenting mothers. Results: Participants had a mean age of 27 years, with the youngest mother at 19 and the oldest at 40. Forty-one percent had finished high school, and 37% had completed undergraduate studies. Eighty-eight percent had strong breastfeeding comprehension, and 96% had a favorable attitude. However, only 32% exclusively breastfed. The study found significant correlations between knowledge and behavior (χ2 = 4.27, P = 0.04) and between attitude and behavior (χ2 = 5.69, P = 0.017). Mothers with adequate knowledge tended to follow recommended feeding practices, and those with a positive attitude displayed good practices. Conclusion: Despite positive attitudes toward breastfeeding, the cultural practice of introducing prelacteal food hinders exclusive breastfeeding, leading to negative outcomes. While there have been some improvements in exclusive breastfeeding rates, addressing this disparity could reduce child mortality rates. The outcomes of the research will be highly beneficial for primary care physicians in their efforts to promote exclusive breastfeeding among expectant mothers.

Sustainable Healing and Therapeutic Design Driven Well-Being in Hospital Environment

Despite the growing awareness of healing hospitals, they are still far from being globally widespread, and traditional hospital building models are increasingly unable to address the serious resource constraints and environmental stresses that we face today. In addition, sustainable development concepts have become key driving forces in the construction process of healing buildings. Currently, while research on healing hospital design continues to grow, there is relatively little that specifically addresses the integration of sustainable development concepts. Hence, this paper aims to explore the current state of development and knowledge structure of sustainable healing and therapeutic design (HTD) in hospital scenarios using a systematic methodology that integrates macro-quantitative bibliometric analysis and follow-up micro-qualitative content analysis methods based on data from the Web of Science (WOS) database, which investigates eight research objectives, including the background, current state, hotspots, high-frequency words, integration with sustainable development goals (SDGs), particularly SDG3, “Ensure healthy lifestyles and promote well-being of people of all ages”, and the challenges posed by public health emergencies, such as the COVID-19 era, for sustainable HTD in hospitals. This paper identified six main clusters: the environment of a hospital, mental health, quality of life, illness and care, COVID-19, and wound healing. These clusters were taken from keyword network visualization analysis, emphasizing key terms focused on wound healing, mental health, quality of life, nursing, children, and evidence-based design via high-frequency keyword analysis. These have been further grouped into three categories: strategy, approach, and method. Subsequently, this paper further explores how hospital HTD relates to SDG 3 targeted on reducing child mortality (SDG 3.2), promoting mental health and physical health (SDG 3.4), and achieving universal health coverage (SDG 3.8) to explore wound healing, mental health, quality of life, nursing, and children, which are stressed in the results of both macro-quantitative bibliometric and follow-up micro-qualitative content analyses. In addition, it is shown that more changes should be made to sustainable hospital HTD in the context of the pandemic era to cope with unpredictable crises. Finally, the expression HTD is discussed to justify the keywords. The results of this study complement sustainable hospital HTD and provide assistance to future architects, policy makers, and healthcare professionals.