Status Of Children Research Articles

The Etiology of Pneumonia in HIV-infected Zambian Children: Findings From the Pneumonia Etiology Research for Child Health (PERCH) Study.

Despite recent declines in new pediatric HIV infections and childhood HIV-related deaths, pneumonia remains the leading cause of death in HIV-infected children under 5. We describe the patient population, etiology and outcomes of childhood pneumonia in Zambian HIV-infected children. As one of the 9 sites for the Pneumonia Etiology Research for Child Health study, we enrolled children 1-59 months of age presenting to University Teaching Hospital in Lusaka, Zambia, with World Health Organization-defined severe and very severe pneumonia. Controls frequency-matched on age group and HIV infection status were enrolled from the Lusaka Pediatric HIV Clinics as well as from the surrounding communities. Clinical assessments, chest radiographs (CXR; cases) and microbiologic samples (nasopharyngeal/oropharyngeal swabs, blood, urine, induced sputum) were obtained under highly standardized procedures. Etiology was estimated using Bayesian methods and accounted for imperfect sensitivity and specificity of measurements. Of the 617 cases and 686 controls enrolled in Zambia over a 24-month period, 103 cases (16.7%) and 85 controls (12.4%) were HIV infected and included in this analysis. Among the HIV-infected cases, 75% were <1 year of age, 35% received prophylactic trimethoprim-sulfamethoxazole, 13.6% received antiretroviral therapy and 36.9% of caregivers reported knowing their children's HIV status at time of enrollment. A total of 35% of cases had very severe pneumonia and 56.3% had infiltrates on CXR. Bacterial pathogens [50.6%, credible interval (CrI): 32.8-67.2], Pneumocystis jirovecii (24.9%, CrI: 15.5-36.2) and Mycobacterium tuberculosis (4.5%, CrI: 1.7-12.1) accounted for over 75% of the etiologic fraction among CXR-positive cases. Streptococcus pneumoniae (19.8%, CrI: 8.6-36.2) was the most common bacterial pathogen, followed by Staphylococcus aureus (12.7%, CrI: 0.0-25.9). Outcomes were poor, with 41 cases (39.8%) dying in hospital. HIV-infected children in Zambia with severe and very severe pneumonia have poor outcomes, with continued limited access to care, and the predominant etiologies are bacterial pathogens, P. jirovecii and M. tuberculosis.

Gender Differences in Nutritional Status of Children in Tea Gardens of Darjeeling: Based on Conventional Indices and Composite Index of Anthropometric Failure

Objectives: The study aims to assess the nutritional status of children aged 1-5 years and its relationship with gender. Further, it also tries to assess the nutritional status of children using conventional indices and the composite index of anthropometric failure (CIAF) and suggests the appropriate method to estimate undernutrition among children.&#x0D; Materials and Methods: The area selected for the study is the tea gardens of Darjeeling. The study is based on the primary survey, and a total of 400 children were included in the study. A Chi-square test is conducted to find out the differences in the nutritional status of children gender-wise.&#x0D; Results: The analysis indicated that the level of undernutrition in tea gardens of Darjeeling is very high (51%). The level of undernutrition estimated through conventional indices indicated that the level of stunting, wasting, and underweight are 43.8%, 20.2%, and 36.2%, respectively, whereas the composite index of anthropometric failure estimated more prevalence rate (51.2%). The analysis indicates that the conventional indices underestimate the prevalence of undernutrition. On the contrary, a composite index of anthropometric failure (CIAF) gives better estimates of undernutrition. Both the indices of nutrition in the study area indicated higher undernutrition among girl children than a boy. However, no significant differences in the nutritional status gender-wise exist.&#x0D; Conclusion: The result depicts the positive sign as it contradicts the general belief that a boy child is more nourished than a girl. However, half of the children in tea gardens of Darjeeling aged 1-5 years, irrespective of gender, are undernourished. The paper highlights the urgent need to work out nutritional strategies to improve child health in the study area.

Authoritarian Parenting Effect on Children's Executive Control and Individual Alpha Peak Frequency

ABSTRACTThere is increasing evidence that the authoritarian parenting style has a negative effect on children's executive control, but little is known about the neurobiological mechanism behind this effect, especially the evidence of the resting‐state EEG related to children's brain function. The current study explored the relations between authoritarian parenting and children's executive control among 40 children aged 8–11 years old and examined associations between authoritarian parenting and individual alpha peak frequency (iAPF). Hierarchical regression analysis indicated that after controlling for children's age and parental socioeconomic status, authoritarian parenting style negatively predicts the children's executive control and iAPF in EEG. This study extends previous research on the effect of parenting styles on children's cognitive abilities and provides evidence at the level of neural mechanisms.

Decision-Making Processes Related to Perseveration Are Indirectly Associated With Weight Status in Children Through Laboratory-Assessed Energy Intake.

Decision-making contributes to what and how much we consume, and deficits in decision-making have been associated with increased weight status in children. Nevertheless, the relationships between cognitive and affective processes underlying decision-making (i.e., decision-making processes) and laboratory food intake are unclear. We used data from a four-session, within-subjects laboratory study to investigate the relationships between decision-making processes, food intake, and weight status in 70 children 7-to-11-years-old. Decision-making was assessed with the Hungry Donkey Task (HDT), a child-friendly task where children make selections with unknown reward outcomes. Food intake was measured with three paradigms: (1) a standard ad libitum meal, (2) an eating in the absence of hunger (EAH) protocol, and (3) a palatable buffet meal. Individual differences related to decision-making processes during the HDT were quantified with a reinforcement learning model. Path analyses were used to test whether decision-making processes that contribute to children’s (a) expected value of a choice and (b) tendency to perseverate (i.e., repeatedly make the same choice) were indirectly associated with weight status through their effects on intake (kcal). Results revealed that increases in the tendency to perseverate after a gain outcome were positively associated with intake at all three paradigms and indirectly associated with higher weight status through intake at both the standard and buffet meals. Increases in the tendency to perseverate after a loss outcome were positively associated with EAH, but only in children whose tendency to perseverate persistedacross trials. Results suggest that decision-making processes that shape children’s tendencies to repeat a behavior (i.e., perseverate) are related to laboratory energy intake across multiple eating paradigms. Children who are more likely to repeat a choice after a positive outcome have a tendency to eat more at laboratory meals. If this generalizes to contexts outside the laboratory, these children may be susceptible to obesity. By using a reinforcement learning model not previously applied to the study of eating behaviors, this study elucidated potential determinants of excess energy intake in children, which may be useful for the development of childhood obesity interventions.

Segmented School Physical Activity And Weight Status In Children: Application Of Compositional Data Analysis

Segmented School Physical Activity And Weight Status In Children: Application Of Compositional Data Analysis

The Role of Life Style Behaviors on Depressive Symptoms in Children during the COVID-19 Pandemic

Background : The lifestyle behaviors such as consumption of fruit and vegetables, along with time spent in physical activities and screen time are crucial for weight management, and improving these behaviors may be a key role in increasing mental health. This study aimed to investigate the role of lifestyle behaviors on depressive symptoms in children during the Covid-19 pandemic. Methods : This was a descriptive correlational study. The statistical population included male and female elementary school students (grades 4-6) in public schools in the eastern cities of Mazandaran province in 2020, among which 530 people were selected by random cluster sampling. Data collection tools included questionnaires of children's physical activity, fruit and vegetable consumption, children's depression, Screen time, and socioeconomic status. Data were analyzed using Mann-Whitney U, Kruskal-Wallis, Spearman correlation coefficient, and multiple linear regression tests. Results: The findings showed that just 13.3% of children had sufficient consumption of fruits and vegetables and 57.6% of students sufficient physical activity did not have.in addition, screen time was increased with age and be more in females. Regression analysis showed that the consumption of fruits and vegetables and physical activity both have the inverse effect on depressive symptoms, with the coefficient of effect -0.191 and -0.21 respectively; while screen time has a positive effect with an effective coefficient of 0.25 (Pvalue<0.05). Conclusion: It seems that in addition to physical activity and consumption of fruits and vegetables, the important role of Screen time in the design of interventions to promote mental health in children, especially during the outbreak of Covid-19 should be considered. Keywords: Depressive symptoms, Fruit and vegetable, Physical activity, Screen time, COVID-19.

Barriers to Receiving Necessary Hearing Care Among US Children.

We aim to clarify the national scope of unmet pediatric hearing care needs and identify specific barriers to hearing care. Cross-sectional study of a nationally representative data set. This study is based on the combined 2016 and 2017 National Survey of Children's Health. This survey covers the physical and emotional health, access to care, and social context of US children and adolescents aged 0 to 17 years. Analysis of parent-reported responses of children's hearing status, access to care, and perceived barriers. Overall, 0.3% (n = 206,200) of US children surveyed reported needing hearing care, which was not received. A further 1.3% (n = 934,000) reported deafness or problems with hearing, and of these, 6.4% (n = 60,000) reported not receiving necessary hearing care. Rates of insurance coverage between children with deafness/hearing problems and the general population were similar (91.7% vs 93.9%); however, deaf or hard-of-hearing children with unmet hearing care needs were more likely to be from non-White backgrounds (P = .009) and to lack health insurance coverage (P = .001). Rates of unfulfilled hearing care by reason were as follows: 57.5% without eligibility for the service, 45.4% reporting the service was not available in their area, 53.7% with difficulty obtaining an appointment, and 53.5% reporting issues with cost. Over 200,000 children annually do not receive necessary hearing-related care despite high rates of insurance coverage, and nearly 60,000 of these children are deaf or hard of hearing. Cost, eligibility for and distribution of services, and timely appointments are the primary barriers to hearing health care.

Corporal punishment and early childhood development in 49 low- and middle-income countries

ObjectiveTo systematically assess the association between corporal punishment and young children's development in low- and middle-income countries (LMICs). MethodData for 69 population-based surveys from the Multiple Indicators Cluster Survey (MICS) were combined. The sample included 131,164 children aged 36–59 months living in 49 LMICs. The surveys included information about children's developmental status and exposure to corporal punishment in the prior month. Logistic models, random-effects meta-analysis, and moderation analysis were used to obtain pooled estimates and assess the extent to which the association between corporal punishment and child developmental outcomes varied across countries. ResultsOn average, children exposed to corporal punishment were about 24% (β = 0.76, 95% CI 0.72–0.80) less likely to be developmentally on track than children who were not exposed to corporal punishment. Challenges in social-emotional development may drive the association between child development and corporal punishment. Corporal punishment was not associated with any positive developmental outcome in any country. There was minor heterogeneity in the estimated associations, which was not explained by the extent to which corporal punishment was normative within countries. ConclusionsAll forms of corporal punishment – including spanking – are likely to be harmful to young children's development and wellbeing. Public education, legal prohibition of corporal punishment, and other efforts are needed to protect children from corporal punishment and promote their wellbeing, health, and development.

Premarital genetic screening and care of Tanzanian children with sickle cell disease: a qualitative study on parents' views and experiences.

Genetic testing and counselling is one of the approaches to reduce the high birth rate of individuals with sickle cell disease (SCD). A descriptive phenomenological approach was used to explore parents' views on premarital genetic screening for sickle cell trait and their experiences in the care of Tanzanian children with SCD using a face-to-face in-depth interview. The study was conducted at sickle cell clinic at tertiary hospital in Dar es Salaam region between June and August 2020. The study found that most of the parents with SCD children knew about genetic testing and counselling after the diagnosis of their children's SCD status. Major approaches employed in managing SCD crises were supportive, preventive, and symptomatic. Parents expressed a heavy burden related to caretaking due to the lack of financial support and stigmatization. These affected their children's quality of care and management. In conclusion, participants expressed a preference for premarital genetic testing, where others insisted it becomes compulsory. In addition, there should be an adequate clinic for early screening, accessible therapeutic support and long-term follow up for children with SCD. Support to poor families with individual with SCD through national health assurance scheme and free provision of preventive medications such as hydroxyurea, is recommended.

Dietary Sugar Exposure and Oral Health Status in Children with Autism Spectrum Disorder: A Case-control Study.

This case-control study compared dietary sugar exposure and oral health status between children with and without Autism Spectrum Disorder (ASD), aged 5-12years (n = 136, each). Data regarding socio-demographics, child's oral hygiene practices and behavior, diet-related behavior, oral habits and dental trauma were obtained. Child's diet on the previous day was recorded using 24-h recall method and sugar exposure was calculated using Dental Diet Diary (D3) mobile application. Oral Hygiene Index-Simplified (OHI-S), deft and DMFT were recorded. Results showed no significant differences in sugar exposure, deft and DMFT between the groups. Although oral hygiene practices were significantly better in children with ASD, their OHI-S was significantly worse. Significantly more children with ASD reported mouth-breathing, bruxism and self-injurious habits.

Parent-Reported Symptoms and Perceived Effectiveness of Treatment in Children Hospitalized with Advanced Heart Disease

To characterize parent-reported symptom burden and effectiveness of symptom management in children hospitalized with advanced heart disease. Prospective survey study of 161 parents whose child was admitted to a single institution with advanced heart disease between March 2018 and February 2019 using the Survey about Caring for Children with Heart Disease. Of the 161 patients, 54% were under 2years old with a diagnosis of single ventricle physiology (39%), pulmonary hypertension (12%), and other congenital heart disease (28%). Over one-half (56%) of parents reported that their child was experiencing a high degree ("a great deal"/"a lot") of symptoms. The most frequently reported symptoms were pain (68%), fatigue (63%), and breathing difficulties (60%). Of the symptoms that were treated, parents perceived successful treatment to be least likely for their child's sleep disturbance (24%), depression (29%), and fatigue (35%). Parents who reported their child's functional status as New York Heart Association class III/IV were more likely to report that their child was experiencing "a great deal" of symptoms, compared with those who reported class I/II (51% vs 19%, P<.001). Parents who reported their child was experiencing a high degree of suffering from fatigue were also more likely to report a high symptom burden (P<.001). Parents of children with advanced heart disease reported high symptom burden with a broad spectrum of symptoms. Parents reported fatigue and psychiatric symptoms frequently and rarely reported treatment as successful. Parents' view of their child's symptom burden was concordant with their perception of their child's functional status.

Patients, caregivers, and clinicians differ in performance status ratings: Implications for pediatric cancer clinical trials.

The Lansky Play-Performance Scale (LPPS) is often used to determine a child's performance status for cancer clinical trial eligibility. Differences between clinician and caregiver LPPS ratings and their associations with child-reported functioning have not been evaluated. Children aged 7 to 18 years who were receiving cancer treatment and their caregivers were recruited from 9 pediatric cancer centers. Caregivers and clinicians reported LPPS scores, and children completed Patient-Reported Outcomes Measurement Information System (PROMIS) pediatric functioning and symptom measures before treatment (time 1 [T1]) and after treatment (time 2 [T2]). t tests and mixed-linear models were used to assess differences in caregiver and clinician LPPS scores; polyserial correlations quantified associations between PROMIS and LPPS scores. Of 482 children, 281 had matched caregiver- and clinician-reported LPPS T1/T2 scores. Caregivers rated children significantly worse on the LPPS than clinicians at both T1 (mean, 73.3 vs 87.4; P < .01) and T2 (mean, 67.9 vs 83.1; P < .01). These differences were not related to a child's age (P = .89), diagnosis (P = .17), or sex (P = .64) or to the time point (P = .45). Small to moderate associations existed between caregiver- and clinician-reported LPPS ratings and child-reported PROMIS scores for mobility (caregiver T1/T2 r = 0.51/0.45; P < .01; clinician T1/T2 r = 0.40/0.35; P < .01), fatigue (caregiver T1/T2 r = -0.46/-0.37; P < .01; clinician T1/T2 r = -0.26/-0.27; P < .01), and pain interference (caregiver T1/T2 r = -0.32/-0.30; P < .01; clinician T1/T2 r = -0.17/-0.31; P < .01). Caregivers and clinicians assigned significantly lower LPPS scores at T2 (caregiver Δ = -5.37; P < .01; clinician Δ = -4.20; P < .01), whereas child-reported PROMIS scores were clinically stable. Significant differences between clinician and caregiver LPPS ratings of child performance were sustained over time; their associations with child reports were predominantly small to moderate. These data suggest that clinician-reported LPPS ratings by themselves are inadequate for determining clinical trial eligibility and should be supplemented by appropriate measures of a child's functional status reflecting the child and caregiver perspectives.

The Application of Article 53 of KHI (Islamic Law Compilation) Regarding Pregnant Marriage in Lottery Marriage

Pregnant marriagebecomes a phenomenon that is still happening in Indonesia and is even one of the most significant contributors to the reason for the dispensation of marriage. In Parangdistrict, Magetan Regency, pregnant marriage is also one of the solutionsfor a case in which many women get pregnant without a legal marriage. Pregnancies were not initiated from sexual intercourse between a man and a woman but were carried out by many men, so the model of determination was by lottery. Furthermore, this article will analyze the pregnant woman who is married to a man who does not impregnate her and the child's status according to article 53 of KHI. In article 53 KHI, no line explicitly explains the permissibility or prohibition of a pregnant woman to marry a man who does not impregnate her. Still, many interpret that this is not allowed.Meanwhile, a legitimate child in KHI is a child born during a legal bond. So, when DNA testing proof or the like is not done to see the legality of the child, then this child is still considered a legitimate child by both of them because they were born in a marriage bond. In sum, a pregnant marriage in a lottery marriage with a man who does not impregnate the woman has many sides of ambiguity. So, there must be a revision of article 53 and article 99 of KHI.

How Widowhood and Gender Shape the Impact of Maternal Favoritism on Adult Children's Psychological Well-Being.

Our goal was to extend research on within-family differences in mother-child relations in later life by focusing on 2 social structural characteristics of mothers and offspring that may play important roles in shaping the impact of maternal favoritism on adult children's depressive symptoms-mother's marital status and child's gender. Mixed-methods data were collected as part of the Within-Family Differences Study from 641 adult children nested within 273 families in which: (a) there were at least 2 living adult siblings, and (b) mothers were married or widowed. Multilevel analyses indicated that perceiving oneself as the child to whom one's mother was most emotionally close was a strong predictor of higher depressive symptoms among daughters of widowed mothers; in contrast, perceptions of favoritism did not predict depressive symptoms among sons of either widowed or married mothers, or daughters of married mothers. Qualitative analyses revealed that daughters, but not sons, of widowed mothers tended to attribute their greater closeness with their mothers to their roles as their mothers' "emotional caregivers," particularly solo caregivers, during times when mothers faced negative life events that neither they nor their children could control or ameliorate. The quantitative and qualitative findings we present underscore how social structural positions-in this case, mother's marital status and child's gender-combine with social psychological processes to shape how parent-child relations affect children's well-being in adulthood.

Surrogate Mother Validity against Children’s Civil Status: Comparative Study, Surrogate Mother in Indonesia and Ukraine

Nowadays, technology is getting more advanced. For example, IVF or "In Vitro Fertilization (IVF)" with a surrogate mother. A surrogate mother is a woman who has no relationship at all with a spouse who owns the seed then makes an agreement with them to rent out her uterus in exchange for material things. This study aims to determine the Surrogate Mother validity in Indonesia and in Ukraine on born children's civil status. This study employed normative juridical methods. The findings revealed Surrogate mothers is not allowed as it against the existing law in Indonesia. This is stated in Article 127 of Law Number 36 the Year 2009, the prohibition of the surrogate mother agreement. However, if a child is born from a Surrogate Mother, his civil status will be of surrogate mother's child. In Ukraine, on the other hand, the surrogate mother is legal. This is stated in Article 123 of the Family Code of Ukraine 2002, the children’s civil status is a genetic child of a spouse who owns the seed

Sleep-Related Breathing Problem Trajectories Across Early Childhood and Academic Achievement-Related Performance at Age Eight.

Background: Childhood sleep disordered breathing (SDB) has been linked to poorer academic performance; however, research has not investigated the extent improvement in SDB may alter outcomes across key academic skills. This study aimed to investigate if children's early SDB status could predict later academic outcomes, and if an improvement in SDB status across the early childhood years would coincide with better, later performance in key academic skills related to reading, numeracy, and listening comprehension.Methods: Eighty five case children with an SDB symptom score >25 (maximum 77) were matched to 85 control children (score <12) at recruitment (age 3). SDB severity (symptom history and clinical assessment) was evaluated at ages 3, 4, 6, and 8 years and performance on individually-administered academic skills assessed at age 8 (91% retention from age 3). Case children were categorized into “improved” or “not-improved” groups based on SDB trajectories over the 5 years. Contributions of SDB status and trajectory group to academic performance were determined using regression analysis adjusted for demographic variables.Results: History of SDB from age 3 predicted significantly poorer performance on some key academic skills (oral reading and listening skills) at age 8. Children whose SDB improved (45%) performed better in oral reading fluency than those whose SDB did not improve, but difficulties with specific tasks involving oral language (listening retell) remained when compared to controls.Conclusion: Findings support links between early SDB and worse academic outcomes and suggest key academic areas of concern around oral language. Findings highlight the need for child mental health professionals to be aware of children's sleep problems, particularly SDB (past and present), when assessing potential barriers to children's achievement, to assist with appropriate and timely referrals for evaluation of children's sleep difficulties and collaborative evaluation of response to intervention for sleep difficulties.

Association Between Obsessive-Compulsive Symptom Dimensions in Mothers and Psychopathology in Their Children.

Background: The non-clinical presentation of obsessive–compulsive symptoms (OCS) in women may impact not only their daily lives and well-being but also increase the risk for emotional and behavioral problems in their children. This study aims to investigate the OCS dimension distribution in a large sample of mothers from a cohort of school age children and the association between these OCS dimensions with their own psychopathology, and with the presence of OCS and other psychopathology in their children.Method: Our final sample consisted of 2,511 mother-children dyads recruited from the elementary schools of two large cities. Throughout multiple regression analysis, we examined the correlations between demographic and clinical variables of mothers assessed by the Mini International Psychiatric Interview (MINI) and the Dimensional Yale-Brown Obsessive-Compulsive Scale-Short Version (DY-BOCS-SV) with children's psychopathology status reported by the Child Behavior Checklist (CBCL).Results: The overall prevalence of mothers who reported experiencing at least one OCS was 40% (N = 1,004). “Aggression/violence” was the most frequent symptom dimension (32.2%), followed by the “symmetry/ordering” (16.4%) and the “sexual/religious” dimensions (13.8%). There was a significant correlation between the presence of OCS and maternal psychopathology in general (p < 0.001, r = 0.397). Not only the presence but also the severity of the mother's OCS were strongly correlated to the total (p < 0.001), internalizing (p < 0.001), externalizing (p < 0.001), and OCS subscale scores (p < 0.001) on the CBCL.Conclusion: OCS dimensions are highly prevalent in women. Presence and severity of maternal OCS are related to children's psychopathology and behavioral problems.

Physical health, behavioral and emotional functioning in children of gulf war veterans

ObjectiveWe examined whether the prevalence of medical and behavioral conditions is higher in children of deployed veterans (DVs) versus non-deployed veterans (NDVs) after the 1991 Gulf War. MethodsWe examined 1387 children of 737 veterans. Children ages 2-18 had physical exams and parental reports of physical history and behavior. ResultsPhysical health was analyzed using GEE models. Behavioral health [total, internalizing, and externalizing behavior problems (TBP, IBP, EBP)] was analyzed with mixed-effects regression models. Analyses were conducted by age group (2-3, 4-11, 12-18), and gender (ages 4-11, 12-18). Children of DVs ages 2-3 had significantly worse dentition (13.9% vs. 4.8%, P = 0.03) and more EBP {least square means (lsmeans) 54.31 vs. 47.59, P = 0.02}. Children of DVs ages 4-11 had significantly more obesity (18.8% vs. 12.7%, P = 0.02). Among children 4-11, male children of DVs had significantly more TBP (lsmeans 70.68 vs. 57.34, P = 0.003), IBP (lsmeans 63.59 vs. 56.16, P = 0.002) and EBP (lsmeans 61.60 vs. 52.93, P = 0.03), but female children did not. For children ages 12-18, male children of DVs had more EBP (lsmeans 63.73 vs. 43.51, P = 0.008), while female children of DVs had fewer EBP (lsmeans 45.50 vs. 50.48, P = 0.02). Veteran military characteristics and mental health, and children's social status and health, including obesity, predicted children's TBP for one or more age groups. ConclusionsChildren of DVs experienced worse dentition, greater obesity, and more behavioral problems compared to NDV children, suggesting adverse health effects associated with parental deployment in need of further exploration.

Prosedur Ideal Pengakuan bagi Anak Luar Hasil Perkawinan Siri Pasca Putusan Mahkamah Konstitusi Nomor 46/PUU-VIII/2010

This study aimed to discuss the forms of recognition of children resulting from unregistered marriages, the reasons for the need to recognize children resulting from unregistered marriages, and regulating procedures for filing recognition of children's status. The study used a normative juridical type with a conceptual approach and a statutory approach. The form of recognition for out-of-wedlock children was in the form of a notary certificate of recognition as well as a birth certificate based on the results of a DNA test (deoxyribonucleic acid). The reason for the need for legal recognition of the status of the child of unregistered marriage by his father was based on philosophical, sociological, and juridical reasons. The procedure for recognizing the status of a child was carried out by identifying the problem, checking DNA, getting married, and distributing inheritance.

Parents' Attitudes toward Immunization and its Relation with Pediatric Immunization Compliance at Primary Health Care Centers in Karbala City, Iraq

Objective(s): To assess parents' attitude toward immunization and its relation with their compliance and to find out the relationship between parents' attitude and their socio-demographic characteristics.Methodology: A descriptive design is conducted from the period of 19th September 2020 to the 6th of March 2021. A non-probability (convenient) sample of (292) parents was selected from (5) primary health care centers in Karbala city. These centers are distributed throughout (2) primary health care sectors selected randomly as (20%) from each sectors. The questionnaire is developed and composed of three parts: First part: parent's socio-demographic characteristics, Second part: parents' attitude domain, which involves (13 items), and Third part: child's immunization status and reason for non-compliancy by parents with the routine immunization schedule. The reliability of the questionnaire is determined through a pilot study and the content validity through a panel of (17) experts. The data are collected by the questionnaire. The data are analyzed through using the Statistical Package of Social Sciences (SPSS version 22.0) which is performed through the use of descriptive and inferential statistical analysis procedures.Results: The results of the study indicate that most of the study sample have high (good) attitude toward children immunization and are significantly associated with their residence. Also, the child's is partially immunized for more than 60% of the children of the study sample (parents). In addition, the study results reveal that there is no significant association between parents' attitudes towards immunization and their compliance to the routine immunization schedule for their children. Recommendations: The study recommends that it is necessary to raise parents awareness of the importance of immunization by implementing educational programs, activating the role of traditional and social media, and promote periodically assessment to cover child's immunization timings.