Socioeconomic inequality in child health outcomes in India: analyzing trends between 1993 and 2021.

BACKGROUND: The health of India's children has improved over the past thirty years. Rates of morbidity and anthropometric failure have decreased. What remains unknown, however, is how those patterns have changed when examined by socioeconomic status. We examine changes in 11 indicators of child health by household wealth and maternal education between 1993 and 2021 to fill this critical gap in knowledge. Doing so could lead to policies that better target the most vulnerable children. METHODS: We used data from five rounds of India's National Family Health Survey conducted in 1993, 1999, 2006, 2016, and 2021 for this repeated cross-sectional analysis. We studied mother-reported cases of acute respiratory illness and diarrhea, hemoglobin measurements for anemia, and height and weight measurements for anthropometric failure. We examined how the prevalence rates of each outcome changed between 1993 and 2021 by household wealth and maternal education. We repeated this analysis for urban and rural communities.  RESULTS: The socioeconomic gradient in 11 indicators of child health flattened between 1993 and 2021. This was in large part due to large reductions in the prevalence among children in the lowest socioeconomic groups. For most outcomes, the largest reductions occurred before 2016. Yet as of 2021, except for mild anemia, outcome prevalence remained the highest among children in the lowest socioeconomic groups. Furthermore, we show that increases in the prevalence of stunting and wasting between 2016 and 2021 are largely driven by increases in the severe forms of these outcomes among children in the highest socioeconomic groups. This finding underscores the importance of examining child health outcomes by severity. CONCLUSIONS: Despite substantial reductions in the socioeconomic gradient in 11 indicators of child health between 1993 and 2021, outcome prevalence remained the highest among children in the lowest socioeconomic groups in most cases. Thus, our findings emphasize the need for a continued focus on India's most vulnerable children.

Trends in maternal and child health in China and its urban and rural areas from 1991 to 2020: a joinpoint regression model.

The long-term trends in maternal and child health (MCH) in China and the national-level factors that may be associated with these changes have been poorly explored. This study aimed to assess trends in MCH indicators nationally and separately in urban and rural areas and the impact of public policies over a 30‒year period. An ecological study was conducted using data on neonatal mortality rate (NMR), infant mortality rate (IMR), under-five mortality rate (U5MR), and maternal mortality ratio (MMR) nationally and separately in urban and rural areas in China from 1991 to 2020. Joinpoint regression models were used to estimate the annual percentage changes (APC), average annual percentage changes (AAPC) with 95% confidence intervals (CIs), and mortality differences between urban and rural areas. From 1991 to 2020, maternal and child mortalities in China gradually declined (national AAPC [95% CI]: NMRs - 7.7% [- 8.6%, - 6.8%], IMRs - 7.5% [- 8.4%, - 6.6%], U5MRs - 7.5% [- 8.5%, - 6.5%], MMRs - 5.0% [- 5.7%, - 4.4%]). However, the rate of decline nationally in child mortality slowed after 2005, and in maternal mortality after 2013. For all indicators, the decline in mortality was greater in rural areas than in urban areas. The AAPCs in rate differences between rural and urban areas were - 8.5% for NMRs, - 8.6% for IMRs, - 7.7% for U5MRs, and - 9.6% for MMRs. The AAPCs in rate ratios (rural vs. urban) were - 1.2 for NMRs, - 2.1 for IMRs, - 1.7 for U5MRs, and - 1.9 for MMRs. After 2010, urban‒rural disparity in MMR did not diminish and in NMR, IMR, and U5MR, it gradually narrowed but persisted. MCH indicators have declined at the national level as well as separately in urban and rural areas but may have reached a plateau. Urban‒rural disparities in MCH indicators have narrowed but still exist. Regular analyses of temporal trends in MCH are necessary to assess the effectiveness of measures for timely adjustments.

La pediatría social. Herramienta necesaria para combatir la pandemia de COVID-19 en Cuba / Social Pediatrics: A Necessary Tool to Combat the COVID-19 Pandemic in Cuba

Introducción: La pediatría social se orienta hacia la atención integral del niño. Estudia las causas sociales que alteran su salud y también los problemas de esta índole que repercuten en su entorno social. En el contexto de la actual pandemia, caracterizada por alta morbilidad y mortalidad, se produjeron significativas consecuencias psicosociales. Objetivo: Describir el impacto de la pediatría social sobre la salud infanto-juvenil durante la pandemia de COVID-19. Métodos: Se realizó una revisión en las bases de datos bibliográficas PubMed y BVS. Se empleó el Google Académico como motor de búsqueda. Se utilizaron, en español y en inglés, los siguientes descriptores: pediatría social, pandemia COVID-19, aislamiento social, bienestar psicológico, salud mental y población pediátrica. Análisis y síntesis de la información: Se expusieron argumentos desde la mirada psicosocial del pediatra, relacionados con el desarrollo y el bienestar socioemocional de los niños, y la repercusión sobre ellos del aislamiento social; además, se describió el impacto de la pandemia en la infancia, y el papel desempeñado por el especialista y otros profesionales vinculados con la atención pediátrica. Conclusiones: La pandemia se caracterizó por afectar todas las esferas de la vida del niño. La pediatría social resultó indispensable en el enfrentamiento de las consecuencias médico-biológicas, psicológicas y sociales que ocasionó el azote de la COVID-19, por lo que su rol influyó en el restablecimiento del equilibrio biopsicosocial de la población infantil(AU)

Introduction: Social pediatrics is oriented towards the comprehensive care of children. It studies the social causes that alter their health, and also the problems of this nature that affect their social environment. In the context of the current pandemic, characterized by high morbidity and mortality, there were significant psychosocial consequences. Objective: To describe the impact of social pediatrics on children and adolescents health during the COVID-19 pandemic. Methods: A review was conducted in the bibliographic databases PubMed and VHL. Google Scholar was used as a search engine. The following descriptors were used in Spanish and English: social pediatrics, COVID-19 pandemic, social isolation, psychological well-being, mental health and pediatric population. Analysis and synthesis of information: Arguments were presented from the psychosocial perspective of the pediatrician, related to the development and socio-emotional well-being of children, and the impact on them of social isolation. In addition, the impact of the pandemic on children was described, and the role played by the specialists and other professionals linked to pediatric care. Conclusions: The pandemic was characterized by affecting all spheres of the child's life. Social pediatrics was indispensable in confronting the medical-biological, psychological and social consequences caused by the scourge of COVID-19, so its role influenced the restoration of the biopsychosocial balance of the children population(AU)