Health status and public health needs in a Togolese child health care centre modelled after the Dutch system.

BACKGROUND: The charity foundation Association Soutien Enfants Togo started a child health care (CHC) centre in Togo that was modelled after the Dutch high-quality CHC system to improve child health. AIM: To describe health care data of children who visited the centre. SUBJECTS AND METHODS: Data were routinely collected between October 2010-July 2017. Outcomes were completed vaccinations, growth, development, lifestyle, physical examination, and laboratory testing results. RESULTS: In total, 8,809 children aged 0-24 years were available. Half (47.5%) of children aged 0-4 years did not receive all eligible free vaccinations from the government. The proportions of stunted children (all) or with a developmental delay (0-4 years) were 10.1% and 9.5%, respectively. In total, 40-50% of all children did not wash their hands with soap after toilet or before eating, or did not use clean drinking water. Furthermore, 5.1-6.6% had insufficient vision, high eye pressure or hearing loss. Sickle cell disease was detected in 5.3%. CONCLUSION: A large group of children in need of prevention and early treatment were detected, informed and treated by the centre. Further research is needed to confirm if this strategy can improve children's health in Sub-Saharan Africa. Our data are available for further research.

Disordered eating prevention: Co-designing a brief intervention for use in Community Child Health Services.

Dietary habits established in childhood, often persist into adulthood highlighting the importance of early intervention. However, limited interventions exist promoting "how" to establish healthful eating behaviors in children. To create impactful interventions, it is important they are based on evidence and co-designed with end-users. Fifteen child health nurses participated in this co-design study, underpinned by the Knowledge to Action Framework. Child health nurses reviewed evidence-based statements and then workshopped practical strategies. Findings from the co-design sessions were used to inform the development of a preventive intervention. The study has important health marketing implications for conducting co-design with child health nurses.

'As soon as they can hold a glass, they begin taking alcohol': a qualitative study on early childhood substance use in Mbale District, Uganda.

BACKGROUND: Globally, substance use is a leading contributor to the burden of disease among young people, with far reaching social, economic and health effects. Following a finding of harmful alcohol use among 5-8-year-old children in Mbale District, Uganda, this study aims to investigate community members' views on early childhood substance use among children below the age of 10 years. METHODS: In 2016, we conducted eight focus group discussions with 48 parents and 26 key informant interviews with teachers, health workers, alcohol distributors, traditional healers, religious leaders, community leaders and youth workers. We used thematic content analysis. Four participants and two research assistants reviewed and confirmed the findings. RESULTS: Alcohol in everyday life: 'Even children on laps taste alcohol': Almost all participants confirmed the existence of and concern for substance use before age 10. They described a context where substance use was widespread in the community, especially intake of local alcoholic brews. Children would access substances in the home or buy it themselves. Those living in poor neighbourhoods or slums and children of brewers were described as particularly exposed. Using substances to cope: 'We don't want them to drink': Participants explained that some used substances to cope with a lack of food and resources for childcare, as well as traumatic experiences. This made children in deprived families and street-connected children especially vulnerable to substance use. Participants believed this was a result of seeing no alternative solution. CONCLUSIONS: To our knowledge, this is the first study to describe the context and conditions of childhood substance use before age 10 in Mbale District, Uganda. The study shows that community members attributed early childhood substance use to a social context of widespread use in the community, which was exacerbated by conditions of material and emotional deprivation. These social determinants for this practice deserve public health attention and intervention.

Promoting Confident Body, Confident Child in community child health: A mixed-methods implementation study.

OBJECTIVE: To evaluate population-level implementation of Confident Body, Confident Child (CBCC); an evidence-based program providing parenting strategies to promote healthy eating, physical activity and body satisfaction in children aged 2-6 years; with community child health nurses (CHNs). METHODS: This study utilised an implementation-effectiveness hybrid design, with dual focus on assessing: (a) CBCC implementation into Child Health Centres at a regional health service in Queensland, Australia (process evaluation); and (b) CBCC's effect on CHNs' knowledge and attitudes (outcomes evaluation). Process (CBCC reach, dose, fidelity) and outcome data (CHN knowledge of child body image; and attitudes towards higher body weights) were collected during implementation, and pre- and post-intervention delivery to CHNs, respectively. RESULTS: Twenty-six CHNs (all female; mean age 52.7 ± 9.5 years) participated in the study by attending a 1-day CBCC training workshop and completing demographic and outcome surveys. Process evaluation found that CBCC was implemented as planned and reached 56% of CHNs across the health service. Outcome evaluation showed small but non-significant improvements in CHN knowledge (P = .077) and attitudes towards overweight (using Anti-Fat Attitudes scale; significant improvements on willpower sub-scale only (P < .05)). DISCUSSION: This is the first study to evaluate population-wide CBCC implementation in a real-world health service setting with CHNs. Findings highlight the potential for using pragmatic, implementation-focused methodologies to translate preventive eating disorder programs into community child health services.

Mental health literacy in primary care: Canadian Research and Education for the Advancement of Child Health (CanREACH).

The effectiveness of a continuing education programme in paediatric psychopharmacology designed for primary healthcare providers was objectively measured based on the assumption that training would lead to measurable changes in referral patterns and established clinical measures of referred patients. Using established, valid and reliable measures of clinical urgency embedded in to a regional healthcare system since 2002, the referrals to child and adolescent psychiatric services of physicians who participated in the training (n=99) were compared pretraining and post-training, and to non-participating/untrained referring physicians (n=7753) making referrals over the same time period. Referrals were analysed for evidence of change based on frequencies and measures of clinical urgency. Participants of the training programme also completed standardised baseline and outcome self-evaluations. Congruent with participants self-reported evaluative reports of improved knowledge and practice, analysis of referral frequency and the clinical urgency of referrals to paediatric psychiatric services over the study period indicated that trained physicians made more appropriate referrals (clinically more severe) and reduced referrals to emergency services. Quantitative clinical differences as completed by intake clinicians blind to referrals from the study group designations were observed within the trained physician group pretraining and post-training, and between the trained physician group and the unexposed physician group. The results illustrate a novel model for objectively measuring change among physicians based on training in paediatric mental health management.

Association between ultra-processed food consumption, sociodemographic characteristics, malnutrition and obesity among urban school-aged children in Lilongwe, Malawi: a cross-sectional study.

INTRODUCTION: The escalating consumption of ultra-processed foods (UPFs) among school-aged children in developing countries poses a significant threat to public health, contributing to the dual burden of malnutrition. In Malawi, where undernutrition coexists with a burgeoning obesity epidemic, understanding the determinants of UPF consumption and its impact on children's nutritional status is imperative. This study, conducted in Lilongwe, Malawi, aimed to investigate the association between UPF consumption, sociodemographic factors and the nutritional status of school-aged children. MATERIALS AND METHODS: 511 children aged 7-14 were recruited from 2 densely populated townships using systematic random sampling. Data on sociodemographic factors, UPF consumption and nutritional status were collected through face-to-face interviews and anthropometric measurements. UPF consumption was assessed using a validated Food Frequency Questionnaire while multinomial logistic regression was employed to analyse associations. RESULTS: Results revealed alarmingly high UPF consumption among children, particularly those high in sugar. Multinomial logistic regression identified significant predictors of malnutrition outcomes. Notably, children consuming UPFs more than three times a week were more likely to be malnourished. Overweight status was positively associated with sausage intake (ß=0.226, adjusted OR 1.254, 95% CI 1.004 to 1.566, p=0.046) and age (ß=0.020, adjusted OR=0.257, 95% CI 0.156 to 0.28, p=0.003). Conversely, underweight status was linked with residential location (ß=4.507, adjusted OR 0.01, 95% CI 0.000 to 0.281, p=0.006) and fizzy drinks (ß=1.071, adjusted OR 2.919, 95% CI 1.413 to 6.028, p=0.004). CONCLUSION: The high prevalence of UPF consumption among school-aged children is significantly associated with malnutrition. Moreover, sociodemographic factors influence UPF consumption, highlighting the need for targeted interventions to reduce malnutrition. These findings may inform public health policies to mitigate malnutrition among children in Malawi's urban communities.

Cost-effectiveness of a radio intervention to stimulate early childhood development: protocol for an economic evaluation of the SUNRISE trial in Burkina Faso.

INTRODUCTION: Approximately 250 million children under 5 years of age are at risk of poor development in low-income and middle-income countries. However, existing early childhood development (ECD) interventions can be expensive, labour intensive and challenging to deliver at scale. Mass media may offer an alternative approach to ECD intervention. This protocol describes the planned economic evaluation of a cluster-randomised controlled trial of a radio campaign promoting responsive caregiving and opportunities for early learning during the first 3 years of life in rural Burkina Faso (SUNRISE trial). METHODS AND ANALYSIS: The economic evaluation of the SUNRISE trial will be conducted as a within-trial analysis from the provider's perspective. Incremental costs and health outcomes of the radio campaign will be compared with standard broadcasting (ie, 'do nothing' comparator). All costs associated with creating and broadcasting the radio campaign during intervention start-up and implementation will be captured. The cost per child under 3 years old reached by the intervention will be calculated. Incremental cost-effectiveness ratios will be calculated for the trial's primary outcome (ie, incremental cost per SD of cognitive gain). A cost-consequence analysis will also be presented, whereby all relevant costs and outcomes are tabulated. Finally, an analysis will be conducted to assess the equity impact of the intervention. ETHICS AND DISSEMINATION: The SUNRISE trial has ethical approval from the ethics committees of the Ministry of Health, Burkina Faso, University College London and the London School of Hygiene and Tropical Medicine. The results of the economic evaluation will be disseminated in a peer-reviewed journal and presented at a relevant international conference. TRIAL REGISTRATION NUMBER: The SUNRISE trial was registered with ClinicalTrials.gov on 19 April 2019 (identifier: NCT05335395).

Determination of appropriate policy targets to reduce the prevalence of stunting in children under five years of age in urban-poor communities in Indonesia: a secondary data analysis of the 2022 Indonesian national nutritional status survey.

OBJECTIVE: Based on previous studies, urban-poor societies are very vulnerable to stunted children under five. The study aims to determine the appropriate policy targets to reduce the prevalence of stunted under-five children in urban-poor communities in Indonesia. DESIGN: A study was conducted using a secondary data analysis. The study analysed existing data from the 2022 Indonesian National Nutritional Status Survey. SETTING AND PARTICIPANTS: At the national level, Indonesia encompassed 43 284 toddlers. INTERVENTIONS: Non-intervention study. PRIMARY AND SECONDARY OUTCOMES: The study's eight independent factors were the mother's age, education, marital status, employment, wealth, antenatal care (ANC), children's age and sex, with nutritional status as the dependent variable. We employed a binary logistic regression test for the most recent exam. RESULTS: Maternal age was related to stunted toddlers in communities of urban poor in Indonesia. The lower the education, the higher the possibility of having stunted kids. Unemployed mothers were 1.153 times more likely than employed mothers to have stunted under-five children (95% CI 1.145 to 1.160). The poorest were 1.235 times more likely to get stunted under-five than the poorer (95% CI 1.227 to 1.242). Mothers without ANC during pregnancy were 1.212 times more likely to get stunted kids than those with ANC during pregnancy (95% CI 1.186 to 1.240). All kids' ages were more probable than 0-11 to be stunted. Boys were 1.099 times more likely to be stunted than girls (AOR 1.099; 95% CI 1.093 to 1.105). CONCLUSION: The appropriate policy targets to reduce the prevalence of stunted under-five children in urban-poor communities in Indonesia were younger mothers, those with poor education, those unemployed, the most impoverished, those without ANC, those with older under-five and those with boy kids.

Incidence of anaemia and its predictors among HIV-infected children receiving highly active antiretroviral treatment in North-West Ethiopia: a multicentre retrospective follow-up study.

BACKGROUND: Anaemia is one of the most common problems in HIV-infected patients associated with increased HIV progression, decreased functional capacity, survival and quality of life. For better interventions, up-to-date information concerning anaemia among HIV-infected children less than 5 years of age on antiretroviral therapy (ART) is vital. Thus, this study aims to determine the predictors of anaemia among HIV-infected children less than 5 years of age receiving ART in North-West Ethiopia. DESIGN: An institution-based retrospective follow-up study was conducted. STUDY SETTING: Amhara region Comprehensive Specialized Hospitals, North-West Ethiopia. PARTICIPANTS: In total, we examined 460 HIV-infected children less than 5 years of age who had followed highly active antiretroviral treatment from 2010 to 2020. OUTCOME MEASURES: The outcome measures were median time to detection of anaemia, the incidence and the effects of cotrimoxazole preventive therapy (CPT), ART adherence, tuberculosis (TB), WHO clinical stage and wasting on anaemia. RESULTS: The overall follow-up time was 9234 person-months of observation. The incidence density of anaemia was 8.34 per 1000 person-months of observation (95% CI 6.67 to 10.43). The cumulative survival probability of children after the last months of follow-up was 0.54. The independent predictors of anaemia were not receiving CPT (adjusted HR (AHR)=4.44; 95% CI 2.48 to 7.93), poor adherence to ART (AHR=2.46; 95% CI 1.37 to 4.42), TB (AHR=3.40; 95% CI 1.72 to 6.72), severe WHO clinical stage (AHR=3.03; 95% CI 1.40 to 6.58) and severe wasting (AHR=1.98; 95% CI 1.08 to 3.64). CONCLUSION AND RECOMMENDATION: The incidence rate of anaemia was high and it was provoked by predictors like CPT, ART adherence, TB, WHO clinical stage and wasting. Therefore, it is necessary to emphasise for these predictors.

Comparison of healthcare quality for uninsured and underinsured children through community health centres in Canada and the USA: a scoping review protocol.

INTRODUCTION: Children and youth who are uninsured or underinsured in Canada and the USA have limited options where they can receive healthcare. In both countries, community health centres (CHCs) have been established as a solution to provide quality care to children without adequate insurance, including those who are newcomers or refugees. However, little is known about how well these models deliver paediatric care. Cross-country analysis provides an important viewpoint to identify areas of success and growth. The purpose of this scoping review is to compare quality of care for uninsured and underinsured children through CHCs in the USA and Canada. METHODS: This scoping review follows the methodological guidelines from the Joanna Briggs Institute Evidence synthesis. The protocol has been registered with the Open Science Framework Registries and can be accessed online. A search will be conducted in electronic databases of peer-reviewed literature (Ovid MEDLINE ALL, CINAHL Complete via EbscoHost, Scopus; Health Business Elite via EbscoHost and Sociological Abstracts via ProQuest) as well as the grey literature. Two reviewers will review all titles and abstracts for inclusion in full-text review. Studies that meet inclusion criteria will be included in full-text review. Data will be extracted into Covidence, using the Donabedian model as a conceptual framework. Findings will be synthesised in a narrative format. ETHICS AND DISSEMINATION: As this study only uses publicly available data, ethics approval is not required. Findings will be shared at national and international conferences and published in a peer-reviewed journal. In addition, findings will be prepared into a policy brief or white paper to be shared with relevant policy stakeholders to advocate for a better model of care for marginalised children and youth.

Influence of paternal preconception health on pregnancy, intrapartum, postpartum and early childhood outcomes: protocol for a parallel scoping review.

INTRODUCTION: Preconception care is the provision of behavioural, social or biomedical interventions to women and couples prior to conception. To date, preconception research has primarily focused on maternal health, despite the male partner's contribution before birth to both short-term and long-term child outcomes. The objectives of the reviews are: (1) to identify, consolidate and analyse the literature on paternal preconception health on pregnancy and intrapartum outcomes, and (2) to identify, consolidate and analyse the literature on paternal preconception health on postpartum and early childhood outcomes. METHODS AND ANALYSIS: A scoping review will be conducted following the Joanna Briggs Institute methodology. MEDLINE, PsycINFO, Embase, Scopus and CINAHL databases will be searched for articles published in English. Two independent reviewers will screen titles and abstracts and then full text using Covidence, with conflicts resolved by a third reviewer. Data extraction will be performed using Covidence. ETHICS AND DISSEMINATION: Ethics approval is not required for this scoping review. Results will be published in peer-reviewed journals as well as presented at relevant national and international conferences and meetings.