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1.
Trials ; 22(1): 629, 2021 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-34526072

RESUMO

BACKGROUND: Universal Health Coverage ensures access to quality health services for all, with no financial hardship when accessing the needed services. Nevertheless, access to quality health services is marred by substantial resource shortages creating service delivery gaps in low-and middle-income countries, including Kenya. The Innovative Partnership for Universal Sustainable Healthcare (i-PUSH) program, developed by AMREF Health Africa and PharmAccess Foundation (PAF), aims to empower low-income women of reproductive age and their families through innovative digital tools. This study aims to evaluate the impact of i-PUSH on maternal and child health care utilization, women's health including their knowledge, behavior, and uptake of respective services, as well as women's empowerment and financial protection. It also aims to evaluate the impact of the LEAP training tool on empowering and enhancing community health volunteers' health literacy and to evaluate the impact of the M-TIBA health wallet on savings for health and health insurance uptake. METHODS: This is a study protocol for a cluster randomized controlled trial (RCT) study that uses a four-pronged approach-including year-long weekly financial and health diaries interviews, baseline and endline surveys, a qualitative study, and behavioral lab-in-the-field experiments-in Kakemega County, Kenya. In total, 240 households from 24 villages in Kakamega will be followed to capture their health, health knowledge, health-seeking behavior, health expenditures, and enrolment in health insurance over time. Half of the households live in villages randomly assigned to the treatment group where i-PUSH will be implemented after the baseline, while the other half of the households live in control village where i-PUSH will not be implemented until after the endline. The study protocol was reviewed and approved by the AMREF Ethical and Scientific Review Board. Research permits were obtained from the National Commission for Science, Technology and Innovation agency of Kenya. DISCUSSION: People in low-and middle-income countries often suffer from high out-of-pocket healthcare expenditures, which, in turn, impede access to quality health services. Saving for healthcare as well as enrolment in health insurance can improve access to healthcare by building capacities at all levels-individuals, families, and communities. Notably, i-PUSH fosters savings for health care through the mobile-phone based "health wallet," it enhances enrolment in subsidized health insurance through the mobile platform-M-TIBA-developed by PAF, and it seeks to improve health knowledge and behavior through community health volunteers (CHVs) who are trained using the LEAP tool-AMREF's mHealth platform. The findings will inform stakeholders to formulate better strategies to ensure access to Universal Health Coverage in general, and for a highly vulnerable segment of the population in particular, including low-income mothers and their children. TRIAL REGISTRATION: Registered with Protocol Registration and Results System (protocol ID: AfricanPHRC; trial ID: NCT04068571 : AEARCTR-0006089 ; date: 29 August 2019) and The American Economic Association's registry for randomized controlled trials (trial ID: AEARCTR-0006089; date: 26 June 2020).


Assuntos
Saúde da Criança , Aceitação pelo Paciente de Cuidados de Saúde , Criança , Feminino , Humanos , Quênia , Registros Médicos , Avaliação de Resultados em Cuidados de Saúde , Ensaios Clínicos Controlados Aleatórios como Assunto
3.
BMC Health Serv Res ; 21(1): 898, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34465317

RESUMO

BACKGROUND: There have been dozens of strikes by health workers in Kenya in the past decade, but there are few studies of their impact on maternal and child health services and outcomes. We conducted a retrospective survey study to assess the impact of nationwide strikes by health workers in 2017 on utilization of maternal and child health services in western Kenya. METHODS: We utilized a parent study to enroll women who were pregnant in 2017 when there were prolonged strikes by health workers ("strike group") and women who were pregnant in 2018 when there were no major strikes ("control group"). Trained research assistants administered a close-ended survey to retrospectively collect demographic and pregnancy-related health utilization and outcomes data. Data were collected between March and July 2019. The primary outcomes of interest were antenatal care (ANC) visits, delivery location, and early child immunizations. Generalized estimating equations were used to estimate risk ratios between the strike and control groups, adjusting for socioeconomic status, health insurance status, and clustering. Adjusted risk ratios (ARR) were calculated with 95% confidence intervals (95%CI). RESULTS: Of 1341 women recruited in the parent study in 2017 (strike group), we re-consented 843 women (63%) to participate. Of 924 women recruited in the control arm of the parent study in 2018 (control group), we re-consented 728 women (79%). Women in the strike group were 17% less likely to attend at least four ANC visits during their pregnancy (ARR 0.83, 95%CI 0.74, 0.94) and 16% less likely to deliver in a health facility (ARR 0.84, 95%CI 0.76, 0.92) compared to women in the control group. Whether a child received their first oral polio vaccine did not differ significantly between groups, but children of women in the strike group received their vaccine significantly longer after birth (13 days versus 7 days, p = 0.002). CONCLUSION: We found that women who were pregnant during nationwide strikes by health workers in 2017 were less likely to receive WHO-recommended maternal child health services. Strategies to maintain these services during strikes are urgently needed.


Assuntos
Serviços de Saúde Materna , Cuidado Pré-Natal , Criança , Saúde da Criança , Feminino , Humanos , Quênia/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde , Gravidez , Estudos Retrospectivos
4.
Cien Saude Colet ; 26(suppl 2): 3765-3780, 2021.
Artigo em Português, Inglês | MEDLINE | ID: mdl-34468670

RESUMO

This paper aimed to characterize actions directed to children's mental health (CMH) in Primary Health Care (PHC), based on an integrative review of Brazilian literature (2006-2017). The searches were carried out from LILACS, SciELO and VHL Network databases. After applying the inclusion and exclusion criteria, 13 articles were identified for analysis, which were presented in three thematic axes: 1) Characterization of the demands on CMH for PHC; 2) Actions and interventions on CMH carried out in PHC; and 3) Difficulties and propositions for the implementation of actions on CMH in PHC. The literature points, as the main actions, the identification of CMH problems and their referral to care by specialties. Some studies described specific actions of professionals such as physicians, pediatricians, and psychologists. Interventions of a local character or in partnerships with universities were also identified. The analysis of this material indicated that PHC has been considered as an important field of action in CMH, but that nevertheless requires greater investments, especially in professional training and work organization.


Assuntos
Saúde Mental , Atenção Primária à Saúde , Brasil , Criança , Saúde da Criança , Programas Governamentais , Humanos
5.
BMC Public Health ; 21(1): 1630, 2021 09 06.
Artigo em Inglês | MEDLINE | ID: mdl-34488691

RESUMO

BACKGROUND: IMPROVE aims to conduct a hybrid type 3 evaluation design to test the effectiveness of bundled implementation strategies on intervention fidelity of the Healthy School Start (HSS) program, while simultaneously monitoring effects on health outcomes of children and parents. The HSS is a 4-component family support program for children starting school (5-7 years of age) promoting healthy dietary habits and physical activity in the home environment to prevent childhood obesity and parents' risk of developing type 2 diabetes. METHODS: IMPROVE is a cluster-randomized controlled trial with two arms to evaluate and compare the effects of two different bundles of implementation strategies on intervention fidelity expressed as adherence and responsiveness at 12 and 24 months (primary outcomes). Thirty schools in two municipalities will participate in the study reaching about 1400 families per school year. In stakeholder workshops, key implementation determinants were identified according to the domains of the Consolidated Framework for Implementation Research. Through a consensus process with stakeholders, two bundles of implementation strategies were tailored to address context-specific determinants. Schools randomly assigned to group 1 will receive bundle 1 (Basic) and group 2 will receive bundle 1 + 2 (Enhanced). Bundle 2 consists of external facilitation, fidelity monitoring and feedback strategies. Secondary outcomes will include change in acceptability, appropriateness, feasibility, and organisational readiness as perceived by school staff. In addition, child weight status and diet, and parents' feeding practices and risk of type 2 diabetes will be monitored. Linear and ordinal regression analysis will be used to test the effect on the primary and secondary outcomes, taking clustering and covariates into consideration where needed. Process evaluation will be conducted through key stakeholder interviews to investigate experiences of the program and perceptions on sustainability. DISCUSSION: This systematic approach to investigating the effectiveness of two different bundles of implementation strategies tailored to context-specific determinants on the fidelity of the HSS intervention will provide new insight into feasible implementation strategies and external support needed for the HSS to be effective and sustainable. Results will help inform how to bridge the gap between the research on school-based health programs and routine practice in schools. TRIAL REGISTRATION: Registered prospectively at ClinicalTrials.gov ID: NCT04984421 , registered July 30, 2021.


Assuntos
Diabetes Mellitus Tipo 2 , Obesidade Pediátrica , Criança , Saúde da Criança , Promoção da Saúde , Humanos , Sobrepeso , Obesidade Pediátrica/prevenção & controle , Avaliação de Programas e Projetos de Saúde , Ensaios Clínicos Controlados Aleatórios como Assunto , Serviços de Saúde Escolar , Instituições Acadêmicas
6.
BMC Health Serv Res ; 21(Suppl 1): 512, 2021 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-34511080

RESUMO

BACKGROUND: Routine health facility data are a critical source of local monitoring of progress and performance at the subnational level. Uganda has been using district health statistics from facility data for many years. We aimed to systematically assess data quality and examine different methods to obtain plausible subnational estimates of coverage for maternal, newborn and child health interventions. METHODS: Annual data from the Uganda routine health facility information system 2015-2019 for all 135 districts were used, as well as national surveys for external comparison and the identification of near-universal coverage interventions. The quality of reported data on antenatal and delivery care and child immunization was assessed through completeness of facility reporting, presence of extreme outliers and internal data consistencies. Adjustments were made when necessary. The denominators for the coverage indicators were derived from population projections and health facility data on near-universal coverage interventions. The coverage results with different denominators were compared with the results from household surveys. RESULTS: Uganda's completeness of reporting by facilities was near 100% and extreme outliers were rare. Inconsistencies in reported events, measured by annual fluctuations and between intervention consistency, were common and more among the 135 districts than the 15 subregions. The reported numbers of vaccinations were improbably high compared to the projected population of births or first antenatal visits - and especially so in 2015-2016. There were also inconsistencies between the population projections and the expected target population based on reported numbers of antenatal visits or immunizations. An alternative approach with denominators derived from facility data gave results that were more plausible and more consistent with survey results than based on population projections, although inconsistent results remained for substantive number of subregions and districts. CONCLUSION: Our systematic assessment of the quality of routine reports of key events and denominators shows that computation of district health statistics is possible with transparent adjustments and methods, providing a general idea of levels and trends for most districts and subregions, but that improvements in data quality are essential to obtain more accurate monitoring.


Assuntos
Serviços de Saúde da Criança , Serviços de Saúde Materna , Criança , Saúde da Criança , Feminino , Instalações de Saúde , Humanos , Recém-Nascido , Gravidez , Cuidado Pré-Natal , Uganda/epidemiologia
7.
BMC Health Serv Res ; 21(Suppl 1): 195, 2021 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-34511092

RESUMO

BACKGROUND: In conflict-affected settings, data on reproductive, maternal, newborn and child health (RMNCH) are often lacking for priority setting and timely decision-making. We aimed to describe the levels and trends in RMNCH indicators within Kivu provinces between 2015 and 2018, by linking conflict data with health facility (HF) data from the District Health Information System 2 (DHIS2). METHODS: We used data from the DHIS2 for the period 2015-2018, the 2014 Demographic and Health Survey, the 2018 Multiple Indicators Cluster Survey and the Uppsala Conflict Data Program. Health zones were categorised in low, moderate and high conflict intensity level, based on an annual conflict death rate. We additionally defined a monthly conflict death rate and a conflict event-days rate as measures of conflict intensity and insecurity. Outcomes were completion of four antenatal care visits, health facility deliveries, caesarean sections and pentavalent vaccine coverage. We assessed data quality and analyzed coverage and trends in RMNCH indicators graphically, by conflict categories and using HF data aggregated annually. We used a series of fixed-effect regression models to examine the potential dose-response effect of varying conflict intensity and insecurity on RMNCH. RESULTS: The overall HF reporting was good, ranging between 83.3 and 93.2% and tending to be lower in health zones with high conflict intensity in 2016 and 2017 before converging in 2018. Despite the increasing number of conflict-affected health zones over time, more in North-Kivu than in South-Kivu, we could not identify any clear pattern of variation in RMNCH coverage both by conflict intensity and insecurity. North-Kivu province had consistently reported better RMNCH indicators than South-Kivu, despite being more affected by conflict. The Kivu as a whole recorded higher coverage than the national level. Coverage of RMNCH services calculated from HF data was consistent with population-based surveys, despite year-to-year fluctuation among health zones and across conflict-intensity categories. CONCLUSIONS: Although good in general, the HF reporting rate in the Kivu was negatively impacted by conflict intensity especially at the beginning of the DHIS2's rolling-up. Routine HF data appeared useful for assessing and monitoring trends in RMNCH service coverage, including in areas with high-intensity conflict.


Assuntos
Saúde da Criança , Serviços de Saúde Reprodutiva , Conflitos Armados , Criança , República Democrática do Congo , Feminino , Instalações de Saúde , Humanos , Recém-Nascido , Saúde Materna , Gravidez
9.
Artigo em Espanhol | PAHO-IRIS | ID: phr-54844

RESUMO

[EXTRACT]. Al Editor: A nivel global las patologías cardiometabólicas siempre han sido materia de discusión en salud pública, la aparición de casos nuevos dificulta el control de la enfermedad en la población. La prevalencia de la obesidad entre niños, niñas y adolescentes en comparación con años anteriores muestran un incremento en el 47%, teniendo esto un impacto negativo a corto y largo plazo en todos los ámbitos referentes al bienestar físico, psicológico, social y económico (1).En Colombia, el exceso de peso en los menores en edad esco-lar se incrementó del 18,8% en 2010 a 24,4% en 2015, según demuestran los datos de la Encuesta Nacional de Situación Nutricional (ENSIN) (2), lo que denota la importancia de implementar medidas oportunas en nuestro territorio nacional para disminuir la incidencia de la enfermedad.


Assuntos
Pediatria , Sobrepeso , Obesidade , Obesidade Pediátrica , Saúde Pública , Saúde da Criança , Saúde do Adolescente
10.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde | ID: lis-48397

RESUMO

A obesidade infantil é um problema de saúde e vai muito além de um número na balança: a avaliação da obesidade infantil precisa considerar outros fatores, como acesso à alimentos saudáveis, acompanhamento do crescimento e desenvolvimento, entre outros


Assuntos
Obesidade Pediátrica/prevenção & controle , Ganho de Peso , Sobrepeso/prevenção & controle , Saúde da Criança
11.
Nutrients ; 13(8)2021 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-34444978

RESUMO

It is well established that the maternal diet during the periconceptional period affects the progeny's health. A growing body of evidence suggests that the paternal diet also influences disease onset in offspring. For many years, sperm was considered only to contribute half of the progeny's genome. It now appears that it also plays a crucial role in health and disease in offspring's adult life. The nutritional status and environmental exposure of fathers during their childhood and/or the periconceptional period have significant transgenerational consequences. This review aims to describe the effects of various human and rodent paternal feeding patterns on progeny's metabolism and health, including fasting or intermittent fasting, low-protein and folic acid deficient food, and overnutrition in high-fat and high-sugar diets. The impact on pregnancy outcome, metabolic pathways, and chronic disease onset will be described. The biological and epigenetic mechanisms underlying the transmission from fathers to their progeny will be discussed. All these data provide evidence of the impact of paternal nutrition on progeny health which could lead to preventive diet recommendations for future fathers.


Assuntos
Dieta , Pai , Comportamento Alimentar , Fenômenos Fisiológicos da Nutrição , Resultado da Gravidez , Adulto , Animais , Criança , Saúde da Criança , Doença Crônica , Exposição Ambiental , Epigênese Genética , Feminino , Humanos , Masculino , Redes e Vias Metabólicas , Estado Nutricional , Gravidez , Efeitos Tardios da Exposição Pré-Natal , Ratos
12.
Nutrients ; 13(8)2021 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-34444985

RESUMO

BACKGROUND: Breastfeeding is recommended due to its beneficial effects on human health. However, the effect of breastfeeding on health differs, resulting in various childhood diseases. OBJECTIVE: Our purpose was to investigate the association between breastfeeding at least in the first 4 months and the subsequent development of 15 certainly defined childhood diseases until 10 years of age, the all-cause hospitalization rate and growth at 6-7 years of age. METHODS: Participants included propensity-score matched 188,052 children born between January 2008 and December 2009, who were followed up till 10 years of age. Data were taken from the National Investigation of birth Cohort in Korea study 2008 database. Risk ratios were obtained using a modified Poisson regression and weighted risk differences using binomial regression. RESULTS: Compared to formula feeding, breastfeeding was associated with decreased risks of febrile convulsion, attention deficit hyperactivity disorder and autism spectrum disorder, pneumonia, acute bronchiolitis, hypertrophic pyloric stenosis, asthma, all-cause hospitalization, overweight/obesity and short stature. Exclusive breastfeeding at 4 to 6 months of age had similar results to exclusive breastfeeding over 6 months of age. CONCLUSIONS: Breastfeeding in early infancy reduces the risk for various childhood diseases, all-cause hospitalization rate, obesity, and short stature during childhood.


Assuntos
Aleitamento Materno , Saúde da Criança , Leite Humano , Transtorno do Deficit de Atenção com Hiperatividade/prevenção & controle , Transtorno do Espectro Autista/prevenção & controle , Criança , Pré-Escolar , Feminino , Transtornos do Crescimento/prevenção & controle , Hospitalização , Humanos , Lactente , Masculino , Obesidade/prevenção & controle , Razão de Chances , Estenose Pilórica Hipertrófica/prevenção & controle , República da Coreia , Doenças Respiratórias/prevenção & controle , Fatores de Risco
13.
Health Qual Life Outcomes ; 19(1): 193, 2021 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-34344386

RESUMO

BACKGROUND: This study was conducted in a general population of schoolchildren in Sweden, with the aim to assess the psychometric properties of a generic preference-based health related quality of life (HRQoL) instrument, the Swedish Child Health Utility 9D (CHU9D), among schoolchildren aged 7-15 years, and in subgroups aged 7-9, 10-12 and 13-15 years. METHODS: In total, 486 school aged children, aged 7-15 years, completed a questionnaire including the CHU9D, the Pediatric quality of life inventory 4.0 (PedsQL), KIDSCREEN-10, questions on general health, long-term illness, and sociodemographic characteristics. Psychometric testing was undertaken of feasibility, internal consistency reliability, test-retest reliability, construct validity, factorial validity, concurrent validity, convergent validity and divergent validity. RESULTS: The CHU9D evidenced very few missing values, minimal ceiling, and no floor effects. The instrument achieved satisfactory internal consistency (Cronbach's Alfa > 0.7) and strong test-retest reliability (r > 0.6). Confirmatory factor analyses supported the proposed one-factor structure of the CHU9D. For child algorithm, RMSEA = 0.05, CFI = 0.95, TLI = 0.94, and SRMR = 0.04. For adult algorithm RMSEA = 0.04, CFI = 0.96, TLI = 0.95, and SRMR = 0.04. The CHU9D utility value correlated moderately or strongly with KIDSCREEN-10 and PedsQL total scores (r > 0.5-0.7). The CHU9D discriminated as anticipated on health and on three of five sociodemographic characteristics (sex, age, and custody arrangement, but not socioeconomic status and ethnic origin). CONCLUSIONS: This study provides evidence that the Swedish CHU9D is a feasible, reliable and valid measure of preference-based HRQoL in children. The study furthermore suggests that the CHU9D is appropriate for use among children 7-15 years of age in the general population, as well as among subgroups aged 7- 9, 10-12 and 13-15 years.


Assuntos
Saúde da Criança , Qualidade de Vida , Inquéritos e Questionários/normas , Adolescente , Criança , Estudos de Viabilidade , Feminino , Humanos , Masculino , Psicometria , Reprodutibilidade dos Testes , Instituições Acadêmicas , Suécia
14.
JAMA Netw Open ; 4(8): e2121675, 2021 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-34436611

RESUMO

Importance: Previous studies have shown reductions in self-reported physical activity levels in children associated with implementation of COVID-19 mitigation measures, and data on objectively assessed health parameters are limited. Objective: To examine the association of COVID-19 mitigation measures with changes in cardiorespiratory fitness (CRF) measures and body mass index (BMI) among primary schoolchildren. Design, Setting, and Participants: This cohort study included children aged 7 to 10 years from 12 randomly selected primary schools in urban and rural districts of Klagenfurt, Austria. Baseline CRF and BMI measurements were obtained in September 2019 before COVID-19 mitigation measures were implemented, and follow-up measurements were obtained in June and September 2020. Exposures: COVID-19 mitigation measures. Main Outcomes and Measures: Cardiorespiratory fitness was measured with a 6-minute endurance run test. Height and weight were objectively measured. Standard deviation scores were calculated for CRF and BMI. Changes over time were analyzed using analyses of variance. Secondary analyses were performed for subgroups stratified by sex. Results: A total of 764 children (383 girls [50.1%]) aged 7 to 10 years had all measurements completed. From September 2019 to September 2020, CRF SD scores changed by -1.06 (95% CI, -1.13 to -1.00), with a similar decrease in both boys and girls. Body mass index SD scores had increased by 0.12 (95% CI, 0.06-0.16) in June 2020 and by 0.16 (95% CI, 0.12-0.20) in September 2020 compared with September 2019. The increase in BMI SD scores (from September 2019 to September 2020) was greater among boys (0.23; 95% CI, 0.18-0.29) than among girls (0.09; 95% CI, 0.04-0.15). During the 1-year period, the percentage of children with overweight or obesity increased from 20.3% (155 children) to 24.1% (184 children) (difference, 3.8% [29 children]). Conclusions and Relevance: In this cohort study of children in Austria, COVID-19 mitigation measures were associated with decreases in CRF measures and increases in BMI. The findings suggest that collaborative efforts are needed to reverse these changes in children's health to prevent long-term negative health outcomes.


Assuntos
Índice de Massa Corporal , COVID-19 , Aptidão Cardiorrespiratória , Exercício Físico , Obesidade/etiologia , Pandemias , Distanciamento Físico , Áustria , COVID-19/prevenção & controle , Criança , Saúde da Criança , Estudos de Coortes , Feminino , Humanos , Masculino , Sobrepeso , SARS-CoV-2 , Instituições Acadêmicas , Esportes
15.
BMJ Open ; 11(8): e040841, 2021 08 17.
Artigo em Inglês | MEDLINE | ID: mdl-34404694

RESUMO

OBJECTIVE: To evaluate the effectiveness of training programme on knowledge related to new interventions proposed under India Newborn Action Plan (INAP) and Integrated Action Plan against Pneumonia and Diarrhoea (IAPPD). DESIGN: Quality improvement study with pre-evaluation and post evaluation. SETTING: The study was conducted in 17 districts of Odisha, India. PARTICIPANTS AND INTERVENTIONS: The participants were healthcare providers and programme managers involved in maternal and child health programmes. Intervention was a short-structured (8 hours) training delivered to 127 batches with expected participation of 30 trainees in each batch. Training was divided into four modules covering new interventions related to INAP and IAPPD like causes of neonatal death, kangaroo mother care (KMC), feeding of low birthweight (LBW) infants, use of injection gentamicin, identification of possible serious bacterial infection (PSBI), identification and management of pneumonia and diarrhoea and key interventions for maternal health. Various modalities of teaching-learning method were used. OUTCOME MEASURES: Pretraining and post-training knowledge assessment was done with a pretested tool consisting of 15 items. Each item carried equal weightage in calculation of knowledge score thus maximum possible knowledge score was 15. Feedback assessment was also done after the training. RESULTS: The mean (SD) knowledge score significantly improved to 10.24 (2.24) after training as compared with 4.73 (1.94) before training, p<0.001 (n=982). There was significant improvement in knowledge for majority of the components namely causes of neonatal death (61.9% vs 28.1%), KMC (68.0% vs 54.6%), feeding of LBW infants (77.7% vs 6.9%), use of injection gentamicin (69.7% vs 11.2%), identification of PSBI (69.5% vs 59.5%). The improvement in knowledge score was more when healthcare providers and programme managers had provided a favourable response on feedback. CONCLUSION: Systematic pretest and post-test assessment coupled with feedback assessment can ensure the effectiveness of training programmes offered in programmatic settings.


Assuntos
Método Canguru , Criança , Saúde da Criança , Pessoal de Saúde , Humanos , Índia , Recém-Nascido , Melhoria de Qualidade
16.
Artigo em Inglês | MEDLINE | ID: mdl-34444309

RESUMO

Child labour remains a prevalent global concern, and progress toward eradicating harmful children's work appears to have stalled in the African continent and henceforth, integrated social policy intervention is still required to address the problem. Among several forms of social policy interventions, stomach infrastructure (i.e., in-kind and/or cash transfers) have been a key policy approach to support vulnerable families to lighten households' resources burden, which forces them to consider child labour as a coping strategy. There is growing evidence on the impacts of these programs in child labour. However, this evidence is often mixed regarding children's work outcomes, and the existing studies hardly describe such heterogeneous outcomes from the child-sensitive approach. To this end, a systematic literature search was conducted for studies in African countries. From 743 references retrieved in this study, 27 studies were included for the review, and a narrative approach has been employed to analyse extracted evidence. Results from the current study also demonstrate a mixed effect of in-kind and cash transfers for poor households on child labour decisions. Hence, the finding from the current review also demonstrates a reduced participation of children in paid and unpaid work outside the household due to in-kind and cash transfers to poor households, but children's time spent in economic and non-economic household labour and farm and non-farm labour, which are detrimental to child health and schooling, has been reported increasing due to the program interventions. The question remains how these programs can effectively consider child-specific and household-related key characteristics. To this end, a child-sensitive social protection perspective has been applied in this study to explain these mixed outcomes to inform policy design.


Assuntos
Trabalho Infantil , África , Criança , Saúde da Criança , Características da Família , Humanos , Estômago
18.
PLoS One ; 16(8): e0256099, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34383861

RESUMO

BACKGROUND: The remarkable progress seen in maternal and child health (MCH) in India over the past two decades has been impacted by the COVID-19 pandemic. We aimed to undertake a rapid assessment to identify key priorities for public health research in MCH in India within the context and aftermath of the COVID-19 pandemic. METHODS: A web-based survey was developed to identify top research priorities in MCH. It consisted of 26 questions on six broad domains: vaccine preventable diseases, outbreak preparedness, primary healthcare integration, maternal health, neonatal health, and infectious diseases. Key stakeholders were invited to participate between September and November 2020. Participants assigned importance on a 5-point Likert scale, and assigned overall ranks to each sub-domain research priority. Descriptive statistics were used to examine Likert scale responses, and a ranking analysis was done to obtain an "average ranking score" and identify the top research priority under each domain. RESULTS: Amongst the 84 respondents from across 15 Indian states, 37% were public-health researchers, 25% healthcare providers, 20% academic faculty and 13% were policy makers. Most respondents considered conducting systems strengthening research as extremely important. The highest ranked research priorities were strengthening the public sector workforce (vaccine preventable diseases), enhancing public-health surveillance networks (outbreak preparedness), nutrition support through community workers (primary care integration), encouraging at least 4-8 antenatal visits (maternal health), neonatal resuscitation to reduce birth asphyxia (neonatal health) and screening and treatment of tuberculosis (infectious diseases). Common themes identified through open-ended questions primarily included systems strengthening priorities across domains. CONCLUSIONS: The overall focus for research priorities in MCH in India during the COVID-19 pandemic is on strengthening existing services and service delivery, rather than novel research. Our results highlight pivotal steps within the roadmap for advancing and sustaining maternal and child health gains during the ongoing COVID-19 pandemic and beyond.


Assuntos
COVID-19 , Saúde da Criança , Saúde Materna , Pesquisa , Criança , Feminino , Humanos , Índia , Pandemias , Gravidez , Saúde Pública
19.
BMC Pediatr ; 21(1): 367, 2021 08 27.
Artigo em Inglês | MEDLINE | ID: mdl-34452603

RESUMO

BACKGROUND: The onset of walking is thought to be an indicator of early development. However, evidence is mixed and clear data on this relationship at preschool age is missing. The study aimed at investigating if walking onset and motor and cognitive development in preschool children are related. METHODS: A total of 555 children (mean age 3.86 years) of the Swiss Preschoolers' Health Study SPLASHY were tested twice at their childcare center (at baseline and one year later). Motor skills and cognitive skills were assessed by standardized testing procedures and parents were asked to provide information on walking onset of their child. RESULTS: Late onset of walking was related to poorer motor skills (fine motor skills, static and dynamic balance (all p < 0.003)) and poorer cognitive skills (selective attention and visual perception (p = 0.02; p = 0.001) in late preschool age. CONCLUSIONS: For children with late walking onset a close monitoring of their development in the regular pediatric child health visits may be reasonable. TRIAL REGISTRATION: ISRCTN41045021 .


Assuntos
Destreza Motora , Caminhada , Criança , Creches , Saúde da Criança , Pré-Escolar , Cognição , Humanos
20.
Health Qual Life Outcomes ; 19(1): 205, 2021 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-34446001

RESUMO

BACKGROUND: Although there is emerging data regarding the psychometric properties of the Child Health Utility-9D instrument, more evidence is required with respect to its validity for use in different country settings. The aim of this study was to examine the construct validity of the CHU-9D-CHN instrument in Chinese children. METHODS: Baseline Health-Related Quality of Life (HRQoL) and demographic data were collected from children recruited to the CHIRPY DRAGON obesity prevention intervention randomised controlled trial in China. HRQoL was measured using the Chinese version of the CHU-9D instrument (CHU-9D-CHN) and the PedsQL instrument. CHU-9D-CHN utility scores were generated using two scoring algorithms [UK and Chinese tariffs]. Discriminant validity, known-group validity and convergent validity were evaluated using non-parametric test for trend, Kruskal-Wallis test and Spearman correlation coefficient analysis respectively. RESULTS: Data was available for 1,539 children (mean age 6 years). The CHU-9D-CHN was sensitive to known group differences determined by the median PedsQL total score. Furthermore, the mean CHU-9D-CHN utility values decreased linearly with increasing levels of severity on each dimension of the PedsQL for emotional and social functioning domains. They decreased monotonically with increasing levels of severity on each dimension of the PedsQL for physical and school functioning domains (p < 0.001). Contrary to studies conducted in Western countries, and although not statistically significant, we found an indication that HRQoL, using both the CHU-9D-CHN and the PedsQL, was higher in children whose parents had lower levels of education, compared to those whose parents were university educated. The correlation between the CHU-9D-CHN utility values using UK and Chinese tariffs, and PedsQL total scores showed a statistically significant moderate positive correlation (Spearman's rho = 0.5221, p < 0.001 and Spearman's rho = 0.5316, p < 0.001), respectively. However, each CHU-9D-CHN dimension was either weakly, or very weakly correlated with each of the predetermined PedsQL domain functioning scores. CONCLUSIONS: Overall, the findings provide some support for the construct validity of the CHU-9D-CHN within a Chinese population aged 6-7 years. However, some uncertainty remains. We recommend future studies continue to test the validity of the CHU-9D in different country settings. TRIAL REGISTRATION: ISRCTN Identifier ISRCTN11867516, Registered on 19/08/2015.


Assuntos
Saúde da Criança/normas , Psicometria/métodos , Qualidade de Vida/psicologia , Inquéritos e Questionários/normas , Grupo com Ancestrais do Continente Asiático , Criança , China , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes , Instituições Acadêmicas
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