Postmortem minimally invasive tissue sampling in communities: exploring perceptions of families, funeral workers, religious and community leaders and healthcare providers from Pakistan.

BACKGROUND: Minimally invasive tissue sampling (MITS) has increasingly been used to improve the diagnosis of disease and identification of the cause of death, particularly in underserved areas. However, there are multiple barriers to accessing those who die within the community, our study aimed to explore the perceptions and insights of community members and healthcare providers regarding the feasibility of implementing MITS in community settings. METHODS: A qualitative exploratory study was conducted. A total of twenty one in-depth interviews were conducted with deceased infants' parents, elders of the family, religious leaders, community leaders, and funeral workers. Focus group discussions were conducted with health care providers (n = 14) in two peri-urban slum areas of Karachi, Pakistan. The duration of this study was from August to October 2020. Data was analyzed using thematic analysis and was coded and merged into categories forming eight major themes. RESULTS: In general, participants viewed minimally invasive tissue sampling (MITS) as beneficial for improving child health, though some had concerns about disrespecting the deceased during sample collection. Misinformation, fear of needles, and medical procedures were major barriers to MITS implementation. To enhance acceptance, community and religious leaders suggested using religious rulings, obtaining parental consent, ensuring confidentiality, and increasing efforts of community engagement. Community healthcare providers, along with funeral workers, recommended providing community members with grief counseling to increase study participation. Besides concerns about sampling interfering with respect for the decease, community members also raised concerns about misinformation. Further, participants provided feedback on the design and appearance of the mobile van used to collect MITS samples from children under the age of five. CONCLUSION: This study is critical for understanding the challenges associated with implementation of community-based MITS sampling in Pakistan. Integrating the use of a mobile van for sample collection, grief counseling along with community engagement sessions and advocacy will help address community-based misinformation and develop community trust.

Global climate change and health in Canadian children.

Climate change is a reality. Numerous expert authorities warn of the critical need to undertake and adapt environmental efforts to protect human health. Climate change is accelerating, and countries in high latitudes, such as Canada, are experiencing climate change more directly and, for some end points, more dramatically than mid- and low-latitude countries. Children are vulnerable to climate change health effects, and physicians and other health care providers need to be ready to identify, manage, and prevent climate change-related health hazards. This practice point highlights specific, climate change-related threats to the health of children and youth, and provides resources for health care providers. Climate challenges and their health impacts on children are described, based on key Canadian reports and scientifically referenced information. Enhanced awareness of the immediate and longer-term health effects of climate change on children allows physicians and other health care providers to counsel families and practice more effectively.

Demographic, socioeconomic, and health characteristics of the MAL-ED network study site in rural Pakistan.

The Pakistan study site of the Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) cohort study is located in Molhan union council of Naushahro Feroze district in the Sindh province. The study site is located in a rural district, where the majority of the population has an agrarian livelihood. Most families are nuclear families and the average household has 7 persons. More than half the women in the region have no formal education, and the median parity is 6. Only 48%-61% of the households across the district, province, and country have access to an improved toilet facility. Similar to the provincial and national estimates, the district has a low rate of exclusive breastfeeding at 6 months, and the prevalence of prelacteal feeding is high. There is also a high proportion of malnourished children. In addition, the acute respiratory infection and diarrheal illness burden and the mortality rates in children <5 years old in the district are high but comparable with the provincial and national estimates. Overall, the district is representative of rural populations at the regional and national level in terms of demographics, socioeconomic status, and general health and mortality indicators.

Assessment of child health services under Reproductive, Maternal, Neonatal, Child and Adolescent (RMNCH+A) strategy at primary health care level in Doiwala block of Dehradun District, Uttarakhand, India - A cross - sectional study.

Background: The reproductive, maternal, newborn, child + adolescent health (RMNCH+A) strategy was launched by the Indian government in the year 2013 to remain in the lead of the global war against child and maternal mortality and morbidity. Under RMNCH+A program in Uttarakhand state, according to the State public health policy, various provisions are needed to be done for maintenance of downtrend in infant mortality rate (IMR). There are various thrust areas under the child health program. The purpose of our study is to monitor the program implementation in terms of Input and Process indicators and to identify if there are any gaps in the child health services provided by RMNCH+A in the PHCs and subcentres of Doiwala block of Dehradun district, Uttarakhand. Aim: To evaluate Input and the process indicators of child health services under RMNCH+A strategy at Primary health care level in Doiwala block of Dehradun district, Uttarakhand. Methods: This Cross-sectional study was carried out in Doiwala Block of Dehradun district, Uttarakhand in 3 randomly selected Primary health centres (PHCs) and their 6 subcentres using a validated standard checklist for PHCs and subcentres. Results: In PHCs, mean obtained score for Input indicators was 56% and for Process indicators was 35%. The mean obtained score in subcentres for Input indicators and Process indicators was 53% and 51%, respectively. Conclusions: Both the input and the process indicators for child health services in PHCs and subcentres of Dehradun district were inadequate. Most indicators scored less than 50% at both the PHCs and subcentres.

Role of the nurse in addressing vaccine hesitancy and misinformation on social media.

Vaccine hesitancy, defined as the refusal or delay of acceptance of vaccines, is a threat to the elimination and/or eradication of vaccine-preventable diseases, and therefore has significant implications for global health. Negative and conflicting vaccination information on social media can lead to vaccine hesitancy, including among parents who need to decide whether to have their children vaccinated. This article discusses the dissemination and content of vaccination information on social media, and explores the effects this can have on vaccine hesitancy and uptake. It also outlines various strategies that nurses can use to address vaccine hesitancy and misinformation on social media.

Clinical features of paediatric uveitis at a tertiary referral centre in São Paulo, SP, Brazil.

AIMS: To analyse the clinical features, systemic associations, treatment and visual outcomes of uveitis in children from a referral centre in São Paulo, Brazil. METHODS: Clinical records of patients under 16 years old who attended the Uveitis Service, Hospital das Clinicas, Faculdadede Medicina, Universidade de São PauloFMUSP, between April and September 2017, were reviewed retrospectively. Patients with incomplete medical records, previous ocular trauma, or less than six6 months of follow-up were excluded. RESULTS: Thirty-nine children (25 female/14 male) were included. There was predominance of bilateral (89.7%), asymptomatic (56.4%) and recurrent/chronic cases (84.6%). The mean age at study inclusion was 10.7±3.4 years (range 3-16 years). Improvement or preservation of visual acuity (VA) was observed in 27 patients (84%); VA was not informed in 8 patients. Patients were referred early to tertiary centre (55% within 6 months of uveitis diagnosis). Anterior uveitis was the most common involvement (46%), followed by intermediate uveitis (26%). Juvenile idiopathic arthritis (JIA)-associated uveitis (41%) and immune-mediated intermediate uveitis (25.6%) were the principal non-infectious conditions; ocular toxoplasmosis (7.7%) and toxocariasis (5.1%) were the most common infectious conditions. Ocular complications were observed at first visit in 46% of patients and in 90% during final evaluation. Oral prednisone, immunosuppressive therapy (IMT) and/or biologic agents were used in all non-infectious conditions (32 children, 82%); IMT and/or biologic agents were used in all patients with JIA-associated uveitis and in 50% of patients with immune-mediated intermediate uveitis. CONCLUSION: Paediatric patients with uveitis are referred early to this centre and, although severe, adequate management with systemic IMT may preserve VA.