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System barriers to effective healthcare engagement and navigation contribute to healthcare disparities among Latino children with immigrant parents in the US. We evaluated a nine-minute educational video supporting healthcare navigation and engagement skills of Spanish-speaking Latino parents of infants. Participants viewed the video at their child's 2-month well-visit, completed a pre-and post-video knowledge evaluation, and answered open-ended questions on video style. A paired t test was used to examine differences in knowledge and open-ended responses were coded using an iterative, consensus-based process. Of the 79 participants, 63.3% had an education level below high school diploma/GED and 84.8% were at risk for limited health literacy. There was a significant gain in healthcare navigation and engagement knowledge after watching the video (p < 0.001). Parents expressed that the video was interesting and provided useful information. Parents valued the knowledge gained and preferred videos over written materials for receiving culturally and linguistically tailored health education. [ABSTRACT FROM AUTHOR]

Purpose: The Child Friendly Cities Initiative (CFCI) is a UNICEF framework based on the UN Convention on the Rights of the Child (CRC). CFCI was launched globally in 1996 to protect children's rights throughout the world. There are child friendly cities in over 44 countries around the globe, but none presently in the United States. The purpose was to establish a Child Friendly City in the United States. Description: Child friendly cities are a child-rights and equity-based approach designed to ensure all children in a community reach their full potential for optimal health, development, and well-being. The paper discusses the development of the guiding principles of the CFCI-Minneapolis Model as well as a community needs assessment. Assessment: The assessment consisted of a digital survey of 60 questions on the SurveyMonkey platform. The sample included 173 Minneapolis youth 10-18 years of age and 85 parents with children less than five years of age. The participants were drawn from four of the 83 Minneapolis neighborhoods that had the highest concentration of children and youth, communities of color, and immigrant families that have historically been under resourced. Conclusion: The results of the community assessment guided the development of four programmatic initiatives. These included child rights learning & awareness, emergency preparedness & planning, community safety, and youth participation in decision making. The paper concludes with the lesson learned to date in the implementation of the CFCI-Minneapolis Model. These include partnership, dedication, leadership, community engagement, coalition building, and celebrating success. CFCI-Minneapolis received full designation from UNICEF USA as a child friendly city in February 2024. [ABSTRACT FROM AUTHOR]

In India, undernutrition among children has been extremely critical for the last few decades. Most analyses of undernutrition among Indian children have used the administrative boundaries of a state or a district level as a unit of analysis. This paper departs from such a practice and focuses instead on the political boundaries of a parliamentary constituency (PC) as the unit of analysis. The PC is a critical geopolitical unit where political parties and party candidates make election promises and implement programmes to improve the socio-economic condition of their electorate. A focus on child undernutrition at this level has the potential for greater policy and political traction and could lead to a paradigm shift in the strategy to tackle the problem by creating a demand for political accountability. Different dimensions and new approaches are also required to evaluate the socio-economic status and generate concrete evidence to find solutions to the problem. Given the significance of advanced analytical methods and models embedded into geographic information system (GIS), the current study, for the first time, uses GIS tools and techniques at the PC level, conducting in-depth analysis of undernutrition and its predictors. Hence, this paper examines the spatial heterogeneity in undernutrition across PCs by using geospatial techniques such as univariate and bivariate local indicator of spatial association and spatial regression models. The analysis highlights the high–low burden areas in terms of local hotspots and identifies the potential spatial risk factors of undernutrition across the constituencies. Striking variations in the prevalence of undernutrition across the constituencies were observed. Most of these constituencies that performed poorly both in terms of child nutrition and socio-economic indicators were located in the northern, western, and eastern parts of India. A statistically significant association of biological, socio-economic, and environmental factors such as women's body mass index, anaemia in children, poverty, household sanitation facilities, and institutional births was established. The results highlight the need to bring in a mechanism of political accountability that directly connects elected representatives to maternal and child health outcomes. The spatial variability and pattern of undernutrition indicators and their correlates indicate that priority setting in research may also be greatly influenced by the neighbourhood association. [ABSTRACT FROM AUTHOR]

Background: Adiponectin is an adipocyte-derived hormone that acts as a marker of insulin sensitivity. Bloodspot sampling by fingerstick onto filter paper may increase the feasibility of large-scale studies of the determinants of insulin sensitivity. We first describe the validation of an enzyme-linked immunoassay (ELISA) for quantifying adiponectin from dried blood spots and then demonstrate its application in a large trial (PROBIT). Methods: We quantified adiponectin from 3-mm diameter discs (≈3 µL of blood) punched from dried blood spots obtained from: i) whole blood standards (validation); and ii) PROBIT trial samples (application) in which paediatricians collected blood spots from 13,879 children aged 11.5 years from 31 sites across Belarus. We examined the distribution of bloodspot adiponectin by demographic and anthropometric factors, fasting insulin and glucose. Results: In the validation study, mean intra-assay coefficients of variation (n = 162) were 15%, 13% and 10% for ‘low’ (6.78 µg/ml), ‘medium’ (18.18 µg/ml) and 'high’ (33.13 µg/ml) internal quality control (IQC) samples, respectively; the respective inter-assay values (n = 40) were 23%, 21% and 14%. The correlation coefficient between 50 paired whole bloodspot versus plasma samples, collected simultaneously, was 0.87 (95% CI: 0.78 to 0.93). Recovery of known quantities of adiponectin (between 4.5 to 36 µg/ml) was 100.3–133%. Bloodspot adiponectin was stable for at least 30 months at −80°C. In PROBIT, we successfully quantified fasting adiponectin from dried blood spots in 13,329 of 13,879 (96%) children. Mean adiponectin (standard deviation) concentrations were 17.34 µg/ml (7.54) in boys and 18.41 µg/ml (7.92) in girls and were inversely associated with body mass index, fat mass, triceps and subscapular skin-fold thickness, waist circumference, height and fasting glucose. Conclusions: Bloodspot ELISA is suitable for measuring adiponectin in very small volumes of blood collected on filter paper and can be applied to large-scale studies. [ABSTRACT FROM AUTHOR]

In order to discern the causes of the health and developmental problems of children, and thence develop preventative strategies, longitudinal cohort studies offer major advantages. They can monitor the consequences of exposure to physical and psychological events and thence identify antecedents of various disorders. We describe the historical background to the development in the UK of this study design, and the uptake of longitudinal birth cohorts in low- and middle-income countries (LMICs), using the cohorts in Jamaica, South Africa and Brazil as exemplars. We describe the benefits of such studies and show how undertaking longitudinal cohort studies can have major health and financial benefits to the populations concerned. Additionally, the paper outlines the advantages of collaboration between studies and the pooling of data. [ABSTRACT FROM AUTHOR]

Background: Tree of Life Groups (a narrative therapy technique) have been used successfully in a number of paediatric populations. The group intervention aims to give children a space to express their difficulties whilst also holding in mind their strengths and hopes, thereby creating a preferred identity incorporating their physical health condition. No studies were identified which described this approach in a paediatric epilepsy population or involving siblings, families and the multidisciplinary team. Methods: The current paper describes a pilot intervention to facilitate a one-day psychoeducational Tree of Life group for children with epilepsy, their siblings and parents. Separate parent and sibling groups were facilitated concurrently. The groups were co-facilitated by Paediatric Psychology and Paediatric Epilepsy team members. Quantitative feedback was completed by the patient group. Patients, siblings, and parents provided qualitative feedback. Results: A total of 6 patients, 14 siblings and 15 parents attended the group. Quantitative feedback indicated some improvement in patients' confidence and knowledge of managing epilepsy, as well as some improvements in psychological adjustment and thoughts about epilepsy. 87.5% of patients and siblings detailed that they would recommend the group to others. Qualitative feedback from patients, siblings and parents indicated the helpfulness of relating to others and safely expressing difficulties. Conclusions: The results indicated that this pilot group intervention was well received by children with epilepsy and their families. Future studies incorporating a larger sample are warranted to explore this further. [ABSTRACT FROM AUTHOR]

Parenting stress has been related to adverse health outcomes in parents, children, and their families. This systematic review aimed to provide an overview of parental, child, and situational factors related to parenting stress in mothers and fathers. We searched Embase, Medline Epub (Ovid), PsychInfo (Ovid), Web of Science, and Google scholar for studies published between January 1980 and May 2021 evaluating the association between at least one factor and parenting stress. Studies were included only if they reported the association in a general population sample of mothers and fathers with children aged 0–12 years. The parent–child relationship model by Abidin guided the data synthesis. Quality of the evidence was assessed using the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a variety of fields. In total, 29 studies were included with excellent quality (55%), good (31%), and adequate (14%) methodological quality. There was evidence of an association between maternal depression, child overall problems, child externalizing and internalizing problems, social support, maternal educational level and maternal parenting stress. Evidence was inconsistent for an association between maternal anxiety, family income and maternal parenting stress. There was no evidence of an association for maternal age, child sex and maternal parenting stress. Several modifiable factors (i.e., parental depression and social support) were identified that might guide the development of preventive interventions. Future research should employ longitudinal study designs evaluating protective and risk factors and the pathways that lead to parenting stress, among both fathers and mothers. [ABSTRACT FROM AUTHOR]

This paper examines the impact of exposure to violence during pregnancy on anthropometric and cognitive outcomes of children in the medium run. I combine detailed household-level data on more than 36,000 children with geo-coded information on civilian casualties in the aftermath of the US invasion of Iraq between 2003 and 2009 and exploit within-mother differences in prenatal exposure to violence. I find that one violent incident during pregnancy decreases height- and weight-for-age z-scores by 0.13 standard deviations and lowers cognitive and behavioral skills of children. Leveraging information on the severity, type and perpetrator of violence, I isolate the effect of stress from access to prenatal care. The analysis reveals that stressful events, particularly those involving direct threats to personal safety (violence directed at the civilian population and involving execution and torture), exert an even larger negative impact on child health than those incidents that disrupt health infrastructure and access to prenatal care. [ABSTRACT FROM AUTHOR]

Background: In high income countries one in five children still lives in poverty, which is known to adversely shape the life course health trajectory of these children. However, much less is understood on whether social and fiscal policies have the capacity to reverse this damage, which intervention is likely to be most effective and when these interventions should be delivered to maximise their impact. This systematic review attempts to address these questions by looking at the impact of income-support interventions, delivered during the first 1,000 days of life, on cardiovascular, metabolic, respiratory and mental health outcomes. Methods: The review was restricted to experimental or quasi experimental studies conducted in high income countries. Studies were retrieved from multidisciplinary databases as well as health, economic, social sciences-specific literature browsers. All papers retrieved through the search strategy were double screened at title, abstract and full text stage. Relevant data of the selected studies were extracted and collected in tables, then summarised via narrative synthesis approach. Robustness of findings was assessed by tabulating impact by health outcome, type of intervention and study design. Results: Overall, 16 relevant papers were identified, including 15 quasi-experimental studies and one randomized control trial (RCT). Income-support interventions included were unconditional/conditional cash transfers, income tax credit and minimum wage salary policies. Most studies were conducted in United States and Canada. Overall, the evidence suggested limited effect on mental health indicators but a positive, albeit small, effect of most policies on birth weight outcomes. Despite this, according to few studies that tried to extrapolate the results into public health terms, the potential number of negative outcomes averted might be consistent. Conclusions: Income-support interventions can positively affect some of the health outcomes of interest in this review, including birth weight and mental health. Given the large number of people targeted by these programs, one could infer that – despite small – the observed effect may be still relevant at population level. Nonetheless, the limited generalisability of the evidence gathered hampers firm conclusions. For the future, the breadth and scope of this literature need to be broadened to fully exploit the potential of these interventions and understand how their public health impact can be maximised. [ABSTRACT FROM AUTHOR]

Background: Electronic clinical decision-making support systems (eCDSS) aim to assist clinicians making complex patient management decisions and improve adherence to evidence-based guidelines. Integrated management of Childhood Illness (IMCI) provides guidelines for management of sick children attending primary health care clinics and is widely implemented globally. An electronic version of IMCI (eIMCI) was developed in South Africa. Methods: We conducted a cluster randomized controlled trial comparing management of sick children with eIMCI to the management when using paper-based IMCI (pIMCI) in one district in KwaZulu-Natal. From 31 clinics in the district, 15 were randomly assigned to intervention (eIMCI) or control (pIMCI) groups. Computers were deployed in eIMCI clinics, and one IMCI trained nurse was randomly selected to participate from each clinic. eIMCI participants received a one-day computer training, and all participants received a similar three-day IMCI update and two mentoring visits. A quantitative survey was conducted among mothers and sick children attending participating clinics to assess the quality of care provided by IMCI practitioners. Sick child assessments by participants in eIMCI and pIMCI groups were compared to assessment by an IMCI expert. Results: Self-reported computer skills were poor among all nurse participants. IMCI knowledge was similar in both groups. Among 291 enrolled children: 152 were in the eIMCI group; 139 in the pIMCI group. The mean number of enrolled children was 9.7 per clinic (range 7-12). IMCI implementation was sub-optimal in both eIMCI and pIMCI groups. eIMCI consultations took longer than pIMCI consultations (median duration 28 minutes vs 25 minutes; p = 0.02). eIMCI participants were less likely than pIMCI participants to correctly classify children for presenting symptoms, but were more likely to correctly classify for screening conditions, particularly malnutrition. eIMCI participants were less likely to provide all required medications (124/152; 81.6% vs 126/139; 91.6%, p= 0.026), and more likely to prescribe unnecessary medication (48/152; 31.6% vs 20/139; 14.4%, p = 0.004) compared to pIMCI participants. Conclusions: Implementation of eIMCI failed to improve management of sick children, with poor IMCI implementation in both groups. Further research is needed to understand barriers to comprehensive implementation of both pIMCI and eIMCI. (349) Clinical trials registration: Clinicaltrials.gov ID: BFC157/19, August 2019. [ABSTRACT FROM AUTHOR]

Medical-legal partnerships connect legal advocates to healthcare providers and settings. Maintaining effectiveness of medical-legal partnerships and consistently identifying opportunities for innovation and adaptation takes intentionality and effort. In this paper, we discuss ways in which our use of data and quality improvement methods have facilitated advocacy at both patient (client) and population levels as we collectively pursue better, more equitable outcomes. [ABSTRACT FROM AUTHOR]

Background: In high income countries one in five children still lives in poverty, which is known to adversely shape the life course health trajectory of these children. However, much less is understood on whether social and fiscal policies have the capacity to reverse this damage, which intervention is likely to be most effective and when these interventions should be delivered to maximise their impact. This systematic review attempts to address these questions by looking at the impact of income-support interventions, delivered during the first 1,000 days of life, on cardiovascular, metabolic, respiratory and mental health outcomes. Methods: The review was restricted to experimental or quasi experimental studies conducted in high income countries. Studies were retrieved from multidisciplinary databases as well as health, economic, social sciences-specific literature browsers. All papers retrieved through the search strategy were double screened at title, abstract and full text stage. Relevant data of the selected studies were extracted and collected in tables, then summarised via narrative synthesis approach. Robustness of findings was assessed by tabulating impact by health outcome, type of intervention and study design. Results: Overall, 16 relevant papers were identified, including 15 quasi-experimental studies and one randomized control trial (RCT). Income-support interventions included were unconditional/conditional cash transfers, income tax credit and minimum wage salary policies. Most studies were conducted in United States and Canada. Overall, the evidence suggested limited effect on mental health indicators but a positive, albeit small, effect of most policies on birth weight outcomes. Despite this, according to few studies that tried to extrapolate the results into public health terms, the potential number of negative outcomes averted might be consistent. Conclusions: Income-support interventions can positively affect some of the health outcomes of interest in this review, including birth weight and mental health. Given the large number of people targeted by these programs, one could infer that – despite small – the observed effect may be still relevant at population level. Nonetheless, the limited generalisability of the evidence gathered hampers firm conclusions. For the future, the breadth and scope of this literature need to be broadened to fully exploit the potential of these interventions and understand how their public health impact can be maximised. [ABSTRACT FROM AUTHOR]

Background: In many Westernised countries, children do not consume a sufficient amount of vegetables for optimal health and development. Child-feeding guidelines have been produced to address this, but often only promote offering vegetables at midday/evening meals and snack times. With guidance having limited success in increasing children's vegetable intake at a population level, novel approaches to address this must be developed. Offering vegetables to children at breakfast time in nursery/kindergarten settings has the potential to increase children's overall daily vegetable consumption as children typically attend nursery/kindergarten and many routinely eat breakfast there. However, the feasibility and acceptability of this intervention (Veggie Brek) to children and nursery staff has not been investigated. Methods: A feasibility and acceptability cluster randomised controlled trial (RCT) was undertaken in eight UK nurseries. All nurseries engaged in one-week baseline and follow-up phases before and after an intervention/control period. Staff in intervention nurseries offered three raw carrot batons and three cucumber sticks alongside children's main breakfast food each day for three weeks. Control nurseries offered children their usual breakfast. Feasibility was assessed by recruitment data and nursery staff's ability to follow the trial protocol. Acceptability was assessed by children's willingness to eat the vegetables at breakfast time. All primary outcomes were assessed against traffic-light progression criteria. Staff preference for collecting data via photographs versus using paper was also assessed. Further views about the intervention were obtained through semi-structured interviews with nursery staff. Results: The recruitment of parents/caregivers willing to provide consent for eligible children was acceptable at 67.8% (within the amber stop–go criterion) with 351 children taking part across eight nurseries. Both the feasibility and acceptability of the intervention to nursery staff and the willingness of children to consume the vegetables met the green stop–go criteria, with children eating some part of the vegetables in 62.4% (745/1194) of instances where vegetables were offered. Additionally, staff preferred reporting data using paper compared to taking photographs. Conclusions: Offering vegetables to children at breakfast time in nursery/kindergarten settings is feasible and acceptable to children and nursery staff. A full intervention evaluation should be explored via a definitive RCT. Trial registration: NCT05217550. [ABSTRACT FROM AUTHOR]

Background: Exposure to environmental tobacco smoke (ETS) is arguably the most ubiquitous and hazardous, even at very low levels, starting in early life. The objective of this study was to describe the state of research and future trends on ETS exposure and Children's Health (CH) topics with bibliometrics and altmetrics. Methods: An electronic search was performed in Scopus database on January 31, 2023. Consensus was arrived on 100 most-cited articles by two reviewers. These papers were then cross matched with citations harvested from Web of Science (WoS) and Google Scholar. Altmetric Attention Score (AAS) and Dimension counts were also collected. Analysis and network visualization of authors, countries, and keywords were generated using VOSviewer software. Results: Among a total of 1107 articles published on ETS and CH, the 100 top-cited articles appeared in 54 journals, with Pediatrics (n = 12) contributing a maximum number of articles. The time period between 2000 and 2009 accounted for 44% of all publications. With respect to the research design employed across these studies, cross-sectional design took precedence over others accounting for approximately 40%. Predominantly, articles focused on childhood asthma; however, current research trends have shifted towards emerging fields such as children's oral health and DNA methylation. Twitter, policy documents, and news outlets were the main platforms where outputs were discussed. The AAS was not associated with journal impact factor or access type. Weak correlations were observed between AAS and citation count in Scopus, WoS, and Google Scholar (r = 0.17 to 0.27) while a positive association existed between dimension count and the number of citations across all three databases (r = 0.84 to 0.98). Conclusion: This study demonstrates the evolution, digital dissemination and research hotspots in the field of ETS and CH, predicting the possible future research directions. High-quality studies with more specific exposure classification are warranted to better understand the relationship between ETS and CH. [ABSTRACT FROM AUTHOR]

Child stunting prevalence is primarily used as an indicator of impeded physical growth due to undernutrition and infections, which also increases the risk of mortality, morbidity and cognitive problems, particularly when occurring during the 1000 days from conception to age 2 years. This paper estimated the relationship between stunting prevalence and age for children 0–59 months old in 94 low‐ and middle‐income countries. The overall stunting prevalence was 32%. We found higher stunting prevalence among older children until around 28 months of age—presumably from longer exposure times and accumulation of adverse exposures to undernutrition and infections. In most countries, the stunting prevalence was lower for older children after around 28 months—presumably mostly due to further adverse exposures being less detrimental for older children, and catch‐up growth. The age for which stunting prevalence was the highest was fairly consistent across countries. Stunting prevalence and gradient of the rise in stunting prevalence by age varied across world regions, countries, living standards and sex. Poorer countries and households had a higher prevalence at all ages and a sharper positive age gradient before age 2. Boys had higher stunting prevalence but had peak stunting prevalence at lower ages than girls. Stunting prevalence was similar for boys and girls after around age 45 months. These results suggest that programmes to prevent undernutrition and infections should focus on younger children to optimise impact in reducing stunting prevalence. Importantly, however, since some catch‐up growth may be achieved after age 2, screening around this time can be beneficial. Key message: Stunting prevalence was higher for older children until around age 28 months.The age with the highest stunting prevalence was fairly consistent across UNICEF regions.However, the stunting prevalence and gradient of the rise and fall in stunting prevalence across age varied between countries, living standards and sex.Programmes to prevent undernutrition and infections should focus on younger children to optimise impact in reducing stunting prevalence.Some catch‐up growth may be achieved after age 2, so screening around this time can be beneficial. [ABSTRACT FROM AUTHOR]

This paper estimates the moderating effect of soil organic carbon content (a measure of soil health) on child health in response to rainfall shocks in a low-income country setting. Focusing on rural India, I leverage the Demographic and Health Survey data set and high-resolution spatial data on soil organic carbon content and meteorological variables. The results show that a high level of soil organic carbon significantly reduces the negative impact of rainfall shock on children’s weight-for-height z-scores, but not on height-for-age z-scores. [ABSTRACT FROM AUTHOR]

Background: This is the final of 10 papers that describe the implementation of the Expanded Census-Based, Impact-Oriented Approach (CBIO+) by Curamericas/Guatemala in the Cuchumatanes mountains of the Department of Huehuetenango and its effectiveness in improving the health and well-being of women and children in a population of 98,000 in three municipalities. The CBIO+ Approach consists of three components: the CBIO (Census-Based, Impact-Oriented) Approach, the Care Group Approach, and the Community Birthing Center Approach. Methods: Each of the preceding papers was summarized. An assessment was made regarding the degree to which the initial implementation research hypotheses were confirmed. The total field cost per capita for operation of the Project was calculated. An assessment of the cost-effectiveness of the Project was made based on the estimated impact of the Project, the number of lives saved, and the number of disability-adjusted life years averted. Results: The Project attained a number of notable achievements in terms of expanding the coverage of key maternal and child health interventions, improving the nutritional status of children, reducing the mortality of children and mothers, providing quality care for mothers at the Community Birthing Centers (Casas Maternas Rurales) that integrate traditional midwives (comadronas) into the care of women during childbirth at the birthing centers, as well as empowering women and building social capital in the communities. CBIO+ is an effective and affordable approach that is particularly notable for its capacity to engage communities in the process of improving the health of mothers and children. Overall, there is strong and consistent evidence in support of the research hypotheses. The findings did produce evidence of declines in under-5 and maternal mortality, but they were not as robust as had been hoped. Conclusion: CBIO+ is an approach that has been effective in engaging communities in the process of improving the health of their mothers and children and in reducing health inequities in this marginalized, difficult-to-reach population of Indigenous Maya people. The CBIO+ Approach is cost-effective and merits further development and broader application in Guatemala and beyond. [ABSTRACT FROM AUTHOR]

Background: The Curamericas/Guatemala Maternal and Child Health Project, 2011–2015, implemented the Census-Based, Impact-Oriented Approach, the Care Group Approach, and the Community Birthing Center Approach. Together, this expanded set of approaches is known as CBIO+. This is the fifth of 10 papers in our supplement describing the Project and the effectiveness of the CBIO+ Approach. This paper assesses causes, levels, and risk factors for mortality along with changes in mortality. Methods: The Project maintained Vital Events Registers and conducted verbal autopsies for all deaths of women of reproductive age and under-5 children. Mortality rates and causes of death were derived from these data. To increase the robustness of our findings, we also indirectly estimated mortality decline using the Lives Saved Tool (LiST). Findings: The leading causes of maternal and under-5 mortality were postpartum hemorrhage and pneumonia, respectively. Home births were associated with an eight-fold increased risk of both maternal (p = 0.01) and neonatal (p = 0.00) mortality. The analysis of vital events data indicated that maternal mortality declined from 632 deaths per 100,000 live births in Years 1 and 2 to 257 deaths per 100,000 live birth in Years 3 and 4, a decline of 59.1%. The vital events data revealed no observable decline in neonatal or under-5 mortality. However, the 12–59-month mortality rate declined from 9 deaths per 1000 live births in the first three years of the Project to 2 deaths per 1000 live births in the final year. The LiST model estimated a net decline of 12, 5, and 22% for maternal, neonatal and under-5 mortality, respectively. Conclusion: The baseline maternal mortality ratio is one of the highest in the Western hemisphere. There is strong evidence of a decline in maternal mortality in the Project Area. The evidence of a decline in neonatal and under-5 mortality is less robust. Childhood pneumonia and neonatal conditions were the leading causes of under-5 mortality. Expanding access to evidence-based community-based interventions for (1) prevention of postpartum hemorrhage, (2) home-based neonatal care, and (3) management of childhood pneumonia could help further reduce mortality in the Project Area and in similar areas of Guatemala and beyond. [ABSTRACT FROM AUTHOR]

Background: Indigenous Maya women in the rural highlands of Guatemala have traditionally faced constraints to decision-making and participation in community affairs. Anecdotal experiences from previous Curamericas Global projects in Guatemala and Liberia have suggested that interventions using the CBIO+ Approach (which consists of implementing together the Census-Based, Impact-Oriented Approach, the Care Group Approach, and Community Birthing Centers), can be empowering and can facilitate improvements in maternal and child health. This paper, the eighth in a series of 10 papers examining the effectiveness of CBIO+ in improving the health and well-being of mothers and children in an isolated mountainous rural area of the Department of Huehuetenango, explores changes in women's empowerment among mothers of young children associated with the Curamericas/Guatemala Maternal and Child Health Project, 2011–2015. Methods: Knowledge, practice, and coverage (KPC) surveys and focus group discussions (FGDs) were used to explore six indicators of women's empowerment focusing on participation in health-related decision-making and participation in community meetings. KPC surveys were conducted at baseline (January 2012) and endline (June 2015) using standard stratified cluster sampling. Seventeen FGDs (9 with women, 3 with men, 2 with mothers-in-law, and 3 with health committees), approximately 120 people in all, were conducted to obtain opinions about changes in empowerment and to identify and assess qualitative factors that facilitate and/or impede women's empowerment. Results: The KPC surveys revealed statistically significant increases in women's active participation in community meetings. Women also reported statistically significant increases in rates of participation in health-related decision-making. Further, the findings show a dose-response effect for two of the six empowerment indicators. The qualitative findings from FGDs show that the Project accelerated progress in increasing women's empowerment though women still face major barriers in accessing needed health care services for themselves and their children. Conclusion: The Project achieved some notable improvements in women's decision-making autonomy and participation in community activities. These improvements often translated into making decisions to practice recommended health behaviors. Traditional cultural norms and the barriers to accessing needed health services are not easily overcome, even when empowerment strategies are effective. [ABSTRACT FROM AUTHOR]

Background: In Guatemala, Indigenous women have a maternal mortality ratio over twice that of non-Indigenous women. Long-standing marginalization of Indigenous groups and three decades of civil war have resulted in persistent linguistic, economic, cultural, and physical barriers to maternity care. Curamericas/Guatemala facilitated the development of three community-built, -owned, and -operated birthing centers, Casas Maternas Rurales (referred to here as Community Birthing Centers), where auxiliary nurses provided physically accessible and culturally acceptable clinical care. The objective of this paper is to assess the management of complications and the decision-making pathways of Birthing Center staff for complication management and referral. This is the sixth paper in the series of 10 articles. Birthing centers are part of the Expanded Census-based, Impact-oriented Approach, referred to as CBIO+. Methods: We undertook an explanatory, mixed-methods study on the handling of pregnancy complications at the Birthing Centers, including a chart review of pregnancy complications encountered among 1,378 women coming to a Birthing Center between 2009 and 2016 and inductively coded interviews with Birthing Center staff. Results: During the study period, 1378 women presented to a Birthing Center for delivery-related care. Of the 211 peripartum complications encountered, 42.2% were successfully resolved at a Birthing Center and 57.8% were referred to higher-level care. Only one maternal death occurred, yielding a maternal mortality ratio of 72.6 maternal deaths per 100,000 live births. The qualitative study found that staff attribute their successful management of complications to frequent, high-quality trainings, task-shifting, a network of consultative support, and a collaborative atmosphere. Conclusion: The Birthing Centers were able to resolve almost one-half of the peripartum complications and to promptly refer almost all of the others to a higher level of care, resulting in a maternal mortality ratio less than half that for all Indigenous Guatemalan women. This is the first study we are aware of that analyzes the management of obstetrical complications in such a setting. Barriers to providing high-quality maternity care, including obtaining care for complications, need to be addressed to ensure that all pregnant women in such settings have access to a level of care that is their fundamental human right. [ABSTRACT FROM AUTHOR]

Background: The Curamericas/Guatemala Maternal and Child Health Project, 2011–2015, included implementation research designed to assess the effectiveness of an approach referred to as CBIO+ , composed of: (1) the Census-Based, Impact-Oriented (CBIO) Approach, (2) the Care Group Approach, and (3) the Community Birthing Center Approach. This is the second paper in a supplement of 10 articles describing the implementation research and its findings. Paper 1 describes CBIO+ , the Project Area, and how the Project was implemented. Objective: This paper describes the implementation research design and details of how it was carried out. Methods: We reviewed the original implementation research protocol and the methods used for all data collection related to this Project. The protocol and methods used for the implementation research related to this Project were all standard approaches to the monitoring and evaluation of child survival projects as developed by the United States Agency for International Development Child Survival and Health Grants Program (CSHGP) and the CORE Group. They underwent independent peer review supervised by the CSHGP before the implementation research began. Results: The study area was divided into two sets of communities with a total population of 98,000 people. Project interventions were implemented in Area A from 2011 until the end of the project in 2015 (44 months) and in Area B from late 2013 until 2015 (20 months). Thus, Area B served as a quasi-comparison area during the first two years of Project implementation. The overarching study question was whether the CBIO+ Approach improved the health and well-being of children and mothers. The outcome indicators included (1) changes in population coverage of evidence-based interventions, (2) changes in childhood nutritional status, (3) changes in the mortality of children and mothers, (4) quality of care provided at Community Birthing Centers, (5) the impact of the Project on women's empowerment and social capital, (6) stakeholder assessment of the effectiveness of the CBIO+ Approach, and (7) the potential of wider adoption of the CBIO+ Approach. Conclusion: The implementation research protocol guided the assessment of the effectiveness of the CBIO+ Approach in improving the health and well-being of children, mothers, and their communities. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study is to conduct a concept analysis of adolescents' emotional well‐being resulting from healthy social media use. Background: Adolescents are the group that uses mobile social media the most. They connect to others and achieve life satisfaction via social media. Here, we consider both the positive and negative aspects of social media use and recognize the need for clear guidance on proper social media use among adolescents. Design: This study utilized an eight‐step method of concept analysis. Data sources A systematic literature search of PubMed, CINAHL and PsycInfo was conducted, and 10 articles were selected. Review methods: We defined attributes, model cases, antecedents, consequences and referents. Results: The attributes of adolescent emotional well‐being on social media are (a) relationships with others, (b) internet‐based communication and (c) being happy and maintaining emotional health. Adolescents use social media to feel safe, seek information and connect to others. Adolescents reported having better relationships and positive affect as a result of social media use. Conclusion: This concept analysis will help health‐care providers understand how adolescent emotional well‐being is attained through social media. Additionally, this study will provide the basis of behavioural theories and future interventions that guide adolescent use of social media. Summary statement: What is already known about this topic? Most adolescents use smartphones as a means of personal communication.Adolescents have both positive and negative feelings when using social media. What this paper adds? Adolescent emotional well‐being on social media is defined as 'being happy and maintaining emotional health through relationships with others on internet‐based communication'.Adolescents obtain better relationships and positive affects as a result of social media use. The implications of this paper Nurses can utilize the results of this study to guide adolescents and their parents in healthy social media use.Nursing interventions may be developed based on these findings to promote adolescent emotional well‐being through social media use. [ABSTRACT FROM AUTHOR]

The purpose of this perspective article is to emphasise the importance of the 'First 2000 Days' policy of life from conception to age five, and to propose new directions in which the policy's implementation could be extended for the benefit of children and families. The proposed approach highlights principles of responsiveness, integration, sustainability and equity, specifying initiatives that embody the kind of innovation each principle aspires to. The article also proposes innovations in data collection and linkages that would strengthen the implementation of first 2000 days policies and frameworks. This perspective proposes a framework that could improve health systems implementation of services in the first 5 years of life, by proposing a well-coordinated continuum of services with integrated physical and digital solutions. This has the potential to transform how the health system monitors and responds to children and families' needs in the critical early years of life during and beyond the current pandemic. What is known about the topic? The 'First 2000 Days' policy is publicly available, it represents an important effort to highlight the importance of the first 5 years of life for a child's development. This policy and others like it have been broadly adopted around Australia. What does this paper add? This paper is a constructive critique of the policy that suggests greater responsiveness, integration, sustainability and equity. What are the implications for practitioners? This paper helps us understand how best to shape early childhood health services so they can be most effective. [ABSTRACT FROM AUTHOR]

The humanitarian crisis precipitated by the ongoing conflict in Sudan poses profound risks to the health and welfare of the country's children. This paper explores essential policy interventions to safeguard child mental health services under these challenging circumstances. Crucial strategies include enhancing healthcare accessibility for children and their caregivers, promoting education, and improving household living conditions. Additionally, it is vital to provide improved access to information about nutritious food and strengthen health systems in areas directly exposed to conflict. Cooperation with international aid organizations is paramount to delivering medical supplies to functioning health facilities. The paper also recommends partnerships with local non-governmental and humanitarian organizations to execute public health programs effectively. These multi-faceted policy measures underscore the importance of a comprehensive response to ensure the health and well-being of children amid the turmoil in Sudan. Through these strategies, we aim to provide a blueprint for policymakers and humanitarian organizations to mitigate the devastating impacts of the conflict on the country's most vulnerable population. [ABSTRACT FROM AUTHOR]

Child sexual abuse is a detrimental experience that could cause deleterious mental-health outcomes in the survivor. Decades of research have revealed the complex nature of child sexual abuse in terms of its characteristics, dynamics, causes, and consequences. Efficacious psychological interventions for managing child sexual abuse-related outcomes in children exist. However, it is now well recognized that interventions alone are not enough for recovery from sexual or any other type of trauma; it requires an entire human service system that is well-informed about trauma and its effects. Given the lack of awareness about the consequences of child sexual abuse and the stigmatization that exists in the Indian context, which significantly contributes toward the evolution and severity of trauma outcomes in victimized children, this paper is an attempt to discuss the relevance of adopting a trauma-informed approach while responding to child sexual abuse. [ABSTRACT FROM AUTHOR]

Background: Existing sedentary behaviour guidelines for children and youth target overall sedentary behaviour and recreational screen time, without any specific recommendations regarding school-related sedentary behaviours (i.e., sedentary behaviours performed during the school day, or within the influence of school). The purpose of this paper is to describe the development of international evidence-based recommendations for school-related sedentary behaviours for children and youth, led by the Sedentary Behaviour Research Network (SBRN). Methods: A panel of international experts was convened by SBRN in November 2020 to guide the development of these recommendations for children and youth aged ~ 5–18 years. The recommendations were informed by 1) age-relevant existing sedentary behaviour guidelines, 2) published research on the relationship between overall sedentary behaviour and health, 3) a de novo systematic review on the relationship between school-related sedentary behaviours and health and/or academic outcomes, and 4) a de novo environmental scan of the grey literature to identify existing recommendations for school-related sedentary behaviours. Draft recommendations were presented to the Expert Panel in June 2021. Following thorough discussion and modifications, updated recommendations were distributed for stakeholder feedback from July 9–26. Feedback was received from 148 stakeholders across 23 countries, leading to additional updates to the recommendations. Following further rounds of discussion and updates with the Expert Panel in August and September 2021, consensus was achieved on the final recommendations. Results: A healthy day includes breaking up extended periods of sedentary behaviour and incorporating different types of movement into homework whenever possible, while limiting sedentary homework. School-related screen time should be meaningful, mentally or physically active, and serve a specific pedagogical purpose that enhances learning. Replacing sedentary learning activities with movement-based learning activities, and replacing screen-based learning activities with non-screen-based learning activities, can further support students' health and wellbeing. Discussion: This paper presents the first evidence-based recommendations for school-related sedentary behaviours for children and youth. These recommendations will support the work of parents, caregivers, educators, school system administrators, policy makers, researchers and healthcare providers interested in promoting student health and academic success. [ABSTRACT FROM AUTHOR]

Background: In recent decades, community-based interventions have been increasingly adopted in the field of health promotion and prevention. While their evaluation is relevant for health researchers, stakeholders and practitioners, conducting these evaluations is also challenging and there are no existing standards yet. The objective of this review is to scope peer-reviewed scientific publications on evaluation approaches used for community-based health promotion interventions. A special focus lies on children and adolescents' prevention. Methods: A scoping review of the scientific literature was conducted by searching three bibliographic databases (Medline, EMBASE, PsycINFO). The search strategy encompassed search terms based on the PCC (Population, Concept, Context) scheme. Out of 6,402 identified hits, 44 articles were included in this review. Results: Out of the 44 articles eligible for this scoping review, the majority reported on studies conducted in the USA (n = 28), the UK (n = 6), Canada (n = 4) and Australia (n = 2). One study each was reported from Belgium, Denmark, Germany and Scotland, respectively. The included studies described interventions that mostly focused on obesity prevention, healthy nutrition promotion or well-being of children and adolescents. Nineteen articles included more than one evaluation design (e.g., process or outcome evaluation). Therefore, in total we identified 65 study designs within the scope of this review. Outcome evaluations often included randomized controlled trials (RCTs; 34.2%) or specific forms of RCTs (cluster RCTs; 9.8%) or quasi-experimental designs (26.8%). Process evaluation was mainly used in cohort (54.2%) and cross-sectional studies (33.3%). Only few articles used established evaluation frameworks or research concepts as a basis for the evaluation. Conclusion: Few studies presented comprehensive evaluation study protocols or approaches with different study designs in one paper. Therefore, holistic evaluation approaches were difficult to retrieve from the classical publication formats. However, these publications would be helpful to further guide public health evaluators, contribute to methodological discussions and to inform stakeholders in research and practice to make decisions based on evaluation results. [ABSTRACT FROM AUTHOR]

Background: This is the fourth paper in our supplement on improving the health and well-being of rural indigenous Maya mothers and children in the Western Highlands of Guatemala, where the prevalence of stunting is the highest in Latin America and among the highest in the world. Reducing childhood undernutrition was one of the objectives of the Maternal and Child Health Project, 2011–2015, implemented by Curamericas/Guatemala. The implementation research portion of the Project attempted to determine if there were greater improvements in childhood nutritional status in the Project Area than in comparison areas and whether or not a dose–response effect was present in terms of a greater improvement in the Project Area with a longer duration of interventions. Methods: The Project provided nutrition-related messages to mothers of young children, cooking sessions using locally available nutritious foods, a lipid-based nutrient supplement (Nutributter®) for a short period of time (4 months), anti-helminthic medication, and repeated growth monitoring and nutrition counseling. Measures of height and weight for calculating the prevalence of underweight, stunting, and wasting in under-2 children were analyzed and compared with the anthropometric data for children in the rural areas of the Northwestern Region and in the Western Highlands of Guatemala. Results: The prevalence of stunting declined in Area A from 74.5% in September 2012 to 39.5% in June 2015. Area A comprised approximately one-half of the Project Area and was the geographic area with the greatest intensity and duration of nutrition-related Project interventions. Minimal improvements in stunting were observed in the Northwestern Region, which served as a comparison area. Improvements in multiple output and outcome indicators associated with nutritional status were also observed in Areas A and B: infant and young child feeding practices, routine growth monitoring and counseling, and household practices for the prevention and treatment of diarrhea. Conclusion: The Project Area in which Curamericas/Guatemala implemented the CBIO+ Approach experienced a reduction in the prevalence of stunting and other measures of undernutrition in under-2 children. Given the burden of undernutrition in Guatemala and other parts of the world, this approach merits broader application and further evaluation. [ABSTRACT FROM AUTHOR]

Background: While there is extensive published evidence regarding the effectiveness of the Care Group Approach in promoting community-wide health behavior change, there is no published evidence regarding its empowering effect on its participants. Our study aimed to understand if the Care Group Approach as applied in the Curamericas/Guatemala Maternal and Child Health Project in isolated rural mountainous communities in Guatemala produced evidence of empowerment among the female participants. This is the seventh of 10 papers describing the expanded Census-Based, Impact-Oriented (CBIO+) Approach in improving the health and well-being of mothers and children in the rural highlands of the Department of Huehuetenango, Guatemala. Methods: We conducted semi-structured individual and group interviews with 96 female Care Group participants –including Level-1 Care Group Promoters, Care Group Volunteers, and Self-Help Group participants. The participants were from six communities – two from each of the three municipalities making up the Project Area. Data were analyzed both using deductive thematic and by exploring the following social constructs: perceived social status, self-efficacy, decision-making autonomy, and formation of social capital. Results: The findings supported the hypothesis that Care Group participation was an empowering process. The primary themes that emerged included increased respect accorded to women in the community, women's willingness and ability to make decisions and their confidence in making those decisions, and the development of stronger bonds among Care Group members, with other community members, and with community leaders. Conclusion: Through increased theoretical and practical knowledge about important maternal and child health matters and through the social experience of obtaining this knowledge and sharing it with other community members, participation in the Care Group Approach empowered participants to make positive health behavior changes for themselves and for their children and families. This, in turn, led many participants to become more engaged in community activities for improved health and beyond, thereby enhancing social capital in the community. We conclude that the Care Group Approach, as applied in this setting, has made it possible for marginalized indigenous women living in a male-dominated society to become more empowered. [ABSTRACT FROM AUTHOR]

Low and middle-income countries continue to use Verbal autopsies (VAs) as a World Health Organisation-recommended method to ascertain causes of death in settings where coverage of vital registration systems is not yet comprehensive. Whilst the adoption of VA has resulted in major improvements in estimating cause-specific mortality in many settings, well documented limitations have been identified relating to the standardisation of the processes involved. The WHO has invested significant resources into addressing concerns in some of these areas; there however remains enduring challenges particularly in operationalising VA surveys for deaths amongst women and children, challenges which have measurable impacts on the quality of data collected and on the accuracy of determining the final cause of death. In this paper we describe some of our key experiences and recommendations in conducting VAs from over two decades of evaluating seminal trials of maternal and child health interventions in rural Ghana. We focus on challenges along the entire VA pathway that can impact on the success rates of ascertaining the final cause of death, and lessons we have learned to optimise the procedures. We highlight our experiences of the value of the open history narratives in VAs and the training and skills required to optimise the quality of the information collected. We describe key issues in methods for ascertaining cause of death and argue that both automated and physician-based methods can be valid depending on the setting. We further summarise how increasingly popular information technology methods may be used to facilitate the processes described. Verbal autopsy is a vital means of increasing the coverage of accurate mortality statistics in low- and middle-income settings, however operationalisation remains problematic. The lessons we share here in conducting VAs within a long-term surveillance system in Ghana will be applicable to researchers and policymakers in many similar settings. [ABSTRACT FROM AUTHOR]

Background: Electronic decision-making support systems (CDSSs) can support clinicians to make evidence-based, rational clinical decisions about patient management and have been effectively implemented in high-income settings. Integrated Management of Childhood Illness (IMCI) uses clinical algorithms to provide guidelines for management of sick children in primary health care clinics and is widely implemented in low income countries. A CDSS based on IMCI (eIMCI) was developed in South Africa. Methods: We undertook a mixed methods study to prospectively explore experiences of implementation from the perspective of newly-trained eIMCI practitioners. eIMCI uptake was monitored throughout implementation. In-depth interviews (IDIs) were conducted with selected participants before and after training, after mentoring, and after 6 months implementation. Participants were then invited to participate in focus group discussions (FGDs) to provide further insights into barriers to eIMCI implementation. Results: We conducted 36 IDIs with 9 participants between October 2020 and May 2021, and three FGDs with 11 participants in October 2021. Most participants spoke positively about eIMCI reporting that it was well received in the clinics, was simple to use, and improved the quality of clinical assessments. However, uptake of eIMCI across participating clinics was poor. Challenges reported included lack of computer skills which made simple tasks, like logging in or entering patient details, time consuming. Technical support was provided, but was time consuming to access so that eIMCI was sometimes unavailable. Other challenges included heavy workloads, and the perception that eIMCI took longer and disrupted participant’s work. Poor alignment between recording requirements of eIMCI and other clinic programmes increased participant’s administrative workload. All these factors were a disincentive to eIMCI uptake, frequently leading participants to revert to paper IMCI which was quicker and where they felt more confident. Conclusion: Despite the potential of CDSSs to increase adherence to guidelines and improve clinical management and prescribing practices in resource constrained settings where clinical support is scarce, they have not been widely implemented. Careful attention should be paid to the work environment, work flow and skills of health workers prior to implementation, and ongoing health system support is required if health workers are to adopt these approaches (350). [ABSTRACT FROM AUTHOR]

Background: The socio-environmental aspects of southern Assam reflect a general pattern of backwardness. Moreover, child healthcare resources in the region are inadequately used, leading to low vaccination coverage. Given this background, this paper attempted to comprehend wealth-based inequality in full vaccination in rural areas of southern Assam. Methodology: Based on a multistage cluster sampling approach, 360 children of 12–23 months were selected from the study area. To identify the predictors of a child, a non-linear model was estimated by using the generalized linear model (GLM) approach followed by Erreygers decomposition technique to quantify the wealth inequality in the obtained predictors in explaining the disparity in full vaccination. Result: The Bacillus Calmette–Guérin (BCG) vaccination recorded the highest vaccination coverage, at nearly 90% and the lowest was observed for the measles vaccine, around 61 percent. Slightly more than half of the eligible children (54 percent) were vaccinated against all the Universal Immunization Programme (UIP)-recommended vaccines. The decomposition analysis revealed that the occupation of the child's father, maternal age, birth order of the child, and health-seeking behavior such as antenatal care (ANC) were the prime factors related to inequality in full vaccination in the region. Conclusion: Vaccination coverage in the region has improved over time, however, full vaccination is concentrated towards the economically advantaged section of the society in rural southern Assam. Targeted, context-specific, and expanded government initiatives could aid in addressing the overall wealth-related full vaccination inequalities in the valley. [ABSTRACT FROM AUTHOR]

Aims: The aim was to describe the experiences of nurses in broaching the issue of overweight and obesity at maternity and child health clinics. Background: The mother's obesity and excessive weight gain during pregnancy and rapid weight gain in early childhood increase the risk of obesity of the newborn baby both in childhood and throughout life. Attention must be paid to the prevention of weight gain in families already during pregnancy and before school age. Methods: Informants were nurses working at maternity and child health clinics (N = 28). The qualitative data were collected by a focus group interview in spring 2016 and analysed using inductive content analysis. Findings The nurses interviewed considered it their duty to broach the issue and felt that they have sufficient courage to bring up overweight. They sometimes found it frustrating to talk about overweight and obesity, because families do not commit themselves to making lifestyle changes, and changes happen slowly. Nurses found the lasting relationship with families helpful for bringing up overweight. Conclusion: Nurses need more broaching skills, more training, supervising and tools for bringing up overweight and obesity with client families. The continuity of care in primary health care supports bringing up overweight. Summary statement: What is already known about this topic? Overweight means the risk of obesity, and obesity is defined as excessive fat accumulation in the body.Early recognition of the risk factors for overweight and addressing them play a key role, because treating obesity and reaching lasting results is difficult.Nurses working at maternity and child health clinics play an important role in preventing overweight and obesity in pregnant families and families with children and in broaching the issue, because almost all families use maternity and child health clinics' services. Whatthis paper adds? Nurses consider broaching the issue of overweight and obesity as their duty and an integral part of their work.Nurses recognize the feelings of frustration and negative emotions sometimes associated with taking up the issue of overweight and obesity, but they have difficulties to support families in this kind of situations.Nurses found the lasting relationship with families helpful for bringing up overweight. The implications of this paper: When in practice both nurses and clients recognize bringing up overweight and obesity, nurses need more training and support how to motivate families for the necessary change, identify family‐specific ways and utilize the family's own resources in spite of their own frustration.More attention has to be paid in nursing education on how to bring up overweight or some other emotional issues with clients. Nurses need more broaching skills, more training, supervising and more tools for bringing up overweight and obesity.We need more scientific knowledge about how negative emotions steer the operation of nurses and how they affect the willingness of families to make lifestyle changes. [ABSTRACT FROM AUTHOR]

This systematic review summarises the parenting intervention literature for parents of children who have a sibling with a chronic health condition, and evaluates intervention efficacy for improving parent (parenting skills, parenting efficacy) and child (emotional and behavioural adjustment, condition knowledge, quality of life) outcomes. Electronic databases were searched to identify relevant papers published in English from inception until May 2020. Reference lists of eligible papers were further searched for relevant articles. Six papers (two controlled trials, four uncontrolled trials) evaluating four separate intervention programs met inclusion criteria. All included parent- and child-focused intervention components. Results showed an overall trend for pre- to post-intervention improvement in children's behavioural and emotional adjustment and health condition knowledge. Few studies examined effects on parent outcomes, and there was no evidence of change on these measures. Overall, results suggest that parenting interventions may help to improve siblings' emotional and behavioural adjustment and condition knowledge; however, all of the interventions combined parent- and child-directed intervention components, making it difficult to determine which intervention elements drive change. Further research is needed to test mechanisms by which parenting interventions may improve outcomes for siblings of children with chronic health conditions, and to establish the efficacy of this approach. [ABSTRACT FROM AUTHOR]

Background: Children with osteogenesis imperfecta (OI) experience a diversity of symptoms that expose them to difficult physical, mental, and social challenges. Sisom (DHealth) is an interactive assessment and communication tool designed to help children aged 6-12 years with chronic conditions express their symptoms. Recently, the co-design of the Sisom OI paper prototype was launched by seeking the perspectives of end users, including children with OI and their clinicians. Objective: The aim of this study is to describe the experiences that children with OI were prompted to share with researchers during the co-design of the Sisom OI paper prototype. Methods: A secondary analysis of qualitative data was conducted at a university-affiliated, pediatric, orthopedic hospital. The data sources consisted of interview transcripts, drawings, field notes, and observations derived from interviewing 12 children with OI who participated in the co-design of the Sisom OI paper prototype. The themes and subthemes identified from the data sources were generated using qualitative description. Results: Three themes were identified. The first, Relating to Others, described the balance between feeling different versus feeling similar to other children. The subthemes were Common OI Experience, Feeling Different, and Feeling Just Like Others. The second, Relating to Their Condition, described children's positive and negative interactions with their own condition and health care. The subthemes were Understanding Their Condition, Special Relationship with the Hospital, and Difficult Treatments and Procedures. The third, Reflecting on Capabilities, described children's recognition of their strengths and limitations. The subthemes were Perceiving Limitations, Overcoming Isolation, and Celebrating Strengths. Conclusions: This co-design process provided children with OI the space to not only contribute to the development of the end product but also eloquently describe their experiences. These findings, based on the descriptions given by the children themselves, offer us a unique understanding of what it means to grow up with OI. [ABSTRACT FROM AUTHOR]

In 2020, the Australian Government introduced temporary Medicare Benefits Schedule item numbers for GP telehealth consultations to combat the spread of the COVID-19 pandemic. Patient satisfaction has been positive; however, the paediatric cohort has not been sufficiently investigated. We aimed to explore the rates of satisfaction of paediatric patients undergoing telehealth compared with standard consultations, as well as looking at any barriers faced. We developed and distributed an online survey to eligible patients (or their guardian) aged 0–17 years who underwent a general practice telehealth consultation between March 2020 and May 2020 at 12 participating medical centres in Perth. We received 68 total responses with 35 deemed complete. The mean (s.d.) age of participants was 8.22 (5.34) years. A total of 88.2% of participants indicated that the level of care provided via telehealth was equal to or better than a standard consultation. A total of 70.6% of patients reported no barriers faced, with the most common barrier being lack of examination (20.6%). This study describes high public satisfaction with telehealth GP consultations for paediatric patients, with a good level of patient outcomes and minimal barriers. There may be benefit to widespread and ongoing use of telehealth consultations for the paediatric population and the extension of the temporary Medicare Benefits Schedule items. COVID-19 has influenced an increase in telehealth use in Australia. In this paper, we investigated the level of patient satisfaction for GP consults with telehealth services for the paediatric population. To our knowledge, this has not previously been reported on. Our results show that patients reported a high level of satisfaction with GP telehealth consultations for paediatric patients, and with limited barriers there is significant scope for the more widespread use and support of these services. [ABSTRACT FROM AUTHOR]

The article describes a quality improvement project aimed at reducing the incidence of pressure injuries in children caused by peripheral intravenous cannulaes (PIVC), conducted at a general children's ward in a hospital in Far North Queensland. Topics discussed are pressure injuries specific to PIVC, modification of PIVC audit tool to observe the effect of the changes made to PIVC care, staff education and adoption of practice changes, and ethical considerations for conducting the project.

Objectives: To identify features of mental health services that affect the uptake of services among parents of children with chronic medical conditions, to inform the design of pathways into mental health care. Methods: A discrete choice experiment in which participants made choices between hypothetical mental health services described in terms of service features: cost, wait time, provider knowledge of chronic medical conditions, recommendations, opening hours, and travel time. Participants were parents of children attending The Royal Children's Hospital outpatient clinics for the management of a chronic medical condition who completed the online survey between August 2020 and January 2021. The uptake of mental health services with differing features was predicted based on regression models examining the relationship between choice and service features, and accounting for participant characteristics and unobserved heterogeneity. Results: The sample comprised 112 parents, of whom 52% reported unmet needs. The most influential service features were wait times, cost, recommendation from medical specialists, and mental health provider knowledge of chronic medical conditions. Predicted uptake of a realistic service showed inequalities across income, parental education, and single parent status. A service comprising preferred features was predicted to eliminate these inequalities. Conclusions: Reducing cost and wait time for mental health services could reduce unmet need among children with chronic medical conditions. Specific approaches to tackle the high levels of unmet needs in this group include equipping medical specialists to recommend mental health providers and training mental health providers on the impacts of chronic medical conditions on children. Offering preferred services could increase uptake and reduce inequalities in mental health care. What is known about the topic? Children with chronic medical conditions have high rates of unmet need for mental healthcare. Qualitative research has indicated features of mental health services that may be important to consider in service design to address these unmet needs. What does this paper add? A detailed understanding of parents' preferences for features of mental health services for children with chronic medical conditions, including their importance and prediction of uptake under different scenarios. What are the implications for practitioners? Parents preferred services with recommendation from specialists, mental health providers who understand the impact of chronic conditions, lower cost, and shorter wait time. Offering preferred mental health services is predicted to significantly reduce unmet needs and reduce inequalities in care. [ABSTRACT FROM AUTHOR]

BACKGROUND: Recess provides many physical, mental, and social benefits for students; however, the most recent systematic review examining the benefits of recess was conducted over a decade ago. The purpose of this paper was to determine the current benefits of school recess by conducting an updated systematic review of the literature. METHODS: Multiple databases were systematically examined to find articles fitting the following inclusionary criteria: (a) school recess, (b) all schooling before college, and (c) recess benefits of any kind. Research was limited to literature published between June 2009 and July 2020. RESULTS: Nine studies were included in this review. The majority of studies examined elementary‐aged students. Seven studies were conducted in the United States, and 2 studies were conducted internationally. Recess provided school‐aged children academic and cognitive benefits, behavioral and emotional benefits, physical benefits, and social benefits. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Providing recess for all school levels positively impacts the whole child; there was no literature implicating negative impacts of recess. CONCLUSIONS: Schools can improve overall student health and belonging by redesigning and/or implementing daily recess. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to estimate the association between Protestantism and child mortality for Brazil. This paper employs data from the 1991, 2000, and 2010 Brazilian censuses. The association between Protestantism and child mortality was estimated using a conventional negative binomial regression model for women between the age of 20 and 34 years. This paper finds that the death rate of children born to Protestant mothers is around 5% lower compared to non-Protestant mothers, even after controlling for an extensive array of demographic and social characteristics. When Protestants are split into 'Traditional' and 'Pentecostal' groups, we find that the child mortality rate is substantially lower for Traditional Protestants. Our study contributes to the literature by providing recent empirical results on the association between child mortality and Protestantism in Brazil. [ABSTRACT FROM AUTHOR]

Objectives This paper aims to describe low-income recipients of a community-based diaper bank and the multiple daily challenges they face. Our paper seeks to document the health, social, and financial outcomes recipients experienced after receiving assistance. Methods We surveyed families (n = 150) about their experiences receiving diapers from a diaper bank in the southeastern United States. Additionally, we conducted short, focused interviews with families (n = 15) about outcomes after receiving diapers. Results Families experience regularly a range of challenges meeting basic needs. These difficulties include high unmet needs for transportation, food, and nonfood essentials such as personal hygiene items. Families experiencing the greatest difficulty in paying utility or medical bills were significantly more likely to have a high level of diaper need compared to families facing these challenges less often (AORs ranging from 3.40 to 9.39). As a result of receiving diapers, families reported positive health, social, and economic outcomes. Families reported positive changes in parental mood; improved child health and happiness; increased opportunities for childcare, work, and school attendance; and the ability to divert household finances toward other basic needs, including utilities and medical care. Conclusions for Practice The monetary value of the supplemental provision of diapers is a small investment in affected families' economic, social, and health outcomes. The positive effects continue far longer than the diapers provided. We demonstrate the social value of such an operation, and recommend the expansion of federal, state, and local safety net programs to help low-income families secure a steady supply of diapers. [ABSTRACT FROM AUTHOR]

Child and maternal health, a key marker of overall health system performance, is a policy priority area by the World Health Organization and the United Nations, including the Sustainable Development Goals. Previous realist work has linked child and maternal health outcomes to globalization, political tradition, and the welfare state. It is important to explore the role of other key policy-related factors. This paper presents a realist synthesis, categorising policy instruments according to the established NATO model, to develop an explanatory model of how policy instruments impact child and maternal health outcomes. A systematic literature search was conducted to identify studies assessing the relationships between policy instruments and child and maternal health outcomes. Data were analysed using a realist framework. The first stage of the realist analysis process was to generate micro-theoretical initial programme theories for use in the theory adjudication process. Proposed theories were then adjudicated iteratively to produce a set of final programme theories. From a total of 43,415 unique records, 632 records proceeded to full-text screening and 138 papers were included in the review. Evidence from 132 studies was available to address this research question. Studies were published from 1995 to 2021; 76% assessed a single country, and 81% analysed data at the ecological level. Eighty-eight initial candidate programme theories were generated. Following theory adjudication, five final programme theories were supported. According to the NATO model, these were related to treasure, organisation, authority-treasure, and treasure-organisation instrument types. This paper presents a realist synthesis to develop an explanatory model of how policy instruments impact child and maternal health outcomes from a large, systematically identified international body of evidence. Five final programme theories were supported, showing how policy instruments play an important yet context-dependent role in influencing child and maternal health outcomes. • A realist synthesis was conducted. • Assessed relationship between policy instruments and child and maternal health. • Synthesis informed by 132 unique studies. • Five final programme theories were supported. • Impact of policy instruments was context-dependent. [ABSTRACT FROM AUTHOR]

Background & Aims The role of the family in the health of the child is very vital because a major part of a child’s development. The present study investigates the health behaviors and related factors in mothers of hospitalized children in Kashan, Iran. Materials & Methods This cross-sectional study was conducted on 216 mothers of children hospitalized in children’s wards of two teaching hospitals in Kashan from November 2019 to March 2021. Meanwhile, sampling was done through continuous sampling. The first author (a nurse in the children’s wards) indirectly observed the mothers’ health-related behaviors toward their children and then immediately recorded them using a checklist. Data were then analyzed in SPSS software (v. 26) using descriptive statistics, Pearson correlation test, one-way ANOVA, independent t-test, and linear regression analysis. Results The mean age of mothers of hospitalized children was 29.27±5.60 years. Based on the results, the following items had the highest compliance scores: “use of fresh and safe drinking water for the child” (97.5%), “washing hands with soap and water in case of clear hand contamination” (95.6%), “Changing the child’s clothes and bedding as soon as they become contaminated with diarrhea, vomit, blood, and other contaminants” (90.7%), and “Washing hands after changing the child’s diaper” (87.3%). On the other hand, some other items, including “washing hands before changing the child’s diaper” (8%), “covering the mobile phone with a plastic to avoid contamination” (8.8%), and “washing hands with soap and water after touching the surrounding surfaces” (15.8%), had the lowest compliance scores. Conclusion The results indicated that mothers failed to comply with behaviors such as washing their children’s hands regularly and washing their own hands before breastfeeding. It is necessary to teach and inform them regarding the observation of behaviors related to the child’s health upon entering the hospital to ensure their child’s safety. [ABSTRACT FROM AUTHOR]

Under-five years old acute watery diarrhea (U5AWD) accounts for most diarrheal diseases' burden, but little is known about the adjusted effect of meteorological and socioeconomic determinants. A dataset containing the seasonal numbers of U5AWD cases at the district level of Iran is collected through MOHME. Accordingly, the district-level standardized incidence ratio and Moran's I values are calculated to detect the significant clusters of U5AWD over sixteen seasons from 2014 to 2018. Additionally, the author tested twelve Bayesian hierarchical models in order to determine which one was the most accurate at forecasting seasonal number of incidents. Iran features a number of U5AWD hotspots, particularly in the southeast. An extended spatiotemporal model with seasonally varying coefficients and space–time interaction outperformed other models, and so became the paper's proposal in modeling U5AWD. Temperature demonstrated a global positive connection with seasonal U5AWD in districts (IRR: 1.0497; 95% CrI: 1.0254–1.0748), owing to its varying effects during the winter ((IRR: 1.0877; 95% CrI: 1.0408–1.1375) and fall (IRR: 1.0866; 95% CrI: 1.0405–1.1357) seasons. Also, elevation (IRR: 0.9997; 95% CrI: 0.9996–0.9998), piped drinking water (IRR: 0.9948; 95% CrI: 0.9933–0.9964), public sewerage network (IRR: 0.9965; 95% CrI: 0.9938–0.9992), years of schooling (IRR: 0.9649; 95% CrI: 0.944–0.9862), infrastructure-to-household size ratio (IRR: 0.9903; 95% CrI: 0.986–0.9946), wealth index (IRR: 0.9502; 95% CrI: 0.9231–0.9781), and urbanization (IRR: 0.9919; 95% CrI: 0.9893–0.9944) of districts were negatively associated with seasonal U5AWD incidence. Strategically, developing geoinformation alarm systems based on meteorological data might help predict U5AWD high-risk areas. The study also anticipates increased rates of U5AWD in districts with poor sanitation and socioeconomic level. Therefore, governments should take appropriate preventative actions in these sectors. [ABSTRACT FROM AUTHOR]

Though preventable, children with disabilities have a high risk of victimization, contributing to worsening health conditions. Hence, this study examined the exposure of school-age children with mental, emotional, developmental, or behavioral (MEDB) disorder to bully victimization. This study used the 2018 National Survey of Children's Health (NSCH) data of 23,494 children ages 5–17 to estimate multilevel logistic regression with fixed and random effects. Children's health conditions were treated as level one variables, while family poverty level and neighborhood characteristics such as vandalism and presence/absence of recreational centers were treated as level two variables. The paper presents the prevalence of bullying victimization among children with at least one disorder (MDBB = 39.5%), anxiety (20.6%), depression (10.8%), ADD/ADHD (18.3%), behavioral problems (14.9%), learning disability (11.9%), Tourette syndrome (0.5%), developmental delay (10.1%), Autism spectrum disorder (4.6%), speech disorder (10.7), and intellectual disability (1.6%), respectively. Bullying victimization was positively associated with anxiety (AOR = 1.995, 95% CI = 1.634–2.436), depression (AOR = 2.688, 95% CI = 2.031–3.557), developmental delay (AOR = 1.804, 95% CI = 1.422–2.288), but inversely associated with Autism spectrum disorder (AOR = 0.614, 95% CI = 0.399–0.946). Neighborhood disorganization and poverty were also associated with bullying victimization. The NSCH data suggests that children with disabilities in the US had a higher prevalence rate of victimization. Consequently, effective bullying prevention strategies that can protect and improve children's quality of life with special needs should be prioritized. [ABSTRACT FROM AUTHOR]

Background: There is no agreed way to measure the effects of social accountability interventions. Studies to examine whether and how social accountability and collective action processes contribute to better health and healthcare services are underway in different areas of health, and health effects are captured using a range of different research designs.Objectives: The objective of our review is to help inform evaluation efforts by identifying, summarizing, and critically appraising study designs used to assess and measure social accountability interventions' effects on health, including data collection methods and outcome measures. Specifically, we consider the designs used to assess social accountability interventions for reproductive, maternal, newborn, child, and adolescent health (RMNCAH).Data Sources: Data were obtained from the Cochrane Library, EMBASE, MEDLINE, SCOPUS, and Social Policy & Practice databases.Eligibility Criteria: We included papers published on or after 1 January 2009 that described an evaluation of the effects of a social accountability intervention on RMNCAH.Results: Twenty-two papers met our inclusion criteria. Methods for assessing or reporting health effects of social accountability interventions varied widely and included longitudinal, ethnographic, and experimental designs. Surprisingly, given the topic area, there were no studies that took an explicit systems-orientated approach. Data collection methods ranged from quantitative scorecard data through to in-depth interviews and observations. Analysis of how interventions achieved their effects relied on qualitative data, whereas quantitative data often raised rather than answered questions, and/or seemed likely to be poor quality. Few studies reported on negative effects or harms; studies did not always draw on any particular theoretical framework. None of the studies where there appeared to be financial dependencies between the evaluators and the intervention implementation teams reflected on whether or how these dependencies might have affected the evaluation. The interventions evaluated in the included studies fell into the following categories: aid chain partnership, social audit, community-based monitoring, community-linked maternal death review, community mobilization for improved health, community reporting hotline, evidence for action, report cards, scorecards, and strengthening health communities.Conclusions: A wide range of methods are currently being used to attempt to evaluate effects of social accountability interventions. The wider context of interventions including the historical or social context is important, as shown in the few studies to consider these dimensions. While many studies collect useful qualitative data that help illuminate how and whether interventions work, the data and analysis are often limited in scope with little attention to the wider context. Future studies taking into account broader sociopolitical dimensions are likely to help illuminate processes of accountability and inform questions of transferability of interventions. The review protocol was registered with PROSPERO (registration # CRD42018108252). [ABSTRACT FROM AUTHOR]

Objective: In this paper, we suggest that father involvement plays a significant role in the lives of fathers, children, and health and there is a need to expand research and evaluation on responsible fatherhood programs to assess the effects of fatherhood programming on families and society. Methods: We point to data that confirm the importance of fathers, provide an overview of funding for fatherhood programming, and provide summaries of relevant research that has examined the effects of responsible fatherhood interventions. Results: We ask researchers and practitioners to think about the benefits of responsible fatherhood programs and how best to demonstrate that such programs do, in fact, have long-term impacts on quality of life for fathers and their children. However, we also note that changes in outcome variables that are statistically significant and may even have a large effect size do not necessarily produce substantial long-term impact on quality of life. Conclusion: Responsible fatherhood programs can play a vital role in the health and success of children, fathers, and communities. Researchers should engage in rigorous evaluation of fatherhood programs to add data to the field related to the effect of these programs and father involvement. [ABSTRACT FROM AUTHOR]

Aim: To develop a comprehensive, hands‐on assessment tool for assessing health in children under five in underserved regions. Design Methodological study design and usability testing were used. Sample Eight nurses working at two health posts and 261 children under five living in the migrant villages participated in the study. Measurement The developed tool was evaluated using 10 items of a questionnaire based on the honeycomb model of Morville (2004). Community nurses administered the questionnaire then followed with a focus group interview after completing a child health exam using the developed tool. Data were collected during July 2017. Results: The Hands‐on Assessment Tool for Child Health is composed of developmental screening, identification of risk factors and clinical signs, growth measurement, diagnostic tests and interpretation of each subdomain, and final impressions. Management strategies include parent education, resource networking, referral to a paediatrician, and follow‐up plans. Usability testing revealed high scores on the facets "valuable," "useful," "desirable," and "findable." Conclusions: Considering the demand for hands‐on tools in underserved regions, the developed tool can provide nurses with resources for competent management of child assessment, interpretation, and nurses' intervention strategies, fortified with clinical judgement processes. SUMMARY STATEMENT: What is already known about this topic? Many child health problems are preventable with early detection and intervention. Health problems in children under five affect the growth and development of the whole life.Community nurses in underserved regions need comprehensive and hands‐on assessment tools with point‐of‐care to identify child health problems and provide right care.Currently developed assessment tools for child health have limitations for use in underserved areas. What this paper adds? The Hands‐on Assessment Tool for Child Health (HATCH) helped community nurses to identify the child's health status and nurses to establish a proper care plan.The tool provided clinical judgement process of assessment, interpretation, and nurses' intervention strategies. The implications of this paper: The result of the research can contribute to a concrete intervention strategy for child health promotion by assessing health and development in underserved regions. [ABSTRACT FROM AUTHOR]

Preference weights are widely used to score generic health states into utility indexes for estimation of quality adjusted life years (QALYs) and to aid health care funding decisions. To date, health state utilities are predominantly derived using stated preference methods based on decision utility. This paper tests an alternative and generates preference weights using experienced utility for children based on the Child Health Utility 9D (CHU9D) descriptive system. We estimate the relative values of the CHU9D health states with regard to experienced utility, where experienced utility is approximated by self-reported happiness. A nationally-representative longitudinal survey was used including 6090 Australian children aged 12–17 years surveyed over 2014–2018. The derived weights were then applied to calculate the utility decrements for a few common child health conditions. We found that the estimated utility decrements are largely similar to those estimated using the published CHU9D Australian adolescent weights based on decision utility, except for pain and depression. A smaller utility decrement for pain and a larger utility decrement for depression were indicated by experienced utility. We contribute to the literature by showing that using experienced utility methods to generate preference weights for health states is possible, and we discuss some important methodological challenges for future studies such as the impracticability of anchoring to 'dead' when utilizing experienced utility. • Established methods of valuing health states rely on decision utility. • We use experienced utility to generate preference weights for children. • The estimated decrements for health conditions are similar to published weights. • We see smaller impact for pain, larger for depression compared to published weights. • Feasibility is demonstrated using child experienced utility for preference weights. [ABSTRACT FROM AUTHOR]

This paper explains how The Lives Saved Tool (LiST), a computer-based model that estimates the impact of scaling up interventions on stillbirths, maternal, neonatal and child health, can contribute to evaluations of programs being delivered at scale to improve maternal and child health. LiST can be used to estimate the impact of a program in advance, allowing planners to refine, streamline and set appropriate program targets. LiST can also be used to estimate the impact of a program, which is particularly useful given the high costs of measuring changes in population health. Finally, LiST can be used to estimate the relative contributions of different interventions or sets of interventions within programs that are found to have a positive impact. The latest version of LiST allows users to manipulate both utilization and quality of service to generate estimates of effective coverage. In addition, a new, web-based version of LiST is now available, with a simpler and more streamlined interface designed to increase accessibility to beginning users. LiST modeling can help program planners, evaluators and funders respond to core evaluation questions related to program design and impact, providing evidence to support decisions about how best to use available resources to save the lives of women and children. [ABSTRACT FROM AUTHOR]