The present output was carried out under the reimbursable advisory services (RAS) agreement concluded for the development of plans for the de-institutionalization of children deprived of parental care and their transfer to community-based care, between the world bank and the national authority for the protection of children’s rights and adoption (AMPDCA), on may 12, 2016. the agreement covers the technical assistance for the ANPDCA project development of the plan for the deinstitutionalization of children in residential care and their transition to community-based care – code SIPOCA 2, funded by the European social fund under the operational program for administrative capacity. Between May-October 2018, the world bank team collected and analyzed the data needed to prepare the sixth output under the agreement (output 6). This report is a continuation of the first five outputs, already submitted to the ANPDCA (in March, June and December 2017 and June, September 2018), this being the last output under this agreement. output 6 incorporates the ideas and comments formulated during eight regional consultation seminars (one per each region of the country), organized in July 2018 by the national authority for child protection and adoption (ANPDCA), attended by over 400 representatives of county and local authorities, as well as NGOs from this field. Output 6 are (i) Analysis of the survey of families of institutionalized children living in source communities, (ii) identification of children exposed to the risk of separation in at least 30 source communities, (iii) 30 plans for the development of preventative services in rural source communities, (iv) a plan for the monitoring and evaluation of closing Residential Centers, and (v) a dissemination report presenting the results of the RAS (Romania)
The Sahel Women’s Empowerment and Demographics Project of Benin has the objective to increase women and adolescent girls’ empowerment and their access to quality reproductive, child and maternal health services in selected areas of the participating countries, including theRecipients' territory, and to improve regional knowledge generation and sharing as well as regional capacity and coordination. This project is comprised of three components. (1) Improve Regional Demand for Reproductive Maternal Neonatal Child and Adolescent Health and Nutrition (RMNCAHN) Services and Increase Empowerment for Women and Adolescents. (2) Ensuring availability and sustainability of family planning services, including supply chain of modern contraceptives will be a key factor in accelerating the demographic transition in Benin. (3) National capacity in Benin will be built to collect, analyze, translate and use data that can inform population policy, investments in human capital and gender interventions. (Western Africa)
The adoption of the Law on the Protection of Children and Adolescents in 2019 represents a significant turning point in the evolution of Iranian criminal policy toward minors. This article examines the conceptual foundations, legal innovations, and structural implications of the statute with particular emphasis on the emergence of the category of “children at risk.” Moving beyond traditional offender-centered approaches, the law introduces a preventive and protection-oriented framework that allows state intervention prior to the occurrence of criminal harm. Through doctrinal legal analysis and criminal policy evaluation, the study explores how the legislation restructures the relationship between criminal law, social welfare institutions, and family responsibility. The findings indicate that the 2019 law expands the scope of criminal protection by criminalizing neglect and endangerment, establishing mandatory reporting obligations, strengthening institutional coordination, and introducing child-sensitive procedural safeguards. These reforms shift Iranian criminal policy from reactive punishment toward proactive prevention, positioning children as rights-bearing individuals whose vulnerability justifies early intervention. The law also reflects an attempt to reconcile domestic legal traditions with contemporary international child protection standards while maintaining doctrinal continuity within the national legal system. Despite these advances, the article identifies several structural challenges affecting implementation, including conceptual ambiguity in defining risk, tensions between preventive intervention and legal certainty, institutional capacity limitations, and the need to balance child protection with family autonomy. The study argues that the effectiveness of the reform depends not only on legislative innovation but also on sustained institutional development, professional training, and interpretative coherence. Ultimately, the 2019 law constitutes a paradigm shift in Iranian criminal policy by embedding preventive protection at the center of legal responses to childhood vulnerability. It establishes the foundation for a rights-based and preventive model of criminal justice that seeks to reduce victimization, promote social reintegration, and strengthen long-term child welfare.
Zeinab Forouzeshnia, Ebrahim Rajabi Taj Amir, Amir Ahmadi
This study examined the impact of portfolio assessment on evaluating the English language skills of pupils with hearing impairment in Fako Division, Cameroon. Portfolio assessment, as an informal and learner-centred approach, was explored within the framework of inclusive education, where traditional assessment methods often fail to adequately reflect the abilities of learners with hearing loss. The research utilised a quasi-experimental design involving pupils with hearing impairment in selected inclusive primary schools. Data were gathered through English language tests, classroom observations, and interviews with parents, teachers, head teachers, and the divisional delegate. Quantitative data were analysed using descriptive statistics, t-tests, and regression analysis, while qualitative data underwent thematic analysis. The results indicated that pupils subjected to portfolio assessment performed significantly better in English language skills than those assessed through conventional methods. Statistical analysis (SPSS t-tests and regression) showed that pupils assessed via portfolios scored notably higher on post-tests (portfolio group mean=12.78 versus control=11.14; t(38)=2.919, p<.05). Regression analysis demonstrated that portfolio use was a strong predictor of language improvement (β=0.336, p<.001). Classroom observations and interview findings further revealed that portfolio assessment encouraged ongoing learning, increased learner engagement, self-reflection, and heightened teacher awareness of individual progress. The study concludes that portfolio assessment is an effective method for evaluating the English language skills of pupils with hearing impairment and recommends its systematic adoption within inclusive classroom practice.
Background : Globally, one in five infants under 6 months is at risk of death, illness and poor development. They may be identified as being malnourished, growing poorly, or underweight and may have been born too early or too small. The MAMI Care Pathway Package is an integrated care pathway approach, with a package of adaptable resources to guide inter-disciplinary continuity of care for these at-risk infants under 6 months and their mothers within health systems. This approach supports implementation of WHO health and nutrition guidelines that recommend outpatient care. However, the MAMI Care Pathway approach has not been robustly tested within national health systems that has impeded national policy transtion from inpatient-only care for this age-group. To address this evidence gap, the MAMI RISE (Research, Innovate, Scale, Establish) Research Project was developed to test the MAMI Care Pathway in a randomised controlled trial (RCT) in outpatient clinics in Ethiopia. This five-year project (2019-2025) was delivered in a co-creative partnership between LSHTM, Emergency Nutrition Network, Jimma University and GOAL Ethiopia funded by the Eleanor Crook Foundation. Within this research project, I investigated what factors influence implementation of an integrated care pathway in outpatient clinics in Ethiopia through three studies. Methods: I undertook a scoping review of global policies to appraise global policy guidance relevant to the care of at-risk infants under 6 months and their mothers in Ethiopia (Study 1); a pre-trial feasibility study to identify factors that may influence implementation of the MAMI Care Pathway in outpatient health facilities (Study 2); and a realist-informed process evaluation to evaluate how the MAMI Care Pathway worked, for whom and under what circumstances during the RCT (Study 3). The scoping review of global policies involved a literature search of publicly available data according to PRISMA-ScR guidance. The feasibility study involved interviews with health workers and senior policymakers in Ethiopia to explore both health service and policy fit. The process evaluation involved interviews with mothers, fathers, health and research staff in intervention and control sites, and secondary RCT data from research team meetings and incident logs. Results: The scoping review of global policies found rich but fragmented policy guidance that mask interdiscipline policy synergies and important guidance gaps. Evidenced growth markers of infant mortality risk are largely absent from WHO health-oriented guidance. Continuity of care for mothers and infants lacked depth and detail. Using the MAMI Care Pathway to support WHO recommendation uptake is constrained by institutional procedures that limit consideration of nonUN guidance. Transitioning to a living guideline system is necessary and urgent. Applying the WHOINTEGRATE framework to handle complexity within guidance could improve policy fit for implementation of integrated care. The feasibility study found the intervention was perceived by staff as feasible to implement in outpatient services with additional structural support and likely acceptable to mothers. High staff acceptability was influenced by perceived demand, need, implementation realities and integration potential with Integrated Management of Childhood Illness (IMCI) protocols. Identified service constraints included low availability of maternal nutrition and health services and limited breastfeeding and mental health counselling competencies. Policymakers identified good coherence of the MAMI Care Pathway with national policy provisions and intent but emphasised their need for implementation evidence to appraise policy implications of RCT findings. Overall, the process evaluation found the MAMI Care Pathway approach was acceptable, feasible, valued and impactful during a pragmatic, responsive RCT in outpatient services. Positive and varied RCT outcomes were explainable, given case complexities, setting differences, and implementation conditions. Synergism between intervention components, people and health-research systems maximised what was possible. Shared vision gave purpose and drove impact. Adaptive changes meant implementation varied between clinics, settings and over time. Both mothers and health workers had improved access to resources and experienced motivational outcomes that empowered them to cooperatively act. The study also identified that routine service gaps have negative consequences for infants, mothers and families. It is likely that greater scope and intensity of intervention is needed for some cases. Embedded staff generated rich transferable knowledge that strengthens integration potential. Evidencing approaches should transition to locally led implementation research embedded in health services. In summary, the scoping review of global policies identified strong potential but important limitations with global policy content and processes that risk limiting implementation of integrated care. The feasibility study confirmed consistency of the MAMI Care Pathway approach with national policy guidance and IMCI based outpatient protocols. The process evaluation confirmed intervention fit with outpatient services in Ethiopia and strong integration potential. Implications: This body of research provides contextualised evidence for the interpretation of an RCT of the MAMI Care Pathway approach in Ethiopia. Findings have informed national policy development on malnutrition management in Ethiopia. This research provides transferable learning on evidencing and implementing integrated, equitable and just systems of health for localised, scalable, and sustainable care. Co-creative research partnerships that plan for scale maximise national policy fit and system readiness. Implementation research should accompany trials of complex health interventions. The generative knowledge of local stakeholders is essential to evidencing how to deliver effective sustainable care. Programming approaches for at risk infants and mothers must extend beyond nutrition interventions, health interventions must embed action on infant growth and maternal wellbeing. Integrated care is feasible with structural and professional support for staff. Multi-level research, programming and policy action and interaction is necessary for synergistic effects. Inter-disciplinary and inter-system brokerage and stronger global accountability mechanisms to secure better international policy order are needed to achieve this. My findings demonstrate how implementation of integrated care requires policies and programmes that empower local stakeholders to develop, adapt and deliver interventions for at risk infants under 6 months and their mothers. This approach will require a re-focus of international support on catalytic long-term investments in systems of person-centred care, and the pursuit of sustainable scale through contextually grounded, locally led implementation research and learning exchange.
Over recent decades, the issues of Japan’s multi-racial identity and society have piqued both lay and academic interest. Whilst the majority of studies have focused on early life stages: childhood/adolescence (Kamada, 2010; Nakamura, 2020; Seiger, 2019) and young adults (Murphy-Shigematsu, 2008; Oshima, 2014; Yoshida & Oikawa, 2012), research on haafu adults - the so-called first generation of mixed-race Japanese - is comparatively limited (e.g., Kich 1982; Shaitan & McEntee-Atalianis, 2017). This thesis addresses this lacuna by investigating the small stories (Bamberg & Georgakopoulou, 2008) participants tell about their biracial identity/identification. Drawn from ethnographically informed semi-structured interviews, their small stories reveal how haafu adults construct, contest and navigate their identities in interaction when discussing dominant discourses circulating in Japanese society about being ‘haafu.’ The study seeks to extend Bakhtin’s (1981) concept of chronotopes (literally, “time space”) to an empirical analysis of narratives told by seven self-identified haafu adults (three female and four male). It illuminates the connectedness of temporal and spatial relationships in any discursive event and how “spatial and temporal indicators are fused into one carefully thought-out, concrete whole” (Bakhtin, 1981: 84). In addition, the notion of chronotopes foregrounds the inseparability of time and space between the narrated (story) and narrating event (storytelling) where participants address and at times coalesce the past with the present, thereby framing instances of discursive expressions, deictic indices, and agents described in the story from a distant ‘there-and-then’ to the ‘here-and-now’ storytelling event, as if the events were occurring at present (Perrino, 2007; 2015). Analysis found that informants oriented to three developmental stages as they described turning points in their identity formation. Parallels to Kich’s (1982; 1992) stages of biracial/bicultural identity development were found. Informants described: an enforced awareness by society of being different (relayed as being experienced most keenly in childhood), a struggle for acceptance/ a declared ‘identity crisis’ (most salient in adolescence/youth) and a conscious movement in adulthood to self-acceptance and a preferred assertion of interracial identity. Based on the data, Kich’s framework is extended by adding a fourth stage articulated by all in their tellings, i.e., identity as life-long navigation, as unresolved and forever mobile and fluid. Informant accounts resonated with Turner’s (1969) notion of liminality, i.e., haafu individuals described living between fixed and ‘floating worlds’, accompanied by ‘status-less-ness’ at various stages in life. In addition, some participants whose phenotypical makeup did not mark them as different from the majority of Japanese and/or the country of their non-Japanese parent, displayed a ‘chameleon ability’ to negotiate a temporary sense of freedom (where they could pass as a Japanese) from the restrictions and ambiguities of being ‘both’, ‘neither’ and/or ‘between’ and ‘betwixt’- of being neither fully Japanese nor other. Overall, results revealed that all participants deployed small stories to provide salient accounts of their lived experiences as bi-/multiracial individuals across their life course. These were deployed to justify, contest and resist dominant discourses and master narratives circulating in society about being ‘half’ and used to negotiate their status in ‘real time’ interaction in response to questions. Findings also revealed variation across informants, associated with individual characteristics/circumstance: family racial makeup and background (e.g., Caucasian, Asian, Black), phenotypical features, types of education (e.g., Japanese school vs. international school), group affiliations and the extent to which informants had maintained contact with their extended ‘non-Japanese’ family. Contrary to Kich (1982) and Turner (1969), participants in this study did not reach a stable, and ‘achieved identity’ (Ping & Ong, 2007). Rather, their identities were subject to ongoing negotiation in different contexts and interactions, whilst their sense of agency was reported to develop with maturity.
Research Context: Children have been systematically under-researched in Anglo-Saxon archaeology due to low burial representation and methodological challenges. This research addresses gaps in understanding childhood experiences in early medieval communities within the East Anglian Fenlands' unique wetland environment, which created distinct living conditions that shaped community organisation and childhood experiences differently from inland settlements. Aims and Objectives: The research aims to reconstruct children's lived experiences and lifecycle identity through interdisciplinary methods combining osteological assessment, burial analysis, and biomolecular techniques. Objectives explore childhood identity development and gendered burial practices; analyse health experiences and environmental impacts; and reconstruct dietary patterns and weaning practices. Materials and Methods: The focal site of investigation is the 5th-6th century Anglo-Saxon cemetery at Oakington, Cambridgeshire, where subadults comprise 51.2% of the population – an unusually high proportion compared to contemporary sites. Three further contemporaneous sites (Lakenheath, Edix Hill and Littleport) which occupy areas in and around the Fenlands are used for contextualisation within the wider Anglo-Saxon landscape. Methods include skeletal examination recording age, health indicators, and pathological conditions; burial analysis; peptide analysis for biological sex determination; and stable isotope analysis (δ¹³C, δ¹⁵N, δ³⁴S) reconstructing dietary and weaning practices. Key Findings: Isotopic analysis reveals distinctive Fenland subsistence strategies with intensive wetland exploitation. Health analysis demonstrates notably higher stress indicators in Fenland children compared to upland sites, potentially linked with malaria and nutritional deficiencies. Four potential lifecycle thresholds are identified through distinctions in grave goods and body treatment and isotope values: birth, weaning, onset of puberty, and transition to adulthood. A variety of evidence from foetal remains provides information on wider maternal health and mobility patterns in early Anglo-Saxon Fenland communities including elevated δ¹⁵N values suggestive of maternal physiological stress during pregnancy; outlier δ¹³C and δ³⁴S values indicative of dietary sources outside of the range for the Oakington community; and peripheral burial locations reflecting cultural beliefs about the liminal status of pregnancy and birth. Carbon and nitrogen stable isotope patterns show weaning ages fell between one and three years old with the main weaning foods likely being made up of soft foods like cereals, milk, grains and potentially even fish. Pots are uniquely found with infants at Oakington, potentially highlighting their association with weaning foods, outlining an identity specific to the transitional period of starting to eat solid foods and identifying survival through infancy as a potential lifecycle threshold. Fenland communities show stronger female-oriented identity development compared to inland sites, with male-gendered grave goods appearing primarily in adulthood. The integration of peptide analysis reveals previously undetectable patterns, such as contradictory knife distributions between subadults and adults, demonstrating age-specific gendered perceptions that have previously remained invisible. Original Contribution: This research advances early Anglo-Saxon subadult archaeology by demonstrating how environmental contexts shaped distinctive childhood identity formation. Peptide analysis establishes a crucial tool for studying gendered practices, while δ³⁴S analysis reveals unique wetland isotopic signatures and community interaction with the wider East Anglian landscape. Findings highlight complex adaptive strategies of Fenland communities and emphasise integrating biological, environmental, and social evidence in archaeological childhood studies.
Background: The Expanded Programme on Immunization (EPI) is one of the most successful and cost effective public health interventions for vaccine-preventable diseases of under-5 children in Bangladesh. Complete and timely immunization of under-5 children largely depends upon the knowledge and practice of caregivers’ regarding vaccination. Evaluating caregivers’ knowledge and practices regarding EPI is necessary to find out the gaps and enhance immunization services. Objective: To assess the knowledge and practice of caregivers of under-5 children regarding EPI at Bangladesh Shishu Hospital & Institute, Dhaka. Methods: It was a descriptive cross-sectional study conducted from 8th to 22nd February 2025 among caregivers of under-5 children attending the outpatient department (OPD) and EPI centre of Bangladesh Shishu Hospital and Institute, Dhaka. The knowledge and practice of the caregivers regarding EPI were assessed using 8 questions on knowledge and 5 on practice, assigning a score of 1 for each correct response and 0 for each incorrect response. Purposive sampling technique was used for data collection and the final sample size was 148. The data were analysed via SPSS (version 31.0). Results: The mean age of the under-5 children was 16.12±12.37 months (mean±SD) and the majority (53.4%) of under-5 children were aged 0-12 months. The study population included 50.7% males and 49.3% females. The majority were Muslim (72.3%) and resided in urban areas (70.3%). More than three-fifths (62.2%) of the caregivers reported health centres as their source of knowledge about EPI. Three-fourths (75%) of the participants had adequate knowledge, while the majority (95.3%) demonstrated good practices regarding EPI. Conclusion: The results of our study revealed that the majority of the participants had an adequate level of knowledge and demonstrated good practice regarding immunization of under-5 children. The majority first heard about vaccination from health centres and were aware that tuberculosis, measles, rubella, polio, diphtheria, whooping cough, tetanus and hepatitis B can be prevented by vaccine. However, most of the participants lacked knowledge that vaccine can prevent diseases like meningitis and pneumonia also. DS (Child) H J 2025; 41(1): 31-35
B H Nazma Yasmeen, Md Tahmidul Islam, Akhand Tanzih Sultana et al.
This study investigates the effects of fertility rate, infant mortality rate, population growth rate, and net migration on life expectancy in Nigeria over the period 1991-2025. The study was motivated by limited empirical evidence on the combined influence of key demographic variables on longevity despite their importance for health and development policy. Annual time-series data were analysed using the Autoregressive Distributed Lag (ARDL) approach following Phillips Perron unit root tests and ARDL bounds cointegration analysis. The results confirmed the existence of a stable long-run relationship among the variables. Fertility rate exerted a positive and statistically significant effect on life expectancy, whereas infant mortality rate and population growth rate exhibited significant negative effects. Net migration showed a negative but statistically insignificant relationship with life expectancy. Diagnostic tests revealed no evidence of serial correlation or heteroskedasticity, while normality, specification, and stability tests confirmed the robustness and reliability of the estimated model. The findings suggest that demographic characteristics remain important determinants of life expectancy in Nigeria. The unexpected positive fertility coefficient is interpreted cautiously because it may reflect improvements in maternal and child healthcare, broader socioeconomic progress, and unobserved structural factors rather than a direct beneficial effect of higher fertility. The study concludes that sustained reductions in infant mortality and effective population management are essential for improving longevity. It recommends strengthening maternal and child healthcare services, expanding primary healthcare coverage, promoting voluntary family planning and reproductive health education, and improving demographic data systems. Future research should employ panel datasets to address endogeneity in Nigeria.
Abstract Background COVID-19 pandemic modified trends of infant bronchiolitis, leading cause of emergency room (ER) attendance in infants in high income countries, primarily due to Respiratory Syncytial Virus. Understanding recent pandemic-related epidemiological shifts could inform affordable prevention efforts to improve sustainability and coverage of prophylactic treatments beyond maternal vaccines and infant monoclonal antibodies. Methods We estimated incidence rates (IR) of bronchiolitis ER presentations in 0-6month olds in 2012-2023 in a region-wide cohort of almost 1 million births using administrative health data from Lombardy, Italy. To assess potential contributors, we investigated direct and indirect COVID-19-related factors, including disease severity, shape of the epidemic peak, parental health seeking behaviour and vaccine coverage. We estimated COVID-19 maternal vaccination associations using mothers-infants data linkages and multivariable-adjusted logistic regression. Findings Compared to pre-pandemic levels, IRs doubled in 2021-2023 (from 2 to ≥ 4/100 person-time). The surge could not be explained by changes in infant age at ER visit, clinical severity or in the shape of the epidemic peak. Adjusted models showed little support for a role of infant routine or maternal COVID-19 vaccination on bronchiolitis episodes (respectively hazard ratio 1.09, 95%CI: 0.98–1.22 and odds ratio 0.91, 95%CI: 0.76–1.09). Interpretation The post-pandemic increase in infant bronchiolitis is likely driven by multiple epidemiological changes rather than a single factor. As maternal RSV vaccination and infant RSV monoclonal antibodies are introduced and scale up, identifying these mechanisms will be critical to maximise their public health impact, inform complementary prevention strategies, and improve preparedness for future RSV epidemics.
Valeria Nazzari, Albert Navarro Gallinad, Laura Ghirardi et al.
