According to the latest official figures, more than 3 million Syrians are residing in Turkey under the status of temporary protection, and more than 50% of these are under 18 years old. The number of children from Syria between 5 and 14 years of age is 677,217 and 315,000 for the 15–19 age group, meaning that more than 1 million children are at a school age. According to the temporary protection status, children from Syria have the right to access education, including preschool education in Turkey. However, the percentage of registered children in schools varies 15–30% and this ratio is significantly lower outside of the camps. After the introduction of new regulations, more registration is expected. In this article, we focus on the factors that determine being out of school for children from Syria living in Turkey. We use the findings of the fieldwork conducted for the Baseline Assessment Study for an NGO in Turkey as a basis in order to understand the current situation. Our data comprise 541 interviews conducted in Şanlıurfa and Hatay, two cities where Syrians form a significant portion of the population, in February and March 2016. According to the findings, providing support to families with the lowest incomes, those families who have more than four children and those parents with the lowest education will increase children’s access to school, which definitely contributes to their overall well-being.
Refugee children’s mental health through war, conflict and flight is strongly influenced by family environment and quality of relationships with parents and primary caregivers. Parental support and supervision of the child by the parent is a fundamental protective moderator for child outcomes. Knowledge of parents’ support needs through displacement into pre-resettlement contexts is vital in designing interventions to improve outcomes for refugee children and families. This qualitative study aimed to explore the parenting support needs of Syrian parents who had recently fled conflict and were residing in refugee camps and shelters in Syria and in Turkey, to understand the perceived feasibility and value of intervention at this stage. A total of 29 mothers and professional support workers in refugee camps and humanitarian contexts in Turkey and Syria participated in interviews or focus groups. Data were analysed using thematic analysis and structured into three themes: parents’ desire for parenting advice and actively seeking support; the value of discussing parenting issues, and perceived barriers to accessing support. Parents were very interested in receiving parenting support and were motivated to understand how best to parent in this context. They had made active attempts to acquire information, despite the highly challenging circumstances they had experienced, and were still living through. They had clear views on what they wanted support with and how best to receive it, though they were left frustrated at the very limited available resources. Result indicated that providing tailored support for families at this stage of their refugee journey could have significant benefits for the well-being of both refugee children and their parents. Recognition of the crucial role of parents in policy and practice can help protect the mental health of children and families in their refugee journey. This information should inform policies for refugee families in pre-resettlement contexts.
Indonesia is a country that is highly prone to natural disasters, while at the same time faces a high child marriage prevalence compared to other Asia Pacific countries. Many studies show that in times of humanitarian crisis, child marriage practices, which heavily affect girls, are increasing. This study then intends to examine quantitatively any association between natural disasters and child marriages in Indonesia by using the 2015 National Socio-Economic Survey (SUSENAS) and the 2014 Village Potential Census (PODES). By applying logistic regression and controlling the model with several socio-economic conditions such as education, religion and regional characteristics, this study finds that natural disasters are positively associated with the probability of girls entering child marriage. Child marriage could be one of the options for households to reduce the burden when they face adverse welfare effects from natural disasters. Furthermore, disaster mitigation significantly reduces the probability of child marriage because disaster mitigation and preparedness will lessen the devastating shocks of the disasters, reducing the need to then enter into child marriage. The strong relationship between child marriage and natural disasters should attract the attention of policymakers to conduct better disaster mitigation programs, as well as to effectively provide assistance to the most vulnerable members of communities when natural disasters occur.
Nomophobia is a form of behavioral addiction towards smartphone referring to the anxiety caused by disconnected from the mobile network or inability to have access to a smartphone. Nomophobia has multi-dimensional traits ranging from social, physiological, and physical symptoms that are summarized into very dependency upon smartphone. The study examines nomophobia among youth and how to overcome nomophobia. The study deployed a qualitative approach by interviewing respondents mostly at their first-year undergraduate level and text mining analytics from respondents’ conversation to extract the common patterns, characteristics, and proposed solutions for nomophobia.
Pneumonia continues to be the leading cause of mortality in children worldwide, with India accounting for 20% of those deaths and a higher burden of childhood pneumonia than any other country.1 In The Lancet Child & Adolescent Health, Brian Wahl and colleagues2 report the first comprehensive evaluation of state-specific pneumonia incidence in children in India using a risk factor-based modelling approach. By calculating the effect of temporal changes in prevalence of well-known pneumonia risk factors such as malnutrition, incomplete immunisation, and exposure to indoor air pollution on incidence, the authors estimated the change in pneumonia morbidity over time.
BACKGROUND: The absolute number of pneumonia deaths in India has declined substantially since 2000. However, pneumonia remains a major cause of morbidity in children in the country. We used a risk factor-based model to estimate pneumonia and severe pneumonia morbidity in Indian states in 2000 and 2015. METHODS: In this modelling study, we estimated the burden of pneumonia and severe pneumonia in children younger than 5 years using a risk factor-based model. We did a systematic literature review to identify published data on the incidence of pneumonia from community-based longitudinal studies and calculated summary estimates. We estimated state-specific incidence rates for WHO-defined clinical pneumonia between 2000 and 2015 using Poisson regression and the prevalence of risk factors in each state was obtained from National Family Health Surveys. From clinical pneumonia studies, we identified studies reporting the proportion of clinical pneumonia cases with lower chest wall indrawing to estimate WHO-defined severe pneumonia cases. We used the estimate of the proportion of cases with lower chest wall indrawing to estimate WHO-defined severe pneumonia cases for each state. FINDINGS: Between 2000 and 2015, the estimated number of pneumonia cases in Indian HIV-uninfected children younger than 5 years decreased from 83·8 million cases (95% uncertainty interval [UI] 14·0-300·8) to 49·8 million cases (9·1-174·2), representing a 41% reduction in pneumonia cases. The incidence of pneumonia in children younger than 5 years in India was 657 cases per 1000 children (95% UI 110-2357) in 2000 and 403 cases per 1000 children (74-1408) in 2015. The estimated national pneumonia case fatality rate in 2015 was 0·38% (95% UI 0·11-2·10). In 2015, the estimated number of severe pneumonia cases was 8·4 million (95% UI 1·2-31·7), with an incidence of 68 cases per 1000 children (9-257) and a case fatality ratio of 2·26% (0·60-16·30). In 2015, the estimated number of pneumonia cases in HIV-uninfected children was highest in Uttar Pradesh (12·4 million [95% UI 2·1-45·0]), Bihar (7·3 million [1·3-26·1]), and Madhya Pradesh (4·6 million [0·7-17·0]). Between 2000 and 2015, the greatest reduction in pneumonia cases was observed in Kerala (82% reduction). In 2015, pneumonia incidence was greater than 500 cases per 1000 children in two states: Uttar Pradesh (565 cases per 1000 children [95% UI 94-2047]) and Madhya Pradesh (563 cases per 1000 children [88-2084]). INTERPRETATION: The estimated number of pneumonia and severe pneumonia cases among children younger than 5 years in India decreased between 2000 and 2015. Improvements in socioeconomic indicators and specific government initiatives are likely to have contributed to declines in the prevalence of pneumonia risk factors in many states. However, pneumonia incidence in many states remains high. The introduction of new vaccines that target pneumonia pathogens and reduce risk factors will help further reduce the burden of pneumonia in the country. FUNDING: Bill & Melinda Gates Foundation.
Brian Wahl, Maria Deloria Knoll, Anita Shet et al.
BACKGROUND: Mental health problems are a leading cause of disability in adolescents worldwide. Problem solving is a well-tested mental health intervention in many populations. We aimed to investigate the effectiveness of a brief, transdiagnostic problem-solving intervention for common adolescent mental health problems when delivered by non-specialist school counsellors in New Delhi, India. METHODS: This randomised trial was done in six government-run schools (three all-boys schools, two all-girls schools, and one co-educational school) that serve low-income communities. We recruited participants from grades 9 to 12 (ages 12-20 years) by selecting students with persistently elevated mental health symptoms accompanied by distress or functional impairment. Clinical eligibility criteria were assessed by research assistants using the Hindi-language version of the Strengths and Difficulties Questionnaire (SDQ), with reference to locally validated borderline cutoff scores of 19 or greater for boys and 20 or greater for girls on the SDQ Total Difficulties scale, an abnormal score of 2 or more on the SDQ Impact scale, and persistence of more than 1 month on the SDQ Chronicity index. Participants were randomly allocated (1:1) to problem solving delivered through a brief (2-3 week) counsellor-led intervention with supporting printed materials (intervention group), or problem solving delivered via printed booklets alone (control group). Primary outcomes were adolescent-reported mental health symptoms (SDQ Total Difficulties scale) and idiographic psychosocial problems (Youth Top Problems [YTP]) at 6 weeks. Primary analyses were done on an intention-to-treat basis at the 6-week endpoint. The trial is registered with ClinicalTrials.gov, NCT03630471. FINDINGS: Participants were enrolled between Aug 20, and Dec 4, 2018. 283 eligible adolescents were referred to the trial, and 251 (89%) of these were enrolled (mean age 15·61 years; 174 [69%] boys). 125 participants were allocated to each group (after accounting for one participant in the intervention group who withdrew consent after randomisation). Primary outcome data were available for 245 (98%) participants. At 6 weeks, the mean YTP scores were 3·52 (SD 2·66) in the intervention group and 4·60 (2·75) in the control group (adjusted mean difference -1·01, 95% CI -1·63 to -0·38; adjusted effect size 0·36, 95% CI 0·11 to 0·61; p=0·0015). The mean SDQ Total Difficulties scores were 17·48 (5·45) in the intervention group and 18·33 (5·45) in the control group (-0·86, -2·14 to 0·41; 0·16, -0·09 to 0·41; p=0·18). We observed no adverse events. INTERPRETATION: A brief lay counsellor-delivered problem-solving intervention combined with printed booklets seemed to have a modest effect on psychosocial outcomes among adolescents with diverse mental health problems compared with problem-solving booklets alone. This counsellor-delivered intervention might be a suitable first-line intervention in a stepped care approach, which is being evaluated in ongoing studies. FUNDING: Wellcome Trust.
Daniel Michelson, Kanika Malik, Rachana Parikh et al.
BACKGROUND: Adolescent pregnancy and child undernutrition are major social and public health concerns. We aimed to examine associations between adolescent pregnancy and child undernutrition in India, where one in five adolescents live, and one in three of the world's stunted children. METHODS: Data were from India's fourth National Family Health Survey, 2015-16. Primiparous women aged 15-49 years who gave birth between 2010 and 2016 were classified on the basis of age at first birth: 10-19 years (adolescence), 20-24 years (young adulthood), and 25 years or older (adulthood). Primary outcomes were anthropometric measures of offspring undernutrition. Multivariable regression and structural equation models were used to understand the extent to which these measures were linked to adolescent pregnancy and the potential social, biological, and programmatic pathways. FINDINGS: Of the 60 096 women in the sample, 14 107 (25%) first gave birth during adolescence. Children born to adolescent mothers had lower Z scores for length or height-for-age (mean difference -0·53 SD), weight-for-age (-0·40 SD), and weight-for-length or height (-0·16 SD) than children born to adult mothers. Compared with adult mothers, adolescent mothers were shorter (-1·21 cm, 95% CI -1·78 to -0·65), more likely to be underweight (18 percentage points, 15-21) and anaemic (8 percentage points, 6-11), less likely to access health services (-4 to -15 percentage points), and had poorer complementary feeding practices (-3 to -9 percentage points). Adolescent mothers also had less education (-3·30 years, 95% CI -3·68 to -2·91), less bargaining power (-7 to -15 percentage points), and lived in poorer households (-0·66 SD, 96% CI -0·82 to -0·50) with poorer sanitation (-28 percentage points, -32 to -24). In the path analysis, these intermediate factors predicted child anthropometry, with the strongest links being mother's education (18%), socioeconomic status (13%), and weight (15%). INTERPRETATION: Children born to adolescent mothers are at risk of being undernourished. Adolescent pregnancy is related to child undernutrition through poor maternal nutritional status, lower education, less health service access, poor complementary feeding practices, and poor living conditions. Policies and programmes to delay pregnancy and promote women's rights could help break the intergenerational cycle of undernutrition through many routes. FUNDING: Bill & Melinda Gates Foundation through Partnerships and Opportunities to Strengthen and Harmonize Actions for Nutrition in India, led by the International Food Policy Research Institute.
Phuong Hong Nguyen, Samuel Scott, Sumanta Neupane et al.
BACKGROUND: Malnutrition is a major contributor to disease burden in India. To inform subnational action, we aimed to assess the disease burden due to malnutrition and the trends in its indicators in every state of India in relation to Indian and global nutrition targets. METHODS: We analysed the disease burden attributable to child and maternal malnutrition, and the trends in the malnutrition indicators from 1990 to 2017 in every state of India using all accessible data from multiple sources, as part of Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017. The states were categorised into three groups using their Socio-demographic Index (SDI) calculated by GBD on the basis of per capita income, mean education, and fertility rate in women younger than 25 years. We projected the prevalence of malnutrition indicators for the states of India up to 2030 on the basis of the 1990-2017 trends for comparison with India National Nutrition Mission (NNM) 2022 and WHO and UNICEF 2030 targets. FINDINGS: Malnutrition was the predominant risk factor for death in children younger than 5 years of age in every state of India in 2017, accounting for 68·2% (95% UI 65·8-70·7) of the total under-5 deaths, and the leading risk factor for health loss for all ages, responsible for 17·3% (16·3-18·2) of the total disability-adjusted life years (DALYs). The malnutrition DALY rate was much higher in the low SDI than in the middle SDI and high SDI state groups. This rate varied 6·8 times between the states in 2017, and was highest in the states of Uttar Pradesh, Bihar, Assam, and Rajasthan. The prevalence of low birthweight in India in 2017 was 21·4% (20·8-21·9), child stunting 39·3% (38·7-40·1), child wasting 15·7% (15·6-15·9), child underweight 32·7% (32·3-33·1), anaemia in children 59·7% (56·2-63·8), anaemia in women 15-49 years of age 54·4% (53·7-55·2), exclusive breastfeeding 53·3% (51·5-54·9), and child overweight 11·5% (8·5-14·9). If the trends estimated up to 2017 for the indicators in the NNM 2022 continue in India, there would be 8·9% excess prevalence for low birthweight, 9·6% for stunting, 4·8% for underweight, 11·7% for anaemia in children, and 13·8% for anaemia in women relative to the 2022 targets. For the additional indicators in the WHO and UNICEF 2030 targets, the trends up to 2017 would lead to 10·4% excess prevalence for wasting, 14·5% excess prevalence for overweight, and 10·7% less exclusive breastfeeding in 2030. The prevalence of malnutrition indicators, their rates of improvement, and the gaps between projected prevalence and targets vary substantially between the states. INTERPRETATION: Malnutrition continues to be the leading risk factor for disease burden in India. It is encouraging that India has set ambitious targets to reduce malnutrition through NNM. The trends up to 2017 indicate that substantially higher rates of improvement will be needed for all malnutrition indicators in most states to achieve the Indian 2022 and the global 2030 targets. The state-specific findings in this report indicate the effort needed in each state, which will be useful in tracking and motivating further progress. Similar subnational analyses might be useful for other low-income and middle-income countries. FUNDING: Bill & Melinda Gates Foundation; Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India.
Soumya Swaminathan, Hemalatha Rajkumar, Anamika Pandey et al.
This article examines whether international human rights law (ihrl) allows States to make exceptions based on the serious nature of the crime alleged and the age of a child accused of an offence. It specifically analyses the compatibility with ihrl of India’s Juvenile Justice (Care and Protection of Children) Act, 2015, which allows children 16 or above and accused of heinous offences to be tried as adults. The central argument is that trial and punishment of children as adults, for any offence, violates the right to non-discrimination recognised under ihrl as well as the principle of best interest, reintegration objective of juvenile justice and rights of juveniles provided in the UN Convention on Rights of the Child, 1989 and other international instruments.
