Microbiological diagnosis of childhood pulmonary tuberculosis can be challenging. We investigated the accuracy of Xpert MTB/RIF Ultra on the induced sputum, focused on high-risk groups (infants, malnourished children, and those living with HIV), where data is limited. Children (under 15 years) investigated for pulmonary tuberculosis at Dora Nginza Hospital, South Africa, were prospectively enrolled between January 2018 and January 2024, and followed up for 12 months. Induced sputa were tested with liquid culture and Xpert MTB/RIF Ultra (Ultra). Children were categorized with confirmed, unconfirmed, or unlikely tuberculosis, according to NIH consensus definitions. Ultra diagnostic accuracy was calculated against culture, with analysis by high-risk subgroups. Of 636 children (median age, 27.4 (IQR 11.8-61.6) months), 173 (27.2%) were classified with confirmed TB, 384 (60.4%) with unconfirmed TB, and 79 (12.4%) with unlikely TB. There were 223 (37.8%) children underweight-for-age, 168 (26.5%) living with HIV, and 163 (25.6%) infants. Of 557 children with TB, 145 (26.0%) were confirmed on induced sputa; with 137/557 (24.6%) confirmed on Ultra (46.0%; 63/137, of which were "trace positive"), and 88/557 (15.8%), on culture. Of those confirmed, 57/145 (39.3%) were Ultra positive, culture negative - contributing 10.2% to the overall yield. Ultra performed better in children over 5 years and with weight-for-height Z-scores < -3. Overall, Ultra sensitivity was 90.9% (95%CI 82.9-96.0) and specificity, 89.6% (95%CI 86.7-92.0), with high accuracy across high-risk groups. Mortality amongst children treated for PTB was 4.9% (27/557) with aRR highest for stunted children (7.3; 95% CI, 2.2-24.2), followed by children with HIV (3.5; 95% CI, 1.6-7.5), and infants (3.3; 95% CI, 1.6-6.7). Ultra on induced sputum was feasible, with high yield and diagnostic accuracy for high-risk children.
Juaneta Luiz, Lesley Jean Workman, Cynthia B. Whitman et al.
Recently, Early Childhood Care and Learning has become a central point in the South African education spectrum. Unfortunately, this sector faces challenges, especially in economically challenged societies. Practitioners are not receiving sufficient professional development from relevant government departments, and they also struggle to find teaching and learning resources due to the prevalent socio-economic issues in the societies where their centres are located. This interpretive project, which is premised on Participatory Action Learning and Action Research as a research design, was conceptualised to support early childhood practitioners and parents in creating diverse teaching media, using recyclable materials. Engagements with practitioners after the implementation stage indicate the following: children enjoy manipulating recyclable material, practitioners value recyclable material; practitioners appreciate new pedagogical strategies; activities involving recyclable material improve children’s vocabulary significantly; the activities cement schemata; interaction in literacy classrooms improves critical skills such as critical thinking, effective listening, following instructions, speaking, problem-solving, and communication. The project concludes that literacy instruction using recyclable materials in early childhood learning may sustainably improve literacy.
Introduction/Objective Armed conflicts threaten maternal and neonatal health, yet evidence on neonatal outcomes remains fragmented. This scoping review mapped evidence on armed conflict’s impact on neonatal health and identified pathways influencing outcomes. Methods This scoping review followed Arksey and O’Malley’s framework and PRISMA-ScR guidelines. MEDLINE/PubMed, Web of Science, Embase, Global Health (CABI), and CINAHL were searched, supplemented by Google Scholar and reference-list screening. Articles published from 2006 to 2025 reporting neonatal health outcomes (0-28 days) in conflict-affected settings were included. Maternal and pregnancy-related factors were considered when linked to neonatal outcomes. Twenty-nine articles were synthesized thematically. Results Four overarching themes emerged: (1) war-driven neonatal adversity, (2) health system collapse impact, (3) risks associated with alternative and non-formal care practices, and (4) stress-associated biological and epigenetic changes. Armed conflict was associated with increased neonatal mortality, preterm birth, low birth weight, congenital anomalies, and neonatal morbidity. Pathways included violence exposure, healthcare disruption, displacement, food insecurity, environmental hazards, and maternal psychological stress. Discussion Conflict affects neonatal health through interconnected biological, social, environmental, and health system pathways. Health system disruption, reduced access to skilled care, unsafe care practices, and maternal stress may compound adverse outcomes. Emerging evidence of epigenetic changes suggests potential longer-term consequences and underscores the need for integrated humanitarian and health system responses. Conclusion Priorities include strengthening health system resilience, ensuring continuity of maternal-newborn services, and integrating context-appropriate maternal mental health and psychosocial support. Further research should identify feasible, culturally responsive, and scalable interventions in underrepresented and protracted conflict settings.
Childhood illnesses such as anaemia and malaria continue to pose significant health risks for children under five in sub-Saharan Africa. These conditions often co-occur, reflecting complex interdependencies driven by shared biological and environmental factors. Traditional analytical approaches typically assume independence between health outcomes, potentially overlooking meaningful associations. This study aims to identify the dependence structure among anaemia and malaria in children under five using a joint modeling approach. Data were drawn from the most recent Malaria Indicator Survey (MIS), comprising 5,755 children. A bivariate probit model was estimated using a Gaussian copula framework with probit margins for each outcome. This approach allowed for the simultaneous modeling of the marginal probability of each illness and the latent correlations among them. The model incorporated a range of child-, household-, and maternal-level covariates. Average Marginal Effects (AMEs) were calculated to facilitate interpretation. The copula correlation (ρ) between anaemia and malaria from the copula structure was estimated to quantify the dependence between the two illnesses. Descriptive analyses revealed substantial co-occurrence: 13.8% of children experienced both illnesses simultaneously. The joint copula model detected significant positive copula correlations (ρ ≈ 0.19) between anaemia and malaria. Several covariates displayed differential effects in the joint versus separate models. For instance, the association between maternal anaemia and child malaria risk reversed direction once interdependence was accounted for. Joint modeling yielded more stable and plausible estimates across outcomes. This study highlights the critical importance of accounting for outcome dependence in the analysis of child morbidity. The significant correlations among malaria and anaemia suggest that these illnesses are influenced by common or interacting risk factors. Joint modeling using a Gaussian copula framework enhances both the precision of marginal effect estimates and the understanding of comorbidity patterns. These findings support the design of integrated health interventions that address the interconnected nature of childhood illnesses in high-burden settings.
Grace Kakaire, Robert Too, Gregory Kibet Kerich et al.
Abstract Child malnutrition remains a major public health challenge in Indonesia. However, the factors associated with multidimensional child health outcomes (MCHO), defined as the coexistence of anthropometric failure and infectious morbidity, remain poorly understood. Examining these conditions jointly is important because undernutrition and infection are biologically interconnected, frequently coexist, and together impose a greater burden on child health than either condition alone. This study examined maternal and child determinants of MCHO in a cross-sectional analysis nested within an ongoing birth cohort of 142 mother–child pairs (children aged 6–13 months) participating in an ongoing birth cohort in an urban poor setting in Makassar, Indonesia. Nutritional status was assessed using World Health Organization anthropometric indicators, and associations were estimated using Firth penalised-likelihood logistic regression with sensitivity analyses based on modified Poisson regression and E-values. MCHO affected 14.79% of children, while stunting, wasting, underweight, and recent infectious morbidity affected 23.94%, 19.72%, 11.97%, and 30.99%, respectively. Caesarean delivery was independently associated with MCHO, though estimated from a model with a modest events-per-variable ratio (AOR 3.09, 95% CI 1.18–8.10, p = 0.022; adjusted prevalence ratio [aPR] 2.60, 95% CI 1.17–5.77; E-value 5.63). Recent infectious morbidity was independently associated with wasting (AOR 2.57, 95% CI 1.07–6.16, p = 0.034; aPR 2.01, 95% CI 1.03–3.93; E-value 4.58). Unimproved drinking water showed consistent positive associations with MCHO, stunting, and wasting (all p < 0.10). These findings highlight the associations of maternal, infectious, and environmental factors with child health and underscore the need for integrated interventions that address nutrition, infection prevention, maternal and child health, and household environmental conditions simultaneously.
Ryza Jazid BaharuddinNur, Eri Wijaya, Irmayanti Irmayanti et al.
Nutritional status is an important indicator that reflects the balance between nutrient intake and the body's requirements to support children's growth, development, and overall health. Nutritional problems among children under five remain a major public health concern because they are influenced by various factors, including dietary patterns, parental caregiving, socioeconomic status, Posyandu attendance, and a history of infectious diseases. This study aimed to analyze the factors associated with the nutritional status of children aged 12–59 months in Truko Village, Kangkung District, Kendal Regency. This study employed a retrospective cross sectional involving 84 children under five, selected using purposive sampling. Data were collected through interviews using a semiquantitative Food Frequency Questionnaire (FFQ), structured questionnaires, anthropometric measurements, and data from the Maternal and Child Health (MCH) Handbook. Data analysis included univariate analysis, sing logistic regression, with a significance level of p<0.05. The results showed significant associations between dietary patterns (p<0.001), parental caregiving (p=0.003), socioeconomic status (p=0.012), Posyandu attendance (p=0.001), and a history of infectious diseases (p<0.001) with the nutritional status of children under five. Dietary patterns were identified as the most dominant factor associated with nutritional status. In conclusion, improving dietary patterns, strengthening parental caregiving, increasing regular participation in Posyandu services, and preventing infectious diseases are essential strategies to improve the nutritional status of children under five.
Ruddy Haryanto, Chairunisa Nur Rarastiti, Catur Retno Lestari
This study “Assessment of nutritional deficiency and its effect on the growth of the less privilege children in Taraba State, Nigeria” is designed to investigate the effect which nutritional deficiency has on the less privileged children and whether nutritional deficiency have significant negative effect on the children. This is because there is a general notion that most retarded growth experienced in our children is occasioned by nutrient deficiency in feeds. It is believed that constant consumption of foods containing nutrients in the right proportion will make children grow normally and in good health. The study us a descriptive survey research design. Target population of the study was 864 participants. Sample of the study was 273 respondents. The sample size was obtained using Slovin’s model for sample size determination. Instrument for data collection was the researchers’ structured questionnaire. The instrument was structured using Likerts’ modified response option of Strongly Agreed (SA), Agreed (A), Disagree (D) and Strongly Disagree (SD). Data collected were analyzed using descriptive and inferential statistics. The null hypotheses formulated were tested using regression analysis and the associated ANOVA. Findings of the study indicated that most of the less privileged children are not opportune to feed on balanced diet, and that militates against their growth and development. The major recommendation was that charity organizations, philanthropist and government should consider the less privileged and provide assistance that could enable them meet up with the required nutritive foods for proper growth and development.
ABSTRACT Background: Nutritional problems among children under five remain a public health concern in Indonesia because they affect children’s growth and development. One factor influencing nutritional status is mothers’ knowledge and attitudes toward child feeding practices. This study aimed to determine the relationship between mothers’ knowledge and attitudes regarding child feeding practices and the nutritional status of children under five in Siulak District in 2026. Methods: This analytical quantitative study employed a cross-sectional design involving 68 mothers with children aged 1–5 years. The independent variables were mothers’ knowledge and attitudes, while the dependent variable was the nutritional status of children under five. Data were collected using questionnaires and anthropometric assessment based on the Weight-for-Age (W/A) index and analyzed using univariate analysis and Spearman’s Rank correlation test (p<0.05). Results: Most mothers had good knowledge (52.9%) and positive attitudes (39.7%). Most children had normal nutritional status (83.8%). Significant relationships were found between mothers’ knowledge and children’s nutritional status (r=0.712; p=0.001) and between mothers’ attitudes and children’s nutritional status (r=0.482; p=0.012). Conclusion: Mothers’ knowledge and attitudes regarding child feeding practices were significantly associated with the nutritional status of children under five in Siulak District in 2026. Keywords: Mothers’ Knowledge, Mothers’ Attitudes, Child
BACKGROUND AND OBJECTIVES: Indonesia, a middle-income country with a large population of young children, is predicted to have a demographic bonus in 2045. However, to benefit from this bonus, the government must optimally manage the triple burden of malnutrition to prevent long-term effects that can significantly decrease quality of life. National data in 2023 showed an increased prevalence of acute malnutrition com-pared to previous years, a wake-up call for the government to address important contributing factors. This article aims to identify the current position of Indonesian guidelines on acute malnutrition (AM) and to provide recommendations. METHODS AND STUDY DESIGN: A document analysis was conducted to examine the existing guidelines for the treatment of acute malnutrition in children under 5 years of age in Indonesia and their implementation. RESULTS: The Ministry of Health published the latest guidelines in 2019 and a technical guide-line for the treatment of moderate acute malnutrition (MAM) in 2024. National guidelines were not uniformly implemented across regions due to several factors, such as funding availability, human resources, and logistics. Of the four main components of the latest severe acute malnutrition (SAM) guideline, hospitalisation management has been adequately implemented. Meanwhile, community mobilisation, the availability of out-patient therapeutic regimens, and treatment for moderate acute malnutrition faced numerous challenges. CONCLUSIONS: The implementation of three of the four components of SAM treatment should be improved, with a focus on screening and early detection of acute malnutrition, strengthening the referral system, providing therapeutic regimens, and developing a sustainable reporting system.
Moretta Damayanti Fauzi, Marinka van der Hoeven, Damayanti D. Soekarjo et al.
Background. Stunting remains a major public health challenge in low- and middle-income countries (LMICs), including Indonesia, with consequences extending beyond linear growth deficits to impaired neurodevelopment. Although early stimulation and parenting interventions have been shown to improve neurodevelopmental outcomes and mitigate these effects, few studies have evaluated structured, nurse-led programmes targeting toddlers at risk of stunting. Objective. To assess the effectiveness of a nurse-led early stimulation and structured parenting education intervention on neurodevelopment among toddlers at risk of stunting. Methods. This quasi-experimental pretest–post-test control group study involved 200 toddlers aged 36 months in Tangerang Regency, Indonesia. There were 100 participants in the intervention group and 100 in the control group. The intervention group received six weekly nurse-led sessions incorporating play-based stimulation and parenting education, while the control group received routine care. The Bayley‑III Scales of Infant and Toddler Development were used to measure neurodevelopmental outcomes, which were analysed using ANCOVA and multiple linear regression. Results. Postintervention, the intervention group showed significantly higher adjusted scores across all Bayley‑III domains, namely cognitive (F=20.21; p<0.001; η²=0.093), receptive language (F=18.64; p<0.001; η²=0.087), expressive language (F=17.82; p<0.001; η²=0.083), fine motor (F=21.47; p<0.001; η²=0.098) and gross motor (F=24.10; p<0.001; η²=0.109). Regression analysis revealed that pretest scores (p<0.001) and session attendance (p<0.05) were significant predictors of post-test outcomes, while maternal education and child’s age were not. Conclusion. Nurse-led early stimulation and parenting interventions were associated with significant improvements in neurodevelopmental outcomes among toddlers at risk of stunting. This model could be integrated into primary healthcare services and may provide a scalable approach to addressing developmental delays in LMICs.
