Enteric pathogens can be transmitted through multiple environmental pathways, yet little is known about the relative contribution of each pathway to diarrhea risk among children. The authors aimed to identify fecal transmission pathways in the household environment associated with prospectively measured child diarrhea in rural Bangladesh. The authors measured the presence and levels of Escherichia coli in tube wells, stored drinking water, pond water, child hand rinses, courtyard soil, flies, and food in 1843 households. Gastrointestinal symptoms among children ages 0−60 months were recorded concurrently at the time of environmental sample collection and again a median of 6 days later. Incident diarrhea was positively associated with the concentration of E. coli on child hands measured on the first visit, while other pathways were not associated. In cross-sectional analysis, there were no associations between concurrently measured environmental contamination and diarrhea. The authors findings suggest higher levels of E. coli on child hands are strongly associated with subsequent diarrheal illness rates among children in rural Bangladesh. (Bangladesh)
A multi sector effort is essential to improve the nutritional status of children and women. For effective and efficient implementation of multi sector interventions, each sector should be well positioned to deliver the required services. With the aim to understand the bottlenecks to effective implementation of nutrition operations in Nepal and provide strategies and recommendations to overcome these challenges, researchers from the World Bank conducted a qualitative study in 2016/17 entitled: "Study of Operational Strategies to Reduce Malnutrition in Nepal". This research brief highlights various institutional structures and non-government partnership arrangements that contribute to effective implementation of nutrition related activities. (Nepal)
Nutritional problems often occur in Indonesia due to the lack of knowledge, believes, values and norms in the community. Eating nutritious food is an important habit for children’s health and development. Over a third of children and infants’ death as well as eleven percent of diseases in the world are caused by under nutrition in pregnant women and children. Furthermore, under nutrition in pregnant women could lead to physical, mental and intellectual development impairments for the child. A stunted and wasted newborn will have a substandard growth and become an adult with a short body as well as low intelligence and income. In order to have a smart child with optimum growth, a family needs to pay close attention to the critical period of first 1000 days of life (1000 Hari Pertama Kehidupan), from the pregnancy period to first 2 years since the child is born. The first 1000 days are critical period where any occurring impairment will have a permanent and untreatable effect. This session will discuss the healthy behaviors that need to be adopted during pregnancy (9 months or 270 days). (Indonesia)
Ratings for the Second Education Quality Improvement Program Project for Afghanistan were as follows: outcomes were moderately satisfactory, the risk to development outcome was low or negligible, the Bank performance was satisfactory. and the monitoring and evaluation quality was substantial. Some lessons learned included: projects with large construction components need capacity to develop detailed construction and procurement plans as well as strong management and supervision teams to be successful. Under EQUIP II, MoE had: (i) very low capacity for developing construction and procurement plans, (ii) school designs were followed that were not suitable to local conditions; (iii) school drawings and technical specifications were not detailed enough making monitoring difficult; (iv) limited procurement knowledge leading to substantial delays; and (v) very poor construction supervision and its monitoring as most of supervision staff was poorly qualified and to make it worse even they could not access many sites due to security conditions. EQUIP II included supply and demand features to increase girls’ enrollment with the inclusion of infrastructure investments (i.e. boundary wall, toilet, water) and well as scholarships for girls to attend TTC. The EQRA project will expand on these activities to further increase girls’ enrollment and retention. The EQUIP project played a significant role in increasing the number of trained teachers and improving the qualification level of teachers. This was a good beginning to improving the quality of education in Afghanistan but only a small proportion of teacher college graduates entered the teaching force. EQUIPII had a nationwide focus which presented difficulties for completing civil works and monitoring given the increased security concerns during project implementation. Moreover, the nationwide focus spread resources thinly over the country. Going forward, the new EQRA project will focus resources specifically on lagging provinces with regard to access interventions where the proportion of out-of-school girls is the highest. (Afghanistan)
The development objective of Essential Health Services Access Project for Myanmar is to increase coverage of essential health services of adequate quality, with a focus on maternal, newborn and child health (MNCH), and, in the event of an eligible crisis or emergency, to provide immediate and effective response to said eligible crisis or emergency. This restructuring requires the following changes: (a) extension of the project period by twenty one months, from June 30, 2019 to March 31, 2021, to adjust to the change in the government’s fiscal year, as well as to allow sufficient time for component 2 implementation, requiring a change in implementation schedule; (b) recalibration of the Disbursement Linked Indicator (DLI) targets for year 3 and year 4, which involves lowering the target number of townships meeting the DLIs; (c) modification of the results framework for two reasons: (i) DLI targets, which are a part of the RF, are to be changed; and (ii) as a result of reallocation from IRM, the indicator on procurement of goods under IRM will be deleted; (d) extension of the Interim Unaudited Financial Report (IFR) reporting period from 45 days to 60 days, the primary reason being that the collecting of financial data from township continues to be done manually and this lengthens the time required for the union level to compile and submit the IFR; (e) reallocations between disbursement categories to reflect from category (3) to category (2), which was initially reallocated from category (2) to category (3) for purposes of the immediate response mechanism to respond to the 2015 floods and landslides, based on the government’s ultimate decision not to utilize project funds for this purpose. (Myanmar)
This report was prepared to make an inventory of key social protection (SP) programs (over 60) in the Philippines, with the main objective to inform the ongoing review of the country SP Framework and to determine their relevance. The overall level of effort and institutional development is high, with a coherent architecture around the three typical pillars in SP: social assistance, social insurance, and labor market interventions.SP programming is mature across all pillars, and especially in social assistance, and has proven to be resilient to recent changes in administration after the 2016 presidential elections. There is also a serious commitment to SP by the level of spending. In recent years, there has been a significant increase in spending levels and improvement in allocations. However, the insurance pillar shows relatively low coverage rates. Like in many countries, SP in the Philippines is not governed by a single unified group of legislation, but rather by a collection of sector- or program specific laws that evolve over time. covering areas such as child protection, poverty alleviation, labor regulation, health insurance, and pensions. The stated focus on both protection from short-term collapses in consumption/income and alleviation of chronic poverty is aligned with both considerable and well identifiable share of the population unable to meet its basic needs (at least 20 percent) and almost equal share of those who suffer from consequences of shocks in a country where natural disasters are a regular occurrence, and employment levels are fairly sensitive to shifting international economic forces. The stated objectives of building adaptability and capacity for human capital accumulation are sensible, given the human capital deficiencies especially with respect to education and nutrition.Finally, SP programs in the Philippines are flexible and can respond to emergencies, shocks, or crisis. Some of the SP programs in this report can respond quickly to emergencies, but not all have embedded a sound monitoring and evaluation (M&E) system that allows them to provide regular monitoring and periodic evaluation of their implementation during emergencies. Also, an overall framework for predictable response to shocks is still missing. Similarly, it is notable that none of the SP programs have in place an automatic process of indexation of benefits. Information dissemination varies across programs, with some having strong communication channels and staff adequately trained to effectively communicate modifications or adjustments, while others lack these mechanisms. (Philippines)
Countries around the world have committed to implementing Sustainable Development Goals (SDGs).Implementation of UHC is a key element of goal number 3 “to ensure healthy lives and promote well-being for all, at all ages.” GHG is helping the Government of Georgia move toward achieving SDG 3 with a strategy that promotes greater access to healthcare, while providing financial protections to the most vulnerable populations. GHG is addressing the medical skills gap, and it is offering essential services including maternal, newborn, child health, infectious, and non-communicable diseases treatments in communities where Georgians live and work. As GHG expands the availability of quality primary care at outpatient polyclinics, it can help control costs and reduce premature mortality from non-communicable diseases through prevention. As countries are embracing UHC principles, all are struggling with affordability. Georgia’s model of cooperation proves that UHC can be delivered to a wide range of citizens very quickly and efficiently by leveraging the scalethat the private sector can deliver. (Georgia)
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.
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.
Background: Immunization is among the most cost-effective public health interventions, but awareness does not necessarily translate into timely completion of the schedule. This study assessed mothers' knowledge, attitude, and practice (KAP) regarding immunization of under-five children and factors associated with immunization status. Methods: A hospital-based cross-sectional study was conducted at the pediatric outpatient department of Assam Medical College and Hospital, Dibrugarh, from June 2015 to May 2016. In all, 360 mothers of under-five children were interviewed using a predesigned, pretested proforma. Associations were tested using chi-square and Fisher exact tests, with p<0.05 considered significant. Results: Overall, 322 mothers (89.44%) were aware of childhood immunization, the commonest source being health facilities (40.99%). Knowledge regarding the purpose of immunization (72.78%) and the correct starting age at birth (85%) was good; however, schedule-specific knowledge was weaker, notably the correct age for measles (46.67%) and the number of DPT doses (41.67%). Attitudes were largely favourable (86.11% considered immunization important). However, only 264 children (73.33%) were completely immunized; 51 (14.17%) were partially immunized and 45 (12.50%) unimmunized. Child sickness (46.88%) and lack of knowledge (39.58%) were the leading reasons for incomplete immunization, and lack of knowledge accounted for 62.38% of missed scheduled doses. Maternal literacy was associated with immunization knowledge, and immunization status with child sex and maternal religion (p<0.05). Conclusions: A clear knowledge–practice gap was evident; awareness and attitudes were favourable, but about one in four children was incompletely immunized. Schedule-specific counselling, appropriate advice during childhood illness and reduction of access barriers may help convert favourable attitudes into timely immunization.
