Background Drowning is the leading cause of death among children aged 0-17 years in rural Bangladesh, resulting in over 14 438 deaths annually-an average of 43 deaths per day. This study aims to identify socioeconomic, demographic and environmental factors linked to child drowning deaths in Northern Bangladesh-a region of high poverty, which is behind in overall socioeconomic indicators compared with other regions in the country. Methods We conducted a cross-sectional survey through purposive sampling to identify child fatal and non-fatal drownings among a total of 18 004 households, comprising 71 185 people, in 2 unions in Northern Bangladesh. Interviews were conducted between January and March 2024 with the households that experienced child drownings in the region. We employed a mixed-methods approach to data collection, using quantitative analysis to examine socioeconomic, demographic and environmental factors, alongside qualitative analysis to explore situational factors associated with drownings in the region. Results Through household visits, a total of 117 households were identified that faced child drowning incidents, comprising 84 fatal (71.8 %) and 33 non-fatal (28.2 %) drownings between 2018 and 2023. The households that faced drownings were comparatively of lower income groups, had lower rates of education and were mostly engaged in agriculture and other domestic work. In 2023, the number of drowning incidents was 34. Out of 117 drownings, 95% occurred between 9:00 and 15:00 hours, and more than 82% occurred between June and October. Out of 117 drowning incidents, approximately 97% of children did not know how to swim prior to the incident. Out of 117 respondents, 73.5% stated that they did not teach their child how to swim. Of those who taught their child to swim, the average age for learning to swim was 8.33 years. Out of 84 child drowning deaths, 75% were male and 25% were female, and the average age was 3.9 years. Out of the 84 fatal drowning deaths, 72.6% occurred in ponds. Conclusion Identification of socioeconomic, demographic and environmental factors associated with child drownings will help to develop feasible prevention strategies and interventions in the region.
Abstract Background Despite well-recognised benefits, Irish breastfeeding rates remain suboptimal. Although associations between breastfeeding and allergic disease are well-researched in younger children, evidence for continued effect in older children is sparse. This Irish prospective cohort study investigated associations between breastfeeding and allergic disease at age nine. Methods The study sample included all nine-year-old children enrolled in the Growing Up in Ireland Infant Cohort Study whose mothers had participated in both Wave 1 and Wave 5. Mothers self-reported infant feeding practices at nine months and allergic diseases at nine years. Multiple logistic regression was used to generate adjusted odds ratios (aOR) for associations between breastfeeding and allergic diseases; re-weighting was applied to enhance generalisability. Results Response rate was 72% (N = 8,006). Most mothers (53%) had ever-breastfed their child; younger mothers, smokers and those of lower socioeconomic status were significantly less likely to have ever-breastfed. Compared to never-breastfeeding, ever-breastfeeding was protective against asthma (aOR 0.74, 95%CI 0.62-0.87) and eczema (aOR 0.72, 95%CI 0.55-0.93) at age nine. Ever-breastfeeding increased the risk of atopic rhinitis (aOR 1.44, 95%CI 1.07-1.94); the association with food allergy was inconclusive (aOR 1.17, 95%CI 0.83-1.64). Breastfeeding ≥6 months was protective against asthma (aOR 0.57, 95%CI 0.39-0.82) and any allergic disease (aOR 0.72, 95%CI 0.55-0.96). Exclusive breastfeeding (3-5 months) was protective against asthma (aOR 0.67, 95%CI 0.50-0.89) and eczema (aOR 0.54, 95%CI 0.34-0.86). Conclusions This study provides new evidence suggesting breastfeeding may be protective against asthma and eczema but may increase the risk of atopic rhinitis in older Irish children. Results must be considered in light of high Irish allergic disease prevalence and action in support of breastfeeding prior to and following birth prioritised accordingly. Key messages Findings lend support to a protective association between breastfeeding and asthma and eczema in later childhood and indicate breastfeeding may play a role in allergic disease prevention. Breastfeeding may reduce the risk of asthma and eczema in Irish children: findings should be used to drive impactful breastfeeding promotion and reorientate cultural norms in favour of breastfeeding.
Introduction We need to live in harmony with our lifestyle rhythms to stay healthy. A problem in our time is that technical devices have no respect for rhythm.If we get caught up in the technique and start neglecting our natural body needs such as sleep, eat and exercise – it will affect our health negatively. Today, children have increasing problems with mental health. When analyzing the problem we find rhythmical problems, often associated to technology. Being a parent in our time is hard. Time has come for us to take active care of our natural rhythms, to stay healthy. Objectives Increasing mental health problems among the young is a global issue in the industrialized world. We see a connection between digitization, the intro of smartphones 2007 and the increase of anxiety, depression and melt downs in children who are left with to little adult guidance. Their screen time becomes to long leading to impaired health due to long sedentary time. The result is not enough physical activity, obesity, introversy because of lack of IRL social contact etc. The problems are well known but why don´t we talk more about them and help our children to deal with it? Methods Read any statistics about mental helath among the young in the industrialized countries. Results While studying the statistics in Sweden over time the results of the bad sustainability of living are clear. Conclusions The adult world needs a wake up call which I will give in my oral presentation. I will also present proposals of solution. Disclosure No significant relationships.
Abstract Background Multisystem Inflammatory Syndrome in Children (MIS-C) is a novel, life-threatening gghyperinflammatory condition that develops in children about 2–6 weeks1 after infection with SARSCoV2. It can create a diagnostic challenge especially if there is no clear history of prior COVID-19 infection or exposure, and because of the varying range of phenotypes and severity. The prognosis however is good as only a 5% mortality has been reported thus far. Methods-Case report Feldstein LR, Rose EB, Horwitz SM, Collins JP, Newhams MM, Son MBF, et al. Multisystem Inflammatory Syndrome in U.S. Children and Adolescents. N Engl J Med. 2020; 383(4):334–46. Case description A 1 year 7-month-old African male presented with persistent fever, vomiting, diarrhoea and poor feeding for 6 days with irritability for 1 day prior to admission. The fever peaked at 40.2C. He had no cough, runny nose or difficulty in breathing. Five days prior to onset of the above symptoms, he was on outpatient treatment for acute tonsillitis and otitis media post exposure to SARS-CoV-2 from the older sibling. On examination he was noted to have oral thrush. 68 Table 1 Summary of initial investigationsWBC (x109/L)ANC (x109/L)HB (g/dL)MCV (fl)Platelets (103/µL)BUN (mmol/L)HCO3 (mmol/L)Na (mmol/L)K (mmol/L)CRP (mg/l)18.811.978.37914615.516.91373.49139 Stool M/C/S: Campylobacter positive Vitamin D: 16.9. He was admitted to the general paediatric ward and was started intravenous fluids, azithromycin, ceftriaxone, paracetamol, ibuprofen and nystatin. Two days after admission, he was noted to be in fluid refractory shock, that needed inotropic support. He was transferred to Paediatric High Dependency Unit and received Intravenous fluids, oxygen via nasal prongs and transfused with packed red blood cells. On day 3 of admission, he was noted to have red swollen cracked lips, exfoliation of skin, swollen feet with a vasculitic rash and a strawberry tongue. A diagnosis of Kawasaki disease with a differential of multisystem inflammatory syndrome was then made. Further investigations were done An ECHO was done that showed moderate cardiac dysfunction, with an Ejection Fraction of 51%, dilated chambers, and mild tricuspid and mitral valve regurgitation which was in support of MIS-C according to the CDC case definition. The child was started on IV immunoglobulin, and subsequent resolution of fevers and hypotension ensued. Three days later, he was noted to have recurrence of fevers and tachypnoea, with persistence of the swelling of the extremities. He received a 2nd dose of IV immunoglobulin and aspirin. Antibiotics were changed to Meropenem, Vancomycin and Fluconazole. His respiratory status worsened, with increased oxygen demand. A chest X-Ray done showed features of pneumonia and a right sided pleural effusion. He was then transferred to ICU. A thoracocentesis was with drainage of 45mls of yellowish blood-stained fluid, with a mixed picture when subjected to Light’s Criteria. At this point, the results from a COVID-19 IgG came back positive, clarifying the diagnosis to be MIS-C. Incidentally, was noted to have hypocalcaemia with low Vitamin D levels. The patient improved with resolution of shock and the pleural effusions, and was discharged home after 13 days in hospital, on Aspirin, Prednisone, Omeprazole, Calcimax, Aldactone and Furosemide. He was reviewed as an outpatient 12 days later, and he was clinically stable. A repeat ECHO was done which showed a structurally normal heart with an EF of 70%. He was advised to taper off steroids, stop furosemide and continue aspirin. A subsequent review 1 month later, showed that he was doing well. Aspirin was discontinued and he was discharged from the cardiac clinic. He was to be reviewed again in the rheumatology clinic after 4 months. Discussion Our patient’s initial presentation was a confounder as it presented as acute gastroenteritis. His clinical picture evolved to present with features that fulfilled the criteria for Kawasaki disease and the case definitions for Multisystem Inflammatory Syndrome in Children (MIS-C)1–3. The initial presentation of gastrointestinal symptoms pointed towards a diagnosis of MIS-C, where gastrointestinal symptoms present in > 80% patients, with some presenting with acute surgical abdomen. His illness progressed rapidly to the point of requiring critical care due to haemodynamic instability, severe cardiac dysfunction and multi-organ involvement (renal, pulmonary, haematological). This is not in keeping with Kawasaki disease, in which <5% of patients develop Kawasaki Disease Shock Syndrome (KDSS) need ICU management. 1The child was also noted to have low vitamin D levels. This raises the possibility of a relationship between MIS-C and low vitamin D levels, as Vitamin D is known to be involved in immune modulation.1,4 Conclusion A high index of suspicion of MIS-C is required in children with COVID exposure with otherwise typical presentation of common paediatric emergency ailments. Although the management is symptom-driven, early recognition and institution of management for MIS-C could be important in delaying or avoiding complications. Further studies would be needed to better understand the aetiology of this disease, as well as the disease course, and hence if timely management contributes to a better clinical outcome for our patients. CDC (2020) Multisystem Inflammatory Syndrome in Children (MIS-C) [Internet]. Centers for Disease Control and Prevention. 1 Multisystem inflammatory syndrome in children and adolescents with COVID-19 (2020) Scientific brief: World Health Organisation. 2Royal College of Paediatrics and Child Health (2020) Guidance—Pediatric multisystem inflammatory syndrome temporally associated with COVID-19, 2020. 3Kabeerdoss J, Pilania RK, Karkhele R, Kumar TS, Danda D, Singh S. Severe COVID-19, multisystem inflammatory syndrome in children, and Kawasaki disease: immunological mechanisms, clinical manifestations and management. Rheumatol Int. 2021; 41(1):19–32 4Yılmaz, K., & Şen, V. (2020). Is vitamin D deficiency a risk factor for COVID-19 in children? Pediatric pulmonology, 55(12), 3595–3601. https://doi.org/10.1002/ppul.25106
Abstract Introduction Many burn patients initially seek treatment at a community hospital after suffering a burn injury and are then transferred to various hospitals before being evaluated by a burn specialist. Due to the increased volume of patients in the emergency department, pediatric burn patients in the past have waited on average 90 minutes to be assessed by a burn provider. A new process was implemented to decrease wait times and increase overall patient and family satisfaction. A breakdown in the process, noted by burn care staff, was the availability of burn care supplies located in the emergency department. Methods • A process developed for burn unit nurses to respond to the emergency department to evaluate all pediatric burn patients was implemented. • A survey was sent to burn nurses looking for the most used supplies while caring for a pediatric burn patient. • Collaborative efforts with the pharmacy department to obtain space in the medication pyxis for the most used ointments in burn care. • Collaborative efforts with the Child Life Specialist to stock the cart with stickers, small toys, and distraction items for pediatric patients. • Collaborative efforts with the attending burn surgeon to develop and implement a protocol for burn team response. • Collaborative efforts with infection control department to ensure proper regulation standards of the cart. Cart Contents: • Gauze • Securement wraps • Wound cleansers • Silver impregnated foam dressing • Non-stick petroleum gauze • Staplers • IV start supplies • Paper tracking tool • Discharge & dressing change instructions • Stickers, small toys, & distraction items Results The Hydro on Wheels cart was implemented in January 2022. A retrospective study of data including pediatric burn patients seen in 2021 was completed. The average wait time to be seen by a burn provider in the emergency department decreased from 90 minutes in 2021 to 34 minutes in the first 6 months of 2022. A follow up survey was sent to hydrotherapy burn nurses to assess the satisfaction of the new process and equipment available. Conclusions Overall decreased wait time for pediatric burn patients to be evaluated by a burn care provider. Burn care nurses felt prepared when responding to a pediatric burn patient in the emergency department. Applicability of Research to Practice The burn unit plans to continue this approach to improve patient and family satisfaction & patient outcomes Future considerations to further improve the process would be to include a patient and family follow up satisfaction survey.
Background Although the United States of America is widely perceived as having superior healthcare, it remains one of the most dangerous wealthy countries for childbirth, with the highest maternal mortality rate (MMR) among developed countries. Despite this, some middle-income Ghanaian mothers continue to travel there to give birth. This study examines the limited empirical research on African expectant mothers seeking maternal care and associated benefits in the United States. Methods This study investigated how twelve Ghanaian mothers and three spouses, purposively sampled from two urban Ghanaian communities, were interviewed between May 2017 and March 2018. Together, they had 37 children: 25 born in the United States (including twins), 11 in Ghana, and one in the UK. The interviews focused on their travel to the U.S., specifically to give birth and access maternal healthcare. The participants described their experiences and compared the expected benefits of American maternal care with what they would have experienced in Ghana. Results The data show that receiving American maternal care was the highlight of their travels, despite eventually obtaining U.S. citizenship for their newborns, who then later pass on its associated benefits to close relatives. In addition to highlighting positive experiences with the U.S. maternal healthcare system, this paper also addresses the challenges faced by birth tourists and their responses to these challenges. Conclusion Drawing on these Ghanaian experiences, this paper calls for a holistic approach to better understand the complex nuances of birth tourism.
Introduction Maternal health services, such as antenatal care (ANC) and institutional delivery, may reduce maternal and child health burdens. However, disparities in service coverage persist across Ethiopia. Pregnant women experiencing intersecting vulnerabilities face particularly significant barriers to accessing care. Understanding how social contexts shape maternal care-seeking behaviours can provide valuable insights into supporting underserved pregnant women, offering guidance for future research and practice. This study examines the influence of social and gender norms, as well as spousal relationship dynamics, on service utilisation among this population. Methods This study is based on cross-sectional baseline data from a parent quasi-experimental study. Screening tools were developed to identify pregnant women facing vulnerabilities in accessing maternal care. A total of 470 pregnant women participated in the survey, which assessed perceived social norms, gender norms, couple communication, decision-making, social support, ANC visits and institutional delivery experiences. Logistic and linear regression analyses were performed. Results Our results showed that descriptive norms, injunctive norms, couple communication and joint decision-making were significantly associated with ANC visits. Descriptive and injunctive norms predicted institutional delivery. ANC visit partially mediated the relationship between social norms and institutional delivery and fully mediated the influence of couple communication on institutional delivery. Our findings also revealed interaction effects among social norms, couple communication and gender norms on health service use. Conclusions This study revealed that health service use among underserved pregnant women is heavily influenced by social norms-the behaviours, attitudes and beliefs of people in their social networks. Interpersonal communication with husbands also played a significant role in shaping maternal service utilisation. The findings suggest that future programmes should engage and educate male partners, family members and peer pregnant women to foster a supportive social environment that encourages care-seeking behaviours among new mothers facing intersecting barriers.
Background Reliable subnational fertility estimates are critical for evidence-based demographic policy and planning. While Botswana's national fertility decline is well documented, less is known about district-level fertility variation and the demographic and socioeconomic mechanisms underlying these patterns. This study aims to: (i) produce district-level fertility estimates using standard direct demographic procedures applied to census data; (ii) assess the consistency of direct estimates with established indirect and model-based fertility estimation techniques; and (iii) examine how women's age structure, child mortality, socioeconomic status, and marital patterns shape spatial fertility differentials across districts. Methods The analysis uses data from the 2022 Botswana Population and Housing Census for women aged 15-49. Direct fertility estimation was conducted through the calculation of age-specific fertility rates (ASFRs) and total fertility rates (TFRs). These estimates were systematically compared with indirect and model-based approaches, including Rele (1967), Hauer et al. (2013), Ponnapalli and Soren (2018), and Hauer and Schmertmann (2020), to assess robustness and internal consistency. Data quality was evaluated using parity distributions and reports of recent births, with attention to potential biases arising from recall error, proxy reporting, and reference-period misclassification. Descriptive demographic analysis was used to assess the influence of age structure, child mortality, women's socioeconomic characteristics, and marital composition on district-level fertility variation. Results Direct and model-based fertility estimates were closely aligned, with national TFR values ranging between 2.6 and 3.0 children per woman, confirming Botswana's advanced stage of fertility transition and the reliability of census-based estimation. However, substantial subnational heterogeneity was observed. Urban districts (e.g., Gaborone, Francistown, Jwaneng) exhibited below-replacement fertility, associated with higher female educational attainment, delayed entry into childbearing, and greater labour market participation. In contrast, predominantly rural districts (e.g., Ngamiland West, Barolong, Central Mahalapye) maintained higher fertility levels (approximately 3.5-4.5), linked to elevated child mortality, lower levels of women's empowerment, and persistent traditional reproductive norms. Districts undergoing socioeconomic transition displayed intermediate fertility profiles. Differences in age structure and child survival emerged as key demographic mechanisms reinforcing spatial fertility inequalities. Conclusion By integrating standard direct demographic techniques with indirect and model-based validation, this study demonstrates the robustness of census data for subnational fertility estimation in Botswana. Persistent spatial and socioeconomic disparities highlight the need for differentiated policy responses: rural districts require intensified investments in child health, female education, and reproductive health services to sustain fertility decline, while urban areas must plan for the social and economic implications of sustained below-replacement fertility. Addressing these divergent trajectories is essential for achieving balanced and equitable demographic development in Botswana.
Executive summary Health visiting is a statutory, universal service at the core of the Healthy Child Programme. It delivers five mandated health and development reviews for all families with children, alongside non-mandated targeted support when needs are identified. These services are led by Health Visitors (HVs) and delivered by multidisciplinary health visiting teams composed of both HVs and Clinical Skill Mix Staff (CSMS). Since commissioning responsibilities were transferred to Local Authorities in 2015, the service has faced sustained workforce and financial pressures. Drawing on new data collected under the Freedom of Information Act from a large sample of Local Authorities across England, this report documents trends in team composition, caseloads, redeployment during the COVID-19 pandemic, and public spending between 2016 and 2021, and considers their implications for current policy. The evidence points to a service under sustained strain: most areas have seen substantial reductions in the number of Health Visitors, rising reliance on lower-band staff, and widespread caseloads above recommended levels. Spending on mandated health visiting has fallen by nearly 20% in real terms. Unless workforce rebuilding and sustained investment are prioritised, the ambitions set out in the NHS 10-Year Health Plan and the Department for Education’s new early years strategy will remain structurally constrained. To inform future policy design, we also provide estimates of the staffing increases and associated costs required to restore caseloads to recommended levels under different workforce-mix scenarios. Key findings Health Visitors fell by 21% between 2016 and 2021, while Clinical Skill Mix Staff rose by 33% ; overall workforce capacity contracted. Workforce composition shifted across England, with nearly 80% of Local Authorities experiencing a decline in the HV share within their teams. Caseload pressures were widespread: around 74% of Local Authorities exceed the recommended 250 children per practitioner , with some exceeding 1,000. During the first wave of COVID-19, 68.7% of Local Authorities redeployed at least one member of their health visiting workforce, often for sustained periods; redeployment was more limited in the second wave. Spending on mandated services across all Local Authorities in England fell by almost 20% in real terms between 2016-17 and 2024-25. Spending cuts have been system-wide: while more deprived Local Authorities typically spend more and employ more health visiting staff per child, spending reductions have followed similar trajectories across all deprivation groups, limiting the scope for early-years public health services to address regional inequalities. Based on 2020 pre-pandemic workforce data scaled to the mid-2024 under-5 population, restoring caseloads to the recommended level of 250 children per practitioner would require hiring around 3,100 staff and an estimated additional £120 million per year in wages .
Background Early in the COVID-19 pandemic, there was a lack of consensus regarding maternity care infection mitigation practices, including maternal-infant separation when COVID-19 was suspected or confirmed, partner presence and breastfeeding. Aim To gain insight into the perceived maternity care and birth experiences of women during and following the COVID-19 pandemic in two neighbouring WHO European-Region countries. Methods Qualitative content analysis was conducted using the text responses to open-ended questions in an online survey regarding hospital-based maternity care experiences of 157 women who gave birth between 2020-2023 in Cyprus and Israel. Findings Three common themes of women's experiences and perceptions in both countries were identified: COVID-19 shaped maternity care context; professional atmosphere of the birth experience; and professionalism of breastfeeding support. Women feared infection, faced restricted partner presence, were separated from their infants, experienced unprofessional communication and received limited breastfeeding support. Conclusion The findings highlight that challenges were amplified during the pandemic, underscoring the urgency for healthcare providers and policymakers to address these concerns. Findings can inform improvement of post-pandemic maternity care to enhance birth experiences and guide emergency preparedness, protecting the needs and rights of birthing women, including permitting a companion of choice, reducing maternal-infant separation and providing early breastfeeding support. Trial registration Clinical Trials NCT04847336.
Artzi-Medvedik R, Hadjigeorgiou E, Kolokotroni O et al.
