Antimicrobial use among children in Japan has declined substantially; however, tetracycline use has increased among adolescents, particularly after 2017 and during the COVID-19 period, and the underlying clinical indications remain unclear. We aimed to characterize long-term trends in oral tetracycline use, changes in clinical indications, and treatment patterns among individuals aged < 20 years in Japan. We conducted a time-series analysis using a nationwide administrative claims database of Japan Health Insurance Association from 2015 to 2023, including 24 million individuals aged < 20 years. Oral tetracycline use was measured as days of therapy (DOTs) per 1000 inhabitants per day, and clinical indications were identified using ICD-10 codes. We assessed trends in tetracycline use and indications over time and described treatment patterns, including concomitant therapies, among patients with acne vulgaris. Oral tetracycline use increased from 0.95 to 1.76 DOTs per 1000 inhabitants per day between 2015 and 2023, primarily driven by doxycycline, with a marked rise after 2020 and highest use among adolescents. The clinical indications shifted substantially, with the proportion of acne vulgaris increasing from 34.1% to 73.6% while respiratory infections decreased, and the mean treatment duration for acne was 37.9 days. Among patients with acne, concomitant use of adapalene- and benzoyl peroxide-based therapies was limited, whereas topical antibiotics were commonly used. Oral tetracycline use among individuals aged < 20 years in Japan increased substantially, with a marked shift in clinical indications toward acne vulgaris. These findings provide a basis for further evaluation of acne treatment patterns, including the use of oral tetracyclines and non-antibiotic topical therapies, in Japan.
Objectives A population approach focuses on improving the health status of the entire population, depending on the fact that the majority of diseases occur among low-risk individuals rather than high-risk individuals. However, the onset of permanent tooth caries in children with high or low caries risk remains unclear, especially among children of different socioeconomic statuses. This study investigated the distribution of caries occurrence in children across different caries experience and income groups. Methods This cohort study was based on the Adachi Child Health Impact of Living Difficulty (A-CHILD) study, which surveyed all elementary school children in Adachi City, Japan. The explanatory variables were the number of permanent carious teeth and three tertiles of income when children were 7 or 8 years old in 2016. The outcome was an increase in permanent carious teeth when children were 11 or 12 years old, between 2016 and 2020. Negative binomial regression analyses were applied with adjustment for sex. Results Among the participants (n=3,321), the low-income group had 1.44 (95% CI: 1.14; 1.81) times higher risk than the high-income group. Children with two or more carious teeth showed 2.52 (95% CI: 1.57; 4.06) times higher caries risk than caries-free children. However, over 80% of carious teeth occurred among caries-free children in all income groups. Conclusions The majority of new caries cases occurred not merely in high-risk children but in a large number of initially low-risk children, regardless of income level. These findings suggest the importance of a population approach in preventing caries. Clinical significance The majority of new caries lesions occurred in caries-free children across all income statuses. The population approach appears appropriate for preventing the incidence of dental caries among elementary school children.
Abstract Background Infant mortality characterizes a critical public health concern in developing country like India, with considerable disparities across socio-economically marginalized and deprived communities. Despite widespread research at the national and state levels, inadequate empirical evidence exists regarding infant mortality among the tea garden labour community in Assam, who exhibits distinct socio-cultural and livelihood conditions. Addressing this gap, the current study aims to explore the level and determinants of infant mortality among the tea garden community in Assam. Method The study is empirical in nature, based on primary data collected from 1,308 households across five main tea-growing districts of the state- Dibrugrah, Tinsukia, Sivasagar, Jorhat and Sonitpur, adopting a multistage random sampling method. Information was obtained from women belonging to the reproductive age group (15–49 years). The analysis of the research employs a binary logistic regression model to determine the key factors influencing infant mortality. Result The findings of the study reveal that average infant mortality rate in the study area is 33.14 per 1000 live births during the reference period 2019–2023. The results of the regression analysis reveals that maternal education, pre-maturity at the time of birth and ante-natal care of the mother during pregnancy are the most significant determinants (p < 0.001) of infant mortality in the study. Moreover, sanitation facility (p < 0.05) and sex of the child (p < 0.10) are also found to be significant factors having marginal effects on infant mortality. On the contrary, the influence of other variables such as Monthly Income of Household, Mother’s Age at birth, Birth Order of infant, and Access to Safe Drinking Water are not found to have significant impact on experience of infant mortality. Conclusion The study therefore highlights the need for targeted policy measures and interventions focusing on maternal education, healthcare availability and accessibility, and improved sanitation to reduce infant mortality among the tea garden communities. These findings of the study provide context-specific insights that can help in policy formulation for marginalized population in Assam.
Background Diarrhoeal diseases remain a major cause of under-five mortality in South Asia despite global health progress. This study quantifies the economic losses due to premature under-five deaths from diarrhoeal diseases, analyzing trends, aetiologies, and risk factors across five South Asian countries between 2010 and 2023. Methods Using data from the datasets published by the Institute for Health Metrics and Evaluation (IHME) and World Bank indicators, the study applied the human capital approach to estimate the present value of lost future labour income associated with diarrhoeal deaths among children under five. Losses were estimated in both purchasing power parity (PPP)-adjusted and nominal U.S. dollars to reflect real productivity losses and fiscal implications, respectively. Results While age-standardized mortality and DALY rates declined significantly across South Asia (EAPC - 5.2 for both), the economic burden of premature mortality due to childhood diarrhoeal diseases remained substantial. India accounted for the largest absolute loss in future labour income, estimated at USD 5,581 million PPP, followed by Pakistan (USD 1,571 million PPP) and Bangladesh (USD 360 million PPP). When expressed relative to national GDP using nominal estimates, Pakistan experienced the highest proportional economic loss, equivalent to approximately 0.055% of GDP in 2023, followed by India (0.020%), Bangladesh (0.012%), and Nepal (0.005%). Major etiological agents included rotavirus, Shigella, and Escherichia coli, while unsafe water, poor sanitation, and child undernutrition were the leading attributable risk factors. Conclusions and policy implications Despite epidemiological gains, diarrhoeal diseases continue to impose substantial economic and developmental costs in South Asia. Strengthened investments in WASH infrastructure, nutrition, and vaccination programs can yield dual benefits by saving lives and reducing future productivity losses. Integrating child health strategies into national economic planning is imperative for sustainable growth.
Introduction Bidis (small hand-rolled cigarillos) account for 85% of smoked tobacco products in India. The bidi industry is criticised for health hazards, economic exploitation, poor social security, long hours, low wages and contractualisation. This study examines bidi industry practices in India and how these allow it to resist tobacco control measures. Methods The study was conducted in Murshidabad (West Bengal) and Jabalpur/Narsinghpur (Madhya Pradesh) districts, which were selected for their significant bidi roller populations. Interviews were conducted with 200 bidi rollers and 17 key stakeholders, including munshis (middle-men/intermediaries), community/youth club representatives and labour union leaders, with assistance from 10 'champions' (trusted community insiders). Participants provided informed consent and their confidentiality was ensured. Interview data, in Bangla and Hindi, were translated into English and then analysed thematically. Findings Five major themes emerged. First, bidi companies engage in image-building corporate social responsibility activities that mirror tactics used by multinational cigarette companies, creating a facade of social responsibility while exploiting workers. Second, the industry systematically violates government policies through wage discrepancies, provident fund fraud and false worker registration to evade compliance. Third, systemic inequity pervades the sector, with median wages at only 38-53% of government-mandated rates. Fourth, unjustified bidi rejections facilitate widespread illicit trade that evades taxation and government oversight. Fifth, child labour remains entrenched in West Bengal. Conclusion Bidi companies' current practices perpetuate labour exploitation and illicit trade. We recommend uniform national guidelines that require transparent operations and mandatory registration of all bidi rollers.
Neonatal hyperbilirubinemia is common, but bilirubin-induced neurologic dysfunction (BIND) remains an important cause of preventable morbidity, particularly in preterm infants. Japan has developed a distinctive approach centered on unbound bilirubin (UB), the biologically active fraction. Nakamura and colleagues pioneered neonatal UB measurement in the 1970s and incorporated UB measurements into the Kobe University (Nakamura) criteria in 1991. With improved survival of extremely preterm infants, bilirubin encephalopathy was still observed despite modest total serum bilirubin (TSB) levels that persisted beyond the first postnatal week. These observations led Morioka to revise the criteria in 2017, incorporating gestational age (GA), corrected GA, UB levels, and staged treatment throughout the prolonged neonatal course. Clinical experience suggests that this approach may reduce phototherapy exposure without increasing UB levels or exchange transfusion, although multicenter evidence with long-term neurodevelopmental outcomes remains limited. The Japanese experience emphasizes longitudinal monitoring and bilirubin-albumin binding characteristics beyond TSB levels alone. Transcutaneous bilirubin, albumin, and bilirubin-albumin molar ratio may facilitate screening, while emerging fluorescence-based methods may improve UB accessibility. UB measurement should be viewed as a framework for individualized risk assessment, with principles adaptable to diverse populations and clinical settings.
Objective Type 1 diabetes (T1D) management in children requires a comprehensive approach tailored to developmental stages and school environments. This study investigated the locations of self-management behaviors at school, examining factors influencing location choice and their associations with glycemic control. Research design and methods This multicenter, cross-sectional study analyzed 2018 registration data from 1,105 children with T1D attending schools or preschools in Japan. Associations among HbA1c, care behaviors, locations, treatment modalities, age, and sex were statistically evaluated. Results The mean (SD) HbA1c was 8.01% (1.12%) (64.0 [12.2] mmol/mol). Care locations were the classroom (36.9%), designated rooms (52.6%), and the restroom (5.9%). HbA1c was significantly higher in the restroom group at 8.56% (0.98%) (70.1 [10.7] mmol/mol) than in the classroom group at 8.00% (1.20%) (63.9 [13.1] mmol/mol) and designated room group at 7.95% (1.08%) (63.4 [11.8] mmol/mol) (P < 0.001). Restroom use and omitting prelunch blood glucose monitoring were independently associated with higher HbA1c. Pump use, continuous glucose monitoring, and male sex predicted higher classroom use and lower restroom use. Joinpoint analysis showed that classroom use declined after age 6 (elementary school entry), whereas restroom use emerged from age 11 and spiked markedly at age 16 (20.8%), coinciding with high school entry, even among pump users. Conclusions Care location choice shifts dynamically with age and school transitions, with restroom use being linked to poorer glycemic control. Supporting youth during school transitions requires targeted environmental adjustments and enhanced school-wide understanding to ensure safe and appropriate care locations.
Abstract Street-working children occupy a paradoxical position in rapidly urbanising economies: they are legally too vulnerable to be treated as ordinary workers, yet often too poor to withdraw from work without a viable survival alternative. This study examined social risks and protection gaps affecting street-working children. A mixed-methods field study was conducted in Ho Chi Minh City, Vietnam, in May 2024. It included a questionnaire survey of 150 children aged 5–17 years, 40 in-depth interviews, six focus-group discussions, and five case studies. Findings show that street work is embedded in a household-street economy shaped by precarious housing, fragile schooling, informal urban demand, and family reliance on children's earnings. Among surveyed children, 59.7% had dropped out of school, 62.7% worked seven days per week, and 69.7% of cash earners used their income to support family needs. Reported protection-relevant exposures included stigma or discrimination (26.7%), physical attack (20.7%), inappropriate touching (7.3%), and forced unwanted sex (2.7%). Formal prevention contact was limited: more than 80% had never participated in several child-labour-prevention activities, and 93.5% did not know of local programmes. Drawing on child-labour, street-situation, and rights and service-access scholarship, effective exit pathways require coordinated child protection, school continuity, family livelihood support, and sustained outreach.
The rapid expansion of digital technology has revolutionized education, communication and healthcare but created a parallel crisis: e-waste. Globally, 53.6 million tonnes were generated in 2019, with only 17.4% formally recycled. The remainder is processed through unsafe methods such as open burning, acid leaching and crude dismantling. Children and pregnant women are especially vulnerable due to rapid growth, immature organs and special circumstances. India is the world's third-largest e-waste generator, producing 1.71 million tonnes annually,1 while WHO estimates report 3230 kilotons in 2019.1 Over 90% is handled informally, often involving child labour or exposure in contaminated communities. Documented childhood injury includes impaired neurodevelopment, poor birth outcomes, respiratory illness, endocrine disruption, immune dysfunction, DNA damage and higher lifetime risk of chronic diseases. Despite E-Waste Management Rules, awareness among paediatricians, policymakers and parents remains limited. Urgent measures include training, biomonitoring, prohibition of child labour and integration of e-waste risks into national child health programmes. Protecting children from e-waste is both a health necessity and a developmental imperative aligned with many local Sustainable Development Goals.
Background: Determinants of non-institutional delivery, particularly in the antenatal period, have been described previously, but less is known about the sequence of events during pregnancy and decision-making processes occurring between labour onset and birth. Aim: We explored reasons for non-institutional births and pathways leading to home and in-transit deliveries in a north Indian setting, with the aim of identifying context-specific, actionable recommendations. Methods: Participants were women from the north Indian site of the Redefining Maternal Anemia in Pregnancy and Postpartum (ReMAPP) cohort who experienced non-institutional delivery. We conducted an exploratory qualitative study using a semi-structured in-depth interview guide. An a priori conceptual framework was developed based on existing continuum-of-care literature and structured around the antenatal, intrapartum, and postnatal phases of care. The framework focused on the "decision-to-delivery pathway" and was subsequently iteratively refined and elaborated based on the thematic findings. Findings: Of the 2000 women enrolled at the north Indian site of the ReMAPP study, 75 (3.8%) experienced non-institutional delivery; among these, 50 participants were interviewed. Among those interviewed, 19 had planned, and 31 had unplanned non-institutional deliveries. Themes identified for planned non-institutional deliveries included perceived mistrust in healthcare, institutional avoidance, reliance on informal maternity care systems, and decision-making uncertainty. For unplanned non-institutional deliveries, themes included intention to institutional delivery, delay in obtaining appropriate maternity care, physical access barriers, reliance on informal birth assistance, and opportunities to avail health system services for post-delivery or newborn care. Conclusions: Our findings suggest that improving institutional delivery coverage requires more than physical access to facilities. Trust, respectful maternity care, timely responsiveness during labour, and birth preparedness appear to strongly influence whether women are able to reach and utilise institutional delivery services.
