Showing papers in "Pediatric Health, Medicine and Therapeutics in 2020"

Magnitude and Factors Associated with Preoperative Anxiety Among Pediatric Patients: Cross-Sectional Study.

Abstract: Background Anesthesia and surgery are common sources of anxiety and stressful experiences in children. This unpleasant sensation depends on several factors. This study aimed to determine the magnitude of preoperative anxiety and associated factors in pediatrics patients at the University of Gondar Comprehensive Specialized Hospital North West Ethiopia 2020. Methods An institutional-based cross-sectional observational study was conducted from March to September 2020 at the University of Gondar Comprehensive Specialized Hospital. After obtaining ethical approval from the institutional review board. All consecutive ASA physical status I & II boys and girls with the age of 2-12 years scheduled for a variety of elective (general, urologic, ENT, ophthalmic and other surgical) operations were included. The level of anxiety was measured using the Modified Yale Preoperative Anxiety Scale short form (m-YPAS-SF) observational tool. Parental anxiety was assessed using Spielberger's short version of state-trait anxiety. Binary logistic regression analysis was performed to identify the association between preoperative children's anxiety and independent variables. The strength of the association was present by adjusted odds ratios. Results The magnitude of preoperative anxiety in children in the operation room was 75.44% (95% confidence interval (CI): 68.36, 81.34). Age (AOR: 3.83; 95% CI: 1.58, 9.30), previous surgery and anesthesia (AOR: 6.73, 95% CI: 1.25, 36.19), outpatient surgery (AOR: 5.16, 95% CI: 1.32, 20.23) and parental anxiety (AOR: 3.26, 95% CI: 1.30, 20.23) were significantly associated with preoperative children anxiety. Conclusion The magnitude of preoperative anxiety in pediatric patients was considerably high in our setup. Younger age, previous surgery and anesthesia, outpatient surgical setting, and parental anxiety were the independent risk factors for preoperative anxiety. Therefore, the operating staff should assess the child's anxiety and should consider appropriate anxiety reduction methods during the preoperative visit of pediatric patients and their families.

Systematic Review of Kingella kingae Musculoskeletal Infection in Children: Epidemiology, Impact and Management Strategies.

Abstract: Kingella kingae, a pathogen often responsible for musculoskeletal infections in children is the most common cause of septic arthritis and osteomyelitis in children 6 to 36 months of age. The aim of this study was to perform a systematic review of previous studies to determine the proportion of K. kingae in bacteriologically proven musculoskeletal infections among the pediatric population. A secondary objective was to describe the diagnostic strategies and outcome of patients with musculoskeletal infections caused by K. kingae. A systematic review was conducted to identify publications that report on musculoskeletal infections caused by K. kingae in the pediatric population (patients 0 to <18 years old with microbiologic culture and/or polymerase chain reaction (PCR) confirmation of K. kingae and a description of the musculoskeletal infection involved). Of 144 studies included in this review, we sought to determine the proportion of K. kingae pediatric musculoskeletal infections. A total of 711 (30.8%) out of 2308 pediatric cases with culture and/or PCR proven musculoskeletal infections had K. kingae successfully identified from twenty-nine studies. Of the 1070 patients who were aged less than 48 months, K. kingae was the organism identified in 47.6% of infections. We found the average age from the collated studies to be 17.73 months. Of 520 pediatric musculoskeletal patients in which K. kingae infections were identified and where the studies reported the sites of infection, a large proportion of cases (65%) were joint infections. This was followed by 18.4% osteoarticular infection (concomitant bone and joint involvement), with isolated bone and spine at 11.9% and 3.5%, respectively. Twenty-one papers reported clinical and laboratory findings in children with confirmed K. kingae infection. The median temperature reported at admission was 37.9°C and mean was 38.2°C. Fourteen studies reported on impact and treatment, with the majority of children experiencing good clinical outcome and function following antibiotic treatment with no serious orthopaedic sequelae.

Prevalence and Factors Associated with Neonatal Mortality at Ayder Comprehensive Specialized Hospital, Northern Ethiopia. A Cross-Sectional Study

Abstract: Background The neonatal period is the most vulnerable time of human life for diseases. Neonatal morbidity and mortality are significant contributors to under-five morbidity and mortality in sub-Saharan Africa. Objective To assess prevalence and factors associated with neonatal mortality at Ayder Comprehensive Specialized Hospital. Methods A facility-based cross-sectional study was conducted on neonates admitted to the neonatal intensive care unit of Ayder Comprehensive Specialized Hospital from June 1, 2018 to May 30, 2019. Data were taken retrospectively from patient records during admission, discharge, and death certificate issue. The data were entered and analyzed using SPSS version 23. Descriptive and logistic regression analysis was done to describe and identify associated factors with neonatal mortality. P-values Results During the study period, 1785 neonates were seen and 1069 (60%) were males. Neonatal mortality rate was 298 (16.7%). Of all the deaths, 98.3% occurred during the first 7 days of age. Respiratory distress syndrome (AOR: 12.56; 95% CI: 6.40-24.66:), perinatal asphyxia (AOR: 19.64; 95% CI: 12.35-31.24), congenital anomaly (AOR: 2.42; 95% CI: (1.48-4.01), early neonatal sepsis (AOR: 3.68; 95% CI: 2.32-5.81), late onset sepsis (AOR: 8.9; 95% CI: 4.14-19.21), gestational age, 34-36+6 weeks (AOR: 0.09; 95% CI: 0.014-0.59), 3741+6 weeks (AOR: 0.025; 95% CI: 0.0030.218), >42 weeks (AOR: 0.039; 95% CI: 0.004-0.4250), parity (AOR: 0.64; 95% CI: 0.44-0.93) and hospital stay (AOR: 0.09; 95% CI: 0.05-0.14) were significantly associated with neonatal mortality. Neonates with a birth weight of less than 1500 g were at 49%, 70%, and 80% increased odds of mortality compared to those 1500-2499 g, 2500-3999 g, and more than 4000 g, respectively. Conclusion In this study neonatal mortality was significantly high. Neonatal mortality was highly associated with primipara, prematurity, low birth weight, perinatal asphyxia, respiratory distress syndrome, congenital anomaly, neonatal sepsis and duration of hospital stay. Many of those cases could be prevented by improving antenatal care follow up, emergency obstetric services, and the enhancement of neonatal resuscitation skills and management of sick neonates.

Effectiveness of Action Observation Training on Upper Limb Motor Function in Children with Hemiplegic Cerebral Palsy: A Systematic Review of Randomized Controlled Trials.

Abstract: The purpose of this review was to evaluate and examine the current best evidence for the effectiveness of action observation therapy on upper limb function rehabilitation in children with hemiplegic cerebral palsy. A comprehensive search of literature published between September 2010 and May 2020 was conducted using the following electronic databases: PubMed, Google Scholar, the Physiotherapy Evidence Database (PEDro), EMBASE, Cochrane library, and Scopus. Only randomized controlled trials evaluating the effect of action observation therapy on upper limb motor function in children with hemiplegic cerebral palsy were included. PEDro scale was used to assess the risk of bias of included trials. This study was reported according to the guideline of the PRISMA statement. The overall methodological quality of the studies was done using the PEDro scale and GRADE approach. The primary outcome measures of this review were the Melbourne Assessment Scale, Assisting Hand Assessment scale to evaluate physical function and structures. Furthermore, the ABILHAND-Kids test, and Box and Block Test primary outcome measures were used to determine the subjects' activities and participation. Nine randomized controlled trials involving 234 participants were analyzed. The overall quality of evidence was rated from moderate to high. This review suggests action observation therapy was found to be a promising intervention for upper limb rehabilitation in children with cerebral palsy.

Juvenile-Onset Recurrent Respiratory Papillomatosis Diagnosis and Management - A Developing Country Review.

Abstract: Recurrent respiratory papillomatosis (RRP) is a condition caused by human papillomavirus (HPV), usually HPV types 6 and 11, which is characterized by recurrent papillomas of the respiratory tract, mainly the larynx. Patients usually present between the ages of 2 and 6 years. The initial presenting symptom is progressive dysphonia, followed by stridor and respiratory distress. Treatment consists of repeated microlaryngoscopic procedures to remove the papillomas as there is no cure. The poor availability and accessibility of appropriate healthcare services in developing countries are barriers to the early diagnosis and appropriate management of patients with juvenile-onset recurrent respiratory papillomatosis (JoRRP), requiring many patients to have a tracheostomy. The introduction of prophylactic vaccines that include HPV6 and HPV11 is necessary in order to reduce the incidence of JoRRP.

Biotinidase Deficiency: Prevalence, Impact And Management Strategies

Abstract: Biotinidase deficiency is an autosomal recessive inherited neurocutaneous disorder. Clinically untreated patients with BD can present with variable neurological and dermatological signs, such as seizures, hypotonia, feeding problems, developmental delay, hearing loss, optic atrophy ataxia, alopecia, and skin rash. Clinical findings of patients with partial BD reported in the literature show that it can occur from infancy to adulthood. Outcomes of newborn screening programs support the fact that biotin treatment started after birth prevents patients with biotinidase deficiency from developing symptoms. Presence of late-onset cases with different clinical findings indicates that there is still much to learn about BD.

Mother's Handwashing Practices and Health Outcomes of Under-Five Children in Northwest Ethiopia.

Abstract: Background Improving handwashing practices of mothers is important in developing countries to reduce child morbidity, mortality, and hygiene-related illnesses. This study aimed to assess mothers handwashing practice and the health effects on under-five children in northwest Ethiopia. Methods The study was an institution-based cross-sectional study conducted from November 2018 to January 2019 at the University of Gondar comprehensive specialized hospital. Four hundred and twenty two randomly selected mothers who have had under-five children were included in the study. Structured questioners were developed to assess handwashing practics and sociodemographic characterististics of mothers, and medical history related data of children were extracted from medical charts. Data entry and clearance were performed by Epi-infoTM version-7 software and exported for analysis to SPSS 22. Adjusted odds ratio with a 95% confidence interval was used to declare statistically significant variables on the basis of p-value Results The proportion of mothers who practiced good handwashing was 39.1% [95% CI: (34.8-43.9)]. More than half (54.3% and 53.6%) of the mothers indicated that they always remind their children to wash their hands before and after eating, respectively. However, 28% of under-five children were admitted to hospital with a diarrheal disease which may have been due to the poor hand washing practices of their mother. The odds of having good knowledge of handwashing practices were 0.26 times lower. Being married increased the handwashing practices of mothers by 2.62 times. Conclusion The majority of mothers who were knowledgable about handwashing were not executing it accuractely. Diarrheal admissions among under-five children have been influenced by their mother's poor hand washing practices. Therefore, it is imperitive to improve the understanding of proper handwashing practices of mothers at every level in the community.

Determinants of Low Birth Weight Among Newborns Delivered in Public Hospitals in Addis Ababa, Ethiopia: Case-Control Study

Abstract: Background Birth weight predicts the infant's future health, growth, and viability. It is a good summary measure of many public health problems that include long-term maternal malnutrition, and poor health care during pregnancy. In developing countries, a birth weight below 2500 g is the leading cause of infant and child mortality. In Ethiopia, LBW had more than 13% prevalence. Determinants of low birth weight were yet to be completely understood. Therefore, this study investigates the predictors of low birth weight. Objective To identify determinants of low birth weight among newborns delivered at Addis Ababa public hospitals, 2019. Methods Institution-based unmatched case-control study was conducted among 279 (93 cases and 186 controls) newborns delivered from March 15 to April 30, 2019, in Addis Ababa public hospitals. Consecutive and systematic random sampling were employed to select cases and controls, respectively. Data were collected by interview using structured and pretested questionnaire. Finally, data were entered using Epi-data 4.2 and analysed using SPSS version 25. Factors having P-value < 0.25 in the bivariable logistic regression model were entered into a multivariable logistic regression model. Statistical significance was declared at P-value ≤ 0.05. Results From 279 selected participants, 270 new-borns (90 cases and 180 controls) participated. In logistic regression model, significant association was found with gestational hypertension [AOR 3.7 (95% CI 1.6-8.7)], maternal height [AOR 5.7 (95% CI 1.7-19.7)], incomplete antenatal visit [AOR 6.7 (95% CI 3.2-15.3)], and low maternal educational status [AOR 3.8 (95% CI 1.3-10.9)]. Conclusion Predictors of low birth weight were maternal height <155 cm, complications during pregnancy, gestational hypertension, and incomplete Antenatal visit, and low maternal education. Stakeholders would better work together to reduce low birth weight by preparing appropriate intervention and monitoring policy.

Pediatric Antimicrobial Stewardship Programs: Current Perspectives

Abstract: With the rapid growth of the field of pediatric antimicrobial stewardship, there has been a marked increase in the establishment of programs dedicated to this specialty. Shared objectives of all pediatric antimicrobial stewardship programs (ASPs) include optimization of antibiotic use and improvement in clinical outcomes for children, while certain core operational strategies and metrics used to measure program effectiveness are typically utilized by pediatric ASPs. Antimicrobial stewardship is the responsibility of every individual who prescribes, dispenses, and administers antibiotics to children, and pediatric ASP principles are rooted in collaboration and cooperation. Pediatric ASPs are uniquely suited to meet the needs of the local populations they serve and the environments within which they practice while also fostering an awareness of the interconnected global nature of pediatric stewardship. As such, pediatric ASPs are well positioned to confront the evolving challenges of antimicrobial overuse and resistance.

Essential Newborn Care and Associated Factors Among Obstetrical Care Providers in Awi Zone Health Facilities, Northwest Ethiopia: An Institutional-Based Cross-Sectional Study.

Abstract: Background Each year, millions of newborns die as a result of birth asphyxia, infections, and complications of preterm birth. This burden of death is disproportionately concentrated in low-income countries including Ethiopia. As a result, the care given immediately after birth is crucial for making a successful transition from intrauterine to extrauterine function and to reduce neonatal mortality. Methods Facility-based cross-sectional study design was carried out on a sample size of 208 obstetrical care providers. A simple random sampling technique was used to select the study subjects. The data were collected through Interview-administered questionnaires and observational checklists. The data were entered into Epi-info version 7 and exported to SPSS 23 for analysis. Results A total of 201 obstetric care providers participated in the study, making a response rate of (96.6%). This study revealed that 62.7% of obstetric care providers practiced essential newborn care properly. The factors significantly associated were received in-service training (AOR = 2.7, 95% CI: 1.35, 5.51), level of education (AOR = 0.46, 95% CI: 0.22, 0.96), midwifery profession (AOR = 3.1, 95% CI: 1.35, 7.39), having good knowledge of essential newborn care (AOR = 2.1, 95% CI: 1.03, 4.49), availability of drugs for essential newborn care (AOR = 2.3, 95% CI: 1.16, 4.72), and availability of medical equipment to perform essential newborn care (AOR = 2, 95% CI: 1.01, 3.96). Conclusion The practice of essential newborn care was generally low. Having in-service training, midwifery profession, a good knowledge of essential newborn care, availability of drugs, level of education, and availability of medical equipment for essential newborn care were the determinant factors for essential newborn care practice. Improvement in essential newborn care practices could be attained through modifiable proven interventions like provision of in-service training, availed drugs, and medical equipment for essential newborn care.

A Facility-Based Cross-Sectional Study on the Implementation of the IMNCI Program in Public Health Centers of Soro District, Hadiya Zone, Southern Ethiopia

Abstract: Background Integrated Management of Neonatal and Childhood Illnesses (IMNCI) is one of the child health programs and it provides an integrated approach and focuses on the well-being of the whole child. Globally, nearly nine million children pass away every year with preventable and treatable conditions. IMNCI program is provided by the health facilities to aid children under five years of age from illness. This study is aimed at assessing the implementation of the IMNCI program in public health centers of Soro District, Hadiya Zone, Southern Ethiopia. Methods The implementation of the IMNCI program was studied using a facility-based cross-sectional study design integrating both qualitative and quantitative data collected from 9 public health centers in Soro district, Hadiya Zone, Southern Ethiopia. A total of 390 (92%) caregivers were included in the study by the proportion of under-five outpatient coverage from each public health center. Data were collected through face to face interviewer-administered questionnaires, document review checklist, observation checklist, and in-depth interview guide. Results Based on agreed criteria resources' availability was 80.11% and judged as fair. Less than 50% of health centers (HCs) had cotrimoxazole and gentamycin. The compliance of health workers was 85.5% and judged as good. Below 85% of prescribed drugs were given correctly for the classified disease. Counseling on medication and follow updates were given for less than 80% of caretakers. The overall satisfaction of clients on IMNCI was 79.5% according to the judging criteria. The caretakers who took less than 30 minutes to reach the health center on foot (AOR=7.7, 95% CI [3.787-15.593]), caretakers who waited for less than 30 minutes to see the health care provider (AOR=2, 95% CI [1.00-3.77]), the caretakers who found prescribed drugs in HCs pharmacy (AOR = 3.7,95% CI [1.91-7.34]), the caretakers who have less than four family size (AOR=2, 95% [1.109-4.061]) were more satisfied in IMNCI services, whereas, caregivers who measured the weight of child were negatively associated with satisfaction (AOR= 0.24, 95% CI [0.13-0.45]). Conclusion This study found that the overall implementation of the Integrated Management of Neonatal and Childhood Illnesses was good. All health centers had trained health workers, ORS, paracetamol, vitamin A, chart booklet, and IMNCI guidelines were available; however, cotrimoxazole, gentamycin, ampicillin, and mebendazole were less abundant drugs in health centers. Further, a large-scale study is required to be conducted in future in other districts to ensure proper implementation of the IMNCI program in Ethiopia.

Prevalence of Intestinal Parasitic Infection and Its Associated Factors Among School Children in Two Primary Schools in Harbu Town, North East Ethiopia: Cross-Sectional Study

Abstract: Background Intestinal parasitic infections (IPIs) are major health problems in many developing countries. School children between the ages of 5 and 15 years suffer the highest infection rate and parasitic burden that are attributed to poor sanitation and hygiene. In Ethiopia, the prevalence of IPIs among school children is high (ranging from 66.7% to 83.8%). Methods School-based cross-sectional study was conducted in two primary schools at Harbu Town, Northeast Ethiopia from February to May, 2018. Systematic random sampling technique was employed to select study participants from the two school compounds. The sample size was determined by a single population proportion statistical formula and the minimum numbers of study participants defined were 400 school children. Socio-demographic and risk factor-related information were collected using structured questionnaire. Data about detection and identification of intestinal parasites were obtained from laboratory examination of stool specimen by using wet mount and formol-ether concentration techniques. Stool specimen from each study participant was collected using clean, properly labeled and leak-proof stool cup. The data were processed and analyzed using SPSS version 20 software. Results Out of a total of 400 study participants, 86 (21.5%) were found with one or more IPIs. Six different types of intestinal parasites were identified, Entamoeba histolytica was the most 33 (8.3%) detected parasite followed by Hymenolopis nana 19 (4.8%) and Schistosoma mansoni 19 (4.8%). The least identified parasite was Giardia lamblia, detected only from four study participants. Male study participants showed 2.42 times risk (AOR = 2.42, 95% CI = 1.25-4.7, P = 0.009) of acquiring parasitic infection than female. Presence of water body near to home and having contact with water bodies showed 7.64 (AOR= 7.64, 95% CI= 3.3-17.8, P= 0.000) and 4.6 (AOR=4.6, 95% CI: 2.04-10.57, P= 0.000) times risk of infection with parasitic infection among school children, respectively. Conclusion IPIs were highly prevalent health problem among the two primary school children in Harbu Town. Sex, availability of water bodies near to house and contact with water bodies were having significant association with the prevalence of IPIs.

Clinical Profile of Covid-19 in Children, Review of Existing Literatures

Abstract: WHO has confirmed that COVID-19 disease is a pandemic on March 11, 2020. The disease is caused by a new virus called SARS-CoV-2. Since, the pandemic was announced around 18,854,287 cases and 708,639 deaths were reported as of August 7, 2020. This review aimed to explore the etiology, pathogenesis, manifestation and complication. The phylogenetic study showed that SARS-CoV-2 is a single-stranded RNA virus. The virus is very contagious and has rapidly spread globally. Its unique structure called S glycoproteins help the virus enters in and cause infection in the body. Children's body reacts against SARS-CoV-2 infections through the involvement of innate and adaptive immune system. The clinical manifestation in children is not specific and not determined. However, fever and cough have mostly been profiled. Though the severe condition is rarely reported in children compared with adults, life-threatening complications, and death associated with COVID-19 disease have been documented. Underlying chronic pulmonary disease, cardiovascular disease, immunosuppression, and obesity significantly contribute to the complications.

Risk Factors of Perinatal Asphyxia Among Newborns Delivered at Public Hospitals in Addis Ababa, Ethiopia: Case-Control Study.

Abstract: Background Perinatal asphyxia determines the newborn's future health status and viability with risk factors yet to be completely understood. It measures the status of the healthcare delivery of an organization including antenatal, intranatal, and postnatal care. In Ethiopia, 31.6% of neonatal mortality was attributed to perinatal asphyxia. This study aimed to assess the risk factors of perinatal asphyxia. Methods An unmatched case-control study was conducted on 213 (71 cases selected using lottery method and 142 controls systematically) subjects in Addis Ababa from November 1, 2018 to June 30, 2019. Data were collected using a structured questionnaire through face-to-face interviews, entered to Epi data version 4.4, and exported to SPSS version 25 for analysis. Logistic regression was used for analysis. Variables with p< 0.25 in bivariate analysis were taken to multivariable analysis. Statistical significance was declared at P<0.05 and findings were presented using texts and tables. Results A total of 210 newborns (70 cases and 140 controls) and their mothers were included with an overall response rate of 98.5%. Antepartum hemorrhage [AOR=7.17; 95% CI 1.73-29.72], low birth weight [AOR=2.87; 95% CI 1.01-8.13], preterm birth [AOR=3.4; 95% CI 1.04-11.16], caesarean section delivery [AOR=2.75; 95% CI 1.01-7.42], instrumental delivery [AOR=4.88; 95% CI 1.35-17.61], fetal distress [AOR=4.77; 95% CI 1.52-14.92] and meconium-stained amniotic fluid [AOR=9.02; 95% CI 2.96-30.24] were significantly associated with perinatal asphyxia. Hence, efforts ought to go to improve the quality of antenatal and intra-natal services.

Exclusive Breast Feeding and Its Associated Factors Among Mothers of <12 Months Old Child in Harar Town, Eastern Ethiopia: A Cross-Sectional Study.

Abstract: Background Exclusive breast-feeding is the practice of feeding breast milk during the first 6 months and no other liquids and solid foods except medications. Despite its demonstrated benefits, exclusive breast-feeding practice in many countries including Ethiopia is lower than the international recommendation. However, studies about exclusive breast-feeding in the study area are limited. Therefore, this study aimed to fill this gap. Methods and Materials Community-based cross-sectional study was employed. A cluster sampling method was used to select 577 women who had a child aged <12 months. Data were collected using a pretested interviewer-administered questionnaire. Epi-Data version 3.1 and SPSS version 21 were used for data entry and analysis. Bivariate and multivariate logistic regressions were used to analyze the association between the dependent and independent variables. Results A total of 577 study participants have participated in the study which gives 97.8% response. Exclusive breast-feeding practice among the mothers was 45.8%. Women in the age group of 26-40 were 2 times more likely to breast-feed than women in the age group of 18-25 at (AOR = 1.980 [95% CI = 1.098, 3.570]). Women who have information about exclusive breast-feeding were two times more likely to breast feed than those who have no information at (AOR = 1.952 [95% CI = 1.130, 3.373]). Those women who initiated breast-feeding early were 12 times more likely to breastfeed than those women who did not initiate early at (AOR = 12.336 [95% CI = 1.331, 14.316]). Conclusion The overall exclusive breast-feeding practice among the women was found to be less. Age, information on breast-feeding and early initiation of breast-feeding were found as important predictors of exclusive breast-feeding. Improving access to information on recommended infant feeding is vital, and encouraging exclusive breast-feeding among mothers through proper counseling and mother-friendly work environment is advisable.

Determinants of Birth Asphyxia Among Newborns in Referral Hospitals of Amhara National Regional State, Ethiopia

Abstract: Background Globally, every year, 2.5 million infants die within their first month of life. Birth asphyxia is one of the leading causes in all low- and middle-income countries and the leading single cause of neonatal mortality in Ethiopia. Therefore, the aim of this study was to identify the determinants of birth asphyxia among newborns admitted to neonatal intensive care units (NICU) in Amhara region referral hospitals, Ethiopia. Methods Facility-based unmatched case-control study was employed from March 1 to April 30, 2018. Cases were newborn babies admitted to neonatal intensive care units with an admission criteria of birth asphyxia with APGAR score of <7 at five min of birth and controls were newborn babies admitted to NICU with an admission criteria of other complications (such as jaundice, congenital anomalies, sepsis, hemorrhagic diseases) with APGAR score of ≥7 at five min of birth. Using SPSS version 20, bivariate logistic regression model was fitted to check the relation of each independent variable to the outcome variable. Variables with p<0.2 in bivariate analysis were transferred to multivariable logistic regression model for final analysis. Variables with an adjusted odds ratio (AOR) of 95%CI and p<0.05 were reported as determinants of birth asphyxia. Results Data were collected from 193 cases and 193 controls with a response rate of 100%. Low birth weight (AOR: 8.94, 95%CI: 4.08, 19.56), born at health centers (AOR: 7.36, 95%CI: 2.44, 22.13), instrumental delivery (AOR: 3.03, 95%CI: 1.41, 6.49), and prolonged labor (AOR: 2.00, 95%CI: 1.20, 3.36) were significant determinants of birth asphyxia. Conclusion Even though most of the identified variables are the common and familiar causes of birth asphyxia, neonates born at health centers were more exposed to birth asphyxia than neonates born in hospitals. This might be due to delay of referral process and lack of skilled professionals in health centers. Further research might be needed to identify the root causes of delays and follow-up issues by adding qualitative component.

Factors Affecting Under-Five Mortality in Ethiopia: A Multilevel Negative Binomial Model.

Abstract: Purpose Even though remarkable declines in under-five mortality rates noticed globally, nearly 5.6 million children still die annually before celebrating their fifth birthday. The 2016 Ethiopian Demographic and Health Survey (EDHS) report revealed that 67 children per 1000 live births died before the fifth birthday. This study aimed at determining factors affecting under-five mortality in Ethiopia using EDHS, 2016. Materials and Methods The data were retrieved from the EDHS 2016, and a total weighted number of 11,023 under-five children were included. Descriptive statistics were reported using tables, graphs, and texts. A multilevel negative binomial regression model was fitted, and adjusted incidence rate (ARR) with a 95% confidence interval (CI) and a p-value <0.05 were reported. The deviance test was used to check the goodness of fit. Results Mother attained higher education (ARR=0.25, 95% CI: 0.10-0.66), female-headed household (ARR=1.32, 95% CI: 1.05-1.66), age of household head (AIRR=1.07, 95% CI: 1.03,1.11), preceding birth interval ≥48 months (ARR=0.51, 95% CI: 0.42-0.61), child who had history of diarrhea (ARR=1.23, 95% CI: 1.08-1.41), multiple birth type (ARR=1.80, 95% CI: 1.34-2.42), mothers who delivered in health facility (ARR=0.86, 95% CI: 0.73,0.94), residents of Addis Ababa (ARR=0.52, 95% CI: 0.28-0.98), and Amhara region (ARR=1.43, 95% CI: 1.09, 1.88) were statistically significant with the number of under-five mortality. Conclusion In this study, under-five mortality remains a public health problem in Ethiopia. Educational status of the mother, women delivered at health institution, preceding birth interval 24-35 and ≥48, and residents of Addis Ababa reduced the incidence of under-five mortality. On the other hand, being a female household head, age of mother at first giving birth, being employed, having multiple births, and childhood diarrhea were associated with a higher incidence of under-five mortality. This finding suggests that enhancing opportunities to female education, addressing regional disparities, and encouraging mothers to deliver at health institutions will help to reduce the burden of under-five mortality.

The Relationship Between the Level of Copper, Lead, Mercury and Autism Disorders: A Meta-Analysis.

Abstract: Background and objectives There is a likelihood of a possible relationship between the concentrations of copper, lead, and mercury and autism. The present review was carried out to determine the relationship between the concentrations of these elements and autism by meta-analysis. Methods In this study, searching Scopus, PubMed, and Science Direct databases, 18 articles conducted in different countries from 1982 to 2019 were collected. Studies' heterogeneity was investigated using the I2 index. The data were analyzed using R and STATA software. Results In these 18 studies, 1797 patients (981 cases and 816 controls) aged 2 to 16 years were examined. Concentration of the samples (blood, hair, and nails) for both case and control groups was evaluated. There was no significant relationship between copper concentration and autism (SMD (95% CI): 0.02 (-1.16,1.20); I2=97.7%; P=0.972); there was a significant relationship between mercury concentration and autism (SMD (95% CI): 1.96 (0.56,3.35); I2=98.6%; P=0.006); there was also a significant relationship between lead concentration and autism (SMD (95% CI): 2.81 (1.64,3.98); I2=97.8%; P=0.000). Conclusion There is, nevertheless, a significant relationship between mercury concentration and autism. Thus, the concentration of mercury can be listed as a pathogenic cause (disease-causing) for autism.

Magnitude of Dental Caries and Its Associated Factors Among Governmental Primary School Children in Debre Berhan Town, North-East Ethiopia.

Abstract: Background In Ethiopia, oral health prevention and treatment have gotten low attention in the government, and the existing dental services are privately owned and thus expensive. Hence, this study aimed to assess the prevalence of dental caries and its associated factors among governmental primary school children in Debre Berhan town, Ethiopia, 2019. Methods An institutional-based cross-sectional study was conducted from January 30 to February 14/2019. A total of 417 primary school children were selected using computer-generated simple random sampling and interviewed using structured and pretested questionnaires. Data were coded, entered, and cleaned using Epi-data version 3.1 and export to SPSS version 22 for analysis. Binary logistic regression analysis was employed to test the association between dependent and independent variables. P-value less than 0.05 was taken as significant association. Finally, the result of this study was present by text, tables, and graphs. Results Out of the 396 study participants, 135 (34.1%) had dental caries. Of these, more than half, 95 (59.37%) had the pre-molar decayed. Two hundred eighty-five (72.0%) of them were cleaned their teeth. The Independent predictors of dental caries were drinking sugared tea [AOR= 2.034, 95% CI: (1.223-3.385)] and food particle on their teeth [AOR= 6.709, 95% CI: (3.475-12.954)], which had shown a significant association with dental caries. Conclusion The over magnitude of dental caries was relatively high and found to be a public health problem. Drinking sugar tea, presence of food particles, or dental plaque were significantly associated with dental caries. In contrast, merchant occupation reduced the chance of dental caries. Giving health education to minimize drinking sugar tea and cleaning their teeth after consumption of sugar tea should be given attention.

Prevalence and Associated Factors of Macrosomia Among Newborns Delivered in University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia: An Institution-Based Cross-Sectional Study.

Abstract: Background Macrosomia is defined as a birth weight of newborns ≥4000 grams irrespective of gestational age. It is becoming a burning public health issue in most developing countries and contributes to maternal and newborn complications. Though macrosomia has been increasing in Ethiopia, evidence about its magnitude and associated factors is limited yet. Therefore, this study aimed to assess the prevalence and associated factors of macrosomia among newborns delivered at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. Methods An institution-based cross-sectional study was carried out from February 23rd to April 23rd, 2020. A total of 491 mothers and their newborns were included in the study. The data were collected by interviewing the mothers and reviewing their charts using a structured questionnaire. The outcome variable was newborn birth weight. Data were entered using Epi-data version 4.6 and analyzed using STATA version 14 software. Bivariable and multivariable binary logistic regression were used to identify the factors associated with macrosomia. Results The prevalence of macrosomia was 7.54%. Gestational age ≥40 weeks (adjusted odds ratio (AOR) = 4.1 (95% CI = 1.7-9.7)), diabetes mellitus (AOR=5.5 (95% CI = 1.2-25)), previous history of macrosomia (AOR = 3.7 (95% CI = 1.4-10)), and male sex (AOR = 3.4 (95% CI = 1.3-8.7)) were significantly associated with macrosomia. Conclusion In the current study, the prevalence of macrosomia was relatively high. The study revealed that maternal diabetes mellitus, higher gestational age, history of macrosomia, and male newborns were the predictors of macrosomia. Thus, obstetric caregivers should give attention to early detection and management of mothers with diabetes mellitus, history of macrosomia, and gestational age of ≥40 weeks during pregnancy to prevent macrosomia and its complications.

Moderate to Severe Diarrhea and Associated Factors Among Under-Five Children in Wonago District, South Ethiopia: A Cross-Sectional Study.

Abstract: Background Diarrheal disease is the second leading cause of death in children under five years old and is responsible for killing around 525 000 children every year. Based on the world health organization estimates, diarrhea contributes to more than one in every ten (13%) child deaths in Ethiopia. Despite the emphasis given to improving child health, many children are still dying due to easily preventable and treatable diarrheal disease in Ethiopia. Methods A community cross-sectional study was conducted on randomly selected under-five children who live in Wonago district. Three hundred eighteen households were selected using a systematic sampling technique. Data were collected using a structured closed-ended questionnaire. Data were cleaned, coded, and entered into the statistical package for social sciences window version 20 statistical software analysis. Results The magnitude of moderate to severe diarrhea in the Wonago district was 30.9%. The number of family members (AOR: 2.7, 95% CI [1.277-5.716]), presence of animals in households (AOR: 2.591, 95% CI [1.188-5.650]), availability of latrine (AOR: 2.129, 95% CI [1.006-4.505]), and hand washing practice during a critical time (AOR: 2.683, 95% CI [1.139-6.319]) were strongly associated with moderate to severe diarrhea. Conclusion Childhood diarrhea remains an important health concern in the study area. This calls for a holistic and multimodal approach for the prevention, early identification, and intervention of diarrhea in children. More emphasis should also be given on personal, household, and environmental hygiene, as well as family planning.

Determinants of Severe Acute Malnutrition Among HIV-positive Children Receiving HAART in Public Health Institutions of North Wollo Zone, Northeastern Ethiopia: Unmatched Case–Control Study

Abstract: Background Over half of the children living with HIV/AIDS suffer from severe acute malnutrition especially in countries having food insecurity like Ethiopia. However, determinants of severe acute malnutrition among HIV-positive children receiving care and treatment in antiretroviral therapy clinics in Ethiopia are not abundantly investigated. The aim of this study was to assess the determinants of severe acute malnutrition among HIV-positive children receiving highly active antiretroviral therapy in public health institutions of the North Wollo Zone, Northeastern Ethiopia. Methods An institutional-based unmatched case-control study was conducted on 204 under-fifteen, HIV-positive children (68 cases and 136 controls). The data were collected by reviewing medical records and by interviewing attendants. Binary and multiple logistic regressions were employed, and odds ratio with 95%CI was used to interpret results. A p-value of <0.05 was considered as a significant difference between cases and controls for the exposure variable of interest. Results A total of 204 under-fifteen, HIV-positive children were included in this study. Of them, 49.5% were males. About 79.4% of those children had acquired HIV infection through vertical transmission. Poor adherence to ART Adj-OR: 5.72 (1.08-30.27), duration on ART Adj-OR: 5.54 (1.44-21.24), severe immunodeficiency Adj-OR: 6.41 (1.09-37.86), advanced WHO clinical stage Adj-OR: 3.58 (1.03-12.43), oropharyngeal disease Adj-OR: 4.72 (1.13-19.73) and chronic diarrhea Adj-OR: 3.98 (1.05-15.04) were identified to be determinants of SAM in those children. Conclusion Determinant factors for SAM among HIV-positive children were chronic diarrhea, severe immunodeficiency, duration and adherence to ART, oropharyngeal disease and advanced WHO clinical stage. Therefore, it is better if interventions are developed and implemented to address these identified factors.

Newborn Care Practices and Associated Factors Among Lactating Mothers at Home in the Rural Districts of Gedeo Zone, Southern Ethiopia.

Abstract: Introduction Globally, approximately three million neonates die in the first month of life. Neonatal mortality is a public problem in low and middle-income counties. Home-based good newborn care practice by lactating mothers is vital to improve newborns' health. In Ethiopia, home-based cultural newborn care practice among lactating mothers is very common, in contrast to standard essential newborn care practice. Thus, this study aimed to assess home-based newborn care practices among lactating mothers and associated factors in rural districts of Gedeo Zone, Southern Ethiopia, in 2018. Methods A community-based cross-sectional study was conducted in the rural districts of Gedeo Zone, Southern Ethiopia. A single population formula was used to determine the sample size, and 834 lactating mothers were enrolled in the study. Multistage sampling techniques were used to select study participants. Data were collected using a pre-tested interviewer-administered structured questionnaire and analyzed by SPSS version 22 software (IBM Corporation, Armonk, NY, USA). To determine associated factors with good newborn care practice among lactating mothers, the odds ratio with 95% confidence interval was used. Results The level of good newborn care practice among lactating mothers at home was 24.1% with 95% CI: 2.5-9.7. The factors significantly associated were maternal education (adjusted OR=2.6; 95% CI: 1.8-3.9), maternal employment (adjusted OR=2.1; 95% CI: 1.4-3.1), pregnancy intention (adjusted OR=1.7, 95% CI: 1.2-2.2), antenatal care visit (adjusted OR=5.7, 95% CI 3.9-7.9), and birth interval (adjusted OR=1.9, 95% CI: 1.3-2.8). Conclusion The level of good newborn care practices among lactating mothers at home was found to be low. Thus, advancing women's education and employment in the community, and providing quality prenatal care are suggested to scale up good newborn care practice among lactating mothers at home. Additionally, an observational study might be needed to identify further associated factors.

Preterm Neonatal Mortality and Its Determinants at a Tertiary Hospital in Western Uganda: A Prospective Cohort Study

Abstract: Background Prematurity contributes greatly to the neonatal mortality burden in sub-Saharan Africa. This study evaluated the proportion of preterm neonatal death, medical conditions at admission, and determinants of mortality of preterm neonates in the neonatal intensive care unit (NICU) of a tertiary hospital in Western Uganda. Materials and methods A prospective cohort study of 351 consecutively enrolled preterm neonates was conducted from March to June 2019. Interviewer-administered questionnaires and physical assessment of neonates were used to obtain socio-demographic and clinical data for mothers and their preterm neonates. Descriptive statistics for participants' characteristics were generated, while bivariate and multivariate logistic regression models were fitted so as to establish the determinants of mortality outcome. A p-value Results In-hospital neonatal mortality of 31.6% (95% CI: 26.9-36.7) was noted, with 65.8% of deaths occurring within 72 hours from admission. The most common medical conditions at admission were: hypothermia (67.2%), respiratory distress syndrome (43.0%), small for gestational age (15.7%), and perinatal asphyxia (14.5%). Under multivariate regression modelling, maternal age ≥35 years (AOR: 4.5; 95% CI: 1.35-15.31), no antenatal care (AOR: 4.7; 95% CI: 1.05-21.21), >4 ANC visits (AOR: 5.3; 95% CI: 1.88-15.21), neonatal resuscitation (AOR: 3.4; 95% CI: 1.66-6.82), outborn status (AOR: 2.3; 95% CI: 1.20-4.50), singleton pregnancy (AOR: 3.7; 95% CI: 1.74-7.89), Conclusion and recommendations In-hospital mortality of preterm neonates was high. We identified various maternal and neonatal risk factors, indicating a need for stakeholders to enhance efforts towards prevention of preterm-associated complications and optimize facility-based continuum of care.

Risk Factors of Birth Asphyxia Among Neonates Born in Public Hospitals of Tigray, Northern Ethiopia.

Abstract: Introduction Birth asphyxia is defined by the World Health Organization as not initiating and maintaining default breathing at birth. Approximately 24% of neonatal deaths occurred annually worldwide due to birth asphyxia. About 3% of the 120 million neonates born each year acquire asphyxia in third world countries. Long-term survivors may experience cerebral palsy, delay in growth, vision, hearing and intellectual deficiency, epilepsy, difficulties with communication and behavior. Thus, this study aims to determine the risk factors of birth asphyxia among neonates who were delivered at public hospitals of Tigray, Ethiopia. Materials and methods Hospital-based unmatched case-control study design was implemented on 390 samples from January to February 2018. Data were collected by interviews using a structured questionnaire and checklist. The collected data were coded and entered using EpiData version 3.1 statistical software and transported to statistical package for social science (SPSS) version 20 software for analysis. Cross-tabulation and odds ratio with 95% confidence interval were computed. Bivariate logistic regression and multivariable logistic regression were done. Multicollinearity was checked. Goodness of fit was checked by the Hosmer-Lemeshow test. Results A total of 260 controls and 130 cases were enrolled in the study. Multivariable logistic regression showed that Primi-parity [AOR 5.5 (CI: 2.5, 12.3)], pre-eclamcia/pregnancy-induced hypertension [AOR12.4 (CI: 4.17, 37.15)], post-term pregnancy [AOR 2.73 (CI: 1.00, 7.55)] meconium-stained liquor [AOR 29.2 (CI: 12.0, 71.1)], cord entangled [AOR 5.67 (CI: 1.66,19.3)] and non-vertex presentation [AOR 5.49 (CI: 2.20,13.7)] were found to be risk factors for perinatal birth asphyxia. Conclusion and recommendations Intrapartum factors and neonatal factors in the index pregnancy have an association with perinatal birth asphyxia. The research finding suggests effective antenatal care follow-up and follow-up of labor progress using partograph after labor initiation.

Geographic Variability and Pathogen-Specific Considerations in the Diagnosis and Management of Chronic Granulomatous Disease

Abstract: Chronic granulomatous disease (CGD) is a rare but serious primary immunodeficiency with varying prevalence and rates of X-linked and autosomal recessive disease worldwide. Functional defects in the phagocyte nicotinamide adenine dinucleotide phosphate oxidase complex predispose patients to a relatively narrow spectrum of bacterial and fungal infections that are sometimes fastidious and often difficult to identify. When evaluating and treating patients with CGD, it is important to consider their native country of birth, climate, and living situation, which may predispose them to types of infections that are atypical to your routine practice. In addition to recurrent and often severe infections, patients with CGD and X-linked female carriers are also susceptible to developing many non-infectious complications including tissue granuloma formation and autoimmunity. The DHR-123 oxidation assay is the gold standard for making the diagnosis and it along with genetic testing can help predict the severity and prognosis in patients with CGD. Disease management focuses on prophylaxis with antibacterial, antifungal, and immunomodulatory medications, prompt identification and treatment of acute infections, and prevention of secondary granulomatous complications. While hematopoietic stem-cell transplantation is the only widely available curative treatment for patients with CGD, recent advances in gene therapy may provide a safer, more direct alternative.

Incidence, Risk and Protective Factors for Unintentional, Nonfatal, Fall-Related Injuries at Home : A Community-Based Household Survey from Ujjain, India

Abstract: Background Childhood injury is an increasing public health burden and considered a major cause of childhood morbidity and mortality worldwide. In this study, we identified the distribution and risk factors for fall-related child injuries at home in Ujjain, India. Methods A community-based, cross-sectional study was conducted in 2017 in Ujjain, India, which included 6308 children up to 18 years of age living in 2518 households. Data were collected using a pretested, semi-structured, proforma from the parents of the included children. Results The overall incidence of home injury was 7.78% (95% confidence interval [CI]: 7.12-8.84) in the last 1 year, ie, 2015-16. The incidence was significantly higher at 5-10 years of age (odds ratio [OR]: 2.91, 95% CI: 1.75-4.85; P 10; aOR: 0.69, 95% CI: 0.56-0.86; P < 0.001 and aOR: 0.67, CI: 0.48-0.94; P < 0.023, respectively), cooking area (combined vs separate; aOR: 0.82, 95% CI: 0.68-1.00; P = 0.057), and whether mother is alive vs not alive (aOR: 2.09, 95% CI: 1.10-3.94; P = 0.023). Conclusion The incidence of fall injuries among children at home in Ujjain, India, was similar to other resource constraint settings. The incidence was higher in rural areas, in the age group of 5-10 years, and in families in which the mother was not alive. By contrast, large and combined families had a lower incidence of falls.

Contribution of Home and School Environment in Children's Food Choice and Overweight/Obesity Prevalence in African Context: Evidence for Creating Enabling Healthful Food Environment.

Abstract: This review aimed primarily to investigate the current trends of overweight and obesity in school children in the African context, secondly to explore the contribution of home and school environments on the children's food choices and lastly suggesting measures for creating a healthier food environment. Despite the increase in overweight and obesity among school children, empirical evidence on their determinants in the African context is scarce, thus calls for consideration of home and school environments. A literature search was conducted between October and December 2018 using Medline (PubMed), Directory of Open Access Journals, Google Scholar, manual search and "grey" literature. This review included articles published between the 1st January 2008 and 30th June 2018. Out of 343 articles, 49 were included for the full text reading after meeting the inclusion criteria. Five reports from grey literature were also included. Results show that the prevalence of overweight and obesity among school children in Africa is increasing and ranges from 40% in the 10-year period in which the review was taken. High socio-economic status, urban residence and female gender predicted higher prevalence of overweight/obesity. Few reviewed articles on the contribution of home and school environments on children's food choices showed a shred of evidence, thus calls for further research to address this gap. This review found an increasing prevalence of overweight and obesity in school children in Africa. Therefore, further investigation of home and school environment is imperative to curb the increase in the magnitude of overweight and obesity.

Prevalence of Exclusive Breast Milk Feeding at Discharge and Associated Factors Among Preterm Neonates Admitted to a Neonatal Intensive Care Unit in Public Hospitals, Addis Ababa, Ethiopia: A Cross-Sectional Study

Abstract: Background Studies show that rates of breast milk feeding are much lower among preterm infants than term infants, and breast milk feeding at discharge varies widely between countries. However, research examining factors associated with exclusive breast milk feeding at discharge among preterm neonates in Ethiopia is limited. The study aimed to assess the prevalence of exclusive breast milk feeding at discharge and associated factors among preterm neonates at the neonatal intensive care unit (NICU) in public hospitals, Addis Ababa, Ethiopia. Methods This facility-based cross-sectional study was conducted from February to March 2017 among preterm infants discharged from the NICU of public hospitals. Data were collected using pretested structured questionnaires. Purposive sampling technique was used. Factors associated with exclusive breast milk-fed infants at discharge among preterm neonates were determined using bivariate and multivariate logistic regression models. Statistically significant associations were declared at P<0.05. Results The study assessed 263 mother-preterm dyads. The findings from this study revealed that 71.9% of exclusive breast milk-fed infants at discharge at NICU of the selected Public hospitals in Addis Ababa. Factors associated with exclusive breast milk-fed infants at discharge included duration of hospital stay for 7-14 days (AOR 0.19, 95% CI 0.049-0.808) and more than 14 days (AOR 0.20, 95% CI 0.046,0.891), Initiation of breast milk expression later than 48 hrs postpartum (AOR 0.10, 95% CI 0.032-0.365) and receiving hospital support (AOR 39.00, 95% CI 11.676-130.290). Conclusion In this study, nearly ¾ of the NICU premature population exclusively breast milk fed at discharge, which designates to establish exclusive breastfeeding in the majority of preterm infants in this cohort. Thus, support for exclusive breast milk fed should be at the forefront of maternity practice in hospital and mothers of preterm infants to be guided to initiation of early breast milk expression as soon after delivery as possible and frequent expression thereafter.

Scrub Typhus in Children at Tribhuvan University Teaching Hospital in Nepal

Abstract: Introduction Scrub typhus is an acute undifferentiated febrile illness with varied nonspecific manifestations. It dramatically responds to appropriate antibiotic if started earlier in the course of disease leading to significant reduction in morbidities and mortalities. Objective To describe the clinical profile, treatment and prognosis of scrub typhus in children. Patients and methods Serologically confirmed children with scrub typhus admitted to Tribhuvan University Teaching Hospital (TUTH) over a period of 3 years (April 15, 2015, to April 14, 2018) were retrospectively analyzed for clinical manifestations, investigations, complications and treatment outcomes. Findings A total of 84 children (39 boys, 45 girls) were found to have serologically confirmed scrub typhus. Apart from fever which was invariably present in all children, the most common symptoms were that of respiratory system such as shortness of breath, gastrointestinal system which were vomiting and abdomen pain followed by headache. On physical examination, the most frequent clinical signs were hepatosplenomegaly, edema, eschar and lymphadenopathy. Hepatitis, myocarditis and meningitis were the most common complications. Most patients had the shortest defervescence of less than 48 hours with oral doxycycline (64.7%) followed by intravenous chloramphenicol (56.7%). The overall mortality rate was 4.8%, all due to multiorgan dysfunction. Conclusion In a country like Nepal, scrub typhus should be suspected in any child who presents with fever associated with shortness of breath, abdomen pain, vomiting, headache and clinical findings suggestive of multisystem involvement such as hepatitis, myocarditis or meningitis. Early empirical medical management based on high clinical suspicion while waiting for definitive serological report with oral doxycycline or intravenous chloramphenicol may prevent complications of scrub typhus thereby reducing mortality.