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Childhood poverty matters—not only because of the disturbingly high number of children affected, but also because of the deleterious impact on their human flourishing, both now and in the future. Effectively addressing child poverty requires clear identification of the nature and causes of the problem, as well as an understanding of how it is experienced. This paper aims to deepen understanding of child poverty, by drawing on key elements of a capability approach, rights-based approaches, and feminist standpoint theory, and empirical research. It is grounded in the findings of rights-based, participatory research with children aged between 7 and 15 years in Indonesia and in Australia, which cast new light on the dimensions of poverty that are most egregious from a child-driven standpoint. It presents a three-dimensional typology of material, opportunity, and relational poverty. [ABSTRACT FROM AUTHOR]

Social inclusion in Australian higher education was high on the agenda of the recent Rudd/Gillard Australian Government. This paper offers an assessment of that agenda, particularly the extent to which it worked in favour of under-represented groups. It argues that the Government's widening and expansion policies and its equity and aspiration strategies lacked sociological imagination, projecting deficits onto individuals who refused to be taken in by its ambitions for higher education participation. The paper concludes that in the absence of a sociological imagination in government policy, the freedoms of disadvantaged groups continued to be curtailed: not just to choose futures in keeping with their goals but also the freedom to formulate choices. [ABSTRACT FROM AUTHOR]

This paper discusses the regressive nature of tax exemptions for children compared to child allowances and estimates the decline in child poverty in several developed countries due to child allowances. The paper then estimates the decline in child poverty in the United States due to tax exemptions for children and simulates the impact of various possible child allowance programs on child poverty in the United States. It finds that a $3000 to $4000 child allowance would reduce child poverty in the United States to the level of other developed nations and, due to the costs associated with child poverty, be a cost effective policy change. [ABSTRACT FROM AUTHOR]

This review examines the extant Australian literature on process quality in ECEC, which is understood as children’s actual experience within a childcare setting such as interactions between educators and children. A thematic analysis of empirical evidence from the 21 qualified articles reveals key characteristics of ECEC process quality studies, the benefits of process quality to child outcomes, and some factors influencing process quality. The review highlights the increasing interest in ECEC process quality in Australia and that process quality can be linked to children’s outcomes in the early years. It also underscores that outdoor environments and educators’ attributes such as personal experiences and qualifications stood out as the key supporting factors of process quality. More importantly, the review found that most of the process quality studies in Australia were conducted in metropolitan areas, and there were only two studies focused on children from disadvantaged backgrounds. The paper calls for more actions to combine process quality with equity across types of ECEC services. [ABSTRACT FROM AUTHOR]

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Early childhood is an important time for the development of resilience. A recently completed study has followed three cohorts of resilient children and young people living in disadvantaged areas in Victoria, Australia, through different transitions in their educational careers. This paper focuses on the early childhood cohort, where we have followed children from kindergarten/preschool into primary school. Using data gathered primarily through interviews with parents (mothers in each case), this paper presents a qualitative naturalistic sub-study that used deductive thematic analysis to explore the different strategies used by families to support their child's resilience. Our findings highlight that resilience was a salient concept for all of the mothers in the study and each mother articulated a range of strategies they used within the family to try and support their child's development and resilience. These strategies were constrained by the settings in which the families lived. [ABSTRACT FROM AUTHOR]

Background: The quality of the home learning environment has a significant influence on children's language and communication skills during the early years with children from disadvantaged families disproportionately affected. This paper describes the protocol and participant baseline characteristics of a community-based effectiveness study. It evaluates the effects of 'smalltalk', a brief group parenting intervention (with or without home coaching) on the quality of the early childhood home learning environment.Methods/design: The study comprises two cluster randomised controlled superiority trials (one for infants and one for toddlers) designed and conducted in parallel. In 20 local government areas (LGAs) in Victoria, Australia, six locations (clusters) were randomised to one of three conditions: standard care (control); smalltalk group-only program; or smalltalk plus (group program plus home coaching). Programs were delivered to parents experiencing socioeconomic disadvantage through two existing age-based services, the maternal and child health service (infant program, ages 6-12 months), and facilitated playgroups (toddler program, ages 12-36 months). Outcomes were assessed by parent report and direct observation at baseline (0 weeks), post-intervention (12 weeks) and follow-up (32 weeks). Primary outcomes were parent verbal responsivity and home activities with child at 32 weeks. Secondary outcomes included parenting confidence, parent wellbeing and children's communication, socio-emotional and general development skills. Analyses will use intention-to-treat random effects ("multilevel") models to account for clustering.Recruitment and Baseline Data: Across the 20 LGAs, 986 parents of infants and 1200 parents of toddlers enrolled and completed baseline measures. Eighty four percent of families demonstrated one or more of the targeted risk factors for poor child development (low income; receives government benefits; single, socially isolated or young parent; culturally or linguistically diverse background).Discussion: This study will provide unique data on the effectiveness of a brief group parenting intervention for enhancing the early home learning environment of young children from disadvantaged families. It will also provide evidence of the extent to which additional one-on-one support is required to achieve change and whether there are greater benefits when delivered in the 1st year of life or later. The program has been designed for scale-up across existing early childhood services if proven effective.Trial Registration: 8 September 2011; ACTRN12611000965909 . [ABSTRACT FROM AUTHOR]

Foster care has been provided for thousands of vulnerable Australian children from the early nineteenth century. Despite the prevalence of this system of care as the preferred means of providing out-of-home care across the country from the late nineteenth century, very few people who lived in foster care as children have written about their experiences, a total of 23 in all. Although a small sample, these few stories tell a larger one of the complexities of lived experience of foster care: for some it was entirely positive, for others it was wholly negative and for most it was somewhere between those two extremes. What I show in this paper is that what many of the stories have in common, no matter where they sit on that continuum, is the painful acquaintance with social stigma at an early age. [ABSTRACT FROM PUBLISHER]

Background: Positive early development is critical in shaping children's lifelong health and wellbeing. Identifying children at risk of poor development is important in targeting early interventions to children and families most in need of support. We aimed to develop a predictive model that could inform early support for vulnerable children. Methods: We analysed linked administrative records for a birth cohort of 2,380 Northern Territory children (including 1,222 Aboriginal children) who were in their first year of school in 2015 and had a completed record from the Australian Early Development Census (AEDC). The AEDC measures early child development (school readiness) across five domains of development. We fitted prediction models, for AEDC weighted summary scores, using a Partial Least Square Structural Equation Model (PLS-SEM) considering four groups of factors–pre-pregnancy, pregnancy, known at birth, and child-related factors. We first assessed the models' internal validity and then the out-of-sample predictive power (external validity) using the PLSpredict procedure. Result: We identified separate predictive models, with a good fit, for Aboriginal and non-Aboriginal children. For Aboriginal children, a significant pre-pregnancy predictor of better outcomes was higher socioeconomic status (direct, β = 0.22 and indirect, β = 0.16). Pregnancy factors (gestational diabetes and maternal smoking (indirect, β = -0.09) and child-related factors (English as a second language and not attending preschool (direct, β = -0.28) predicted poorer outcomes. Further, pregnancy and child-related factors partially mediated the effects of pre-pregnancy factors; and child-related factors fully mediated the effects of pregnancy factors on AEDC weighted scores. For non-Aboriginal children, pre-pregnancy factors (increasing maternal age, socioeconomic status, parity, and occupation of the primary carer) directly predicted better outcomes (β = 0.29). A technical observation was that variance in AEDC weighted scores was not equally captured across all five AEDC domains; for Aboriginal children results were based on only three domains (emotional maturity; social competence, and language and cognitive skills (school-based)) and for non-Aboriginal children, on a single domain (language and cognitive skills (school-based)). Conclusion: The models give insight into the interplay of multiple factors at different stages of a child's development and inform service and policy responses. Recruiting children and their families for early support programs should consider both the direct effects of the predictors and their interactions. The content and application of the AEDC measurement need to be strengthened to ensure all domains of a child's development are captured equally. [ABSTRACT FROM AUTHOR]

Informal kinship care families in Australia are a large, hidden population. This article provides an overview of international research and policy developments regarding informal kinship care and considers their relevance to Australia. The benefit to children is identified along with the severe economic burden of care falling on caregiving families. Australian Federal and State policy settings are described in relation to the recognition and support of informal kinship care families, and an overwhelming need for better financial and social support is identified. Ways forward to improve the circumstances of these families are considered, together with areas for future research. [ABSTRACT FROM AUTHOR]

Economic disadvantage is a strong predictor of social exclusion, disengagement at school, early school dropout and low educational attainment. This paper shows that experience of significant events - for example, moving home and school following parents' separation; a sudden fall in family income; or illness and death in the family – can greatly exacerbate economically disadvantaged young people's sense of exclusion and disengagement. Survey data are used to show that such negative events (often characterized by young people as 'shocks') are most likely to occur among economically disadvantaged families with children. In-depth interviews with young people are also used to explore young people's construction of these events, which they often describe in terms of a cascade, with several shocks following each other in rapid succession, draining away their, and their families', economic, social and emotional resources, and leaving them at risk of further exclusion. The paper concludes that policy needs to buffer young people better from the effects of these events, and so reduce their disengagement and exclusion. [ABSTRACT FROM AUTHOR]

This paper provides insight into the experiences of six people who completed a Clemente university unit in the second semester of 2009 at the Mission Australia Centre, Sydney. Clemente Australia is a community embedded university humanities course providing higher education opportunity in collaboration with social agencies for people experiencing multiple disadvantage. Each person participated in a semi-structured conversational interview in early 2013 which explored their life journeys since 2009. The responses confirm what is known from the literature regarding the complexity of the lives of people experiencing disadvantage, the immediate and short term value of humanities education, as well as the importance of structures and processes which support this learning. Significantly, the interviews provide a vantage point from which former Clemente students reflected at some distance and considered how participation in Clemente affected their lives. These interviews provide detailed insight into the way each person wove what they encountered in their own way. The findings highlight a shared pattern of Clemente students raising new possibilities, planning on these new possibilities and acting upon them. Together, these insights speak to increased personal self-determination, and offer significant practice and research learnings for Clemente Australia, the higher education sector and social policy. [ABSTRACT FROM AUTHOR]

Child disadvantage is an important issue in Australia today and is one of the key policy target areas of the Federal government. Child disadvantage not only affects child wellbeing in the present time but can also inhibit their future achievements. As well as individual- and family-level effects, there is growing evidence that child wellbeing and achievement is highly affected by the environment in which children grow up, and what resources and role models are available to them in their surrounding areas. In this paper, we examine the spatial clustering of children in jobless households through the computation of the Global and Local Moran's statistics, for the Sydney and Melbourne metropolitan regions, and observe how these clusters have changed between the 2001 and 2006 census years. We find that there are significant spatial clusters of children in jobless households in both periods, suggesting that 'place' is a driver of this particular phenomenon. Further, we observe an expansion of 'hot spots', in both Sydney and Melbourne, suggesting that areas with high proportions of children in jobless households have both persisted and increased despite the sizeable economic growth in Australia over the same period. [ABSTRACT FROM AUTHOR]

Many policymakers assume that children's neighbourhoods shape their career trajectories, but the facts are otherwise. Challenges: (1) Because many children in poor postcodes have disadvantaged families, modelling the causal influence of neighbourhood socioeconomic status (SES) requires a comprehensive set of control variables measuring family background. (2) Adults can choose where to live, so dwelling in a high SES postcode is partially a consequence of occupational success, not a cause. Hence, we must focus on childhood postcode SES. (3) Random measurement error in postcode SES can bias estimates. Data: Large, representative national samples from the International Social Science Survey/Australia. OLS and structural equation models. Correlations between a person's childhood postcode SES and their education, adult occupational status (which robustly measures job quality, social status and permanent income) and family income are all modest, around r =.15. Net of family background (fathers' occupational status, fathers' class, mothers' employment, parents' culture, ethnicity, demographics and respondent's IQ) multivariate analyses show that growing up in a low SES postcode is only a slight disadvantage, which arises entirely because children there get about half a year less education than comparable children in high SES postcodes. Otherwise, there is no statistically significant childhood postcode disadvantage in career opportunities. [ABSTRACT FROM AUTHOR]

The arguments for strategies which prepare children from disadvantaged communities for school are now clear, given research which clearly indicates such children will often commence school behind their peers, a deficit which becomes increasingly difficult to address and leads to longer term economic and social disadvantage. Various countries are attempting a range of strategies to assist these children and their families, including the HIPPY program which addresses the preschool child's educational disadvantage as well as assisting the parents in their role as the child's first teacher. Australia and Turkey are amongst the countries to implement programs utilizing HIPPY principles. This paper reports on recent Australian research which demonstrates that, compared with Australian norms and a comparison group, HIPPY closes the literacy and numeracy gap between disadvantaged children and their peers by the time they enter school. Children utilizing HIPPY had fewer problems in relating to their peers. Parents felt more comfortable in their role, and their parenting style became significantly less angry or hostile. Activities jointly involving parents with their children increased, both in the home and outside in the community. School teachers reported that children who had completed HIPPY were more involved with the school and with their child's learning than other parents, and the children were performing well at school. [ABSTRACT FROM AUTHOR]

Spatial microsimulation techniques have become an increasingly popular way of fulfilling the need for generating small-area data estimates. However, the technique also poses numerous methodological challenges, including the utilisation of two different databases simultaneously to produce estimates of population characteristics at the local level. An important but neglected question is whether different distributions of key variables within these two databases may affect the validity of the spatial estimation results. This study uses the significant policy issue of small-area estimates of child poverty rates in Australia to examine this question. The different income distributions for families with children in the two databases and the consequent effect on child-poverty estimates are assessed, while the apparent validity of these synthetic small-area poverty rates is gauged. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the effect of a 2-year post-natal nurse home visiting (NHV) programme delivered in routine clinical practice to socially disadvantaged mothers on children's development at 5 years.Methods: The study was a natural experiment resulting from progressive rollout of NHV (2008-2012). Children of three groups of mothers, all eligible for NHV, were compared: (i) mothers receiving NHV in a metropolitan region (n = 197); (ii) mothers in a rural region prior to NHV being available (n = 94); and (iii) mothers receiving NHV in the rural region after it became available (n = 84). Outcomes were evaluated using the Child Behaviour Checklist, Child-Parent Relationships Scale, Behaviour Inventory of Executive Functioning and Australian Early Development Index.Results: Analyses were conducted using augmented inverse probability weighting accounting for differences in the groups' baseline characteristics. While some differences were observed in the range of 8-12% between the intervention and comparison groups (albeit with wide confidence intervals, e.g. 31% less likely to 4% more likely to be experiencing poor outcomes). For the majority of outcomes, however, there were no differences observed between the intervention and comparison groups.Conclusions: Post-natal NHV provided as a part of routine service delivery did not improve children's outcomes at 5 years. It may be that in the Australian context a NHV intervention, as offered in this study, does not provide additional benefits over standard care. [ABSTRACT FROM AUTHOR]

Our primary objective was to assess if sustained participation in continuous quality improvement (CQI) activities could improve delivery of 'basic developmental care' to disadvantaged children in primary care settings. Secondary objectives were to assess if delivery of developmental care differed by age and geographic location.Data were analysed using multivariable logistic regression and generalised estimating equations. 109 indigenous primary care centres across Australia from 2012 to 2014 and2466 client files from indigenous children aged 3-59 months were included. Outcome measures were delivery of basic developmental care.We found that the proportion of children who received basic developmental care ranged from 55% (advice about physical and mental stimulation of child) (1279, 55.1%) to 74% (assessment of developmental milestones) (1510, 73.7%). Ninety-three per cent (92.6%, 88) of children received follow-up care. Centres with sustained CQI participation (completed three or more consecutive audit cycles) (508, 53.9%) were twofold more likely to deliver basic developmental care compared with centres without sustained CQI (completed less than three consecutive audit cycles) (118, 31.0%) (adjusted OR (aOR) 2.37, 95% CI 1.33 to 4.23). Children aged 3-11 months (229, 54.9%) were more likely to receive basic developmental care than children aged 24-59 months (151, 38.5%) (aOR 2.42, 95% CI 1.67 to 3.51). Geographic location had little effect (aOR 0.68, 95% CI 0.30 to 1.53). Overall our study found that sustained CQI can improve basic developmental care in primary care settings. However, many disadvantaged children are not receiving services. Improved resourcing of developmental care and CQI in primary care centres is needed. [ABSTRACT FROM AUTHOR]

This study contributes to child voice research that seeks to understand the early childhood education and care (ECEC) experiences of young children. Forty-seven children from seven disadvantaged communities in NSW Australia, including urban, rural and remote areas, participated in a faceto- face interview guided by Ecocultural theory. The children were asked to describe their experiences of the routines and activities of the ECEC service they attended. Analysis of the qualitative data revealed three main themes: connectedness (the importance to children of feeling connected to their peers and carers); special objects (the importance of things from home and ownership) and congruence (the extent to which the centre reflected or contradicted their home environment). Discussion of these findings includes implications for practice. [ABSTRACT FROM AUTHOR]

Background: The ubiquitous supply of junk foods in our food environment has been partly blamed for the increased rates in overweight and obesity. However, consumption of these foods has generally been examined individually perhaps obscuring the true extent of their combined consumption and impact on health. An overall measure of children's junk food consumption may prove useful in the development of child obesity prevention strategies. We describe the development of a children's Junk Food Intake Measure (JFIM) to summarise temporal change in junk food consumption and examine the association between the JFIM and health-related behaviours.Methods: Cross-sectional population surveillance survey of Australian children age 5-16 years collected in 2010 and 2015. Data were collected by questionnaire with parent's proxy reporting for children in years K, 2 and 4 and children in years 6, 8 and 10 by self-report. Information on diet, screen-time and physical activity was collected using validated questionnaires. The JFIM comprised consumption of fried potato products, potato crisps/salty snacks, sweet and savoury biscuits/cakes/doughnuts, confectionary and, ice cream/ice blocks.Results: A total of 7565 (missing = 493, 6.1%) and 6944 (missing n = 611, 8.1%) children had complete data on consumption of junk foods, in 2010 and 2015, respectively. The 2015 survey data showed that among students from high socio-economic status neighbourhoods, there were fewer high junk food consumers than low junk food consumers. Children from Middle Eastern cultural backgrounds had higher junk food consumption. High junk food consumers were more likely to consume take-away ≥3/week, eat dinner in front of the television, receive sweet rewards, be allowed to consume snacks anytime, have soft drinks available at home and a TV in their bedroom. There was a lower proportion of high junk food consumers in 2015 compared to 2010.Conclusion: This is the first study to provide and examine a summary measure of overall junk food consumption among Australian children. The results indicate that junk food consumption among Australian children is lower in 2015, compared with 2010. Still, the public health workforce must continue their efforts as levels of junk food consumption remain of concern among Australian children. [ABSTRACT FROM AUTHOR]

Background: The educational and cognitive differences associated with low socioeconomic status begin early in life and tend to persist throughout life. Coupled with the finding that levels of sedentary time are negatively associated with cognitive development, and time spent active tends to be lower in disadvantaged circumstances, this highlights the need for interventions that reduce the amount of time children spend sitting and sedentary during childcare. The proposed study aims to assess the effects of reducing sitting time during Early Childhood Education and Care (ECEC) services on cognitive development in toddlers from low socio-economic families. Methods/Design: We will implement a 12-months 2-arm parallel group cluster randomised controlled trial (RCT) with Australian toddlers, aged 12 to 26 months at baseline. Educators from the ECEC services allocated to the intervention group will receive professional development on how to reduce sitting time while children attend ECEC. Participants' cognitive development will be assessed as a primary outcome, at baseline and post-intervention, using the cognitive sub-test from the Bayley Scales of Infant and Toddler Development. Discussion: This trial has the potential to inform programs and policies designed to optimize developmental and health outcomes in toddlers, specifically in those from disadvantaged backgrounds. [ABSTRACT FROM AUTHOR]

While events associated with the global financial crisis ( GFC) had a profound impact on real family incomes and well-being in many rich countries, impacts in Australia were relatively minor. One reason for this was the massive policy response by the Australian government at the outset of the GFC, which pumped billions of dollars into the pockets of low and middle income families. This article examines the impact of this stimulus on child poverty in Australia in the context of longer-term policies on income support for families with children. We show that the emphasis of longer-term policy has been to moderate support for families with children and that, since the mid-1990s, rates of relative child poverty have not fallen. We find that while the impact of the stimulus was to reduce child poverty, the underlying trajectory of policies towards family assistance and child poverty in Australia has not changed, and therefore there is no expectation that child poverty will continue to fall in the future. [ABSTRACT FROM AUTHOR]

Historically grounded in a tradition of meeting local skills needs and training the children of the poor, vocational education and training (VET) in schools continues to struggle in terms of esteem and parity of status. Associated in the literature with the training of a reliable and compliant class of workers, it has also been tainted by its links to the processes of social selection and its lowly status in the hierarchy of school subjects. However, VET has also been proposed as a means of democratising the school curriculum and improving accessibility for marginalised populations. The evidence presented in this article suggests that VET provision in Australian schools is of relatively poor quality and furthermore is associated with significant levels of social selection - rather than democratisation. The Australian policy framework, strait-jacketed by the belief that it must avoid narrow instrumentalism, has allowed and assisted the evolution of a low quality, low-intensity VET regime which serves a mainly working-class clientele in mainly working-class schools. In reviewing the current Australian evidence, it argues that if the central debate is one between the competing demands of achieving equity (which is associated with comprehensive provision) and that of achieving quality VET (which is associated with tracked provision) then, sadly, Australia fails to deliver effectively on either of these aims. [ABSTRACT FROM AUTHOR]

Background Cortisol levels are increasingly being used as an indicator of stress levels. Research suggests that children who attend child care demonstrate higher cortisol levels than children in their homes, suggesting that child care acts as a risk factor for poor child outcomes. However, it is also suggested that quality influences outcomes. Methods Cortisol levels were measured through samples of saliva taken from children (3–5 years of age) attending long-day care centres in Perth, Western Australia. Quality of the programme was measured using industry national quality assurance indicators designed for child care centres. The analysis employed a 2 (time of collection: average am cortisol, average pm cortisol) by 3 (centre quality: high, satisfactory, unsatisfactory) split plotanova with repeated measures on the time factor. Results Cortisol levels of children attending high-quality programmes demonstrated a decline across the child care day. Levels in children attending unsatisfactory programmes demonstrated an increase across the day. Conclusions Although we do not yet know how high, and for how long, cortisol levels need to be elevated for risk of undesirable outcomes to increase, this research signals the importance of emphasizing the need for high-quality care for young children. [ABSTRACT FROM AUTHOR]

The article highlights Disadvantaged Schools Program (DSP), a compensatory education for children in poverty. Programs of "compensatory education" for children in poverty were set up in a number of affluent Western countries in the 1960s and 1970s. Little known outside Australia, the Disadvantaged Schools Program (DSP) is one of the few compensatory education programs to operate on a national scale. During the 1950s and 1960s Australian education systems had expanded at breakneck pace, riding an industrial boom and driven by enormous increases in demand at secondary and tertiary level. The idea of a targeted poverty program in education was drawn from the United States and Great Britain, traditionally the two main sources of ideas for Australian education. The result of this conjuncture was that the Disadvantaged Schools Program had a framework derived mainly from overseas poverty programs--it was targeted on a minority and had "compensatory" justification--but also had distinctive local features. First, it was based on the school as its unit of action, not the individual disadvantaged child.

Background: Chronic suppurative otitis media (CSOM) causes preventable deafness and disproportionately affects children living in poverty. Our hypothesis was that health promotion in women's groups would increase their knowledge, attitudes and practices (KAP) regarding ear disease and reduce the prevalence of CSOM in their children.Methods: We did a cluster randomised trial in two village development committees (VDCs) in Jumla, Nepal. In July 2014, 30 women's groups were randomly allocated to intervention or control, stratified by VDC and distance to the road. The intervention groups participated in three sessions of health promotion using the WHO Hearing and Ear Care Training Resource Basic Level. The primary outcome was women's KAP score and the secondary outcome was prevalence of CSOM in their children at 12 month follow-up. Analyses were by intention to treat. Participants and the research team were not masked to allocation.Results: In June and July 2014 we recruited 508 women and 937 of their children. 12 months later there was no difference in the women's KAP score (mean difference 0.14, 95% CI - 0.1 to 0.38, P = 0.25) or the prevalence of CSOM in their children (OR 1.10, 95%CI 0.62 to 1.84, P = 0.75) between intervention and control groups. However, overall, there was a significant improvement in the KAP score (mean difference - 0.51, 95% CI - 0.71,to - 0.31, P < 0.0001) and in the prevalence of CSOM from baseline 11.2% to follow-up 7.1% (P < 0.0001).Conclusions: Health promotion in women's groups did not improve maternal KAP or reduce prevalence of CSOM. Over time there was a significant improvement in women's KAP score and reduction in the prevalence of CSOM which may be attributable to our presence in the community offering treatment to affected children, talking to their parents and providing ciprofloxacin drops to the local health posts. More research is needed in low resource settings to test our findings.Trial Registration: Australia and New Zealand Clinical Trial Registry 12,614,000,231,640 ; Date of registration: 5.3.2014: Prospectively registered. [ABSTRACT FROM AUTHOR]