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Background: The Equitable Impact Sensitive Tool (EQUIST) was developed to address the limitations of the traditional cost-effectiveness analysis (CEA) in global health, which often overlooked equity considerations. Its primary aim was to create more effective and efficient health systems by explicitly incorporating equity as a key driver in health policy decisions. This was done in response to the recognition that, while CEA helped reduce mortality rates through interventions like childhood vaccinations, it was insufficient in addressing growing inequalities in health, especially in low-and-middle-income countries (LMICs)., Methods: The development of EQUIST involved a multi-stage process which began in 2011 with the recognition of the need for a more nuanced approach than CEA alone. This led to a proposal for creating a tool that balanced cost-effectiveness with equity. The conceptual framework, developed between March and May 2012, included assessments of intervention efficiency by equity strata, effectiveness, impact, and cost-effectiveness. Key to EQUIST's development was its integration with other data science platforms, notably the Lives Saved Tool and the Marginal Budgeting for Bottlenecks tool, allowing EQUIST to draw on comprehensive data sets and thus enabling a more detailed analysis of health interventions' impacts across different socio-economic strata., Results: EQUIST was validated in 2012 through applications in five representative countries, demonstrating its ability to identify more equitable and cost-effective health interventions which targeted vulnerable populations, leading to more lives saved compared to traditional methods. It was then used to develop investment cases for the Global Financing Facility, resulting in significant funding being made available for maternal and child health programmes. Consequently, EQUIST directly influenced the development of national health policies and resource allocations in over 26 African countries., Conclusions: EQUIST has proven to be a valuable tool in developing health policies that are both cost-effective and equitable. In the future, it will be further integrated with other tools and expanded in scope to address broader health issues, including adolescent health and human immunodeficiency virus/acquired immunodeficiency syndrome programme planning. Overall, EQUIST represents a paradigm shift in global health economics, emphasising the importance of equity alongside cost-effectiveness in health policy decisions. Its development and implementation have had a tangible impact on health outcomes, particularly in LMICs, where it has been instrumental in reducing maternal and child mortality while addressing health inequities., Competing Interests: Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and disclose the following activities and/or relationships: IR and HC are co-Editors-in-Chief of the Journal of Global Health. Mickey Chopra is a member of the editorial council of the Journal of Global Health. To ensure that any possible conflict of interest relevant to the journal has been addressed, this article was reviewed according to best practice guidelines of international editorial organisations., (Copyright © 2023 by the Journal of Global Health. All rights reserved.)

Background: Ghana was one of the few countries commended to have halved extreme poverty after the MDG era yet the under-five mortality rate (U5MR) was dire. Ghana's U5MR is still above the national and global SDG target. As a result, the government has over the years implemented other complementary social and policy interventions to improve the socioeconomic status of households to ensure better child health outcomes. Yet key gaps exist and threaten child health outcome sustainability, and child health-related SDG targets. In this regard, we hypothesize that household wealth should therefore not influence under-five child deaths significantly. Methods: The paper first reports the under-five mortality trend over the past 30 years in Ghana. It uniquely analyses the levels and trends in wealth as measured by the Gross National Income per capita at purchasing power parity (ln GNI/p, ppp) as a proxy of the mean Comparative Wealth Index (CWI) against under-five child deaths in Ghana. Using data from the 2014 Ghana Demographic and Health Survey and employing the logistic regression estimation technique, the paper further estimates the effect of household wealth and other key covariates on under-five child deaths. Implemented government poverty-alleviating policies and intervention programs to reduce childhood mortality in Ghana were reviewed to identify risk gaps to child deaths. Results: The 30 year trend analysis from 1990 to 2020 shows that the under-five mortality rate in Ghana is still high, falling short of the rate of decline that is expected toward achieving the 2030 SDG target for U5MR of 25 deaths per 1000 live births. Our empirical estimations show that household wealth still has a negative and significant relationship with under-five child deaths despite the government's existing poverty-alleviating and pro-poor health policies. In addition, the results show that regional differences, maternal age, the number of children alive, and attendance to postnatal healthcare services are crucial for child survival. Conclusion: The results imply that the government should consolidate universal programmes with intensified targeted interventions toward improving household wealth, especially in the Northern Savannah regions. A new and dynamic child health policy is imminent to reflect strategies towards achieving the SDG target on U5MR. Additionally, intensive education on active maternal participation in postnatal care should be given critical consideration to improve child survival. [ABSTRACT FROM AUTHOR]

Zimbabwe has implemented universal antenatal care (ANC) policies since 1980 that have significantly contributed to improvements in ANC access and early childhood mortality rates. However, Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS), two of Zimbabwe's main sources of health data and evidence, often provide seemingly different estimates of ANC coverage and under-five mortality rates. This creates confusion that can result in disparate policies and practices, with potential negative impacts on mother and child health in Zimbabwe. We conducted a comparability analysis of multiple DHS and MICS datasets to enhance the understanding of point estimates, temporal changes, rural–urban differences and reliability of estimates of ANC coverage and neonatal, infant and under-five mortality rates (NMR, IMR and U5MR, separately) from 2009 to 2019 in Zimbabwe. Our two samples z-tests revealed that both DHS and MICS indicated significant increases in ANC coverage and declines in IMR and U5MR but only from 2009 to 2015. NMR neither increased nor declined from 2009 to 2019. Rural–urban differences were significant for ANC coverage (2009–15 only) but not for NMR, IMR and U5MR. We found that there is a need for more precise DHS and MICS estimates of urban ANC coverage and all estimates of NMR, IMR and U5MR, and that shorter recall periods provide more reliable estimates of ANC coverage in Zimbabwe. Our findings represent new interpretations and clearer insights into progress and gaps around ANC coverage and under-five mortality rates that can inform the development, implementation, monitoring and evaluation of policy and practice responses and further research in Zimbabwe. [ABSTRACT FROM AUTHOR]

ObjectivesVitamin A deficiency affects an estimated 29% of all children under 5 years of age in low/middle-income countries, contributing to child mortality and exacerbating severity of infections. Biannual vitamin A supplementation (VAS) for children aged 6-59 months can be a low-cost intervention to meet vitamin A needs. This study aimed to present a framework for evaluating the equity dimensions of national VAS programmes according to determinants known to affect child nutrition and assist programming by highlighting geographical variation in coverage.MethodsWe used open-source data from the Demographic and Health Survey for 49 countries to identify differences in VAS coverage between subpopulations characterised by various immediate, underlying and enabling determinants of vitamin A status and geographically. This included recent consumption of vitamin A-rich foods, access to health systems and services, administrative region of the country, place of residence (rural vs urban), socioeconomic position, caregiver educational attainment and caregiver empowerment.ResultsChildren who did not recently consume vitamin A-rich foods and who had poorer access to health systems and services were less likely to receive VAS in most countries despite potentially having a greater vitamin A need. Differences in coverage were also observed when disaggregated by administrative regions (88% of countries) and urban versus rural residence (35% of countries). Differences in vitamin A coverage between subpopulations characterised by other determinants of vitamin A status varied considerably between countries.ConclusionVAS programmes are unable to reach all eligible infants and children, and subpopulation differences in VAS coverage characterised by various determinants of vitamin A status suggest that VAS programmes may not be operating equitably in many countries.

Background: Health policy competencies of regional organizations include mandates to create regional health laws and policies, as well as authorities that allow member states to undertake collective actions in the health field. The examination of the health policy competencies of regional organizations is essential, as it constitutes an important prerequisite for regional organizations to govern regional health. This study aims to map the development trajectory of health policy competencies in regional organizations worldwide and investigate their potential correlates. This will contribute to the enhanced promotion of both existing and new regional health cooperation. Methods: This retrospective analysis utilized the health policy competencies of the 76 regional organizations worldwide from 1945 to 2015, as investigated in the Regional Organizations Competencies Database. By aggregating member state data from various sources such as the IHME Global Burden of Disease 2019, the World Bank, and the World Trade Organization, we extracted the mean values and coefficients of variation for the covariates in regional organization characteristics, socioeconomic and demographic factors, health status and health-system capacity. The correlation between changes in the health policy scope of regional organizations and independent variables was analyzed using Poisson pseudo-likelihood regression with multiple levels of fixed effects. Results: From 1945 to 2015, the number of regional organizations with health policy competencies experienced a slow growth stage before 1991 and an explosive growth stage post-1991. By 2015, 48 out of the 71 existing regional organizations had developed their health policy competencies, yet 26 (54.2%) of these organizations possessed only 1–2 health policy competencies. An enhancement in the health policy scope of a regional organization correlated with its founding year, a greater number of policy fields, higher under-five mortality, and larger disparities in trade and healthcare access and quality indexes among member states. In contrast, larger disparities in population, under-five mortality and health worker density among member states, along with more hospital beds per capita, were negatively correlated with the expansion of a regional organization's health policy scope. Conclusion: Since 1991, there has been a surge of interest in health among regional organizations, although health remains a secondary priority for them. The health policy competencies of regional organizations are pivotal for promoting social equity within regional communities. Its establishment is also closely linked to the level and disparities among member states in aspects such as trade, population, child mortality rates, and health system capacity. [ABSTRACT FROM AUTHOR]

Many children die of easily preventable or treatable diseases in developing countries. What are the relationships between corruption, patronage, and child mortality in low‐ and middle‐income countries? We argue that corruption and patronage affect child mortality outcomes for some causes of death, especially those that are more easily prevented or treated with affordable care. To test our hypotheses, we utilize cross‐national time‐series analysis of under‐five child mortality in developing countries between 1996 and 2016. Our study finds that patronage and corruption increase under‐five child mortality arising from easily preventable childhood diseases, but they have almost no effect on under‐five child mortality caused by more complex illnesses. Our study underscores the need to examine cause‐specific health outcomes rather than overall health outcomes in comparative health analysis, as the ability of governments to address specific health issues depends on the nature of the problems. Related Articles: Ireni‐Saban, Liza. 2013. "Give Me Children or Else I Die: The Politics and Policy of Cross‐Border Reproductive Care." Politics & Policy 41(1): 5–38. https://doi.org/10.1111/polp.12004. Lagunes, Paul F. 2012. "Corruption's Challenge to Democracy: A Review of the Issues." Politics & Policy 40(5): 802–26. https://doi.org/10.1111/j.1747‐1346.2012.00384.x. Tusalem, Rollin F. 2022. "Does Gendered Representation in National Legislatures Promote Substantive Representation and Human Development? Evidence from the Developing World." Politics & Policy 50(6): 1096–137. https://doi.org/10.1111/polp.12503. [ABSTRACT FROM AUTHOR]

Measuring health inequalities is essential to inform policy making and for monitoring implementation to reduce avoidable and unfair differences in health status. We conducted a geospatial analysis of child mortality in Iran using death records from the Ministry of Health and Medical Education from 2016 to 2018 stratified by sex, age, province, and district, and household expenditure and income survey data from the Statistical Center of Iran collected in 2017. We applied multilevel mixed-effect models and detected significant inequality in child mortality and the impact of socioeconomic factors, especially household income. We advocate for using mortality rate for young children (< 5 years old) as an indicator for assessing the impact of interventions to reduce inequalities among various socioeconomic groups. We also recommend to design and implement comprehensive and longitudinal data collection systems for accurate, regular, and specific monitoring of health inequalities. [ABSTRACT FROM AUTHOR]

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IntroductionThe China Healthy Cities (Counties) public health initiative has been at the forefront of China's efforts to counteract the growing challenges in the urban environment since the 1990s. It primarily focuses on improving the urban living environment. However, the nationwide health impacts of the initiative remain unexplored.MethodsWe constructed nationwide county-level and city-level panel data from 1996 to 2012 using data on under-5 mortality rates (U5MR), the list of China healthy cities and counties and socioeconomic factors. We used a two-step staggered difference-in-differences approach that exploits variations in the timing of achieving the title of China Healthy City/County. Subgroup analyses by region were performed.ResultsWe included 707 cities in the China Healthy Cities study, and 1631 counties in the China Healthy Counties study. Our results indicate substantial and significant reductions in U5MR associated with the public health initiative in China. The association varies across regions with different socioeconomic statuses. China Healthy Cities were significantly associated with a reduction of 0.7/1000 (95% CI -1.2 to -0.2) in under-5 mortality 5 years after cities gained the title and a decrease of 1.4/1000 (95% CI -2.2 to -0.6) 10 years afterward. Cities from western China saw the largest statistically significant gains with 3.2/1000 and 7.2/1000 reductions in child mortality after 5 and 10 years, respectively. China Healthy Counties were also associated with significant reductions in under-5 mortality 8 years after achieving the title; it was associated with 2.6/1000 reductions in under-5 mortality nationwide and 3.8/1000 reductions in eastern China. Our results are robust to heterogeneous treatment effects across cities/counties over time and various model specifications.ConclusionOur results suggest significant reductions in under-5 mortality associated with this public health intervention focusing on living environment conditions. Future research could explore differential effects across regions and clarify the underlying causal mechanisms.

Aim: To assess the effects of the nursing workforce and advanced nursing practice on the outcomes of patients and life expectancy, including mortality rates of under‐five children in Cambodia, and to develop policy recommendations to increase the influence of the nursing workforce. Background: In low–middle‐income nations, life expectancy and under‐five mortality are important measures of public health. However, there is still a dearth of literature related to the nursing workforce in Southeast Asia. Method: The authors retrieved the data from the World Nursing Report produced by the World Health Organization 2020 for 10 member states. The transparent reporting of a multivariable prediction model for individual prognosis or diagnosis checklist has guided this study. The univariate linear regression model was applied to categorize the potential predictors for each outcome assessment. In addition, the Spearman rank correlation test was selected to assess the potential predictors, and a multivariate statistical analysis was carried out for each of the five outcomes. Results: According to the study's findings, nurse density and advanced practice nursing improve both female and male life expectancy. The existence of advanced nursing roles is associated with decreased under‐five mortality. Conclusions: There are great opportunities to improve the nursing workforce within Cambodia and other Association of Southeast Asian Nations member states to increase patient outcomes. Investment in nursing is essential for improved patient outcomes. Implications for nursing and health policy: Health policy investments in these projects and future initiatives intended to advance nurse density, education, and practice are based on this study's results. Policy initiatives should focus on increasing density because nursing appears to impact life expectancy and other outcomes. [ABSTRACT FROM AUTHOR]

Background: The Central Government of India introduced the National Health Mission (NHM) in 2005 to improve health outcomes by enhancing publicly financed (government) health expenditure and health infrastructure at the state level. This study aims to examine the effects of the state-level heterogeneity in publicly financed spending on health services on major health outcomes such as life expectancy, infant mortality rate, child mortality rate, the incidence of malaria, and immunization coverage (i.e., BCG, Polio, Measles, and Tetanus). Methods: This study investigates the relationships between publicly financed health expenditure and health outcomes by controlling income and infrastructure levels across 28 Indian States from 2005 to 2016. Along with all states, the empirical analysis has also been carried out for high-focus and non-high-focus states as per the NHM fund flow criteria. It has applied panel fixed-effects and random effects model wherever required based on the Hausman test. Results: The empirical results show that publicly financed health expenditure reduces infant mortality, child mortality, and malaria cases. At the same time, it improves life expectancy and immunization coverage in India. It also finds that the relationship between publicly financed health expenditure and health outcomes is weak, especially in the high-focus states. Conclusions: Given the healthcare need for achieving desirable health outcomes, Indian States should enhance publicly financed expenditure on health services. This study augments essential guidance for implementing public health policies in developing countries. [ABSTRACT FROM AUTHOR]

There is widespread agreement that improved health should be regarded as a means and an end in the context of the development process. The health of the populace and the equitable provision of healthcare are two indicators of a society's level of development. A variety of factors influences child mortality. This study investigated the causes of child death and the interaction effect of birth spacing (B.S.) and maternal health care services (MHCS) on child mortality. Using SPSS version 20, we used the Pakistan Demographic and Health Survey (PDHS) 2017–2018 data set to investigate the associated factors of child mortality and the moderating influence of birth spacing using binary logistic regression. The outcome variable is categorical with two categories. The findings indicated that the risk of infant death decreased with adequate B.S. between two pregnancies and access to maternal health care services. Birth spacing was found to moderate the link between access to maternal health care services (MHCS) and child mortality. Our research leads us to conclude that the amount of time between children's births significantly reduces infant mortality. When the birth spacing is at least 33 months, the relationship between maternal health care services and child mortality becomes more evident and negative. [ABSTRACT FROM AUTHOR]

CARAMAL was a large observational study which recorded mortality in children with suspected severe malaria before and after the roll-out of rectal artesunate in Nigeria, Uganda and the Democratic Republic of the Congo. The results of CARAMAL have had a huge impact on public health policy leading to a World Health Organization moratorium on the roll-out of rectal artesunate. The conclusion reported in the abstract uses strong causal language, stating that "pre-referral RAS [rectal artesunate suppositories] had no beneficial effect on child survival". We argue that this causal interpretation of the study results is not justified. Data from the CARAMAL study inform chiefly on the strengths and weaknesses of referral systems in these three countries and do not inform reliably as to the beneficial effect of providing access to a known life-saving treatment. [ABSTRACT FROM AUTHOR]

Background: Despite anaemia is the leading cause of child morbidity and mortality in Africa including Ethiopia, there is inadequate evidence on modelling anaemia related factors among under five years old children in Ethiopia. Therefore, this study is aimed to assess factors that affect the anaemia status among under five years old children and estimate the proportion of overall child-level variation in anaemia status that is attributable to various factors in three regions of Ethiopia, namely Amhara, Oromiya and Southern Nation Nationalities People (SNNP). Methods: This is a cross-sectional study, and the data was extracted from the 2011 Ethiopia National Malaria Indicator Survey which is a national representative survey in the country. A sample of 4,356 under five years old children were obtained from three regions. Based on child hemoglobin level, anaemia status was classified as non-anaemia (>11.0g/dL), mild anaemia (8.0-11.0g/dL), moderate anaemia (5.0-8.0g/dL) and severe anaemia (<5.0g/dL). Various multilevel proportional odds models with random Kebele effects were adopted taking into account the survey design weights. All the models were fitted with the PROC GLIMMIX in SAS. The Brant test for parallel lines assumption was done using the brant() function from brant package in R environment. Results: The prevalence of anaemia status of under five years children varies among the three study regions, where the prevalence of severe child anaemia status was higher in Oromiya region as compared to Amhara and SNNP regions. The results of this study indicate that age (OR = 0.686; 95% CI: 0.632, 0.743), malaria RDT positive (OR = 4.578; 95% 2.804, 7.473), household had used mosquito nets while sleeping (OR = 0.793; 95%: 0.651, 0.967), household wealth status and median altitude (OR = 0.999; 95%: 0.9987, 0.9993), were significantly related to the prevalence of child anaemia infection. The percentage of Kebele-level variance explained by the region and median altitude, and child / household (Level 1) characteristics was 32.1 %. Hence, large part of the Kebele-level variance (67.9%) remain unexplained. Conclusions: The weighted multilevel proportional odds with random Kebele effects model used in this paper identified four child/household and one Kebele level risk factors of anaemia infection. Therefore, the public health policy makers should focus to those significant factors. The results also show regional variation in child anaemia prevalence, thus special attention should be given to those children living in regions with high anaemia prevalence. [ABSTRACT FROM AUTHOR]

Background: This is the final of 10 papers that describe the implementation of the Expanded Census-Based, Impact-Oriented Approach (CBIO+) by Curamericas/Guatemala in the Cuchumatanes mountains of the Department of Huehuetenango and its effectiveness in improving the health and well-being of women and children in a population of 98,000 in three municipalities. The CBIO+ Approach consists of three components: the CBIO (Census-Based, Impact-Oriented) Approach, the Care Group Approach, and the Community Birthing Center Approach. Methods: Each of the preceding papers was summarized. An assessment was made regarding the degree to which the initial implementation research hypotheses were confirmed. The total field cost per capita for operation of the Project was calculated. An assessment of the cost-effectiveness of the Project was made based on the estimated impact of the Project, the number of lives saved, and the number of disability-adjusted life years averted. Results: The Project attained a number of notable achievements in terms of expanding the coverage of key maternal and child health interventions, improving the nutritional status of children, reducing the mortality of children and mothers, providing quality care for mothers at the Community Birthing Centers (Casas Maternas Rurales) that integrate traditional midwives (comadronas) into the care of women during childbirth at the birthing centers, as well as empowering women and building social capital in the communities. CBIO+ is an effective and affordable approach that is particularly notable for its capacity to engage communities in the process of improving the health of mothers and children. Overall, there is strong and consistent evidence in support of the research hypotheses. The findings did produce evidence of declines in under-5 and maternal mortality, but they were not as robust as had been hoped. Conclusion: CBIO+ is an approach that has been effective in engaging communities in the process of improving the health of their mothers and children and in reducing health inequities in this marginalized, difficult-to-reach population of Indigenous Maya people. The CBIO+ Approach is cost-effective and merits further development and broader application in Guatemala and beyond. [ABSTRACT FROM AUTHOR]

Child mortality from infectious diseases is still high in Nigeria. Appropriate illness concepts (IC), healthseeking behaviours (HSB) and breastfeeding practices (BFP) of mothers are critical to addressing child mortality arising from infectious diseases. This study seeks to determine the relationship between mothers' formal education and IC, HSB, BFP, family structure and parity, in market women in rural Plateau State, Nigeria, with a view to making policy recommendations from the data. A total of 993 women from three rural markets in Plateau State were effectively recruited and studied. A structured questionnaire was used to elicit information from the women. Appropriate descriptive and inferential statistical tools were used for data analyses. About 70% of the women had received some formal education while 62.4% of them reported an infectious disease in their homes within the month prior to the study. Exclusive breastfeeding for more than 6 months was practiced by 78% of the population. Almost all the mothers had appropriate IC (99%) and proper HSB (92%). Whereas length of formal education was significantly and negatively correlated with age of mother (r = -0.525; p < 0.001), number of children (r = -0.213; p < 0.001) and family structure (r = -0.494; p < 0.001), it was not significantly correlated with IC, HSB or BFP. Informal modes of education are apparently critical to the dissemination of messages related to proper IC, HSB and BFP among rural market women, and are thus recommended. Subjects: Public Health Policy and Practice; Maternal and Child Health; Occupational Health and Safety; Population Health; Community Health; Epidemiology [ABSTRACT FROM AUTHOR]

Pneumonia remains the leading infectious cause of global childhood deaths, despite the availability of pneumococcal conjugate vaccine (PCV) products and widespread evidence of their safety and efficacy. To map the landscape of countries that are yet to fully include PCV in their National Immunization Programs, we conducted an archetype analysis of country indicators related to barriers and facilitators for PCV decision-making. We created a country matrix focused on three key domains – health characteristics, immunisation factors, and policy framework, and identified ten related indicators. We scored countries based on indicator performance and subsequently ranked and grouped them into three archetypes of low-, moderate-, and high-barrier countries with regard to PCV introduction. Our results indicated 39 countries (33 low- and middle-income countries [LMICs] and 6 high-income countries) that are yet to introduce PCV. Among LMICs, 15 countries were classified as 'low-barrier,' indicating factors favourable for PCV introduction such as high immunisation coverage of common childhood vaccines, supportive governments, and substantial disease burden and eligibility for Gavi support. Countries classified in the 'moderate-barrier' (12) and 'high-barrier' (6) archetypes demonstrated adequate capacity in immunisation systems but had competing national priorities and cost barriers that impeded policy decision-making on PCV introduction. The current health and policy indicator-based categorisation provides an actionable framework to design tailored PCV advocacy within these last-mile countries. Policy approaches emerging from this framework can lead to strengthened decision-making on vaccine introduction and sustained vaccine access that can enhance child survival worldwide. [ABSTRACT FROM AUTHOR]

The 2002 Dutch Euthanasia law applies to patients aged 12 years and older. Developments in end-of-life care and decision-making in the last decade have sparked the debate about usefulness and necessity to extend euthanasia to include children under 12 years of age. This paper describes two opposite positions: the affirmative position of a pediatrician and expert in pediatric palliative care and the negative position of a jurist and specialist in health law. [ABSTRACT FROM AUTHOR]

Cancer is one of the leading causes of death in children and adolescents younger than 19 years. An estimated 10 000 deaths are caused by this disease annually in this age group in Latin America and the Caribbean. In high-income countries, the survival of children and adolescents with neoplasms can reach 85%; however, in middle- and low-income countries, despite progress, survival rates are significantly lower (between 10% and 60%). Important inequities exist is survival from childhood cancer that need to be addressed through decisive actions from the health systems. This report describes the work of the ministries of health and the Secretariat of the Andean Health Organization (Organismo Andino de Salud -- Convenio Hipólito Unánue (ORAS-CONHU)), to develop the Andean Cancer Prevention and Control Policy, with consideration given to childhood cancers. The policy was based on analysis of the cancer situation in the six Andean countries -- Bolivia (Plurinational State of), Colombia, Chile, Ecuador, Peru and Venezuela (Bolivarian Republic of) -- between 2015 and 2020, and it was approved in 2022. An in-depth study is currently being carried out on the situation of childhood cancer in the Andean countries. [ABSTRACT FROM AUTHOR]

Aim: Approximately 96 out of every 1000 children born die worldwide, due to infectious diseases of gastrointestinal and respiratory origin. In Ecuador, 23.2% of all infant deaths in 2018, were due to infectious diseases. Material and method: In the present study, a descriptive research approach was adopted with the objective of examining the specific characteristics of the study population, made up of 20 families with children under 5 years of age who attended the Tulcán Health Center 8 due to infectious diseases. The importance of this study lies in its contribution to scientific knowledge about the situation of infectious diseases in children under 5 years of age in Tulcan Health Center 8. Statistics and Result: It seeks to guide health policies and programs aimed at prevention, early detection and adequate treatment of these diseases. [ABSTRACT FROM AUTHOR]

The article offers information on a California bill, AB 1851, aimed at protecting children from lead exposure in drinking water. Topics include the bill's goal of zero lead in school and childcare drinking water, a state-funded pilot program to test and clean up lead in drinking water in schools, and the collaboration between the Environmental Working Group and Children Now in sponsoring the bill.

Background: The reproductive, maternal, newborn, child + adolescent health (RMNCH+A) strategy was launched by the Indian government in the year 2013 to remain in the lead of the global war against child and maternal mortality and morbidity. Under RMNCH+A program in Uttarakhand state, according to the State public health policy, various provisions are needed to be done for maintenance of downtrend in infant mortality rate (IMR). There are various thrust areas under the child health program. The purpose of our study is to monitor the program implementation in terms of Input and Process indicators and to identify if there are any gaps in the child health services provided by RMNCH+A in the PHCs and subcentres of Doiwala block of Dehradun district, Uttarakhand. Aim: To evaluate Input and the process indicators of child health services under RMNCH+A strategy at Primary health care level in Doiwala block of Dehradun district, Uttarakhand. Methods: This Cross-sectional study was carried out in Doiwala Block of Dehradun district, Uttarakhand in 3 randomly selected Primary health centres (PHCs) and their 6 subcentres using a validated standard checklist for PHCs and subcentres. Results: In PHCs, mean obtained score for Input indicators was 56% and for Process indicators was 35%. The mean obtained score in subcentres for Input indicators and Process indicators was 53% and 51%, respectively. Conclusions: Both the input and the process indicators for child health services in PHCs and subcentres of Dehradun district were inadequate. Most indicators scored less than 50% at both the PHCs and subcentres. [ABSTRACT FROM AUTHOR]

Background: Women's choice of place of delivery has implications on maternal and child mortality. This study aims to provide an updated and detailed comparison of prevalence and determinants of home delivery in the Philippines, and in urban and rural communities. Methods: Based on data from the 2017 Philippine National Demographic and Health Survey (NDHS), we estimated the prevalence of home delivery and determined factors influencing women's decision to deliver at home. Analyses were restricted to data from 7229 women who were cohabiting or married, and their last-born child using logistic regression methods for survey data. Results: There remain a considerable proportion of women aged 15–49 years old who delivered at home (17.92% (95% confidence interval (CI): 15.77, 20.30)). More women in rural areas delivered at home (23.53% (95% CI: 20.38, 26.99)) than their counterparts in urban areas (10.72% (95% CI: 8.23, 13.85)), reflecting a significant difference in the home delivery prevalence of women relative to their place of residence. Our regression analyses showed that there is a relatively greater effect observed for the rural population in most of the proximal factors considered including birth order, women's decision-making power, and emergency preparedness during pregnancy. Wealth index has the most pronounced effect with a significant increase in odds of home delivery among urban and rural women of the lowest wealth categories. Conclusion: The use of institutional childbirth services remains suboptimal in the Philippines with significant disparities between urban and rural communities. Current strategies therefore need to adopt a multi-sectoral approach to address the complex factors influencing women's decision on place of delivery. Targeted efforts specific to population groups should also be made to contextualize and co-create health care services and solutions that will motivate them to deliver in health facilities. [ABSTRACT FROM AUTHOR]

Objective To compare coverage of key child health policy indicators across provinces and to explore their association with under-five mortality and level of conflict in the Democratic Republic of the Congo. Methods We made a secondary analysis of nationally representative data from 1380 health facilities and 20 792 households in 2017--2018. We analysed provincial-level data on coverage of 23 different indicators for improving common causes of childhood mortality, combined into mean scores for: newborn health, pneumonia, diarrhoea, malaria and safe environment. Using negative binomial regression we compared the scores with provincial-level under-five mortality. With binary logistic regression at the individual level we compared indicators (outcome) with living in a conflict-affected province (exposure). Findings All grouped coverage scores demonstrated large ranges across the 26 provinces: newborn health: 20% to 61%; pneumonia: 26% to 86%; diarrhoea: 25% to 63%; malaria: 22% to 53%; and safe environment: 4% to 53%. The diarrhoea score demonstrated the strongest association with under-five mortality (adjusted coefficient: -0.026; 95% confidence interval: -0.045 to -0.007). Conflict-affected provinces had both the highest as well as the lowest mortality rates and indicator coverages. The odds of coverage were higher in conflict-affected provinces for 13 out of 23 indicators, whereas in provinces unaffected by conflict only one indicator had higher odds of coverage. Conclusion Conflict alone is a poor predictor for child health. Ensuring that children in unaffected provinces are not neglected while addressing the needs of the most vulnerable in conflict settings is important. Prevent, protect and treat strategies for diarrhoeal disease could help improve equity in child survival. [ABSTRACT FROM AUTHOR]

Childhood Immunization is one of the critical strategies to decrease infant morbidity and mortality due to infectious diseases, but primary immunization schedules for infants in most countries start at 2 months of age. Childhood vaccines therefore begin providing adequate protection later in life, leaving infants vulnerable to infectious diseases and creating an immunity gap that results in higher morbidity and mortality among younger infants. Maternal immunization, the practice of vaccinating individuals during pregnancy, reduces the risk of infant infection primarily through the transfer of protective maternal antibodies to the fetus during late pregnancy. Although much progress has been made in public health policies to support maternal immunization research, inclusion of pregnant individuals and children in clinical trials remains challenging. This has resulted in paucity of evidence regarding safety and effectiveness of vaccines to support licensure of products intended for use during pregnancy and lactation to prevent disease in the infant. In addition, although safeguards for clinical research in pregnancy are supportive, experimental vaccines, e.g., Respiratory Syncytial Viru s, are more complicated to study because data on safety, efficacy, and dosing are limited. This requires randomized controlled trials with safety monitoring for the mother, the fetus, and the infant with follow-up for at least 1 year or longer to assess long-term health outcomes that may be associated with peripartum vaccine exposure. The goal of this paper is to discuss the general regulatory considerations for clinical research to evaluate safety and effectiveness of vaccines administered during pregnancy to protect infants from disease. This could be useful to inform future vaccine trials. This discussion is not intended to provide agency guidance nor to articulate agency policy. [ABSTRACT FROM AUTHOR]

The authors comment on increased treatment coverage for pediatric patients with HIV. Topics discussed include target adopted by the Joint United Nations Programme on HIV/AIDS (UNAIDS), overview on the Global Alliance to End AIDS in Children, and importance of additional efforts to optimize case-finding and enhance linkage to care and treatment to close the gaps in pediatric antiretroviral therapy (ART) coverage and AIDS mortality.