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Centralisation of perioperative care for small children to a limited number of specialised paediatric centres has many theoretical advantages, but neither the optimal balance nor the current distribution of paediatric anaesthesia on a national scale are well elucidated. The aim of this study was to describe the distribution, adverse events, and mortality in children undergoing anaesthesia in Sweden. In this cohort study, data from all paediatric anaesthesia procedures registered in Sweden during the years 2019–22 were extracted from the Swedish Perioperative Register (SPOR). Data were analysed according to hospital level of care and ASA physical status. Data from 81 hospitals were analysed. During the 4-yr period, 214,964 procedures were registered. Most procedures in neonates and infants were managed in paediatric (73%) and other university hospitals (21%). Adverse events occurred in 2.71% of cases and severe adverse events in 0.067%. The all-cause 24-h mortality rate was 6.6:10,000 anaesthetics and the all-cause 30-day mortality was 14.7:10,000 anaesthetics. The 30-day all-cause estimated mortality was highest in paediatric hospitals (95% confidence interval [CI] 30–39) compared with other university hospitals (95% CI 6.1–12), county (95% CI 1.9–4.8), district (95% CI 0.07–2.2), and smaller hospitals (95% CI 0.0–22). Most procedures in neonates and infants were performed in tertiary centres, with county hospitals managing mainly older children, in accordance with national recommendations. Mortality was more common in tertiary centres, reflecting increased comorbidity and centralisation of anaesthesia of neonates and infants. [ABSTRACT FROM AUTHOR]

As the largest profession within the health care workforce, nurses and midwives play a critical role in the health and wellness of families especially children and infants. This study suggests those countries with higher nurse and midwife densities (NMD) had lower infant mortality rates (IMR). With affluence, low birthweight and urbanization incorporated as potential confounders, this ecological study analyzed the correlations between NMD and IMR with scatterplots, Pearson r correlation, partial correlation and multiple linear regression models. Countries were also grouped for analysing and comparing their Pearson's coefficients. NMD inversely and significantly correlated to IMR worldwide. This relationship remained significant independent of the confounders, economic affluence, low birthweight and urbanization. Explaining 57.19% of IMR variance, high NMD was implicated in significantly reducing the IMR. Countries with high NMD had lower IMRs both worldwide and with special regard to developing countries. This may interest healthcare policymakers, especially those from developing countries, to consider the impacts of global nursing and midwifery staffing shortages. Nurses and midwives are the group of healthcare professionals who spend most with infants and their carers. This may be another alert for the health authorities to extend nurses and midwives' practice scope for promoting infant health. [ABSTRACT FROM AUTHOR]

How serious is indoor air pollution (IAP) as a threat to infants and children? This paper estimates the impact of cooking fuel choice – a predominant source of IAP – on under-five mortality in India, where reliance on biomass fuels such as firewood, animal dung, and agricultural waste is pervasive. Leveraging forest cover and agricultural land ownership for identification and nationally representative data, we find that solid fuel use for cooking significantly increases the child mortality rate - mainly driven by neonatal mortality in the first 28 days after birth. The mortality effect is higher for girls than boys and is magnified in relatively small households where there is limited scope for the division of labor between childcare and cooking responsibilities. Among polluting fuels, we find that biomass fuels drive the impact of polluting fuel use on child mortality. [ABSTRACT FROM AUTHOR]

• A media-based database was used to provide a 15-year review of unintentional fatal childhood drowning in Israel. • There is a rise in childhood mortality due to drowning, with an increase in drowning in domestic swimming pools. • We point to a link between low socioeconomic status and cases of drowning. • We recommend a series of regulatory and legislative steps to reduce fatal childhood drowning. • We recommend that a special focus will be put in municipalities situated at the bottom of the socioeconomic index. Introduction : In this study, we use the media-based database of Beterem-Safe Kids Israel , to provide a 15-year review of unintentional fatal childhood drowning in Israel, between 2008 and 2022. Method: It total, we identified 257 cases of child mortality due to drowning during this period. Results: Our results demonstrate a gradual rise in childhood mortality due to drowning, from 72 cases in 2008–2012, to 85 cases in 2013–2017, and to 100 cases in 2018–2022. Especially worth noting is the increase in childhood drowning in domestic swimming pools. We point to a link between low socioeconomic status and cases of drowning, showing that the risk of drowning extends beyond a mere matter of caregiver inattention. We recommend a series of regulatory and legislative steps to reduce fatal childhood drowning, including fencing built around domestic swimming pools, extending lifeguard activity hours, adding declared beaches, forming programs of safe behavior in water environments for adolescents, and establishing swimming lessons during the 2nd grade, for all populations. We further recommend that a special focus will be put in municipalities situated at the bottom of the socioeconomic index. [ABSTRACT FROM AUTHOR]

Child abuse is a serious concern that can cause the death of a child. In such cases the medico-legal evidence is often pivotal but complex, drawing across multiple medical disciplines and techniques. One key specialism is histopathology, which is considered the gold standard for estimating the age of individual fractures. Another is micro-CT imaging, which can visualise the location of trauma across the body. This case report demonstrates how micro-CT was used to contextualise the histological evidence in the Criminal Justice Proceedings of a fatal child abuse case. This was achieved by overlaying the aged fracture evidence from histopathology onto the visuals rendered from micro-CT imaging. The case was a suspected child abuse of a deceased 1-month old infant who was reported unresponsive by their parents. The child was taken to hospital where they were pronounced dead. Suspicion was raised and post-mortem imaging confirmed head trauma and rib fractures, and the case was escalated for a forensic investigation. This case report details how the micro-CT imaging was merged with the gold standard of histopathology for visualisation of trauma, and how the court presentation was planned alongside Senior Investigating Officers and various medical experts. The presentation was used in court by the histopathologist to present the evidence. The resulting presentation provided additional clarity to jury members regarding the location, severity, frequency, and timings of the injuries. From the perspective of the investigating police force, the resulting presentation was crucial in ensuring understanding of the medico-legal evidence of how the infant died. The prosecuting lawyer noted that combining the histological and micro-CT evidence in this way allowed the evidence to be presented in a sensitive, clear, and impactful manner. [ABSTRACT FROM AUTHOR]

Despite growing cardiogenic shock (CS) research in adults, the epidemiology, clinical features, and outcomes of children with CS are lacking. This study sought to describe the epidemiology, clinical presentation, hospital course, risk factors, and outcomes of CS among children hospitalized for acute decompensated heart failure (ADHF). We examined consecutive ADHF hospitalizations (<21 years of age) from a large single-center retrospective cohort. Patients with CS at presentation were analyzed and risk factors for CS and for the primary outcome of in-hospital mortality were identified. A modified Society for Cardiovascular Angiography and Interventions shock classification was created and patients were staged accordingly. A total of 803 hospitalizations for ADHF were identified in 591 unique patients (median age 7.6 years). CS occurred in 207 (26%) hospitalizations. ADHF hospitalizations with CS were characterized by worse systolic function (P = 0.040), higher B-type natriuretic peptide concentration (P = 0.032), and more frequent early severe renal (P = 0.023) and liver (P < 0.001) injury than those without CS. Children presenting in CS received mechanical ventilation (87% vs 26%) and mechanical circulatory support (45% vs 16%) more frequently (both P < 0.001). Analyzing only the most recent ADHF hospitalization, children with CS were at increased risk of in-hospital mortality compared with children without CS (28% vs 11%; OR: 1.91; 95% CI: 1.05-3.45; P = 0.033). Each higher CS stage was associated with greater inpatient mortality (OR: 2.40-8.90; all P < 0.001). CS occurs in 26% of pediatric hospitalizations for ADHF and is independently associated with hospital mortality. A modified Society for Cardiovascular Angiography and Interventions classification for CS severity showed robust association with increasing mortality. [Display omitted] [ABSTRACT FROM AUTHOR]

The role of parents in decision-making concerning their child's end-of-life care is not clearly defined. Their participation is encouraged by ethical reflection, in particular by the CCNE (French National Ethics Advisory Committee), but laws are limited to imposing a duty to provide information to doctors. Decisions are taken at the end of a collegial meeting (CM) intended to better inform the child's referring physician (RP) who is in charge of the final decision following the French law. The aim of this study was to describe the support provided to bereaved families after they had been invited to attend a CM concerning their child, if they so wished. Additional aims were to determine the differences resulting from their acceptance or their refusal to participate as regards their perception of their child's history and as regards their grieving process. We conducted a retrospective study of all CMs held between November 2016 and May 2021, drawing a distinction between proposals made or not made to parents and their decision to accept or refuse. In total, 49 CMs concerning 46 children were held during the study period. The proposal was not made to the parents in three cases; the parents chose to be present in 28 cases. The psychological follow-up (15/28 parents attending, 10/16 parents absent) illustrated that their presence enabled them to reflect on their child's death after having listened to and understood the reasons why it happened. They did not dispute the team's approach or decisions taken. It is possible to include parents in CMs if they so wish. It would appear more beneficial than merely providing them with the information required. Studies must be carried out to ensure potential long-term benefit. [ABSTRACT FROM AUTHOR]

Mental health problems are a major source of morbidity and mortality for children and adolescents, affecting 15% to 20% of those under 18 years of age in the US.1 Half of all mental health conditions start by age 14 years, although most cases remain undetected and untreated.2 Despite knowing much about mental health conditions affecting children, many speculate that the lack of standardized approaches to patient care contribute to poor outcomes, including substantial diagnostic variation, few remissions, risk for relapse or recidivism, and, ultimately, greater mortality due to an inability to accurately predict who will make a suicide attempt.3-5 Studies support this over-reliance on the "art of medicine" (ie, subjective judgment without use of standardized measures), finding that only 17.9% of psychiatrists and 11.1% of psychologists in the US routinely administer symptom rating scales to their patients, despite studies suggesting that when using clinical judgment alone, mental health providers detect deterioration for only 21.4% of patients.4 [ABSTRACT FROM AUTHOR]

• Rotavirus vaccines prevented around 140,000 child deaths in the period 2006-2019. • Relaxing age restrictions prevented up to 17,000 deaths in the period 2013-2019. • Global use of rotavirus vaccines could prevent over one-third of rotavirus deaths. We estimated the global impact of rotavirus vaccines on deaths among children under five years old by year. We used a proportionate outcomes model with a finely disaggregated age structure to estimate rotavirus deaths prevented by vaccination over the period 2006-2019 in 186 countries. We ran deterministic and probabilistic uncertainty analyses and compared our estimates to surveillance-based estimates in 20 countries. We estimate that rotavirus vaccines prevented 139,000 under-five rotavirus deaths (95% uncertainty interval 98,000-201,000) in the period 2006-2019. In 2019 alone, rotavirus vaccines prevented 15% (95% uncertainty interval 11-21%) of under-five rotavirus deaths (0.5% of child mortality). Assuming global use of rotavirus vaccines and coverage equivalent to other co-administered vaccines could prevent 37% of under-five rotavirus deaths (1.2% of child mortality). Our estimates were sensitive to the choice of rotavirus mortality burden data and several vaccine impact modeling assumptions. The World Health Organization's recommendation to remove age restrictions in 2012 could have prevented up to 17,000 rotavirus deaths in the period 2013-2019. Our modeled estimates of rotavirus vaccine impact were broadly consistent with estimates from post-vaccination surveillance sites. Rotavirus vaccines have made a valuable contribution to global public health. Enhanced rotavirus mortality prevention strategies are needed in countries with high mortality in under-5-year-old children. [ABSTRACT FROM AUTHOR]

Despite promising reductions in mortality from infectious diseases, premature death is a still major public health problem in Brazil. However, little is known about which diseases and injury mechanisms are the main causes of premature death. This paper aimed to detail the trends in leading causes of death among children and adolescents in Brazil. Data were extracted from medical death certificates from the Brazilian Mortality Information System for children and adolescents aged 1–19 years for 2000–2020. The 10 leading causes of death for children and adolescents were defined using primary cause of death codes, grouped by death for diseases and mechanism for injury, according to the ICD-10. All analyses were completed in 2022. From 2000 through 2020, there was a total of 772,729 child and adolescent deaths in Brazil. Despite an overall 34% reduction in child and adolescent mortality from 2000 to 2020, improvements were less pronounced for injury-related deaths than for communicable diseases. Therefore, by 2020, over half of deaths were from injury-related causes. Firearm-related injury was by far the leading cause, accounting for 21% of all deaths. There was a 38% reduction in firearm deaths in the last 4 years against a previously increasing trend, and homicide accounted for over 90% of all firearm deaths because suicide by firearm was rare. Injury-related deaths among children and adolescents are a growing concern in Brazil, and firearms are the current leading cause of child and adolescent death. [ABSTRACT FROM AUTHOR]

Pneumococcal meningitis remains the most common cause of bacterial meningitis in children globally, contributing significantly to childhood morbidity and mortality. In countries where they are used, multi-valent vaccines have reduced the incidence of pneumococcal meningitis over time and altered the predominant serovars and epidemiology. Changing global antimicrobial resistance patterns of invasive Streptococcus pneumoniae have also been observed over time. This article considers current epidemiology and management of pneumococcal meningitis within this shifting landscape and offers practical advice to healthcare professionals working with children and young people. [ABSTRACT FROM AUTHOR]

Children are uniquely vulnerable to injury because of near-complete dependence on caregivers. Unintentional injury is leading cause of death in children under the age of 14. Burns are one of the leading causes of accidental and preventable household injuries, with scald burns most common in younger children and flame burns in older ones. Education is a key tool to address burn prevention, but unfortunately these injuries persist. Critically, there is a paucity of literature investigating adult comprehension with respect to potential risks of household burns. To date, no study has been performed to assess management readiness for these types of injuries without seeking medical care. Qualtrics™ surveys were distributed to laypersons via Amazon Mechanical Turk. Demographics were self-reported. The survey was divided into two parts, management knowledge, and risk identification. The management part involved a photograph of a first-degree pediatric burn injury and required identification of the degree of injury and three potential initial managements. The risk-identification section required correctly identifying the most common mechanisms of burn injury for different age groups followed by general identification of 20 household burn risks. Survey responses were analyzed using two-tailed Student's t-tests and chi-square analyses, univariate and multivariate analysis, and linear regression. Of the 467 respondents, the mean age was 36.57 years, and was 59.7% (279) male. Only 3.2% of respondents were able to correctly identify all 20 potential risks listed in our survey. Additionally, only 4.5% of respondents correctly identified all three appropriate initial management options (cool water, sterile gauze, and over-the-counter analgesics) without misidentifying incorrect options. However, 56.1% of respondents were able to select at least one correct management option. For image-based injury classification, the most common response was incorrectly second-degree with 216 responses (42.2%) and the second-most common response was correctly first-degree with 146 responses (31.3%). Most respondents claimed they would not seek medical attention for the injury presented in the photograph (77.7%). When comparing the responses of individuals with children to those without, there were no statistically significant differences in ability to assess household risks for pediatric burns. For the entire population of respondents, the mean score for correctly identifying risks was 38%. This study revealed a significant gap in public awareness of household risks for pediatric burns. Furthermore, while most individuals would not seek medical care for a first-degree pediatric burn injury, they were readily available to identify proper initial management methods. This gap in knowledge and understanding of household pediatric burn injuries should be addressed with increased burn injury prevention education initiatives and more parental counseling opportunities. • There is a significant gap in public awareness of household risks for pediatric burns. • Most adults incorrectly identified a first-degree burn as a more severe, second-degree burn yet stated they would not seek medical care for the injury. • The average score for readiness management of pediatric burns, among adults, was extremely low. • Risk awareness and management readiness scores did not have a significant association with household income or participant education level. [ABSTRACT FROM AUTHOR]

Paediatric early warning systems (PEWS) aid in the early identification of clinical deterioration events in children admitted to hospital. We aimed to investigate the effect of PEWS implementation on mortality due to clinical deterioration in children with cancer in 32 resource-limited hospitals across Latin America. Proyecto Escala de Valoración de Alerta Temprana (Proyecto EVAT) is a quality improvement collaborative to implement PEWS in hospitals providing childhood cancer care. In this prospective, multicentre cohort study, centres joining Proyecto EVAT and completing PEWS implementation between April 1, 2017, and May 31, 2021, prospectively tracked clinical deterioration events and monthly inpatient-days in children admitted to hospital with cancer. De-identified registry data reported between April 17, 2017, and Nov 30, 2021, from all hospitals were included in analyses; children with limitations on escalation of care were excluded. The primary outcome was clinical deterioration event mortality. Incidence rate ratios (IRRs) were used to compare clinical deterioration event mortality before and after PEWS implementation; multivariable analyses assessed the correlation between clinical deterioration event mortality and centre characteristics. Between April 1, 2017, and May 31, 2021, 32 paediatric oncology centres from 11 countries in Latin America successfully implemented PEWS through Proyecto EVAT; these centres documented 2020 clinical deterioration events in 1651 patients over 556 400 inpatient-days. Overall clinical deterioration event mortality was 32·9% (664 of 2020 events). The median age of patients with clinical deterioration events was 8·5 years (IQR 3·9–13·2), and 1095 (54·2%) of 2020 clinical deterioration events were reported in male patients; data on race or ethnicity were not collected. Data were reported per centre for a median of 12 months (IQR 10–13) before PEWS implementation and 18 months (16–18) after PEWS implementation. The mortality rate due to a clinical deterioration event was 1·33 events per 1000 patient-days before PEWS implementation and 1·09 events per 1000 patient-days after PEWS implementation (IRR 0·82 [95% CI 0·69–0·97]; p=0·021). In the multivariable analysis of centre characteristics, higher clinical deterioration event mortality rates before PEWS implementation (IRR 1·32 [95% CI 1·22–1·43]; p<0·0001), being a teaching hospital (1·18 [1·09–1·27]; p<0·0001), not having a separate paediatric haematology-oncology unit (1·38 [1·21–1·57]; p<0·0001), and having fewer PEWS omissions (0·95 [0·92–0·99]; p=0·0091) were associated with a greater reduction in clinical deterioration event mortality after PEWS implementation; no association was found with country income level (IRR 0·86 [95% CI 0·68–1·09]; p=0·22) or clinical deterioration event rates before PEWS implementation (1·04 [0·97–1·12]; p=0·29). PEWS implementation was associated with reduced clinical deterioration event mortality in paediatric patients with cancer across 32 resource-limited hospitals in Latin America. These data support the use of PEWS as an effective evidence-based intervention to reduce disparities in global survival for children with cancer. American Lebanese Syrian Associated Charities, US National Institutes of Health, and Conquer Cancer Foundation. For the Spanish and Portuguese translations of the abstract see Supplementary Materials section. [ABSTRACT FROM AUTHOR]

Approximately 90% of children with cancer live in low-income and middle-income countries (LMICs), where 5-year survival is lower than 20%. Treatment-related mortality in high-income countries is approximately 3–5%; however, in LMICs, treatment-related mortality has been reported in up to 45% of children with cancer. This study aimed to systematically explore the burden of treatment-related mortality in children with cancer in LMICs and to explore the association between country income level and treatment-related mortality. For this systematic review and meta-analysis we identified articles published between Jan 1, 2010, and June 22, 2021, describing treatment-related mortality in paediatric patients (aged 0–21 years) with cancer in LMICs. We searched PubMed, Trip, Web of Science, Embase, and the WHO Global Metric Index databases. The search was limited to full-text articles and excluded case reports (<10 patients) and haematopoietic stem-cell transplantation recipients. Two reviewers independently screened studies for eligibility, extracted data from included publications, and evaluated data quality. Random and mixed-effects models were used to estimate treatment-related mortality burden and trends. The Cochran-Q statistic was used to assess heterogeneity between studies. This study is registered on PROSPERO (CRD42021264849). Of 13 269 identified abstracts, 501 studies representing 68 351 paediatric patients with cancer were included. The treatment-related mortality estimate was 6·82% (95% CI 5·99–7·64), accounting for 30·9% of overall mortality (4437 of 14 358 deaths). Treatment-related mortality was inversely related to country income. Treatment-related mortality was 14·19% (95% CI 9·65–18·73) in low-income countries, 9·21% (7·93–10·49) in lower-middle-income countries, and 4·47% (3·42–5·53) in upper-middle-income countries (Cochran-Q 42·39, p<0·0001). In upper-middle-income countries, the incidence of treatment-related mortality decreased over time (slope –0·002, p=0·0028); however, outcomes remained unchanged in low-income (p=0·21) and lower-middle-income countries (p=0·16). Approximately one in 15 children receiving cancer treatment in LMICs die from treatment-related complications. Although treatment-related mortality has decreased in upper-middle-income countries over time, it remains unchanged in LMICs. There is an urgent need for targeted supportive care interventions to reduce global disparities in childhood cancer survival. American Lebanese Syrian Associated Charities and National Cancer Institute. [ABSTRACT FROM AUTHOR]

[Display omitted] • The gut microbiota of premature infants is disordered, and its development generally goes through 4 phases. • The intestinal immune system of premature infants is immature and developmentally delayed. • Fecal microbiota transplantation, probiotics, and nutrients are important strategies for early gut microbiota intervention. • The early life period is a critical window period for early intervention. • Probiotics and breast milk nutrients are widely used early intervention strategies, but mechanisms remain poorly understood. Preterm birth is the leading cause of death in children under the age of five. One of the major factors contributing to the high risk of diseases and deaths in premature infants is the incomplete development of the intestinal immune system. The gut microbiota has been widely recognized as a critical factor in promoting the development and function of the intestinal immune system after birth. However, the gut microbiota of premature infants is at high risk of dysbiosis, which is highly associated with adverse effects on the development and education of the early life immune system. Early intervention can modulate the colonization and development of gut microbiota and has a long-term influence on the development of the intestinal immune system. This review aims to summarize the characterization, interconnection, and underlying mechanism of gut microbiota and intestinal innate immunity in premature infants, and to discuss the status, applicability, safety, and prospects of different intervention strategies in premature infants, thus providing an overview and outlook of the current applications and remaining gaps of early intervention strategies in premature infants. This review is focused on three key concepts. Firstly, the gut microbiota of premature infants is at high risk of dysbiosis, resulting in dysfunctional intestinal immune system processes. Secondly, contributing roles of early intervention have been observed in improving the intestinal environment and promoting gut microbiota colonization, which is significant in the development and function of gut immunity in premature infants. Thirdly, different strategies of early intervention, such as probiotics, fecal microbiota transplantation, and nutrients, show different safety, applicability, and outcome in premature infants, and the underlying mechanism is complex and poorly understood. [ABSTRACT FROM AUTHOR]

• After the implementation of PCV-10, the number of hospitalizations has reduced by 24.5% (from 681 to 514). • The hospitalization rate dropped by 22.7% in the five-year period following the implementation of PCV-10. • Based on modeling, after PCV-10, 8,682 hospitalizations were prevented. Pneumonia is a major cause of morbidity and mortality in children, with pneumococcus as the main etiologic agent. In Brazil, the 10-valent pneumococcal conjugate vaccine (PCV-10) was introduced into the childhood immunization schedule in 2010. The aim of this study was to assess the impact caused by implementing PCV-10 on the hospitalizations of children with pneumonia, between 2005 and 2015, in the state of Pernambuco, Brazil. An ecological time series study and a forecasting analysis were conducted. A comparison was made between the hospitalizations of children aged between seven months and four years due to pneumonia in the Brazilian Unified Health System, in the 5 years before (2005–2009) and after (2011–2015) implementation of PCV-10. Descriptive analysis included absolute and relative values, means and rates of hospitalization. The chi-square test was used to compare the annual incidence of hospitalizations and the t-Student test to compare the five-year mean values. For the temporal modeling of hospitalizations, an autoregressive integrated moving average was used, adjusted with seasonal-SARIMA (Box-Jenkins methodology), with a prediction of the monthly number of hospitalizations for 2011–2015. The predicted and observed values for 2011–2015 were then compared. The number of hospitalizations after implementing PCV-10 was reduced by 24.5 %. The monthly average of hospitalizations dropped from 681 (2005–2009) to 514 (2011–2015). The hospitalization rate dropped from 56.1 per thousand live births in the five-year period prior to PCV-10 to 43.4 in the following five-year period (a 22.7% reduction). Comparing the values predicted by the SARIMA model for a scenario without PCV-10 in the second five-year period, with those reported after implementing PCV-10, the estimated number of prevented hospitalizations was 8,682 in the five years following the introduction of the vaccine. In conclusion, in the five years following implementation of PCV-10, hospitalizations of children with pneumonia in Pernambuco decrease by 22%. [ABSTRACT FROM AUTHOR]

Diarrhea, pneumonia, malnutrition, tuberculosis, measles, and fever are the leading causes of mortality in children under five-years of age (0–59 months), whereas diarrhea alone is the world's second-biggest cause of mortality in this population. This study is particularly important for Pakistan as it focuses on one of the main causes of infant mortality, diarrhea, which is a major challenge for Pakistan to achieve the Sustainable Development Goals to reduce infant mortality to 12/1000 live births by 2030. This study was planned to investigate the various household, parental, environmental, and child-related factors causing diarrheal diseases in children aged 0–59 months in Punjab Pakistan. The study used the data of 38,405 households from the Multiple Indicator Cluster Survey (MICS) 2017–18, directed by the Punjab Bureau of Statistics. Comprehensive descriptive statistics, i.e., cross-tabulations and logistic regression were used for the detailed analysis. The results showed that infants are more probable to get diarrhea than older children. A wide range of influences were found to affect the probability of a child getting diarrhea, including child-specific, mother-specific and environment-specific ones. One prominent finding was that, at the mother level, the education of the mother played a significant role in reducing diarrhea among children under five-years of age (0–59 months). The results of the study contribute to the literature by highlighting that it is an interplay of factors that result in diarrhea. Hence, improving the source of drinking water, e.g., tap water and bottled water, can decrease the occurrence of diarrhea, especially in poor households. It was also revealed that households with a toilet facility of flush have less probability of their children being diagnosed with diarrhea than toilet facilities in open drains and fields. On the child level, results suggested that birth order matters as well, with the firstborn child having a lower probability of contracting diarrhea than siblings born after. Interventions targeting infants and mothers of infants aimed at reducing diarrhea are expected to be very effective to reduce child mortality, one of the main child health challenges faced by Pakistan. • Diarrhea is the world's second-biggest cause of infant and under-five mortality, and it demonstrates the potential health and economic impact of the disease on the targeted population. • The Sustainable Development Goals aim to reduce the global infant mortality rate to twelve deaths per thousand live births by the year 2030. • Infants are more likely to get diarrhea than older children. • Improving health facilities, health education, and access to better household & environmental infrastructure are the most effective way for reducing infant and under-five mortality in Pakistan due to diarrhea. [ABSTRACT FROM AUTHOR]

We introduce a unique data set of estimated population losses in Germany as a result of the 30 Years' War (30 YW), fought between 1618 and 1648, which we match to German counties as defined in 1900. We find that counties with larger population losses experience significantly more youth assault crimes in 1900. To support a more causal interpretation of our results, we identify a set of counterfactual counties via propensity score matching. On this matched sample, we find that a county's 30 YW population losses are largely unrelated to a wide range of pre-30 YW social, economic, geographic and religious characteristics, indicating that our result is driven by differential exposure to the violence of the war and not by pre-existing county differences. Although, owing to the historical nature of our data, it is difficult to uncover precise mechanisms, we present additional evidence that suggests 30 YW population losses lead to a general deterioration of county social and economic conditions over time: Differential exposure to the violence of the war led otherwise similar counties to experience more conflict following the 30 YW as well as higher rates of child mortality, less welfare expenditure, and increases in suicides some 250 years later. (JEL : N33, N43, D74, Z10) [ABSTRACT FROM AUTHOR]

Background: Tuberculosis diagnosis might be delayed or missed in children with severe pneumonia because this diagnosis is usually only considered in cases of prolonged symptoms or antibiotic failure. Systematic tuberculosis detection at hospital admission could increase case detection and reduce mortality.Methods: We did a stepped-wedge cluster-randomised trial in 16 hospitals from six countries (Cambodia, Cameroon, Côte d'Ivoire, Mozambique, Uganda, and Zambia) with high incidence of tuberculosis. Children younger than 5 years with WHO-defined severe pneumonia received either the standard of care (control group) or standard of care plus Xpert MTB/RIF Ultra (Xpert Ultra; Cepheid, Sunnyvale, CA, USA) on nasopharyngeal aspirate and stool samples (intervention group). Clusters (hospitals) were progressively switched from control to intervention at 5-week intervals, using a computer-generated random sequence, stratified on incidence rate of tuberculosis at country level, and masked to teams until 5 weeks before switch. We assessed the effect of the intervention on primary (12-week all-cause mortality) and secondary (including tuberculosis diagnosis) outcomes, using generalised linear mixed models. The primary analysis was by intention to treat. We described outcomes in children with severe acute malnutrition in a post hoc analysis. This study is registered with ClinicalTrials.gov (NCT03831906) and the Pan African Clinical Trial Registry (PACTR202101615120643).Findings: From March 21, 2019, to March 30, 2021, we enrolled 1401 children in the control group and 1169 children in the intervention group. In the intervention group, 1140 (97·5%) children had nasopharyngeal aspirates and 942 (80·6%) had their stool collected; 24 (2·1%) had positive Xpert Ultra. At 12 weeks, 110 (7·9%) children in the control group and 91 (7·8%) children in the intervention group had died (adjusted odds ratio [OR] 0·986, 95% CI 0·597-1·630, p=0·957), and 74 (5·3%) children in the control group and 88 (7·5%) children in the intervention group had tuberculosis diagnosed (adjusted OR 1·238, 95% CI 0·696-2·202, p=0·467). In children with severe acute malnutrition, 57 (23·8%) of 240 children in the control group and 53 (17·8%) of 297 children in the intervention group died, and 36 (15·0%) of 240 children in the control group and 56 (18·9%) of 297 children in the intervention group were diagnosed with tuberculosis. The main adverse events associated with nasopharyngeal aspirates were samples with blood in 312 (27·3%) of 1147 children with nasopharyngeal aspirates attempted, dyspnoea or SpO2 less than 95% in 134 (11·4%) of children, and transient respiratory distress or SpO2 less than 90% in 59 (5·2%) children. There was no serious adverse event related to nasopharyngeal aspirates reported during the trial.Interpretation: Systematic molecular tuberculosis detection at hospital admission did not reduce mortality in children with severe pneumonia. High treatment and microbiological confirmation rates support more systematic use of Xpert Ultra in this group, notably in children with severe acute malnutrition.Funding: Unitaid and L'Initiative.Translation: For the French translation of the abstract see Supplementary Materials section. [ABSTRACT FROM AUTHOR]

WHO recommends mass drug administration (MDA) of the antibiotic azithromycin for children aged 1–11 months in areas with high rates of infant and child mortality. Notwithstanding the substantial potential benefits of lowering childhood mortality, MDA raises understandable concerns about exacerbating antibiotic resistance. In this study, we aimed to evaluate the use of MDA using both quantitative and ethical considerations. We performed a series of literature searches between July 2019 and June 2022. We first compared MDA with other uses of antibiotics using the standard metric of 'number needed to treat', and five additional criteria: (1) other widely accepted uses of anti-infectives (2) absolute use (i.e. total number), of antibiotics, (3) risk-benefit trade-off, (4) availability of short-term alternatives, and (5) the precedent for implementing similar interventions. We found that MDA falls well within a justifiable range when compared with widely accepted uses of antibiotics in terms of the number needed to treat. The other five criteria we considered provided further support for the use of MDA to prevent childhood mortality. Although better data on antibiotic use and resistance are needed, efforts to reduce antibiotic use and resistance should not start with halting MDA of azithromycin in the areas with the highest rates of childhood mortality. Improving data to inform this decision is critical. However, on the basis of the best evidence available, we believe that concerns regarding resistance should not thwart MDA; instead, MDA should be accompanied by robust plans to monitor its efficacy and changes in resistance levels. Similar considerations could be included in a framework for evaluating the benefits of antibiotics against the risk of resistance in other contexts. [ABSTRACT FROM AUTHOR]

Unintentional injuries are common among children below the age of 14 years. Although the concern about the need for injury prevention is increasing among caregivers, preventable injuries are still one of the leading causes of death among children aged 0-14 years. Hence, there is a need for an effective system that can empower caregivers, parents and nursery teachers in making better and faster decisions to protect the lives of children through situational design of safe environments. In this paper, as a new situational design tool, we propose a situation-aware system for unintentional injury prevention with the integration of image processing using an RGB-D camera and spatial knowledge graphs. This paper describes the identification of dangerous situations based on the results obtained from an R-Map analysis of a large amount of data on injury situations. This paper also describes an implementation of the system and the advantages that it can offer in understanding possible dangerous situations in indoor environments like classrooms or homes and providing alternative suggestions on what kind of preventive measures can be taken to minimize such injuries. The feasibility of the proposed system was proved by applying it into nursery injury situational data. [ABSTRACT FROM AUTHOR]

It is generally recognized that paternal care is a facultative feature of human cooperative caregiving that helps underpin our evolved life history strategy. Yet, little direct evidence links variation in men's fathering to fitness outcomes. Research in small-scale, subsistence-level societies has focused more on links between fitness and men's social status, which overlaps with paternal care (e.g., hunting prowess/reputation and provisioning) but is distinct. Helping address this gap, we demonstrate linkages between fathers' roles and fitness-related outcomes among the BaYaka, a highly egalitarian Congo Basin forager population. Using measures drawn from community perceptions of men's quality in locally-valued domains of fathering, we find that BaYaka men (N = 31) ranked as better at providing for their families and sharing resources with the community had more living children. We observed a similar pattern for men ranked as better teachers, though evidence from Bayesian regression models was weaker than for these other domains. Those men ranked higher for provisioning and sharing, respectively, also had more total children (living and deceased combined). These fathering qualities were not significantly associated with variation in child mortality. Our results are consistent with long-standing arguments around the evolutionary importance of provisioning as paternal care, and point to other pathways, such as resource sharing, through which higher quality paternal care can be linked to reproductive success. [ABSTRACT FROM AUTHOR]

Background: Poor maternal mental health during childhood hospitalization is associated with post-discharge child mortality. We aimed to establish if maternal PHQ-9 scores during hospitalization are associated with acute stressors, or longer trends in mental health status.Method: Mothers of children admitted to nine hospitals in six countries completed a PHQ-9 assessment during hospitalization, and 45-days post-discharge. Community participants were recruited from homes near the hospitalized children. The prevalence and correlates of high PHQ-9 scores among hospitalized and community mothers were compared.Outcomes: Among 2762 mothers of hospitalized children, 514 (19 %) had PHQ-9 scores ≥10, significantly more than the 116 (10 %, p < 0·001) of 1159 community participants. Recruitment site and food insecurity were PHQ-9 correlates in both groups. Correlates of higher mean PHQ-9 scores among the hospitalized cohort included maternal illness (mean difference [MD]: 1·27, 95%CI: 0·77, 1·77), pregnancy (MD: 0·77, 95%CI: 0·27, 1·28), child HIV-infection (MD: 2·51. 95%CI: 1·55, 3·52), and lower child weight-for-height (MD: 0·21, 95%CI: 0·32, 0·11). Marriage (MD -0·92, 95%CI: -1·36, -0·48) and a positive malaria test (MD: -0·63, 95%CI: -1·15, -0·10) were associated with lower PHQ-9 scores among mothers of hospitalized children. Among mothers with PHQ-9 ≥10 during admission, 410 had repeat assessments 45-days after their child's discharge, and 108 (26 %) continued to meet the high PHQ-9 criterion.Interpretation: Among mothers of hospitalized children, there are subgroups with transient and persistent depressive symptoms. Interventions tailored to address acute stressors may improve post-discharge paediatric and maternal health outcomes.Funding: Bill & Melinda Gates Foundation OPP1131320. [ABSTRACT FROM AUTHOR]

Pneumococcal disease (PD) remains a major health concern with considerable morbidity and mortality in children. Currently licensed pneumococcal conjugate vaccines (PCVs) confer protection against PD caused by most vaccine serotypes, but non-vaccine serotypes contribute to residual disease. V114 is a 15-valent PCV containing all 13 serotypes in Prevnar 13™ (PCV13) and additional serotypes 22F and 33F. This pivotal phase 3 study compared safety and immunogenicity of V114 and PCV13. 1720 healthy infants were randomized 1:1 to receive a 4-dose regimen of V114 or PCV13 concomitantly with other routine pediatric vaccines. Safety was evaluated after each dose as proportion of participants with adverse events (AEs). Serotype-specific anti-pneumococcal immunoglobulin G (IgG) was measured at 1-month post-dose 3 (PD3), pre-dose 4, and 1-month post-dose 4 (PD4). IgG response rates, geometric mean concentrations (GMCs), and opsonophagocytic activity (OPA) were compared between vaccination groups. The proportion, maximum intensity, and duration of injection-site, systemic, and serious AEs were generally comparable between V114 and PCV13 groups. In comparison to PCV13, V114 met non-inferiority criteria for all 15 serotypes based on IgG response rates at PD3. V114 met non-inferiority criteria by IgG GMCs for all serotypes at PD3 and PD4, except for serotype 6A at PD3. V114-induced antibodies had bactericidal activity as assessed by OPA. Further, V114 met superiority criteria for shared serotype 3 and unique serotypes 22F and 33F compared to PCV13 by serotype-specific IgG GMCs at both PD3 and PD4. Immunogenicity of concomitantly administered routine pediatric vaccines was comparable in V114 and PCV13 groups. In healthy infants, V114 displays acceptable safety and tolerability profiles and generates comparable immune responses to PCV13. V114 also met superiority criteria for serotypes 3, 22F, and 33F. These results support use of V114 for prevention of PD as part of routine infant vaccination schedules. Trial registration: ClinicalTrials.gov : NCT03893448; EudraCT: 2018-004109-21. [ABSTRACT FROM AUTHOR]

It is a sad reality that although eminently preventable, and despite possessing such knowledge for >70 years, rheumatic heart disease (RHD) remains the most common cause of cardiovascular morbidity and early mortality in young people worldwide. A disease of the poor, RHD is one of the most neglected diseases. Several challenges are unique to the acute rheumatic fever/RHD continuum and contribute to its persistence, including its sequestration among the poorest, its protracted natural history, the erratic availability of penicillin, and the lack of a concerted effort in endemic regions. However, there is cause for optimism following a resurgence in scientific interest over the last 15 years. This review presents the latest advancements in epidemiology, diagnosis, and management. It also discusses pressing research questions on disease pathophysiology, the barriers to implementation of effective management strategies, and pragmatic policy solutions required for translation of current knowledge into meaningful action. [Display omitted] • Rheumatic heart disease is the most common cause of cardiovascular morbidity and early mortality in children and young adults worldwide. • New data on disease burden have driven advancements in diagnosis and management of patients with rheumatic heart disease. • Pragmatic policies are required to translate current knowledge into improved outcomes for patients with rheumatic heart disease. [ABSTRACT FROM AUTHOR]

• This mature and multidisciplinary trauma service was associated with a very low in-hospital mortality in severely injured children. • Deaths were shown to be almost exclusively non-preventable. • The rate of futile care and extensive emergency surgical procedures significantly decreased during the study period; there were no ED thoracotomies in non-survivors after 2013. In line with international trends, initial treatment of trauma patients has changed substantially over the last two decades. Although trauma is the leading cause of death and disability in children globally, in-hospital pediatric trauma related mortality is expected to be low in a mature trauma system. To evaluate the performance of a major Scandinavian trauma center we assessed treatment strategies and outcomes in all pediatric trauma patients over a 16-year period. A retrospective cohort study of all trauma patients under the age of 18 years admitted to a single institution from 1st of January 2003 to 31st of December 2018. Outcomes for two time periods were compared, 2003–2009 (Period 1; P1) and 2010–2018 (Period 2; P2). Deaths were further analyzed for preventability by the institutional trauma Mortality and Morbidity panel. The study cohort consisted of 3939 patients. A total of 57 patients died resulting in a crude mortality of 1.4%, nearly one quarter of the study cohort (22.6%) was severely injured (Injury Severity Score > 15) and mortality in this group decreased from 9.7% in P1 to 4.1% in P2 (p <0.001). The main cause of death was brain injury in both periods, and 55 of 57 deaths were deemed non-preventable. The rate of emergency surgical procedures performed in the emergency department (ED) decreased during the study period. None of the 11 ED thoracotomies in non-survivors were performed after 2013. A dedicated multidisciplinary trauma service with ongoing quality improvement efforts secured a low in-hospital mortality among severely injured children and a decrease in futile care. Deaths were shown to be almost exclusively non-preventable, pointing to the necessity of prioritizing prevention strategies to further decrease pediatric trauma related mortality. [ABSTRACT FROM AUTHOR]

• Injury remains the leading and most common cause of death in children above the age of one in Quebec. • In Northern Quebec, injury is the leading cause of death in children, occurring at a rate that is 3 to 4 times higher than the national average. • Patients from Northern Quebec were significantly more likely to experience a longer length of hospitalization than their counterparts. • A more sophisticated pre-hospital trauma system allowing for better and culturally sensitive treatment of patients from all of Quebec is needed. Injury is the leading cause of death in children over the age of one in Canada, and remains the most common cause of death in Quebec pediatric patients. Indigenous communities are 3–4 times more likely to be affected by injuries than the national average. In Quebec, health centres can range from 30 to 1000 km away from the closest level I trauma center. Descriptive analysis and multiple logistic regression were performed for severely injured pediatric trauma patients received at the Montreal Children's Hospital (MCH) over a ten-year period. Outcomes were compared between regional groups in Quebec using forward sortation areas. Two hundred and forty four pediatric patients presented to the MCH with major trauma between 2006 and 2016. Of those, 42% of patients resided in Montreal, 42% off-island, and 16% in Northern Quebec. Admission to the Intensive Care Unit (ICU) was required for 60% of off-island patients and 58% of Northern residents. The median length of hospital stay (LOS) was 5 days for off-island and 15 days for Northern patients. Most patients (78% off-island vs. 76% Northern Quebec) were discharged home. The overall mortality was 5%. In multiple regression analysis, residence in Northern Quebec was associated with increased incidence of longer than median length of stay compared to off-island patients (OR 2.78, 95%CI (1.12–7.29)) after adjusting for injury severity, operative intervention, age, and sex. ICU admission rate was similar among Northern and off-island populations. Patients from Northern Quebec appeared to have longer-than-median hospital length of stay. In-hospital mortality was infrequent and limited to on-island and off-island populations. A further exploration of this data is required to identify the "trauma deserts" and advocate for children involved in trauma in all areas of Quebec. [ABSTRACT FROM AUTHOR]

Objective: Early screening and diagnosis of nocturnal hypoventilation can slow progression to diurnal hypercapnia and mortality in children with neuromuscular disease (NMD). However, gold standard, laboratory-based polysomnography (PSG) testing is a limited resource. Therefore, we evaluated the diagnostic accuracy of ambulatory transcutaneous carbon dioxide (tcCO2) monitoring used in the home compared to PSG in children with NMD.Methods: Prospective, cross-sectional study in children 0-18 years old with a confirmed diagnosis of NMD and a clinically indicated need for PSG. Ambulatory tcCO2 was assessed by a respiratory therapist in participant's homes. Demographics, and PSG (including tcCO2).Results: We enrolled 39 children with NMD; 3 had unusable ambulatory tcCO2 data because of failure of drift correction on the machine (n = 2) or an air bubble (n = 1). The remaining 36 patients aged 11 months to 16 years (median (IQR) 12.5 years (6.0-15.8)) had ambulatory tcCO2 and outpatient level 1 PSG data. Ambulatory tcCO2 monitoring had a sensitivity of 20.0% (95% confidence interval [CI] 0.5-71.6%) and a specificity of 93.5% (95% CI 78.6-99.2%). Almost all children and/or parents (34/36, 94%) preferred ambulatory monitoring over in-hospital PSG.Conclusions: Ambulatory transcutaneous carbon dioxide monitoring was not sufficiently accurate as a clinical tool for the diagnosis of nocturnal hypoventilation our cohort of children with neuromuscular disease despite being preferred over PSG by both children and parents. [ABSTRACT FROM AUTHOR]

This study aimed at evaluating territorial inequalities in avoidable mortality in children under 5 years of age in Colombia between 2000 and 2019. This was an ecological study. An ecological, longitudinal, multigroup study was conducted using secondary sources. Because of the hierarchical structure of the data, the effect of territorial characteristics on the count of avoidable under-five deaths was estimated using a three-level negative binomial regression model with random intercepts for municipality and fixed intercepts for time and departments. Between 2000 and 2019, there were 216,809 avoidable under-five deaths in Colombia (91.3% of all registered deaths of children under 5 years of age). A total of 1117 municipalities located in 33 departments were analyzed over five 4-year periods. Ecological relationships were found between avoidable under-five mortality and the percentage of adolescent births, female illiteracy, and multidimensional poverty at the municipal level (standardized mortality ratio: 1.43 95% confidence interval: 1.33–1.54 for the group with the highest level vs the group with the lowest level of poverty). Furthermore, multidimensional poverty was a confounding factor for the association between the percentage of the population living in rural areas and avoidable child mortality. Systematic and avoidable gaps were observed in mortality in children aged under 5 years in Colombia, where the territory constitutes an axis of inequality. Implementing strategies and programs that contribute to improving the conditions of women and socio-economic conditions in the territories should be a priority. [ABSTRACT FROM AUTHOR]

• A 2-dose vs 1-dose measles vaccine (MV) schedule was beneficial in the first RCT. • However, in two later RCTs mortality tended to be higher in the 2-dose group. • We examined whether oral polio vaccine campaigns (C-OPV) explained the pattern. • With no C-OPV-before-enrolment, the hazard ratio (HR) was 0.79 (0.62-1.00). • When C-OPV was received before enrolment the HR was 1.39 (0.97-1.99). Between 2003 and 2019, three trials (randomised controlled trials [RCTs]) in Guinea-Bissau randomised infants to an early 2-dose measles vaccine (MV) schedule at 4 and 9 months vs standard MV at 9 months. The RCTs produced contradictory mortality results; the effect being beneficial in the 2-dose group in the first but tending to have higher mortality in the last two RCTs. We hypothesised that increased frequency of campaigns with oral polio vaccine (C-OPV) explained the pattern. We performed per-protocol analysis of individual-level survival data from the three RCTs in Cox proportional hazards models yielding hazard ratios (HR) for the 2-dose vs the 1-dose MV group. We examined whether timing of C-OPVs and early administration of OPV0 (birth to day 14) affected the HRs for 2-dose/1-dose MV. The combined HR(2-dose/1-dose) was 0.79 (95% confidence interval: 0.62-1.00) for children receiving no C-OPV-before-enrolment, but 1.39 (0.97-1.99) for those receiving C-OPV-before-enrolment (homogeneity, P = 0.01). C-OPV-before-enrolment had a beneficial effect in the 1-dose group but tended to have a negative effect in the 2-dose group, especially in females. These effects were amplified further by early administration of OPV0. In the absence of C-OPVs, an early 2-dose MV strategy had beneficial effects on mortality, but frequent C-OPVs may have benefitted the 1-dose group more than the 2-dose MV group, leading to varying results depending on the intensity of C-OPVs. [ABSTRACT FROM AUTHOR]

Diarrhoea is the second most common cause of death among children under five worldwide. About 90 percent of diarrhoeal diseases occur in South Asia and sub-Saharan countries. In Pakistan, it causes almost 53,000 children to die every year. Against this background, this study aimed to analyze the geographical variations in the socio-economic and climatic determinants of under-five diarrhoea cases in districts of Pakistan. We used Generalized Linear Regression (GLR) and Multiscale Geographically Weighted Regression (MGWR) to explore the spatial variation of diarrhoea and its associated determinants. The MGWR model with 10 independent variables outperforms the GLR model (R2 = 0.72) with an adjusted R2 of 0.86. The local accuracy of the MGWR model increases from southwest to northeast. Furthermore among ten selected regressors, significant geographic diversity was found in the determinants of diarrhoea, including altitude, temperature, fever, ARI, and sanitation practices. These insights demand the need for targeted public health interventions, such as immunization campaigns, improved sanitation, and access to clean water and nutritional supplements, poverty eradication, especially in rural and high-risk regions. Future research should employ longitudinal designs and advanced spatial modeling to evaluate the impact of strategies and inform evidence-based policies to reduce the burden of childhood diarrhoea in Pakistan. [Display omitted] • GLR, GWR, and MGWR are applied to explore the association of multiple factors in diarrhoea among children in Pakistan. • MGWR model explained 86 % of the spatial variations of diarrhoea among children. • ARI symptoms, fever episodes, and rural population are key diarrhoea determinants in under-five children. [ABSTRACT FROM AUTHOR]

This paper investigates the nexus between women's empowerment and child health, in particular examining whether having more rights, and which rights, leads to improvements in the well-being of children, as reflected by child mortality rates. We distinguish between civil rights, political rights, and economic rights. In our sample of 134 countries over the period 1950–2018, and employing 27 separate rights-based measures of empowerment, women's empowerment commonly contributes to a reduction in child mortality in high-income countries, however, low- and middle-income countries reveal striking differences across some measures. For example, while women's participation in public administration or employment in the public sector is associated with reduced child mortality, the opposite is observed for the right to run a business and access to banking. Results suggest that strong institutions are needed to ensure rights are translated into better welfare. • Overarching study of rights-based measures of women's empowerment and their association with child mortality in 134 countries from 1950–2018. • Women's empowerment measures are commonly associated with a reduction in child mortality in high-income countries (HIC). • Association between women's empowerment and child health in low- and middle-income countries (LMIC) is less clearcut. • Women's participation in public sector and administration is associated with reduced child mortality in LMIC. • Results suggest strong institutions are needed to ensure rights are translated into better welfare. [ABSTRACT FROM AUTHOR]

What are the health effects of violent conflict? It is well known that wars kill civilians away from the battlefield and long after the fighting has stopped. Yet why this happens remains only partially understood. While we have good evidence that factors such as the destruction of infrastructure, political neglect, and the out-migration of health workers – what may be called supply-side factors – negatively affect health outcomes, we know much less about how violence shapes the attitudes and behavior towards healthcare use among civilians exposed to violent conflict – what may be called demand-side factors. Here, I theorize that exposure to violence suppresses civilian demand for healthcare through two mediating channels – mistrust of government institutions and fear of future violence – with adverse consequences for health outcomes, particularly child health. To test this theory empirically, I combine information from over 80,000 interviews conducted in 22 conflict-affected countries in Africa with individual- and context-level measures of exposure to violent conflict. Exposure to violence is associated with significantly lower levels of political trust and increased fear of future violence, which in turn predict lower healthcare utilization, lower immunization rates, and higher infant and child mortality. To fully address the health consequences of armed conflict, it is essential that we better understand the attitudinal and behavioral correlates of exposure to violence. • Violent conflict increases child mortality by reducing the demand for healthcare. • Conflict instills fear and mistrust, reducing health-seeking and vaccination rates. • Data come from over 80,000 interviews from 22 conflict-affected African countries. • Interventions should ensure secure access to healthcare and help rebuild trust. [ABSTRACT FROM AUTHOR]

This paper evaluates how maternal education affects child mortality in the context of 52 low- and middle-income countries. The sister fixed-effects model is employed, where we compare the child mortality outcome between biological sisters who attain different numbers of educational years. We find that an additional year of maternal education is linked with a 0.4 percentage point decrease in the likelihood of child mortality (a 4.3 % reduction relative to the sample mean). Additionally, the mechanism analysis reveals that improved women's labor market outcome, increased access to information, assortative matching, and health input allocation are possible pathways to the link between maternal education and child mortality. • The paper explores the intergenerational effects of female education. • The study is conducted in the context of developing countries. • Maternal education decreases child mortality. • Potential mechanisms are explored. [ABSTRACT FROM AUTHOR]

[Display omitted] • We first revealed the association between hot and cold nights and childhood pneumonia. • Hot nights are associated with a higher disease burden than hot days. • Impact of hot and cold nights on childhood pneumonia varies across countries. Studies have shown that abnormal temperature at night is a risk factor for respiratory health. However, there is limited evidence on the impact of hot and cold nights on cause-specific diseases such as pneumonia, which is a leading cause of morbidity and mortality in children. We collected daily data on pneumonia hospitalisations in children under five years from 2011 to 2017 in three low-, middle- and high-income countries (Bangladesh, China, and Australia). The intensity of hot and cold nights was measured by excess temperature. A space–time-stratified case-crossover analysis was used to estimate the association between hot and cold nights and childhood pneumonia hospitalisations. We further estimated the fraction of childhood pneumonia hospitalisations attributable to hot and cold nights. Both hot and cold nights were associated with an increased risk of hospitalisations for childhood pneumonia in low-, middle-, and high-income countries, with a greater disease burden from hot nights. Specifically, the fraction of childhood pneumonia attributable to hot nights was the largest in Australia [21.2%, 95% confidence interval (CI): 11.8%-28.1%], followed by Bangladesh (15.2%, 95% CI: 4.1%–23.8%) and China (2.7%, 95% CI: 0.4%-4.7%). Additionally, the fraction of childhood pneumonia attributable to cold nights was 1.3% (95% CI: 0.4%-2.0%) in Bangladesh and 0.4% (95% CI: 0.1%-0.7%) in China. This multi-country study suggests that hot and cold nights are not only associated with a higher risk of pneumonia hospitalisations in children but also responsible for substantial fraction of hospitalisations, with a greater impact from hot nights. [ABSTRACT FROM AUTHOR]

Spinal muscular atrophy (SMA) is an autosomal recessive disease that leads to progressive apoptosis of the motor neuron due to changes in the production of the SMN1 protein. In the pre-treatment era, it was considered the main genetic cause of mortality in children. Since then, diagnosing and instituting early treatment has become a pediatric genetic urgency. This work aims to characterize the diagnostic journey of patients with SMA 5q in a Brazilian reference center. This is a cross-sectional observational study carried out using data collected from the medical records of patients between 0 and 18 years old. 38 patients were included, 11 with SMA type 1, 19 with SMA type 2 and 8 with SMA type 3. A significant delay in diagnosis was found, patients with SMA type 1 (n=6, 54.5%, p<0.001) and 2 (n=10, 55.6%, p<0.001) received diagnosis between 12 months and 2 years, and those with type 3 SMA after 5 years of age (n=5, 62.5%, p<0.001). Consequently, there was also a significant delay in instituting treatment. Despite this, a significant increase in the life expectancy of patients with type I SMA was noticed, since 20% of the assessment were between 3 and 5 years old and 50% were over 5 years old. This study reinforces the need to establish early SMA diagnosis programs to obtain better results with the established therapies. Furthermore, it is relevant because we have few Brazilian epidemiological studies on the post-treatment era. [ABSTRACT FROM AUTHOR]

An ineffective cough contributes to morbidity and mortality in children with neuromuscular disorders (NMD). Mechanical cough augmentation is recommended in clinical practice guidelines and used in standardised care, but has not been assessed in South Africa (SA). This feasibility study investigated the effect of cough augmentation among children with NMD (5-18 years) hospitalised for respiratory infections, secretion retention and weak cough. Patients were randomly allocated to either manually assisted cough (MAC, n=6) or mechanical insufflation exsufflation (MI-E, n=5). Both groups were similar at baseline. All 11 participants (median (IQR): 5.58 (4.33 – 14.33) years) attended the same Paediatric hospital in the Western Cape, SA. The majority were female (n=8), non-ambulant (n=10) and presented with spinal muscular atrophy (n=6). No differences in ventilatory support duration, vital signs, and patient satisfaction with cough technique were found between groups. There was however a significantly lower NMD severity score (/13) at discharge [mean difference (95% CI): -2.300 (-4.359 – (-0.241))], favouring the MAC participants and a trend towards shorter hospitalisation for the MI-E group [mean difference (95% CI): 2.150 (-0.198 – 4.498) days]. The use of MAC showed no adverse events and only one participant experienced nausea and vomiting during MI-E. Although feedback from parents/caregivers in the MI-E group (4/5) preferred MI-E above MAC due to comfort and perceived efficacy, neither technique seems superior in the treatment of children with NMD. Therefore, both cough augmentation strategies seem to be safe in this patient cohort, however, larger, experimental studies are required to inform clinical practice in SA. [ABSTRACT FROM AUTHOR]

With the availability of novel disease-modifying therapies (DMT), survival in Spinal Muscular Atrophy (SMA) has increased, but mortality is not rare in severely affected cases. We aimed to characterise causes of mortality in children with SMA over the last five years since the introduction of DMT. This was a retrospective review of all patients with SMA registered on the SMA-REACH UK database, who died between 2019 and 2023. In the last 5 years, 521 patients were registered with SMA-REACH (1 SMA0; 241 SMA1; 188 SMA2; 91 SMA3). Twenty-five paediatric patients with SMA, in the SMA-REACH cohort, died in this time period: 1 SMA0(4%), 20 SMA1(80%), 4 SMA2(16%), 0 SMA3. In the SMA 0/ SMA 1 cohort, 8/21(38%) patients were treatment naïve (6 ineligible; 1 died prior to commencement; 1 declined treatment). Eleven patients received nusinersen with a median treatment duration of 6 months (range 1 month-6.5 years of treatment), 1 received risdiplam and 1 received zolgensma at 2 years of age. The median age of death was 10 months (range 7 weeks-13 years), and 76% (16/21) died of respiratory-related causes. In the SMA 2 cohort, 2/4 patients were ineligible for DMT, one enrolled in a clinical trial (olesoxime) and one received risdiplam at 13 years old for a duration of 2.7 years and died as result of a traumatic brain injury. The median age of death in this sub-cohort was 17 years 9 months (range 16 years-21 years). One other death was respiratory-related and 2 cases of cardiac arrest. In conclusion, over the last 5 years, 5% of SMA patients registered with SMA-REACH died. The majority had SMA 1, and at severe end of the spectrum. Respiratory-related deaths occurred in 68% of known causes of death. While survival has increased since the introduction of new therapies, mortality is still present in this cohort of children, especially in those more severely affected. Standard of care for respiratory management and ceiling of care discussions should continue to be a key part of the overall management in these patients. [ABSTRACT FROM AUTHOR]

The "Hispanic Paradox" refers to a commonly noted tendency for Hispanic immigrants to have good health outcomes relative to risks faced. This paper demonstrates the presence of the Hispanic Paradox relative to child maltreatment, with a focus on how it appears to "fade" generationally. To use national child maltreatment and census data to determine if the protective effects of the Hispanic Paradox are weaker ("fade") for counties with fewer foreign-born Hispanics. Census data, including the percentage of Hispanics in a county who were foreign-born, was used to predict child maltreatment rates as observed in the National Child Abuse and Neglect Data System. The analysis was done at a county level and included a number of covariates (e.g. Hispanic Median Income, Rural/Urban status...). We included national child maltreatment data at the county level. A negative binomial mixed effects model showed that for each point of increase in the percentage of the Hispanic foreign-born population of a county, the county Hispanic child maltreatment rate was expected to drop by 1 %. Variation in Hispanic national origin (i.e. Puerto Rico) was found to significantly moderate this relationship. Counties with higher percentages of foreign-born Hispanics have lower child maltreatment rates after controlling for other factors. This is consistent with emerging findings in the child mortality data and suggests that for child maltreatment, the Hispanic Paradox may fade generationally. [ABSTRACT FROM AUTHOR]

Pneumonia, an acute inflammatory lesion of the lung, is the leading cause of death in children aged < 5 years. We aimed to study the function and mechanism of Golgi phosphoprotein 3 (GOLPH3) in infantile pneumonia. Lipopolysaccharide (LPS)-induced acute lung injury (ALI) mice and injury of MLE-12 cells were used as the pneumonia model in vitro. After GOLPH3 was knocked down, the histopathological changes of lung tissues were assessed by hematoxylin-eosin (H&E) staining. The Wet/Dry ratio of lung tissues was calculated. The enzyme-linked immunosorbent assay (ELISA) method was used to detecte the contents of inflammatory factors in bronchoalveolar lavage fluid (BALF). The damaged DNA in apoptotic cells in lung tissues was tested by Terminal deoxynucleotidyl transferase-mediated dUTP Nick end labeling (TUNEL) staining. Immunofluorescence staining analyzed LC3II and Golgi matrix protein 130 (GM130) expression in lung tissues and MLE-12 cells. The apoptosis of MLE-12 cells was measured by flow cytometry analysis. Additionally, the expression of proteins related to apoptosis, autophagy and Golgi stress was examined with immunoblotting. Results indicated that GOLPH3 knockdown alleviated lung tissue pathological changes in LPS-triggered ALI mice. LPS-induced inflammation and apoptosis in lung tissues and MLE-12 cells were remarkably alleviated by GOLPH3 deficiency. Besides, GOLPH3 depletion suppressed autophagy and Golgi stress in lung tissues and MLE-12 cells challenged with LPS. Moreover, Rapamycin (Rap), an autophagy inhibitor, counteracted inflammation and apoptosis inhibited by GOLPH3 silencing in LPS-induced MLE-12 cells. Furthermore, brefeldin A (BFA) pretreatment apparently abrogated the inhibitory effect of GOLPH3 knockdown on autophagy in MLE-12 cells exposed to LPS. To be concluded, GOLPH3 knockdown exerted lung protective effect against LPS-triggered inflammation and apoptosis by inhibiting Golgi stress mediated autophagy. • GOLPH3 knockdown alleviated lung tissue pathological changes in LPS-induced ALI mice. • GOLPH3 knockdown relieved LPS-induced inflammation and apoptosis in lung tissues and MLE-12 cells. • GOLPH3 knockdown suppressed autophagy and Golgi stress in LPS-induced mice lung tissues and MLE-12 cells. • GOLPH3 knockdown suppressed LPS-induced autophagy in MLE-12 cells by inhibiting Golgi stress. [ABSTRACT FROM AUTHOR]

• Childhood vaccines could reduce mortality and improve later life health, schooling, and economic outcomes. • We examined the long-term associations of India's Universal Immunization Programme (UIP) with future demand for children. • UIP was associated with reduced likelihood of having at least one child and fewer desired children. Childhood vaccinations can increase population growth in the short term by improving the survival rates of young children. Over the long run, reductions in child mortality rates are associated with lower demand for children and lower fertility rates (known as "demographic transition"). Vaccination programs could potentially aid demographic transition by lowering child mortality and improving future health, schooling, and labor market outcomes of vaccinated mothers, but these long-term demographic benefits remain untested. We address this major gap in the literature by examining the associations of India's national childhood vaccination program (the Universal Immunization Programme or UIP) with future demand for children. We combine data on the district-wise rollout of UIP during 1985–1990 with fertility preference data of 625,000 adult women from the National Family Health Survey of India 2015–2016. We include women who were born five years before and after the rollout period (1980–1995) and were cohabiting with a partner at the time of the survey. We divide these 20–36-year-old women into two groups: those who were exposed to UIP at birth (treatment group) and those who were born before the program (control group). After controlling for individual- and household-level factors and age and district fixed effects, treatment group women are 2% less likely to have at least one child and want 2% fewer children in their lifetime as compared with the control group. The negative associations with at least one childbirth are larger for more educated and richer women, while the associations with desired number of children is larger for uneducated and poorer women. [ABSTRACT FROM AUTHOR]

• COVID-19 mortality declined in 2022 for age groups with high vaccine uptake (3–11 and 12–17 year olds). • COVID-19 mortality did not decline in 2022 for the 0–2 year old age group, which had low vaccine uptake. • The 2022 COVID-19 death rates were 16–18 times lower for those with at least two vaccine doses compared to the unvaccinated. • Pre-vaccination mortality from other diseases for which vaccination is compulsory was lower than yearly COVID-19 deaths during 2020–2022. Argentina authorized COVID-19 vaccination for adolescents 12 years and older in August 2021, and then for children three years and older in October 2021. Children aged 6 months–2 years received a two-dose regimen beginning July 2022. This study aims to analyze the impact of COVID-19 vaccination among children aged 0–17, considering vaccination status and mortality for the 2020–2022 period. We conducted a population-level analysis examining all-cause mortality, COVID-19 cases, deaths, and vaccination records. We compared outcomes with child mortality for diseases for which vaccination is compulsory, before and after each vaccine rollout. A decrease in COVID-19-related deaths was observed in 2022 for pediatric age groups (3–11 and 12–17) with relatively higher vaccination coverage. However, no decrease was observed for the 0–2 year old age group, which had the longest delay in access to immunization and lowest vaccination coverage. When compared to unvaccinated populations in 2022, we observe an 8–15-fold reduction in cumulative death rates for pediatric populations vaccinated with 1 or more doses, and a 16–18-fold reduction for those vaccinated with 2 or more doses. Historical analysis shows that for diseases for which vaccination is now compulsory in many countries, pre-vaccine-rollout mortality was lower than COVID-19 deaths during 2020–2022. SARS-CoV-2 immunization was associated with reduced COVID-19 deaths for children and adolescents in Argentina. Our findings suggest that greater efforts should be undertaken to ensure wider COVID-19 vaccine coverage in children and adolescents, especially infants. [ABSTRACT FROM AUTHOR]

Background: A head-to-head comparison of the most widely used oral rotavirus vaccines has not previously been done, particularly in a high child mortality setting. We therefore aimed to compare the immunogenicity of RotaTeq (Merck, Kenilworth, NJ, USA) and Rotarix (GlaxoSmithKline, Rixensart, Belgium) rotavirus vaccines in the same population and examined risk factors for low seroresponse.Methods: We did a randomised, controlled, open-label, parallel, phase 4 trial in urban slums within Mirpur and Mohakahli (Dhaka, Bangladesh). We enrolled eligible participants who were healthy infants aged 6 weeks and full-term (ie, >37 weeks' gestation). We randomly assigned participants (1:1), using block randomisation via a computer-generated electronic allocation with block sizes of 8, 16, 24, and 32, to receive either three RotaTeq vaccine doses at ages 6, 10, and 14 weeks or two Rotarix doses at ages 6 and 10 weeks without oral poliovirus vaccine. Coprimary outcomes were the rotavirus-specific IgA seroconversion in both vaccines, and the comparison of the rotavirus IgA seroconversion by salivary secretor phenotype in each vaccine arm. Seroconversion at age 18 weeks in the RotaTeq arm and age of 14 weeks in the Rotarix arm was used to compare the complete series of each vaccine. Seroconversion at age 14 weeks was used to compare two RotaTeq doses versus two Rotarix doses. Seroconversion at age 22 weeks was used to compare the immunogenicity at the same age after receiving the full vaccine series. Safety was assessed for the duration of study participation. This study is registered with ClinicalTrials.gov, NCT02847026.Findings: Between Sept 1 and Dec 8, 2016, a total of 1144 infants were randomly assigned to either the RotaTeq arm (n=571) or Rotarix arm (n=573); 1080 infants (531 in the RotaTeq arm and 549 in the Rotarix arm) completed the study. Rotavirus IgA seroconversion 4 weeks after the full series occurred in 390 (73%) of 531 infants age 18 weeks in the RotaTeq arm and 354 (64%) of 549 infants age 14 weeks in the Rotarix arm (p=0·01). At age 14 weeks, 4 weeks after two doses, RotaTeq recipients had lower seroconversion than Rotarix recipients (268 [50%] of 531 vs 354 [64%] of 549; p<0·0001). However, at age 22 weeks, RotaTeq recipients had higher seroconversion than Rotarix recipients (394 [74%] of 531 vs 278 [51%] of 549; p<0·0001). Among RotaTeq recipients, seroconversion 4 weeks after the third dose was higher than after the second dose (390 [73%] of 531 vs 268 [50%] of 531; p<0·0001]. In the RotaTeq arm, rotavirus IgA seroconversion was lower in non-secretors than in secretors at ages 14 weeks (p=0·08), 18 weeks (p=0·01), and 22 weeks (p=0·02). Similarly, in the Rotarix arm, rotavirus IgA seroconversion was lower in non-secretors than in secretors at ages 14 weeks (p=0·02) and 22 weeks (p=0·01). 65 (11%) of 571 infants had adverse events in the RotaTeq arm compared with 63 (11%) of 573 infants in the Rotarix arm; no adverse events were attributed to the use of either vaccine. One death due to aspiration occurred in the RotaTeq arm, which was not related to the vaccine.Interpretation: RotaTeq induced a higher magnitude and longer duration of rotavirus IgA response than Rotarix in this high child mortality setting. Additional vaccination strategies should be evaluated to overcome the suboptimal performance of current oral rotavirus vaccines in these settings.Funding: US Centers for Disease Control and Prevention. [ABSTRACT FROM AUTHOR]

We investigate the extent to which the subsidy for children's healthcare in Japan affects children's healthcare use and outcomes. The subsidy, which made children's healthcare services essentially free for patients, was introduced and expanded to preschool-age children in the 1990s. We use a difference-in-differences framework by exploiting variations in subsidy status, as the introduction timing and eligibility age differ across municipalities. We find that the subsidy significantly increased the use of outpatient care, as measured by the number of patients, visit intervals, and monthly spending. We also find evidence on the increase of inpatient use only for infants under 12 months of age (i.e., aged zero). Furthermore, the subsidy significantly improved children's subjective health symptoms reported by parents and contributed to reducing the mortality rate for infants by 0.79/1,000 individuals. In summary, our results suggest that free healthcare for children improves their access to healthcare as well as health outcomes, thus prioritizing this investment as part of national healthcare plans. [ABSTRACT FROM AUTHOR]

To find out risk factors for disease severity and mortality of pediatric COVID-19 in the fourth wave of COVID-19 in Vietnam. This retrospective cohort study was performed at Children's Hospital 1 from July to December 2021. All children with COVID-19 confirmed by a positive Realtime RT-PCR SARS-CoV-2 result and treated at COVID-19 department for at least 72 h were included. Of the 850 cases admitting to COVID-19 department, 555 children with COVID-19 confirmed by positive RT-PCR and treated at our center for more than 72 h. Median age of confirmed cases was 22.3 (IQR: 3.2–88.6) months, 55.1% were male, and 84.5% had a history of close contact with confirmed COVID-19 patients. The rate of mild, moderate and severe/critical cases was 73,7%, 9.0% and 17.3%, respectively. One hundred ninety-two children (34.6%) had underlying diseases, in which, neurologic disease was the most common underlying disease (7.9%). Underlying disease, dyspnea, elevated CRP >20 mg/L and elevated ferritin were independent factors related to severe illness. Twenty-point two percent of patients in our study needed respiratory support, including 22 invasive mechanical ventilation cases. Eighteen cases (3.2%) died because of severe comorbidities, poor response to treatment. In our study, the severe/critical and mortality rates in pediatric COVID-19 cases were relatively high. All fatal cases had severe comorbidities. Underlying disease, dyspnea, and elevated inflammatory markers were independent factors related to severity in pediatric COVID-19 cases. [ABSTRACT FROM AUTHOR]

• Average child mortality rate was lower for children born after the outbreak ended. • Relation of child mortality and outbreak intensity was stronger after the outbreak. • Disrupted maternal health services were recovered with different trends. The Ebola virus disease outbreak in 2014—2016 had a substantial impact on population health in Guinea, Liberia, and Sierra Leone. This study aimed to assess whether the impact continued after the outbreak ended regarding child mortality. Cross-sectional logistic regressions were run using data from the Demographic and Health Surveys in the three countries. The average child mortality rate was significantly lower for children born after the outbreak than for those born before. However, the association of the child mortality rate with an increase in the number of Ebola cases per 100,000 people was significantly stronger for children born after the outbreak ended. Also, the change in the utilization of maternal health services after the outbreak varied across health services. Restoring disrupted child health services to pre-Ebola levels may be more difficult in areas that suffered a higher number of Ebola cases. The recovery of maternal health services after the outbreak might be affected by factors such as the resilience of health systems at the subnational level. This study suggests that strengthening the health system is crucial to fully recover from the Ebola outbreak and cope with future epidemics. [ABSTRACT FROM AUTHOR]

[Display omitted] • We provided a comprehensive and the latest evaluation of the global childhood cancer burden. • The childhood cancer burden has been decreasing globally over the last 30 years. • Age-standardized incidence and prevalence rates of childhood cancer were more notable in higher SDI quintiles. • Age-standardized death and disability-adjusted life year rates of childhood cancer decreased with SDI. • Leukemia was still the most common cancer and the leading cause of death among children. Cancer is the leading cause of death among children. We report on the latest estimates of the burden of cancer among children at the global, regional, and national levels from 1990 to 2019. Based on the Global Burden of Disease Study 2019, children's cancer data were analyzed by sex, age, year, and location. Age-standardized rates were used to compare the burdens among regions and nations. Joinpoint analysis was applied to assess the temporal trend of the global childhood cancer burden. In 2019, 291,319 (95% uncertainty interval [UI], 254,239 to 331,993) new cases and 98,834 (86,124 to 113,581) deaths from childhood cancer were documented globally. Further, 8,302,464 (7,230,447 to 9,555,118) DALYs and 1,806,630 (1,567,808 to 2,089,668) prevalent cases were recorded in the same year. Age-standardized incidence and prevalence rates of childhood cancer were greatest in higher SDI settings and increased most significantly in Australasia and Southern Latin America over the last 30 years. However, although age-standardized death and DALY rates of childhood cancer have remarkably decreased in all regions since 1990, countries with a lower SDI showed the highest rates in 2019, particularly in countries in Eastern Sub-Saharan Africa. Among all cancers, leukemia has shown the largest decrease in burden since 1990. Despite this, leukemia was still the most common cancer and the leading cause of death among children in 2019, followed by brain and central nervous system cancer. On a global scale, the childhood cancer burden has significantly fallen over the last 30 years, but is still higher in lower SDI countries. Effective interventions and collaborations among nations should be facilitated to improve healthcare among children with cancer in countries with lower SDI. [ABSTRACT FROM AUTHOR]

Infectious diseases are the major cause of children's deaths all over the world. With the development of evidence-based medicine, etiological diagnosis becomes more and more important. Since traditional methods have been unable to meet the needs of diagnosis and treatment, metagenomic next-generation sequencing (mNGS) gradually shows its unique advantages for pathogen diagnosis. This article aimed to introduce the application of mNGS technology in the diagnosis and treatment of neonatal and puerile infectious diseases by providing some examples. [ABSTRACT FROM AUTHOR]

Introduction: Mortality attributed to fire and flame for children (0-14 years) over a fifty-year period has not been previously analyzed in Australia. The literature has focused on these deaths over a shorter time period or disaggregated with other causes of burns or deaths in one burns center. However, mortality associated with fire/flames affects this age group the greatest. The aims of this study are to: (1) develop a trends analysis of fire and flames mortality between1968 to 2016, using the Australian Bureau of Statistics (ABS) mortality database and, (2) determine the association of interventions with fire and flames mortality using the Haddon's categorical intervention framework.Methods: International Classification of Disease (ICD) codes were extracted and code equivalencies between ICD 8, 9, 10 and the Australian Bureau of Statistics for fire/flames data between 1968--2016 were assessed. To determine whether population changes affected the risks of mortality, the frequency and, rates per 100,000 were used. A literature review was conducted that summarized the current knowledge of interventions associated with the major decreases in the fire and flames mortality rate.Results: In Australia, we found was a downward trend for the period although with significant variation from year to year when compared to external cause mortality. Additionally, there were multiple successful interventions associated with a sustained decrease in mortality. After 2016, child fire-related mortality remains a problem particularly in low socioeconomic groups and indigenous peoples. A combination of research, public awareness, engineering, legal enforcement, advancements in burns care and, evidence-based policy development all have a role to play in future injury prevention initiatives. Although direct causation to an individual is not possible, associations can be drawn from interventions on a population level to decreases in mortality.Conclusion: We found was a steady decline in both rates and frequency of childhood fire and flames mortality from 1968 to 2016 associated with multiple interventions. [ABSTRACT FROM AUTHOR]

Background Dietary diversity (DD) is a key component of diet quality, and malnutrition due to poor diet quality leads to child morbidity and mortality. However, in Bangladesh, there is a lack of information on childhood DD (for children aged 6–59 mo) amid the coronavirus disease 2019 (COVID-19) pandemic. Objectives The purpose of this study was to assess the minimum DD and its associated factors among children aged 6–59 mo during the COVID-19 pandemic in Bangladesh. Methods A cross-sectional study was carried out in 6 districts of Bangladesh. A total of 1190 respondents were included using cluster random sampling. The Individual Dietary Diversity Score (IDDS) for children was used to assess the children's DD. Factors associated with DD of children were identified using a multilevel binary logistics regression model. Results About 70% of the children aged 6–59 mo had minimum DD during the COVID-19 pandemic in Bangladesh. Children who belonged to slum areas [adjusted odds ratio (AOR): 0.45; 95% CI: 0.24, 0.83], family income 12,000–15,000 Bangladeshi taka (BDT) (AOR: 1.79; 95% CI: 1.06, 3.05) and >15,000 BDT (AOR: 2.59; 95% CI: 1.47, 4.57), mothers aged 26–30 y (AOR: 0.35; 95% CI: 0.20, 0.62) and >30 y (AOR: 0.43; 95% CI: 0.22, 0.85), respondents who had 2 children <5 y old (AOR: 0.43; 95% CI: 0.28, 0.66), and children aged 12–23 mo (AOR: 1.89; 95% CI: 1.14, 3.20) were significantly associated with DD among children aged 6–59 mo. Conclusions The findings of this study highlight the need for food and nutrition-related intervention, particularly targeting mothers of younger age and with >2 children <5 y old, mothers from slum regions, and fathers who were unemployed, to improve children's DD practices. [ABSTRACT FROM AUTHOR]