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Thyroid cancer is the most common endocrine malignancy in the pediatric population. A recent study has revealed a recent decline in overall US thyroid cancer incidence rates. The aim of this study is to assess whether there has been a corresponding decline in incidence rates in the pediatric population. We used the Surveillance, Epidemiology, and End Results (SEER) database to analyze the pediatric thyroid cancer incidence rate. The results demonstrate that the incidence rate of pediatric thyroid cancer continued to increase from 2000 to 2018. Future studies are needed to understand how recent changes in guidelines are affecting incidence rates. [ABSTRACT FROM AUTHOR]

This paper reports child mortality and associated factors among tribal (indigenous) populations from a South Indian district. In India, 104 million people belonged to 705 tribal groups, constituting 8.6% of India's population. Of the 705 tribal groups, 75 were classified as particularly vulnerable tribal groups (PVTG). The present study aims to report the under-five child mortality among the tribal (both PVTG and non-PVTG) population in Visakhapatnam district, a district with a higher concentration of tribes in the Indian state of Andhra Pradesh. Four sub-districts were selected to conduct a cross-sectional study to understand health and health-seeking behavior, including maternal and child health. Socio-demographic details and obstetric history were collected through a pre-tested, interviewer-administered questionnaire from mothers with a child aged up to one year. These 277 mothers gave birth to 632 liveborn children, out of which 56 children died within 12 months. Multiple logistic regression revealed that living in villages with no health facility, woman-headed households, younger age at first childbirth and mother' aged 30 years or above were significantly associated with mothers experiencing child death. Implementation of home-based neonatal care is crucial in the vulnerability context of the tribes due to socioeconomic conditions and remote habitation. Health educational interventions to address early marriages leading to teenage pregnancies are needed immediately. This disaggregated analysis of under-five mortality and associated factors among the tribes highlights the need for population-specific interventions and improving infrastructural facilities like all-weather roads and improved access to quality healthcare services in addition to the overall socio-economic development. [ABSTRACT FROM AUTHOR]

Only 14% of births had information on birth weight available at the time of birth in Ethiopia. Hence, previous studies underestimate the magnitude and associated factors of low birth weight (LBW). As a result, the goal of this study is to fill those gaps in the previous studies. An institution-based cross-sectional study was employed. Binary logistic regression was used to identify the associated factors. In this study, the magnitude of LBW was 13.06%. History of chronic medical illness (AOR = 3; 95% CI: (1.02, 9.17)), haemoglobin level during pregnancy (AOR = 0.23; 95% CI: (0.10, 0.50)), iron/folic acid supplementation (AOR = 0.27; 95% CI: (0.10, 0.72)) and extra meal during pregnancy (AOR = 3.2; 95% CI: (1.52, 7.00)) were significantly associated with LBW. The magnitude of LBW in this study was comparable to the Ethiopian Demographic and Health Survey (EDHS) report from 2016. It is better to intervene in those identified factors in order to reduce LBW. What is already knownon this subject? Low birth weight (LBW) accounts for 60–80% of all neonatal deaths each year. In developing countries like Ethiopia, LBW is a major public health concern. Almost half of the world's infants are not weighed at birth, a figure that is especially high in sub-Saharan Africa including Ethiopia. What dothe resultsof this study add? Only 14% of births had information on birth weight available at the time of birth in Ethiopia. Hence, previous studies underestimate the magnitude and associated factors of LBW. To meet the Sustainable Development Goals (SDGs)-2030 targets for neonatal and child mortality, sufficient evidence on the magnitude of LBW and associated factors must be important in order to contribute to the development of timely interventions. A history of chronic medical illness, haemoglobin level, iron/folic acid supplementation and extra meal during pregnancy was associated with LBW. What are the implications of these findings for clinical practice and/or further research? The findings of this study will be useful in developing better health policies to prevent LBW as well as interventions that can target the identified factors. [ABSTRACT FROM AUTHOR]

Disclosure of HIV status is an important part of pediatric care. We studied disclosure and clinical outcomes in a multi-country Asian cohort of children and adolescents with HIV. Those 6–19 years of age who initiated combination antiretroviral therapy (cART) between 2008 and 2018, and who had at least one follow-up clinic visit were included. Data up to December 2019 were analyzed. Cox and competing risk regression analyses were used to assess the effect of disclosure on disease progression (WHO clinical stage 3 or 4), loss to follow-up (LTFU; > 12 months), and death. Of 1913 children and adolescents (48% female; median [IQR] age 11.5 [9.2–14.7] years at last clinic visit), 795 (42%) were disclosed to about their HIV status at a median age of 12.9 years (IQR: 11.8–14.1). During follow-up, 207 (11%) experienced disease progression, 75 (3.9%) were LTFU, and 59 (3.1%) died. There were lower hazards of disease progression (adjusted hazard ratio [aHR] 0.43 [0.28–0.66]) and death (aHR 0.36 [0.17–0.79]) for those disclosed to compared with those who were not. Disclosure and its appropriate implementation should be promoted in pediatric HIV clinics in resource-limited settings. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has profoundly impacted the rituals and practices surrounding death, dying, and grief worldwide. This study examines how the pandemic has influenced grief and rituals of parents who have lost a child. Using an explanatory sequential research design, this mixed-methods study collected quantitative data through an online survey and qualitative data from in-depth interviews and open-ended survey questions. A total of 112 parents completed the survey, and eight parents participated in the in-depth interviews. The merged results demonstrated that the pandemic had a severe impact on all the rituals associated with the death of a child. However, most parents felt able to say goodbye to their child in the best possible way. The merged findings also show that most parents experienced a high level of grief after the death of their child, particularly mothers, whereby their grief was negatively impacted by pandemic restrictions and lack of social support. The viewing of the deceased child was associated with lower levels of grief, while upsetting viewings, establishing a digital memory page, not wanting a memorial, and conducting an alternative service were associated with higher levels of grief. Higher levels of grief, including unexpected death, female gender, lower educational attainment, and living in rural areas, were associated with higher levels of grief. Our findings highlight the need for follow-up care during and after a pandemic. [ABSTRACT FROM AUTHOR]

And domestic politics need to be managed to break out of the polarization which left the US with lower COVID vaccination rates and higher death rates than most other large high-income countries.[55] The second is support for vaccine and other capacity building in low- and middle-income countries, such as the mRNA Vaccine Technology Transfer Hub which includes 15 countries in the Global South. But even if Iran violates non-weaponization understandings with the International Atomic Energy Agency (IAEA) and the US were to resort to military force, claims of rule-enforcing against Iranian rule-breaking would be unlikely to carry the day given the US' highly mixed rule-abiding, rule-abusing record. It's hard to find a major Biden administration speech or policy document that doesn't invoke the "rules-based order." The United States for politics trumping science to such an extent that, as Francis Fukuyama put it, "its current highly polarized society and incompetent leader blocked the state from functioning effectively."[31] A bevy of countries for vaccine nationalism. [Extracted from the article]

Care after the death of a child and support of their bereaved family is an important element of the services offered by children's hospices in the United Kingdom. The study aims to explore the emotional challenges of those delivering care to families of children in hospice cool rooms. An internet-based questionnaire was sent to all practitioners to explore their perspectives of providing care to bereaved families whilst the child's body was in the hospice, as well as caring for a child's body after death. In total, 94.9% (n = 56) of staff responded. Two key themes were identified that represent the emotional challenges perceived by staff: the impact of deterioration of a child's body; and witnessing the acute grief of families. Practitioners seek to provide care that recognises the importance of family and demonstrates family-centred care, as well as supporting families to deal with the changes that occur after death. Organisations can support practitioners to deliver care in cool rooms by providing training and education on anticipating and managing the pathophysiological changes that occur after death as well as training in grief and loss, and how to support a bereaved family. [ABSTRACT FROM AUTHOR]

Background: Despite the increase in ventriculoperitoneal shunt surgeries performed for children with hydrocephalus, the potential complications and survival of patients after the procedure remains the major challenge for both clinical and public health aspects. This study intends to assess the survival status and scrutinize the predictive factors of mortality among children after a ventriculoperitoneal shunt. Methods: A retrospective cohort study was employed by reviewing charts of 337 systematically selected children who have undergone a ventriculoperitoneal shunt from 2016 to 2018 in Addis Ababa. The extraction tool was used for data collection, Epi-data version 4.4.2 for data entry, and Stata version-14 for cleaning and analysis. Kaplan-Meier curve, log-rank test, and life table were used to describe the data. Cox proportional hazard regression model was used for analysis. Any variable at p < 0.25 in the bi-variable analysis was fitted to multivariate analysis, and significance was declared at p ≤ 0.05. Then, AHR with 95% CI was used to report the association and test the statistical significance. Finally, texts and tables were used to present the results. Results and Conclusion: The incidence rate of mortality was 58.4 per 1000 child-months of observation with a median survival time of 12 months (95%CI: 9.04–14.96). Communicative hydrocephalus (AHR: 1.99, 95% CI: 1.18–3.36), post-traumatic brain injury (AHR: 7.43, 95% CI: 3.21–16.88), emergency surgery (AHR: 1.86, 95% CI: 1.17–3.13) as well as revised shunt procedure (AHR: 8.01, 95% CI: 6.12–13.43) were independent predictors of death. Besides, sunset eye (ARH: 2.01; 95% CI: 1.17–3.47), rapidly increased head size (ARH: 2.05, 95% CI: 1.14–3.37), prolonged antibiotics treatment (AHR: 2.46, 95% CI: 1.82–7.37), and gram-negative infections (AHR: 1.95, 95% CI: 1.60–12.64) were also significantly associated. Hence, health professionals ought to give special attention to patients with identified predictors. [ABSTRACT FROM AUTHOR]

There is an ongoing resurgence of diphtheria infection worldwide despite a vaccine being available to prevent it for more than four decades. To study the clinical characteristics and risk factors for mortality of diphtheria cases among children 1–12 years of age treated in our hospital from 1 April 2014 to 31 March 2021. The data of hospitalised cases of childhood diphtheria from 1 April 2014 to 31 March 2019 were retrospectively analysed from the medical records department of our hospital. All hospitalised children with diphtheria from 1 April 2019 to 31 March 2021, were prospectively studied. All categorical variables were expressed as proportion/percentage and all continuous variables were expressed as median with interquartile range (IQR). Risk factors for morbidity and mortality were analysed and tested for significance. Unadjusted odds ratio (OR) was calculated and significant variables were subjected to multivariate logistic regression. Of the 58 children with diphtheria, 62% were lab-confirmed, most cases (45%) were between 5 and 9 years of age. Majority (57%) were completely immunised as per the national immunisation schedule. Fever (97%) was the most predominant clinical symptom. The classical diphtheria pseudo membrane was identified in all. Respiratory failure was the most predominant complication, followed by myocarditis and acute kidney injury. The case fatality rate was 8.6%. Diphtheria cases were seen among children 5–9 years of age more commonly. Infection requiring hospitalisation was seen in vaccinated children too. No atypical manifestations were observed. Complications of the disease adversely affected the overall survival. [ABSTRACT FROM AUTHOR]

The study examined the extent, demographics and risks for child pedestrian, burns and drowning mortality in Johannesburg. Information on the demographics, scene and temporal circumstances for childhood injury deaths from 2000 to 2010 was gleaned from the National Injury Mortality Surveillance System. Descriptive statistical methods were used. The study recorded 756 pedestrian (8.7/100,000), 439 drowning (5.1/100,000), and 399 burn injury deaths (4.6/100,000) among children aged 0–14 years. Male children were the main victims, with male-to-female ratios of 2.3 for drowning, 1.7 for pedestrian and 1.2 for burn mortality. The pattern of child mortality differed across age groups with older children recording higher rates for pedestrian deaths and younger children higher rates for the non-traffic deaths. Pedestrian and burn mortality especially affected black children, while drowning affected both black and white children. The time, day and month of greatest injury mortality varied by injury cause, with e.g. pedestrian mortality common in afternoons and evenings, weekends, and dispersed across the year although increasing towards year end. The study highlighted the salience of differentiating risks for childhood injuries by discrete external cause for purposes of informing prevention responses. [ABSTRACT FROM AUTHOR]

The Dutch have a remarkable history when it comes to height. From being one of the shortest European populations in the 19th Century, the Dutch grew some 20 cm and are currently the tallest population in the world. Wealth, hygiene, and diet are well-established contributors to this major increase in height. Some have suggested that natural selection may also contribute to the trend, but evidence is weak. Here, we investigate the potential role of natural selection in the increase in height through simulations. We first ask what if natural selection was solely responsible for the observed increase in height? If the increase in average height was fully due to natural selection on male height, then across six consecutive generations, men who were two standard deviation above average height would need to have eight times more children on average. If selection acted only through those who have the opportunity to reproduce, then reproduction would need to be restricted to the tallest third (37%) of the population in order to give rise to the stark increase in height over time. No linear relationship between height and child mortality is able to account for the increase over time. We then present simulations based on previously observed estimates of partnership, mortality, selection and heritability and show that natural selection had a negligible effect (estimates from 0.07 to 0.36 cm) on the increase in height in the period 1850 to 2000. Our simulations highlight the plasticity of height and how remarkable the trend in height is in evolutionary terms. Only by using a combination of methods and insights from different disciplines, including biology, demography, and history are we potentially able to address how much of the increase in height is due to natural selection versus other causes. [ABSTRACT FROM AUTHOR]

Helpful workplace support strategies and accommodations (WSSA) for bereaved parents returning to work was assessed via comprehensive search of databases from 1990 to January 21, 2022. Eleven of 45 qualitative articles met inclusion. Bereaved parents often felt returning to work provided a coping strategy for and/or distraction from grief; however, some received insensitive comments by employer/coworkers. Helpful WSSA included flexibility on date to return to work and schedule. In conclusion, due to the intensity of their grief, bereaved parents benefit from a workplace offering individualized time off for bereavement and workplace accommodations to address potential difficulty meeting prior productivity demands. [ABSTRACT FROM AUTHOR]

Natural disasters, pandemics, and epidemics have devastating impacts on communities. Poverty, famine, ill health, social isolation, and death are some of the consequences of such events. Transformations in culture, religion, political and economic stability, and other social aspects can also be attributed to catastrophic incidents. Whilst such events have been well documented and studied, little attention has been given to their effect on children. Using osteoarchaeological and historical evidence, this review article explores how children appear to have been affected during, and in the aftermath of, natural disasters and epidemics. A range of cases from Antiquity to the modern day is provided, alongside three focal case studies. This research demonstrates analogies with the present-day where countries face disease outbreaks, droughts, floods, and earthquakes. Ultimately, the findings presented in this paper illustrate the extent to which these events shaped the lives and deaths of children in the past. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses articles in the issue on topics including 'or newly arrived Afghan women, help-seeking for domestic violence can be hindered by cultural barriers and by cultural norms that censure help-seeking beyond the family', and book reviews highlighting critical practice perspectives and policy development relevant for everyday ethical, frontline practice with children, families, and communities.

Northeast India is located away from mainland India and has a poor connectivity with the mainland India. Many inhabitants of the region have sociocultural beliefs and practices that are different from the mainstream Hindu and Islamic culture. It has the highest under-five child mortality rate in India and diarrhea is the third leading cause of death among under-five children, previous studies reported low treatment-seeking for diarrhea in the region. The region is also very common in the practice of traditional health remedies. Practicing of traditional remedies is common in the remote and inaccessibility region. The purpose of this paper is to understand the predictors of women's practices in managing childhood diarrhea and the quality of diarrhea management practices by the source of care. The study is based on the unit level data from District Level Household Survey (DLHS-4) and 789 women age 15–49 years were analyze by applying logistic regression analysis to identify the potential predictors of diarrhea management. Continue normal breastfeeding during diarrhea decreases with increasing age of the mother. Seeking care from the government or private health care facilities increases the likelihood of the mother administering of Oral Rehydration Salt (ORS) or Zinc to a sick child. Appropriate diarrhea management practices were found to be associated with seeking care from government or private health facilities as compared to non-treatment seekers; inappropriate practices were observed among mothers who were agricultural workers. In order to improve the quality of diarrhea management practices among the non-treatment seekers, efforts should be made through the Intensified Diarrhea Control Fortnight (IDCF) program to create more awareness among mothers regarding prevention and effective and low-cost diarrhea treatments. [ABSTRACT FROM AUTHOR]

Only 14% of births had information on birth weight available at the time of birth in Ethiopia. Hence, previous studies underestimate the magnitude and associated factors of low birth weight (LBW). As a result, the goal of this study is to fill those gaps in the previous studies. An institution-based cross-sectional study was employed. Binary logistic regression was used to identify the associated factors. In this study, the magnitude of LBW was 13.06%. History of chronic medical illness (AOR = 3; 95% CI: (1.02, 9.17)), haemoglobin level during pregnancy (AOR = 0.23; 95% CI: (0.10, 0.50)), iron/folic acid supplementation (AOR = 0.27; 95% CI: (0.10, 0.72)) and extra meal during pregnancy (AOR = 3.2; 95% CI: (1.52, 7.00)) were significantly associated with LBW. The magnitude of LBW in this study was comparable to the Ethiopian Demographic and Health Survey (EDHS) report from 2016. It is better to intervene in those identified factors in order to reduce LBW. What is already knownon this subject? Low birth weight (LBW) accounts for 60–80% of all neonatal deaths each year. In developing countries like Ethiopia, LBW is a major public health concern. Almost half of the world's infants are not weighed at birth, a figure that is especially high in sub-Saharan Africa including Ethiopia. What dothe resultsof this study add? Only 14% of births had information on birth weight available at the time of birth in Ethiopia. Hence, previous studies underestimate the magnitude and associated factors of LBW. To meet the Sustainable Development Goals (SDGs)-2030 targets for neonatal and child mortality, sufficient evidence on the magnitude of LBW and associated factors must be important in order to contribute to the development of timely interventions. A history of chronic medical illness, haemoglobin level, iron/folic acid supplementation and extra meal during pregnancy was associated with LBW. What are the implications of these findings for clinical practice and/or further research? The findings of this study will be useful in developing better health policies to prevent LBW as well as interventions that can target the identified factors. [ABSTRACT FROM AUTHOR]

While there have been notable advancements in child health in Egypt, disparities in child mortality still exist. Understanding these disparities is crucial to addressing them. The objective of this study is to explore the factors linked to child mortality in Egypt, providing a comprehensive understanding of the disparities in child mortality rates. The study utilises cross-sectional data from Egypt's Demographic and Health Survey (EDHS) in 2014 to examine child mortality. The dataset consists of 15,848 observations from mothers with children born within five years prior to the survey. The choice of explanatory variables was guided by the Mosely and Chen Framework and logistic multivariate regression was used to conduct the analyses. The study finds lower education, early childbearing, insufficient birth spacing, lack of breastfeeding, and absence of improved toilet facilities (proxy for living conditions) were all significantly linked to an increased likelihood of child loss. Additionally, poorer people in rural settings experienced the worst child mortality. The findings align with the World Health Organization's Conceptual Framework for Action on the Social Determinants of Health (CSDH). Recommended policy interventions include targeting women in rural areas, improving living conditions and removing financial/other barriers to accessing care. [ABSTRACT FROM AUTHOR]

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

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

Critical disparities threaten health care in developing countries and hinder progress towards global development commitments. Almost a billion people and thousands of public services are not yet connected to electricity – a majority in sub-Saharan Africa. In economically fragile settings, clinics and health services struggle to gain and maintain their access to the most basic energy infrastructure. Less than 30% of health facilities in LMICs report access to reliable energy sources, truncating health outcomes and endangering patients in critical conditions. While 'universal health coverage' and 'sustainable energy for all' are two distinct SDGs with their respective targets, this review challenges their disconnect and inspects their interdependence in LMICs. To evaluate the impact of electrification on healthcare facilities in LMICs, this systematic review analysed relevant publications up to March 2021, using MEDLINE, Embase, Scopus, CENTRAL, clinicaltrials.gov and CINAHL. Outcomes captured were in accordance with the WHO HHFA modules. A total of 5083 studies were identified, 12 fulfilled the inclusion criteria of this review – most were from Africa, with the exception of two studies from India and one from Fiji. Electrification was associated with improvements in the quality of antenatal care services, vaccination rates, emergency capabilities and primary health services; with many facilities reporting high-quality, reliable and continuous oxygen supplies, refrigeration and enhanced medical supply chains. Renewable energy sources were considered in six of the included studies, most highlighting their suitability for rural health facilities. Notably, solar-powered oxygen delivery systems reduced childhood mortality and length of hospital stay. Unavailable and unreliable electricity is a bottleneck to health service delivery in LMICs. Electrification was associated with increased service availability, readiness and quality of care – especially for women, children and those under critical care. This study indicates that stable and clean electrification allows new heights in achieving SDG 3 and SDG7 in LMICs. [ABSTRACT FROM AUTHOR]

Purpose Our aim is to analyze the clinical characteristics and prognostic factors of Epstein-Barr (EB) virus-associated hemophagocytic lymphohistiocytosis (EBV-HLH) in children. Methods Children with newly diagnosed HLH were retrospectively analyzed. Results Finally, a total of 95 children with HLH were enrolled in this study, including 43 (45.3%) with EBV-HLH and 52 (54.7%) with non-EBV-HLH. Laboratory tests showed that the levels of absolute neutrophil count (ANC) decrease (P = 0.031) and triglycerides (TG) increase (P = 0.036) in the EBV-HLH group were statistically significant compared with those in the non-EBV-HLH group, respectively. We found that the remission rate during induction period in the EBV-HLH group and non-EBV-HLH group was 75.8% and 89.3%, respectively. The correlation analysis showed that the elevated degree of total bilirubin (TBIL) (P = 0.042), triglyceride (TG) (P = 0.009), serum ferritin (SF) (P = 0.008) and interleukin-8 (IL-8) (P = 0.004) were related with the remission rate during induction in the EBV-HLH group. Further univariate analysis showed that the elevated degree of TBIL (P = 0.048) and TG (P = 0.019) were significant risk factors for the remission rate during induction in the EBV-HLH group. In the multivariate analysis, we observed that there was statistical significance for the degree of TG elevation (P = 0.015) between the two groups. The correlation analysis showed that the elevated degree of TBIL (P = 0.030), the elevated degree of SF (P = 0.020) and the elevated degree of interleukin-6 (P = 0.010) were related to the induction mortality of children with EBV-HLH. Conclusion TBIL and TG are valid indicators to assess the efficacy and prognosis of EVBHLH among children in induction period. [ABSTRACT FROM AUTHOR]

The study aimed to estimate the relationship between childhood mortality and maternal age using bivariate association and logistic regression using the nationally representative data from India through NFHS-4 (2015–2016). The study reveals that the odds ratio of childhood mortality was comparatively higher among lower aged women (<20 years old) and aged women (30 years and more). The result depicted that childhood mortality was comparatively less among those women of 20–29 age groups and suggests raising maternal education to avoid child marriage and early marriage, not to plan a child at the upper age (>40 years old). [ABSTRACT FROM AUTHOR]

Severe acute malnutrition (SAM) is an important global and national public health concern. It contributes to under-five mortality but is also largely a preventable disease. This study aimed to assess the prevalence of and mortality associated with SAM. A retrospective review of hospital files was conducted. Dora Nginza Hospital, Eastern Cape, South Africa was the site of the study. The study included children from 6 to 59 months of age admitted to the paediatric ward between January 1, 2018 and December 31, 2018. Children with chronic disease were excluded. Ethics approval was granted by Walter Sisulu University (053/2019). Anthropometric, co-morbid and outcomes data were retrieved and analysed. A total of 1 296 children were included in the study, 93 with SAM. The prevalence of SAM was 7.2%. Children with SAM had a median age of 16 months (IQR 11–25). Gender distribution was 52 (56%) females and 41 (44%) males. The inpatient mortality rate for children with SAM was 6.5%. Children with SAM were at significantly increased risk of mortality (RR 5.97, 95% CI 3.1–11.6, p-value < 0.0005). Three factors were significantly associated with mortality: nutritional oedema, sepsis, and hypokalaemia. The prevalence of SAM at Dora Nginza Hospital is high, and children with SAM are at significantly increased risk of mortality. Specific risk factors for mortality include sepsis, urinary tract infection, nutritional oedema and hypokalaemia. Modifiable factors associated with SAM and SAM-related mortality need to be targeted urgently to improve outcomes. [ABSTRACT FROM AUTHOR]

The violent death of a child leaves mothers devastated, bereaved, and desperate for meaning. This study examined 15 Muslim Arab bereaved mothers (aged 28–46) from northern Israel, whose children (aged 1–6) died in home accidents 2–7 years earlier. Using a descriptive phenomenological approach, thematic analysis identified three themes: "enduring mental effects," "self-blame," and "struggle to ascribe meaning to the loss within the Islamic faith and social values." The role of attributing meaning, managing guilt, and the struggle to reconcile conflicting religious and societal views are examined. A need for treating bereaved mothers' feelings of guilt was revealed. [ABSTRACT FROM AUTHOR]

This article analyses infant and child sex ratios in late Imperial Russia relying on district-level information obtained from the 1897 Russian census (489 districts). The article shows that child sex ratios were, on average, relatively low (around 98 boys per hundred girls) due to the biological female advantage: the extremely high infant and child mortality rates took a greater toll on boys and pushed sex ratios down. These figures, however, hide significant geographical variation and the number of boys (relative to girls) was especially high in Southern, Western and Northern Russia. Apart from the direct impact that different mortality environments could have exerted on sex-specific mortality rates and therefore on the sex ratios of the surviving children, this article explores the potential role of economic, ethnic and religious factors and suggest that particular contexts shaped the perceived relative value of girls and resulted in discriminatory practices against girls. In particular, our results show the importance of different ethnic groups in explaining these patterns conditional on economic and religious factors. In addition, the residuals of our models show clear spatial patterns, thus suggesting that unobserved factors were playing an additional role in explaining son preference. Lastly, this article demonstrate a positive link between historical sex ratios and female discriminatory norms in modern societies and therefore points to persisting factors affecting gender imbalances. [ABSTRACT FROM AUTHOR]

Recent research argues that discriminatory practices unduly inflated female excess mortality during infancy and childhood in historical Europe. This article reviews the existing evidence by (1) evaluating the sources that can be used to study this phenomenon; (2) providing a state-of-the-art account of the prevalence of these discriminatory practices, as well as the factors that explain them; and (3) outlining a research agenda that could fill in the gaps in the literature. [ABSTRACT FROM AUTHOR]

The relationship between gender and mortality in nineteenth-century Europe has been highly debated. In particular, historians disagree about the manner and degree to which gender discrimination affected the mortality risk of the female population. This article contributes by examining the evidence of gendered mortality differences among children and adolescents in nineteenth-century Denmark. It makes use of both child sex ratios and mortality rates to explore the prevalence of excess female mortality. We show that the female mortality rate in Denmark was higher than that of males starting from around age four and lasting until adulthood, for the majority of the nineteenth century. This mortality gap, while initially narrow, was systematic and most pronounced in rural areas and during late adolescence. The gap was produced by a faster mortality decline among males. This pattern is clear both in time, as the gap widened during the nineteenth century, and during the life course, as the male mortality rate declined faster and reached lower levels during late childhood and early adolescence. While it is possible that various forms of gender discrimination slowed the mortality decline of females, the aggregated nature of the data limits our interpretation. However, by comparing the two mortality measures employed, we argue that in a low child-mortality setting such as Denmark, sex ratios are not always sensitive enough to measure excess female mortality in childhood. Further, since sex ratios primarily excel at measuring 'hidden' or unregistered mortality, they may be a suboptimal measure of mortality differences in the presence of a thorough and reliable vital registration system. [ABSTRACT FROM AUTHOR]

The aim was to study mothers' experiences of online peer support groups after the death of a child. Participants (N = 8) were recruited through a newsletter for the Swedish association for families/children with heart defects, and two closed support groups on Facebook (900 and 100 members) and interviewed by telephone. Transcripts were analyzed with qualitative content analysis. The groups were available around the clock, regardless of support need, and mothers joined both to receive and provide support. Participation in online peer support groups may provide a sense of belonging to a caring community and serve as a valuable complement to healthcare. [ABSTRACT FROM AUTHOR]

We test a conjecture to explain Turkey's decades-long 'underachievement' in early child mortality improvements. We argue that it is largely a consequence of cultural barriers to embracing available modern medical technology and healthcare practices. The empirical test rests on a reformulation of Coale's Ready–Willing–Able (RWA) framework for explaining fertility changes, which makes it suitable to understand mortality changes. We use structural equation modelling and Demographic and Health Surveys spanning 1993–2013 to estimate basic parameters of the reformulated framework. These parameters are then used to classify mothers into four groups with different configurations of RWA dimensions and different probabilities of adopting modern medical practices. We find that observed behaviours in these groups were consistent with RWA expectations. In addition, we find that an important contributor to Turkey's lagging mortality decline was a population distribution biased towards groups more reticent to adopting modern healthcare. [ABSTRACT FROM AUTHOR]

This paper argues that son preference resulted in gender-based discriminatory practices that unduly increased mortality rates for females at birth and throughout infancy and childhood in nineteenth- and early-twentieth-century Greece. The relative numbers of boys and girls at birth was extremely high and under-registration of females cannot on its own explain this result. The infanticide and/or mortal neglect of infant girls was therefore more common than previously acknowledged. Likewise, sex ratios increased as children grew older, thus suggesting that parents continued to treat boys and girls differently throughout childhood. A large body of qualitative evidence (contemporary accounts, folklore traditions, feminist newspapers, and anthropological studies) further supports the conclusion that girls were neglected due to their inferior status in society. [ABSTRACT FROM AUTHOR]

The aim of this study is to examine, to what extent the chance of survival of children under 5 years of age was influenced by a biological parent's death in the region of western Bohemia. Young children's mortality is considered in relation to family structure, since persons raising the child in its early childhood significantly influenced the quality of child care. Given the gender-specific division of labour in pre-modern families we focus chiefly on the possible different effects of a mother's death or a father's death. In addition, we try to establish whether the negative impact of a biological parent's death could be compensated by the entrance of a stepparent. For the purposes of this analysis we used the Cox proportional hazards mixed-effect model. Our research has shown that although maternal death had more serious consequences compared to paternal death, especially if it occurred in the child's first year of life, even paternal death increased child mortality since the need to assume the paternal role prevented the surviving mother from taking optimum care of her children. The entrance of a stepparent in general increased children's chance of survival although in the case of stepmothers the positive effect was limited and could mainly be observed among children over 3. In contrast, our research has shown that there was no major difference in survival chances resulting from the presence of a biological father vs. a stepfather, an interesting result demonstrating that in the functioning of the pre-modern family biological ties were of only relative importance. [ABSTRACT FROM AUTHOR]

Asynclitism is malposition and malpresentation of the head in the pelvis. It is shown that asynclitism during the configuration (molding) of the head leads to an uneven distribution of the tension forces of the tentorium cerebelli (TC) and to its one-sided ruptures, mainly in the left half. It is indicated that with asynclitism larger more than 15 mm (moderate degree of asynclitism), the risk of birth trauma to the skull and brain increases. It was shown that not only severe degree of asynclitism, but also a moderate degree are pathological due to possible complications. The data on the sonographic diagnosis of asynclitism are presented. The negative effects of vacuum extraction (VE), the forceps application are considered. The mechanism of subaponeurotic hemorrhages is described. The importance of timely asynclitism diagnosis in labor to prevent its complication is shown. The cesarean section is practiced as extreme solution to the problem. The widespread use of sonography for the asynclitism diagnosis will prevent the birth trauma and reduce the incidence of mobility and mortality of the children and mother. [ABSTRACT FROM AUTHOR]

Primary health care facilities offer an entry point to the health care system in Malawi. Challenges experienced by these facilities include limited resources (both material and human), poor or inadequate knowledge, skills and attitudes of health care workers in emergency management, and delay in referral from primary care level to other levels of care. These contribute to poor outcomes including children dying within the first 24 hours of hospital admission. Training of health care workers and support staff in Emergency Triage Assessment and Treatment (ETAT) at primary care levels can help improve care of children with acute and severe illnesses. Health care workers and support staff in the primary care settings were trained in pediatric ETAT. The training package for health care workers was adapted from the Ministry of Health ETAT training for district and tertiary health care. Content for support staff focused on non-technical responsibility for lifesaving in emergency situations. The primary health care facilities were provided with a minimum treatment package comprising emergency equipment, supplies and drugs. Supportive supervisory visits were conducted quarterly. The training manual for health care workers was adapted from the Ministry of Health package and the support staff training manual was developed from the adapted package. Eight hundred and seventy-seven participants were trained (336 health care workers and 541 support staff). Following the training, triaging of patients improved and patients were managed as emergency, priority or non-urgent. This reduced the number of referral cases and children were stabilized before referral. Capacity building of health care workers and support staff in pediatric ETAT and the provision of a basic health center package improved practice at the primary care level. The practice was sustained through institutional mentorship and pre-service and in-service training. The practice of triage and treatment including stabilization of children with dangerous signs at the primary health care facility improves emergency care of patients, reduces the burden of patients on referral hospitals and increases the number of successful referrals. [ABSTRACT FROM AUTHOR]

Does the political empowerment of women increase human development? Using equality of access to schooling and health as indicators of pro-poor development policy and objective measures of female school completion and child mortality under the age of five as measures of human capital development, pooled ordinary least square (OLS) fixed effects regressions show robustly that the political empowerment of women associates positively with higher human capital. These results are statistically significant and substantively large, and the effects of gender empowerment trump those of democracy and good governance. Since the political empowerment of women is driven by structural conditions underlying democracy and economic development, the independent effect of gender empowerment relative to effects of democracy and institutional quality suggests a powerful role for the former. Interactions between gender empowerment and factors associated with higher child mortality; namely, strict autocracy and the Middle East and North Africa region, suggest that empowerment conditions these known adverse factors in the direction of lower child mortality. For addressing endogeneity, we use 10- and 20-year lagged values of gender empowerment as instruments for current empowerment, which pass both instrument relevance and instrument exclusion criteria. Two-stage least square regressions confirm our basic results. While the causal effects of gender empowerment remain somewhat speculative, a barrage of tests on our data suggests a powerful role for gender empowerment for increasing human capital. [ABSTRACT FROM AUTHOR]

Vitamin A deficiency is highly prevalent and remains the major cause of nutritional blindness in children in low-and middle-income countries, despite supplementation programmes. Xeropthalmia (severe drying and thickening of the conjunctiva) is caused by vitamin A deficiency and leads to irreversible blindness. Vitamin A supplementation programmes effectively reduce vitamin A deficiency but many rural children are not reached. Home food production may help prevent rural children's vitamin A deficiency. We aimed to systematically review trials assessing effects of home food production (also called homestead food production and agricultural interventions) on xeropthalmia, nightblindness, stunting, wasting, underweight and mortality (primary outcomes). We searched Medline, Embase, Scopus, Cochrane CENTRAL and trials registers to February 2019. Inclusion of studies, data extraction and risk of bias were assessed independently in duplicate. Random-effects meta-analysis, sensitivity analyses, subgrouping and GRADE were used. We included 16 trials randomizing 2498 children, none reported xerophthalmia, night-blindness or mortality. Home food production may slightly reduce stunting (mean difference (MD) 0.13 (z-score), 95% CI 0.01 to 0.24), wasting (MD 0.05 (z-score), 95% CI −0.04 to 0.14) and underweight (MD 0.07 (z-score), 95% CI −0.01 to 0.15) in young children (all GRADE low-consistency evidence), and increase dietary diversity (standardized mean difference (SMD) 0.24, 95% CI 0.15 to 0.34). Home food production may usefully complement vitamin A supplementation for rural children. Large, long-duration trials with good randomization, allocation concealment and correct adjustment for clustering are needed to assess effectiveness of home food production on nutritional blindness in young children. [ABSTRACT FROM AUTHOR]

This study profiled mothers whose children were admitted to hospital for malnutrition in a rural hospital in the North West province. A quantitative and cross-sectional design, using a researcher-developed questionnaire, was used to collect data from 94 mother and child pairs who were admitted to hospital for malnutrition. Stata statistical software was used to analyse the data. The ages of the mothers ranged from 17 to 48 years. Most (83%) lived in dwellings that had electricity, and 92% had running water in their households. Some 83% were not married and 97% were unemployed. Mothers between the ages of 21 and 25 years had the highest number of children with malnutrition (37%, n = 34), followed by mothers between the ages of 26 and 30 years (28%, n = 26). Severe acute malnutrition was experienced by children whose mothers were comparatively young (age group 16–20), accounting for 44.4% of malnourished children. The association between category of malnutrition and maternal age was not statistically significant. Although malnutrition of the children cuts across all maternal age groups, severe acute malnutrition tends to occur among children whose mothers are either young or relatively older, which suggests a need for specific community-based interventions among these groups of mothers. [ABSTRACT FROM AUTHOR]

International migration has increased since 1990, with increasing numbers of migrants originating from low- and middle-income countries (LMICs). Efforts to explain this compositional shift have focused on wage gaps and other push and pull factors but have not adequately considered the role of demographic factors. In many LMICs, child mortality has fallen without commensurate economic growth and amid high fertility. This combination increases young adult populations and is associated with greater outmigration: in the poorest countries, we estimate that a one-percentage-point increase in the five-year lagged growth rate of the population of 15–24-year-olds was associated with a 15 per cent increase in all-age outmigrants, controlling for other factors. Increases in growth of young adult populations led to 20.4 million additional outmigrants across 80 countries between 1990 and 2015. Understanding the determinants of these migration shifts should help policymakers in origin and destination countries to maximize their potential positive effects. [ABSTRACT FROM AUTHOR]

Child health outcomes vary between Parliamentary Constituencies (PCs) in India. There are a total of 543 PCs in India, each of which is a geographical unit represented by a Member of Parliament (MP). MP characteristics, such as age, gender, education, the number of terms they have served, and whether they belong to a Scheduled Caste or Scheduled Tribe, might be associated with indicators of child malnutrition and child mortality. The purpose of this paper was to examine the associations between MP characteristics and measures of child malnutrition and mortality. We did not find any meaningful associations between MP characteristics and child anthropometry, anemia, and mortality. Future research should consider the size of a constituency served by an MP along with MP party affiliations as these factors might help explain between-PC variations in child health outcomes. Our findings also underscore the need to better support female MPs and MPs from marginalized caste and tribal groups. [ABSTRACT FROM AUTHOR]

This paper investigates the relationship between parental education and child mortality in Madagascar. Until recently, most research linking parental education and child mortality had overlooked the case of Sub-Saharan Africa, despite the region having a high childhood mortality rate and a low association between parental education and child survival. Adopting a careful empirical strategy based on availability of schooling infrastructure and internal instruments, this paper contributes to the literature by analyzing the role of both the father's and mother's education as well as different educational levels. The results demonstrate that children's survival probabilities increase when they have a mother with at least primary schooling. Controlling for wealth reduces the effect of mothers' education by only one-third. In contrast, fathers' education does not play a significant role in child survival. HIGHLIGHTS Parental education is strongly associated with improvements in child health in many countries. Father's education is not a strong determinant of child survival in Madagascar. Higher levels of maternal education increase child survival in Madagascar. Wealth only accounts for one-third of the total effect of maternal education. Increasing education levels especially for women will likely reduce child mortality in future generations. [ABSTRACT FROM AUTHOR]

Conditional cash transfer programs are strategies used by countries over the past two decades, and they play a key role in reducing income inequalities and expanding access to basic services such as health and education. The Brazilian Cash Transfer Program (Bolsa Família), the largest conditional cash transfer program in the world, aims to bring immediate poverty alleviation and eradicate hunger. The objective of this study was to analyse the contributions of the Brazilian Cash Transfer Program for reducing social inequalities and ensuring the right to health, food, education and social assistance in Brazil. A review of the scientific literature published between 2003 and 2020 was conducted, associated with documentary research on government websites. There was a relationship between the Brazilian Cash Transfer Program, reduction of child mortality and increase in access to Primary Health Care services; increased access to food, including in natura; higher school attendance and reduced dropout. However, no improvement in the nutritional status of the families entitled to the program was observed, nor the interruption of the intergenerational cycle of poverty was ensured. The Brazilian Cash Transfer Program continues as a potent intersectoral policy for reducing inequities, which reinforces the need to strengthen and combine complementary policies to expand its effects. [ABSTRACT FROM AUTHOR]

Vital statistics are critical for effective public health and monitoring progress towards child survival. Nigeria has the highest global under-five mortality rate; however, deaths are often under- or misreported. We explored perceptions of child deaths and socio-cultural factors influencing the reporting of child deaths in Jigawa State, Nigeria. We conducted a triangulation mixed-methods study in Kiyawa local government area, Jigawa, including: four focus group discussions (FGDs) with 8–12 women, six key informant interviews (KII) with Imams, and process data from 42 verbal autopsies (VAs) conducted with caregivers of deceased children. Data was collected between November 2019-April 2021. Purposive sampling was used to recruit FDG and KII participants and two-stage systematic and simple random sampling was employed to recruit VA participants. Qualitative data was analysed using content analysis; VA data was described with proportions. Five categories emerged from FGDs: culturally grounded perceptions of child death, etiquette in mourning and offering condolence, formal procedures surrounding child death, the improving relationship between hospital and community, and reporting practices. Women expressed that talking or crying about a death was not culturally accepted, and that prayer is the most acceptable form of coping and offering condolence. Many women expressed that death was God's will. These findings correlated with VAs, in which visible signs of emotional distress were recorded in 31% of the interviews. Three categories emerged from KIIs: religion as part of formal procedures surrounding child death, communities support the bereaved, and multilayered reasons for unreported deaths. Imams serve a key role as community leaders, involved in both the logistical and religious aspects of their community, though they are not involved in mortality reporting. Religion plays a central role in burial practices, community mourning rituals, and expression of grief, but does not extend to reporting of child deaths. Imams could provide an opportunity for improving vital registration. [ABSTRACT FROM AUTHOR]

Undernourished children with cancer are at major risk for adverse outcomes. We intended to model nutritional status as risk factor for hospital death. Retrospective analysis of two cohorts of children admitted in an oncology/hematology intensive care unit. Logistic regression was used for model building. The derivation cohort had 155 patients, with a median age of 104.9 mo., and 36 deaths (23.2%). Twenty-eight children (18.1%) had the z score of the body mass index < −2. A multivariate model with the variables "relapse of oncological disease" (Odds Ratio 3.14, P = 0.025), "surgical case" (OR 0.22, P = 0.002), "intubation/mechanical ventilation" (OR 8.38, P = 0.000) and "body mass index z score < −2" (OR 3.21, P = 0.024) generated a logit with good predictive capacity for "hospital death". In the validation cohort, with 450 patients (median age of 92.7 mo.), the model was able to predict 55.5 of the 58 observed deaths (Standardized Mortality Rate = 1.04, 95% CI 0.80–1.34, P = 0.72), with P = 0.68 in the Hosmer test. The AUC was 0.90 (95% CI 0.86–0.93). Undernutrition increases the risk of death, and is a variable that should be included in predictive mortality algorithms. [ABSTRACT FROM AUTHOR]

Anaemia is a significant cause of mortality in children in sub-Saharan Africa where blood transfusion is often available only at referral hospitals. Understanding the pattern of referrals by health facilities is essential to identify the delays that affect child survival. To determine if there was a correlation between change in haemoglobin (Hb) level and distance from referring facilities to Kamuzu Central Hospital (KCH) in Malawi, and whether distance affected mortality rates. This was a retrospective cohort study of 2259 children referred to KCH whose Hb was measured at the referring facility or at KCH. Maps were created using ArcGIS® software. The relationship between distance from KCH and change in Hb was assessed by χ2 analysis and multiple linear regression with SAS© software. The majority of children were referred by health facilities in the Lilongwe District. When categorised as Hb <4, 4–6 or >6 g/dL, 87.0% of children remained in the same category during transfer. There was no significant relationship between Hb drop and distance from KCH. Distance from KCH was not a significant predictor of Hb level at KCH or Hb change. However, mortality rates were significantly higher in facilities that were 10–50 km from KCH than in those which were <10 km away. Using distance as a proxy for time, this suggests that referring facilities are transferring children sufficiently quickly to avert significant reductions in Hb. Despite this, there is a need to identify the factors that influence the decision to transfer anaemic children. [ABSTRACT FROM AUTHOR]

Under-five (U-5) mortality is a major public health problem in lower-middle income countries. The aim of this study is to examine the associations between maternal education and mortality of children below 5 years age in Indian context. We have used bi-variate and multivariate logistic regressions to assess the associations. Our study reveals that increasing level of education among women and in association with socio-economic and demographic factors significantly reduces the incidence of U-5 mortality. The findings suggest that increasing opportunities for female education and addressing socio-economic and demographic vulnerabilities could be effective strategies to combat the incidence of U-5 mortality. [ABSTRACT FROM AUTHOR]

We present a micro-based approach to evaluate the effect of water- and health-related development projects which complements established evaluation methods. We collect information from 1.8 million individuals from DHS clusters (Demographic and Health Surveys) in 38 developing economies between 1986 and 2017. We combine cluster information with over 14,000 sub-national projects from the World Bank. We then investigate the impact of the projects employing fixed effects estimation techniques. Our findings indicate that the time to gather water and child mortality tend to decrease when projects are realised. The quality of drinking water and sanitation facilities are also positively affected by projects. Our data allow us to account for cluster heterogeneity, which is an important extension to the cross-country literature. Various robustness checks support our findings. [ABSTRACT FROM AUTHOR]

This paper examines how normative reasoning was applied to empirical applications of different indicator options in order to revise the global Multidimensional Poverty Index (MPI) indicators in 2018, to better align with the SDGs. Given the emphasis in the SDGs on leaving no one behind, the household surveys used to estimate the global MPI were explored to see which could create individual-level MPIs, however this sharply reduced country coverage by half. Consistent criteria is applied to assess whether 33 potential additional indicators could be added to strengthen the global MPI. A certain set of criteria applied rules out new indicators. Finally, the paper both illustrates and describes the iterative interplay of normative and technical considerations underlying adjustments in three original indicators – child mortality, nutrition, and housing – which involves considering the joint distribution of alternative indicators across twenty trial measures for all countries. [ABSTRACT FROM AUTHOR]

Malaria remains a menace to the existence of humanity in most contexts. Geospatial analysis of malaria mortality is crucial to identifying clusters of high disease burden and areas with limited access to malaria care for targeted control and remedial interventions. This study identified spatial and space-time clusters of malaria mortality in the Kintampo area of central Ghana. We used 1301 malaria deaths archived from 2005 to 2017 and Global Positioning System (GPS) point locations of the sub-districts in which these deaths occurred for our analysis. Mortality risks were smoothed and mapped using the Spatial Empirical Bayesian smoothing technique in Geoda (version 1.12.1.161) whereas spatial and spatio-temporal clustering analysis was done using SaTScan (version 9.6). Malaria mortality risks ranged between 1.2 and 2.4 deaths per 1000 population for persons of all ages and between 3.3 and 6.0 deaths per 1000 population for children under five years of age by sub-district. Two spatial clusters were detected for all-age malaria mortality with only the primary cluster (RR = 1.42, p = 0.001) being statistically significant. Also, two statistically significant space-time clusters were detected for all-age malaria mortality in the study area. The most likely cluster occurred between 2006 and 2011 in five sub-districts with a relative risk of 2.12 (p < 0.001) whilst the secondary cluster which had a relative risk of 2.47 (p < 0.001) occurred between 2005 and 2010 in four sub-districts. Similarly, only the most likely spatial cluster of under-five malaria mortality was statistically significant (RR = 1.36, p = 0.024). Furthermore, three spatio-temporal clusters of under-five malaria mortality were detected in the study area. The primary and second secondary clusters were statistically significant whilst the first secondary cluster had borderline significance. The primary cluster (RR = 4.49, p = 0.002) occurred in two sub-districts between 2006 and 2007. The first secondary cluster (RR = 2.21, P = 0.005) covered four sub-districts and was detected between 2006 and 2011 whereas the second secondary cluster (RR = 2.51, p = 0.003) covered two sub-districts between 2008 and 2013. Ultimately, our analysis identified a number of substantial spatial and apace-time clusters of malaria mortality in the study context, which could aid in the strategic planning, implementation and monitoring of targeted malaria control interventions. [ABSTRACT FROM AUTHOR]

Background: The World Health Organization has a clinical and syndromic approach to the management of severe acute malnutrition which recognises that laboratory investigations are often not possible where children with severe malnutrition present. In low- and middle-income countries including Papua New Guinea, rates of death from severe malnutrition in many hospitals remain 10% or more. Aim: To evaluate the clinical predictors of death and the association between disturbances of electrolytes and haematological investigations in children with severe malnutrition and the risk of mortality. Methods: The clinical and laboratory predictors of death in a prospective cohort of 150 children with severe malnutrition admitted to a provincial hospital in Papua New Guinea were analysed. The clinical signs and electrolytes, complete blood count and liver function tests at presentation and on Days 3 and 5 were recorded. Results: The strongest independent predictors of mortality at assessment on admission were a low child Glasgow coma scale (≤12), hypoxaemia (SpO2 <90%), prolonged capillary refill (>3 seconds) and dysnatraemia (<130 or >150 mmol/L). The area under the receiver operating characteristics curve for these four variables was 0.93. Conclusions: That three of these four criteria correspond closely to the WHO Emergency Clinical Signs reinforces the value of a system of triage and risk assessment in children with severe malnutrition. If a child has emergency signs they should be managed in an area on the ward where close monitoring and supportive care can be provided, the WHO guidelines for severe malnutrition followed, and other specific care provided. Measurements of serum sodium, particularly in children with diarrhoea and dehydration, is also important in risk assessment and management. [ABSTRACT FROM AUTHOR]

In children in sub-Saharan Africa, severe anaemia (SA) is an important cause of mortality, and malaria is a primary cause. The World Health Organization (WHO) recommends blood transfusion for all children with haemoglobin (Hb) <4 g/dL and for those with Hb 4–6 g/dL with signs of instability. In sub-Saharan Africa, evidence of the effect on mortality of transfusion in children with SA with and without malaria is mixed. To determine in children with and without malaria whether receipt of transfusion was associated with lower mortality at WHO transfusion thresholds. This was a retrospective cohort study of 1761 children with SA (Hb ≤6 g/dL) admitted to Kamuzu Central Hospital in Malawi. In those whose Hb was 4–6 g/dL, mortality was compared by transfusion, stratified by haemoglobin, malaria status and signs of instability. Children with profound anaemia (Hb <4 g/dL) and malaria were the only subgroup who had a significant decrease in the odds of in-hospital death if they received a transfusion (OR 0.43, p = 0.01). Although children with Hb 4–6 g/dL and at least one sign of instability had higher mortality than children with none, there was no difference in the odds of mortality between those who received a transfusion and those who did not (OR 1.16, p = 0.62). This study suggests that transfusion of children with profound anaemia and malaria may confer increased in-hospital survival. An understanding of the factors associated with mortality from SA will allow for interventions to prioritise the provision of limited blood. [ABSTRACT FROM AUTHOR]

Acute lymphoblastic leukemia remains a leading cause of cancer-related death in children. Furthermore, subtypes such as Ph-like ALL remain at high-risk of relapse, and treatment resistance remains a significant clinical issue. The patient-derived Ph-like ALL RANBP2-ABL1 fusion gene was transduced into Ba/F3 cells and allowed to become resistant to the tyrosine kinase inhibitors (TKIs) imatinib or dasatinib, followed by secondary resistance to ponatinib. RANBP2-ABL1 Ba/F3 cells developed the clinically relevant ABL1 p.T315I mutation and upon secondary resistance to ponatinib, developed compound mutations, including a novel ABL1 p.L302H mutation. Significantly, compound mutations were targetable with a combination of asciminib and ponatinib. In-vitro modeling of Ph-like ALL RANBP2-ABL1 has identified kinase domain mutations in response to TKI treatment, that may have important clinical ramifications. Early detection of mutations is paramount to guide treatment strategies and improve survival in this high-risk group of patients. [ABSTRACT FROM AUTHOR]