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Single-dose azithromycin is being considered by the WHO as an intervention for prevention of child mortality. However, concerns have emerged related to longer term unintended consequences of early life antibiotic use, particularly among infants. We conducted a long-term follow-up in a random sample of children who had been enrolled in a trial of neonatal azithromycin versus placebo for prevention of mortality to assess whether neonatal azithromycin exposure led to differences in child growth up to 4 years of age. We found no evidence of a difference in any anthropometric outcome among children who had received a single oral dose of azithromycin compared with placebo during the neonatal period. These results do not support long-term growth-promoting or deleterious effects of early life azithromycin exposure.

Improvement of water and sanitation conditions may reduce infant mortality, particularly in countries like India where open defecation is highly prevalent. We conducted a quasi-experimental study to investigate the association between the Swachh Bharat Mission (SBM)-a national sanitation program initiated in 2014-and infant (IMR) and under five mortality rates (U5MR) in India. We analyzed data from thirty-five Indian states and 640 districts spanning 10 years (2011-2020), with IMR and U5MR per thousand live births as the outcomes. Our main exposure was the district-level annual percentage of households that received a constructed toilet under SBM. We mapped changes in IMR and U5MR and toilet access at the district level over time. We fit two-way fixed effects regression models controlling for sociodemographic, wealth, and healthcare-related confounders at the district-level to estimate the association between toilets constructed and child mortality. Toilet access and child mortality have a historically robust inverse association in India. Toilets constructed increased dramatically across India following the implementation of SBM in 2014. Results from panel data regression models show that districts with > 30% toilets constructed under SBM corresponds with 5.3 lower IMR (p

ObjectiveTo test the effect of proactive home visits by trained community health workers (CHWs) on child survival.MethodsWe conducted a two arm, parallel, unmasked cluster-randomized trial in 137 village-clusters in rural Mali. From February 2017 to January 2020, 31 761 children enrolled at the trial start or at birth. Village-clusters received either primary care services by CHWs providing regular home visits (intervention) or by CHWs providing care at a fixed site (control). In both arms, user fees were removed and primary health centres received staffing and infrastructure improvements before trial start. Using lifetime birth histories from women aged 15-49 years surveyed annually, we estimated incidence rate ratios (IRR) for intention-to-treat and per-protocol effects on under-five mortality using Poisson regression models.FindingsOver three years, we observed 52 970 person-years (27 332 in intervention arm; 25 638 in control arm). During the trial, 909 children in the intervention arm and 827 children in the control arm died. The under-five mortality rate declined from 142.8 (95% CI: 133.3-152.9) to 56.7 (95% CI: 48.5-66.4) deaths per 1000 live births in the intervention arm; and from 154.3 (95% CI: 144.3-164.9) to 54.9 (95% CI: 45.2-64.5) deaths per 1000 live births in the control arm. Intention-to-treat (IRR: 1.02; 95% CI: 0.88-1.19) and per-protocol estimates (IRR: 1.01; 95% CI: 0.87-1.18) showed no difference between study arms.ConclusionThough proactive home visits did not reduce under-five mortality, system-strengthening measures may have contributed to the decline in under-five mortality in both arms.

BACKGROUND: Randomized controlled trials found that twice-yearly mass azithromycin administration (MDA) reduces childhood mortality, presumably by reducing infection burden. World Health Organization (WHO) issued conditional guidelines for mass azithromycin administration in high-mortality settings in sub-Saharan Africa given concerns for antibiotic resistance. While prolonged twice-yearly MDA has been shown to increase antibiotic resistance in small randomized controlled trials, the objective of this study was to determine if macrolide and non-macrolide resistance in the gut increases with the duration of azithromycin MDA in a larger setting. METHODS AND FINDINGS: The Macrolide Oraux pour Réduire les Décès avec un Oeil sur la Résistance (MORDOR) study was conducted in Niger from December 2014 to June 2020. It was a cluster-randomized trial of azithromycin (A) versus placebo (P) aimed at evaluating childhood mortality. This is a sub-study in the MORDOR trial to track changes in antibiotic resistance after prolonged azithromycin MDA. A total of 594 communities were eligible. Children 1 to 59 months in 163 randomly chosen communities were eligible to receive treatment and included in resistance monitoring. Participants, staff, and investigators were masked to treatment allocation. At the conclusion of MORDOR Phase I, by design, all communities received an additional year of twice-yearly azithromycin treatments (Phase II). Thus, at the conclusion of Phase II, the treatment history (1 letter per 6-month period) for the participating communities was either (PP-PP-AA) or (AA-AA-AA). In Phase III, participating communities were then re-randomized to receive either another 3 rounds of azithromycin or placebo, thus resulting in 4 treatment histories: Group 1 (AA-AA-AA-AA-A, N = 51), Group 2 (PP-PP-AA-AA-A, N = 40), Group 3 (AA-AA-AA-PP-P, N = 27), and Group 4 (PP-PP-AA-PP-P, N = 32). Rectal swabs from each child (N = 5,340) were obtained 6 months after the last treatment. Each child contributed 1 rectal swab and these were pooled at the community level, processed for DNA-seq, and analyzed for genetic resistance determinants. The primary prespecified outcome was macrolide resistance determinants in the gut. Secondary outcomes were resistance to beta-lactams and other antibiotic classes. Communities recently randomized to azithromycin (groups 1 and 2) had significantly more macrolide resistance determinants than those recently randomized to placebo (groups 3 and 4) (fold change 2.18, 95% CI 1.5 to 3.51, Punadj < 0.001). However, there was no significant increase in macrolide resistance in communities treated 4.5 years (group 1) compared to just the most recent 2.5 years (group 2) (fold change 0.80, 95% CI 0.50 to 1.00, Padj = 0.010), or between communities that had been treated for 3 years in the past (group 3) versus just 1 year in the past (group 4) (fold change 1.00, 95% CI 0.78 to 2.35, Padj = 0.52). We also found no significant differences for beta-lactams or other antibiotic classes. The main limitations of our study were the absence of phenotypic characterization of resistance, no complete placebo arm, and no monitoring outside of Niger limiting generalizability. CONCLUSIONS: In this study, we observed that mass azithromycin distribution for childhood mortality among preschool children in Niger increased macrolide resistance determinants in the gut but that resistance may plateau after 2 to 3 years of treatment. Co-selection to other classes needs to be monitored. TRIAL REGISTRATION: NCT02047981 https://classic.clinicaltrials.gov/ct2/show/NCT02047981.

ImportanceRepeated mass distribution of azithromycin has been shown to reduce childhood mortality by 14% in sub-Saharan Africa. However, the estimated effect varied by location, suggesting that the intervention may not be effective in different geographical areas, time periods, or conditions.ObjectiveTo evaluate the efficacy of twice-yearly azithromycin to reduce mortality in children in the presence of seasonal malaria chemoprevention.Design, setting, and participantsThis cluster randomized placebo-controlled trial evaluating the efficacy of single-dose azithromycin for prevention of all-cause childhood mortality included 341 communities in the Nouna district in rural northwestern Burkina Faso. Participants were children aged 1 to 59 months living in the study communities.InterventionsCommunities were randomized in a 1:1 ratio to receive oral azithromycin or placebo distribution. Children aged 1 to 59 months were offered single-dose treatment twice yearly for 3 years (6 distributions) from August 2019 to February 2023.Main outcomes and measuresThe primary outcome was all-cause childhood mortality, measured during a twice-yearly enumerative census.ResultsA total of 34 399 children (mean [SD] age, 25.2 [18] months) in the azithromycin group and 33 847 children (mean [SD] age, 25.6 [18] months) in the placebo group were included. A mean (SD) of 90.1% (16.0%) of the censused children received the scheduled study drug in the azithromycin group and 89.8% (17.1%) received the scheduled study drug in the placebo group. In the azithromycin group, 498 deaths were recorded over 60 592 person-years (8.2 deaths/1000 person-years). In the placebo group, 588 deaths were recorded over 58 547 person-years (10.0 deaths/1000 person-years). The incidence rate ratio for mortality was 0.82 (95% CI, 0.67-1.02; P = .07) in the azithromycin group compared with the placebo group. The incidence rate ratio was 0.99 (95% CI, 0.72-1.36) in those aged 1 to 11 months, 0.92 (95% CI, 0.67-1.27) in those aged 12 to 23 months, and 0.73 (95% CI, 0.57-0.94) in those aged 24 to 59 months.Conclusions and relevanceMortality in children (aged 1-59 months) was lower with biannual mass azithromycin distribution in a setting in which seasonal malaria chemoprevention was also being distributed, but the difference was not statistically significant. The study may have been underpowered to detect a clinically relevant difference.Trial registrationClinicalTrials.gov Identifier: NCT03676764.

Background Epidermal necrolysis (EN), comprising Stevens–Johnson syndrome and toxic EN, is a rare and severe blistering reaction, mainly induced by drugs. Differences between paediatric and adult patients regarding incidence, causes and outcomes have been discussed but are based on a limited number of patients from small case series. Objectives To directly compare the incidence, cause and prognosis of adult and paediatric EN. Methods We used data from the French Health System Database (1 January 2013–31 December 2022). We identified adult and paediatric patients hospitalized for EN using the International Classification of Diseases, 10th Revision codes combined with validated algorithms. Outcomes were the incidence of EN; the presence of a suspected drug before EN onset (defined as a new drug dispensation from 5 to 56 days prehospitalization); and in-hospital mortality. To estimate the association between paediatric EN and the presence of a suspect drug, we computed a multivariable logistic regression with odd ratios (ORs). To estimate the association with mortality, we computed a multivariable Cox proportional hazard ratio (HR) model. Results A total of 1440 patients [799 (55.5%) female] with EN were included, comprising 219 children and 1221 adults. Among children, the incidence of EN was 1.5 cases [95% confidence interval (CI) 1.3–1.7] per 1 million person-years vs. 2.6 cases (95% CI 2.5–2.7) in adults. Moreover, children had less chance of being given a culprit drug before the onset of EN [ n = 93/219 (42.5%) vs. n = 829/1221 (67.9%)], with an adjusted OR of 0.43 (95% CI 0.32–0.59; P < 0.001), together with a better prognosis: the mortality rate in paediatric patients was 1.4% (95% CI 0.4–3.7) vs. 19.4% (95% CI 17.3–21.7) in adults. The adjusted HR for in-hospital mortality in children was 0.12 (95% CI 0.04–0.38; P < 0.001). Conclusions Paediatric EN appears to be rarer, with less chance of being caused by drugs and has a better prognosis than adult EN. These results suggest the existence of different underlying pathophysiological mechanisms and clinical particularities between adult and paediatric patients with EN. [ABSTRACT FROM AUTHOR]

Precise estimates of the impact of famine on infant and child mortality are rare due to lack of representative data. Using vital statistics reports on the Netherlands for 1935–47, we examine the impact of the Dutch famine (November 1944 to May 1945) on age-specific mortality risk and cause of death in four age groups (stillbirths, <1 year, 1–4, 5–14) in the three largest famine-affected cities and the remainder of the country. Mortality during the famine is compared with the pre-war period January 1935 to April 1940, the war period May 1940 to October 1944, and the post-war period June 1945 to December 1947. The famine's impact was most visible in infants because of the combined effects of a high absolute death rate and a threefold increase in proportional mortality, mostly from gastrointestinal conditions. These factors make infant mortality the most sensitive indicator of famine severity in this setting and a candidate marker for comparative use in future studies. [ABSTRACT FROM AUTHOR]

Acute respiratory infections are the leading cause of death and illness in children under 5 years old and represent a significant burden in older adults. Primarily caused by viruses infecting the lower respiratory tract, symptoms include cough, congestion, and low‐grade fever, potentially leading to bronchiolitis and pneumonia. Messenger ribonucleic acid (mRNA)‐based vaccines are biopharmaceutical formulations that employ mRNA molecules to induce specific immune responses, facilitating the expression of viral or bacterial antigens and promoting immunization against infectious diseases. Notably, this technology had significant relevance during the COVID‐19 pandemic, as these formulations helped to limit SARS‐CoV‐2 virus infections, hospitalizations, and deaths. Importantly, mRNA vaccines promise to be implemented as new alternatives for fighting other respiratory viruses, such as influenza, human respiratory syncytial virus, and human metapneumovirus. This review article analyzes mRNA‐based vaccines' main contributions, perspectives, challenges, and implications against respiratory viruses. [ABSTRACT FROM AUTHOR]

Little is known about the impact of child welfare system-level factors on child mortality as an outcome within foster care. Using data from the Adoption and Foster Care Analysis and Reporting System, 2009–2018, we examined the associations between county-level sociodemographic, foster care performance, and judicial reform characteristics with all-cause mortality rates. Results of random effects negative binomial regression analyses showed that higher proportions of younger children (<1 year: IRR = 1.06, 95% CI [1.02, 1.11]; 5–9 years: IRR = 1.05, 95% CI [1.01, 1.09]); children of color (i.e., non-Hispanic Asian: IRR = 1.07, 95% CI [1.01, 1.13]; multiracial: IRR = 1.03, 95% CI [1.01, 1.04]; non-Hispanic Black: IRR = 1.02, 95% CI [1.01, 1.02]; Hispanic: IRR = 1.01, 95% CI [1.01, 1.02]); and male children (IRR = 1.10, 95% CI [1.05, 1.15]) were associated with higher mortality risks at the county level. Current class action lawsuits (IRR = 0.79, 95% CI [0.63, 0.99]) and active consent decrees (IRR = 0.77, 95% CI [0.63, 0.94]) were associated with lower mortality risks. None of the foster care performance characteristics (e.g., foster care entry, placement stability, permanency) were associated with mortality risks. These findings have implications for addressing health disparities and reforming foster care systems through programmatic and policy efforts. [ABSTRACT FROM AUTHOR]

Objectives: Despite surgical resection, chemoradiation, and targeted therapy, brain tumors remain a leading cause of cancer-related death in children. Immunotherapy has shown some promise and is actively being investigated for treating childhood brain tumors. However, a critical step in advancing immunotherapy for these patients is to uncover targets that can be effectively translated into therapeutic interventions. Methods: In this study, our team performed a transcriptomic analysis across pediatric brain tumor types to identify potential targets for immunotherapy. Additionally, we assessed components that may impact patient response to immunotherapy, including the expression of genes essential for antigen processing and presentation, inhibitory ligands and receptors, interferon signature, and overall predicted T cell infiltration. Results: We observed distinct expression patterns across tumor types. These included elevated expression of antigen genes and antigen processing machinery in some tumor types while other tumors had elevated inhibitory checkpoint receptors, known to be associated with response to checkpoint inhibitor immunotherapy. Conclusion: These findings suggest that pediatric brain tumors exhibit distinct potential for specific immunotherapies. We believe our findings can guide investigators in their assessment of appropriate immunotherapy classes and targets in pediatric brain tumors. [ABSTRACT FROM AUTHOR]

Objective: There is an amelioration in mortality rates of septic shock patients with malignancies over time, but it remains uncertain in children. Therefore, the authors endeavored to compare the clinical characteristics, treatment needs, and outcomes of septic shock children with or without malignancies. Methods: The authors retrospectively analyzed the data of children admitted to the PICU due to septic shock from January 2015 to December 2022 in a tertiary pediatric hospital. The main outcome was in-hospital mortality. Results: A total of 508 patients were enrolled. The proportion of Gram-negative bacteria and fungal infections in children with malignancies was significantly higher than those without malignancies. Septic shock children with malignancies had a longer length of stay (LOS) in the hospital (21 vs. 11 days, p<0.001). However, there were no statistically significant differences in the LOS of PICU (5 vs. 5 days, p = 0.591), in-hospital mortality (43.0 % vs. 49.4 %, p = 0.276), and 28-day mortality (49.2 % vs. 44.7 %, p = 0.452). The 28-day survival analysis (p = 0.314) also showed no significant differences. Conclusion: Although there are significant differences in the bacterial spectrum of infections, the septic shock children with or without malignancies showed a similar mortality rate. The septic shock children with malignancies had longer LOS of the hospital. [ABSTRACT FROM AUTHOR]

The building façade is a vital component of a building's structure and can play a significant role in safety, structure stability, energy efficiency, and aesthetics. Façade issues and failures are increasingly occurring in various buildings and cities. Some of these issues have caused safety incidents with fatalities to the occupants and nonoccupants. Nonoccupant incidents occur in façades located close to the public right away. This has led multiple agencies to implement inspection programs and regulations that the property owners shall comply with to avoid safety incidents. Despite these regulations, façade failures and safety incidents remain an issue, with various root causes, which could be due to insufficient original design documents, construction procedures, loading, or structural aging. This case study will discuss possible façade defect types and locations caused by soil, foundations, temperature changes, wind, and seismic. It will also discuss how to identify defects in various areas of the structure, including bearing and nonbearing exterior walls. In addition to these findings, those should be reported in detail with priorities to ensure effective urgent procedures are in place to avoid incidents. An example of a New York façade inspection program is discussed, and the reporting procedure is discussed with a fatal case study. In 2015, falling pieces of terra cotta caused the death of a two-year-old child; this incident led city officials to adopt changes in inspection requirements and procedures. In conclusion, gaining knowledge about the causes of defects, their location, and proper inspection and reporting procedures are crucial to public safety. This benefits not only the property owner but also the public, all trades involved in new project construction, inspectors, and officials to help avoid safety incidents. [ABSTRACT FROM AUTHOR]

Background: Diarrhea, defined as three or more loose stool per day, is a major cause of child mortality. Exploring its prevalence, and influencing factors is crucial for public health decision and targeted interventions. This study aimed to investigate these aspects using 2021 Madagascar demographic health survey data. Method: This study employed a cross-sectional design, analyzing data from a total of 8,740 weighted under-five children. The dependent variable was the occurrence of diarrhea, which was measured based on caregiver-reported incidents within the previous two weeks prior to the survey. To identify factors associated with diarrhea, a multilevel logistic regression model was utilized, allowing for the examination of both individual and contextual factors. Statistical significance was determined at a p-value of less than 0.05. Results: The analysis identified several significant factors associated with diarrhea in children under five. Children aged 7–12 months had a significantly higher risk of diarrhea (OR = 2.699, 95% CI: 2.028–3.591, p < 0.001) compared to those aged 0–6 months, while those aged 13–24 months were also at increased risk (OR = 2.079, 95% CI: 1.579–2.737, p < 0.001). Children using improved water sources had a lower likelihood of diarrhea (OR = 0.742, 95% CI: 0.583–0.944, p = 0.015). Female children were less likely to experience diarrhea compared to males (OR = 0.823, 95% CI: 0.708–0.956, p = 0.011). Mothers aged 25–34 years (OR = 0.741, 95% CI: 0.626–0.878, p = 0.001) and 35–49 years (OR = 0.628, 95% CI: 0.502–0.787, p = 0.03) had lower odds of their children having diarrhea compared to younger mothers (15–24 years). Primary maternal education was associated with a lower risk of diarrhea (OR = 0.77, 95% CI: 0.622–0.958, p = 0.019). Children from poorer (OR = 0.744, 95% CI: 0.591–0.937, p = 0.012) and middle-income households (OR = 0.732, 95% CI: 0.564–0.949, p = 0.019) had lower odds of diarrhea compared to those from the poorest households. Media exposure was significantly associated with higher odds of diarrhea (OR = 1.462, 95% CI: 1.208–1.769, p < 0.001). Conclusion: Maternal age over 25 years, child age between 7 months to 2 years, and media access are risk factors for diarrhea. In contrast, medium or low wealth levels, the mother's educational status, the child's sex, and the source of drinking water seem to be protective factors. Public health interventions should prioritize improving access to clean water and sanitation facilities, along with promoting handwashing with soap. Educational campaigns targeted towards mothers, especially those with lower education levels, can significantly improve hygiene practices, safe water handling, and early symptom recognition of diarrhea. [ABSTRACT FROM AUTHOR]

Background: Over 1.7 billion instances of diarrheal illness in children are reported worldwide yearly. Diarrhea was a major cause of death in children, accounting for 9% of all global under-five child deaths in 2021. The objective of this study was to identify the association between hygiene practices and childhood diarrhea among under-five children in Myanmar. Method: This cross-sectional study was conducted in 16 townships from 8 states and regions of Myanmar. 1207 children between the ages of 6 and 59 months were recruited by multistage random sampling. Data were collected with a preformed questionnaire after participants provided consent. Multiple logistic regressions were administered to determine the factors associated with childhood diarrhea. Result: This study found that 86 (7.13%) under-five children experienced diarrhea disease. This study identified that children receiving limited hygiene services were 2.85 times (AOR = 2.85, 95% CI: 1.31 to 6.21; p value 0.01) and children without hygiene services were 2.63 times (AOR = 2.63, 95% CI: 1.42 to 4.89; p value 0.01) more likely to have diarrhea disease than those with basic hygiene services. Other factors associated with diarrhea included: fathers who washed their hands less than four steps (AOR = 2.20, 95% CI: 1.29 to 3.74; p value 0.01), families taking more than 15 min to collect water (AOR = 1.77, 95% CI: 1.06 to 2.97; p value 0.03), families sharing toilet usage (AOR = 2.00, 95% CI: 1.15 to 3.48; p value 0.01), mother's inadequate and problematic hygiene promotion health literacy (AOR = 2.20, 95% CI: 1.24 to 3.90; p value 0.01), houses made of bamboo or lacking floors (AOR = 2.31, 95% CI: 1.38 to 3.89; p value 0.01), families with three or more children (AOR = 1.68, 95% CI: 1.01 to 2.79; p value 0.05) and breastmilk being the primary food after 6 months of age (AOR = 2.07, 95% CI: 1.09 to 3.93; p value 0.03). Conclusions: Ensuring access to basic hygiene services, getting water at home 24 h per day, seven days per week, using private toilets, promoting hygiene health literacy, improving house flooring, family planning and introducing a variety of foods after age 6 months could significantly prevent diarrhea among under-five children in Myanmar. This study underscores the critical role of handwashing facilities in reducing the diarrhea incidence in children. [ABSTRACT FROM AUTHOR]

Cryptosporidiosis is a diarrheal disease caused by infection with Cryptosporidium spp. parasites and is a leading cause of death in malnourished children worldwide. The only approved treatment, nitazoxanide, has limited efficacy in this at-risk patient population. Additional safe therapeutics are urgently required to tackle this unmet medical need. However, the development of anti-cryptosporidial drugs is hindered by a lack of understanding of the optimal compound properties required to treat this gastrointestinal infection. To address this knowledge gap, a diverse set of potent lysyl-tRNA synthetase inhibitors was profiled to identify optimal physicochemical and pharmacokinetic properties required for efficacy in a chronic mouse model of infection. The results from this comprehensive study illustrated the importance of balancing solubility and permeability to achieve efficacy in vivo. Our results establish in vitro criteria for solubility and permeability that are predictive of compound efficacy in vivo to guide the optimization of anti-cryptosporidial drugs. Two compounds from chemically distinct series (DDD489 and DDD508) were identified as demonstrating superior efficacy and prioritized for further evaluation. Both compounds achieved marked parasite reduction in immunocompromised mouse models and a disease-relevant calf model of infection. On the basis of these promising data, these compounds have been selected for progression to preclinical safety studies, expanding the portfolio of potential treatments for this neglected infectious disease. Editor's summary: Cryptosporidium spp. parasites are a major cause of potentially fatal, severe diarrhea in malnourished children, with no vaccine available and no reliably effective treatment for this at-risk population. Caldwell et al. studied the physiochemical properties required for lysyl-tRNA synthetase targeting anti-cryptosporidial compounds to be effective given the unique intracellular but extracytoplasmic location of infecting protozoa in the small intestine. Testing of two chemically distinct lead compounds in immunocompromised mouse and neonatal calf models showed improvement in infection, suggesting that these leads should be prioritized for further efficacy and safety studies. —Catherine Charneski [ABSTRACT FROM AUTHOR]

ABSTRACT Introduction Method Results Conclusion The United Nations report in 2021 ranks Pakistan 21st among countries with the highest infant and child mortality rate in the world. It is the fifth most populous country in the world with a growth rate of 2% annually. Therefore, understanding child mortality is crucial to reducing the child mortality burden.The research utilized two waves of the Pakistan Demographic and Health Survey (PDHS), 2012–13 and 2017–18. The data are analyzed using logistic regression with interaction effects of household wealth status and propensity score matching techniques.The study reveals a positive link between polygyny and infant and child mortality. The odd ratios higher than “1” indicate increased mortality risk for infants and children belonging to polygynous families taking monogamous families as a reference category. Mortality risk is higher among children (OR 1.50 CI 0.18–12.63) as compared with infants (OR 1.28 CI 0.37–4.45). The main effect of household shows a negative association with infant and child mortality while after interacting with polygyny it turns out to be positive. The mortality risks increase with increasing wealth status. It can be translated as a positive link between household wealth status, and infant and child mortality in the context of polygyny.Infants and children belonging to polygynous families experience increased mortality risk as compared with monogamous families. The household wealth status may not help improve child mortality. [ABSTRACT FROM AUTHOR]

Key Points: Question: How has the widescale distribution of rapid diagnostic tests for malaria across sub-Saharan African countries affected febrile illness management and mortality for children younger than 5 years of age? Findings: Increasing distribution of rapid diagnostic tests for malaria was associated with increased blood testing, use of antimalarial drugs, and antibiotic use and modestly improved child survival. The greatest benefits occurred in areas with a high prevalence of malaria. Meaning: The distribution of rapid diagnostic tests for malaria was associated with changes in pediatric febrile illness management and improved survival. Importance: A prompt malaria diagnosis is crucial for the management of children with febrile illness in sub-Saharan African countries, where malaria remains a leading cause of mortality among children younger than 5 years of age. The development and distribution of point-of-care rapid diagnostic tests (RDTs) for malaria has transformed practice, but limited systematic evidence exists on how malaria RDTs have affected the management of febrile illness and mortality for children younger than 5 years of age across sub-Saharan Africa countries. Objective: To evaluate the association between the distribution of malaria RDTs and the management of febrile illness and mortality among children younger than 5 years of age in sub-Saharan African countries. Design, Setting, and Participants: This quasi-experimental study used a novel dataset linking malaria RDT distribution to 165 nationally representative household surveys across 35 sub-Saharan African countries with mortality data. The sample comprised approximately 3.9 million child-year observations and approximately 260 000 febrile illness episodes in children younger than 5 years of age between 2000 and 2019. Main Outcomes and Measures: Fixed-effects linear probability models were used to analyze the association between variation in malaria RDTs distributed per child younger than 5 years of age (by country per year) and blood testing, antimalarial drug use, antibiotic use, use of symptomatic treatments, and mortality rates. Variation in the effects of testing and treatment was also assessed across the sub-Saharan African countries that had varying prevalence of malaria. Results: The mortality sample included 1 317 866 children and the fever sample included 256 292 children. The mean age of the children with febrile illness was 2.4 years (SD, 1.3 years) and 49% were female. Each additional malaria RDT distributed per child younger than 5 years of age was associated with an increase of 3.5 percentage points (95% CI, 3.2-3.8 percentage points) in blood testing, an increase of 1.5 percentage points (95% CI, 1.2-1.8 percentage points) in the use of antimalarial drugs, an increase of 0.4 percentage points (95% CI, 0.1-0.6 percentage points) in antibiotic use, and a decrease of 0.4 percentage points (95% CI, 0.1-0.8 percentage points) in the use of treatments for symptoms. Each additional malaria RDT distributed per child younger than 5 years of age was associated with a reduction in child mortality of 0.34 deaths per 1000 child-years (95% CI, 0.15-0.52 deaths per 1000 child-years). The effects of malaria RDT distribution on medication use and child mortality varied across prevalence settings (low vs high) for malaria; there were survival improvements only in areas that had a high prevalence of malaria. Conclusions and Relevance: Increasing distribution of malaria RDTs was associated with increased blood testing, increased use of antimalarial drugs, and modestly improved survival in children younger than 5 years of age in sub-Saharan African countries. However, malaria RDTs were associated with increases in the rates of antibiotic use that were already high, suggesting that more comprehensive approaches to case management of febrile illness are needed. This quasi-experimental study evaluates the association between the distribution of rapid diagnostic tests for malaria and the management of febrile illness and mortality among children younger than 5 years of age in sub-Saharan African countries. [ABSTRACT FROM AUTHOR]

Background Pneumococcal conjugate vaccines (PCVs) provide strong direct protection in children, while limited data are available on their indirect effect on mortality among older age groups. This multicountry study aimed to assess the population-level impact of pediatric PCVs on all-cause pneumonia mortality among children ≥5 years of age, and invasive pneumococcal disease (IPD) cases in Chile. Methods Demographic and mortality data from Argentina, Brazil, Chile, Colombia, and Mexico were collected considering the ≥ 5-year-old population, from 2000 to 2019, with 1 795 789 deaths due to all-cause pneumonia. IPD cases in Chile were also evaluated. Time series models were employed to evaluate changes in all-cause pneumonia deaths during the postvaccination period, with other causes of death used as synthetic controls for unrelated temporal trends. Results No significant change in death rates due to all-cause pneumonia was detected following PCV introduction among most age groups and countries. The proportion of IPD cases caused by vaccine serotypes decreased from 29% (2012) to 6% (2022) among people aged ≥65 years in Chile. Discussion While an effect of PCV against pneumonia deaths (a broad clinical definition that may not be specific enough to measure indirect effects) was not detected, evidence of indirect PCV impact was observed among vaccine-type–specific IPD cases. [ABSTRACT FROM AUTHOR]

Progress in health outcomes across Africa has been uneven, marked by significant disparities among countries, which not only challenges the global health security but impede progress towards achieving the United Nations' Sustainable Development Goals 3 and 10 (SDG 3 and SDG 10) and Universal Health Coverage (UHC). This paper examines the progress of African countries in reducing intra-country health outcome disparities between 2000 and 2019. In other words, the paper investigates the convergence hypothesis in health outcome using a panel data from 40 African countries. Data were sourced from the World Development Indicators, the World Governance Indicators, and the World Health Organization database. Employing a non-linear dynamic factor model, the study focused on three health outcomes: infant mortality rate, under-5 mortality rate, and life expectancy at birth. The findings indicate that while the hypothesis of convergence is not supported for the selected countries, evidence of convergence clubs is observed for the three health outcome variables. The paper further examine the factors contributing to club formation by using the marginal effects of the ordered logit regression model. The findings indicate that the overall impact of the control variables aligns with existing research. Moreover, governance quality and domestic government health expenditure emerge as significant determinants influencing the probability of membership in specific clubs for the child mortality rate models. In the life expectancy model, governance quality significantly drives club formation. The results suggest that there is a need for common health policies for the different convergence clubs, while country-specific policies should be implemented for the divergent countries. For instance, policies and strategies promoting health prioritization in national budget allocation and reallocation should be encouraged within each final club. Efforts to promote good governance policies by emphasizing anti-corruption measures and government effectiveness should also be encouraged. Moreover, there is a need to implement regional monitoring mechanisms to ensure progress in meeting health commitments, while prioritizing urbanization plans in countries with poorer health outcomes to enhance sanitation access. [ABSTRACT FROM AUTHOR]

Diarrheal disease is the second leading cause of death among children under five in developing communities, despite active interventions to improve access to water, sanitation, and hygiene resources. Even interventions with high fidelity and compliance saw minimal improvements in health outcomes, necessitating a need for looking beyond traditionally targeted exposure pathways. This study focuses on the pathogen exposure a young child may receive while playing in the public spaces of informal settlements, where animal feces, human feces, and garbage are frequently observed. The study utilized 79 soil samples previously collected across ten cluster sites in Corail, Haiti and processed using DelAgua cultural assays and quantitative Polymerase Chain Reaction methods. Molecular assays screened for Aeromonas, Vibrio cholera, and several pathogenic Escherichia coli species. Behavioral observations of young children (<5 years old) were also conducted in overlapping areas with the environmental sampling to quantify frequency of risky and mitigating behaviors. Environmental and behavioral data were combined to obtain the posterior distribution of children's pathogen exposure from playing in a public space for one hour. The model estimated that children have a likelihood of approximately 70% of being exposed to a pathogen during one hour of play and a greater than 30% chance of being exposed to multiple pathogens in the same period. While children and toddlers practice fewer risky behaviors compared to infants, they were shown to have higher likelihood of exposure and slightly higher pathogen dose per exposure. As anticipated, a high correlation between genes from the same E. coli species was observed in the model output. These findings demonstrate the need to consider public spaces as an important exposure pathway for young children for both future research and interventions. Author summary: Diarrheal disease is the second leading infectious cause of death among children under five worldwide; however, much is being done through interventions to improve conditions and reduce exposure to pathogens. Despite these efforts, little progress has been made on health outcomes. This study looks at an often-overlooked area in interventions, the public spaces in communities where children frequently play. Soil samples were collected and analyzed for pathogens and children were observed to understand frequency of risky behaviors that could lead to soil ingestion. This data was then fed into a statistical model to replicate thousands of instances of a child playing in a public space for one hour and found that the likelihood of pathogen exposure was high at about 70% with a greater than 30% chance of exposure to multiple pathogens in one instance. This has implications for how we plan interventions to include public spaces. It further serves as a methodologic model for combining site specific behavior and environmental data into a statistical model as a robust way to achieve pathogen exposure frequency and dose. [ABSTRACT FROM AUTHOR]

Background Acute respiratory infection is a common reason why children under the age of five get sick or die (ARIs). Lower respiratory tract infections (LRIs) are the main cause of death in children. The Pediatric Respiratory Severity Score (PRESS) for Respiratory Tract Infection is a novel and less complex bedside scoring method first development in Yokohama hospital. Hence the aim of the study was to determine the implication of PRESS score in evaluation of children admitted with respiratory distress in PICU. Objectives To evaluate PRESS as a severity assessment scoring for acute respiratory infections in pediatric patients. Methods This was a prospective observational study conducted in a tertiary health care center conducted for a duration of 2 year. All the children admitted with respiratory distress having any 2 features such as tachypnoea, use of accessory muscles, use of intercostal and subcostal muscles, grunting, cyanosis, feeding difficulties and wheeze admitted in were included in the study. PRESS scoring system measured five things: breathing rate, wheezing, use of accessory muscles, SpO2, and difficulty feeding. Each part was assigned 0 or 1 point, and the total score showed how mild, moderate, or severe the problem was. Results Total of 344 children were included. Disease was mild in 44 (12.7%), moderate in 188 (54.7%) and severe in 112 (32.5%). There is statistically significant differences present in pH & pCO2 values in various PRESS scores, but there was no correlation with mechanical ventilation, oxygen supply and PICU stay. Conclusion Those with higher PRESS score had longer picu stay and need more oxygen therapy or have higher rate of mechanical ventilation. It is a very simple and easy tool to predict severity of acute respiratory infections and can be used as a guide for severity wise treatment of patients. [ABSTRACT FROM AUTHOR]

Firearm injuries are the leading cause of death among children aged 0 to 17 years in the United States. This study examines the factors associated with recurrent firearm injury among children who presented with a nonfatal firearm injury in the St. Louis, Missouri, region. Visual Abstract. Factors Associated With Recurrent Pediatric Firearm Injury: Firearm injuries are the leading cause of death among children aged 0 to 17 years in the United States. This study examines the factors associated with recurrent firearm injury among children who presented with a nonfatal firearm injury in the St. Louis, Missouri, region. Background: Firearm injuries are the leading cause of death among children aged 0 to 17 years in the United States. Objective: To examine the factors associated with recurrent firearm injury among children who presented with acute (index) nonfatal firearm injury in the St. Louis region. Design: Multicenter, observational, cohort study. Setting: 2 adult and 2 pediatric level I trauma hospitals in St. Louis, Missouri. Participants: Pediatric patients aged 0 to 17 years presenting with an index firearm injury between 2010 and 2019. Measurements: From the St. Louis Region-Wide Hospital-Based Violence Intervention Program Data Repository, we collected data on firearm-injured patient demographics, hospital and diagnostic information, health insurance status, and mortality. The Social Vulnerability Index was used to characterize the social vulnerability of the census tracts of patients' residences. Analysis included descriptive statistics and time-to-event analyses estimating the cumulative incidence of experiencing a recurrent firearm injury. Results: During the 10-year study period, 1340 children presented with an index firearm injury. Most patients were Black (87%), non-Hispanic (99%), male (84%), and between the ages of 15 and 17 years (67%). The estimated risk for firearm reinjury was 6% at 1 year and 14% at 5 years after initial injury. Male children and those seen at an adult hospital were at increased risk for reinjury. Limitation: Our data set does not account for injuries occurring outside of the study period and for reinjuries presenting to nonstudy hospitals. Conclusion: Children who experience an initial firearm injury are at high risk for experiencing a recurrent firearm injury. Interventions are needed to reduce reinjury and address inequities in the demographic and clinical profiles within this cohort of children. Primary Funding Source: National Institutes of Health. [ABSTRACT FROM AUTHOR]

Background and aims: Diarrhoea is one of the deadliest diseases and causing death among children in India, but no systematic attempt is made to understand it especially its control using oral rehydration salts (ORS). It is well known that use of ORS and Zinc have been effective in containing diarrhoea among children. An attempt is made using large scale national data set in India to understand use of ORS and Zinc to control diarrhoea and their associated factors among diarrhoeal children under five in India. Methods: Publicly available most recent cross-sectional National Family Health Survey data in India was used for the study. The multi-stage cluster sampling design was used with 2011 Census of India as a sampling frame. Households were selected using a Systematic Random Sampling design from selected primary sampling units in rural and urban clusters. From the selected households, the eligible children were those who suffered from diarrhoea in the two weeks preceding the survey and were less than 5 years old. Using this criterion, out of 232,920 children in the survey of less than five years, 16,213 sample diarrheal children found to be available for the study. Both descriptive and inferential statistical techniques were used to analyse the data. Results: Across India, 61% and 31% of the children were given ORS and Zinc respectively. However, combined ORS + Zinc treatment was only around 24%. The treatment of ORS, Zinc, and combined ORS + Zinc supplementations were significantly higher among younger children, children of 24–35 age group mothers, children from rich wealth index groups, belong to Hindu religion and general caste compared to their counterparts. The logistic regression results showed that consumption of ORS among diarrhoeal children under five years of age depends upon size of a child at birth. For instance, diarrheal children who were very small size at birth compared to very large at birth, had 39% lower odds of consuming ORS (AOR = 0.61; CI 0.48, 0.78; p<0.001). Another important variable is place of first treatment sought for diarrheal children. That is children who first sought treatment in private hospital compared to government hospital had 52% lower odds of ORS consumption. The logistic regression adjusted AORs are similar with Zinc and ORS + Zinc supplementations. Conclusions: To improve the coverage and management of childhood diarrhoea in India, planning activities should focus not only on distribution, and increasing knowledge of ORS preparation especially for urban slum residents and rural disadvantaged groups through demonstration. There should be also proper focus on providing ongoing pathways to ensure proper supply chains. [ABSTRACT FROM AUTHOR]

This document is copyrighted and is property of the American Academy of Pediatrics and its Board of Directors. All authors have filed conflict of interest statements with the American Academy of Pediatrics. Any conflicts have been resolved through a process approved by the Board of Directors. The American Academy of Pediatrics has neither solicited nor accepted any commercial involvement in the development of the content of this publication. Technical reports from the American Academy of Pediatrics benefit from expertise and resources of liaisons and internal (AAP) and external reviewers. However, technical reports from the American Academy of Pediatrics may not reflect the views of the liaisons or the organizations or government agencies that they represent. The guidance in this report does not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate. All technical reports from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time. [ABSTRACT FROM AUTHOR]

Introduction: Preterm delivery (PTD) is the leading cause of death in children under 5 years of age. Cervical shortening detected by ultrasound can be used to predict PTD, but prediction is not perfect, and complementary diagnostic markers are needed. Recently, specific plasma microribonucleic acid (miRNAs) detected in early second trimester were shown to be associated with spontaneous PTD in high‐risk women with a singleton pregnancy. The aim of this study was to explore to what extent these miRNAs are associated with spontaneous PTD and cervical length in a general population. Material and Methods: This study is a nested case–control study within the CERVIX study. The CERVIX study evaluated the ability of cervical length screening with transvaginal ultrasound to identify women at risk of PTD. In the present study, women who delivered spontaneously <34 weeks (n = 61) were compared with a control group of women who delivered at full term (39 + 0 to 40 + 6 gestational weeks, n = 205). Archived serum samples were analyzed with RT‐qPCR for miRNA expression levels of let‐7a‐5p, miR‐150‐5p, miR‐15b‐5p, miR‐185‐5p, miR‐191‐5p, miR‐19b‐3p, miR‐23a‐3p, miR‐374a‐5p, and miR‐93‐5p. The mean relative expression was compared between the groups. Sub‐analyses were performed for women delivering <32, <30, and <28 weeks vs the full‐term group. Results: The analyzed miRNAs were not significantly differentially expressed in women delivering <34 weeks compared to those delivering at full term. MiR‐191‐5p and miR‐93‐5p were significantly overexpressed in women who delivered <32 weeks, and further increase in fold change was observed with decreasing gestational age at delivery. The level of miR‐15b‐5p was significantly higher in women delivering at <30 weeks compared to those delivering at full term. Conclusions: Our study shows that overexpression of miR‐93‐5p, miR‐15b‐5p, and miR‐191‐5p in serum at early gestation is associated with spontaneous PTD in a general population. Further research is needed to evaluate the potential of these miRNAs as future biomarkers for spontaneous PTD, as well as their pathophysiological role in spontaneous PTD. [ABSTRACT FROM AUTHOR]

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]

Purpose: To assess Black women's exposure to and appraisal of racism-related stress during the postpartum period and to distinguish its impact on three indicators of postpartum mood and anxiety disorders (PMADs) symptoms. Methods: Data from the Black Mothers' Mental Wellness Study (N = 231) and linear regression models estimated the associations between racism-related stress and the PMAD indicators: 3-item Edinburgh Postnatal Depression Scale (EPDS-3), 8-item Patient Health Questionnaire (PHQ-8), and PHQ-15. Results: The majority of participants (80.5%, N = 186) experienced racism a few times a year or more, of which 37.1% (N = 69) were bothered somewhat and 19.3% (N = 36) a lot. Racism-related stress, income, level of education, and history of mental health diagnosis explained greater variance in PMAD symptoms as measured by the PHQ-8 score (R2 = 0.58, p = < 0.001) compared to the EPDS-3 (R2 = 0.46, p = < 0.001) or the PHQ-15 (R2 = 0.14, p = 0.035). Conclusions: Racism is a stressor for Black women living in Los Angeles County, California. Racism-related stress and emotional expression of PMAD symptoms were salient to the postpartum mental health of the Black women in this study. Findings from this study suggest that the PHQ-8 should be used to assess how racism impacts Black women's postpartum mental health. [ABSTRACT FROM AUTHOR]

Despite recent economic growth and reductions in child mortality in many African countries, the region has experienced a slow fertility transition. In this study, we explore whether the slow structural economic change on the continent can explain this discrepancy. We construct a unique panel dataset combining Demographic and Health Surveys and nighttime light intensity data (an indicator of industrialization) from 57 countries at the subnational region level over three decades to analyze the drivers of fertility transitions across low- and middle-income countries. Our results confirm that household wealth, reduced child mortality, and female primary education are crucial for fertility declines. However, our analysis also highlights the importance of indicators of structural economic change, including the share of labor in nonagricultural occupations, industrialization, the share of women with higher education, and the formalization of the economy. Our simulations suggest that if high-fertility countries in sub-Saharan Africa underwent structural economic transformations comparable to those of other low- and middle-income countries with low fertility rates, their fertility levels could fall by 1 to 1.6 children. [ABSTRACT FROM AUTHOR]

We examine theoretically and empirically whether democratic rights might be superior to economic rights in a two‐horse race, utilizing indicators of poverty reduction, such as health‐adjusted life expectancy (HALE) and child mortality as outcomes. The results show robustly that economic freedoms associate positively with HALE and negatively with child mortality, while the effect of democracy is more mixed. Studies reporting a negative effect of political freedoms on child mortality without accounting for economic freedoms, thus, are potentially mis‐specified. These results are robust to a barrage of tests, alternative data, estimating method and formal tests of omitted variables bias. [ABSTRACT FROM AUTHOR]

Public health programs' successful implementation often requires a thorough consideration ⁠ of local cultural contexts and effective community engagement. The complexities and obstacles that public health initiatives may face in culturally ⁠ diverse communities are highlighted by our case study, offering valuable insights. ‍ This article focuses on analyzing a particular incident that occurred in Gobe Challa Village, connected ⁠ to the implementation of the Child Health and Mortality Prevention Surveillance (CHAMPS) program. In Gobe Challa Village, an incident occurred that centered on discord within the community and religious fears, resulting ⁠ from misunderstandings surrounding and a general lack of comprehension about the CHAMPS program. Our resolution process involved engaging the community, and religious leaders in constructive dialogue. Throughout this involvement, we delivered extensive elucidation on the aims and ⁠ protocols of the CHAMPS program, mitigating conflicts within the community. The community successfully achieved acceptance of the CHAMPS program by directly ⁠ and respectfully addressing misconceptions and fears, fostering a common understanding. This study emphasizes the significance of effective communication, community engagement, and ⁠ consideration of cultural customs when implementing public health programs. The experiences derived from this incident can act as a practical ⁠ manual for future public health initiatives encountering analogous cultural and societal dynamics. The main emphasis is on highlighting how a proactive, sensitive, and inclusive approach can ⁠ alleviate potential conflicts while also promoting program acceptance and encouraging community engagement. These discoveries have relevance to various public health initiatives and emphasize the significance ⁠ of a culturally conscious, community-involved approach in executing global health programs. ‍ [ABSTRACT FROM AUTHOR]

This study explores the effects of war on human resource development in Afghanistan using non-linear autoregressive distributed lags (NARDL) and asymmetric causality analysis. The results of the NARDL bound test support an asymmetric long-run relationship between predictors. It reveals that positive and negative shocks from the per capita cost of war, child mortality rate, and population growth rate asymmetrically affect the school enrollment rate in both the short and long runs. Furthermore, it shows that positive shocks from per capita GDP and per capita government expenditures on education increase the school enrollment rate, while their negative shocks have adverse effects, in both the short and long runs. This implies that school enrollment is highly sensitive to changes in the per capita cost of war and reacts swiftly. Moreover, the results reveal significant causality from both the positive and negative components of the per capita cost of war, per capita GDP, per capita government expenditures on education, and population growth to both the positive and negative components of the school enrollment rate. However, there is only a causal nexus from the negative component of the child mortality rate to the school enrollment rate. Based on these findings, relevant policy implications are discussed. [ABSTRACT FROM AUTHOR]

Child malnutrition is one of the major causes of child morbidity and mortality around the globe especially in developing countries. The current study attempts to investigate the factors that contribute to malnutrition captured through WAZ (weight for age) among children in the Cholistan desert area of Punjab, Pakistan. Out of 900 households surveyed, 584 households were identified, having a sample of 1059 children aged between 0 and 59 months. The logit, multilevel logit, generalized linear mixed model, and generalized linear latent and mixed model approaches were employed to analyze the collected data. The findings reveal that the wealth index of households, mother's age at birth of a child, birth order of the child, duration of breastfeeding, distance to the basic health unit, and use of protected/clean water significantly affect children for being underweight. The policy recommendations are made in line with the study findings to suggest ways that can reduce prevalance of underweight children in the area. [ABSTRACT FROM AUTHOR]

We hypothesized that consanguineous marriage will remain a risk factor for pregnancy outcome and offspring mortality, but the development in demographic, socioeconomic conditions and increased utilization of maternal and child health care services during postglobalization era would work as a buffer in the reduction of child mortality rates. Data fromNational Family Health Surveys 4(2015–2016) and 5(2019–2021) were pooled and used for the analysis. Binary logistic regression and Cox proportional hazard regression models were used to examine the effects of close (CC) and distant (DC) consanguinity on spontaneous abortion, stillbirth, neonatal mortality, post-neonatal, and child mortality respectively compared to non-consanguinity (NC). The final model showed that the risk of spontaneous abortion (both CC and DC, p < 0.001) and neonatal mortality (DC, p < 0.001) were significantly higher compared to NC. No significant association was found between consanguinity and child mortality. We conclude that the endogenous effect of consanguinity still pose a serious challenge to the survival of fetus and new born; but exogenous effect reduces the risk of child death. We propose to incorporate socially entrenched practice of consanguinity explicitly into Mosley and Chen's (1984) framework for the aid in understanding child survival in developing countries. [ABSTRACT FROM AUTHOR]

Background: Azithromycin has been shown to be beneficial in preventing infectious diseases, including malaria, infectious diarrhoea and pneumonia. A cluster randomised control trial on azithromycin MDA in children in Niger, Malawi and Tanzania found a reduction in all-cause under-five (U5) mortality in communities who received azithromycin compared to placebo. However, the reduction was largest and statistically significant only in Niger. The purpose of this trial is to evaluate the impact of azithromycin plus intermittent preventive treatment in infants (IPTi), recently renamed by the World Health Organisation as perennial malaria chemoprevention (PMC), with sulfadoxine-pyrimethamine (SP) on all-cause mortality up to 18 months of age in children living in areas of high mortality burden through the Expanded Program on Immunisation (EPI) in Sierra Leone. Methods: The Improving Care through Azithromycin Research for Infants in Africa (ICARIA) trial is a phase III two-arm, individually randomised, double-blinded, placebo-controlled trial administering oral AZI (20 mg/kg bodyweight) at three time points to children attending EPI visits in Sierra Leone. A total of 20,560 infants attending the first EPI contact at around 6 weeks of age are recruited and randomised to AZI or placebo in a 1:1 ratio. The second and third AZI/placebo doses are given at 9 and 15 months of age. The primary outcome of the trial is all-cause mortality rate at 18 months of age assessed through mortality surveillance. Other trial outcomes include the impact on antimicrobial resistance, and on the immune response to certain key routine EPI immunisations, the safety of the intervention, the prevalence of SP resistance markers and the feasibility, and acceptability of adding AZI to the EPI programme. Discussion: The trial will provide the evidence needed to inform policy regarding the adoption and large-scale implementation of AZI in areas of high-mortality burden in sub-Saharan Africa. Trial registration: ClinicalTrials.gov NCT04235816. Registered on 22 January 2020. Pan-African Clinical Trials Registry PACTR202004540256535. Registered on 14 April 2020. [ABSTRACT FROM AUTHOR]

Background: Mauritania, a lower-middle-income country in Northwest Africa, has one of the highest maternal and infant mortality rates worldwide and struggles to ensure optimal use of maternal healthcare services. Raising health awareness through family planning messages can promote maternal healthcare use, potentially reducing preventable maternal and child mortalities. The objective of the study was to assess the potential impact of exposure to family planning messages through social media on the utilization of maternal healthcare services among Mauritanian women. Methods: Data from the 2019-20 Mauritania Demographic and Health Survey (MDHS) on 7,640 women were analyzed. Multiple logistic regression models were applied to examine the associations between exposure to family planning messages through social media and maternal healthcare services, specifically the timing and adequacy of ANC visits, and facility-based childbirth. Adjusted odds ratios with 95% confidence intervals (CI) were estimated. Results: The percentage of timely initiation and adequate use of ANC among the participants were 65.6% and 45.1%, respectively. Approximately 75.0% of the women reported giving birth to their last child at a healthcare facility. Exposure to family planning messages on social media was significantly associated with increased odds of receiving adequate antenatal care visits (OR = 1.38, 95% CI = 1.12,1.71) and giving birth in a health facility (OR = 1.83, 95% CI = 1.09,3.08), Other factors such as age, health insurance, wealth, and desired timing of the last child were also found to be important predictors of maternal healthcare. Conclusion: The findings suggest that exposure to family planning messages on social media is strongly associated with adequate antenatal care and health facility-based childbirth, but not with early timing of antenatal care. Comprehensive maternal healthcare policies should consider the role of social media in promoting family planning messages. [ABSTRACT FROM AUTHOR]

Background: This study systematically reviewed the causes of child death across different age groups based on the International Classification of Diseases, 10th Revision (ICD-10) criteria. Methods: A comprehensive search was conducted in seven electronic databases and two search engines to identify all studies examining child mortality in any part of Iran or the entire country. Hand searching, gray literature, and bibliographies were also utilized. Data were synthesized descriptively and through meta-analysis. Results: A total of 35 studies were included, encompassing 58,519 death cases across various age groups. According to the ICD-10 classification, the most common causes of Neonatal Mortality Rates (NMR) were pregnancy, childbirth, and puerperium-related conditions (41.1%), congenital malformations (19.2%), and certain conditions originating in the perinatal period (14.5%). For Infant Mortality Rates (IMR), the leading causes were congenital malformations (44.0%), pregnancy, childbirth, and related conditions (14.5%), and respiratory and cardiovascular diseases (8.7%). In the age group of 28 days to 5 years, the primary causes of death were pregnancy, childbirth, and puerperium-related issues (27.5%), congenital malformations and chromosomal abnormalities (21.6%), and respiratory and cardiovascular disease (9.3%). For children aged 1 to 5 years, congenital malformations (29.1%), external causes (19.6%), and respiratory and cardiovascular disorders (7.2%) were the most significant causes of death. The meta-analysis revealed that immaturity [0.171 (PI: 0.032–0.561)] in infants aged 0–28 days, and congenital malformations in the age groups of 28 to 1 year [0.261 (PI: 0.166–0.385)] and 28 to 5 years [0.173 (PI: 0.078–0.342)] were the leading causes of death. Conclusions: The findings of this study provide valuable insights for priority-setting interventions aimed at reducing child mortality according to the prevalence rate of specific causes in different age groups. [ABSTRACT FROM AUTHOR]

Background: Diarrheal disease is still the leading cause of morbidity and mortality in children, despite significant progress in diarrhea interventions. Zoonotic transmission is the main cause of the emergence and re-emergence of diseases. Domestic animals are often close to humans, particularly in resource-poor countries. Despite evidence of environmental contamination, there have been limited studies conducted to examine the association between domestic animal exposure and diarrheal disease in low- and middle-income countries (LMIC). Therefore, this systematic review and meta-analysis examines the association between domestic animal exposure and diarrheal disease in children under five years of age in LMIC. Methods: The search strategy followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for the reporting of systematic reviews. All appropriate databases were searched to find relevant articles. Research studies were selected for review if they reported an outcome variable that measured diarrhea and exposure variables of any domestic animals. A data extraction form was used to extract information from each study. The quality of the individual articles was assessed using the Joanna Briggs Institute (JBI's) critical appraisal tools. Publication bias was checked using a funnel plot, Egger's regression test, and Begg's test. The heterogeneity of studies was checked using the Galbraith plot and the I-squared test. A sensitivity analysis was conducted, and a meta-analysis was conducted using STATA 17. Results: After reviewing 113 articles, 11 articles fulfilled the inclusion criteria hence considered for meta-analysis. The finding of these 11 studies revealed that study participants who had animal exposure had 1.95 higher odds of diarrhea as compared to participants who hadn't animal exposure (OR: 1.95, 95%CI: 1.25, 2.66). Conclusions and recommendations: This study reported that diarrheal disease was associated with study subjects who had domestic animal exposure. Therefore, more comprehensive research is needed on specific behaviors and interventions surrounding animal husbandry that may affect the transmission of pathogens between animals and humans; this would facilitate the design and implementation of measures to reduce animal exposure in the domestic environment. [ABSTRACT FROM AUTHOR]

Background: The continuum of maternal health care ensures consistency in the delivery of care from pregnancy to the postnatal period. It recommends a minimum of 4 antenatal visits, skilled birth attendance, and 42 days of postnatal care. This approach helps reduce maternal deaths. The aim of this study was to estimate the proportion of women who had completed the different stages of the continuum of maternal health care (four antenatal visits, given birth under the care of qualified personnel, and received postnatal care within 42 days of delivery). Methods: This was a cross-sectional analytical study conducted in the five communes of Conakry, using a two-stage cluster sampling for data collection. Results were described using medians and percentages. The proportions of women in the continuum of care, and at the different stages of this continuum, have been weighted. Multivariate logistic regression was used to identify the factors associated with non-completion of the different stages of the maternal health care continuum among the women included in this study. Results: We found that 26.9% of women had completed all stages of the maternal health care continuum, while 73.1% had not. While 56.7% received four antenatal visits, only 29.5% delivered under the care of a qualified healthcare professional. Key factors associated with discontinuity were not attending school (AOR 1.825: 1.594--2.089), unemployment (AOR 4.588: 3.983--5.285), having two or more living children (AOR 1.890: 1.016--1.296), and not receiving a free Long-Lasting Insecticidal Net at the first Antenatal Care. Conclusion: Maternal care discontinuity is a major issue in Guinea. The country's Health Development Plan had set an expected level for maternal care which has not been met as of 2022. The completeness of care is influenced by various factors, including individual socio-demographic characteristics and factors related to the organization, availability, and quality of health services. To reduce maternal and child mortality rates, it is essential to improve interpersonal communication during antenatal care, ensure the availability of quality health services, and conduct a national study on maternal health service quality and maternal satisfaction. This will help establish a proper continuum of care for mothers and children. [ABSTRACT FROM AUTHOR]

Diseases caused by S. pneumoniae are the leading cause of child mortality. As antibiotic resistance of S. pneumoniae is rising, vaccination remains the most recommended solution. However, the existing pneumococcal polysaccharides vaccine (Pneumovax® 23) proved only to induce T-independent immunity, and strict cold chain dependence of the protein conjugate vaccine impedes its promotion in developing countries, where infections are most problematic. Affordable and efficient vaccines against pneumococcus are therefore in high demand. Here, we present an intranasal vaccine Lipo+CPS12F&αGC, containing the capsular polysaccharides of S. pneumoniae 12F and the iNKT agonist α-galactosylceramide in cationic liposomes. In BALB/cJRj mice, the vaccine effectively activates iNKT cells and promotes B cells maturation, stimulates affinity-matured IgA and IgG production in both the respiratory tract and systemic blood, and displays sufficient protection both in vivo and in vitro. The designed vaccine is a promising, cost-effective solution against pneumococcus, which can be expanded to cover more serotypes and pathogens. Intranasal immunization with capsular pneumococcal polysaccharides 12F and iNKT agonist α-galactosylceramide in cationic liposomes protects mice from S. pneumoniae 12F infection. [ABSTRACT FROM AUTHOR]

Background: Spontaneous preterm birth (sPTB) is a global disease that is a leading cause of death in neonates and children younger than 5 years of age. However, the etiology of sPTB remains poorly understood. Recent evidence has shown a strong association between metabolic disorders and sPTB. To determine the metabolic alterations in sPTB patients, we used various bioinformatics methods to analyze the abnormal changes in metabolic pathways in the preterm placenta via existing datasets. Methods: In this study, we integrated two datasets (GSE203507 and GSE174415) from the NCBI GEO database for the following analysis. We utilized the "Deseq2" R package and WGCNA for differentially expressed genes (DEGs) analysis; the identified DEGs were subsequently compared with metabolism-related genes. To identify the altered metabolism-related pathways and hub genes in sPTB patients, we performed multiple functional enrichment analysis and applied three machine learning algorithms, LASSO, SVM-RFE, and RF, with the hub genes that were verified by immunohistochemistry. Additionally, we conducted singlesample gene set enrichment analysis to assess immune infiltration in the placenta. Results: We identified 228 sPTB-related DEGs that were enriched in pathways such as arachidonic acid and glutathione metabolism. A total of 3 metabolismrelated hub genes, namely, ANPEP, CKMT1B, and PLA2G4A, were identified and validated in external datasets and experiments. A nomogram model was developed and evaluated with 3 hub genes; the model could reliably distinguish sPTB patients and term labor patients with an area under the curve (AUC) > 0.75 for both the training and validation sets. Immune infiltration analysis revealed immune dysregulation in sPTB patients. Conclusion: Three potential hub genes that influence the occurrence of sPTB through shadow participation in placental metabolism were identified; these results provide a new perspective for the development and targeting of treatments for sPTB. [ABSTRACT FROM AUTHOR]

Objective: The study aimed to assess the equity of access to free maternal and child health services among reproductive- age women in Delta State, Nigeria Design: the study adopted a descriptive cross-sectional survey design Participants: The population for the study were 368 women of reproductive age (15-49 years) who had given birth between April 2015 and December 2015 in two randomly selected senatorial districts of Delta State. Data were collected using a pre-tested interviewer-administered questionnaire. Results: 368 women were recruited for the study, consisting of 73.3% (N =270) from the urban setting and 26.7% (N=98) from the rural setting. 54.1% (N=199) had completed secondary school, while 28.8% (N=106) had completed tertiary education. Most respondents were aged 21 to 30 years 217(59.0%). 20% of respondents belonged to the poorest, poor and least poor socioeconomic status (SES) groups and 19.8% to average poor and rich SES groups. The results showed equity between different SES (0.014) and educational (0.027) backgrounds, as indicated in concentration curves. However, the concentration index between the geographical areas (-0.0200) indicates inequity in access in favour of urban dwellers. Conclusion: Free maternal and child health services (FMCHS) were equitable across the different SES groups and educational levels. However, there was inequity in access due to distance to the hospitals among the women of childbearing age in the communities. This study is relevant to all healthcare professionals, especially those in public health, because it will encourage them to exercise their energy towards home care to reduce maternal and child mortality. [ABSTRACT FROM AUTHOR]

The article focuses on the essential role of global nursing in advancing sustainable development and addressing complex health disparities worldwide. It emphasizes the importance of culturally sensitive care, healthcare policy advocacy, and workforce mobility, highlighting the contributions of nurses in promoting well-being, reducing inequities, and responding to global health challenges.

BACKGROUND: Diagnostic autopsy has been in use for long to determine the cause of death. Since recently however ‘Minimally Invasive Tissue Sampling’ (MITS) is introduced to determine definitive cause of neonatal death. This study describes locally established facilitators to introduce MITS procedures to determine cause of neonatal death in Ethiopia. METHODS: Exploratory study was conducted in Butajira community where twenty-two key informants representing community opinion leaders’ health care workers, five in depth interviews with parents who recently lost neonates and eight FGDs with community members were completed to generate evidences in line with the research question. Interviews and discussions were audio recorded, transcribed verbatim and analysed facilitated by open-code software. Thematic analysis was applied to identify and interpret patterns of the evidences RESULTS: In Butajira, ANC and delivery in health facilities was found to have improved over the years. Yet, child death remains an outstanding problem. While different factors were identified to cause the death of a child, relatively few participants choose to accept newborn death as a natural occurrence or will of the creator. Majority of the study participants expressed interest to know definitive cause of death using MITS. Yet, awareness about MITS and how it works was unanimously desired. It was found that husbands and wives are key to authorize MITS procedure while community opinion leaders including religious leaders were identified as key to influence parental decisions for the procedure CONCLUSION: Building awareness of the community members and engagement of opinion leaders is critical to introduce MITS. [ABSTRACT FROM AUTHOR]

Background and Objectives: Drowning, the leading cause of unintentional injury death among California children less than five years of age, averaged 49 annual fatalities for the years 2010–2021. The California Pool Safety Act aims to reduce fatalities by requiring safety measures around residential pools. This study was designed to analyze annual fatality rates and drowning incidents in California among children 1–4 years of age from 2017–2021. Methods: We identified fatalities, injury hospitalizations, and emergency department (ED) visits from California state vital statistics death data and state hospital and ED discharge data using the EpiCenter California Injury Data Online website. Results: Over the five-year study period, 4,166 drowning incidents were identified: 234 were fatalities, 846 were hospitalizations, and 3,086 were ED visits. The observed difference in fatality rates from 2017 to 2021 failed to achieve statistical significance (P = 0.88). Location-based analysis of the 234 fatal drowning incidents revealed that pools were the most common injury site, accounting for 65% of the cases. Conclusion: Drowning remains the leading cause of unintentional, injury-related death among California children 1–4 years of age, as the annual rate of fatality over the five-year study period did not decline. While the EpiCenter California Injury Data Online website is excellent for analyzing annual rates of drowning incidents among California residents over time, it is limited in providing insight into modifiable risk factors and event circumstances that can further inform prevention. The development of robust integrated fatal and non-fatal local, state, and national systematic data collection systems could aid in moving the needle in decreasing pool fatalities among young children. [ABSTRACT FROM AUTHOR]

Background and Objective: Untreated spinal muscular atrophy (SMA) is the leading genetic cause of death in children younger than 2 years of age. Early detection through newborn screening allows for presymptomatic diagnosis and treatment of SMA. With effective treatments available and reimbursed by the National Health Service, many regions in Italy are implementing newborn screening for SMA. We evaluated the cost effectiveness of universal newborn screening for SMA in Italy. Methods: A decision-analytic model assessed the cost effectiveness of newborn screening from the National Health Service perspective in 400,000 newborns. Newborn screening enabling early identification and presymptomatic treatment of SMA was compared with no newborn screening, symptomatic diagnosis, and treatment. Transition probabilities between health states were estimated from clinical trial data. Higher-functioning health states were associated with increased survival, higher utility values, and lower costs. Long-term survival and utilities were extrapolated from scientific literature. Health care costs were collected from official Italian sources. A lifetime time horizon was applied, and costs and outcomes were discounted at an annual rate of 3%. Deterministic and probabilistic sensitivity analyses were conducted. Results: Newborn screening followed by presymptomatic treatment yielded 324 incremental life-years, 390 incremental quality-adjusted life-years, and reduced costs by €1,513,375 over a lifetime time horizon compared with no newborn screening. Thus, newborn screening was less costly and more effective than no newborn screening. Newborn screening has a 100% probability of being cost effective, assuming a willingness-to-pay threshold of > €40,000. Conclusions: Newborn screening followed by presymptomatic SMA treatment is cost effective from the Italian National Health Service perspective. [ABSTRACT FROM AUTHOR]

Background: Diarrhea is a leading cause of death in young children worldwide. Vitamin D deficiency impairs the body's ability to clear pathogens, reduces tight junction protein expression in intestinal epithelial cells, and enhances Th1‐mediated intestinal inflammation. This study aimed to investigate the effects of serum vitamin D levels on acute invasive enteritis in children. Methods: This prospective cohort study included 82 children aged 1–3 years with clinically diagnosed acute invasive enteritis at Sichuan Maternal and Child Health Hospital from February 2021 to February 2022, alongside a control group of 80 healthy children. Fecal specimens were collected for routine tests and occult blood analysis, while blood samples were taken for routine tests, C‐reactive protein, and 25‐OHD levels. Comparative analyses were performed between groups, and multifactorial logistic regression was used to identify factors influencing invasive enteritis. Results: The study group showed significantly lower serum 25‐OHD levels (27.95 ± 9.91 ng/mL) compared to controls (32.76 ± 10.23 ng/mL, p <.01). Among the study group, 19.5% (16/82) had levels <20 ng/mL, versus 12.5% (10/80) in controls. Regular vitamin D supplementation was lower in the study group (58.5% vs. 77.5%, p <.05). Outdoor activity duration was also reduced (2.57 ± 0.98 h vs. 3.04 ± 0.88 h, p <.01). Multivariate analysis identified that exclusive breastfeeding, greater outdoor activity time and regular vitamin D supplementation were all associated with reduced risk of invasive enteritis (p <.05). Conclusion: The findings indicate an association between low serum 25‐OHD levels and acute invasive enteritis in children aged 1‐3 years, suggesting that consistent vitamin D supplementation and sufficient outdoor activity may protect against this condition. [ABSTRACT FROM AUTHOR]

Background: Severe Plasmodium falciparum malarial anemia is still the principal cause of death in children in underdeveloped countries. An imbalance between proinflammatory and anti‐inflammatory cytokines is associated with malaria progression. This study evaluated circulating levels of selected inflammatory cytokines among malaria‐infected children in Ghana. Methods: This case‐control study was conducted at Tamale Teaching Hospital, Ghana. One hundred and twenty children with malaria and 60 controls, aged 12−144 months were selected from April to July, 2023 for the study. Malaria was diagnosed through microscopy, full blood count was measured using hematology analyzer, and cytokines were measured using enzyme‐linked immunosorbent assay. Results: Malaria‐infected children had higher tumor necrosis factor alpha (TNF‐α) (p <.001), interferon‐gamma (IFN‐ɣ) (p <.001), interleukin (IL)‐1β (p <.001), IL‐6 (p <.001), granulocyte macrophage‐colony stimulating factor (GM‐CSF) (p <.001), and IL‐10 (p <.001) levels than controls. Participants with high parasitemia had raised TNF‐α (p <.001), IFN‐ɣ (p <.001), IL‐1β (p <.001), IL‐6 (p <.001), GM‐CSF (p <.001), and IL‐10 (p <.001), but reduced IL‐3 (p <.001) and TGF‐β (p <.001) than those with low parasitemia. Severe malarial anemic children had elevated TNF‐α (p <.001), IFN‐ɣ (p <.001), IL‐1β (p <.001), IL‐6 (p <.001), GM‐CSF (p <.001), and IL‐10 (p <.001), but lower IL‐3 (p <.001) and TGF‐β (p <.001) than those with uncomplicated malaria. Conclusion: Parasite density was the principal predictor of the cytokine levels, as parasitemia positively associated with IL‐10, GM‐CSF, IL‐6, IL‐1β, IFN‐ɣ, and TNF‐α, but negatively associated with IL‐3 and TGF‐β. Malaria is associated with enhanced secretion of pro‐ and anti‐inflammatory cytokines in Ghanaian children. Inflammatory cytokines may be involved in the development of severe malarial anemia in children. However, IL‐3 and TGF‐β may offer protection against severe malarial anemia. [ABSTRACT FROM AUTHOR]

Background/Objectives: Traumatic brain injury (TBI) is a leading cause of death and disability in children. Currently, no biological test can predict outcomes in pediatric TBI, complicating medical management. This study sought to identify brain-related micro-ribosomal nucleic acids (miRNAs) in saliva associated with moderate-to-severe TBI in children, offering a potential non-invasive, prognostic tool. Methods: A case-control design was used, enrolling participants ≤ 18 years old from three pediatric trauma centers. Participants were divided into moderate-to-severe TBI and non-TBI trauma control groups. Saliva samples were collected within 24 h of injury, with additional samples at 24–48 h and >48 h post-injury from the TBI group. miRNA profiles were visualized with partial least squares discriminant analysis (PLSDA) and hierarchical clustering. Mann–Whitney testing was used to compare miRNAs between groups, and mixed models were used to assess longitudinal expression patterns. DIANA miRPath v3.0 was used to interrogate the physiological functions of miRNAs. Results: Twenty-three participants were enrolled (14 TBI, nine controls). TBI and control groups displayed complete separation of miRNA profiles on PLSDA. Three miRNAs were elevated (adj. p < 0.05) in TBI (miR-1255b-5p, miR-3142, and miR-4320), and two were lower (miR-326 and miR-4646-5p). Three miRNAs (miR-3907, miR-4254, and miR-1273g-5p) showed temporal changes post-injury. Brain-related targets of these miRNAs included the glutamatergic synapse and GRIN2B. Conclusions: This study shows that saliva miRNA profiles in children with moderate-to-severe TBI may differ from those with non-TBI trauma and exhibit temporal changes post-injury. These miRNAs could serve as non-invasive biomarkers for prognosticating pediatric TBI outcomes. Further studies are needed to confirm these findings. [ABSTRACT FROM AUTHOR]

Background: Diarrheal illness is a prominent public health worry in developing countries, resulting in high mortality among children. Sociodemographic characteristics and geographic settings are the main effective factors for the increased incidence of childhood diarrhea. Aeromonas is a neglected organism capable of causing dysentery and diarrhea. The aim of this systematic review and meta-analysis was to determine the prevalence of Aeromonas as an agent in the causation of diarrhea in Asian children. Methods: We conducted a systematic review using Web of Science, PubMed, Wiley Online Library, Science Direct, and Google Scholar for peer-reviewed articles published between January 2000 and February 2023. We considered studies that found Aeromonas in diarrheal stool. A random-effects model was used to determine the pooled prevalence of Aeromonas. Results: Our search returned 2,057 articles, with 17 articles from seven Asian nations being included in the systematic review. The pooled prevalence of Aeromonas was 4.5% (95% confidence interval [CI]: 2.9%–6.8%), with heterogeneity (I2 = 96.85; p < 0.001). There was a greater prevalence in areas with high population living in poverty (12.2%; 95% CI: 5.8%–24%) and lower-middle-income countries (5.0%; 95% CI: 2.7%–9.0%). In addition, the prevalence of Aeromonas was greater in South Asia (10.0%; 95% CI: 5.6%–17.2%), in India (12.9%; 95% CI: 6.8%–23%), and in countries with open defecation rate of 5%–25% (11.3%; 95% CI: 6.3%–19.2%). Conclusion: The prevalence of Aeromonas-associated diarrhea in children in Asia estimated in the present study highlighted the high burden of Aeromonas in some parts of Asia. [ABSTRACT FROM AUTHOR]