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Aim: Child mortality declined significantly in Finland in 1969–2004. We investigated whether the already low mortality rate could still decline from 2005 to 2020. Methods: This was a nationwide register‐based study. The subjects were children under 16 years of age who had resided in Finland between 2005 and 2020. The study population was identified from Finland's Population Information System of the Digital and Population Data Services Agency. Causes of death were obtained from Statistics Finland. Changes in annual overall and cause‐specific mortality rates were evaluated. Results: 3685 children (55% boys) under 16 years of age died in Finland in 2005–2020 from 325 causes. Overall annual child mortality declined by 50% (95% confidence interval 37 to 64%) during the study period, from 0.31/1000 in 2005 to 0.16/1000 in 2020. The mortality rate in children under one year of age declined from 3.1/1000 in 2005 to 1.8/1000 in 2020. The deaths from sudden infant death syndrome fell by 84%, congenital malformations by 62%, infectious diseases by 60%, external causes by 52%, and perinatal disorders by 41%. Conclusion: Finland's low child mortality further declined over the past two decades. Contributing factors likely include achievements in paediatric research, public health, and clinical practice. [ABSTRACT FROM AUTHOR]

Despite significant strides made in childhood survival during the last 75 years, India bears the largest burden of congenital heart disease (CHD) in the world. The care of a child with CHD requires multidisciplinary collaboration and development of distinct training opportunities in developing countries to ensure outcomes similar to those achieved in high-income countries. We present a commentary on the current state of pediatric cardiac critical care in India and propose pathways to fulfil the unmet needs of Indian children. The aim is to achieve self-reliance in pediatric cardiac services and to move towards optimal outcome and intact survival of children with CHD. [ABSTRACT FROM AUTHOR]

Indoor air pollution, stemming from traditional and transitional energy sources for cooking and lighting, poses a significant threat in developing countries. Particularly concerning is its impact on child morbidity and mortality, with 1 in 4 deaths of children under five attributed to environmental factors. This study, using the 2013 Demographic and Health Survey in Nigeria, explores the gender-specific environmental effects on child mortality. Contrary to the belief that girls may have higher immunity, the research employs a logit regression estimator and reveals that both male and female children face mortality risks from traditional and transitional cooking methods. Female children, in particular, exhibit higher mortality risks from traditional energy sources, while outcomes for transitional energy are mixed for both genders. Overall, females face a greater risk of mortality due to indoor air pollution from biomass cooking smoke. The multivariable analysis indicates an 81% increased risk of under-5 mortality for girls using traditional fuels, compared to a 62% increased risk for boys. To mitigate these risks, the study recommends adopting modern energy sources, such as liquefied petroleum gas, and raising awareness about the health hazards associated with traditional and transitional energies. Additionally, factors like education, wealth, breastfeeding, and postnatal check-ups are identified as mitigating factors, while a mother's age, employment, and location amplify the risk of child mortality. [ABSTRACT FROM AUTHOR]

Malnourishment is a risk factor for childhood mortality, jeopardizing the health of children by aggravating pneumonia/acute respiratory infections and diarrheal diseases. Malnourishment causes morphophysiological changes resulting in stunting and wasting that have long-lasting consequences such as cognitive deficit and metabolic dysfunction. Using a pig model of malnutrition, the interplay between the phenotypic data displayed by the malnourished animals, the gene expression pattern along the intestinal tract, microbiota composition of the intestinal contents, and hepatic metabolite concentrations from the same animals were correlated using a multi-omics approach. Samples from the duodenum, jejunum, and ileum of malnourished (protein and calorie-restricted diet) and full-fed (no dietary restrictions) piglets were subjected to RNA-seq. Gene co-expression analysis and phenotypic correlations were made with WGCNA, while the integration of transcriptome with microbiota composition and the hepatic metabolite profile was done using mixOmics. Malnourishment caused changes in tissue gene expression that influenced energetic balance, cell proliferation, nutrient absorption, and response to stress. Repression of antioxidant genes, including glutathione peroxidase, in coordination with induction of metal ion transporters corresponded to the hepatic metabolite changes. These data indicate oxidative stress in the intestine of malnourished animals. Furthermore, several of the phenotypes displayed by these animals could be explained by changes in gene expression.

Background: Global differences in the Covid-19 death toll between various countries are still a matter of debate. We evaluated the potential influence of general burden of infectious diseases prior to the onset of the Covid-19 pandemic on the number of Covid-19 deaths during the pandemic. Methods: We used publicly available data from Worldometer and Our World in Data. In a complete case analysis, 178 countries and territories, where all parameters were available, entered the analysis, representing 99.02% of the global population. Relationships between various parameters of the local burden of infectious diseases as well as childhood mortality, median age, and vaccination as independent variables, on Covid-19 deaths as the dependent variable, were evaluated. Results: Death from diarrheal disease, respiratory disease, pneumonia, pneumonia in childhood, malaria, and HIV, as well as childhood mortality correlated negatively with number of Covid-19 deaths (Spearman rank correlation test: p

Abstract Religion is one of the key instrumental social institutions in determining child health and mortality. Muslim advantage in child survival in India has been widely reported. Recent India’s National Family Health Survey (NFHS) shows that the gap between Hindu–Muslim childhood mortality rates is shrinking—reversing decades of child survival advantage for Muslims. This study examines the factors linked to the diminishing of Muslim advantage in childhood survival and attempts to uncover the mechanisms accounting for the convergence using the characteristics hypothesis of Goldscheider (Population, modernization, and social structure Little, Brown & Co; 1971) and the analytical framework of Guillot and Allendorf (Genus 66(2), 2010). We have analyzed a pooled sample of 23,47,245 all live births and 428,541 of last live births from four rounds of NFHS (1992–2016). Kaplan–Meier survival plots over time by religion confirm convergence in Hindu–Muslim child survival probabilities. The Pyatt decomposition model reveals that the gap in Hindu–Muslim childhood mortality is diminishing due to a decline in within-Hindu inequality. Cox proportional hazard regression model shows that improvement in household and maternal socioeconomic factors has contributed to Hindu children catching up with Muslims—leading to a convergence in Hindu–Muslim childhood survival probabilities. Conditional β-convergence regression model also suggests the convergence in socio-economic status and maternal health care is driving the convergence in child survival of Hindus and Muslims across Indian states.

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

In a large community-randomized trial, biannual azithromycin distributions significantly reduced postneonatal childhood mortality in sub-Saharan African sites. Here, we present a prespecified secondary analysis showing that much of the protective effect was in the first 3 months postdistribution. Distributing more frequently than biannually could be considered if logistically feasible. Clinical Trials Registration. NCT02047981.

Abstract Background Child health, especially childhood mortality, is one of the critical indicators of human development. No child mortality is desirable, but it is still high in Bangladesh. We aimed to assess the effect of the child's desired status on childhood morbidity and mortality in Bangladesh. Methods We used the data from the nationally representative cross-sectional Bangladesh Demographic and Health Survey (BDHS) 2017–18 and restricted the analyses to children born in the past five years preceding the survey. We estimated the undesired status (excess in boy, girl, both, and parity) by subtracting an ideal number of children from the total live birth. We measured childhood mortality (perinatal, early neonatal, neonatal, post-neonatal, infant, child, and under-five mortality), morbidity (fever, diarrhea, cough, and acute respiratory infectious-ARI), nutritional problems (stunting, wasting, underweight, and low birth weight), and treatments (postnatal care, treatment for fever, diarrhea/cough, and vitamin A supplementation). Finally, we utilized the chi-square test and multilevel mixed-effects logistic regression analyses. Results The prevalence of undesired children was 19.2%, 21.5%, 3.7%, and 25.4% for boys, girls, both boys and girls, and parity, respectively. Age, education, residence, division, and wealth index were significantly associated with undesired children. The prevalence of under-five mortality was 3.3% among desired children, almost double (5.4%) among undesired children. The likelihood of under-five mortality was [adjusted odds ratio (aOR): 2.05, p ≤ 0.001] higher among undesired children. Despite lower under-five mortality among higher socioeconomic status, the relative contribution of undesired children to under-fiver mortality was substantial. The undesired girl children were associated with an increased likelihood of moderately wasting (aOR: 1.28, p = 0.072), severely underweight (aOR: 1.41, p = 0.066), and low birth weight (aOR: 1.50, p ≤ 0.05). Moreover, the undesired children were 19% (p ≤ 0.05) more likely to be infected with fever. The undesired children had lower treatment for diarrhea and fever/cough and were less likely to get vitamin A supplementation (aOR: 0.71, p ≤ 0.001). Conclusions The share of childhood morbidity, mortality, and malnutrition were higher among undesired children. Every child should be wanted, and no unwanted pregnancies are desirable; thereby, the government should reemphasize the proper use of family planning methods to reduce child mortality and malnutrition.

The potential death toll from an epidemic is larger than the number of deaths directly associated with the infection. In this study, we find that prenatal exposure to a cholera epidemic in Peru increased childhood mortality and that surviving children were more likely to be underweight and to suffer from diarrhea. We further find that a significant part of this mortality happened during the first day of life, and that prenatal exposure to cholera decreased prenatal care and institutional deliveries, suggesting that the mortality and possibly other longer-term effects were partially driven by a reduction in prenatal investments. [ABSTRACT FROM AUTHOR]

Global differences in the Covid-19 death toll between various countries are still a matter of debate. We evaluated the potential influence of general burden of infectious diseases prior to the onset of the Covid-19 pandemic on the number of Covid-19 deaths during the pandemic. We used publicly available data from Worldometer and Our World in Data. In a complete case analysis, 178 countries and territories, where all parameters were available, entered the analysis, representing 99.02% of the global population. Relationships between various parameters of the local burden of infectious diseases as well as childhood mortality, median age, and vaccination as independent variables, on Covid-19 deaths as the dependent variable, were evaluated. Death from diarrheal disease, respiratory disease, pneumonia, pneumonia in childhood, malaria, and HIV, as well as childhood mortality correlated negatively with number of Covid-19 deaths (Spearman rank correlation test: p < 0.0001 for each parameter), while median age was positively correlated with Covid-19 deaths (p < 0.0001). In a multivariable approach using kernel functions, death from respiratory disease and median age retained statistical significance. When vaccination rate and median age were simultaneously taken into account, vaccination rate showed a significant negative correlation with Covid-19 deaths. Local burden of infectious diseases as well as childhood mortality prior to the onset of the pandemic have a strikingly negative impact on Covid-19 deaths. This effect might be due to an increase in trained immunity and to the overall younger population. Vaccination appears as an effective preventive measure. [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]

Abstract Background Breastfeeding practices and their impact on infant health and survival are unquestionably of global interest. The aim of this study was to examine the link between breastfeeding initiation within one hour of birth, breastfeeding duration and childhood mortality in sub-Saharan Africa. Methods This study used data from the Demographic and Health Survey, which was conducted in 35 Sub-Saharan African countries between 2008 and 2017. Early initiation and duration of breastfeeding, food consumption indices, and infant mortality were all important variables. Analysis used percentage, median/interquartile range, and regression models (logistic, linear, Cox). Results Early initiation of breastfeeding within one hour after birth was lowest in Chad (23.0%) and highest in Burundi (85.0%). The pooled median duration of breastfeeding was 12 months. Female children had 3% significant lower odds of consuming tinned, powdered or fresh milk, compared with male children (OR 0.97; 95% CI 0.94, 0.99). Conversely, female children were more likely to be put to breast within one hour after birth, compared with male children (OR 1.03; 95% CI 1.01, 1.05). Results from the pooled sample showed approximately 20% (HR 0.80; 95% CI 0.67, 0.96) and 21% (HR 0.79; 95% CI 0.77, 0.80) reduction in infant mortality for children breastfed within one hour after birth and for every unit increase in the months of breastfeeding respectively. In addition, countries with the leading infant mortality rate include; Sierra Leone (92 deaths per 1000 live births), Chad (72 deaths per 1000 live births), Nigeria (69 deaths per 1000 live births), Cote d’ Ivoire (68 deaths per 1000 live births), Guinea (67 deaths per 1000 live births), Burkina-Faso (65 deaths per 1000 live births) and Mozambique (64 deaths per 1000 live births) respectively. Conclusions The findings from this study underscores the need for early breastfeeding initiation and prolong breastfeeding to be considered in programmes on improving childhood survival. Efforts should be made to improve optimal breastfeeding practices as only about half of children in the pooled sample had best practices of breastfeeding.

Religion is one of the key instrumental social institutions in determining child health and mortality. Muslim advantage in child survival in India has been widely reported. Recent India's National Family Health Survey (NFHS) shows that the gap between Hindu–Muslim childhood mortality rates is shrinking—reversing decades of child survival advantage for Muslims. This study examines the factors linked to the diminishing of Muslim advantage in childhood survival and attempts to uncover the mechanisms accounting for the convergence using the characteristics hypothesis of Goldscheider (Population, modernization, and social structure Little, Brown & Co; 1971) and the analytical framework of Guillot and Allendorf (Genus 66(2), 2010). We have analyzed a pooled sample of 23,47,245 all live births and 428,541 of last live births from four rounds of NFHS (1992–2016). Kaplan–Meier survival plots over time by religion confirm convergence in Hindu–Muslim child survival probabilities. The Pyatt decomposition model reveals that the gap in Hindu–Muslim childhood mortality is diminishing due to a decline in within-Hindu inequality. Cox proportional hazard regression model shows that improvement in household and maternal socioeconomic factors has contributed to Hindu children catching up with Muslims—leading to a convergence in Hindu–Muslim childhood survival probabilities. Conditional β-convergence regression model also suggests the convergence in socio-economic status and maternal health care is driving the convergence in child survival of Hindus and Muslims across Indian states. [ABSTRACT FROM AUTHOR]

Malnourishment is a risk factor for childhood mortality, jeopardizing the health of children by aggravating pneumonia/acute respiratory infections and diarrheal diseases. Malnourishment causes morphophysiological changes resulting in stunting and wasting that have long-lasting consequences such as cognitive deficit and metabolic dysfunction. Using a pig model of malnutrition, the interplay between the phenotypic data displayed by the malnourished animals, the gene expression pattern along the intestinal tract, microbiota composition of the intestinal contents, and hepatic metabolite concentrations from the same animals were correlated using a multi-omics approach. Samples from the duodenum, jejunum, and ileum of malnourished (protein and calorie-restricted diet) and full-fed (no dietary restrictions) piglets were subjected to RNA-seq. Gene co-expression analysis and phenotypic correlations were made with WGCNA, while the integration of transcriptome with microbiota composition and the hepatic metabolite profile was done using mixOmics. Malnourishment caused changes in tissue gene expression that influenced energetic balance, cell proliferation, nutrient absorption, and response to stress. Repression of antioxidant genes, including glutathione peroxidase, in coordination with induction of metal ion transporters corresponded to the hepatic metabolite changes. These data indicate oxidative stress in the intestine of malnourished animals. Furthermore, several of the phenotypes displayed by these animals could be explained by changes in gene expression.

Background: Child health, especially childhood mortality, is one of the critical indicators of human development. No child mortality is desirable, but it is still high in Bangladesh. We aimed to assess the effect of the child's desired status on childhood morbidity and mortality in Bangladesh.Methods: We used the data from the nationally representative cross-sectional Bangladesh Demographic and Health Survey (BDHS) 2017-18 and restricted the analyses to children born in the past five years preceding the survey. We estimated the undesired status (excess in boy, girl, both, and parity) by subtracting an ideal number of children from the total live birth. We measured childhood mortality (perinatal, early neonatal, neonatal, post-neonatal, infant, child, and under-five mortality), morbidity (fever, diarrhea, cough, and acute respiratory infectious-ARI), nutritional problems (stunting, wasting, underweight, and low birth weight), and treatments (postnatal care, treatment for fever, diarrhea/cough, and vitamin A supplementation). Finally, we utilized the chi-square test and multilevel mixed-effects logistic regression analyses.Results: The prevalence of undesired children was 19.2%, 21.5%, 3.7%, and 25.4% for boys, girls, both boys and girls, and parity, respectively. Age, education, residence, division, and wealth index were significantly associated with undesired children. The prevalence of under-five mortality was 3.3% among desired children, almost double (5.4%) among undesired children. The likelihood of under-five mortality was [adjusted odds ratio (aOR): 2.05, p ≤ 0.001] higher among undesired children. Despite lower under-five mortality among higher socioeconomic status, the relative contribution of undesired children to under-fiver mortality was substantial. The undesired girl children were associated with an increased likelihood of moderately wasting (aOR: 1.28, p = 0.072), severely underweight (aOR: 1.41, p = 0.066), and low birth weight (aOR: 1.50, p ≤ 0.05). Moreover, the undesired children were 19% (p ≤ 0.05) more likely to be infected with fever. The undesired children had lower treatment for diarrhea and fever/cough and were less likely to get vitamin A supplementation (aOR: 0.71, p ≤ 0.001).Conclusions: The share of childhood morbidity, mortality, and malnutrition were higher among undesired children. Every child should be wanted, and no unwanted pregnancies are desirable; thereby, the government should reemphasize the proper use of family planning methods to reduce child mortality and malnutrition. [ABSTRACT FROM AUTHOR]

Background: Mass drug administration (MDA) with azithromycin is the primary strategy for global trachoma control efforts. Numerous studies have reported secondary effects of MDA with azithromycin, including reductions in childhood mortality, diarrhoeal disease and malaria. Most recently, the MORDOR clinical trial demonstrated that MDA led to an overall reduction in all-cause childhood mortality in targeted communities. There is however concern about the potential of increased antimicrobial resistance in treated communities. This study evaluated the impact of azithromycin MDA on the prevalence of gastrointestinal carriage of macrolide-resistant bacteria in communities within the MORDOR Malawi study, additionally profiling changes in the gut microbiome after treatment. For faecal metagenomics, 60 children were sampled prior to treatment and 122 children after four rounds of MDA, half receiving azithromycin and half placebo. Results: The proportion of bacteria carrying macrolide resistance increased after azithromycin treatment. Diversity and global community structure of the gut was minimally impacted by treatment, however abundance of several species was altered by treatment. Notably, the putative human enteropathogen Escherichia albertii was more abundant after treatment. Conclusions: MDA with azithromycin increased carriage of macrolide-resistant bacteria, but had limited impact on clinically relevant bacteria. However, increased abundance of enteropathogenic Escherichia species after treatment requires further, higher resolution investigation. Future studies should focus on the number of treatments and administration schedule to ensure clinical benefits continue to outweigh costs in antimicrobial resistance carriage. Trial registration ClinicalTrial.gov, NCT02047981. Registered January 29th 2014, https://clinicaltrials.gov/ct2/show/NCT02047981 [ABSTRACT FROM AUTHOR]

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Background: Breastfeeding practices and their impact on infant health and survival are unquestionably of global interest. The aim of this study was to examine the link between breastfeeding initiation within one hour of birth, breastfeeding duration and childhood mortality in sub-Saharan Africa. Methods: This study used data from the Demographic and Health Survey, which was conducted in 35 Sub-Saharan African countries between 2008 and 2017. Early initiation and duration of breastfeeding, food consumption indices, and infant mortality were all important variables. Analysis used percentage, median/interquartile range, and regression models (logistic, linear, Cox). Results: Early initiation of breastfeeding within one hour after birth was lowest in Chad (23.0%) and highest in Burundi (85.0%). The pooled median duration of breastfeeding was 12 months. Female children had 3% significant lower odds of consuming tinned, powdered or fresh milk, compared with male children (OR 0.97; 95% CI 0.94, 0.99). Conversely, female children were more likely to be put to breast within one hour after birth, compared with male children (OR 1.03; 95% CI 1.01, 1.05). Results from the pooled sample showed approximately 20% (HR 0.80; 95% CI 0.67, 0.96) and 21% (HR 0.79; 95% CI 0.77, 0.80) reduction in infant mortality for children breastfed within one hour after birth and for every unit increase in the months of breastfeeding respectively. In addition, countries with the leading infant mortality rate include; Sierra Leone (92 deaths per 1000 live births), Chad (72 deaths per 1000 live births), Nigeria (69 deaths per 1000 live births), Cote d' Ivoire (68 deaths per 1000 live births), Guinea (67 deaths per 1000 live births), Burkina-Faso (65 deaths per 1000 live births) and Mozambique (64 deaths per 1000 live births) respectively. Conclusions: The findings from this study underscores the need for early breastfeeding initiation and prolong breastfeeding to be considered in programmes on improving childhood survival. Efforts should be made to improve optimal breastfeeding practices as only about half of children in the pooled sample had best practices of breastfeeding. [ABSTRACT FROM AUTHOR]

Background: Completion of the full series of childhood vaccines on-time is crucial to ensuring greater protection against vaccine-preventable diseases. Aim: To examine determinants of complete and on-time vaccination and evaluate the relationship between vaccination patterns and severe morbidity outcomes. Subjects and methods: Vaccination information from infants in Nairobi Urban Health and Demographic Surveillance System was used to evaluate full and on-time vaccination coverage of routine immunisation. Logistic regression was used to identify determinants of full and on-time vaccination coverage. Cox regression model was used to evaluate the relationship between vaccination status and subsequent severe morbidity. A shared frailty cox model was fitted to account for the heterogeneity in hospitalisation episodes. Results: Maternal age, post-natal care, parity, ethnicity, and residence place were identified as determinants of vaccination completion. Institutional deliveries and residence place were identified as the determinants of on-time vaccination. A significant 58% (confidence interval [CI]: 15–79%) (p = .017) lower mortality was observed among fully immunised children compared with not fully immunised. Lower mortality was observed among on-time immunised children, 64% (CI: 20–84%) compared to those with delays. Conclusions: Improving vaccination timeliness and completion schedule is critical for protection against vaccine preventable diseases and may potentially provide protection beyond these targets.

Background: This study examines the claim that social inequality in health in European populations was absent prior to 1750. This claim is primarily based on comparisons of life expectancy at birth in England between general and ducal (elite aristocrat) social classes from the 1550s to the 1870s. Methods: We examined historic childhood mortality trends among the English ducal class and the general population, based on previously published data. We compared mid-childhood to adolescent mortality (age 5–14) and early-childhood mortality (age 0–4) between the ducal class and the general population from the 17th to 19th centuries. Results: Prior to 1750, ducal early-childhood mortality was higher than the general population. However, mid-childhood to adolescent mortality was lower among the ducal class than the general population in all observed periods for boys, and almost all periods for girls. Among the ducal class, but not the general population, there was a sharp decline in early-childhood mortality around the 1750s which may partly explain the divergent trends in overall life expectancy at birth. Conclusion: Health inequality between the ducal class and general population was present in England from the 16th to mid-18th centuries, with disadvantages in mortality for ducal children in infancy and early childhood, but survival advantages in mid-childhood and adolescence. These opposing effects are obscured in life expectancy at birth data. Relatively high early-childhood mortality among ducal families before 1750 likely resulted from short birth intervals and harmful infant feeding practices during this time.

Purpose: 1.7 billion children lack access to surgical care, particularly in low- and middle-income countries (LMIC). The pediatric surgical workforce density (PSWD), an indicator of surgical access, correlates with survival of complex pediatric surgical problems. To determine if PSWD also correlates with population-level health outcomes for children, we compared PSWD with pediatric-specific mortality rates and determined the PSWD associated with improved survival. Methods: Using medical licensing registries, pediatric surgeons practicing in 26 countries between 2015 and 2019 were identified. Countries' PSWD was calculated as the ratio of pediatric surgeons per 100,000 children. The correlation between neonatal, infant and under 5 mortality rates and PSWD was assessed using Spearman's correlations and piecewise linear regression models. Results: Four LIC, eight L-MIC, ten UMIC and four HIC countries, containing 420 million children, were analyzed. The median PSWD by income group was 0.03 (LIC), 0.12 (L-MIC), 1.34 (UMIC) and 2.13 (HIC). PSWD strongly correlated with neonatal (0.78, p < 0.001), infant (0.82, p < 0.001) and under 5 (0.83, p < 0.001) mortality rates. Survival improved with increasing PSWD to a threshold of 0.37. Conclusion: PSWD correlates with pediatric population mortality rates, with significant improvements in survival with PSWD > 0.37. Currently, PSWD in LMICs is inadequate to meet UN Sustainable Development Goal 3.2 for child mortality. [ABSTRACT FROM AUTHOR]

Background Pneumococcal conjugate vaccines (PCVs) are recommended for use in pediatric immunization programs worldwide. Few data are available on their effect against mortality. We present a multicountry evaluation of the population-level impact of PCVs against death due to pneumonia in children < 5 years of age. Methods We obtained national-level mortality data between 2000 and 2016 from 10 Latin American and Caribbean countries, using the standardized protocol. Time series models were used to evaluate the decline in all-cause pneumonia deaths during the postvaccination period while controlling for unrelated temporal trends using control causes of death. Results The estimated declines in pneumonia mortality following the introduction of PCVs ranged from 11% to 35% among children aged 2–59 months in 5 countries: Colombia (24% [95% credible interval {CrI}, 3%–35%]), Ecuador (25% [95% CrI, 4%–41%]), Mexico (11% [95% CrI, 3%–18%]), Nicaragua (19% [95% CrI, 0–34%]), and Peru (35% [95% CrI, 20%–47%]). In Argentina, Brazil, and the Dominican Republic, the declines were not detected in the aggregated age group but were detected in certain age strata. In Guyana and Honduras, the estimates had large uncertainty, and no declines were detected. Across the 10 countries, most of which have low to moderate incidence of pneumonia mortality, PCVs have prevented nearly 4500 all-cause pneumonia deaths in children 2–59 months since introduction. Conclusions Although the data quality was variable between countries, and the patterns varied across countries and age groups, the balance of evidence suggests that mortality due to all-cause pneumonia in children declined after PCV introduction. The impact could be greater in populations with a higher prevaccine burden of pneumonia. [ABSTRACT FROM AUTHOR]

Objective: To investigate if the survival of children with congenital anomalies has improved from 2000 to 2015 and whether there is heterogeneity in the improvements across Europe. Design: Population‐based study of routine collected data from the WHO database on mortality and causes. Setting: Data on 31 European countries from 2000 to 2015. Main outcome measures: All‐cause and congenital anomaly mortality rates for infants and children up to age 9 in countries and regions of Europe. Results: The relative odds of all‐cause mortality in 2015 compared with 2000 was 0.54 (95% CI: 0.50–0.59) for under 1, 0.48 (95% CI: 0.44–0.53) for ages 1–4, and 0.53 (95% CI: 0.49–0.56) for ages 5–9 with the relative odds of mortality from congenital anomalies being 0.49 (95% CI: 0.44–0.55), 0.51 (95% CI: 0.44–0.60), and 0.65 (95% CI: 0.53–0.80), respectively. The proportion of deaths from congenital anomalies remained relatively constant over time (26, 16, and 9% for under 1, ages 1–4, and ages 5–9, respectively) and was similar in all regions of Europe. For mortality from all causes and from congenital anomalies heterogeneity between countries and regions of Europe was high, with the countries in Eastern Europe having higher rates, but also experiencing greater relative reductions in mortality from 2000 to 2015. Conclusion: There was a large geo‐spatial disparity in all cause and congenital anomaly mortality for infants and children up to 9. However, all regions saw a significant decrease in all cause and congenital anomaly mortality rates, with the proportions of deaths from congenital anomalies remaining constant over this time. [ABSTRACT FROM AUTHOR]

Abstract Background Death of a mother at an early age of the child may result in an increased risk of childhood mortality, especially in low-and-middle-income countries. This study aims to synthesize estimates of the association between a mother’s death and the risk of childhood mortality at different age ranges from birth to 18 years in these settings. Methods Various MEDLINE databases, EMBASE, and Global Health databases were searched for population-based cohort and case-control studies published from 1980 to 2017. Studies were included if they reported the risk of childhood mortality for children whose mother had died relative to those whose mothers were alive. Random-effects meta-analyses were used to pool effect estimates, stratified by various exposures (child’s age when mother died, time since mother’s death) and outcomes (child’s age at risk of child death). Results A total of 62 stratified risk estimates were extracted from 12 original studies. Childhood mortality was associated with child’s age at time of death of a mother and time since a mother’s death. For children whose mother died when they were ≤ 42 days, the relative risk (RR) of dying within the first 1–6 months of the child’s life was 35.5(95%CI:9.7–130.5, p [het] = 0.05) compared to children whose mother did not die; by 6–12 months this risk dropped to 2.8(95%CI:0.7–10.7). For children whose mother died when they were ≤ 1 year, the subsequent RR of dying in that year was 15.9(95%CI:2.2–116.1,p [het] = 0.02), compared to children whose mother lived. For children whose mother died when they were ≤ 5 years of age, the RR of dying before aged 12 was 4.1(95%CI:3.0–5.7),p [het] = 0.83. Mortality was also elevated in specific analysis among children whose mother died when child was older than 42 days. Overall, for children whose mother died

Abstract Background Childhood stunting is the most common manifestation of chronic malnutrition. A growing body of literature indicates that stunting can have negative repercussions on physical and cognitive development. There are increasing concerns that low- and middle-income countries (LMICs) are particularly susceptible to adverse consequences of stunting on economic development. The aim of this review is to synthesize current evidence on interventions and policies that have had success in reducing stunting and explore the impact of successes on economic indicators. Methods This review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles were searched through MEDLINE via PubMed and Ovid, Cochrane Library, Web of Science and ProQuest. Only articles that addressed the effects of nutrition and cash-based interventions and/or policies on stunting and reported effects on childhood mortality and/or human capital indicators were included. Two reviewers independently abstracted data and assessed quality. Results Seventeen studies from Africa (47%), South America (41%), and South Asia (12%) met the eligibility criteria: 8 cohort studies, 4 case studies, 4 Randomized Control Trials (RCTs) and 1 quasi-trial. Three types of interventions/policies were evaluated: multisectoral policies, nutritional supplementations and cash-based interventions (CCT). Overall, 76% of the included studies were successful in reducing stunting and 65% of interventions/policies reported successes on stunting reductions and economic successes. Five of the 11 successful studies reported on nutritional supplementation, 4 reported on multisectoral policies, and 2 reported on CCT interventions. Average Annual Rate of Reduction (AARR) was calculated to assess the impact of multisectoral policies on childhood mortality. AARR for under 5 mortality ranged from 5.2 to 6.2% and all countries aligned with the global target of 4.4% AARR. Quality assessment yielded positive results, with the biggest concerns being attrition bias for cohort studies, blinding for trials and generalizability of results for case studies. Conclusions Evidence suggests that investment in fighting chronic malnutrition through multisectoral policies, multi-year nutritional supplementation (protein or multiple micronutrient supplementation) and possibly CCTs can have a long-term impact on economic development of LMICs. More evidence is needed to inform practices in non-represented regions while prioritizing standardization of economic indicators in the literature.

Background: Sudden unexpected death in epilepsy (SUDEP) accounts for a large percentage of deaths in children with epilepsy. Contributing factors to paediatric SUDEP are incompletely understood. Aims of Study: The Epilepsy Deaths Register (EDR) is an anonymized register that compiles information on deaths related to epilepsy, across all ages and epilepsy classifications. Using the EDR, we sought to identify key risk factors for SUDEP in children to assist the development of preventive measures. Methods: All registrations between the ages of 1 and 16 years were reviewed to identify definite or probable SUDEP. These cases were analysed to identify common demographics, comorbidities, monitoring, treatments and circumstances near to the deaths. Results: We identified forty‐six cases (27 males) of definite or probable SUDEP. Paediatric SUDEP is more common in a 12‐ to 16‐year age group and in those with neuro‐disability. Most paediatric SUDEP occurs during apparent sleep. There were four cases with a vagus nerve stimulator. SUDEP can occur early after the onset of seizures. Conclusions: This is the largest single cohort of SUDEP reported in children. Reports from caregivers can augment population data. Surveillance in sleep is a priority area of development. [ABSTRACT FROM AUTHOR]

Aim: To determine characteristics of death in children with neonatal abstinence syndrome (NAS). Methods: A population‐based linkage study of children from birth to 13 years of age in New South Wales (NSW), Australia, born 1 July 2000 to 31 December 2011. Infants with an International Statistical Classification of Diseases and Related Problems, Australian modification coding of NAS (P96.1, n = 3842) were compared to infants (n = 1 018 421) without NAS by birth, hospitalisation and death records linkage. Results: Forty‐five (1.2%) children with NAS died, compared to 3665 (0.4%) other children. Most deaths (n = 30, 66%) in NAS children occurred between 1 month and 1 year. Risk of death was independently increased in full‐term children (hazard ratio 2.34, 95% confidence interval 1.63–3.35; P < 0.001) from lower socio‐economic groups (1.23, 1.12–1.35; P < 0.001), most commonly from ill‐defined or external causes, including assault and accidents (P < 0.001). Conclusions: Children with NAS, especially those of term gestation and from lower socio‐economic groups, are more likely to die, especially from external causes. [ABSTRACT FROM AUTHOR]

Abstract Background One of the factors responsible for high level of childhood mortality in Nigeria is poor utilization of maternal healthcare (MHC) services. Another important perspective which has been rarely explored is the influence of childhood death on MHC service utilization. In this study, we examined the relationship between death of preceding child and MHC services utilization [antenatal care (ANC), skilled attendant at birth (SAB), and postnatal care (PNC)] among Nigerian women and across the six geo-political zones of the country. Methodology We analyzed reproductive history dataset for 16,747 index births extracted from the 2013 Nigeria Demographic and Health Survey. The main explanatory variable was survival status of preceding child; therefore, only second or higher order births were considered. Analysis involved the use of descriptive statistics and lagged logit models fitted for each measure of MHC utilization. Association and statistical significance were expressed as adjusted odds ratio (AOR) with 95% confidence interval. Results The use of MCH services for most recent births in the 2013 Nigeria DHS were ANC (56.0%), SAB (34.7%), and PNC (27.3%). Univariate models revealed that the death of preceding child was associated with lesser likelihood of ANC (OR = 0.64, CI 0.57–0.71), SAB (OR = 0.56, CI 0.50–0.63), and PNC (OR = 0.65, CI 0.55–0.69). Following adjustment for maternal socio-economic and bio-demographic variables, statistical significance in the relationship disappeared for the three MHC indicators: ANC (AOR = 1.00, CI 0.88–1.14), SAB (AOR = 0.97, CI 0.81–1.15), and PNC (AOR = 0.95, CI 0.83–1.11). There were no significant variations across the six geo-political regions in Nigeria. The likelihood of ANC utilization was higher when the preceding child died in Northcentral (AOR = 1.19, CI 0.84–1.70), Northeast (AOR = 1.26, CI 0.99–1.59), and South-south (AOR = 1.19, CI 0.72–1.99) regions while the reverse is the case in Southeast (AOR = 0.39, CI 0.23–0.60). For the Southeast, similar result was obtained for ANC, SAB, and PNC. Conclusion Death of a preceding child does not predict MHC services use in Nigeria especially when maternal socio-economic characteristics are controlled. Variations across the Northern and Southern regions did not attain statistical significance. Interventions are needed to reverse the pattern such that greater MHC utilization is recorded among women who have experienced child death.

Abstract Background Measles vaccine (MV) may protect against non-measles mortality. We tested whether survival depended on age of measles vaccination. Methods Bandim Health Project follows children under 5 years of age through a Health and Demographic Surveillance System in rural Guinea-Bissau. Children aged 6–36 months with a vaccination card inspected were followed to the next visit or for a maximum of 6 months. In Cox proportional-hazards models adjusted for age and village cluster, we compared the survival of children vaccinated with MV early ( 12+ months) with the survival of measles-unvaccinated children. Among measles-vaccinated children, we modelled the effect of age at measles vaccination linearly to assess mortality changes per month increase in vaccination age. Results From 1999 to 2006, 14,813 children (31,725 observations) were included. Children vaccinated with MV had a Hazard Ratio (HR) of 0.76 (95% CI: 0.63–0.91) compared with measles-unvaccinated children; censoring measles deaths did not change the results (HR = 0.79 (0.65–0.95)). For early MV the HR was 0.68 (0.53–0.87), for MV as recommended the HR was 0.77 (0.62–0.96) and for late MV the HR was 0.86 (0.67–1.11). Limiting the analysis to measles-vaccinated children, age at measles vaccination was associated with a 2.6% (0.4–5.1%) increase in mortality per month increase in vaccination age. Conclusion Early MV was associated with a large survival advantage. The current policy to increase vaccination age, when measles control improves, may not optimize the impact of MV on child survival.

Abstract Background Despite global declaration of the right to life as a fundamental human right and substantial progress in reducing childhood mortality, unacceptably high number of children still die before their fifth birthday every day. Different factors have been studied and implicated for under-five mortality with mixed results. Mortality studies in the current study sites were lacking. Therefore, this study examined environmental and socioeconomic determinants of under-five mortality. Methods The study applied a matched case control study design on 381 cases of children who died before their fifth birthday and 762 controls born within 1 month in the same locality as the cases. We conducted weighted conditional logistic regression to assess the association between selected factors and mortality status. Result The odds of death was found to be significantly lower among children of mothers whose educational status was grade nine or above (Adjusted odds ratio (AOR) of 0.34(0.16–0.72)). The odds of death was significantly higher among children whose mothers’ marital status were separated/divorced or widowed (AOR of 3.60(1.23–10.47)) and whose fathers were daily laborers (AOR of 2.34(1.29–4.23)). Presence of separate kitchen in the household for cooking was a proximate factor which was significantly associated with under-five mortality with AOR of 1.77(1.16–2.70). Conclusion Socioeconomic factors like maternal education, husband occupation and marital status of the mother were shown to be significantly associated with under-five mortality. Hence, in order to enhance reduction in childhood mortality, investing on maternal education targeting those at risk groups is recommended.

Abstract Background Malaria transmission reduction is a goal of many malaria control programmes. Little is known of how much mortality can be reduced by specific reductions in transmission. Verbal autopsy (VA) is widely used for estimating malaria specific mortality rates, but does not reliably distinguish malaria from other febrile illnesses. Overall malaria attributable mortality includes both direct and indirect deaths. It is unclear what proportion of the deaths averted by reducing malaria transmission are classified as malaria in VA. Methods Both all-cause, and cause-specific mortality reported by VA for children under 5 years of age, were assembled from the KEMRI/CDC health and demographic surveillance system in Siaya county, rural Western Kenya for the years 2002–2004. These were linked to household-specific estimates of the Plasmodium falciparum entomological inoculation rate (EIR) based on high resolution spatio-temporal geostatistical modelling of entomological data. All-cause and malaria specific mortality (by VA), were analysed in relation to EIR, insecticide-treated net use (ITN), socioeconomic status (SES) and parameters describing space–time correlation. Time at risk for each child was analysed using Bayesian geostatistical Cox proportional hazard models, with time-dependent covariates. The outputs were used to estimate the diagnostic performance of VA in measuring mortality that can be attributed to malaria exposure. Results The overall under-five mortality rate was 80 per 1000 person-years during the study period. Eighty-one percent of the total deaths were assigned causes of death by VA, with malaria assigned as the main cause of death except in the neonatal period. Although no trend was observed in malaria-specific mortality assessed by VA, ITN use was associated with reduced all-cause mortality in infants (hazard ratio 0.15, 95% CI 0.02, 0.63) and the EIR was strongly associated with both all-cause and malaria-specific mortality. 48.2% of the deaths could be attributed to malaria by analysing the exposure–response relationship, though only 20.5% of VAs assigned malaria as the cause and the sensitivity of VAs was estimated to be only 26%. Although VAs assigned some deaths to malaria even in areas where there was estimated to be no exposure, the specificity of the VAs was estimated to be 85%. Conclusion Interventions that reduce P. falciparum transmission intensity will not only significantly reduce malaria-diagnosed mortality, but also mortality assigned to other causes in under-5 year old children in endemic areas. In this setting, the VA tool based on clinician review substantially underestimates the number of deaths that could be averted by reducing malaria exposure in childhood, but has a reasonably high specificity. This suggests that malaria transmission-reducing interventions such as ITNs can potentially reduce overall child mortality by as much as twice the total direct malaria burden estimated from VAs.

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Background : Pneumonia is the prominent cause of childhood mortality. The disease accounts for 18 per cent deaths in children < 5 years. Pneumonia kills more children than any other illness, more than measles, malaria and AIDS combined. Caring for children with pneumonia is a daunting task in resource-poor countries where caregivers are required to pay for treatment ‘out of pocket’ at the point of care. Objectives: To assess the burden, social and economic consequences of childhood pneumonia and to determine the risk factors associated with it. Methods : A cross sectional study was conducted among the 15 children admitted in Paediatrics Department of KIMS Hubli, with clinical evidence of pneumonia infections using a pretested, semi-structured questionnaire. Results: The incidence of childhood pneumonia was more among males (87%) and in rural population (54%). 53% were in the aged group of 1 and 5yrs. Overcrowding was present in 74%, indoor pollution in 80% and outdoor pollution in 33%. 13% had to cancelled social gatherings and 54% had other impacts on their socialisation. 53% have taken external financial help for the treatment of pneumonia. Conclusion: Treatment of childhood pneumonia requires relatively more care and consequently more resources to manage. The high costs of treatment puts a heavy financial burden on the family that necessitate the need for preventive care interventions which could lead to a reduction in the number of disease cases and decreased socio economic burden on the families. [ABSTRACT FROM AUTHOR]

Background: Completion of the full series of childhood vaccines on-time is crucial to ensuring greater protection against vaccine-preventable diseases. Aim: To examine determinants of complete and on-time vaccination and evaluate the relationship between vaccination patterns and severe morbidity outcomes. Subjects and methods: Vaccination information from infants in Nairobi Urban Health and Demographic Surveillance System was used to evaluate full and on-time vaccination coverage of routine immunisation. Logistic regression was used to identify determinants of full and on-time vaccination coverage. Cox regression model was used to evaluate the relationship between vaccination status and subsequent severe morbidity. A shared frailty cox model was fitted to account for the heterogeneity in hospitalisation episodes. Results: Maternal age, post-natal care, parity, ethnicity, and residence place were identified as determinants of vaccination completion. Institutional deliveries and residence place were identified as the determinants of on-time vaccination. A significant 58% (confidence interval [CI]: 15–79%) (p =.017) lower mortality was observed among fully immunised children compared with not fully immunised. Lower mortality was observed among on-time immunised children, 64% (CI: 20–84%) compared to those with delays. Conclusions: Improving vaccination timeliness and completion schedule is critical for protection against vaccine preventable diseases and may potentially provide protection beyond these targets. [ABSTRACT FROM AUTHOR]

Objective: To assess infant (<1 year) and childhood (1-18 years) mortality in singletons conceived through assisted reproductive techniques (ART) versus naturally conceived singletons.Design: Nationwide prospective study.Setting: Sweden.Patient(s): All singleton liveborn infants born from 1983 to 2012 in Sweden identified using the Medical Birth Register (N = 2,847,108), of whom 43,506 were conceived through ART treatments including in vitro fertilization with and without intracytoplasmic sperm injection.Intervention(s): None.Main Outcome Measures(s): Infant (<1 year) and childhood (1-18 years) mortality.Result(s): Data on ART treatment and covariates were retrieved from population-based registers using the unique personal identity number assigned to all permanent residents in Sweden. Cox proportional hazards models estimated the hazard ratios (HRs) with 95% confidence intervals (CIs) as measures of association between ART treatments and death. The analyses were adjusted for maternal characteristics, infertility, child sex, and birth cohort and were restricted to individuals with complete information on covariates for fully adjusted analysis. Compared with naturally conceived singletons, higher infant mortality risks were seen in infants conceived through ART (adjusted HR 1.45; 95% CI, 1.19-1.77), especially after transfer of cryopreserved embryos (adjusted HR 2.30; 95% CI, 1.46-3.64). Early neonatal mortality risk (deaths during the first week) was increased in children born after transfer of blastocysts (HR 2.40; 95% CI, 1.05-5.48). No increased mortality risk was observed between the ages of 1 and 18 years.Conclusion(s): Singletons conceived through ART had an increased risk of infant mortality from birth up to 1 year of life, predominantly in the early neonatal period and in pregnancies after transfer of frozen and thawed embryos. [ABSTRACT FROM AUTHOR]

The literature implies a 'diminished entelechy' hypothesis in which birth cohorts subjected to relatively many or relatively virulent environmental insults early in life do not realize their otherwise expected lifespan. No direct test of this hypothesis appears in literature.We test the hypothesis directly by measuring the association between mortality in the first 5 years and life expectancy at age 5 for male and female cohorts born in Sweden (1751-1912), Denmark (1835-1913), and England and Wales (1841-1912). The methods control for trends, seasonal cycles, and other forms of autocorrelation that could induce spurious associations.Our results support the hypothesis in that life expectancy at age 5 fell below the values expected from history in cohorts in which child mortality before age 5 increased over its expected value. We find no evidence for culling effects in which a cohort remaining after suffering relatively many environmental insults may be smaller but hardier than expected.These findings converge with individual-level studies and suggest that suffering relatively virulent or many environmental insults during childhood reduces the subsequent lifespan of birth cohorts.

Background. Although decision-making authority is associated with maternal healthcare utilisation, the evidence on the relative importance of individual-level v. community-level decision-making participation for child survival in sub-Saharan Africa is limited. Objectives. To assess the net effects of individual- and community-level measures of decision-making involvement (DMI) on under-5 mortality in Nigeria. Methods. Data on a nationally representative sample of 31 482 children in the 2013 Nigeria Demographic and Health Survey were analysed. Mothers who reported involvement in decision-making on own healthcare, major household purchases and visits to friends and relatives were categorised as having high DMI. Community-level measures of DMI were derived by aggregating the individual measures at the cluster level. Kaplan-Meier estimates of childhood mortality rates were computed. Multilevel discrete-time hazard models were employed to investigate the net effect of individual- and community-level DMI on childhood mortality. Results. Childhood mortality, at 59 months, was higher among children of women with low DMI (120 per 1 000) compared with those with high DMI (84 per 1 000). The full multilevel model showed that there was no difference in the risk of childhood death between children whose mothers had high v. low DMI (hazard ratio (HR) 1.01, CI 0.90 - 1.12). However, mortality risk was found to be lower among children in communities with medium DMI (HR 0.84, CI 0.74 - 0.96). Maternal age at child’s birth, education, household wealth index and preceding birth interval were significantly associated with under-five mortality. Conclusion. Besides socioeconomic and biodemographic characteristics, community- and not individual-level DMI was associated with under-5 mortality. Women’s empowerment programmes targeting maternal and child health outcomes should also focus on communities.

There is a gap in understanding of how national commitments to child nutrition are translated into sub-national implementation. This article is a mixed methods case study of a rural South African health district which achieved accelerated declines in morbidity and mortality from severe acute malnutrition (SAM) in young children, following a district health system strengthening (HSS) initiative centred on real-time death reporting, analysis and response. Drawing on routine audit data, the declining trends in under-five admissions and in-hospital mortality for SAM over a 5-year period are presented, comparing the district with two others in the same province. Adapting Gillespie et al.'s typology of 'enabling environments' for Maternal and Child Nutrition, and based on 41 in-depth interviews and a follow-up workshop, the article then presents an analysis of how an enabling local health system environment for maternal-child health was established, creating the conditions for achievement of the SAM outcomes. Embedded in supportive policy and processes at national and provincial levels, the district HSS interventions and the manner in which they were implemented produced three kinds of system-level change: knowledge and use of evidence by providers and managers ('ways of thinking'), leadership, participation and coordination ('ways of governing') and inputs and capacity ('ways of resourcing'). These processes mainstreamed responsibility, deepened accountability and triggered new service delivery and organizational practices and mindsets. The article concludes that it is possible to foster enabling district environments for the prevention and management of acute malnutrition, emphasizing the multilevel and simultaneous nature of system actions, where action on system 'software' complements the 'hardware' of HSS interventions, and where the whole is more than the sum of the parts. [ABSTRACT FROM AUTHOR]

Keywords: Bacillus Calmette-Guérin; childhood mortality; covid-19; melanoma; Type 1 diabetes; tuberculosis EN Bacillus Calmette-Guérin childhood mortality covid-19 melanoma Type 1 diabetes tuberculosis 611 613 3 12/16/20 20201201 NES 201201 Bacillus Calmette-Guérin (BCG) is derived from I Mycobacterium bovis i , the causative agent of bovine tuberculosis. All continents were represented, and the presentations covered a wide range of subjects, including the history of BCG, the place of BCG in the fight against mycobacterial diseases, genomics of BCG, next-generation BCGs, off-target effects of BCG and the effects of BCG in cancer, autoimmune and inflammatory diseases. Novel tuberculosis vaccines are in development, some of which are based on the original BCG or novel version of BCG-like vaccines. [Extracted from the article]