Quality of Care for Children Under Five with Malaria Using IMCI Approach at Public Health Centre: Literature Review

Integrated Management of Childhood Illness is one of the strategies in health care services for infants and children under five at primary health care facilities. Children with fever in high malaria endemic areas must have a blood test done to check whether the children have malaria or not. IMCI is one of the interventions recommended by WHO to screen and also ensure that children receive proper initial treatment at first-level health facilities. This article aims to discuss the quality of care for children under five with malaria using IMCI approach. This is a systematic review by searching 4 databases including Scopus, Web of Science, SAGE and Proquest. Health care services for children under five with an integrated management of childhood illness are intended to provide immediate and appropriate treatment. The guideline for treating children under five with malaria using IMCI approach is very helpful for nurses both in assessing, classifying, treating/curing and making decisions for pre-referral measures for severe cases. Several factors to support quality of care are trained officers, supervision and procurement of essential medicines, RDT and malaria microscopy. Enforcement of the right diagnosis will improve the quality of life of children and prevent death in children under five. Keywords: IMCI, Malaria, Children under five

Sexual Reproductive Health: Improving Child Survival Initiatives in Botswana

Improving maternal and child survival it’s an important integral part of health care. A large number of deaths in Africa emanate from preventable diseases and largely in the first month of life. Majority of deaths were from preventable causes such as pneumonia, diarrhea and malaria and all accounting to 14.9%, 9.2% and 7.3% respectively. In an endeavour to the prevent and promote healthcare system, the government of Botswana came up with a special programme geared toward protecting the locals against common diseases. The government of Botswana, through the Ministry of Health (MoH), introduced the Accelerated Child Survival and Development (ACSD) strategic plan intervention with a specific focus on reducing the ‘under five mortality rate’ (U5MR). One of the high-impact interventions for reducing the U5MR is the Integrated Management of Childhood Illness (IMCI) strategy. The strategic goal of IMCI is to reduce death, illness, and disability and to promote improved growth and development among children under 5 years of age. Child welfare clinic and Nutrition has been discovered as one of the strategy to promote child’s growth and development. This strategy can be effective if it is implemented with IMCI and Immunisation.

A Breakthrough in Understanding the Pathogenesis of Molar Hypomineralisation: The Mineralisation-Poisoning Model

Popularly known as “chalky teeth”, molar hypomineralisation (MH) affects over 1-in-5 children worldwide, triggering massive amounts of suffering from toothache and rapid decay. MH stems from childhood illness and so offers a medical-prevention avenue for improving oral and paediatric health. With a cross-sector translational research and education network (The D3 Group; thed3group.org) now highlighting this global health opportunity, aetiological understanding is urgently needed to enable better awareness, management and eventual prevention of MH. Causation and pathogenesis of “chalky enamel spots” (i.e., demarcated opacities, the defining pathology of MH) remain unclear despite 100 years of investigation. However, recent biochemical studies provided a pathomechanistic breakthrough by explaining several hallmarks of chalky opacities for the first time. This article outlines these findings in context of previous understanding and provides a working model for future investigations. The proposed pathomechanism, termed “mineralisation poisoning”, involves localised exposure of immature enamel to serum albumin. Albumin binds to enamel-mineral crystals and blocks their growth, leading to chalky opacities with distinct borders. Being centred on extracellular fluid rather than enamel-forming cells as held by dogma, this localising pathomechanism invokes a new type of connection with childhood illness. These advances open a novel direction for research into pathogenesis and causation of MH, and offer prospects for better clinical management. Future research will require wide-ranging inputs that ideally should be coordinated through a worldwide translational network. We hope this breakthrough will ultimately lead to medical prevention of MH, prompting global health benefits including major reductions in childhood tooth decay.

Risk factors for childhood illness and death in rural Uttar Pradesh, India: perspectives from the community, community health workers and facility staff

Background Uttar Pradesh (UP), India continues to have a high burden of mortality among young children despite recent improvement. Therefore, it is vital to understand the risk factors associated with under-five (U5) deaths and episodes of severe illness in order to deliver programs targeted at decreasing mortality among U5 children in UP. However, in rural UP, almost every child has one or more commonly described risk factors, such as low socioeconomic status or undernutrition. Determining how risk factors for childhood illness and death are understood by community members, community health workers and facility staff in rural UP is important so that programs can identify the most vulnerable children. Methods This qualitative study was completed in three districts of UP that were part of a larger child health program. Twelve semi-structured interviews and 21 focus group discussions with 182 participants were conducted with community members (mothers and heads of households with U5 children), community health workers (CHWs; Accredited Social Health Activists and Auxiliary Nurse Midwives) and facility staff (medical officers and staff nurses). All interactions were recorded, transcribed and translated into English, coded and clustered by theme for analysis. The data presented are thematic areas that emerged around perceived risk factors for childhood illness and death. Results There were key differences among the three groups regarding the explanatory perspectives for identified risk factors. Some perspectives were completely divergent, such as why the location of the housing was a risk factor, whereas others were convergent, including the impact of seasonality and certain occupational factors. The classic explanatory risk factors for childhood illness and death identified in household surveys were often perceived as key risk factors by facility staff but not community members. However, overlapping views were frequently expressed by two of the groups with the CHWs bridging the perspectives of the community members and facility staff. Conclusion The bridging views of the CHWs can be leveraged to identify and focus their activities on the most vulnerable children in the communities they serve, link them to facilities when they become ill and drive innovations in program delivery throughout the community-facility continuum.

Intestinal microbiota has important effect on severity of hand foot and mouth disease in children

Background The incidence of hand foot and mouth disease (HFMD) has increased in recent years, making it a very common childhood illness worldwide. The relationship between different enterovirus genotypes and disease severity is not clearly understood. Given that enteroviruses are transmitted through the gastrointestinal tract, we hypothesized that variation in intestinal microorganisms of the host might play a role in the prognosis of HFMD. Methods We carried out a meta-transcriptomic-wide association study of fecal samples obtained from a cohort of children (254 patients, 227 tested positive for enterovirus, including 16 patients co-infectied with 2 kinds of enterovirus) with mild and severe HFMD and healthy controls. Results We found there was no significant difference in the amount of each virus type between the mild and severe cases. Genes of enterovirus 71 (EV71) and coxsackievirus A (CV-A) from the severe and mild cases did not show significant clustering. Clostridium sp. L2-50 and Bacteroides stercoris ATCC 43183 were enriched in the guts of children with severe HFMD and KEGG enrichment was found between mild and severe cases. Conclusions Intestinal microorganisms appear to interact with enterovirus to determine the progression of HFMD. Genes of Bacteroides and Clostridium may be used as predictive markers for a more efficient prognosis and intervention. The enrichment of intestinal bacteria genes with functions may facilitate the development of severe symptoms for HFMD patients.

Magnitude of Common Childhood Illness, Health Care Seeking Behavior, and Associated Factors in Efratana Gidim District, East Amhara, Ethiopia, 2020

Background Childhood infectious illness mainly diarrheal diseases, febrile illnesses, and acute respiratory tract infection remains the leading cause of morbidity and mortality among children below five years. Delay and inappropriate healthcare-seeking behavior of caregivers’ were the major reason for under-five child death in developing countries including Ethiopia. According to WHO, a timely healthcare-seeking practice can effectively save the lives of children by 20%, particularly from ARIs, and significantly minimize morbidities. Therefore the aim of this study was to assess the magnitude of common childhood illness, healthcare-seeking behavior, and associated factors in Efratana Gidim District, East Amhara, Ethiopia, 2020. Methods A community based crossectional study was conducted from March 15 to April 15, 2020, among urban and rural respondents. Multistage sampling technique was employed with a total of 661 respondents by using semi-structured questionnaire through face to face interviews. Bivariate and multivariate logistic regression analyses were carried out to assess the association between healthcare-seeking behavior and predictor variables. Odds ratio along with 95% confidence interval was used to measure the strength of associations and statistical significance was considered at p-value < 0.05. Results the overall two weeks prevalence of childhood illness was 24.1%, (95% CI: 21.1%-27.3%) and 59.1%, (95% CI: 51.1%-66.8%) of caregivers sought treatment at health facility. Moreover, fever, cough, and diarrhea accounted for 16.9%, 16.8%, and 11% respectively. Caregivers’ level of education (AOR = 2.56:95%CI: 1.09, 5.99) and residence (0.26: 95%CI: 0.09, 0.73) were significant factors for childhood illness and experience of child death (AOR = 3.766; 95%CI: 1.726, 8.873), diarrheal symptoms (AOR = 3.914; 95%CI: 2.043, 10.828) and access to transportation (AOR = 3.352; 95%CI: 1.049, 10.710) were predictors of healthcare seeking behavior of caregivers. Conclusion the prevalence of common childhood illness was high however; treatment-seeking behavior of caregivers for common childhood illness was low. Caregivers’ experience of child death before, symptoms of diarrhea, and access to transportation were predictors of Healthcare-seeking behavior. Therefore repeated health education on basic prevention measures of common childhood illnesses and health promotion strategies to enhance caregivers’ Healthcare-seeking behavior are critically important. .

Integrated Management of Neonatal and Childhood Illness Training in Lao PDR: A Pilot Study of an Adaptable Approach to Training and Supervision

Integrated Management of Neonatal and Childhood Illness (IMNCI) has been part of the national strategy for child health in Lao Peoples Democratic Republic since 2003. The program, while running for an extended period, has faced multiple challenges including maintaining the teaching quality for the implementation of the IMNCI guidelines and a structure to enable and support healthcare workers trained to apply the training in their workplace. A revised training model that focused on building skills for teaching according to adult learning principles in a pool of facilitators, a practical and hands-on training workshop for healthcare workers, and the establishment of a program of health center supervision was developed and implemented in three provinces. Participants in the revised model reported increased confidence in implementing IMNCI guidelines, they demonstrated competence in the steps of IMNCI and on follow-up assessment at a supervision visit were found to have improved patient care through the measurement of pediatric case management scores. This study highlights the importance of a focus on education to ensure the translation of guidelines into practice and thereby lead to improvements in the quality of pediatric care. The IMNCI training approach is acceptable and valued by healthcare worker participants.

PERCEPTION OF TRADITIONAL UVULECTOMY AND ASSOCIATED FACTORS AMONG MOTHERS OF UNDER FIVE YEARS’ CHILDREN IN SOKOTO STATE, NIGERIA

Introduction: Children are usually very vulnerable to such abuses by the traditional healers since consent is only obtained from the parents who believes in the benefits derived from traditional uvulectomy. Purpose: To assess the perception of traditional uvulectomy and associated factors among mothers of under five-year children (0-59 months) in Sokoto state. Methods: A cross sectional-study was conducted to assess the perception of traditional uvulectomy and associated factors among 320 mothers of under-five year children selected by multi stage sampling technique from 1st January-31st March 2021 in Sokoto State, Nigeria. A set of pre-tested, semi-structured interviewer- administered questionnaire was used to collect data on the research variables. Data was analysed using IBM® SPSS version 22 statistical package. Results: Majority 136(42.5%) of the respondents were between 25-34 years with a mean age of 29.9± 8.3 years. Most 304 (95.0) were Hausa’s and Muslims 315 (98.4). Fulltime house wives constituted 234(73.1%) of the respondents, while those with children between1-5 were 244(76.2%). Almost two-third (65.0%) of the respondents had inappropriate perception on traditional uvulectomy (TU). Two hundred and fifteen (67.2%) of the respondents believed traditional uvulectomy should be done for under five years’ children. Most (57.2%) of them perceived it is not necessary for government to come up with a law to abolish the practice of TU in the society. Majority (59.9%) of the respondents believed TU should be done for under five-year children as a tradition. Statistically significant association was observed between age, tribe and educational status of the respondents with perception of TU; (p=0.041), (p=0.002,) and (p = 0.018) respectively. Conclusion and Recommendation: This study revealed a high proportion of the respondents with inappropriate perception of traditional uvulectomy and attributed most of the childhood illness to the uvula. This underscore the need for governments at all levels to intensify action on enlightenment campaign and education of the general public through mass media and in all health facilities across the state on the dangers of TU.

Evaluation of Training Course on “Integrated Management of Neonatal & Childhood Illness” (IMNCI) Using Kirkpatrick Model at Level-2

Introduction: Integrated Management of Childhood Illness (IMNCI), taught by a 6-day training course, is an important initiative to decrease childhood mortality. Level 2 of the Kirkpatrick model entails the assessment of the learning achieved by training activity.Objective: To assess improvement in the knowledge of IMNCI content among the participants of the 6-day IMNCI training program.Methods: After taking approval from IRB, this one-group pre-test-post-test study was carried out in the Paediatrics Medicine Department, King Edward Medical University / Mayo Hospital Lahore over 3 months. By non-probability consecutive sampling, all 77 participants of three 6-day courses (with no previous formal training of IMNCI) were included in the study. To assess any improvement in the knowledge (Kirkpatrick Model Level 2), each participant filled a pre-test and a similar post-test after the training.Data was analyzed by SPSS software. As the data was not normally distributed, the Wilcoxon test was applied to compare the overall median scores of pre-test and post-test. Kruskal-Wallis Test was applied for the comparison of the median scores of pre-test and post-test scores of each professional group. While Mann-Whitney U-test was applied for pairwise comparison of the pre-test and post-test scores between different pairs of professional groups.Results: Of the 77 participants, there were 35 doctors, 20 nurses, 20 Lady Health Visitors, and 2 midwives. The overall median score was 3 (IQR 3) of the pre-test and 8 (IQR 2) for the post-test (p-value < 0.001). Except for the midwives, there was a statistically significant improvement in the median score of each group. Item-analysis of the questions showed that compared to the pre-test, the proportion of correct answers in the post-test showed statistically significant improvement for all the 10 questions. Pairwise comparison of the median pre-test and post-test scores between different professional groups did not show statistical significance except for the doctor-nurse pair.Conclusion: IMNCI training program significantly increased the knowledge of health care providers with no statistical difference between the post-test scores of doctors, LHVs, and midwives. KEYWORDS: IMNCI, Training program, Kirkpatrick Model, Childhood mortality, Knowledge evaluation