Search Results (162)

Background/Objectives: Childhood stunting remains a critical public health issue in low- and middle-income countries. Despite Malaysia’s economic growth, there is limited large-scale evidence on the determinants of stunting among children from infancy to primary school age. This cross-sectional study, part of South East Asian Nutrition Surveys II (SEANUTS II), aimed to determine sociodemographic and environmental risk factors for stunting among 2989 children aged 0.5–12 years. Methods: Children were recruited from four regions in Peninsular Malaysia (Central, East Coast, 2022–2030Northern, Southern). Standing height or recumbent length was measured, and stunting was classified based on WHO criteria (height-for-age Z-score below −2 standard deviations). Parents reported information on socioeconomic status, sanitation facilities, and hygiene practices. Multivariate binary logistic regression was used to determine the determinants of stunting. Results: Stunting prevalence was 8.9%, with infants (aOR = 2.92, 95%CI:1.14–7.52) and young children (aOR = 2.92, 95%CI:1.80–4.76) having higher odds than school-aged children. Key biological predictors included low birth weight (aOR = 2.41; 95%CI:1.40–4.13) and maternal height <150 cm (aOR = 2.24; 95%CI:1.36–3.70). Chinese (aOR = 0.56; 95%CI:0.35–0.88) and Indian children (aOR = 0.16; 95%CI:0.05–0.52) had a lower risk of stunting compared to Malays. Conclusions: This study highlights the ongoing challenge of childhood stunting in Malaysia, with age, birth weight, ethnicity, and maternal height identified as key determinants. These findings call for early identification of at-risk households and targeted support, especially through education and financial aid to foster healthy child growth. Full article

The creative city concept has gained global recognition, notably through the UNESCO Creative Cities Network (UCCN). In Japan, facing declining birth rates and economic stagnation, this framework was seen as a revitalization tool to increase the urban quality. Yet, while the creative city concept clearly appears on the theoretical level, its operationalization usually remains unclear. Additionally, previous research considers sustainability questions through economic, social, and cultural lenses but more rarely through environmental aspects. Thus, this paper aims to explore the implementation of the creative city in Japan, unveil the specific elements composing the policies of UNESCO Creative Cities, and question how environmental sustainability is addressed in these policies. The research method includes a qualitative analysis of the membership monitoring reports (MMRs) submitted by cities to UNESCO. Conducting a field survey in a creative facility and a hearing survey with the city government, the research also focuses on Kanazawa as a case study to explore in greater depth the interaction between creative city strategies and environmental sustainability. Among the research findings, economic perspectives—through support for creative industries and the promotion of tourism—and systematic actions targeting children dominate the MMRs, while socio-environmental aspects receive less attention. Most ambitious initiatives toward environmental sustainability were implemented in rural cities. In Kanazawa, it appears the creative city policy is independent of the local environmental policies, although some opportunities exist to connect them. The field survey indeed reveals that some spontaneous initiatives toward environmental sustainability might emanate from a creative facility. Therefore, the paper provides significance in unveiling the specific content of creative city policies in Japan and in re-examining the notion of creativity to integrate environmental sustainability into the creative city agenda. Full article

Background/Objectives: Using healthcare vouchers mitigates the financial burdens of low-income individuals, therefore enhancing mothers’ satisfaction and encouraging service utilization. In Yemen, reducing financial barriers results in marked improvement in reproductive health services utilization for mothers and their newborns. Such financial strain can be addressed through reproductive health vouchers, which reduce out-of-pocket expenses of family planning, pregnancy, birth, postnatal care and neonatal care. This study compares the Safe Motherhood and Family Planning Voucher Program in the Lahj governorate to the non-voucher program in the Abyan governorate in terms of enhancement of reproductive healthcare accessibility and use. Methods: This facility-based, quantitative, comparative, cross-sectional study was conducted in the Lahj governorate, which supports the Safe Motherhood and Family Planning Voucher Program, and the Abyan governorate, which does not. Results: The voucher-supported program has greatly improved mothers’ satisfaction, access, and use of all reproductive health services by covering transportation, covering lodging during hospitalization, and providing free reproductive treatments. Compared to Abyan mothers, Lahj governorate mothers more frequently used rental vehicles (paid for by the voucher program) and free reproductive health services (p-value < 0.001). Lahj governorate mothers (who used the vouchers) used family planning, prenatal care, facility-based delivery, home delivery by competent birth staff, cesarean section, postnatal care, and neonatal care more frequently than Abyan governorate mothers. A health institution which supported the Safe Motherhood and Family Planning Voucher Program (SMHFPVP) provided prenatal care (98.5%), competent birth services (99.0%), and modern contraceptive use (92.3%)—oral contraceptive pills, implants, injectables, contraceptive patches, vaginal rings, and intrauterine devices—for mothers who were interviewed and attended the targeted HFs in the Lahj governorate, compared with (77.6%), (80.3%), and (67.8%), respectively, for mothers in Abyan governorate who were not supported by the SMHFPVP. This study demonstrates substantially higher satisfaction levels among voucher-using mothers in the Lahj governorate compared to those in the Abyan governorate, across all satisfaction domains and overall satisfaction scores. Conclusions: This study found that women without access to maternal health vouchers experienced worse prenatal, natal, and postnatal care and were less satisfied with healthcare services compared with women who used vouchers. Full article

Background/Objectives: The under-five mortality rate (U5MR) remains a serious health challenge in Indonesia, with low birth weight (LBW) being a key risk factor. This study aimed to identify predictors of survival among under-five children with LBW using data from the 2017 Indonesia Demographic and Health Survey (IDHS). Methods: This cross-sectional study included 625 children under five with LBW. The dependent variable was under-five mortality (children aged 0–59 months), while the independent variables include child (gender), maternal (age at delivery, education, empowerment, delivery complications, and breastfeeding history), health service (antenatal care-ANC and place of delivery), and household (wealth quintile and residence) factors. Data were obtained from the 2017 IDHS using household and women’s questionnaires and analyzed using univariate analysis, Kaplan–Meier estimation, and Cox regression. Results: 41 of 625 children born with LBW died before the age of five. The Kaplan–Meier estimation found that maternal (delivery complications and breastfeeding history), health service (ANC history and place of delivery), and household factors (residence) significantly influenced the survival of LBW children. The Cox regression results showed that LBW children who were breastfeed and whose mother had adequate antenatal care visits had a lower risk of under-five mortality. Surprisingly, children born in health facilities had a significantly higher risk of death compared to those born elsewhere. Conclusions: Exclusive breastfeeding, adequate antenatal care, and place of delivery are important determinants of survival among children born with LBW. This support targeted interventions to improve the survival chances of children born with LBW, particularly in their early years of life. Full article

Congenital malformations constitute a major public health issue. Nonetheless, Greece does not participate in the European network of congenital anomalies. To examine the epidemiology of congenital abnormalities and investigate possible factors associated with their development, autopsies were performed on 649 fetuses referred from three healthcare facilities in Thessaloniki during 1992–2008. Adequate statistical analysis methods were implemented. Birth defects were found in 256 fetuses (39.5%)—primarily related to the musculoskeletal (17.3%), nervous (14.5%), cardiovascular (12.5%) and urinary (10.4%) systems. A statistically significant positive correlation (p-values < 0.05) emerged between the presence of a congenital defect and intrauterine growth restriction, inability to identify the fetus’ sex, iatrogenic abortion, nuchal oedema and a single umbilical artery. An inverse association (p-values < 0.05) was deduced with the gestational age, twin pregnancy, stillbirth, chorioamnionitis, infarction and intervillous thrombus of the placenta and nuchal cord. In multivariable analysis, the relationship remained significant (p-values < 0.05) between the development of birth defects and iatrogenic abortion, nuchal oedema, presence of a single umbilical artery, chorioamnionitis, infarction of the placenta and nuchal cord. ROC curve analysis indicated area under the curve = 0.800, 95% confidence interval = 0.76–0.84, p-value = 0.000. Our study revealed the epidemiology of congenital anomalies in Greece, confirming the relationship between various factors and birth defect occurrence. Full article

Mother’s own milk (MOM) offers the highest protection for preterm and low birth weight infants. However, breastfeeding can be challenging during neonatal hospitalization. When MOM is unavailable, donor human milk (DHM) is the recommended alternative for feeding vulnerable neonates. Human milk banks (HMBs) collect, process, and deliver DHM, playing a key role in lactation support and promoting MOM availability. Although HMBs are expanding globally, scale-up remains hindered, restricting equitable DHM access. In Switzerland, despite the existence of eight HMBs, the western region lacked such a facility until 2022. To address this gap, an interdisciplinary team from the Lausanne University Hospital (CHUV) and the Swiss Red Cross Interregional Blood Transfusion Centre (TIR) collaborated to establish a regional HMB. This partnership leveraged both institutions’ available expertise, infrastructure, and resources. After two years of preparation, the CHUV Lactarium launched in 2022 with the support of the Department of Health and Social Action (DSAS) of the Canton of Vaud. This novel human milk bank–blood bank model is fully integrated into the hospital’s neonatal care, nutrition, and breastfeeding programs, operating under a strict quality and coordination system. Since its implementation, the HMB has met 100% of DHM needs, with an 80% breastfeeding bridging rate. It has had a positive impact on neonatal care, family engagement, professional interest, and community awareness of human milk. This case study illustrates how synergistic collaboration can help bridge gaps in establishing a safe, efficient, and equitable HMB model. It also offers a scalable framework adaptable to other settings. Full article

Background: We recently reported that the transcutaneous bilirubinometer (TCB) tends to underestimate the severity of neonatal jaundice (NJ). We hypothesize that the cumulative ambient light exposure contributes to the discrepancy. Objectives: This study aimed to identify factors that affect the TCB underestimation. Methods: We analyzed prospectively collected data over a twenty-month period at a level III medical facility. Neonates at risk for NJ who couldn’t secure an appointment with the primary practitioner were followed by the nursery team. Neonates who had phototherapy or forehead bruises were excluded. Concurrently collected total serum bilirubin (TSB) was determined by the diazo method. The primary endpoint was the discrepancy between TCB and the corresponding TSB (TCB-TSB). A mixed-effects model was used to assess the correlation between (TCB-TSB) and potential contributors, including visit age (in hours), gestational age (GA), sex, TSB, season, birth weight, and race. Results: There were 795 visits for 559 neonates, including 341 males, 179 white, 235 black, 103 Hispanic, 41 Asian, and one unrecorded race. The TSB ranged between 1.8 and 33.9 mg/dL. The (TCB-TSB) ranged between −20.0 and 6.4 mg/dL. The median GA and birth weight were 38.7 weeks and 3214.5 g. The visits occurred between 48 and 381 h of age. 133, 148, 132, and 146 visits were in Spring, Summer, Autumn, and Winter, respectively. Fifty-four neonates (9.7%) were admitted for management. 500 sternum TCB readings were also collected from 350 neonates together with the corresponding forehead TCBs. We found that the forehead (TCB-TSB) was significantly less in winter than in spring and summer (p = 0.0014 and 0.0003, respectively). There was a negative correlation between forehead (TCB-TSB) and visit age in hours (p = 0.0006). After adjusting for visit age and season, the (TCB-TSB) is significantly correlated with TSB (p < 0.0001). Similar findings were also seen in the sternum (TCB-TSB) except for the season (p = 0.0808). Conclusions: Cumulative ambient light exposure and the severity of NJ may contribute to (TCB-TSB). Full article

The first 1000 days of life starts from conception to a child’s second birthday. Research suggests that the period is critical for cognitive, physical, and emotional development. Investments in maternal and child healthcare during this period have a profound impact on long-term health, educational attainment, and economic productivity. This study examined the impact of such investments on child health outcomes in Kenya, using data from the 2015/2016 Kenya Integrated Household Budget Survey (KIHBS). Key areas of focus included maternal healthcare, early antenatal care, skilled delivery, exclusive breastfeeding, proper weaning practices, immunization, and the timely treatment of childhood illnesses. Using the Cox regression hazard model, the study revealed that twins faced a higher risk of mortality compared to single births, while firstborns were less likely to die before their fifth birthday; larger household sizes were associated with reduced child mortality, and children in female-headed households had a lower likelihood of dying, likely due to better adherence to proper health and nutritional practices. Maternal health conditions, the place of delivery, and assistance during childbirth significantly influenced survival, with government health facility deliveries yielding better outcomes than homebirths. This study emphasizes the importance of educating pregnant women and mothers on health risks and public health protocols during this critical period. Strengthening healthcare systems and promoting equitable access to essential services during the first 1000 days could improve child survival rates and enhance long-term economic productivity. Full article

India’s population complexity presents varied challenges in genetic research, and while facilities have gained traction in tier-1 and -2 cities, reliance on international collaborations often delays such investigations. COVID-19 further exacerbated the issues with such sample sharing. Congenital Hyperinsulinism (CHI) is a rare genetic disorder of pancreatic β-cells causing hypoglycaemia in children due to abnormal insulin secretion. Given India’s high birth rate and consanguineous populations, annual CHI cases are estimated to be around up to 10,000, with up to 50% having unexplained genetic causes. Diffuse or atypical lesions in such patients often necessitate near-total-pancreatectomy, risking pancreatic exocrine insufficiency and diabetes, requiring lifelong therapy. Also, novel genetic variations complicate accurate diagnosis, risk assessment, and counselling, emphasising the need for rapid genetic assessment to prevent neurological injuries and inform treatment decisions. Despite significant efforts at many institutes, there are no dedicated organisations for CHI in India. With the implementation of the National Policy for Rare Diseases 2021, we plan to form a non-profit organisation, “Congenital Hyperinsulinism India Association (CHIA)”, comprising paediatric endocrinologists, paediatricians, geneticists, and independent researchers. The aims of this association are to generate a national database registry of patients, formulate a parent support group and CHIA consortium, design patient information leaflets, as well as foster genomic collaborations and promote clinical trials. Such steps will help sensitise the health authorities and policy makers, urging them to improve the allocation of health budgets for rare diseases, as well as empower patients and their families, contributing towards a better quality of life. Full article

Background/Objectives: Measles is a vaccine-preventable disease with a high level of transmissibility. Outbreaks of measles continue globally, with gaps in healthcare and immunisation resulting in pockets of susceptible individuals. Measles outbreaks have been proposed as a “canary in the coal mine” of under-resourced health systems, uncovering broader system weaknesses. We aim to understand whether under-resourced health systems are associated with increased odds of large measles outbreaks in low- and middle-income countries (LMICs). Methods: We used an ecological study design to identify measles outbreaks that occurred in LMICs between 2010 and 2020. Health systems were represented using a set of health system indicators for the corresponding outbreak country, guided by the World Health Organization’s building blocks of health systems framework. These indicators were: the proportion of births delivered in a health facility, the number of nurses and midwives per 10,000 population, and domestic general government health expenditure per capita in USD. We analysed the associations using a predictive model and assessed the accuracy of this model. Results: The analysis included 78 outbreaks. We found an absence of any association between the included health system indicators and large measles outbreaks. When testing predictive accuracy, the model obtained a Brier score of 0.21, which indicates that the model is not informative in predicting large measles outbreaks. We found that missing data did not affect the results of the model. Conclusions: Large measles outbreaks were not able to be used to identify under-resourced health systems in LMICs. However, further research is required to understand whether this association may exist when taking other factors, including smaller outbreaks, into account. Full article

Florida’s Newborn Screening Program campaign aims to increase the awareness and participation of birthing facilities, providers, and parents. This evaluation aimed to determine the effectiveness and reach of the Newborn Screening Program (NBS) Statewide Educational Campaign to pregnant women through surveys and focus groups. The online survey, conducted throughout Florida in English, Spanish, and Haitian Creole, evaluated the reach and effectiveness of educational materials such as paid advertisements and brochures. The surveys also served to recruit participants for in-person focus groups throughout the state. The findings showed that 85.3% of the mothers had discussions with health professionals about the screening program, while others did not hear about it from health professionals. More than 50% of the respondents learned about the program through health facilities, with additional exposure from media platforms such as television, radio, and friends. This study shows the need for increased outreach of the campaign and better communication and education from medical professionals to increase awareness. Full article

Objectives: the current study investigates the link between health insurance coverage and child nutritional status in Pakistan. Methods: Using data from the Pakistan Demographic and Health Survey (PDHS) 2017–18, encompassing 4499 children under 5, a binary logistic regression was applied to analyze the relationship between health insurance and child nutritional status. Due to the non-randomized sample, assessing health insurance continuously posed a practical challenge. To mitigate the sample selection bias, the cross-sectional-based propensity score matching (PSM) using the nearest neighbor method was utilized for the causal relationship, based on potential socio-economic covariates. Results: The prevalence rates of stunting, underweight, and wasting among children under five were 38.13%, 23.04%, and 8.05%, respectively. Malnutrition was found in 43.64% of non-insured children compared with 5% in insured children. The findings of PSM supported a causal relationship, given the cross-sectional nature and potential misplaced variables, as the PSM findings revealed that insured children had significantly better nutritional outcomes compared with non-insured children, with a significance level of 1%. The logistic regression outcomes for the covariates of child nutritional outcome indicated that health insurance coverage, higher wealth status, mother’s education, improved water and sanitation facilities, mother’s normal BMI, and urban residence reduced the likelihood of child malnutrition. The logistic regression results for the covariates of child health insurance depicted that factors such as higher birth order, mother’s low BMI, poor water and sanitation facilities, higher wealth status, women’s employment, higher education level, and child illnesses like diarrhea and malnutrition increased the likelihood of obtaining health insurance. The logistic results confirmed that health insurance coverage reduced the likelihood of child malnutrition, and, similarly, child malnutrition and other illnesses increased the chances of obtaining health insurance coverage. Conclusions: The findings underscore the critical need for health insurance, highlighting its role in enhancing child nutritional status. The government should expand health insurance programs, with a special emphasis on child nutrition and health. Full article

Introduction: Using the essential reproductive care services such as antenatal care (ANC) and skilled birth services are vital for ensuring safe motherhood and controlling maternal and child mortality. There is no recent evidence on the state of using reproductive care services in Pakistan women. The purpose of the cross-sectional study is to explore the timing and frequency of ANC, the hospital and other institutional delivery, the cesarean section (C-section) services and to identify the sociodemographic factors that are associated with the use of these services. Methodology: Using the latest Pakistan Demographic and Health Survey (2017-18 PDHS) for this analysis, the data were collected by face-to-face interviews by trained interviewers, which included 8287 women aged 15–49 years. The data on reproductive services were defined by standard guidelines by the World Health Organization (WHO). Data analyses involved univariate tests and multivariate regression techniques. Results: The percentage of women who attended ANC visits in the first trimester was 62.59%, and those who attended the minimum recommended number of four visits was 49.46%. The percentages of using hospital and C-section services were, respectively, 76.20% and 19.63%. In the regression analysis, place of residence, education, household wealth status, access to using electronic media and learning about family planning from electronic media and before marriage were found to significantly predict the use of ANC and facility delivery services. However, educational and household wealth status stood out as the strongest predictors of all. About half of the women were not having adequate ANC visits and about one-third not making timely ANC contact. More than three-quarters reported choosing to deliver at hospital/other facility, and about one-fifth preferred C-section. Conclusions: The results indicated that, among the predictor of using these services, education and household wealth status were found to have the strongest association, highlighting the role of women’s socioeconomic well-being in availing the basic reproductive healthcare services. Hence, this study suggests that the government and medical institutions should further pay attention to the ANC visits and reduce infant birth mortality rates. Simultaneously, increasing women’s educational opportunities, enhancing women’s socioeconomic well-being and social status, can help improve their health awareness and promote healthy behaviors. Full article

Background: Immunization coverage varies across Papua New Guinea. In East New Britain (ENB) Province in 2022, only 65.5% and 50.2% of children under one year received their first dose of pentavalent (DTP1) and measles–rubella (MR1) vaccine, respectively. This study aimed to examine barriers and enablers to routine immunization in areas of un(der)-vaccination in ENB. Methods: A face-to-face survey was conducted with caregivers of children aged 12–23 months in ENB. We used Poisson regression to calculate incidence rate ratios (IRR) and 95% confidence intervals (95% CI) for factors associated with timely receipt of DTP1 or MR1 vaccines, defined as a child who was vaccinated between –2 and +30 days of the vaccine schedule. Delayed receipt is defined as a child who was vaccinated >30 days from the recommended due date. Results: Among 237 caregivers surveyed, 59.9% of children were vaccinated within the “timely” window for DTP1 and 34.1% for MR1. Timely DTP1 receipt was associated with a facility-based birth (IRR:1.93; 95% CI: 1.10–3.38) and trusting healthcare workers “very much”, compared to “a little or moderately” (IRR:1.53; 95% CI: 1.17–1.99). For MR1, the caregiver having completed tertiary/vocational education (IRR:1.79; 95% CI: 1.15–2.78), reporting taking a child to be vaccinated is affordable (IRR:1.52; 95% CI: 1.04–2.22), and healthcare workers explaining immunization services and answering associated questions (IRR:1.68; 95% CI: 1.18–2.41) were associated with timely vaccination. Conclusions: Activities to improve timely vaccination in ENB could include strengthening healthcare worker interpersonal communication skills to optimize trust and incentivizing women to give birth in a health facility. Full article

Aim: Malaria in pregnancy is a global health problem because it causes anemia in the mother and may result in abortion, stillbirth, uterine growth retardation, and low birth weight in the newborn. The purpose of this study was to assess the effects of HEI on knowledge and adherence to intermittent preventive treatment of malaria among pregnant women at secondary health facilities in Benue State, Nigeria. Methods: This quasi-experimental study included pre-, intervention, and post-intervention. The study recruited 871 pregnant women (436 study and 435 control) using multistage sampling. The study used a semi-structured questionnaire (pre- and post-test), follow-up checklist, and health education module. Participants self-administered the semi-structured questionnaire with 57 open-ended and closed-ended questions. Results: About 41% had high malaria awareness, but 93.9% did throughout pregnancy and intermittent preventive treatment (IPT) after health education intervention (HEI). The majority (93.8%) understood malaria transmission methods after HEI. 95.3% understood malaria symptoms after HEI. The HEI shows 95.6% of participants knew a lot about malaria during pregnancy. Post-HEI, 95% knew malaria prophylaxis. After HEI, 95.4% knew malaria-prevention drugs. Intermittent Preventive treatment (IPT) pregnancy dosages were known by 94.3% of respondents post-HEI. Post-HEI, 95.4% of responders knew the interval between IPT dosages, compared to 59.2% pre-HEI. After HEI, 95% of respondents were aware of IPT adverse effects, up from 29.2% pre-HEI. Pre-HEI showed. Conclusions: Results demonstrate HEI promotes malaria IPT adherence during pregnancy. A health education proves a veritable interventional strategy in influencing a mother’s understanding of malaria IPT, level of adherence to IPT, and drug adherence to directly observed therapy of IP while pregnant. Thus, nurses and midwives should increase IPT health education during antenatal clinic visits to increase its uptake and adherence among pregnant women and reduce malaria burden and death. Sulfadoxine/pyrimethamine (SP) for malaria in pregnancy (MiP) IPT must be distributed by the state health ministry to all health facilities—tertiary, secondary, primary, faith-based, and private. Full article