Biomarkers to Stratify Risk Groups among Children with Malnutrition in Resource-Limited Settings and to Monitor Response to Intervention

2017 ◽  
Vol 88 (1) ◽  
pp. 111-117 ◽  
Author(s):  
Christine J. McGrath ◽  
Michael B. Arndt ◽  
Judd L. Walson
Keyword(s):  
At Risk ◽  
Risk Groups ◽  
Response To Therapy ◽  
Children At Risk ◽  
Resource Limited Settings ◽  
Targeted Interventions ◽  
Growth Faltering ◽  
Resource Limited ◽  
Childhood Morbidity ◽  
Novel Biomarkers

Despite global efforts to reduce childhood undernutrition, current interventions have had little impact on stunting and wasting, and the mechanisms underlying growth faltering are poorly understood. There is a clear need to distinguish populations of children most likely to benefit from any given intervention and to develop tools to monitor response to therapy prior to the development of morbid sequelae. In resource-limited settings, environmental enteric dysfunction (EED) is common among children, contributing to malnutrition and increasing childhood morbidity and mortality risk. In addition to EED, early alterations in the gut microbiota can adversely affect growth through nutrient malabsorption, altered metabolism, gut inflammation, and dysregulation of the growth hormone axis. We examined the evidence linking EED and the gut microbiome to growth faltering and explored novel biomarkers to identify subgroups of children at risk of malnutrition due to underlying pathology. These and other biomarkers could be used to identify specific groups of children at risk of malnutrition and monitor response to targeted interventions.

scholarly journals Prioritization of risk groups for influenza vaccination in resource limited settings – A case study from South Africa

Vaccine ◽  
2019 ◽  
Vol 37 (1) ◽  
pp. 25-33 ◽  
Author(s):  
Meredith L. McMorrow ◽  
Stefano Tempia ◽  
Sibongile Walaza ◽  
Florette K. Treurnicht ◽  
Wayne Ramkrishna ◽  
...  
Keyword(s):  
South Africa ◽  
Influenza Vaccination ◽  
Risk Groups ◽  
Resource Limited Settings ◽  
Resource Limited

scholarly journals Functional Outcomes and Morbidity in Pediatric Sepsis Survivors: A Tanzanian Experience

2022 ◽  
Vol 9 ◽  
Author(s):  
Sarah A. Lau-Braunhut ◽  
Audrey M. Smith ◽  
Martina A. Steurer ◽  
Brittany L. Murray ◽  
Hendry Sawe ◽  
...  
Keyword(s):  
Functional Status ◽  
Functional Outcomes ◽  
Resource Limited Settings ◽  
Resource Limited ◽  
Childhood Morbidity ◽  
Septic Episode ◽  
Scale Scores ◽  
Sepsis Survivors ◽  
Pediatric Sepsis

Pediatric sepsis remains a significant cause of childhood morbidity and mortality, disproportionately affecting resource-limited settings. As more patients survive, it is paramount that we improve our understanding of post-sepsis morbidity and its impact on functional outcomes. The functional status scale (FSS) is a pediatric validated outcome measure quantifying functional impairment, previously demonstrating decreased function following critical illnesses, including sepsis, in resource-rich settings. However, functional outcomes utilizing the FSS in pediatric sepsis survivors have never been studied in resource-limited settings or in non-critically ill septic children. In a Tanzanian cohort of pediatric sepsis patients, we aimed to evaluate morbidity associated with an acute septic episode using the FSS modified for resource-limited settings. This was a prospective cohort study at an urban referral hospital in Tanzania, including children with sepsis aged 28 days to 14 years old over a 12-month period. The FSS was adapted to the site's available resources. Functional status scale scores were obtained by interviewing guardians both at the time of presentation to determine the child's baseline and at 28-day follow-up. The primary outcome was “decline in functional status,” as defined by a change in FSS score of at least 3. In this cohort, 4.3% of the 1,359 surviving children completing 28-day follow-up had a “decline in functional status.” Conversely, 13.8% of guardians reported that their child was not yet back to their pre-illness state. Three-quarters of children reported as not fully recovered were not identified via the FSS as having a decline in functional status. In our cohort of pediatric sepsis patients, we identified a low rate of decline in functional status when using the FSS adapted for resource-limited settings. A higher proportion of children were subjectively identified as not being recovered to baseline. This suggests that the FSS has limitations in this population, despite being adapted for resource-limited settings. Next steps include developing and validating a further revised FSS to better capture patients identified as not recovered but missed by the current FSS.

scholarly journals Identifying HIV most-at-risk groups in Malawi for targeted interventions. A classification tree model

BMJ Open ◽  
2013 ◽  
Vol 3 (5) ◽  
pp. e002459 ◽  
Author(s):  
Jacques B O Emina ◽  
Nyovani Madise ◽  
Mathias Kuepie ◽  
Eliya M Zulu ◽  
Yazoume Ye
Keyword(s):  
At Risk ◽  
Classification Tree ◽  
Risk Groups ◽  
Tree Model ◽  
Targeted Interventions ◽  
Classification Tree Model

scholarly journals Potential Impact of a Free Online HIV Treatment Response Prediction System for Reducing Virological Failures and Drug Costs after Antiretroviral Therapy Failure in a Resource-Limited Setting

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Andrew D. Revell ◽  
Gerardo Alvarez-Uria ◽  
Dechao Wang ◽  
Anton Pozniak ◽  
Julio S. Montaner ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Computational Models ◽  
Economic Benefits ◽  
Hiv Treatment ◽  
Response To Therapy ◽  
Drug Costs ◽  
Treatment Change ◽  
Resource Limited Settings ◽  
Resource Limited ◽  
Drug Regimens

Objective. Antiretroviral drug selection in resource-limited settings is often dictated by strict protocols as part of a public health strategy. The objective of this retrospective study was to examine if the HIV-TRePS online treatment prediction tool could help reduce treatment failure and drug costs in such settings.Methods. The HIV-TRePS computational models were used to predict the probability of response to therapy for 206 cases of treatment change following failure in India. The models were used to identify alternative locally available 3-drug regimens, which were predicted to be effective. The costs of these regimens were compared to those actually used in the clinic.Results. The models predicted the responses to treatment of the cases with an accuracy of 0.64. The models identified alternative drug regimens that were predicted to result in improved virological response and lower costs than those used in the clinic in 85% of the cases. The average annual cost saving was $364 USD per year (41%).Conclusions. Computational models that do not require a genotype can predict and potentially avoid treatment failure and may reduce therapy costs. The use of such a system to guide therapeutic decision-making could confer health economic benefits in resource-limited settings.

scholarly journals Impact of Childhood Malnutrition on Host Defense and Infection

2017 ◽  
Vol 30 (4) ◽  
pp. 919-971 ◽  
Author(s):  
Marwa K. Ibrahim ◽  
Mara Zambruni ◽  
Christopher L. Melby ◽  
Peter C. Melby
Keyword(s):  
Host Defense ◽  
Morbidity And Mortality ◽  
Micronutrient Deficiencies ◽  
Immune Functions ◽  
Targeted Interventions ◽  
Childhood Malnutrition ◽  
Growth Faltering ◽  
Childhood Morbidity ◽  
Increased Risk ◽  
Substantial Progress

SUMMARYThe global impact of childhood malnutrition is staggering. The synergism between malnutrition and infection contributes substantially to childhood morbidity and mortality. Anthropometric indicators of malnutrition are associated with the increased risk and severity of infections caused by many pathogens, including viruses, bacteria, protozoa, and helminths. Since childhood malnutrition commonly involves the inadequate intake of protein and calories, with superimposed micronutrient deficiencies, the causal factors involved in impaired host defense are usually not defined. This review focuses on literature related to impaired host defense and the risk of infection in primary childhood malnutrition. Particular attention is given to longitudinal and prospective cohort human studies and studies of experimental animal models that address causal, mechanistic relationships between malnutrition and host defense. Protein and micronutrient deficiencies impact the hematopoietic and lymphoid organs and compromise both innate and adaptive immune functions. Malnutrition-related changes in intestinal microbiota contribute to growth faltering and dysregulated inflammation and immune function. Although substantial progress has been made in understanding the malnutrition-infection synergism, critical gaps in our understanding remain. We highlight the need for mechanistic studies that can lead to targeted interventions to improve host defense and reduce the morbidity and mortality of infectious diseases in this vulnerable population.

scholarly journals Information interaction of libraries with children at risk

Bibliosphere ◽  
2019 ◽  
pp. 64-70
Author(s):  
I. V. Dolgovykh ◽  
M. V. Maslakova ◽  
L. I. Patrakova
Keyword(s):  
At Risk ◽  
Low Income ◽  
Leisure Activities ◽  
Risk Groups ◽  
Cultural Development ◽  
Gifted Children ◽  
Children At Risk ◽  
Disadvantaged Children ◽  
Number Of Children ◽  
Psychological Assistance

The topic relevance is increasing due to the children number rise of homeless, dysfunctional, incomplete, low-income, left without parental care, from families using destructive methods, bringing to congenital disorders of the physical and psychological development, who could falling into unfavorable environment take the path of asocial behavior, disharmonious development and, as a result, getting into the «risk groups».  The article objective is to determine the library involvement in preventing the children at risk neglect through multiformat forms of the work popularizing books and reading for the educational and cultural development of children.  N. V. Stetsenko describes children at risk groups as exposed to biological, psychological, social influences, their tendency to offenses, violence and other types of antisocial behavior. Сhildren at risk include the following categories: gifted children; poorly educated; children with disabilities; children from problem and dysfunc­tional, asocial families; pedagogically neglected children; children from families in need of socio-economic and socio-psychological assistance and support.  Currently, the work of a librarian with children at risk is an urgent problem related to growth of families and minors of the «special attention group», where the library task is to reach the maximum number of children attracted to the library. Difficult children is a complicated category; therefore, library and information workers need to know the characteristics of such children, effective methods and methods of educational and preven­tive work. Сhildren at risk need to adapt to the world around them, broaden their horizons, communicate with their peers, organize leisure activities, express themselves creatively, receive information and services, and satisfy their intellectual needs. The library has the staff, resources and means capable to form a harmoniously developed child personality , including children at risk.  The library is designed to create for readers not only comfortable (it's important), but productive conditions with the point of intellectual growth, for example, the reader’s participation in organizing library activities (storytelling, makerspace, creative workshops, etc.). The modern library helps to reduce the number of «disadvantaged children», heals the social environment, makes it more friendly and safe for a child.  

scholarly journals ‘Formation of skills for independent life’ a training program for students preparing them to work with children at risk

2019 ◽  
pp. 71-76
Author(s):  
Iskra Petkova
Keyword(s):  
At Risk ◽  
Training Program ◽  
Risk Groups ◽  
Basic Knowledge ◽  
Social Activities ◽  
Children At Risk ◽  
Training Process ◽  
Knowledge And Skills ◽  
Independent Life ◽  
Methodological Principles

A training program, ‘Formation of skills for independent life while working with children at risk’ is presented in the paper. It is intended for students of Social Activities, a field of study. Objectives and tasks are defined in the articles, and the basic knowledge and skills that students receive during the process of training under this program are specified. The content of the program is presented in two parts. Part one covers methodological principles applied in formation of skills for independent life. Three main stages to be mastered by the students in the training process within the stage of forming skills for independent life in children from risk groups are elaborated. Part two of the program covers five sections for mastering individual and group techniques of a practical and applied nature; its content is included in Trainer’s Manual.

MEASURING FOOT LENGTH TO IDENTIFY VULNERABLE NEWBORNS IN NEED OF EXTRA CARE: A CROSS SECTIONAL HOSPITAL BASED STUDY IN SOUTH INDIA

2021 ◽  
pp. 78-80
Author(s):  
Anu Varshni ◽  
Sujitha Sujitha ◽  
Sujatha Sridharan
Keyword(s):  
Birth Weight ◽  
Health Workers ◽  
Tertiary Care ◽  
Care Hospital ◽  
Resource Limited Settings ◽  
Cross Sectional ◽  
Predictive Values ◽  
Targeted Interventions ◽  
Foot Length ◽  
Resource Limited

Background: Neonatal mortality remains high in many developing country settings mainly because of low birth weight (LBW) or preterm births (PTB). Easy-to-use anthropometric parameters like foot length which are appropriate for resource-limited settings are necessary, to guarantee these neonates are distinguished and alluded as required for extra care. This research aimed to estimate the sensitivity and specicity, and the positive and negative predictive values of newborn foot length to identify babies who are LBWand PTB. Materials and Methods: A cross-sectional study of newborn babies in a tertiary care hospital was carried out between July to September 2018. Foot length, birth weight and gestational age were estimated on the rst day of life. Receiver Operating Characteristic (ROC) curves were plotted to determine the operational cut-offs. Results: In hospital 150 babies were recruited and measured within 24 hours of birth. Of the 150 babies, 21 (14.00%) were born LBW (<2500 grams) and 77 (51.33%) were PTB. Mean foot length on the rst day was 7.62 ± 0.47 cm. Day one average foot length 7.32 cm at birth was 84.5% (77.70 – 89.89) sensitive and 90.5% (84.64 – 94.68) specic to identify birth weight ≥2500 grams; foot length 7.47 cm had sensitivity and specicity of 76.70% (69.11 – 83.21) and 49.4% (41.15 – 57.68) to identify those having term births. Conclusion: Measurement of newborn foot length for home births in resource-limited settings has the potential to be used by birth attendants, community health workers so that vulnerable newborns can be identied and receive targeted interventions for improved survival.

Discriminant Validation of the Test of Reading Performance (TORP) for Identifying Children at Risk of Reading Difficulties

2000 ◽  
Vol 16 (2) ◽  
pp. 139-146 ◽  
Author(s):  
Padeliadu Susana ◽  
Georgios D. Sideridis
Keyword(s):  
At Risk ◽  
Elementary School Students ◽  
Reading Difficulties ◽  
Reading Performance ◽  
Low Achievers ◽  
Children At Risk ◽  
School Students ◽  
Students At Risk ◽  
Group A ◽  
The Mean

Abstract This study investigated the discriminant validation of the Test of Reading Performance (TORP), a new scale designed to evaluate the reading performance of elementary-school students. The sample consisted of 181 elementary-school students drawn from public elementary schools in northern Greece using stratified random procedures. The TORP was hypothesized to measure six constructs, namely: “letter knowledge,” “phoneme blending,” “word identification,” “syntax,” “morphology,” and “passage comprehension.” Using standard deviations (SD) from the mean, three groups of students were formed as follows: A group of low achievers in reading (N = 9) including students who scored between -1 and -1.5 SD from the mean of the group. A group of students at risk of reading difficulties (N = 6) including students who scored between -1.5 and -2 SDs below the mean of the group. A group of students at risk of serious reading difficulties (N = 6) including students who scored -2 or more SDs below the mean of the group. The rest of the students (no risk, N = 122) comprised the fourth group. Using discriminant analyses it was evaluated how well the linear combination of the 15 variables that comprised the TORP could discriminate students of different reading ability. Results indicated that correct classification rates for low achievers, those at risk for reading problems, those at risk of serious reading problems, and the no-risk group were 89%, 100%, 83%, and 97%, respectively. Evidence for partial validation of the TORP was provided through the use of confirmatory factor analysis and indices of sensitivity and specificity. It is concluded that the TORP can be ut ilized for the identification of children at risk for low achievement in reading. Analysis of the misclassified cases indicated that increased variability might have been responsible for the existing misclassification. More research is needed to determine the discriminant validation of TORP with samples of children with specific reading disabilities.

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