Prevalence and patterns of adverse events following immunisation among children less than 24 months attending immunisation clinics in Kano, Nigeria

Adverse Events Following Immunisation (AEFI) contribute to child morbidity and mortality as they often lead to low uptake of vaccines with consequent persistence of vaccine-preventable diseases. It is essential to assess the prevalence of AEFIs in northern Nigeria, where misconceptions about immunisation exist. This study assessed the prevalence and pattern of AEFI among children less than 24 months after attending immunisation clinics in Kano, Nigeria. Using a mixed-methods design, adapted intervieweradministered questionnaires were assigned to a cross-section of 384 mother-baby pairs who presented to the immunisation clinics of selected primary healthcare centres (PHCs) within metropolitan Kano. This was followed by six sessions of focus group discussion with a sub-sample of the mothers. Logistic regression and the framework approach were used to analyse the data. The prevalence of AEFI was (43.5%, n=164), and most cases (72.4%, n=273) were mild. Fever was the most common type of AEFI reported (66.5%, n=109) and was higher among infants less than three months (44.5%, n=73). Age of the index child was the only significant predictor of AEFI (OR:0.18, 95% CI: 0.10-0.35). Our study shows that AEFI was common among children less than 24 months old in Kano. We recommend sensitisation and health education of caregivers using valuable communication strategies and sufficient training of immunisation service providers on professional ways to deliver these vaccines safely.

Determinants of growth monitoring and promotion service utilization among children 0–23 months of age in northern Ethiopia: unmatched case-control study

Background One of the strategies to promote child health and reduce child mortality is growth monitoring and promotion services. But, there is limited information on determinants of Growth Monitoring and Promotion service utilization. Objective To identify determinants of growth monitoring and promotion (GMP) service utilization among children 0–23 months of age in Legambo district, South Wollo zone, Northern Ethiopia, 2020. Methods Community based un-matched case-control study was conducted on 363 (91 cases and 272 controls) study participants from March 15 to April 15, 2020. A multi-stage sampling technique was employed to select the study participants. Bivariable and multivariable logistic regressions were performed and an adjusted odds ratio with 95% confidence intervals was estimated to identify determinants of GMP service utilization. Results A total of 358 mothers (89 cases and 269 controls) with 98.6% response rate were included in the study. The mean (±SD) age of child was 11.66(±6.29) months among controls and 15.02 (±6.06) months among cases. Good maternal knowledge (AOR) = 2.42; 95% CI: 1.23, 4.75), favorable attitude (AOR = 2.45; 95% CI; 1.20, 4.98), counseling on GMP (AOR = 2.34; 95% CI; 1.19, 4.56), attending ante natal care services (AOR = 2.46; 95% CI: 1.18, 5.16), index child age 12–17 months (AOR = 3.45; 95% CI: 1.26, 9.41) and 18–23 months (AOR = 4.38; 95% CI: 1.53, 12.49), and short distance to health facilities (AOR = 4.53; 95% CI; 1.99, 10.28) were determinants of GMP service utilization. Conclusion Index child age, good knowledge, favorable attitude, attending antenatal care services, receiving nutritional counseling, and a short distance to health facility were determinants of GMP service utilization. Nutritional interventions should emphasize nutritional counseling and accessibility of growth monitoring and promotion services.

Development and Psychometric Testing of a Children's Version of the Herth Hope Index

Background and PurposeHope in children is critical however multidimensional tools to measure hope are almost nonexistent. The aim of study is to develop and psychometrically evaluate a multidimensional children’s version of the well-regarded Herth Hope Index for those 8–12 years old.MethodsPhase one; qualitative study of hope in children, construction of the Herth Hope Index – Child Version (HHI-C), and validation by focus groups. Phase two; pilot testing with 22 children. Phase three; psychometric evaluation with 125 children.ResultsCronbach’s alpha of 0.856 with 3-week test–retest reliability of 0.966. Construct validity supported factorial isolation of three factors: (a) inner positive readiness; (b) interconnectedness with self and others; (c) temporality and future.ConclusionPsychometric findings support the use of the HHI-C as a multidimensional tool to measure hope in children.

Differential in infant, childhood and under-five death clustering among the empowered and non-empowered action group regions in India

Background With 8,82,000 deaths in the under-five period, India observed varied intra-state and inter-regional differences across infant and child mortality in 2018. However, scarce literature is present to capture this unusual concentration of mortality in certain families by examining the association of the mortality risks among the siblings of those families along with various unobserved characteristics of the mother. Looking towards the regional and age differential in mortality, this paper attempts to provide evidence for the differential in mortality clustering among infants (aged 0–11 months), children (12–59 months) and under-five (0–59 months) period among mothers from the Empowered Action Group (EAG) and non-EAG regions of India. Methods The study used data from the National Family Health Survey (2015–16) which includes all the birth histories of 475,457 women aged 15–49 years. Bivariate and multivariate analyses were used to fulfil the objectives of the study. A two-level random intercept Weibull regression model was used to account for the unexplained mother (family) level heterogeneity. Results About 3.3% and 5.9% of infant deaths and 0.8% and 1.6% of childhood deaths were observed in non-EAG and EAG regions respectively. Among them, a higher percentage of infant and child death was observed due to the death of a previous sibling. There were 1.67 times [95% CI: 1.55–1.80] and 1.46 times [CI: 1.37–1.56] higher odds of infant and under-five mortality of index child respectively when the previous sibling at the time of conception of the index child was dead in the non-EAG regions. In contrast, the odds of death scarring (death of previous sibling scars the survival of index child) were 1.38 times [CI: 1.32–1.44] and 1.24 times [CI: 1.20–1.29] higher for infant and under-five mortality respectively in the EAG regions. Conclusion The extent of infant and child mortality clustering and unobserved heterogeneity was higher among mothers in the non-EAG regions in comparison to their EAG region counterparts. With the growing situation of under-five mortality clustering in non-EAG states, region-wise interventions are recommended. Additionally, proper care is needed to ameliorate the inter-family variation in mortality risk among the children of both EAG and non-EAG regions throughout their childhood.

Clostridioides difficile Infection among Cirrhotic Patients with Variceal Bleeding

Clostridioides difficile infection (CDI) stands as the leading cause of nosocomial infection with high morbidity and mortality rates, causing a major burden on the healthcare system. Driven by antibiotics, it usually affects older patients with chronic disease or immunosuppressed or oncologic management. Variceal bleeding secondary to cirrhosis requires antibiotics to prevent bacterial translocation, and thus patients become susceptible to CDI. We aimed to investigate the risk factors for CDI in cirrhotic patients with variceal bleeding following ceftriaxone and the mortality risk in this patient’s population. We retrospectively screened 367 cirrhotic patients with variceal bleeding, from which 25 patients were confirmed with CDI, from 1 January 2017 to 31 December 2019. We found MELD to be the only multivariate predictor for mortality (odds ratio, OR = 1.281, 95% confidence interval, CI: 0.098–1.643, p = 0.042). A model of four predictors (age, days of admission, Charlson index, Child–Pugh score) was generated (area under the receiver operating characteristics curve, AUC = 0.840, 95% CI: 0.758–0.921, p < 0.0001) to assess the risk of CDI exposure. Determining the probability of getting CDI for cirrhotic patients with variceal bleeding could be a tool for doctors in taking decisions, which could be integrated in sustainable public health programs.

Determinant of Mother’s Health Promotional Measures Practice of Infant with Age 6–12 Months in a Tertiary Hospital of Nepal

Background. Promotion of health is vital for the optimal growth and development of every infant. Globally, many infants died due to common problems such as diarrhoea and respiratory infection; most of these problems are related to inadequate breast feeding, improper complimentary feeding, lack of immunization, and home accident. Infant and child health status depends upon mothers’ knowledge and practice regarding health promotional measures. This study aimed to determine practice and its determinants regarding health promotional measures of infant with 6–12 months age amongst the mothers attending Pediatrics Outpatient Department of Universal College of Medical Science and Teaching Hospital, Bhairahawa, Rupandehi, Nepal. Methods. Hospital-based cross-sectional study was conducted in Universal College of Medical Science, Bhairahawa, Rupandehi, Nepal, among 414 mothers attending pediatrics outpatient department from September 2019–March 2020. Purposive sampling technique was used to select mothers of infants aged 6–12 months. Bivariate analysis was used primarily to assess the association between dependent and independent variables. Variables which were associated in bivariate analysis with p < 0.05 were entered into a multivariable logistic regression model to identify associated factors of health promotional measures. The goodness of fit of multivariate logistic regression was checked by Nagelkerke R square and variation inflation factor. Results. The mean age and family size was 25.89 ± 4.81 years and 5.94 ± 2.48, respectively. A total of 71.5% mothers have good practice of health promotional measures. Mothers from Dalit caste (adjusted odds ratio = 0.04, confidence interval: 0.005–0.30), mothers with below school leaving certificate education (AOR = 0.08, CI: 0.02–0.27), fathers engaged in nonagricultural work (AOR = 7.21, CI: 2.59–20.11), birth space of index child greater than 2 years (AOR = 12.88, CI: 3.49–47.58), and family monthly income greater than 20000 Nepalese rupees (AOR = 3.29, CI: 1.16–13.32 were significantly associated with good practice of health promotional measures. Conclusions. More than one-fourth of the mothers have poor practice of health promotional measures. Ethnicity, mothers’ education, fathers’ occupation, birth space of index child, and family monthly income were found to be independent determinants of practice of health promotion measures. Thus, policy makers should provide specific education regarding health promotional measures to both parents.

Secondary attack rates of COVID-19 in Norwegian families: a nation-wide register-based study

To characterize the family index case for detected SARS-CoV-2 and describe testing and secondary attack rates in the family, we used individual-level administrative data of all families and all PCR tests for SARS-CoV-2 in Norway in 2020. All families with at least one parent and one child below the age of 20 who lived at the same address (N = 662,582), where at least one member, i.e. the index case, tested positive for SARS-CoV-2 in 2020, were included. Secondary attack rates (SAR7) were defined as the share of non-index family members with a positive PCR test within 7 days after the date when the index case tested positive. SARs were calculated separately for parent- and child-index cases, and for parent- and child-secondary cases. We identified 7548 families with an index case, comprising 26,991 individuals (12,184 parents, 14,808 children). The index was a parent in 66% of the cases. Among index children, 42% were in the age group 17–20 and only 8% in the age group 0–6. When the index was a parent, SAR7 was 24% (95% CI 24–25), whilst SAR7 was 14% (95% CI 13–15) when the index was a child. However, SAR7 was 24% (95% CI 20–28) when the index was a child aged 0–6 years and declined with increasing age of the index child. SAR7 from index parent to other parent was 35% (95% CI 33–36), and from index child to other children 12% (95% CI 11–13). SAR7 from index child aged 0–6 to parents was 27% (95% CI 22–33). The percent of non-index family members tested within 7 days after the index case, increased from about 20% in April to 80% in December, however, SAR7 stabilized at about 20% from May. We conclude that parents and older children are most often index cases for SARS-CoV-2 in families in Norway, while parents and young children more often transmit the virus within the family. This study suggests that whilst the absolute infection numbers are low for young children because of their low introduction rate, when infected, young children and parents transmit the virus to the same extent within the family.

Contribution of Serological Rapid Diagnostic Tests to the Strategy of Contact Tracing in Households Following SARS-CoV-2 Infection Diagnosis in Children

Background: The contact tracing and isolation of contagious individuals are cornerstones in the control of the COVID-19 pandemic. Strategies to identify household contacts who should be isolated around index children that tested positive for SARS-CoV-2 remain to be clarified. We aimed to compare contact tracing strategies around an index child positive for SARS-CoV-2 using serological rapid diagnostic testing (RDT, chromatography immunoassay).Methods: We conducted a contact tracing study in households of index cases children in the Paris region, France, between May 8 and July 27, 2020. We compared two strategies, one using SARS-CoV-2 reverse transcriptase polymerase chain reaction (RT-PCR) and one combining RT-PCR and serological RDT, initiated once RDT was available. The contacts RT-PCR–/RDT+ were considered to have been previously infected and not requiring quarantine. The primary outcome was the proportion of contacts that could avoid quarantine with the two screening strategies.Results: We included 34 children as index cases. Median age was 7 years. They generated 184 contacts (111 adults, 73 children) tested by RT-PCR: 24/184 (13%) were positive. The strategy combining RDT and RT-PCR was performed in 120/184 contacts (77 adults, 43 children) of 26 index children: 16/120 (13%) were RT-PCR+ and 47/120 (39%) were RDT+. Among the 16 individuals who were RT-PCR+, 14 (87%) were also RDT+. Among the 104 individuals who were RT-PCR–, 33 were RDT+. Hence 33/120 (27%) individuals were not isolated.Conclusions: Following the diagnosis of SARS-CoV-2 infection in children, a strategy combining serological RDT and nasopharyngeal RT-PCR enabled us to identify around one fourth of contacts with past infection and avoid unnecessary quarantine of these individuals.

Impact of high-risk fertility behaviours on underfive mortality in Asia and Africa: evidence from Demographic and Health Surveys

Background Maternal age < 18 or > 34 years, short inter-pregnancy birth interval, and higher birth order are considered to be high-risk fertility behaviours (HRFB). Underfive mortality being disproportionately concentrated in Asia and Africa, this study analyses the association between HRFB and underfive mortality in selected Asian and African countries. Methods This study used Integrated Public Microdata Series-Demographic and Health Surveys (IPUMS-DHS) data from 32 countries in sub-Saharan Africa, Middle East, North Africa and South Asia from 1986 to 2017 (N = 1,467,728). Previous evidence hints at four markers of HRFB: women’s age at birth of index child < 18 or > 34 years, preceding birth interval < 24 months and child’s birth order > 3. Using logistic regression, we analysed change in the odds of underfive mortality as a result of i) exposure to HRFB individually, ii) exposure to any single HRFB risk factor, iii) exposure to multiple HRFB risk factors, and iv) exposure to specific combinations of HRFB risk factors. Results Mother’s age at birth of index child < 18 years and preceding birth interval (PBI) < 24 months were significant risk factors of underfive mortality, while a child’s birth order > 3 was a protective factor. Presence of any single HRFB was associated with 7% higher risk of underfive mortality (OR 1.07; 95% CI 1.04–1.09). Presence of multiple HRFBs was associated with 39% higher risk of underfive mortality (OR 1.39; 95% CI 1.36–1.43). Some specific combinations of HRFB such as maternal age < 18 years and preceding birth interval < 24 month significantly increased the odds of underfive mortality (OR 2.07; 95% CI 1.88–2.28). Conclusion Maternal age < 18 years and short preceding birth interval significantly increase the risk of underfive mortality. This highlights the need for an effective legislation to curb child marriages and increased public investment in reproductive healthcare with a focus on higher contraceptive use for optimal birth spacing.

Secondary Attack Rates of COVID-19 in Norwegian Families: A Nation-Wide Register-Based Study

To characterize the family index case for detected SARS-CoV-2 and describe testing and secondary attack rates in the family, we used individual-level administrative data of all families and all PCR tests for SARS-CoV-2 in Norway in 2020. All families with at least one parent and one child below the age of 20 who lived at the same address (N=662 582), where at least one member, i.e. the index case, tested positive for SARS-CoV-2 in 2020, were included. Secondary attack rates (SAR7) were defined as the share of non-index family members with a positive PCR test within seven days after the date when the index case tested positive. SARs were calculated separately for parent- and child-index cases, and for parent- and child-secondary cases. We identified 7548 families with an index case, comprising 26 991 individuals (12184 parents, 14808 children). The index was a parent in 66% of the cases. Among index children, 42% were in the age group 17-20 and only 8% in the age group 0-6. When the index was a parent, SAR7 was 24% (95%CI 24 to 25), whilst SAR7 was 14% (95%CI 13 to 15) when the index was a child. However, SAR7 was 24% (95%CI 20 to 28) when the index was a child aged 0-6 years and declined with increasing age of the index child. SAR7 from index parent to other parent was 35% (95%CI 33 to 36), and from index child to other children 12% (95%CI 11 to 13). SAR7 from index child aged 0-6 to parents was 27% (95%CI 22 to 33). The percent of non-index family members tested within 7 days after the index case, increased from about 20% in April to 80% in December, however, SAR7 stabilized at about 20% from May. We conclude that parents and older children are most often index cases for SARS-CoV-2 in families in Norway, while parents and young children more often transmit the virus within the family. This study suggests that whilst the absolute infection numbers are low for young children because of their low introduction rate, when infected, young children and parents transmit the virus to the same extent within the family.