Father Presence, Father Engagement, and Specific Health and Developmental Outcomes of Mongolian Pre-School Children

This study explored father involvement as a social determinant of child health within the context of macro-environmental changes in Mongolia. Using data for children aged 3–4 from UNICEF’s Multiple Indicator Cluster Surveys, this cross-sectional analysis examined the association between father presence and engagement with child health and educational outcomes. Multivariate regression modeling was employed to identify associations between father presence, engagement, and child outcomes including fever, respiratory illness, diarrhea and preschool attendance. In unadjusted analyses, father engagement was associated with higher odds of preschool attendance (Odds Ratio (OR) = 1.12; 95% Confidence Interval (CI) 1.04–1.20) but not with child illness (OR = 1.04; 95% CI 0.95–1.14). Father engagement was no longer associated with preschool attendance after controlling for potentially confounding variables (ORadj = 0.95; 95% CI 0.88–1.03). Unadjusted and adjusted analyses showed that father presence was not associated with acute illness or preschool attendance. Results also suggest that a larger proportion of children were engaged in activities by their mother compared to their father or other adults. Data indicate that father presence and engagement were not associated with child illness or preschool attendance. Factors such as maternal education, household wealth, and region of residence are stronger predictors of preschool attendance and should continue to be considered for promoting child health and development in Mongolia.

Using Cultural Domain Analysis to Understand Community Perceptions of Infant and Young Child Foods in Sri Lanka

Objectives 1) To understand how Sri Lankan caregivers conceptualize young child foods; 2) To explore local food classification systems; 3) To explain why some foods are culturally prescribed (remedies) or proscribed (taboos) for young children Methods Design: This ethnographic sub-study was conducted within a four-phase, mixed methods formative research design across rural, estate, and urban sectors of Sri Lanka. Data collection methods and sampling. Data were collected between Oct. 2020 – Feb. 2021 using free lists, pile sorts, and semi-structured interviews in urban (Batticaloa and Colombo), rural (Kilinochchi, Ratnapura, and Matara), and estate (Nuwara Eliya) sectors of Sri Lanka. Free lists (n = 150) and pile sorts (n = 84) were conducted among caregivers of young children. Both community leaders (n = 24) and caregivers (n = 21) were purposively sampled for interviews. Data analysis. Cultural domain analysis was conducted using Anthropac. Textual analysis of interview data followed an inductive approach whereby themes were identified, coded, and extracted for interpretation using Dedoose. Findings across methods were triangulated to enhance credibility. Results 1. Among all sectors of Sri Lanka, caregivers identified rice as the most important food for young children diets, highlighting the importance of this staple regardless of sector or ethnicity. Only 2 animal source foods (eggs and fish) were included within the top 15 most salient foods. 2. Local food classification systems highlight a ‘hot’ and ‘cold’ paradigm, reflecting the underlying Ayurvedic medical belief system, influencing dietary choices. 3. Overall, 48 food proscriptions were identified, including ‘egg’ and ‘fish, specifically during child illness. Some locally-available fruits and vegetables were also proscribed, depending on their ‘cold’ nature, level of digestibility, and relation to illness causation. Prescribed foods (n = 47) were also found, most of which were herbal remedies (22 food or spice mixtures) to address child illness. Conclusions Understanding local food definitions, food classification systems, and food rules may aid in shaping policies aiming to include culturally-appropriate strategies to improve feeding practices in Sri Lanka. Funding Sources UNICEF.

Father Presence, Father Engagement, and Child Outcomes in Mongolia

This study explored father involvement as a social determinant of child health within the context of macro-environmental changes in Mongolia. Using data for children aged 3-4 from UNICEF’s Multiple Indicator Cluster Surveys, this cross-sectional analysis examined the association between father presence and engagement with child health and educational outcomes. Multivariate regression modeling was employed to identify associations between father presence, engagement, and child outcomes including fever, respiratory illness, diarrhea and preschool attendance. In unadjusted analyses, father engagement was associated with higher odds of pre-school attendance (OR=1.12; 95% CI 1.04-1.20) but not with child illness (OR=1.04; 95% CI 0.95-1.14). Father engagement was no longer associated with pre-school attendance after controlling for potentially confounding variables (ORadj = 0.95; 95% CI 0.88-1.03). Unadjusted and adjusted analyses showed that father presence was not associated with acute illness or preschool attendance. Results also suggest that a larger proportion of children were engaged in activities by their mother compared to their father or other adults. Data indicate that father presence and engagement were not associated with child illness or pre-school attendance. Factors such as maternal education, household wealth, and region of residence are stronger predictors of preschool attendance and should continue to be considered for promoting child health and development in Mongolia.

Limiting factors for snail’s pace success of immunization

Background: The practice of immunization dates back to hundreds of years. Buddhist monks drank snake venom to confer the immunity against snake bite. World Health Organization (WHO) covers broad scope of global activities in order make the globe free of vaccine preventable diseases. Many surveillance activities are going on, in order to fulfill the aim of disease free globe.Methods: Children admitted to the Pediatric ward of Belgavi Institute of Medical Sciences were enrolled and parents/ guardians were enquired about the vaccination the child received and their knowledge about immunization and interpretation was done to find out the reasons for snail’s pace of successful elimination of the vaccine preventable diseases.Results: Out of 630 participants, 364 had partial immunization and 12 (1.9%) were un- immunized. Poor knowledge being the first reason found in 247 (67.9%) children. No visit by the health worker was the 2nd reason found in 220 (60.4%) children and child illness was the third reason in 116 (31.9%) children.Conclusions: In order to increase the rates of immunization in the community, improving the knowledge of community, about the benefits of immunizing their children as well as empowering the grass root health workers in immunizing the children of their locality can help us achieve a nation free of vaccine preventable diseases.

Applying a gender lens to understand pathways through care for acutely ill young children in Kenyan urban informal settlements

Background In many African settings, gender strongly influences household treatment-seeking and decision-making for childhood illnesses. While mothers are often the primary engagers with health facilities, their independence in illness-related decisions is shaped by various factors. Drawing on a gender lens, we explored treatment-seeking pathways pre- and post-hospital admission for acutely ill young children living in low income settlements in Nairobi, Kenya; and the gendered impact of child illness both at the household and health system level. Methods Household members of 22 children admitted to a public hospital were interviewed in their homes several times post hospital discharge. In-depth interviews covered the child’s household situation, health and illness; and the family’s treatment-seeking choices and experiences. Children were selected from an observational cohort established by the Childhood Acute Illness and Nutrition (CHAIN) Network. Results Treatment-seeking pathways were often long and complex, with mothers playing the key role in caring for their children and in treatment decision-making. Facing many anxieties and dilemmas, mothers often consulted with significant influencers - primarily women - particularly where illnesses were prolonged or complex. In contrast to observations in rural African contexts, fathers were less prominent as influencers than (often female) neighbours, grandparents and other relatives. Mothers were sometimes blamed for their child’s condition at home and at health facilities. Children’s illness episode and associated treatment-seeking had significant gendered socio-economic consequences for households, including through mothers having to take substantial time off work, reduce their working hours and income, or even losing their jobs. Conclusion Women in urban low-income settings are disproportionately impacted by acute child illness and the related treatment-seeking and recovery process. The range of interventions needed to support mothers as they navigate their way through children’s illnesses and recovery include: deliberate engagement of men in child health to counteract the dominant perception of child health and care as a ‘female-domain’; targeted economic strategies such as cash transfers to safeguard the most vulnerable women and households, combined with more robust labour policies to protect affected women; as well as implementing strategies at the health system level to improve interactions between health workers and community members.

The evaluation of immunization coverage under mission Indradhanush: a review

The government of India introduced mission Indradhanush (MI) to strengthen the routine immunization planning and delivery mechanism. It was launched on 25th December 2014 with an objective to achieve more than 90% full immunization (FI) coverage in the country. To evaluate universal immunization coverage, barriers encountered for not achieving the target and problem solving in removing the barriers. PubMed and google scholar were used to search the relevant articles. PRISMA tool was used for the review process and for in­clusion of potential articles. The studies conducted in Manipur, Madhya Pradesh, Bihar and south Kerala reported successful achievement of MI goal. The minimum FI percentage was 57% and the maximum was 96.4%. The most common reason for not achievement of the goal was lack of awareness, illiteracy, child illness, fear of adverse effects.

Pakistan’s Community-based Lady Health Workers (LHWs): Change Agents for Child Health?

BACKGROUND: In Pakistan’s high child mortality context, a large-scale Lady Health Worker (LHW) Program raises the need to look at whether LHWs are delivering their key mandate as agents of change for child health. This study examines the quantity and quality of LHW interactions with mothers for child health and their impact on mothers' knowledge and child health practices. METHODS: 1,968 mothers of children <2 years (n=1,968) were interviewed through a cross-sectional survey in two rural districts of Pakistan focusing on immunization, nutrition, and early child illness. Data on frequency of LHW’s visits; services provided, specific services related to routine immunization (RI), nutrition and child illness, and maternal knowledge and practices were analyzed using median values for continuous variables and counts and percentages for categorical data. RESULTS: Monthly visits by LHW were reported by only 63% of LHW covered households. During LHW monthly encounters, Oral Polio drops administration was most frequently reported (77%), followed by RI (59%), breastfeeding counseling (20%), child illness management advice (18%), growth monitoring (9.5%), while none reported receiving hygiene counseling. Although LHWs were reported to be the main information source for child health; limited impact of LHW-mother interaction was seen on maternal knowledge and practices: 76% mothers reported receiving ORS packets from LHWs but only 27% knew of correct usage, only 34% washed hands before feeding children, less than a third could correctly recall early signs of pneumonia and awareness of Vaccine Preventable Diseases other than Polio ranged from 42%-9% only. CONCLUSION: Although LHWs are main information source for child health services but infrequent, poor quality household encounters indicate ineffective delivery on the key mandate of community-based child health. Policy debate instead of focusing on scaling up or downsizing the program, should prioritize quality and supervision to improve value for money of a critical community resource.

Closing the inequality gaps in reproductive, maternal, newborn and child health coverage: slow and fast progressors

IntroductionUniversal Health Coverage (UHC) is a critical goal under the Sustainable Development Goals (SDGs) for health. Achieving this goal for reproductive, maternal, newborn and child health (RMNCH) service coverage will require an understanding of national progress and how socioeconomic and demographic subgroups of women and children are being reached by health interventions.MethodsWe accessed coverage databases produced by the International Centre for Equity in Health, which were based on reanalysis of Demographic and Health Surveys, Multiple Indicator Cluster Surveys and Reproductive and Health Surveys. We limited the data to 58 countries with at least two surveys since 2008. We fitted multilevel linear regressions of coverage of RMNCH, divided into four main components—reproductive health, maternal health, child immunisation and child illness treatment—to estimate the average annual percentage point change (AAPPC) in coverage for the period 2008–2017 across these countries and for subgroups defined by maternal age, education, place of residence and wealth quintiles. We also assessed change in the pace of coverage progress between the periods 2000–2008 and 2008–2017.ResultsProgress in RMNCH coverage has been modest over the past decade, with statistically significant AAPPC observed only for maternal health (1.25, 95% CI 0.90 to 1.61) and reproductive health (0.83, 95% CI 0.47 to 1.19). AAPPC was not statistically significant for child immunisation and illness treatment. Progress, however, varied largely across countries, with fast or slow progressors spread throughout the low-income and middle-income groups. For reproductive and maternal health, low-income and lower middle-income countries appear to have progressed faster than upper middle-income countries. For these two components, faster progress was also observed in older women and in traditionally less well-off groups such as non-educated women, those living in rural areas or belonging to the poorest or middle wealth quintiles than among groups that are well off. The latter groups however continue to maintain substantially higher coverage levels over the former. No acceleration in RMNCH coverage was observed when the periods 2000–2008 and 2008–2017 were compared.ConclusionAt the dawn of the SDGs, progress in coverage in RMNCH remains insufficient at the national level and across equity dimensions to accelerate towards UHC by 2030. Greater attention must be paid to child immunisation to sustain the past gains and to child illness treatment to substantially raise its coverage across all groups.

Minimum acceptable diet and stunting among children aged 6-23 months in Dalit and Non-Dalit and associated factors: A cross-sectional comparative study of Dhanusha district, Nepal

Background The complementary feeding practices contributes for development and survival of infant and young child, it reduces the risk of under-nutrition. The aim of the study assessed the status and identify factors associated with minimum acceptable diet and stunting among children aged 6-23 months in Dalit and Non-Dalit.Methods The study method adopted cross-sectional comparative and conducted among mothers with their children aged 6-23 months children of Dhanusha district. Altogether 599 respondents were taken of which 299 were from Dalit and 300 from Non-Dalit and used multistage simple random sampling. Data collection techniques applied for interview and anthropometry measurement and structure questionnaire was practiced as a tool. Descriptive and inferential analyses were carried out by using Statistical Package for the Social Science.Results The prevalence of minimum acceptable diet (MAD) and stunting were 43.8% and 49.9% among Dalit while 44.3%, and 39% among Non-Dalit. The MAD were significantly associated with the age of child (AOR=0.25, 95 CI: 0.11-0.54), child illness in the past two weeks (AOR=4.31, 95% CI: 1.56-11.88) and knowledge on child feeding (AOR=0.31, 95% CI: 0.16-0.61) among Dalit while age of child (AOR=0.37, 95 CI: 0.21-0.64), child illness in the past two weeks (AOR=4.80, 95% CI: 2.23-10.32,knowledge on child feeding (AOR=0.26, 95% CI: 0.16-0.42) and birth interval (AOR=1.92, 95% CI: 1.56-3.19) among Non-Dalit. Stunting was significantly associated with family types (AOR=1.93, 95% CI: 1.11-3.34) among Dalit while Ante Natal Care (ANC) visit (AOR=3.20, 95% CI: 1.15-8.90), media exposure (AOR=3.10, 95% CI: 1.11-8.64 and age of child (AOR=0.24, 95% CI: 0.10-0.57) in Non-Dalit.Conclusion The proportion of minimum acceptable diet practices got similar in both groups. Being key associated factors of MAD practices, age of child, child illness and knowledge on child feeding existed in Dalit and Non-Dalit, while birth interval also among Non-Dalit. Similarly, family type provided an important factor of stunting in Dalit while age of child, ANC visit and media exposure among Non-Dalit. To improve the nutritional status among children, community based maternal nutrition education, access and utilization of health services should be recommended.