Special Issue on "International Growth and Development Conference"

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Individual or Group-based Approach to the Assessment of Preschool Children: A Comparison using the INTERGROWTH-21st Neurodevelopment Assessment (INTER-NDA)

Introduction: It is unclear if the assessment of early child development can be carried out using a group approach, as opposed to individually. Objective: To compare scores obtained from children aged 22 to 26 months assessed either in small groups or individually using the INTERGROWTH-21st Neurodevelopment Assessment (INTER-NDA), which measures cognition, language, motor skills, behavior, attention and socio-emotional reactivity. Methods: A small group based strategy for administering and scoring the INTER-NDA was developed. Thirty-six preschool children attending four Centros de Cuidado y Atención Infantil of the Sistema Nacional para el Desarrollo Integral de la Familia (DIF) of Mexico were assessed in small groups of three children by a teacher specifically trained in the INTER-NDA. A second teacher, unaware of the group results, assessed the children individually on a different day. The sex, age, weight, length and head circumference of the children at the time of assessment were recorded. Results: INTER-NDA domain scores for group and individual assessments were statistically significantly correlated (range r=0.35 to r=1.00) for all domains except receptive language (r=0.25, p=0.14). Bland-Altman analysis showed agreement between group and individual scores for the language, behavior, attention and socio-emotional reactivity domains, and consistency (but not agreement) between group and individual scores for the cognitive and motor domains. None of the differences between group and individual scores examined were statistically significant, even after adjusting for the children’s age, sex, nutritional status and location of the preschool. Conclusion: INTER-NDA domain specific scores obtained following group and individual assessment of children aged 22 to 26 months are consistent. It is feasible for trained preschool teachers to administer INTER-NDA at both group and individual level.

The Impact of Information and Communication Technology (ICT) on Community Pharmacy

Information and communication technologies (ICTs) are transforming health services throughout the world. Health information and technologies (HITs) involve application of information processing using computer for storage, retrieval, sharing and use of information and knowledge for communication by a pharmacist. Similarly electronic prescription (EP) services have made the dispensing and reimbursement processes more efficient. Maintenance of patient record become easy by using ICTs. Barcode identification of medicines can be used to reduce medicine administration errors and to improve the medication history of patients. Telecare using digital communications technology provides healthcare consultations and other health care services to rural, old & handicap patients easily and improves their access to healthcare by reducing their hospital attendance. In developing countries like India, it is quite a challenging task to provide access to information and communication technologies. As the geographical diversity is also a challenging for implementation of ICTs at everywhere. Information and technologies are giving a way to access the data all over the globe. ICTs have brought transformation in education in all over the world. Information and technologies are removing barriers from learning education. ICT applications are becoming indispensable tools for traditional and vocational education. In the field of pharmaceutical sciences, ICTs can further enhance the quality of education. As lots of modifications and newer drugs are coming in the market, it is quite a challenging task to a pharmacist to update knowledge to serve the society in an efficient way. ICT can be utilized in health care to improve quality of patient centric services.

OBESITY INTERVENTION AT SCHOOL SETTINGS, SOCIAL MOBILIZATIONS, FAMILY ENGAGEMENT AND BEHAVIOURAL APPROACH

Background: Obesity and overweight are recognized as major global public health phenomena. Its long term consequences are many chronic conditions like hypertension, Diabetes mellitus, and many more. Childhood obesity is complex and multidimensional, which has been identified as a public health priority. Objectives: To assess the impact of a multi-approach population-based childhood obesity intervention over three years at school population in Dubai. Methodology: Follow up was conducted on about 260000 students in the age range of 5-18 years (grades 1 –12) over about 180 private schools in Dubai, United Arab Emirates in three consequence academic years 2014-2015, 2015-2016 and 2016-2017. BMI measurement as per WHO growth charts was used at the beginning of each academic year (September). Wide variety of interventions have been designed an applied like health promotion, school nutritional education activities, Food labelling, happy schools initiatives, 10/10 initiative physical activity platform, parents awareness, students health file initiative, City Makers (blue team initiative), community participation (private –public partnership, Governmental stockholders intersect oral collaborations school canteen policy and guideline. Results: The current study revealed that about 10.1% of the total students in private schools in Dubai in the academic year 2014-2015 were obese. Obesity prevalence during the academic year 2015-2016 was 9.88%. The study reflected that prevalence of obesity among student population at private schools in Dubai during the academic year 2016-2017 was 8.9%. The study revealed that the trend of obesity prevalence among students population at private schools in Dubai is declining over that last three academic years (2014-2015, 2015-2016 and 2016-2017) showing that about 1.2% total reduction during the three year period of applying effective intervention program. Conclusion: Multi approach public health intervention for childhood obesity is significant. Maintaining intervention need to be revised, re assessed, monitored and there is a need for strengthening sustainable long term approach through governmental and nongovernmental accountability.

GROWTH MONITORING FOR LOW BIRTH WEIGHT INFANTS IN OMDURMAN MATERNITY HOSPITAL, SUDAN

This was a longitudinal study to investigate the growth monitoring of Low Birth Weight (LBW) infants, (weight, length and head circumference) from birth to 6 months of age. 84 LBW infants delivered at Omdurman Maternity were included in the study, normal birth weight or preterm infants were excluded. Data was collected by questionnaire included background of the families and Infant's health and feeding. Mothers were interviewed first in the wards 3-4 h after delivery, then during home visits after 2 w and monthly follow up monitoring were used up to 6 mo. Infant's birth weight was taken immediately after birth and classified as LBW (1500-<2500 g) or VLBW (1000-<1500 g), as well as length and head circumference. Weights taken after 2 w and during monthly follow up. Infant's length and head circumference were measured to the nearest 0.1. cm. The data was analysed using statistical package for social science program (SPSS) and Chi-square test. 96.4% of the infants had LBW and 3.6% VLBW, 78.4% had normal health at birth and the rest suffered from jaundice, chest infection and diarrhoea were transferred to New Born Intensive Care Unit (NICU) for 1-3 w. 32.1% of the infants reached standard weight at the 6th month and 33.3% never reached it at any age. Mean weight attained at every age from birth to 6 months was always below standard weight. Weight attained at 2 w was 1.3 times and at 6 months 3 times the birth weight. Boys and girls had the same mean weight at birth and both doubled their weight in the second month. Length at birth was 58.3% and at 6th month was 53.6% standard length, however, there were 2 growth spurts, in the 2nd week (70.2%) and 4th month (80.9%). There was a steady increase in head circumference (≥ standard) and then a drop in the 5th (51.2%) and 6th (54.8%) months. Growth monitoring using Z-scores showed that girls had normal weight-for-age growth from 1st to 6th months but boys suffered mild underweight for the same period. Both had normal length-for-age growth from 1st to 6th months and both had normal weight-for-length growth only in the 5th and 6th months. Determinants of infants reaching standard weight at 6 months were: order of infant (P<0.037), number of family members (P<0.039), type of area (P<0.027) and diarrhoea infection (P<0.042). There was a significant correlation (P<0.000) between weight at birth and at 2 w but not with any other weights. The study recommended special care for LBW infants by admitting to the new born intensive care unit (NICU) till they achieve the optimum weight for their age.

Exploratory study into awareness of heart disease and healthcare seeking behaviour among Emirati women (UAE) - Cross sectional descriptive study

Introduction: Cardiovascular disease was the leading cause of death among women in the United Arab Emirates (UAE) in 2010. Heart attacks usually occur at an older age in women compared to men, consequently the atypical symptoms of heart disease that often appear among women are masked by symptoms of other chronic diseases. Non-recognition of symptoms could explain the reason behind delays in seeking healthcare and the high mortality following a heart attack among Emirati women. This study seeks to a) highlight the awareness of heart diseases among Emirati women and b) to understand Emirati women’s healthcare seeking behaviour. Methods: A cross sectional, descriptive study was conducted using a survey instrument adapted from the American Heart Association National survey. A convenience sample of 676 Emirati women between the ages of 18-55 years completed the questionnaire. Results: The study showed low levels of awareness of heart disease and associated risk factors in Emirati women; only 19.4% participants were found to be aware of heart diseases. Awareness levels were highest in Dubai (OR 2.18, p<0.05) among all the other emirates and in the 18-45 years age group (OR 2.74, p<0.05). Despite low awareness levels, women paradoxically perceived themselves to be self-efficacious in seeking healthcare. Interestingly, just 49.1% Emirati women believed that good quality and affordable healthcare was available in the UAE. Only 28.8% of the participants believed there were sufficient female doctors to respond to health needs of women in UAE. Furthermore, only 36.7% Emirati women chose to be treated in the UAE over treatment in other countries. Conclusion: Emirati women clearly lack knowledge on severity and vulnerability to heart disease in the region that is essential to improve cardiovascular related health outcomes. This study has identified the need for wider outreach that focuses on gender and age specific awareness on heart disease risks and symptoms. The study has also highlighted potential modifiable barriers in seeking healthcare that should be overcome to reduce morbidity and mortality due to heart disease among national women of UAE.

Interventions in the workplace to support breastfeeding for women

Support breastfeeding in work place have positive impact on the working mothers and their children, we all know the benefits of breastfeeding and few changes and support to the working mothers will help breastfeeding to continue. Workplace programs could help women to continue to breastfeed, and some programs may help women to initiate breastfeeding. By promoting and supporting the programs, employers may be able to influence the duration of breastfeeding (including exclusive breastfeeding) and so improve the health of mother and baby, but also benefit from less work absenteeism, high productivity and increased employee morale and retention.

Effect of high fiber breakfast cereal consumption at suhur on satiety and digestive symptoms during the month of Ramadan

Introduction: Fasting during Ramadan involves large changes in daily eating patterns which strongly impacts the daily biorhythm, and challenges the regular function of the digestive tract. In the UAE, more than seven out of ten children and adolescents consume less fiber than recommended. A common problem reported during Ramadan is poor digestion health accompanied by an increase in the occurrence of constipation. Objective: To assess satiety, bowel habits, body composition, blood glycaemia, and blood lipidemia after the consumption of high fiber All Bran cereal at Suhur meal. Methodology: This research study is a controlled, randomized, parallel-design study. Subjects (n= 45) consumed either 90g of All Bran Raisins (11g/100g fiber) or 90g All Bran Flakes (15g/100g) at Suhur for 20 consecutive days compared with control group (n= 36). Results: After 20 days, significant differences were found for the intervention group for appetite, digestive symptoms and lipid outcomes. Fifteen minutes after Suhur, 100% of the high fiber intervention group (n=45) and 32% of the control group (n=36) experienced satisfaction after the meal. Eight hours later, 53% of the control group and 23% of the intervention group felt hungry. Bloating symptoms were significantly improved for intervention group compared to the control group and had improved bowel functioning (60.5%, 48.6%; P < 0.001, respectively). The high fiber group had significant higher fiber intakes: the control group stayed at 18.5g fiber per day while in the intervention group fiber intake increased from 18 to 25.5g fiber/day. There were no significant changes in body weight, % body fat, and BMI after 20 days for both groups. Moreover, cholesterol and LDL levels have increased significantly in the control group but were maintained in intervention group. Finally, there was no significant increase in blood glucose and triglycerides for the control group. Conclusions: There is a clear positive effect of consuming high fiber breakfast cereal on health and wellbeing during Ramadan with better satiety, improved bowel functions, and blood lipids. Increasing the intake of dietary fiber/day in Ramadan would have many health benefits for the people in the Arab Gulf countries. This research was funded and supported by Kellogg EMEA.

Performance of PRISM score III in predicting the outcome of patients admitted in tertiary care pediatric intensive care unit (P.I.C.U.): A pilot study

Introduction: P.I.C.U is a unit that provides care to the critically ill patients with purpose of reducing the rate of mortality and morbidity. Various scoring systems are used to assess and compare the standards of care of different P.I.C.U.s. Among them, PRISM III scoring has shown promising results, especially in developing countries. In Pakistan, these studies are fewer in numbers with conflicting results in different hospital settings (private and public sector). Since our hospital is also a tertiary care hospital, we planned a pilot study to evaluate PRISM III score in our P.I.C.U. Objective: To evaluate the performance of PRISM III score in predicting the outcome of patients admitted in P.I.C.U of tertiary care hospital of Karachi. Method: PRISM III is Pediatric Risk of Mortality Scoring system consisting of clinical assessment (Glasgow Coma Scale, pupillary reflex, temperature, heart rate, systolic blood pressure) and lab parameters (arterial blood gas, urea, nitrogen, creatnine, blood sugar, potassium, white cell count, platelets, PT/APTT). It is a cross-sectional study and data was collected from admitted patients in P.I.C.U, Unit II of Abbasi Shaheed Hospital during 1st October to 31st December 2016. PRISM score is being calculated from all the patients within 24 hours of admission. Result: Total of 70 patients of which 51(72%) survived and 19(27%) expired. 49 were males and 21 females. Age range of non-survivors was 2 to 18 months. Duration of PI.C.U stay was 72 hours for survivors. Patients who were referred, had malnutrition, depressed mental status, deranged renal functions and required mechanical ventilation during first hour of admission had poor outcome. Out of 19 non-survivors, PRISM III predicted mortality in 15 patients (78.9%). Conclusion: High total PRISM III score was significantly associated with poor outcome i.e. death in this pilot study. Thus PRISM III score was found to be a valid predictor of outcome in our P.I.C.U. There is no conflict of interest keywords: P.I.C.U, Mortality, PRISM III score, Outcome.

The gluten free diet in depth

The gluten free diet has been gaining recognition globally and is being applied by many patients. This diet was first developed for Celiac's patients however with the emergence of a new diagnosis: non-celiac gluten sensitivity (NCGS), more patients are finding relief from their symptoms when following this diet. The symptoms of NCGS also overlap with those of Irritable Bowel Syndrome and there are studies that suggest a possible link between NCGS and neuropsychiatric disorders, like autism and others. In this presentation we will review the new research about gluten and also answer the following questions. Where is gluten found? How to remove it from the diet? How to follow a healthy diet?.