Outbreak of Fatal Childhood Lead Poisoning Related to Artisanal Gold Mining in Northwestern Nigeria, 2010.

Background: In May 2010, a team of national and international organizations was assembled to investigate children's deaths due to lead poisoning in villages in northwestern Nigeria. Objectives: To determine the cause of the childhood lead poisoning outbreak, investigate risk factors for child mortality, and identify children aged <5 years in need of emergency chelation therapy for lead poisoning. Methods: We administered a cross-sectional, door-to-door questionnaire in two affected villages, collected blood from children aged 2-59 months, and soil samples from family compounds. Descriptive and bivariate analyses were performed with survey, blood-lead, and environmental data. Multivariate logistic regression techniques were used to determine risk factors for childhood mortality. Results: We surveyed 119 family compounds. One hundred eighteen of 463 (25%) children aged <5 years had died in the last year. We tested 59% (204/345) of children, aged <5 years, and all were lead poisoned (≥10 µg/dL); 97% (198/204) of children had blood-lead levels ≥45 µg/dL, the threshold for initiating chelation therapy. Gold ore was processed inside two-thirds of the family compounds surveyed. In multivariate modeling significant risk factors for death in the previous year from suspected lead poisoning included: the child's age, the mother performing ore-processing activities, community well as primary water source, and the soil-lead concentration in the compound. Conclusion: The high levels of environmental contamination, percentage of children aged <5 years with elevated blood-lead levels (97%, >45 µg/dL), and incidence of convulsions among children prior to death (82%) suggest that most of the recent childhood deaths in the two surveyed villages were caused by acute lead poisoning from gold ore-processing activities. Control measures included environmental remediation, chelation therapy, public health education, and control of mining activities

Referrals and Management Strategies for Pediatric Obesity—DocStyles Survey 2017

Background: Childhood obesity care management options can be delivered in community-, clinic-, and hospital-settings. The referral practices of clinicians to these various settings have not previously been characterized beyond the local level. This study describes the management strategies and referral practices of clinicians caring for pediatric patients with obesity and associated clinician characteristics in a geographically diverse sample.Methods: This cross-sectional study used data from the DocStyles 2017 panel-based survey of 891 clinicians who see pediatric patients. We used multivariable logistic regression to estimate associations between the demographic and practice characteristics of clinicians and types of referrals for the purposes of pediatric weight management.Results: About half of surveyed clinicians (54%) referred &lt;25% of their pediatric patients with obesity for the purposes of weight management. Only 15% referred most (≥75%) of their pediatric patients with obesity for weight management. Referral types included clinical referrals, behavioral referrals, and weight management program (WMP) referrals. Within these categories, the percentage referrals ranged from 19% for behavioral/mental health professionals to 72% for registered dieticians. Among the significant associations, female clinicians had higher odds of referral to community and clinical WMP; practices in the Northeast had higher odds of referral to subspecialists, dieticians, mental health professionals, and clinical WMP; and clinics having ≥15 well child visits per week were associated with higher odds of referral to subspecialists, mental health professionals, and health educators. Not having an affiliation with teaching hospitals and serving low-income patients were associated with lower odds of referral to mental health professionals, and community and clinical WMP. Compared to pediatricians, family practitioners, internists, and nurse practitioners had higher odds of providing referrals to mental health professionals and to health educators.Conclusion: This study helps characterize the current landscape of referral practices and management strategies of clinicians who care for pediatric patients with obesity. Our data provide insight into the clinician, clinical practice, and reported patient characteristics associated with childhood obesity referral types. Understanding referral patterns and management strategies may help improve care for children with obesity and their families

Factors Associated with Daily Fruit and Vegetable Intakes among Children Aged 1–5 Years in the United States

To describe child, caregiver, and household characteristics associated with fruit and vegetable intakes among US children aged 1–5 years, we examined fruit and vegetable intakes (less than daily vs. daily) using data from the 2021 National Survey of Children’s Health among children aged 1–5 years. Multiple logistic regression provided adjusted odds ratios for factors associated with (1) daily fruit and (2) daily vegetable intakes. Among children aged 1–5 years, 68% (n = 11,124) consumed fruit daily, and 51% (n = 8292) consumed vegetables daily. Both daily fruit and daily vegetable intake were associated with child age, child race and ethnicity, and frequency of family meals. For example, children who ate a family meal 4–6 days/week (aOR 0.69; 95% CI 0.57, 0.83) or 0–3 days/week (aOR 0.57; 95% CI 0.46, 0.72) were less likely to consume fruit daily compared to children who had a family meal every day. Participation in food assistance programs, food insufficiency, and household income were not significantly associated with odds of daily fruit or daily vegetable intake in the adjusted models. Several factors were associated with daily fruit and vegetable intake among children aged 1–5. Strategies aimed at increasing fruit and vegetable consumption in early childhood may consider these child, caregiver, and household characteristics. Pediatric healthcare providers, early childhood education centers, and families of young children may be important partners in this work

Knowledge, attitudes, and practices of nonpharmaceutical interventions following school dismissals during the 2009 Influenza A H1N1 pandemic in Michigan, United States.

BACKGROUND: Many schools throughout the United States reported an increase in dismissals due to the 2009 influenza A H1N1 pandemic (pH1N1). During the fall months of 2009, more than 567 school dismissals were reported from the state of Michigan. In December 2009, the Michigan Department of Community Health, in collaboration with the United States Centers for Disease Control and Prevention, conducted a survey to describe the knowledge, attitudes, and practices (KAPs) of households with school-aged children and classroom teachers regarding the recommended use of nonpharmaceutical interventions (NPIs) to slow the spread of influenza. METHODS: A random sample of eight elementary schools (kindergarten through 5th grade) was selected from each of the eight public health preparedness regions in the state. Within each selected school, a single classroom was randomly identified from each grade (K-5), and household caregivers of the classroom students and their respective teachers were asked to participate in the survey. RESULTS: In total, 26% (2,188/8,280) of household caregivers and 45% (163/360) of teachers from 48 schools (of the 64 sampled) responded to the survey. Of the 48 participating schools, 27% (13) experienced a school dismissal during the 2009 fall term. Eighty-seven percent (1,806/2,082) of caregivers and 80% (122/152) of teachers thought that the 2009 influenza A H1N1 pandemic was severe, and >90% of both groups indicated that they told their children/students to use NPIs, such as washing hands more often and covering coughs with tissues, to prevent infection with influenza. CONCLUSIONS: Knowledge and instruction on the use of NPIs appeared to be high among household caregivers and teachers responding to the survey. Nevertheless, public health officials should continue to explain the public health rationale for NPIs to reduce pandemic influenza. Ensuring this information is communicated to household caregivers and teachers through trusted sources is essential

Household caregiver and teacher responses to selected items from school dismissal survey on nonpharmaceutical interventions (NPIs) by school dismissal Status in fall 2009^*, from 48 elementary schools^†, Michigan, USA.

<p>* Schools selected randomly (irrespective of size) from each of the eight public health preparedness regions in Michigan.</p>†<p>Of the 48 schools included in the survey, 13 were reactively dismissed due to student/teacher absenteeism and 35 remained open during the fall 2009.</p>‡<p>p-Values are calculated based on Pearson's Chi-square test.</p><p>Differences were considered statistically significant if p<0.0022.</p

Household caregiver and teacher instruction to children/students on the use of nonpharmaceutical interventions (NPIs), by concern about being infected with influenza H1N1.

<p>* Pearson's Chi-square test was used to compare NPIs between caregivers who reported concern and non-concerned caregivers.</p>†<p>Pearson's Chi-square test was used to compare NPIs between caregivers and teachers.</p><p>Differences were considered statistically significant if p<0.05.</p

Household caregiver responses regarding source of information on the 2009 influenza A H1N1 pandemic (pH1N1)^*.

<p>* Schools selected randomly (irrespective of size) from each of the eight public health preparedness regions in Michigan.</p>†<p>p-Values are calculated based on Pearson's Chi-square test.</p>‡<p>Government Health Officials include the U.S. Centers for Disease Control and Prevention as well as state and local health departments in Michigan.</p>§<p>Schools include teachers, principals, superintendents, school staff, PTA (Parent and Teacher Association) and school websites.</p

Household caregiver and teacher responses to school dismissal survey^* on knowledge, attitudes, and practices regarding pH1N1.

<p>* Schools selected randomly (irrespective of size) from each of the eight public health preparedness regions in Michigan, United States.</p>†<p>Households attending dismissed schools.</p>‡<p>Pearson's Chi-square test was used to compare differences between caregivers and teachers.</p><p>Differences were considered statistically significant if p<0.05.</p