Knowledge, Utilization, and Accessibility of Child Welfare Card among Caregivers in a Tertiary Center in South West Nigeria

Background: The Child Welfare Card (CWC) contains the records of a child's immunization and information on the other aspects of the child's health, including growth curves and home treatment of diarrheal disease to mention a few. How easily retrievable these records are and what influence the cards have on parents/caregivers regarding the child's nurture are uncertain in our environment. Aim: The present study was aimed at assessing the parents/caregivers' knowledge and utilization of CWCs as well as the health-providers' accessibility of the card in the hospital. Method: This study was a cross-sectional descriptive one that involved the parents/caregivers of children aged 60 months and below, attending the children's clinics and wards in a tertiary center. We collected the relevant information, including the sociodemographic data of the parents/caregivers, their knowledge, and assessed the utilization of CWC. The analysis of the categorical data was performed with the IBM Statistical Package for Social Sciences (S.P.S.S) version 23.0 for windows. P values < 0.05 were considered significant. Results: Of the 377 parents/caregivers enrolled in the study, good knowledge of the contents of the CWC was demonstrated by 82 (21.8%) while 78 (20.7%) made the cards available to the health care providers. Eighty (21.2%) made adequate use of the cards at home. A greater number of parents/caregivers from the higher social class had good knowledge of the intervention contents of the CWC (P = 0.005). The accessibility of the cards to the health care-providers was significantly higher among the older parents/caregivers (P = 0.010), those with a good knowledge of CWC (P = 0.020) and parents/caregivers from higher social class (P = 0.001). Subjects with good knowledge were 2.4 times (OR = 2.4, 95% CI = 1.4-4.2) more likely to utilize the intervention contents in the CWC. Conclusion: The overall knowledge, utilization, and accessibility of the CWC were poor. Parents/caregivers with good knowledge were more likely to utilize the information on the CWC compared with participants with poor knowledge

Pediatric Trauma Care in Low Resource Settings: Challenges, Opportunities, and Solutions

Trauma constitutes a significant cause of death and disability globally. The vast majority -about 95%, of the 5.8 million deaths each year, occur in low-and-middle-income countries (LMICs) 3–6. This includes almost 1 million children. The resource-adapted introduction of trauma care protocols, regionalized care and the growth specialized centers for trauma care within each LMIC are key to improved outcomes and the lowering of trauma-related morbidity and mortality globally. Resource limitations in LMICs make it necessary to develop injury prevention strategies and optimize the use of locally available resources when injury prevention measures fail. This will lead to the achievement of the best possible outcomes for critically ill and injured children. A commitment by the governments in LMICs working alone or in collaboration with international non-governmental organizations (NGOs) to provide adequate healthcare to their citizens is also crucial to improved survival after major trauma. The increase in global conflicts also has significantly deleterious effects on children, and governments and international organizations like the United Nations have a significant role to play in reducing these. This review details the evaluation and management of traumatic injuries in pediatric patients and gives some recommendations for improvements to trauma care in LMICs

Filtered sunlight versus intensive electric powered phototherapy in moderate-to-severe neonatal hyperbilirubinaemia: a randomised controlled non-inferiority trial

Summary: Background: Kernicterus resulting from severe neonatal hyperbilirubinaemia is a leading cause of preventable deaths and disabilities in low-income and middle-income countries, partly because high-quality intensive phototherapy is unavailable. Previously, we showed that filtered-sunlight phototherapy (FSPT) was efficacious and safe for treatment of mild-to-moderate neonatal hyperbilirubinaemia. We aimed to extend these studies to infants with moderate-to-severe hyperbilirubinaemia. Methods: We did a prospective, randomised controlled non-inferiority trial in Ogbomoso, Nigeria—a simulated rural setting. Near-term or term infants aged 14 days or younger who were of 35 weeks or more gestational age and with total serum bilirubin concentrations at or above the recommended age-dependent treatment levels for high-risk neonates were randomly assigned (1:1) to either FSPT or intensive electric phototherapy (IEPT). Randomisation was computer-generated, and neither clinicians nor the parents or guardians of participants were masked to group allocation. FSPT was delivered in a transparent polycarbonate room lined with commercial tinting films that transmitted effective phototherapeutic light, blocked ultraviolet light, and reduced infrared radiation. The primary outcome was efficacy, which was based on assessable treatment days only (ie, those on which at least 4 h of phototherapy was delivered) and defined as a rate of increase in total serum bilirubin concentrations of less than 3·4 μmol/L/h in infants aged 72 h or younger, or a decrease in total serum bilirubin concentrations in those older than 72 h. Safety was defined as no sustained hypothermia, hyperthermia, dehydration, or sunburn and was based on all treatment days. Analysis was by intention to treat with a non-inferiority margin of 10%. Findings: Between July 31, 2015, and April 30, 2017, 174 neonates were enrolled and randomly assigned: 87 to FSPT and 87 to IEPT. Neonates in the FSPT group received 215 days of phototherapy, 82 (38%) of which were not assessable. Neonates in the IEPT group received 219 treatment days of phototherapy, 67 (31%) of which were not assessable. Median irradiance was 37·3 μW/cm2/nm (IQR 21·4–56·4) in the FSPT group and 50·4 μW/cm2/nm (44·5–66·2) in the IEPT group. FSPT was efficacious on 116 (87·2%) of 133 treatment days; IEPT was efficacious on 135 (88·8%) of 152 treatment days (mean difference −1·6%, 95% CI −9·9 to 6·7; p=0·8165). Because the CI did not extend below −10%, we concluded that FSPT was not inferior to IEPT. Treatment was safe for all neonates. Interpretation: FSPT is safe and no less efficacious than IEPT for treatment of moderate-to-severe neonatal hyperbilirubinaemia in near-term and term infants. Funding: Thrasher Research Fund and National Center for Advancing Translational Sciences

Susceptibility of asthmatic children to respiratory infection Susceptibilidade de crianças asmáticas a infecções respiratórias

OBJECTIVE: A case-control study of patients with pneumonia was conducted to investigate whether wheezing diseases could be a risk factor. METHODS: A random sample was taken from a general university hospital in S. Paulo City between March and August 1994 comprising 51 cases of pneumonia paired by age and sex to 51 non-respiratory controls and 51 healthy controls. Data collection was carried out by two senior paediatricians. Diagnoses of pneumonia and presence of wheezing disease were independently established by each paediatrician for both cases and controls. Pneumonia was radiologically confirmed and repeatability of information on wheezing diseases was measured. Logistic regression analysis was used to identify risk factors. RESULTS: Wheezing diseases, interpreted as proxies of asthma, were found to be an important risk factor for pneumonia with an odds ratio of 7.07 (95%CI= 2.34-21.36), when the effects of bedroom crowding (odds ratio = 1.49 per person, 95%CI= 0.95-2.32) and of low family income (odds ratio = 5.59 against high family income, 95%CI= 1.38-22.63) were controlled. The risk of pneumonia attributable to wheezing diseases is tentatively calculated at 51.42%. CONCLUSION: It is concluded that at practice level asthmatics should deserve proper surveillance for infection and that at public health level pneumonia incidence could be reduced if current World Health Organisation's guidelines were reviewed as to include comprehensive care for this illness.<br>OBJETIVO: Investigar, através de um estudo caso-controle de pacientes com pneumonia, se as doenças chiadoras poderiam constituir-se em fator de risco. MÉTODOS: De um hospital universitário, na cidade de São Paulo, Brasil, entre março e agosto de 1994, foi tomada uma amostra de 51 casos de pneumonia pareados por sexo e idade a 51 controles sadios e 51 controles não respiratórios. O diagnóstico de pneumonia e a presença de doença chiadora foram investigados de forma independente por cada pediatra tanto para casos quanto para controles. Foi confirmada pneumonia radiologicamente e a repetibilidade da informação sobre doença chiadora foi medida. Foi utilizada regressão logística para identifição de riscos. RESULTADOS: As doenças chiadoras, entendidas como representantes de asma, mostraram ser importante fator de risco para pneumonia, com um odds ratio de 7,07 (IC95%= 2,34-21,36), controlados os efeitos de aglomeração no quarto de dormir (odds ratio de 1,49 por pessoa a mais no quarto, IC95%= 0,95-2,32) e a baixa renda familiar (odds ratio de 5,59 contra alta renda familiar, IC95%= 1,38-22,63). O risco atribuível às doenças chiadoras foi calculado de forma exploratória em 51,42%. CONCLUSÃO: Conclui-se que os clínicos devem ter atenção sobre asmáticos para o risco de infecção e que ao nível da saúde pública a incidência de pneumonia poderia ser reduzida se as orientações atuais da Organização Mundial da Saúde pudessem ser revistas para oferecer atenção integral para os doentes