Participatory paediatrics

Professor Monica Lakhanpaul discusses how her passion for improving child healthcare has been the driving force behind her exemplary career as a consultant paediatrician and researche

Learning Together 1: an educational model for training GPs, paediatricians: initial findings.

Learning Together is primarily an educational intervention, where paediatric registrars [SpRs] and General Practice (GP) registrars [GPSTs] see children together in a primary care setting. Over a six month period in 2013/2014, 44 learning pairs were set up mainly in North East and Central London. Proof of concept for the model at scale was achieved. Reported learning demonstrated: clinical learning themes of new knowledge, skill and communication skills; and collaborative themes of ongoing collaboration, satisfaction with team working and change in attitudes. These themes were identified in both sets of trainees. The self-reported learning is backed up by the results of a retrospective notes review of four common conditions based on NICE guidelines; constipation, asthma, feverish illness and eczema (CAFE). Guidance adherence improved from 57% before the intervention in solo GP training consultations to 72% during the joint clinic intervention (p < 0.01). After the intervention when the GP registrars returned to normal consultations, guidance adherence was 77% compared to before the intervention (p < 0.01). In addition 99% of the parents, who handed in feedback forms or took part in interviews, reported a good experience of care, and 87% reported increased confidence to manage their children's health following the consultation. A second, linked article examines the cost utility of Learning Together in its South London extension

'Birthing a Better Future': A mixed-methods evaluation of an exhibition on the early years of life

BACKGROUND: Our study aimed to evaluate to what extent Zero2 Expo's 'Birthing a Better Future', a co-created multimedia exhibition, was effective in raising awareness on the importance of the first 1001 days of life and explore what refinements would help to optimize the impact of future exhibitions. METHODS: We conducted a mixed-methods evaluation of the exhibition delivered in the John Radcliffe Hospital, Oxford. Through convenience sampling, 14 participants were selected to participate in 12 structured interviews and 19 participants completed a questionnaire. Interviews were thematically analysed alongside quantitative analysis of questionnaire responses through Likert scales. RESULTS: The majority (78.6%, n = 11/14) of participants who completed the questionnaire either agreed or strongly agreed that the exhibition raised their awareness about the first 1001 days of life. This was supported by the analysis of interviews. The use of art was found to provoke an emotional engagement from participants. Participants felt that the length of the written pieces and location of the exhibition were important factors for designers to consider in future exhibitions. CONCLUSION: This study demonstrated that multimedia exhibitions, combining science with art, may be an effective way to raise awareness of public health messages. Engaging with key stakeholders will be an essential step in order to improve future public health exhibitions. PUBLIC CONTRIBUTION: When designing the study, the public reviewed the study tools, which were refined based on their feedback. At every phase of the study, members of the public who are artists co-created the exhibition content

Multiple and complex links between babyWASH and stunting: An evidence synthesis

Studies have shown linkages between water, sanitation and hygiene (WASH) and stunting in children under 2 years in sub-Saharan Africa. WASH interventions have been shown to reduce stunting rates; however, the biological mechanisms and socio-economic influences responsible for this trend remain poorly understood. This paper reviews the literature regarding these links, and the efficacy of both general WASH interventions and those targeted at children in their first 1,000 days, known as babyWASH, for stunting reduction. Fifty-nine papers published between 2008 and 2019 were reviewed, retrieved from Science Direct, Scopus and Web of Science databases, comprising field trials and data analysis, and literature and systematic reviews. Key findings showed that stunting is directly attributed to diarrhoea, environmental enteric dysfunction and undernutrition although a more comprehensive understanding of these biological mechanisms is necessary. Interventions to interrupt the faecal transmission cycle proved to effectively reduce stunting rates, particularly improved sanitation facilities to reduce open defaecation, increased proximity to water and widespread behavioural change. Methodologies should move away from randomised controlled trials towards selected contexts, mixed data collection methods and inclusion of broader social, cultural and environmental conditions. Improved cross-sectoral collaboration is encouraged, particularly to ensure the complexity of social and contextual factors is fully considered

Why are acute admissions to hospital of children under 5 years of age increasing in the UK?

Children’s use of hospital services in the UK has been increasing rapidly since the late 1990s.1–6 Findings from the latest QualityWatch report show significant increases in emergency hospital admissions for infants (23%) and young children aged 1–4 years (11%) between 2006/2007 and 2015/2016 (data have been adjusted for population increases in each childhood age group), while children over the age of 15 years showed a decrease in emergency admissions

Water, Sanitation, and Hygiene: Linkages with Stunting in Rural Ethiopia

Stunting is a global burden affecting nearly 160 million children younger than five years of age. Whilst the linkages between nutrition and stunting are well recognized, there is a need to explore environmental factors such as water and sanitation, which may influence feeding practices and result in potential infection pathways. This paper explores the linkages between stunting and water, sanitation and hygiene (WASH) factors in Ethiopia, which is a relatively understudied context. The research draws upon baseline data for children under the age of five from 3200 households across four regions in Ethiopia as part of a wider study and integrated program led by the United Nations Children’s Fund (UNICEF). Using World Health Organization (WHO) z-scoring, the average stunting rate in the sample is 47.5%. This paper also takes into account demographic and social behavioural factors such as the age, gender of children, and gender of the primary caregiver, in addition to handwashing behaviour and drinking water facilities. The evidence recommends efforts to improve handwashing behaviour for mothers and children with a focus on access to clean water. Higher stunting rates with an increase in the age of children highlight the need for continued interventions, as efforts to improve nutrition and WASH behaviours are most effective early on in promoting long-term health outcomes for children

Urinary tract infections in children and the risk of ESRF.

Paediatric guidance on diagnosis and treatment of urinary tract infections (UTIs) has in the past largely focused on identifying children with vesicoureteral reflux, thought to be at greatest risk of renal scarring. This practice has been questioned, specifically the accepted association between UTI and end-stage renal failure (ESRF) through renal scarring. The aim of this article is to ascertain whether we can predict with confidence the true level of risk that a child with a first-time UTI will subsequently develop ESRF attributable to UTI

An Uphill Task for POSHAN Abhiyan: Examining the Missing Link of 'Convergence'

The Participatory Approach for Nutrition in Children: Strengthening Health, Education, Engineering and Environment Linkages (PANChSHEEEL) project is a collaboration between University College London, Save the Children India, Jawaharlal Nehru University and Indian Institute of Technology Delhi to develop a socio-culturally appropriate, tailored, integrated and interdisciplinary intervention in rural India and test its acceptability for delivery through Anganwadi Centre (AWCs) and schools. Recognizing the socio-ecological determinants of under-nutrition, the POSHAN Abhiyan (POSHAN Mission) adopts a multi-sectoral approach to achieve five goals, of which two are directly related to children. The POSHAN Abhiyan resonates with the conceptual framework of the PANChSHEEEL study in its interdisciplinary scope and focus on local linka ges. This paper draws upon empirical evidence from the PANChSHEEEL Project in Banswara (one of the POSHAN mission districts), Rajasthan to help understand linkages between policy and practice, specifically the challenges of operationalizing ‘convergence’, the core strategy of the Abhiyan

A referral pathway for potentially abnormal neurodevelopment in children with heart disease in the United Kingdom: A Delphi consensus

Introduction: Children with congenital heart disease have complex medical and neurodevelopmental needs. We aimed to develop a multi-professional consensus-based referral pathway applicable to action the results of the brief developmental assessment (BDA), a validated early recognition tool, that categorises the neurodevelopmental status as green (appropriate for age), amber (equivocal) or red (delayed) in children aged between 4 months and 5 years. Methods: A Delphi consensus survey detailing two scenarios—a child categorised as delayed (red) and another as equivocal (amber) on administration of the BDA at the time of discharge from the tertiary centre—was sent to 80 expert professionals from primary, secondary and tertiary care seeking agreement on next steps and referral pathways. An iterative process was proposed with a pre-defined rule of 75% for consensus. Results: The survey was completed by 77 Delphi panel experts in Round 1, 73 in Round 2 and 70 in Round 3. Consensus was achieved (1) for the child with amber or red BDA, the child should be under the care of a paediatrician with expertise in cardiology (PEC) (or general paediatrician if no PEC) based at their local hospital, (2) for the child with red BDA, the PEC should initiate referral to community services at first assessment, (3) for child with amber BDA, a re-assessment by the health visitor should occur within 1–2 months, with referral to community services and notification to the PEC if on-going concerns. Conclusions: The Delphi process enabled a consensus to be reached between health professionals on referral pathways for specialist neurodevelopmental assessment/treatment for children with heart disease, in response to amber or red BDA results. The agreed referral pathway, if implemented, could underpin a national guideline to address and intervene on the neurodevelopmental difficulties in children with heart disease

Barriers to Optimal Health for Under 5s Experiencing Homelessness and Living In Temporary Accommodation in High-Income Countries: A Scoping Review

BACKGROUND: The first 5 years of life are crucial for optimising growth, health, and cognitive development. However, many children do not reach their full cognitive and developmental potential because of multilevel barriers, including those resulting from poverty and homelessness. This review summarises the evidence characterising the barriers to achieving optimal health and cognitive outcomes, and to accessing health services for homeless children younger than 5 years of age (U5s)-one of the most vulnerable populations in High Income Countries (HICs). METHODS: For this scoping review, we followed the PRISMA-ScR checklist and CATS framework. We searched Medline, PubMed, Embase, CINAHL, Web of Science, OVID Maternity and Infant Care, and The Cochrane Library (publications dates from Jan 1, 1980, to Jun 23, 2020) using the key words “homelessness”, “housing”, “paediatrics”, “interpersonal relations”, “social exclusion”, “toddler”, “children under 5”, “engagement”, and “communication and insecurity”. The search strategy yielded 3253 articles. Retrieved articles were organised by study design. Because of the considerable heterogeneity of methods and outcomes, we used a narrative synthesis analytic approach. Our outcome of interest was barriers to optimal health and accessing health services, focusing on U5s living in HICs. FINDINGS: Twenty-nine full texts were selected in the final synthesis, including primary research studies and systematic or narrative reviews of primary research studies from HICs. There was limited evidence describing links among housing insecurity, health, and cognitive outcomes in U5s. This age group was rarely studied as a discrete group and often combined with older ages (eg, ≤25 years). The quality of articles varied greatly because of the heterogeneity in study design. Nevertheless, important themes were identified: barriers were described at the individual and family level (eg, ethnicity, immigration status, and fear), system level (eg, policies, poor access to medication, absence of care plan, and no insurance) and community level (eg, transportation limitations and poor housing conditions). INTERPRETATION: Although evidence is sparse, further methodologically rigorous research is needed to identify what barriers exist for U5s and their parents in accessing health services, and how this affects the child’s health. The multi-level nature of these barriers implies a system’s approach may be required. However, more evidence is needed including cross-sector studies and tailored interventions to address these barriers by working directly with experts with experience of social exclusion and their children