Long-Term Mental Health and Quality of Life Outcomes of Neonatal Insults in Kilifi, Kenya

We examined the mental health and quality of life (QoL) outcomes and their correlates of school-aged survivors of neonatal jaundice (NNJ), hypoxic-ischemic encephalopathy (HIE), and a comparison group. The Child Behavior Checklist and the Pediatric Quality of Life Inventory were administered to assess the mental health and QoL of 375 children (134 with NNJ, 107 with HIE, and 134 comparison group) aged 6 to 12 years [Median age 9 (interquartile range 7 to 11)]. The results showed that survivors of NNJ and HIE have mental health problems and QoL similar to the comparison group. Maternal mental health was the predominant covariate of mental health and QoL in survivors of NNJ and HIE. This result could indicate that mothers with mental health problems are more likely to have children with mental health issues, but also that caring for children with these adversities may affect mental health well-being of the caregivers. There is a need for early mental health screening and psychosocial intervention for caregivers and their children to enhance both their mental health and QoL

A randomized control trial of phototherapy and 20% albumin versus phototherapy and saline in Kilifi, Kenya

Objective: The study evaluated the efficacy of phototherapy and 20% albumin infusion to reduce total serum bilirubin (TSB) in neonates with severe hyperbilirubinemia. The primary outcome was a reduction of TSB at the end of treatment. The secondary outcomes were the need for exchange transfusion, inpatient mortality, neurological outcomes at discharge, and development outcomes at 12-months follow-up. Results: One hundred and eighteen neonates were randomly assigned to phototherapy and 20% albumin (n = 59) and phototherapy and saline (n = 69). The median age at admission was 5 (interquartile range (IQR) 3–6) days, and the median gestation was 36 (IQR 36–38) weeks. No significant differences were found in the change in TSB (Mann–Whitney U =609, p = 0.98) and rate of change in TSB per hour after treatment (Mann–Whitney U = 540, p = 0.39) between the two groups. There were no significant differences between the two groups in the proportion of participants who required exchange transfusion (χ2 (2) = 0.36, p = 0.546); repeat phototherapy (χ2 (2) = 2.37, p = 0.123); and those who died (χ2 (2) = 0.92, p = 0.337). Trial registration The trial was registered in the International Standardized Randomized Controlled Trial Number (ISRCTN); trial registration number ISRCTN89732754

Long-term outcomes of survivors of neonatal insults: A systematic review and meta-analysis

Background: The Millennium Developmental Goals ensured a significant reduction in childhood mortality. However, this reduction simultaneously raised concerns about the long-term outcomes of survivors of early childhood insults. This systematic review focuses on the long-term neurocognitive and mental health outcomes of neonatal insults (NNI) survivors who are six years or older. Methods: Two independent reviewers conducted a comprehensive search for empirical literature by combining index and free terms from the inception of the databases until 10th October 2019. We also searched for additional relevant literature from grey literature and using reference tracking. Studies were included if they: were empirical studies conducted in humans; the study participants were followed at six years of age or longer; have an explicit diagnosis of NNI, and explicitly define the outcome and impairment. Medians and interquartile range (IQR) of the proportions of survivors of the different NNI with any impairment were calculated. A random-effect model was used to explore the estimates accounted for by each impairment domain. Results: Fifty-two studies with 94,978 participants who survived NNI were included in this systematic review. The overall prevalence of impairment in the survivors of NNI was 10.0% (95% CI 9.8–10.2). The highest prevalence of impairment was accounted for by congenital rubella (38.8%: 95% CI 18.8–60.9), congenital cytomegalovirus (23.6%: 95% CI 9.5–41.5), and hypoxic-ischemic encephalopathy (23.3%: 95% CI 14.7–33.1) while neonatal jaundice has the lowest proportion (8.6%: 95% CI 2.7–17.3). The most affected domain was the neurodevelopmental domain (16.6%: 95% CI 13.6–19.8). The frequency of impairment was highest for neurodevelopmental impairment [22.0% (IQR = 9.2–24.8)] and least for school problems [0.0% (IQR = 0.0–0.00)] in any of the conditions. Conclusion: The long-term impact of NNI is also experienced in survivors of NNI who are 6 years or older, with impairments mostly experienced in the neurodevelopmental domain. However, there are limited studies on long-term outcomes of NNI in sub-Saharan Africa despite the high burden of NNI in the region

The Geochemistry of Rocks from Asama Volcano, Japan. New Approaches in the Quantitative Interpretation of the Chemical Composition of Volcanic Rocks

In dealing with the geochemistry of volcanic rocks, it appears imperative, first, to refine the procedure of rock analysis with respect to both major and minor components, and second, to improve present methods of interpreting analytical data on common rock suites such as basalts, andesites and dacites. In regard to the first problem, the rapid method of silicate analysis as described by Shapiro and Brannock (1956) and by Riley (1958) deserves special attention. With such a method it is possible to estimate the accuracy and precision of data with far greater ease than is possible with a classical one, yet without any loss of quality. For the determination of some components, however, it is felt that the procedures recommended previously lack precision and/or simplicity. In Part I of this paper, new methods are suggested for these components. The sum of Mg, Ca and Mn is titrated with EDTA in the presence of Al, Fe and other metals, using thymolphthalein complexone as indicator at pH 10-10.5. The sum of Al and Fe is determined by the back-titration of excess EDTA with the standard Cu solution. PAN is used as indicator at pH about 4, and tartrate is added as the masking agent of Ti. Na and K are determined by flame photometry using very dilute solutions (1-5ppm Na or K), without the separation of other metals and without the use of the internal standard. Sr is included in the scheme of analysis, and is determined by flame photometry according to the standard addition technique. These procedures are tested for their accuracy using the standard samples G-1 and W-1 (Tables 3, 5, 9, 12 and 15). Procedures for other components are also described in the text in full detail. The system of analytical procedures recommended is shown in Table 16. To investigate the problem of the interpretation of compositional variation, typical rocks from Asama volcano and the surrounding area were selected, namely, andesites and dacites of calc-alkaline type. Twenty-one samples, described in Tables 18 and 19, are analyzed according to the above procedures. Results are shown in Table 20. Variation diagrams are presented in Figs. 3 to 5. Since it may be questioned whether the "trend" seen in the diagrams implies a genetic relationship, a least squares approximation technique has been introduced in order to determine whether the composition of the main components of a rock (F) can be expressed by the linear combination of a selected set of compositions of a magma and the phenocrysts crystallized from it : F(o)=F(1)x(1)+F(2)x(2)+······+F(m)x(m) ······(1) where F(1), F(2), ... denote the compositions of a magma and minerals, and F(o) is the calculated composition of F. These calculations lead to the conclusion that there are at least two series of rocks in Asama (Tables 25 to 30 and Fig. 9), distinguished from each other mainly by their K(2)O content. Those rocks showing features of assimilation (Aramaki, 1963) all belong to the K(2)O-rich series. Contents of minor components such as TiO(2), MnO, P(2)O(5) and SrO are analyzed by the linear regression technique in two ways, for example : TiO(2)(o)=C(1)x(1)+C(2)x(2)+ ······(2) and TiO(2)(o)=aMgO+bFe(o) +cK(2)O ······(3) These methods are found useful in discriminating rocks of different ongm and in distinguishing the characteristic behavior of each component. Results of calculations (Tables 31 to 34) support the conclusion reached by calculations based on the contents of major components

Quality of life in children and adolescents in Central Kenya: associations with emotional and behavioral problems

Purpose: To assess the quality of life (QoL) of children and adolescents in Kenya as rated by parents and youth themselves, and examine how QoL is related to emotional and behavioral problems (EBP). Method: QoL and EBP reports were obtained from 1022 Kenyan parents and 533 adolescents living in the country’s Central Province. Parents with children between 6 and 18 years completed the Pediatric Quality of Life Inventory (PedsQL) and the Child Behavior Checklist, while the adolescents (12–18) completed the PedsQL and the Youth Self-Report. Results: Parent-reported QoL in Kenyan youth was somewhat above that of US standardization samples, while levels of adolescent self-reports were well within the range of those from most high- and middle-income countries. Average adolescent girls’ self-reports were lower on all QoL scales than boys. QoL in children/adolescents with clinical to borderline levels of EBP (cf. multicultural norms, Achenbach and Rescorla, 2007) was lower than QoL in agemates with normal levels of EBP. Regression analyses indicated unique associations of QoL with parent-reported withdrawn/depressed, somatic complaints, attention problems, and aggressive behavior, and with adolescent self-reported somatic complaints, attention problems, and rule-breaking behavior. Conclusion: QoL levels were well within ranges of other countries. Moreover, associations of QoL with EBP indicated that those with borderline/clinical levels of EBP had a much lower QoL most notable for those with somatic complaints and attention problems. Mental health providers might focus on interventions that reduce EBP in Kenyan children and adolescents and simultaneously reduce the risk of lowered QoL

Emotional and Behavioral Problems in Children and Adolescents in Central Kenya

Emotional and behavioral problems (EBP) during childhood and adolescence are a common concern for parents and mental health stakeholders. However, little has been documented about their prevalence in Kenyan children and adolescents. This study aimed to close this gap. The study included Child Behavior Checklist reports from 1022 Kenyan parents on their children (ages 6–18 years) and Youth Self-Reports from 533 adolescents (ages 12–18) living in Kenya’s Central Province. EBP in Kenya are highly prevalent compared to multi-cultural standards for parent reports, with 27 and 17% scoring in the borderline and clinical range, respectively. Based on parent reports, younger children scored higher on EBP than older children, and higher on internalizing problems. Based on self-reports girls scored higher than boys, particularly on internalizing problems. The study provides evidence on elevated parent-reported EBP in Kenyan youths. Mental health providers should focus on interventions that reduce EBP in Kenyan youths

Patterns of neurobehavioral functioning in school-aged survivors of neonatal jaundice and hypoxic-ischemic encephalopathy in Kilifi, Kenya: A cross-sectional study

Background: Studies in high-income countries have reported that school-aged children who survive neonatal jaundice (NNJ) and hypoxic-ischemic encephalopathy (HIE) develop long-term neurocognitive problems. However, less is known about the patterns of functioning in school-aged survivors of NNJ and HIE in sub-Saharan Africa. This study examined patterns of functioning in school-aged children who survived NNJ and HIE in Kilifi, Kenya. Methods: : This is a cross-sectional study that included 107 survivors of NNJ/HIE (64 with NNJ, 43 with HIE), aged 6-12 years, admitted to Kilifi County Hospital on the Kenyan Coast. The Gross Motor Function Classification System (GMFCS), Adapted Communication Profile, Raven’s Coloured Progressive Matrices (RCPM) and an epilepsy screening tool were used to assess gross motor function, communication function, intellectual functioning, and epilepsy, respectively. Results: : Most of the survivors of NNJ (95.2%) and HIE (95.3%) had no impairments in gross motor functioning. A small percentage of the children in the NNJ and HIE groups had profound problems in their communication (4.7% and 4.7%); expressive communication function (4.7% and 4.7%); social functions (3.1% and 2.3%); receptive communication (4.7% and 2.3%); and communicative effectiveness (4.7% and 2.3%). Cognitive impairment was reported in 10.9% and 11.9% for NNJ and HIE survivors, respectively. Active epilepsy was detected in 1.6% of survivors of NNJ and 2.3% of survivors of HIE. A subgroup of severe NNJ and HIE survivors without co-occurring conditions had the worst intellectual and active epilepsy outcomes. All children had normal hearing and visual functioning except one participant who presented with mild visual acuity problems. Conclusions: : Most school-aged children who survive with NNJ and HIE have normal motor and communication function; however, one in ten are likely to present with lowered intellectual functioning compared to the normative sample

Long-Term Mental Health and Quality of Life Outcomes of Neonatal Insults in Kilifi, Kenya

We examined the mental health and quality of life (QoL) outcomes and their correlates of school-aged survivors of neonatal jaundice (NNJ), hypoxic-ischemic encephalopathy (HIE), and a comparison group. The Child Behavior Checklist and the Pediatric Quality of Life Inventory were administered to assess the mental health and QoL of 375 children (134 with NNJ, 107 with HIE, and 134 comparison group) aged 6 to 12 years [Median age 9 (interquartile range 7 to 11)]. The results showed that survivors of NNJ and HIE have mental health problems and QoL similar to the comparison group. Maternal mental health was the predominant covariate of mental health and QoL in survivors of NNJ and HIE. This result could indicate that mothers with mental health problems are more likely to have children with mental health issues, but also that caring for children with these adversities may affect mental health well-being of the caregivers. There is a need for early mental health screening and psychosocial intervention for caregivers and their children to enhance both their mental health and QoL

Patterns of neurobehavioral functioning in school-aged survivors of neonatal jaundice and hypoxic-ischemic encephalopathy in Kilifi, Kenya:A cross-sectional study [version: 1; peer review: 2 approved with reservations, 1 not approved]

Background: Studies in high-income countries have reported that school-aged children who survive neonatal jaundice (NNJ) and hypoxic-ischemic encephalopathy (HIE) develop long-term neurocognitive problems. However, less is known about the patterns of functioning in school-aged survivors of NNJ and HIE in sub-Saharan Africa. This study examined patterns of functioning in school-aged children who survived NNJ and HIE in Kilifi, Kenya. Methods: This is a cross-sectional study that included 107 survivors of NNJ/HIE (64 with NNJ, 43 with HIE), aged 6-12 years, admitted to Kilifi County Hospital on the Kenyan Coast. The Gross Motor Function Classification System (GMFCS), Adapted Communication Profile, Raven’s Coloured Progressive Matrices (RCPM) and an epilepsy screening tool were used to assess gross motor function, communication function, intellectual functioning, and epilepsy, respectively. Results: Most of the survivors of NNJ (95.2%) and HIE (95.3%) had no impairments in gross motor functioning. A small percentage of the children in the NNJ and HIE groups had profound problems in their communication (4.7% and 4.7%); expressive communication function (4.7% and 4.7%); social functions (3.1% and 2.3%); receptive communication (4.7% and 2.3%); and communicative effectiveness (4.7% and 2.3%). Cognitive impairment was reported in 10.9% and 11.9% for NNJ and HIE survivors, respectively. Active epilepsy was detected in 1.6% of survivors of NNJ and 2.3% of survivors of HIE. All children had normal hearing and visual functioning except one participant who presented with mild visual acuity problems. Conclusions: Most school-aged children who survive with NNJ and HIE have normal motor and communication function; however, one in ten are likely to present with lowered intellectual functioning compared to the normative sample