Journal of Tropical Pediatrics最新文献

Early identification of developmental and behavioral delays could improve child's health in the long term. The aim was to determine the prevalence and explore the associated factors with child development and behavior. A cross-sectional study was carried out with Brazilian children aged 4 years old and their respective caregivers. Child's development and behavior were assessed using the Brazilian screening tool version of the Survey of Well-being of Young Children. Generalized linear models were used to analyze the associations between explicative variables and outcomes. Prevalence of suspected development delay was 28.0% and behavior problems was 39.5%. Children sex, school period, daily reading, and behavior domain were associated with development domain, while sleeping time, development domain, food insecurity, and ultraprocessed food score were associated with behavior domain. It is necessary to encourage the expansion of screening instruments in daily primary health-care practice, expand professional's specialization, and improve multisectoral integration.

To assess the effects of delayed cord clamping (DCC) at birth on newborns diagnosed with intrauterine growth restriction (IUGR). This prospective, randomized, controlled study included newborns diagnosed with IUGR during pregnancy follow-up and born at a gestational age of ≥28 weeks. Early cord clamping (ECC) was performed immediately after birth, whereas DCC was performed 60 s postdelivery. The ECC and DCC groups were compared based on cord blood and 24-h venous hematocrit levels, polycythemia rates, and clinical complications associated with polycythemia. A total of 96 newborns, 48 in each group, were analyzed. Gestational weeks, birth weight, Apgar score, delivery mode, and maternal features were similar between the groups (P > .05). At 24 h postnatally, hematocrit values were significantly higher in the DCC group (61.27% ± 5.93%) compared to the ECC group (57.42% ± 7.10%) (P = .005). The 24-h polycythemia rate was also higher in the DCC group (31.3% vs. 12.5%, P = .02). Partial exchange transfusion (PET) was required for one neonate in the DCC group (2.1%). The rates of respiratory distress, phototherapy-requiring jaundice, hypoglycemia within the first two days, intensive care admission, and need for close monitoring were similar between the groups (P > .05). In neonates with IUGR, delayed cord clamping for 60 s at birth led to increased venous hematocrit levels and a higher polycythemia rate. Larger studies are warranted to clarify whether DCC influences the need for PET and the frequency or severity of polycythemia-associated clinical complications.

Data from studies conducted on histoplasmosis in Nigeria are mostly from the adult age group with sparse information about its occurrence in our paediatric population. Histoplasmosis, often overlooked in tropical paediatric populations, is a critical differential diagnosis in regions with a high tuberculosis (TB) burden, especially in low- and middle-income countries (LMIC). In addition, case series from Nigeria show histoplasmosis is commonly misdiagnosed as TB in paediatric population. This study investigated Nigerian children with presumptive TB for histoplasmosis using Histoplasma antigen assay. This was a descriptive cross-sectional study conducted across paediatric TB clinics in three sites in Nigeria, namely, Uyo, Ibadan, and Calabar. One hundred participants were recruited; 73 were unconfirmed cases of TB, 27 were confirmed TB cases, while 21 were participants with advanced HIV disease. The urine samples were assayed for the detection of Histoplasma antigen using the MiraVista lateral flow assay (MVD LFA) and Clarus IMMY ELISA. Of the 100 sampled participants, two participants tested positive for Histoplasma antigen with MVD LFA, while none were positive with ELISA. Notably, these individuals were unconfirmed cases of TB. Paediatric histoplasmosis is not an uncommon finding in Nigerian children presenting with symptoms mimicking TB. The findings highlight the urgent need for cost-effective, accessible diagnostics in resource-limited settings to improve paediatric care, with further research required for the validation of Histoplasma antigen assay diagnostics in children.

Lactobacillus reuteri DSM 17938 (L. reuteri) has been recommended for treating acute diarrhoea; however, literature data about its efficacy are scarce and controversial. This study investigated the effectiveness of L. reuteri supplementation on the treatment outcome of children with acute diarrhoea. A randomized double-blind controlled trial was conducted in children with acute diarrhoea who attended the outpatient clinic of Srinakharinwirot University Hospital, Thailand. Eligible children were randomly allocated to receive either L. reuteri 1 × 108 colony-forming units or a placebo for 5 days. The primary outcome was the time diarrhoea was resolved. Of the 48 participants (23 in L. reuteri and 25 in the placebo group), 29 (60.4%) were male and the mean age (range) was 12.3 months (1-26 months). The median time for diarrhoea to be resolved was significantly shorter in the L. reuteri group compared to the control (48 and 60 h, respectively, P-value = .042). The percentage of participants who recovered within 48 h was significantly higher in the L. reuteri group (65.2%) compared to the control group (36.0%) [relative risk (RR) 3.33, 95% confidence interval (CI) 1.02-10.89, P-value = .043]. The percentage of participants who recovered from diarrhoea within 72 h was 87.0% and 60%, respectively, [RR 4.44, 95% CI 1.04-19.0, P-value = .036]. No persistent diarrhoea or severe adverse effects were observed in both groups.The use of L. reuteri DSM 17938 as an adjunct therapy led to a significantly shorter duration of diarrhoea in children with acute diarrhoea.

Access to advanced clinical training and experienced instructors is often limited in many low- and middle-income countries (LMICs), highlighting the need for practical, scalable, and resource-efficient teaching approaches. This study aimed to ascertain the application value of student-standardized patient (SSP) scenario-based simulation teaching mode in combination with serialized micro-course instruction in pediatric clinical nursing teaching. A quasi-experimental design was employed. Third-year nursing students from the 2017 and 2018 cohorts were selected via convenience sampling, with 45 students in both the control and experimental groups. The control group received traditional teaching methods, while the experimental group was instructed using a teaching model combining SSP scenario-based simulation with serialized micro-course instruction. Outcomes assessed included theoretical and practical examination scores, self-directed learning, communication, empathy, humanistic care, self-efficacy, professional identity, and teaching satisfaction. Nursing students in the experimental group possessed higher scores in both theoretical and practical assessment, better self-learning ability, communication ability, empathy ability, humanistic caring ability, self-efficacy and professional identity, and more satisfaction with teaching versus nursing students in the control group (P-value <.05). The application of SSP scenario-based simulation teaching mode combined with serialized micro-course instruction in pediatric clinical nursing teaching can effectively enhance nursing students' theoretical and practical assessment skills, self-learning, communication, empathy, humanistic caring, self-efficacy, professional identity, and satisfaction with teaching. Due to its flexibility and low demand for resources, this model presents a feasible and scalable option for enhancing nursing education, particularly in settings with limited educational infrastructure, such as LMICs.

RSV is a major health concern for infants. A new long-acting anti-RSV monoclonal antibody has been introduced in some countries. This study aims to assess pregnant women's awareness of RSV and their attitudes toward infant immunization with the anti-RSV monoclonal antibody. A survey on the RSV mAb was conducted with 217 pregnant women, consisting of 28 questions on sociodemographic characteristics, knowledge of RSV infection and the RSV mAb, and attitudes toward giving the mAb to their infant. Pregnant women were specifically surveyed about the use of nirsevimab. Among the participants, 18.5% reported that their child had previously experienced an RSV infection, with 47.6% requiring hospitalization. Willingness expressed by 50.7% to get the RSV mAb, 27.8% were undecided, and 21.6% would not get immunized. The main reason for refusal was lack of information (67.3%). Notably, 58.4% of undecided mothers would consider the RSV mAb if included in the routine immunization schedule. Multiple logistic regression analysis revealed that "having previously heard of the RSV mAb" and "receipt of other nonroutine vaccines" were independent factors influencing the consideration of the RSV mAb. A thorough literature review revealed no other studies assessing pregnant women's attitudes toward RSV mAb; it showed they would be more willing to accept it if included in Turkey's national vaccine programs. Further studies are needed globally to find if RSV vaccination rates increase if the benefits of infection protection and detailed information about the RSV vaccine are provided to mothers or families.

Diarrhoeal diseases remain a significant public health concern globally, particularly among under-five children. Understanding the factors influencing diarrhoea prevalence and treatment practices is crucial for improving child health outcomes. Hence, this study aimed to assess the burden, determinants, and management practices of diarrhoeal diseases among under-five children in India. We conducted a secondary data analysis of NFHS-5, covering 707 districts across India. The survey employed a stratified two-stage sampling method, and analysis included 186 920 under-five children. Poisson regression was utilized for identifying determinants of diarrhoeal burden and health-seeking behaviour and reported as adjusted prevalence ratio with 95% confidence interval. Prevalence of diarrhoea in under-five children has decreased from 9.5% in 2015-16 to the current estimate of 7.5% in 2019-21. Health seeking behaviour for diarrhoea has changed from 76.2% in 2015-16 to 76.8% in 2019-21. Age, gender, birth weight, malnutrition, maternal age, and education level were significantly associated with diarrhoea prevalence. Geographical region and wealth index influenced health-seeking behaviour towards diarrhoeal illness. The study shows a marginal decline in the diarrhoeal prevalence among children under-five years in India. Key determinants identified highlight the critical areas where targeted interventions are urgently needed.

Early differentiation between severe multi-inflammatory syndrome in children (MIS-C) and severe presentations of dengue, scrub typhus, and other endemic tropical infections could help clinicians devise appropriate treatment strategies. This study aims to identify the diagnostic markers that may be used to discriminate between MIS-C versus endemic tropical infections, namely dengue and scrub typhus, which frequently occur in endemic areas. A retrospective study was conducted in a pediatric intensive care unit (PICU) of a tertiary care center in New Delhi, India between 2020 and 2023. Comparative analysis of 33 children diagnosed with MIS-C was done versus 77 children with five endemic tropical infections-dengue, scrub typhus, typhoid fever, malaria, and leptospirosis. Rash [63.63% vs. 31.64% (P = 0.005)], conjunctival redness [63.63% vs. 8.86% (P < 0.001)], and altered sensorium [45.45% vs. 22.78% (P = 0.031)] were seen in a greater proportion of MIS-C cases than those with tropical infections. C-reactive protein (CRP) (mg/dl) was significantly higher in children with MIS-C versus those with tropical infections [176.1 (112.61, 198.32) vs. 9.25 (24.05, 69.38), P ≤ 0.001]. Ferritin and lactate dehydrogenase (LDH) were observed to be significantly higher in children with tropical infections compared to those with MIS-C. Using multivariable logistic regression analysis, the odds of having a rash were higher among children with MIS-C than those with dengue [OR = 8.07 (95% CI: 1.22-53.48, P = 0.03)]; followed by altered sensorium [OR = 16.04 (95% CI: 2.06-124.62, P = 0.008)]; myocardial involvement [OR = 7.18 (95% CI: 1.12-45.93, P = 0.037)]; and CRP (>50 mg/dl) [OR = 17.59 (95% CI: 2.69-114.92, P = 0.003)]. The findings of our study suggest that several clinical and laboratory measures could potentially distinguish between patients with severe MIS-C and endemic tropical infections. Clinical markers such as rash, altered sensorium, myocardial involvement, and shock were seen in a greater proportion of cases with MIS-C. Inflammatory markers such as CRP were higher in children with MIS-C, whereas ferritin and LDH were higher in dengue, scrub typhus, typhoid fever, malaria, and leptospirosis.

Vaccine-preventable diseases (VPD) account for a major proportion of childhood morbidity and mortality in developing countries. This study aimed to evaluate the seroprotection status of common VPD in children with type 1 diabetes mellitus (T1DM). The study enrolled 38 children aged 3-18 years with T1DM and 40 age-and sex-matched healthy controls. Demographic and clinical parameters were recorded. Venous blood samples were collected to estimate glycated hemoglobin (HbA1c) and antibody titers against hepatitis B and measles, mumps, and rubella (MMR). Both groups had completed immunization for these diseases by 2 years of age. The median age was 9.5 years with mean (SD) HbA1c 11.41 (2.57) %. Adequate seroprotection against hepatitis B, MMR were 42.5%, 32.5%, 50%, and 65% in T1DM, respectively and 55%, 50%, 40%, 65% in controls, respectively (P > .05). The median (first and third quartile) antibody levels for hepatitis B and measles in T1DM were 4.32 (0, 113.67) mIU/l and 127.4 (44.78, 347.68) mIU/l, respectively, both below the seroprotection cut-offs and lower than in controls (P > 0.05). The correlation (r) of age with anti-measles, antimumps, and antirubella antibody titers was 0.326 (P = 0.040), 0.096 (P = 0.554), and 0.334 (P = 0.035), respectively, in the cases. Anti-Hepatitis B titers correlated negatively with age (r = -0.287, P = .072). Lower seroprotection (statistically insignificant) to hepatitis B and measles were observed in children with T1DM than in controls. Physicians should consider surveillance of hepatitis B and measles, mumps, and rubella seroprotection in T1DM to evaluate the need for further boosters. Larger and more robust studies are needed on seroprotection in patients with T1DM.