Pediatric health, medicine and therapeutics最新文献

Purpose: Vaccination is one of the most effective and efficient health interventions for reducing morbidity and mortality from infectious diseases, particularly in sub-Saharan Africa. Understanding the determinants of access to vaccines can help improve immunization coverage and control vaccine-preventable diseases. The aim of this study was to explore the contribution of certain determinants to access to pentavalent 3 in children aged 0-23 months in Cameroon via demographic and health survey data.

Materials and methods: This was a cross-sectional nested case‒control study in which children aged 0-23 months were selected via cluster random sampling in households in the 10 regions of Cameroon. Secondary data from the Demographic and Health Survey, which was conducted in Cameroon from 2017-2018, were used. Univariate and multivariate logistic models were used to analyze the determinants of access to the pentavalent 3 vaccine.

Results: The vaccination coverage of the pentavalent 3 vaccine (P3V) among children aged 0-23 months was 69.5%. The access to the P3V with Christian religion, compared with non-Christian experienced 63% of P3V (adjusted Odds ratio (AOR)=1.63, 95% CI, [1.22-2.17], p=0.001). Compared with those living in other regions in Cameron, those living in the northern regions of Cameroon were observed 37% less likely to have access to P3V (AOR=AOR=0.63, 95% CI, [0.44-0.87], p=0.006), while mother's marital status (married) compared with unmarried mothers were 37% more likely to experience access to P3V (AOR=1.37, 95% CI, [1.04-1.81], p=0.024). Relative to subjects with less education, those with at least secondary or higher education were 92% more likely to have access to P3V, (AOR=1.92, 95% CI [1.47-2.51], p<0.001), while those with cell phone experienced 44% increased access to P3V, (AOR=1.44, 95% CI, [1.17-1.78], p=0.001).

Conclusion: Access to the pentavalent 3 vaccine in Cameroon does not meet national targets and is affected by various socio-demographic factors, including region of residence, religion, educational attainment, maternal marital status, and cell phone ownership.

Background: Tuberculosis (TB) is one of the oldest and most persistent infectious diseases, continuing to pose a significant public health challenge worldwide. Children diagnosed with TB are particularly vulnerable to developing depressive disorders, which can significantly reduce their quality of life and negatively affect treatment adherence and recovery. This study aimed to identify risk and prognostic factors associated with depressive disorders in pediatric patients diagnosed with tuberculosis through a prospective analysis.

Materials and methods: A prospective study was conducted on 190 pediatric patients, aged 7 to 18 years, diagnosed with tuberculosis and treated at the Pneumophthisiology Hospital in Galați, Romania, between 2019 and 2021. The CDI (Children's Depression Inventory) was administered to assess depressive symptoms over the course of the study.

Objective: The study aims to determine the prevalence of depressive disorders in children and adolescents by analyzing risk factors such as age, gender, place of origin, and access to medical services, as well as the effectiveness of CDI as a diagnostic tool. It also seeks to correlate clinical and demographic data with CDI scores and evaluate changes over time to identify solutions that support early diagnosis and intervention.

Results: Out of the initial 190 patients, 158 completed the CDI, as some did not return for follow-up evaluations or declined to participate. Of these, 146 (92.4%) demonstrated clinically significant depressive symptoms. Key risk factors for depressive disorders included a rural background, male gender, and age between 15 and 18 years.

Conclusion: Specific risk factors and vulnerabilities contribute to the development of depressive disorders in pediatric TB patients. Early identification and monitoring of these factors in a prospective framework are essential for improving the prognosis of both depression and tuberculosis, ultimately enhancing the overall outcomes for affected children.

Objective: This study aimed to assess the association between sleep bruxism (SB) among children and parental sociodemographic characteristics and SB risk factors (eg, nose obstruction).

Methods: A cross-sectional survey was conducted with 250 parents of children under the age of 13 who visited pediatric dental clinics. Data were collected through a questionnaire completed by parents. Sociodemographic characteristics, the child's medical history, sleep patterns and parents' awareness of bruxism and its symptoms were investigated. Descriptive, bivariate and binary logistic regression analyses were performed.

Results: The response rate was 85.2% (55% females, 45% males) and 25.8% of the parents self-reported that their children had bruxism. The regression analysis revealed that parents reporting SB among their children were significantly more likely to have SB themselves (8.62 [3.68-20.16], p = 0.001). While children whose mothers had lower education level and were unaware of bruxism-related symptoms (such as teeth, jaw, or face pain) were less likely to be reported as having SB (0.35 [0.16-0.75], p = 0.007; 0.36 [0.14-0.97], p = 0.043, respectively). Parents who identified nose obstruction as a cause of bruxism also had children with a higher likelihood of having SB (5.49 [1.04-29.08], p = 0.045).

Conclusion: The findings highlighted that parental sociodemographic characteristic and SB risk factors associated signficantly with the prevalence of childhood SB.

Purpose: Tanzania is the fifth country with the highest sickle cell disease (SCD) prevalence globally. Although hydroxyurea (HU) is available, only 25% of persons with SCD are reported to use it in Tanzania. Perceived disease threat is associated with medication usage in patients with chronic diseases. We assessed the factors associated with caregivers' perceived threat of SCD complications and its relationship with HU use among children with SCD in Dar-es-Salaam.

Methods: We conducted a cross-sectional hospital-based study from May to August 2023. We enrolled 374 caregivers of health-insured children with SCD from 4 public SCD clinics. We adapted the modified original and revised Champion's Health Belief Model Scales to derive perceived threat scores. We used Mann-Whitney and Kruskal-Wallis tests to compare the outcomes across sociodemographic characteristics and regression analysis for factors associated with perceived SCD threat.

Results: The median score (InterQuartile Range) for perceived threat of SCD complications was 559 (175, 598). Sixty-one percent of caregivers had a high SCD perceived threat. The caregivers of under-five children had 141 lower median SCD threat scores than those of children aged 13-17 years, p-value < 0.001. Participants from Regional Referral Hospitals (RRH) had lower median threat scores compared to participants attending Muhimbili National Hospital (MNH), 177 for Amana RRH, 325 Temeke RRH, 585 MNH Mloganzila, and 557 MNH Upanga, p-value <0.001. Children of caregivers with high perceived SCD threat were 3.4 times more likely to use HU compared to those with low SCD threat perception (Incidence Rate Ratio 3.4, 95% CI: 2.7-4.5).

Conclusion: The perceived threat of SCD predicts the likelihood of SCD patients using HU in Dar-es-Salaam, Tanzania. We recommend health education to caregivers aiming to improve their SCD threat perception and thus improve the use of HU among children with SCD in similar settings.

Objective: To investigate the predictive value of T-lymphocyte activation-related cytokines in non-responsive Kawasaki disease.

Methods: Eighty-two children with Kawasaki disease, hospitalized from June 2022 to December 2023, were divided into two groups based on treatment response: the sensitive Kawasaki disease group (n=71) and the non-responsive Kawasaki disease group (n=11). Serum levels of T-lymph activation-related cytokines, including interleukin-2, 6, 7, 12, 15, 17, and tumor necrosis factor alpha, were measured before and after IVIG treatment in both groups. The differences in cytokine levels between the two groups were compared pre- and post-treatment. The ability of these cytokines to discriminate non-responsive Kawasaki disease was evaluated using ROC curves to determine the cut-off value.

Results: Before initial treatment, IL-2, IL-6, IL-7, IL-12, IL-15, IL-17, and tumor necrosis factor-α values were significantly higher in the non-responsive Kawasaki disease group compared to the sensitive Kawasaki disease group. Comparisons before and after initial treatment showed significant decreases in IL-6 and 17 in the sensitive Kawasaki disease group and significant decreases in IL-6 and 7 in the non-responsive Kawasaki disease group. IL-6 and 17 significantly increased in the sensitive group compared to the non-responsive group after initial treatment. The ROC curves indicated that IL-6 predicted the area under the curve (AUC) for non-responsive Kawasaki disease to be 0.859 before treatment and 0.920 after treatment. Similarly, IL-17 had AUC values of 0.699 before treatment and 0.884 after treatment.

Conclusion: Reassessing IL-6 and IL-17 following the initial treatment for Kawasaki disease may improve early warning signals for unresponsive Kawasaki disease.

Purpose: Rotavirus is the leading cause of severe and fatal diarrhea in African children. The aim of this study is to investigate the prevalence of rotavirus in children with acute gastroenteritis admitted to a tertiary hospital in Somalia.

Patients and methods: 5804 children who applied with complaints of acute gastroenteritis between January 2020 and December 2023 were examined retrospectively. Rotavirus antigens were detected in the feces of 1324 patients by qualitative immunochromatographic analysis. The frequency of rotavirus gastroenteritis was evaluated according to age, gender and seasonal distribution. Statistical analysis was done using SPSS version 22.0.

Results: In the years, an increase in the number of patients tested with suspicion of rotavirus and an increase in rotavirus positivity was observed. While the positivity rate was 8.1% (n = 107) in 2020, it increased to 41.4% (n = 548) in 2023. Viral antigens were identified in 1324 of 5804 patients (22.8%). 743 (56.1%) of the children were boys and 581 (43.9%) were girls. The incidence of rotavirus positive cases was higher in the summer and spring months and in children aged 0-2 years (78.6%) (p<0.001). Diarrhea due to rotavirus was seen throughout the year. The monthly rotavirus antigen positivity rate in patients admitted to the hospital due to acute gastroenteritis reached its peak in May with 17.2%.

Conclusion: The results of this study showed us that rotavirus is a common cause of acute gastroenteritis in infants. Rotavirus gastroenteritis, which causes significant mortality and morbidity all over the world, is still seen at a high rate of 22.8% in Somalia. We are of the opinion that public health education, good hygiene practices and an effective vaccination program can reduce rotavirus infection.

Objective: To establish the noninferiority of the rapid and sensitive multiplex polymerase chain reaction (M-PCR) method versus standard urine culture (SUC) in pediatric urinary tract infection (UTI) diagnostic testing.

Methods: A United States of America (USA)-based single-center prospective observational study of 44 female and four male patients aged 3-21 years old presenting to a Pediatric Emergency Department in New Jersey with clinically suspected UTI. Urine specimens were primarily collected via midstream voiding. Patients with antibiotic exposure within the week prior to presentation were excluded. Patient demographic data, clinical manifestations, and urinalysis results were recorded. Noninferiority testing comparing M-PCR and SUC was conducted using a method for paired binary data, with a noninferiority margin set at 5%. Noninferiority was concluded if the lower bound of the 95% confidence interval of the difference in detection rates between M-PCR and SUC lies entirely to the right of the value minus the noninferiority margin. All statistical calculations were performed using Python 3.10.12.

Results: The two methods were concordant in two-thirds of cases. Of the 14 M-PCR-positive/SUC-negative discordant specimens, 13 (93%) contained a fastidious and/or emerging uropathogen (A. urinae, A. schaalii, G. vaginalis, C. riegelii, U. urealyticum, Viridans group Streptococci (VGS), and/or Coagulase-negative Staphylococci (CoNS)). Neither symptom presentation nor urinalysis results differed significantly between participants with concordant positive results for UTI diagnosis and those with concordant negative results (non-UTI group).

Conclusion: In this pediatric population, similar to previous findings in an older adult population, M-PCR established not only noninferiority but also superiority over SUC in detecting microorganisms in the urine.

Background: The presence of abnormal vision during early childhood has been shown to have a substantial impact on the development of visual, motor, and cognitive functions, potentially resulting in long-term adverse psychosocial outcomes. The objective of this study was to examine the prevalence and associated risk factors of abnormal vision among preschool children aged 4-6 years in Shaoxing, China.

Methods: A cross-sectional study was conducted from March to May 2023 in Shaoxing, involving a sample of 9913 children within the specified age range. Parents were interviewed using a structured questionnaire that gathered information on sociodemographic characteristics and other relevant factors.

Results: The study revealed that 14.4% of participants had abnormal vision. Logistic regression analysis indicated that individuals who watched TV for more than 3 hours daily had a 2.206 times higher likelihood of developing abnormal vision (P<0.05). Additional risk factors for abnormal vision included watching TV at a distance of less than 3 meters, misalignment of eyes and screen while watching TV, early exposure to electronic devices before the age of 2, parents are unaware of the impact of chewing on eye development, and lack of promotion of good eye habits in children (P < 0.05). An association was found between parent's and children's refractive error (P < 0.05), with good family lighting and a balanced dietary structure being identified as protective factors against abnormal vision.

Conclusion: The study concluded that exposure to electronic products was a significant factor in the development of abnormal vision among children aged 4-6. Furthermore, family environment and genetic predisposition were also found to influence vision. Regular ocular screenings and early interventions may be effective in preventing abnormal vision.

Since aspirin resistance is rarely assessed in pediatric patients and thrombosis might cause damage in vital organs, such as the myocardium or brain, we aimed to determine its incidence and the pivotal role of routine screening. The point-of-care test by platelet function analyzer (PFA-200) and bedside bleeding time (BT) was compared to standard whole blood impedance aggregometry (IA), the time-consuming and sophisticated assays. This single-center cross-sectional study was investigated in Thai children (≤15 years). All participants received at least five-day administrations of aspirin (3 to 5 mg/kg/day or equivalent to a single tablet of 81 mg) for any prior thrombotic risks. Platelet aggregation >5 ohms on IA with 0.5 mM arachidonic acid, closure time <180 seconds on collagen/epinephrine PFA-200, and modified Ivy BT ≤7 minutes, defined resistance. Of 37 patients, 2.7% had confirmed aspirin resistance to IA. Despite the 100% sensitivity, PFA-200 showed higher specificity than BT (83.3% vs 36.1%). However, both were not comparable (exact McNemar P < 0.05), with a slight/fair reliability (ĸ=0.215 vs ĸ=0.030 respectively). Aspirin resistance is uncommon in Thai children. Routine screening is discouraged but recommended only in cases with recurrent thrombosis despite good aspirin compliance or the presence of resistant risk factors. Although the gold standard IA could not be replaced, the rapid assay of PFA-200, not bedside BT, can potentially be considered a point-of-care alternative screening test to detect aspirin resistance in children.

Background: Globally, >1.1 million children had tuberculosis (TB) and >214,000 died in 2022. The integration of pediatric TB screening should help in the identification and management of cases among children attending clinics at entry points. This study aimed to establish the extent of integrating pediatric TB screening into mainstream childcare activities and the factors affecting integration of TB screening among children.

Methods: A cross-sectional design using both quantitative and qualitative methods. Simple random sampling was used to select and observe 40 participants for integration of TB screening in the routine assessment of children. Twenty key informants were interviewed and two focus group discussions conducted on the integration of pediatric TB screening.

Results: Of the 302 children assessed, only 41.1% underwent pediatric TB screening integrated in their assessment. A binary logistic regression model using Wald chi-square showed that a cadre having worked at outpatient department (OPD) and young child clinic (YCC) significantly affected integration, with a p-value of 0.002 and 95% CI (1.040-1.152) and a p-value of 0.002 and 95% CI (1.000-1.519). Participants who had 3 to 5 years in service were 7.05 times more likely to integrate pediatric TB screening at the OPD and Cadres who had over 6 years in service were 6.32 times more likely at the YCC. Being a nurse or a midwife was associated with an increased likelihood of integrating pediatric tuberculosis screening. Knowledge, skills, and confidence gaps in screening and assessing for tuberculosis in children among staff and lack of necessary logistics were identified barriers.

Conclusion: The integration of pediatric TB screening in routine assessments at the OPD/YCC was low. Focus more on HC IIIs to improve health workers' involvement and capacity to integrate TB screening at entry points in health facilities and provide logistics.