Factors Influencing Children’s Full Immunization in Ethiopia

Child morbidity and mortality in Ethiopia is mainly due to vaccine preventable diseases. Although numerous interventions have been made since the 1980’s to increase vaccination coverage, the level of full immunization is low in the country. This study examines factors influencing children’s full immunization based on data on 1927 children aged 12-23 months extracted from the 2011 Ethiopian Demographic and Health Survey. Multinomial logistic regression model was fitted to identify predictors of full immunization. The result shows that only 24.3% of the children were fully immunized. There was significant difference between regions in immunization coverage in which Tigray, Dire Dawa, and Addis Ababa performed well. In Oromia, Afar, Somali, Benishangul-Gumuz, and Gambela regions, the likelihood of children’s full immunization was significantly lower. Children born to mothers living in households with better socio-economic status, with frequent access to media, and who visit health facilities for antenatal care were more likely to be fully immunized. The results imply the importance of narrowing regional differences, improving women’s socio-economic status and utilization of antenatal care services, and strengthening culture-sensitive media campaign as a means of achieving full immunization of all children

Flexible bronchoscopy contribution in the approach of diagnosis and treatment of children’s respiratory diseases: the experience of a unique pediatric unit in Tunisia.

Objective: Our study aimed at assessing the role of flexible bronchoscopy (FB) in improving diagnosis and management of children’s respiratory conditions in the pediatric unit of FB, newly created and unique in Tunisia. Methods: Retrospective study including all the FB achieved in our pediatric unit from 2009 to 2014. Results: We performed 365 FB in 333 patients aged 46 months on average (1 month - 15 years), often under conscious anesthesia (81.6%). FB was performed for diagnostic purposes in 341 cases and for therapeutic purposes in 24 cases. Eight anatomical abnormalities were revealed in 22 patients. An intraluminal bronchial obstruction was found in 71 FB, mainly due to a foreign body (n=36). A vascular anomaly was responsible for nine cases out of 17 extraluminal obstructions. Airways malacia was observed in 60 FB. Bronchoalveolar lavage was performed in 196 cases. It was determinant in 43.9% of the cases. FB was of great diagnostic value in 74.8% of the cases. It influenced the management of the patients in 58% of the cases. The FB for therapeutic purposes was beneficial in all cases. Few complications occurred (5.5%). Conclusion: FB is a safe tool providing precious diagnostic and/or therapeutic help for the clinician. Keywords:

Hookworm-like eggs in children’s faecal samples from a rural area of Rwanda.

Background: Hookworm eggs identification and quantification is usually carried out by Kato-Katz method. However various structures present in the smear may be confused with eggs of such parasites. Objective: To document the presence of structures in Kato-Katz slides that could initially be misinterpreted as hookworm eggs. Method: 497 faecal samples were analysed by Kato-Katz technique, diphasic concentration technique, agar-plate coprocultive and larvae obtained were analysed by PCR and characterized by sequencing. Results: Hookworm-like eggs were found in 159 (32%) of the samples by Kato-Katz, finally identified as Caenorhabditis elegans by PCR technique. Conclusion: The diagnosis of human hookworm eggs, only by the use of Kato-Katz technique can lead to false positives because of similarities with eggs of other free-living worms, from wet soils like those of Rwanda that could contaminate stool samples.

Establishing a children’s orthopaedic hospital for Malawi: A review after 10 years

Background BEIT CURE International Hospital (BCIH) opened in 2002 providing orthopaedic surgical services to children in Malawi. This study reviews the hospital’s progress 10 years after establishment of operational services. In addition we assess the impact of the hospital’s Malawi national clubfoot programme (MNCP) and influence on orthopaedic training. Methods All operative paediatric procedures performed by BCIH services in the 10th operative year were included. Data on clubfoot clinic locations and number of patients treated were obtained from the MNCP. BCIH records were reviewed to identify the number of healthcare professionals who have received training at the BCIH. Results 609 new patients were operated on in the 10th year of hospital service. Patients were treated from all regions; however 60% came from Southern regions compared with the 48% in the 5th year. Clubfoot, burn contracture and angular lower limb deformities were the three most common pathologies treated surgically. In total BCIH managed 9,842 patients surgically over a 10-year period. BCIH helped to establish and co-ordinate the MNCP since 2007. At present the program has a total of 29 clinics, which have treated 5748 patients. Furthermore, BCIH has overseen the full or partial training of 5 orthopaedic surgeons and 82 orthopaedic clinical officers in Malawi. Conclusion The BCIH has improved the care of paediatric patients in a country that prior to its establishment had no dedicated paediatric orthopaedic service, treating almost 10,000 patients surgically and 6,000 patients in the MNCP. This service has remained consistent over a 10-year period despite times of global austerity. Whilst the type of training placement offered at BCIH has changed in the last 10 years, the priority placed on training has remained paramount. The strategic impact of long-term training commitments are now being realised, in particular by the addition of Orthopaedic surgeons serving the nation.

The Comparison of Under-Five-Children’s Nutrition Status Among Ethnic Groups in North of Iran, 1998 - 2013; Results of a Three Stages Cross-Sectional Study

Background: Despite improvements in child health, malnutrition still remains one of the main public health challenges in Iran. Objectives: The aim of this study was to compare under nutrition among under-five children with regard to ethnicity in rural area in north Iran. Patients and Methods: In three cross-sectional studies 7575 subjects in three time-periods including 2339 children in 1998, 2749 in 2004, and 2487 in 2013, were evaluated. All under-five-children in 20 out of 118 villages were chosen by random sampling and assessed. Under nutrition was defined as underweight, stunting and wasting lower than -2 SD (Z < -2 SD). Results: Generally, stunting was declined 17.1% and underweight and wasting were increased 0.9% and 1%, respectively during 15 years (1998 - 2013). Underweight increased 0.5% in Fars-natives and 3.2% in Turkmans and it was decreased 0.9% in Sistanis. Statistical difference in Turkman children among the three stages of the study was significant (P = 0.001). Stunting has decreased 28.7% in Fars-natives and 35.1% in Sistanis, it was increased 9.3% in Turkman group. Statistical differences among three stages in inter-ethnic groups were significant (P = 0.001 for all). Compared the group with good economic status, the odds ratio was 1.831 in poor economic group (P = 0.001). The risk of under nutrition in Sistanis was 1.754 times more than in Fars-natives (P = 0.001). Conclusions: Under nutrition remains one of the main health problems in under-five-year children in north Iran being more common in Sistani children. Stunting in Sistani children deeply decreased while in Turkman children slightly increased during the 15-year period study. Poor economic status is a risk factor for under nutrition in this area.

A Qualitative Study of the Status of Children’s Play From the Viewpoints of Experts and Suggestions for Promotion Interventions

Background: The latest national census reports the population of Iranian children (1 - 8 years old) about 11 millions. On the other hand, the latest population policies approved by supreme cultural revolution council (SCRC) will make this population increase faster. Childhood development is one of the social determinants of health, of which “child’s play” is a part. Objectives: This study is an effort to identify difficulties and challenges of the plays influential on Iranian children’s health nationwide, in order to present enhancive strategies by utilizing the views of stakeholders and national studies. Patients and Methods: Analyzing children’s play stakeholders, main organizations were identified and views of 13 informed people involved in the field were investigated through deep semi-structured interview. A denaturalized approach was employed in analyzing the data. In addition to descriptions of the state, interventions development, and designing the conceptual model, national reports and studies, and other countries’ experiences were also reviewed. Results: Society’s little knowledge of “children’s plays”, absence of administrators for children’s play, shortage of public facilities for children’s play and improper geographical and demographic availability, absence of policies for Iranian “toy”, and little attention of media to the issue are the five major problems as stated by interviewees. Conclusions: The proposed interventions are presented as “promoting the educational levels of parents and selected administrators for children’s play”, “approving the play and toy policy for Iran 2025”, and “increasing public facilities for children’s play with defined distribution and availability”.