child health care

To determine if children presenting without complaints related to the Integrated Management of Childhood Illness (IMCI) are at greater risk for suboptimal screening for IMCI conditions, we randomly sampled and observed 3072 sick child visits in 33 provinces of Afghanistan. The study indicated that children with non-IMCI complaints are at greater risk of suboptimal screening compared to children with IMCI-related complaints. We concluded that facility and provider capacity needs to be improved, particularly during training, supervision and guideline dissemination, to ensure that all children receive routine screening for common IMCI conditions.

The Ethiopian Paediatric HIV Cohort was established to identify clinical and laboratory predictors of virological treatment failure to ultimately develop a clinical–immunological prediction rule with area under the curve of >0.80 for detecting first-line antiretroviral therapy failure (ARTF). It will also assess the performance of the current WHO guidelines for detection of first-line ARTF in children. Using a prospective cohort design, HIV-infected children and adolescents below the age of 18 years are followed every 6 months with a set of clinical and laboratory parameters at 6 hospitals in southern Ethiopia. From October 2015 through April 2016, 628 children have been enrolled. The cohort will be completed in September 2017. The successful completion of this study will allow for better targeting of viral-load testing to those at highest risk in resource-poor settings and provide clinicians and policymakers with a practical prediction rule.

We are conducting a cluster randomised controlled trial in Mokhotlong district, Lesotho, to evaluate a newly developed community-based intervention program to integrate HIV-testing and treatment services, early childhood care and development, and nutrition education for caregivers with children aged 1-5 years living in rural villages. Caregivers and their children are randomly assigned by village to intervention or control condition. We select, train, and supervise community health workers recruited to implement the intervention, which consists of nine group-based sessions with caregivers and children over 12 weeks (eight weekly sessions, and a ninth top-up session 1 month later), followed by a locally hosted community health outreach day event. This study provides a unique opportunity to assess the potential of an integrated early childhood development intervention to prevent or mitigate developmental delays in children living in a context of extreme poverty and high HIV rates in rural Lesotho. This paper presents the intervention content and research protocol for the study.

The aim of this study was to assess the incidence and nature of adverse drug events (ADEs) in hospitalized children at a teaching hospital in Ethiopia. We studied 600 children hospitalized at Jimma University Specialized Hospital between 1 February and 1 May 2011. Fifty-eight ADEs were identified, with an incidence of 9.2 per 100 admissions, 1.7 per 1000 medication doses and 9.4 per 1000 patient-days. One-third of ADEs were preventable; 91% caused temporary harms and 9% resulted in permanent harm/death. A strategy to prevent ADEs, including education of nurses and physicians, is of paramount importance.

The Ethiopian HIV epidemic is currently on the wane. However, the situation for infected children is in some ways lagging behind due to low treatment coverage and deficient prevention of mother-to-child transmission. Too few studies have examined HIV infected children presenting to care in low-income countries in general. Considering the presence of local variations in the nature of the epidemic, a study in Ethiopia could be of special value for the continuing fight against HIV. The aim of this study is to describe the main characteristics of children with HIV presenting to care at a district hospital in a resource-limited area in southern Ethiopia. The aim is also to analyse factors affecting pre-ART loss to follow-up, time to ART-initiation, and disease stage upon presentation. The loss to follow-up is alarmingly high and children present too late. Further research is needed to explore specific causes and possible solutions.

Given similar performance and knowledge of health workers trained in 7-day and 11-day courses, potential cost savings, the possibility of training more health workers and the relative ease with which health workers in remote settings might participate in a short course, it seems prudent to standardize the 7-day course in Afghanistan, where child mortality rates remain unacceptably high.

Integrated community case management (iCCM) can be an effective strategy for expanding the provision of diarrhea, pneumonia, and malaria services to children under 5 years old but there are concerns in some countries about the corresponding cost and impact. This paper presents and compares findings from a multi–country analysis of iCCM program costs. Data were collected on iCCM programs in seven sub–Saharan African countries: Cameroon, the Democratic Republic of the Congo, Malawi, Senegal, Sierra Leone, South Sudan and Zambia. The data were used to compare some elements of program performance as well as costs per capita and costs per service (which are key indicators of resource allocation and efficiency). A comprehensive understanding of iCCM program costs and results can help countries obtain resources and use them efficiently. To be cost–effective and affordable, iCCM programs must be well utilized, while program management and supervision should be organized to minimize costs and ensure quality of care. iCCM programs will not always be low–cost, however, particularly in small, remote villages where supervision and supply challenges are greater.

Although antiretroviral treatment (ART) has reduced the incidence of HIV-related opportunistic infections among children living with HIV, access to ART remains limited for children, especially in resource-limited settings. This paper reviews current knowledge on the contribution of opportunistic infections and common childhood illnesses to morbidity and mortality in children living with HIV, highlights interventions known to improve the health of children, and identifies research gaps for further exploration.

Summary Points Expansion of prevention of mother-to-child transmission in resource-limited settings remains a challenge. In many countries, most HIV-exposed infants do not benefit from PMTCT programs, which results in a 30% or more transmission rate.

Background: Recognition and referral of sick children to a facility where they can obtain appropriate treatment is critical for helping reduce child mortality. A well-functioning referral system and compliance by caretakers with referrals are essential.

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