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Peer Reviewed

Title: A new agenda for children affected by HIV/AIDS [editorial]
Source: Lancet. 2009 Feb 14;373(9663):517.
Abstract: As is so often the case in the provision of health care and deciding research agendas, children have been sidelined in the fight against HIV/AIDS. According to the latest UNAIDS figures, nearly 2 million children live with HIV worldwide, two-thirds in sub-Saharan Africa. In addition, 12 million children in sub-Saharan Africa have lost one or two parents due to HIV/AIDS. Many more live with a parent or carer with HIV. A very small proportion of infected children receive antiretroviral treatment, and prevention of mother-to-child transmission is only given to a third of women. Diagnosis in infancy is difficult and therefore often delayed. Child-friendly medication is lacking. 60% of children in southern Africa live in poverty. Now that HIV/AIDS is evolving from an acute emergency into a chronic epidemic, the way to deliver treatment and achieve prevention needs to change radically from an individualistic approach to a broader strategic one. Children and families need to take centre stage. In an excellent report, based on 2 years of research and analyses, the Joint Learning Initiative on Children and HIV/AIDS-an independent alliance of researchers, implementers, activists, policy makers, and people living with HIV-has presented recommendations for such a change in direction. Home Truths: Facing the Facts on Children, AIDS, and Poverty, released on Feb 10, points out three broad policies that will make an immediate and long lasting difference to children: support children through immediate or extended families and deliver integrated family-centred services; strengthen community action to support families; and address family poverty through national social protection. Such policies are AIDS-sensitive but not AIDS-directed. The family is the most important support structure for children. The report argues that the way orphans have been defined (as having lost one or both parents) and have become the centre of attention for many HIV/AIDS policies has been unhelpful, if not damaging. 88% of children labelled as orphans have a surviving parent and overall 95% continue to live with extended families. Additionally, children who live with HIV-positive parents have needs long before their parents die. Children need to stay within a family or kinship structure. Infected children usually live with others who are infected with the virus. The whole family, not the individual, needs to become the unit for support and treatment. The report advocates home health visiting and early childhood development interventions together with strategies to encourage children's education. The use of schools as intervention platforms misses the opportunity to reach children early and to reach those who are not in education-the majority in some countries. Economic strengthening of families has to be the basis to allow many of these programmes to fully succeed. The best immediate support for families is given by com munity groups. International donors need to work with these groups in partnership to avoid duplication, confusion, and waste of time and money. The authors suggest that coordination could be strengthened with a district committee that maintains an active register of community activities and devises a system of accountability that is understood by all and serves the com munity. All activities should be delivered within a framework that is based on best practice. Communities also have a crucial role to act as a backstop when families break down or when children live in an abusive environment. Family poverty and undernutrition can be addressed through income-transfer programmes, such as Mexico's Oportunidades programme or South Africa's child support grants. These projects are efficient and simple, empower women, and can act as a springboard for other more complex schemes, such as microfinance loans. Such economic support increases school attendance, reduces illnesses, improves growth, and encourages uptake of health services. The largest portion of money is usually used to purchase food. Extreme poverty, rather than HIV infection, should be used as a criterion to avoid stigma and resentment. The report argues that "any developing country, no matter how poor, can afford social protection packages for children". The positive effect of this policy is now established beyond doubt and no further pilot studies are needed. To integrate all these strategies, governments need to take the lead with national plans and frameworks to scale-up programmes for children and families. With this approach, society as a whole will be strengthened with intergenerational effects that will go a long way towards, but also go well beyond, tackling the effects of HIV/AIDS. Putting children and families at the centre will show long-term vision with guaranteed future benefits. (fulll-text)
Language: English
Keywords:
AFRICA, SUB SAHARAN | SUMMARY REPORT | CHILDREN | HIV INFECTIONS | AIDS | POVERTY | MALNUTRITION | CHILD HEALTH | HEALTH SERVICES | DELIVERY OF HEALTH CARE | TREATMENT | Africa | Developing Countries | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Viral Diseases | Diseases | Socioeconomic Factors | Economic Factors | Nutrition Disorders | Health | Medical Procedures | Medicine
Document Number: 341049

Title: Diarrheal disease: solutions to defeat a global killer.
Author: Program for Appropriate Technology in Health [PATH]
Source: Washington, D.C., PATH, 2009. 38 p.
Abstract: Today, the leading causes of death among children under the age of five, particularly in the developing world, are pneumonia and diarrhea. These illnesses are both preventable and treatable. The global health community possesses the interventions and knowledge to save millions of children's lives worldwide. We can do this by reprioritizing diarrheal disease on the global health agenda; educating, increasing awareness, and mobilizing health care providers, policymakers, and the larger global community around the burden of diarrheal disease and the lifesaving interventions that exist today; and by implementing these solutions with a coordinated approach. Proven, lifesaving, prevention and treatment methods [include]: safe water, improved sanitation and good hygiene; vaccines; exclusive breastfeeding and optimal complementary feeding; oral rehydration therapy (ORT) / oral rehydration solution (ORS); zinc treatment and other micronutrients. (Excerpts)
Language: English
Keywords:
DEVELOPING COUNTRIES | SUMMARY REPORT | LOW INCOME POPULATION | CHILDREN | DIARRHEA | MALNUTRITION | CHILD MORTALITY | ZINC | WATER QUALITY | CAUSES OF DEATH | SANITATION | TREATMENT | Social Class | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Diseases | Nutrition Disorders | Mortality | Population Dynamics | Metals | Vitamins and Minerals | Physiology | Biology | Water | Natural Resources | Environment | Public Health | Health | Medical Procedures | Medicine | Health Services | Delivery of Health Care
Document Number: 331382

Title: Handbook on the Optional Protocol on the Sale of Children, Child Prostitution and Child Pornography.
Author: UNICEF. Innocenti Research Centre
Source: Florence, Italy, UNICEF, Innocenti Research Centre, 2009. [74] p.
Abstract: The Convention on the Rights of the Child, the main international instrument for protecting children's rights, is supplemented by two optional protocols. One addresses the sale of children, child prostitution, and child pornography, and the other the involvement of children in armed conflict. This handbook addresses the former issue. The publication describes the genesis, scope, and content of the protocol and provides examples of measures taken by governments to fulfill their obligations under this protocol.
Language: English
Keywords:
DEVELOPING COUNTRIES | SUMMARY REPORT | CHILDREN | SOCIAL PROTECTION | TREATIES | PHYSICAL ABUSE | SEXUAL ABUSE | HUMAN RIGHTS | HUMAN TRAFFICKING | VIOLENCE | INTERNATIONAL COOPERATION | PREVENTION AND CONTROL | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Political Factors | Sociocultural Factors | Behavior | Crime | Social Problems | Diseases
Document Number: 331375

Peer Reviewed

Title: Assessment of childhood immunisation coverage [letter]
Author: Aaby P; Benn CS
Source: Lancet. 2009 Apr 25;373(9673):1428.
Abstract: Stephen Lim and colleagues scrutinise coverage with the third dose of diphtheria-tetanus-pertussis vaccine (DTP3) in 193 countries. With donor emphasis on DTP3 coverage, it is not surprising that the national estimates might be inflated. Still, there is little doubt that DTP3 coverage has increased in recent decades. But maybe we should be more concerned about the health implications of this trend than about the accuracy of the estimate. From a public health perspective, the fact that DTP3 coverage is now higher than measles vaccine coverage in most African countries is of questionable value. Numerous studies have shown that measles vaccine is beneficial for child survival, but there are conflicting data about the effect of DTP. DTP has frequently been associated with increased mortality in situations with herd immunity. Furthermore, as a result of the drive to increase the DTP3 coverage, more children receive DTP simultaneously with or after measles vaccine. We have found consistently that DTP given simultaneously with measles vaccine (table) or after it is associated with increased mortality compared with having measles vaccine alone as the most recent vaccine. In a study from Bangladesh, children who received DTP/BCG after the age of measles vaccine administration had around threefold higher mortality than unvaccinated children. These observations have not been contradicted. If they are true, the drive to boost the DTP3 coverage could lead to increased child mortality. Current policy is based on the assumption that receiving three DTP vaccines is associated with decreased child mortality. It should be a major priority to determine whether this assumption is correct. (full-text)
Language: English
Keywords:
DEVELOPING COUNTRIES | CRITIQUE | CROSS-CULTURAL COMPARISONS | EPIDEMIOLOGIC METHODS | CHILDREN | IMMUNIZATION | PERTUSSIS | TETANUS | DIPHTHERIA | Comparative Studies | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Primary Health Care | Health Services | Delivery of Health Care | Health | Bacterial and Fungal Diseases | Infections | Diseases
Document Number: 341150

10.

Title: Prevention of invasive pneumococcal disease in HIV-infected children: expanding the toolbox [editorial]
Author: Abzug MJ; Pelton SI
Source: Journal of Infectious Diseases. 2009 Apr 15;199(8):1109-11.
Abstract: Invasive pneumococcal disease (IPD) remains a threat to HIV-infected children, adolescents, and adults in both developed and emerging nations. In the pre-highly active antiretroviral therapy (HAART) era, Mao et al. identified a cumulative incidence of 6.1 cases per 100 patient-years through age 7 years among HIV-infected children in Massachusetts, a rate 100-300-fold that seen in HIV-uninfected immunocompetent children in the United States. Similarly, Westwood et al. reported an IPD rate of 13 cases per 100 patient-years in Capetown, South Africa, a large proportion of which were lower respiratory tract infections. With widespread use of HAART in the United States, the rate of pneumococcal bacteremia declined by 80%, to 1.9 cases per 100 patient-years; this residual rate still remained at least 10-fold greater than that among HIV-uninfected children, and children who suffered an episode of pneumococcal bacteremia were more likely to die during follow-up than were HIV-infected children without an episode. These data identify the need to protect HIV-infected children from infection with Streptococcus pneumoniae, even in populations treated with HAART. (excerpt)
Language: English
Keywords:
UNITED STATES OF AMERICA | MASSACHUSETTS | SOUTH AFRICA | SUMMARY REPORT | CLINICAL TRIALS | PERSONS LIVING WITH HIV/AIDS | CHILDREN | ADULTS | ADOLESCENTS | ANTIRETROVIRAL THERAPY | DISEASE PREVENTION | VACCINES | Developed Countries | North America | Americas | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Clinical Research | Research Methodology | HIV Infections | Viral Diseases | Diseases | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | HIV | Prevention and Control | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 341354

11.

Title: Breastfeeding and obesity among Kuwaiti preschool children.
Author: Al-Qaoud N; Prakash P
Source: Medical Principles and Practice. 2009;18(2):111-7.
Abstract: OBJECTIVES: To determine if breastfeeding and its duration are associated with a reduced risk of obesity among Kuwaiti preschool children. SUBJECTS AND METHODS: The sample consisted of 2,291 (1,092 males and 1,199 females) preschool children (3-6 years of age) and their mothers. The data were collected from September 2003 to June 2004. Height and weight measurements were used for defining weight status while other data were collected by questionnaire. RESULTS: There was no significant association of breastfeeding or its duration with either overweight or obesity among preschool children after adjusting for effects of the confounders. The child's gender, age and birth weight were the significant factors influencing current weight. Girls were at 32% higher risk of becoming obese than boys. Children aged 4-5 years were at nearly 3 times higher risk of overweight and obesity than children of less than 4 years. Children with higher birth weight (>or=4 kg) had double the risk of obesity than those of normal birth weight (>or=2.5 to <4.0 kg). Maternal obesity was a strong predictor of obesity in the children. A child with an obese mother had nearly 2 times higher risk of being overweight (BMI between the 85th the 95th percentiles) and 3 times of being obese (BMI >or=95th percentile) compared to a child born to a mother with a normal body weight. CONCLUSION: Breastfeeding and its duration are not associated with obesity status. However, there is a positive association between child and maternal obesity.
Language: English
Keywords:
KUWAIT | RESEARCH REPORT | PREVALENCE | CHILDREN | BREASTFEEDING | OBESITY | BODY WEIGHT | CHILD HEALTH | Middle East | Developed Countries | Measurement | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Infant Nutrition | Nutrition | Health | Physiology | Biology
Document Number: 341031

12.

Peer Reviewed

Title: Socioeconomic and environmental factors important for acquiring non-severe malaria in children in Yemen: a case-control study.
Author: Al-Taiar A; Assabri A; Al-Habori M; Azazy A; Algabri A; Alganadi M; Whitty CJ; Jaffar S
Source: Transactions of the Royal Society of Tropical Medicine and Hygiene. 2009 Jan;103(1):72-8.
Abstract: Little is known about the relative importance of environmental and socioeconomic factors for acquiring malaria in Yemen. A case-control study was conducted to determine the importance of these factors for acquiring malaria among children in Yemen. Cases of non-severe malaria were recruited from health centres; community controls were from the neighbourhood of the cases. Data were collected by personal interview and direct inspection during home visits. In total, 320 cases and 308 controls were recruited. In the multivariate analysis, environmental factors (living near streams and freshwater marshes), earth roofs of houses and history of travel were all significantly and positively associated with the occurrence of malaria, whilst regular spraying with insecticides at home was a protective factor. There was no association with socioeconomic factors, including crowding, education and occupation of parents, and ownership of house assets. An index created based on a number of indicators of wealth showed a significant association with malaria in the univariate analysis but was not significant in the multivariate analysis. Control activities can be targeted on identifiable environmental factors such as stream and freshwater marshes, although this needs further investigation. Extra protective measures may be needed by all those who travel in Yemen.
Language: English
Keywords:
YEMEN | MIDDLE EAST | RESEARCH REPORT | CASE STUDIES | CHILDREN | MALARIA | SOCIOECONOMIC FACTORS | RISK FACTORS | Developing Countries | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Parasitic Diseases | Diseases | Economic Factors | Health
Document Number: 330835

13.

Peer Reviewed

Title: Determinants of perceived morbidity and use of health services by children less than 15 years old in rural Bangladesh.
Author: Alam N; van Ginneken JK; Timaeus I
Source: Maternal and Child Health Journal. 2009 Jan;13(1):119-29.
Abstract: This study examined the association of a number of social and economic and other factors with perceived morbidity and use of health services by children in rural Bangladesh, using the data of a health and socioeconomic survey conducted in Matlab, Bangladesh in 1996. One of the factors of interest was women's social position measured with indicators such as their education, domestic autonomy, social networks and social prestige. Other factors of interest were economic in nature and included the availability of high-quality primary health care (PHC) facilities in one part of the study area. A total of 52% of the 3,793 children below 15 had an episode of an acute illness in the month preceding the interview. The medical care sought for acute illnesses was grouped into four categories: medical doctors, paramedics, traditional and untrained village doctors (including drug sellers) and homeopaths. A total of 55% of the children who were sick in the past month consulted any type of health provider. Logistic regression was used to estimate the effects of the various independent variables on the two dependent variables: perceived morbidity of under-15 children and health service use for under-15 sick children. The results revealed that age of the child was the most important factor influencing perceived morbidity while social and economic variables were in general not related to perceived morbidity. Prolonged and severe illnesses and illnesses of young and male children were more likely to be treated by health providers, particularly by physicians. While women's education and social network influenced visits to any health providers socioeconomic indicators influenced visits to physicians. Availability of PHC facilities in one part of the study area also led to more use of modern medical care. The findings highlight that improvement of women's education and of social and economic status in general, in combination with more availability of high-quality PHC will in Bangladesh lead to better health care of children.
Language: English
Keywords:
BANGLADESH | RESEARCH REPORT | CHILDREN | MORBIDITY | INFECTIONS | UTILIZATION OF HEALTH CARE | BEHAVIOR | MATERNAL HEALTH | EDUCATION | SOCIAL NETWORKS | Developing Countries | Asia, Southern | Asia | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Diseases | Health Services | Delivery of Health Care | Health | Friends and Relatives | Family and Household | Sociocultural Factors
Document Number: 330857

14.

Peer Reviewed

Title: Diarrhoeagenic Escherichia coli are not a significant cause of diarrhoea in hospitalised children in Kuwait.
Author: Albert MJ; Rotimi VO; Dhar R; Silpikurian S; Pacsa AS; Molla AM; Szucs G
Source: BMC Microbiology. 2009;9:62.
Abstract: BACKGROUND: The importance of diarrhoeagenic Escherichia coli (DEC) infections in the Arabian Gulf including Kuwait is not known. The prevalence of DEC (enterotoxigenic [ETEC], enteropathogenic [EPEC], enteroinvasive [EIEC], enterohemorrhagic [EHEC] and enteroaggregative [EAEC]) was studied in 537 children < or = 5 years old hospitalised with acute diarrhoea and 113 matched controls from two hospitals during 2005-07 by PCR assays using E. coli colony pools. RESULTS: The prevalence of DEC varied from 0.75% for EHEC to 8.4% for EPEC (mostly atypical variety) in diarrhoeal children with no significant differences compared to that in control children (P values 0.15 to 1.00). Twenty-seven EPEC isolates studied mostly belonged to non-traditional serotypes and possessed beta and theta intimin subtypes. A total of 54 DEC isolates from diarrhoeal children and 4 from controls studied for antimicrobial susceptibility showed resistance for older antimicrobials, ampicillin (0 to 100%), tetracycline (33 to 100%) and trimethoprim (22.2 to 100%); 43.1% of the isolates were multidrug-resistant (resistant to 3 or more agents). Six (10.4%) DEC isolates produced extended spectrum beta-lactamases and possessed genetic elements (blaCTX-M, blaTEM and ISEcp1) associated with them. CONCLUSION: We speculate that the lack of significant association of DEC with diarrhoea in children in Kuwait compared to countries surrounding the Arabian Gulf Region may be attributable to high environmental and food hygiene due to high disposable income in Kuwait.
Language: English
Keywords:
KUWAIT | RESEARCH REPORT | CONTROL GROUPS | CHILDREN | BACTERIAL AND FUNGAL DISEASES | DIARRHEA | DIARRHEA, INFANTILE | PREVALENCE | ANTIBIOTICS | DRUG RESISTANCE | Middle East | Developed Countries | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Infections | Diseases | Measurement | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 341689

15.

Title: The use of home-based therapy with ready-to-use therapeutic food to treat malnutrition in a rural area during a food crisis.
Author: Amthor RE; Cole SM; Manary MJ
Source: Journal of the American Dietetic Association. 2009 Mar;109(3):464-7.
Abstract: When the international community declared a famine in Malawi in January of 2006, emergency food aid reached only populations with pre-existing health care services. To treat the widespread childhood malnutrition in Machinga district, a rural area lacking health care facilities, in February 2006 five outpatient therapeutic programs were implemented that utilized home-based therapy and ready-to-use therapeutic food. Children with severe malnutrition, defined as the presence of edema and/or a weight-for-height less than 70% of the reference standard, were enrolled in the program. Two senior clinical nurses trained village health aides in each of the five communities. Children visited the health aides biweekly. During the visits, health aides collected demographic and anthropometric information and distributed a 2-week supply of ready-to-use therapeutic food, providing 175 kcal/kg/d. Treatment continued for 8 weeks; children were discharged before 8 weeks if they reached a weight-for-height more than 100% of the reference standard, or required admission to the hospital due to systemic infection or recurrence of edema. Of the 826 children enrolled, 775 (93.7%) recovered, 13 (1.8%) remained malnourished, 30 (3.6%) defaulted, and 8 (0.9%) died. Mean weight gained was 2.7+/-3.7 g/kg/d, height gained 0.3+/-0.9 mm/d, and mid-upper arm circumference gained 0.2+/-0.3 mm/d. Home-based therapy with ready-to-use therapeutic food administered by village health aides is an effective approach to treating malnutrition during food crises in areas lacking health services.
Language: English
Keywords:
DEVELOPING COUNTRIES | MALAWI | RESEARCH REPORT | RURAL AREAS | COMMUNITY | CHILDREN | FAMINE | FOOD SECURITY | NUTRITION DISORDERS | ANTHROPOMETRY | BODY WEIGHT | BODY HEIGHT | MALNUTRITION | HOME CARE | TREATMENT | Africa, Southern | Africa, Sub Saharan | Africa | Geographic Factors | Population | Residence Characteristics | Population Distribution | Youth | Age Factors | Population Characteristics | Demographic Factors | Food Supply | Natural Resources | Environment | Diseases | Measurement | Research Methodology | Physiology | Biology | Care and Support | Health Services | Delivery of Health Care | Health | Medical Procedures | Medicine
Document Number: 330803

16.

Title: Does where you live influence what you know? Community effects on health knowledge in Ghana.
Author: Andrzejewski CS; Reed HE; White MJ
Source: Health and Place. 2009 Mar;15(1):228-38.
Abstract: This paper examines community effects on health knowledge in a developing country setting. We examine knowledge about the etiology and prevention of child illnesses using a unique 2002 representative survey of communities and households in Ghana. We find that community context matters appreciably, even after adjusting for the anticipated positive effects of an individual's education, literacy, media exposure and household socioeconomic status. The proportion of literate adults and the presence of a market in a community positively influence a person's health knowledge. In other words, even if a person herself is not literate, living in a community with high levels of literacy or a regular market can still positively affect her health knowledge. Our results suggest that social networks and diffusion play a key role in these community effects. In turn, these results offer policy implications for Ghana and sub-Saharan Africa.
Language: English
Keywords:
GHANA | RESEARCH REPORT | KAP SURVEYS | COMMUNITY | CHILDREN | SOCIAL NETWORKS | KNOWLEDGE | LOCALE | CHILD HEALTH | DISEASE PREVENTION | EDUCATIONAL STATUS | LITERACY | MASS MEDIA | SOCIOECONOMIC STATUS | SOCIAL POLICY | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Surveys | Sampling Studies | Studies | Research Methodology | Residence Characteristics | Population Distribution | Geographic Factors | Population | Youth | Age Factors | Population Characteristics | Demographic Factors | Friends and Relatives | Family and Household | Sociocultural Factors | Health | Prevention and Control | Diseases | Socioeconomic Factors | Economic Factors | Communication | Policy | Political Factors
Document Number: 330296

17.

Peer Reviewed

Title: Faith and child survival: the role of religion in childhood immunization in Nigeria.
Author: Antai D
Source: Journal of Biosocial Science. 2009 Jan;41(1):57-76.
Abstract: This study assessed the role of mother's religious affiliation in child immunization status of surviving children 12 months of age and older in Nigeria, using data from the 2003 Nigeria Demographic and Health Survey (NDHS). Guided by two competing hypotheses--the 'characteristics hypothesis' and the 'particularized theology hypothesis'--variations in the risks of child immunization in Nigeria were examined using logistic regression analysis. The results indicate that religion plays a role in the risk of non-immunization; religion was not associated with the risk of partial immunization; however, religion was significantly associated with the reduced risk of full immunization.
Language: English
Keywords:
NIGERIA | RESEARCH REPORT | DEMOGRAPHIC AND HEALTH SURVEYS | MOTHERS | CHILDREN | IMMUNIZATION | RELIGION | UTILIZATION OF HEALTH CARE | BELIEFS | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Youth | Age Factors | Population Characteristics | Primary Health Care | Health Services | Delivery of Health Care | Health | Culture
Document Number: 330568

18.

Peer Reviewed

Title: Sensitivity of paediatric AIDS score vs. WHO case classification in Indian children--a retrospective study.
Author: Banerjee T; Pensi T; Banerjee D
Source: Journal of Tropical Pediatrics. 2009 Apr;55(2):91-6.
Abstract: This study was conducted at the Department of Paediatrics, Dr Ram Manohar Lohia Hospital, to test the statistical significance of existing World Health Organization (WHO) clinical case definition (CCD) for diagnosis of AIDS in areas where diagnostic resources are limited. A total of 360 cases between 18 months and 12 years of age satisfying WHO case definitions of AIDS were included in study group. Our study detected 16.66% (60) of HIV incidence in children visiting the paediatrics outpatient clinic. Twenty percent of cases manifested three major and two minor signs, which had sensitivity of 73.33%; specificity, 90.66% and positive predictive value (PPV), 61.11%. Stepwise logistic analysis identified weight loss, chronic fever >1 month and total lymphocyte count <1500 cells mm(-3) as important predictors. Eighty-six cases (23.89%) showed two major and two minor signs with sensitivity and specificity of 86.66 and 88.66%, respectively. Thus a CCD based on 13 clinical signs/symptoms was proposed for paediatric AIDS with better sensitivity and PPV than the WHO case definition but with almost similar specificity.
Language: English
Keywords:
INDIA | RESEARCH REPORT | RETROSPECTIVE STUDIES | CHILDREN | PERSONS LIVING WITH HIV/AIDS | HIV TESTING | AIDS | LABORATORY PROCEDURES | EXAMINATIONS AND DIAGNOSES | SIGNS AND SYMPTOMS | STANDARDS | Asia, Southern | Asia | Developing Countries | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | HIV Infections | Viral Diseases | Diseases | Laboratory Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 331192

19.

Peer Reviewed

Title: Evidence behind the WHO guidelines: hospital care for children: what is the evidence that BCG vaccination should not be used in HIV-infected children?
Author: Bannister C; Bennett L; Carville A; Azzopardi P
Source: Journal of Tropical Pediatrics. 2009 Apr;55(2):78-82.
Abstract: The World Health Organization has produced guidelines for the management of common illnesses in hospitals with limited resources. This series reviews the scientific evidence behind WHO's recommendations. The WHO guidelines, and more reviews are available at: http://www.ichrc.org. This review addresses the question: What is the evidence that BCG vaccination should not be used in HIV-infected children? The limited evidence currently available has been the basis of the WHO recommendation that BCG vaccination should not be used in HIV-positive children, as severe complications appear more commonly in HIV-infected individuals [8]. This decision is supported by the findings from the Fallo [13] and Hesseling [18, 20] studies. Although the WHO have suggested that HIV-infected infants should not be vaccinated this is obviously difficult in countries where BCG vaccination is administered before HIV status can be detected. Many high HIV-burden countries do not have viral-specific testing (such as PCR) routinely available to adequately assess the infection status of every new born infant. More research needs to be undertaken in this area to clarify the situation, and treating clinicians need to be made aware of this issue with all its complexity. The WHO recommendation highlights the need for viral-specific testing to be widely available in developing countries. This will ensure HIV-infected infants are not exposed to BCG which may be potentially dangerous and HIV-exposed but uninfected infants are not denied this important vaccine.
Language: English
Keywords:
AUSTRALIA | RESEARCH REPORT | WHO | STANDARDS | CHILDREN | HOSPITALS | DELIVERY OF HEALTH CARE | VACCINES | HIV INFECTIONS | Oceania | Developed Countries | UN | International Agencies | Organizations | Political Factors | Sociocultural Factors | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Health Facilities | Health | Medical Procedures | Medicine | Health Services | Viral Diseases | Diseases
Document Number: 341013

20.

Peer Reviewed

Title: Social and environmental malaria risk factors in urban areas of Ouagadougou, Burkina Faso.
Author: Baragatti M; Fournet F; Henry MC; Assi S; Ouedraogo H; Rogier C; Salem G
Source: Malaria Journal. 2009;8:13.
Abstract: BACKGROUND: Despite low endemicity, malaria remains a major health problem in urban areas where a high proportion of fevers are presumptively treated using anti-malarial drugs. Low acquired malaria immunity, behaviour of city-dwellers, access to health care and preventive interventions, and heterogenic suitability of urban ecosystems for malaria transmission contribute to the complexity of the malaria epidemiology in urban areas. METHODS: The study was designed to identify the determinants of malaria transmission estimated by the prevalence of anti-circumsporozoite (CSP) antibodies, the prevalence and density of Plasmodium falciparum infection, and the prevalence of malarial disease in areas of Ouagadougou, Burkina-Faso. Thick blood smears, dried blood spots and clinical status have been collected from 3,354 randomly chosen children aged 6 months to 12 years using two cross-sectional surveys (during the dry and rainy seasons) in eight areas from four ecological strata defined according to building density and land tenure (regular versus irregular). Demographic characteristics, socio-economic information, and sanitary and environmental data concerning the children or their households were simultaneously collected. Dependent variables were analysed using mixed multivariable models with random effects, taking into account the clustering of participants within compounds and areas. RESULTS: Overall prevalences of CSP-antibodies and P. falciparum infections were 7.7% and 16.6% during the dry season, and 12.4% and 26.1% during the rainy season, respectively, with significant differences according to ecological strata. Malaria risk was significantly higher among children who i) lived in households with lower economic or education levels, iii) near the hydrographic network, iv) in sparsely built-up areas, v) in irregularly built areas, vi) who did not use a bed net, vii) were sampled during the rainy season or ii) had traveled outside of Ouagadougou. CONCLUSION: Malaria control should be focused in areas which are irregularly or sparsely built-up or near the hydrographic network. Furthermore, urban children would benefit from preventive interventions (e.g. anti-vectorial devices or chemoprophylaxis) aimed at reducing malaria risk during and after travel in rural areas.
Language: English
Keywords:
BURKINA FASO | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | URBAN AREAS | RURAL AREAS | CHILDREN | MALARIA | TRANSMISSION | ANTIBODIES | RISK FACTORS | Africa, Western | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Geographic Factors | Population | Youth | Age Factors | Population Characteristics | Demographic Factors | Parasitic Diseases | Diseases | Infections | Immunologic Factors | Immunity | Immune System | Physiology | Biology | Health
Document Number: 330546

21.

Title: Postpartum traditions and nutrition practices among urban Lao women and their infants in Vientiane, Lao PDR.
Author: Barennes H; Simmala C; Odermatt P; Thaybouavone T; Vallee J; Martinez-Aussel B; Newton PN; Strobel M
Source: European Journal of Clinical Nutrition. 2009 Mar;63(3):323-31.
Abstract: BACKGROUND/OBJECTIVE: To assess the traditional postpartum practices, mother and child nutritional status and associated factors. SUBJECTS/METHODS: A cross-sectional study in 41 randomly selected villages on the outskirts of Vientiane capital city, Lao PDR (Laos). 300 pairs of infants (< 6 months of age) and their mothers were enrolled. Information was collected about pregnancy, delivery and traditional practices through a standardized questionnaire. Dietary intake and food frequency were estimated using the 24 h recall method, calibrated bowls and FAO food composition tables. Mothers' and infants' anthropometry was assessed and multivariate analysis performed. RESULTS: Contrasting with a high antenatal care attendance (91%) and delivery under health professional supervision (72%), a high prevalence of traditional practices was found, including exposure to hot beds of embers (97%), use of traditional herb tea as the only beverage (95%) and restricted diets (90%). Twenty-five mothers (8.3%) were underweight. Mothers had insufficient intake of calories (55.6%), lipids (67.4%), iron (92.0%), vitamins A (99.3%) and C (45%), thiamin (96.6%) and calcium (96.6%). Chewed glutinous rice was given to infants as an early (mean 34.6, 95% CI:29.3-39.8 days) complementary food by 53.7% of mothers, and was associated with stunting in 10% children (OR=1.35, 95% CI:1.04-1.75). CONCLUSION: The high prevalence of traditional postpartum restricted diets and practices, and inadequate maternal nutritional intake in urban Laos, suggest that antenatal care may be an important opportunity to improve postpartum diets.
Language: English
Keywords:
LAOS | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | PREVALENCE | INFANT | CHILDREN | MOTHERS | FOOD AND BEVERAGE | DIET | CHILD NUTRITION | INFANT NUTRITION | Asia, Southeastern | Asia | Developing Countries | Research Methodology | Measurement | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Nutrition | Health
Document Number: 341041

22.

Peer Reviewed

Title: HIV infection, malnutrition, and invasive bacterial infection among children with severe malaria.
Author: Berkley JA; Bejon P; Mwangi T; Gwer S; Maitland K; Williams TN; Mohammed S; Osier F; Kinyanjui S; Fegan G; Lowe BS; English M; Peshu N; Marsh K; Newton CR
Source: Clinical Infectious Diseases. 2009 Aug 1;49(3):336-43.
Abstract: BACKGROUND: Human immunodeficiency virus (HIV) infection, malnutrition, and invasive bacterial infection (IBI) are reported among children with severe malaria. However, it is unclear whether their cooccurrence with falciparum parasitization and severe disease happens by chance or by association among children in areas where malaria is endemic. METHODS: We examined 3068 consecutive children admitted to a Kenyan district hospital with clinical features of severe malaria and 592 control subjects from the community. We performed multivariable regression analysis, with each case weighted for its probability of being due to falciparum malaria, using estimates of the fraction of severe disease attributable to malaria at different parasite densities derived from cross-sectional parasitological surveys of healthy children from the same community. RESULTS: HIV infection was present in 133 (12%) of 1071 consecutive parasitemic admitted children (95% confidence interval [CI], 11%-15%). Parasite densities were higher in HIV-infected children. The odds ratio for admission associated with HIV infection for admission with true severe falciparum malaria was 9.6 (95% CI, 4.9-19); however, this effect was restricted to children aged 1 year. Malnutrition was present in 507 (25%) of 2048 consecutive parasitemic admitted children (95% CI, 23%-27%). The odd ratio associated with malnutrition for admission with true severe falciparum malaria was 4.0 (95% CI, 2.9-5.5). IBI was detected in 127 (6%) of 2048 consecutive parasitemic admitted children (95% CI, 5.2%-7.3%). All 3 comorbidities were associated with increased case fatality. CONCLUSIONS: HIV, malnutrition and IBI are biologically associated with severe disease due to falciparum malaria rather than being simply alternative diagnoses in co-incidentally parasitized children in an endemic area.
Language: English
Keywords:
KENYA | RESEARCH REPORT | CONTROL GROUPS | MULTIVARIATE ANALYSIS | CHILDREN | MALARIA | SIGNS AND SYMPTOMS | HIV INFECTIONS | MALNUTRITION | BACTERIAL AND FUNGAL DISEASES | CASE FATALITY RATE | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Data Analysis | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Parasitic Diseases | Diseases | Viral Diseases | Nutrition Disorders | Infections | Death Rate | Mortality | Population Dynamics
Document Number: 342633

23.
Title: Growth and nutritional status of pre-school children in India: rural-urban and gender differences.
Author: Bharati P; Bharati S; Pal M; Chakrabarty S; Som S; Gupta R
Source: Collegium Antropologicum. 2009 Mar;33(1):7-21.
Abstract: This cross-sectional study of growth and nutritional status makes an attempt to find the gender and rural-urban differences among Indian preschool children. This study is based on the data of weight and height of children aged 0-35 months taken from 26 States (total 26,369 children; 13784 boys and 12585 girls). The children are found to be lighter and shorter compared to International standards irrespective of age and sex. Boys are heavier and taller than girls. Urban preschool children are heavier and taller compared to rural counterparts. In the urban area, higher percentages of girls are affected by underweight (37.1%) and stunting (35.0%) than boys. In rural areas, the prevalence of underweight is also higher among girls (47.9%) compared to boys (45.7%), which is found to be much significant (p < 0.01). There is a significant rural-urban as well as gender difference in growth and nutritional status of Indian preschool children.
Language: English
Keywords:
INDIA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | RURAL POPULATION | URBAN POPULATION | CHILDREN | PRIMARY SCHOOLS | GROWTH | CHILD NUTRITION | CHILD DEVELOPMENT | Asia, Southern | Asia | Developing Countries | Research Methodology | Population Characteristics | Demographic Factors | Population | Youth | Age Factors | Schools | Education | Biology | Nutrition | Health
Document Number: 341201

24.
Title: Risk of mortality in pediatric intensive care unit, assessed by PRISM-III.
Author: Bilan N; Galehgolab BA; Emadaddin A; Shiva Sh
Source: Pakistan Journal of Biological Sciences. 2009 Mar 15;12(6):480-5.
Abstract: This study aimed at evaluating the mortality rate in a PICU applying PRISM-III. Two hundred and twenty one infants and children consecutively admitted to PICU of Tabriz Children's Hospital were studied during a 13 months period of time. Data required for calculating the PRISM-III score were collected during the first 24 h of PICU stay in all patients. The prediction of actual mortality by PRISM-III scoring was evaluated by the Hosmer and Lemeshow goodness-of-fit test. Receiver Operating Characteristic (ROC) curve was constructed, as well. The observed (O) short-term (during hospital stay) mortality rate was compared with the expected (E) figures as the O/E ratio. The mean value of the PRISM-III score was 14.22 +/- 9.57(2-42). ROC analysis indicated a strong predictive power for the PRISM-III (area under the curve = 0.898) and the test was well fit to the designed study (goodness-of-fit p-value = 0.161). The observed short-term mortality rate was 9.05% and the expected mortality rate by the PRISM-III scoring was 9% (O/E ratio = 1.005). The PRISM-III scoring system was highly calibrated in our institute.
Language: English
Keywords:
IRAN | RESEARCH REPORT | EVALUATION | INFANT | CHILDREN | DEATH RATE | RISK FACTORS | Middle East | Developing Countries | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Mortality | Population Dynamics | Health
Document Number: 342232

25.

Title: Effectiveness of an intervention to improve breastfeeding knowledge and attitudes among fifth-grade children in Brazil.
Author: Bottaro SM; Giugliani ER
Source: Journal of Human Lactation. 2009 Aug;25(3):325-32.
Abstract: This cluster-randomized trial evaluated the effectiveness and residual effect of an educational intervention to improve breastfeeding knowledge and attitudes among fifth grade children of both sexes in Brazil. Schools were considered clusters and analysis of variance was used to compare an intervention group (n = 298) and a control group (n = 253) regarding knowledge, perceptions, and beliefs about breastfeeding before and after the intervention, measured through a standardized 25-item, multiple-choice questionnaire. The scores in the intervention group improved significantly, with the effect lasting at least 3 months. The intervention had greater impact on girls and on students between 9 and 11 years of age when compared with boys and students between 12 and 17 years old and also between students from public schools. Results suggest that pro-breastfeeding interventions in schools improve breastfeeding knowledge and attitudes.
Language: English
Keywords:
BRAZIL | RESEARCH REPORT | INTERVENTIONS | CHILDREN | PRIMARY SCHOOLS | STUDENTS | BREASTFEEDING | KNOWLEDGE | ATTITUDES | PROGRAM EFFECTIVENESS | South America, Eastern | South America | Latin America | Americas | Developing Countries | Programs | Organization and Administration | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Schools | Education | Infant Nutrition | Nutrition | Health | Sociocultural Factors | Psychological Factors | Behavior | Program Evaluation
Document Number: 342903

26.

Peer Reviewed

Title: Impact of Plasmodium falciparum infection on the frequency of moderate to severe anaemia in children below 10 years of age in Gabon.
Author: Bouyou-Akotet MK; Dzeing-Ella A; Kendjo E; Etoughe D; Ngoungou EB; Planche T; Koko J; Kombila M
Source: Malaria Journal. 2009 Jul 20;8(1):166.
Abstract: ABSTRACT: BACKGROUND: Improving the understanding of childhood malarial anaemia may help in the design of appropriate management strategies. METHODS: A prospective observational study was conducted over a two-year period to assess the burden of anaemia and its relationship to Plasmodium falciparum infection and age in 8,195 febrile Gabonese children. RESULTS: The proportion of children with anaemia was 83.6% (n=6830), higher in children between the ages of six and 23 months. Those under three years old were more likely to develop moderate to severe anaemia (68%). The prevalence of malaria was 42.7% and P. falciparum infection was more frequent in children aged 36-47 months (54.5%). The proportion of anaemic children increased with parasite density (p<0.01). Most of infected children were moderately to severely anaemic (69.5%, p<0.01). Infants aged from one to 11 months had a higher risk of developing severe malarial anaemia. In children over six years of age, anaemia occurrence was high (>60%), but was unrelated to P. falciparum parasitaemia. CONCLUSION: Malaria is one of the main risk factors for childhood anaemia which represents a public health problem in Gabon. The risk of severe malarial anaemia increases up the age of three years. Efforts to improve strategies for controlling anaemia and malaria are needed.
Language: English
Keywords:
GABON | RESEARCH REPORT | PROSPECTIVE STUDIES | CHILDREN | MALARIA | ANEMIA | PREVALENCE | FEVER | RISK FACTORS | AGE FACTORS | HEMOGLOBIN LEVEL | Africa, Western | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Youth | Population Characteristics | Demographic Factors | Population | Parasitic Diseases | Diseases | Measurement | Body Temperature | Physiology | Biology | Health | Hemic System
Document Number: 342284

27.

28.

Peer Reviewed

Title: Kaposi sarcoma-associated herpesvirus (KSHV) seroprevalence in population-based samples of African children: evidence for at least 2 patterns of KSHV transmission.
Author: Butler LM; Dorsey G; Hladik W; Rosenthal PJ; Brander C; Neilands TB; Mbisa G; Whitby D; Kiepiela P; Mosam A; Mzolo S; Dollard SC; Martin JN
Source: Journal of Infectious Diseases. 2009 Aug 1;200(3):430-8.
Abstract: BACKGROUND: Kaposi sarcoma-associated herpesvirus (KSHV) infection is endemic among adult populations in Africa. A prevailing view is that childhood transmission is primarily responsible for the high seroprevalence of KSHV among adults that is observed throughout the continent. However, few studies have directly examined children, particularly in locations where KS is not commonly endemic. METHODS: Participants were children aged 1.5-8.9 years, including 427 children from a population-based sample in South Africa, 422 from a population-based sample in Uganda, and 567 from a clinic-based sample in Uganda. All serum specimens were tested by the same laboratory for KSHV antibodies with use of 2 enzyme immunoassays (against K8.1 and ORF65) and 1 immunofluorescence assay. RESULTS: KSHV seroprevalence was 7.5%-9.0% among South African children and was not associated with age. In contrast, in the Ugandan population-based sample, KSHV seroprevalence increased from 10% among 2-year-old children to 30.6% among 8-year-old children ([Formula: see text]). In the Ugandan clinic-based sample, seroprevalence increased from 9.3% among 2-year-old children to 36.4% among 8-year-old children ([Formula: see text]). CONCLUSION: Two distinct relationships between age and KSHV infection among children imply that KSHV transmission among children is not uniform throughout Africa and is therefore not always responsible for the high seroprevalence observed in adults. There are at least 2 patterns of KSHV transmission in Africa.
Language: English
Keywords:
SOUTH AFRICA | UGANDA | RESEARCH REPORT | CHILDREN | HIV TESTING | LABORATORY PROCEDURES | HIV TRANSMISSION | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Africa, Eastern | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | HIV Infections | Viral Diseases | Diseases
Document Number: 342893

29.

Peer Reviewed

Title: Longitudinal antiretroviral adherence in HIV+ Ugandan parents and their children initiating HAART in the MTCT-plus family treatment model: role of depression in declining adherence over time.
Author: Byakika-Tusiime J; Crane J; Oyugi JH; Ragland K; Kawuma A; Musoke P; Bangsberg DR
Source: AIDS and Behavior. 2009 Jun;13(Suppl 1):S82-S91.
Abstract: The authors conducted a study to assess the effect of family-based treatment on adherence amongst HIV-infected parents and their HIV-infected children attending the Mother-To-Child-Transmission Plus program in Kampala, Uganda. Adherence was assessed using home-based pill counts and self-report. Mean adherence was over 94%. Depression was associated with incomplete adherence on multivariable analysis. Adherence declined over time. Qualitative interviews revealed lack of transportation money, stigma, clinical response to therapy, drug packaging, and cost of therapy may impact adherence. Our results indicate that providing ART to all eligible HIV-infected members in a household is associated with excellent adherence in both parents and children. Adherence to ART among new parents declines over time, even when patients receive treatment at no cost. Depression should be addressed as a potential barrier to adherence. Further study is necessary to assess the long-term impact of this family treatment model on adherence to ART in resource-limited settings.
Language: English
Keywords:
UGANDA | RESEARCH REPORT | FOCUS GROUPS | PARENTS | CHILDREN | PERSONS LIVING WITH HIV/AIDS | ANTIRETROVIRAL THERAPY | USER COMPLIANCE | QUESTIONNAIRES | DEPRESSION | PACKAGING | STIGMA | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Data Collection | Research Methodology | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | HIV Infections | Viral Diseases | Diseases | HIV | Behavior | Mental Disorders | Marketing | Economic Factors | Social Problems
Document Number: 341904

30.

Peer Reviewed

Title: A visual dosing aid for first-line pediatric antiretroviral treatment in resource-poor settings.
Author: Callens SF; Westreich D; Kitetele F; Lusiama J; Shabani N; Belhorn T; Colebunders R; Behets F; Van Rie A
Source: Journal of Tropical Pediatrics. 2009 Apr;55(2):135-7.
Abstract: The visual dosing aid (VDA) was developed to facilitate dosing calculations in response to children's; growth and weight during antiretroviral treatment. The theoretical accuracy of the VDA was assessed using anthropometric data from 55 children receiving care in the USA and 324 children in the Democratic Republic of the Congo. The VDA dose was similar to the WHO recommended dose. A potentially significant relative dosing difference of >or=20% occurred in <3% of children for NVP, AZT and d4T, but was observed in 20% for 3TC, overdosing being more frequent. The VDA compared well with generic pediatric fixed dose combination tablets. Results did not differ between sites. The VDA enables accurate dosing of pediatric ART in distinct populations and could facilitate roll-out of pediatric ART in resource-poor settings.
Language: English
Keywords:
DEMOCRATIC REPUBLIC OF THE CONGO | RESEARCH REPORT | CHILDREN | ANTIRETROVIRAL DRUGS | ANTIRETROVIRAL THERAPY | TREATMENT | ADMINISTRATION AND DOSAGE | BODY WEIGHT | Developing Countries | Africa, Central | Africa, Sub Saharan | Africa | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | HIV | HIV Infections | Viral Diseases | Diseases | Drugs | Physiology | Biology
Document Number: 331199


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