Infant Mortality Screening and Prevention Initiatives in Nepal

Infant mortality is one of the leading public health crises in Nepal. While Nepal has made significant advances in mitigating under-five mortality, much work is still needed to be done regarding the healthcare of infants. The Nepalese government has identified this as a problem and has introduced a series of interventions to improve the health outcomes of infants. The aim of this review is to identify the goals, interventions, and effectiveness of major infant mortality prevention programs around the country. A comprehensive literature search was performed using PubMed and Google Scholar. The literature search revealed six programs that Nepal has utilized to combat infant mortality. The Community Based Management of Childhood Illness (CB-IMCI) program utilizes specially trained community workers to help identify and treat children with common childhood illnesses. The National Neonatal Health Strategy (NNHS) links families to the community and then to the broader healthcare system, with success found in its referral system. The Safe Delivery Incentives Program (SDIP) has found success with monetizing safe delivery practices, and shown an increase in safe deliveries with skilled healthcare workers present. Free Newborn Care (FNC) services were aimed at treating sick newborns for free, but ongoing concerns for program sustainability have led to further revision. The Every Newborn Action Plan (ENAP) is another plan aimed at preventing newborn deaths through improving health system administration and finances, but with limited efficacy data, it is hard to determine its success due to the lack of objective benchmark markers and data collected. Finally, the Birth Preparedness Package (BPP) is a highly efficacious program that encourages communities to plan for pregnancies by planning for delay barriers. Nepal has made significant strides in reducing infant mortality; however, much work still needs to be done. From 1990 to 2020, Nepal has reduced the under-five mortality rate from 138.8 deaths per 1,000 live births to 28.2 deaths per 1,000 live births.

2021 U.S. Virgin Islands Zika health brigade: Providing recommended pediatric health screenings for children born to mothers with laboratory evidence of possible Zika virus infection during pregnancy

BACKGROUND

The United States Virgin Islands (USVI) Department of Health (DOH) conducted a second Zika health brigade (ZHB) in 2021 to provide recommended Zika-related pediatric health screenings, including vision, hearing, neurologic, and developmental screenings, for children in the USVI. This was replicated after the success of the first ZHB in 2018, which provided recommended Zika-related pediatric health screenings to 88 infants and children exposed to Zika virus (ZIKV) during pregnancy.

METHODS

Ten specialty pediatric care providers were recruited and traveled to the USVI to conduct the screenings. USVI DOH scheduled appointments for children included in CDC's U.S. Zika Pregnancy and Infant Registry (USZPIR). During the ZHB, participants were examined by pediatric ophthalmologists, pediatric audiologists, and pediatric neurologists. We report the percentage of participants who were referred for additional follow-up care or given follow-up recommendations in the 2021 ZHB and compare these referrals and recommendations to those given in the 2018 ZHB.

RESULTS

Thirty-three children born to mothers with laboratory evidence of ZIKV infection during pregnancy completed screenings at the 2021 ZHB, of which 15 (45%) children were referred for additional follow-up care. Ophthalmological screenings resulted in the highest number of new referrals for a specialty provider among ZHB participants, with 6 (18%) children receiving referrals for that specialty. Speech therapy was the most common therapy referral, with 10 (30%) children referred, of which 9 (90%) were among those who attended the 2018 ZHB.

CONCLUSIONS

Thirty-three children in a jurisdiction with reduced access to healthcare specialists received recommended Zika-related pediatric health screenings at the ZHB. New and continuing medical and developmental concerns were identified and appropriate referrals for follow-up care and services were provided. The ZHB model was successful in creating connections to health services not previously received by the participants.

[The impact of district nurses in screening visual impairments]

INTRODUCTION

The children's physical and mental health is determinative for the whole society. Parents, teachers, district nurses, and doctors share the duty to ensure their uninterrupted visual development. District nurses compose key elements in connecting families and health care providers, since they have the chance to detect any visual anomalies, and to refer the children to a pediatrician, ophthalmologist, or a neurologist. Their team work yields advantages to the whole community as beyond preserving good vision, children get a real chance of right physical and mental development.

OBJECTIVE

Our aim was to recollect district nurses' areas of activity and to collect data about their present status in visual screening programs. Furthermore, to assess their screening methods and circumstances, and to reshape their continuous learning programs linked to the universities.

METHOD

Questionnaires were sent online anonymously to district nurses in practice, in order to collect data referring to their focuses during the visual screening methods. Administration of online parental tutorials was assessed, and measures of professional support in nurses' education was debated.

RESULTS

Visual screening among infants looks for potential strabismus, and among school-age children looks for potential refractive errors. Vision tests and stereo tests are usually available as screening tools, but pen lights are underused. Only a few nurses suggest online tutorials to enhance patient education, but nurses are highly motivated in postgraduate courses about vision screening.

CONCLUSION

Our results reflect good adherence to the screening protocols but there is some uncertainty in some fields. In harmony with the results, adequate technical and educational support and specific training were compiled for postgraduate district nurses. Coaching and training in visual screening (in the form of seminars or e-learning) should be available in spring 2023. Orv Hetil. 2023; 164(3): 88-95.

Understanding caregiver acceptance of screening for family substance use in pediatric clinics serving economically disadvantaged children

Background: Children of parents with substance use disorders are at greater risk for mental and physical health co-morbidities. Despite guidelines, pediatricians rarely screen for substance use in the family/household, citing fear of offending parents. The objectives of this study were to examine (1) caregiver acceptance of pediatricians screening for family/household substance use during well-child visits, (2) prevalence of family/household substance use, and (3) the association between family/household substance use and trust in their child's pediatrician. Methods: This cross-sectional study surveyed adult caregivers presenting a child for medical care at two urban pediatric outpatient clinics using a brief anonymous computer-based survey. The primary outcome measured the acceptability of pediatrician screening for family/household substance use. Substance use and concerns about use in the family/household were also assessed. Results: Adult caregivers (n = 271) surveyed were mean age 35 years, 73% mothers, 90% African American, and 85% on Medicaid. Over half (51%) of caregivers reported substance use by someone in the family/household, most commonly cigarettes (38%), followed by alcohol (19%) and marijuana (10%). Sixty-one percent of caregivers who reported family substance use expressed concern about the use of this substance. The majority (87%) agreed it is appropriate for pediatricians to ask caregivers about family/household substance use. No differences were found between caregivers who did and did not report substance use in their family/household. Caregivers with concerning substance use in their family/household were less likely to trust their pediatrician [OR = 0.21, 95%CI: 0.05, 0.85] Conclusions: Caregivers endorsed acceptance of universal screening for substance use, including illicit substances, and substance use disorders in the family/household during well-child visits. Pediatricians are trusted professionals with expertise in communicating with parents to maximize the health of their patients; assessing family history of substance use and substance use disorders is a natural extension of their role.

High Level of Food Insecurity among Families with Children Seeking Routine Care at Federally Qualified Health Centers during the Coronavirus Disease 2019 Pandemic

Objective

To assess food insecurity during pediatric visits to federally qualified health centers (FQHCs) during the coronavirus disease-19 pandemic.

Study design

Interviews using the validated American Academy of Pediatrics 2-question food insecurity screen were performed with 200 consecutive families presenting for pediatric care to 2 FQHC in Central Texas from April 14 to May 20, 2020, during the initial phase of the pandemic in Texas. Brief qualitative interviews were conducted to determine whether families found a worsening of food insecurity during the pandemic.

Results

Overall, 47% of families had a positive food insecurity screen. More than 90% of these were worrying about food running out and about 60% were positive for the question related to food not lasting. Among families with food insecurity, 94% indicated this had begun or worsened during the pandemic. Of the 115 families volunteering information about employment, 46% reported job loss during this time period. Both ethnicity (P < .001) and Special Supplementation Nutrition Program for Women, Infants and Children (WIC) participation (P = .03) were associated with greater levels of food insecurity. Among primarily Spanish-speaking families participating in the WIC program, 64% reported food insecurity.

Conclusions

Approximately one-half of families receiving routine pediatric care at a FQHC during the coronavirus disease-19 pandemic reported food insecurity and this was associated with loss of jobs during the pandemic. Participation in the WIC program was not protective against food insecurity. Increased frequency of food insecurity was detected in Hispanic and Spanish-speaking families. Screening of families at an FQHC should be strongly considered as a part of routine pediatric care. Knowledge of community resources is important for providers to share with patients. (J Pediatr: X 2020;4:100044).

Trial Registration

ClinicalTrials.gov: NCT04378595

Pediatric Practitioners' Screening for Adverse Childhood Experiences: Current Practices and Future Directions

This pilot study surveyed pediatric medical practitioners on their screening of Adverse Childhood Experiences (ACEs). The study focused on perspectives related to engagement in screening and barriers to screening. Practitioners were pediatric and family physicians and physician assistants (N = 48). Results suggest that although practitioners believed it was their role to screen, less than half did so. They were more likely to screen if they were familiar with the research on ACEs, or had received training on ACEs screening. Perceived barriers included lack of professional education on the topic, not enough time to screen, and lack of appropriate screening tools. Other issues such as which ACEs were most likely to be screened for and follow-up practices after positive screening also were explored. Further work is needed to understand screening and treatment practices, and policy changes should be explored in an attempt to increase practitioner involvement in ACEs screening.

Feasibility of screening for T1D and celiac disease in a pediatric clinic setting

OBJECTIVE

Type 1 diabetes (T1D) or celiac disease (CD) develops in at least 2% of the general population. Early detection of disease-specific autoimmunity and subsequent monitoring would be possible if screening tests were more widely available. Currently, screening for islet autoimmunity is available only in a research setting, and CD-specific autoimmunity screening is limited to those in high-risk groups. This study assessed the feasibility of incorporating T1D and CD autoantibody screening into a pediatric practice.

METHODS

Patient engagement strategies, blood collection preference, blood sample volume, rate of autoantibody detection in the general population, and parental satisfaction were assessed. Over 5 weeks, research staff recruited 200 patients, aged 2-6 yr from two pediatric practices in the Denver area to be screened for islet autoantibodies (IAs) and the transglutaminase antibody.

RESULTS

Of the 765 parents approached, 200 (26%) completed the same-day screening. Of the 565 subjects who did not complete the screening, 345 expressed interest, but were unable to make a participation decision. A finger stick, compared with a venous draw, was the preferred method of sample collection. Both methods yielded sufficient blood volume for autoantibody determination. IAs or the transglutaminase antibody were detected in 11 subjects. Parents expressed satisfaction with all aspects of participation.

CONCLUSIONS

The results of this study suggest that it is feasible to conduct this type of screening in a pediatric clinic. Such screening could lead to increased disease awareness and the possible benefits that can result from early detection.