BMJ Paediatrics Open

Importance: Preschool children in care are at high risk for psychosocial health concerns. Population-based evidence is limited. Objective: Estimate prevalence of psychosocial health concerns in children in care and not in care, and assess care-status differences stratified by deprivation. Design: Population-based cross-sectional study using 27-30 Month Health Review data from April 2013 to March 2023. Setting: Universal health review program in Scotland. Participants: 7887 children in care and 445 547 children not in care. Exposures: Care status at review, classified as in care or not. Main Outcomes and Measures: Four outcome categories (emotional, behavioral, and/or attentional; personal and/or social; speech, language, and/or communication; and other developmental concerns) plus an aggregate indicator of any of the four. We estimated adjusted odds ratios between children in care and not in care, including variation with deprivation. Models adjusted for sex, age, ethnicity, and deprivation. Results: Psychosocial health concerns were more common in children in care (2290; 29.0%) than children not in care (77 836; 17.5%; relative risk 1.66). Concerns were more common in children in care across all outcomes. The adjusted odds ratio comparing children in care with children not in care for any recorded concern was 1.86 (95% CI, 1.77-1.96). Adjusted odds ratios varied by outcome from 1.57 (95% CI, 1.49-1.66) for speech, language, and/or communication concerns to 2.49 (95% CI, 2.34-2.66) for emotional, behavioral, and/or attentional concerns. Relative inequities between children in care and not in care decreased with increasing deprivation from aOR of 1.58 (95% CI, 1.45-1.72) in the most deprived fifth of areas to 2.61 (95% CI, 2.25-3.03) in the least deprived fifth. Prevalence of any recorded concern increased with deprivation in both care groups. The relative risk comparing the most deprived with least deprived fifth of areas was 1.46 (95% CI, 1.29-1.66) among children in care and higher at 2.34 (95% CI, 2.29-2.40) among children not in care. Conclusions and Relevance: Psychosocial health inequities are evident at an early age between children in care and not in care, and vary with deprivation. Support for children in care and children living in more deprived areas should be prioritized.

Background: In Tanzania and many other resource-limited settings, early diagnosis of Autism Spectrum Disorder (ASD) is often delayed due to a lack of culturally validated screening tools. Most available ASD screening tools were developed in Western countries and may not reflect local cultural and linguistic contexts. Purpose: This study aimed to culturally adapt and linguistically validate the Swahili versions of both the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT R/F) and the Social Communication Questionnaire (SCQ) for use in the Tanzanian context. Methods: A sequential mixed-methods study was conducted in Moshi Municipality and Hai District, Kilimanjaro Region, Tanzania. The study involved translation, cross-cultural adaptation, cognitive debriefing, expert panel review, and pilot testing of the psychometric evaluation of the M-CHAT R/F and SCQ. Qualitative interviews and focus group discussions explored comprehension and contextual appropriateness of the tools. Pilot testing involved 32 caregivers of children aged 1-8 years. Internal consistency was assessed using Cronbach's alpha and KR-20. Results: Participants found both the adapted tools understandable and culturally appropriate. Unfamiliar examples, such as vacuum cleaners and dinosaurs, were replaced with locally familiar examples including domestic animals, loud music, and vehicle sounds. The M-CHATR/F demonstrated acceptable internal consistency (Cronbach's alpha = 0.77; KR-20 = 0.79), while the SCQ showed good reliability (Cronbach's alpha= 0.83; KR-20 = 0.84). Cognitive debriefing and expert review confirmed the clarity and comprehension of the adapted tools for community use. Conclusion: The adapted Swahili versions of the M-CHAT R/F and SCQ demonstrated promising preliminary reliability and cultural relevance for ASD screening in Tanzania. These findings support the use of culturally tailored screening tools to improve early identification and referral of children with ASD in Tanzania. Keywords: Autism Spectrum Disorder, Cultural adaptation, M-CHAT R/F, SCQ, Swahili, Screening tools

Background: Socioeconomic deprivation is associated with childhood morbidity, but nationwide evidence on critical illness and death in a health system with universal insurance coverage is scarce. We assessed the association between area-level deprivation and the population-level incidence of hospital admission, complex intensive care treatment (CICT), and CICT-related mortality in German children, and changes over time. Methods: Population-based analysis of complete German hospital discharge data, 2016 to 2023, covering all cases aged > 28 days to < 18 years. Cases were linked to the German Index of Socioeconomic Deprivation (GISD) via the municipality of residence and grouped into quintiles (Q1 least, Q5 most deprived). Incidence rates were calculated per 100,000 child years. Negative binomial regression adjusted for calendar year, with population as offset, yielded adjusted incidence rate ratios (aIRR) per one-quintile increase in deprivation; sensitivity analyses additionally adjusted for age group. Excess cases were estimated by applying Q1 incidence rates to Q2 to Q5. Results: Of 8,890,103 pediatric cases, 140,509 (1.6 %) received CICT and 3,386 (2.40 %) of these died. Incidence rose with deprivation from Q1 to Q5: admissions 6,191 to 9,255 per 100,000 child years, CICT 97 to 128, mortality 2.54 to 2.96. Each one-quintile increase was associated with higher risk of admission (aIRR 1.10, 95 % CI 1.10-1.11), CICT (1.07, 1.05-1.08), and mortality (1.04, 1.01-1.06); estimates were unchanged after age adjustment. Relative to Q1 rates, Q2 to Q5 accounted for 1,295,896 excess admissions (20.8 %), 11,254 excess CICT cases (12.6 %), and 194 excess deaths (8.7 %). Case fatality among CICT cases was lower in more deprived quintiles (2.35 % in Q5 versus 2.64 % in Q1), as were organ dysfunction and chronic conditions. Disparities in admission and CICT narrowed over time, whereas the mortality gradient persisted. Conclusions: Universal health insurance did not eliminate socioeconomic inequalities in pediatric critical illness. Deprivation increased the population burden of admission, intensive care, and death, but did not worsen outcomes once intensive care had begun, indicating that inequalities arise before pediatric intensive care and that prevention upstream in the care continuum is the primary target.

BACKGROUND: We used anthropometric data from electronic health records (EHRs) of Swiss childrens hospitals to evaluate growth references and estimate centile curves. METHODS: We received EHRs extracted from seven Swiss childrens hospitals and analysed two samples: all children with a height, weight, body mass index (BMI), or head circumference recording, and a subsample restricted to children without diseases potentially affecting growth, weighted to represent the general population. We calculated mean z-scores based on the World Health Organization growth references adopted for Switzerland in 2011 (CH-WHO 2011) and current Swiss growth references (Swiss 2026). We estimated sex-specific centile curves in the subsample using generalised additive models for location, scale, and shape. RESULTS: We included 213,868 children with height, 448,002 with weight, 209,244 with BMI, and 67,397 with head circumference recordings. Mean z-scores in the all children sample were (CH-WHO 2011; Swiss 2026): height (0.10; -0.19), weight (0.16; -0.09), BMI (0.04; -0.07), head circumference (-0.28, -0.28); and in the subsample: height (0.34; 0.00), weight (0.27; 0.01), BMI (0.18; 0.05), and head circumference (0.04; 0.01). The 50th height, weight, BMI, and head circumference centiles of girls and boys in the subsample closely followed those of Swiss 2026, with slightly wider 3rd and 97th centiles in infancy and adolescence. CONCLUSION: Height, weight, BMI, and head circumference centiles aligned well with the Swiss 2026 growth references in Switzerland, demonstrating that hospital EHRs could contribute to future growth references.

Background: Chronic pain affects approximately 20% of children and youth worldwide and is associated with mental and physical health impacts. Canada-specific data on the prevalence of chronic pain in children and youth are limited, highlighting the need for current high-quality population-based estimates Aims: The aim of this study is to provide national estimates of self-reported chronic pain among Canadian children and youth by pain type (headache stomach ache, backache), sex (female, male), age group (5-11, 12-17 years) and province or territory. Methods: Publicly available data were used from the 2019 Canadian Health Survey on Children and Youth (CHSCY), a population-based survey conducted by Statistics Canada using a nationally representative sample of Canadian children and youth Results: Overall, headaches were the most commonly reported pain type (15.4%), followed by stomach aches (12.5%), and backaches (11.1%). Prevalence was consistently higher among females than males and among youth than children, with youth girls reporting the highest prevalence across all pain types. Prevalence also varied geographically, with some of the highest estimates observed in the Atlantic Provinces. Conclusions: Chronic pain affects substantial proportions of Canadian children and youth with disparities observed by pain type, sex, age, and geography. These findings under score pediatric chronic pain as an important public health issue and highlight the need for equity-oriented approaches that address the needs of populations experiencing the greatest burden.

Background Persistence with stimulant medication is poor in children and adolescents with ADHD, and the evidence base is derived predominantly from high-income countries. We describe methylphenidate utilisation patterns and predictors of 12-month retention across 14 years in a large South African public health service. Methods Retrospective cohort study using routine pharmacy data from the Western Cape provincial health service (2011-2024). Children aged 5-18 at first prescription were included. Treatment episodes were defined as continuous prescription sequences with no gap exceeding 90 days and classified as initiations or restarts. Logistic regression modelled 12-month retention against early visit frequency and formulation type as pre-specified exposures. Findings 421,925 prescription events for 23,243 children across 115 facilities generated 65,885 treatment episodes. Median age at first prescription was 10 years (IQR 8-12); 77.6% were male. Kaplan-Meier 12-month survival was 28.2% for initiations and 15.4% for restarts, substantially below high-income country comparators. A quarter of all initiating prescriptions were not followed by a subsequent dispensing event; nearly 40% of patients had three or more treatment episodes. Early visit frequency was the strongest predictor of 12-month retention (high vs low: OR 2.85, 95% CI 2.65-3.06). The sustained-release formulation effect was present but attenuated on multivariable adjustment. Treatment re-initiations showed a marked seasonal pattern consistent with the South African school calendar. Interpretation Twelve-month retention was markedly lower than high-income country rates. Against a backdrop of high attrition, both early visit frequency and sustained-release formulation access predicted persistence; clinical engagement and reducing structural barriers to access are modifiable factors in this setting. Funding None.

Background: Early relational health (ERH) constructs are derived fromresearch observations rather than lived experiences. This study foregrounds diverse parent voices to examine how they describeconnectionwith their young children. Methods: Usingcommunity-based participatory research (CBPR),this study was co-designed withparent leadersfromReach Out and Read. A semi-structured interview guidewas co-designed,and parent leaderssubsequentlyconducted and transcribed 18 interviews with parents from their networks.Researchersanalyzed transcripts using Reflexive Thematic Analysis.Member checking sessions with parent leadersinformedthe analytic framework. Results:Sixorganizing principleswereidentified.(1) Parent-child connection begins with an instinctual sense of responsibility.(2)Connectionebbs and flows as parent and child adapt to one another through dailyactivities.(3) Family circumstances, including family structure, cultural expectations, and intergenerational values, directly shape this connection. (4) Parents' own upbringings and past relationships indirectly shape how they connect with their child. (5) Forconnectionto grow, parents must show up physically and emotionally for their children despite competing demands. (6) Parentsgrow through engaged parenting, and that growth feeds back into the connection, creating a self-sustaining cycle of relational health.Conclusions:Our analysis generated twoconstructs underspecified in ERH frameworks.Parents described their sense of responsibility as immediate and instinctual, preceding an emotional bond.Parentsdemonstratedtheir agency in deciding what to carry forward from their relational histories, a pattern this study termsrelational legacy. Integrating parent-generated language into ERH measurementresearchmay shape a more comprehensive picture of ERHreflectinghow families experience connection.

Background Obtaining uncontaminated urine samples from children can be difficult. Clean catch urine (CCU) is non-invasive but may be slow and lead to a contaminated sample, whereas transurethral bladder catheterisation (TUBC) and suprapubic aspiration (SPA) are invasive. We assessed the feasibility of randomising children to a definitive trial. Methods FROG was a multicentre, randomised feasibility trial with a mixed-methods perspectives study, health-economic analysis and stakeholder consensus meeting. Children under 16 years requiring urine testing for suspected urinary tract infection (UTI) who could not provide a midstream sample were eligible for the feasibility trial. Parents, children and healthcare professionals were eligible for the perspectives study and consensus meeting. Results Of 703 children screened, 170 were offered the study and 99 were recruited. Overall, 64/170 (37.6%) consented to randomisation, exceeding the feasibility threshold (33%); 32 were allocated to CCU and 32 to TUBC. The allocated method was received by 46/64 (71.9%); delays, unsuccessful collection and distress contributed to non-receipt. Among participants with available cultures, contamination occurred in 2/12 (16.7%) allocated CCU and 0/6 allocated TUBC. No participants consented to randomisation involving SPA. The perspectives study included 14 parent interviews, 89 parent questionnaires and 28 staff across 5 focus groups and 1 interview. CCU and TUBC were considered acceptable, although participants balanced speed and accuracy against pain and distress. SPA availability and acceptability were limited. A total of 19 stakeholders attended the consensus meeting; 94% supported recruiting children aged under 18 months and 100% supported comparing CCU with TUBC, without SPA. Accuracy was the highest-ranked outcome. Conclusions A definitive trial comparing CCU-first with TUBC-first in children aged under 18 months is feasible. Its primary outcomes should reflect diagnostic accuracy and clinical consequences of contamination, with successful collection, collection time, pain and distress assessed as key secondary outcomes.

Background: Children born prematurely (before 37 weeks) or admitted to the neonatal unit (NNU) are at increased risk of adverse long-term physical health outcomes. It is also recognised that there is an association with later academic performance and special educational needs, however it is not clear whether these broad risk factors could be used as stand-alone heuristics to identify children who may benefit from additional support in educational settings. We aimed to examine the associations between neonatal unit (NNU) admission and educational attainment in mid-childhood. Methods and Findings: Pregnancy data from a prospective birth cohort (Pregnancy Outcome Prediction Study, Cambridge, United Kingdom, 2008-2012) were linked to national educational outcomes (Department for Education, United Kingdom). Multivariable regression models adjusted for maternal, child, and socioeconomic factors were used to evaluate associations between (i) all NNU admissions, (ii) at term NNU admissions >48 hours, (iii) preterm birth without ongoing physical health needs, and educational outcomes at ages 5-11 years. Children who required any NNU care were more likely not to meet expected educational standards across multiple ages and domains in early and mid-childhood: age 5 early year foundation (aOR 1.64, 95% CI 1.19-2.27, p=0.003), phonics at age 6 (aOR 2.43, 95% CI 1.72-3.57, p<0.001), and at age 7 (here assessments were divided into multiple domains): reading (aOR 1.67, 95% CI 1.18-2.38, p=0.004), writing (aOR 1.72, 95% CI 1.25-2.38, p<0.001), mathematics (aOR 1.56, 95% CI 1.09-2.22, p=0.020), and science (aOR 1.85, 95% CI 1.22-2.78, p=0.003). Similar patterns were observed among both at term-born infants who stayed >48hrs in NNU (phonics assessment at age 6 aOR 2.26, 95% CI 1.51-3.36, p<0.001) and in children born preterm without long-term physical health sequelae (phonics assessment at age 6 aOR 3.07, 95% CI 1.96-4.81, p<0.001). These associations were robust to adjustment for demographic, perinatal, and socio-economic factors. By age 11, differences in academic attainment were attenuated and no longer clearly distinguishable across all exposure groups. However, there was an increased likelihood of special educational needs (SEN) at age 11 associated with any NNU admission (aOR 1.78, 95% CI 1.15-2.73, p=0.009), at term NNU admission for >48hrs (aOR 1.88, 95% CI 1.19-3.00, p=0.007), and children born preterm without long-term physical health sequelae (aOR 1.50, 95% CI 1.00-2.25, p=0.049). Predictive performance of any NNU admission for SEN at age 11 was moderate (AUC 0.70, 95% CI: 1.14-2.65, p=0.010), with balanced sensitivity and specificity and high negative predictive value. Conclusions: NNU admission, for both term and preterm infants, is associated with poorer educational outcomes and an increased likelihood of special educational needs in mid-childhood.

Introduction: Early childhood vision screening is critical for detecting amblyopia and other vision-threatening conditions. Despite screening recommendations during well-child visits, rates remain low. Red reflex assessment is recommended to identify serious ocular pathology, yet its use in primary care is not well described. We examined rates and drivers of vision screening in pediatric primary care. Methods: We conducted a retrospective review of electronic health records for children 3 to 5 years attending well-child visits in 2022 in one of three representative primary care clinics within a university health system. Outcomes were documented red reflex and functional vision tests. We evaluated associations with patient demographics and clinic site using multivariable logistic regression Results: Among 1,003 visits, 21.1% (n=212) had a documented red reflex assessment, and 60.8% (n=610) a functional vision test. Younger children (ages 3 and 4 vs. 5 years) had higher odds of red reflex assessment [adjusted odds ratio (aOR) 9.00 and 8.64], and lower odds of a functional vision (aOR 0.47 and 0.59) test. Females had higher odds of red reflex assessment (aOR 1.53). Other/Multiracial children had lower odds of red reflex assessment than Non-Hispanic White children (aOR 0.48). Screening rates varied significantly by clinic site Conclusions: Visual function and red reflex assessment are inconsistently performed in pediatric primary care, with particularly low rates of red reflex documentation. Screening rates varied between clinics and were affected by age. These findings highlight missed opportunities for early detection of vision-threatening conditions and identify targets for improving adherence to pediatric vision screening recommendations

Gastrointestinal (GI) conditions are common among children with neurodevelopmental disabilities (NDDs), and are associated with functional impairment, behavioral symptoms, and increased health care utilization. A unique relationship between autism and GI dysfunction has been proposed, leading to a focus on autism in GI research, management guidelines, and clinical tool development. Leveraging >20 years of electronic health record data and a cohort of 42,204 cases with attention-deficit/hyperactivity disorder, autism, cerebral palsy, epilepsy, or intellectual disability and 297,402 controls without NDDs, we quantified associations between NDDs and GI conditions in children. GI conditions were more common in cases than controls across all individual NDDs; intellectual disability and cerebral palsy were most strongly associated with having a GI condition. In this work, clinically recognized GI morbidity was elevated across all NDDs and not unique to autism, suggesting that a broader, transdiagnostic approach to GI dysfunction in children with NDDs is warranted.

Abstract Background. Low-birth-weight (LBW) neonates carry a disproportionate burden of morbidity and mortality in resource-limited newborn units, yet facility-level evidence on the determinants of severe in-hospital outcomes at county referral level in Kenya is limited. We determined the maternal, neonatal and care-related determinants of severe adverse outcomes among LBW neonates admitted to Kericho County Referral Hospital (KCRH) and used healthcare-provider perspectives to explain the quantitative findings. Methods. We conducted a facility-based, convergent mixed-methods cross-sectional study. Quantitative data were obtained from 169 LBW neonate-mother pairs through structured maternal interviews and clinical-record abstraction; qualitative data came from nine key informant interviews with newborn-unit healthcare workers. A severe adverse outcome was defined as the occurrence of at least one of respiratory distress, sepsis, hypothermia, hypoglycaemia, prolonged neonatal unit stay ([&ge;]7 days) or neonatal death. Associations were examined using bivariate tests and a multivariable binary logistic regression model entering 13 candidate predictors simultaneously, with multicollinearity, calibration and discrimination diagnostics. Interviews were analysed thematically and integrated with the quantitative results in a joint display. Results. A severe adverse outcome occurred in 136 of 169 neonates (80.5%); respiratory distress was the most common single complication (69.8%), and neonates experienced a mean of 2.46 (SD 1.31) adverse outcomes. In the adjusted model (omnibus {chi}{superscript 2}(13) = 57.70, p < 0.001; Nagelkerke R{superscript 2} = 0.46; area under the receiver-operating-characteristic curve = 0.879), three factors independently predicted severe adverse outcome: lower birth weight (adjusted odds ratio [AOR] 0.997 per gram, 95% CI 0.995-0.999, p = 0.012), maternal pregnancy-induced hypertension (AOR 18.49, 95% CI 1.87-182.47, p = 0.013) and warm-chain care (AOR 10.94, 95% CI 1.40-85.41, p = 0.023; a direction consistent with confounding by indication). Providers emphasised the fragile first hour of stabilisation, staffing and workload, warm-chain maintenance, infection prevention, commodity availability and referral coordination. Conclusions. Severe adverse outcomes were near-universal among LBW neonates at KCRH and were driven by neonatal biological vulnerability, maternal hypertensive disease and the readiness of newborn-unit care. Improving outcomes requires early, birth-weight-based risk stratification of the smallest neonates alongside strengthening of antenatal detection of hypertension and reliable, timely newborn-unit care processes.

Abstract Background The globally low birth weight is estimated to account for about 15-20% of all births. Global annual preterm delivery is about fifteen million, more than 60% of which occurs in Asia and Sub-Saharan Africa. The Kenyan preterm birth rate is estimated to be 14 per 100 live births. Prematurity, the leading cause of low birth weight, and its associated complications account for a large proportion of neonatal and under 5 morbidity and mortality. Premature and low birth weight (LBW) infants have rapid growth with increased nutritional demands despite their inadequate nutrient stores. This predisposes them to post-natal growth restriction (PNGR). Timely and adequate nutrition is important to prevent PNGR that has been shown to have long term neurodevelopmental and growth consequences. Immaturity and clinical instability of these infants makes providing adequate nutrition for them a great challenge. This study was done to determine the prevalence of and factors associated with PNGR among LBW infants at discharge from a rural public referral hospital in Kenya. Methods This was a single center retrospective descriptive study, of infants with birth weight <1800g discharged between 1st January 2022 and 31st December 2023, done to determine the prevalence of and the factors associated with PNGR among these infants at discharge. PNGR was defined as poor growth after birth during the initial hospitalization period. Cross sectional PNGR was discharge weight less than 10th centile while longitudinal PNGR was a drop in centiles lines for weight at discharge. Moderate PNGR was discharge weight between 3rd and 10th centile while severe PNGR was discharge weight less than the 3rd centile. Weight at birth and discharge was obtained and presented as Z scores and centiles using the respective gender specific intergrowth 21 charts. Maternal, clinical and nutritional data were also obtained from the patient files and analyzed to determine their association with PNGR. Results Among the 143 LBW infants included in the study, the prevalence of PNGR was 63% (n=90) (severe 44.8%) and 53.2% (n=76) (severe 16.1%) for cross sectional and longitudinal PNGR respectively. Statistically significant associations for longitudinal PNGR were found in patients who received any supplements aOR(95%CI) 3.0(1.1-8.3) p=0.037, took 14 days or more to regain birth weight aOR (95%CI) 0.1(0.1-0.4) p=<0.01 and were admitted for 30 days or more aOR(95%CI) 0.3(0.1-0.9) p=0.025. Conclusion More than half of LBW infants in Nyeri County Referral Hospital are discharged with PNGR, a sizeable proportion with severe form. There is need to update local LBW infants feeding protocols to include breast milk fortification, parenteral nutrition and avail resources to support the high nutritional needs of this population.

ScreenPlus is a consented pilot program that aims to screen 100,000 babies for a panel of rare disorders. Given its size, ScreenPlus provides a unique opportunity to learn about optimal recruitment practices. ScreenPlus recruitment strategy includes recruiter-initiated Active and Hybrid modes and parent-initiated Independent mode. Active recruitment occurs in-person at the postpartum bedside, whereas Hybrid recruitment includes other attempt types. In Independent recruitment, parents access online educational and e-consent forms. Analysis of 47,642 completed recruitment profiles from May 2021 through April 2025 showed that Active recruitment was used in 72.2% and had the highest percentage of parents consenting (65.5%) in an average of 1.2 days. Hybrid recruitment was used in 27.1% of profiles and resulted in a 44.5% consent rate in an average of 8.6 days, with electronic medical record messaging being the attempt type most likely to lead to a consent. Independent recruitment was used in less than 1% of profiles. In Active and Hybrid Recruitment, non-English speakers were more likely to consent compared with English speakers. Collectively, these findings emphasize that although optimal pilot NBS recruitment is multi-modal, direct communication between parents and study team has the highest consent yield.

Background Diarrheal disease remains a major public health concern among under-five children, particularly in the displaced population, where sanitation, water supply, and health care access are limited. Although it is a 3rd leading cause of under-five morbidity and mortality, limited data exist on the prevalence and determinants of diarrhea in IDP centers. Objective To assess the prevalence and associated factors of diarrhea among under-five children in Debre Birhan City Internally Displaced People's centers in 2025. Methods A cross-sectional study was conducted from December 16--30, 2025, in Debre Berhan citys internally displaced people centers. A total of 355 mothers/caregivers were selected using systematic random sampling. Data were collected through face-to-face interviews using structured, pre-tested questionnaires via the Kobo Collect application. The data were analyzed by using SPSS version 26. Bivariable and multivariable logistic regression were fitted to identify factors associated with the outcome variable. An adjusted odds ratio with its 95% CI was used to determine the strength of association, and variables with a p-value of <0.05 were considered significant. Result The prevalence of diarrhea among children under five years in Debre Berehan city internally displaced peoples center was 32.4% (95% CI: 28-37). Three factors, unable to read and write educational status of mothers (AOR =3.1; CI: 1.27-7.6), open dumping waste disposal method (AOR=2.63, 95%CI: 1.27-5.5), unvaccination (AOR=3.9, 95%CI: 1.4-10.85) and partial vaccination (AOR= 2.22, 95%CI: 1.25-3.95) were significantly associated with the outcome variable diarrhea. Conclusion The prevalence of diarrhea among children under five in the IDP center of Debre Berhan city was high. Management strategies to improve maternal health literacy, promote proper waste management and sanitation, and enhance outreach immunization services are crucial for reducing the burden of diarrhea.

Objectives: To characterize prevalence and secular trends in stunting, thinness, overweight, obesity, and the double burden of malnutrition (DBM) in urban Vietnamese children. Methods: We analyzed 249,745 annual health check visits from 97,111 children aged 18 months to 18 years attending a private school system in Hanoi, Ho Chi Minh City, and Haiphong from 2018 to 2025. Temporal trends in stunting, thinness, and obesity were modelled using generalized estimating equation (GEE) logistic regression. Results: A total of 51,034 males and 46,077 females were included. Stunting prevalence was low but rose significantly in both sexes (males: 0.7% to 1.3%, p=0.006, females: 0.7% to 1.7%, p<0.001), concentrated in children under 10 years (GEE OR/year=1.076 and 1.089, both p<0.05), females exceeded males by 2025. Obesity declined overall in males (21.4% to 17.0%) and females (6.2% to 5.0%, both p<0.001), but rose significantly among males aged 15-18 years (OR=1.055, p=0.021). Overweight increased in males (19.7% to 20.5%, p=0.010) but declined in females (18.0% to 14.8%, p<0.001). Individual-level DBM (concurrent stunting with overweight/obesity) was uncommon (<0.2%). City-level heterogeneity was marked, with Haiphong showing the highest male obesity (22.7% in 2025) and individual-level DBM. Conclusion: Vietnamese urban schoolchildren experienced simultaneous, divergent nutritional burdens from 2018-2025: rising stunting and thinness under age 10, declining early childhood obesity, and rising adolescent male obesity. Individual-level DBM was rare, but a population-level double burden was evident across age groups. City, age, and sex specific nutrition and school health policies are needed to address this complex malnutrition transition.

Background: Childhood obesity is a prevalent public health concern, particularly among children from marginalized backgrounds. Epigenomic mechanisms, including DNA methylation (DNAm), offer insight into the biological embedding of metabolic risk, yet protective family-level factors remain understudied. This study examined whether participation in a positive parenting intervention was associated with reduced epigenetic cardiometabolic risk among preschool-aged children. Methods: Participants were 74 children (n = 35 intervention; n = 39 services-as-usual; mean age = 36 months). Using a secondary analysis of a randomized controlled trial, DNAm-derived body mass index (BMI) and anthropometric BMI were assessed at baseline and 12-month follow-up, and parenting practices were observed post-treatment. Results: Children in the intervention group demonstrated significantly lower DNAm BMI at 12 months relative to controls, adjusting for child sex, race and/or ethnicity, and anthropometric BMI. No treatment effect was observed for anthropometric BMI, and DNAm BMI was not associated with anthropometric BMI at 12 months. Although parenting practices improved, they did not mediate intervention effects on DNAm-derived BMI. Conclusions: Parenting interventions may influence biological pathways related to cardiometabolic risk, even before changes in anthropometric outcomes, underscoring the potential of family-centered approaches to promote early metabolic health.

Background: Maternal postpartum checks with a general practitioner (GP) are recognised as an essential service in England and vital for recovery after pregnancy and reducing risk of long-term morbidity. Despite this, its reported fewer than of women have a record of the examination in the recommended 6-8 weeks, with observed disparities in uptake nationally. The impact of the COVID-19 pandemic disrupted delivery of these checks nationally, but there is limited data on the impact of the pandemic and its recovery for regional populations representing diversity and areas of dense poverty and ethnic minority populations. This study utilised region level data to assess the impact of COVID-19 on postnatal care. Methods: Anonymised electronic health records with clinical coded birth events for females, aged 16-49 years, were analysed for patients registered with a GP using the Greater Manchester Care Record (GMCR) between January 2018 and August 2023. Unique delivery episodes were defined and monthly rates calculated separately for women with a postnatal-related code within 4-, 6-, 8-, or 12-weeks or 1 year follow-up. Rates were also generated by key maternal demographics to assess any differences in postpartum care. Interrupted time series, modelling the onset of the pandemic estimated the IRR of 0.49 (95% CI 0.40-0.58). To assess the impact of maternal characteristics on the odds of non-attendance at examination, a logistic regression adjusting for various maternal characteristics was fitted. Results: There were 114,874 unique delivery episodes, relating to 85,076 women in the 12-week follow up cohort; 72,595 episodes to 55,784 women in 8-weeks and 28,846 episodes to 24,018 women in 6-weeks. The rate of postpartum checks was greater the longer the follow-up period. For checks within 8 weeks the first lockdown reduced from ~325 per 1000 delivery episodes in 2019 to 225 per 1000 by April 2020 (30.8%), which remained low, before returning to pre-pandemic rates by rates by October 2022. Rates remained lower overall for Black, or Asian women compared to White. Conclusion: The COVID-19 pandemic reduced postnatal follow-up in primary care across Greater Manchester, with rates frequently falling outside the recommended 6-8 week window. Significant disparities exist in the provision and uptake of these services. Improved integration of data across care sites, combined with enhanced risk management, could increase equity in access and support the timely delivery of care for those at greatest risk of postnatal complications and longer-term health issues.

Objectives To explore caregiver and clinicians perspectives on implementing mental health conversations and supports for caregivers of children with chronic conditions in paediatric outpatient clinics. Specifically, views were sought on (a) screening approaches and measures (phase 1) and (b) how feedback and support could be provided to caregivers experiencing mental health difficulties (phase 2). Methods Caregivers and clinicians from two outpatient clinics (neuromuscular and diabetes) at a tertiary paediatric hospital in Melbourne, Australia participated in online focus groups in July and August 2024. Caregivers were recruited from outpatient clinics and clinicians were recruited via email. Both groups were combined for phase 1 before separating into breakout rooms for phase 2. Two authors conducted reflexive thematic analysis of transcripts using NVivo. Results Sixteen participants (caregivers n = 8; and clinicians n = 8) took part in in two semi-structured focus groups. Analysis generated two overarching domains, each comprising multiple themes. Domain 1, Addressing caregiver mental health, captured themes of overwhelm and invisibility, diverse caregiving roles, and the need for time and resources to support wellbeing conversations. Domain 2, Housing the mental health conversation, encompassed themes of screening preferences, caregiver agency in confidentiality, delivery of feedback, and access to tailored supports. Conclusions Caregivers and clinicians support routine caregiver mental health discussions in paediatric outpatient settings. Caregivers favour screening at diagnosis and key transitions, with clear, and actionable feedback delivered away from the child. Questions about record-keeping warrant further exploration, as do the perspectives of fathers.

Background Despite cerebrospinal fluid (CSF) analysis being the gold standard for definitively diagnosing meningitis, its practical application has presented considerable difficulties, especially in environments with limited resources. Cranial ultrasound (CUS), while not a replacement for CSF analysis, provides rapid imaging to identify meningeal irregularities. Nevertheless, achieving a timely diagnosis of meningitis, particularly in its nascent stages, remains problematic, and healthcare professionals exhibit a notably low awareness of CUS's utility in diagnosing this condition. Methods This was a prospective cohort that recruited 273 term mother-neonate pairs. The neonates were initially divided into those with sepsis-meningitis (exposure group) and those with sepsis (non-exposure group) based on clinical assessment done by the admitting team. The research team further divided the participants into 4 diagnostic subgroups based on CUS findings: positive CUS for meningitis, positive clinical diagnosis for meningitis, positive CUS & clinical diagnosis for meningitis and those with negative CUS & clinical diagnosis for meningitis /sepsis only. Data on socio-demographics, clinical characteristics, blood works and CSF analysis reports, neurologic deficits and mortality outcomes were recorded for each neonate. Descriptive and inferential statistics were performed. Results The 4 diagnostic subgroups based on CUS findings were: positive CUS for meningitis (24.5%), positive clinical diagnosis for meningitis (4.4%), positive CUS & clinical diagnosis for meningitis (6.6%) and those with negative CUS & clinical diagnosis for meningitis /sepsis only (64.5%). Overall, duration of hospitalization was 11 days (range 2-45 days; interquartile range [IQR] 6,16) and the median chronological age of the neonates was 13 days (IQR 7, 21). Meningitis was suspected in 11% of neonates admitted with clinical sepsis. Uptake for lumbar puncture (LP) or ventricular tap (VT) was low at 4.4% (n = 12), underlining barriers to CSF-based diagnosis in this setting. Late-onset sepsis was associated with only 31.9% of NSM. The chronological age of the neonates at admission (p=0.002) and their duration of hospitalization (p=0.042) were significantly different across the 4 categories of neonates. Prominent sulci, hyperechoic brain lesions, ventriculitis, and lateral ventriculomegaly were the most common abnormal findings on CUS. Overall, neonates with meningitis presented later in age and stayed longer on the ward than those with sepsis: clinical meningitis diagnosis was likely to be made in older neonates and was associated with a shorter duration of hospitalization than CUS-diagnosed meningitis. Overall mortality rate was 2.2%. Mortality (16.7%) was highest amongst those with clinical & CUS diagnosed-NSM. Prevalence of Near-Miss cases of NSM was at least 27.6%. A neonate with clinical diagnosis of NSM was 3.94 times (95% CI 1.80, 8.62; p<0.001) more likely to have abnormal CUS at the time of admission. Percent agreement between the clinical and CUS diagnosis for NSM was 71.1%. Nine (75%) out of the 12 CSF reports was positive for meningitis; and the majority 55.6% (5) of the positive CSF report belonged to the category of neonates with sepsis only. Compared to CSF analysis, sensitivity of clinical diagnosis of NSM was 22.2%; specificity was 33.3%; positive predictive value (PPV) was 50%; negative predictive value (NPV) was 12.5% and likelihood ratio (LR) was 0.33. Whereas, sensitivity of CUS was 44.4%; specificity of CUS was 66.7%; PPV was 80%; NPV was 28.6% and LR was 1.33. Conclusion The CUS was only moderately effective at diagnosing meningitis whereas the presence of positive CSF among neonates with sepsis only within this study, further reaffirms the irreplaceability of CSF analysis in the diagnosis of NSM. Nevertheless, the integration of clinical assessment and CUS findings for diagnosing NSM emerged as possessing greater clinical significance in contexts characterized by limited resources. The systematic adoption of CUS for neonates exhibiting features suggestive of sepsis or meningitis (while exploring measures to improve on uptake of CSF analysis) could enhance the promptness of diagnosis, inform the selection of suitable therapeutic interventions, and potentially mitigate mortality rates and the occurrence of long-term neurological impairments, especially within environments facing resource limitations.