Current Issue : April - June Volume : 2012 Issue Number : 2 Articles : 7 Articles
Background: Despite recent achievements to reduce child mortality, neonatal deaths continue to remain high, accounting\r\nfor 41% of all deaths in children under five years of age worldwide, of which over 90% occur in low- and middle-income\r\ncountries (LMICs). Infections are a leading cause of death and limitations in care seeking for ill neonates contribute to high\r\nmortality rates. As estimates for care-seeking behaviors in LMICs have not been studied, this review describes care seeking\r\nfor neonatal illnesses in LMICs, with particular attention to type of care sought.\r\nMethods and Findings: We conducted a systematic literature review of studies that reported the proportion of caregivers\r\nthat sought care for ill or suspected ill neonates in LMICs. The initial search yielded 784 studies, of which 22 studies\r\ndescribed relevant data from community household surveys, facility-based surveys, and intervention trials. The majority of\r\nstudies were from South Asia (n = 17/22), set in rural areas (n = 17/22), and published within the last 4 years (n = 18/22). Of\r\nthe 9,098 neonates who were ill or suspected to be ill, 4,320 caregivers sought some type of care, including care from a\r\nhealth facility (n = 370) or provider (n = 1,813). Care seeking ranged between 10% and 100% among caregivers with a\r\nmedian of 59%. Care seeking from a health care provider yielded a similar range and median, while care seeking at a health\r\ncare facility ranged between 1% and 100%, with a median of 20%. Care-seeking estimates were limited by the few studies\r\nconducted in urban settings and regions other than South Asia. There was a lack of consistency regarding illness, careseeking,\r\nand care provider definitions.\r\nConclusions: There is a paucity of data regarding newborn care-seeking behaviors; in South Asia, care seeking is low for\r\nnewborn illness, especially in terms of care sought from health care facilities and medically trained providers. There is a need\r\nfor representative data to describe care-seeking patterns in different geographic regions and better understand\r\nmechanisms to enhance care seeking during this vulnerable time period....
Background: Assumptions about survival of HIV-infected children in Africa without antiretroviral therapy need to be\nupdated to inform ongoing UNAIDS modelling of paediatric HIV epidemics among children. Improved estimates of infant\nsurvival by timing of HIV-infection (perinatally or postnatally) are thus needed.\nMethodology/Principal Findings: A pooled analysis was conducted of individual data of all available intervention cohorts and\nrandomized trials on prevention of HIV mother-to-child transmission in Africa. Studies were right-censored at the time of infant\nantiretroviral initiation. Overall mortality rate per 1000 child-years of follow-up was calculated by selected maternal and infant\ncharacteristics. The Kaplan-Meier method was used to estimate survival curves by childââ?¬â?¢s HIV infection status and timing of HIV\ninfection. Individual data from 12 studies were pooled, with 12,112 children of HIV-infected women. Mortality rates per 1,000\nchild-years follow-up were 39.3 and 381.6 for HIV-uninfected and infected children respectively. One year after acquisition of\nHIV infection, an estimated 26% postnatally and 52% perinatally infected children would have died; and 4% uninfected\nchildren by age 1 year. Mortality was independently associated with maternal death (adjusted hazard ratio 2.2, 95%CI 1.6ââ?¬â??3.0),\nmaternal CD4,350 cells/ml (1.4, 1.1ââ?¬â??1.7), postnatal (3.1, 2.1ââ?¬â??4.1) or peri-partum HIV-infection (12.4, 10.1ââ?¬â??15.3).\nConclusions/Results: These results update previous work and inform future UNAIDS modelling by providing survival\nestimates for HIV-infected untreated African children by timing of infection. We highlight the urgent need for the\nprevention of peri-partum and postnatal transmission and timely assessment of HIV infection in infants to initiate\nantiretroviral care and support for HIV-infected children....
Background: Neonatal intensive care improves survival, but is associated with high costs and disability amongst survivors.\nRecent health reform in Mexico launched a new subsidized insurance program, necessitating informed choices on the\ndifferent interventions that might be covered by the program, including neonatal intensive care. The purpose of this study\nwas to estimate the clinical outcomes, costs, and cost-effectiveness of neonatal intensive care in Mexico.\nMethods and Findings: A cost-effectiveness analysis was conducted using a decision analytic model of health and\neconomic outcomes following preterm birth. Model parameters governing health outcomes were estimated from Mexican\nvital registration and hospital discharge databases, supplemented with meta-analyses and systematic reviews from the\npublished literature. Costs were estimated on the basis of data provided by the Ministry of Health in Mexico and World\nHealth Organization price lists, supplemented with published studies from other countries as needed. The model estimated\nchanges in clinical outcomes, life expectancy, disability-free life expectancy, lifetime costs, disability-adjusted life years\n(DALYs), and incremental cost-effectiveness ratios (ICERs) for neonatal intensive care compared to no intensive care.\nUncertainty around the results was characterized using one-way sensitivity analyses and a multivariate probabilistic\nsensitivity analysis. In the base-case analysis, neonatal intensive care for infants born at 24ââ?¬â??26, 27ââ?¬â??29, and 30ââ?¬â??33 weeks\ngestational age prolonged life expectancy by 28, 43, and 34 years and averted 9, 15, and 12 DALYs, at incremental costs per\ninfant of US$11,400, US$9,500, and US$3,000, respectively, compared to an alternative of no intensive care. The ICERs of\nneonatal intensive care at 24ââ?¬â??26, 27ââ?¬â??29, and 30ââ?¬â??33 weeks were US$1,200, US$650, and US$240, per DALY averted,\nrespectively. The findings were robust to variation in parameter values over wide ranges in sensitivity analyses.\nConclusions: Incremental cost-effectiveness ratios for neonatal intensive care imply very high value for money on the basis\nof conventional benchmarks for cost-effectiveness analysis....
Objectives: Our aim was to establish whether there is an interconnection between the compositional development of the\r\ngut microbiota and the amount of fussing and crying in early infancy.\r\nMethods: Behavioral patterns of 89 infants during the 7th and 12th week of life were recorded in parental diaries. Total\r\ndistress was defined as the sum of daily amounts of crying and fussing. Infantsââ?¬â?¢ gut microbiota profiles were investigated by\r\nseveral molecular assays during the first six months of life.\r\nResults: The median (range) duration of total distress among the infants was 106 (0ââ?¬â??478) minutes a day during the 7th and\r\n58 (0ââ?¬â??448) minutes a day during the 12th week. The proportion of Bifidobacterium counts to total bacterial counts was\r\ninversely associated with the amount of crying and fussing during the first 3 months of life (p = 0.03), although the number\r\nof Bifidobacterium breve was positively associated with total distress (p = 0.02). The frequency of Lactobacillus spp. at the age\r\nof 3 weeks was inversely associated with total infant distress during the 7th week of life (p = 0.02).\r\nConclusions: Bifidobacterium and Lactobacillus appear to protect against crying and fussing. Identification of specific strains\r\nwith optimal protective properties would benefit at-risk infants....
During the Northern Hemisphere winter of 2003ââ?¬â??2004 the emergence of a novel influenza antigenic variant, A/Fujian/411/\n2002-like(H3N2), was associated with an unusually high number of fatalities in children. Seventeen fatal cases in the UK were\nlaboratory confirmed for Fujian/411-like viruses. To look for phylogenetic patterns and genetic markers that might be\nassociated with increased virulence, sequencing and phylogenetic analysis of the whole genomes of 63 viruses isolated\nfrom fatal cases and non fatal ââ?¬Ë?ââ?¬Ë?controlââ?¬â?¢Ã¢â?¬â?¢ cases was undertaken. The analysis revealed the circulation of two main genetic\ngroups, I and II, both of which contained viruses from fatal cases. No associated amino acid substitutions could be linked\nwith an exclusive or higher occurrence in fatal cases. The Fujian/411-like viruses in genetic groups I and II completely\ndisplaced other A(H3N2) viruses, but they disappeared after 2004. This study shows that two A(H3N2) virus genotypes\ncirculated exclusively during the winter of 2003ââ?¬â??2004 in the UK and caused an unusually high number of deaths in children.\nHost factors related to immune state and differences in genetic background between patients may also play important roles\nin determining the outcome of an influenza infection....
Background: Preterm birth is considered to be associated with an estimated 27% of neonatal deaths, the majority in\nresource-poor countries where rates of prematurity are high. There is no information on medium term outcomes after\naccurately determined preterm birth in such settings.\nMethods and Findings: This community-based stratified cohort study conducted between Mayââ?¬â??December 2006 in\nSouthern Malawi followed up 840 post-neonatal infants born to mothers who had received antenatal antibiotic prophylaxis/\nplacebo in an attempt to reduce rates of preterm birth (APPLe trial ISRCTN84023116). Gestational age at delivery was based\non ultrasound measurement of fetal bi-parietal diameter in early-mid pregnancy. 247 infants born before 37 wk gestation\nand 593 term infants were assessed at 12, 18, or 24 months. We assessed survival (death), morbidity (reported by carer,\nadmissions, out-patient attendance), growth (weight and height), and development (Ten Question Questionnaire [TQQ] and\nMalawi Developmental Assessment Tool [MDAT]). Preterm infants were at significantly greater risk of death (hazard ratio\n1.79, 95% CI 1.09ââ?¬â??2.95). Surviving preterm infants were more likely to be underweight (weight-for-age z score; p,0.001) or\nwasted (weight-for-length z score; p,0.01) with no effect of gestational age at delivery. Preterm infants more often\nscreened positively for disability on the Ten Question Questionnaire (p = 0.002). They also had higher rates of developmental\ndelay on the MDAT at 18 months (p = 0.009), with gestational age at delivery (p = 0.01) increasing this likelihood.\nMorbidityââ?¬â?visits to a health centre (93%) and admissions to hospital (22%)ââ?¬â?was similar for both groups.\nConclusions: During the first 2 years of life, infants who are born preterm in resource poor countries, continue to be at a\ndisadvantage in terms of mortality, growth, and development. In addition to interventions in the immediate neonatal\nperiod, a refocus on early childhood is needed to improve outcomes for infants born preterm in low-income settings....
Children�s time estimation literature lacks of studies comparing prospective and retrospective time estimates of long lasting\r\necological tasks, i.e. tasks reflecting children�s daily activities. In the present study, children were asked to estimate\r\nprospectively or retrospectively how much time they played a video game or read a magazine. Regardless of the task, the\r\nresults revealed that prospective time estimates were longer than the retrospective ones. Also, time estimates of the video\r\ngame task were longer, less accurate and more variable than those of the reading task. The results are discussed in the light\r\nof the current literature about time estimation of long lasting ecological tasks....
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