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Dec 2023 DOI 10.14302/issn.2324-7339.jcrhap-23-4634
Makura AlfredCorresponding author
Introduction Human Immunodeficiency Virus (HIV) remains a persistent global public health challenge. In 2020, approximately 37.9 million individuals were living with HIV globally, including 1.7 million children <15 years old, with a global HIV prevalence of 0.8% among adults. A larger portion of people living with HIV are found in low-and middle-income countries, and Sub-Saharan Africa (SSA) is home to about 68% of people living with HIV in the world. Strikingly, with increased uptakes in PMTCT, challenges in ART programs, and high viremia among children and adolescents in SSA, the success rate of ART might be quickly compromised, with possible HIVDR emergence, particularly after years of paediatric ART exposure. Therefore, monitoring ART response in children and adolescents in terms of HIVDR patterns and other socio-economic determinants of disease progression might help achieve better treatment outcomes at individual levels. At a programmatic level, this can guide further optimization of treatment options for SSA especially Zimbabwean rural where there is paucity of information on HIVDR prevalence in children and adolescents. Methods We enrolled 89 children and adolescents experiencing virologic failure from Chidamoyo Christian Hospital in Hurungwe. We managed to amplify all the 89 using nested PCR and 32.5% (29) had resistance to at least one ART drug and analysis was done using the 29 samples. Results Among the 89 participants with virologic failure,29 were resistant to at least one of their ART drugs. 39.2% of males and 23.07% of females had HIV-1 with resistance to at least one medication. Among 29 participants with HIVDR mutations, the prevalence of at least one HIVDR mutation to protease inhibitors (PIs), Nucleotide Reverse Transcriptase Inhibitors (NRTI), and Non-Nucleotide Reverse Transcriptase Inhibitors (NNRTI) were 6.47% ,46.76% and 46.76% respectively. Of the 29 participants who had HIVDR 19 (65.5%) had resistance to a drug they were currently taking and they needed to be switched to a better effective ART regimen Conclusion Use of HIVDR testing in guiding and monitoring development of HIVDR at the start of ART or at 1st failure can be very important in treatment options and patient management.
May 2022 DOI 10.14302/issn.2379-7835.ijn-22-4190
Bartle JodieCorresponding author
Department of Nutrition & Food Services, Royal Children’s Hospital, Melbourne.
Background Nutrition support during the acute phase post allogeneic haematopoietic stem cell transplantation (HSCT) is required to optimise short- and long-term outcomes for children. An algorithm was developed and evaluated to assist clinicians to make objective and consistent enteral feeding decisions. Methods The algorithm was evaluated on all patients who underwent allogeneic HSCT treatment between November 2017 - February 2019. Results Of the 48 patients, 43 had a nasogastric tube (NGT) inserted, of which 36 patients received a hydrolysed peptide-based formula, 5 patients received a whole protein formula only and 2 patients were fed an amino acid-based formula. Parenteral nutrition (PN) was used in 41 of the patients. Eleven did not have an NGT in-situ at the commencement of HSCT. Of the remaining 37 patients, 26 followed the algorithm and 11 patients did not comply. The group of patients who did not follow the algorithm had the longest median length of stay (LOS) of 49 days. Patients receiving only EN had the lowest median LOS of 30 days. The two groups that reported better weight outcomes were those who followed the algorithm and those who were fully EN fed. Conclusions Effective use of the HSCT feeding algorithm indicated improved patient outcomes for children undergoing HSCT, with better weight outcomes and reduced LOS. Recommendations to improve the efficacy and compliance of the algorithm include regular education/input to the oncology medical teams to better understand objective thresholds for EN and PN commencement.
Aug 2018 DOI 10.14302/issn.2324-7339.jcrhap-18-2202
AA OkechukwuCorresponding author
Department of Pediatrics, University of Abuja Teaching Hospital, Gwagwalada.
Background: Ideally, disclosure of HIV status to infected children and adolescents should involve both health care workers and parents/caregivers. Most studies on disclosure in children have focus mainly on parents/caregivers with little information on health care workers. We conduct this study to evaluate the practice, perception of the healthcare workers in our health facility on disclosure to infected children and adolescents. It is envisaged that such information will help in the design of better strategies on disclosure in our environment. Methods: A cross sectional hospital based study was conducted among health care workers at the special treatment clinic, and heart to heart unit of the University of Abuja Teaching Hospital, Gwagwalada from January to March 2017 for the above objective. A structured questionnaire was used to collect information on disclosure among the healthcare workers, which include among others: their bio-data, knowledge, perception, and practice on disclosure in the two service areas of the hospital. Results: Of the 80 health care workers interviewed, 60(75.0%) were females, 11(13.8%) were doctors, 9(11.3%) nurses, 17(21.3%) monitoring/evaluation/record clerks, and 16(20.0%) were either voluntary counseling and testing counselors or adherence counselors. Their mean age and duration in service in the two areas were 39.70±7.10 and 7.93±4.99 years respectively. Over half 48(60.0%) of the health care workers were unaware of the hospital having guideline on disclosure, 64(80.0%) have not been trained, and 68(85.0%) does not know any key information on disclosure. While all 80(100%) felt that disclosure was a good practice for better adherence, only 16(20.0%) had actually disclosed, with 6(37.5%) not seeking any formal permission from parent/caregivers before disclosing. Ages 8-16 years was recommended by 60(75%) as the appropriate age to disclose, however 28(35.0%) recommended age 14-16 years. Over half of the respondents 58(72.5%) admitted that disclosure should be a shared responsibility between themselves and the caregivers, most however perceive their role as only preparing the parents/caregivers for disclosure, and providing ongoing counseling to both the parents/caregivers and the children and adolescents. Lack of training on disclosure, and none availability of guideline in the health institution were major setback on the ability of the healthcare providers to fully participate in disclosure process. Conclusion: While healthcare providers support the idea of disclosing at mid and late adolescent, their perceived role was that of support and provision of ongoing counseling. Lack of training and none availability of disclosure guideline affects their perceived role. There is need to train and retrain healthcare workers on disclosure guideline, and making such guideline available in the health facilities.
Jan 2017 DOI 10.14302/issn.2476-1710.jdt-16-1324
Meiser SusanneCorresponding author
University of Potsdam, Department of Psychology
An important step in the validation of disorder-specific etiological models is the examination of the predictive specificity of proposed vulnerability factors. It may advance the understanding of the emergence of comorbidity and the identification of at risk-populations for mental disorders. To enhance the currently limited evidence on the specificity of Beck´s cognitive diathesis-stress model of depression, the present study investigated longitudinal effects of dysfunctional attitudes and stressful life events on the development of depressive, eating disorder and aggressive symptoms in children and adolescents. A large sample of initially asymptomatic children and adolescents completed self-report symptom measures at study entrance and again approx. 20 months later, and reported stressful life events during the study interval. Stressful life events proved to be a risk factor to all investigated symptom domains. Dysfunctional attitudes at T1 were prospectively related to depressive symptoms, aggressive behavior and weight concerns at T2. However, types of associations varied as dysfunctional attitudes showed linear associations with weight concern, but nonlinear effects on depressive and aggressive symptomatology. Findings of the current study thus suggest that dysfunctional attitudes are not uniquely related to the development of depressive symptomatology in children and adolescents, but may contribute to adverse outcomes in various symptom domains. Thus, intervention efforts based on Beck´s vulnerability - stress model of depression may turn out to be useful in reducing vulnerability to a variety of outcomes in children and adolescents.
Dec 2016 DOI 10.14302/issn.2474-3585.jpmc-16-1281
H. Alghamdi AhmedCorresponding author
Faculty of Medicine, Albaha University, Kingdom of Saudi Arabia.
Objectives This study describes and compares the epidemiological criteria of children with diabetes from 2007 to 2014. Methods A prospective study conducted with 372 children with diabetes mellitus. An access program was used for data collection, and SPSS 17 was used to analyses the results. Results A total of 372 cases with diabetes were studied and were divided into three groups according age. The first age group was between one day and six years and comprised 128 (34.4%) patients. The second group aged 7- 12 years of age comprised 174 (46.7%) patients. The third group aged 13-18 years of age comprised 58 (15.59%) patients. The average age was 8.32 years. Females constituted 52 % (194 cases) of all cases. T1DM constituted 95.4%, equal to 355 patients, T2DM constituted 1.88%, equal to seven cases. Monogenic diabetes affected three patients or 0.79%, with one case of monogenic neonatal diabetes confirmed by genetic study, and two other cases suspected to be MODY. The highest incidence was observed in the autumn months, with 105 children affected, constituting 27.8 % cases. The year 2012 had the highest incidence rate, with 59 children and adolescents affected at an incidence rate of 25.48 / 100000.Al-Baha region had the highest number of cases constituting 37.7 % of cases. Diabetic ketoacidosis was the first presentation and constituted 44.2% of cases. Conclusion. Diabetes in children is increasing significantly in recent years, requiring more detailed analysis of its epidemiological factors to find out any significant correlations which may help in its prevention.
Jun 2026 DOI 10.14302/issn.2379-7835.ijn-25-5909
Bisai SamiranCorresponding author
The high prevalence of anemia among children and adolescents in India is still an overwhelming problem. Not only that, there is also a considerable deficiency of various micronutrients such as Vitamin A, Vitamin B12, Vitamin D, serum ferritin, Zinc and Folate etc. in children. These micronutrients have several functional roles for the normal growth and development of children. Unfortunately, recent studies on public health and nutrition intervention have so far focused less on these micronutrition and more on anemia and nutrition. Data for this study obtained from the Comprehensive National Nutrition Survey (CNNS 2016-18), a nationally representative survey covering different age group. Specifically, it includes information on 9767 children aged 1-4 years. Out of these surveyed children biomarker data for hemoglobin, serum ferritin, zinc, folate, vitamin A, vitamin B12 and Vitamin D were collected from 8242 children. Micronutrient deficiencies were identified based on WHO and other established cut-off criteria. Wealth quintiles were computed to identify household economic inequality. The prevalence of anemia at the national level was 40.7%. Among micronutrients, folate (22.9%) and zinc (18.7%) deficiencies were most commonly observed, followed by vitamins A (18.3), vitamin B12 (13.8%) and vitamin D (14.0%). Iron deficiency as measured by ferritin was present in 31.6% of children. It is alarming that nearly one in three children (32.8%) suffer from deficiencies in two or more micronutrients. Clear socioeconomic disparities were observed for all micronutrient deficiencies (MND); children in the poorest groups had significantly higher levels of micronutrient deficiencies than children in the richest groups. Among the states, Gujarat and Madhya Pradesh had the highest overall micronutrient deficiencies, while West Bengal and Kerala had the lowest. This clearly shows that a large proportion of preschool children in India suffer from anemia and MND, with the prevalence being even more alarming in lower socio-economic settings. This study suggests that there is a need to move beyond single-nutrient interventions and implement comprehensive, multi-micronutrient supplementation or food fortification strategies seamlessly into the existing national health and nutrition programs.
Mar 2016 DOI 10.14302/issn.2379-8572.joa-15-891
Osterbauer BethCorresponding author
Children’s Hospital Los Angeles
Background: Despite its expense, labor and intrusiveness, polysomnography (PSG) is the gold standard for diagnosing obstructive sleep apnea (OSA). Recently, commercially available electronic activity monitors, such as Fitbit, have become widely accepted and can provide an estimate of sleep patterns for screening children with possible OSA. A previous study demonstrated Fitbit to be valid compared to PSG in adults. To date, these devices have not been extensively utilized for research in children with sleep disordered breathing (SDB). Objective: To evaluate the validity of the Fitbit activity monitor compared to PSG in children and adolescents with SDB. Methods: Data was collected from 14 children, ages 3 through 11, who were scheduled for a PSG during the study period. Fitbit was worn concurrently during the night of the PSG. Analyses were performed by comparing total sleep time, number of awakenings, sleep efficiency and wake after sleep onset (WASO) Fitbit parameters with the corresponding parameters measured by PSG using Spearman’s rho. Fitbit movement epochs were also compared to PSG epochs showing movement behavior. Results: Pilot data suggest that Fitbit demonstrates a high sensitivity for sleep, a low specificity for wake and a trend suggesting good association of movement measurements. Conclusion: Although Fitbit is not as accurate as PSG for determining wakefulness, it may be a useful screening device to assess gross sleep quality in children. Further studies are indicated to validate these findings.