Attendance at day care centers increases the risk of childhood pneumonia among the urban poor in Fortaleza, Brazil

Determinants of pneumonia among under-five children in Oromia region, Ethiopia: unmatched case-control study

BACKGROUND

Pneumonia is the single largest infectious disease that causes more under-five morbidity and mortality than any other infectious disease in the world, including Ethiopia. The aim of this study is to assess determinants of pneumonia among under-five children in the South West Shewa Zone, Oromia Region, Ethiopia, 2021.

METHODS

We used an unmatched case-control study design from March 15 to April 30, 2021, in the South West Shewa Zone, Ethiopia. A sample of 398 (199 cases and 199 controls) participated in the study. Trained data collectors through a pre-tested structured questionnaire collected data. We used Epi Info to enter data and analyzed using SPSS version 23. We described our data using descriptive statistics. We identified predictors of pneumonia using logistic regression analysis. We declared predictors of pneumonia at a P-value of 0.05 or less.

RESULTS

Breastfeeding for less than 6 months [AOR:3.51, 95%CI:(1.12,11.00)], lack of Vitamin A supplementation [AOR:3.56,95%CI:(1.58, 8.05)], history of URTI [AOR:9.66, 95%CI:(4.69,19.87)], family child care practices [AOR:6.46, 95%CI, (2.83,14.76)], sleeping with three to five persons in a room [AOR:2.90, 9%CI: (1.23,6.84)], having above five persons in a room [AOR: 3.88, 95%CI: 1.02,14.77), use of wood as a source of fuel [AOR = 3.02 95% CI: 1.41,6.46)] and not opening windows [AOR:2.56 95%CI: (1.21,5.41)] were independent factors of pneumonia among under five children.

CONCLUSION

Pneumonia is associated with breastfeeding for less than 6 months, lack of vitamin A supplementation, history of URTI, types of childcare practice, indoor overcrowding, use of wood as a source of fuel, and not opening windows. Therefore, exclusive breastfeeding, improving vitamin A supplementation, early control of respiratory tract infection through promoting good hygiene and ventilation strategies in crowded homes, and promoting how to reduce indoor air pollution through affordable clean stoves will be relevant interventions to reduce under-five pneumonia.

[Incidence of community-acquired infections of lower airways among infants]

OBJECTIVE

To estimate the incidence of community-acquired infections of the lower respiratory tract and the risk factors associated with its occurrence in infants, in their first year of life.

METHODS

A prospective cohort study of infants who were followed up during the first 12 months of life. Interviews were conducted with their mothers, and children were clinically monitored bimonthly to investigate the occurrence of the incidence density of community-acquired infections of the lower respiratory tract. Cox regression analysis was used to estimate the crude and adjusted relative risk of the variables associated with the outcome.

RESULTS

The mean age of the mothers was 26 years, 62% of them had more than 11 years of schooling, and 23.5 were at risk of social exclusion regarding economic income. The incidence density of pneumonia and bronchiolitis were, respectively, 0.51 and 3.10 episodes per 100 children-months. Children who had low birth weight (<2500g) were 5.96 (95%CI 1.75-20.40) times more likely to have pneumonia than infants weighing 2500g or over.

CONCLUSIONS

The incidence of acute lower respiratory tract infection in children was similar to that found in other studies. Only low birth weight was an independent risk factor for the occurrence of pneumonia.

Centre-based day care for children younger than five years of age in low- and middle-income countries

BACKGROUND

Because of poverty, children and families in low- and middle-income countries often face significant impediments to health and well-being. Centre-based day care services may influence the development of children and the economic situation of parents by providing good quality early childhood care and by freeing parents to participate in the labour force.

OBJECTIVES

To assess the effects of centre-based day care without additional interventions (e.g. psychological or medical services, parent training) on the development, health and well-being of children and families in low- and middle-income countries (as defined by the World Bank 2011).

SEARCH METHODS

In April 2014, we searched CENTRAL, Ovid MEDLINE, EMBASE, PsycINFO, ERIC and 16 other sources, including several World Health Organization (WHO) regional databases. We also searched two trials registers, websites of government and non-government agencies and reference lists of relevant studies.

SELECTION CRITERIA

We included randomised and quasi-randomised controlled trials and prospective non-randomised studies with contemporaneous control groups and assessments both before and after intervention. We considered non-randomised controlled trials, as centre-based care in low- and middle-income countries is unlikely to be studied using randomised controlled trials (Higgins 2011). We included the following outcomes: child intellectual development, child psychosocial development, maternal and family outcomes and incidence of infectious diseases.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed risk of bias and extracted data from the single included study.

MAIN RESULTS

Only one trial, involving 256 children, met the inclusion criteria for this review. This study was assessed as having high risk of bias because of non-random allocation, incomplete outcome data and insufficient control of confounding factors. Results from this study suggest that centre-based day care may have a positive effect on child cognitive ability compared with no treatment (care at home) (assessed using a modified version of the British Ability Scale-II (BAS-II) (standardised mean difference (SMD) 0.74, 95% confidence interval (CI) 0.48 to 1.00, 256 participants, 1 study, very low-quality evidence). This study did not measure other variables relevant to this review.

AUTHORS' CONCLUSIONS

The single study included in this review provides limited evidence on the effects of centre-based day care for children younger than five years of age in low- and middle-income countries. This study was at high risk of bias and may have limited generalisability to other low- and middle-income countries. Many of the studies excluded from this review paired day care attendance with co-interventions that are unlikely to be provided in normal day care centres. Effectiveness studies on centre-based day care without these co-interventions are few, and the need for such studies is significant. In future studies, comparisons might include home visits or alternative day care arrangements.

Risk factors for hospital admission due to acute lower respiratory tract infection in Guarani indigenous children in southern Brazil: a population-based case-control study

OBJECTIVE

To assess risk factors associated with hospital admission due to acute lower respiratory tract infection (ALRTI) in indigenous Guarani children <5 years of age in southern Brazil.

METHODS

Population-based matched case-control study from May 2007 to June 2008 in 81 Guarani villages. Cases were defined as hospital admissions due to confirmed ALRTI. Two controls free from acute respiratory infection, matched according to age, sex and place of residence, were selected for each case at the time of the case's hospitalisation. Both cases and controls were recruited by a surveillance routine established for the study.

RESULTS

The analysis was performed on 120 cases and 201 controls. The risk factors that remained significantly associated with hospitalisation due to ALRTI in the hierarchical multivariate conditional logistic regression were: low stable monthly per capita household income (<US$30.00 = OR: 2.77, IC95% : 1.51-5.10; no income= OR: 1.88, IC95% : 1.02-3.47); large number of persons in the household (6-9 =  OR: 2.03, IC95% : 1.06-3.88; 10-16 =  OR: 5.00, IC95% : 1.81-13.86); indoor exposure to fumes from burning firewood used for cooking (OR: 3.08, IC95% : 1.39-6.84);low maternal age (OR: 2.77, IC95% : 1.42-5.39); and low birthweight (OR: 6.12, IC95% : 1.44-26.13).

CONCLUSION

Acute respiratory infections are a major cause of morbidity and mortality among Guarani children. Our study provides the first evidence about their determinants in indigenous peoples in Brazil that can help to better understand the epidemiology of respiratory infections in indigenous children.

Population-based study of the impact of childcare attendance on hospitalizations for acute respiratory infections

OBJECTIVES

It is well known that children attending childcare have a higher risk of acute respiratory infections compared with children in home care; however, knowledge is sparse regarding how the excess risk of acute respiratory infection varies with age, time since enrollment, and other factors.

METHODS

A national register-based study of 138,821 inpatient admissions to hospital for acute respiratory infection during 3,982,925 person-years of follow-up in Danish children aged 0 to 5 years. Data on child and family characteristics, childcare attendance, and hospitalizations were obtained from Danish registries. The outcome of the study was inpatient admissions to hospital for acute respiratory infection. Incidence rate ratios were estimated using Poisson regression.

RESULTS

In children < 1 year of age, the first 6 months of enrollment in the first childcare facility were associated with a 69% higher incidence of hospitalizations for acute respiratory infection compared with children in home care. Similar figures for children aged 1, 2, and > or = 3 years were 47%, 41%, and 8%, respectively. The incidence decreased after the first 6 months, and after > or = 1 year in childcare the incidence was comparable with that of children in home care. Similar patterns were seen after second enrollment. For 0- to 2-year-old children living in households with no additional children < 5 years, the excess incidence during the first 6 months of enrollment was 100% compared with 25% and 9% for children living with 1 and > or = 2 additional children, respectively.

CONCLUSIONS

The increased risk of acute respiratory infection was most pronounced among 0- to 2-year-old children living with no other children during the first 6 months of enrollment. Our findings may suggest that it would be optimal to postpone enrollment into childcare until after 1 year of age.

Full breastfeeding and hospitalization as a result of infections in the first year of life

OBJECTIVE

Our objective was to assess the effect of breastfeeding on the probability of hospitalization as a result of infectious processes during the first year of life

METHODS

We followed 1385 infants from birth to age 1 year between 1996 and 1999. Recruitment and data collection were done at the 6-month well-infant visit under the National Child Health Program. Full breastfeeding, hospital admission, and other relevant variables related to the delivery, infant, mother, health services system, and sociologic aspects were recorded. The statistical analysis included Kaplan-Meier test, Cox regression to obtain the hazard ratio, and the adjusted attributable risk.

RESULTS

Full breastfeeding at discharge after delivery and at 3, 4, and 6 months of age were 85%, 52%, 41%, and 15%, respectively; 78 hospital admissions as a result of infections were recorded (38 respiratory tract, 16 gastrointestinal tract). Mean age at admission was 4.1 months. After estimating the attributable risk, it was found that 30% of hospital admissions would have been avoided for each additional month of full breastfeeding. Seemingly, 100% of full breastfeeding among 4-month-old infants would avoid 56% of hospital admissions in infants who are younger than 1 year.

CONCLUSIONS

On the basis of the present data, we conclude that full breastfeeding would lower the risk for hospital admission as a result of infections among infants who are younger than 1 year within an industrialized country.

Varicella zoster in children attending day care centers

OBJECTIVE

To describe morbidity associated to varicella in children attending day care centers.

METHODS

Descriptive study carried out through inquiries with parents of 664 children who acquired varicella after admission to day care centers in Taubaté (population: 244,165, census of 2004), a prosperous city in the State of São Paulo.

RESULTS

The median age was 36 months (range 6 to 80 months); 8.4% of the children had varicella before 1 year of age. The main symptoms were: exanthema (100.0%), fever (85.4%) anorexia (39.6%), and headache (15.3%). 517 children (77.9%) had at least 1 medical visit, and 80.6% received at least 1 medication; 73 (11.0%) received nonsteroidal antiinflammatory drugs, and 52 (7.8%) received antibiotics. Complications occurred in 38 children (5.7%; 95% confidence interval: 3% - 8%); 8 (1.2%) were hospitalized, and 5 (0.7%) had sequelae. Complications and hospitalizations rates were 3 times more frequent in children with less than 1 year of age than in older children. More than half of the children and of the working parents were absent from their regular activities for more than a week.

CONCLUSIONS

Varicella was associated with significant morbidity, affected younger children, was complicated in more than 5%, and left sequelae in 0.7% of children. More than 10% of the children received nonsteroidal antiinflammatory drugs, highlighting the need to warn the population about the risks of these drugs. Although varicella vaccination is not recommended for children younger than 12 months, vaccination of the children older than a year could avoid by herd immunity the transmission to babies. Brazilian public health authorities should be alerted to this issue and offer varicella vaccine to children attending day care centers.

Repercussão da desnutrição infantil na família

O estado nutricional infantil reflete o consumo alimentar e o estado de saúde, de modo que esses fatores dependem da disponibilidade de alimento no domicílio, da salubridade, do ambiente e do cuidado destinado à criança. Objetivou-se compreender como a família convive com a problemática da desnutrição infantil. Trata-se de estudo qualitativo em que se apresentam percepções e sentimentos obtidos mediante entrevistas semi-estruturadas e observações realizadas com 10 mães de crianças desnutridas, que residem na periferia de Fortaleza - Ceará, Brasil. As categorias temáticas emergidas no discurso transcrito foram desemprego e incerteza do alimento. A síntese das categorias analisadas evidenciou que o agravante da fome é caracterizado frente a uma incerteza da família. Assim, buscam opções de apoio, como o posto de saúde, familiares, igreja e comunidade. Conclui-se sobre a necessidade de priorizar um trabalho preventivo, mediante políticas públicas de saúde, objetivando medidas que perpassem o real mundo da promoção da saúde.

Anemia em crianças menores de cinco anos que freqüentam creches públicas do município do Rio de Janeiro, Brasil

OBJETIVOS: estimar a prevalência de anemia em crianças matriculadas em creches municipais do Rio de Janeiro e identificar os subgrupos de maior risco. MÉTODOS: foram avaliadas 865 crianças. A hemoglobina (Hb) foi dosada em fotômetro portátil (HemoCue) e a anemia foi definida quando Hb <11g/dL e <9,5g/dL para maiores e menores de seis meses, respectivamente. Foram obtidas informações biológicas e socioeconômicas através de questionários aplicados às mães. RESULTADOS: A prevalência de anemia foi de 47,3%. As crianças anêmicas apresentaram médias de z escore de peso para a idade (-0,239) e a altura para a idade (-0,548) mais baixas do que as não-anêmicas. O risco de anemia foi maior para as crianças com idade abaixo de dois anos (razão de prevalência [RP]=1,73; intervalo de confiança [IC95%: 1,52-1,97), para as que tinham pais com menos de quatro anos de estudo (RP=1,57; IC95%:1,24-1,99) e moravam em domicílios com mais de oito moradores (RP=1,45; IC95%:,1,07-1,95). . CONCLUSÕES: a prevalência de anemia foi elevada. As crianças com mais baixo peso e estatura para a idade, menores de dois anos, que moravam em residências com número elevado de pessoas e que tinham pais com baixa escolaridade foram as mais vulneráveis à anemia, devendo ser alvo de políticas de controle e prevenção.

The knowledge of staff in day nurseries about some basic measures which promote child health

Purpose

This paper aims to determine the knowledge that staff in day nurseries in Brazil had of basic measures to promote child health which are connected with high child mortality. These measures included breastfeeding, oral rehydration therapy, child growth follow‐up, immunization and the identification of signs that indicate that the child must be referred to a health facility.

Design/methodology/approach

A cross‐sectional study was performed in day nurseries in the state of Bahia, Brazil, involving 194 care staff from 77 different establishments. Questionnaires, the observation of practical exercises and documentary evidence were used to assess knowledge.

Findings

Seventeen percent of professionals were able to use growth charts correctly, 37.1 percent were able to prepare an oral rehydration solution adequately, 77.8 percent were able to provide appropriate breastfeeding counseling, 65.0 percent were able to identify children who showed respiratory danger signs and refer them to a health facility, and 58.5 percent were able to check the immunization status. This suggests a serious lack of basic knowledge in key areas.

Research limitations/implications

The losses observed in the beginning of the study and the possibility of the existence of memory bias related to the verbal information obtained might have influenced the results.

Practical implications

These findings suggest that there is an urgent need to address the lack of knowledge about basic child health measures shown by these key workers through appropriate educational programs.

Originality/value

This is one of the first studies of levels of knowledge about basic child health measures in professionals who work outside the medical profession, and in particular in day nurseries. It also provides valuable information about health knowledge in a developing country.

Estado nutricional e fatores associados ao déficit de crescimento de crianças freqüentadoras de creches públicas do Município de São Paulo, Brasil

O presente estudo relata o estado nutricional de crianças freqüentadoras de creches da rede municipal de São Paulo, Brasil. Foi avaliada uma amostra representativa das crianças atendidas, totalizando 827 crianças menores de 84 meses. Características sócio-econômicas, dados de morbidade e o estado nutricional (altura/idade e/ou peso/altura) foram obtidos. Verificou-se que 7,0% (IC95%: 3,60-10,40) das crianças apresentavam déficit de altura. Na análise univariada, os fatores que se associaram ao déficit nutricional foram: idade da criança (< 24 meses), RC = 2,10 (IC95%: 1,11-3,98); relato de diarréia no mês anterior, RC = 2,84 (IC95%: 1,42-5,66); escolaridade do responsável até três anos de estudo, RC = 3,87 (IC95%: 1,10-13,68); número de moradores no domicílio (sete ou mais), RC = 3,02 (IC95%: 1,46-6,22); número de irmãos (dois ou mais), RC = 4,81 (IC95%: 1,72-13,44). Na análise multivariada, a ocorrência de diarréia no mês anterior e número de irmãos mantiveram-se associados ao retardo de crescimento (RC = 2,54; IC95%: 1,20-5,38 e RC = 7,40; IC95%: 2,20-24,93, respectivamente).

Intervenções para reduzir a mortalidade infantil pré-escolar e materna no Brasil

O presente trabalho teve como objetivo analisar o possível impacto de intervenções para reduzir a mortalidade de crianças e mães brasileiras. Através de uma combinação de métodos demográficos diretos e indiretos, avaliaram-se as tendências temporais, as variações regionais e a distribuição por causas da mortalidade de mães e crianças. Avaliou-se também a atual cobertura de programas preventivos. Com base nesses parâmetros, assim como em uma revisão da literatura sobre a efetividade das intervenções disponíveis, foram obtidas estimativas do impacto potencial de cada tipo de intervenção. A mortalidade em crianças vem sendo reduzida, mas os níveis atuais ainda são elevados e há importantes desigualdades regionais, com o Nordeste e Norte apresentando os mais altos índices. Devido à predominância de causas perinatais na mortalidade de crianças brasileiras, as medidas de maior potencial são aumentos na qualidade e cobertura do atendimento pré-natal e ao parto, seguidos pelo manejo integrado de doenças infecciosas e de problemas nutricionais. Melhorias no pré-natal e parto também contribuiriam para reduzir a mortalidade materna. É importante, ainda, garantir a sustentabilidade dos avanços já alcançados em áreas como as imunizações, a terapia de reidratação oral e o planejamento familiar, assim como investir intensamente na redução das importantes desigualdades regionais.

Acesso à creche e estado nutricional das crianças brasileiras: diferenças regionais, por faixa etária e classe de renda

O trabalho visa descrever o acesso das crianças brasileiras às creches nas diferentes macro-regiões, centralizando a atenção no estado nutricional e, também, nas classes de renda. A base de dados adotada é constituída pelas informações individuais das crianças (n = 10 667) menores de seis anos, integrantes da Pesquisa Nacional sobre Saúde e Nutrição, realizada em 1989. De forma geral os resultados demonstram que os programas de creches favorecem as crianças mais velhas (com dois anos ou mais). Verificam-se que apenas 8,49% das crianças, com renda domiciliar per capita menor do que US$40.00 freqüentam creche. No grupo com rendimento per capita pelo menos igual a US$80.00, aquela proporção alcança 28,37%. A menor cobertura das creches foi observada na Região Centro-Oeste (apenas 10,94% das crianças freqüentavam a creche). Quando se analisa o estado nutricional das crianças observa-se, de forma sistemática, maiores proporções de crianças com escore-Z de altura para idade <-2 entre aqueles que não freqüentam creche.

[Daycare centers in a medium-sized Brazilian city: operations, child-care practices, infrastructure, and safety]

Ninety-two daycare centers (23 public, 10 charitable, and 59 private) were identified in the municipality of Pelotas, RS, Southern Brazil. These centers were studied in relation to their organization, services, child-care practices, and infrastructure. All public centers worked full-time, while most private centers operated in the afternoon and received a smaller proportion of children under the age of two. The child-to-attendant ratio was similar in both types of centers, and the nurseries were the classes most frequently above the recommended maximum. Group and center sizes were larger in the public centers. Attendant schooling was higher in the private centers, but task specificity was lower. The infrastructure deficiencies most commonly observed in the public centers were lack of an internal recreational area and playground equipment. Private centers lacked adequate diapering facilities and exclusive toilets for the children. A small proportion of centers had staff trained to handle fire emergencies and administer first aid, revealing insufficient concern over safety issues.

Child-care attendance and common morbidity: evidence of association in the literature and questions of design

Papers on child-care attendance as a risk factor for acute respiratory infections and diarrhea were reviewed. There was great variety among the studies with regard to the design, definition of exposure and definition of outcomes. All the traditional epidemiological study designs have been used. The studies varied in terms of how child-care attendance in general was defined, and for different settings. These definitions differed especially in relation to the minimum time of attendance required. The outcomes were also defined and measured in several different ways. The analyses performed were not always appropriate, leading to sets of results of uneven quality, and composed of different measures of association relating different exposures and outcomes, that made summarizing difficult. Despite that, the results reported were remarkably consistent. Only two of the papers reviewed failed to show some association between child-care attendance and increased acute respiratory infections, or diarrhea. On the other hand, the magnitude of the associations reported varied widely, especially for lower respiratory infections. Taken together, the studies so far published provide evidence that children attending child-care centers, especially those under three years of age, are at a higher risk of upper respiratory infections, lower respiratory infections, and diarrhea. The studies were not consistent, however, in relation to attendance at child-care homes. Children in such settings were sometimes similar to those in child-care centers, sometimes similar to those cared for at home, and sometimes presented an intermediate risk.