Tania Gavidia

Respiratory impedance and bronchodilator responsiveness in healthy children aged 2-13 years

The forced oscillation technique (FOT) can be used in children as young as 2 years of age and in those unable to perform routine spirometry. There is limited information on changes in FOT outcomes in healthy children beyond the preschool years and the level of bronchodilator responsiveness (BDR) in healthy children. We aimed to create reference ranges for respiratory impedance outcomes collated from multiple centers. Outcomes included respiratory system resistance (Rrs) and reactance (Xrs), resonant frequency (Fres), frequency dependence of Rrs (Fdep), and the area under the reactance curve (AX). We also aimed to define the physiological effects of bronchodilators in a large population of healthy children using the FOT.

Factors associated with early initiation of breastfeeding among Nepalese mothers: further analysis of Nepal Demographic and Health Survey, 2011

BackgroundTimely initiation of breastfeeding has been reported to reduce neonatal mortality by 19.1%. The World Health Organisation recommends early initiation of breastfeeding i.e. breastfeeding a newborn within the first hour of life. Knowledge on the rate and the determinants of early initiation of breastfeeding may help health program managers to design and implement effective breastfeeding promotion programs. The aim of this study was to determine the rate and the determinants of early initiation of breastfeeding in Nepal.MethodsThis study used the data from Nepal Demographic and Health Survey (NDHS) 2011 which is a nationally representative sample study. Chi square test and multiple logistic regression analysis were used to examine the factors associated with early initiation of breastfeeding (within one hour of birth).ResultsOf 4079 mothers, 66.4% initiated breastfeeding within one hour of delivery. Mothers with higher education (Odds Ratio (OR) 2.56; 95% CI : 1.26, 5.21), mothers of disadvantaged Janjati ethnicity (OR 1.43; 95% CI : 1.04, 1.94), mothers who were involved in agriculture occupation (OR 1.51; 95% CI : 1.16, 1.97), mothers who delivered in a health facility (OR 1.67; 95% CI : 1.25, 2.23), whose children were large at birth (OR 1.46; 95% CI : 1.07, 1.99) were more likely to initiate breastfeeding within the first hour of child birth.ConclusionsResults suggest that two thirds of children in Nepal were breastfed within the first hour after birth. Although there was a higher prevalence of early initiation of breastfeeding among mothers who delivered in health facilities compared to mothers who delivered at home, universal practice of early initiation of breastfeeding should be a routine practice. The findings suggest the need of breastfeeding promotion programs among the mothers who are less educated, and not working. Such breastfeeding promotion programmes could be implemented via Nepal’s extensive network of community-based workers.

Children's environmental health: an under-recognised area in paediatric health care

The knowledge that the environment in which we live, grow and play, can have negative or positive impacts on our health and development is not new. However the recognition that adverse environments can significantly and specifically affect the growth and development of a child from early intrauterine life through to adolescence, as well as impact their health later in adulthood, is relatively recent and has not fully reached health care providers involved in paediatric care.Over the past 15 years, world declarations and statements on childrens rights, sustainable development, chemical safety and most recently climate change, have succeeded in cultivating a global focus on childrens health and their right to a healthy environment. Many international calls for research in the area, have also been able to identify patterns of environmental diseases in children, assess childrens exposures to many environmental toxicants, identify developmental periods of vulnerability, and quantify the cost benefits to public health systems and beyond, of addressing environmentally related diseases in children. Transferring this information to front-line health care providers and increasing their awareness about the global burden of disease attributed to the environment and childrens especial vulnerability to environmental threats is the salient aim of this commentary.

Children's environmental health—from knowledge to action

WHO estimates that up to 25% of the global burden of disease is due to preventable environmental exposures. Children are especially vulnerable because they receive a higher dose than adults, with more extreme consequences. The unborn child’s health can also be aff ected, because the environment can infl uence gene expression and organogenesis. The burden of disease is unevenly distributed, with greatest exposure to children in developing and low-income countries. While children in such countries still have to cope with traditional threats, including lack of access to safe water, poor sanitation and hygiene, and infectious diseases, they suff er from HIV/AIDS response is more eff ectively shared between African partner states and the broader international community. This model must compel African countries to take a lead role in this fi ght, eventually to assume the responsibility entirely. To plan rationally, accurate measurement of HIV/AIDS incidence and trends is crucial. Only evidence of the true challenge ahead will allow fully informed decisions about resource allocation. Knowing the local and national magnitude of the epidemic is the only rational way to assess the success of prevention eff orts, and estimate the current and future demands on the health needs for those already infected and those who might become infected. Meeting the challenge of an increasingly overburdened national health workforce is the fi rst planning priority. The global community needs to work with African countries to facilitate better use of their existing health-care personnel through the sharing of tasks with less-specialised health professionals, as well as using management and other support staff from outside the health sector. This delegation of administrative duties will free up clinicians for vital clinical work. Partnerships between the USA and African institutions will be critical—particularly public and private sector institutional partnerships, and academic partnerships—to propel Africa to move forward, independently, toward a sustainable and healthier future. Diffi cult questions inevitably will arise about prioritising access to life-saving treatment; the answers will have profound implications on who will live and who will die. To ensure transparency and accountability, governance structures to ensure procedural justice will need to be expanded. Health-care professionals and other policy makers will benefi t from ethical training on just allocation of scarce resources. The decisions made today can, and will, have far-reaching eff ects on the lives of those living with HIV/AIDS in Africa—now and for decades to come. Procrastination will not serve Africa well. Ensuring that African countries can meet the prevention, treatment, and care challenges 10–15 years into the future will require strategic planning and investments in institutional partnerships well before that time. And only together, each being accountable to the other, will we be able to plan for the burden we know is yet to come.

Impactos ambientales sobre la salud respiratoria de los niños: Carga global de las enfermedades respiratorias pediátricas ligada al ambiente

The childs respiratory system is a primary target for air pollutants, including tobacco smoke, biomass fuels and pollution from mobile and fixed sources. Children are, in general more susceptible to the effects of air pollutants; however, individual susceptibility also plays a role. Exposure to pollutants in early life decrease lung growth and results in reduced lung function. The range of respiratory illnesses with an environmental contribution includes: acute viral and bacterial lower respiratory infections; otitis media; asthma and chronic respiratory diseases. This review presents an overview of the identified risks posed by the environment to childrens health and their health consequences.

Poor thermal care practices among home births in Nepal: further analysis of Nepal Demographic and Health Survey 2011.

Introduction Hypothermia is a major factor associated with neonatal mortality in low and middle income countries. Thermal care protection of newborn through a series of measures taken at birth and during the initial days of life is recommended to reduce the hypothermia and associated neonatal mortality. This study aimed to identify the prevalence of and the factors associated with receiving ‘optimum thermal care’ among home born newborns of Nepal. Methods Data from the Nepal Demographic and Health Surveys (NDHS) 2011 were used for this study. Women who reported a home birth for their most recent childbirth was included in the study. Factors associated with optimum thermal care were examined using Chi-square test followed by logistic regression. Results A total of 2464 newborns were included in the study. A total of 57.6 % were dried before the placenta was delivered; 60.3% were wrapped; 24.5% had not bathing during the first 24 hours, and 63.9% were breastfed within one hour of birth. Overall, only 248 (10.7%; 95% CI (8.8 %, 12.9%)) newborns received optimum thermal care. Newborns whose mothers had achieved higher education (OR 2.810; 95% CI (1.132, 6.976)), attended four or more antenatal care visits (OR 2.563; 95% CI (1.309, 5.017)), and those whose birth were attended by skilled attendants (OR 2.178; 95% CI (1.428, 3.323)) were likely to receive optimum thermal care. Conclusion The current study showed that only one in ten newborns in Nepal received optimum thermal care. Future newborn survival programs should focus on those mothers who are uneducated; who do not attend the recommended four or more attend antenatal care visits; and those who deliver without the assistance of skilled birth attendants to reduce the risk of neonatal hypothermia in Nepal.

Impactos ambientales sobre la salud respiratoria de los niños. Carga global de las enfermedades respiratorias pediátricas ligada al ambiente [Environmental impacts on the respiratory health of children: Global burden of paediatric respiratory diseases l

The childs respiratory system is a primary target for air pollutants, including tobacco smoke, biomass fuels and pollution from mobile and fixed sources. Children are, in general more susceptible to the effects of air pollutants; however, individual susceptibility also plays a role. Exposure to pollutants in early life decrease lung growth and results in reduced lung function. The range of respiratory illnesses with an environmental contribution includes: acute viral and bacterial lower respiratory infections; otitis media; asthma and chronic respiratory diseases. This review presents an overview of the identified risks posed by the environment to childrens health and their health consequences.

Environmental impacts on the respiratory health of children: Global burden of paediatric respiratory diseases linked to the environment

The childs respiratory system is a primary target for air pollutants, including tobacco smoke, biomass fuels and pollution from mobile and fixed sources. Children are, in general more susceptible to the effects of air pollutants; however, individual susceptibility also plays a role. Exposure to pollutants in early life decrease lung growth and results in reduced lung function. The range of respiratory illnesses with an environmental contribution includes: acute viral and bacterial lower respiratory infections; otitis media; asthma and chronic respiratory diseases. This review presents an overview of the identified risks posed by the environment to childrens health and their health consequences.