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Background The COVID-19 outbreak has resulted in governments implementing disease containment measures such as school closures, social distancing, and home quarantine. To date, only a few studies have drawn attention to the psychological impact of lockdown on Italian children’s mental health. The present study aimed to investigate the psychological distress (anxiety and mood symptoms) and perceived changes in routine among Italian primary and middle school students during the COVID-19 quarantine. Methods This interview study was performed between the 18th of May and 7th of June 2020: it involved a sample of 82 children and adolescents living in Milan (Italy), attending primary and middle school (aged 6 to 14 years), and their parents. Results Almost 30 % of the subjects reported having struggled to adjust to home learning. 36 responders completely changed their dietary habits during the lockdown: they were not eating the same amount of food and were consuming more junk food. Sleep habits were also affected by the lockdown measures: 28 % of the sample had difficulties sleeping and wished to sleep in their parents’ bed. Concerning psychological distress, 64 (78 %) children and adolescents had anxiety symptoms; 43.9 % of the students reported significant mood symptoms. Conclusions Children are not indifferent to the dramatic impact of the COVID-19 epidemic: our data confirm their difficulties in adapting to the quarantine measures. The effects of stress exposure may not manifest later on during the children’s development, and, for this reason, it would be interesting to follow up on these participants to improve our understanding of how long these outcomes may last.

Background Despite increased understanding of Adverse Childhood Experiences (ACEs), very little advancement has been made in how ACEs are defined and conceptualized. The current objectives were to determine: 1) how well a theoretically-derived ACEs model fit the data, and 2) the association of all ACEs and the ACEs factors with poor self-rated mental and physical health. Methods Data were obtained from the Well-Being and Experiences Study, survey data of adolescents aged 14 to 17 years ( n  = 1002) and their parents ( n  = 1000) in Manitoba, Canada collected from 2017 to 2018. Statistical methods included confirmatory factor analysis (CFA) and logistic regression models. Results The study findings indicated a two-factor solution for both the adolescent and parent sample as follows: a) child maltreatment and peer victimization and b) household challenges factors, provided the best fit to the data. All original and expanded ACEs loaded on one of these two factors and all individual ACEs were associated with either poor self-rated mental health, physical health or both in unadjusted models and with the majority of findings remaining statistically significant in adjusted models (Adjusted Odds Ratios ranged from 1.16–3.25 among parents and 1.12–8.02 among adolescents). Additionally, both factors were associated with poor mental and physical health. Conclusions Findings confirm a two-factor structure (i.e., 1) child maltreatment and peer victimization and 2) household challenges) and indicate that the ACEs list should include original ACEs (i.e., physical abuse, sexual abuse, emotional abuse, emotional neglect, physical neglect, exposure to intimate partner violence (IPV), household substance use, household mental health problems, parental separation or divorce, parental problems with police) and expanded ACEs (i.e., spanking, peer victimization, household gambling problems, foster care placement or child protective organization (CPO) contact, poverty, and neighborhood safety).

Background Stunting has been identified as one of the major proximal risk factors for poor physical and mental development of children under-5 years. Stunting predominantly occurs in the first 1000 days of life (0–23 months) and continues to the age of five. This study examines factors associated with stunting and severe stunting among children under-5 years in Nigeria. Methods The sample included 24,529 children aged 0–59 months from the 2013 Nigeria Demographic and Health Survey (NDHS). Height-for-age z-scores (HFAz), generated using the 2006 World Health Organisation (WHO) growth reference, were used to define stunting (HFAz < −2SD) and severe stunting (HFAz < −3SD). Multilevel logistic regression analyses that adjusted for cluster and survey weights were used to determine potential risk factors associated with stunting and severe stunting among children under-5 years in Nigeria. Results The prevalence of stunting and severe stunting were 29% [95% Confidence interval (Cl): 27.4, 30.8] and 16.4% [95%Cl: 15.1, 17.8], respectively for children aged 0–23 months, and 36.7% [95%Cl: 35.1, 38.3] and 21% [95%Cl: 19.7, 22.4], respectively for children aged 0–59 months. Multivariate analysis revealed that the most consistent significant risk factors for stunting and severe stunting among children aged 0–23 months and 0–59 months are: sex of child (male), mother’s perceived birth size (small and average), household wealth index (poor and poorest households), duration of breastfeeding (more than 12 months), geopolitical zone (North East, North West, North Central) and children who were reported to having had diarrhoea in the 2 weeks prior to the survey [Adjusted odds ratio (AOR) for stunted children 0–23 months = 1.22 (95%Cl: 0.99, 1.49)];[AOR for stunted children 0–59 months = 1.31 (95%Cl: 1.16, 1.49)], [AOR for severely stunted children 0–23 months = 1.31 (95%Cl: 1.03, 1.67)]; [AOR for severely stunted children 0–59 months = 1.58 (95%Cl: 1.38, 1.82)]. Conclusions In order to meet the post-2015 sustainable development goals, policy interventions to reduce stunting in Nigeria should focus on poverty alleviation as well as improving women’s nutrition, child feeding practices and household sanitation.

Background The emerging of psychological problems triggered by COVID-19 particularly in children have been extensively highlighted and emphasized, but original research in this respect is still lagging behind. Therefore, we designed this study to evaluate the impact of COVID-19 pandemic on mental health and the effectiveness and attitudes towards online education among Chinese children aged 7–15 years. Methods A detailed questionnaire, comprising of 62 questions was designed and parents or caretakers of 7 to 15 years old children were invited to participate via WeChat, a multi-purpose messaging, social media and mobile payment app, which is widely used by the Chinese population. A total of 668 parents across different regions of China were included. Results During COVID-19 pandemic, 20.7 and 7.2% children report experiencing post-traumatic stress disorder (PTSD) and depressive symptoms due to the COVID-19 pandemic. PTSD and SMFQ-P scores are significantly higher in middle school and boarding school students compared to primary and day school students. Multiple logistic regression analysis revealed that school system and province of origin are factors significantly associated with developing PSTD symptoms. 44.3% respondents feel online education is effective in gaining knowledge and improving practical and communications skills. 78.0% believe the online education system is efficient. Overall 79.8% respondents are satisfied and children can adapt to this new education system. During the COVID-19 pandemic, we found 1 in five children have PTSD and 1 in 14 children have depressive symptoms. Conclusion In summary, COVID-19 epidemic has caused PTSD and depression symptoms among Chinese children aged 7 to 15 years. In general, a large proportion of respondents are satisfied with online education, but still a substantial proportion of students are not comfortable with this new form of learning. Authorities should optimize online education systems and implement effective interventions to cope with the psychological effects of COVID-19 on children, as it is affecting the global population and remains uncertain when it will end.

Background Reducing child mortality and morbidity is a public health concern globally. Like many other developing countries, Bangladesh is struggling to improve child health status as the use of medical treatment is still not at a satisfactory level. Hence, the objective of this study is to identify the contributing factors for inequalities in the use of medical treatment for common childhood illnesses in Bangladesh. Methods The study used data from the latest Bangladesh Demographic and Health Survey (BDHS)-2014. Children who had diarrhea, fever and cough in the 2 weeks preceding the survey were included in this study. Bivariate and multivariate analyses were conducted to unearth the influential factors for medical treatment use among under-five children with childhood illnesses. In the multivariate logistic regression, adjusted odds ratios with p values less than 0.05 were considered for determining significant predictors. Results This study found that only 37% of children suffering from fever/cough sought medical treatment while this figure was approximately 36% for diarrhea. Age of children, household wealth status, father’s education level, region of residence, number of children in the household, access to electronic media were identified as factors contributing to inequality in health care utilization for common childhood illnesses in Bangladesh. Conclusions Various socio-economic factors substantially influence the utilization of medical treatment for childhood illnesses. Therefore, to enhance equitable access to health care for children, interventions should be designed targeting children from households with low socio-economic status. Various awareness-raising health education programs, poverty alleviation programs especially for rural areas can contribute in this regard.

Background Despite improvements in child survival in the past four decades, an estimated 6.3 million children under the age of five die each year, and more than 40% of these deaths occur in the neonatal period. Interventions to reduce neonatal mortality are needed. Kangaroo mother care (KMC) is one such life-saving intervention; however it has not yet been fully integrated into health systems around the world. Utilizing a conceptual framework for integration of targeted health interventions into health systems, we hypothesize that caregivers play a critical role in the adoption, diffusion, and assimilation of KMC. The objective of this research was to identify barriers and enablers of implementation and scale up of KMC from caregivers’ perspective. Methods We searched Pubmed, Embase, Web of Science, Scopus, and WHO regional databases using search terms ‘kangaroo mother care’ or ‘kangaroo care’ or ‘skin to skin care’. Studies published between January 1, 1960 and August 19, 2015 were included. To be eligible, published work had to be based on primary data collection regarding barriers or enablers of KMC implementation from the family perspective. Abstracted data were linked to the conceptual framework using a deductive approach, and themes were identified within each of the five framework areas using Nvivo software. Results We identified a total of 2875 abstracts. After removing duplicates and ineligible studies, 98 were included in the analysis. The majority of publications were published within the past 5 years, had a sample size less than 50, and recruited participants from health facilities. Approximately one-third of the studies were conducted in the Americas, and 26.5% were conducted in Africa. We identified four themes surrounding the interaction between families and the KMC intervention: buy in and bonding (i.e. benefits of KMC to mothers and infants and perceptions of bonding between mother and infant), social support (i.e. assistance from other people to perform KMC), sufficient time to perform KMC, and medical concerns about mother or newborn health. Furthermore, we identified barriers and enablers of KMC adoption by caregivers within the context of the health system regarding financing and service delivery. Embedded within the broad social context, barriers to KMC adoption by caregivers included adherence to traditional newborn practices, stigma surrounding having a preterm infant, and gender roles regarding childcare. Conclusion Efforts to scale up and integrate KMC into health systems must reduce barriers in order to promote the uptake of the intervention by caregivers.

Background Childhood vaccinations have been shown to be effective in protecting children against vaccine-preventable diseases. The systematic investigation of the causes of incomplete immunization is critical for the full immunization and develop health system interventions to improve immunization coverage. To date, no community-based immunization coverage assessment study was conducted in Minjar-shenkora district. Therefore, the aim of this study was to assess the immunization coverage and its factors among 12–23 months old children in Minjar-shenkora district, Ethiopia. Methods Community-based cross-sectional study was conducted from September to November 2017. A total of 566 children aged 12–23 months and their mothers/caregivers were successfully interviewed using structured and pre-tested questionnaire. A stratified sampling technique was employed. Study participants were selected systematically. Data were entered into Epi data version 3.1 and exported into SPSS version 21 for analysis. Logistic regression analyses were done. A significant association was declared at a p -value less than 0.05. Results Three fourth (75.6%) of 12–23 months old children were fully vaccinated. Incorrect appointment date (46.4%), the experience of child sickness with previous vaccination (35.2%) and disrespectful behavior of health professionals (14.3%) were the most common reasons cited by mothers/caregivers for incomplete vaccination of children. Being unmarried (AOR = 3.52, CI = 2.61, 9.15), not being a member of health development army (AOR = 3.31, CI = 2.01, 11.65) and traveling time greater than two hours on foot (AOR = 2.46, CI = 5.01, 17.18) were predictors of incomplete immunization. Conclusions Child immunization coverage was still below the governmental plan of 90% in 2020. Being unmarried, not being a member of health development army and traveling time greater than two hours on foot were predictors of incomplete immunization. Strengthen health development army programmatic interventions in the community will improve child vaccination completion in the district. The issue of long travel time should be addressed by increasing the number of new vaccination sites/clusters in the district.

Background Child malnutrition is a huge health problem having multifaceted consequences for child survival and long-term well-being. Although, several studies investigated stunting, underweight, and wasting in low- and middle-income countries, in Nigeria, the link between them received little attention. The aim of this study is, therefore, to assess the association between anthropometric indicators of under-five children such as stunting, underweight and wasting given that of other characteristics of children and households. Methods The data for this study was obtained from Nigerian Demographic and health survey (NDHS) in 2018. A total of 11,314 under-five children were involved. Multivariate logistic regression model was used to determine the association between stunting, underweight and wasting given that of the estimated effect of other determinants. Results From 11,314 under-five children the study considered 36.2, 21.4 and 6.7% of them suffered from stunting, underweight and wasting, respectively. About half (50.7%) of the children were male, 24.1% was obtained from North West region of Nigeria, and 37.8% of them were from households having unimproved drinking water. The pairwise dependency between stunting and underweight; underweight and wasting was measured using odds ratio (OR) of 15.796, and 16.750 respectively. The estimated odds of children from richest household to become stunted, underweight, and wasted was respectively 0.392, 0.540, 0.786 times that of the estimated odds of children from poorest households. Conclusion The prevalence of under-five children with stunting, underweight and/or wasting in Nigeria was very high. The important determinants of stunting, underweight, and wasting for under five children were household wealth index, women body mass index, sex of the child, anemia, mothers’ age at first birth, and a diarrhea two weeks prior to the survey. Whereas, region, religion, multiple birth, women’s educational level significantly associated with both stunting and underweight. Both stunting and wasting significantly associated with underweight.

Background Childhood vaccinations are a vital preventive measure to reduce disease incidence and deaths among children. As a result, immunisation coverage against measles was a key indicator for monitoring the fourth Millennium Development Goal (MDG), aimed at reducing child mortality. India was among the list of countries that missed the target of this MDG. Immunisation targets continue to be included in the post-2015 Sustainable Development Goals (SDG), and are a monitoring tool for the Indian health care system. The SDGs also strongly emphasise reducing inequalities; even where immunisation coverage improves, there is a further imperative to safeguard against inequalities in immunisation outcomes. This study aims to document whether socioeconomic inequalities in immunisation coverage exist among children aged 12–59 months in India. Methods Data for this observational study came from the fourth round of the National Family Health Survey (2015–16). We used the concentration index to assess inequalities in whether children were fully, partially or never immunised. Where children were partially immunised, we also examined immunisation intensity. Decomposition analysis was applied to examine the underlying factors associated with inequality across these categories of childhood immunisation. Results We found that in India, only 37% of children are fully immunised, 56% are partially immunised, and 7% have never been immunised. There is a disproportionate concentration of immunised children in higher wealth quintiles, demonstrating a socioeconomic gradient in immunisation. The data also confirm this pattern of socioeconomic inequality across regions. Factors such as mother’s literacy, institutional delivery, place of residence, geographical location, and socioeconomic status explain the disparities in immunisation coverage. Conclusions In India, there are considerable inequalities in immunisation coverage among children. It is essential to ensure an improvement in immunisation coverage and to understand underlying factors that affect poor uptake and disparities in immunisation coverage in India in order to improve child health and survival and meet the SDGs.

Background Health-related quality of life (HQoL) indicators are considered valid measures of patient assessment in physical, mental and oral healthcare. This study aimed to examine the evidence on the relationship of oral health status, demographic and socioeconomic characteristics with oral health-related quality of life (OHRQoL) in children. Methods Studies in English published up to December 2019 were searched on PsycINFO, PubMed, SciELO, Scopus, and Web of Science databases. Epidemiological studies simultaneously assessing sociodemographic factors related to oral health (age, income, gender, maternal education), oral health measures (orthodontic treatment needs, dental caries and periodontal disease) and OHRQoL in children aged 3–12 years were included. Methodological quality was assessed using a Critical Appraisal Checklist. Meta-analysis was used to estimate pooled measures between sociodemographic factors and oral health measures with OHRQoL. Results Eleven articles were included. Lower children’s age (3–5 years vs > 5), gender (girls vs boys), lower income (< 70$ vs ≥ $70), low maternal education (≤ 6 vs > 6 years) were associated with poor OHRQoL among children. Orthodontic treatment needs, dental caries and periodontal diseases were also associated with poor children’s OHRQoL. Meta-regression showed that Human Development Index, sample size, year of publication and participant’s age were relevant aspects that influenced the above mentioned relationships. Conclusions Our findings suggest that oral health promotion strategies to improve children’s OHRQoL should consider the social and environmental where they live as well their oral health status. Further longitudinal studies are needed to explore the determinants of OHQoL in children.