Mobile health interventions for improving maternal and child health outcomes in South Africa:a systematic review

Background:Maternal and child health(MCH)remains a significant public health concern globally despite previous efforts made to improve MCH services.Initiatives such as antenatal care,postnatal care services exclusive breastfeeding,child vaccination and supplements have been rolled out to improve MCH outcomes.However,inadequate maternal healthcare,socioeconomic factors,obstetric haemorrhaging,complications of hypertension during pregnancy,lack of maternal information,poor universal health coverage and uptake of MCH services exacerbate maternal mortality and child mortality rates,especially in resource-constrained areas in many sub-Saharan African countries including South Africa.Objective:This study aimed to review mobile health(mHealth)interventions deployed to improve maternal and child health outcomes.Methods:The study adopted the Preferred Reporting Items for Systematic Reviews and Meta-Analyses model to search and retrieve relevant literature from reputable,prominent electronic databases(Google Scholar,Scopus,PubMed,Embase,CINAHL,Web of Science,etc.).A total of 26 papers were selected and analyzed.Results:The findings revealed several mHealth interventions such as MomConnect,Mobile Alliance for Maternal Action,NurseConnect,ChildConnect,CommCare,Road to Health Application and Philani Mobile Video Intervention for Exclusive Breastfeeding have been utilized by healthcare workers and women to improve access to MCH services.However,inadequate digital infrastructure,digital divide,resistance to change,inadequate funding,language barriers,short message service and data costs,lack of digital skills and support,compatibility,scalability and interoperability issues,legislative and policy compliance,lack of mHealth awareness,data security and privacy concerns hinder uptake and utilisation of mHealth interventions.There is a need to scale up and sustain mHealth interventions and update existing regulatory framework,policies and strategies.Conclusion:mHealth interventions offer unprecedented opportunities to improve access to maternal information and substantially improve maternal and child health services.Stakeholder engagement and the development of sustainable funding strategies are important for successfully implementing and scaling mHealth projects while addressing existing and emerging key issues.

Association of Congenital Heart Defects (CHD) with Factors Related to Maternal Health and Pregnancy in Newborns in Puerto Rico

Background:Given the pervasive issues of obesity and diabetes both in Puerto Rico and the broader United States,there is a compelling need to investigate the intricate interplay among body mass index(BMI),pregesta-tional,and gestational maternal diabetes,and their potential impact on the occurrence of congenital heart defects(CHD)during neonatal development.Methods:Using the comprehensive System of Vigilance and Surveillance of Congenital Defects in Puerto Rico,we conducted a focused analysis on neonates diagnosed with CHD between 2016 and 2020.Our assessment encompassed a range of variables,including maternal age,gestational age,BMI,pregestational diabetes,gestational diabetes,hypertension,history of abortion,and presence of preeclampsia.Results:A cohort of 673 patients was included in our study.The average maternal age was 26 years,within a range of 22 to 32 years.The mean gestational age measured 39 weeks,with a median span of 38 to 39 weeks.Of the 673 patients,274(41%)mothers gave birth to neonates diagnosed with CHD.Within this group,22 cases were linked to pre-gestational diabetes,while 202 were not;20 instances were associated with gestational diabetes,compared to 200 without;and 148 cases exhibited an overweight or obese BMI,whereas 126 displayed a normal BMI.Conclusion:We identified a statistically significant correlation between pre-gestational diabetes mellitus and the occurrence of CHD.However,our analysis did not show a statistically significant association between maternal BMI and the likelihood of CHD.These results may aid in developing effective strategies to prevent and manage CHD in neonates.

Affordability, Accessibility, and Quality of Maternal Health Care Services and Level of Satisfaction of Mothers in Rural Areas in China

Objective:This study aimed to understand the affordability,accessibility,and quality of maternal and child health services for postpartum mothers,and their impact on satisfaction.Methods:The study utilized the Anderson model and revised the Maternal Pregnancy and Perinatal Health Service Questionnaire.A survey was conducted among 289 mothers aged 20–49 in Feicheng City.Results:Regarding accessibility,most respondents(133)reported that travel time to healthcare services exceeded 60 minutes,while 99 respondents indicated a travel time of 16–30 minutes.The issue of affordability was highlighted,with 86.85%of participants perceiving maternal healthcare services as costly,indicating a significant financial burden.More than 50%of respondents were satisfied with two specific dimensions(P<0.05)regarding the quality of maternal healthcare services.Conclusion:The study found that accessibility,affordability,and quality significantly affect mothers’satisfaction with maternal health services.Future research should focus on developing more suitable service pathways for rural mothers.

Maternal perceived self-efficacy, perceived vulnerability and child health outcome in Ibadan, South-West Nigeria

Objective:The problems associated with child health continue to constitute a global concern,and child morbidity and mortality remain problematic in Sub-Sahara Africa(SSA).Utilizing a community-based survey conducted in Ibadan North Local government,Southwest Nigeria the study examined the influences of maternal perceived self-efficacy(MPSE)and maternal perceived vulnerability(MPV)on child health outcomes(CHO).Methods:The study appraised data from 683 nursing mothers aged 15-45 obtained from 20 major primary healthcare centers in the region undergoing routine health checks for their children.Three regression models were fitted to examine the effects of MPV,MPSE,and confounding variables of maternal preventive actions such as insecticide-treated nets(ITN)usage and child immunization,among other maternal and child sociodemographic attributes on CHO.Results:The study finds that MPV has no correlation with CHO and MPSE but positively correlates with maternal age(r=0.123,P<0.05).However,CHO has a negative correlation with MPSE(r=-0.200,P<0.05)while positively correlated with child age(r=0.134,P<0.05).MPSE has a unique effect on CHO(β=-0.203,P<0.05),maternal preventive action of ITN usage show a positive association with CHO in the study Model 2(β=-0.163,P<0.05),while in Model 3,child's age has a positive association with CHO(β=0.180,P<0.05).The net effect of the study models accounted for approximately 10%of the variance in CHO reported among the children.Conclusion:Overall,MPSE and ITN usage are essential factors for understanding and reducing the potential adverse CHO.Global effort must continue to improve maternal education to support child health and preventive carepractices in SSA.

The Effect of the COVID-19 Pandemic on Health Service Accessibility for Children under 5 in the Mayo-Tsanaga and Logone & Chari Departments, Far North Cameroon

Context/objectives: The COVID-19 pandemic has disrupted all programs, potentially impacting access to health services for children under 5 years old. The Far North of Cameroon is one of the northern regions with a prevalence of malnourished children ranging from 5% to 10%. Due to the barrier measures implemented to combat the pandemic, many parents are reluctant to take their children to healthcare facilities. Some of these children were benefiting from the Ambulatory Care Center (ACC) program prior to the COVID-19 outbreak. The main objective of this research is to assess the impact of COVID-19 on access to health services for children under 5 in the Mayo Tsanaga (MT) and Logone & Chari (LC) departments. The implementation of barrier measures could significantly increase the risk of malnutrition among children under 5 years old. Method: A cross-sectional analytical study was conducted in the MT and LC departments, employing both retrospective and prospective approaches. Data was collected through questionnaire, interview guide and a review of existing data prior to the pandemic (DHIS 2). Kobo Collect software was used for data collection, and R software was used for analysis. Results: Children who benefitted from the ACC program during the COVID-19 period were found to have a lower prevalence of malnutrition compared to those who did not benefit (OR: 0.09, CI {0.0 - 0.44}). Conclusion: COVID-19 has led to a decrease in the utilization of health facilities in both departments of the study, resulting in an increase in health issues such as malnutrition among children under 5 years old. Various policies have been implemented to improve attendance at health facilities.

Establishing a child and adolescent mental health center in Herat,Afghanistan:a project description

Objective:Afghanistan has witnessed a long-lasting 4-decade armed conflict,which together with high levels of poverty and interpersonal violence,resulted in high incidence and prevalence of mental disorders in general population,including children and adolescents.Until mid-2018,there was neither mental health care facility nor a child psychiatrist in Afghanistan.Here,we report the establishment of the first children and adolescents'mental health center(CAMHC)in Herat province of Afghanistan.Methods:In July 2018,CAMHC was initiated at Mental Health Training Center-Herat.CAMHC was initially planned by the International Assistance Mission(IAM)and Herat Public Health Directorate;and financially supported by the Tearfund UK,the United Methodist Committee on Relief and Tearfund Australia.The target population of CAMHC was children and adolescents in Herat and neighboring provinces,healthcare professionals,staff of government and non-governmental organizations,school teachers and community leaders.Results:A group of eight mental health professionals were trained and made the interdisciplinary board for diagnosis and management of mental disorders in children and adolescents.During the initial three-year period,2448 patients,including 1264(51.6%)boys and 1184(48.4%)girls,presented with mental disorders to CAMHC.Diagnosis and management of mental disorders were performed according to standard international protocols.Eighteen awareness-raising seminars were held;2000 leaflets,10000 posters,and 30000 brochures were prepared and distributed;and two short video clips were produced and broadcast via IAM website,social media and local TV channels.A database was developed to house for project data,assessment of outcomes and reporting to stakeholders.Conclusion:Establishment of CAMHC resulted in significant achievements in diagnosis and management of mental disorders among children and adolescents,healthcare staff capacity building,and awareness-raising about mental disorders.Data obtained in CAMHC offers government,mental health professionals and the community the opportunity of improving mental health in the region.

Comments by opponents on the British Medical Association’s guidance on non-therapeutic male circumcision of children seem one-sided and may undermine public health

The British Medical Association(BMA)guidance on non-therapeutic circumcision(NTMC)of male children is limited to ethical,legal and religious issues.Here we evaluate criticisms of the BMA’s guidance by Lempert et al.While their arguments promoting autonomy and consent might be superficially appealing,their claim of high procedural risks and negligible benefits seem one-sided and contrast with high quality evidence of low risk and lifelong benefits.Extensive literature reviews by the American Academy of Pediatrics and the United States Centers for Disease Control and Prevention in developing evidence-based policies,as well as risk-benefit analyses,have found that the medical benefits of infant NTMC greatly exceed the risks,and there is no reduction in sexual function and pleasure.The BMA’s failure to consider the medical benefits of early childhood NTMC may partly explain why this prophylactic intervention is discouraged in the United Kingdom.The consequence is higher prevalence of preventable infections,adverse medical conditions,suffering and net costs to the UK’s National Health Service for treatment of these.Many of the issues and contradictions in the BMA guidance identified by Lempert et al stem from the BMA’s guidance not being sufficiently evidence-based.Indeed,that document called for a review by others of the medical issues surrounding NTMC.While societal factors apply,ultimately,NTMC can only be justified rationally on scientific,evidence-based grounds.Parents are entitled to an accurate presentation of the medical evidence so that they can make an informed decision.Their decision either for or against NTMC should then be respected.

Systematic evaluation of maternal and infant health literacy assessment tools based on COSMIN guidelines

Background:To systematically evaluate the measurement performance of the maternal and child health literacy scale and the study’s methodological quality and to provide a reference for selecting and developing related health outcome measurement tools.Methods:Databases such as CNKI,PubMed,and Embase were searched,and the search time frame was established until January 2023.The literature was independently screened by two researchers.The methodological quality and measurement performance of the included scales were evaluated using the health measurement tool selection criteria,and the evaluation results were summarized and analyzed using descriptive analysis.Results:A total of six papers were included,covering six specific scales,with significant differences in the methodological quality and measurement performance of their development studies,none of which evaluated hypothesis testing,the validity of scales,cross-cultural validity,measurement error,or responsiveness.Conclusion:The methodological quality and scale measurement performance of the maternal health literacy inventory in pregnancy,the women’s reproductive health literacy in pregnancy questionnaire,and the maternal and infant health literacy scale development studies are relatively high,but the number of studies on maternal and infant health literacy specific scales is relatively insufficient,and more studies should be conducted in the future.

Impact of Antimicrobial Stewardship Programs on Antibiotic Use and Drug Resistance:Analysis of Data from Maternal and Child Health Care Hospitals in Hubei Province,China

ObjectiveTo evaluate the impact of Antimicrobial Stewardship Programs(ASPs)on antibiotic use and drug resistance.MethodsThis was a retrospective,multicenter,management intervention study.The data from 85 maternity hospitals(maternal and child health care hospitals)in Hubei province from 2012 to 2019 were collected.The indicators related to antimicrobial drug use included the utilization rate of different grades of antimicrobial drugs,the intensity of antimicrobial agent use,the rational use of prophylactic antimicrobial agents before class I surgical incision,and pathogenic detection and consultation rates before antimicrobial drug use.ResultsSince the implementation,the purchase of antimicrobial agents in hospitals has been maintained within the prescribed range,and the defined daily dose system(DDDs)of antimicrobial agents has been reduced,prophylactic use and accurate treatment of antimicrobial agents related to class I surgical incision have been more reasonable.With the implementation of ASPs,the detection rate of imipenem-resistant Acinetobacter baumannii,cefotaxime-resistant Escherichia coli,and methicillin-resistant Staphylococcus aureus has been decreased in China from national bacterial resistance surveillance data.ConclusionASPs have positive effects on antibiotic use and drug resistance in 85 maternity hospitals(maternal and child health care hospitals).

Children’s Health, Parent-Child Activities, Using Digital Devices, and Social Competence: Serial Mediation

Background: Studies have pointed out the influence of different children’s activities and prolonged use of digital products on their social development. However, whether the parent-child activities and using digital devices were serial mediators of the relationship between children’s health and social development needs further verification. Purpose: This study explored how parent-child activities and children’s use of digital devices influence the relationship between children’s health and their social competence. Method: This study used data from Kids in Taiwan: National Longitudinal Study of Child Development and Care. A total sample of 2164 participants was used in this study. Serial mediation analyses were performed using model six of Hayes’ PROCESS (2012). Results: This study found that parent-child activities and the use of digital devices can serially mediate the relationship between children’s health and social competence. Children’s health could directly improve their social competence, but it could also serially mediate social competence by increasing parent-child activities and reducing the use of digital devices. Conclusion: Childcare policy planners and parenting educators should not only call on parents to reduce the use of electronic products for their children, but also encourage parents to spend more time interacting with their children, so that children can learn social skills by interacting with others in their daily lives.

Prevention of Maternal-to-Child Transmission of HIV: Knowledge, Attitude and Factors Influencing Active Participation among HIV-Positive Men in a Military Health Facility in Lagos, South Western Nigeria

Introduction: Traditionally, Prevention of Maternal-to-Child Transmission (PMTCT) of HIV involves women and excludes men despite their important roles. There is a need for more data on factors influencing male participation in PMTCT programs. Design: This was a cross-sectional, descriptive study of married HIV-positive men receiving care at the adult ART clinic, 68 Nigerian Army Reference Hospital Yaba. Data were collected from March 15 to April 30, 2018. Result: Out of the 366 respondents, 333 (91%) were aware that HIV can be transmitted from mother to child. However, only 43.2% correctly identified that it can be transmitted during pregnancy, while 30.2% stated during labour. Almost all of the respondents (96.4%) would also accept that their positive partners take antiretroviral treatment to protect her unborn baby, 86.9% would support non breastfeeding option after delivery, and 95.6% indicated readiness to buy formula milk for the baby. Similarly, majority believed that a pregnant woman can be tested for HIV without the permission of her partner (Mean = 1.47 ± 0.893), and that men should accompany their spouse to ANC/PMTCT clinics (Mean = 1.86 ± 0.921). Conclusion: This study revealed that despite low knowledge of PMTCT among men, there is a good level of attitude and involvement among them. We recommend further study to fully explore the impact of education on men’s participation.

The Potential Role of a Health and Demographic Surveillance System in Rural Northern Nigeria to Reduce Maternal and Child Deaths

There exist a huge gap between generation of evidence-based research findings and its use to inform policies in most developing countries. Further, it is evident that most developing countries are lagging behind in formulating appropriate policies aimed at improving people’s lives due to lack of evidence-based research findings. We describe the potential of a Health and Demographic Surveillance System (HDSS) in informing appropriate health interventions towards reducing the high maternal and child deaths in rural communities of north western Nigeria through the Verbal Autopsy (VA) data collection. VA data collection involves the use of VA questionnaires—set of open ended and closed ended questions adapted from the World Health Organization (WHO) module— administered to the caregivers, parents or family members of a deceased person to elicit information on signs and symptoms and their durations, and other pertinent information about the deceased in the period before death. VA interviews were conducted by trained VA enumerators on all 2100 deaths reported during the update round 4 of routine data collection (July-December, 2012) and returned forms were checked for consistencies and completeness by a trained research officer. The forms were later coded by trained medical doctors for possible cause of death using the WHO International Classification of Diseases (ICD 10) codes. Fifty cases of neonatal deaths, 1650 cases of infant and child deaths, and 400 cases of adult deaths were reported during the update round 4 data collection. Neonatal sepsis was reported as the leading cause of neonatal deaths (58%) while malaria and intestinal infectious diseases were reported as the leading cause of infant and child deaths and adult deaths respectively (45% and 17%, respectively). The study provides documented evidence of high neonatal deaths due to neonatal sepsis in an area with low hygiene and high home delivery rates. The findings from the VA data collection at Nahuche HDSS inform the intervention study on home distribution of chlorhexidine to pregnant women. The findings from this study call on government and other stakeholders to strengthen research capacity to generate timely data and findings returned to policy makers within the shortest period of time for decision making.

Opportunities to Integrate Primary Health Care Digital Innovations in Maternal and Child Health Care Services in Kenya

Background: Adequate and quality Maternal and Child Health (MNCH) care is considered essential in reduction of maternal and child mortality. More than half of the global maternal deaths (66%) are in sub-Saharan Africa with infant mortality of 51/1000 live births in the WHO Africa region [1]. There is potential to improve access and utilization of health services through investing in Primary Health Care (PHC) digital innovations [2] especially in underserved settings [3]. In the last quarter of the year 2021 after lifting of the COVID-19 restrictions, Tekeleza project, aims to integrate digital health innovations into MNCH care within PHC settings in Kenya. The project team undertook a baseline survey in three rural counties (Kisii, Kajiado and Migori) characterized with low social-economic status to identify opportunities to leverage on the use of evidence-based digital innovations to reverse the adverse trends in Maternal and Child Health. Methods: A cross-sectional and descriptive study was conducted in 15 Community Health Units (CHUs) in Kenya that were linked to selected Primary Health Care (PHC) facilities from three rural counties. Mixed methods were used to collect data from 404 Households (HHs) selected across the sampled CHUs on Probability Proportionate to Size (PPS). The selected households were assigned unique household or respondent identifiers. The sampling frame for household surveys consisted of all women 18 - 49 years of age, who were either pregnant or in their 18 months post-delivery. From the constructed sampling frame, a simple random sampling procedure was used to select the study sample. An audit was also carried out at the selected PHC facilities and sixty-two (62) Primary Health Workers (PHCWs) including facility managers were interviewed to establish challenges affecting ICT infrastructure and sustainable financing of MNCH services. Findings: The majority of the sampled women (64.9%) were lactating at the time of the study, with 34.4% being pregnant and 0.7% both pregnant and lactating. Despite the high proportions of mothers who received Skilled Birth Attendance, discontinuity in seeking antenatal and postnatal care services was observed in all three counties. The proportion of mothers (n = 404) who reported to have attended at least one ANC was 46.8%. This was attributed to limited access to health facilities, poor staff attitude, and negative cultural practices that got exacerbated by the COVID-19 pandemic. An average of 53.2% of the respondents started attending ANC clinics much later after 12 weeks of gestation to minimize the costs and time they will spend on attending ANC clinics. It also emerged that 68.7% of the respondents had low knowledge levels of selected perinatal and infant care practices. On the making of Sexual and Reproductive Health (SRH) health-seeking decisions, 54.7% of the respondents said, it is their husbands who decide. The PHCWs expressed limited access to Continuing Professional Development (CPDs), a situation that worsened with the COVID-19 Pandemic. Notably, only 54.9% of the PHCWs reported having access to either a Smartphone or desktop at the point of service delivery. Nearly the same proportion (54.8%) has access to the internet at their workstations. Facilities reported delayed reimbursement of National Hospital Insurance Fund (NHIF) and only 54% of the women interviewed had registered in Linda mama NHIF package meant to enable them to access free maternity care. Only one county (Migori) had significant utilization of CHVs. Conclusion: There is increasing access to Skilled Birth Attendance (SBA) in rural Kenya but discontinuous pregnancy care is still a problem and it got worse during the COVID-19 pandemic. Rural PHC facilities have poor ICT infrastructure and despite the 98% rural access to a phone by women, there is limited bankable usage of handheld technology to improve health information literacy on self and infant care among women of reproductive age. Recommendations: Feasibility studies to be conducted on how to sustainably deploy Primary Health Care digital solutions to improve the quality of, access to, and Utilization of Maternal and Child Health (MNCH) services.

Marked Improvement in China's Maternal and Child Health

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Maternal and Child Health Care Quality Assessment: An Improved Approach Using K-Means Clustering

High maternal and child deaths in developing countries are frequently linked to poor health services provided to pregnant women and children. To improve the quality of maternal, neonatal and child health (MNCH) services, the government and other stakeholders in MNCH emphasize the importance of quality assessment. However, effective quality assessment approaches are mostly lacking in most developing countries, particularly in Tanzania. This study, therefore, aimed at developing a quality assessment approach that can effectively assess and report on the quality of MNCH services. Due to the need for a good quality assessment approach that suits a resource-constrained environment, machine learning-based approach was proposed and developed. K-means algorithm was used to develop a clustering model that groups MNCH data and performs cluster summarization to discover the knowledge portrayed in each group on the quality of MNCH services. Results confirmed the clustering model’s ability to assign the data points into appropriate clusters;cluster analysis with the collaboration of MNCH experts successfully discovered insights on the quality of services portrayed by each group.

Maternal Mortality: A Matter of Public Health Policies

Maternal mortality is a worldwide problem and concern, continuing to be a public health problem, the ratio of the same has been decreasing but still to those recommended by the World Health Organization. Objective: To perform a literature review, highlighting current aspects of maternal mortality. Method: The research was carried out in electronic databases Lilacs, Bireme-BVS, Scielo and BDENF, limited to the last 23 years. Those addressed pre-defined aspects of interest to the study proposal were selected—maternal mortality, public health policies, and the new approaches to the problem. Results: Maternal death is directly related to the living conditions of the population, showing variability from country to country (developed and developing), but its decrease is inherent to public policies and political will.

Mental health of mothers and their premature infants for the prevention of child abuse and maltreatment

Birth of preterm infants is a stressful event for their parents, particularly for mothers. The mothers of preterm infants often feel hard to relate their infants because they have separated since their first days after delivery. Long term separation and less attractive, less responsive appearance of preterm infants also make it difficult to build mother-child relationships. In addition, the mothers of preterm infants are likely to have mood disorders such as depression, anxiety, and stress-related disorders. The mothers’ psychiatric illnesses affect the psychosocial development of preterm infants and are often regarded as a risk factor for child abuse and maltreatment in later life. Child abuse and maltreatment are also prevalent among preterm infants than the full term infants. Intervention from the early period of preterm birth is an important issue for both preterm infants and their mothers. Medical and co-medical professionals should pay attention to developmental outcome of preterm as well as psychosocial conditions of their mothers for the improvement of their mental health.

Maternal and Neonatal Death Review (MNDR): A Useful Approach to Identifying Appropriate and Effective Maternal and Neonatal Health Initiatives in Bangladesh

Objectives: To identify the effects of Maternal and Neonatal Death Review (MNDR) in terms of improving maternal and neonatal health at the community level in Bangladesh. Methods: Both quantitative and qualitative methods were undertaken for collecting data in Kashipur Union, Bangladesh. Death notifications from households, subsequent data collections from a focus-group discussion (FGD), a group discussion (GD) and in-depth interviews (IDIs) were obtained using structured tools and guidelines. Results: A total of four maternal deaths, 21 neonatal deaths and 15 still births were reported in the MNDR death notification system at Kashipur Union in 2010. Data were presented to local programme managers, who took various initiatives including awareness programmes, pregnancy registration, antenatal care, birth planning, and also the revitalization of a community clinic. The coverage of antenatal care, delivery in clinics, postnatal care and referral of complications increased through the active participation of the community. Community healthcare providers, care recipients and members of the community expressed satisfaction with the quality of maternal and neonatal services. In the preceding two years, maternal and neonatal deaths substantially reduced in Kashipur (in 2011 maternal death = 1, neonatal death = 20, still birth = 8;in 2012 maternal death = 1, neonatal death = 8, still birth = 13). Conclusions: The MNDR system successfully delivered notification of all maternal and neonatal deaths in the defined area and collected information for the formulation and implementation of specific interventions, which resulted in visible and tangible changes in care-seeking and client satisfaction.

Poverty and Nutritional Health of the Child: Some Evidence from 2005 Demographic and Health Survey of Congo

The objective of this study is to identify the ways in which poverty could affect the nutritional health of the child and to analyze the strength of these links. On the whole, it appears that the relationship between poverty (measured by the wealth index) and health of the child (measured by an anthropometric index) is positive and highly significant.

Classification,prevalence and integrated care for neurodevelopmental and child mental health disorders:A brief overview for paediatricians

‘Neurodevelopmental disorders’comprise a group of congenital or acquired longterm conditions that are attributed to disturbance of the brain and or neuromuscular system and create functional limitations,including autism spectrum disorder,attention deficit/hyperactivity disorder,tic disorder/Tourette’s syndrome,developmental language disorders and intellectual disability.Cerebral palsy and epilepsy are often associated with these conditions within the broader framework of paediatric neurodisability.Co-occurrence with each other and with other mental health disorders including anxiety and mood disorders and behavioural disturbance is often the norm.Together these are referred to as neurodevelopmental,emotional,behavioural,and intellectual disorders(NDEBIDs)in this paper.Varying prevalence rates for NDEBID have been reported in developed countries,up to 15%,based on varying methodologies and definitions.NDEBIDs are commonly managed by either child health paediatricians or child/adolescent mental health(CAMH)professionals,working within multidisciplinary teams alongside social care,education,allied healthcare practitioners and voluntary sector.Fragmented services are common problems for children and young people with multi-morbidity,and often complicated by subthreshold diagnoses.Despite repeated reviews,limited consensus among clinicians about classification of the various NDEBIDs may hamper service improvement based upon research.The recently developed“Mental,Behavioural and Neurodevelopmental disorder”chapter of the International Classification of Diseases-11 offers a way forward.In this narrative review we search the extant literature and discussed a brief overview of the aetiology and prevalence of NDEBID,enumerate common problems associated with current classification systems and provide recommendations for a more integrated approach to the nosology and clinical care of these related conditions.