To enable improvements in global child health, the focus must move beyond child survival to child wellbeing. In the Pacific Islands, the wellbeing of children has received little attention. This ...study aimed to investigate the wellbeing of children from three primary schools in Tonga.
A cross-sectional survey was completed in three primary schools in Nuku'alofa with children aged 5-15 years. The study participants (256 children, 143 caregivers) completed the Child Health and Illness Profile - Child Edition, CHIP-CE (Version 1.0).
On average, >70% of children and caregivers described home and school environments as positive. From the children's reports, boys had significantly lower scores for risk avoidance than girls (3.40 vs. 3.73, P < 0.001). Children aged 5-7 versus 8-15 years had significantly lower scores for satisfaction (3.63 vs. 3.92, P = 0.002), resilience (3.34 vs. 3.56, P = 0.016) and achievement (3.25 vs. 3.62, P = 0.002). From the caregivers' report, girls had significantly lower scores for academic performance than boys (3.60 vs. 3.81, P = 0.04). Boys had significantly lower scores for individual risk association compared to girls (3.93 vs. 4.29, P = 0.01). Overall CHIP-CE scores were lower than those of comparable populations in the West, while at the same time protective factors were documented.
Understanding child wellbeing in the Pacific is critical for strengthening protective factors known to mitigate poor child health outcomes. Continuing to base global child health success on child survival alone misses opportunities for improving the wellbeing of nations.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Growing Up Milk (GUM) was developed to assist young children in meeting their nutritional requirements during the second year of life. However, there is limited evidence that GUM improves nutritional ...status and growth in young children.
To evaluate the effect of consuming Growing Up Milk “Lite” (GUMLi) (reduced protein with synbiotics and micronutrients added) compared with standard cow milk as part of a whole diet for 1 y on body composition at 2 y of age.
GUMLi Trial was a multicenter, double-blind, randomized placebo-controlled trial conducted in Auckland and Brisbane. Healthy 1-y-olds were recruited and randomly assigned to receive either GUMLi or standard cow milk for 12 mo as part of a whole diet. The primary outcome was percentage body fat at 2 y of age measured by bioelectrical impedance. All regression models adjusted for baseline outcome and study center.
160 children (80 per arm) were randomly assigned, and 134 (67 per arm) were included in the modified intention-to-treat analyses. The mean percentage body fat at 12 mo was 23.3% (SD 7.9) in the GUMLi group and 25.7% (SD 7.2) in the cow milk group. After adjusting for baseline outcome and study location, the estimated mean difference in percentage body fat between the intervention and control at 12 mo was −2.19% (95% CI: −4.24, −0.15; P = 0.036). Per-protocol analysis showed a similar effect (mean difference: −2.09%; 95% CI: −4.16, −0.03; P = 0.047). Both fat mass and the fat mass index were significantly lower in the GUMLi group at 12 mo than in the cow milk group.
At 2 y of age, children who consumed a GUM with a lower protein content than cow milk over 12 mo had a lower percentage of body fat. This trial was registered at the Australian New Zealand Clinical Trials Registry as ACTRN12614000918628.
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CMK, GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
A child's diet is an important determinant of growth and development. Because of this, the accurate assessment of dietary intake in young children remains a challenge. A systematic search of studies ...validating FFQ methodologies in children 12 to 36 months of age was completed. English-language articles published until March 2016 were searched using three electronic databases (MEDLINE, EMBASE and CINAHL). Quality assessment of the identified studies was carried out using The Reduced Summary Score and EURopean micronutrient RECommendations Aligned (EURRECA) scoring system. Seventeen studies were included and categorised according to whether they reflected long-term (≥7 d) or short-term (<7 d) intake, or used a biomarker. A total score for each micronutrient was calculated from the mean of the correlation coefficients weighted by the study quality score. At least three validation studies per micronutrient were required for inclusion. Fifteen studies (83 %) that considered validity of the FFQ in assessing nutrient intakes had quality scores from 2·5 to 6·0. Of those, ten (67 %) studies found FFQ to have good correlations in assessing dietary intake (>0·4). Of the nutrients with three or more studies available, FFQ validated using a reference method reflecting short-term intake had a good weighted correlation for Ca (0·51), and acceptable weighted correlations for vitamin C (0·31) and Fe (0·33). Semi-quantitative FFQ were shown to be valid and reproducible when estimating dietary intakes at a group level, and are an acceptable instruments for estimating intakes of Ca, vitamin C and Fe in children 12 to 36 months of age.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Birth cohort studies are a valuable source of information about potential risk factors for childhood asthma. To better understand similarities and variations in findings between birth cohort studies, ...the methodologies used to measure asthma require consideration.
To review and appraise the definitions of “asthma” used in birth cohort studies.
A literature search, conducted in December 2017 in the MEDLINE database and birth cohort repositories, identified 1721 citations published since 1990. Information extracted included: study name, year of publication, sample size, sample age, prevalence of asthma (%), study region, source of information about asthma, measured outcome, and asthma case definition. A meta-analysis evaluated whether asthma prevalence in cohorts from Europe and North America varied by the studies’ definition of asthma and by their data sources.
The final review included 67 birth cohorts, of which 48 (72%) were from Europe, 14 (21%) from North America, 3 (5%) from Oceania, 1 (1%) from Asia and 1 (1%) from South America. We identified three measured outcomes: “asthma ever”, “current asthma”, and “asthma” without further specification. Definitions of “asthma ever” were primarily based upon an affirmative parental response to the question whether the child had ever been diagnosed with asthma by a physician. The most frequently used definition of “current asthma” was “asthma ever” and either asthma symptoms or asthma medications in the last 12 months. This definition of “current asthma” was used in 16 cohorts. There was no statistically significant difference in the pooled asthma prevalence in European and North American cohorts that used questionnaire alone versus other data sources to classify asthma.
There is substantial heterogeneity in childhood asthma definitions in birth cohort studies. Standardisation of asthma case definitions will improve the comparability and utility of future cohort studies and enable meta-analyses.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Pertussis (whooping cough) is a highly infective cause of cough that causes significant morbidity and mortality. Existing case definitions include paroxysmal cough, whooping, and posttussive ...vomiting, but diagnosis can be difficult. We determined the diagnostic accuracy of clinical characteristics of pertussis-associated cough.
We systematically searched CINAHL, Embase, Medline, and SCI-EXPANDED/CPCI-S up to June 2016. Eligible studies compared clinical characteristics in those positive and negative for Bordetella pertussis infection, confirmed by laboratory investigations. Two authors independently completed screening, data extraction, and quality and bias assessments. For each characteristic, RevMan was used to produce descriptive forest plots. The bivariate meta-analysis method was used to generate pooled estimates of sensitivity and specificity.
Of 1,969 identified papers, 53 were included. Forty-one clinical characteristics were assessed for diagnostic accuracy. In adult patients, paroxysmal cough and absence of fever have a high sensitivity (93.2% CI, 83.2-97.4 and 81.8% CI, 72.2-88.7, respectively) and low specificity (20.6% CI, 14.7-28.1 and 18.8% CI, 8.1-37.9), whereas posttussive vomiting and whooping have low sensitivity (32.5% CI, 24.5-41.6 and 29.8% CI, 8.0-45.2) and high specificity (77.7% CI, 73.1-81.7 and 79.5% CI, 69.4-86.9). Posttussive vomiting in children is moderately sensitive (60.0% CI, 40.3-77.0) and specific (66.0% CI, 52.5-77.3).
In adult patients, the presence of whooping or posttussive vomiting should rule in a possible diagnosis of pertussis, whereas the lack of a paroxysmal cough or the presence of fever should rule it out. In children, posttussive vomiting is much less helpful as a clinical diagnostic test.
The information fathers receive about infant vaccination may influence their decision to vaccinate. We describe fathers' sources of vaccination information and paternal determinants of timely infant ...vaccinations. Participants were from a child cohort study in New Zealand. The child cohort was established by enrolling pregnant women and their partners. During pregnancy, fathers (n = 4017) of the cohort children born 2009-2010 described information sources that encouraged or discouraged infant vaccination. The National Immunization Register provided infant vaccination data. Independent associations of the vaccination information received by fathers with the timeliness of their infant's vaccination were determined using multivariable logistic regression. Associations were described using adjusted odds ratios and 95% confidence intervals. One-third of fathers (1430/4017 36%) recalled receiving vaccination information, 64% of which encouraged vaccination. Most infants (2900/4017 72%) received all their vaccinations on time, however only 58% of Māori infants were vaccinated on time. Paternal determinants of vaccination timeliness were the father receiving discouraging or conflicting information about vaccination, father's ethnicity, father's vaccination hesitancy, and whether the mother received vaccination information. To improve vaccination uptake and timeliness, a vaccination conversation with mothers, fathers and whānau could be included in routine antenatal care, informing and supporting decision-making, and addressing concerns. Vaccination education should address present and historic distrust of the health system. Framing vaccination within a Māori model of health and including fathers and whānau in decision-making will address vaccination inequities in New Zealand.
In Tonga, pneumococcal conjugate vaccine is not a scheduled immunization. We identified all children in Tonga with invasive pneumococcal disease from 2010 to 2013. The average annual invasive ...pneumococcal disease incidence rate was 113/100,000 (<2 years), 50/100,000 (<5 years) and 25/100,000 (<15 years). The case fatality rate (<5 years) was 25%. The incidence rate and high case fatality rate indicate the need for pneumococcal conjugate vaccine.
We aimed to provide comprehensive estimates of laboratory-confirmed respiratory syncytial virus (RSV)-associated hospitalisations. Between 2012 and 2015, active surveillance of acute respiratory ...infection (ARI) hospitalisations during winter seasons was used to estimate the seasonal incidence of laboratory-confirmed RSV hospitalisations in children aged <5 years in Auckland, New Zealand (NZ). Incidence rates were estimated by fine age group, ethnicity and socio-economic status (SES) strata. Additionally, RSV disease estimates determined through active surveillance were compared to rates estimated from hospital discharge codes. There were 5309 ARI hospitalisations among children during the study period, of which 3923 (73.9%) were tested for RSV and 1597 (40.7%) were RSV-positive. The seasonal incidence of RSV-associated ARI hospitalisations, once corrected for non-testing, was 6.1 (95% confidence intervals 5.8-6.4) per 1000 children <5 years old. The highest incidence was among children aged <3 months. Being of indigenous Māori or Pacific ethnicity or living in a neighbourhood with low SES independently increased the risk of an RSV-associated hospitalisation. RSV hospital discharge codes had a sensitivity of 71% for identifying laboratory-confirmed RSV cases. RSV infection is a leading cause of hospitalisation among children in NZ, with significant disparities by ethnicity and SES. Our findings highlight the need for effective RSV vaccines and therapies.
Human milk is typically low in vitamin D activity (VDA). Whether the vitamin D content of breast milk at birth can be increased by supplementing the mother during pregnancy has not been reported to ...the best of our knowledge.
We examined the effect of vitamin D supplementation during pregnancy on breast-milk VDA in the first 2 mo of lactation.
Breast-milk samples were obtained from women who were enrolled in a randomized, double-blinded, placebo-controlled trial of vitamin D supplementation during pregnancy. Pregnant women were enrolled at 27 wk of gestation and randomly assigned to the following 3 groups: a placebo group, a group who received one dosage of daily oral vitamin D3 (1000 IU), or a group who received 2 dosages of daily oral vitamin D3 (2000 IU). Serum 25-hydroxyvitamin D 25(OH)D was measured at enrollment, at 36 wk of gestation, and in cord blood at birth. Study participants who were breastfeeding were invited to provide breast-milk samples for VDA measurement concentration of vitamin D2, vitamin D3, 25(OH)D2, and 25(OH)D3 at 2 wk and 2 mo postpartum. A linear mixed model was used to compare breast-milk VDA between the 3 study groups.
A total of 75 women provided breast-milk samples (44 women provided breast-milk samples at both 2 wk and 2 mo postpartum). The mean (95% CI) VDA at age 2 wk was 52 IU/L (12, 217 IU/L) in the placebo group, 51 IU/L (17, 151 IU/L) in the 1000-IU group, and 74 IU/L (25, 221 IU/L) in the 2000-IU group; and at age 2 mo, the mean (95% CI) VDA was 45 IU/L (16, 124 IU/L), 43 IU/L (18, 103 IU/L), and 58 IU/L (15, 224 IU/L), respectively. There was no significant interaction in VDA between the sample-collection time and treatment (P = 0.61), but there was a difference between lower- and higher-dosage treatment groups (P = 0.04).
Maternal vitamin D supplementation during pregnancy of 2000 IU/d (compared with 1000 IU/d and with a placebo) results in a higher VDA of breast milk ≥2 mo postpartum. This trial was registered at the Australian New Zealand Clinical Trials Registry as ACTRN12610000483055.
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CMK, GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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