IntroductionMore than 40% of children under 5 years of age in low-income and middle-income countries are at risk of not reaching their developmental potential. The international Guide for Monitoring Child Development (GMCD) early intervention package is a comprehensive programme to address developmental difficulties using an individualised intervention plan for young children and their families. We will conduct a hybrid type 1 effectiveness–implementation evaluation of the GMCD intervention in rural India and Guatemala.Methods and analysisUsing a cluster-randomised design, 624 children aged 0–24 months in 52 clusters (26 in India, 26 in Guatemala) will be assigned to usual care or the GMCD intervention plus usual care delivered by frontline workers for 12 months. After 12 months, the usual care arm will cross over to the intervention, which will continue for 12 additional months (24 total). The intervention will be delivered using a digital mobile device interface. Effectiveness will be assessed for developmental functioning (Bayley Scales of Infant Development, 3rd edition) and nurturing care (Home Observation for Measurement of the Environment Scale) outcomes. Implementation will be assessed using the Reach, Effectiveness, Adoption, Implementation, Maintenance framework. Explanatory qualitative analysis guided by the Consolidated Framework for Implementation Research will explore determinants between clusters with high versus low implementation effectiveness.Ethics and disseminationThe study has been approved by the Institutional Review Boards of Brigham and Women’s Hospital, Mahatma Gandhi Institute of Medical Sciences and Maya Health Alliance; and by the Indian Council of Medical Research/Health Ministry Screening Committee. Key study findings will be published in international open-access journals.Trial registration numberNCT04665297, CTRI/2020/12/029748.Protocol version1.0 (12 November 2020).
BackgroundEarly intervention delivered through telehealth is critically needed during crises, particularly for children in low and middle-income countries (LMICs). We aimed to determine the applicability of the international Guide for Monitoring Child Development (GMCD) intervention delivered through telehealth during the COVID-19 lockdown in Turkey.MethodsUsing a mixed-methods longitudinal design, we recruited children with developmental difficulties aged 0–42 months with an appointment during the first lockdown at Ankara University Developmental Pediatrics Division and seen face-to-face only once before. Developmental pediatricians applied the GMCD intervention during a single telephone call. As a novel intervention component, caregivers were asked to record and send back videos of the child's development when there were doubts about the child's functioning. Caregivers were called 1 year later by blinded independent researchers and a semi-structured interview on applicability was conducted. Applicability of the caregiver recorded video component of the intervention was assessed by a blinded observer using the GMCD Video Observation Tool.ResultsOf 122 children that received the telehealth delivered GMCD intervention, 114 (93.4%) were included in the 1-year outcome study. Most were boys (51.8%); median age was 16.5 (IQR: 10.0–29.0) months, 51.0% had chronic health conditions, and 66.7% had developmental delay. All caregivers that received the intervention were mothers; 75.4% had at least high school education. The intervention was reported as applicable by 80.7% with high levels of satisfaction. On multivariate regression analysis, absence of chronic health related conditions was significantly associated with applicability (OR = 2.87, 95% CI = 1.02–8.09). Of 31 caregivers that were asked for videos, 19 sent back 93 videos that were technically observable. One or more developmental domains were observed in all videos; in 52.6%, caregivers provided early learning opportunities.ConclusionsThe findings of this study imply that the telehealth delivered GMCD intervention for children with developmental difficulties is applicable during the pandemic. The intervention content and frequency needs to be augmented for children with chronic health conditions. Further research is required to examine applicability and effectiveness of the GMCD intervention in other settings, particularly in LMICs.
A 6-month-old girl was admitted to the intensive care unit of a tertiary pediatric hospital for shortness of breath and respiratory distress for three days following one month of cough. A er ve days antibiotics therapy (amoxicillin sulbactam for three days followed by meropenem for two days), chest CT scan showed severe pneumonia with local consolidation. A er beroptic bronchoscopy and alveolar lavage, she was intubated for ventilation and transported by ambulance to our hospital because of persistent cyanosis. e girl was gravida 2 para 2 and vaginal delivered spontaneously at full gestation age to a gravida 2 para 2 mother with Apgar score of 10 at rst minute and birth weight 4000 g. Her non-consanguineous parents and elder brother were healthy. ere was no family history of tuberculosis. She was vaccinated at birth for BCG and hepatitis B and no other vaccinations were given because of recurrent infections with oral herpes, bronchitis and pneumonia a er one month old.Physical examination revealed le sub-axillary lymphadenitis (Figure 1) and bilateral pulmonary rales, no rash and no hepatosplenomegaly were observed and failure to thrive (6000g at admission). Peripheral blood routine test showed: white blood cell counts 9.7 × 10 9 /L, lymphocytes di erential 8%, hemoglobin and platelet were normal. C-reactive protein, procalcitonin, serum electrolytes, biochemical enzymes of organs, liver and renal function and coagulation function were normal. Chest radiographs showed bilateral in ltration pneumonia. Abdominal sonography was normal. Super cial sonography showed le sub-axillary lymph node enlargement and liquefaction. High-throughput sequencing on Bronchoalveolar Lavage Fluid (BALF) identi ed 697 sequences of Mycobacteruim tuberculosis complex and 95146 sequences of Pneumocystis jiroveci, respectively.
BackgroundThe WHO reports excessive rates of ill-defined neurological diagnoses and ineffective and potentially harmful drug treatments in children in the Commonwealth of Independent States (CIS). Collectively termed perinatal encephalopathy and the syndrome of intracranial hypertension (PE-SIH), these diagnoses are important contributors to perceived childhood morbidity and disability in the CIS. A systematic compilation of information on PE-SIH is lacking.MethodsWe systematically reviewed publications between 1970 and 2020 on PE-SIH in Azerbaijani, English, Russian and Ukrainian languages and summarised information on PE-SIH.ResultsWe identified 30 publications (70% in Russian) published 1976–2017. The diagnosis of PE-SIH was either based on unreported criteria (67% of reports), non-specific clinical features of typically developing children or those with common developmental disorders (20% of reports) or cranial ultrasound (13% of reports). The reported proportion of children with PE-SIH in the study samples ranged from 31% to 99%. There were few published studies on reassessments of children diagnosed with PE-SIH, and these did not confirm neurological disease in the majority of children. Treatments included multiple unlicenced drugs without established effectiveness and with potential unwanted effects.ConclusionThis review suggests that PE-SIH is a medical diagnostic label that is used in numerous children without substantive associated disease. The diagnosis and treatment of PE-SIH is a multidimensional, iatrogenic, clinical and public health problem in the CIS. With increasing use of evidence-based medicine guidelines in the region, it is hoped that PE-SIH will gradually disappear, but actions to accelerate this change are nevertheless needed.
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