Changing patterns of emergency paediatric presentations during the first wave of COVID-19: learning for the second wave from a UK tertiary emergency department

BackgroundThe SARS-CoV-2 pandemic and initial public health response led to significant changes in health service delivery, access and utilisation. However, SARS-CoV-2 illness burden in children and young people (CYP) is low. To inform effective child public health interventions, we aimed to compare patterns of paediatric emergency department presentation during the initial pandemic response with a previous non-pandemic period.MethodsRetrospective review of attendances (0–18 years) over the initial pandemic (2 March 2020–3 May 2020) compared with 2019. Outcome measures included number of attendances, referral source, presenting complaint, discharge diagnosis and disposal. Descriptive statistics with subgroup analysis by age/sex/ethnicity and pandemic time periods (pre-lockdown, lockdown weeks 1–3 and lockdown weeks 4–6) was performed.Results4417 attendances (57% illness and 43% injuries) occurred, compared with 8813 (57% illness and 43% injuries), a reduction of 50%, maximal in lockdown week 2 (−73%). Ranking of top three illness presentations changed across the pandemic weeks. Breathing difficulty dropped from first (300, 25%) to second (117, 21%) to third (59, 11%) (p<0.001). Abdominal pain rose from the third pre-lockdown (87, 7%) and lockdown weeks 1–3 (37, 7%) to second in weeks 4–6 (62, 12%; p=0.004). Fever ranked second (235, 19%) in pre-lockdown and first in weeks 1–3 (134, 24%) and weeks 4–6 (94, 18%; p=0.035).ConclusionsDespite a 50% reduction, there was no significant change in acuity of illness. Rank of illness presentations changed, with abdominal pain ranking second and fever first, an important change from previous, which should prompt further research into causes. CYP-specific public health messaging and guidance for primary care are required in this second wave to ensure access to appropriate emergency services.

Priorities for the child public health response to the COVID-19 pandemic recovery in England

Child health is at risk from the unintended consequences of the COVID-19 response and will suffer further unless it is given proper consideration. The pandemic can be conceived as a systemic shock to the wider determinants of child health, with impacts on family functioning and income, access to healthcare and education. This article outlines COVID-19 impacts on children in England. Key priorities relate to the diversion of healthcare during lockdown; interruption and return to schooling; increased health risks and long-term impacts on child poverty and social inequalities. We provide an overview of mitigation strategies and policy recommendations aimed to assist both national and local professionals across child health, education, social care and related fields to inform the policy response.

Child public health part 4: paramedics at the forefront of child protection

Paramedics are ideally placed in communities to facilitate screening and promote healthy behaviour in children, as well as identify those who may at risk of abuse or neglect. This last instalment of this four-part series on child public health explores the position of paramedics in the larger picture of child protection.

Child public health part 3: promoting healthy childhood

Child health promotion focuses on individuals and communities adopting healthy behaviours. This article, the third part of four on child public health, explores health promotion strategy and theory, as well as the areas in which paramedics can contribute to improving their own health promotion beyond the clinical setting.

Child public health part 2: prevention and where paramedics contribute

The second part of the series on child public health explores the levels of prevention implemented in order to hinder diseases from affecting the lives of children, and how paramedics implement prevention strategies in their practice both in prehospital and primary care settings.

6.C. Workshop: Digitalizing maternal and child public health

Digital Technologies have transformed many sectors in societies, and, increasingly, is changing the health care sector and health research. In comparison the potential of digital technologies in public health has been less explored. The workshop aims to address both the challenges and potentials of digital public health with focus on maternal and child public health. Presenters will provide examples of how digital technologies and digital health innovations can sustain and improve maternal and child health. The workshop presents three perspectives on digital maternal and child public health from different continents. This is a deliberate choice to highlight the universal and global relevance of digitalization in maternal and child public health. After the presentations, time is foreseen for a discussion on potential and limitations, as well as the generalizability of methods and results for maternal and child health globally, as well as on the question of governance in digital public health. The workshop topics will span from digital health information seeking to monitoring and the use of artificial intelligence for policy development. Each presentation covers a different technology or digital approach to public health. The presentations will critically explore how these technologies and approaches can improve public health from a local and global perspective, and will raise central issues, such as acceptance and availability of novel technologies, generalizability of results, governance and participatory approaches in the digital transformation in maternal and child health globally. Key messages Digital technologies can provide different impact for maternal and child public health depending on area of implementation, e.g. health promotion, policy development. Challenges and potentials range from specifically local and health-system related to globally generalizable factors.

The use of future scenario thinking for child public health in a local authority

Background Socioeconomic, cultural, technological, environment and ecological changes are rapidly transforming how children and young people (CYP) grow up, yet their impacts on CYP are difficult to predict. The traditional ways that Public Health practitioners work may not capture such complex and dynamic change. To address this, Lambeth Council used future scenario thinking. Methods A literature review looked at political, socioeconomic and other ‘transitions’ in the borough. Interviews, focus groups and workshops were held with CYP, parents, carers, local statutory and non-statutory stakeholders about the future for Lambeth CYP in the decade ahead. Themes were analysed to identify which had the potential for the biggest impact or the most uncertainty. Results The main transitions were described, 100 stakeholders interviewed, and five ‘drivers’ of the future were identified: protracted austerity, technological explosion, demographic shift, ‘democratic shake-up‘ and planetary health. From all these data, four future scenarios were developed: ‘communities care for themselves’, ‘collaborating to care for all’, ‘nobody cares’ and ‘who cares?’ Conclusions New insights were gained about promoting more responsibility for, and active participation of CYP. This led to Lambeth’s CYP Plan and the ‘Made in Lambeth’ campaign aiming to enlist the community and business in creating a child-friendly borough.

Child public health part 1: strategies for health

Child public health is an area that focuses on child health outcomes that can have an impact through the life course. This article briefly explores some key concepts such as public health strategies and the potential role of paramedics in improving child health. The following articles in this series will delve further into the impact of paramedic practice on the three main elements of child public health: prevention, promotion and protection.

Improving knowledge, attitude, and practices of complementary feeding using practical intervention training for parents living in stunting villages in Central Lombok, Indonesia: A community-based study

BackgroundStunting is one of the major child public health concerns in Indonesia. West Nusa Tenggara (WNT) province, specifically, is still struggling to reduce its stunting prevalence as it is still higher than the average national prevalence, accounted for 31.4% in 2018. Ensuring knowledge, attitude, and practices (KAP) of complementary feeding among parents is relevant to succeeding in the implementation of stunting reduction programs. This study aimed to assess the effectiveness of interventions in the form of seminar and workshop on preparing complementary feeding in stunting villages in Central Lombok, Indonesia.MethodsThis is a quasi-experimental community-based study, held in three stunting villages of Central Lombok, WNT, from June until August 2019. Three villages were chosen randomly from ten stunting-villages in Central Lombok District and divided into three groups, i.e., control group, seminar group and seminar and workshop group. We assessed KAP before and after intervention with a four-week interval.ResultsA total of 205 participants were enrolled in this study, consisting of 67, 70, and 68 participants for the control group, the first intervention group, and the second intervention group, respectively. Most participants had poor knowledge (75.1%) of complementary feeding in the baseline assessment. We found an insignificant change in knowledge, but notable alterations in attitudes and practices after intervention. Seminar intervention could increase practice, while complete intervention (seminar and workshop) could increase both practices and attitudes significantly (p = 0.015 dan p = 0.014). We found that complete intervention was more effective in increasing attitudes compared to the control group (p = 0.039). In contrast, practices in both seminar and complete intervention was increased effectively than controls (p = 0.006 vs. p = 0.008), and no differences between seminar and complete intervention group (p = 0.943).ConclusionsComplementary feeding KAP among parents in stunting villages in Central Lombok was inadequate. Our study showed that the combination of seminar and workshop increased parents’ attitudes and practices, while the seminar only increased parents’ practices. We suggest further prospective study to assess how long the effectivity of such interventions could impact and last; and obtain any cultural concerns.Trial registration: 376/UN18.8/ETIK/2018

Stress perceived by pregnant and decision-making factors of maternal caesarean section request

Background Pregnancy is a time of psychological vulnerability which can generate intense stress. This represents a maternal and child public health problem. Prenatal stress has harmful impacts on the foetus, the newborn and can cause an increased maternal request for caesareans sections, with nonmedical grounds. The perceived level of prenatal stress factors was assessed in women, as well as mothers’ incentives and decision-making factors for a caesarean section on maternal request. Methods A descriptive study on 203 pregnant women, then a comparative study between primiparas (n = 72) and multiparas (n = 131) were carried out with the Antenatal perceived stress inventory. Incentives and decision-making factors for a caesarean on the mother’s demand were studied by in-depth interviews with primiparas mothers (n = 16) who had made this choice. Results The perception of stress level during pregnancy is higher at the first quarter regarding the foetus’ health, medical and obstetric risks and reverses with the perception of projections linked to giving birth at the last quarter. Primiparas are significantly (p &lt; 0.001) more stressed. All the elements of the three assessed factors are very significantly (p &lt; 0.001) correlated for the whole population. Among them, 75% choose a caesarean section on maternal request during the first quarter. This choice is confirmed at the end of the second quarter or during the third one for 50% of them, with a one-month time to think for 58.3% of them. The main incentives are tokophobia (66.7%) and preserving the baby’s health (50%). Conclusions Pregnancy causes important stress, which is pronounced in primiparas. In France, these results speak in favour of screening tokophobia and an earlier start of birth and parenthood preparation classes in order to handle stress from the first quarter of pregnancy, when medical and prenatal exams are initiated. Birth preparation should be taken on at the last quarter. Key messages Investigate stress perceived and identification incentives and decision-making factors of maternal caesarean section request it’s a solution to building bridge for solidarity with tokophobic women. The relation enter stress perceived by pregnant women and decision-making factors of maternal caesarean section request, represents a maternal and child public health problem.