Search results for: child healthcare

Authors: Soroush Pakniyat-Jahromi, Jessica Bucciarelli, Souparno Mitra, Neda Motamedi, Ralph Amazan, Samuel Rothman, Jose Tiburcio, Douglas Reich, Vicente Liz

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Violence is defined as an act of physical force that is intended to cause harm and may lead to physical and/or psychological damage. Violence toward healthcare workers (HCWs) is more common in psychiatric settings, emergency departments, and nursing homes; however, healthcare workers in medical setting are not spared from such events. Workplace violence has a huge burden in the healthcare industry and has a major impact on the physical and mental wellbeing of staff. The purpose of this study is to compare the prevalence of patient agitation and violence in medical-surgical settings in BronxCare Hospital (BCH) Bronx, New York, one year before and during the COVID-19 pandemic. Data collection occurred between June 2021 and August 2021, while the sampling time was from 2019 to 2021. The data were separated into two separate time categories: pre-COVID-19 (03/2019-03/2020) and COVID-19 (03/2020-03/2021). We created frequency tables for 19 variables. We used a chi-square test to determine a variable's statistical significance. We tested all variables against “restraint type”, determining if a patient was violent or became violent enough to restrain. The restraint types were “chemical”, “physical”, or both. This analysis was also used to determine if there was a statistical difference between the pre-COVID-19 and COVID-19 timeframes. Our data shows that there was an increase in incidents of violence in COVID-19 era (03/2020-03/2021), with total of 194 (62.8%) reported events, compared to pre COVID-19 era (03/2019-03/2020) with 115 (37.2%) events (p: 0.01). Our final analysis, completed using a chi-square test, determined the difference in violence in patients between pre-COVID-19 and COVID-19 era. We then tested the violence marker against restraint type. The result was statistically significant (p: 0.01). This is the first paper to systematically review the prevalence of violence in medical-surgical units in a hospital in New York, pre COVID-19 and during the COVID-19 era. Our data is in line with the global trend of increased prevalence of patient agitation and violence in medical settings during the COVID-19 pandemic. Violence and its management is a challenge in healthcare settings, and the COVID-19 pandemic has brought to bear a complexity of circumstances, which may have increased its incidence. It is important to identify and teach healthcare workers the best preventive approaches in dealing with patient agitation, to decrease the number of restraints in medical settings, and to create a less restrictive environment to deliver care.

Keywords: COVID-19 pandemic, patient agitation, restraints, violence

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Authors: Bridget J. Kenny, Elizabeth Hoban, Jo Williams

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Adolescent pregnancy presents a significant public health challenge for Cambodia. Despite declines in the overall fertility rate, the adolescent fertility rate is increasing. Adolescent pregnancy is particularly problematic in the Northeast provinces of Ratanak Kiri and Mondul Kiri where 34 percent of girls aged between 15 and 19 have begun childbearing; this is almost three times Cambodia’s national average of 12 percent. Language, cultural and geographic barriers have restricted qualitative exploration of the sexual and reproductive health (SRH) challenges that face indigenous adolescents in Northeast Cambodia. The current study sought to address this gap by exploring the SRH practices of adolescent mothers from indigenous populations in Ratanak Kiri Province. Twenty-two adolescent mothers, aged between 15 and 19, were recruited from seven indigenous villages in Ratanak Kiri Province and asked to participate in a combined body mapping exercise and semi-structured interview. Participants were given a large piece of paper (59.4 x 84.1 cm) with the outline of a female body and asked to draw the female reproductive organs onto the ‘body map’. Participants were encouraged to explain what they had drawn with the purpose of evoking conversation about their reproductive bodies. Adolescent mothers were then invited to participate in a semi-structured interview to further expand on topics of SRH. The qualitative approach offered an excellent avenue to explore the unique SRH challenges that face indigenous adolescents in rural Cambodia. In particular, the use of visual data collection methods reduced the language and cultural barriers that have previously restricted or prevented qualitative exploration of this population group. Thematic analysis yielded six major themes: (1) understanding of the female reproductive body, (2) contraceptive knowledge, (3) contraceptive use, (4) barriers to contraceptive use, (5) sexual practices, (6) contact with healthcare facilities. Participants could name several modern contraceptive methods and knew where they could access family planning services. However, adolescent mothers explained that they gained this knowledge during antenatal care visits and consequently participants had limited SRH knowledge, including contraceptive awareness, at the time of sexual initiation. Fear of the perceived side effects of modern contraception, including infertility, provided an additional barrier to contraceptive use for indigenous adolescents. Participants did not cite cost or geographic isolation as barriers to accessing SRH services. Child marriage and early sexual initiation were also identified as important factors contributing to the high prevalence of adolescent pregnancy in this population group. The findings support the Ministry of Education, Youth and Sports' (MoEYS) recent introduction of SRH education into the primary and secondary school curriculum but suggest indigenous girls in rural Cambodia require additional sources of SRH information. Results indicate adolescent girls’ first point of contact with healthcare facilities occurs after they become pregnant. Promotion of an effective continuum of care by increasing access to healthcare services during the pre-pregnancy period is suggested as a means of providing adolescents girls with an additional avenue to acquire SRH information.

Keywords: adolescent pregnancy, contraceptive use, family planning, sexual and reproductive health

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Authors: Vicent Lwanga

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Background: Elderly Widows Orphans Family Support, a Community Based Organization operating in Kapchorwa with the main focus of reducing economic and social vulnerability among children affected by HIV/AIDS. The survey on reducing vulnerability targeted HIV/AIDS affected households, which included 111 adults and 185 children. The broad objective of the study was to determine how the needs of the children affected by HIV/AIDS could be appropriately met by specifically examining the situation of children affected by HIV/AIDS and establishing their needs. Methodology: The survey applied a structured questionnaire. Parents whose consent for the interview of the children had been obtained then communicated to the selected child/children. If the child consented, an arrangement for the interview was made as regards the time and place of the interview. Lessons: Adult respondents included 22.2% males and 77.8% females. Child respondents were males, 49.5%, and females 50.5%. The majority of the households are from lower economic strata. 74.1% and 63.0% of males and females, respectively, indicated that their illness had affected their income-earning activities; some of the adults have lost their jobs due to AIDS. A fair number of the children are engaged in economic activity: some of those still in school worked after school for wages and looked after their siblings. The income earned was spent mostly on household needs and school fees — one-fifth of children linked parents` inability to do more of what they desired to their ill-health. Elderly Widows Orphans Family Support secured sponsors to educate 22 girls and 16 boys in the community. Income-generating projects like piggery and skill training are given to orphans. The specific vulnerability of HIV/AIDS orphan's needs is responded to now more than ever. Community organisations interventions such as financial support to orphans introduced to moderate the impact of the disease on orphans and families.

Keywords: aids, children, needs, vulnerability

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Authors: Kldiashvili Ekaterina, Burduli Archil, Ghortlishvili Gocha

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Introduction – Medical information system (MIS) is at the heart of information technology (IT) implementation policies in healthcare systems around the world. Different architecture and application models of MIS are developed. Despite of obvious advantages and benefits, application of MIS in everyday practice is slow. Objective - On the background of analysis of the existing models of MIS in Georgia has been created a multi-user web-based approach. This presentation will present the architecture of the system and its application for image based second opinion consultations. Methods – The MIS has been created with .Net technology and SQL database architecture. It realizes local (intranet) and remote (internet) access to the system and management of databases. The MIS is fully operational approach, which is successfully used for medical data registration and management as well as for creation, editing and maintenance of the electronic medical records (EMR). Five hundred Georgian language electronic medical records from the cervical screening activity illustrated by images were selected for second opinion consultations. Results – The primary goal of the MIS is patient management. However, the system can be successfully applied for image based second opinion consultations. Discussion – The ideal of healthcare in the information age must be to create a situation where healthcare professionals spend more time creating knowledge from medical information and less time managing medical information. The application of easily available and adaptable technology and improvement of the infrastructure conditions is the basis for eHealth applications. Conclusion - The MIS is perspective and actual technology solution. It can be successfully and effectively used for image based second opinion consultations.

Keywords: digital images, medical information system, second opinion consultations, electronic medical record

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Authors: Samereh Abdoli, Amit Vora, Anusha Vora

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Aim: To qualitatively investigate diabetes burnout in parents of children with Type 1 Diabetes (T1D) who shared their experiences through YouTube videos in order to inform future interventions and improve diabetes practice. Methods: A qualitative descriptive approach was used to explore YouTube videos. Of the 568 videos that were identified, only 9 videos met the inclusion criteria of the study. Results: After the videos were transcribed and analyzed using qualitative content analysis, it was revealed that parents shared common concerns and experiences and they translated into three main themes: I do not ever get a break, I am exhausted, I can’t burn out, and I just need a break Conclusion: All in all, the literature revealed that there are negative psychosocial outcomes associated with caring for a child with T1D, but there is a lack of information on diabetes burnout and how parents’ well-being are affected. Reports of self-neglect and sleep deprivation only confirm the need for intervention for parents of children with T1D. The hope with this study is that burnout can be recognized early on and appropriate interventions put in place to help parents cope with the stressors of caring for a child with a chronic disease.

Keywords: Diabetes burnout, type 1 diabetes, qualitative research, parents

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Authors: Rana Alkhamra

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Background: Child's earliest experiences with books and stories during the first years of his life are strongly linked with the development of his early language and literacy skills. Interacting in routine learning activities, such as shared book reading, storytelling, and teaching about the letters of the alphabet make a critical foundation for early learning, language growth and emergent literacy. Aim: The current study explores family and preschool early interactive literacy practices in families and preschools (nursery and kindergarten) in Jordan. It highlights the importance of early interactive literacy activities on child language and literacy growth and development. Methods: This is a cross sectional study that surveyed 243 Jordanian families. The survey investigated literacy routine practices, largely shared books reading, at home and at preschool; child speech and language development; and family demographics. Results: Around 92.5% of the families read books and stories to their children, as frequently as 1-2 times weekly or monthly (75%). Only 19.6% read books on daily basis. Many families reported preferring story-telling (97%). Despite that families acknowledged the importance of early literacy activities, on language, reading and writing, cognitive, and academic development, 45% asked for education and training pertaining to specific ways and ideas to help their young children develop language and literacy skills. About 69% of the families reported reading books and stories to their children for 15 minutes a day, while 71.2% indicated having their children watch television for 3 to > 6 hours a day. At preschool, only 52.8% of the teachers were reported to read books and stories. Factors like parent education, monthly income, living inside (33.6%) or outside (66.4%) the capital city of Amman significantly (p < 0.05) affected child early literacy interactive activities whether at home or at preschool. Conclusion: Early language and literacy skills depend largely on the opportunities and experiences provided to children in the home and in preschool environment. Family literacy programs can play an important role in bridging the gap in early literacy experiences for families that need help. Also, speech therapists can work in collaboration with families and educators to ensure that young children have high quality and sufficient opportunities to participate in early literacy activities both at home and in preschool environments.

Keywords: literacy, interactive activities, language, practices, family, preschool, Jordan

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Authors: Katherine Maurer

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Background and purpose: Violence that occurs within families is a global social problem. Children who are victims or witness to family violence are at risk for many negative effects both proximally and distally. One of the most disconcerting long-term effects occurs when child victims become adult perpetrators: the intergenerational transmission of family violence (ITFV). Early identification of those children most at risk for ITFV is needed to inform interventions to prevent future family violence perpetration and victimization. Only about 25-30% of child family violence victims become perpetrators of adult family violence (either child abuse, partner abuse, or both). Prior research has primarily been conducted using dichotomous measures of exposure (yes; no) to predict ITFV, given the low incidence rate in community samples. It is often assumed that exposure to greater amounts of violence predicts greater risk of ITFV. However, no previous longitudinal study with a community sample has tested a dose-response model of exposure to physical child abuse and parental physical intimate partner violence (IPV) using count data of frequency and severity of violence to predict adult ITFV. The current study used advanced statistical methods to test if increased childhood exposure would predict greater risk of ITFV. Methods: The study utilized 3 panels of prospective data from a cohort of 15 year olds (N=338) from the Project on Human Development in Chicago Neighborhoods longitudinal study. The data were comprised of a stratified probability sample of seven ethnic/racial categories and three socio-economic status levels. Structural equation modeling was employed to test a hurdle regression model of dose-response to predict ITFV. A version of the Conflict Tactics Scale was used to measure physical violence victimization, witnessing parental IPV and young adult IPV perpetration and victimization. Results: Consistent with previous findings, past 12 months incidence rates severity and frequency of interpersonal violence were highly skewed. While rates of parental and young adult IPV were about 40%, an unusually high rate of physical child abuse (57%) was reported. The vast majority of a number of acts of violence, whether minor or severe, were in the 1-3 range in the past 12 months. Reported frequencies of more than 5 times in the past year were rare, with less than 10% of those reporting more than six acts of minor or severe physical violence. As expected, minor acts of violence were much more common than acts of severe violence. Overall, regression analyses were not significant for the dose-response model of ITFV. Conclusions and implications: The results of the dose-response model were not significant due to a lack of power in the final sample (N=338). Nonetheless, the value of the approach was confirmed for the future research given the bi-modal nature of the distributions which suggest that in the context of both child physical abuse and physical IPV, there are at least two classes when frequency of acts is considered. Taking frequency into account in predictive models may help to better understand the relationship of exposure to ITFV outcomes. Further testing using hurdle regression models is suggested.

Keywords: intergenerational transmission of family violence, physical child abuse, intimate partner violence, structural equation modeling

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Authors: Olarinde Olaniran, Oluyomi A. Sowemimo

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Toxoplasmosis is frequently misdiagnosed or underdiagnosed, and it is the third most common cause of hospitalization due to food-borne infection. Intra-uterine infection with Toxoplasma gondii due to active parasitaemia during pregnancy can cause severe and often fatal cerebral damage, abortion, and stillbirth of a fetus. The aim of the study was to investigate the prevalence of T. gondii infection in women of childbearing age in selected communities of Osun State with a view to determining the risk factors which predispose to the T. gondii infection. Five (5) ml of blood was collected by venopuncture into a plain blood collection tube by a medical laboratory scientist. Serum samples were separated by centrifuging the blood samples at 3000 rpm for 5 mins. The sera were collected with Eppendorf tubes and stored at -20°C analysis for the presence of IgG and IgM antibodies against T. gondii by commercially available enzyme-linked immunosorbent assay (ELISA) kit (Demeditec Diagnostics GmbH, Germany) conducted according to the manufacturer’s instructions. The optical densities of wells were measured by a photometer at a wavelength of 450 nm. Data collected were analysed using appropriate computer software. The overall seroprevalence of T. gondii among the women of child-bearing age in selected seven communities in Osun state was 76.3%. Out of 76.3% positive for Toxoplasma gondii infection, 70.0% were positive for anti- T. gondii IgG, and 32.3% were positive for IgM, and 26.7% for both IgG and IgM. The prevalence of T. gondii was lowest (58.9%) among women from Ile Ife, a peri-urban community, and highest (100%) in women residing in Alajue, a rural community. The prevalence of infection was significantly higher (P= 0.000) among Islamic women (87.5%) than in Christian women (70.8%). The highest prevalence (86.3%) was recorded in women with primary education, while the lowest (61.2%) was recorded in women with tertiary education (p =0.016). The highest prevalence (79.7%) was recorded in women that reside in rural areas, and the lowest (70.1%) was recorded in women that reside in peri-urban area (p=0.025). The prevalence of T. gondii infection was highest (81.4%) in women with one miscarriage, while the prevalence was lowest in women with no miscarriages (75.9%). The age of the women (p=0.042), Islamic religion (p=0.001), the residence of the women (p=0.001), and water source were all positively associated with T. gondii infection. The study concluded that there was a high seroprevalence of T. gondii recorded among women of child-bearing age in the study area. Hence, there is a need for health education and create awareness of the disease and its transmission to women of reproductive age group in general and pregnant women in particular to reduce the risk of T. gondii in pregnant women.

Keywords: seroepidemiology, Toxoplasma gondii, women, child-bearing, age, communities, Ile -Ife, Nigeria

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Authors: Hajar Aman Key Yekani, Yusra Mushtaq, Behnaz Farahani, Hamed Abdi

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This study explores associations between parental restriction and children's appetitive traits, putting to test the hypothesis that parental 'restriction' is associated with having a child with stronger food approach tendencies (food enjoyment (FE) and food over-responsiveness (FR)). The participants, from 55 nationalities, targeting 1081 parents of 5- to 11-year-old children from 7 private schools in Dubai, UAE, who completed self-reported questionnaires over the 2011-2012 school year. The questionnaire has been a tailored amalgamation of CEBQ and CFQ in order to measure the children’s appetitive traits and parental restriction, respectively. The findings of this quantitative, descriptive, cross-sectional analysis confirmed the hypothesis in that 'parental restriction' was positively associated with child food responsiveness (r, 0.183), food enjoyment (r, 0.102). To conclude, as far as the figures depict, the parents controlling their children’s food intake would seemingly a reverse impact on their eating behaviour in the short term.

Keywords: parental restriction, children, eating behaviour, schools in Dubai

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Authors: Md Monoarul Haque

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Nutritional status is a sensitive indicator of community health and nutrition among preschool children, especially the prevalence of undernutrition that affects all dimensions of human development and leads to growth faltering in early life. The present study is an attempt to assess the food intake pattern and nutritional status of pre-school Chakma tribe children. It was a cross-sectional community based study. The subjects were selected purposively. This study was conducted at Savar Upazilla of Rangamati. Rangamati is located in the Chittagong Division. Anthropometric data height and weight of the study subjects were collected by standard techniques. Nutritional status was measured using Z score according WHO classification. χ2 test, independent t-test, Pearson’s correlation, multiple regression and logistic regression was performed as P<0.05 level of significance. Statistical analyses were performed by appropriate univariate and multivariate techniques using SPSS windows 11.5. Moderate (-3SD to <-2SD) to severe underweight (<-3SD) were 23.8% and 76.2% study subjects had normal weight for their age. Moderate (-3SD to <-2SD) to severe (<-3SD) stunted children were only 25.6% and 74.4% children were normal and moderate to severe wasting were 14.7% whereas normal child was 85.3%. Significant association had been found between child nutritional status and monthly family income, mother education and occupation of father and mother. Age, sex and incomes of the family, education of mother and occupation of father were significantly associated with WAZ and HAZ of the study subjects (P=0.0001, P=0.025, P=0.001 and P=0.0001, P=0.003, P=0.031, P=0.092, P=0.008). Maximum study subjects took local small fish and some traditional tribal food like bashrool, jhijhipoka and pork very much popular food among tribal children. Energy, carbohydrate and fat intake was significantly associated with HAZ, WAZ, BAZ and MUACZ. This study demonstrates that malnutrition among tribal children in Bangladesh is much better than national scenario in Bangladesh. Significant association was found between child nutritional status and family monthly income, mother education and occupation of father and mother. Most of the study subjects took local small fish and some traditional tribal food. Significant association was also found between child nutritional status and dietary intake of energy, carbohydrate and fat.

Keywords: food intake pattern, nutritional status, preschool children, Chakma ethnic community

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Authors: Ashleigh Medina

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Chronic conditions account for the majority of total health care spending both in the United States and globally. Encouraging self-management to improve chronic conditions, which in turn could decrease the strain placed on hospitals, requires resources to address the patient’s social concerns in addition to their medical concerns. Transitional care has been identified as a possible bridge between acutely managing conditions at the hospital to chronically managing conditions in a community setting. The aim of this integrative review was to examine the impact of transitional care on self-management outcomes of chronic conditions in un/underinsured populations. Both transitional care, by assisting with resources such as funding sources for healthcare and medications or identifying a healthcare provider for continued care, and self-management, by increasing responsibility for one’s care through goal setting and taking action, can impact health outcomes while providing health care cost-savings.

Keywords: chronic conditions, self-management, transitional care, uninsured

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Authors: Muhammad Tahir Khalily

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Aim: The purpose of the present study was to examine the effectiveness of alpha-theta brainwave Neuro feedback treatment for the internal self-exploration of individuals with conversion disorder. Method: A Purposive sample technique was used and data collected from Kalsoom International Hospital Islamabad and Al-Malik Medical Center Rawalpindi. 123 participants were examined, Male child = 5, female child = 6, male adult = 64, female adult = 48. This study retrospectively examined the symptomatic changes in clients with a range of psychiatric disorders particularly 13 (Male = 3, Female = 10) conversion disorder clients who have received Neuro feedback treatment. Results: Our results indicated a significant improvement (P < .001) in the amelioration of our clients’ symptoms which have enabled them to bring their emotional memories into conscious awareness for the peaceful resolution without self-detachment. Conclusion: Majority of the clients improved their psychiatric symptoms including the symptoms of conversion disorder and was discharged from therapy with the accomplishment of therapeutic goals.

Keywords: EEG, neurofeedback, conversion, therapy

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Authors: Trenton Hubbard, Kenneth Soyemi, Emily Siffermann

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Introduction: According to the American Academy of Pediatrics (AAP) there are different weight-based recommendations for the treatment of Chlamydia trachomatis (CT) in patients who are being evaluated for sexual assault. Current AAP Red Book guidelines recommend that uncomplicated C. trachomatis anogenital infection in prepubertal patients weighing less than =<45 kg be treated with oral erythromycin 50 mg/kg/day QID for 14 days with no alternative therapies, and for patients whose weight => 45 kg are Azithromycin 1 gm PO once. Our study objective was to determine the efficacy of single-dose Azithromycin therapy for the treatment of Chlamydia trachomatis in patients weighing less than 50 kg who were evaluated for child sexual abuse in an urban setting. Methods: We conducted a retrospective chart review of historical medical records (paper and electronic) patients weighing less than 50 kg who were evaluated for child sexual abuse and subsequently treated for C. trachomatis infection with Azithromycin (20 mg/kg PO once up to a maximum 1 gm) and received a Test of Cure (TOC) from 2006-2016. Qualitative variables were expressed as percentages. Quantitative variables were expressed as mean values (+/- standard deviation [SD]) if they followed a normal distribution or as median values (interquartile range[IQR]) if they did not. Wilcoxson two-sample test was used to compare means of Azithromycin Dose, mg/kg, and TOC timing between treatment responders and non-responders. Results: We reviewed records of 34 patients, average age (SD) was 5.4 (2.0) years, 33 (97%) were treated for CT and 1(3%) for both GC and CT. 25 (74%) were females. Urine PCR was the most commonly used test at evaluation and as TOC with 13 (38%) patients completing both tests. The average (SD) dose of Azithromycin at treatment was 470 (136) mg and average (SD) mg/kg dose of 20 (1.9) mg/kg for all patients. Median (IQR) timing for TOC testing was 19 (14-26) days. Of the 33 with complete data 25 (74%) had a negative TOC. When compared with treatment non-responders (TOC failures), treatment responders received higher doses (average dose (SD) received 495 (139) vs 401(110), P 0.06)); similar average (SD) weight base dosing received (20.8(2.0) vs 19.7 (1.5), P 0.15)), and earlier average (SD)TOC test timing (18.8 (5.6) vs 32 (28.6) P 0.02)). Conclusion: Azithromycin dosing appears to be efficacious in the treatment of CT post sexual assault as majority of patients responded. Although treatment responders and non-responders received similar weight based doses, there is need for additional studies to understand variances and predictors of response.

Keywords: child sexual abuse, chlmaydia trachmotis infection, single-dose azithromycin, weight less than or equal to 45 kilograms

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Authors: Anita Paddy, Millicent Obodai, Lebbaeus Asamani

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The management of sickle cell disease requires a multidisciplinary team for better outcomes. Thus, literature on the application of the biopsychosocial model for the management and explanation of chronic pain in sickle cell disease (SCD) and other chronic diseases abound. However, there is limited research on the use of the biopsychosocial model, together with a spiritual component (biopsychosocial-spiritual model). The study investigated the extent to which healthcare providers utilized the biopsychosocial-spiritual model in the management of chronic pain to improve the quality of life (QoL) of patients with SCD. This study employed the descriptive survey design involving a consecutive sampling of 261 patients with SCD who were between the ages of 18 to 79 years and were accessing hematological services at the Clinical Genetics Department of the Korle Bu Teaching Hospital. These patients willingly consented to participate in the study by appending their signatures. The theory of integrated quality of life, the gate control theory of pain and the biopsychosocial(spiritual) model were tested. An instrument for the biopsychosocial-spiritual model was developed, with a basis from the literature reviewed, while the World Health Organisation Quality of Life BREF (WHOQoLBref) and the spirituality rating scale were adapted and used for data collection. Data were analyzed using descriptive statistics (means, standard deviations, frequencies, and percentages) and partial least square structural equation modeling. The study revealed that healthcare providers had a great leaning toward the biological domain of the model compared to the other domains. Hence, participants’ QoL was not fully improved as suggested by the biopsychosocial(spiritual) model. Again, the QoL and spirituality of patients with SCD were quite high. A significant negative impact of spirituality on QoL was also found. Finally, the biosocial domain of the biopsychosocial-spiritual model was the most significant predictor of QoL. It was recommended that policymakers train healthcare providers to integrate the psychosocial-spiritual component in health services. Also, education on SCD and its resultant impact from the domains of the model should be intensified while health practitioners consider utilizing these components fully in the management of the condition.

Keywords: biopsychosocial (spritual), sickle cell disease, quality of life, healthcare, accra

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Authors: A. Alrasheed, I. Connerton

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Providing patients with safe meals on a daily basis is one of the challenges in the healthcare sector. In Saudi Arabia matters related to food safety and hygiene have been the heart of the Ministry of Health (MOH) and Saudi Food and Drugs Authority (SFDA). The aim of this study is to examine the causes of inadequate implementation of food safety management systems such as HACCP in Riyadh’s MOH hospitals. By the law, food safety must be managed using a documented, HACCP based approach, and food handlers must be appropriately trained in food safety. Food handlers in Saudi Arabia are not required to provide a certificate or attend a food handling training course even in healthcare sectors. Since food safety and hygiene issues are of increasing importance for Saudi Arabian health decision makers, the SFDA has been established to apply food hygiene requirements in all food operations. It should be pointed out that the implications of food outbreaks on the whole society may potentially go beyond individual health impacts but also impact on the Nation’s health and bring about economic repercussions.

Keywords: food safety, patient, hospital, HACCP

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Authors: Riina I. Bray, Yifan Wang, Nikolas Argiropoulos, Stephanie Robins, John Molot, Kelly Tragash, Lynn M. Marshall, Margaret E. Sears, Marie-Andrée Pigeon, Michel Gaudet, Pierre Auger, Emily Bélanger, Rohini Peris

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Multiple chemical sensitivity (MCS) is a chronic medical condition characterized by intolerances to chemical substances. Since the arrival of the COVID-19 pandemic and associated health measures, people experiencing MCS (PEMCS) are at a heightened risk of environmental exposures associated with cleaners, disinfectants, and sanitizers. Little attention has been paid to the well-being of PEMCS in the context of the COVID-19 pandemic. Objective: This study assesses the lived experiences of Canadian adults with MCS in relation to their living environment, access to healthcare, and levels of perceived social support before and during the pandemic. Methods: A total of 119 PEMCS completed an online questionnaire. McNemar Chi-Squared and Wilcoxon Signed Rank tests were used to evaluate if there were statistically significant changes in participants’ perception of their living environment, access to healthcare, and levels of social support before and after March 11, 2020. Results: Both positive and negative outcomes were noted. Participants reported an increase in exposure to disinfectants/sanitizers that entered their living environment (p<.001). There was a reported decrease in access to a family doctor during the pandemic (p<0.001). Although PEMCS experienced increased social isolation (p<0.001), they also reported an increase in understanding from family (p<0.029) and a decrease in stigma for wearing personal protective equipment (p<0.001). Conclusion: PEMCS reported experiencing: increased exposure to disinfectants or sanitizers, a loss of social support, and barriers in accessing healthcare during the pandemic. However, COVID-19 provided an opportunity to normalize the living conditions of PEMCS, such as wearing masks and social isolation. These findings can guide decision-makers on the importance of implementing nontoxic alternatives for cleaning and disinfection, as well as improving accommodation measures for PEMCS.

Keywords: covid-19, multiple chemical sensitivity, MCS, quality of life, social isolation, physical environment, healthcare

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Authors: Jamel Slaughter

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Father involvement across the development of a child has been linked to children’s psychological adjustment, fewer behavioral problems, and higher educational attainment. Conversely, there is much less research that highlights father involvement in relation to childhood development during early childhood period prior to preschool age (ages 1-3 years). Most research on fathers and child outcomes have been limited by its focus on the stages of adolescence, middle childhood, and infancy. This study examined the influence of father involvement, during the toddler stage, on 5th grade cognitive development, rule-breaking, and behavior outcomes measured by Child Behavior Checklist (CBCL) scores. Using data from the Early Head Start Research and Evaluation (EHSRE) Study, 1996-2010: United States, a total of 3,001 children and families were identified in 17 sites (cities), representing a diverse demographic sample. An independent samples t-test was run to compare cognitive development, aggressive, and rule-breaking behavior mean scores among children who had early continuous father involvement for the first 14 – 36 months to children who did not have early continuous father involvement for the first 14 – 36 months. Multiple linear regression was conducted to determine if continuous, or non-continuous father involvement (14 month-36 months), can be used to predict outcome scores on the Child Behavior Checklist in aggressive behavior, rule-breaking behavior, and cognitive development, at 5th grade. A statistically significant mean difference in cognitive development scores were found for children who had continuous father involvement (M=1.92, SD=2.41, t (1009) =2.81, p =.005, 95% CI=.146 to .828) compared to those who did not (M=2.60, SD=3.06, t (1009) =-2.38, p=.017, 95% CI= -1.08 to -.105). There was also a statistically significant mean difference in rule-breaking behavior scores between children who had early continuous father involvement (M=1.95, SD=2.33, t (1009) = 3.69, p <.001, 95% CI= .287 to .940), compared to those that did not (M=2.87, SD=2.93, t (1009) = -3.49, p =.001, 95% CI= -1.30 to -.364). No statistically significant difference was found in aggressive behavior scores. Multiple linear regression was performed using continuous father involvement to determine which has the largest relationship to rule-breaking behavior and cognitive development based on CBCL scores. Rule-breaking behavior was found to be significant (F (2, 1008) = 8.353, p<.001), with an R2 of .016. Cognitive development was also significant (F (2, 1008) = 4.44, p=.012), with an R2 of .009. Early continuous father involvement was a significant predictor of rule-breaking behavior and cognitive development at middle childhood. Findings suggest early continuous father involvement during the first 14 – 36 months of their children’s life, may lead to lower levels of rule-breaking behaviors and thought problems at 5th grade.

Keywords: cognitive development, early continuous father involvement, middle childhood, rule-breaking behavior

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Authors: Wildan Maulana Wildan, Siti Annisa Rahmayani Icha

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Nowadays advances in information technology are needed by all the inhabitants of the earth for the sake of ease all their work, but it is worth to introduced the technological advances in the world of children. Before the technology is growing rapidly, children busy with various of traditional games and have high socialization. Moreover, after it presence, almost all of children spend more their time for playing gadget, It can affect the education of children and will change the character and personality children. However, children also can not be separated with the technology. Because the technology insight knowledge of children will be more extensive. Because the world can not be separated with advances in technology as well as with children, there should be developed a smartphone operating system that is child-friendly. The operating system is able to filter contents that do not deserve children, even in this system there is a reminder of a time study, prayer time and play time for children and there are interactive contents that will help the development of education and children's character. Children need technology, and there are some ways to introduce it to children. We must look at the characteristics of children in different environments. Thus advances in technology can be beneficial to the world children and their parents, and educators do not have to worry about advances in technology. We should be able to take advantage of advances in technology best possible.

Keywords: information technology, smartphone operating system, education, character

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Authors: Nomcebo N. Mpili, Cynthia Z. Madlabana

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The South African Primary Health Care (PHC) system has undergone a number of transformations such as the introduction of National Health Insurance (NHI) to bring about easily accessible universal health coverage and to meet the health needs for all its citizens. This provides ongoing challenges to ensure that health workers are equipped with appropriate knowledge, support, and skills to meet these changes. Therefore it is crucial to understand the experiences and challenges of nurses as the backbone of PHC in providing quality healthcare services. In addition there has been a need to understand nurses’ experiences with management support, role ambiguity and role conflict amongst other challenges in light of the current reforms in healthcare. Indeed these constructs are notorious for having a detrimental impact on the outcomes of change initiatives within any organisation, this is no different in healthcare. This draws a discussion on professional nurses within the South African health care system especially since they have been labelled as the backbone of PHC, meaning any healthcare backlog falls on them. The study made use of semi-structured interviews and adopted the interpretative phenomenological approach (IPA) as the researcher aimed to explore the lived experiences of (n= 18) participants. The study discovered that professional nurses experienced a lack of management support within PHC facilities and that management mainly played an administrative and disciplinary role. Although participants mainly held positive perceptions with regards to changes happening in health care however they also expressed negative experiences in terms of how change initiatives were introduced resulting in role conflict and role ambiguity. Participants mentioned a shortage of staff, inadequate training as well as a lack of management support as some of the key challenges faced in facilities. This study offers unique findings as participants have not only experienced the various reforms within the PHC system however they have also been part of NHI pilot. The authors are not aware of any other studies published that examine management support, role conflict and role ambiguity together especially in South African PHC facilities. In conclusion understanding these challenges may provide insight and opportunities available to improve the current landscape of PHC not only in South Africa but internationally.

Keywords: management support, professional nurse, role ambiguity, role conflict

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Authors: Elanz Alimi, Mehdi Ghanadzade

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This current study compared the parents reported treatment and education priorities between verbal and nonverbal children with an autism spectrum disorder (ASD). Participants were 196 parents of 2 to 21-year-old (83 non-verbal and 113 verbal) children and adolescents with an ASD who completed questionnaires measuring parent’s treatment and education priorities, child’s educational and intervention programs and current child’s level of performance according to each skill. Results of this study indicated that parents of verbal children with autism spectrum disorder considered communication skills, community living skills and academic skills correspondingly as their highest intervention and education priorities and parents of non-verbal children with ASD reported communication skills, social relationship skills and self-care skills as the most significant priorities for their children. Findings show that for Iranian parents of both verbal and non-verbal children with ASD, communication skills are the most crucial treatment priority.

Keywords: autism, communication skills, Iran, parent’s priorities

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Authors: Lenell D. Walton

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African American families have consistently contended that their child’s special education team does not provide the services necessary to meet their child’s academic goals. Special education teams must guide and mentor African American students and their families through the special education process. This qualitative study examined African American female caregivers' perceptions, experiences, and expectations regarding the special education process. Data collection methods utilized in the study included a survey, semi-structured interviews, and three focus groups. Data were analyzed and compared to identify themes. Three themes emerged from the survey: education and training, participation, and challenges. Six major themes emerged: (a) differences in treatment and cultural disconnect, (b) lack of support and resources, (c) participants’ experiences of the special education process, (d) parent participation, (e) barriers and concerns, and (f) expectations. Implications for policy and practice to improve the special education process are discussed.

Keywords: African American, caregivers, critical race theory, special education

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Authors: Rukhsana Kausar, Nida Zafar

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The present research investigated socio-demographic predictors of divorce adjustment in Pakistani women. The sample comprised of 80 divorced women from different areas of Lahore. Self developed Socio-Demographic predictor scale and Divorce Adjustment Scale by (Fisher, 2001) was used for assessment. Analyses showed that working divorced women living with joint family system are more adjusted as compared to non-working divorced women living with joint family system. Women having one child are more adjusted as compared to women having more than one child. Findings highlight importance of presence of father for healthy development of adolescents. Adjustment of divorcee women was positively associated with income, social support from the family, having favorable attitudes toward marital dissolution prior to divorce, and being the partner who initiated the divorce. In addition, older women showed some evidence of poorer adjustment than did younger women. Findings highlight importance of support for divorce adjustment.

Keywords: socio-demographic, adjustment, women, divorce

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Authors: Sheng-Fen Fan, Sung-Hui Tseng

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Attention deficit hyperactivity deficit (ADHD) child display diverse sensory processing difficulty behaviors. There is less evidence to figure out how the association between executive function and sensory deficit. To determine whether sensory deficit influence the executive functions, we examined sensory processing by SPM and try to indicate hot/cold executive function (EF) by BRIEF2, respectively. We found that the hot executive function deficit might associate with auditory processing in a variety of settings, and vestibular input to maintain balance and upright posture; the cold EF deficit might opposite to the hot EF deficit, the vestibular sensory modulation difficulty association with emotion shifting and emotional regulation. These results suggest that sensory processing might be another consideration factor to influence the higher cognitive control or emotional regulation of EF. Overall, this study indicates the distinction between hot and cold EF impairments with different sensory modulation problem. Moreover, for clinician, it needs more cautious consideration to conduct intervention with ADHD.

Keywords: hot executive function, cold executive function, sensory processing, ADHD

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Authors: Laleh Boroumand, Muhammad Shiraz, Abdullah Gani, Rashid Hafeez Khokhar

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Cloud computing being the use of hardware and software that are delivered as a service over a network has its application in the area of health care. Due to the emergency cases reported in most of the medical centers, prompt for an efficient scheme to make health data available with less response time. To this end, we propose a mobile global healthcare village (MGHV) model that combines the components of three deployment model which include country, continent and global health cloud to help in solving the problem mentioned above. In the creation of continent model, two (2) data centers are created of which one is local and the other is global. The local replay the request of residence within the continent, whereas the global replay the requirements of others. With the methods adopted, there is an assurance of the availability of relevant medical data to patients, specialists, and emergency staffs regardless of locations and time. From our intensive experiment using the simulation approach, it was observed that, broker policy scheme with respect to optimized response time, yields a very good performance in terms of reduction in response time. Though, our results are comparable to others when there is an increase in the number of virtual machines (80-640 virtual machines). The proportionality in increase of response time is within 9%. The results gotten from our simulation experiments shows that utilizing MGHV leads to the reduction of health care expenditures and helps in solving the problems of unqualified medical staffs faced by both developed and developing countries.

Keywords: cloud computing (MCC), e-healthcare, availability, response time, service broker policy

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Authors: Haripriya Chakraborty

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The healthcare system in the United States is considered to be one of the most inefficient and expensive systems when compared to other developed countries. Consequently, there are persistent concerns regarding the overall functioning of this system. For instance, the large number of uninsured individuals and high premiums are pressing issues that are shown to have a negative effect on health outcomes with possible life-threatening consequences. The Affordable Care Act (ACA), which was signed into law in 2010, was aimed at improving some of these inefficiencies. This paper aims at providing a computational mechanism to examine some of these inefficiencies and the effects that policy proposals may have on reducing these inefficiencies. Agent-based modeling is an invaluable tool that provides a flexible framework to model complex systems. It can provide an important perspective into the nature of some interactions that occur and how the benefits of these interactions are allocated. In this paper, we propose a novel and versatile agent-based model with realistic assumptions to simulate the dynamics of a health insurance marketplace that contains a mixture of private and public insurers and individuals. We use this model to analyze the characteristics, motivations, payoffs, and strategies of these agents. In addition, we examine the effects of certain policies, including some of the provisions of the ACA, aimed at reducing the uninsured rate and the cost of premiums to move closer to a system that is more equitable and improves health outcomes for the general population. Our test results confirm the usefulness of our agent-based model in studying this complicated issue and suggest some implications for public policies aimed at healthcare reform.

Keywords: agent-based modeling, healthcare reform, insurance markets, public policy

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Authors: Elisabeth Mamani-Mategula

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Background: Anaemia has significant consequences on both the mother and child's health as it results in maternal haemorrhage, low childbirth weight, premature delivery, poor organ development, and infections at birth and hence the need for treatment. In low-middle income countries, anaemic pregnant women are recommended to take 30 mg to 60 mg of elemental iron daily throughout pregnancy which are often poorly tolerated and adhered to. A potential alternative to oral iron is intravenous (IV) iron which allows the saturation of the body’s iron stores quickly. Currently, a randomised controlled trial on the Effect of intravenous iron on Anaemia in Malawian Pregnant women (REVAMP) is underway. Since this is new in Africa and Malawi is the second country to implement it, its acceptability to both the providers and end-users is not known. Suppose the use of IV iron during pregnancy would be acceptable in Malawi, it could change how we treat and manage pregnant women with anaemia and be scaled up throughout Malawi to improve maternal and child health. Objectives: To identify the barriers and facilitators of implementing IV iron in the Malawian healthcare system and identify ‘touchpoints’ and co-develop strategies to support and inform the implementation of the trial Methodology: A qualitative study was conducted with policymakers, government partners, and health managers through in-depth interviews to identify barriers and facilitators relating to the implementation of IV iron in the health system of Malawi. From the interviews, touchpoints were identified that formed the basis of the discussion in further discussing the barriers and suggested solutions in the co-design workshops with the community members and the health workers, respectively. We purposively recruited 20 health workers (10 male, 10 Female). 20 community members (10 male, 10 female) were recruited randomly. Data was collected through group discussions and interactive sessions and was recorded through audios, flip charts, and sticky notes. We familiarized ourselves with the data and identified themes. Results: Two co-design workshops were conducted with different community members and different health worker carders. Identified individual factors included lack of knowledge about anaemia, lack of male involvement, the attitude of health workers and patient non-compliance with appointments. Community factors included myths and misconceptions about IV iron, including associating the use of IV iron with vampirism and covid 19 vaccination. Health system factors identified were a shortage of staff and equipment, unfamiliarity with IV iron and its cost. Discussion: The use of IV iron, as suggested by the community members and health workers, demands civic education through bringing awareness to end-users and training to providers. Through these co-design workshops, community sensitization and awareness, briefing and training of health workers and creation of educational materials were done.

Keywords: acceptability, IV iron, barriers, facilitators, co-design

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Authors: Enido Fabiano de Ramos, Ieda Kanashiro Makiya, Francisco I. Giocondo Cesar

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This study investigates the application of Digital Twins (DT) in Smart Hospital Environments (SHE), through a bibliometric study and literature review, including comparison with the principles of Industry 4.0. It aims to analyze the current state of the implementation of digital twins in clinical and non-clinical operations in healthcare settings, identifying trends and challenges, comparing these practices with Industry 4.0 concepts and technologies, in order to present a basic framework including stages and maturity levels. The bibliometric methodology will allow mapping the existing scientific production on the theme, while the literature review will synthesize and critically analyze the relevant studies, highlighting pertinent methodologies and results, additionally the comparison with Industry 4.0 will provide insights on how the principles of automation, interconnectivity and digitalization can be applied in healthcare environments/operations, aiming at improvements in operational efficiency and quality of care. The results of this study will contribute to a deeper understanding of the potential of Digital Twins in Smart Hospitals, in addition to the future potential from the effective integration of Industry 4.0 concepts in this specific environment, presented through the practical framework, after all, the urgent need for changes addressed in this article is undeniable, as well as all their value contribution to human sustainability, designed in SDG3 – Health and well-being: ensuring that all citizens have a healthy life and well-being, at all ages and in all situations. We know that the validity of these relationships will be constantly discussed, and technology can always change the rules of the game.

Keywords: digital twin, smart hospital, healthcare operations, industry 4.0, SDG3, technology

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Authors: Hani Malik

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Background: Clinician burnout is a growing phenomenon in current health systems worldwide. Increasing emotional exhaustion, depersonalisation, and reduced personal accomplishment threaten the effective delivery of healthcare. This can potentially be mitigated by mindfulness practice, which has shown promising results in reducing burnout, restoring compassion, and preventing moral injury in clinicians. Objectives: To conduct a scoping review and identify high-quality studies on mindfulness practice in clinician burnout, synthesize themes that emerge from these studies, and discuss the implications of the results to healthcare leadership and innovation. Methodology: A focused scoping review was carried out to investigate the effects of mindfulness practice on clinician burnout. High-ranking journals were targeted to analyse high-quality studies and synthesize common themes in the literature. Studies conducted on current, practicing physicians were included. Mindfulness practice of varying forms was the main intervention studied. Grey literature and studies conducted only on allied health personnel were excluded from this review. Analysis:31 studies were included in this scoping review. Mindfulness practice was found to decrease emotional exhaustion and depersonalisation while improving mood, responses to stress, and vigour. Self-awareness, compassion, and empathy were also increased in study participants. From this review, four themes emerged which include: innovations in mindfulness practice, mindfulness and positive psychology, the impact of mindfulness on work and patient care, and barriers and facilitators to clinician mindfulness practice. Conclusion: Mindfulness had widely been reported to benefit mental health and well-being, but the studies reviewed seemed to adopt a mono focus and omitted key considerations to healthcare leadership, systems-level culture, and practices. Mindfulness practice is a quintessential component of positive psychology and is inherently linked to effective leadership. A mindful and compassionate clinician leader will play a crucial role in addressing gaps in current practice, prioritise staff mental health, and provide a supportive platform for innovation.

Keywords: mindfulness practice, clinician burnout, healthcare leadership, COVID-19

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Authors: Mandayachepa C. Nyando, Lauren Suchman, Innocencia Mtalimanja, Address Malata, Tamanda Jumbe, Martha Kamanga, Peter Waiswa

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Background: Subcutaneous depot medroxyprogesterone acetate (DMPA-SC) is a new innovation in contraceptive methods that allow users to inject themselves with a hormonal contraceptive in their own homes. Self-injection (SI) of DMPA-SC has the potential to improve the accessibility of family planning to women who want it and who are capable of injecting themselves. Malawi started implementing this new innovation in 2018. SI was incorporated into the DMPA-SC delivery strategy from its outset. Methodology: This study involved two districts in Malawi where DMPA-SC SI was rolled out: Mulanje and Ntchisi. We used a qualitative cross-sectional study design where 60 in-depth interviews were conducted with women of reproductive age group stratified as 15-45 age band. These included women who were SI users, non-users, and any woman who was on any contraceptive methods. The women participants were tape-recorded, and data were transcribed and then analysed using Dedoose software, where themes were categorised into mother and child themes. Results: Women perceived DMPA SC SI as uniquely private, convenient, and less painful when self-injected. In terms of privacy, women in Mulanje and Ntchisi especially appreciated that self-injecting allowed them to use covertly from partners. Some men do not allow their spouses to use modern contraceptive methods; hence women prefer to use them covertly. “… but I first reach out to men because the strongest power is answered by men (MJ015).” In addition, women reported that SI offers privacy from family/community and less contact with healthcare providers. These aspects of privacy were especially valued in areas where there is a high degree of mistrust around family planning and among those who feel judged or antagonized purchasing contraception, such as young unmarried women. Women also valued the convenience SI provided in terms of their ability to save time by injecting themselves at home rather than visiting a healthcare provider and having more reliable access to contraception, particularly in the face of stockouts. SI allows for stocking up on doses to accommodate shifting work schedules in case of future stockouts or hard times, such as the period of COVID-19, where there was a limitation in the movement of the people. Conclusion: Our findings suggest that SI may meet the needs of many women in Malawi as long as the barriers are eliminated. The barriers women mentioned include fear of self-inject and proper storage of the DMPA SC SI, and these barriers can be eliminated by proper training. The findings also set the scene for policy revision and direction at a national level and integrate the approach with national family planning strategies in Malawi. Findings provide insights that may guide future implementation strategies, strengthen non-clinic family planning access programs and stimulate continued research.

Keywords: family planning, Malawi, Sayana press, self-injection

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Authors: Divya Palaniappan

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Early Childhood assessment tools must measure the quality and the appropriateness of a curriculum with respect to culture and age of the children. Preschool assessment tools lack psychometric properties and were developed to measure only few areas of development such as specific skills in music, art and adaptive behavior. Existing preschool assessment tools in India are predominantly informal and are fraught with judgmental bias of observers. The World of Discovery TM curriculum focuses on accelerating the physical, cognitive, language, social and emotional development of pre-schoolers in India through various activities. The curriculum caters to every child irrespective of their dominant intelligence as per Gardner’s Theory of Multiple Intelligence which concluded "even students as young as four years old present quite distinctive sets and configurations of intelligences". The curriculum introduces a new theme every week where, concepts are explained through various activities so that children with different dominant intelligences could understand it. For example: The ‘Insects’ theme is explained through rhymes, craft and counting corner, and hence children with one of these dominant intelligences: Musical, bodily-kinesthetic and logical-mathematical could grasp the concept. The child’s progress is evaluated using an assessment tool that measures a cluster of inter-dependent developmental areas: physical, cognitive, language, social and emotional development, which for the first time renders a multi-domain approach. The assessment tool is a 5-point rating scale that measures these Developmental aspects: Cognitive, Language, Physical, Social and Emotional. Each activity strengthens one or more of the developmental aspects. During cognitive corner, the child’s perceptual reasoning, pre-math abilities, hand-eye co-ordination and fine motor skills could be observed and evaluated. The tool differs from traditional assessment methodologies by providing a framework that allows teachers to assess a child’s continuous development with respect to specific activities in real time objectively. A pilot study of the tool was done with a sample data of 100 children in the age group 2.5 to 3.5 years. The data was collected over a period of 3 months across 10 centers in Chennai, India, scored by the class teacher once a week. The teachers were trained by psychologists on age-appropriate developmental milestones to minimize observer’s bias. The norms were calculated from the mean and standard deviation of the observed data. The results indicated high internal consistency among parameters and that cognitive development improved with physical development. A significant positive relationship between physical and cognitive development has been observed among children in a study conducted by Sibley and Etnier. In Children, the ‘Comprehension’ ability was found to be greater than ‘Reasoning’ and pre-math abilities as indicated by the preoperational stage of Piaget’s theory of cognitive development. The average scores of various parameters obtained through the tool corroborates the psychological theories on child development, offering strong face validity. The study provides a comprehensive mechanism to assess a child’s development and differentiate high performers from the rest. Based on the average scores, the difficulty level of activities could be increased or decreased to nurture the development of pre-schoolers and also appropriate teaching methodologies could be devised.

Keywords: child development, early childhood assessment, early childhood curriculum, quantitative assessment of preschool curriculum

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