Search results for: child adoption

Authors: Vinti Davar

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India is one among the many countries where child malnutrition is severe and also a major underlying cause of child mortality. The Mid Day Meal (MDM) program was launched to improve the nutritional status of children, attendance, and retention in schools. It was based on one meal provided to the children, who are attending elementary school (primary school). The objective of present study was to evaluate the impact of mid-day meal on the nutritional status of primary school children in Haryana, India. The present work was carried out on 1200 children between 6-11years of age, studying in primary schools in Haryana, India. Out of these 960 students as, the experimental group was selected from schools where mid-day meal is supplied by the government, and 240 students as control group where mid-day meal is not supplied. The mean height, weight, and BMI of children of both the groups were found to be significantly low as compared to NCHS standards. Stunting was found in 56.40% MDMB (Mid-day meal beneficiaries) and 62.50 % NMDMC (non- mid-day meal children).The weight of almost all subjects were low according to age indicating thinness. Anemia was more prevalent in MDMB as compared to NMDMC may be because school meals did not include vegetables. The consumption of energy, proteins, fat, calcium, iron, vitamins was significantly low (P ≤ .01) in both groups especially in girls of NMDM. The consumption of various food groups except vegetables was better in MDMB compared to NMDMC. It is concluded that with certain improvements, mid-meal can be beneficial in meeting everyday requirements of school going children.

Keywords: foods, meals, nutritional status, school going children

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Authors: Yash Bingi, Yiqiao Yin

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Reduction of child mortality is an ongoing struggle and a commonly used factor in determining progress in the medical field. The under-5 mortality number is around 5 million around the world, with many of the deaths being preventable. In light of this issue, Cardiotocograms (CTGs) have emerged as a leading tool to determine fetal health. By using ultrasound pulses and reading the responses, CTGs help healthcare professionals assess the overall health of the fetus to determine the risk of child mortality. However, interpreting the results of the CTGs is time-consuming and inefficient, especially in underdeveloped areas where an expert obstetrician is hard to come by. Using a support vector machine (SVM) and oversampling, this paper proposed a model that classifies fetal health with an accuracy of 99.59%. To further explain the CTG measurements, an algorithm based on Randomized Input Sampling for Explanation ((RISE) of Black-box Models was created, called Feature Alteration for explanation of Black Box Models (FAB), and compared the findings to Shapley Additive Explanations (SHAP) and Local Interpretable Model Agnostic Explanations (LIME). This allows doctors and medical professionals to classify fetal health with high accuracy and determine which features were most influential in the process.

Keywords: machine learning, fetal health, gradient boosting, support vector machine, Shapley values, local interpretable model agnostic explanations

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Authors: Sijuade A. A., Oguntoye J. P., Awodoye O. O., Adedapo O. A., Wahab W. B., Okediran O. O., Omidiora E. O., Olabiyisi S. O.

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Electronic voting systems have been introduced to improve the efficiency, accuracy, and transparency of the election process in many countries around the world, including Nigeria. However, concerns have been raised about the security and integrity of these systems. One way to address these concerns is through the implementation of electronic forensic election audit systems. This study aims to evaluate voters' intention to the adoption of electronic forensic election audit systems using the Unified Theory of Acceptance and Use of Technology (UTAUT) model. In the study, the UTAUT model which is a widely used model in the field of information systems to explain the factors that influence individuals' intention to use a technology by integrating performance expectancy, effort expectancy, social influence, facilitating conditions, cost factor and privacy factor to voters’ behavioural intention was proposed. A total of 294 sample data were collected from a selected population of electorates who had at one time or the other participated in at least an electioneering process in Nigeria. The data was then analyzed statistically using Partial Least Square Structural Equation Modeling (PLS-SEM). The results obtained show that all variables have a significant effect on the electorates’ behavioral intention to adopt the development and implementation of an electronic forensic election audit system in Nigeria.

Keywords: election Audi, voters, UTAUT, performance expectancy, effort expectancy, social influence, facilitating condition social influence, facilitating conditions, cost factor, privacy factor, behavioural intention

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Authors: Tsvetomira Braynova, Miglena Simonska

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The article presents the results of research on phonological processes in three and four-year-old children. For the purpose of the study, an author's test was developed and conducted among 120 children. The study included three areas of research - at the level of words (96 words), at the level of sentence repetition (10 sentences) and at the level of generating own speech from a picture (15 pictures). The test also gives us additional information about the articulation errors of the assessed children. The main purpose of the icing is to analyze all phonological processes that occur at this age in Bulgarian children and to identify which are typical and atypical for this age. The results show that the most common phonology errors that children make are: sound substitution, an elision of sound, metathesis of sound, elision of a syllable, and elision of consonants clustered in a syllable. All examined children were identified with the articulatory disorder from type bilabial lambdacism. Measuring the correlation between the average length of repeated speech and the average length of generated speech, the analysis proves that the more words a child can repeat in part “repeated speech,” the more words they can be expected to generate in part “generating sentence.” The results of this study show that the task of naming a word provides sufficient and representative information to assess the child's phonology.

Keywords: assessment, phonology, articulation, speech-language development

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Authors: Arkadiusz Gut, Joanna Afek

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The first issue that we discuss in this paper is a battery of research demonstrating that culture influences children’s performance in tasks testing their theory of mind, also known as mindreading. We devote special attention to research done within Chinese culture; namely, studies with children speaking Cantonese and Mandarin natively and growing up in an environment dominated by the Chinese model of informal home education. Our attention focuses on the differences in development and functioning of social abilities and competences between children from China and the West. Another matter we turn to is the description of the nature of Chinese early childhood education. We suggest that the differences between the Chinese model and that of the West reveal a set of modifiers responsible for the variation observed in empirical research on children’s theory of mind (mindreading). The modifiers we identify are the following: (1) early socialization – that is, the transformation of the child into a member of the family and society that set special value by the social and physical environment; (2) the Confucian model of education – that is, the Chinese alphabet and tradition that determine a certain way of education in China; (3) the authoritarian style of upbringing – that is, reinforcing conformism, discouraging voicing of private opinions, and respect for elders; (4) the modesty of children and protectiveness of parents – that is, obedience as a desired characteristic in the child, overprotectiveness of parents, especially mothers; and (5) gender differences – that is, different educational styles for girls and boys. In our study, we conduct a thorough meta-analysis of empirical data on the development of mindreading and ToM (children’s theory of mind), as well as a cultural analysis of early childhood education in China. We support our analyses with questionnaire and narrative studies conducted in China that use the ‘Children’s Social Understanding Scale’ questionnaire, conversations based on the so-called ‘Scenarios Presented to Parents’, and questions designed to measure the ‘my child and I’ relation. With our research we aim to identify the factors in early childhood education that serve as moderators explaining the nature of the development and functioning of social cognition based on mind reading in China. Additionally, our study provides a valuable insight for comparative research of social cognition between China and the West.

Keywords: early childhood education, China, mindreading, parenting

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Authors: Ebenezer Joseph

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Chess is a useful tool to enhance general and specific cognitive functioning in children. The present study aims to assess the impact of chess on cognitive in children and to measure the differential impact of socio-demographic factors like age and gender of the child on the effectiveness of the chess intervention.This research study used an experimental design to study the impact of the Training in Chess on the intelligence of children. The Pre-test Post-test Control Group Design was utilized. The research design involved two groups of children: an experimental group and a control group. The experimental group consisted of children who participated in the one-year Chess Training Intervention, while the control group participated in extra-curricular activities in school. The main independent variable was training in chess. Other independent variables were gender and age of the child. The dependent variable was the cognitive functioning of the child (as measured by IQ, working memory index, processing speed index, perceptual reasoning index, verbal comprehension index, numerical reasoning, verbal reasoning, non-verbal reasoning, social intelligence, language, conceptual thinking, memory, visual motor and creativity). The sample consisted of 200 children studying in Government and Private schools. Random sampling was utilized. The sample included both boys and girls falling in the age range 6 to 16 years. The experimental group consisted of 100 children (50 from Government schools and 50 from Private schools) with an equal representation of boys and girls. The control group similarly consisted of 100 children. The dependent variables were assessed using Binet-Kamat Test of Intelligence, Wechsler Intelligence Scale for Children - IV (India) and Wallach Kogan Creativity Test. The training methodology comprised Winning Moves Chess Learning Program - Episodes 1–22, lectures with the demonstration board, on-the-board playing and training, chess exercise through workbooks (Chess school 1A, Chess school 2, and tactics) and working with chess software. Further students games were mapped using chess software and the brain patterns of the child were understood. They were taught the ideas behind chess openings and exposure to classical games were also given. The children participated in mock as well as regular tournaments. Preliminary analysis carried out using independent t tests with 50 children indicates that chess training has led to significant increases in the intelligent quotient. Children in the experimental group have shown significant increases in composite scores like working memory and perceptual reasoning. Chess training has significantly enhanced the total creativity scores, line drawing and pattern meaning subscale scores. Systematically learning chess as part of school activities appears to have a broad spectrum of positive outcomes.

Keywords: chess, intelligence, creativity, children

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Authors: Frantisek Kopriva, Kamila Michalkova, Radim Dudek, Jana Volejnikova

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Rationale: Diagnostic criteria of asthma–COPD overlap syndrome (ACOS) are controversial in pediatrics. Emphysema is characteristic of COPD and usually does not occur in typical asthma; its presence in patients with asthma suggests the concurrence with COPD. Low-dose chest computed tomography (CT) allows a non-invasive assessment of the lung tissue structure. Here we present CT findings of emphysematous changes in a child with ACOS. Patient and Methods: In a 6-year-old boy, atopy was confirmed by a skin prick test using common allergen extracts (grass and tree pollen, house dust mite, molds, cat, dog; manufacturer Stallergenes Greer, London, UK), where reactions over 3 mm were considered positive. Treatment with corticosteroids was started during the course of severe asthma. At 12 years of age, his spirometric parameters deteriorated despite treatment adjustment (VC 1.76 L=85%, FEV1 1.13 L=67%, TI%VCmax 64%, MEF25 19%, TLC 144%) and the bronchodilator test became negative. Results: Low-dose chest CT displayed irregular regions with increased radiolucency of pulmonary parenchyma (typical for hyperinflation in emphysematous changes) in both lungs. This was in accordance with the results of spirometric examination. Conclusions: ACOS is infrequent in children. However, low-dose chest CT scan can be considered to confirm this diagnosis or eliminate other diagnoses when the clinical condition is deteriorating and treatment response is poor.

Keywords: child, asthma, low-dose chest CT, ACOS

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Authors: Bincy Mathew, B. William Dharma Raja

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Successful decision making in a social setting depends on the ability to understand the intentions, emotions and beliefs of others. Children live and grow in the social world. Individuals think to satisfy their curiosity and mush of their social thought is practical, to attain their goal. Children’s thought about their social world influences how they behave towards it. The main purpose of this paper is to review the influence of decision making on adjustment behaviour of visually challenged adolescents. The sample was purposively selected to study the cases of two of the visually challenged adolescents from a Special School, in Tirunelveli, Tamil Nadu, India. The authors appraised the observed behaviour of adjustment in these children. It may be concluded that the social cognitive ability of decision making is at least, to certain extent, influences adjustment behaviour of visually challenged adolescents. Adjustment behaviour attempts to maintain a child’s level of physiological and psychological equilibrium and it is directed towards tension reduction. It involves a state of harmonious relationship existing between the individual and one’s environment so that adjustment is a matter of interaction between the capacities of the individual and the demands of the environment. The study also found that music induces a receptive mood that generally enhances cognitive processing and every decision that the child makes has its brunt on the behaviour. It is solely based on the case study carried out by the authors.

Keywords: social cognition, decision making, adjustment behaviour, adolescents

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Authors: Tebogo Sethibe, Jabulile Mabuza

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The COVID-19 pandemic has been commonly referred to as a ‘black swan event’; it has changed the world, from how people live, learn, work and socialise. It is believed that the pandemic has fast-tracked the adoption of technology in many organisations to ensure business continuity and business sustainability; broadly said, the pandemic has fast-tracked digital transformation (DT) in different organisations. This paper aims to study the impact of the COVID-19 pandemic on DT in organisations in South Africa by focusing on the changes in IT capabilities in the DT framework. The research design is qualitative. The data collection was through semi-structured interviews with information communication technology (ICT) leaders representing different organisations in South Africa. The data were analysed using the thematic analysis process. The results from the study show that, in terms of ICT in the organisation, the pandemic had a direct and positive impact on ICT strategy and ICT operations. In terms of IT capability transformation, the pandemic resulted in the optimisation and expansion of existing IT capabilities in the organisation and the building of new IT capabilities to meet emerging business needs. In terms of the focus of activities during the pandemic, there seems to be a split in organisations between the primary focus being on ‘digital IT’ or ‘traditional IT’. Overall, the findings of the study show that the pandemic had a positive and significant impact on DT in organisations. However, a definitive conclusion on this would require expanding the scope of the research to all the components of a comprehensive DT framework. This study is significant because it is one of the first studies to investigate the impact of the COVID-19 pandemic on organisations, on ICT in the organisation, on IT capability transformation and, to a greater extent, DT. The findings from the study show that in response to the pandemic, there is a need for: (i) agility in organisations; (ii) organisations to execute on their existing strategy; (iii) the future-proofing of IT capabilities; (iv) the adoption of a hybrid working model; and for (v) organisations to take risks and embrace new ideas.

Keywords: digital transformation, COVID-19, bimodal-IT, digital transformation framework

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Authors: Susan Thurstans, Natalie Sessions, Carmel Dolan, Kate Sadler, Bernardette Cichon, Shelia Isanaka, Dominique Roberfroid, Heather Stobagh, Patrick Webb, Tanya Khara

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For many years, wasting and stunting have been viewed as separate conditions without clear evidence supporting this distinction. In 2014, the Emergency Nutrition Network (ENN) examined the relationship between wasting and stunting and published a report highlighting the evidence for linkages between the two forms of undernutrition. This systematic review aimed to update the evidence generated since this 2014 report to better understand the implications for improving child nutrition, health and survival. Following PRISMA guidelines, this review was conducted using search terms to describe the relationship between wasting and stunting. Studies related to children under five from low- and middle-income countries that assessed both ponderal growth/wasting and linear growth/stunting, as well as the association between the two, were included. Risk of bias was assessed in all included studies using SIGN checklists. 45 studies met the inclusion criteria- 39 peer reviewed studies, 1 manual chapter, 3 pre-print publications and 2 published reports. The review found that there is a strong association between the two conditions whereby episodes of wasting contribute to stunting and, to a lesser extent, stunting leads to wasting. Possible interconnected physiological processes and common risk factors drive an accumulation of vulnerabilities. Peak incidence of both wasting and stunting was found to be between birth and three months. A significant proportion of children experience concurrent wasting and stunting- Country level data suggests that up to 8% of children under 5 may be both wasted and stunted at the same time, global estimates translate to around 16 million children. Children with concurrent wasting and stunting have an elevated risk of mortality when compared to children with one deficit alone. These children should therefore be considered a high-risk group in the targeting of treatment. Wasting, stunting and concurrent wasting and stunting appear to be more prevalent in boys than girls and it appears that concurrent wasting and stunting peaks between 12- 30 months of age with younger children being the most affected. Seasonal patterns in prevalence of both wasting and stunting are seen in longitudinal and cross sectional data and in particular season of birth has been shown to have an impact on a child’s subsequent experience of wasting and stunting. Evidence suggests that the use of mid-upper-arm circumference combined with weight-for-age Z-score might effectively identify children most at risk of near-term mortality, including those concurrently wasted and stunted. Wasting and stunting frequently occur in the same child, either simultaneously or at different moments through their life course. Evidence suggests there is a process of accumulation of nutritional deficits and therefore risk over the life course of a child demonstrates the need for a more integrated approach to prevention and treatment strategies to interrupt this process. To achieve this, undernutrition policies, programmes, financing and research must become more unified.

Keywords: Concurrent wasting and stunting, Review, Risk factors, Undernutrition

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Authors: V. Churkin, M. Lopatin

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The purpose of the paper is to estimate the US small wind turbines market potential and forecast the small wind turbines sales in the US. The forecasting method is based on the application of the Bass model and the generalized Bass model of innovations diffusion under replacement purchases. In the work an exponential distribution is used for modeling of replacement purchases. Only one parameter of such distribution is determined by average lifetime of small wind turbines. The identification of the model parameters is based on nonlinear regression analysis on the basis of the annual sales statistics which has been published by the American Wind Energy Association (AWEA) since 2001 up to 2012. The estimation of the US average market potential of small wind turbines (for adoption purchases) without account of price changes is 57080 (confidence interval from 49294 to 64866 at P = 0.95) under average lifetime of wind turbines 15 years, and 62402 (confidence interval from 54154 to 70648 at P = 0.95) under average lifetime of wind turbines 20 years. In the first case the explained variance is 90,7%, while in the second - 91,8%. The effect of the wind turbines price changes on their sales was estimated using generalized Bass model. This required a price forecast. To do this, the polynomial regression function, which is based on the Berkeley Lab statistics, was used. The estimation of the US average market potential of small wind turbines (for adoption purchases) in that case is 42542 (confidence interval from 32863 to 52221 at P = 0.95) under average lifetime of wind turbines 15 years, and 47426 (confidence interval from 36092 to 58760 at P = 0.95) under average lifetime of wind turbines 20 years. In the first case the explained variance is 95,3%, while in the second –95,3%.

Keywords: bass model, generalized bass model, replacement purchases, sales forecasting of innovations, statistics of sales of small wind turbines in the United States

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Authors: Norjali Wazir M. R. W., Pion P., Mostaert M., De Meester A., Lenoir M., Bardid F.

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Background and study aim: Most of the people assume that someone will perform well on something they like. A tool evaluating how much an individual likes an activity can also be guidance for talent detection and to keep youngster doing what they like as a recreational sport. The purpose of this study was to identify the relationship between physical performances with something that they like. Material and methods: In this cross-sectional study, 558 pupils age between 8 years to 11 years were tested using test battery containing 7 physical performance tests (I Do) compared to a pictorial scale containing 7 pictures (I Like) referring to the physical performance tests. Pearson correlation was computed to investigate the relation between the actual performance and the enjoyment. Results: Moderate significant correlations between each of the respective I Do, and I Like components were found. It appears that the correlation between the endurance items is higher as compared to the other six characteristics. Rerunning the analysis for age and sex groups separately resulted in only one significant correlation across all age group, namely between the evaluations of cardiovascular endurance. Conclusions: Information on enjoyment appears to be a useful and cost-effective addition to current multidimensional test batteries in a sport. By providing a clear picture on activities the young child or athlete likes or dislikes, attrition can be increased if a child starts his ‘career’ in a sport that alludes to skills or tasks he/she likes. This enjoyment will increase the intrinsic motivation, which is beneficial for sustained sports participation as well as for avoiding dropout in promising young athletes.

Keywords: I Do, I Like, physical performance, enjoyment

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Authors: Mbuotidem Brendan, Nathanael Afolabi

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Teenage pregnancy is a major health concern because of its association with high morbidity and mortality for both mother and child. In 2013, 23% of women in Nigeria, aged 15 - 19 yr have begun childbearing: 17% have had a child and 5% are pregnant with their first child. Reported differences across locations have been attributed to factors such as educational attainment and exposure to mass media. This study therefore seeks to determine the difference in the level of exposure among teenage mothers and older women of reproductive age in Nigeria. Over 12,000 women of reproductive age (18 – 49 yr) were interviewed across 8 states from the Northern and Southern region of Nigeria. The women were further segregated into two groups of 0 (women aged 18 – 20 yr who had children of their own) and 1 (women of reproductive age excluding teenage mothers). Data was collected via structured questionnaires on mobile devices using the open data kit platform. Initial data formatting and recoding was done using STATA 13 package. Initial analysis was also conducted using SPSS version 21 and the data points were mapped on QuantumGIS package. From the results of analyzed data obtained from the studied states, there were various mean ages of first births across the supported states. Though Akwa Ibom had one of the oldest mean ages (21.2 yr) at first birth and the lowest fertility rate of 3.9 births/woman according to the National Demographic Health Survey 2013, Akwa Ibom had the highest rate of teenage pregnancy (18.2%) across the respondents. Based on education, the respondents that had completed secondary school education (56.9%) made up the greatest cohorts of the teenage parents. This is counter indicative of the initial thinking that there is an inverse relationship between level of education and teenage pregnancy. Akwa Ibom, Bauchi and Delta states are states where respondents felt that contraceptive use is dangerous to health and they were the top 4 states that had a large proportion of teenage mothers. Similarly, across the states examined, all the women of reproductive age felt they could convince their spouses to use contraceptives, as using family planning does not cause women to be promiscuous. This study thus reveals that across the states studied, there was no marked variation in the perception of family planning between teenage parents and women of reproductive age. The study also highlights the need for future planning and exposure to family planning messages at secondary school level.

Keywords: adolescent, family planning, mass media, teenage mothers

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Authors: Inci Aksu Kargin

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The civil war which began in the Daraa province of Syria in March 2011, has caused thousands of Syrians to die and millions more to seek refuge in other countries such as Turkey, Lebanon, Jordan, Iraq, and Egypt. In order to understand the Syrian refugees’ living conditions and the problems they have experienced in Turkey in-depth, and to analyze how the arrival of the Syrian refugees in Turkey has affected the local people who live in Turkish-Syrian border, this study employed interviews, which were conducted with three different groups. First, 60 Syrian refugees, who have settled in Hatay and Gaziantep, were interviewed. Then, the Turkish government institutions, and NGOs, which are responsible for assisting the refugees, were interviewed. These interviews revealed that many Syrian refugees have encountered with several issues such as access to labor and housing markets as well as free healthcare and public education services. Second, 60 Turkish citizens living in Hatay and Gaziantep provinces were interviewed. These interviews shed light on the many issues (e.g., increase of unemployment, increase in the rental and sale prices of the houses, decrease in the quality of healthcare services, increase in traffic problems, problems with regard to the usage of parks and gardens) that Turkish citizens began experiencing after mass asylum claim of the Syrian refugees to Turkey. In addition to these, the existing social problems in Turkey such as child labor, begging, child brides, and illegal marriages (religious marriages) worsen.

Keywords: migration, refugees, Syrian civil war, Turkey

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Authors: Poteet Frances, Glovinski Ira

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INTRODUCTION: The interoceptive nervous system continuously senses chemical and anatomical changes and helps you recognize, understand, and feel what’s going on inside your body so it is important for energy regulation, memory, affect, and sense of self. A newborn needs predictable routines rather than confusion/chaos to make connections between internal experiences and emotions. AIM: Current legal protocols of removing babies from drug-addicted mothers impact the critical window of bonding. The newborn’s brain is social and the attachment process influences a child’s development which begins immediately after birth through nourishment, comfort, and protection. DESCRIPTION: Our project aims to educate drug-addicted mothers, and medical, nursing, and social work professionals on interoceptive concepts and practices to sustain the mother/newborn relationship. A mother’s interoceptive knowledge predicts children’s emotion regulation and social skills in middle childhood. CONCLUSION: When mothers develop an awareness of their inner bodily sensations, they can self-regulate and be emotionally available to co-regulate (support their newborn during distressing emotions and sensations). Our project has enhanced relationship preservation (mothers understand how their presence matters) and the overall mother/newborn connection.

Keywords: drug-addiction, interoception, legal, mothers, newborn, self-regulation

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Authors: Wing Chi Wong

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Globally, studying parents caring for children with attention deficit/ hyperactivity disorder (ADHD) is valuable in order to design measures in supporting those parents by health care providers and government. Such parents in Hong Kong seem to encounter detrimental stress and enormous difficulties which are exacerbated by the traditional Chinese culture, exclusion from social members and fiercely competitive educational system. However, seldom studies scrutinize this issue in Hong Kong. This article aims to review the literature regarding parents caring offsprings with ADHD in Hong Kong. Criteria were set for searching among published studies listed in various databases, including MEDLINE, CINCAHL, PsycINFO, ProQuest, Embase, Cochrane Library and Springer Link. Articles with words 'Attention Deficit Hyperactivity Disorder', 'parenting', 'parent', 'family', 'father', 'mother', 'care' in titles and abstracts were identified. Articles with all types of research designs and methods, regardless in English or Chinese, were included. They were limited to years between January 2008 and September 2018. Four relevant studies have resulted. Of them, two were exploratory studies, one was a qualitative study, and one was a survey. Samples were recruited from child psychiatric clinic, Child and Adolescent Mental Health Unit, or multiple family group therapy centres. Authors proclaimed that quality of life of those parents was usually low; particularly mothers perceived a higher stress than fathers; parenting barriers existed; conflicts were commonly raised in parent-child relationship resulting in probable maltreatment to children. Previous studies generally suggested the potential negative outcomes of parents caring children with ADHD. The types and effectiveness of interventions to those parents on relieving their tortures under Hong Kong context had not been explored and systematically evaluated. The scanty studies and existing understanding could not give a promising conclusion pertaining to the appropriate family intervention to parents living with children with ADHD. A stringent research design is necessary to establish evidence on the effectiveness of interventions for those families.

Keywords: attention deficit/ hyperactivity disorder, Hong Kong, parents, interventions

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Authors: Supriadi Hardianto, Aditya Daniswara

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Today's workplace, flooded by millennial Generation or known also as Generation Y. A common problem that faced by the company towards Gen Y is a high turnover rate, attitudes problem, communication style, and different work style than the older generation. This is common in private sector. The objective of this study is to get a better understanding of the Gen Y Career Attitude at the workplace. The subject of this study is focusing on 430 respondent of Gen Y which age between 20 – 35 years old who works for a private company. The Questionnaire as primary data source captured 9 aspects of career attitude based on Career Attitudes Strategy Inventory (CASI). This Survey distributes randomly among Gen Y in the IT Industry (125 Respondent) and Manufacture Company (305 Respondent). A Random deep interview was conducted to get the better understanding of the etiology of their primary obstacles. The study showed that most of Indonesia Gen Y have a moderate score on Job satisfaction but in the other aspects, Gen Y has the lowest score on Skill Development, Career Worries, Risk-Taking Style, Dominant Style, Work Involvement, Geographical Barrier, Interpersonal Abuse, and Family Commitment. The top 5 obstacles outside that 9 aspects that faced by Gen Y are 1. Lower communication & networking support; 2. Self-confidence issues; 3. Financial Problem; 4. Emotional issues; 5. Age. We also found that parent perspective toward the way they are nurturing their child are not aligned with their child’s real life. This research fundamentally helps the organization and other Gen Y’s Stakeholders to have a better understanding of Gen Y Career Attitude at the workplace.

Keywords: career attitudes, CASI, Gen Y, career attitude at workplace

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Authors: Suphaphon Udomluck, Pannathorn Chachvarat

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Information Communication Technology (ICT) using management is essential for effective decision making in organization. The Concerns Based Adoption Model (CBAM) was employed as the conceptual framework. The purposes of the study were to assess the situation of Information Communication Technology (ICT) using management in College of Nursing under the Praboromarajchanok Institute. The samples were multi – stage sampling of 10 colleges of nursing that participated include directors, vice directors, head of learning groups, teachers, system administrator and responsible for ICT. The total participants were 280; the instrument used were questionnaires that include 4 parts, general information, Information Communication Technology (ICT) using management, the Stage of concern Questionnaires (SoC), and the Levels of Use (LoU) ICT Questionnaires respectively. Reliability coefficients were tested; alpha coefficients were 0.967for Information Communication Technology (ICT) using management, 0.884 for SoC and 0.945 for LoU. The data were analyzed by frequency, percentage, mean, standard deviation, Pearson Product Moment Correlation and Multiple Regression. They were founded as follows: The high level overall score of Information Communication Technology (ICT) using management and issue were administration, hardware, software, and people. The overall score of the Stage of concern (SoC)ICTis at high level and the overall score of the Levels of Use (LoU) ICTis at moderate. The Information Communication Technology (ICT) using management had the positive relationship with the Stage of concern (SoC)ICTand the Levels of Use (LoU) ICT(p < .01). The results of Multiple Regression revealed that administration hardwear, software and people ware could predict SoC of ICT (18.5%) and LoU of ICT (20.8%).The factors that were significantly influenced by SoCs were people ware. The factors that were significantly influenced by LoU of ICT were administration hardware and people ware.

Keywords: information communication technology (ICT), management, the concerns-based adoption model (CBAM), stage of concern(SoC), the levels of use(LoU)

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Authors: Jolien Rijlaarsdam, Charlotte A. M. Cecil, J. Marieke Buil, Pol A. C. Van Lier, Edward D. Barker

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Although there is mounting evidence that the experience of being bullied associates with both internalizing and externalizing symptoms, it is not known yet whether the identified associations are specific to these symptoms or shared between them. The primary focus of this study is to assess the prospective associations of bullying exposure with both general and specific (i.e., internalizing, externalizing) factors of psychopathology. This study included data from 6,210 children participating in the Avon Longitudinal Study of Parents and Children (ALSPAC). Child bullying was measured by self-report at ages 8 and 10 years. Child psychopathology symptoms were assessed by parent-interview, using the Development and Well-being Assessment (DAWBA) at ages 7 and 13 years. Bullying exposure is significantly associated with the general psychopathology factor in early adolescence. In particular, chronically victimized youth exposed to multiple forms of bullying (i.e., both overt and relational) showed the highest levels of general psychopathology. Bullying exposure is also associated with both internalizing and externalizing factors from the correlated-factors model. However, the effect estimates for these factors decreased considerably in size and dropped to insignificant for the internalizing factor after extracting the shared variance that belongs to the general factor of psychopathology. In an integrative longitudinal model, higher levels of general psychopathology at age seven are associated with bullying exposure at age eight, which, in turn, is associated with general psychopathology at age 13 through its two-year continuity. Findings suggest that exposure to bullying is a risk factor for a more general vulnerability to psychopathology through mutually influencing relationships.

Keywords: bullying exposure, externalizing, general psychopathology, internalizing, longitudinal

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Authors: Thimira Pasas P, Nirmala Priyadarshani M, Ishani R

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Obesity is a global health issue. Early identification is essential to plan interventions and intervene than to reduce the worsening of obesity and its consequences on the health issues of the individual. Childhood obesity is multifactorial, with both modifiable and unmodifiable risk factors. A genetically susceptible individual (unmodifiable), when placed in an obesogenic environment (modifiable), is likely to become obese in onset and progression. The present study was conducted to identify the age of onset of childhood obesity and the influence of modifiable risk factors for childhood obesity among school children living in a suburban area of Sri Lanka. The study population was aged 11-12 years of Piliyandala Educational Zone. Data were collected from 11–12-year-old school children attending government schools in the Piliyandala Educational Zone. They were using a validated, pre-tested self-administered questionnaire. A stratified random sampling method was performed to select schools and to select a representative sample to include all 3 types of government schools of students due to the prevailing pandemic situation, information from the last school medical inspection on data from 2020used for this purpose. For each obese child identified, 2 non-obese children were selected as controls. A single representative from the area was selected by using a systematic random sampling method with a sampling interval of 3. Data was collected using a validated, pre-tested self-administered questionnaire and the Child Health Development Record of the child. An introduction, which included explanations and instructions for filing the questionnaire, was carried out as a group activity prior to distributing the questionnaire among the sample. The results of the present study aligned with the hypothesis that the age of onset of childhood obesity and prediction must be within the first two years of child life. A total of 130 children (66 males: 64 females) participated in the study. The age of onset of obesity was seen to be within the first two years of life. The risk of obesity at 11-12 years of age was Obesity risk was identified at 3-time s higher among females who underwent rapid weight gain within their infancy period. Consuming milk prior to breakfast emerged as a risk factor that increases the risk of obesity by three times. The current study found that the drink before breakfast tends to increase the obesity risk by 3-folds, especially among obese females. Proper monitoring must be carried out to identify the rapid weight gain, especially within the first 2 years of life. Consumption of mug milk before breakfast tends to increase the obesity risk by 3 times. Identification of the confounding factors, proper awareness of the mothers/guardians and effective proper interventions need to be carried out to reduce the obesity risk among school children in the future.

Keywords: childhood obesity, school children, age of onset, weight gain, feeding pattern, activity level

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Authors: Siqi Fang, Man Cheung Chung

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This study examined the inter-relationship between childhood maltreatment, cognitive distortion, alexithymia, eudemonic well-being, and psychological distress. One hundred and eighty-two university students participated in the study and completed an online survey comprising the Childhood Trauma Questionnaire, Cognitive Distortion Scale, Toronto Alexithymia Scale, Psychological Well-Being Scale, and General Health Questionnaire-28. Hierarchical multiple regression analysis showed that child maltreatment, perceptions of hopelessness and helplessness, preoccupation with danger, personal growth, and purpose in life predicted psychological distress. However, alexithymia was not a significant predictor. Further analysis using the regression models with bootstrapping procedure showed that feeling hopeless, helpless and preoccupation with danger mediated the path between child maltreatment and psychological distress. Meanwhile, coping with beliefs in personal growth and life purpose moderated the mediation effects of distorted cognition on psychological distress. To conclude, childhood maltreatment is associated with psychological distress. This relationship is influenced by people’s perceptions of life being hopeless, helpless or dangerous. At the same time, the effect of hopelessness, helplessness, and feelings of danger also depends on the degree of using coping strategies of positive psychological functioning.

Keywords: alexithymia, childhood maltreatment, cognitive distortion, eudemonic well-being, psychological distress

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Authors: Haruka Ando

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Undernutrition of children is a critical issue, especially for people in the remote areas of the Republic of Djibouti, since household food insecurity, inadequate child caring and feeding, unhealthy environment and lack of clean water, as well as insufficient maternal and child healthcare, are underlying causes which affect. Nomadic pastoralists living in the Dikhil region (Dikhil) are socio-economically and geographically more vulnerable due to displacement, which in turn worsens the situation of child stunting. A high prevalence of inappropriate complementary feeding among pastoral mothers might be a significant barrier to child growth. This study aims to identify health promotion intervention strategies that would support an increase in optimal complementary feeding among pastoral mothers of children aged 6-23 months in Dikhil. There are four objectives; to explore and to understand the existing practice of complementary feeding among pastoral mothers in Dikhil; to identify the barriers in appropriate complementary feeding among the mothers; to critically explore and analyse the strategies for an increase in complementary feeding among the mothers; to make pragmatic recommendations to address the barriers in Djibouti. This is an in-depth study utilizing a conceptual framework, the behaviour change wheel, to analyse the determinants of complementary feeding and categorize health promotion interventions for increasing optimal complementary feeding among pastoral mothers living in Dikhil. The analytical tool was utilized to appraise the strategies to mitigate the selected barriers against optimal complementary feeding. The data sources were secondary literature from both published and unpublished sources. The literature was systematically collected. The findings of the determinants including the barriers of optimal complementary feeding were identified: heavy household workload, caring for multiple children under five, lack of education, cultural norms and traditional eating habits, lack of husbands' support, poverty and food insecurity, lack of clean water, low media coverage, insufficient health services on complementary feeding, fear, poor personal hygiene, and mothers' low decision-making ability and lack of motivation for food choice. To mitigate selected barriers of optimal complementary feeding, four intervention strategies based on interpersonal communication at the community-level were chosen: scaling up mothers' support groups, nutrition education, grandmother-inclusive approach, and training for complementary feeding counseling. The strategies were appraised through the criteria of effectiveness and feasibility. Scaling up mothers' support groups could be the best approach. Mid-term and long-term recommendations are suggested based on the situation analysis and appraisal of intervention strategies. Mid-term recommendations include complementary feeding promotion interventions are integrated into the healthcare service providing system in Dikhil, and donor agencies advocate and lobby the Ministry of Health Djibouti (MoHD) to increase budgetary allocation on complementary feeding promotion to implement interventions at a community level. Moreover, the recommendations include a community health management team in Dikhil training healthcare workers and mother support groups by using complementary feeding communication guidelines and monitors behaviour change of pastoral mothers and health outcome of their children. Long-term recommendations are the MoHD develops complementary feeding guidelines to cover sector-wide collaboration for multi-sectoral related barriers.

Keywords: Afar, child food, child nutrition, complementary feeding, complementary food, developing countries, Djibouti, East Africa, hard-to-reach areas, Horn of Africa, nomad, pastoral, rural area, Somali, Sub-Saharan Africa

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Authors: Getahun Nigusie Demise

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Background; antiretroviral treatment reduce HIV-related morbidity, and prolonged survival of patients however, there is lack of up-to-date information concerning the treatment long term effect on the survival of HIV positive children especially in the study area. Objective: The aim of this study is to assess the incidence and predictors of mortality among HIV positive children on antiretroviral therapy (ART) in public hospitals of Harer town who were enrolled from 2011 to 2021. Methodology: Institution based retrospective cohort study was conducted among 429 HIV positive children enrolled in ART clinic from January 1st 2011 to December30th 2021. Data were collected from medical cards by using a data extraction form, Descriptive analyses were used to Summarized the results, and life table was used to estimate survival probability at specific point of time after introduction of ART. Kaplan Meier survival curve together with log rank test was used to compare survival between different categories of covariates, and Multivariate Cox-proportional hazard regression model was used to estimate adjusted Hazard rate. Variables with p-values ≤0.25 in bivariable analysis were candidates to the multivariable analysis. Finally, variables with p-values < 0.05 were considered as significant variables. Results: The study participants had followed for a total of 2549.6 child-years (30596 child months) with an overall mortality rate of 1.5 (95% CI: 1.1, 2.04) per 100 child-years. Their median survival time was 112 months (95% CI: 101–117). There were 38 children with unknown outcome, 39 deaths, and 55 children transfer out to different facility. The overall survival at 6, 12, 24, 48 months were 98%, 96%, 95%, 94% respectively. being in WHO clinical Stage four (AHR=4.55, 95% CI:1.36, 15.24), having anemia(AHR=2.56, 95% CI:1.11, 5.93), baseline low absolute CD4 count (AHR=2.95, 95% CI: 1.22, 7.12), stunting (AHR=4.1, 95% CI: 1.11, 15.42), wasting (AHR=4.93, 95% CI: 1.31, 18.76), poor adherence to treatment (AHR=3.37, 95% CI: 1.25, 9.11), having TB infection at enrollment (AHR=3.26, 95% CI: 1.25, 8.49),and no history of change their regimen(AHR=7.1, 95% CI: 2.74, 18.24), were independent predictors of death. Conclusion: more than half of death occurs within 2 years. Prevalent tuberculosis, anemia, wasting, and stunting nutritional status, socioeconomic factors, and baseline opportunistic infection were independent predictors of death. Increasing early screening and managing those predictors are required.

Keywords: human immunodeficiency virus-positive children, anti-retroviral therapy, survival, treatment, Ethiopia

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Authors: Md. Shafiullah

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This study delves into the evolving landscape of urban childcare in Bangladesh, focusing on the experiences and challenges faced by parents in Dhaka city. This paper argues that the traditional childcare arrangement of city families is inadequate to meet the development needs of children. The study aims to explore the childcare challenges faced by urban parents as they transition from traditional family-based childcare networks to alternative caregiving arrangements amidst urbanization, economic shifts, and social transformations. Utilizing a mixed-method research approach, combining quantitative surveys (n = 200) and four qualitative interviews, the research examines the parental viewpoints on childcare practices and the role of societal norms and values. The study finds childcare crises in both the family and daycare settings. In family care, caregiving suffers from the less availability of grandparents, a lack of skills of caregivers, and a lack of child interaction. As for the daycare, it is affected by the absence of appropriate policies, a lack of quality, health and safety concerns, affordability issues, and cultural concerns. Additionally, the study highlights inadequacies in childcare policies and regulatory frameworks, calling for comprehensive reforms to address the childcare vacuum in urban areas. By shifting the focus from developed to developing countries, this study contributes to the literature and suggests policy implications for Bangladesh and beyond.

Keywords: childcare, child development, childcare policy, daycare, Bangladesh

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Authors: Tagel Gebrehiwot, Carolina Castilla

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Food insecurity and child malnutrition are among the most critical issues in Ethiopia. Accordingly, different reform programs have been carried to improve household food security. The Food Security Program (FSP) (among others) was introduced to combat the persistent food insecurity problem in the country. The FSP combines a safety net component called the Productive Safety Net Program (PSNP) started in 2005. The goal of PSNP is to offer multi-annual transfers, such as food, cash or a combination of both to chronically food insecure households to break the cycle of food aid. Food or cash transfers are the main elements of PSNP. The case for cash transfers builds on the Sen’s analysis of ‘entitlement to food’, where he argues that restoring access to food by improving demand is a more effective and sustainable response to food insecurity than food aid. Cash-based schemes offer a greater choice of use of the transfer and can allow a greater diversity of food choice. It has been proven that dietary diversity is positively associated with the key pillars of food security. Thus, dietary diversity is considered as a measure of household’s capacity to access a variety of food groups. Studies of dietary diversity among Ethiopian rural households are somewhat rare and there is still a dearth of evidence on the impact of PSNP on household dietary diversity. In this paper, we examine the impact of the Ethiopia’s PSNP on household dietary diversity and child nutrition using panel household surveys. We employed different methodologies for identification. We exploit the exogenous increase in kebeles’ PSNP budget to identify the effect of the change in the amount of money households received in transfers between 2012 and 2014 on the change in dietary diversity. We use three different approaches to identify this effect: two-stage least squares, reduced form IV, and generalized propensity score matching using a continuous treatment. The results indicate the increase in PSNP transfers between 2012 and 2014 had no effect on household dietary diversity. Estimates for different household dietary indicators reveal that the effect of the change in the cash transfer received by the household is statistically and economically insignificant. This finding is robust to different identification strategies and the inclusion of control variables that determine eligibility to become a PSNP beneficiary. To identify the effect of PSNP participation on children height-for-age and stunting we use a difference-in-difference approach. We use children between 2 and 5 in 2012 as a baseline because by then they have achieved long-term failure to grow. The treatment group comprises children ages 2 to 5 in 2014 in PSNP participant households. While changes in height-for-age take time, two years of additional transfers among children who were not born or under the age of 2-3 in 2012 have the potential to make a considerable impact on reducing the prevalence of stunting. The results indicate that participation in PSNP had no effect on child nutrition measured as height-for-age or probability of beings stunted, suggesting that PSNP should be designed in a more nutrition-sensitive way.

Keywords: continuous treatment, dietary diversity, impact, nutrition security

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Authors: Margherita Cardellini

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To our knowledge, dark skinned children are often victims of discrimination from adults and society, but few studies specifically focus on skin color discrimination on children coming from the same children. Even today, the 'color blind children' ideology is widespread among adults, teachers, and educators and maybe also among scholars, which seem really careful about study expressions of racism in childhood. This social and cultural belief let people think that all the children, because of their age and their brief experience in the world, are disinterested in skin color. Sometimes adults think that children are even incapable of perceiving skin colors and that it could be dangerous to talk about melaninic differences with them because they finally could notice this difference, producing prejudices and racism. Psychology and neurology research projects are showing for many years that even the newborns are already capable of perceiving skin color and ethnic differences by the age of 3 months. Starting from this theoretical framework we conducted a research project to understand if and how primary school children talk about skin colors, picking up any stereotypes or prejudices. Choosing to use the focus group as a methodology to stimulate the group dimension and interaction, several stories about skin color discrimination's episodes within their classroom or school have emerged. Using the photo elicitation technique we chose to stimulate talk about the research object, which is the skin color, asking the children what was ‘the first two things that come into your mind’ when they look the photographs presented during the focus group, which represented dark and light skinned women and men. So, this paper will present some of these stories about episodes of discrimination with an escalation grade of proximity related to the discriminatory act. It will be presented a story of discrimination happened within the school, in an after-school daycare, in the classroom and even episode of discrimination that children tell during the focus groups in the presence of the discriminated child. If it is true that the Declaration of the Right of the Child state that every child should be discrimination free, it’s also true that every adult should protect children from every form of discrimination. How, as adults, can we defend children against discrimination if we cannot admit that even children are potential discrimination’s actors? Without awareness, we risk to devalue these episodes, implicitly confident that the only way to fight against discrimination is to keep her quiet. The right not to be discriminated goes through the right to talk about its own experiences of discrimination and the right to perceive the unfairness of the constant depreciation about skin color or any element of physical diversity. Intercultural education could act as spokesperson for this mission in the belief that difference and plurality could really become elements of potential enrichment for humanity, starting from children.

Keywords: colorism, experiences of discrimination, primary school children, skin color discrimination

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Authors: Eliziane Fernanda Navarro, Aparecida Eleonora Sitta

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Child of the Dark is the work of the Brazilian author Carolina Maria de Jesus, published at the first time by Ática and Francisco Alves in 1960. It is, mostly, a story of lack of rights. It lacks to men who live in the slums what is essential in order to take advantage of the privilege of rationality to develop themselves as civilized humans. It is, therefore, in the withholding of the basic rights that inequality finds space to build itself to be the main misery on Earth. Antonio Candido, a Brazilian sociologist claims that it is the right to literature has the ability to humanize men, once the aptitude to create fiction and fable is essential to the social balance. Hence, for the forming role that literature holds, it must be thought as the number of rights that assure human dignity, such as housing, education, health, freedom, etc. When talking about her routine, Carolina puts in evidence something that has great influence over the formation of human beings, contributing to the way they live: the slum. Even though it happens in a distinct way and using her own linguistics variation, Carolina writes about something that will only be discussed later on Brazil’s Cities Statute and Erminia Maricato: the right to the city, and how the slums are, although inserted in the city, an attachment, an illegal city, a dismissing room. It interests ourselves, for that matter, in this work, to analyse how the deprivation of the rights to the city and literature, detailed in Carolina’s journal, conditions human beings to a life where the instincts overcome the social values.

Keywords: Child of the Dark, slum, literature, architecture and urbanism, fundamental rights, Brazil

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Authors: Mareli Fischer, Kevin G. F. Thomas

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Although Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most prevalent childhood neurobehavioural disorders, little empirical research has been published on its clinical presentation in Africa, and, globally, few studies evaluate ADHD intervention programs that emphasize parent training. Hence, Stage 1 of this research programme aimed to describe the functional impairment of South African children with ADHD, and also sought to investigate the influence of sociodemographic variables (e.g., sex, age, socioeconomic status, family environment) and clinical variables (e.g., ADHD subtype and comorbidity) on the degree of that impairment. We used the Mini International Neuropsychiatric Interview for Children and Adolescents as a diagnostic tool, and the Child Behavior Checklist, the Strengths and Difficulties Questionnaire, and the Impairment Rating Scale as measures of functional impairment. Results from this stage of the research indicated that South African children and adolescents who meet diagnostic criteria for ADHD experience most functional impairment in the school domain, as well as in the area of social functioning. None of the measured sociodemographic variables had a significant detrimental or protective effect on how ADHD symptoms impacted on functioning. In terms of comorbidity, the presence of Major Depressive Disorder, Conduct Disorder, and Oppositional Defiant Disorder were all associated with significantly impaired overall functioning. Stage 2 of the research programme aimed to design, implement, and evaluate a child-specific intervention that targeted the primary areas of impairment identified in Stage 1. Existing literature suggests that a positive parent-training programme, in the group format, is one of the best options for cost-effective and successful ADHD intervention. Hence, the intervention took that form. Parents were taught basic behaviour analysis concepts within a supportive group context. Evaluation of the intervention’s efficacy used many of the same measures as in Stage 1, but also featured semi-structured interviews with participants and naturalistic observation of parent-child interaction. We will discuss preliminary results of that evaluation. Studying functional impairment and designing intervention plans in this way will pave the way for evidence-based treatment plans for children and adolescents diagnosed with ADHD.

Keywords: attention deficit/hyperactivity disorder, children, intervention, parenting groups

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Authors: Wegene Demeke

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Background: The demand for healthcare services is growing in developing and developed countries. Information and communication technology is used to facilitate healthcare services. In the case of developing countries, implementing telemedicine is aimed at providing healthcare for people living in remote areas where health service is not accessible. The implementations of telemedicine in developing countries are unsuccessful. For example, the recent study indicates that 90% of telemedicine projects are abandoned or failed in developing countries. Several researchers reported the technological challenges as the main factor for the non-adoption of telemedicine. However, this research reports the health professionals’ perspectives arising from technical, social and organizational factors that are considered as key elements for the setting and running of telemedicine in Ethiopia. The importance and significance of telemedicine for healthcare is growing. For example, the use of telemedicine in the current pandemic situation becomes an essential strategic element in providing healthcare services in developed countries. Method: Qualitative and quantitative exploratory research methods used to collect data to find factors affecting the adoption of Information and communication technologies for telemedicine use. The survey was distributed using emails and Google forms. The email addresses were collected from personal contact and publicly available websites in Ethiopia. The thematic analysis used to build the barriers and facilitators factors for establishing telemedicine services. A survey questionnaire with open-and-close questions was used to collect data from 175 health professionals. Outcome: The result of this research will contribute to building the key barriers and facilitators factors of telemedicine from the health professional perspectives in developing countries. The thematic analysis provides barriers and facilitators factors arising from technical, organizational, and social sources.

Keywords: telemedicine, ICT, developing country, Ethiopia, health service

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Authors: Nitika Sharma, Yogesh Jain

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Introduction: An efficient Information System helps in improving the service delivery as well provides the foundation for policy and regulation of other building blocks of Health System. Health care organizations require an integrated working of its various sub-systems. An efficient EMR software boosts the teamwork amongst the various sub-systems thereby resulting in improved service delivery. Although there has been a huge impetus to EMR under the Digital India initiative, it has still not been mandated in India. It is generally implemented in huge funded public or private healthcare organizations only. Objective: The study was conducted to understand the factors that lead to the successful adoption of an affordable EMR in the low level healthcare organization. It intended to understand the design of the EMR and address the solutions to the challenges faced in adoption of the EMR. Methodology: The study was conducted in a non-profit registered Healthcare organization that has been providing healthcare facilities to more than 2500 villages including certain areas that are difficult to access. The data was collected with help of field notes, in-depth interviews and participant observation. A total of 16 participants using the EMR from different departments were enrolled via purposive sampling technique. The participants included in the study were working in the organization before the implementation of the EMR system. The study was conducted in one month period from 25 June-20 July 2018. The Ethical approval was taken from the institute along with prior approval of the participants. Data analysis: A word document of more than 4000 words was obtained after transcribing and translating the answers of respondents. It was further analyzed by focused coding, a line by line review of the transcripts, underlining words, phrases or sentences that might suggest themes to do thematic narrative analysis. Results: Based on the answers the results were thematically grouped under four headings: 1. governance of organization, 2. architecture and design of the software, 3. features of the software, 4. challenges faced in adoption and the solutions to address them. It was inferred that the successful implementation was attributed to the easy and comprehensive design of the system which has facilitated not only easy data storage and retrieval but contributes in constructing a decision support system for the staff. Portability has lead to increased acceptance by physicians. The proper division of labor, increased efficiency of staff, incorporation of auto-correction features and facilitation of task shifting has lead to increased acceptance amongst the users of various departments. Geographical inhibitions, low computer literacy and high patient load were the major challenges faced during its implementation. Despite of dual efforts made both by the architects and administrators to combat these challenges, there are still certain ongoing challenges faced by organization. Conclusion: Whenever any new technology is adopted there are certain innovators, early adopters, late adopters and laggards. The same pattern was followed in adoption of this software. He challenges were overcome with joint efforts of organization administrators and users as well. Thereby this case study provides a framework of implementing similar systems in public sector of countries that are struggling for digitizing the healthcare in presence of crunch of human and financial resources.

Keywords: EMR, healthcare technology, e-health, EHR

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