Search results for: mentally disabled children
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 3384

Search results for: mentally disabled children

2454 Impact of Motor Behaviour Aspects of Autism on Cognitive Ability in Children with Autism Spectrum Disorder

Authors: Rana Zeina

Abstract:

Cognitive and behavioral symptoms may, in fact, overlap and be related to the level of the general cognitive function. We measured the behavioral aspects of autism and its correlation to the cognitive ability in 30 children with ASD. We used a neuropsychological battery CANTAB eclipse to evaluate the ASD children's cognitive ability. Individuals with ASDs and challenging behaviors showed significant correlation between some cognitive abilities and motor behavior aspects. Based on these findings we can conclude that the motor behavioral problems in autism affect specific cognitive abilities in ASDs such as comprehension, learning, reversal, acquisition, attention set shifting, and speed of reaction to one stimulus. Future research should also focus on the relationship between motor stereotypes and other subtypes of repetitive behaviors, such as verbal stereotypes, and ritual and routine adherence and use different types of CANTAB tests.

Keywords: cognitive ability, CANTAB test, behaviour motor aspects, autism spectrum disorders

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2453 The Effect of Music Therapy on Anxiety, Fear and Pain Management in 6-12 Year Old Children Undergoing Surgery

Authors: Özgür Bahadir, Meltem Kurtuncu

Abstract:

The study was designed as quasi-experimental and conducted to determine the effect of music therapy on anxiety, fear and pain management in 6-12-year-old children undergoing surgery. The present study was carried out between 01.01.2016 and 19.08.2016 in BEU. Application and Research Center. The children aged 6 -12 who applied for surgery between the mentioned dates constituted the universe of the study. In the quasi-experimental study that was conducted in the clinics where children received operational treatment, two groups were formed: experimental group (the children who received musical therapy before the surgery) and control group (the children who were administered surveys and the surgery service routines only). Each group consisted of 30 children, and the participants of the study were 60 children in total. Necessary permissions were obtained from the parents of the children hospitalized before the beginning of the implementation. The data was collected through Child Anxiety Sensitivity Index (CASI), “Fear In Medical Treatment Scale”, Face, Legs, Activity, Cry, Consolability Scale (FLACC), Visual Analog Scale (VAS) and Participant Information Form. In the analysis of the data, Kolmogorov-Smirnov distribution scale was used to examine the normality of the distribution along with descriptive statistics methods (Frequency, Percentage, Mean, Standard Deviation). Data was presented in the tables in numbers and percentages. Means were demonstrated along with the standard deviations. The research compared children received; case and control groups include socio-demographic perspective, non-significant difference statistically among similar groups are intertwined. The general level of fear regarding the medical processes before returning to service after the operation and 30 minutes before getting discharged was found to be significantly low in the experimental group compared to control group (p<0.05). No statistically significant difference was found between experimental and control groups in terms of general level of fear regarding the medical processes before the operation, during the operation day and in the recovery room after the operation (p>0.05). Total CASI AD (anxiety sensitivity) levels before the operation, day of the operation and 30 minutes before the discharge for patients in experimental group was found to be significantly higher than the control group (p>0.05). There was no statistically significant difference between the experimental and control groups in the total CASI AD levels for the post-operative recovery room and for returning to the service room after the operation (p>0.05). VAS levels for patients in the experimental group in the post-operative recovery room was significantly higher than the control group (p>0.05). There was no statistically significant difference between the groups in terms of VAS findings in returning to service room after the operation and in 30 minutes before the discharge (p>0.05). As a result of the research; applied children music therapy in the experimental group anxiety, fear, and pain of the scales, their scores average, is lower than the control group children in this situation an increase in the satisfaction of children and parents was observed. In line with this, music therapy preoperative anxiety, fear, and can be used as an effective method of decreasing postoperative pain clinics is suggested.

Keywords: anxiety, children, fear, music therapy, pain

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2452 Effect of Exercise and Mindfulness on Cognitive and Psycho-Emotional Functioning in Children with ADHD

Authors: Hannah Bigelow, Marcus D. Gottlieb, Michelle Ogrodnik, Jeffrey, D. Graham, Barbara Fenesi

Abstract:

Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental disorders affecting approximately 6% of children worldwide. ADHD is characterized by a combination of persistent deficits including impaired inhibitory control, working memory and task-switching. Many children with ADHD also have comorbid mental health issues such as anxiety and depression. There are several treatment options to manage ADHD impairments, including drug and behavioural management therapy, but they all have drawbacks, such as worsening mood disturbances or being inaccessible to certain demographics. Both physical exercise and mindfulness meditation serve as alternative options to potentially help mitigate ADHD symptoms. Although there is extensive support for the benefits of long-term physical exercise or mindfulness meditation programs, there is insufficient research investigating how acute bouts (i.e., single, short bouts) can help children with ADHD. Thus, the current study aimed to understand how single, short bouts of exercise and mindfulness meditation impacts executive functioning and psycho-emotional well-being in children with ADHD, as well as to directly compare the efficacy of these two interventions. The study used a a pre- post-test, within-subjects design to assess the effects of a 10-minute bout of moderate intensity exercise versus a 10-minute bout of mindfulness meditation (versus 10 minutes of a reading control) on the executive functioning and psycho-emotional well-being of 16 children and youth with ADHD aged 10-14 (male=11; White=80%). Participants completed all three interventions: 10 minutes of exercise, 10 minutes of mindfulness meditation, and 10 minutes of reading (control). Executive functioning (inhibitory control, working memory, task-switching) and psycho-emotional well-being (mood, self-efficacy) were assessed before and after each intervention. Mindfulness meditation promoted executive functioning, while exercise enhanced positive mood and self-efficacy. Critically, this work demonstrates that a single, short bout of mindfulness meditation session can promote inhibitory control among children with ADHD. This is especially important for children with ADHD as inhibitory control deficits are among the most pervasive challenges that they face. Furthermore, the current study provides preliminary evidence for the benefit of acute exercise for promoting positive mood and general self-efficacy for children and youth with ADHD. These results may increase the accessibility of acute exercise for children with ADHD, providing guardians and teachers a feasible option to incorporate just 10 minutes of exercise to assist children emotionally. In summary, this research supports the use of acute exercise and mindfulness meditation on varying aspects of executive functioning and psycho-emotional well-being in children and youth with ADHD. This work offers important insight into how behavioural interventions could be personalized according to a child’s needs.

Keywords: attention-deficit hyperactivity disorder (ADHD), acute exercise, mindfulness meditation, executive functioning, psycho-emotional well-being

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2451 Positive Impact of Cartoon Movies on Adults

Authors: Yacoub Aljaffery

Abstract:

As much as we think negatively about social media such as TV and smart phones, there are many positive benefits our society can get from it. Cartoons, for example, are made specifically for children. However, in this paper, we will prove how cartoon videos can have a positive impact on adults, especially college students. Since cartoons are meant to be a good learning tool for children, as well as adults, we will show our audience how they can use cartoon in teaching critical thinking and other language skills.

Keywords: social media, TV, teaching, learning, cartoon movies

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2450 The Impact of Artificial Intelligence on the Behavior of Children and Autism

Authors: Sara Fayez Fawzy Mikhael

Abstract:

Inclusive education services for students with Autism remains in its early developmental stages in Thailand. Despite many more children with autism are attending schools since the Thai government introduced the Education Provision for People with Disabilities Act in 2008, the services students with autism and their families receive are generally lacking. This quantitative study used Attitude and Preparedness to Teach Students with Autism Scale (APTSAS) to investigate 110 primary school teachers’ attitude and preparedness to teach students with autism in the general education classroom. Descriptive statistical analysis of the data found that student behavior was the most significant factor in building teachers’ negative attitudes students with autism. The majority of teachers also indicated that their pre-service education did not prepare them to meet the learning needs of children with autism in particular, those who are non-verbal. The study is significant and provides direction for enhancing teacher education for inclusivity in Thailand.

Keywords: attitude, autism, teachers, thailandsports activates, movement skills, motor skills

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2449 Green Spaces in Sustaining Cognitive Behaviour for Treating Anxiety and Depression in Children: A Prospective Study

Authors: Minakshi Jain, I. P. Singh

Abstract:

Due to the era of outstanding technology and modern lifestyle, human beings are debasing their physical, psychological, and mental well-being. The effect of this leads to a trail of chronic diseases like anxiety, loneliness, and depression, especially in children and young adults. This is visible in individuals who suffer from clinical depression, which leads to impaired mood and distortion of cognition, particularly in children. The Members of the WHO European Region made a declaration to provisioning each child with access to healthy and safe environments by 2020, and the decision was taken at the Conference on Environment and Health in 2010 as an initiative to improve access to green spaces in cities which provides universal access for quality spaces for both social interaction and human well-being. In line with this, the paper aims to establish a prospective study on linking green spaces and CBT (Cognitive behavior therapy) in order to treat disorders with reference to children and young adults. A questionnaire was adopted to explore the possibility of green spaces as additive measures for the existing modes of therapy. The results adapted from the questionnaire show that certain species of vegetation have a significant effect in enhancing effective mental well-being.

Keywords: CBT, therapeutic gardens UCLA loneliness scale, anxiety, depression, green spaces, biophilia, environmental psychology

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2448 The Impact of Artificial Intelligence on Autism Attitude and Skills

Authors: Samwail Fahmi Francis Yacoub

Abstract:

Inclusive education services for students with Autism remains in its early developmental stages in Thailand. Despite many more children with autism are attending schools since the Thai government introduced the Education Provision for People with Disabilities Act in 2008, the services students with autism and their families receive are generally lacking. This quantitative study used Attitude and Preparedness to Teach Students with Autism Scale (APTSAS) to investigate 110 primary school teachers’ attitude and preparedness to teach students with autism in the general education classroom. Descriptive statistical analysis of the data found that student behavior was the most significant factor in building teachers’ negative attitudes students with autism. The majority of teachers also indicated that their pre-service education did not prepare them to meet the learning needs of children with autism in particular, those who are non-verbal. The study is significant and provides direction for enhancing teacher education for inclusivity in Thailand.

Keywords: attitude, autism, teachers, movement skills, motor skills, children, behavior.

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2447 Changes in Serum Hepcidin Levels in Children with Inflammatory Bowel Disease during Anti-Inflammatory Treatment

Authors: Eva Karaskova, Jana Volejnikova, Dusan Holub, Maria Velganova-Veghova, Michaela Spenerova, Dagmar Pospisilova

Abstract:

Background: Hepcidin is the central regulator of iron metabolism. Its production is mainly affected by an iron deficiency and the presence of inflammatory activity in the body. The aim of this study was to compare serum hepcidin levels in paediatric patients with newly diagnosed inflammatory bowel disease and hepcidin levels during maintenance therapy, correlate changes of serum hepcidin levels with selected markers of iron metabolism and inflammation and type of provided treatment. Methods: Children with newly diagnosed Crohn's disease (CD) and ulcerative colitis (UC) were included in this prospective study. Blood and stool samples were collected before treatment (baseline). Serum hepcidin, hemoglobin levels, platelet counts, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), interleukin-6 (IL 6), ferritin, iron, soluble transferrin receptors, and fecal calprotectin were assessed. The same parameters were measured and compared with the baseline levels in the follow-up period, during maintenance therapy (average of 39 months after diagnosis). Results: Patients with CD (n=30) had higher serum hepcidin levels (expressed as a median and interquartile range) at diagnosis than subjects with UC (n=13). These levels significantly decreased during the follow-up (from 36.5 (11.5-79.6) ng/ml to 2.1 (0.9-6.7) ng/ml). Contrarily, no significant serum hepcidin level changes were observed in UC (from 5.4 (3.4-16.6) ng/ml to 4.8 (0.9-8.1) ng/ml). While in children with CD hepcidin level dynamics correlated with disease activity and inflammatory markers (ESR, CRP), an only correlation with serum iron levels was observed in patients with UC. Conclusion: Children with CD had higher serum hepcidin levels at diagnosis compared to subjects with UC. Decrease of serum hepcidin in the CD group during anti-inflammatory therapy has been observed, whereas low hepcidin levels in children with UC have remained unchanged. Acknowledgment: This study was supported by grant MH CZ–DRO (FNOl, 00098892).

Keywords: children, Crohn's disease, ulcerative colitis, anaemia, hepcidin

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2446 Allergy to Animal Hair in the Algerian Population

Authors: Meriche Hacene

Abstract:

Introduction: Allergy to animal hair is hypersensitivity to animal appendages to look for in front of any rhinoconjunctivitis or asthma. An anamnesis associated with the prick-tests makes it possible to guide the diagnosis, which will be supplemented in case of doubt by specific immunoglobulin E (IgE) assays. The objective of our study is to study the characteristics of patients sensitized to animal hair. Patients and methods: Retrospective study conducted on 105 adult patients and 69 children over a period of 3 years, including patients who received a specific IgE assay (respiratory panel and pediatric panel) by immunodot method. Result: 105 adult patients, including 74 women and 31 men, with an average age of 41 years, of which 8.5% had sensitization to animal hair (5 men and 4 women), namely: cat (5%), horse (4.7%) and dog (3.8%). For the 69 children, a slight female predominance was noted (56%), with an average age of 7.5 years, of which (13%) are sensitized to animal hair (5 girls and 4 boys): cat (10%), while awareness of dog and horse hair was less frequent with an identical prevalence of (4.34%). The dominant symptoms are rhinorrhea and sneezing for both categories, respectively (40% and 26.6% in adults and 23% for both symptoms in children). Cross-sensitization was observed in the 2 series: 1 single cat-dog and cat-horse case and 2 dog-horse cases in adults. In children, 100% of patients with sensitization to dog hair had cross-sensitization to cat hair, only 1 case was observed for cat-horse cross-reactivity. Conclusion This work shows that allergy to animal hair is common. Studies on more representative samples are recommended.

Keywords: specific IgE, allergy, cat, fed1

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2445 The Evaluation of Children Who Had Chest Pain on Pediatric Emergency Department

Authors: Sabiha Sahin

Abstract:

Background: Chest pain is a common complaint in children visiting the emergency department (ED). True organic problems like cardiac disease are rare. We assess the etiology of chest pain among children visiting a Pediatric ED in Eskisehir Osmangazi University. Method: We prospectively evaluated of children with chest pain who visited our Pediatric ED between 1 January 2013 and 31 December 2014. Any case of trauma-associated chest pain was excluded from this study. Results: A total of 100 patients (54 boys, 46 girls), mean age: 11,86±3,51 (age range, 6–17 years) were enrolled into this study; 100 patients had chest radiograms (100 %). Pneumonia was identified in 15 patients. All patients had electrocardiogram study (100 %) and 16 of them showed abnormalities. Additional diagnostic tests were performed on all patients including complete blood count analysis, cardiac markers (CK-MB, Troponin I) and lactate (blood gas analysis). Echocardiograms were performed on all patients and 16 of them showed abnormality (five of majör abnormality). Panendoscopy was done in 20 patients, and gastroesophageal reflux was found in 12 (%12). Overall, idiopathic chest pain and myalgia was the most common diagnosis (32 %). Other associated disorders were asthma (12 %), panic attack (13 %). Conclusion: The most common cause of chest pain prompting a child to visit the ED is idiopathic chest pain. Careful physical examination can reveal important clues and save many unnecessary examinations.

Keywords: child, chest pain, pediatric emergency department, evaluation

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2444 Mural Exhibition as a Promotive Strategy to Proper Hygiene and Sanitation Practices among Children: A Case Study from Urban Slum Schools in Nairobi, Kenya

Authors: Abdulaziz Kikanga, Kellen Muchira, Styvers Kathuni, Paul Saitoti

Abstract:

Background: Provision of adequate levels of water, sanitation, and hygiene in schools is a strategic objective in achieving universal primary education among children in low and middle-income countries. However, lack of proper sanitation and hygiene practices in schools, especially those in informal settlement has resulted to an increased rate of school absenteeism thereby affecting the education and health outcomes of the children in those setting. Intervention or Response: Catholic Relief Services in Kenya supports five schools in informal settlements of Nairobi by painting of key hygiene messages on school walls to promote proper hygiene and sanitation practices among the school children. The mural exhibitions depict the essence of proper hygiene practices, proper latrine use, and hand washing after visiting the latrine. The artwork is context specific and its aimed at improving the uptake of proper hygiene and sanitation practices among the school children. Review of project related documents was conducted including interviews with the school children. Thematic analysis was used to interpret the qualitative information generated. Results and Lessons Learnt: 12 school children have interviewed on proper hygiene and sanitation practices and the exercise revealed that painted murals were the best communication platforms for creating awareness on proper sanitation on issues relating to water, sanitation, and hygiene in schools. The painting mural provided a strong knowledge base for the formation of healthy habits in both the school and informal settlement. In addition, these sanitation messages on the school walls empower the children to share these practices with their siblings, parents, and other family members thereby acting as agents of change to proper hygiene and sanitation in those informal settlements. The findings revealed that by adopting proper sanitation and hygiene practices, there has been a reduction of school absenteeism due to a decrease in disease related to inadequate sanitation and hygiene in schools. Conclusion: The adoption of proper sanitation in schools entails more than just a painted mural wall. Insights revealed that to have a lasting sanitation and hygiene intervention, there is a need to invest in effective hygiene educational programming that encourages the formation of proper hygiene habits and promotes changes in behavior.

Keywords: education outcomes, informal settlement, mural exhibition, school hygiene and sanitation

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2443 Going beyond Elementary Algebraic Identities: The Expectation of a Gifted Child, an Indian Scenario

Authors: S. R. Santhanam

Abstract:

A gifted child is one who gives evidence of creativity, good memory, rapid learning. In mathematics, a teacher often comes across some gifted children and they exhibit the following characteristics: unusual alertness, enjoying solving problems, getting bored on repetitions, self-taught, going beyond what teacher taught, ask probing questions, connecting unconnected concepts, vivid imagination, readiness for research work, perseverance of a topic. There are two main areas of research carried out on them: 1)identifying gifted children, 2) interacting and channelizing them. A lack of appropriate recognition will lead the gifted child demotivated. One of the main findings is if proper attention and nourishment are not given then it leads a gifted child to become depressed, underachieving, fail to reach their full potential and sometimes develop negative attitude towards school and study. After identifying them, a mathematics teacher has to develop them into a fall fledged achiever. The responsibility of the teacher is enormous. The teacher has to be resourceful and patient. But interacting with them one finds a lot of surprises and awesomeness. The elementary algebraic identities like (a+b)(a-b)=a²-b², expansion of like (a+b)²(a-b)² and others are taught to students, of age group 13-15 in India. An average child will be satisfied with a single proof and immediate application of these identities. But a gifted child expects more from the teacher and at one stage after a little training will surpass the teacher also. In this short paper, the author shares his experience regarding teaching algebraic identities to gifted children. The following problem was given to a set of 10 gifted children of the specified age group: If a natural number ‘n’ to expressed as the sum of the two squares, will 2n also be expressed as the sum of two squares? An investigation has been done on what multiples of n satisfying the criterion. The attempts of the gifted children were consolidated and conclusion was drawn. A second problem was given to them as: can two natural numbers be found such that the difference of their square is 3? After a successful solution, more situations were analysed. As a third question, the finding of the sign of an algebraic expression in three variables was analysed. As an example: if a,b,c are real and unequal what will be sign of a²+4b²+9c²-4ab-12bc-6ca? Apart from an expression as a perfect square what other methods can be employed to prove an algebraic expression as positive negative or non negative has been analysed. Expressions like 4x²+2y²+13y²-2xy-4yz-6zx were given, and the children were asked to find the sign of the expression for all real values of x,y and z. In all investigations, only basic algebraic identities were used. As a next probe, a divisibility problem was initiated. When a,b,c are natural numbers such that a+b+c is at least 6, and if a+b+c is divisible by 6 then will 6 divide a³+b³+c³. The gifted children solved it in two different ways.

Keywords: algebraic identities, gifted children, Indian scenario, research

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2442 D-Epi App: Mobile Application to Control Sodium Valproat Administration in Children with Idiopatic Epilepsy in Indonesia

Authors: Nyimas Annissa Mutiara Andini

Abstract:

There are 325,000 children younger than age 15 in the U.S. have epilepsy. In Indonesia, 40% of 3,5 millions cases of epilepsy happens in children. The most common type of epilepsy, which affects 6 out of 10 people with the disorder, is called idiopathic epilepsy and which has no identifiable cause. One of the most commonly used medications in the treatment of this childhood epilepsy is sodium valproate. Administration of sodium valproat in children has a problem to fail. Nearly 60% of pediatric patients known were mildly, moderately, or severely non-adherent with therapy during the first six months of treatment. Many parents or caregiver took far less medication than prescribed, and the treatment-adherence pattern for the majority of patients was established during the first month of treatment. 42% of the patients were almost always given their medications as prescribed but 13% had very poor adherence even in the early weeks and months of treatment. About 7% of patients initially gave the medication correctly 90% of the time, but adherence dropped to around 20% within six months of starting treatment. Over the six months of observation, the total missing of administration is about four out of 14 doses in any given week. This fail can cause the epilepsy to relapse. Whereas, current reported epilepsy disorder were significantly more likely than those never diagnosed to experience depression (8% vs 2%), anxiety (17% vs 3%), attention-deficit/hyperactivity disorder (23% vs 6%), developmental delay (51% vs 3%), autism/autism spectrum disorder (16% vs 1%), and headaches (14% vs 5%) (all P< 0.05). They had a greater risk of limitation in the ability to do things (relative risk: 9.22; 95% CI: 7.56–11.24), repeating a school grade (relative risk: 2.59; CI: 1.52–4.40), and potentially having unmet medical and mental health needs. In the other side, technology can help to make our life easier. One of the technology, that we can use is a mobile application. A mobile app is a software program we can download and access directly using our phone. Indonesians are highly mobile centric. They use, on average, 6.7 applications over a 30 day period. This paper is aimed to describe an application that could help to control a sodium valproat administration in children; we call it as D-Epi app. D-Epi app is a downloadable application that can help parents or caregiver alert by a timer-related application to warn whether it is the time to administer the sodium valproat. It works not only as a standard alarm, but also inform important information about the drug and emergency stuffs to do to children with epilepsy. This application could help parents and caregiver to take care a child with epilepsy in Indonesia.

Keywords: application, children, D-Epi, epilepsy

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2441 Effect of Classroom Acoustic Factors on Language and Cognition in Bilinguals and Children with Mild to Moderate Hearing Loss

Authors: Douglas MacCutcheon, Florian Pausch, Robert Ljung, Lorna Halliday, Stuart Rosen

Abstract:

Contemporary classrooms are increasingly inclusive of children with mild to moderate disabilities and children from different language backgrounds (bilinguals, multilinguals), but classroom environments and standards have not yet been adapted adequately to meet these challenges brought about by this inclusivity. Additionally, classrooms are becoming noisier as a learner-centered as opposed to teacher-centered teaching paradigm is adopted, which prioritizes group work and peer-to-peer learning. Challenging listening conditions with distracting sound sources and background noise are known to have potentially negative effects on children, particularly those that are prone to struggle with speech perception in noise. Therefore, this research investigates two groups vulnerable to these environmental effects, namely children with a mild to moderate hearing loss (MMHLs) and sequential bilinguals learning in their second language. In the MMHL study, this group was assessed on speech-in-noise perception, and a number of receptive language and cognitive measures (auditory working memory, auditory attention) and correlations were evaluated. Speech reception thresholds were found to be predictive of language and cognitive ability, and the nature of correlations is discussed. In the bilinguals study, sequential bilingual children’s listening comprehension, speech-in-noise perception, listening effort and release from masking was evaluated under a number of different ecologically valid acoustic scenarios in order to pinpoint the extent of the ‘native language benefit’ for Swedish children learning in English, their second language. Scene manipulations included target-to-distractor ratios and introducing spatially separated noise. This research will contribute to the body of findings from which educational institutions can draw when designing or adapting educational environments in inclusive schools.

Keywords: sequential bilinguals, classroom acoustics, mild to moderate hearing loss, speech-in-noise, release from masking

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2440 Effects of Exposure to Domestic Physical Violence on Children's Behavior: A Chinese Community-Based Sample

Authors: Cao Yuping, Li Longfei, Zhao Xingfu, Zhang Yalin

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Purpose: This study examined the effects of exposure to domestic physical violence (DPV) on children’s behavior in a community sample. Method: Ninety-three 12-16 year-old adolescents exposed to DPV were matched with 54 adolescents with no exposure to DPV based on age, gender, family composition and parental age and education level. Participation included assessment with the Childhood Trauma Questionnaire (CTQ-SF) and Child Behavior Checklist (CBCL) by the adolescents and their parents respectively. Results: CBCL total score and anxiety/depression, social interaction problems, attention problems, delinquency, aggression and externalizing scores were significantly higher in adolescents exposed to DPV than those in controls (all ps<0.05).The CBCL total score and scores of anxiety/depression, social interaction problems, attention problems, delinquency, aggression and externalizing behaviors of boys were significantly higher in the research group than in the controls (all ps<0.05). Delinquency scores in abused adolescents were significantly higher than in DPV witnessed (p<0.05), but no other scores of CBCL were significant different. Different subtypes of behavioral problems were associated with different types of abuse. Conclusions: DPV exposure is associated with adverse behaviors in children, especially among boys. Children witness DPV alone have similar behavioral scores as the abused children. We recommend that both abused and DPV witness adolescents in Chinese communities need treatment to mitigate the effects on maladjusted behaviors.

Keywords: domestic violence, child, behavior, community, China

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2439 Bluetooth Piconet System for Child Care Applications

Authors: Ching-Sung Wang, Teng-Wei Wang, Zhen-Ting Zheng

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This study mainly concerns a safety device designed for child care. When children are out of sight or the caregivers cannot always pay attention to the situation, through the functions of this device, caregivers can immediately be informed to make sure that the children do not get lost or hurt, and thus, ensure their safety. Starting from this concept, a device is produced based on the relatively low-cost Bluetooth piconet system and a three-axis gyroscope sensor. This device can transmit data to a mobile phone app through Bluetooth, in order that the user can learn the situation at any time. By simply clipping the device in a pocket or on the waist, after switching on/starting the device, it will send data to the phone to detect the child’s fall and distance. Once the child is beyond the angle or distance set by the app, it will issue a warning to inform the phone owner.

Keywords: children care, piconet system, three-axis gyroscope, distance detection, falls detection

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2438 Traced Destinies: A Study on the Migration of Brazilian Children for Switzerland

Authors: Flavia Schuler Gomes, Cristina Brito Dias, Emily Schuler

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One of the emerging themes in modern society is migration. What in the past was a route mostly traveled by men, is currently carried out by women and even children. In this sense, the objective of this research was to understand the experiences and repercussions of the migration in the life of young Brazilians who went to Switzerland. The specific objectives were: to know the causes and consequences of migration; how was the adaptation in the country in emotional and educational terms; as how the interviewees feel the impact of living with two cultures simultaneously. The research had a qualitative methodology. The participants were eight young men and women, between the ages of 18 and 25, who migrated to Switzerland as a child. The instrument used was interview technique of life history. The collected data were analyzed through the thematic content analysis. The results indicate that the young people migrated to accompany their mothers; in terms of nationality, two participants feel completely Swiss, and six believe they share Swiss and Brazilian aspects. None of the participants followed an academic career, having secondary education.

Keywords: adaptation, children, culture, migration

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2437 Influence of Non-Formal Physical Education Curriculum, Based on Olympic Pedagogy, for 11-13 Years Old Children Physical Development

Authors: Asta Sarkauskiene

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The pedagogy of Olympic education is based upon the main idea of P. de Coubertin, that physical education can and has to support the education of the perfect person, the one who was an aspiration in archaic Greece, when it was looking towards human as a one whole, which is composed of three interconnected functions: physical, psychical and spiritual. The following research question was formulated in the present study: What curriculum of non-formal physical education in school can positively influence physical development of 11-13 years old children? The aim of this study was to formulate and implement curriculum of non-formal physical education, based on Olympic pedagogy, and assess its effectiveness for physical development of 11-13 years old children. The research was conducted in two stages. In the first stage 51 fifth grade children (Mage = 11.3 years) participated in a quasi-experiment for two years. Children were organized into 2 groups: E and C. Both groups shared the duration (1 hour) and frequency (twice a week) but were different in their education curriculum. Experimental group (E) worked under the program developed by us. Priorities of the E group were: training of physical powers in unity with psychical and spiritual powers; integral growth of physical development, physical activity, physical health, and physical fitness; integration of children with lower health and physical fitness level; content that corresponds children needs, abilities, physical and functional powers. Control group (C) worked according to NFPE programs prepared by teachers and approved by school principal and school methodical group. Priorities of the C group were: motion actions teaching and development; physical qualities training; training of the most physically capable children. In the second stage (after four years) 72 sixth graders (Mage = 13.00) attended in the research from the same comprehensive schools. Children were organized into first and second groups. The curriculum of the first group was modified and the second - the same as group C. The focus groups conducted anthropometric (height, weight, BMI) and physiometric (VC, right and left handgrip strength) measurements. Dependent t test indicated that over two years E and C group girls and boys height, weight, right and left handgrip strength indices increased significantly, p < 0.05. E group girls and boys BMI indices did not change significantly, p > 0.05, i.e. height and weight ratio of girls, who participated in NFPE in school, became more proportional. C group girls VC indices did not differ significantly, p > 0.05. Independent t test indicated that in the first and second research stage differences of anthropometric and physiometric measurements of the groups are not significant, p > 0.05. Formulated and implemented curriculum of non-formal education in school, based on olympic pedagogy, had the biggest positive influence on decreasing 11-13 years old children level of BMI and increasing level of VC.

Keywords: non – formal physical education, olympic pedagogy, physical development, health sciences

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2436 The Relationship between Self-Injury Behavior and Social Skills among Children with Mild Intellectual Disability in the State of Kuwait

Authors: Farah Al-Shatti, Elsayed El-Khamisi, Nabel Suleiman

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The study aimed at identifying the relationship between self-injury behavior and social skills among children with mild intellectual disability (ID) in the state of Kuwait. The sample of the study consisted of 65 males and females with ID; their ages ranged between 8 to 12 years. The study used a measure for rating self-injury behavior designed by the researcher; and a measure for rating social skills was designed. The results of the study showed that there was an increase in the percentages of the two dimensions of the self-injury behavior for children with ID; the self-injury behavior by child’s own body was higher than the self-injury behavior by environmental tools, additionally the results showed that there were statistically significant differences between males and females on the dimensions and total scorer of self-injury scale favor the males, and there were statistically significant differences between them on the dimensions of the social skills and total score favor the females, It also indicated that there was statistically significant negative relationship between the dimensions of the self-injury and the dimensions of the social skills for children with intellectual disability.

Keywords: mild intellectual disability, self injury behavior, social skills, state of Kuwait

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2435 Effects of Music Training on Social-Emotional Development and Basic Musical Skills: Findings from a Longitudinal Study with German and Migrant Children

Authors: Stefana Francisca Lupu, Jasmin Chantah, Mara Krone, Ingo Roden, Stephan Bongard, Gunter Kreutz

Abstract:

Long-term music interventions could enhance both musical and nonmusical skills. The present study was designed to explore cognitive, socio-emotional, and musical development in a longitudinal setting. Third-graders (N = 184: 87 male, 97 female; mean age = 8.61 years; 115 native German and 69 migrant children) were randomly assigned to two intervention groups (music and maths) and a control group over a period of one school-year. At baseline, children in these groups were similar in basic cognitive skills, with a trend of advantage in the control group. Dependent measures included the culture fair intelligence test CFT 20-R; the questionnaire of emotional and social school experience for grade 3 and 4 (FEESS 3-4), the test of resources in childhood and adolescence (FRKJ 8-16), the test of language proficiency for German native and non-native primary school children (SFD 3), the reading comprehension test (ELFE 1-6), the German math test (DEMAT 3+) and the intermediate measures of music audiation (IMMA). Data were collected two times at the beginning (T1) and at the end of the school year (T2). A third measurement (T3) followed after a six months retention period. Data from baseline and post-intervention measurements are currently being analyzed. Preliminary results of all three measurements will be presented at the conference.

Keywords: musical training, primary-school German and migrant children, socio-emotional skills, transfer

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2434 Unstructured Learning: Development of Free Form Construction in Waldorf and Normative Preschools

Authors: Salam Kodsi

Abstract:

In this research, we sought to focus on constructive play and examine its components in the context of two different educational approaches: Waldorf and normative schools. When they are free to choose, construction is one of the forms of play most favored by children. Its short-term and long-term cognitive contributions are apparent in various areas of development. The lack of empirical studies about play in Waldorf schools, which addresses the possibility of this incidental learning inspired the need to enrich the body of existing knowledge. 90 children (4-6 yrs.old) four preschools ( two normative, two Waldorf) participated in a small homogeneous city. Naturalistic observations documented the time frame, physical space, and construction materials related to the freeform building; processes of construction among focal representative children and its products. The study’s main finding with respect to the construction output points to a connection between educational approach and level of construction sophistication. Higher levels of sophistication were found at the Waldorf preschools than at the mainstream preschools. This finding emerged due to the differences in the level of sophistication among the older children in the two types of preschools, while practically no differences emerged among the younger children. Discussion of the research findings considered the differences between the play environments in terms of time, physical space, and construction materials. The construction processes were characterized according to the design model stages. The construction output was characterized according to the sophistication scale dimensions and the connections between approach, age and gender, and sophistication level.

Keywords: constructive play, preschool, design process model, complexity

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2433 Clinical Profile of Renal Diseases in Children in Tertiary Care Centre

Authors: Jyoti Agrawal

Abstract:

Introduction: Renal diseases in children and young adult can be difficult to diagnose early as it may present only with few symptoms, tends to have different course than adult and respond variously to different treatment. The pattern of renal disease in children is different from developing countries as compared to developed countries. Methods: This study was a hospital based prospective observational study carried from March, 2014 to February 2015 at BP Koirala institute of health sciences. Patients with renal disease, both inpatient and outpatient from birth to 14 years of age were enrolled in the study. The diagnosis of renal disease was be made on clinical and laboratory criteria. Results: Total of 120 patients were enrolled in our study which contributed to 3.74% % of total admission. The commonest feature of presentation was edema (75%), followed by fever (65%), hypertension (60%), decreased urine output (45%) and hematuria (25%). Most common diagnosis was acute glomerulonephritis (40%) followed by Nephrotic syndrome (25%) and urinary tract infection (25%). Renal biopsy was done for 10% of cases and most of them were steroid dependent nephrotic syndrome. 5% of our cases expired because of multiorgan dysfunction syndrome, sepsis and acute kidney injury. Conclusion: Renal disease contributes to a large part of hospital pediatric admission as well as mortality and morbidity to the children.

Keywords: glomerulonephritis, nephrotic syndrome, renal disease, urinary tract infection

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2432 Addressing Oral Sensory Issues and Possible Remediation in Children with Autism Spectrum Disorders: Illustrated with a Case Study

Authors: A. K. Aswathy, Asha Manoharan, Arya Manoharan

Abstract:

The purpose of this study are to define the nature of oral sensory issues in children with autism spectrum disorder (ASD), identify important components of the assessment and treatment of this issues specific to this population, and delineate specific therapeutic techniques designed to improve assessment and treatment within therapeutic settings. Literature review and case example is used to define the predominant nature of the oral sensory issues that are experienced by some children on the autism spectrum. Characteristics of this complex disorder that can have an impact on feeding skill and behavior are also identified. These factors are then integrated to create assessment and intervention techniques that can be used in conjunction with traditional feeding approaches to facilitate improvements in eating as well as reducing oral apraxic component in this unique population. The complex nature of ASD and its many influences on feeding skills and behavior create the need for modification to both assessment and treatment approaches. Additional research is needed to create therapeutic protocols that can be used by speech-language pathologists to effectively assess and treat feeding and oro motor apraxic difficulties that are commonly encountered in children with ASD.

Keywords: autism, assessment, feeding, intervention, oral sensory issues, oral apraxia

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2431 Food Intake Pattern and Nutritional Status of Preschool Children of Chakma Ethnic Community

Authors: Md Monoarul Haque

Abstract:

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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2430 Community Engagement in Child Centered Space at Disaster Events: A Case Story of Sri Lanka

Authors: Wasantha Pushpakumara Hitihami Mudiyanselage

Abstract:

Since recent past, Sri Lanka is highly vulnerable to reoccurring climate shocks that severely impact the food security, loss of human & animal lives, destructions of human settlements, displacement of people and damaging properties. Hence, the Government of Sri Lanka has taken important steps towards strengthening legal and institutional arrangements for Disaster Risks management in the country in May 2005. Puttalam administrative district is one of the disaster prone districts in Sri Lanka which constantly face the devastating consequences of the increasing natural disasters annually. Therefore disaster risk management will be a timely intervention in the area to minimize the adverse impacts of the disasters. The few functioning Disaster Risk management networks do not take children’s specific needs and vulnerabilities during emergencies into account. The most affected children and their families were evacuated to the government schools and temples and it was observed that children were left to roaming around as their parents were busy queuing up for relief goods and other priorities. In this sense, VOICE understands that the community has vital role that has to be played in facing challenges of disaster management in the area. During and after the disaster, it was viewed that some children were having psychological disorders which could be impacted negatively to children well–being. Need of child friendly space at emergency is a must action in the area to turn away negative impact coming from the hazards. VOICE with the support of national & international communities have established safer places for the children (Child Centered Spaces – CCS) and their families at emergencies. Village religious venues and schools were selected and equipped with necessary materials to be used for the children at emergency. Materials such as tools, stationeries, play materials, which couldn’t be easily found in surrounding environment, were provided for CCS centers. Village animators, youth and elders were given comprehensive training on Disaster management and their role at CCS. They did the facilitation in keeping children without fear and stress at flooding occurred in 2015 as well as they were able to improve their skills when working with children. Flooding in 2016, the government agencies have taken service of these village animators at early stage of flooding to make all disaster-related recovery actions productively & efficiently. This mechanism is sustained at village level that can be used for disaster events.

Keywords: child centered space, impacts, psychological disorders, village animators

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2429 A Proposed Inclusive Motor Skill Intervention Programme for Pre-schoolers in Low Resources Areas in Preparation of School Readiness

Authors: J. Van der Walt, N. A. Plastow, M. Unger

Abstract:

Gross and fine motor skill difficulties among children affect their ability to learn and progress in school. Research indicates that children in low socio-economic areas are at a higher risk of motor skill difficulties, while therapy resources are limited. The Hopscotch motor skill programme is a well-researched accessible in-school intervention developed by occupational and physiotherapists through complex intervention development. The development stage of the complex intervention development model firstly included a prevalence study in a low-resourced area in the West Coast of South Africa, indicating a high prevalence with significant motor skill difficulties among pre-school children at 14.5% with fine motor skill difficulties at 24.6%. A scoping review identifies motor skill interventions for pre-school children and a proposed a framework of fundamental concepts to consider when developing a motor skill intervention. a Delphi-study considered the framework and encouraged collaboration between therapists and educators to make the programme accessible, resource and cost effective, specifically geared towards a rural, low resourced area. The results from the Delphi study, together with the proposed framework from the scoping review was used to develop the Hopscotch programme, adopting a task-shifting approach. The eight-week small-group programme is facilitated by teachers with the support of therapists. The programme aims to improve the motor skills of pre-school aged children with motor skill difficulties to promote academic readiness through obstacle courses, ball skill games and fine motor games and crafts. A randomised controlled trial is planned as a next stage to determine the preliminary effect of the programme on the motor and early academic skills of pre-school children.

Keywords: accesible learning, motor skill intervention, school readiness, task shifting

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2428 Effect of Phenytoin and Cyclosporine on Connective Tissue Enzymes in Gingival Fibroblasts of Adult and Children

Authors: V. Surena, B. Nazemisalman, F. Noghrehkar

Abstract:

Introduction: Gingival overgrowth (GO) is a common side effect involving users of antiepileptic, immunosuppressive and calcium channel blocker drugs. Cyclosporine and phenytoin are amongst the most widely used drugs associated with GO. Gingival fibroblasts seem to have a significant role in the production of certain enzymes after administration of the drugs contributing to GO. Previous studies have shown a higher prevalence of GO in children and adolescents. The aim of this study was to compare normal human gingival fibroblasts with those exposed to Cyclosporine or phenytoin in measuring the production levels of certain enzymes that could have a possible role in GO. Methods: samples were obtained from the gingival biopsies of seven adult and seven children and were cultured into plates. With the growth of fibroblast cells, they were treated with or without either Cyclosporine or phenytoin. Reverse transcriptase-polymerase chain reaction (RT-PCR) was used to determine the expressed levels of R-EGF, cathepsin B,L, Lysyl oxidase, COL1, TGF β1, MMP-1,2, and TIMP1. Results: according to RT-PCR analyses, the expressed levels of R-EGF, cathepsin B, L, Lysyl oxidase, COL1, TGF β1, MMP-1, 2 and TIMP1 were affected by Cyclosporine and phenytoin. TGF-β1, TIMP, Cathepsin B and EGF showed comparable values in the adult and pediatric groups. Conclusions: Different expressed levels of enzymes after treatment of the gingival fibroblasts of adults and pediatrics with phenytoin or Cyclosporine could be the reason for the higher severity of GO in children. More studies need to be performed on the pathogenesis of GO at different age groups.

Keywords: cyclosporine, fibroblasts, phenytoin, gingivae

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2427 A Foucauldian Analysis of Child Play: Case Study of a Preschool in the United States

Authors: Meng Wang

Abstract:

Historically, young members (children) in the society have been oppressed by adults through direct violent acts. Direct violence was evident in rampant child labor and child maltreatment cases. After acknowledging the rights of children from the United Nations, it is believed in public that children have been protected against direct physical violence. Nevertheless, at present, this paper argues from Foucauldian and disability study standpoints that similar to the old times, children are oppressed objects in the context of child play, which is constructed by adults to substitute direct violence in regulating children. Particularly, this paper suggests that on the one hand, preschool play is a new way that adults adopt to oppress preschoolers and regulate the society as a whole; on the other hand, preschoolers are taught how to play as an acquired skill and master self-regulation through play. There is a line of contemporary research that centers on child play from social constructivism perspective. Yet, current teaching practices pertaining to child play including guided child play and free play, in fact, serve the interest of adults and society at large. By acknowledging and deconstructing the prevalence of 'evidence-based best practice' in early childhood education field within western society, reconstruction of child-adult power relation could be achieved and alternative truth could be found in early childhood education. To support the argument of this paper, an on-going observational case study is conducted in a preschool setting in the United States. Age range of children is 2.5 to 4 years old. Approximately 10 children (5 boys) are participating in this case study. Observation is conducted throughout the weekdays as children follow through the classroom routine with a lead and an assistant teacher. Classroom teachers are interviewed pertaining to their classroom management strategies. Preliminary research finding of this case study suggested that preschool teachers tended to utilize scenarios from preschoolers’ dramatic play to impart core cultural values to young children. These values were pre-determined by adults. In addition, if young children have failed to follow teachers' guidance in terms of playing in a correct way, children ran the risk of being excluded from the play scenario by peers and adults. Furthermore, this study tended to indicate that through child play, preschoolers are obliged to develop an internal violence system, that is self-regulation skill to regulate their own behavior; and if this internal system is unestablished based on various assessments by adults, then potentially there will be consequences of negative labeling and disabling toward young children intended by adults. In conclusion, this paper applies Foucauldian analysis into the context of child play. At present, within preschool, child play is not free as it seems to be. Young children are expected to perform cultural tasks through their play activities designed by adults. Adults utilize child play as technologies of governmentality to further predict and regulate future society at large.

Keywords: child play, developmentally appropriate practice, DAP, poststructuralism, technologies of governmentality

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2426 Child Labor and Injury Occurrence in Nicaragua: A Gender Perspective Analysis

Authors: Cristina Domínguez, Steven N. Cuadra

Abstract:

Aims: The aims of this study are: 1) to describe the occurrence and estimate the risk of suffering injuries of any kind, especially work-related injuries, in rural children working in agricultural activities and in urban children working on the street 2) to explore factors that might be associated with the occurrence of work-related injuries among child workers such as gender, school attendance, and performance of household chore. Method: We performed a crossectional study among working children in agricultural activities (120) and on the street (108) and in non-working referents (140) in 2019. We investigated self-reported injuries during the last 12 months, with focus on work-related injuries. Incidence rate, rate ratios, and 95% CI were calculated by Poisson regression. Results: Agricultural workers have a higher incidence of work-related injuries (2.1 per 1000 person-days) than children working on the street (1.8 per 1000 person-days). However, when considering girl’s unpaid work at home, girls had higher occurrence. Girls had a 30% increase on the risk of suffering work related injuries compared to boys. Performing household chore and attending school were the major predictors of injury occurrence. Discussion: Our data suggest If such partial and full-time girl’s housework is taken into account, there would be little or no variation between the sexes with regard to injuries occurrence, and the incidence rate of work related injuries among girls could even exceed that of boys A greater understanding of the interaction of factors related to how child workers spend their time, and its impact on children’s health, is needed in order to identify feasible and appropriate strategies to reduce the negative effect of work on children when elimination of child labor is not reachable in the short term. Clearly, gender aspects on child labor may allow for more effective targeting of prevention efforts.

Keywords: injuries, child labor, agricultural work, gender

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2425 Missed Opportunities for Immunization of under Five Children in Calabar South County Cros River State, Nigeria, the Way Forward

Authors: Celestine Odigwe, Epoke Lincoln, Rhoda-Dara Ephraim

Abstract:

Background; Immunization against the childhood killer diseases is the cardinal strategy for the prevention of these diseases all over the world in under five children, these diseases include; Tuberculosis, Measles, Polio, Tetanus, Diphthria, Pertusis, Yellow Fever, Hepatitis B, Haemophilus Influenza type B. 6.9 million children die before their fifth birthday , 80% of the worlds death in children under 5 years occur in 25 countries most in Africa and Asia and 2 million children can be saved each year with routine immunization Therefore failure to achieve total immunization coverage puts several children at risk. Aim; The aim of the study was to ascertain the prevalence, Investigate the various reasons and causes why several under five children in a suburb of calabar municipal county fail to get the required immunizations as at and when due and possibly the consequences, so that efforts can be re-directed towards the solution of the problems so identified. Methods; the study was a community based cross sectional study. The respondents were the mothers/guardians of the sampled children who were all aged 0-59 months. To be eligible for recruitment into the study, the parent or guardian was required to give an informed consent, reside within the Calabar South County with his/her children aged 0-59 months. We calculated our sample size using the Leslie-Kish formula and we used a two-staged sampling method, first to ballot for the wards to be involved and then to select four of the most populated ones in the wards chosen. Data collection was by interviewer administered structured questionnaire (Appendix I), Data collected was entered and analyzed using Statistical Package for the Social Sciences (SPSS) Version 20. Percentages were calculated and represented using charts and tables Results; The number of children sampled was 159. We found that 150 were fully immunized and 9 were not, the prevalence of missed opportunity was 32% from the study. The reasons for missed opportunities were varied, ranging from false contraindications, logistical problems resulting in very poor access roads to health facilities and poor organization of health centers together with negative health worker attitudes. Some of the consequences of these missed opportunities were increased susceptibility to vaccine preventable diseases, resurgence of the above diseases and increased morbidity and mortality of children aged less than 5 years. Conclusion; We found that ignorance on the part of both parents/guardians and health care staff together with infrastructural inadequacies in the county such as- roads, poor electric power supply for storage of vaccines were hugely responsible for most missed opportunities for immunization. The details of these and suggestions for improvement and the way forward are discussed.

Keywords: missed opportunity, immunization, under five, Calabar south

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