Asian Journal of Pediatric Research

Early Initiation of Breastfeeding and Associated Factors in a Private Healthcare Facility in Port Harcourt, Nigeria: A Before-and-After PDSA Cycle Study

2026-06-02T12:14:53+00:00

Background: Early breastfeeding initiation ensures that the newborn receives the nutrients- and immunoglobulin-rich colostrum, reduces reliance on prelacteal feeds and promotes exclusive breastfeeding, protecting the child from infections and offering other health benefits that significantly decrease neonatal and infant morbidity and mortality.

Aims: The present study evaluates the prevalence of early initiation of breastfeeding (EIBF) 2 years before and after a Quality Improvement Project (QIP) using the Plan-Do-Study-Act (PDSA) cycle, and assesses associated maternal and child factors.

Study design – A retrospective hospital-based before and after a PDSA cycle study.

Place and Duration of Study: the maternity ward of a 50-bedded private specialist hospital in Port Harcourt, Nigeria using data of mothers that delivered in the hospital over 4 years and their babies. Those that delivered from January 2020 to December 2021 were termed the ‘before QIP’ group and those from January 2023 to December 2024 the ‘after QIP’ group. Mothers who delivered in 2022, the year of the QIP and their babies were not included in the study

Methodology: Details of the mothers and their babies were obtained from the hospital’s medical records. Data were summarized and analyzed, differences between the before and after QIP groups were assessed using the independent samples t-test, prevalence of EIBF in each study population was determined; and the difference between the two groups and categorical variables between EIBF and selected variables were assessed using the Chi-square test or Fisher’s Exact where appropriate.

Results: Prevalence of EIBF improved significantly from 45.4% in the before to 90% in the after group. (P-value < 0.001). Vaginal delivery was significantly associated with EIBF in the before group (P-value < 0.001) and multiparity in the after group (P-value = 0.03). Maternal age, education, utilization of antenatal services, socio-economic class and baby’s age and sex were not significantly associated with EIBF.

Conclusion: The prevalence of EIBF significantly increased after a PDSA cycle and was sustained for up to 2 years, supporting its use to improve healthcare gaps. Lack of association of EIBF with most evaluated factors calls for further research into other factors not evaluated in this study.

The Prevalence, and Social Determinants of Depression among In-school Adolescents in Dhaka and Khulna Divisions of Bangladesh: A Comparative Cross-Sectional Study

2026-06-15T12:05:17+00:00

Background: Depression is one of the leading causes of illness and disability among adolescents globally, with a disproportionately higher burden in low- and middle-income countries. In Bangladesh, rapid urbanization, intense academic pressure, socioeconomic inequality, and recurrent climate-related disasters may substantially influence adolescent mental health, particularly depression.

Objective: To determine the prevalence of depression and to identify its associated sociodemographic, familial, academic, lifestyle, digital, and environmental factors among adolescents in Dhaka and Khulna Divisions of Bangladesh.

Methods: A school-based cross-sectional study was conducted among 5,600 adolescents aged 10–18 years (Dhaka: n=2,800; Khulna: n=2,800) using a multistage cluster sampling technique. Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9). Associations between depression and explanatory variables were analyzed using chi-square tests.

Results: The prevalence of moderate-to-severe depressive symptoms (PHQ-9 ≥10) was significantly higher among adolescents in Khulna Division compared to Dhaka (p<0.001). Overall depressive symptoms were reported by 61.2% of adolescents in Dhaka and 97.2% in Khulna. Severe depression was rare in Dhaka (2.5%) but highly prevalent in Khulna, where nearly three-quarters of adolescents fell into moderately severe or severe categories. Minimal or no depression was common in Dhaka (57.3%) but nearly absent in Khulna (~3%). Depression was significantly associated with older age (15–18 years), higher grade level (10–12), low household income, and low parental education in both divisions (all p<0.001), with stronger associations observed in Khulna. Urban residence showed a particularly strong association in Khulna (χ²=832.41, p<0.001). Family and social factors—including poor parent–child communication, low parental interaction, family conflict, and low peer support—were significantly linked to depressive symptoms in both regions (all p<0.001). Academic stressors such as high academic pressure, exam anxiety, and heavy study workload were also strong predictors. Lifestyle factors, including short sleep duration, poor sleep quality, unhealthy diet, and excessive digital media use (>3 hours/day), demonstrated robust associations with depression across both divisions (all p<0.001). Environmental stressors showed the greatest regional disparity, particularly flood exposure in Khulna (χ²=285.44, p<0.001). PHQ-9 item analysis revealed higher mean scores for key symptoms, including anhedonia and suicidal ideation, among adolescents in Khulna compared to Dhaka.

Conclusion: Adolescent depression is highly prevalent in both divisions, with a markedly higher burden in environmentally vulnerable Khulna. Interventions addressing academic stress, family support, lifestyle behaviors, and climate-related vulnerabilities are urgently required.

Classic Rett Syndrome with Developmental Regression and Epilepsy in a Four-Year-Old Child: A Case Report

2026-06-22T12:27:50+00:00

Rett syndrome is a rare neurodevelopmental disorder that predominantly affects girls and is commonly associated with pathogenic variants in the methyl-CpG-binding protein 2 (MECP2) gene. It is characterised by apparently normal early development followed by developmental regression, loss of acquired communication and purposeful hand skills, stereotypic hand movements, seizures, and acquired deceleration of head growth. We report the case of a four-year-old girl who presented with developmental regression and recurrent seizures. Early development was reported to be normal until nine months of age, when the child had her first fever-associated seizure, followed by recurrent seizure episodes. Between 12 and 18 months of age, she showed progressive loss of purposeful hand movements, communication abilities, and previously attained motor skills. By approximately two years of age, stereotypic hand movements, including hand wringing and hand mouthing, were observed, along with acquired microcephaly and bruxism. Magnetic resonance imaging of the brain, cerebrospinal fluid analysis, and metabolic investigations were normal. Electroencephalography demonstrated bilateral epileptiform activity. Genetic testing identified a pathogenic MECP2 variant, supporting the diagnosis of classic Rett syndrome; however, detailed mutation nomenclature was not available for review. The child was managed with antiepileptic therapy, physiotherapy, occupational therapy, speech therapy, nutritional supplementation, and planned multidisciplinary surveillance for associated complications. This case highlights the importance of considering Rett syndrome in girls with developmental regression, stereotypic hand movements, seizures, and acquired deceleration of head growth after a period of apparently normal early development. Timely recognition may support appropriate diagnostic evaluation, symptom-directed management, rehabilitation, and ongoing family counselling.

Behaviour Management in Children with Autism: What Lies Beyond Applied Behaviour Analysis and Sensory Integration?

2026-06-11T08:13:32+00:00

Autism spectrum disorder (ASD) is a heterogeneous neurodevelopmental condition characterised by persistent challenges in social communication, restricted and repetitive patterns of behaviour, and, in many cases, atypical sensory processing. For several decades, applied behaviour analysis (ABA) and sensory integration (SI) therapy have occupied dominant positions in clinical practice and educational provision for children on the spectrum. While both approaches rest on substantive evidence bases, each has attracted mounting scrutiny concerning methodological rigour, ethical acceptability, and adequacy in addressing the full range of developmental needs across the diverse ASD population. This critical review examines the theoretical foundations and principal limitations of ABA and SI, before turning to an appraisal of the wider landscape of emerging and complementary intervention approaches. Drawing on a narrative review of peer-reviewed literature published primarily between 2000 and 2026, the article synthesises evidence for a range of complementary frameworks and argues for a shift towards personalised, multimodal, and autonomy-respecting models of behaviour support. The literature informing this review was identified through comprehensive searches of multiple academic databases, including Web of Science, Scopus, PubMed, and Google Scholar. The alternatives considered include naturalistic developmental behavioural interventions, pivotal response treatment, developmental relationship-based models such as DIR/Floortime and Relationship Development Intervention, social communication therapies including the Preschool Autism Communication Trial (PACT) and JASPER programmes, cognitive behavioural therapy adaptations for autism, and mindfulness-based approaches. Technology-mediated strategies — encompassing robotic, computer-assisted, and virtual reality interventions — are also examined alongside family-centred, parent-mediated, and neurodiversity-affirming frameworks. Significant gaps — including questions of long-term outcomes, cultural generalisability, and individual variability — are identified throughout. The review concludes that no single intervention paradigm is sufficient to meet the diverse needs of children with ASD, and that integrated approaches grounded in scientific rigour, developmental sensitivity, and respect for autistic identity represent the most promising direction for both clinical practice and future research.

Rare Genetic Ataxias in Childhood and Future Implications for Curing Gene Therapy Options

2026-05-22T07:24:48+00:00

Rare genetic ataxias in childhood are usually progressive neurological disorders characterized by coordination problems (balance/gait instability, fine motor skills) due to damage to the cerebellum. Ataxias are movement disorders that mainly originate from the cerebellum and its connections, leading to a coordination disorder. The first symptom usually perceived by the patient is instability in standing and walking. As the condition progresses, speech and limb coordination disturbances occur, often manifesting as changes in fine motor skills. Speech becomes slow and slurred, and early eye movement disorders are common. Other neurological and non-neurological symptoms may also occur. Diagnosis relies on medical history, neurological examination, and cranial magnetic resonance imaging, followed by molecular genetic and possibly biochemical tests. The low prevalence and marked heterogeneity of ataxias complicate the diagnostic process. Ataxias can be classified into acquired ataxias (e.g., metabolic/toxic, immune-mediated), sporadic degenerative ataxias with cerebellar-type multisystem atrophy, or genetically inherited ataxias (e.g., Friedreich's ataxia, spinocerebellar ataxias). Early diagnosis is crucial to avoid unnecessary testing and provide appropriate patient counseling. Specific therapies are available for certain ataxias and symptoms, and rehabilitative therapies are essential components of treatment. In childhood, common forms include ataxia-telangiectasia, Niemann Pick type C, episodic and spinocerebellar ataxias. Diagnosis involves MRI, neurological examinations, and genetic tests, as therapies are rarely causative but increasingly gene-based research is being explored. Genetic ataxias are usually not curable, but research is focusing on gene therapies and molecular approaches. Occupational therapy, physiotherapy, and speech therapy are essential to maintain mobility and quality of life for as long as possible. This manuscript is an overview of rarely found ataxia types in childhood.