BACKGROUND: Globally, 240,000 babies die in the neonatal period annually due to congenital anomalies (CA). Malta reports the highest neonatal mortality rate (NMR) among EU (European Union) Countries, constituting a public health concern.
OBJECTIVE: This study describes the contribution of CA to NMR in Malta, investigating possible associations with known maternal risk factors of maternal age, nationality, and education. Additionally, it provides an update on the contribution of CA to neonatal deaths in Malta and other EU countries.
METHODS: Anonymous data for births and neonatal deaths were obtained for 2006-2020 from the National Obstetrics Information System (NOIS) in Malta. Regression analyses adjusting for maternal risk factors were run on this data to explore possible associations with NMR. NMRs published by EUROSTAT 2011-2020 were used to compare mortality by underlying cause of death (CA or non-CA causes) for Malta and other EU countries.
RESULTS: Between 2006 and 2020, 63,890 live births with 283 neonatal deaths were registered in Malta, (NMR 4.4 per 1000 live births). CA accounted for 39.6% of neonatal deaths. No time trends were observed in either total NMR, NMR attributed to CA or mortality due to non-CA causes. Adjusted variables revealed associations for women hailing from non-EU, low-income countries. Malta registered high NMRs compared to EU countries, most marked for deaths attributed to CA.
CONCLUSIONS: Between 2006 and 2020, Malta\'s NMR remained stable. Maternal Nationality, from non-EU low-income countries, was associated with higher neonatal mortality. The influx of such migrants may play a partial role in the high NMRs experienced. Malta\'s high NMR was primarily driven by early neonatal deaths, which included high proportions of deaths due to CA and is linked to the fact that termination of pregnancy is illegal in Malta.

OBJECTIVE: This study examines the impact of the COVID-19 pandemic on both routine and non-routine vaccinations in infants during their initial 18 months of life, concurrently exploring the complex influence of sociodemographic factors.
METHODS: A cohort study was conducted, involving 2007 children in two distinct periods: pre-pandemic (January-June 2018) and pandemic (March 2020-May 2021). Participants were classified into two cohorts: 962 children in the 2018 group and 1045 children in the 2020-21 group. Utilizing unconditional logistic regression, the association between vaccination (complete or non-routine) and socioeconomic factors was examined, with adjustments for potential confounding variables such as age, breastfeeding, gestational age, and twins.
RESULTS: The study\'s analysis reveals that in the post-pandemic period, mothers were three times more likely to opt for non-routine vaccines (95% CI 2.25-4.23). However, no significant alterations were observed in routine vaccination rates. Protective factors for complete vaccination included having an employed mother, higher education, and a medium-to-high income. Conversely, a higher income was associated with a reduced likelihood of complete vaccination (OR 0.34, 95% CI 0.20-0.59).
CONCLUSIONS: Contrary to initial expectations, this study concludes that the COVID-19 pandemic did not have a substantial impact on childhood complete vaccination rates. Nevertheless, a noticeable increase in the choice of non-routine vaccination was observed. Sociodemographic factors, such as maternal education, income, and employment status, emerged as key influencers, particularly in the context of deciding on non-routine vaccinations.

Background The infant mortality rate is defined as the number of infant deaths for every 1000 live births. In 2020, the infant mortality rate was 5.8% in the state of Florida, compared to 7.0% in 2000. Although infant mortality rates have declined in the state of Florida, disparities influencing these rates exist across varying Florida counties, with the widest differences being compared between the healthiest versus unhealthiest counties in Florida. Many factors can contribute to high infant mortality rates in certain counties, including income inequality, access to and quality of healthcare, race/ethnicity, obesity, and disadvantaged socioeconomic status (SES). Methods This study utilized data from Florida Health Charts on infant mortality rates in the state of Florida and the Pregnancy and Young Child Profiles in 10 counties to examine how certain risk factors impact infant mortality outcomes in the state of Florida. These 10 counties consist of five healthiest and five unhealthiest counties, as determined by the 2022 County Health Rankings data. T-tests were used to evaluate the relationship between county health status and several county health indicators. Results The average infant mortality rate from 2011 to 2020 differed significantly among healthy and unhealthy counties (p-value=0.0000). Median household income, individuals below the poverty level, and those aged zero to 17 years old were found to differ significantly by county health status (p-values 0.0000, 0.001, and 0.009, respectively). However, mothers having no high school education, births with first-trimester care, births with adequate care, and births with late or no prenatal care were not statistically significant. Conclusion Our study suggests that counties more likely to have fewer resources than other counties, such as those considered unhealthy, are more impacted by a higher infant mortality rate. The unhealthy counties in this study were found to have lower average median household income, higher rates of no high school education among mothers, and less prenatal care in comparison to healthy counties.

This systematic review and meta-analysis aimed to examine the association between maternal education and completion of childhood vaccination among aged 12-23 months children in Ethiopia. Systematic review and meta-analysis. PubMed-Medline, EMBASE, SCOPUS, Global Health, and Google Scholar were searched for articles published from January 2010 to January 2020. The data extraction was reported based on the PRISMA guideline (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. We performed the I2 test and a funnel plot to assess heterogeneity and check for publication bias. We assessed 841 studies for eligibility, of which 43 studies were included in the qualitative synthesis, and 28 studies were fully accessed for meta-analysis. The overall pooled effect of this systematic review and meta-analysis demonstrated a positive association between maternal education and completion of childhood vaccination. Having a primary level of maternal education was correlated with a 1.87 times higher likelihood (95% CI 1.76-1.98) of completing childhood vaccination compared to having no education. Furthermore, attending secondary education and above was associated with a 3.47 times higher likelihood (95% CI 3.18-3.78) of completing childhood vaccination compared to having no education. This systematic review and meta-analysis study revealed that as the level of maternal education increases, the completion of childhood vaccination accelerates. Therefore, investment in maternal education should be prioritized as an intervention. Empowering mothers through education can contribute to the reduction and prevention of vaccine-preventable diseases and associated risks.

Based on a sample of 8271 mothers, this study explored a set of psychological and sociodemographic factors associated with their vocabulary, drawing on data from a large, nationally representative sample of children born in 2000. The dependent variable was maternal vocabulary assessed when cohort members were at fourteen years of age, and the mothers were in their mid-forties. Data were also collected when cohort members were at birth, 9 months old, and at ages 3, 7, 11 and 14 years. Correlational analysis showed that family income at birth, parent-child relationship quality at age 3, maternal educational qualifications at age 11, and maternal personality trait Openness at age 14 were significantly and positively associated with maternal vocabulary. It also showed maternal malaise at 9 months and children\'s behavioral adjustment at age 7, and maternal traits Neuroticism and Agreeableness at age 14 were significantly and negatively associated with maternal vocabulary. Maternal age was also significantly and positively associated with vocabulary. Regression analysis showed that maternal age, malaise, parent-child relationship quality, children\'s behavioral adjustment, maternal educational qualifications, and traits Openness and Agreeableness were significant predictors of maternal vocabulary, accounting for 33% of total variance. The implications and limitations are discussed.

Background. Maternal education may influence child supervision practices in low-and middle-income countries (LMIC). However, little is known about the maternal factors that can improve child supervision in LMIC with scarce childcare facilities. Objective. To investigate the prevalence of children under 5 years home alone and examine the association between mother\'s formal education and children home alone across 63 LMIC. Methods. The study used data from 50 Multiple Indicator Cluster Surveys and 13 Demographic and Health Surveys with a sample of 501 769 children. We estimated Prevalence Ratios (PRs) for the association between maternal education and children home alone using multivariable Poisson regression, adjusting for covariates such as child\'s age and sex, mother\'s age and marital status, number of adults inhabiting the households, and urbanicity. Results. Prevalence of children home alone across 63 LMIC ranged from 1.1% to 50.1%. A significant negative association between mothers with more years of formal education and children home alone was found across 16 LMIC. However, the opposite trend was observed in Nigeria, Senegal, and Côte d\'Ivoire. Null association was found across 44 LMIC. Conclusions. The varied pattern of the associations observed across LMIC underscores the importance of regional and local factors when developing policies and interventions to ensure safety and adequate care for children aged under 5 years in LMIC.

OBJECTIVE: The epidemiology of adult attention deficit hyperactivity disorder (ADHD) is not well explored in India. The present study aims to systematically review the literature on the prevalence of adult ADHD in India and also estimate the prevalence and sociodemographic correlates of adult ADHD among the young adults in Delhi-NCR.
METHODS: For the systematic review, 494 articles were identified of which 10 were included in the review. Simultaneously, a cross-sectional study was conducted involving 1665 adults (18-25 years; mean age 19.92) of both sexes (69.1% females) from different colleges in Delhi-NCR, India. Data was collected using structured interviews and standardized diagnostic tool ASRS V1.1 was used for screening of ADHD.
RESULTS: The systematic review revealed a high prevalence of adult ADHD ranging from 5.48 to 25.7% among general and specific populations of India. Further, in the cross-sectional study, 14% of participants were screened positive for ADHD. While factors like South Indian origin and higher maternal education were associated with an increased risk of adult ADHD, low socioeconomic status was found to be protective.
CONCLUSIONS: Considering the high prevalence of adult ADHD in India, there is an urgent need to increase awareness regarding adult ADHD and identify vulnerable populations to facilitate informed interventions.

Early vocabulary development is crucial for future cognitive and academic outcomes, and parent-child booksharing has been recognized as a powerful home literacy practice to promote word learning. However, evidence about the link between booksharing and language development in diverse cultural and socioeconomic settings is currently limited, hindering the formulation of a broadly applicable framework to understand the favorable conditions for early vocabulary development. This study explores the relationship between booksharing and early receptive and expressive vocabulary in a sample of 183 mothers and their toddlers in Costa Rica, a context where reading is not a common practice and children have limited access to books. Mothers completed an interview about their booksharing practices and reported children\'s receptive and expressive vocabulary. Results demonstrated a positive link between maternal booksharing and children\'s expressive vocabulary. Child gender moderated the link between booksharing and receptive vocabulary, exhibiting a stronger association in girls than in boys. Mothers with lower education levels reported higher expressive vocabulary scores for their children than mothers with higher education levels. These findings underscore the significance of booksharing in the home literacy environment, even in cultural contexts with distinct reading practices. Moreover, they highlight the need to incorporate sociocultural factors into comprehensive accounts concerning the role of booksharing in early word learning.

BACKGROUND: Adverse childhood experiences (ACEs) of mothers have been shown to be associated with children\'s mental health and behavior problems. It is important to identify effective intervention points to prevent negative consequences among children. This study aimed to investigate whether mothers\' education is protective against children\'s depressive symptoms in families with mothers who experienced parental divorce in childhood.
METHODS: Data from a cross-sectional study of 5th and 8th grade children and their caregivers in a prefecture in Japan were used. Final analytic sample consisted of 9666 child-caregiver pairs. Mediation analyses using inverse odds weighting were performed where the exposure was maternal experience of parental divorce in childhood, outcome was child depressive symptoms, and potential mediators were maternal education beyond high school, maternal mental health, and household income.
RESULTS: Maternal experience of parental divorce was associated with an elevated risk of child depressive symptoms (risk ratio: 1.22, 95 % confidence interval (CI): 1.07-1.39). Mediation analyses indicated that the combination of maternal education, maternal depression and household income mediated about half of the total effect. In the model where maternal education was the sole mediator, maternal education mediated nearly half of the total effect (risk ratio: 1.10, 95 % CI: 1.01-1.20).
CONCLUSIONS: Results should be cautiously interpreted given observational and cross-sectional nature of the data.
CONCLUSIONS: Maternal education beyond high school may be protective against negative mental health consequences among children due to mothers\' experience of parental divorce. Further studies are needed regarding potential mechanisms and the roles of other potential mediators.

BACKGROUND: The goal of the United Nations Sustainable Development Goal (SDG) 4 is to ensure inclusive and equitable quality education and promote lifelong learning opportunities for all. The aim of this scoping review was to map the current evidence on the association between the prevalence of early childhood caries (ECC) and parental education; and to identify possible pathways by which parental education may protect against ECC.
METHODS: The two questions that guided this review were: what is the existing evidence on the association between maternal and paternal education and ECC; and what are the pathways by which parental education protects against ECC? The initial search was conducted in January 2023 in PubMed, Web of Science and Scopus. Articles published in English between January 2000 and October 2022 that reported on the association between parental education and ECC were screened, and the extracted data were compiled, summarized, and synthesized. Review papers and non-primary quantitative research papers were excluded from the full-text review. Open coding was applied to develop a conceptual framework.
RESULTS: In total, 49 studies were included: 42 cross-sectional, 3 case-control and 4 cohort studies. The majority (91.8%) reported on the associations between ECC and maternal (n = 33), paternal (n = 3), and parental (n = 9) level of education, and 13 (26.7%) reported on the association between parental education and the severity of ECC. Mothers with more than primary school education (n = 3), post-secondary/college/tertiary education (n = 23), and more than 4-12 years of education (n = 12) had children with lower risk for ECC. Two studies reporting on parental education found an association between maternal but not paternal education and ECC. The review suggests that achieving the SDG 4.1 may reduce the risk of ECC. Possible pathways by which maternal education protects from ECC were feeding practices, oral hygiene practices, and the use of dental services.
CONCLUSIONS: The study findings suggests that higher maternal educational level may reduce the risk for the consumption of cariogenic diet, poor oral hygiene practices and poor use of dental services for caries prevention. However, the association between paternal education and ECC was not consistently observed, with significant associations less frequently reported compared to maternal education. Future studies are needed to define the magnitude and modifiers of the impact of maternal education on the risk for ECC.