The Child Opportunity Index is calculated based on Education, Health & Built Environment and Neighborhood Social & Economic Opportunity indicators.

ObjectiveTo describe the development of an area-level measure of children's opportunity, the Ohio Children's Opportunity Index (OCOI).Data Sources/Study SettingSecondary data were collected from US census based-American Community Survey (ACS), US Environmental Protection Agency, US Housing and Urban Development, Ohio Vital Statistics, US Department of Agriculture-Economic Research Service, Ohio State University Center for Urban and Regional Analysis, Ohio Incident Based Reporting System, IPUMS National Historical Geographic Information System, and Ohio Department of Medicaid. Data were aggregated to census tracts across two time periods.Study DesignOCOI domains were selected based on existing literature, which included family stability, infant health, children's health, access, education, housing, environment, and criminal justice domains. The composite index was developed using an equal weighting approach. Validation analyses were conducted between OCOI and health and race-related outcomes, and a national index.Principal FindingsComposite OCOI scores ranged from 0–100 with an average value of 74.82 (SD, 17.00). Census tracts in the major metropolitan cities across Ohio represented 76% of the total census tracts in the least advantaged OCOI septile. OCOI served as a significant predictor of health and race-related outcomes. Specifically, the average life expectancy at birth of children born in the most advantaged septile was approximately 9 years more than those born in least advantaged septile. Increases in OCOI were associated with decreases in proportion of Black (48 points lower in the most advantaged vs. least advantaged septile), p < 0.001) and Minority populations (54 points lower in most advantaged vs. least advantaged septile, p < 0.001). We found R-squared values > 0.50 between the OCOI and the national Child Opportunity Index scores. Temporally, OCOI decreased by 1% between the two study periods, explained mainly by decreases in the children health, accessibility and environmental domains.ConclusionAs the first opportunity index developed for children in Ohio, the OCOI is a valuable resource for policy reform, especially related to health disparities and health equity. Health care providers will be able to use it to obtain holistic views on their patients and implement interventions that can tackle barriers to childhood development using a more tailored approach.

ObjectivesRegional sleep differences may reflect other important indicators of health and well-being. Examining sleep health at the regional level can help inform policies to improve population health. We examined the relationship between neighborhood-level adult sleep health (modeled in this study via adult sleep duration) and other health metrics and multiple indicators of child-relevant opportunity.MethodsData were obtained from the “500 Cities” data collected by the CDC, including the proportion of the adult population in each tract that report obtaining at least 7 h of sleep. The Child Opportunity Index (COI) provides indices for “education,” “health and environment,” and “social and economic” domains, as well as a global score. When data were merged, 27,130 census tracts were included. Linear regression analyses examined COI associated with the proportion of the adult population obtaining 7 h of sleep.ResultsAdult sleep duration was associated with global COI, such that for each additional percent of the population that obtains ≥ 7 h of sleep, COI increases by 3.6 points (95%CI[3.57, 3.64]). Each component of COI was separately related to adult sleep duration. All associations were attenuated but significant in adjusted analyses. In stepwise analyses, sleep health via adult sleep duration emerged as the strongest correlate of global COI, accounting for 57.2% of the variance (p 

BackgroundChildren from families with low socioeconomic status (SES), as determined by income, experience several negative outcomes, such as higher rates of newborn mortality and behavioral issues. Moreover, associations between DNA methylation and low income or poverty status are evident beginning at birth, suggesting prenatal influences on offspring development. Recent evidence suggests neighborhood opportunities may protect against some of the health consequences of living in low income households. The goal of this study was to assess whether neighborhood opportunities moderate associations between household income (HI) and neonate developmental maturity as measured with DNA methylation.MethodsUmbilical cord blood DNA methylation data was available in 198 mother-neonate pairs from the larger CANDLE cohort. Gestational age acceleration was calculated using an epigenetic clock designed for neonates. Prenatal HI and neighborhood opportunities measured with the Childhood Opportunity Index (COI) were regressed on gestational age acceleration controlling for sex, race, and cellular composition.ResultsHigher HI was associated with higher gestational age acceleration (B = .145, t = 4.969, p = 1.56x10-6, 95% CI [.087, .202]). Contrary to expectation, an interaction emerged showing higher neighborhood educational opportunity was associated with lower gestational age acceleration at birth for neonates with mothers living in moderate to high HI (B = -.048, t = -2.08, p = .03, 95% CI [-.092, -.002]). Female neonates showed higher gestational age acceleration at birth compared to males. However, within males, being born into neighborhoods with higher social and economic opportunity was associated with higher gestational age acceleration.ConclusionPrenatal HI and neighborhood qualities may affect gestational age acceleration at birth. Therefore, policy makers should consider neighborhood qualities as one opportunity to mitigate prenatal developmental effects of HI.

Maps the number of children under 5 years of age,against the Child Opportunity Index

This collection of maps looks at the locations of Head Start programs, child care programs, and public schools in the context of a number of different factors. These factors include race/ethnicity, poverty, and the Child Opportunity Index.

Demographic, risk, and protective factors by neonate sex.

BackgroundFragile X syndrome (FXS) is the most common inherited cause of intellectual disability and is caused by reduced or absent Fragile X messenger ribonucleoprotein (FMRP). Cognitive and adaptive skills widely vary among individuals with FXS, and these individual phenotypic differences are not fully accounted for by individual differences in FMRP expression. Social-environmental factors, including social determinants of health, may help further explain these individual differences, but these environmental factors have been under-studied in FXS.Methods175 participants with FXS (123 males; age range: 4–72 years) completed the Stanford-Binet, Fifth Edition to estimate IQ and a blood draw to quantify peripheral FMRP levels. Caregivers from a subset of participants also completed the Vineland Adaptive Behavior Scales. Neighborhood-level social-environmental information was extracted by linking participants’ home addresses to rankings of neighborhood resources (e.g., household income, pollution, healthcare access) from the Child Opportunity Index (COI). We calculated the unique variance in IQ and adaptive behaviors accounted for by these neighborhood-level social-environmental factors from the COI while covarying for FMRP expression.ResultsEven after accounting for individual differences in FMRP, numerous neighborhood factors were associated with greater IQ in males with FXS, including social resources and indicators of healthcare access. Different social-environment factors were associated with stronger adaptive skills in males with FXS, including economic and educational resources. Almost no neighborhood factors were associated with clinical outcomes in females.DiscussionOur finding of stronger links between neighborhood resources and clinical outcomes in males with FXS is consistent with previous work and may reflect increased reliance on social-environmental supports in males who typically have more significant intellectual and adaptive deficits than females. Consistent associations between greater social resources, higher IQ, and stronger adaptive skills suggest social support (e.g., social cohesion, resource and knowledge sharing) may be a particularly salient target for intervention. Associations between economic resources and adaptive communication skills also highlight the benefits of targeted economic supports for families affected by FXS. Together, our findings underscore the role of social determinants of health as key contributors to individual differences and the importance of considering these factors in clinical studies of FXS.

Goal 4Ensure inclusive and equitable quality education and promote lifelong learning opportunities for allTarget 4.1: By 2030, ensure that all girls and boys complete free, equitable and quality primary and secondary education leading to relevant and effective learning outcomesIndicator 4.1.1: Proportion of children and young people (a) in grades 2/3; (b) at the end of primary; and (c) at the end of lower secondary achieving at least a minimum proficiency level in (i) reading and (ii) mathematics, by sexSE_TOT_PRFL: Proportion of children and young people achieving a minimum proficiency level in reading and mathematics (%)Indicator 4.1.2: Completion rate (primary education, lower secondary education, upper secondary education)SE_TOT_CPLR: Completion rate, by sex, location, wealth quintile and education level (%)Target 4.2: By 2030, ensure that all girls and boys have access to quality early childhood development, care and pre-primary education so that they are ready for primary educationIndicator 4.2.1: Proportion of children aged 24-59 months who are developmentally on track in health, learning and psychosocial well-being, by sexiSE_DEV_ONTRK: Proportion of children aged 36−59 months who are developmentally on track in at least three of the following domains: literacy-numeracy, physical development, social-emotional development, and learning (% of children aged 36-59 months)Indicator 4.2.2: Participation rate in organized learning (one year before the official primary entry age), by sexSE_PRE_PARTN: Participation rate in organized learning (one year before the official primary entry age), by sex (%)Target 4.3: By 2030, ensure equal access for all women and men to affordable and quality technical, vocational and tertiary education, including universityIndicator 4.3.1: Participation rate of youth and adults in formal and non-formal education and training in the previous 12 months, by sexSE_ADT_EDUCTRN: Participation rate in formal and non-formal education and training, by sex (%)Target 4.4: By 2030, substantially increase the number of youth and adults who have relevant skills, including technical and vocational skills, for employment, decent jobs and entrepreneurshipIndicator 4.4.1: Proportion of youth and adults with information and communications technology (ICT) skills, by type of skillSE_ADT_ACTS: Proportion of youth and adults with information and communications technology (ICT) skills, by sex and type of skill (%)Target 4.5: By 2030, eliminate gender disparities in education and ensure equal access to all levels of education and vocational training for the vulnerable, including persons with disabilities, indigenous peoples and children in vulnerable situationsIndicator 4.5.1: Parity indices (female/male, rural/urban, bottom/top wealth quintile and others such as disability status, indigenous peoples and conflict-affected, as data become available) for all education indicators on this list that can be disaggregatedSE_GPI_PTNPRE: Gender parity index for participation rate in organized learning (one year before the official primary entry age), (ratio)SE_GPI_TCAQ: Gender parity index of trained teachers, by education level (ratio)SE_GPI_PART: Gender parity index for participation rate in formal and non-formal education and training (ratio)SE_GPI_ICTS: Gender parity index for youth/adults with information and communications technology (ICT) skills, by type of skill (ratio)SE_IMP_FPOF: Immigration status parity index for achieving at least a fixed level of proficiency in functional skills, by numeracy/literacy skills (ratio)SE_NAP_ACHI: Native parity index for achievement (ratio)SE_LGP_ACHI: Language test parity index for achievement (ratio)SE_TOT_GPI: Gender parity index for achievement (ratio)SE_TOT_SESPI: Low to high socio-economic parity status index for achievement (ratio)SE_TOT_RUPI: Rural to urban parity index for achievement (ratio)SE_ALP_CPLR: Adjusted location parity index for completion rate, by sex, location, wealth quintile and education levelSE_AWP_CPRA: Adjusted wealth parity index for completion rate, by sex, location, wealth quintile and education levelSE_AGP_CPRA: Adjusted gender parity index for completion rate, by sex, location, wealth quintile and education levelTarget 4.6: By 2030, ensure that all youth and a substantial proportion of adults, both men and women, achieve literacy and numeracyIndicator 4.6.1: Proportion of population in a given age group achieving at least a fixed level of proficiency in functional (a) literacy and (b) numeracy skills, by sexSE_ADT_FUNS: Proportion of population achieving at least a fixed level of proficiency in functional skills, by sex, age and type of skill (%)Target 4.7: By 2030, ensure that all learners acquire the knowledge and skills needed to promote sustainable development, including, among others, through education for sustainable development and sustainable lifestyles, human rights, gender equality, promotion of a culture of peace and non-violence, global citizenship and appreciation of cultural diversity and of culture’s contribution to sustainable developmentIndicator 4.7.1: Extent to which (i) global citizenship education and (ii) education for sustainable development are mainstreamed in (a) national education policies; (b) curricula; (c) teacher education; and (d) student assessmentTarget 4.a: Build and upgrade education facilities that are child, disability and gender sensitive and provide safe, non-violent, inclusive and effective learning environments for allIndicator 4.a.1: Proportion of schools offering basic services, by type of serviceSE_ACS_CMPTR: Schools with access to computers for pedagogical purposes, by education level (%)SE_ACS_H2O: Schools with access to basic drinking water, by education level (%)SE_ACS_ELECT: Schools with access to electricity, by education level (%)SE_ACC_HNDWSH: Schools with basic handwashing facilities, by education level (%)SE_ACS_INTNT: Schools with access to the internet for pedagogical purposes, by education level (%)SE_ACS_SANIT: Schools with access to access to single-sex basic sanitation, by education level (%)SE_INF_DSBL: Proportion of schools with access to adapted infrastructure and materials for students with disabilities, by education level (%)Target 4.b: By 2020, substantially expand globally the number of scholarships available to developing countries, in particular least developed countries, small island developing States and African countries, for enrolment in higher education, including vocational training and information and communications technology, technical, engineering and scientific programmes, in developed countries and other developing countriesIndicator 4.b.1: Volume of official development assistance flows for scholarships by sector and type of studyDC_TOF_SCHIPSL: Total official flows for scholarships, by recipient countries (millions of constant 2018 United States dollars)Target 4.c: By 2030, substantially increase the supply of qualified teachers, including through international cooperation for teacher training in developing countries, especially least developed countries and small island developing StatesIndicator 4.c.1: Proportion of teachers with the minimum required qualifications, by education leveliSE_TRA_GRDL: Proportion of teachers who have received at least the minimum organized teacher training (e.g. pedagogical training) pre-service or in-service required for teaching at the relevant level in a given country, by sex and education level (%)

BackgroundEnvironmental resources are related to childhood obesity risk and altered brain development, but whether these relationships are stable or if they have sustained impact is unknown. Here, we utilized a multidimensional index of childhood neighborhood conditions to compare the influence of various social and environmental disparities (SED) on body mass index (BMI)-brain relationships over a 2-year period in early adolescence.MethodsData were gathered the Adolescent Brain Cognitive Development Study® (n = 2,970, 49.8% female, 69.1% White, no siblings). Structure magnetic resonance imaging (sMRI), anthropometrics, and demographic information were collected at baseline (9/10-years-old) and the 2-year-follow-up (11/12-years-old). Region of interest (ROIs; 68 cortical, 18 subcortical) estimates of cortical thickness and subcortical volume were extracted from sMRI T1w images using the Desikan atlas. Residential addresses at baseline were used to obtain geocoded estimates of SEDs from 3 domains of childhood opportunity index (COI): healthy environment (COIHE), social/economic (COISE), and education (COIED). Nested, random-effects mixed models were conducted to evaluate relationships of BMI with (1) ROI * COI[domain] and (2) ROI * COI[domain]* Time. Models controlled for sex, race, ethnicity, puberty, and the other two COI domains of non-interest, allowing us to estimate the unique variance explained by each domain and its interaction with ROI and time.ResultsYouth living in areas with lower COISE and COIED scores were heavier at the 2-year follow-up than baseline and exhibited greater thinning in the bilateral occipital cortex between visits. Lower COISE scores corresponded with larger volume of the bilateral caudate and greater BMI at the 2-year follow-up. COIHE scores showed the greatest associations (n = 20 ROIs) with brain-BMI relationships: youth living in areas with lower COIHE had thinner cortices in prefrontal regions and larger volumes of the left pallidum and Ventral DC. Time did not moderate the COIHE x ROI interaction for any brain region during the examined 2-year period. Findings were independent of family income (i.e., income-to-needs).ConclusionCollectively our findings demonstrate that neighborhood SEDs for health-promoting resources play a particularly important role in moderating relationships between brain and BMI in early adolescence regardless of family-level financial resources.

Research project

The project “Educational Success and Social Participation of Socially and Educationally Disadvantaged Students with Migration Background in Extended Education” (abbr. in German: GeLeGanz) was funded by the German Federal Ministry of Education and Research (BMBF) under the funding code 01JB211A-C from 2021 to 2025.

Traditionally, the German education system is organized as a “half-day”-system; instruction usually takes place in the morning. Many stakeholders see the conversion from half-day to all-day schooling as a way of overcoming the challenges facing the system, including those posed by immigration. High expectations are attached to the expansion of all-day schooling, in particular the strengthening of the educational success and social participation of socially and educationally disadvantaged students with a migration background. As yet however, these goals have not been sufficiently achieved in Germany. Education systems in other countries have established comparable offerings of high quality that appear to be effective. The GeLeGanz project aims to use findings and knowledge from other countries to better exploit the potential of all-day schools in Germany, particularly at the primary school level. The primary focus of the GeLeGanz project is on the potential of all-day primary schools to improve the educational opportunities of socially and educationally disadvantaged students, in particular those who live in a migrant family.

GeLeGanz is a collaborative project, carried out by three partners.

Freie Universität Berlin (FU):

• Prof. Dr. Marianne Schüpbach (Coordinator of the collaborative project, Co-head of the subproject FU Berlin): marianne.schuepbach@fu-berlin.de
• Dr. Nanine Lilla (Co-head of the subproject FU Berlin): nanine.lilla@fu-berlin.de
• Dr. Haiqin Ning (Researcher, Operational coordinator of the collaborative project): haiqin.ning@fu-berlin.de
• Jule Schmidt (Researcher): jule.swaantje.schmidt@fu-berlin.de

German Children and Youth Foundation (DKJS):

• Anna-Margarete Davis (Co-head of the subproject DKJS): anna-margarete.davis@dkjs.de
• Nicola Andresen (Co-Lead of the subproject DKJS and school counselling): nicola.andresen@dkjs.de

University of Hamburg (UHH):

• Prof. Dr. Dr. h.c. mult. Ingrid Gogolin (head of the subproject UHH): gogolin@uni-hamburg.de
• Luise Krejcik (Researcher): luise.krejcik@uni-hamburg.de

To achieve the objectives, the project was divided into the following phases:

Phase I: Expert interviews with researchers from the German and international research context on their perception of quality features and conditions for the successful design of all-day schools.

Phase II: The experts were interviewed again to evaluate and further specify the results with regard to the target group. For this, they were provided with a summary of the statements made by researchers from the German and international research context in Phase I.

Phase III: Focus group interviews with various practice-oriented actors from the German all-day school context, based on the results of expert interviews, to gain information and assessments related to the implementation of measures that might improve all-day schooling in Germany.

Phase IV: Based on the insights gained in the first three parts of the project, materials and concepts should be developed together with practice partner DKJS and transfer partners.

Project website: https://www.ewi-psy.fu-berlin.de/en/v/geleganz/index.html

Data set in UHH

The present data set comprises 30 expert interviews with 15 researchers from the German education research community, which were collected as part of the GeLeGanz project in phase I and II.

Experts: 15 researchers were interviewed twice (1x in phase I and 1x in phase II of the project). All were experts with relevant research experience, but different perspectives on the project’s guiding questions: all-day schools, informal and nonformal education, cultural and language diversity, social inequality and school development. The interview partners were identified via a review of empirical research on conditions of educational success of socially disadvantaged children with a migrant background and the potential advantages of all-day schools.

Interview procedure & topics: A sequential approach was chosen for conducting the interviews: In Phase I, interviewees were asked for

1. research-based assessments of features of high-quality all-day schools, especially for the support of socially disadvantaged children with a migration history,
2. factors that promote or hinder participation in all-day schools’ offers,
3. assessments of the current all-day school landscape in Germany.

In Phase II, the experts were interviewed again. They were provided with a summary of the statements made by the German and international experts in interviews of phase I. Experts were invited to prioritize the mentioned quality features and the potential for adaptation and implementation in the German context.

A semi-structured, problem-centred approach was used to conduct the interviews (Witzel, 2000). The guidelines included narrative-generating impulse questions, follow-up questions to promote understanding and narrative generation, and ad hoc questions on the topics discussed. The interviews were conducted in German by two trained interviewers (online or analogous). All interviews were recorded based on informed consent.

Period of the survey: The interviews were conducted from March to December 2022.

Transcription & anonymization: The transcripts were initially computer-generated, then completely revised manually according to established transcription and anonymization rules (Rädiker and Kuckartz, 2019, p. 44f).

Contents of the data set UHH:

• Collected storage of the 30 interview transcripts in a single MAXQDA project (version 2022, MX22-file)
• Individual file of the 30 interview transcripts in Excel format (xls) and html format
• Anonymization and transcription rules, data naming scheme (pdf)

Note: The dataset is stored in the ZFMD repository of the University of Hamburg in both an open-access (DOI 10.25592/uhhfdm.14815) and a restricted-access version (DOI 10.25592/uhhfdm.14771). Both datasets are available from January 1, 2026. In the open access dataset, research-related data such as research projects and studies of the respondents are anonymized in addition to personal and school-related data. In the restricted access dataset, only the respondents' personal and school-related data are anonymized.

References:

Rädiker, S., & Kuckartz, U. (2019). Analyse qualitativer Daten mit MAXQDA: Text, Audio und Video. Springer Fachmedien.

Witzel, A. (2000). Das problemzentrierte Interview [25 Absätze]. Forum: Qualitative Social Research, 1(1), Article 22. http://nbnresolving.de/urn:nbn:de:0114-fqs0001228

Discover the booming indexed and whole juvenile life insurance market projected to reach $89 Billion by 2033, growing at a 15% CAGR. This comprehensive analysis explores market drivers, trends, and key players like Allianz, MetLife, and AXA, offering insights for investors and industry professionals. Learn more about securing your child's future.

BackgroundAs new interventions to reduce childhood mortality are identified, careful consideration must be given to identifying populations that could benefit most from them. Promising reductions in childhood mortality reported in a large cluster randomized trial of mass drug administration (MDA) of azithromycin (AZM) prompted the development of visually compelling, easy-to-use tools that synthesize country-specific data on factors that would influence both potential AZM benefit and MDA implementation success.Methodology/Principal FindingsWe assessed the opportunity to reduce mortality and the feasibility of implementing such a program, creating Opportunity and Feasibility Indices, respectively. Countries with high childhood mortality were included. A Country Ranking Index combined key variables from the previous two Indices and applied a scoring system to identify high-priority countries. We compared four scenarios with varying weights given to each variable.Twenty-five countries met inclusion criteria. We created easily visualized tools to display the results of the Opportunity and Feasibility Indices. The Opportunity Index revealed substantial variation in the opportunity for an MDA of AZM program to reduce mortality, even among countries with high overall childhood mortality. The Feasibility Index demonstrated that implementing such a program would be most challenging in the countries that could see greatest benefit. Based on the Country Ranking Index, Equatorial Guinea would benefit the most from the MZA of AZM in three of the four scenarios we tested.Conclusions/SignificanceThese visually accessible tools can be adapted or refined to include other metrics deemed important by stakeholders, and provide a quantitative approach to prioritization for intervention implementation. The need to explicitly state metrics and their weighting encourages thoughtful and transparent decision making. The objective and data-driven approach promoted by the three Indices may foster more efficient use of resources.

BackgroundRespiratory viruses such as rhinovirus and respiratory syncytial virus (RSV) are common triggers of asthma exacerbations in children. The COVID-19 pandemic introduced non-pharmaceutical interventions (NPIs) that altered viral circulation; however, their long-term effects on pediatric asthma outcomes remain unclear.ObjectiveTo evaluate how the epidemiology and severity of respiratory viral infections in children with asthma changed before, during, and after COVID-19-related NPIs.MethodsWe conducted a cross-sectional analysis of pediatric asthma patients (ages 4–18) with laboratory-confirmed respiratory viral infections from 2018 to 2024 at Arkansas Children's (AC) and AC Northwest (ACNW). Viral detection was performed using the BioFire® Respiratory Panel. Clinical severity was evaluated using a modified World Health Organization Ordinal Scale for Clinical Improvement (mWHO OSI). Patients were categorized by period (pre-NPI, NPI, post-NPI), viral type, rurality, and Childhood Opportunity Index (COI).ResultsThis study included 9,391 pediatric asthma patients with laboratory-confirmed viral infections. RV/EV was the most common virus during all periods. Viral incidence decreased during NPIs but rebounded post-NPI with unusual seasonality. mWHO OSI scores declined over time (pre-NPI: 2.98; NPI: 2.49; post-NPI: 2.28), with significant reductions in hospitalizations, PICU admissions, and oxygen use (p 

Decomposition of Inequality of opportunity in stunting (Oaxaca decomposition of D-index).

IntroductionMalnutrition among children is one of the major health challenges in Pakistan. The National Nutritional Survey 2018 revealed that 44% of children are stunted. Different circumstances surrounding a child’s birth can lead to inequality of opportunity in early childhood, with significant nutritional inequalities between rural and urban areas. This study aims to identify the drivers of inequality of opportunity in stunting among children under-five years of age in Pakistan.MethodsThis study used Pakistan Demographic and Health Survey, 2017–18 to identify the factors contributing to inequality of opportunity in child’s stunting. The Dissimilarity index (D-index), along with Oaxaca decomposition, and Shapely decomposition were employed to measure and decompose inequality in opportunity in stunting. Regional variations in stunting among children under various circumstances were analyzed using Geographic Information System or GIS.ResultsThe burden of stunting is exceptionally high in Pakistan, with the prevalence in rural areas significantly exceeding that in urban areas from 1990 to 2018. Shapley decomposition of the contributors to inequality in opportunity indicates that maternal education accounted for 24% of total inequality among rural children and 44% among urban children. Water and sanitation contributed 22% to overall inequality in rural areas but only 2% in urban areas, highlighting the critical role of inadequate water and sanitation in rural settings. The wealth index was a predominant contributor to inequality both nationally and in urban areas. Southern regions exhibit a higher prevalence of stunting and a greater proportion of households lacking adequate water and sanitation. Additionally, the concentration of uneducated mothers and stunted children is notably high in Balochistan and Sindh.ConclusionsThe lack of maternal education, inadequate access to water and sanitation services, and lower socio-economic status are key factors contributing to inequality of opportunity in stunting among children under five in Pakistan. Understanding the critical role of these circumstances can help policymakers address the situation and implement concrete steps to enhance equal opportunities for child health.

There are 750,000 emergency department (ED) visits by children for asthma exacerbations in the United States annually. Despite changing evidence and epidemiology, there have not been recent assessments of acute asthma prevalence, management, and outcomes from pediatric EDs. This 40-center retrospective evaluation utilizes the Pediatric Hospital Information System to characterize pediatric ED asthma presentations from 2015-2020. Children 2–18 years with asthma ICD-9/10 code and receipt of albuterol were included. Demographics, Child Opportunity Index (COI), ED management, return visits, and adjusted costs were evaluated. Data were summarized using standard descriptive statistics and trends assessed using Mann-Kendall trend test. There were 414,264 encounters made by 256,209 unique patients; 21% had >1 visit in 12 months. Median age was 6 years, 61.6% male, 44.5% Black, and 68.5% publicly insured; 58.3% of visits were by patients with very low/low COI. Systemic corticosteroids were administered in 86.3% of visits; 52.7% used dexamethasone. Chest radiographs were obtained in 23% of encounters. Most (74.9%) encounters resulted in ED discharge with a downward trend of visits for exacerbations per 1,000 ED visits of −9.77, 95% CI [–9.99,-9.54], increase in disposition to intensive care unit of 2.01 [1.87,2.41] and decrease in home/other of −3.77 [–4.34,–3.20]. There was no significant trend in return visits. Total adjusted costs were ∼$900 million. ED visits for asthma remain frequent and disproportionately affect children with lower social determinants of health. Dexamethasone has not been widely adopted as corticosteroid of choice and use of ancillary testing continues, highlighting opportunities for improvement in asthma care.

Cohort characteristics for pediatric patients admitted to the ICU from 2010 to 2022.

Overall early childhood development and early childhood development by domain.

Adjusted associations between overall inadequate early childhood development, domains, and urban characteristics.