Background: Hospitalization can be a source of great stress for children and their families. In high-income countries, there are specialized staff to help children cope using different techniques including play. However, it is a major challenge in low and middle-income countries (LMIC) due to financial constraints and untrained human resource. The objective of study was to develop and test the feasibility and acceptance of a psychology trainee-delivered model postulated on employing play as a means of enhancing child-parent interactions leading to reduced stress during hospitalization.Methods: This study was conducted in the paediatric ward of a tertiary care private hospital in Pakistan. Pre-intervention survey revealed that parental stress stemmed mainly from seeing their child irritable, distressed, or in pain. Using a theory of change model, a play-based psychosocial intervention was developed to address these factors. The intervention approach was informed by principles of Nurturing Care Framework and play therapy. Children between birth and 6 years admitted in the acute care ward were eligible. The intervention was delivered between March 2019 and December 2020 by psychology trainees who were supervised by a clinical psychologist. The play-based sessions were delivered at the bedside and ranged from 20 to 40 min. Parents receiving the intervention were later interviewed for their stress, child emotions, and feedback about the service using structured surveys administered by psychology graduates. The trainees delivering the intervention were requested to provide their feedback as a written qualitative open-ended narrative. These narratives were analyzed using an inductive approach.Results: The survey was conducted with 223 families with about half of the sample having children under 2 years of age. Forty-five percent of parents reported play intervention to be one of 3 key factors in improving their experience during hospital stay. Only 5% of parents reported feeling stressed about the child illness after the intervention. Ninety to 96% parents felt respected, listened to, and understood by the therapists. Thematic analysis of the feedback by trainees indicated the internship to be a useful experience and a new avenue for professional life whereas physicians appreciated the interventions.Conclusions: The authors conclude that psychology trainees can feasibly deliver a play-based intervention under supervision for reduced stress in children and their parents during hospitalization with mutual benefits.

Background: Poor personal hygiene and inadequate sanitation practices among young children leads to communicable diseases. There remains a gap in the holistic assessment of school children’s hygiene literacy, practices and effectiveness of school-based hygiene interventions in Pakistan. Therefore, a school-based intervention protocol has been designed to promote personal and environmental hygiene practices for primary school children. Towards improving children’s hygiene behaviors, the study will also focus on enhancing mothers' hygiene knowledge and practices.Methods: Using quasi-experimental design with mixed methods data collection approaches, this study will be conducted in schools located in an urban squatter settlements in Pakistan. To assess primary grade children and their mothers‘ hygiene status, a survey will be held in the pre-intervention phase. This phase also includes qualitative exploration of key stakeholders (mothers, teachers, health & education authorities representatives’) perceptions about the factors facilitating and impeding the adaption of hygiene behaviors among school children. In-depth guides and focus group discussion tools will be used for this purpose. This will be followed by multi-component intervention phase with behavior change strategies to improve children‘s and mothers’ hygiene literacy and behaviors. The post-intervention phase will assess the intervention effectiveness in terms of enhancing hygiene knowledge and practices among school children and mothers, alongside exploration of mothers and teachers’ insights into whether or not the intervention has been effective in improving hygiene practices among children. Pairedt-test will be applied pre and post-intervention to measure the differences between the mothers and children's hygiene literacy and knowledge scores. Similar test will be performed to assess the differences in children’s hygiene knowledge and practice scores, pre and post-intervention (< 50 = poor, 50–75 = good and > 75 = excellent). Thematic analysis will be carried out for qualitative data.Discussion: Multi-component intervention aimed at improving personal and environmental hygiene among primary school children offers an opportunity to design and test various behavioral change strategies at school and in home settings. The study findings will be significant in assessing the intervention’s effectiveness in improving children‘s overall hygiene.Trial registration: Retrospectively registered with ClinicalTrials.gov (NCT03942523) on 5th May 2019.

Background: Pakistan’s immunization uptake rates are still significantly lower than anticipated despite several initiatives. Lack of awareness, forgetting about vaccination schedule, and vaccine misconception/misinformation are a few of the major drivers that mitigate the rates of immunization. The current COVID-19 pandemic emphasizes the importance of immunization. The significant reductions in regular childhood vaccination during pandemic have increased the risk of outbreaks of vaccine-preventable diseases. Concerns among parents over possibly exposing their children to COVID-19 during child visits may have contributed to the reported declines. Innovative and cost-effective mHealth interventions must be implemented in order to address the problem of inadequate immunization rates. In addition, it is also critical to understand the end user needs in order to reflect on the highly relevant essence of the customized healthcare experience. Objective: The aim of this study was to learn about caregivers’ attitudes toward the usability and acceptability of behavior-change smartphone applications (mobile phones) for improving immunization coverage in Pakistan. Methods: A mixed-method design was employed for this study. The study was conducted at Aga Khan University, Hospital. Parents visiting the Community Health Center for 6-week vaccination of their children were recruited. The study was conducted in two stages. Stage 1 consisted of qualitative interviews that grasped the parent’s attitudes and challenges to immunization, as well as their acceptability and accessibility of the smartphone-based behavior-change application to increase vaccine uptake. Stage 1 was followed by stage 2, in which data were collected through a questionnaire designed by using data from qualitative interviews. Results: The majority of participants agreed that immunization serves an important role in protecting their child from illnesses that cause morbidity and mortality. Almost all of them emphasized the importance of using a pre-appointment method at vaccination center in order to reduce the waiting time. Furthermore, participants were also interested in AI-based behavior modification applications related to immunization. They also wanted to have applications in their native language for better understanding and communication of related information. In our study, approximately 95.2 percent of participants agreed to accept SMS immunization updates, which was also reasonably high. Lastly, the majority of them identified forgetfulness as a significant contributor to regular immunization. Conclusion: To enhance the uptake of childhood vaccines, overall vaccination rates, and overcome barriers related to vaccination coverage, cost-effective and user-friendly mHealth AI-based smart phone applications are required to raise awareness regarding the continuation of vaccination service and the importance of timely vaccination. Parents’ experiences and attitudes must be considered while designing and evaluating the efficacy of mHealth-based interventions.

Children with disabilities are twice as likely to experience violence compared to peers without disabilities. While evaluations of school-based interventions targeting the prevention of violence against children in schools are growing in number, it is unclear whether these interventions are inclusive of, or effective for, children with disabilities. We searched six databases (Medline, Cochrane Library, Embase, Global Health, PsycINFO, Web of Science) and utilised professional networks to identify systematic reviews which included randomised controlled trials (RCTs) of school-based violence prevention interventions up to May 2024. Once we identified our final sample of systematic reviews (n = 29) we hand searched the included papers within these reviews and included all RCTs of school-based violence prevention interventions. We applied criteria to assess disability inclusion and conducted a narrative synthesis of study characteristics, adaptations to intervention and/or data collection design, and effect estimates. We assessed risk of bias using the Cochrane Risk of Bias tool. This review was registered on PROSPERO (CRD42023463384). We identified 160 articles of school-based violence prevention interventions. Of these, 13 articles reporting on 10 trials (8.13%) explicitly mentioned disability: 3/10 trials reported on the magnitude of intervention effects among children with disabilities; 4/10 trials mentioned adaptations to research or intervention design to include children with disabilities; 6/10 trials mentioned disability as part of the sample characteristics but did not report further sub-group analysis. 3 trials were effective in reducing violence in schools for children with disabilities, with risk of bias ranging from ‘low’ (n = 1) to ‘some concerns’ (n = 2). Despite growing evidence on how to prevent school violence, there is limited research on the effect of such interventions for children with disabilities. There is a need for future evaluations to stratify effects by disability, conduct disability-inclusive research, and tailor interventions for children with disabilities. This research was partially funded by the 10.13039/501100020171 Foreign, Commonwealth and Development Office under the PENDA project (PO8073).

Background: Experiencing violence in school is a violation of a child’s rights and can increase school absence, affect academic achievement, employment prospects, and later-life health. Effective school-based violence prevention interventions are crucial, however, most are universally targeted. It is less clear if current interventions to prevent violence in schools ensure subgroups of children benefit equitably. Methods: We conducted a systematic review. We drew on professional networks and searched Medline, Cochrane Library, Embase, Global Health, PsycINFO, and Web of Science to identify systematic reviews ( n = 29) which included randomised controlled trials (RCTs) of school-based violence prevention interventions. Reviews conducted searches until December 2023. We screened all included articles within the final review sample to identify all RCTs of universal school-based violence prevention interventions. We examined what sociodemographic characteristics were measured, assessed intervention effectiveness by subgroups, and applied criteria to assess equity. Results: Out of 160 articles of RCTs evaluating violence prevention interventions in schools, we identified 19 articles reporting on 16 trials that reported effects by the following subgroups: sex ( n = 16), disability ( n = 1), sexuality ( n = 1), race/ethnicity ( n = 1) and socioeconomic status ( n = 1). Subgroup and moderation analysis found mixed results of intervention effectiveness by subgroups, with some evidence of heterogeneity. Conclusions: Most trials of school-based violence prevention interventions do not report whether they are effective for subgroups of minoritised children, or children at higher risk of experiencing violence, and therefore may not contribute to advancing health equity. Ensuring a commitment to equity in the design, delivery, and impact of school-based violence prevention is essential to achieving the Sustainable Development Goals. Review registration: PROSPERO: CRD42023463384.