International cooperative study on drug use in pregnancy : results from Malta

The risks of teratogenesis and other adverse effects on the neonate have created a cautious attitude towards the use of drugs during pregnancy. It is generally believed that drug intake in pregnancy is high and variable in different countries, but the quality of prescriptions and use of drugs by the majority of physicians and women has by no means been adequately clarified. To identify the pattern of drug use in pregnancy a collaborative network was set up by WHO - IRO to collect comparable data on a population large enough to represent the current situation across various ’cultural’ and health care settings. This study has shown that, except in the case of the prophylactic administration of haematologicals during the antenatal period and the intrapartum prescriptions to manage labour actively, the majority of pregnant women and health care professionals in Malta have a conservative attitude towards drug prescription in pregnancy and lactation using medications only when they are considered essential.peer-reviewe

In-hospital safety in field conditions of Nifurtimox Eflornithine Combination Therapy (NECT) for T. B. Gambiense Sleeping Sickness

Trypanosoma brucei (T.b.) gambiense Human African trypanosomiasis (HAT; sleeping sickness) is a fatal disease. Until 2009, available treatments for 2(nd) stage HAT were complicated to use, expensive (eflornithine monotherapy), or toxic, and insufficiently effective in certain areas (melarsoprol). Recently, nifurtimox-eflornithine combination therapy (NECT) demonstrated good safety and efficacy in a randomised controlled trial (RCT) and was added to the World Health Organisation (WHO) essential medicines list (EML). Documentation of its safety profile in field conditions will support its wider use

The Potential Role of Mother-in-Law in Prevention of Mother-to-Child Transmission of HIV: A Mixed Methods Study from the Kilimanjaro Region, Northern Tanzania.

In the Kilimanjaro region the mother-in-law has traditionally had an important role in matters related to reproduction and childcare. The aim of this study was to explore the role of the mothers-in-law in prevention of mother-to-child transmission (PMTCT) service utilization and adherence to infant feeding guidelines. The study was conducted during 2007-2008 in rural and urban areas of Moshi district in the Kilimanjaro region of Tanzania. Mixed methods were used and included focus group discussions with mothers-in-law, mothers and fathers; in-depth interviews with mothers-in-law, mothers, fathers and HIV-infected mothers, and a survey of 446 mothers bringing their four-week-old infants for immunisation at five reproductive and child health clinics. The study demonstrated that the mother-in-law saw herself as responsible for family health issues in general and child care in particular. However she received limited trust, and couples, in particular couples living in urban areas, tended to exclude her from decisions related to childbearing and infant feeding. Mothers-in-law expected their daughters-in-law to breastfeed in a customary manner and were generally negative towards the infant feeding methods recommended for HIV-infected mothers; exclusive replacement feeding and exclusive breastfeeding. Decreasing influence of the mother-in-law and increasing prominence of the conjugal couples in issues related to reproduction and child care, reinforce the importance of continued efforts to include male partners in the PMTCT programme. The potential for involving mothers-in-law in the infant feeding component, where she still has influence in some areas, should be further explored

UK Breastfeeding Helpline support: An investigation of influences upon satisfaction

Background Incentive or reward schemes are becoming increasingly popular to motivate healthy lifestyle behaviours. In this paper, insights from a qualitative and descriptive study to investigate the uptake, impact and meanings of a breastfeeding incentive intervention integrated into an existing peer support programme (Star Buddies) are reported. The Star Buddies service employs breastfeeding peer supporters to support women across the ante-natal, intra-partum and post-partum period. Methods In a disadvantaged area of North West England, women initiating breastfeeding were recruited by peer supporters on the postnatal ward or soon after hospital discharge to participate in an 8 week incentive (gifts and vouchers) and breastfeeding peer supporter intervention. In-depth interviews were conducted with 26 women participants who engaged with the incentive intervention, and a focus group was held with the 4 community peer supporters who delivered the intervention. Descriptive analysis of routinely collected data for peer supporter contacts and breastfeeding outcomes before and after the incentive intervention triangulated and retrospectively provided the context for the qualitative thematic analysis. Results A global theme emerged of 'incentives as connectors', with two sub-themes of 'facilitating connections' and 'facilitating relationships and wellbeing'. The incentives were linked to discussion themes and gift giving facilitated peer supporter access for proactive weekly home visits to support women. Regular face to face contacts enabled meaningful relationships and new connections within and between the women, families, peer supporters and care providers to be formed and sustained. Participants in the incentive scheme received more home visits and total contact time with peer supporters compared to women before the incentive intervention. Full participation levels and breastfeeding rates at 6-8 weeks were similar for women before and after the incentive intervention. Conclusion The findings suggest that whilst the provision of incentives might not influence women's intentions or motivations to breastfeed, the connections forged provided psycho-social benefits for both programme users and peer supporters

Knowledge, attitudes and practices of health professionals and women towards medication use in breastfeeding: A review

Many breastfeeding women require and regularly take medicines, especially those available over-the-counter, and the safe use of these is dependent on the advice provided by health professionals such as general practitioners and pharmacists. The primary aim of this review therefore, was to investigate the literature relating to health professionals' and women's knowledge, attitudes and practices towards medication use and safety in breastfeeding. The limited literature that was uncovered identified that general practitioners and pharmacists have poor knowledge, but positive attitudes, and variable practices that are mostly guided by personal experience. They tend to make decisions about the use of a medicine whilst breastfeeding based on the potential 'risk' that it poses to the infant in terms of possible adverse reactions, rather than its 'compatibility' with breast milk. The decision-making process between health professionals and women is usually not a negotiated process, and women are often asked to stop breastfeeding whilst taking a medicine. Women, in turn, are left dissatisfied with the advice received, many choosing not to initiate therapy or not to continue breastfeeding. Some directions for future research have been suggested to address the issues identified in this critical area. This review is important from a societal perspective because many breastfeeding women require and regularly take medications, especially those available without prescription, and the safe use of these is dependent on the advice provided by health professionals, which is ultimately influenced by their knowledge, attitudes and practices. However, there is an absence of high quality evidence from randomised controlled trials on the safety of medications taken during breastfeeding, which naturally would hinder health professionals from appropriately advising women. It is equally important to know about women's experiences of advice received from health professionals, and whether there is consistency between recommendations made across resources on medication safety in breastfeeding, in order to gain a full understanding of the issues prevalent in this area of practice

Evaluating the audio-diary method in qualitative research

Purpose Audio-diary methods are under-utilised in contemporary qualitative research. In this paper we discuss participants and researchers’ experiences of using audio-diaries alongside semi-structured interviews to explore breastfeeding experiences in a short-term longitudinal study with 22 first-time mothers. Design/methodology/approach We provide a qualitative content analysis of the participants’ feedback about their experiences of the audio-diary method and supplement this with the perspectives of the research team based on fieldwork notes, memos and team discussions. We pay particular attention to the ways in which the data attained from diaries compared with those from the interviews. Findings The diaries produced were heterogeneous in terms of data length and quality. Participants’ experiences with the method were varied. Some found the process therapeutic and useful for reflecting upon the development of breastfeeding skills whilst negative aspects related to lack of mobility, self-consciousness and concerns about confidentiality. Researchers were positive about the audio-diary method but raised certain ethical, epistemological and methodological concerns. These include debates around the use of prompts, appropriate support for participants and the potential of the method to influence the behaviour under scrutiny. Interview and diary accounts contrasted and complemented in ways which typically enriched data analysis. Practical implications The authors conclude that audio-diaries are a flexible and useful tool for qualitative research especially within critical realist and phenomenological paradigms Originality/value This appears to be the first paper to evaluate both participants and researchers’ experiences of using audio-diaries in a detailed and systematic fashio

Setting standards for preventative services to reduce child health inequalities in Greater Manchester

Recent policy documents such as Every Child Matters and the National Service Framework for Children, Young People and Maternity Services have indicated a fundamental shift in ways of thinking about child health, emphasising the crucial role of preventative action as well as treatment for ensuring that children have the best possible chance to reach their full potential. This is paramount in deprived areas, where child poverty translates itself into social disadvantage that affects the life chances of children from birth onwards. Whilst the NHS cannot tackle the fundamental drivers of child poverty, it can make a substantial contribution to improving the health and life chances of children living in deprived areas through making sure that parents have access to the services they need and have the information and support to make the best choices about the health and development of their children. The World Health Organisation (WHO) in its strategy on equity in health states that disparities in health status between different groups in the population should be reduced by improving the health of the disadvantaged. Hence, the National Service Framework for Children, Young People and Maternity Services set down 11 standards that define, in general terms, the aims and objectives of services for all children (standards 1-5), services for particular groups of children and young people (standards 6-10) and maternity services (standard 11). These standards underpin a more generic health inequalities target that sets the goal of a reduction of at least 10% in the gap in infant mortality between manual groups and the population as a whole in 2010

Evaluation of HIV counseling and testing in ANC settings and adherence to short course antiretroviral prophylaxis for PMTCT in Francistown, Botswana

Worldwide, it is estimated that two million children are infected with HIV (USAID 2005). The vast majority of these infections are the result of mother-to-child transmission (MTCT) of the virus during pregnancy, labor, or breastfeeding. However, there are effective methods for prevention of mother-to-child transmission (PMTCT). Botswana is one of the first countries in the developing world with a national PMTCT program that uses an efficacious and complex regimen to reduce vertical transmission. At the time of this evaluation (August - December 2005), the standard of care for prevention of MTCT of HIV in Botswana included three-drug antiretroviral therapy for HIV-infected women with a CD4 count of 200 (300 mg AZT in the morning and 300 mg AZT in the evening); four weeks of AZT for their infants; single-dose maternal and infant nevirapine (NVP); and 12 months of free infant formula. Botswana's PMTCT program also provided routine HIV testing for all pregnant women during antenatal care (ANC) to identify HIV-positive women for prophylaxis or treatment. While programs often report the number of individuals beginning AZT and receiving nevirapine for PMTCT, effectiveness is dependent on the level of adherence of individuals to these regimens. To describe adherence of pregnant women to the current PMTCT regimen, the Horizons Program of the Population Council, in collaboration with the Centers for Disease Control and Prevention (CDC) and Premiere Personnel in Botswana, conducted an evaluation to describe HIV-related services provided to women during their pregnancies, document the content of post-test counseling sessions for HIV-positive pregnant women, whether HIV-positive women remembered what had been discussed, the extent of AZT adherence based on self-reports, and the operational successes and barriers to adherence to AZT for PMTCT