Children's Medicines in Tanzania: A National Survey of Administration Practices and Preferences.

The dearth of age-appropriate formulations of many medicines for children poses a major challenge to pediatric therapeutic practice, adherence, and health care delivery worldwide. We provide information on current administration practices of pediatric medicines and describe key stakeholder preferences for new formulation characteristics. We surveyed children aged 6-12 years, parents/caregivers over age 18 with children under age 12, and healthcare workers in 10 regions of Tanzania to determine current pediatric medicine prescription and administration practices as well as preferences for new formulations. Analyses were stratified by setting, pediatric age group, parent/caregiver education, and healthcare worker cadre. Complete data were available for 206 children, 202 parents/caregivers, and 202 healthcare workers. Swallowing oral solid dosage forms whole or crushing/dissolving them and mixing with water were the two most frequently reported methods of administration. Children frequently reported disliking medication taste, and many had vomited doses. Healthcare workers reported medicine availability most significantly influences prescribing practices. Most parents/caregivers and children prefer sweet-tasting medicine. Parents/caregivers and healthcare workers prefer oral liquid dosage forms for young children, and had similar thresholds for the maximum number of oral solid dosage forms children at different ages can take. There are many impediments to acceptable and accurate administration of medicines to children. Current practices are associated with poor tolerability and the potential for under- or over-dosing. Children, parents/caregivers, and healthcare workers in Tanzania have clear preferences for tastes and formulations, which should inform the development, manufacturing, and marketing of pediatric medications for resource-limited settings

A Collaborative Approach to Providing Best-Practice Childhood Feeding Guidance

Objective: To examine whether training on Division of Responsibility, provided to members of a childhood feeding collaborative, increased familiarity, knowledge, and confidence in disseminating information to parents of young children. Methods: Training was provided to 47 public health nurses and 22 breastfeeding task force members. A within-group pretest, posttest, follow-up design assessed changes in familiarity, knowledge and confidence. Results: Amongst public health nurses, training resulted in a significant increase in familiarity (P < .001); knowledge that restricting amount of food provided to overweight infants and/or children is inappropriate (P < .05); and that children need frequent exposure to new foods (P < .05). Confidence in disseminating information also significantly increased (P < .001). Conclusions and Implications: Health care providers who counsel parents about childhood feeding practices should be trained to increase familiarity with, knowledge of, and confidence in disseminating best practice feeding guidelines to help ensure provision of consistent, accurate messaging

Promoting healthy weight for all young children: a mixed methods study of child and family health nurses' perceptions of barriers and how to overcome them.

Background:Childhood obesity is a global health concern. Early intervention to help parents adopt best practice for infant feeding and physical activity is critical for maintaining healthy weight. Australian governments provide universal free primary healthcare from child and family health nurses (CFHNs) to support families with children aged up to five years and to provide evidence-based advice to parents. This paper aims to examine factors influencing the child obesity prevention practices of CFHNs and to identify opportunities to support them in promoting healthy infant growth. Methods:This mixed methods study used a survey (n = 90) and semi-structured interviews (n = 20) with CFHNs working in two local health districts in Sydney, Australia. Survey data were analysed descriptively; interview transcripts were coded and analysed iteratively. Survey and interview questions examined how CFHNs addressed healthy infant feeding practices, healthy eating, active play and limiting sedentary behaviour during routine consultations; factors influencing such practices; and how CFHNs could be best supported. Results:CFHNs frequently advised parents on breastfeeding, introducing solid foods, and techniques for settling infants. They spent less time providing advice on evidence-based formula feeding practices or encouraging physical activity in young children. Although nurses frequently weighed and measured children, they did not always use growth charts to identify those at risk of becoming overweight or obese. Nurses identified several barriers to promoting healthy weight gain in infants and young children, including limited parental recognition of overweight in their children or motivation to change diet or lifestyle; socioeconomic factors (such as the cost of healthy food); and beliefs and attitudes about infant weight and the importance of breastfeeding and physical activity amongst parents and family members. Conclusions:CFHNs require further education and support for their role in promoting optimal child growth and development, especially training in behaviour change techniques to increase parents' understanding of healthy infant weight gain. Parent information resources should be accessible and address cultural diversity. Resources should highlight the health effects of childhood overweight and obesity and emphasise the benefits of breastfeeding, appropriate formula feeding, suitable first foods, responsiveness to infant feeding cues, active play and limiting screen time

The Child Feeding Guide:A digital health intervention for reducing controlling child feeding practices and maternal anxiety over time

Fussy eating and food refusal are common in young children. These behaviours can contribute to anxiety or concern in parents and caregivers, who have called for credible support to help them navigate the challenges of feeding young children. Given recent increases in technology, and use of the Internet as a trusted source of parenting support, the Child Feeding Guide digital health intervention was created to provide evidence-based support to parents and caregivers to help them to feed children and establish healthy eating habits from the early years. An evaluation was conducted with 25 mothers (with a child aged 6 months to 4 years) who used the Child Feeding Guide website/app over 4 weeks. Mothers provided information about their feeding practices and anxiety levels at baseline, and again 4 weeks later, and answered questions regarding the acceptability and use of the digital support resource. Significant decreases were seen in maternal anxiety and in maternal use of pressure to eat and restriction of food from children for weight reasons. Mothers reported that the Child Feeding Guide was easy to use, that they valued its credibility and reassurances, and that its content helped them to better understand their child’s eating behaviour. These promising findings suggest that naturalistic use of a digital health intervention could contribute to reductions in mothers’ use of controlling feeding practices and levels of anxiety. Such findings are important for supporting the development of healthy eating habits in young children and are likely to be relevant to health and childcare professionals

Transition to parenthood during the transition to modernity in Jordan: new parents' views on family and healthcare support systems

Aims and Objectives This study aims to explore new parents' experiences of family support during their transition to parenthood. Background Family support is widely considered a crucial factor in contributing toward positive outcomes for parents during transition to parenthood. However, inter-generational and socio-cultural differences among family members in understandings and practices of childcare can be a source of tension between new parents and family members. Few studies have examined the role of family support in the context of rapid social change taking place in Middle Eastern countries. This study aims to address this gap by examining the parenting experiences of young Jordanian couples within the family context they are embedded in. Research Design and Methods A qualitative study was conducted in Jordan involving sixty semi-structured, in-depth interviews. Twenty mothers, twenty fathers, and twenty family members identified as support providers were interviewed. Results The key theme, “it's too much” emerged from interviews to describe the nature of family support experienced by new parents from marriage to pregnancy and until after the arrival of their first child. The study found varied interpretations of traditional child-care practices among older and younger generation of family members, leading to family conflict. This study also found that the lack of credible information from the health system about child-care compelled them to accept the only available information for them from their parents, often times with much resistance and reluctance. This created a situation of stress and anxiety among young parents and undermined the potential for healthy parenting experience. This study also found that not all social support during early days of parenthood led to beneficial health outcomes to mother and child.”Social visiting” by family members to hospital and home, was particularly found to interfere with new parents' pursuit toward privacy and family bonding, immediately following the birth of child. Conclusion This study has produced a new understanding of the experience of Jordanian new parents' transition to parenthood. This study particularly sheds light on the current dilemma in which these Jordanian new parents find themselves in, which reflect a clash between traditional and modern values. Although the findings aim to contribute to the body of literature that deals with cultural influences on new parents' experiences in Jordon, the learning could be relevant to the other contexts in the Middle Eastern societies

Obesity prevention in infants using m-Health: the Growing Healthy program

About one quarter of Australian pre-school children are overweight. Early childhood is an important period for establishing behaviours that will affect weight gain and health across the life course. Early feeding choices, including breast and/or formula, timing of introduction of solids, physical activity and electronic media use among infants and young children are considered likely determinants of childhood obesity. Parents play a primary role in shaping these behaviours through parental modelling, feeding styles and the food and physical activity environments provided. Children from low socio-economic backgrounds have higher rates of obesity making early intervention particularly important. However, such families are often more difficult to reach and may be less likely to participate in traditional programs that support healthy behaviours. Parents across all socio-demographic groups frequently access primary health care (PHC) services including nurses in community health services and general practices, providing unparalleled opportunity for engagement to influence family behaviours. One emerging and promising area that might maximise engagement at a low cost is the provision of support for healthy parenting through electronic media such as the Internet or smart phones. This is referred to as mobile or m-health. The Growing Healthy study aimed to explore the feasibility of providing information and support for healthy parenting through electronic media in the form of an application for smart phones (app) and a website. Our background research suggested this as an emerging and promising area for engagement with families with young children and may provide a referral option for primary health care providers. It is also an intervention with a relatively low cost and potential for high reach. As families with young children have high levels of engagement with PHC services, these could be leveraged to recruit study participants via referral to the app. Complementing and not replacing the information and support provided by these existing primary health care services was an important objective as was ensuring the online information and support aligned with that provided by primary health care services and national guidelines. The aim was to make the app a ‘trusted source’ of information and support for families with children from birth to nine months of age.The research reported in this paper is a project of the Australian Primary Health Care Research Institute which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research Evaluation and Development Strategy

Exploring barriers to consistent condom use among sub-Saharan African young immigrants in Switzerland.

No study to date has focused on barriers to condom use specifically among young immigrants to Europe from sub-Saharan Africa. Based on a qualitative study in sociology, this paper explores generational differences in barriers to condom use between first-generation immigrants (born in Africa and arrived in Switzerland after age 10) and second-generation immigrants (born in Switzerland to two native parents or arrived in Switzerland before age 10). Results are based on in-depth, semistructured individual interviews conducted with 47 young women and men aged 18 to 25 to understand how individual, relational, and cultural dimensions influence sexual socialization and practices. Six main barriers to consistent condom use were identified: reduced pleasure perception, commitment and trust, family-transmitted sexual norms and parental control, lack of accurate knowledge on HIV transmission, lack of awareness about HIV in Switzerland, and gender inequalities. The three first barriers concerned both generations of immigrants, whereas the three last revealed generational differences. These findings can help sexual health providers identify social causes for young sub-Saharan immigrants not using condoms. The findings also highlight the necessity of offering accurate, accessible, and adapted information to all young immigrants, as well as the particular importance of addressing families' lack of discussions about sex, understanding the sexual norms transmitted by parents, and taking into consideration cultural differences among young people born in immigration countries

Transition to adult services experienced by young people with cerebral palsy: A cross‐sectional study

Aim: To assess if young people with cerebral palsy experience and health profession-als provide practices that may improve transition from child to adult health services.Method: Seventy-five young people (31 females, 44 males; mean age 18 years 5 months [standard deviation 2 years 2 months]) and/or parents and 108 health professionals completed a questionnaire describing their experience or the provision of nine tran-sition practices.Results: The percentage of young people reporting each practice was: appropriate parent involvement (90%); promotion of health self-efficacy (37%); named worker who supports the transition process (36%); self-management support for physical health (36%); self-management support for mental health (17%); information about the transition process (24%); meeting the adult team (16%); and life skills training (16%). Post-discharge, 10% of young people reported that their general practitioner (GP) received a discharge letter. The percentage of health professionals reporting each practice was: promotion of health self-efficacy (73.2%); self-management support (73.2%); information (69%); consulting the parent and young person about parent involvement (63% and 66%); discharge letter to a GP (55%); life skills training (36%); named worker (35%); meeting the adult team (30%); and senior manager (20%).Interpretation: Many young people did not experience practices that may improve the experience and outcomes of transition. Young people should be involved in the development and delivery of transition to ensure it meets their needs.Open access funding provided by IReL. This research was funded by the Health Research Board and the Central Remedial Clinic (no. APA-2019-004)

An exploration of the knowledge of and involvement of fathers in the practice of complementary feeding of infants and young children in Tsholotsho District, Zimbabwe

Magister Public Health - MPHThe first 1000 days of life represents the period from conception right up to a child’s second birthday. Over the years, there has been a growing body of evidence focusing on the importance of nutrition during this period; also referred to as the ‘window of life’. It is during this period that most incidents of stunting occur. Age appropriate nutrition can provide a child with positive health benefits for the rest of their life. During these first two years infant and young child feeding practices are ideally made up of optimal breastfeeding practices (i.e. exclusive breastfeeding from birth up to six months and continued breastfeeding up to or beyond two years), along with age appropriate complementary feeding practices from six months up to two years. To date, local research studies that have explored the role of parents in infant and young child feeding have tended to focus, firstly, more on the mothers than the fathers, and secondly, have tended to focus more on breastfeeding than complementary feeding and practices. By conducting this research study, it was anticipated that rich information would be accessed from fathers in the district that could then be used to assist the local health workers and district health management team to improve the current infant and young child feeding interventions being implemented at district and community level specifically for children 6 to 23 months

Family at the Center

To better understand how family engagement supports school readiness in Los Angeles County, The David and Lucile Packard Foundation and the LA Partnership for Early Childhood Investment convened an advisory group of early childhood leaders and stakeholders to provide advice and explore opportunities to strengthen parent engagement. This report summarizes key insights and recommendations that emerged through these discussions and additional research about parent engagement programs and practices