Improving neonatal health in Nepal: Major challenges to achieving millennium development goal 4

Background: Globally, more than 40% of all under-five child deaths occur during the neonatal period. Neonatal mortality in Nepal is 33 per 1,000 live births, eight times that of developed regions. So there is an urgent need for neonatal care to prevent these deaths, in order to achieve the fourth Millennium Development Goal by 2015. Objective: The objective of this article was to review the major challenges in improving neonatal health in Nepal and to identify possible keys to achieving Millennium Development Goal 4. Methodology: Key literature searches were conducted of electronic databases and relevant web-sites. Furthermore, personal contact with the local population in Nepal and hand searching of key journals was performed. Results: In Nepal, there exist harmful cultural practices during pregnancy and after childbirth. Under utilization of basic maternal and neonatal healthcare, limited health infrastructure with a shortage of trained health care professionals, poverty, illiteracy, women's low status in the society and political instability are major challenges facing neonatal health in Nepal. Conclusions: In order to improve neonatal health in Nepal, it is imperative to focus on biomedical, nursing and social interventions, in addition to family centred care. Health promotion regarding the practices to be adopted during pregnancy and after childbirth, improving health infrastructure and integrating skilled delivery personnel into local health services are important measures. Longer-term solutions could include: improving mother's nutrition and women's position in society, increasing the proportions of girls attending school, as well as involving men in neonatal health matters

Creating Confident and Connected Families: A Program to Improve Parental Self-Efficacy in the Neonatal Intensive Care Unit

Infants in the Neonatal Intensive Care Unit (NICU) require life sustaining intervention for weeks to months after birth. This intervention is remarkably stressful for both the infant, who is ill-equipped to handle life outside the womb, and for the parents who are filled with fear and stress due to the illness of their son or daughter. The experience of hospitalization can lead to stress, shame, anxiety, and even post-traumatic stress disorder for families of NICU infants. Knowledge about the unique stressors, challenges, and needs for support of preterm infants has proven helpful to boost confidence and feelings of wellbeing within the NICU family population. This capstone paper discusses a program designed in the NICU to improve the education, knowledge, confidence, and self-efficacy of parents in the NICU. Details of program design, implementation, results, and implications for the future will be presented

Reducing stress in the neonatal intensive care unit:an occupational therapy approach to preterm infant massage

Thesis (Ph.D.)--Boston UniversityPreterm infants and their parents in the neonatal intensive care unit (NICU) are a growing client population for occupational therapists. The NICU environment of care can be over stimulating and cause high amounts of stress for preterm infants and their parents. Evidence-based literature supports preterm infant massage to decrease stress for preterm infants and improve overall neurobehavioral development. Evidenced-based literature also supports decreased stress for parents that perform preterm infant massage with their child as well as improved confidence of parental skills and infant-parent attachment. Despite these benefits, infant massage is practiced in less than half of the NICUs in the United States (Field, Diego & Hernandez-Reif, 2010). This may be related to the underlying mechanisms not being well understood and/or cost effectiveness considerations. This doctoral project (1) identifies evidenced-based literature to support the benefits of preterm infant massage for both the infant and the parent, (2) investigates evidence and best practice in designing a preterm infant massage parent education program in the NICU that supports the infant-parent dyad, (3) provides an overview of best practice for implementing a preterm infant massage parent education program in the NlCU, (4) describes a detailed evaluation plan and dissemination of the results including estimated budgets for implementation and dissemination. This project's target audiences are medical directors, directors of occupational therapy departments, neonatal occupational therapists, neonatologists, other health care staff in the NICU, and parents of preterm infants in the NICU. This project will be presented to the medical director of a Level IV NlCU and the director of occupational therapy at University of Rochester Medical Center-Golisano Children's Hospital for consideration of implementation. This project contributes to three areas of occupational therapy: (1) addressing best practice for implementing a preterm infant massage program in the NlCU to reduce stress levels for infants and parents, (2) providing more evidenced-based practice with a growing occupational therapy population of preterm infants and their parents, and (3) building a more diverse occupational therapy profession

Maternity Care and Consumer-Driven Health Plans

Compares out-of-pocket costs of maternity care under consumer-driven health plans (CDHP) to a traditional health insurance plan. Explores related factors including prenatal care coverage and unpredictability of costs for delivery and hospital stays

Evaluation of an Evidence-Based Breastfeeding Education Program for Pediatric and Women\u27s Health Care Providers, Family Practice Residents, Medical Students, and Physician Assistant Students

Background.;Every year approximately {dollar}13 billion are spent and an estimated 900 infant lives are lost in the United States as a result of infants not exclusively receiving breast milk for the first six months of life. Many health care providers lack knowledge and supportive skills regarding basic breastfeeding management. However, the results of several research studies indicate that health care providers who provide support and who are knowledgeable in breastfeeding management can improve the breastfeeding rates of the maternal-infant dyads that they serve. An evidence-based breastfeeding educational program can significantly increase the breastfeeding knowledge and attitudes of health care providers.;Objectives.;The goal of this project was to significantly increase the breastfeeding knowledge and attitudes of family practice residents, medical students and Physician Assistant students and the pediatric and women\u27s health clinical faculty practicing within the outpatient clinics of a rural hospital located in eastern Kentucky.;Design.;This study used a quasi-experimental pre-test and post-test design. Clinical faculty working in the pediatric and women\u27s health clinics attended a 1-hour evidence-based breastfeeding education program. Family practice residents, medical students, and Physician Assistant students attended 12 1-hour breastfeeding education seminars which occurred twice weekly for six weeks during hospital Grand Rounds. Pre- and post- measurements included knowledge and attitude scores. Clinical faculty completed the modified Physicians Breastfeeding Assessment Survey pre- and post-intervention. Residents, medical students, and Physician Assistance students completed the American Academy of Pediatrics Breastfeeding Residency Curriculum Tests, the modified Physicians Breastfeeding Assessment Survey, and the modified Nursing Support for Breastfeeding Questionnaire pre- and post- intervention.;Subjects.;Thirty clinical faculty members were eligible to attend the program and the program was completed by 27 clinical faculty. All 14 eligible students attended and completed the Grand Rounds program.;Results.;Clinical faculty members had a statistically significant improvement in knowledge scores on the modified Physicians Breastfeeding Assessment Survey after attending the 1-hour program (p \u3c 0.001). Clinical faculty did not display a statistically significant improvement in attitude scores (p = 0.19). Residents and students had statistically significant improvement in knowledge scores on the modified Physicians Breastfeeding Assessment Survey and the American Academy of Pediatrics Breastfeeding Residency Curriculum Tests (p \u3c 0.001; p \u3c 0.001, respectively). Residents and students also experienced statistically significant improvement in breastfeeding attitudes on the modified Physicians Breastfeeding Assessment Survey and the modified Nursing Support for Breastfeeding Questionnaire (p = 0.054; p \u3c 0.001, respectively).;Conclusion.;The implementation of an evidence-based breastfeeding education program for students and faculty improved breastfeeding knowledge and attitudes of students and breastfeeding knowledge of faculty. Evidence-based breastfeeding programs are a cost-effective strategy to improve knowledge of heath care providers

Stress and stressors experienced by the parents of high-risk neonates admitted in neonatal intensive care unit: Systematic review and meta-analysis evidence available from India

The aim of the systematic review and meta-analysis is to determine the stress and stressors experienced by the parents of high-risk neonates admitted to the neonatal intensive care unit (NICU) in India. We included both quantitative and qualitative studies. The Joanna Briggs Institute Critical Appraisal Checklist and Critical Appraisal Skill Programme checklist were used to assess the quality of included studies. A systematic search was conducted in PubMed, EMBASE, SCOPUS, EBSCOhost, Web of Science, ProQuest, Microsoft Academic, DOAJ, Indian Citation Index, and J-Gate to identify relevant studies. Additionally, online hand searching was performed on Indian websites of relevant institutions, women and child health departments, repositories, registries, and paediatric journals. Twelve of the 21 quantitative studies found that maternal stress was higher than fathers due to the separation from their babies and the medical condition of the neonate. One qualitative study reported that financial burden, alterations in the parenting role, and concern over domestic issues are significant causes of fathers' stress. A meta-analysis of the included studies assessed the prevalence of maternal, paternal, and parental stress and reported that mothers experienced higher stress levels than fathers across all subscales. The most typical stressors for parents were changes in neonatal looks, behaviour, and altered parental roles. Beyond the immediate NICU care and interactions, other triggering factors of stress among parents must be considered to design multicomponent interventions in a local (Indian) context. Moreover, parental psychological support and regular counselling can be incorporated into the standard neonatal intensive care policy

FAMILY EDUCATION STRATEGIES IN CARING FOR CHILDREN WITH CONGENITAL ADRENAL HYPERPLASIA (CAH): A LITERATURE REVIEW

Families having children with congenital adrenal hyperplasia (CAH) may have low knowledge and awareness in some aspects of  CAH management. Information and education regarding caring for children with CAH is essential for families so that they can provide proper care and treatment to their children. This study aims to describe the strategy of family education about caring for children with CAH from the existing literature. A literature review was performed by investigating relevant studies from online databases of Google Scholar, Science Direct, PubMed, and BioMed Central. Keywords of “education” and “children” and “congenital adrenal hyperplasia” and “family or parents” were used in searching the data. The results of the review showed various strategies that can be applied to provide education to families, especially parents. These strategies include providing detailed care instructions about adrenal crisis management, encouraging families/ parents to use positive and useful coping strategies, increasing knowledge and awareness on the use of medical alert IDs, providing Psychosocial Education Program (PEP), increasing nurses’ knowledge and comfort in providing education to families, and suggestions for improving the provision of family education. The provision of education to families or parents having children with CAH should consider some individual aspects such as emotional states, health literacy, learning styles, the amount of information, and knowledge assessment of each family/parent