Reducing neonatal mortality in rural Ghana : understanding current newborn care practices and their cultural context

Dramatic improvements have been made in child survival over the last 30 years. However, despite the gains of the child survival revolution, neonatal mortality rates have stagnated as infant and child mortality has decreased. Every year 4 million newborns die before they reach 28 days of life. The Millennium Development Goals urge the reduction of under five mortality (from the 1990 level) by two thirds by the year 2015; this will not be achievable unless there is at least a halving in the number of neonatal deaths, which currently account for 36% of all childhood deaths. Some promising interventions have recently been shown to improve newborn survival through home and community based care and there is considerable interest in whether these can be implemented on a wide scale. They are particularly needed where a large proportion of births take place at home and access to health services is suboptimal. Such interventions depend on understanding sociocultural factors that form the basis for newborn care practices. Research elucidating these factors has recently been identified as a priority in several peer reviewed publications and within the international health community. Although the number of newborn deaths is highest in South Asia, the risk of newborn death is highest in Sub Saharan Africa, with West Africa having the highest rates. The present study critically examined the social, cultural, and behavioural factors that play a role in determining care practices during childbirth and the neonatal period in Kintampo District in rural Ghana. A qualitative, ethnographic, study design was used including participant observation, in-depth interviews, semi- structured interviews, expert interviews, narratives, and group discussions, with grounded theory as the guiding theoretical paradigm. It was carried out in four sites: Kintampo town and three villages, Apesika, Jema, and Kawampe. The study benefited from the ongoing ObaapaVitA Vitamin A maternal mortality trial database. This allowed triangulation of the ethnographic findings through analysis of birth cohort data on all 2,878 singletons born alive to mothers in the trial in Kintampo District within the year July 2003 - June 2004. Available data included: location of birth, presence of an attendant, wrapping and drying after birth, substances applied to the umbilical cord, bathing and early infant feeding practices. Narrative interviews from verbal autopsies conducted through the ObaapaVitA trial were also used to capture information on actual newborn deaths. The study findings are presented separately for the following three domains: Pregnancy and Preparation for Childbirth; Neonatal Care Practices; and Newborn Illness, Death and Care Seeking. These highlight several gaps in current practices where improvements might lead to reductions in neonatal mortality. Lessons learned have also been drawn together, both from the perspective of implications for the design of interventions to reduce neonatal mortality and concerning methodological issues in conducting formative research on newborn care practices.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Family experiences of infant and young child feeding in lower-income countries: protocol for a systematic review of qualitative studies

PRISMA-P checklist. Completed checklist indicating inclusion of items noted. (DOCX 128 kb

Qualitative research on Breakthrough ACTION’s Advocacy Core Group Model for integrated social behavior change programming in Nigeria

This report presents the results of a qualitative assessment conducted by Breakthrough RESEARCH/Nigeria of the Advocacy Core Group (ACG) model implemented by Breakthrough ACTION/Nigeria. The goal of the study was to examine, through qualitative inquiry, the operation and potential effectiveness of the ACG model, which works through key opinion leaders and influencers to influence community-level health norms and individual behaviors, focusing specifically on the uptake of essential reproductive, maternal, newborn, and child health services. Results inform Breakthrough ACTION/Nigeria’s program implementation and contribute toward the broader social and behavior change (SBC) implementation science literature surrounding the roles, effectiveness, successes, and challenges of leveraging religious and traditional leaders and social structures to improve social normative environments for health. The work further addresses issues surrounding the ACG model within the context of integrated SBC programming. Research was undertaken in two phases to provide a comprehensive and additive approach to the qualitative evaluation. Researchers sought to examine the effectiveness, success, and challenges of the ACG approach, particularly in the context of integrated SBC programming across health areas, per the approved study protocol

INTEGRAL high energy sky: The keV to MeV cosmic sources

After almost 5 years of operation, ESA's International Gamma-Ray Astrophysics Laboratory (INTEGRAL) Space Observatory has unveiled a new soft Gamma ray sky and produced a remarkable harvest of results, ranging from identification of new high energy sources, to the discovery of dozens of variable sources to the mapping of the Aluminum emission from the Galaxy Plane to the presence of electrons and positrons generating the annihilation line in the Galaxy central radian. INTEGRAL is continuing the deep observations of the Galactic Plane and of the whole sky in the soft Gamma ray range. The new IBIS gamma ray catalogue contains more than 420 sources detected above 20 keV. We present a view of the INTEGRAL high energy sky with particular regard to sources emitting at high energy, including Active Galactic Nuclei (AGN), HESS/MAGIC counterparts and new view of the cosmic gamma ray diffuse background.Comment: Nucl. Instr. and Meth. A, in press. Proc. of Roma International Conference on Astroparticle Physics (RICAP'07

Frailty, psychological well-being, and social isolation in older adults with cognitive impairment during the SARS-CoV-2 pandemic: data from the GeroCovid initiative

Background: The containment measures linked to the COVID-19 pandemic negatively affected the phyco-physical well-being of the population, especially older adults with neurocognitive disorders (NCDs). This study aims to evaluate whether the frailty of NCD patients was associated with different changes in multiple health domains, in particular in relation to loneliness and social isolation, pre- and post-lockdown. Materials and methods: Patients were recruited from 10 Italian Centers for Cognitive Disorders and Dementia. Data were collected in the pre-pandemic period (T0), during the pandemic lockdown (T1), and 6-9 months post-lockdown (T2). The UCLA Loneliness Scale-3, Activities of Daily Living (ADL), Instrumental ADL (IADL), Mini-Mental State Examination, and Neuropsychiatric Inventory (NPI) were administered. Caregivers' burden was also tested. Patients were categorized as non-frail, pre-frail, and frail according to the Fatigue, Resistance, Ambulation, Illness, and Loss of Weight scale. Results: The sample included 165 subjects (61.9% women, mean age 79.5 ± 4.9 years). In the whole sample, the ADL, IADL, and NPI scores significantly declined between T0 and T2. There were no significative variations in functional and cognitive domains between the frail groups. During lockdown we recorded higher Depression Anxiety Stress Scales and Perceived Stress Scale scores in frail people. In multivariable logistic regression, frailty was associated with an increase in social isolation, and a loss of IADL. Conclusions: We observed a global deterioration in functional and neuro-psychiatric domains irrespective of the degree of frailty. Frailty was associated with the worsening of social isolation during lockdown. Frail patients and their caregivers seemed to experience more anxiety and stress disorders during SARS-CoV-2 pandemic

Selected abstracts from the Breastfeeding and Feminism International Conference 2016

Table of contents A1. Infant feeding and poverty: a public health perspective in a global context Lisa H. Amir A2. Mothers’ experiences with galactagogues for lactation: an exploratory cross sectional study Alessandra Bazzano, Shelley Thibeau, Katherine P. Theall A3. The motherhood journey and breastfeeding: from self-efficacy to resilience and social stigma Anna Blair, Karin Cadwell A4. Breastfeeding as an evolutionary adaptive behavior Emily A. Bronson A5. Conflict-of-interest in public health policy: as real as that logo on your website Elizabeth C. Brooks A6. Co-opting sisterhood and motherhood: behind the scenes of Similac’s aggressive social media campaigns Jodine Chase A7. The exclusion of women from the definition of exclusive breastfeeding Ellen Chetwynd, Rebecca Costello, Kathryn Wouk A8. Healthy maternity policies in the workplace: a state health department’s experience with the “Bring Your Infant to Work” program Lindsey Dermid-Gray A9. Implications for a paradigm shift: factors related to breastfeeding among African American women Stephanie Devane-Johnson, Cheryl Woods Giscombe, Miriam Labbok A10. Social experiences of breastfeeding: building bridges between research and policy: an ESRC-funded seminar series in the UK Sally Dowling A11. Manager’s perspectives of lactation breaks Melanie Fraser A12. The challenging second night: a dialogue from two perspectives Jane Grassley, Deborah McCarter-Spaulding, Becky Spencer A13. The role of lactation consultants in two council breastfeeding services in Melbourne, Australia – some preliminary impressions Jennifer Hocking, Pranee Liamputtong A14. Integrating social marketing and community engagement concepts in community breastfeeding programs Sheree H. Keitt, Harumi Reis-Reilly A15. What happens before and after the maternity stay? Creating a community-wide Ten Steps approach Miriam Labbok A16. #RVABREASTFEEDS: cultivating a breastfeeding-friendly community Leslie Lytle A17. Public health vs. free trade: a longitudinal analysis of a global policy to protect breastfeeding Mary Ann Merz A18. Legislative advocacy and grassroots organizing for improved breastfeeding laws in Virginia Kate Noon A19. Breastfeeding and the rights of incarcerated women Krista M Olson A20. Barriers and support for Puerto Rican breastfeeding working mothers Ana M. Parrilla-Rodríguez, José J. Gorrín-Peralta Melissa Pellicier, Zeleida M. Vázquez-Rivera A21. Pumping at work: a daily struggle for Puerto Rican breastfeeding mothers in spite of the law Melissa Pellicier A22. “I saw a wrong and I wanted to stand up for what I thought was right:” a narrative study on becoming a breastfeeding activist Jennifer L. Pemberton A23. Peer breastfeeding support: advocacy and action Catherine McEvilly Pestl A24. Good intentions: a study of breastfeeding intention and postpartum realities among first-time Central Brooklyn mothers Jennifer Pierre, Philip Noyes, Khushbu Srivastava, Sharon Marshall-Taylor A25. Women describing the infant feeding choice: the impact of the WIC breastfeeding classes on infant feeding practices in Ionia, Michigan Jennifer Proto, Sarah Hyland Laurie Brinks A26. Local and state programs and national partnership to reduce disparities through community breastfeeding support Harumi Reis-Reilly, Martelle Esposito, Megan Phillippi A27. Beyond black breastfeeding week: instagram image content analysis for #blackwomendobreastfeed/#bwdbf Cynthia L. Sears, Delores James, Cedric Harville, Kristina Carswell A28. Stakeholder views of breastfeeding education in the K-12 environment: a review of the literature Nicola Singletary, L. Suzanne Goodell, April Fogleman A29. “The Breastfeeding Transition”: a framework for explaining changes in global breastfeeding rates as related to large-scale forces shaping the status of women Paige Hall Smith A30. Breastfeeding, contraception, and ethics, oh my! Advocacy and informed decision-making in the post-partum period Alison M. Stuebe, Amy G. Bryant, Anne Drapkin Lyerly A31. A hard day’s night: juggling nighttime breastfeeding, sleep, and work Cecilia Tomori A32. Empowering change in Indian country through breastfeeding education Amanda L. Watkins, Joan E. Dodgson A33. Servants and “Little Mothers” take charge: work, class, and breastfeeding rates in the early 20th-century U.S. Jacqueline H. Wol

Reducing neonatal mortality in rural Ghana: understanding current newborn care practices and their cultural context

Dramatic improvements have been made in child survival over the last 30 years. However, despite the gains of the child survival revolution, neonatal mortality rates have stagnated as infant and child mortality has decreased. Every year 4 million newborns die before they reach 28 days of life. The Millennium Development Goals urge the reduction of under five mortality (from the 1990 level) by two thirds by the year 2015; this will not be achievable unless there is at least a halving in the number of neonatal deaths, which currently account for 36% of all childhood deaths. Some promising interventions have recently been shown to improve newborn survival through home and community based care and there is considerable interest in whether these can be implemented on a wide scale. They are particularly needed where a large proportion of births take place at home and access to health services is suboptimal. Such interventions depend on understanding sociocultural factors that form the basis for newborn care practices. Research elucidating these factors has recently been identified as a priority in several peer reviewed publications and within the international health community. Although the number of newborn deaths is highest in South Asia, the risk of newborn death is highest in Sub Saharan Africa, with West Africa having the highest rates. The present study critically examined the social, cultural, and behavioural factors that play a role in determining care practices during childbirth and the neonatal period in Kintampo District in rural Ghana. A qualitative, ethnographic, study design was used including participant observation, in-depth interviews, semi- structured interviews, expert interviews, narratives, and group discussions, with grounded theory as the guiding theoretical paradigm. It was carried out in four sites: Kintampo town and three villages, Apesika, Jema, and Kawampe. The study benefited from the ongoing ObaapaVitA Vitamin A maternal mortality trial database. This allowed triangulation of the ethnographic findings through analysis of birth cohort data on all 2,878 singletons born alive to mothers in the trial in Kintampo District within the year July 2003 - June 2004. Available data included: location of birth, presence of an attendant, wrapping and drying after birth, substances applied to the umbilical cord, bathing and early infant feeding practices. Narrative interviews from verbal autopsies conducted through the ObaapaVitA trial were also used to capture information on actual newborn deaths. The study findings are presented separately for the following three domains: Pregnancy and Preparation for Childbirth; Neonatal Care Practices; and Newborn Illness, Death and Care Seeking. These highlight several gaps in current practices where improvements might lead to reductions in neonatal mortality. Lessons learned have also been drawn together, both from the perspective of implications for the design of interventions to reduce neonatal mortality and concerning methodological issues in conducting formative research on newborn care practices

Qualitative Studies of Infant and Young Child Feeding in Lower-Income Countries: A Systematic Review and Synthesis of Dietary Patterns

Continued high rates of both under- and over-nutrition in low- and low-middle-income countries highlight the importance of understanding dietary practices such as early and exclusive breastfeeding, and dietary patterns such as timely, appropriate complementary feeding—these behaviors are rooted in complex cultural ecologies. A systematic review and synthesis of available qualitative research related to infant and young child dietary patterns and practices from the perspective of parents and families in low income settings is presented, with a focus on barriers and facilitators to achieving international recommendations. Data from both published and grey literature from 2006 to 2016 was included in the review. Quality assessment consisted of two phases (Critical Appraisal Skills Program (CASP) guidelines and assessment using GRADE-CERQual), followed by synthesis of the studies identified, and subsequent thematic analysis and interpretation. The findings indicated several categories of both barriers and facilitators, spanning individual and system level factors. The review informs efforts aimed at improving child health and nutrition, and represents the first such comprehensive review of the qualitative literature, uniquely suited to understanding complex behaviors leading to infant and young child dietary patterns

Improvement in excoriation (skin-picking) with use of risperidone in a patient with developmental disability

Patients with Autism Spectrum Disorder present with a heterogeneous mix of features beyond the core symptoms of the disorder. These features can be emotional, cognitive or behavioral. Behavioral symptoms often include self-injury, and this may take the form of repetitive skin-picking. The prevalence of skin-picking disorder in Autism is unknown. Skin-picking may lead to significant medical and psychosocial complications. Recent data suggest that behavioral interventions may be more effective than medications at reducing skin-picking in neurotypical patients. In this case, an 11-year-old male with intellectual disability and autistic spectrum disorder, with self-injurious skin-picking, was treated with risperidone with complete resolution of skin-picking symptoms. risperidone has been approved for irritability and aggression in Autistic spectrum disorder, and may be a valuable treatment option for skinpicking in pediatric patients with developmental disabilities

Qualitative Studies of Infant and Young Child Feeding in Lower-Income Countries: A Systematic Review and Synthesis of Dietary Patterns

Continued high rates of both under- and over-nutrition in low- and low-middle-income countries highlight the importance of understanding dietary practices such as early and exclusive breastfeeding, and dietary patterns such as timely, appropriate complementary feeding—these behaviors are rooted in complex cultural ecologies. A systematic review and synthesis of available qualitative research related to infant and young child dietary patterns and practices from the perspective of parents and families in low income settings is presented, with a focus on barriers and facilitators to achieving international recommendations. Data from both published and grey literature from 2006 to 2016 was included in the review. Quality assessment consisted of two phases (Critical Appraisal Skills Program (CASP) guidelines and assessment using GRADE-CERQual), followed by synthesis of the studies identified, and subsequent thematic analysis and interpretation. The findings indicated several categories of both barriers and facilitators, spanning individual and system level factors. The review informs efforts aimed at improving child health and nutrition, and represents the first such comprehensive review of the qualitative literature, uniquely suited to understanding complex behaviors leading to infant and young child dietary patterns