Effectiveness of the UNICEF/WHO 20-hour Course in Improving Health Professionals’ Knowledge, Practices, and Attitudes to Breastfeeding: Before/After Study of 5 Maternity Facilities in Croatia

Aim To evaluate knowledge, practices, and attitudes to breastfeeding among Croatian health professionals before and after the United Nations International Children’s Emergency Fund/World Health Organization (UNICEF/WHO) 20-hour course. Methods Study included 5 of 9 maternity hospitals in southern Croatia˝, which had completed the UNICEF/WHO 20-hour breastfeeding training course between December 2007 and February 2009. An anonymous questionnaire testing knowledge, practices, and attitudes was distributed to 424 health professionals before training and to 308 health professionals afterwards. Health professionals’ attitudes were assessed using the validated Iowa Infant Feeding Attitude Scale. Results The pre-training response rate was >90%, but only 53% of data were analyzed; the post-training response rate was 69%. Only one-fifth of health professionals prior to training knew that breast preparation in pregnancy was unnecessary, but this increased to 57% after training (P < 0.001). The proportion of health professionals who recognized hospital practices that support breastfeeding and signs of poor positioning when breastfeeding nearly doubled after training (P < 0.001). The proportion of health professionals correctly recommending immediate “skinto- skin” contact post-Cesarean section under local anesthesia did not improve significantly, and stratification analyses showed that younger respondents (<36 years) were more likely to support this practice. Although the proportion of health professionals who correctly managed mastitis improved significantly as a result of the training, the proportion of those who after training inappropriately recommended partial or complete cessation of breastfeeding remained high at 47%. The number of staff with positive attitudes toward breastfeeding increased from 65% to 79%, whereas the number of staff with neutral attitudes dropped from 26.6% to 9.9% (P < 0.001). Even after training, a substantial proportion of health professionals showed uncertainty in their attitude toward alcohol consumption and breastfeeding. Conclusion The UNICEF/WHO 20-hour course appears to be an effective tool for improving health professionals’ breastfeeding knowledge, attitudes, and practices

Redefining the technical and organizationalcompetences of children vaccination clinics in order to improve performance. A practical experience at the ULSS 12 Venetian Public Health and Hygiene Service

Introduction. Since Regione Veneto suspended compulsory vaccination for children in 2008, and because of an increasing disaffection of parents to the vaccine practice, the vaccination rates have been slowly but steadily decreasing. The aim of this study was to analyze internal and external factors of immuniza- tion reduction and to implement potential solutions of the prob- lem. Methods. Servizio Igiene e Sanita? Pubblica of ULSS 12 Venezi- ana (SISP ? Hygiene and Public Health Service) analyzed and addressed both, the reasons of parents who do not vaccinate their children and the internal problems regarding vaccination clinics management, information to families, procedures and guidelines and, in general, the communication skills of the vaccination staff. Results. A positive trend in vaccination rates was observed, espe- cially in Venice historical centre. Moreover the staff reported a better working atmosphere and benefit from sharing common goals and procedures, even though the workforce was reduced of about 30% in terms of equivalent unit (EU). Discussion. The continuous quality improvement method fol- lowed in this experience led to a steady increase in vaccination coverage in all territorial clinics, to a better adhesion of guide- lines and standard operating procedures and to a general pro- fessional empowerment of SISP staff. The service now offered to the population is better and more efficient, since the workforce has been reduced. Future goals are to improve information about vaccinations among the population

Protection, promotion and support of breast-feeding in Europe: progress from 2002 to 2007.

Objective To assess progress in the protection, promotion and support of breast-feeding in Europe. Design Data for 2002 and 2007 were gathered with the same questionnaire. Of thirty countries, twenty-nine returned data for 2002, twenty-four for 2007. Results The number of countries with national policies complying with WHO recommendations increased. In 2007, six countries lacked a national policy, three a national plan, four a national breast-feeding coordinator and committee. Little improvement was reported in pre-service training; however, the number of countries with good coverage in the provision of WHO/UNICEF courses for in-service training increased substantially, as reflected in a parallel increase in the number of Baby Friendly Hospitals and the proportion of births taking place in them. Little improvement was reported as far as implementation of the International Code on Marketing of Breastmilk Substitutes is concerned. Except for Ireland and the UK, where some improvement occurred, no changes were reported on maternity protection. Due to lack of standard methods, it was difficult to compare rates of breast-feeding among countries. With this in mind, slight improvements in the rates of initiation, exclusivity and duration were reported by countries where data at two points in time were available. Conclusions Breast-feeding rates continue to fall short of global recommendations. National policies are improving slowly but are hampered by the lack of action on maternity protection and the International Code. Pre-service training and standard monitoring of breast-feeding rates are the areas where more efforts are needed to accelerate progress

Effectiveness of the UNICEF/WHO 20-hour Course in Improving Health Professionals’ Knowledge, Practices, and Attitudes to Breastfeeding: A Before/After Study of 5 Maternity Facilities in Croatia

Aim To evaluate knowledge, practices, and attitudes to breastfeeding among Croatian health professionals before and after the United Nations International Children’s Emergency Fund/World Health Organization (UNICEF/WHO) 20-hour course. Methods Study included 5 of 9 maternity hospitals in southern Croatia˝, which had completed the UNICEF/WHO 20-hour breastfeeding training course between December 2007 and February 2009. An anonymous questionnaire testing knowledge, practices, and attitudes was distributed to 424 health professionals before training and to 308 health professionals afterwards. Health professionals’ attitudes were assessed using the validated Iowa Infant Feeding Attitude Scale. Results The pre-training response rate was >90%, but only 53% of data were analyzed; the post-training response rate was 69%. Only one-fifth of health professionals prior to training knew that breast preparation in pregnancy was unnecessary, but this increased to 57% after training (P < 0.001). The proportion of health professionals who recognized hospital practices that support breastfeeding and signs of poor positioning when breastfeeding nearly doubled after training (P < 0.001). The proportion of health professionals correctly recommending immediate “skinto- skin” contact post-Cesarean section under local anesthesia did not improve significantly, and stratification analyses showed that younger respondents (<36 years) were more likely to support this practice. Although the proportion of health professionals who correctly managed mastitis improved significantly as a result of the training, the proportion of those who after training inappropriately recommended partial or complete cessation of breastfeeding remained high at 47%. The number of staff with positive attitudes toward breastfeeding increased from 65% to 79%, whereas the number of staff with neutral attitudes dropped from 26.6% to 9.9% (P < 0.001). Even after training, a substantial proportion of health professionals showed uncertainty in their attitude toward alcohol consumption and breastfeeding. Conclusion The UNICEF/WHO 20-hour course appears to be an effective tool for improving health professionals’ breastfeeding knowledge, attitudes, and practices

Management of meningococcal outbreaks: are we using the same language? Comparison of the public health policies between high-income countries with low incidence of meningococcal disease

Background Invasive meningococcal disease (IMD) in high-income countries usually occurs sporadically with low incidence and occasionally as small clusters or outbreaks. The WHO guidelines (GLs) for IMD outbreak applies only to African countries with high endemic incidence. Several high-income countries developed their own GLs on IMD outbreak, and we compare their terminology, classification, definitions and public health interventions. Methods National IMD outbreak GLs of the European Union and the Organisation for Economic Co-operation and Development member states were compared. Due to linguistic barriers, seventeen out of forty one countries were selected and the GLs on the websites of the national health authorities were independently screened by two researches. Results National GLs on IMD outbreak were available for twelve countries. All GLs classify IMD outbreak into organization and community based using different terminology (cluster, epidemic, etc.). Two GLs introduce also a third condition of hyperendemic. Definitions, thresholds and countermeasures vary among countries. Conclusions Different definitions of organization and community-based outbreaks and countermeasures are expected because of uncertainties about their effectiveness, and differences between countries in health care systems and public health policy approaches. Nevertheless, variations in terminology, definitions and countermeasures are confusing and reflect the need for an international standardization

Redefining the technical and organizational competences of children vaccination clinics in order to improve performance. A practical experience at the ULSS 12 Venetian Public Health and Hygiene Service.

Introduction. Since Regione Veneto suspended compulsory vaccination for children in 2008, and because of an increasing disaffection of parents to the vaccine practice, the vaccination rates have been slowly but steadily decreasing. The aim of this study was to analyze internal and external factors of immunization reduction and to implement potential solutions of the problem. Methods. Servizio Igiene e Sanit\ue0 Pubblica of ULSS 12 Veneziana (SISP \u2013 Hygiene and Public Health Service) analyzed and addressed both, the reasons of parents who do not vaccinate their children and the internal problems regarding vaccination clinics management, information to families, procedures and guidelines and, in general, the communication skills of the vaccination staff. Results. A positive trend in vaccination rates was observed, especially in Venice historical centre. Moreover the staff reported a better working atmosphere and benefit from sharing common goals and procedures, even though the workforce was reduced of about 30% in terms of equivalent unit (EU). Discussion. The continuous quality improvement method followed in this experience led to a steady increase in vaccination coverage in all territorial clinics, to a better adhesion of guidelines and standard operating procedures and to a general professional empowerment of SISP staff. The service now offered to the population is better and more efficient, since the workforce has been reduced. Future goals are to improve information about vaccinations among the population

Essential Workers’ COVID-19 Vaccine Hesitancy, Misinformation, and Informational Needs in the Republic of North Macedonia

The COVID-19 pandemic has resulted in over 5.2 million deaths. Vaccine hesitancy remains a public health challenge, especially in Eastern Europe. Our study used a sample of essential workers living in the Republic of North Macedonia to: (1) Describe rates of vaccine hesitancy and risk perception of COVID-19; (2) Explore predictors of vaccine hesitancy; and (3) Describe the informational needs of hesitant and non-hesitant workers. A phone survey was administered in North Macedonia from 4–16 May 2021. Logistic regression explored associations of COVID-19 vaccine hesitancy with sociodemographic characteristics, non-COVID-19 vaccine hesitancy, previous diagnosis of COVID-19, and individual risk perception of contracting COVID-19. Chi-squared analyses compared differences in informational needs by hesitancy status. Of 1003 individuals, 44% were very likely to get the vaccine, and 56% reported some level of hesitancy. Older age, Albanian ethnicity, increased education, previous COVID-19 diagnosis, acceptance of other vaccines, and increased risk perception of COVID-19 infection were negatively associated with vaccine hesitancy. Results indicated significant differences in top informational needs by hesitancy status. The top informational needs of the hesitant were the freedom to choose to be vaccinated without consequences (57% vs. 42%, p p < 0.01)