Comparison of two sources of iodine delivery on breast milk iodine and maternal and infant urinary iodine concentrations in southern Ethiopia: A randomized trial

Iodine deficiency during pregnancy and lactation could expose the infant to severe iodine deficiency disorders. A randomized supplementation trial among rural lactating women was conducted in Sidama zone, southern Ethiopia, to compare the methods of iodine delivery on breast milk iodine, and on maternal and infant urinary iodine concentrations. Women were randomly assigned either to receive 225 μg iodine as potassium iodide capsule daily for 6 months or 450 g of appropriately iodized salt (30–40 μg I as KIO3/g of salt) weekly for household consumption for 6 months. Breast milk iodine concentration (BMIC) and maternal and infant urinary iodine concentration (UIC) were measured at baseline and at 6 months. The women did not differ in BMIC and UIC, and infants did not differ in UIC in a time by treatment interaction. Median (IQR, interquartile range, IQR) BMIC at baseline was 154 [43, 252] μg/L and at 6 months was 105 [36, 198] μg/L, maternal UIC at baseline was 107 [71, 161] μg/L and at 6 months was 130 [80, 208] μg/L; infant UIC at baseline was 218 [108, 356] μg/L and at 6 months was 222 [117, 369] μg/L. Significant correlations among the three variables were obtained in both groups at both times. We conclude that for lactating women an adequate amount of appropriately iodized salt (30–40 μg I/g) had similar effects as a daily supplement of 225 μg I on BMIC and on maternal and infant UIC

A meta-ethnographic study of health care staff perceptions of the WHO/UNICEF Baby Friendly Health Initiative

Background Implementation of the Baby Friendly Health Initiative (BFHI) is associated with increases in breastfeeding initiation and duration of exclusive breastfeeding and ‘any’ breastfeeding. However, implementation of the BFHI is challenging. Aim To identify and synthesise health care staff perceptions of the WHO/UNICEF BFHI and identify facilitators and barriers for implementation. Method Seven qualitative studies, published between 2003 and 2013 were analysed using meta-ethnographic synthesis. Findings Three overarching themes were identified. First the BFHI was viewed variously as a ‘desirable innovation or an unfriendly imposition’. Participants were passionate about supporting breastfeeding and improving consistency in the information provided. This view was juxtaposed against the belief that BFHI represents an imposition on women's choices, and is a costly exercise for little gain in breastfeeding rates. The second theme highlighted cultural and organisational constraints and obstacles to BFHI implementation including resource issues, entrenched staff practices and staff rationalisation of non-compliance. Theme three captured a level of optimism and enthusiasm amongst participants who could identify a dedicated and credible leader to lead the BFHI change process. Collaborative engagement with all key stakeholders was crucial. Conclusions Health care staff hold variant beliefs and attitudes towards BFHI, which can help or hinder the implementation process. The introduction of the BFHI at a local level requires detailed planning, extensive collaboration, and an enthusiastic and committed leader to drive the change process. This synthesis has highlighted the importance of thinking more creatively about the translation of this global policy into effective change at the local level

WHO & UNICEF: Baby friendlly hospital initiative

WHO&UNICEFin alkuperäisestä ohjelmasta kääntänyt ja Suomen olosuhteisiin työstänyt imetyksen edistämisen työryhmä, jossa mukana Sirpa Sairanen (Stakes)10 askeleen ohjelm

Moderate malnutrition: do we know how to manage it?

Prepared from 'Proceedings of the WHO/UNICEF/United Nations High Commissioner for Refugees Consultation on the Management of Moderate Malnutrition in children under 5 years of age'

The role of mothers-in-law in antenatal care decision-making in Nepal: a qualitative study

Background Antenatal care (ANC) has been recognised as a way to improve health outcomes for pregnant women and their babies. However, only 29% of pregnant women receive the recommended four antenatal visits in Nepal but reasons for such low utilisation are poorly understood. As in many countries of South Asia, mothers-in-law play a crucial role in the decisions around accessing health care facilities and providers. This paper aims to explore the mother-in-law’s role in (a) her daughter-in-law’s ANC uptake; and (b) the decision-making process about using ANC services in Nepal. Methods In-depth interviews were conducted with 30 purposively selected antenatal or postnatal mothers (half users, half non-users of ANC), 10 husbands and 10 mothers-in-law in two different (urban and rural) communities. Results Our findings suggest that mothers-in-law sometime have a positive influence, for example when encouraging women to seek ANC, but more often it is negative. Like many rural women of their generation, all mothers-in-law in this study were illiterate and most had not used ANC themselves. The main factors leading mothers-in-law not to support/ encourage ANC check ups were expectations regarding pregnant women fulfilling their household duties, perceptions that ANC was not beneficial based largely on their own past experiences, the scarcity of resources under their control and power relations between mothers-in-law and daughters-in-law. Individual knowledge and social class of the mothers-in-law of users and non-users differed significantly, which is likely to have had an effect on their perceptions of the benefits of ANC. Conclusion Mothers-in-law have a strong influence on the uptake of ANC in Nepal. Understanding their role is important if we are to design and target effective community-based health promotion interventions. Health promotion and educational interventions to improve the use of ANC should target women, husbands and family members, particularly mothers-in-law where they control access to family resources

Progress on Sanitation and Drinking-Water 2010 Update

This report by the WHO/UNICEF Joint Monitoring Program for Water Supply and Sanitation (JMP) confirms that advances continue to be made towards greater access to safe drinking-water. Progress in relation to access to basic sanitation is however insufficient to achieve the Millennium Development Goal (MDG) target to halve, by 2015, the proportion of people without sustainable access to safe drinking-water and basic sanitation. The information presented in this report includes data from household surveys and censuses completed during the period 2007-2008. It also incorporates datasets from earlier surveys and censuses that have become available to JMP since the publication of the previous JMP report in 2008. In total, data from around 300 surveys and censuses covering the period 1985-2008, have been added to the JMP database

Health System Support for Childbirth care in Southern Tanzania: Results from a Health Facility Census.

Progress towards reaching Millennium Development Goals four (child health) and five (maternal health) is lagging behind, particularly in sub-Saharan Africa, despite increasing efforts to scale up high impact interventions. Increasing the proportion of birth attended by a skilled attendant is a main indicator of progress, but not much is known about the quality of childbirth care delivered by these skilled attendants. With a view to reducing maternal mortality through health systems improvement we describe the care routinely offered in childbirth offered at dispensaries, health centres and hospitals in five districts in rural Southern Tanzania. We use data from a health facility census assessing 159 facilities in five districts in early 2009. A structural and operational assessment was undertaken based on staff reports using a modular questionnaire assessing staffing, work load, equipment and supplies as well as interventions routinely implemented during childbirth. Health centres and dispensaries attended a median of eight and four deliveries every month respectively. Dispensaries had a median of 2.5 (IQR 2--3) health workers including auxiliary staff instead of the recommended four clinical officer and certified nurses. Only 28% of first-line facilities (dispensaries and health centres) reported offering active management in the third stage of labour (AMTSL). Essential childbirth care comprising eight interventions including AMTSL, infection prevention, partograph use including foetal monitoring and newborn care including early breastfeeding, thermal care at birth and prevention of ophthalmia neonatorum was offered by 5% of dispensaries, 38% of health centres and 50% of hospitals consistently. No first-line facility had provided all signal functions for emergency obstetric complications in the previous six months. Essential interventions for childbirth care are not routinely implemented in first-line facilities or hospitals. Dispensaries have both low staffing and low caseload which constraints the ability to provide high-quality childbirth care. Improvements in quality of care are essential so that women delivering in facility receive "skilled attendance" and adequate care for common obstetric complications such as post-partum haemorrhage

Social Accountability for Safe and Sustainable Domestic Water Provision in Dar es Salaam and Morogoro

This paper reports the full results of a baseline survey on access to water for domestic use and social accountability in four districts of Dar es Salaam, Tanzania’s largest city, and Morogoro, a provincial town around 200 kilometres west of Dar. From 7th to 29th March 2018, the survey team interviewed 2,164 adults about their access to water, perceptions of water quality, sanitation and hygiene facilities, readiness to pay for water services, social accountability for water provision, civic engagement and social demographics. The survey included core questions developed by the WHO/UNICEF Joint Monitoring Programme (JMP) for Water Supply, Sanitation and Hygiene, as well as questions on social accountability and civic engagement developed in previous rounds of the Afrobarometer, Asian Barometer, European Social Survey and Twaweza’s SzW survey programmes. Details of sampling procedures are provided at the end of the report

Coagulation defects in obstetrics

A paper read at a WHO/UNICEF Seminar on "Anemia and the Use of Blood Transfusion in M.C.H. Work" 6th June, 1967. Kampala. Coagulation defects are only rarely met with in obstetrics. It is probable that the complication is nowadays being diagnosed with increasing frequency, owing mainly to a greater awareness of the condition. In Mulago Hospital where the author practises, it occurred 11 times in about 33,500 deliveries in the period 1964-66. This gives an incidence of about 0.03%. In cases of concealed accidental hemorrhage the incidence is however higher; it appears to occur in some 5% of cases. A historical background of this condition is presented, and a description of how the clotting mechanism takes place is also explained. Furthermore, a detailed diagram describes the mechanism by which coagulation failure is produced. The author analysed cases at Mulago Hospital, indicating the relative clinical diagnosis and treatment, the latter consisting of two forms, preventive and curative.peer-reviewe