The baby box : Enhancing the wellbeing of babies and mothers around the world

The baby box is a Finnish social innovation that has captivated interest around the globe. This book highlights the journey of the baby box in over 60 countries, offering a comprehensive overview of the Finnish baby box and its many international adaptations. The story of the baby box begins in post-war Finland, where it evolved from a community-based resource to a nationally-funded and internationally recognized social benefit. The global mapping of the baby box presented in this book expands on this history by exploring the influence of the baby box concept internationally, from refugee camps and high-income countries to remote islands and prisons. Written by an international, multi-disciplinary team of researchers, this book explores the baby box concept from various angles. The diverse and expansive nature of this study makes it an excellent resource for parents, researchers, and anyone generally interested in the baby box concept. Also showcased are the many creative solutions that baby box programme organisers have devised to address context-specific challenges, making it additionally useful as a handbook for policy-makers or professionals developing their own programme.The baby box is a social innovation: a maternity package with baby clothes and other items for expectant mothers to promote the wellbeing of baby and family. In Finland, the baby box (officially called the maternity package) has been a universal benefit since 1949 and is given to all expectant mothers provided they attend antenatal care (ANC). The baby box is still considered to be a valuable social benefit in Finland today, with 95% of first-time mothers choosing the box instead of a cash grant. Although it is known that the baby box concept has been adapted across the world, there is little information available about how these adaptations have been made and for what purpose the boxes are given out. In order to map these programmes, we conducted a research project on baby boxes globally. Based on our findings, this report introduces the baby box concept, its various adaptations, and its possible uses to improve maternal and child health and wellbeing globally. The contents of this report are based on a mapping of 91 baby box programmes and an in-depth study of 29 programmes across different world regions in high-, middle- and low-income countries. These programmes were initiated by governmental bodies, non-profit organisations, United Nations (UN) agencies, hospitals, and academic institutions. Although we use the term baby “box” throughout the report, many programmes used a different container, such as a basket or bag, to package the items. The programmes ranged in scale from small to nationwide and targeted various groups, from specific vulnerable communities to all pregnant women in a country. Programmes set various goals, including reducing infant or maternal mortality, promoting the wellbeing of babies and mothers, easing financial and parenting burden, encouraging the uptake of health and community support services, and strengthening communities and reducing inequalities. They intended to achieve their goals through the practical support provided by the box and items, as well as the conditions attached to claiming the box (e.g. attendance at services) and additional education (e.g. booklets or arranged groups) included in the programme. The impact of the baby box is of timely concern, as governments are increasingly interested in the concept. However, it is difficult to provide an unequivocal answer to the question of whether the baby box “works,” as this depends on the desired outcomes of the programme. In addition, due to resource constraints, few programmes measure the impact of their intervention systematically. In response to this question and these restraints, we outline the potential current contributions of the baby box to the wellbeing of mothers and babies and provide a commentary on its possible future impact. For example, there is emerging evidence globally that baby box programmes can increase the rates of attending ANC or giving birth at a health facility, which may save lives in contexts where these rates are traditionally low. Baby box programmes may also provide psychosocial support for the mother during the vulnerable time of childbirth. Beyond their potential to support families in their everyday lives, baby box programmes may also be valuable in contexts where families have been forced to flee their homes, such as natural disasters or refugee camps. In addition to our findings, we also discuss high-interest topics surrounding the baby box, including safety issues. Ultimately, we intend for our report to serve as an overview of baby box programmes and a foundation for further research, as well as a reference for those interested in the topic or aiming to implement or evaluate a baby box programme themselves. The baby box is not a one-size-fits-all solution to intricate health challenges. However, it offers significant health and social gains, especially for those who are commonly the most vulnerable in communities: mothers and babies.31,00 euroanonPeerReviewedVertaisarvioimato

A modular systematic review of antenatal interventions targeting modifiable environmental exposures in improving low birth weight

BACKGROUND: Low birth weight (LBW) increases the risk of short- and long-term morbidity and mortality from early life to adulthood. Despite research effort to improve birth outcomes the progress has been slow. OBJECTIVE: This systematic search and review of English language scientific literature on clinical trials aimed to compare the efficacy antenatal interventions to reduce environmental exposures including a reduction of toxins exposure, and improving sanitation, hygiene, and health-seeking behaviors, which target pregnant women to improve birth outcomes. METHODS: We performed eight systematic searches in MEDLINE (OvidSP), Embase (OvidSP), Cochrane Database of Systematic Reviews (Wiley Cochrane Library), Cochrane Central Register of Controlled Trials (Wiley Cochrane Library), CINAHL Complete (EbscoHOST) between 17 March 2020 and 26 May 2020. RESULTS: Four documents identified describe interventions to reduce indoor air pollution: two randomised controlled trials (RCTs), one systematic review and meta-analysis (SRMA) on preventative antihelminth treatment and one RCT on antenatal counselling against unnecessary caesarean section. Based on the published literature, interventions to reduce indoor air pollution (LBW: RR: 0.90 [0.56, 1.44], PTB: OR: 2.37 [1.11, 5.07]) or preventative antihelminth treatment (LBW: RR: 1.00 [0.79, 1.27], PTB: RR: 0.88 [0.43, 1.78]) are not likely to reduce the risk of LBW or Preterm birth (PTB). Data is insufficient on antenatal counselling against caesarian-sections. For other interventions, there is lack of published research data from RCTs. CONCLUSIONS: We conclude that there is a paucity of evidence from RCT on interventions that modify environmental risk factors during pregnancy to potentially improve birth outcomes. Magic bullets approach might not work and that it would be important to study the effect of the broader interventions, particularly in LMIC settings. Global interdisciplinary action to reduce harmful environmental exposures, is likely to help to reach global targets for LBW reduction and sustainably improve long-term population health.Peer reviewe

Antenatal interventions to address harmful behaviors and psychosocial risk factors in the prevention of low birth weight

Background: Risk factors related to the harmful behaviors, psychosocial wellbeing, and socio-economic circumstances in the lives of pregnant women can lead to adverse birth outcomes, including low birth weight (LBW). Objective: This systematic search and review aims to provide a comparative evidence synthesis on the effect of eleven antenatal interventions targeted to address psychosocial risk factors on adverse birth outcomes. Methods: We searched MEDLINE, Embase, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials and CINAHL Complete between March 2020 and May 2020. We included randomized controlled trials (RCTs) and reviews of RCTs of eleven antenatal interventions for pregnant females reporting LBW, preterm birth (PTB), small-for-gestational-age or stillbirth as outcomes. For interventions where randomization was either not feasible or unethical, we accepted non-randomized controlled studies. Results: Seven records contributed data to the quantitative estimates of the effect sizes and 23 contributed to narrative analysis. Psychosocial interventions for reducing smoking in pregnancy likely reduced the risk of LBW, and professionally provided psychosocial support for at-risk women possibly reduced the risk of PTB. Financial incentives or nicotine replacement therapy as smoking cessation aids, or virtually delivered psychosocial support did not appear to reduce the risk of adverse birth outcomes. The available evidence on these interventions was primarily from high-income countries. For other reviewed interventions (psychosocial interventions to reduce alcohol use, group based psychosocial support programs, intimate partner violence prevention interventions, antidepressant medication, and cash transfers) there was little evidence in any direction regarding the efficacy or the data was conflicting. Conclusions: Professionally provided psychosocial support during pregnancy in general and specifically as a means to reduce smoking can potentially contribute to improved newborn health. The gaps in the investments for research and implementation of psychosocial interventions should be addressed to better meet the global targets in LBW reduction.Peer reviewe

Antenatal interventions to reduce risk of low birth weight related to maternal infections during pregnancy

Background: Maternal infections during pregnancy have been linked to increased risk of adverse birth outcomes, including low birth weight (LBW), preterm birth (PTB), small for gestational age (SGA), and stillbirth (SB). Objectives: The purpose of this article was to summarize evidence from published literature on the effect of key interventions targeting maternal infections on adverse birth outcomes. Methods: We searched MEDLINE, Embase, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and CINAHL Complete between March 2020 and May 2020 with an update to cover until August 2022. We included randomized controlled trials (RCTs) and reviews of RCTs of 15 antenatal interventions for pregnant women reporting LBW, PTB, SGA, or SB as outcomes. Results: Of the 15 reviewed interventions, the administration of 3 or more doses of intermittent preventive treatment in pregnancy with sulphadoxine–pyrimethamine [IPTp-SP; RR: 0.80 (95% CI: 0.69, 0.94)] can reduce risk of LBW compared with 2 doses. The provision of insecticide-treated bed nets, periodontal treatment, and screening and treatment of asymptomatic bacteriuria may reduce risk of LBW. Maternal viral influenza vaccination, treatment of bacterial vaginosis, intermittent preventive treatment with dihydroartemisinin–piperaquine compared with IPTp-SP, and intermittent screening and treatment of malaria during pregnancy compared with IPTp were deemed unlikely to reduce the prevalence of adverse birth outcomes. Conclusions: At present, there is limited evidence from RCTs available for some potentially relevant interventions targeting maternal infections, which could be prioritized for future research.Peer reviewe

Improving birth weight measurement and recording practices in Kenya and Tanzania: a prospective intervention study with historical controls

BACKGROUND: Low birth weight (LBW) is a significant public health concern given its association with early-life mortality and other adverse health consequences that can impact the entire life cycle. In many countries, accurate estimates of LBW prevalence are lacking due to inaccuracies in collection and gaps in available data. Our study aimed to determine LBW prevalence among facility-born infants in selected areas of Kenya and Tanzania and to assess whether the introduction of an intervention to improve the accuracy of birth weight measurement would result in a meaningfully different estimate of LBW prevalence than current practice. METHODS: We carried out a historically controlled intervention study in 22 health facilities in Kenya and three health facilities in Tanzania. The intervention included: provision of high-quality digital scales, training of nursing staff on accurate birth weight measurement, recording and scale calibration practices, and quality maintenance support that consisted of enhanced supervision and feedback (prospective arm). The historically controlled data were birth weights from the same facilities recorded in maternity registers for the same calendar months from the previous year measured using routine practices and manual scales. We calculated mean birth weight (95% confidence interval CI), mean difference in LBW prevalence, and respective risk ratio (95% CI) between study arms. RESULTS: Between October 2019 and February 2020, we prospectively collected birth weights from 8441 newborns in Kenya and 4294 in Tanzania. Historical data were available from 9318 newborns in Kenya and 12,007 in Tanzania. In the prospective sample, the prevalence of LBW was 12.6% (95% confidence intervals [CI]: 10.9%-14.4%) in Kenya and 18.2% (12.2%-24.2%) in Tanzania. In the historical sample, the corresponding prevalence estimates were 7.8% (6.5%-9.2%) and 10.0% (8.6%-11.4%). Compared to the retrospective sample, the LBW prevalence in the prospective sample was 4.8% points (3.2%-6.4%) higher in Kenya and 8.2% points (2.3%-14.0%) higher in Tanzania, corresponding to a risk ratio of 1.61 (1.38-1.88) in Kenya and 1.81 (1.30-2.52) in Tanzania. CONCLUSION: Routine birth weight records underestimate the risk of LBW among facility-born infants in Kenya and Tanzania. The quality of birth weight data can be improved by a simple intervention consisting of provision of digital scales and supportive training

Evidence-based antenatal interventions to reduce the incidence of small vulnerable newborns and their associated poor outcomes

A package of care for all pregnant women within eight scheduled antenatal care contacts is recommended by WHO. Some interventions for reducing and managing the outcomes for small vulnerable newborns (SVNs) exist within the WHO package and need to be more fully implemented, but additional effective measures are needed. We summarise evidence-based antenatal and intrapartum interventions (up to and including clamping the umbilical cord) to prevent vulnerable births or improve outcomes, informed by systematic reviews. We estimate, using the Lives Saved Tool, that eight proven preventive interventions (multiple micronutrient supplementation, balanced protein and energy supplementation, low-dose aspirin, progesterone provided vaginally, education for smoking cessation, malaria prevention, treatment of asymptomatic bacteriuria, and treatment of syphilis), if fully implemented in 81 low-income and middle-income countries, could prevent 5·202 million SVN births (sensitivity bounds 2·398-7·903) and 0·566 million stillbirths (0·208-0·754) per year. These interventions, along with two that can reduce the complications of preterm (<37 weeks' gestation) births (antenatal corticosteroids and delayed cord clamping), could avert 0·476 million neonatal deaths (0·181-0·676) per year. If further research substantiates the preventive effect of three additional interventions (supplementation with omega-3 fatty acids, calcium, and zinc) on SVN births, about 8·369 million SVN births (2·398-13·857) and 0·652 million neonatal deaths (0·181-0·917) could be avoided per year. Scaling up the eight proven interventions and two intrapartum interventions would cost about US$1·1 billion in 2030 and the potential interventions would cost an additional$3·0 billion. Implementation of antenatal care recommendations is urgent and should include all interventions that have proven effects on SVN babies, within the context of access to family planning services and addressing social determinants of health. Attaining high effective coverage with these interventions will be necessary to achieve global targets for the reduction of low birthweight births and neonatal mortality, and long-term benefits on growth and human capital.Peer reviewe