Interventions with pregnant women, new mothers and other primary caregivers for preventing early childhood caries.

BACKGROUND: Dental caries, a common chronic disease of childhood, is associated with adverse health and economic consequences for infants and their families. Socioeconomically disadvantaged children have a higher risk of early childhood caries (ECC). This review updates one published in 2019. OBJECTIVES: To assess the effects of interventions undertaken with pregnant women, new mothers or other primary caregivers of infants in the first year of life, for preventing ECC (from birth to six years). SEARCH METHODS: We searched Cochrane Oral Health's Trials Register, Cochrane Pregnancy and Childbirth's Trials Register, CENTRAL, MEDLINE (Ovid), Embase (Ovid), CINAHL EBSCO, the US National Institutes of Health Ongoing Trials Register (clinicaltrials.gov) and WHO International Clinical Trials Registry Platform (apps.who.int/trialsearch). The latest searches were run on 3 January, 2023. SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing interventions with pregnant women, or new mothers and other primary caregivers of infants in the first year of life, against standard care, placebo or another intervention, reporting on a primary outcome: caries presence in primary teeth, dmfs (decayed, missing, filled primary surfaces index), or dmft (decayed, missing, filled teeth index), in children up to six years of age. Intervention types include clinical, oral health promotion/education (hygiene education, breastfeeding and other dietary advice) and policy or service. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed study eligibility, extracted data, assessed risk of bias, and assessed certainty of evidence (GRADE). MAIN RESULTS: We included 23 RCTs (5 cluster-randomised), involving 25,953 caregivers (mainly mothers) and their children. Fifteen trials assessed oral health education/promotion interventions against standard care. Six trials assessed a clinical intervention for mother dentition, against placebo, or a different type of clinical intervention. Two trials assessed oral health/education promotion plus clinical intervention (for mother's dentition) against standard care. At most, five trials (maximum of 1326 children and 130 mothers) contributed data to any comparison. Enamel-only caries were included in the diagnosis of caries in some studies. For many trials, the risk of bias was unclear due to lack of methodological details reported. In thirteen trials, participants were socioeconomically disadvantaged. No trial indicated receiving funding that was likely to have influenced their results. Oral health education/promotion interventions Child diet and feeding practice advice versus standard care: We observed a probable 15 per cent reduced risk of caries presence in primary teeth with the intervention (RR 0.85, 95% CI 0.75 to 0.97; 3 trials; 782 participants; moderate-certainty evidence), and there may be a slightly lower mean dmfs (MD -0.29, 95% CI -0.58 to 0; 2 trials; 757 participants; low-certainty evidence); however, the evidence is very uncertain regarding the difference between groups in mean dmft (MD -0.90, 95% CI -1.85 to 0.05; 1 trial; 340 participants; very low-certainty evidence). Breastfeeding promotion and support versus standard care: We observed little or no difference between groups in the risk of caries presence in primary teeth (RR 0.96, 95% CI 0.89 to 1.03; 2 trials; 1148 participants; low-certainty evidence) and in mean dmft (MD -0.12, 95% CI -0.59 to 0.36; 2 trials; 652 participants; low-certainty evidence). dmfs was not reported. Child diet advice compared with standard care: We are very uncertain about the effect on the risk of caries presence in primary teeth (RR 1.08, 95% CI 0.34 to 3.37; 1 trial; 148 participants; very low-certainty evidence). dmfs and dmft were not reported. Oral hygiene, child diet and feeding practice advice versus standard care: The evidence is very uncertain about the effect on the risk of caries presence in primary teeth (RR 0.73, 95% CI 0.50 to 1.07; 5 trials; 1326 participants; very low-certainty evidence) and there maybe little to no difference in mean dmfs (MD -0.87, 95% CI -2.18 to 0.43; 2 trials; 657 participants; low-certainty evidence) and mean dmft (MD -0.30, 95% CI -0.96 to 0.36; 1 trial; 187 participants; low-certainty evidence). High-dose versus low-dose vitamin D supplementation during pregnancy: We are very uncertain about the effect on risk of caries presence in primary teeth (RR 0.99, 95% CI 0.70 to 1.41; 1 trial; 496 participants; very low-certainty evidence). dmfs and dmft were not reported. Clinical interventions (for mother dentition) Chlorhexidine (CHX, a commonly prescribed antiseptic agent) or iodine-NaF application and prophylaxis versus placebo: We are very uncertain regarding the difference in risk of caries presence in primary teeth between antimicrobial and placebo treatment for mother dentition (RR 0.97, 95% CI 0.80 to 1.19; 3 trials; 479 participants; very low-certainty evidence). No trial reported dmfs or dmft. Xylitol compared with CHX antimicrobial treatment: We are very uncertain about the effect on caries presence in primary teeth (RR 0.62, 95% CI 0.27 to 1.39; 1 trial, 96 participants; very low-certainty evidence), but we observed there may be a lower mean dmft with xylitol (MD -2.39; 95% CI -4.10 to -0.68; 1 trial, 113 participants; low-certainty evidence). No trial reported dmfs. Oral health education/promotion plus clinical interventions (for mother dentition) Diet and feeding practice advice for infants and young children plus basic dental care for mothers compared with standard care: We are very uncertain about the effect on risk of caries presence in primary teeth (RR 0.44, 95% CI 0.05 to 3.95; 2 trials, 324 participants; very low-certainty evidence) or on mean dmft (1 study, not estimable). No trial reported dmfs. No trials evaluated policy or health service interventions. AUTHORS' CONCLUSIONS: There is moderate-certainty evidence that providing advice on diet and feeding to pregnant women, mothers or other caregivers with children up to the age of one year probably leads to a slightly reduced risk of early childhood caries (ECC). The remaining evidence is low to very-low certainty and is insufficient for determining which, if any, other intervention types and features may be effective for preventing ECC, and in which settings. Large, high-quality RCTs of oral health education/promotion, clinical, and policy and service access interventions, are warranted to determine the effects and relative effects of different interventions and inform practice. We have identified 13 ongoing studies. Future studies should consider if and how effects are modified by intervention features and participant characteristics (including socioeconomic status).

The effects of video-assisted breastfeeding education given to primiparous pregnant women on breastfeeding self-efficacy: randomized control study.

BACKGROUND: Breastfeeding is vitally important for the health of the mother, baby, family and society. Especially the perception of breastfeeding self-efficacy of primiparous pregnant women is an important factor in breastfeeding. This study was conducted to determine the effects of online video-supported breastfeeding education on breastfeeding self-efficacy in primiparous pregnant women. METHODS: This randomized controlled study was conducted with primiparous pregnant women admitted to a university hospital in northern Turkey. The study involved 80 pregnant women, with 40 assigned to the experimental group and 40 to the control group. Participants in the intervention group received online video-assisted education, which covered the first meeting of the mother and baby as well as the initial breastfeeding session. The data for the breastfeeding self-efficacy scale were gathered at the onset of the study and three weeks later. In data analysis, categorical variables were assessed using the chi-square test, continuous variables and intergroup comparisons were conducted through the independent sample t-test, and intragroup comparisons were performed using the paired sample t-test. RESULTS: While the baseline breastfeeding self-efficacy levels of the primiparous pregnant women were similar between the groups, statistically significant differences were observed both within (p = 0.000) and between (p = 0.000) groups in the breastfeeding self-efficacy scores of pregnant women in the intervention group after the education intervention. CONCLUSION: Breastfeeding self-efficacy levels in the education group showed a statistically significant increase compared to both the pre-education and control groups. This highlights the importance of nurses providing support to primiparous pregnant women through video-assisted education during pregnancy to enhance breastfeeding self-efficacy. TRIAL REGISTRATION: ClinicalTrials.gov: NCT06121973 date of first registration (27/10/2023), retrospectively registered (08/11/2023).

The effect of breastfeeding education given through the teach-back method on mothers' breastfeeding self-efficacy and breastfeeding success: a randomized controlled study.

BACKGROUND: An individualized education using visual aids, allowing the woman to demonstrate what she has learned, and providing the opportunity for the woman to ask questions are important in terms of breastfeeding self-efficacy, breastfeeding success, and the sustainability of the education. This study is original in evaluating the effectiveness and sustainability of breastfeeding education provided through the teach-back method in terms of breastfeeding self-efficacy and success in a short period of time. Therefore, the aim of this study is to examine the impact of teach-back method on mothers' breastfeeding self-efficacy and breastfeeding success. MATERIALS AND METHODS: This is a randomized controlled study. The population of this study consisted of women who gave birth in the obstetrics and gynecology department of a state hospital located in Çorlu, in the northwest region of Turkey, between March 2022 and August 2022. The sample of this study consisted of a total of 100 postpartum women, with 50 participants in the experimental group and 50 participants in the control group, who gave birth in the obstetrics and gynecology department of Çorlu State Hospital. Computer-assisted simple randomization was employed to ensure the homogeneous distribution of the women into the experimental and control groups. The women in the experimental group received education and counseling services using the Teach-Back Method, based on the content of the prepared Breastfeeding Education Guide. The control group mothers, on the other hand, received standard breastfeeding education and counseling services. The data were collected through face-to-face interviews during the first 24 h postpartum and at the 1-month follow-up visits. In the study, the data collection tools used were a Personal Information Form, LATCH Breastfeeding Assessment and Evaluation Scale, Postpartum Breastfeeding Self-Efficacy Scale (short form), and the Teach-Back Observation Tool. In the evaluation of the research findings, the SPSS (Statistical Package for the Social Sciences) version 25.0 (IBM Corp., Armonk, NY, USA) program was used for statistical analyses. Descriptive, graphical, and statistical methods were employed to examine whether the scores obtained from each continuous variable followed a normal distribution. The Kolmogorov-Smirnov test was used to assess the normality of the scores derived from a continuous variable using statistical methods. RESULTS: In the study, no significant difference was found in the distribution of the socio-demographic characteristics of the participants according to the study groups. In the experimental group, which received training with the tell-what-you-learned method, the mothers' average EÖYÖ scores before the training, at the 24th hour after the training and at the 1st month after the training were 46.41 ± 11.26, respectively; It was determined to be 66.23 ± 6.94 and 67.84 ± 6.27. In the measurements made during the follow-up, it was determined that there was a significant difference in the study group's EÖYÖ score averages (p < 0,001). For mothers in the experimental group, the average LATCH score of the mothers before training, 24 h after training and 1 month after training was 7.73 ± 1.81, respectively; It was determined that these values were 8.66 ± 1.61 and 9.95 ± 0.30, and there was a significant difference in the mean LATCH scores of the study group in the measurements made during the follow-up (p < 0.001). CONCLUSIONS: Breastfeeding education provided through the teach-back method is more effective in increasing both breastfeeding success and breastfeeding self-efficacy when compared to standard breastfeeding education. TRIAL REGISTRATION: Iran Randomized Clinical Trial Center IRCT20220509054795N2 Date of first registration: 10/11/2022.

Promoting mental wellbeing in pregnant women living in Pakistan with the Safe Motherhood-Accessible Resilience Training (SM-ART) intervention: a randomized controlled trial.

BACKGROUND: The negative impact of adverse perinatal mental health extends beyond the mother and child; therefore, it is essential to make an early intervention for the management of mental illness during pregnancy. Resilience-building interventions are demonstrated to reduce depression and anxiety among expectant mothers, yet research in this field is limited. This study aims to examine the effect of the 'Safe Motherhood-Accessible Resilience Training (SM-ART)' on resilience, marital adjustment, depression, and pregnancy-related anxiety in a sample of pregnant women in Karachi, Pakistan. METHOD: In this single-blinded block randomized controlled study, 200 pregnant women were recruited and randomly assigned to either an intervention or a control group using computer-generated randomization and opaque sealed envelopes. The intervention group received the SM-ART intervention consisting of six, weekly sessions ranging from 60 to 90 min. Outcomes (Resilience, depression, pregnancy-related anxiety and marital harmony) were assessed through validated instruments at baseline and after six weeks of both intervention and control groups. RESULTS: The results revealed a significant increase in mean resilience scores (Difference:6.91, Effect size: 0.48, p-value < 0.05) and a decrease in depressive symptoms (Difference: -2.12, Effect size: 0.21, p-value < 0.05) in the intervention group compared to the control group. However, no significant change was observed in anxiety and marital adjustment scores. CONCLUSION: The SM-ART intervention has the potential to boost resilience scores and decrease depressive symptoms in pregnant women and offers a promising intervention to improve maternal psychological health. TRIAL REGISTRATION: NCT04694261, Date of first trial registration: 05/01/2021.

Knowledge and trust of mothers regarding childhood vaccination in Rwanda.

INTRODUCTION: Knowledge and trust are some of the contributing factors to vaccine acceptance(VA) and Vaccine hesitancy (VH) is one of the top threats to global health. A significant drop in childhood vaccination has been observed in recent years. One important reason that influences mothers' choice to either postpone or avoid children's vaccinations is knowledge and trust in childhood vaccines. This study aimed to assess mothers' knowledge and trust on vaccination of their children, and to examine the association between vaccination knowledge and selected socio-demographic factors. METHODS: A cross-sectional survey was conducted from January 2022 to March 2022 to assess the knowledge and trust of mothers regarding childhood vaccination. Data was collected with self-administered questionnaires. Multivariable logistic regression analysis was employed to assess factors associated with childhood vaccine knowledge and trust. RESULTS: Of the 2,126 Rwandan parents who participated in the study, the proportions with good knowledge of - and good trust in childhood vaccination were 95.5% and 91.4%, respectively. The popular sources of information about childhood vaccination were health care professionals (91.8%) and mass media (28.9%). Multinomial logistic regression analysis showed that good knowledge of - and trust in childhood vaccination were associated with the relationship with child(ren), education, occupation, and monthly income. The Multinomial logistic regression also revealed that the determinants of good knowledge of - and trust in childhood vaccination were; caregiver (p = 4.0 × 10-4, adjusted Odds Ratio (aOR); 1.7, 95%C.I; 1.3 - 2.3), no formal educational status (p = 3.3 × 10-2, aOR; 1.7, 95%C.I; 1.0 - 3.0), the unemployed occupational status (p = 2.4 × 10-2, aOR; 1.2, 95%C.I; 1.0 - 1.4), and persons on more than $401 per month (p = 2.0 × 10-4, aOR; 3.5, 95%C.I; 1.8 - 6.8). CONCLUSION: The majority of parents in Rwanda had both good knowledge of-and good trust regarding childhood vaccination. Public health strategies to promote vaccination, education programmes as well as improved communication tools between health care professionals/traditional leaders/religious leaders and parents need to be considered to achieve favourable vaccination attitudes and practices for all parents in Rwanda.

A community based intervention to modify preventive behaviors of cutaneous leishmaniasis in children: a randomized controlled trial based on PRECEDE PROCEED model.

OBJECTIVES: Iran ranks among the top six countries globally with a significant incidence of Cutaneous Leishmaniasis (CL). Using planning models is one community-based intervention to promote preventive behaviors. The purpose of our study was to evaluate the effectiveness of the PRECEDE-PROCEED model (PPM) in modifying preventive behaviors related to CL in children through mother training in a community intervention. METHODS: A randomized controlled trial based on the PPM model was conducted on 168 mothers (intervention (n = 84) and control group (n = 84) with 10 years old children in the rural areas of Iran. Mothers from 7 village areas were randomly allocated to the intervention (2 village) and control groups (5 village). The intervention group received a program comprising eight 90-minute training sessions and environmental interventions. In this study, we utilized the PPM as a framework to design the questionnaires on Leishmaniosis prevention behavior. Participants in both groups completed the questionnaires at baseline (before the intervention), immediately after the intervention, and at the 2-month follow-up. Analysis of the data was conducted utilizing SPSS20, with statistical significance set at p < 0.05. RESULTS: Compared to the control group, the intervention group showed significant increases in knowledge, enabling factors, reinforcing factors, attitude, and preventive behaviors related to Cutaneous Leishmaniasis over time from baseline to follow-up (P < 0.001). No significant differences (P > 0.05) were observed in the alterations of the PPM construct, knowledge, and preventive behaviors within the control group from pre-intervention to follow-up. CONCLUSIONS: Community (education and environmental) intervention based on PPM is feasible and acceptable to modify preventive behaviors of Cutaneous Leishmaniasis in children by increasing a mother's knowledge and attitude as well as changing enabling and reinforcing factors. TRIAL REGISTRATION: IRCT20160619028529N8.

The potential effectiveness of community health and nutrition volunteers on mothers' infant and young children feeding knowledge and practice in remote areas, Hajjah, Yemen.

BACKGROUND: The Infant and young child feeding (IYCF) practices directly affect the health, development and nutritional status of children under two years of age. However, IYCF counseling is one of the Community Health and Nutrition Volunteers (CHNVs) activities provided, which may contribute to improving the IYCF knowledge and practice among mothers. Since establishment of the CHNVs program in Yemen, its outcome has never been evaluated. Therefore, the aim of this study was to evaluate the role of CHNVs in improving the IYCF knowledge and practice among mothers in Hajjah governorate. METHODS: A comparative cross-sectional study design was conducted in Bani Qais and Al-Maghrabah districts, Hajjah governorate between January and April 2023. A three-stage cluster sampling method was used to select districts, volunteer villages and households. A total of 926 mothers were interviewed. A pre-tested structured questionnaire was used to collect data. SPSS 26 was used for data analysis. The multinomial logistic regression and Chi-Square test were used to compare the IYCF knowledge and practices among mothers between the volunteer and non-volunteer villages. Odds Ratio (OR) with 95% Confidence Interval (CI) were calculated. A p-value < 0.05 was considered statistically significant. RESULTS: The mothers in volunteer villages had significantly better breastfeeding and complementary feeding (CF) knowledge than mothers in non-volunteer villages. The OR of having good and moderate knowledge of breastfeeding were 3.5 (95%CI: 2.4-5.2) and 1.6 (95% CI: 1.2-2.2), respectively. The OR for good and moderate knowledge of CF were 1.7 (95% CI: 1.1-2.7) and 2.2 (95% CI: 1.5-3.0), respectively. Moreover, there is a statistically significant association in prevalence of Exclusively breastfed for the first two days after birth (EBF2D), Mixed milk feeding under six months (MixMF) and Bottle feeding 0-23 months (BoF) between volunteer and non-volunteer villages [(OR = 1.4, 95% CI: 1.0-1.8), (OR = 0.4, 95% CI: 0.2-0.8) and (OR = 0.5, 95% CI: 0.4-0.7), respectively]. CONCLUSIONS: The study found that CHNVs play a significant effect in improving the breastfeeding and CF knowledge, and prevalence of EBF2D, MixMF and BoF practices among mothers in their villages compared to non-volunteer villages. Future follow-up study and expansion to other settings in different governorates is recommended.

Minimum acceptable diet and associated factors among children aged 6-23 months in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: To ensure a child's full growth, health, and development during infancy and the early years, adequate nutrition is crucial. A crucial window of opportunity for ensuring children's proper growth and development through adequate eating exists during the first two years of life. According to the evidence of the efficacy of interventions, achieving universal coverage of optimal breastfeeding could prevent 13% of deaths in children under the age of 5 worldwide, and using complementary feeding methods appropriately would lead to an additional 6% decrease in under-five mortality. METHODS: From several electronic databases, all published, unpublished, and gray literature was extracted and exported into EndNote version X20. For further analysis of the review, the retrieved data from the excel sheet were imported into the statistical software program Stata version. Metanalysis was used to determine the prevalence of MAD, and a random effects model was used to estimate the pooled prevalence of MAD. The DerSimonian-Laird Random effects model (REM) was used to combine the determinant factors from all qualifying papers for the meta-analysis, and the heterogeneity was independently assessed using a χ2 test, Q statistics, and matching I2 statistics. To retrieve the extent of publication bias, funnel plots were scattered and tested for asymmetry and, additionally, Egger's test was computed with the user-written "meta bias" command in Stata (version 11) software. To end, sensitivity analyses with trim and fill were performed. RESULTS: The pooled estimate of the overall prevalence of minimum acceptable diet in 16 studies in Ethiopia was 22% with (95% CI: 16, 28%) with a random effect model. However, eight papers were filled during trim and fill in order to counteract the small study effect. The overall filled pooled estimate was 7.9% with (95%CI: 11, 14.8%). Maternal education (primary and secondary) is 1.714 (95% CI 1.244,2.363) and 2.150(95% CI: 1.449,3.190), respectively, Ages of children with range of 12-17 months (2.158 (95% CI 1. 9,3.006) and 18-23 months 2.948(95% CI: 1.675,5.190)), Nutrition information ((1.883 (95% CI 1.169,3.032)) media exposure (1.778(95% CI: 1.396,2.265), and maternal knowledge (2.449 (95% CI 1.232, 5.027) were significantly associated with MAD. CONCLUSION: The pooled estimate of the overall prevalence of minimum acceptable diet in 16 studies in Ethiopia were low. Maternal education (primary and secondary), ages of child with range of 12-17 month and 18-23 months, mothers having nutrition information, mothers who have media exposure,and mothers having good knowledge were significantly associated with Minimum acceptable diet. The government, NGO, and other stakeholders should focus on improving Minimum acceptable diet among 6 to 23 months of children through promoting with mass media, focuses on nutrition council during critical contact point in health facility, and doing capacity building for the mothers/caregivers.

Magnitude and determinant of healthcare-seeking behavior for childhood acute respiratory tract infections in Ethiopia: a cross-sectional study.

BACKGROUND: Acute respiratory infections (ARIs) remain a major public health concern which become the leading cause of mortality and morbidity in children under the age of five. A large percentage of childhood deaths and complications can be avoided by seeking proper medical care. Therefore, this study aimed to assess the magnitude, and individual and community-level determinants of mothers' healthcare-seeking behavior for their children under the age of five who had ARI symptoms in Ethiopia. METHOD: A secondary data analysis was conducted using the 2016 Ethiopian Demographic and Health Surveys(EDHS) with a total weighted sample of 643 under-five children who had ARI symptoms within two weeks of the survey. Due to the hierarchical nature of the EDHS data, a multi-level logistic regression model was used to identify the individual and community-level factors influencing mothers' health care-seeking behavior for their children with ARI symptoms. In the multivariable multilevel analysis, those variables with a p-value < 0.05 were considered to be significant predictors of the outcome variable. RESULTS: Healthcare-seeking behavior among mothers or caregivers for children with symptoms of ARIs was 32.61% (95% CI: 29.08-36.33%) in Ethiopia. The ICC in the null model indicated that about 55% of the total variability of treatment-seeking behavior was due to differences between clusters. Child aged > 24 months [AOR = 0.35; 0.19-0.63], having primary education [AOR = 3.25; 1.27-8.32], being media exposed [AOR = 2.49; 1.15, 5.38], female household head[AOR = 3.90; 1.35, 11.24], and delivery at health institution[AOR = 2.24; 1.00, 5.01] were significant predictors of health care seeking behavior of mother for their children with ARI symptoms. CONCLUSION: There is poor treatment-seeking behavior for children with symptoms of ARI in Ethiopia with significant community level variations. The multilevel logistic regression analysis showed that improving mothers' education, women's empowerment, facilitating institutional delivery and media accessibility are critical to promoting health-seeking behaviors among mothers or caregivers of under-five children with ARI symptoms. Hence, concerned bodies should design targeted interventions that increase mothers' or caregivers' treatment-seeking behavior for childhood ARI to reduce child morbidity and mortality.

Impact of educational intervention on mothers of infants with iron-deficiency anemia.

This intervention study aimed to assess mothers' knowledge of iron-deficiency anemia (IDA). It also measured the impact of a health education program on their level of knowledge and their infants' IDA rates in rural areas of Nablus Governorate. Using a randomized pretest-posttest control group design, the efficacy of 3 months' education program was examined against control group. Assessments were made at baseline and after 3 months of conducting the intervention. A structured interviewing questionnaire was used to assess the knowledge about IDA, and blood samples were collected from infants in both groups. Only 1.9% of mothers in the intervention group and 3.5% of mothers in the control group had good level of knowledge at baseline. After the educational intervention, a significant statistical difference was observed in the mean total knowledge score between the intervention and control groups (33.68 + 5.366 versus 26.12 + 5.243), and the intervention group was seven times more likely to have good knowledge (relative risk = 7.332). Regarding IDA rate, there was a decrease in the infants with IDA in the intervention group (relative risk = 0.671) compared to infants in the control group. The planned health education program was effective in improving mothers' knowledge and reducing the risk of IDA among their infants.

A Mobile Gaming App to Train Teenage Mothers on Appropriate Child Feeding Practices: Development and Validation Study.

BACKGROUND: Undernutrition is an underlying factor in nearly 50% of 1 million estimated annual deaths among Nigerian children aged <5 years. Inappropriate maternal infant and young child feeding (IYCF) practices are basic contributors to child undernutrition. Teenage motherhood exacerbates the problem of inadequate child feeding. One possible intervention method to improve IYCF knowledge and practices of teenage mothers is the use of mobile gaming technologies. Despite extreme poverty in low- and middle-income countries, a ubiquity of mobile phone networks exists. OBJECTIVE: This study aims to develop and validate a mobile gaming app, called BabyThrive, to train Nigerian teenage mothers on appropriate IYCF practices. METHODS: To identify gaps in current IYCF practices in northern Nigeria, we conducted an extensive search of the literature and held 2 focus group interviews with 16 teenage mothers with low-income status. An initial app content design was then created, and content validity was established by 10 nutrition experts. Next, we developed an app prototype, which was assessed for quality by 7 nutrition and mobile gaming experts and evaluated for usability by 90 teenage mothers from rural areas in Abuja, the country's capital. The final app, BabyThrive, is a 2D mobile game that is fully functional offline and available in English as well as Hausa, which is commonly spoken in northern Nigeria. The efficacy of the BabyThrive app was assessed using IYCF knowledge scores obtained from the administration of the validated Teen Moms Child Feeding Questionnaire for Sub-Saharan Africa. Construct validity was established via crossover design by comparing the total IYCF knowledge scores of the teenage mothers obtained after a verbal training program and BabyThrive app use. RESULTS: Large proportions of the study participants were married (53/90, 59%) and had no personal income (63/90, 70%). The mean quality rating for the BabyThrive app was 4.3 (SD 0.39) out of 5.0. High levels (>80%) of usability and user satisfaction were documented. Knowledge of exclusive breastfeeding (P<.001) and total knowledge scores (P=.002) were significantly higher in the BabyThrive group than in the verbal training group. The IYCF knowledge scores obtained from both groups showed coherence, with a statistically significant Spearman correlation coefficient of 0.50 (P<.001). CONCLUSIONS: This research developed and validated a novel, offline mobile gaming app. It will be an easy, effective, and acceptable method to disseminate critical knowledge on IYCF practices to teenage mothers in rural Nigeria.

Benefits and Challenges of Implementing an Adaptation of Family Integrated Care in a Ugandan Setting.

BACKGROUND: Family Integrated Care (FICare) integrates parents as partners in neonatal intensive care unit care. Our team adapted and implemented this approach in a Ugandan unit for hospitalized neonates. PURPOSE: This qualitative descriptive study examined the perceptions of mothers and healthcare professionals (HCPs) of the benefits and challenges of this new approach to care. METHODS: Fifty-one mothers of hospitalized neonates born weighing greater than 2000 g participated in the program. They were taught to assess neonate danger signs, feeding, and weight. After discharge, a subsample (n = 15) participated in focus groups to explore benefits and challenges of their participation in care. Interviews with 8 HCPs were also conducted for the same purpose. Transcripts from focus groups and interviews were analyzed using inductive content analysis to describe the benefits and challenges from the perspectives of mothers and HCPs. RESULTS: For mothers a benefit was decreased stress. Both mothers and HCPs reported that the knowledge and skills mothers acquired were a benefit as was their ability to apply these to the care of their neonate. Improved relations between mothers and HCPs were described, characterized by greater exchange of information and HCPs' attentiveness to mothers' assessments. Mothers felt ready for discharge and used their knowledge at home. HCPs noted a decrease in their workload. Challenges included the need for mothers to overcome fears about performing the tasks, their own well-being and literacy skills, and access to equipment. IMPLICATIONS FOR PRACTICE: Mothers' participation in their neonates' care can have benefits for them and their neonate.

A cluster randomised controlled trial of an early childhood parenting programme delivered through early childhood education centres in rural Zimbabwe.

BACKGROUND: Early childhood is a critical period for child development. Effective approaches to support families in low-resource settings in the use of responsive and stimulating parenting are needed. AIM: The aim of this study was to examine the effects of the Reach Up early childhood parenting programme on children's development, parenting attitudes and practices, when delivered through early childhood development (ECD) centres in Zimbabwe. METHODS: A cluster randomised controlled trial was conducted in Sanyati, a rural district in Zimbabwe. Twenty-four of 51 available centres were randomised to intervention (n = 12) or control (n = 12) groups. Sixteen mothers with a child aged 12-30 months were recruited from each centre's catchment area (n = 189 intervention; n = 193 control). The intervention comprised two home visits per month delivered by centre teaching assistants over a period of 27 months. Primary outcomes were child Developmental Quotient (DQ), Language, Eye and Hand coordination, Performance and Practical Reasoning subscale scores assessed at follow-up. Secondary outcomes were mothers' attitudes about child development, parenting practices and maternal depressive symptoms all measured at baseline and follow-up. Intention to treat analyses was conducted using mixed-effects regression models with the standard error adjusted for cluster and inverse proportionality weights to adjust for attrition. Significance was set at P < 0.05. RESULTS: A total of 285 (74.6%) of 382 children enrolled were tested, with 97 children lost to follow-up. The intervention improved the children's DQ by 3.55 points (95% CI 0.82 to 6.28), Eye and Hand by 3.58 (95% CI 0.59 to 6.56) and Practical Reasoning by 4.19 (95% CI 0.96 to 7.42). No significant improvements to Performance or Language scores, parenting attitudes, parenting practices and depressive symptoms were identified. CONCLUSIONS: A home visiting intervention delivered by ECD teaching assistants promoted children's development. This suggests that outreach from preschools may be an effective platform for delivery of parenting interventions.

Assessing the acceptability of a culturally adapted group-based pediatric intervention, Kokajjiriri, for Marshallese mothers and infants to improve nutrition and prevent childhood obesity.

BACKGROUND: Marshallese Pacific Islanders experience higher rates of obesity than other racial and/or ethnic communities. Despite the obesity rates experienced in this community, there are currently no childhood obesity prevention interventions designed for Marshallese Pacific Islanders in the United States. The purpose of this study is to assess the acceptability and feasibility of a culturally adapted group-based pediatric intervention, Kokajjiriri, with Marshallese mothers to improve nutrition and reduce childhood obesity. METHODS: A multi-methods design was used to culturally adapt the Kokajjiriri intervention for Marshallese mothers in Arkansas (n = 17). In phase one, we conducted 24-h dietary recalls with 20 Marshallese mothers to inform the cultural adaptation of the group-based pediatric intervention, and then in phase two, we culturally adapted and piloted three sessions of the intervention to determine the acceptability and feasibility of the intervention. RESULTS: Participants found the adapted intervention to be acceptable and feasible, found the location to be convenient and found the facilitator to be knowledgeable. Four themes emerged from the qualitative data: (1) Lactation Support; (2) Introducing Healthy Solids; (3) Rice Portion Control; and (4) Finding Resources. CONCLUSIONS: This is the first study to assess the acceptability and feasibility of a culturally adapted group-based pediatric intervention, Kokajjiriri, with Marshallese mothers to improve nutrition and reduce childhood obesity. The results from this culturally adapted group-based pediatric intervention, Kokajjiriri, will be used to inform future adaptations and implementation of the full intervention for Marshallese women and children.

Online occupational therapy group training for mothers of children with feeding problems: A randomized controlled trial.

AIM: The aim of this study was to scrutinize how online occupational therapy group training for mothers influenced their attitudes and stress levels relating to feeding their children and the eating behaviours of the children. The secondary purpose of the study is to evaluate the satisfaction of the participants of this program. Twenty-nine mothers of children aged 3-6 years, experiencing feeding issues, were randomly allocated to either an intervention or control group. BACKGROUND: Feeding problems including selective eating, loss of appetite, and mealtime behaviour problems are prevalent during childhood. Parents play a fundamental role in acquiring knowledge about feeding. Problems in the feeding process may lead to parental stress, feelings of despair, and incorrect attitudes. RESULTS: The mothers in the research group participated in the 4-week training. Results indicated positive effects on both maternal attitudes and their children's eating behaviours (p < 0.05). No significant change was found in mothers' state and trait anxiety levels (p > 0.05). Participants were asked to score their satisfaction level with the program between 1 and 10, and the average of the scores was 9.78 ± 0.42. CONCLUSION: This study shows that online group education for mothers can support existing treatments and guide clinicians working with children with feeding problems.

Mother's milk-mother's gift: Mobile-based training to increase self-efficacy of nursing women during postpartum and puerperium: A quasi-experimental study.

BACKGROUND: The World Health Organization recommends exclusive breastfeeding for 6 months followed by continued breastfeeding with complementary food up to 2 years of age or beyond. This study aimed to investigate the effect of mobile -based education on the self-efficacy of lactating women in the postpartum period. METHODS: A quasi-experimental study was carried out in 2018 in Shirvan, Iran among 69 postpartum women. Participants were assigned to intervention (n = 33) and control (n = 36) groups on the first day after delivery by random allocation. Intervention group received the mobile-based training for 4 weeks in the form of text messages, photos, video clips, and audio files. The control group received routine hospital care and training. Data were collected on demographic characteristics, delivery information, and the breastfeeding self-efficacy. Self-efficacy was measured in two groups at three time points; the first day after delivery, 4 weeks after delivery and 8 weeks after delivery. FINDINGS: The mean and standard deviation of breastfeeding self-efficacy score was higher in the intervention than control group 4 weeks (155.30 ± 10.93 vs 132.52 ± 19.70, P < 0.001) and 8 weeks after delivery (160.18 ± 11.33 vs 132.30 ± 24.09, P < 0.001). Compared to the control group, the rate of exclusive breastfeeding in the intervention group was significantly higher 4 and 8 weeks after the delivery (Pall < 0.05). DISCUSSION: The findings from this study showed a substantial increase in breastfeeding self-efficacy and exclusive breastfeeding in the group who received training through mobile-based education compared to the group that received routine care. APPLICATION TO PRACTICE: Mobile-based breastfeeding education might be a promising strategy to increase breastfeeding self-efficacy. It is suggested that midwives include the design of mobile-based educational programs as part of their educational strategies and use the advantages of this educational method during pregnancy and after childbirth. TRAIL REGISTRATION: This article has been registered in Iran's Clinical Trial Center with the code: 2 N20171024036972 IRCT.

The effectiveness of sexual health and development education given to children with intellectual disabilities: A randomized controlled study.

PURPOSE: The purpose of this study is to determine the effectiveness of an educational program implemented to support the sexual health and development of children with intellectual disabilities, using the Mastery Learning Model, on their knowledge of sexual health and development, as well as on their mothers' awareness of their children's sexual development. METHOD: This study was conducted as a randomized controlled trial with 48 children who have intellectual disabilities, divided into two groups: an education group (n = 24) and a control group (n = 24). The program implemented was a sexual health and development education program based on the Mastery Learning Model. The data collection tools used were 'The Sexual Development Characteristics of Children with Adolescent Intellectual Disability Scale' for mothers and 'The Sexual Development Knowledge Assessment Scale for Children with Intellectual Disabilities' for children. RESULTS: Following the educational program, the children in the education group demonstrated an increase in knowledge regarding their sexual development and health. Additionally, the mothers in the education group showed an increased awareness of their children's sexual health and development. One month after implementing the education program, which utilized mastery learning, the children in the education group exhibited a greater level of knowledge compared to the control group. CONCLUSION: This study utilized the Mastery Learning Model to achieve effective and comprehensive sexual health and development education for children with intellectual disabilities. PRACTICE IMPLICATIONS: Pediatric and school nurses are recommended to use the Mastery Learning Model for sexual health education in clinics and school health practices.

The effect of online breastfeeding education on breastfeeding motivation: A randomized controlled study.

PURPOSE: The aim of this study was to examine the effect of online breastfeeding education on breastfeeding motivation. DESIGN AND METHODS: The study had a single blind randomized, controlled, experimental design. The women in the online education group were primipara and in their postpartum 4-8 weeks and fulfilled inclusion criteria for the study. The study population comprised of the women presenting to the pregnancy outpatient clinic or giving birth in the gynecological and obstetrics clinic of a university hospital hospital in the West of Turkey and hearing about the Online Breastfeeding Education through social media. The sample size was calculated through a similar study. Data were collected between February 2022-November 2022. Simple random sampling was used and the study sample comprised of 50 women, of whom 25 were in the online breastfeeding education group and 25 were in the control group. Online breastfeeding education was given in groups of three or two, depending on availability, via the video communication platform (Zoom Video Communications). The control group received routine care. Data analysis was made with descriptive statistics, Wilcoxon rank sum test and Mann Whitney U test. RESULTS: Integrative motivation (U = 284, p < .05) and intrinsic motivation-identified regulation (U = 196, p < .05) significantly increased compared to the control group. CONCLUSION: Online breastfeeding education offered in the postpartum period can help to increase breastfeeding rates. PRACTICE IMPLICATIONS: It is recommended that nurses monitor breastfeeding status in the postpartum period and motivate mothers with online breastfeeding training in cases where access is not available. TRIAL REGISTRATION: Registered 12 February 2022 on www. CLINICALTRIALS: gov (NCT05262231).

Impact of psychosexual development theory-based breastfeeding education on infant feeding attitudes and knowledge of primiparous mothers: A randomized controlled study.

PURPOSE: The first year of life is known as the "Oral Stage" in psychosexual development theory. We investigated the impact of psychosexual development theory-based breastfeeding education on primiparous mothers' feeding attitudes and behaviors. DESIGN AND METHODS: We conducted this randomized controlled study at a baby-friendly hospital between December 2022 and July 2023. Participants were randomized to intervention (n = 21) and control (n = 19) groups. All participants received the same standard discharge education in the hospital, and the intervention group received additional psychosexual development theory-based breastfeeding education. Data collection for both groups involved conducting face-to-face and telephone interviews, utilizing the Personal Information Form, IOWA Infant Feeding Attitude Scale (IIFAS), Breastfeeding Form, and Psychosexual Theory and Breastfeeding Knowledge Form. The study was recorded in the Clinicaltrials.gov PRS system (ID: NCT06009120). RESULTS: The mean IIFAS score of mothers in the intervention group was 76.23 ± 4.10, while mothers in the control group was 66.31 ± 5.72, which was statistically significant (p < .001). Additionally, mothers in the intervention group fed their babies with formula less often on days 5 to 8 after birth (p < .05) and breastfed more frequently and for longer durations on days 3 to 8 compared to the control group (p < .05). CONCLUSIONS: Psychosexual development theory-based breastfeeding education reduced the use of formula, increased mothers' attitudes towards breastfeeding, and increased the duration and frequency of breastfeeding. PRACTICE IMPLICATION: Integrating psychosexual development theory-based breastfeeding education into routine maternal and infant care may enhance breastfeeding attitudes and practices, potentially improving infant feeding outcomes.

The effect of motivational interviewing techniques on the knowledge level of asthma control among mothers of children with allergic asthma.

PURPOSE: This study aims to evaluate the effect of education given with motivational interviewing techniques on mothers of children with allergic asthma aged 4-11 years on asthma control and knowledge level. METHODS: The research was designed according to the CONSORT checklist with a randomized controlled design. 76 participants were randomly assigned to either an intervention (n = 38) or control group (n = 38). The intervention group received asthma education utilizing motivational interviewing techniques from a pediatric nurse. The control group received no further education. The Childhood Asthma Control Test and Asthma Knowledge Level Questionnaire were used to collect data. The control group received only education at the time of discharge. RESULTS: The mothers' asthma control and asthma knowledge scores in the experimental group were significantly higher than in the control group (p < 0.001). In the experimental group, asthma control scores increased from 14.29 ± 4.27 to 21.37 ± 1.57 after education. The mean score of the asthma knowledge score increased from 54.74 ± 10.89 to 73.47 ± 7.17 after intervention. CONCLUSIONS: The study showed that education using motivational interviewing techniques for mothers of children with allergic asthma increased their knowledge and positively affected asthma control. IMPLICATIONS TO PRACTICE: Education is important in improving mothers' knowledge about allergic asthma. Asthma education using motivational interviewing techniques should be provided when their children are newly diagnosed. Education practices should be implemented as a policy in hospitals and pediatric clinics, and nurses should be supported in ensuring the implementation of education practices.