Maternal and Child Health During Forced Displacement.

PURPOSE: To discuss the effects of forced displacement on maternal and child health, highlight the major pitfalls in delivering humanitarian services to this vulnerable group, and underscore the need for multilayered interventions to improve health, protect rights, and reduce vulnerabilities during forced displacements. METHODS: A comprehensive literature search was undertaken from databases including Medline, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), EBSCOhost, Google Scholar, Scopus, and ProQuest. No restrictions were placed on geographical region, type, and year of publication. The key words used were displacement, children, women, health, challenges, disaster response, emergency medicine, terrorism, maladjustment, morbidity, disaster response, cultural sensitivity, and interventions. CONCLUSIONS: Forced displacement negatively affects maternal and child health. The key challenges during forced displacement include food insecurity, lack of shelter, unavailability of clean water and sanitation, poor infrastructure of healthcare services, unavailability of birth attendants and healthcare professionals to manage medical emergencies, inaccessibility to educational and training facilities, and lack of cultural sensitivity of humanitarian workers. The ultimate outcome of forced displacement is a sudden rise in maternal and child mortality and morbidity, maladjustment, psychological issues, altered familial roles, displaced parenting, and vulnerability to exploitation. In view of Bronfenbrenner's socio-ecological framework, multilayered interventions are proposed to improve maternal and child health during forced displacements. CLINICAL RELEVANCE: In view of the effects of forced displacement on maternal and child health and considering the major pitfalls in the delivery of humanitarian services to this vulnerable group, the proposed multilayered interventions can improve health, protect rights, and reduce vulnerabilities surrounding maternal and child health during forced displacements.

Parenting Practices of African Immigrants in Destination Countries: A Qualitative Research Synthesis.

PROBLEM: While studies have discussed the parenting practices and challenges of African immigrants, no paper has synthesized the results of these qualitative studies. We conducted a qualitative synthesis of the literature to summarize and interpret knowledge of African immigrants' parenting practices and challenges in destination countries to identify future directions for research, policy, and practice. ELIGIBILITY: We used a qualitative research synthesis method involving meta-summary and meta-synthesis of the literature. A research librarian assisted in searching ten databases. Two members of the research team independently reviewed 1794 articles. We included articles that: (a) reported a qualitative research study; (b) was written in English; and (c) provided the perspective of African immigrant parents on their parenting practices and/or challenges. SAMPLE: A total of 24 articles met our inclusion criteria. RESULTS: Our results indicate that parenting practices of African immigrants include the following: changes in discipline practices across transnational borders and the use of physical discipline, respect as a deeply embedded value of parenting, integration of cultural values into parenting, and integration of religious practices into parenting. We also found gender differences in parenting. Challenges faced by African immigrants in parenting their children in destination countries include lack of informal/community support, access to services and lack of formal support, cultural conflict in parenting, fear related to social services, and language barriers. CONCLUSION AND IMPLICATIONS: Our study identifies a need for culturally appropriate policies and practices that build on the strengths of African immigrants in destination countries while addressing their unique challenges.

The capability approach: a guiding framework to improve population health and the attainment of the Sustainable Developmental Goals.

The world is progressing in terms of communication, innovative technology and cure of various diseases through advanced pharmacological preparations. Unfortunately, populations are still struggling with ill-health, disabilities, poverty, hunger, inequality, gender disparities and conflicts. Several questions come to mind in this regard: why are prosperity, health, peace and progress not evenly distributed and what is the best approach to address the issues associated with population health? The capability approach may offer a possible model. This approach is a blend of 5 key concepts: capabilities, functioning, agency, endowment, and conversion factors. It proposes an innovative approach to examine and enhance the quality of life and wellbeing of individuals. This reflective paper provides an overview of the capability approach, critically analyses population health from the theoretical lens of the capability approach and highlights the relevance of this approach to achieving the Sustainable Developmental Goals.

Concept Analysis of Maternal Autonomy in the Context of Breastfeeding.

PURPOSE: The purpose of this article is to analyze the concept of maternal autonomy in the context of breastfeeding and propose a clearer definition of the concept. METHODS: A concept analysis was undertaken using Walker and Avant's eight-stage approach. FINDINGS: The concept analysis suggests that maternal autonomy in the context of breastfeeding refers to a mother's ability to make autonomous decisions using her control, agency, independence, and ethical reasoning. The antecedents are maternal competence, availability of support, nature of the setting, and available alternatives with respect to breastfeeding. The consequences are improvement in child health, maternal-child bonding, breastfeeding decisions, and maternal healthcare-seeking behavior. CONCLUSIONS: A clearer understanding of maternal autonomy in the context of breastfeeding will guide the development of a conceptual framework and expand nursing knowledge development. CLINICAL RELEVANCE: A clearer definition of the concept of maternal autonomy in the context of breastfeeding will guide clinicians, researchers, and policy makers in protecting, promoting, and supporting breastfeeding globally towards achieving the United Nations Sustainable Development Goals, 2015-2030.

Barriers Affecting Breastfeeding Practices of Refugee Mothers: A Critical Ethnography in Saskatchewan, Canada.

Refugee mothers are vulnerable to cultural stereotyping and socioeconomic hardships when they migrate to a new country. This vulnerability often has a negative impact on refugee mothers' breastfeeding practices. Saskatchewan is one of the growing provinces in Canada that has a noticeable increase in refugee population with young children and limited availability of healthcare settings with baby-friendly status. Considering existing gaps in knowledge, this critical ethnographic study aimed to explore barriers that impede the breastfeeding practices of refugee mothers in Saskatchewan. After seeking ethics approval, data were collected using multiple methods, including in-depth interviews undertaken with 27 refugee mothers with young children of age range 1 day to 24 months, a review of media communications and field observations of community-based services/facilities available to refugee mothers. Findings suggest that psychosocial barriers, healthcare barriers, environmental barriers, and maternal and child health-related barriers impede the breastfeeding practices of refugee mothers in Saskatchewan. Breastfeeding practices of refugee mothers can be promoted through healthcare support, culturally appropriate services, interpretation services in healthcare settings, implementation of baby-friendly initiatives, hospital and community-based breastfeeding campaigns, and follow-up services. Collaborative efforts by healthcare settings, healthcare providers, policymakers, public health agencies, service providers, and governments are essential to support the breastfeeding practices of refugee mothers.

Barriers to Women's Menstrual Hygiene Practices during Recurrent Disasters and Displacement: A Qualitative Study.

Disasters that involve displacement are particularly challenging for managing personal and menstrual hygiene, which can increase the risk of toxic shock syndrome, infections and other health conditions that can endanger women's lives. This study aimed to examine the menstrual hygiene challenges experienced by internally displaced women affected by recurrent natural disasters and subsequent displacement in the context of a low-middle-income country, i.e., Pakistan. A critical ethnographic study was undertaken in disaster-relief camps in the northern region of Pakistan. Data were collected using multiple methods, including field observations, review of media reports and in-depth interviews with 18 women. The findings suggested that the key barriers to the personal and menstrual hygiene of women during recurrent disasters and displacement in the mountainous rural region of Pakistan include inadequate housing, lack of infrastructure and humanitarian aid, no waste disposal system and lack of women-friendly spaces in disaster-relief camps. Community-based collaboration is necessary for the implementation of effective interventions. A comprehensive menstrual response to promote the health and well-being of women during disasters must include menstruation supplies, supportive facilities (mainly toilets and bathing facilities), supplementary supplies for storing, washing and drying, disposal/waste management facilities, education and culturally appropriate spaces and supplies.

Sociocultural Factors Affecting Breastfeeding Practices of Mothers During Natural Disasters: A Critical Ethnography in Rural Pakistan.

Natural disasters affect the health and well-being of mothers with young children. During natural disasters, this population is at risk of discontinuation of their breastfeeding practices. Pakistan is a middle-income country that is susceptible to natural disasters. This study intended to examine sociocultural factors that shape the breastfeeding experiences and practices of internally displaced mothers in Pakistan. This critical ethnographic study was undertaken in disaster-affected villages of Chitral, Pakistan. Data were collected utilizing multiple methods, including in-depth interviews with 18 internally displaced mothers and field observations. Multiple sociocultural factors were identified as either barriers or facilitators to these mothers' capacities to breastfeed their children. Informal support, formal support, breastfeeding culture, and spiritual practices facilitated displaced mothers to sustain their breastfeeding practices. On the other hand, lack of privacy, cultural beliefs, practices and expectations, covert oppression, and lack of healthcare support served as barriers to the breastfeeding practices of displaced mothers.

Child with idiopathic pulmonary hemosiderosis: a case report from Pakistan with multiple ethical and moral issues.

This report discusses the case of a young Pakistani child diagnosed with idiopathic pulmonary hemosiderosis (IPH). The key features of IPH were iron deficiency anemia and pulmonary symptoms due to recurrent pulmonary hemorrhages. The child showed complications of the disease process because of late diagnosis. Because various ethical and moral issues were associated with the diagnosis and management of IPH, this case provides insights about the care burden of health care professionals and a child's parents in a Pakistani pediatric setting. During the course of the child's treatment at one of the private tertiary care settings of Karachi, Pakistan, the key challenges were as follows: declaring the diagnosis to the parents, dealing with the request of the child's parents for withdrawal of ventilatory support and withholding treatment, deciding the code status of the child, and ensuring the quality of the child's life after discharge from the hospital. It was learned from this case report that shared decision making and open communication with the child's family enabled the pediatric health care professionals to determine what was in the best interest of the child, resulting in provision of effective palliative care to the child. Moreover, it was realized that early detection of the disease and availability of hospice care can facilitate palliative care of children diagnosed with IPH.

Violence against women in Pakistan: contributing factors and new interventions.

Pakistan ranks 125th out of 169 countries on the Gender Development Index and has high prevalence rates of Violence against Women (VAW). Contributing factors toward gender based violence at the micro, meso and macro levels include the acceptability of violence amongst both men and women, internalization of deservability, economic disempowerment, lack of formal education, joint family systems, entrenched patriarchal norms and values, and a lack of awareness of legal and other support systems. These factors have a long-lasting impact on the health of women and children. The gender disparities in the experience of women seeking health care in Pakistan are well-recognized and documented. In the past, common government policy responses to these disparities have included developing the role of community health workers (CHWs) and lady health visitors (LHVs). Despite being commendable initiatives, these too have been unsuccessful in addressing these multi-faceted disparities. Within this complex scenario, new interventions to address VAW and its impact on health in Pakistan include Group Counselling, Economic Skills Building, Health-Based Microfinance, and Family-Based models that increase male involvement, especially at the primary health care level. The purpose of this article is to outline key contributing factors to VAW, explore tested and new interventions, and highlight the opportunities that exist in implementing them.

Malnutrition in young Pakistani children.

BACKGROUND: Pakistan is a developing country with the second highest infant and child mortality rate in South Asia. In this region, malnutrition underlies much of the high infant and under five child morbidity and mortality rates. Although struggle to tackle the issue of malnutrition among young Pakistani children has been going on since many decades, till yet a realistic solution for this growing problem has not been found. OBJECTIVE: This paper aims at reviewing literature to analyse the biological, maternal, socio-cultural, environmental, and politico-economical determinants of malnutrition among young children in Pakistan so that need based interventions can be recommended to prevent and overcome this growing issue. METHODS: A systematic search of national, regional, and international literature was undertaken from peer-reviewed databases for 1991-2011 including MEDLINE, CINAHL, and PubMed. The search was augmented by reviewing the literature from WHO and UNICEF websites, books, local newspapers, and reference lists of articles thought to be relevant. CONCLUSION: Determinants of malnutrition among Pakistani children are multiple and are prevalent at the level of individual, family, and community. An analysis of biological, maternal, socio-cultural, environmental, and politico-economical factors indicate that most of these factors are interrelated; therefore, to tackle this issue, there is a need to plan composite interventions at the level of malnourished children, their families, and the Pakistani community.

Impact of COVID-19 on Women Who Are Refugees and Mothering: A Critical Ethnographic Study.

Refugee women often experience trauma and social disconnection in a new country and are at risk of experiencing reduced physical, mental, and emotional well-being. Globally, COVID-19 has affected the health and well-being of the population at large. This critical ethnographic study aimed to explore the effects of COVID-19 on women who are refugees and mothering in Saskatchewan, Canada. In-depth interviews were undertaken with 27 women who are refugees and mothering young children aged 2 years and under. This study suggests that during COVID-19, refugee women are at high risk of experiencing add-on stressors due to isolation, difficulty in accessing health care, COVID-19-related restrictions in hospitals, limited follow-up care, limited social support, financial difficulties, and compromised nutrition. During COVID-19, collaborative efforts by nurses, other health-care professionals, and governmental and non-governmental organizations are essential to provide need-based mental health support, skills-building programs, nutritional counseling, and follow-up care to this vulnerable group.

Humanitarian aid and breastfeeding practices of displaced mothers: a qualitative study in disaster relief camps.

BACKGROUND: During disasters and displacement, affected families often receive humanitarian aid from governmental and nongovernmental organizations and donor agencies. Little information is available on the effects of humanitarian aid on the breastfeeding practices of mothers affected by disaster and displacement. AIMS: The aim of this study was to explore the effects of humanitarian aid on the breastfeeding practices of displaced mothers affected by natural disasters in Chitral, Pakistan. METHODS: This was qualitative study of residents of four villages of Chitral who had experienced a recent flood and later an earthquake. Data were collected through field observations, analysis of various documents (e.g. aid-agency documents, published reports and newspaper articles) and in-depth interviews with 18 internally displaced mothers living in disaster relief camps in Chitral. RESULTS: Three main themes developed from the data: humanitarian aid as a life saver, insufficient humanitarian aid affecting breastfeeding, and systemic injustices in the distribution of humanitarian aid. CONCLUSION: Although humanitarian aid facilitated the survival, health and well-being of the displaced mothers and their family members, there were various problems with the humanitarian aid that increased the vulnerability of the displaced mothers and negatively affected their breastfeeding practices. Humanitarian aid must be gender-sensitive, thoughtful, timely, needs-based, equitable and context-specific. A systematic process of aid allocation and restricted donation of formula milk or any other form of breast-milk substitute is recommended during disasters.

Knowledge mobilization tool to promote, protect, and support breastfeeding during COVID-19.

SETTING: This knowledge mobilization project was conceptualized to increase awareness among breastfeeding mothers and the general public on safe infant feeding practices during the COVID-19 pandemic by addressing myths and misconceptions associated with breastfeeding practices, guiding breastfeeding mothers to make informed decisions around child feeding practices, and offering meaningful guidance in simple language through a short online animated video. INTERVENTION: This project was undertaken in four phases. During phase 1, an informal discussion was held with the breastfeeding mothers, service providers, and community partner in identifying issues surrounding lactation counselling facilities during the COVID-19 pandemic. During phase 2, recommendations from 23 organizations with regard to breastfeeding during COVID-19 were reviewed and analyzed. During phase 3, using evidence from reliable sources, a 5-minute animated e-resource on breastfeeding during COVID-19 was conceptualized and developed. During phase 4, the e-resource was disseminated to the breastfeeding mothers, general public, post-secondary institutions, and organizations providing services to breastfeeding mothers in Canada. OUTCOMES: This evidence-based e-resource facilitated addressing misconceptions around breastfeeding during COVID-19 and raising public awareness on safe infant feeding practices during this pandemic. Overall, the video was described as an informative, user-friendly, useful, and easily accessible resource by breastfeeding mothers who were in self-isolation with little access to healthcare services during the pandemic. IMPLICATIONS: This project highlighted the importance of patient engagement and collaboration with the community partner in protecting breastfeeding during the COVID-19 pandemic. It further illustrated how informational e-resources can protect breastfeeding in situations where breastfeeding mothers' access to healthcare services is compromised.

RéSUMé: LIEU: Notre projet de mobilisation des connaissances vise à sensibiliser les mères allaitantes et le grand public aux pratiques d'alimentation sûres pour les nourrissons durant la pandémie de COVID-19 en abordant les mythes et les idées fausses associés aux pratiques d'allaitement maternel, en aidant les mères allaitantes à prendre des décisions éclairées quant aux pratiques d'alimentation des bébés et en offrant des conseils utiles, en langage simple, dans une courte vidéo animée accessible en ligne. INTERVENTION: Le projet a été mené en quatre phases. Pendant la phase 1, nous avons eu une discussion informelle avec les mères allaitantes, les dispensateurs de services et le  partenaire associatif pour définir les problèmes entourant les services-conseils sur la lactation durant la pandémie de COVID-19. Pendant la phase 2, nous avons vu et analysé les recommandations de 23 organismes concernant l'allaitement durant la COVID-19. Pendant la phase 3, à l'aide de données probantes provenant de sources fiables, nous avons conceptualisé et créé une cyberressource animée de cinq minutes sur l'allaitement durant la COVID-19. Pendant la phase 4, nous avons diffusé cette cyberressource aux mères allaitantes, au grand public, à des établissements d'enseignement postsecondaires et à des organismes de services aux mères allaitantes au Canada. RéSULTATS: Cette cyberressource factuelle a permis d'aborder plus facilement les idées fausses entourant l'allaitement durant la COVID-19 et de sensibiliser le public aux pratiques sûres d'alimentation des nourrissons durant la pandémie. Dans l'ensemble, des mères allaitantes en isolement, qui avaient peu accès aux services de soins de santé durant la pandémie, ont trouvé notre vidéo informative, conviviale, utile et facilement accessible. CONSéQUENCES: Ce projet souligne l'importance du contact avec la patiente et de la collaboration avec le partenaire associatif pour protéger l'allaitement maternel durant la pandémie. Il montre aussi que des ressources informationnelles accessibles en ligne peuvent protéger l'allaitement dans les situations où les mères allaitantes ont moins accès aux services de soins de santé.

Aluminium phosphide poisoning: a case report.

This paper reports the case of a family in which three children were presented at Emergency Room (ER) with poisoning after the use of a pesticide at home. Initially, the cases were managed as routine cases of organophosphorus poisoning; however, the death of two children made the health team members realise that the poison's effects were delayed and devastating. Later, the compound was identified as Aluminium Phosphide (ALP), and the life of the last surviving child in the family was saved.

Breastfeeding in Disaster Relief Camps: An Integrative Review of Literature.

Breastfeeding is the safest mode of infant feeding during disasters and displacement. Although challenges associated with breastfeeding during humanitarian emergencies are global, they are particularly problematic in low- and middle-income countries such as Pakistan. To examine the factors that affect breastfeeding practices of displaced mothers in disaster relief camps, an integrative review of literature was undertaken. The review suggests that the breastfeeding experiences, behaviors, and practices of displaced mothers are shaped by a combination of gender-based, sociocultural, economic, and geopolitical factors. A thorough understanding of these factors will assist nurses and other stakeholders to improve breastfeeding practices and decrease child deaths in disaster relief camps.

Realism and Relativism in the Development of Nursing as a Discipline.

In today's era of nursing, the role of a unique disciplinary knowledge that is grounded in philosophy is essential to inform nursing practice, fill knowledge gaps, improve the quality of nursing education, and guide the theoretical development of nursing. Realism and relativism have contributed to the development of the nursing discipline by providing the basis of evidence-based nursing practice, nursing research, nursing education, and theoretical construction. This article explores the role of realism and relativism in the development of the discipline of nursing and presents their contributions to the work of nurse clinicians, nurse researchers, nurse educators, and nurse theorists.

A Pilot Study of a 6-Week Parenting Program for Mothers of Pre-school Children Attending Family Health Centers in Karachi, Pakistan.

BACKGROUND: Recently, parenting programs to address behavioural and emotional problems associated with child maltreatment in developing countries have received much attention. There is a paucity of literature on effective parent education interventions in the local context of Pakistan. This study aimed to assess the feasibility of offering a 6-week parenting program for mothers of pre-school children attending family health centres (FHCs) in Karachi, the largest metropolitan city of Pakistan. METHODS: A pilot quasi-experimental trial was conducted. Two FHCs were selected, one as the intervention and the second as the control. A total of 57 mothers of pre-school children (n = 30 intervention; n = 27 control) participated in this study. Mothers in the intervention group received SOS Help for parents module, while mothers in the control group received information about routine childcare. A parenting scale (PS) was administered before the program was implemented and repeated 2 weeks after the program was completed in both groups. Statistical analysis was performed to compare participants' attributes. Descriptive analysis was conducted to compare pre- and post-test mean scores along with standard deviation for parenting subscales in the intervention and control groups. RESULTS: A total of 50 mothers (n = 25 intervention; n = 25 control) completed the 6-week program. Attrition was observed as 5/30 (17%) in the intervention arm and 2/27 (2%) in the control arm. Mothers commonly reported the burden of daily domestic and social responsibilities as the main reason for dropping out. Furthermore, the majority of participants in the control group recommended increasing the duration of weekly sessions from 1 to 1.5 hours, thereby decreasing the program period from 6 to 4 weeks. Mothers in intervention group reported substantial improvement in parenting skills as indicated by mean difference in their pre- and post-test scores for laxness and over-reactivity. CONCLUSION: Parenting programs can be implemented for mothers attending FHCs in Pakistan. Mothers require positive reinforcement and constant encouragement at the participant level. Integrating such programs into primary healthcare at the population level has the potential to maximize child health benefits and to improve parenting skills at the country level.

Evidence based workplace interventions to promote breastfeeding practices among Pakistani working mothers.

BACKGROUND AND AIM: Breastfeeding is an essential source of nutrition for young babies; however, it is challenging for employed mothers to continue breastfeeding with employment, especially if workplace support is minimal or missing. In Pakistan, from 1983 to 2008, the prevalence of breastfeeding at 6 months has decreased from 96% to 31%. In this region, workplace barriers have been reported as one of the reasons that result in early cessation of breastfeeding among working mothers. This paper aims at reviewing global literature to explore workplace interventions that can promote the breastfeeding practices among working mothers in Pakistan. METHODS: A literature search of peer reviewed databases, including CINHAL (1980-2009), MEDLINE (1980-2009), Pub Med (1980-2009), Springer Link (1980-2008), and Cochrane Database of Systematic Reviews (3rd quarter, 2008), was undertaken. Considering the pre-set inclusion and exclusion criteria, out of more than 500 literature sources, 50 were shortlisted and reviewed. RESULTS: A review of global literature revealed that in order to promote breastfeeding practices among employed mothers, the most powerful workplace interventions include: educating working mothers about management of breastfeeding with employment; enhancing employers' awareness about benefits of breastfeeding accommodation at workplace; arranging physical facilities for lactating mothers (including privacy, childcare facilities, breast pumps, and breast milk storage facilities); providing job-flexibility to working mothers; and initiating mother friendly policies at workplace that support breastfeeding. CONCLUSION: In Pakistani workplace settings, where little attention is paid to sustain breastfeeding practices among working mothers, there is a need to initiate lactation support programmes. These programmes can be made effective by implementing composite interventions at the level of breastfeeding working mothers, employers, and workplace.

The experiences of urban, professional women when combining breastfeeding with paid employment in Karachi, Pakistan: a qualitative study.

INTRODUCTION: Pakistan has the second highest child mortality rate in South Asia. Breastfeeding can promote infant health, prevent infection and possibly mortality. However, a gradual decline in breastfeeding is reported for Pakistan; especially among urban, educated, employed women. Little research exists regarding the experiences of professional women in Pakistan who are breastfeeding and employed. AIM: To describe the experiences of urban, professional women who breastfeed and are employed, as related to facilitators and barriers of breastfeeding. METHODOLOGY: Using a qualitative descriptive design, nine full-time employed women were recruited through purposive sampling from a private tertiary care health setting in Karachi, Pakistan. A pre-tested, semi-structured interview guide was used for an in-depth interview of 40-45min with each participant. FINDINGS: Most women spoke about the challenges of combining breastfeeding with employment, which resulted in early cessation of breastfeeding. The study indicated that positive maternal attributes such as knowledge about breastfeeding, planning, self-commitment, and open communication, as well as availability of social and workplace support is essential to enable urban, professional women in Pakistan to continue breastfeeding while employed. CONCLUSION: Pakistan has high infant and child mortality rate and decreasing prevalence of breastfeeding, especially among employed professional women. Our findings indicate an urgent need for lactation support programs that include integrated interventions for lactating women that offer informational support, social support, and formal workplace support.