Resilience learning from the COVID-19 pandemic and its relevance for routine immunization programs.

INTRODUCTION: The COVID-19 pandemic represents a threat that has posed a challenge to public health response and threatens immunization programs globally. Despite recommendations to continue routine immunization services, disruptions have been observed to these and mass vaccination campaigns. This may result in setbacks to immunization initiative successes and a rise in cases of vaccine-preventable diseases. AREAS COVERED: We conducted a systematic literature review to identify studies globally that described how indicators of health system resilience, defined using the Resilient Health System Framework, enabled routine immunizations to continue during the COVID-19 pandemic. A systematic search was conducted in Embase, Web of Science, PsychInfo, medRxiv, bioRxiv, and the gray literature between 1 January 2020, and 12 November 2021. Information was extracted from the studies identified describing how the specific elements of resiliency (being aware, diverse, self-regulating, integrated, and adaptive) were applied to their routine immunization programs. EXPERT OPINION: Our study demonstrates the use of tools that contributed to immunization program resilience during the COVID-19 pandemic in all geographic regions and for countries with different income levels. These tools may help inform preparations for other immunization programs to catch up from the COVID-19 pandemic or mitigate the impact of future threats.

A Multiple Streams Framework Approach to Access to Domestic Violence Services in an Indigenous Community.

This article focuses on access to domestic violence services within Belize. Using data from community asset mapping, interviews with key informants, and focus groups with community members, the multiple streams framework was used to identify potential areas for intervention to improve access and ameliorate the effects of family violence in Belize. Identified challenges to accessing limited domestic violence resources were mainly confidentiality concerns and mistrust. Existing laws and regulations, organizational structures, and policies and plans also influenced access. Women's groups, nongovernmental organizations, and the health department can play a crucial role in improving access to domestic violence services.

The Knowledge and Perceptions of Florida Pharmacists in Administering Inactivated Influenza Vaccines to Pregnant Women.

BACKGROUND: Influenza vaccine rates in pregnant women remain suboptimal despite the recommendations from healthcare organizations. Though pharmacists can provide immunization services as a result of the standing order, few studies have examined the role of the pharmacist in providing immunization to pregnant women or explored their perspective on their role in providing influenza vaccines among pregnant women. PURPOSE: This study explored the perceptions and knowledge of Florida pharmacists in administering inactivated influenza vaccines (IIV) to pregnant women. METHODS: Semi-structured in-depth interviews guided by the theory of planned behavior were conducted with 18 licensed Florida pharmacists, including clinical and retail pharmacists. A thematic analysis was conducted. RESULTS: The majority of pharmacists (94%) were knowledgeable about the IIV in pregnant women. Participants expressed mixed attitudes, identified barriers and facilitators, and subjective norms influencing vaccine administration in pregnant women. Participants expressed the importance of trust and how that influenced vaccine uptake. Participants also expressed their position not to only provide immunization services but also to counsel and educate patients. CONCLUSION: There is a need to strengthen immunization services, provided by pharmacists to more individuals, including high-risk groups such as pregnant women.

An Assessment of Pharmacy School Curricula in Florida and Inactivated Influenza Vaccine (IIV) Administration to Pregnant Women.

Background: There is a high risk for morbidity and mortality in pregnant women associated with influenza virus illness. Vaccine uptake rates in pregnant women remain lower than the targeted Healthy People 2020 goals despite recommendations from the Centers for Disease Control (CDC). Few studies have examined the role of the pharmacist in providing immunization services to pregnant women, fewer still have directly examined the PharmD curricula and the perspectives of pharmacy students on how they perceive their role in providing influenza inactivated vaccine (IIV) to pregnant women. Objective: This study examined the PharmD curricula instruction with regard to immunizing pregnant women and how pharmacy students perceive it. Methods: Semi-structured, in-depth, in-person qualitative interviews were conducted with the six Academic Deans of the accredited schools of pharmacy in Florida, and three focus group sessions were held with third- and fourth-year pharmacy students (n = 18) in Florida. A thematic analysis was conducted. Results: Most academic deans reported providing instruction on immunization in schools with respect to vaccine administration in pregnant women and called for a need for all schools to make it compulsory to include pregnant-women-specific content. Pharmacy students reported a gap in knowledge of content related to administering the IIV in pregnant women, but feel that when presented with the opportunity, they will be willing to provide IIV to pregnant women. Conclusions: Pharmacists are in a good position to play a role in increasing IIV rates among pregnant women. Implications for practice include the need for incorporation of pregnancy-specific content to immunization curricula.

Family-Centered Management of Birth Defects Diagnosis and Referral in Hospital Settings in Florida.

OBJECTIVE: Families' experiences of children diagnosed with birth defects vary greatly in navigating care systems and there is no comprehensive national protocol or standards for support and referral processes at birth. This study builds on the results of previous literature examining these variations in access to care. A survey was conducted among providers from across Florida to determine current practices and recommendations for providing information, medical/community referrals, discharge planning, and family-centered care in hospital settings. METHODS: Fifty-four hospital health care providers across Florida completed an online survey for 11 congenital conditions through closed and open-ended responses. Survey questions were based on a literature review that focused on identifying and understanding the current practices related to providing information, support and referrals to families of infants born with birth defects. Analyses included descriptive statistics, and content analysis of the open-ended responses. RESULTS: Survey respondents identified key personnel, practices, and challenges related to family-centered care in birth hospitals. While information and referral are often provided to the family by the physician or nurse, other health care providers and community agencies also play an important role. Processes for information and referral vary by birth defect; however common structures that support Family-centered management include written materials for family information and support, participatory discharge planning, interdisciplinary communication and coordination, and provider training/awareness. CONCLUSION: Through additional resources, staffing, increased communication, education, and coordination between health care providers, families and hospitals improvements can be made in the management of birth defect diagnosis and referrals. Best practices must be agreed upon, operationalized, disseminated, and evaluated so that parents consistently receive sensitive, individualized, timely information and referrals relative to their child's condition.

Predictors of early childhood undernutrition in Nigeria: the role of maternal autonomy.

OBJECTIVE: To investigate the relationship between maternal autonomy and various indices of child undernutrition among children aged <2 years in Nigeria, considering the cultural context and sociodemographic factors. DESIGN: Population-based, cross-sectional study. Associations between various indices of maternal autonomy and child undernutrition (specifically stunting, underweight and wasting) were determined using weighted bivariate and multivariable logistic regression modelling. SETTING: 2013 Nigerian Demographic Health Survey. PARTICIPANTS: Children aged between 3 and 24 months (n 7532). RESULTS: Overall, 31·4 % (n 2270), 29·8 % (n 2060) and 25·0 % (n 1755) of children in the sample were stunted, underweight and wasted, respectively. Women with acceptance of domestic violence (low autonomy) were approximately 18 and 14 % less likely to have stunted (OR = 0·82; 95 % CI 0·71, 0·94) and underweight children (OR = 0·86; 95 % CI 0·75, 0·99), respectively. Similarly, women with low power in their couple relations were 17 % less likely to have children who were wasted (OR = 0·83; 95 % CI 0·72, 0·97). Sociodemographic predictors of all indices of undernutrition included maternal education and Hausa ethnicity. Additionally, stunting was predicted by lack of exclusive breast-feeding, low income and being of Fulani ethnicity; wasting by having mothers with low BMI; and underweight by breast-feeding initiation within 1 h hour of birth, polygamous homes, mothers with low BMI and being of Fulani ethnicity. CONCLUSIONS: Women with acceptance of domestic violence and low power in couple relations were found to be less likely to have children with indices of undernutrition. This unexpected finding calls for future exploratory research, and policies and interventions that target at-risk subgroups.

'Why do we need a policy?' Administrators' perceptions on breast-feeding-friendly childcare.

OBJECTIVE: Mothers' return to work and childcare providers' support for feeding expressed human milk are associated with breast-feeding duration rates in the USA, where most infants are regularly under non-parental care. The objective of the present study was to explore Florida-based childcare centre administrators' awareness and perceptions of the Florida Breastfeeding Friendly Childcare Initiative. DESIGN: Semi-structured interviews were based on the Consolidated Framework for Implementation Research and analysed using applied thematic analysis. SETTING: Childcare centre administrators in Tampa Bay, FL, USA, interviewed in 2015.ParticipantsTwenty-eight childcare centre administrators: female (100 %) and Non-Hispanic White (61 %) with mean age of 50 years and 13 years of experience. RESULTS: Most administrators perceived potential implementation of the Florida Breastfeeding Friendly Childcare Initiative as simple and beneficial. Tension for change and a related construct (perceived consumer need for the initiative) were low, seemingly due to formula-feeding being normative. Perceived financial costs and relative priority varied. Some centres had facilitating structural characteristics, but none had formal breast-feeding policies. CONCLUSIONS: A cultural shift, facilitated by state and national breast-feeding-friendly childcare policies and regulations, may be important for increasing tension for change and thereby increasing access to breast-feeding-friendly childcare. Similar to efforts surrounding the rapid growth of the Baby Friendly Hospital Initiative, national comprehensive evidence-based policies, regulations, metrics and technical assistance are needed to strengthen state-level breast-feeding-friendly childcare initiatives.