Geographical variation and predictors of missing essential newborn care items during the immediate postpartum period in Ethiopia: Spatial and multilevel count analyses.

BACKGROUND: Essential Newborn care (ENC) is a High-quality universal newborn health care devised by the World Health Organization for the provision of prompt interventions rendered to newborns during the postpartum period. Even though conducting comprehensive studies could provide a data-driven approach to tackling barriers to service adoption, there was a dearth of studies in Ethiopia that assess the geographical variation and predictors of missing ENC. Hence, this study aimed to identify geographical, individual, and community-level predictors of missing ENC messages at the national level. METHODS: This study used the 2016 Ethiopian Demographic and Health Survey, by using a weighted sample of 7,590 women who gave birth within two years prior to the survey. The spatial analysis was carried out using Arc-GIS version 10.7 and SaTScan version 9.6 statistical software. Spatial autocorrelation (Moran's I) was checked to figure out the non-randomness of the spatial variation of missing ENC in Ethiopia. Six items of care used to construct a composite index.0of ENC uptake were cord examination, temperature measurement, counselling on danger signs, counselling on breastfeeding, observation of breastfeeding, and measurement of birth weight. To assess the presence of significant differences in the mean number of ENC items across covariates, independent t-tests and one-way ANOVA were performed. Finally, a multilevel multivariable mixed-effect negative binomial regression was done by using STATA version 16. The adjusted incidence rate ratio (aIRR) with its corresponding 95% CI was used as a measure of association and variables with a p-value<0.05 were identified as significant predictors of ENC. RESULTS: The overall prevalence of missing ENC was 4,675 (61.6%) (95% CI: 60.5, 62.7) with a significant spatial variation across regions. The majority of Somali, Afar, south Amhara, and SNNPR regions had statistically significant hotspots for missing ENC. The mean (±SD) number of ENC items received was 1.23(±1.74) with a variance of 3.02 indicating over-dispersion. Living in the poorest wealth quintile (aIRR = 0.67, 95%CI: 0.51, 0.87), lack of Antenatal care (aIRR = 0.52, 95%CI: 0.49, 0.71), birth at home (aIRR = 0.27, 95% CI: 0.17, 0.34), living in rural area (aIRR = 0.39, 95% CI: 0.24, 0.57) were significant predictors of ENC uptake. CONCLUSION: The level of missing ENC was found to be high in Ethiopia with a significant spatial variation across regions. Hence, the government and policymakers should devise strategies for hotspot areas to improve women's economic capabilities, access to education, and health-seeking behaviours for prenatal care and skilled delivery services to improve ENC uptake.

The effect of maternal concerns about childbirth and postpartum period on obsessive and compulsive behaviors related to baby care / Efecto de las preocupaciones maternas sobre el parto y el puerperio en las conductas obsesivas y compulsivas relacionadas con el cuidado del bebé

INTRODUCTION: Postpartum anxiety after childbirth is a common condition among pregnant women due to reasons such as the uncertainty of experiencing pregnancy and childbirth for the first time, or previous negative experiences. Fear of childbirth can affect the mother's baby care process. OBJECTIVE: This study was conducted analytically with a single-subject design to determine the effects of maternal concerns about childbirth and the postpartum period on obsessive and compulsive behaviors related to baby care. MATERIALS AND METHODS: The study was conducted with 260 mothers. Data were collected using a descriptive information form, and the scales 'Fear of Childbirth and Postpartum Period', and 'Obsessive and Compulsive Behaviors of Mothers in the Postpartum Period Related to Baby Care'. The data were analyzed using the SPSS™ software to calculate percentages, mean values, t tests, ANOVA, Pearson's correlation, and simple linear regression analysis. RESULTS: A statistically significant and positive correlation was found between participant scores of the 'Fear of Childbirth and Postpartum Period' and the 'Obsessive and Compulsive Behaviors of Mothers in the Postpartum Period Related to Baby Care' scales (p < 0.01). The regression model showed that 18.0% of the total variance in the obsessive and compulsive behaviors of mothers in the postpartum was explained by the fear of childbirth and the postpartum period (corrected R2 = 0.180). CONCLUSIONS: Fear of childbirth and the postpartum period were moderate. However, as the fear of women regarding childbirth and the postpartum period increased, their postpartum obsessive and compulsive behaviors about baby care also increased.

Introducción: La ansiedad del parto y el posparto es una condición común entre las mujeres embarazadas por la incertidumbre de vivir el embarazo y el parto por primera vez o por previas experiencias negativas. El miedo al parto puede afectar el proceso del cuidado del bebé de la madre. Objetivo: Determinar el efecto de las preocupaciones maternas sobre el parto y el puerperio y su efecto sobre las conductas obsesivas y compulsivas relacionadas con el cuidado del bebé. Materiales y métodos: El estudio se realizó con 260 madres. Los datos fueron recolectados en el formulario de información descriptiva y se usaron la "Escala de miedo al parto y al período posparto" y la de "Comportamientos obsesivos y compulsivos de las madres en el período posparto relacionados con el cuidado del bebé". Los datos fueron evaluados mediante el software SPSS™ mediante el cálculo de porcentajes, promedio, prueba t, ANOVA, correlación de Pearson y análisis de regresión múltiple. Resultados: Se encontró una correlación positiva y estadísticamente significativa entre la "Escala de miedo al parto y del período posparto" y la de "Comportamientos obsesivos y compulsivos de las madres en el período posparto relacionadas con el cuidado del bebé" (p < 0.01). En el modelo creado por análisis de regresión se observó que el 18,0% del cambio en la escala de comportamientos obsesivos-compulsivos estaba explicado por el miedo al parto y al puerperio (R2 corregido = 0,180). Conclusiones: En el estudio se determinó que el miedo al parto y al puerperio era moderado. Sin embargo, a medida que aumentaba el puntaje de miedo al parto y al período posparto, también aumentaban los comportamientos obsesivos y compulsivos de las madres en el puerperio relacionados con el cuidado del bebé.

Association between pregnancy intention and completion of newborn and infant continuum of care in Sub-Saharan Africa: systematic review and meta-analysis.

BACKGROUND: The newborn and infant continuum of care such as essential newborn care, early initiation and exclusive breastfeeding, and immunisation are highly recommended for improving the quality of life and survival of infants. However, newborn and infant mortality remains high across Sub-Saharan African countries. While unintended pregnancies are associated with adverse newborn and infant health outcomes, there is inconclusive evidence on whether pregnancy intention influences newborn and infant continuum of care completion. Therefore, this review aimed to pool findings reported in the literature on the association between pregnancy intention and newborn and infant health care across the continuum of care in Sub-Saharan Africa. METHODS: We searched MEDLINE Complete, EMBASE, CINAHL Complete, and Global Health databases for studies potentially eligible for this systematic review and meta-analysis. Two researchers independently screened the identified articles by abstract and title, and then full-text using Covidence. We used the Newcastle-Ottawa Scale to assess the quality of the included studies. The Cochran's Q test and I2 were executed to detect and quantify the presence of statistical heterogeneity in the studies. Meta-analysis was done for each outcome when more than one original study reported relevant data, using Stata statistical software version 18. RESULTS: Eleven studies were included from a total of 235 articles identified by the search. The odds of completing essential newborn care (pooled odds ratio: 3.04, 95% CI: 1.56, 5.90), early initiation of breastfeeding (pooled odds ratio: 1.30, 95% CI: 1.13, 1.52), exclusive breastfeeding (pooled odds ratio: 2.21, 95% CI: 1.68, 2.89), and being fully immunised (pooled odds ratio: 2.73, 95% CI: 1.16, 6.40) were higher among infants born to women with intended pregnancies as compared to women with unintended pregnancies. CONCLUSION: Intended pregnancy was positively associated with essential newborn care completion, early initiation and exclusive breastfeeding, and full immunisation of infants in SSA countries. Thus, policy-makers and stakeholders should strengthen the provision of quality family planning services to prevent unintended pregnancy. Furthermore, follow-up of women with unintended pregnancies is needed to increase women's opportunity to access essential newborn health care services that further reduce the risk of newborn and infant morbidity and mortality. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration number CRD42023409148.

Experiences, barriers and perspectives of midwifery educators, mentors and students implementing the updated emergency obstetric and newborn care-enhanced pre-service midwifery curriculum in Kenya: a nested qualitative study.

INTRODUCTION: To achieve quality midwifery education, understanding the experiences of midwifery educators and students in implementing a competency-based pre-service curriculum is critical. This study explored the experiences of and barriers to implementing a pre-service curriculum updated with emergency obstetric and newborn care (EmONC) skills by midwifery educators, students and mentors in Kenya. METHODS: This was a nested qualitative study within the cluster randomised controlled trial investigating the effectiveness of an EmONC enhanced midwifery curriculum delivered by trained and mentored midwifery educators on the quality of education and student performance in 20 colleges in Kenya. Following the pre-service midwifery curriculum EmONC update, capacity strengthening of educators through training (in both study arms) and additional mentoring of intervention-arm educators was undertaken. Focus group discussions were used to explore the experiences of and barriers to implementing the EmONC-enhanced curriculum by 20 educators and eight mentors. Debrief/feedback sessions with 6-9 students from each of the 20 colleges were conducted and field notes were taken. Data were analysed thematically using Braun and Clarke's six step criteria. RESULTS: Themes identified related to experiences were: (i) relevancy of updated EmONC-enhanced curriculum to improve practice, (ii) training and mentoring valued as continuous professional development opportunities for midwifery educators, (iii) effective teaching and learning strategies acquired - peer teaching (teacher-teacher and student-student), simulation/scenario teaching and effective feedback techniques for effective learning and, (iv) effective collaborations between school/academic institution and hospital/clinical staff promoted effective training/learning. Barriers identified were (i) midwifery faculty shortage and heavy workload vs. high student population, (ii) infrastructure gaps in simulation teaching - inadequate space for simulation and lack of equipment inventory audits for replenishment (iii) inadequate clinical support for students due to inadequate clinical sites for experience, ineffective supervision and mentoring support, lack/shortage of clinical mentors and untrained hospital/clinical staff in EmONC and (iv) limited resources to support effective learning. CONCLUSION: Findings reveal an overwhelmed midwifery faculty and an urgent demand for students support in clinical settings to acquire EmONC competencies for enhanced practice. For quality midwifery education, adequate resources and regulatory/policy directives are needed in midwifery faculty staffing and development. A continuous professional development specific for educators is needed for effective student teaching and learning of a competency-based pre-service curriculum.

Family-centered care for newborns: a global perspective and review.

Person-centered models of care built on newborn and family needs and rights, such as nonseparation immediately after birth and during the care process, can address the complex needs of the newborn, family, and health system. This is particularly important in low- and middle-income countries, where cost-effective modalities are highly needed to accelerate the survival of newborn babies. We conducted a systematic review to explore country experiences on implementation and challenges to implement and scale-up family-centered newborn care models of care. MEDLINE, CINAHL, EMBASE, and PsycINFO databases were searched to identify studies on patient-centered care and newborns between 1990 and 2023. Studies meeting our predefined inclusion criteria were quality assessed and relevant data extracted. We utilized the World Health Organization framework on integrated people-centered health services to summarize and analyze findings while highlighting patterns. Forty-one studies were included for review (including approximately 60% from low- and middle-income countries). Different research conducted over time highlighted how immediate and uninterrupted skin-to-skin care facilitates a series of critical processes for newborns, parents, and health system, including breastfeeding initiation and exclusivity rates, reduced incidence of post-partum depression, and prevention of infection and hospitalization. Thanks to the close contact of the kangaroo position or skin-to-skin contact, parents recount becoming more and more attached to and familiar with their baby, easily establishing a relationship. Overall, countries could transform the newborn care service in terms of family center care by adopting three simple rules: (i) minimizing mother-child separation; (ii) involving fathers; (iii) empowering parents from the time of birth. A paradigm shift is required to change the conventional model of provider-centric care to one of person-centered neonatal health care. Such an approach is feasible in diverse country settings and should be facilitated through political commitment and policies enabling early focus on the maternal-infant relationship. This could, in turn, help achieve improved dignity of care and help create a more efficient and responsive health system and society.

Virtual reality versus low level simulation in newborn care teaching in Turkey.

The aim of this study is a virtual reality versus low level simulation in newborn care teaching in Turkey. Data were collected in 2019-2020 academic year in midwifery students in Turkey. In the first stage, virtual reality simulation software was developed. In the second stage, newborn care was provided with a virtual reality simulator to the experimental group and a low-fidelity simulator to the control group. Students' practice, self-confidence and satisfaction levels were compared using two different simulators. There was a difference between the two groups in terms of their skills, satisfaction and self-confidence. The simulator, which was developed and evaluated in the research, increased the students' satisfaction, self-confidence and skills. It was also found to be more effective than the classical method.

Le but de cette étude est une réalité virtuelle versus simulation de bas niveau dans l'enseignement des soins aux nouveau-nés en Turquie. Les données ont été collectées au cours de l'année universitaire 2019-2020 auprès d'étudiantes sages-femmes en Turquie. Dans un premier temps, un logiciel de simulation de réalité virtuelle a été développé. Dans la deuxième étape, les soins aux nouveau-nés ont été fournis avec un simulateur de réalité virtuelle pour le groupe expérimental et un simulateur basse fidélité pour le groupe témoin. Les niveaux de pratique, de confiance en soi et de satisfaction des étudiants ont été comparés à l'aide de deux simulateurs différents. Il existe une différence entre les deux groupes en termes de compétences, de satisfaction et de confiance en soi. Le simulateur développé et évalué dans le cadre de la recherche a accru la satisfaction, la confiance en soi et les compétences des étudiants. Elle s'est également révélée plus efficace que la méthode classique.

Encontro com Especialistas - Método Canguru: cuidado integral antes e após o nascimento

No Dia Internacional do Método Canguru, Encontro com Especialistas Sônia Venâncio, Coordenadora da Atenção à Saúde Integral da Criança e do Adolescente (CACRIAD/DGCI/SAPS/MS); Zeni Lamy, médica neonatologista, docente da UFMA; Sérgio Marba, médico neonatologista, docente da Unicamp; Mariana Bahia, assessora técnica da Coordenação de Atenção à Saúde da Mulher (COSMU/CGACI/DGCI/SAPS/MS); Celmário Brandão, Coordenador da Saúde do Homem (COSAH/CGACI/DGCI/SAPS/MS); Roseli Calil, médica neonatologista do Caism/Unicamp; e Mariane Curado Borges, Coordenação de Políticas de Aleitamento Materno da SES/DF.

Quality Assessment of Interactive Mobile Application - Maternal and Infant Care for Tribal Birth Attendants.

Digital health interventions can overcome geographical barriers and prepare health-care providers for better health outcomes in rural and remote tribal areas, however, it has not been explored among traditional birth attendants (TBAs). A mobile application, "maternal and infant care" (MAI) for capacity building of tribal birth attendants was developed and its quality was evaluated using the Mobile Application Rating Scale for user's interest in and satisfaction with the esthetics, information, and functionality. Thirteen Android user TBAs with the MAI application were piloted with the MARS checklist. Engagement, functionality, esthetics, and information quality; and one subjective quality scale having 29 items were used. The application was found to be entertaining excellent rating (mean score ± standard deviation) (4.00 ± 0.58), and scored high on performance (3.77 ± 0.93); layout design (3.85 ± 0.90); subjective quality (4.23 ± 0.93), however, scored minimum on interest; gestural design; visual appeal, etc. MAI is a user-friendly, culturally acceptable Android app that can be used for the capacity building of frontline workers.

Psychometric testing of the Chinese version of the Perinatal Infant Care Social Support tool: a methodological study.

PURPOSE: This study aimed to translate the Perinatal Infant Care Social Support (PICSS) instrument into Chinese and to verify the reliability and validity of the translated version. METHODS: This study used a cross-sectional design to examine the reliability and validity of the Chinese version of the PICSS (C-PICSS). A cohort of 150 first-time mothers in China participated, attending hospital follow-up care at 6 weeks postpartum. Data were collected after obtaining informed consent from the mothers. RESULTS: The majority of mothers were aged between 20 and 29 years, with a mean age of 26.25 (±3.90) years. An item analysis of the 19 items in the C-PICSS showed that all items had an item-total score correlation above 0.2. This resulted in a Kaiser-Meyer-Olkin value of 0.92 and a significant Bartlett's test of sphericity (χ2=1,778.65, p<.001), confirming the suitability of the data for factor analysis. Correlation analyses revealed a strong positive relationship between infant care social support and general social support (r=.62, p<.001), and a negative relationship between infant care social support and postpartum depression (r=-.38, p<.001). Higher scores for infant care social support were associated with reporting positive relationships with their husbands (t=3.72, p<.001) and high levels of spousal involvement (t=4.09, p<.001). In terms of structural support, spouses were identified as the primary source. CONCLUSION: The research results indicate that C-PICSS is reliable and valid as an indicator of social support for infant care among Chinese mothers.

Exploring the shift in newborn care practices among mothers and grandmothers in rural Odisha, India - a qualitative study.

BACKGROUND: This study delves into newborn care and infant-feeding practices in rural Odisha, specifically focusing on the rural KBK + region of Odisha (Kalahandi-Bolangir-Koraput region), inhabited predominantly by Schedule Tribes and Schedule Castes individuals. There has been an improvement in the health indicators in these areas in recent times. In the background of improved health indicators in these areas, this research explores the current and changing newborn care practices and attempts to gain insight into people's perceptions of the factors that brought about the changes. METHODS: This qualitative study was conducted between February and July 2023 at Christian Hospital, Bissamcuttack in Odisha. The methodology involved focused group discussions with mothers and grandmothers. RESULTS: Analysis revealed healthy practices like exclusive breastfeeding till six months of age, appropriate timing of the first bath, and prompt healthcare-seeking behavior for minor illnesses among the mothers. The use of cow ghee or breast milk in a baby's eyes, the application of ash on the umbilical cord, and the use of herbal medicines for minor illnesses were practiced more by the grandmothers in the past and were not as popular among the mothers. It is noteworthy that the cultural practices to ward off the 'evil eye' were practiced by both mothers and grandmothers alike. Despite the influence of traditional cultural practices on the beliefs and norms of the community, the study identified a shift in health-seeking behavior, with increased reliance on healthcare providers and safe healthcare practices. The study identifies the pivotal role of Accredited Social Health Activists (ASHAs) as a bridge between the rural communities and the healthcare system. CONCLUSIONS: This research provides valuable insights for healthcare providers aiming to enhance community-centric safe newborn care practices in rural settings. The emphasis is on the importance of understanding the current and changing local practices. This would help the healthcare providers to encourage healthy practices while eliminating the harmful practices related to newborn care through community workers like ASHA and Anganwadi workers.

Educational technology to promote self-efficacy in newborn care: a validation study.

Objective: To build and validate an educational technology consisting of a flipchart to promote self-efficacy in newborn care. Methods: A methodological study was carried out in two stages: (i) creation of the flipchart and (ii) validation by 25 experts and 50 people who could be the target audience (pregnant women, mothers or family members of newborns). Clarity, language, practical relevance and theoretical relevance were reviewed using the Suitability Assessment of Materials (SAM) instrument. The Content Validity Index and the Flesch Readability Index were calculated. Results: The serial album "Can you take care of your baby" consists of 30 pages. The overall Content Validity Index was 0.93 among experts and 1.0 among the target audience. The flipchart was considered superior quality material, reaching an agreement percentage of 94.9, indicating that it is suitable as an educational technology. Participants suggested adjustments, incorporated into the material for printed production. Conclusion: The flipchart developed and with content validated by experts is suitable for use in health education activities that aim to promote self-efficacy in caring for newborns.

Effect of Routine Nurse Caregiving on the Stress Responses and Behavior State in Preterm Infants: A Systematic Review.

BACKGROUND: Although routine nurse caregiving is vital for the overall health of preterm infants, variations in approaches may exert distinct effects on preterm infants' stress responses and behavior state. PURPOSE: The purpose of this systematic review was to examine routine nurse caregiving in the neonatal intensive care unit and its effect on stress responses and behavior state in preterm infants. DATA SOURCES: A systematic search was conducted using PubMed, Embase, and CINAHL for studies published between 2013 and 2023. STUDY SELECTION: Included studies enrolled preterm infants born <37 weeks gestational age and investigated nurse caregiving practices and effects on stress responses and/or behavior state. DATA EXTRACTION: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, data about study design, methods, findings, and limitations were extracted and summarized. Included studies were evaluated for bias using the National Health, Lung, and Blood Institute quality assessment tools. RESULTS: All 13 studies included in the review received a fair quality rating. Nurse caregiving activities, including suctioning, diaper changes, bathing, and weighing, were associated with increases in heart and respiratory rates, blood pressure, energy expenditure, and motor responses, lower oxygen saturations, and fewer sleep states. IMPLICATIONS FOR PRACTICE AND RESEARCH: Adapting nurse caregiving frequency and duration, aligning caregiving with infant state, and integrating developmental care strategies may reduce infant stress responses and support behavioral rest. Further research is needed to understand how caregiving activities affect stress responses and behavior state in preterm infants, aiding in identifying modifiable caregiving stressors to promote optimal development.

Infant Care: Predictors of Outdoor Walking, Infant Carrying and Infant Outdoor Sleeping.

BACKGROUND: Although spending time outdoors is beneficial for development, little is known about outdoor time during infancy. The aim of this study was to assess frequencies and durations of (1a) outdoor walking and carrying in mother-infant dyads and (1b) infant outdoor sleeping in a stationary cot or pram. We furthermore aimed to identify associations of (2a) outdoor walking and carrying and (2b) infant outdoor sleeping, with infant, maternal and environmental sample characteristics. METHODS: An online survey was distributed among mothers of 0- to 12-month-old infants. Initially, 1453 mothers were recruited, of which 1275 were included in the analyses. With respect to (1a) the outcomes of interest were: mother-infant dyads' total weekly duration of walking in minutes, frequency of walking on weekdays, as well as weekends, and the frequency of using an infant carrier during walks, as well as the daily duration of carrying in hours (indoors and outdoors together). With respect to (1b) the outcome variables were: placing the infant outdoors to sleep (yes/no), the total weekly duration of outdoor sleeping and the weekly frequency of outdoor sleeping. For aim 2, associations of the outcome variables with infant (i.e., age), maternal (i.e., working status) and environmental (i.e., house type) sample characteristics were assessed. RESULTS: Mother-infant dyads engaged in walks for a total weekly duration of 201 min, for approximately one to three walks over weekdays (Monday through Friday), as well as one to three walks on the weekend. The infant carrier was used by 22% of mothers at least half of the time during outdoor walks, and 18% reported a daily duration of infant carrying of one hour or more. Among other associations, infant and maternal enjoyment of outdoor walking correlated positively with the duration as well as the frequency of walking during weekdays and during the weekend. Furthermore, employed mothers walked for a shorter duration and less frequently on weekdays as compared to mothers on maternity leave or mothers without a paid job. The availability of nearby recreational areas correlated positively with the weekly duration and frequency of walks. The infant carrier was used more frequently during outdoor walks if more than one child lived in the household. Infant carrying during outdoor walks was also related to infant behavior at night. Roughly a third of the mothers (29%) regularly had their infant sleep outdoors for a weekly duration of four hours and a weekly frequency of approximately one to two times. Younger infants, infants of mothers with higher education and infants living in detached houses were more likely to be placed outdoors to sleep. DISCUSSION: We identified associations of infant, maternal and environmental characteristics with outdoor time spent during infancy. These results lay the foundation for future research on the effects of the outdoors on child development as well as on facilitators and barriers for caregivers.

Promoting Safe Sleep: The Role of Doulas in Black Communities.

BACKGROUND: Accidental suffocation and strangulation in bed continues to be a critical issue in Black communities, despite the widespread initiatives to promote safe sleep. Doulas are in an ideal position to promote safe sleep, particularly in hard-to-reach communities that are more distrusting of conventional medical providers. Little is known about their practices and perspectives for putting infants down to rest. This study informs this gap in the literature. PURPOSE: The purpose of this study was to explore doulas' perspectives and practices in the field of putting infants down to sleep. The researchers aimed to determine whether Black caregivers that work with doulas are likely to encounter safe sleep education. METHODS: The researchers used a descriptive approach to inquiry. They conducted three focus groups with a total of 17 Black doulas. The researchers independently and critically reviewed the transcriptions and observation notes from each group to identify codes. They then triangulated the results using Artificial Intelligence-driven tools. FINDINGS: The study found four themes: (1) Individualized Services, (2) Cultural Sensitivity, (3) Negotiating Safety, and (4) Safe Sleep Education. CONCLUSIONS: The study concluded doulas have a commitment to promoting safe sleep. The researchers found that doulas engage in practices that help caregivers to integrate safe sleep practices into their lifestyle and to adapt them to meet their needs. The researchers also documented a desire for more information and instruction on safe sleep among practicing doulas.

"Doing being a good parent" in the pediatric clinic: Parents' knowledge displays in advice requests on infants' everyday care.

Parents and pediatricians play pivotal roles in promoting a nurturing environment for children's growth and development, especially during the critical first thousand days of life. Given the challenges involved in infant care and rearing, parents often rely on pediatricians' professional support in a wide range of daily caregiving practices as diverse as complementary feeding, hygiene management, pacifier use, or sleep routines. Nevertheless, little attention has been devoted to the in vivo observation of how parents actually request advice on babies' everyday care, and how pediatricians attend to such requests. By adopting a conversation analysis approach to a corpus of 23 videorecorded Italian pediatric well-child visits, the article explores the different ways through which parents navigate the face-threatening activity of soliciting the pediatrician's advice on infants' everyday care and management. The analysis illustrates that parents overall display (different degrees of) prior knowledge and competence on the topics brought to the pediatrician's attention while, at the same time, acknowledging the pediatrician's expertise and professional role. In this way, I argue that parents display themselves as competent, knowledgeable, caring, and therefore "good parents". After discussing the results, in the concluding remarks I point to what seems to be a cultural change in parent-healthcare provider interactions.

Effects of infant care posture and weight on static postural balance.

BACKGROUND: Studies investigating postural balance during various infant care postures have not been reported yet. OBJECTIVE: The aim of this study was to measure static postural balance when holding an infant dummy in-arms and carrying an infant dummy on back according to different infant dummy weights. METHODS: Sixteen healthy young subjects participated in a balance test. Infant dummies with weights of 4.6 kg (1-month) and 9.8 kg (12-month) were used in this study. All subjects were asked to naturally stand on a force platform in two infant care postures (holding an infant in-arms and carrying an infant on one's back). Center of pressure (COP) was measured from the force platform. Quantitative variables were derived from the COP. Two-way repeated measure analysis of variance (ANOVA) was performed to determine main effects of infant care postures, infant weight, and their interactions on COP variables. RESULTS: Back carrying a 12-month infant dummy had the greatest amplitude in all COP variables. Back carrying posture showed significantly greater mean distance and peak power, faster mean velocity, and wider COP area compared to holding posture (P< 0.05). There were significant weight effects of most COP variables mainly in AP direction (P< 0.01). CONCLUSIONS: Our results could contribute to the prevention of musculoskeletal diseases or prevention of fall due to various infant care activities by developing an assisting device to improve postural balance.

Promoting infant safe sleep practices among neonatal and paediatric nurses through simulation-based training program.

PURPOSE: To evaluate the effect of a Simulation-based training (SBT) program on neonatal and paediatric nurses' knowledge regarding infant safe sleep practices. BACKGROUND: Sudden infant death syndrome (SIDS) presents a major public health concern, preventable through the promotion of optimal safe sleep practices, particularly among neonatal and paediatric nurses. Despite its effectiveness in enhancing nurses' knowledge and clinical skills, SBT is not an adopted training method for nurses in Egypt. DESIGN AND METHODS: A single-group pre- and post-test design involved 57 nurses from Neonatal Intensive Care Unit, Paediatric Intensive Care Unit, and Paediatric In-patient Unit. The study consisted of two stages. In the first stage, knowledge assessment to identify deficiencies. The second stage, researchers developed four SBT scenarios. Two of these scenarios were recorded for training purposes, while the other two were intended for nurses to actively participate in. Data were collected from May 2022 to January 2023. RESULTS: A significant improvement in nurses' knowledge of infant safe sleep practices and SIDS prevention was observed (p = 0.000). Nurses expressed high satisfaction with the training program (mean score 45.035 ± 4.38). CONCLUSION: This study provides evidence that simulation-based training is an effective approach to promoting safe infant sleep practices among neonatal and paediatric nurses. PRACTICE IMPLICATIONS: Integrating SBT programs into nursing education can enhance nurses' knowledge and skills in infant-safe sleep practices, providing a realistic and interactive learning experience.

Stakeholders' Perspectives on the "Helping Babies Breathe" Program Situation in Nepal Following the COVID-19 Pandemic.

BACKGROUND: The COVID-19 pandemic impacted healthcare systems, including resuscitation training programs such as Helping Babies Breathe (HBB). Nepal, a country with limited healthcare resources, faces challenges in delivering effective HBB training, managing deliveries, and providing neonatal care, particularly in remote areas. AIMS: This study assessed HBB skills and knowledge postpandemic through interviews with key stakeholders in Nepal. It aimed to identify strategies, adaptations, and innovations to address training gaps and scale-up HBB. METHODS: A qualitative approach was used, employing semistructured interviews about HBB program effectiveness, pandemic challenges, stakeholder engagement, and suggestions for improvement. RESULTS: The study encompassed interviews with 23 participants, including HBB trainers, birth attendants, officials, and providers. Thematic analysis employed a systematic approach by deducing themes from study aims and theory. Data underwent iterative coding and refinement to synthesize content yielding following 5 themes: (1) pandemic's impact on HBB training; (2) resource accessibility for training postpandemic; (3) reviving HBB training; (4) impacts on the neonatal workforce; and (5) elements influencing HBB training progress. CONCLUSION: Postpandemic, healthcare workers in Nepal encounter challenges accessing essential resources and delivering HBB training, especially in remote areas. Adequate budgeting and strong commitment from healthcare policy levels are essential to reduce neonatal mortality in the future.

Newborn care knowledge and practices among care givers of newborns and young infants attending a regional referral hospital in Southwestern Uganda.

A child born in developing countries has a 10 times higher mortality risk compared to one born in developed countries. Uganda still struggles with a high neonatal mortality rate at 27/1000 live births. Majority of these death occur in the community when children are under the sole care of their parents and guardian. Lack of knowledge in new born care, inappropriate new born care practices are some of the contributors to neonatal mortality in Uganda. Little is known about parent/caregivers' knowledge, practices and what influences these practices while caring for the newborns. We systematically studied and documented newborn care knowledge, practices and associated factors among parents and care givers. To assess new born care knowledge, practices and associated factors among parents and care givers attending MRRH. We carried out a quantitative cross section methods study among caregivers of children from birth to six weeks of life attending a regional referral hospital in south western Uganda. Using pretested structured questionnaires, data was collected about care givers' new born care knowledge, practices and the associated factors. Data analysis was done using Stata version 17.0. We interviewed 370 caregivers, majority of whom were the biological mothers at 86%. Mean age was 26 years, 14% were unemployed and 74% had monthly earning below the poverty line. Mothers had a high antenatal care attendance of 97.6% and 96.2% of the deliveries were at a health facility Care givers had variant knowledge of essential newborn care with associated incorrect practices. Majority (84.6%) of the respondents reported obliviousness to putting anything in the babies' eyes at birth, however, breastmilk, water and saliva were reportedly put in the babies' eyes at birth by some caregivers. Hand washing was not practiced at all in 16.2% of the caregivers before handling the newborn. About 7.4% of the new borns received a bath within 24 hours of delivery and 19% reported use of herbs. Caregivers practiced adequate thermal care 87%. Cord care practices were inappropriate in 36.5%. Only 21% of the respondents reported initiation of breast feeding within 1 hour of birth, Prelacteal feeds were given by 37.6% of the care givers, water being the commonest prelacteal feed followed by cow's milk at 40.4 and 18.4% respectively. Majority of the respondents had below average knowledge about danger signs in the newborn where 63% and mean score for knowledge about danger signs was 44%. Caretaker's age and relationship with the newborn were found to have a statistically significant associated to knowledge of danger signs in the newborn baby. There are variable incorrect practices in the essential new born care and low knowledge and awareness of danger signs among caregivers of newborn babies. There is high health center deliveries and antenatal care attendance among the respondents could be used as an opportunity to increase caregiver awareness about the inappropriate practices in essential newborn care and the danger signs in a newborn.