Giving new meaning to the impact of touch in Shantala massage: mothers' perceptions of maternal and child well-being.

OBJECTIVES: to understand maternal perceptions of maternal and child well-being based on Shantala massage and discuss its association with the third Sustainable Development Goal. METHODS: a descriptive-exploratory study in the light of Symbolic Interactionism. Eight women, mothers of infants, participated in five online meetings to teach Shantala massage, collected in focus groups, between November and December 2021. The data was subjected to thematic content analysis and lexical analysis with IRAMUTEQ®. RESULTS: two categories emerged, 1) Maternal perceptions of Shantala massage and its promotion of child well-being and 2) Maternal perceptions of Shantala massage and its impact on their well-being, interconnected with subcategories. FINAL CONSIDERATIONS: Shantala massage promoted mutual impacts on maternal and child well-being, working together to achieve the third Sustainable Development Goal.

The Relationships Between Trust Beliefs in Physicians by Children With Asthma, Those by Their Mothers and the Children's Medical Health.

BACKGROUND: The study examined whether there were linear and curvilinear relationships between the trust beliefs in physicians by the children, those by their mothers and the children's medical health. The study examined whether there were changes in those relationships across time. METHODS: The data gathered in a previous study were subjected to further analyses. One hundred and forty-three children with asthma (116 males, Mage = 12 years and 7 months) and their mothers were administered standardized scales twice across 1 year. The scales assessed the children's trust beliefs in physicians, the mothers' trust beliefs in physicians, the children's quality of life and the children's adherence to prescribed medical regimes. RESULTS: Quadratic relationships were found between the children's quality of life and both their and their mothers' trust beliefs in physicians. The quadratic relationship increased over time. Linear relationships were found between trust beliefs in physicians and children's adherence to prescribed medical regimes. CONCLUSION: Children with asthma are prone to a lower quality of life when they and their mothers hold very high, as well as hold very low, trust beliefs in physicians. Children's trust beliefs in physicians increase the probability of adherence to prescribed medical regimes.

Effects of kangaroo mother care combined with nurse-assisted mindfulness training for reducing stress among mothers of preterm infants hospitalized in the NICU: a randomized controlled trial.

BACKGROUND: Kangaroo mother care (KMC) can have a positive effect on the mental well-being of a mother. However, there are specific challenges associated with the process that may contribute to increased anxiety for the mother. By integrating nurse-assisted mindfulness training alongside KMC guidance, nurses may effectively alleviate maternal stress to a greater extent. METHODS: A single-centre randomized controlled trial was conducted to investigate the effects of KMC combined with nurse-assisted mindfulness training. The study included preterm infants with a gestational age of less than 32 weeks or a birth weight of less than 1500 g and their mothers, who were randomly divided into two groups. The intervention group consisted of mothers who received KMC combined with nurse-assisted mindfulness training for 14 days. The control group comprised mothers who received only KMC for 14 days. Data from both groups were collected and compared for analysis. RESULTS: Forty-seven infants and their mothers were included in the intervention group, whereas 44 pairs were included in the control group. After the intervention, the parental stressor scale scores for the neonatal intensive care unit (PSS: NICU) (3), PSS: NICU (4), and Hospital Anxiety and Depression Scale (HADS) scores for the intervention group were lower than those for the control group, whereas the Five Facet Mindfulness Questionnaire (FFMQ) (1), FFMQ (4), and FFMQ (5) scores for the intervention group were higher. The degree of change in the PSS: NICU and HADS scores was inversely correlated with the degree of change in the FFMQ score. The breast milk feed rate and weight gain rate were greater in the intervention group than in the control group. No adverse reactions were observed in either group. CONCLUSIONS: Kangaroo mother care combined with nurse-assisted mindfulness training is an acceptable, feasible, and effective procedure for reducing anxiety in mothers of preterm infants in the NICU, with potential benefits for the short-term prognosis of these infants. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR1900023697, registered on June 8, 2019, retrospectively registered.

Prevalence of early initiation of breastfeeding and its associated factors among women in Mauritania: evidence from a national survey.

BACKGROUND: Timely initiation of breastfeeding is crucial for positive health outcomes for babies and mothers. Understanding the factors influencing timely initiation of breastfeeding is vital for reducing child morbidities and mortalities in Mauritania. This study, therefore, assessed the prevalence of early initiation of breastfeeding and its associated factors among women in Mauritania, providing significant insights for improving maternal and child health in the country. METHODS: We performed a secondary analysis of the 2019-2021 Mauritania Demographic and Health Survey data. A weighted sample of 4,114 mother-child pairs was included in the study. We used percentage to present the prevalence of early initiation of breastfeeding. A four-modelled multilevel binary logistic regression was used to examine the factors associated with early initiation of breastfeeding. The regression results were presented using adjusted odds ratio (aOR) with their respective 95% confidence interval (CI). Stata software version 17.0 was used to perform all the analyses. RESULTS: The prevalence of early initiation of breastfeeding was 57.3% (95% CI 54.5, 60.00). Birth order was associated with early initiation of breastfeeding with the highest odds among those in the fourth birth order (aOR 1.61; 95% CI 1.08, 2.39). Mothers who practiced skin-to-skin contact were more likely to initiate breastfeeding early than those who did not (aOR 1.46; 95% CI 1.14, 1.87). There were regional disparities in the early initiation of breastfeeding. The odds of timely initiation of breastfeeding was lower among women who were delivered by caesarean section (aOR 0.22; 95%CI 0.14, 0.36), those who were working (aOR 0.57; 95% CI 0.45, 0.73), those who had four or more antenatal care visits (aOR 0.67; 95%CI 0.47, 0.94)], and those in the richest wealth quintile (aOR 0.61; 95% CI 0.38, 0.98) compared to those who had normal delivery, those who were not working, those who had zero antenatal care visits, and those in the poorest wealth quintile households, respectively. CONCLUSION: Our study found a relatively low prevalence of early initiation of breastfeeding among women in Mauritania. Factor such as birth order, region of residence, mother and newborn skin-to-skin contact after birth, antenatal care visits, caesarean delivery, employment status, and wealth index were associated with early initiation of breastfeeding. Improving optimal breastfeeding practices, such as early initiation of breastfeeding in Mauritania, should be given adequate attention. There is a need for interventions such as baby-friendly facilities, providing an enabling environment for mothers to breastfeed their newborns early. Addressing regional health access disparities is important to improve early initiation of breastfeeding and other maternal, newborn, and child health interventions.

Reducing stunting and underweight through mother's birth spacing: evidence from Ghana.

BACKGROUND: Researchers over the years have underscored the role of birth spacing on maternal health, however, inadequate maternal repletion due to shorter birth intervals could also affect the health of the child. Even so, limited studies exist on the linkage between birth spacing and child nutrition. This study examines the association between birth spacing and child stunting and underweight using the 2014 Ghana Demographic and Health Survey. METHODS: The study sourced data on 1, 904 children less than 59 months from the 2014 Ghana Demographic and Health Survey. The study employed bivariate analysis and logistic regressions to establish the association between birth spacing, and child stunting and underweight. RESULTS: The analyses reveal that childbirth spacing between 24 and 35 months (OR = 0.62, 95% CI: 0.38-0.99; p < 0.05), 36 to 47 months (OR = 0.42, 95% CI: 0.25-0.70; p < 0 0.01), and beyond 47 months (OR = 0.47, 95% CI: 0.28-0.78; p < 0.01) have lower odds of child stunting than children with birth spacing less than 24 months. Children with birth spacing between 24 and 35 months (OR = 0.53, 95% CI: 0.29-0.98; p < 0.05), 36 to 47 months (OR = 0.44, 95% CI: 0.22-0.90; p < 0.01) and beyond 47 months (OR = 0.49, 95% CI: 0.26-0.94; P < 0.05) have lower odds of being underweight than those with birth spacing less than 24 months. CONCLUSION: The study reveals that mothers with a birth spacing of at least two to three years compared to their counterparts with less than two years of birth spacing have lower odds of having a stunted and underweight child under age five. The study recommends that Ghana Health Service and other healthcare providers should educate mothers on the gains of birth spacing of at least two years on their children.

Idiosyncratic gesture use in a mother-infant dyad in chimpanzees (Pan troglodytes schweinfurthii) in the wild.

One promising method to tackle the question, "In which modality did language evolve?" is by studying the ontogenetic trajectory of signals in human's closest living relatives, including chimpanzees (Pan troglodytes). Concerning gestures, current debates centre on four different hypotheses: "phylogenetic ritualization", "social transmission through imitation", "ontogenetic ritualization", and "social negotiation". These differ in their predictions regarding idiosyncratic gestures, making such occurrences a crucial area of investigation. Here, we describe a novel and potential idiosyncratic behaviour - 'hand-on-eye' - which was initially observed in one mother-infant dyad in a community of chimpanzees living in the wild. We systematically investigated the form, sequential organisation, intentionality, usage, function, and distribution of the behaviour over a five-year period. The results showed that 'hand-on-eye' was nearly exclusively deployed in a single mother-infant dyad, was accompanied by hallmarks of intentionality, and served to initiate or resume joint dorsal travel. Although the behaviour was observed once in each of three other mother-infant dyads, these lacked the same frequency and hallmarks of intentionality. 'Hand-on-eye' thus qualifies as an idiosyncratic gesture. The proposed developmental pathway gives support to both the "ontogenetic ritualization" and "social negotiation" hypotheses. It also stresses the crucial need for longitudinal approaches to tackle developmental processes that are triggered by unique circumstances and unfold over relatively long time windows.

Identifying postpartum depression: Using key risk factors for early detection.

BACKGROUND: Personal and family history of psychiatric disorders are key risk factors for postpartum depression (PPD), yet their combined contribution has been understudied. OBJECTIVE: To examine personal and family psychiatric history, alone and combined, and their effect on absolute risk and relative risk (RR) of mild/moderate or severe PPD. METHODS: In this cohort study, we used data from 142 064 childbirths with PPD screenings from 2015 to 2021 merged with population registers. Exposures were personal and family psychiatric history defined as a psychiatric hospital contact or psychotropic prescription fills by index mothers and their parents prior to delivery. Outcomes were mild/moderate PPD (Edinburgh Postnatal Depression Scale, cut-off: ≥11 within 12 weeks post partum) and severe PPD (antidepressant fill or depression diagnosis within 6 months post partum). We calculated absolute risks and RRs using Poisson regression models adjusted for parity, education, maternal age, and calendar year. FINDINGS: Of the 142 064 participants, 23.4% had no psychiatric history, 47.4% had only family history, 6.0% had only personal history, and 23.2% had both. The latter group had the highest risk of PPD: absolute risk of mild/moderate PPD was 11.7% (95% CI 11.5%; 11.8%), and adjusted RR: 2.35 (95% CI 2.22; 2.49). Alone, personal psychiatric history was the most potent risk factor. Dose-response relationship based on severity of personal and family psychiatric history was found. DISCUSSION: Our study documents a substantial association between personal and family psychiatric history and PPD risk. CLINICAL IMPLICATIONS: Evaluating combinations of risk factors is important to improve risk assessment.

Experiences of maternal healthcare delivery in South Africa: Perinatal women's viewpoints.

Becoming a mother should be an exciting experience in woman's life. No mother should have to endure adverse encounters. while seeking healthcare in any maternal services facility. this is a phenomenon occurring globally. Delivery of these maternal healthcare services has a bearing on the obstetrical outcomes of mothers from preconception until six weeks after delivery. The study aims to understand the experiences of perinatal women regarding maternal healthcare services in the public hospitals of Gauteng province in South Africa. This study followed an exploratory and descriptive qualitative approach using a purposive sampling method. The study was conducted in three selected public hospitals representing different levels of care namely, district, tertiary provincial, and academic in the Gauteng province. A total of forty-six perinatal women were selected to take part in six focus groups. Data were thematically analysed following the six steps given by Braun and Clarke (2013). Three themes emerged as follows: 1) individual 2) interpersonal reasons and 3) impact of poor complaints procedure on maternal healthcare. The study showed that maternity services rendered to perinatal women in the three selected public hospitals are affected by several factors, such as midwives' attitudes, knowledge and skills, professional ethics, communication, and delayed maternal healthcare. These findings demonstrate an urgent need for practice and policy interventions that go beyond just a routine service but quality and organised maternal healthcare services provided in public hospitals, for improved healthcare outcomes at the point of service.

Devenir mère devrait être une expérience passionnante dans la vie d'une femme. Aucune mère ne devrait avoir à subir des rencontres défavorables. tout en recherchant des soins de santé dans un établissement de services maternels. c'est un phénomène qui se produit à l'échelle mondiale. La prestation de ces services de santé maternelle a une incidence sur les résultats obstétricaux des mères depuis la préconception jusqu'à six semaines après l'accouchement. L'étude vise à comprendre les expériences des femmes périnatales concernant les services de santé maternelle dans les hôpitaux publics de la province de Gauteng en Afrique du Sud. Cette étude a suivi une approche qualitative exploratoire et descriptive utilisant une méthode d'échantillonnage raisonné. L'étude a été menée dans trois hôpitaux publics sélectionnés représentant différents niveaux de soins, à savoir le district, le niveau tertiaire provincial et le niveau universitaire de la province de Gauteng. Au total, quarante-six femmes périnatales ont été sélectionnées pour participer à six groupes de discussion. Les données ont été analysées thématiquement selon les six étapes données par Braun et Clarke (2013). Trois thèmes ont émergé : 1) les raisons individuelles, 2) les raisons interpersonnelles et 3) l'impact d'une mauvaise procédure de plainte sur la santé maternelle. L'étude a montré que les services de maternité rendus aux femmes périnatales dans les trois hôpitaux publics sélectionnés sont affectés par plusieurs facteurs, tels que les attitudes, les connaissances et les compétences des sages-femmes, l'éthique professionnelle, la communication et les retards dans les soins maternels. Ces résultats démontrent un besoin urgent d'interventions pratiques et politiques qui vont au-delà d'un simple service de routine, mais aussi de services de santé maternelle organisés et de qualité fournis dans les hôpitaux publics, pour améliorer les résultats des soins de santé au point de service.

Digital communication between mothers and community health workers to support neonatal health (CHV-NEO): study protocol for a randomized controlled trial.

BACKGROUND: Provision of essential newborn care at home, rapid identification of illness, and care-seeking by caregivers can prevent neonatal mortality. Mobile technology can connect caregivers with information and healthcare worker advice more rapidly and frequently than healthcare visits. Community health workers (CHWs) are well-suited to deliver such interventions. We developed an interactive short message service (SMS) intervention for neonatal health in Kenya, named CHV-NEO. CHV-NEO sends automated, theory-based, actionable, messages throughout the peripartum period that guide mothers to evaluate maternal and neonatal danger signs and facilitate real-time dialogue with a CHW via SMS. We integrated this intervention into Kenya's national electronic community health information system (eCHIS), which is currently used at scale to support CHW workflow. METHODS: The effect of CHV-NEO on clinical and implementation outcomes will be evaluated through a non-blinded cluster randomized controlled trial. Twenty sites across Kisumu County in Western Kenya were randomized 1:1 to provide either the national eCHIS with integrated CHV-NEO messaging (intervention) or standard of care using eCHIS without CHV-NEO (control). We will compare neonatal mortality between arms based on abstracted eCHIS data from 7200 pregnant women. Secondary outcomes include self-reported provision of essential newborn care (appropriate cord care, thermal care, and timely initiation of breastfeeding), knowledge of neonatal danger signs, and care-seeking for neonatal illness, compared between arms based on questionnaires with a subgroup of 2000 women attending study visits at enrollment in pregnancy and 6 weeks postpartum. We will also determine CHV-NEO's effect on CHW workflows and evaluate determinants of intervention acceptability, adoption, and fidelity of use through questionnaires, individual interviews, and messaging data. DISCUSSION: We hypothesize that the CHV-NEO direct-to-client communication strategy can be successfully integrated within existing CHW workflows and infrastructure, improve the provision of at-home essential newborn care, increase timely referral of neonatal illness to facilities, and reduce neonatal mortality. The intervention's integration into the national eCHIS tool will facilitate rapid scale-up if it is clinically effective and successfully implemented. TRIAL REGISTRATION: ClinicalTrials.gov, NCT05187897 . The CHV-NEO study was registered on January 12, 2022.

Prevalence of nocturnal enuresis among children and adults in Saudi Arabia: a systematic review and meta-analysis.

BACKGROUND: Nocturnal enuresis (NE) is defined as any intermittent incontinence while sleeping in a child over the age of 5. This disorder can have emotional and psychological implications. Here, we performed the first meta-analysis to provide an overall assessment of the prevalence of NE and the factors associated with it in Saudi Arabia. We also examined its psychological impact and mothers' behavior in dealing with this disorder. PATIENTS AND METHODS: A thorough search was conducted on PubMed, Scopus, Cochrane, and Web of Science databases for studies assessing the prevalence of NE. Comprehensive Meta-Analysis Version 3.3 was used to conduct the analysis. We evaluated NE prevalence, NE frequencies, NE by time, social shame and embarrassment in children with NE, and mothers seeking medical advice. A meta-regression analysis was performed to determine the correlation between the frequency of NE and NE in parents, NE in siblings, gender, and age. The quality of the included studies was assessed by Newcastle Ottawa Scale. RESULTS: Sixteen cross-sectional studies, totaling 14 284 participants, were included. NE prevalence was 24.8% (95% CI: 17, 34). The prevalence of NE one to two times per week was 26.8% (95% CI: 15.1, 43.0), three to four times was 31.8% (95% CI: 18.5, 48.9), and five to seven times was 33.8% (95% CI: 18.2, 54.1). NE occurring at night was 24.4% (95% CI: 22.8, 26.2) and at day and night was 16.6% (95% CI: 15.3, 17.9). A significant difference was found between the regions of Saudi Arabia in the prevalence of NE, with the southern and eastern regions having the highest prevalence and the central region having the lowest prevalence. The overall pooled prevalence of embarrassment and social shame in children with NE was 63% (95% CI: 46, 77). The percentage of mothers seeking medical advice was 54.4% (95% CI: 39.7, 68.3). The prevalence of NE is positively correlated with the prevalence of NE in parents and siblings, but no association was found with males or age. CONCLUSION: A quarter of Saudi Arabian children suffer from NE, and it is associated with feelings of embarrassment and social shame. Half of the mothers seek medical counseling. Having parents or siblings with NE increases the likelihood of NE in the child. Future research is needed to corroborate the findings of other risk factors, such as age and gender. Future research will also be required to identify the precise causes or effects within each region that contribute to the varying prevalence of NE.

Motherhood penalty for female physicians in Japan: evidence from a medical school's alumni data.

BACKGROUND: Female physicians with children often work fewer hours and take fewer shifts due to additional family responsibilities. This can contribute to a gender pay gap in the medical profession. However, limited research in Japan has quantitatively examined the factors contributing to this gap. This study aims to address this gap in the literature. METHODS: We analyzed the alumni data from a medical school in Hokkaido, Japan, for 260 physicians (198 males and 62 females). We used multivariable regression models to identify factors influencing earnings from medical practice, with a focus on gender, work schedules, parenthood, and any career interruptions related to childcare. RESULTS: Our analysis revealed a 25.0% earnings gap between male and female physicians. Nearly all female physicians with children experienced career interruptions due to childcare, while this was uncommon for male physicians. When these childcare-related interruptions were factored in, the gender pay gap narrowed by 9.7%. After adjusting for work schedules and specialty choices, female physicians with children still earned 37.2% less than male physicians, while those without children earned only 4.4% less. This suggests that motherhood is a significant driver of the gender pay gap among physicians. CONCLUSIONS: These findings highlight the negative impact of motherhood on female physicians' earnings. This emphasizes the need for policy measures to mitigate the disadvantages faced by mothers in the medical profession.

Like mama always said: family socio-economic status, maternal attitudes and leader role occupancy in adulthood.

Leadership research has always recognised the importance of childhood factors for the occupation of formal or informal leader positions later in life. Still, empirical research in the field has mainly been based on retrospective accounts from selective and small samples. Such research has also concentrated on individual traits and experiences, less on characteristics of the family. Our aim is to fill this void by prospectively examining the role of the family of origin on educational attainment and holding a managerial position in adulthood. Analyses were based on the Stockholm Multigenerational Study, including register and survey data, regarding 3,088 males born between 1950 and 1976 and their mothers' attitudes to education and child-rearing in the late 1960s. Our results showed a significant effect of family socio-economic status (SES) on managerial role occupancy in late adulthood. This effect was mainly mediated through educational level. However, a noteworthy share of the total effect of family SES was channelled through maternal attitudes towards education. Positive attitudes towards education in the home environment accounted for an equally large share of the total indirect effect of family SES as the offspring's cognitive capacity did. Authoritarian attitudes to child-rearing among mothers were also found to have a negative impact on cognitive capacity and educational level - two well-known antecedents to leader emergence. Parental attitudes may boost or modify structural characteristics and individual traits associated with holding formal leader roles such as a managerial position - but also showed an independent effect several decades later.

"She mimicked the manipulations on my hand": fostering embodied care among children with recurrent acute respiratory tract infections in Southern China.

INTRODUCTION: When young children experience recurrent respiratory infections, caregivers face the challenge of preventing new episodes whilst maintaining close rapport with their children. Pediatric massage, such as pediatric Tuina, entails soft massage of the skin, administered by trained providers. This non-pharmaceutical measure is used to prevent new respiratory infections in China. The aim of this study is to deepen our understanding of caregivers' experiences and perceptions of providing pediatric Tuina treatment to their children with recurrent respiratory tract infections. METHODS: A qualitative study, based on semi-structured interviews, was conducted in accordance with the Consolidated Criteria for Reporting Qualitative Research checklist. Sixteen mothers from Southern China, whose children had received pediatric Tuina for recurrent respiratory tract infections, participated online. Analysis was conducted according to the principles of reflexive thematic analysis, using the NVivo qualitative research software. RESULTS: The overarching theme was "Fostering embodied care with children". Caregivers assessed pediatric Tuina by hearing others' experiences of pediatric Tuina, as well as observing the manipulations on their child's body and their bodily reactions during pediatric Tuina sessions. Caregivers also closely observed children's bodily changes after pediatric Tuina sessions. Embodied attachment between children and adults was nurtured through the pediatric Tuina. Compared to other treatments or medical consultations, children were more relaxed and more involved in embodied care, which involved direct skin touching and verbal communication from the pediatric Tuina provider. Children also took the initiative to bring pediatric Tuina into their family life, by asking caregivers to perform it on them and mimicking the manipulations on the caregivers' hand. CONCLUSIONS: Pediatric Tuina served as a means of interaction between children and adults, fostering an embodied care on both a physical and emotional level. Beyond its potentially preventive effect on recurrent respiratory tract infections, pediatric Tuina could be a support for parents of children with recurrent or chronic disease at home.

Factors influencing perceptions of processed baby foods and feeding practices among Indian mothers: a qualitative investigation.

OBJECTIVE: To explore how professionally qualified, working Indian mothers conceptualize healthy foods in general, perceive processed infant and baby foods available commercially and what feeding practices they actually follow with their children at home. DESIGN: Five focus groups with 8-12 participants were conducted around the participants' conceptualization of healthy food, their perceptions about commercially available processed baby and infant foods and their actual feeding practices that they routinely follow with their children. Discussion transcripts were analyzed using an inductive coding approach. SETTING: India. PARTICIPANTS: Fifty-one professionally qualified, working women with at least one child under 5 years of age. RESULTS: Participants agreed that fresh food is healthiest. They also had favorable opinions about processed infant and baby foods with regards to healthfulness, hygiene and safety. Healthy foods were largely conceptualized in relation to nutrient claims, ingredients and discernible health outcomes. They use cues, such as health claims, brand, price, package design and others to determine healthfulness of the product. Perception was heavily influenced by these extrinsic cues rather than by participants' own nutrition knowledge. Despite having the knowledge, most participants admitted to using these foods on account of factors such as their own inability to lactate, social pressure, lack of time and convenience. CONCLUSIONS: Most educated and well off people continue to use these products. While they rue the lack of stringent regulatory measures in India, they feel there is an urgent need to address this huge policy gap by way of legislation and regulation.

Process evaluation of a breastfeeding support intervention to promote exclusive breastfeeding and reduce social inequity: a mixed-methods study in a cluster-randomised trial.

BACKGROUND: Breastfeeding is a powerful public health intervention that produces long-term health benefits. However, in high-income countries such as Denmark, breastfeeding rates are suboptimal and unequally distributed across socio-economic positions. The 'Breastfeeding - a good start together' intervention, to promote longer duration of exclusive breastfeeding and reduce social inequity, was implemented in a cluster-randomised trial during 2022-2023 across 21 municipalities in two Danish regions. A process evaluation was conducted to assess the implementation, mechanisms of impact, and possible contextual factors affecting the intervention. METHODS: The study was guided by the Medical Research Council's guidance for conducting process evaluations and employed a mixed-methods approach in a convergence design. Quantitative data: contextual mapping survey (n = 20), health visitor survey (n = 284), health visitor records from 20 clusters and intervention website statistics. Qualitative data: dialogue meetings (n = 7), focus groups (n = 3) and interviews (n = 8). RESULTS: Overall, the intervention was delivered as planned to intended recipients, with few exceptions. Health visitors responded positively to the intervention, noting that it fitted well within their usual practice and enhanced families' chances of breastfeeding. Mothers expressed having received the intervention with few exceptions, and reacted positively to the intervention. Although health visitors were concerned about the potential stigmatisation of mothers receiving the intensified intervention, none of the interviewed mothers felt stigmatised. Contextual factors impacting the intervention implementation and mechanisms included staff and management turnover, project infrastructure and mothers' context, such as resources, social networks and previous experiences. The overall fidelity of the intervention delivery was high. CONCLUSIONS: Health visitors and families responded well to the intervention. Interventions aimed at enabling health care providers to deliver simplified and structured breastfeeding support, in alignment with support provided in other sectors of the health care system, may increase breastfeeding rates and reduce social inequity in breastfeeding, even in international contexts. TRIAL REGISTRATION: Clinical Trials: NCT05311631. First posted April 5, 2022.

Why "free maternal healthcare" is not entirely free in Ghana: a qualitative exploration of the role of street-level bureaucratic power.

BACKGROUND: Ghana introduced a free maternal healthcare policy within its National Health Insurance Scheme (NHIS) in 2008 to remove financial barriers to accessing maternal health services. Despite this policy, evidence suggests that women incur substantial out-of-pocket (OOP) payments for maternal health care. This study explores the underlying reasons for these persistent out-of-pocket payments within the context of Ghana's free maternal healthcare policy. METHODS: Cross-sectional qualitative data were collected through interviews with a purposive sample of 14 mothers and 8 healthcare providers/administrators in two regions of Ghana between May and September 2022. All interviews were audio-recorded, transcribed and imported into the NVivo 14.0 software for analysis. An iteratively developed codebook guided the coding process. Our thematic data analysis followed the Attride-Sterling framework for network analysis, identifying basic, organising themes and global themes. RESULTS: We found that health systems and demand-side factors are responsible for the persistence of OOP payments despite the existence of the free maternal healthcare policy in Ghana. Reasons for these payments arose from health systems factors, particularly, NHIS structural issues - delayed and insufficient reimbursements, inadequate NHIS benefit coverage, stockouts and supply chain challenges and demand-side factors - mothers' lack of education about the NHIS benefit package, and passing of cost onto patients. Due to structural and system level challenges, healthcare providers, exercising their street-level bureaucratic power, have partly repackaged the policy, enabling the persistence of out-of-pocket payments for maternal healthcare. CONCLUSIONS: Urgent measures are required to address the structural and administrative issues confronting Ghana's free maternal health policy; otherwise, Ghana may not achieve the sustainable development goals targets on maternal and child health.

Predicting Neonatal Hypoglycemia Using AI Neural Networks in Infants from Mothers with Gestational Diabetes Mellitus.

BACKGROUND This study aimed to develop a predictive model for the association between maternal and neonatal anthropometric data and neonatal hypoglycemia based on data from mothers with gestational diabetes mellitus (GDM) and their neonates. MATERIAL AND METHODS We included 106 pregnant women with GDM (based on the World Health Organization International Association of Diabetes and Pregnancy Study Groups) and their neonates. Neonatal hypoglycemia was defined as a threshold of 2.5 mmol/L. Neonatal blood glucose levels were performed at 0, 0.5, 1, 3, and 24 h after birth. An artificial neural network (ANN) and recurrent neural network (RNN) were developed to predict the neonate blood concentrations and investigate the relative contribution of maternal and neonate clinical variables to neonatal hypoglycemia. RESULTS Of 106 mothers with GDM, 85% had obesity, and 78% had vaginal deliveries, with neonates averaging a birth weight of 3335.83 g. The ANN model, based on the clinical data from mothers and neonates, predicted blood glucose levels with a high degree of accuracy, achieving a coefficient of determination of 0.869 and a root mean square error (RMSE) of 0.274. Neonatal birth weight and maternal body mass index were the 2 most significant factors in predicting neonatal hypoglycemia, contributing 18.6% and 15.9%, respectively. The RNN model similarly forecasted glucose levels effectively, addressing the dynamic changes in blood glucose with 0.63 mmol/L RMSE and 0.53 mmol/L mean absolute error. CONCLUSIONS ANN and RNN models effectively predict neonatal hypoglycemia in infants of mothers with GDM, highlighting the critical role of maternal and neonatal factors.

Uptake of early infant HIV diagnosis and its associated factors in Tanzania: an analytical cross-sectional study.

The uptake of early infant HIV diagnosis services is crucial for preventing mother to child transmission of virus, and timely management. However, the uptake of the services remains a global challenge, despite major advances in HIV testing. This study investigated the uptake of early infant HIV diagnosis and its associated factors among mothersof exposed infants. The results showed that the uptake of early infant HIV diagnosis was 76%. Factors associated with the uptake are caregivers being married, have higher income level and having adequate knowledge on early infant HIV diagnosis.

Geographical variation, socioeconomic inequalities of low birth weight, and its relationship with maternal dietary diversity: Insights from the maternal infant and young child nutrition programme in Bangladesh.

Background: Globally, every year, 20 million neonates are born with weights below 2500 g and are considered low birth weight (LBW). About 90% of these births occur in low- and middle-income countries. Information regarding the geographical variation, socioeconomic inequalities of LBW neonates, and the relationship between maternal inadequate dietary diversity and LBW is limited in rural areas of Bangladesh. We aimed to explore the geographical disparities and socioeconomic inequalities in the prevalence of LBW and its association with inadequate maternal dietary diversity. Methods: We extracted data from a large-scale evaluation programme conducted as a part of the maternal infant and young child nutrition phase two in Bangladesh, implemented by BRAC. We used the concentration index (CIX) to measure the socioeconomic inequalities of LBW. We performed a cluster-adjusted multiple logistic regression analysis to determine the association between LBW and maternal dietary diversity. Results: A total of 4651 children aged <5 years with their mother's information were included. The overall prevalence of LBW was 13.5%. About 16% of mothers living in the poorest wealth quintile gave birth to LBW babies, whereas 10% of mothers living in the richest households gave birth to LBW babies. The CIX exhibited LBW babies were more prevalent among the socioeconomically worst-off (poorest) group (CIX = -0.08), indicating mothers of the poorest households are vulnerable to giving birth to normal-weight babies. An adjusted multiple logistic regression model indicated that mothers with inadequate dietary diversity had higher odds (adjusted odds ratio (AOR) = 1.27; 95% confidence interval (CI) = 1.04, 1.54) of giving birth to LBW babies. Notably, in the interaction of mothers' age and dietary diversity, we found that adolescent mothers (aged ≤ 19 years) with inadequate dietary diversity had 2.56 times (AOR = 2.56; 95% CI = 1.14, 5.76) higher odds of giving birth to LBW babies compared to adult mothers (aged >19 years) who consumed diversified foods. Conclusions: Intervention strategies for reducing LBW prevalence should target the poorest households. Also, interventions for improving the dietary diversity of adolescent pregnant mothers are expected to reduce the number of LBW babies from the rural areas of Bangladesh.