Adaptation and application of the Parent Attitudes About Childhood Vaccines survey tool in the Vietnamese language: a cross-sectional study.

BACKGROUND: Parental vaccine hesitancy could lead to outbreaks of vaccine-preventable diseases. Although parental vaccine hesitancy exists in the Vietnamese community, no research has directly investigated this social phenomenon in Vietnam. Among the validated measures, the 15-item Parent Attitudes About Childhood Vaccines survey tool (PACV) was reliable for predicting vaccine-hesitant parents. However, the PACV was not available in Vietnamese. This study aimed to develop a Vietnamese version of the PACV and examine factors associated with parental vaccine hesitancy in Hue city, Vietnam. METHODS: This study was a cross-sectional study. The English PACV was translated into Vietnamese with content and face validation. Self-administered questionnaires were distributed to 400 parents at ten commune health centres in Hue city, Vietnam. The parents were asked to answer the questionnaire again after two weeks for the test-retest reliability. The Vietnamese PACV reliability was assessed using Cronbach's alpha and McDonald's omega, and the intra-class correlation (ICC) coefficients were used for the test-retest reliability. The construct validity was tested by the hypothesis that parental vaccine hesitancy would be related to the intention of getting the children vaccinated. Exploratory factor analysis was also undertaken to determine the construct validity. Bivariate and multivariable logistic regression were used to identify the factors associated with parental vaccine hesitancy. RESULTS: The Vietnamese PACV final version (PACV-Viet) contained 14 items. Three hundred and fifteen parents returned completed questionnaires, giving a response rate of 78.8%. The Cronbach's alpha and McDonald's omega were 0.72 and 0.70, respectively. Out of 315 parents, 84 responses were returned for test-retest reliability. All ICCs were good to excellent, ranging from 0.81 to 0.99. The PACV-Viet was confirmed to have construct validity. Using the PACV-Viet, 8.9% of the parents were found hesitant to childhood vaccination. Being unemployed and having seen the news about adverse events following immunisation were associated with parental vaccine hesitancy, with AOR = 3.2 (95% CI 1.3-8.0) and AOR = 4.5 (95% CI 1.2-16.7), respectively. CONCLUSIONS: The PACV-Viet is a valid and reliable tool. Community outreach is necessary to alleviate parents' concerns about childhood vaccination.

What are the factors affecting primary care choice when the access under health insurance scheme is limited?: a cross-sectional study in Bandung, Indonesia.

BACKGROUND: Ensuring equal access to primary care services is crucial, as the gateway to a higher level of care. Indonesia has been trying to increase financial access to medical care by administering national health insurance known as BPJS-Health (Badan Penyelenggara Jaminan Sosial Kesehatan) since 2014. However, BPJS-Health beneficiaries can only use their benefits at a limited number of registered primary care providers (BPJS-Health partners). This study investigated the geographical coverage of BPJS-Health and BPJS-Health beneficiaries' primary care choices, based on their characteristics and healthcare preferences in the target areas of Bandung, Indonesia. METHODS: The setting of this cross-sectional study was the areas with low physical access to BPJS-Health partners but high physical access to non-BPJS-Health partners. Physical access was determined by spatial network analysis, resulting in a geographical coverage map. A total of 216 adults were recruited and they completed the questionnaire about their primary care choice. All participants had been registered with the BPJS-Health system and living in the study areas. Their participation in non-BPJS-Health was also evaluated. Participants' choice of care was assessed in three different scenarios, when the individual was experiencing mild, chronic, and serious illnesses. RESULTS: BPJS-Health partners' geographical coverage was unequally distributed in Bandung. Being registered with non-BPJS-Health company was negatively associated with the more frequent choice of using BPJS-Health partners' services (AOR = 0.18; 95% CI, 0.06-0.58, P = 0.004) among BPJS-Health beneficiaries. For serious illnesses, having a high income was associated with choosing non-BPJS-Health partners and hospitals (AOR = 4.90; 95% CI, 1.16-20.77, P = 0.031). When dealing with mild and chronic illnesses, participants were concerned about the quality of treatment they would receive as a major factor in choosing a primary care provider. However, receiving better treatment quality was negatively associated with choosing BPJS-Health partners in all cases of illness severities. CONCLUSIONS: Sociodemographic characteristics, healthcare preference factors, and health insurance status were associated with participants' primary care choices in the target areas of Bandung, Indonesia. BPJS-Health partners' coverage map and the preference factors are potentially important for policymakers, especially for the development of future BPJS-Health partnerships.

Challenging the utility of 24-hour recall of exclusive breast feeding in Japan.

INTRODUCTION: WHO recommends exclusive breast feeding from birth to 6 months. However, to monitor populations, it recommends using the proportion of infants under 6 months who were exclusively breastfed during the previous 24 hours. To assess the usefulness of 24-hour recall, we (1) compared the prevalence of exclusive breast feeding measured by since-birth recall to the prevalence measured by 24-hour recall and (2) quantified each indicator's association with WHO-recommended, well-established methods for in-hospital breastfeeding support. METHODS: We conducted two online surveys of mothers in Japan (total n=4247) who had a healthy singleton delivery in the previous 25 months. They reported on their breast feeding (a) from birth to 5 months; or (b) during the previous 24 hours, for those with infants under 5 months; or (c) both, for those who participated in the initial survey and also in the follow-up survey. All mothers also reported on their in-hospital support. The strength of each indicator's association with provision of in-hospital support was quantified as the area under the curve (AUC). RESULTS: The prevalences of exclusive breast feeding by since-birth recall were 4.4% (first survey) and 2.5% (second survey). By 24-hour recall, the prevalence appeared to be 29.8%. More in-hospital support was moderately well associated with more exclusive breast feeding measured by since-birth recall: AUC 0.72 (95%CI 0.66 to 0.78). That association is consistent with the known benefits of in-hospital support. In contrast, when exclusive breast feeding was measured by 24-hour recall, its association with in-hospital support appeared to be extremely weak: AUC 0.59 (95% CI 0.54 to 0.65). CONCLUSION: Using 24-hour recall substantially overestimates the prevalence of exclusive breast feeding since birth, and it conceals the benefits of in-hospital breastfeeding support. To monitor population achievement of exclusive breast feeding for the first 6 months, or to evaluate breastfeeding interventions, 24-hour recall of exclusive breast feeding should not be used alone.

Improving the quality of maternal and newborn healthcare at the district level: Addressing newborn deaths in Nepal.

Maternal and newborn care quality can be measured in three dimensions (Dimensions 1: care provision, 2: care experience, and 3: human and physical resources); however, little is known about which dimensions are associated with newborn and perinatal deaths. We examined the association between care quality and newborn and perinatal deaths in Nepal. This study incorporated secondary data from Nepal Service Provision Assessments (NSPA) 2015 (623 delivery facilities, facility inventory survey; 1,509 women, ANC clients interviews; 1,544 women, ANC observation) and Nepal Demographic and Health Surveys (NDHS) 2016 (5,038 women who reported having given birth in the five years preceding data collection). The outcome variables were newborn and perinatal deaths derived from the NDHS. The exposure variables were district-level maternal and newborn care quality scores calculated from the NSPA data. Covariates were women's sociodemographic, health, and obstetric characteristics. We applied the administrative boundary method to link these two surveys. We conducted binary logistic regression analyses to examine the association between care quality and newborn/perinatal deaths. In Dimension 1, higher mean and maximum quality scores at the district level were associated with a lower number of newborn deaths (mean: odds ratio [OR] = 0.04, 95% confidence interval [CI]: 0.00-0.76; max: OR = 0.09, 95% CI: 0.01-0.58), but not with perinatal deaths. In Dimensions 2 and 3, the quality score was not significantly associated with newborn deaths and perinatal. Enhancing the quality of care provision at its average and highest levels in each district may contribute to the reduction of newborn deaths, but not perinatal death. Health administrators should assess the quality of care at the administrative division level and focus on enhancing both average and maximum care quality of health facilities in each region in the care provision dimension.

Understanding competency of nursing students in the course of case-based learning in Cambodia: a convergent mixed method study.

BACKGROUND: In the last decade, nursing education has begun to reform to competency-based education worldwide, including in low-and middle-income countries. Case-Based Learning (CBL), an approach to delivering competency-based education, contributes to acquiring critical thinking competency, problem-solving, higher knowledge, professional value and attitude. However, it needs to be taught in a culturally appropriate manner. In Cambodia, CBL was initiated in a classroom and clinical practicum by faculty and preceptors who graduated from the upgrading course. This study examined the factors associated with the competency level of nursing students, explored the practice and perceptions of teaching-learning activities among students, faculty members and preceptors and assessed the coherence of qualitative and quantitative findings. METHODS: This was a convergent, mixed methods study. Data were collected from eight educational institutions for quantitative and qualitative studies and seven hospitals for qualitative studies. From June to September 2019, a cross-sectional survey of nursing students in the third year of the three-year programme (n = 719), eight focus group discussions (FGDs; n = 55) with 6-8 members and 15 FGDs with faculty (n = 38) and clinical preceptors (n = 37) with 4-7 members were conducted to elicit the teaching-learning experience and perceptions. Multiple linear regression was performed to investigate the factors associated with student competency. Moreover, the study conducted thematic content analysis on the qualitative data. The integrated analysis was presented as side-by-side joint displays. RESULTS: First, the quantitative and qualitative findings confirmed each other 's CBL learning experiences. Students had higher levels of nursing competencies if they had CBL experiences, both in the classroom and clinical practicum, both in a group manner. Next, the quantitative and qualitative findings complemented students' academic satisfaction with the teaching by faculty members and preceptors. Finally, the quantitative and qualitative findings were expanded to explain students' academic satisfaction with the programme. CONCLUSIONS: The finding of CBL experiences in a group and students' satisfaction with faculty members' and preceptors' teaching improved nursing students' competency development. Meanwhile, students' satisfaction with the design and delivery of the educational programme provides implications for policy level to narrow the theory and practice gaps in low- and middle-income countries.

Determinants of health-related quality of life among patients with systemic lupus erythematosus in Hanoi, Vietnam.

BACKGROUND: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease which impacts patients' lives. Many studies in high-income countries have focused on their health-related quality of life (HRQoL). However, evidence of awareness of SLE and HRQoL in low- and middle-income countries is lacking. Therefore, this study aimed to identify the determinants of HRQoL of SLE patients in Vietnam, a lower-middle income country. METHODS: This cross-sectional study was conducted at the National Hospital of Dermatology and Venereology in 2019. A pre-tested structured questionnaire was used to collect data. It consisted of Short Form-36 to assess HRQoL which comprised physical and mental component summaries, Multidimensional Scale of Perceived Social Support, Satisfaction with Life Scale, and Mental Adjustment to SLE. Multiple linear regression was used to identify the determinants of HRQoL. RESULTS: One hundred thirty four patients with SLE participated in this study. The majority of the patients were women (n = 126, 94.0%). The mean age of all participants was 37.9 years old (standard deviation [SD] 12.5). Of 134 participants, 104 (77.6%) were married. Older patients were more likely to have a lower score of mental component summary (B=-0.45, 95% CI -0.73, -0.17). Patients with more children were more likely to have a lower score of physical component summary (B=-5.14, 95% CI -9.27, -1.00). Patients who felt more helplessness or hopelessness were more likely to have lower scores of physical and mental component summaries (B=-1.85, 95% CI -2.80, -0.90; B=-1.69, 95% CI -2.57, -0.81). Also, patients who felt more anxious were more likely to have a lower score of mental component summary (B=-1.04, 95% CI -1.77, -0.32). Patients who were more satisfied with their lives were more likely to have higher scores of physical and mental component summaries (B = 1.07, 95% CI 0.50, 1.64; B = 1.08, 95% CI 0.55, 1.61). CONCLUSION: Factors associated with lower HRQoL in Vietnam were feelings of helplessness or hopelessness, and burdens of parenting roles. However, social support can contribute to a higher HRQoL, such as information support, self-support groups, and daycare services provided at the community level.

Japanese health and safety information for overseas visitors: a randomized controlled trial.

INTRODUCTION: International travel to Japan increased steadily until the coronavirus disease 2019 (COVID-19) outbreak. Although international travel was curtailed worldwide due to the pandemic, the number of overseas visitors to Japan should increase again after the restrictions are lifted. We assessed the effect of a five-minute digital game on the knowledge of health information and the level of satisfaction with educational health resources of overseas visitors to Japan. METHODS: We conducted a randomized controlled trial among 1062 previous and potential visitors to Japan utilizing an internet portal. We recruited previous and potential visitors to Japan from the internet portal sites of the UK, the US and Australia. We randomly allocated participants to two groups: an intervention group that played an animated game and a control group that viewed an online animation. All participants answered a self-administered questionnaire online from March 16 to 19, 2021. We assessed visitors' levels of health knowledge and satisfaction using the CSQ-8. We analyzed the data with a t test and the difference in differences test. Our RCT followed the SPIRIT guidelines. RESULTS: Of the 1062 previous and potential visitors recruited via the three countries' internet portals (354 from each country), some had visited Japan previously (174 in the intervention group, 220 in the control group), while some were potential visitors to Japan (357 in the intervention group, 311 in the control group). Some had gathered health and safety information about Japan prior to this study (180 in the intervention group, 211 in the control group). Both groups improved their health information levels after the intervention. The level of satisfaction with health information in Japan was significantly increased in the intervention group (average difference of 4.5 points) compared to that in the control group (average difference of 3.9 points) (p < 0.05). Both groups' mean CSQ-8 scores increased significantly after the intervention (p < 0.001): from 23 to 28 in the intervention group and from 23 to 24 in the control group. CONCLUSIONS: Our study introduced unique educational strategies using an online game to provide health and safety information to previous and potential visitors to Japan. The online game was a more effective way to increase satisfaction than the online animation about health information. This study was registered in the UMIN-CTR (University Hospital Medical Information Network Center Clinical Trials Registry) as Version 1, and the trial registration data are available as UMIN000042483, 17/11/2020. TRIAL REGISTRATION: Trials UMIN-CTR (University Hospital Medical Information Network Center Clinical Trials Registry), UMIN000042483 (Japanese health and safety information for overseas visitors: A randomized controlled trial), 17/11/2020.

Association between the person-centered maternity care experience and mental health after delivery in urban and rural Dhading, Nepal: a cross-sectional study.

BACKGROUND: Person-centered maternity care is a component of quality care, which includes effective communication, respect, and dignity. Supportive care has a positive effect on mothers' perinatal experience. In contrast, negative childbirth experiences can cause psychological problems. However, the impact of person-centered maternity care experience on mothers' mental health after delivery remains unknown. Therefore, in this study, we examined the association between person-centered maternity care experience at healthcare facilities and maternal mental health after delivery among Nepali women. METHODS: We conducted a cross-sectional study in urban and rural areas in Dhading District, Nepal. Participants were women who gave birth at public healthcare facilities, and their baby's age was between 1 and 12 months. After purposively selecting the target areas, we recruited the women from July to August 2019 and interviewed them using questionnaires. We conducted multiple regression analyses to analyze the association between delivery care experience and depressive symptoms and the association between delivery care experience and mental well-being. RESULTS: In total, 595 women were included in the data analysis. The experience of better person-centered maternity care was associated with lower depressive symptom scores in urban (unstandardized coefficient [B]= - 0.09, p < 0.001) and rural areas (B= - 0.10, p < 0.001). Moreover, the experience of better person-centered maternity care was associated with higher mental well-being scores in both urban (B= 0.30, p < 0.001) and rural areas (B= 0.15, p = 0.017). CONCLUSIONS: Person-centered maternity care was associated with lower depressive symptom scores and higher mental well-being, regardless of the setting in Nepal. Person-centered maternity care during childbirth can potentially improve mental health after delivery. Maternity care should be improved with more attention to person-centered maternity care aspects.

Association of workload and practice of respectful maternity care among the healthcare providers, before and during the early phase of COVID-19 pandemic in South Western Nepal: a cross-sectional study.

INTRODUCTION: Respectful maternity care is an approach that involves respecting women's belief, choices, emotions, and dignity during the childbirth process. As the workload among maternity care workforce affects intrapartum quality care, respectful maternity care might have also been affected, particularly during the pandemic. Thus, this study was conducted to examine the association between workload among healthcare providers and their practice of respectful maternity care, before and during the early phase of pandemic. METHODS: A cross-sectional study was conducted in South Western Nepal. A total of 267 healthcare providers from 78 birthing centers were included. Data collection was done through telephone interviews. The exposure variable was workload among the healthcare providers, and the outcome variable was respectful maternity care practice before and during the COVID-19 pandemic. Multilevel mixed-effect linear regression was used to examine the association. RESULTS: The median client-provider ratio before and during the pandemic was 21.7 and 13.0, respectively. The mean score of respectful maternity care practice was 44.5 (SD 3.8) before the pandemic, which was decreased to 43.6 (SD 4.5) during the pandemic. Client-provider ratio was negatively associated with respectful maternity care practice for both times; before (Coef. -5.16; 95% CI -8.41 to -1.91) and during (Coef. -7.47; 95% CI -12.72 to -2.23) the pandemic. CONCLUSIONS: While a higher client-provider was associated with a lower respectful maternity care practice score both before and during the COVID-19 pandemic, the coefficient was larger during the pandemic. Therefore, workload among the healthcare providers should be considered before the implementation of respectful maternity care, and more attention should be given during the pandemic.

Impact of oral intervention on the oral and overall health of children living with HIV in Cambodia: a randomized controlled trial.

BACKGROUND: Maintaining oral health is essential for improving overall health of children living with HIV. Therefore, we evaluated the effectiveness of an oral health intervention for improving their oral and overall health. In addition, we examined their longitudinal association between changes in oral and overall health. METHODS: We conducted a 2-year randomized controlled trial involving children living with HIV in Cambodia. Children aged 3-15 years and their caregivers were randomly allocated either to the intervention (group A) or control (group B) arm. A second control arm (group C) included children without HIV. The group A children received oral health education sessions and practiced home-based daily care. RESULTS: In the baseline survey, 482 children participated (group A: n = 160, group B: n = 168, group C: n = 154), and 350 completed the endline survey. An interaction effect in teeth brushing duration was observed in children in group A relative to group B (AOR = 2.69, 95% CI: 1.37-5.31) and group C (AOR = 3.78, 95% CI: 1.70-8.40). Longitudinal associations were observed between changes in oral hygiene and overall health, as presented by alterations in dental caries in permanent teeth with viral load detection (adjusted odds ratio = 3.58, 95% CI: 1.10 - 11.73), in salivary flow quantity with the overall quality of life (ß = 0.07, 95% CI: < 0.01 - 0.13), as well as in dental caries, salivary pH, debris index with body mass index for age among group A children. CONCLUSIONS: Oral health intervention may improve oral care behaviors and potentially enhance overall health among children living with HIV in antiretroviral therapy in a resource-constrained setting. TRIAL REGISTRATION: ISRCTN 15177479.

Identifying positive and negative deviants and factors associated with healthy dietary practices among young schoolchildren in Nepal: a mixed methods study.

BACKGROUND: School-based interventions have been implemented in resource-limited settings to promote healthy dietary habits, but their sustainability remains a challenge. This study identified positive deviants (PDs) and negative deviants (NDs) from the control and treatment groups in a nutrition-sensitive agricultural intervention in Nepal to identify factors associated with healthy dietary practices. METHODS: This is an explanatory mixed methods study. Quantitative data come from the endline survey of a cluster randomized controlled trial of a school and home garden intervention in Nepal. Data were analyzed from 332 and 317 schoolchildren (grades 4 and 5) in the control and treatment group, respectively. From the control group, PDs were identified as schoolchildren with a minimum dietary diversity score (DDS) ≥ 4 and coming from low wealth index households. From the treatment group, NDs were identified as schoolchildren with a DDS < 4 and coming from high wealth index households. Logistic regression analyses were conducted to identify factors associated with PDs and NDs. Qualitative data were collected through in-depth phone interviews with nine pairs of parents and schoolchildren in each PD and ND group. Qualitative data were analyzed thematically and integrated with quantitative data in the analysis. RESULTS: Twenty-three schoolchildren were identified as PDs, and 73 schoolchildren as NDs. Schoolchildren eating more frequently a day (AOR = 2.25; 95% CI:1.07-5.68) and whose parents had a higher agricultural knowledge level (AOR = 1.62; 95% CI:1.11-2.34) were more likely to be PDs. On the other hand, schoolchildren who consumed diverse types of vegetables (AOR = 0.56; 95% CI: 0.38-0.81), whose parents had higher vegetable preference (AOR = 0.72; 95% CI: 0.53-0.97) and bought food more often (AOR = 0.71; 95% CI: 0.56-0.88) were less likely to be NDs. Yet, schoolchildren from households with a grandmother (AOR = 1.98; 95% CI: 1.03-3.81) were more likely to be NDs. Integrated results identified four themes that influenced schoolchildren's DDS: the availability of diverse food, the involvement of children in meal preparation, parental procedural knowledge, and the grandmother's presence. CONCLUSION: Healthy dietary habit can be promoted among schoolchildren in Nepal by encouraging parents to involve their children in meal preparation and increasing the awareness of family members.

Does benefits-of-breastfeeding language or risks-of-formula-feeding language promote more-positive attitudes toward breastfeeding among midwives and nurses?

BACKGROUND: Midwives and nurses are crucial in breastfeeding support. Few studies have explored appropriate language for nursing education on breastfeeding. We assessed the impact of the language used on breastfeeding attitudes among midwives and nurses. METHODS: A quasi-experimental study was conducted online in Japan among 174 midwives and nurses who had work experience in obstetrics or pediatrics. Participants were allocated to three groups to receive different text messages as the intervention (the benefit of breastfeeding for Group 1; the risk of formula feeding for Group 2; the importance of childcare for Group 3 as the comparison). The Japanese version of the Iowa Infant Feeding Attitude Scale (IIFAS-J) was used to assess breastfeeding attitudes before and after reading the texts. Also, participant reactions to the text were assessed by their responses to three statements. ANOVA, the chi-square test, and the t-test were used for outcome assessments. RESULTS: The post-test IIFAS-J score was significantly higher than the pre-test score only for Group 1 (p <  0.01). The percentage of participants who agreed with the content of the text was 70.7% in Group 1 and 48.3% in Group 2. The percentage of participants who reported discomfort with the text was 34.5% in Group 1 and 55.2% in Group 2. No significant difference among groups existed regarding interest in the text. In all three groups, participants who agreed with the text had a higher post-test IIFAS-J score than those who disagreed with the text (6.85 points higher, p <  0.01 in Group 1; 7.19 points higher, p <  0.01 in Group 2; 8.00 points higher, p <  0.02 in Group 3). Discomfort with the text and interest in the text were associated with a significantly higher post-test IIFAS-J score in Group 1 and Group 2 but not in Group 3. CONCLUSIONS: "Benefits of breastfeeding" language, which conveys the information in a positive manner, appears to be more appropriate than "risks of infant formula" language for creating a positive attitude toward breastfeeding in nursing education. TRIAL REGISTRATION: This study was registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN000023322). Registered 05/08/2016.

Accommodation and disability-specific differences in nutritional status of children with disabilities in Kathmandu, Nepal: A cross-sectional study.

BACKGROUND: Worldwide, more than 150 million children < 18 years live with disabilities. These children are more vulnerable to malnutrition regardless of institutional care that they receive, such as daycare or residential care. In Nepal, little is known about the status of malnutrition and factors associated with malnutrition among children with disabilities. This study was conducted to investigate the factors associated with malnutrition based on the types of disability and accommodation. METHODS: This institution-based, cross-sectional study was conducted in 22 institutions in the Kathmandu Valley, Nepal. From these institutions, parents/guardians of all children with disabilities were recruited who were present there on the day of data collection. They were interviewed using a structured questionnaire. The questionnaire included questions on demographic characteristics, disability type and severity, accommodation place, feeding practices, and dietary patterns. The outcome variables, stunting, underweight, and obesity were measured using height-for-age, weight-for-age, and body mass index-for-age, respectively. A generalized linear model was used to investigate the factors associated with stunting and underweight, and multinomial logistic regression was used to identify the factors associated with overweight and obesity. RESULTS: Among the 345 children with disabilities, 45% were stunted, 33% were underweight, 19% were thin, and 12% were overweight. Children with physical disabilities (relative risk ratio = 1.88, 95% confidence interval [CI] = 1.26-2.81) were more likely to be stunted than those with sensory disabilities. Children with autism (adjusted odds ratio [aOR] = 5.56, 95% CI: 1.23-25.23) and intellectual disabilities (aOR = 5.84, 95% CI: 1.59-21.51) were more likely to be overweight and obese than those with sensory disabilities. No evidence was found regarding an association between accommodation type and malnutrition. CONCLUSION: Children with disabilities are vulnerable to malnutrition in several ways. Different types of disabilities are associated with different forms of malnutrition. Considering the types of disabilities, tailor-made approaches should be adopted to improve malnutrition status.

Cross-Cultural Information for Japanese Nurses at an International Hospital: A Controlled Before-After Intervention Study.

This study sought to evaluate the efficacy of providing health information through an ordinary travel guidebook combined with a short digital video compared with an ordinary travel guidebook alone by measuring the anxiety levels of Japanese nurses dealing with foreign patients. We conducted a controlled before-after intervention study in 2016 at a major international hospital in Japan. We created two interventions: (1) a brief piece of health information from a travel guidebook for Japan, (2) the same travel guidebook, and a four-minute digital video in English on health information in Japan, titled Mari Info Japan for nurses. After each intervention, we assessed the nurses' levels of anxiety about caring for foreign patients. We evaluated the results through statistical testing and the State-Trait Anxiety Inventory Form Y. Of 111 nurses, 83 (74.8%) completed both interventions and the questionnaires. The second intervention (the guidebook and video) proved more effective than the first (the guidebook) for reducing anxiety related to caring for foreign patients. Japanese nurses can lower their anxiety about dealing with foreign patients by learning about the content of various forms of health care information currently accessible to overseas visitors. Using both guidebooks and digital videos can help to reduce nurses' anxiety.

Association between Robson classification groups and cesarean delivery: a longitudinal analysis in Mongolia.

BACKGROUND: The number of cesarean deliveries has increased sharply worldwide over the last 3 decades. The World Health Organization recommends using the Robson classification as the best tool for monitoring and auditing cesarean delivery rates and to safely reduce the rate of avoidable cesarean deliveries. OBJECTIVE: This study aimed to identify the association between the Robson classification groups and cesarean delivery in 2008 and 2018 at the Urguu Maternity Hospital, Ulaanbaatar, Mongolia, and to examine the changes in this association over 10 years. STUDY DESIGN: This cross-sectional study was conducted using 21,225 participants' electronic birth records (9544 in 2008 and 11,681 in 2018) from the Urguu Maternity Hospital. Birth records were categorized into 10 groups using the Robson classification report table. Multiple logistic regressions were conducted to examine the association between the Robson classification group and the cesarean delivery rate for 2008 and 2018. The same regression analysis was subsequently conducted using a pooled data set to capture the changes in the association among the Robson classification group, a birth-year dummy, and the cesarean delivery rate. RESULTS: The odds of having a cesarean delivery when classified in group 1 in 2018 (adjusted odds ratio, 3.02; 95% confidence interval, 1.85-4.94; P<.001) was 3 times greater than that in 2008. Moreover, the odds of having a cesarean delivery when classified in group 2 (adjusted odds ratio, 0.66; 95% confidence interval, 0.51-0.85; P=.001), group 3 (adjusted odds ratio, 0.21; 95% confidence interval, 0.16-0.29; P<.001), or group 4 (adjusted odds ratio, 0.33; 95% confidence interval, 0.25-0.45; P<.001) declined in 2018 when compared with 2008. The odds of having a cesarean delivery were the lowest among mothers classified in group 3 and the highest among mothers in group 5 in both study years. CONCLUSION: The high percentage of mothers classified as group 5 who gave birth via cesarean delivery suggests that healthcare providers should work with mothers in group 5 to increase their willingness to give birth vaginally after a previous cesarean delivery in an attempt to reduce the overall cesarean delivery rates. Further research is needed to better understand the factors that may influence the increasing rates of birth through cesarean delivery.

Health literacy as a key to improving weight status among Palestinian adolescents living in chronic conflict conditions: a cross-sectional study.

OBJECTIVE: To examine the moderating role of health literacy in the association between direct exposure to violence and weight status among Palestinian adolescents. DESIGN: A household cross-sectional study conducted in 2017. SETTING: A Palestinian district of the West Bank. PARTICIPANTS: Palestinian adolescents aged 11-16 years. RESULTS: After excluding underweight adolescents from the 1200 who were initially recruited, the data of 1173 adolescents were analysed. A high proportion (62%) of adolescents were directly exposed to violence. The prevalence of obesity and overweight was 6.5% and 17.1%, respectively. The odds of obesity and overweight were 2.8 and 1.8 times higher among adolescents who were not exposed to domestic and school violence when they had low health literacy in the communication subscale. The odds of obesity were 62% and 57% lower among adolescents with high functional health literacy when exposed to domestic and school violence and to any form of violence, respectively. Among adolescents who were not exposed to any form of violence, those who had high health literacy in the communication subscale were 72% less likely to be obese compared with those who had low health literacy. CONCLUSIONS: Health literacy moderated the association between direct exposure to violence and weight status. When health literacy levels were higher, lower obesity rates were observed among adolescents who were directly exposed to any form of violence or exposed either to political violence only or domestic and school violence only. The results warrant further investigation of the role of health literacy in adolescent health. It is recommended that policy-makers integrate the health literacy concept into both education and health systems.

The effectiveness of a behavioral science and design intervention for family savings on use of maternal health services and male involvement: study protocol for a randomized controlled trial.

BACKGROUND: Lack of financial preparedness for pregnancy can lead to adverse outcomes during childbirth. Behavioral science interventions have been shown to influence savings behavior. Financial savings interventions can be adapted for the purpose of encouraging individuals to save towards maternal healthcare costs. This article describes a protocol to assess the effectiveness of an intervention formulated with a behavioral science approach for encouraging use of maternal health services through increased financial savings for birth preparedness and maternal healthcare costs among pregnant women or their partners in Uganda. METHODS: A randomized controlled trial will be conducted to assess the effectiveness of the intervention among pregnant women or their partners in Uganda's central region, including the capital of Kampala. Seven hundred pregnant women (12-35 gestational weeks) or their partners will be recruited. All participants will receive access to a committed mobile money health savings account provided by a local organization that also offers savings targets and reminders for antenatal care appointments and health tips as part of a "Mamas Program" offered to expectant mothers. The time period in the intervention is from the day of enrollment until two weeks after the delivery date. The control group will receive the standard Mama Program offering. The intervention group will receive the standard Mama Program offering plus behavioral designs encouraging savings behavior through short-message service (SMS) text messages. The primary outcome is usage of maternal health services measured by level of birth preparedness and delivery at a health facility. Secondary outcomes include male involvement in maternal healthcare, measured by financial support, as well as total savings for healthcare, assessed using the validated amount of savings accrued in participants' clinicPesa accounts from the day of enrollment plus any withdrawals for healthcare expenditures during the intervention period. DISCUSSION: The study will contribute to a better understanding of the effectiveness of behavioral designs encouraging financial savings during pregnancy into committed mobile money health savings accounts. The study could contribute to demonstrating the effectiveness of savings on birth preparedness, usage of maternal health services, and male involvement in maternal healthcare. TRIAL REGISTRATION: UMIN-CTR Clinical Trial, UMIN000046472. Registered on 19 January 2022. https://center6.umin.ac.jp/cgi-open-bin/icdr_e/ctr_view.cgi?recptno=R000053008.

Effects of the maternal and child health handbook and other home-based records on mothers' non-health outcomes: a systematic review.

OBJECTIVE: This review aimed to investigate the effects of the maternal and child health (MCH) handbook and other home-based records on mothers' non-health outcomes. DESIGN: Systematic review. DATA SOURCES: PubMed, Web of Science, CINAHL, Academic Search Complete, PsycArticles, PsycINFO, SocINDEX, CENTRAL, NHS EED, HTA, DARE, Ichuushi and J-STAGE through 26 March 2022. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Original research articles examining home-based records and mothers' non-health outcomes published in English or Japanese across various study designs. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers extracted relevant data and assessed the risk of bias. We assessed the certainty of evidence for each study using the Grading of Recommendations Assessment, Development, and Evaluation approach. Due to the heterogeneity of the included studies, we conducted a narrative synthesis of their findings. RESULTS: Of the 4199 articles identified, we included 47 articles (20 in Japanese) in the review. Among the different types of home-based records, only the MCH handbook provided essential information about the mother-child relationship, and its use facilitated the mother-child bonding process. Mothers reported generally feeling satisfied with the use of home-based records; although their satisfaction with health services was influenced by healthcare providers' level of commitment to using these records. While home-based records positively affected communication within the household, we observed mixed effects on communication between mothers/caregivers and healthcare providers. Barriers to effective communication included a lack of satisfactory explanations regarding the use of home-based records and personalised guidance from healthcare providers. These records were also inconsistently used across different health facilities and professionals. CONCLUSIONS: The MCH handbook fostered the mother-child bond. Mothers were generally satisfied with the use of home-based records, but their engagement depended on how these records were communicated and used by healthcare providers. Additional measures are necessary to ensure the implementation and effective use of home-based records. PROSPERO REGISTRATION NUMBER: CRD42020166545.

Influence of the COVID-19 pandemic on breastfeeding support for healthy mothers and the association between compliance with WHO recommendations for breastfeeding support and exclusive breastfeeding in Japan.

Background: Professional breastfeeding support contributes to maternal and child health. However, the influence of the current coronavirus disease 2019 (COVID-19) pandemic on breastfeeding support has not been carefully examined. Therefore, we assessed maternal breastfeeding intention and professional breastfeeding support before and during the pandemic. We further examined the association of compliance with World Health Organization (WHO) recommendations for professional breastfeeding support with exclusive breastfeeding during the pandemic. Methods: This cross-sectional, internet-based, questionnaire study analyzed data from 484 healthy women with live singleton births between 15 October 2019 and 25 October 2020 in Japan. A delivery before 5 March 2020 was classified as a before-pandemic delivery (n = 135), and a delivery after 6 March 2020 was a during-pandemic delivery (n = 349). Among the ten breastfeeding support steps recommended by the WHO, we assessed the five steps that are measurable by maternal self-report and would likely exhibit variability. Receipt of a free formula sample or invitation to a free sample campaign by the time of survey was also asked. Infant feeding status at the time of the survey was measured among women with infants younger than 5 months, which was a subgroup of mothers who delivered during the pandemic. Mothers were asked what was given to infants during the 24 h before the survey and when nothing other than breast milk was given, the status was classified as exclusive breastfeeding. Results: While 82.2% of women with a delivery before the pandemic intended to breastfeed, the rate was 75.6% during the pandemic (p = 0.120). The average number of breastfeeding support steps received was 3.24 before the pandemic but it was 3.01 during the pandemic (p = 0.069). In particular, rooming-in was less frequent (39.3% before vs. 27.8% during the pandemic, p = 0.014). Among mothers with infants younger than 5 months who had a delivery during the pandemic (n = 189), only 37.0% (n = 70) reported exclusively breastfeeding during the 24 h before completing the survey. Multiple logistic regression analysis indicated that receiving support for all five steps was positively associated with exclusive breastfeeding during the 24 h before the survey (adjusted odds ratio 4.51; 95% CI [1.50-13.61]). Receipt of a free formula sample or invitation to a free sample campaign was negatively associated with exclusive breastfeeding (adjusted odds ratio 0.43; 95% CI [0.19-0.98]). Other factors related to non-exclusive breastfeeding were older maternal age, lower education level, primiparity, and no breastfeeding intention. Conclusions: The pandemic weakened breastfeeding support for healthy women in Japan; however, support practice that adhered to WHO recommendations appeared to be effective during the pandemic.

Mediating role of social capital in the association between socioeconomic status and childcare practices in rural Malawi: a cross-sectional study.

OBJECTIVES: Childcare practices determine the child nutritional outcomes, but resources for good practices are unequally distributed across socioeconomic status (SES). This study first examined the associations between social capital and childcare practices separately across SES groups. It then investigated the mediation effect of social capital between SES and childcare practices. DESIGN: This cross-sectional study used the Short Version of the Adapted Social Capital Assessment Tool to measure structural social capital (group membership, social support and citizenship activities) and cognitive social capital of mothers. Data were analysed using multilevel logistic regressions with random intercepts and mediation modellings. SETTING: Rural Lilongwe, Malawi. PARTICIPANTS: A total of 320 mothers with a child aged between 12 months and 23 months. PRIMARY OUTCOME MEASURES: Childcare practice outcomes included were minimum dietary diversity, handwashing and complete vaccination. RESULTS: Among structural social capital dimensions, social support was found to be positively associated with minimum dietary diversity (adjusted OR (AOR)=1.44, 95% CI 1.22 to 1.71; p<0.001) and handwashing for all mothers (AOR=1.42, 95% CI 1.23 to 1.64; p<0.001). In the subgroup analysis, the higher SES group had higher odds of meeting the minimum dietary diversity (AOR=1.63, 95% CI 1.18 to 2.26; p=0.01) and handwashing with increased social support (AOR=1.53, 95% CI 1.13 to 2.08; p=0.01) than the lower SES. The mediation effect of social support accounted for 27.3% of the total effect between SES and minimum dietary diversity. Cognitive social capital was negatively associated with vaccination for the lower SES group (AOR=0.07, 95% CI 0.01 to 0.68; p=0.03). CONCLUSIONS: To improve feeding and handwashing practices and to reduce health inequalities in rural Malawi, governments and organisations should consider promoting the value of social support and health. Future research is needed to explain the negative association between cognitive social capital and vaccination among the lower SES group.