Knowledge and trust of mothers regarding childhood vaccination in Rwanda.

INTRODUCTION: Knowledge and trust are some of the contributing factors to vaccine acceptance(VA) and Vaccine hesitancy (VH) is one of the top threats to global health. A significant drop in childhood vaccination has been observed in recent years. One important reason that influences mothers' choice to either postpone or avoid children's vaccinations is knowledge and trust in childhood vaccines. This study aimed to assess mothers' knowledge and trust on vaccination of their children, and to examine the association between vaccination knowledge and selected socio-demographic factors. METHODS: A cross-sectional survey was conducted from January 2022 to March 2022 to assess the knowledge and trust of mothers regarding childhood vaccination. Data was collected with self-administered questionnaires. Multivariable logistic regression analysis was employed to assess factors associated with childhood vaccine knowledge and trust. RESULTS: Of the 2,126 Rwandan parents who participated in the study, the proportions with good knowledge of - and good trust in childhood vaccination were 95.5% and 91.4%, respectively. The popular sources of information about childhood vaccination were health care professionals (91.8%) and mass media (28.9%). Multinomial logistic regression analysis showed that good knowledge of - and trust in childhood vaccination were associated with the relationship with child(ren), education, occupation, and monthly income. The Multinomial logistic regression also revealed that the determinants of good knowledge of - and trust in childhood vaccination were; caregiver (p = 4.0 × 10-4, adjusted Odds Ratio (aOR); 1.7, 95%C.I; 1.3 - 2.3), no formal educational status (p = 3.3 × 10-2, aOR; 1.7, 95%C.I; 1.0 - 3.0), the unemployed occupational status (p = 2.4 × 10-2, aOR; 1.2, 95%C.I; 1.0 - 1.4), and persons on more than $401 per month (p = 2.0 × 10-4, aOR; 3.5, 95%C.I; 1.8 - 6.8). CONCLUSION: The majority of parents in Rwanda had both good knowledge of-and good trust regarding childhood vaccination. Public health strategies to promote vaccination, education programmes as well as improved communication tools between health care professionals/traditional leaders/religious leaders and parents need to be considered to achieve favourable vaccination attitudes and practices for all parents in Rwanda.

Assessment of knowledge about neonatal danger signs among primiparous women at discharge from healthcare facilities.

This study explores the evaluation of knowledge regarding neonatal danger signs (NDS) among first-time mothers in Pakistan during their discharge from healthcare facilities. The investigation aimed to establish connections between their understanding of NDS and factors such as sociodemographic background, prenatal check-ups, and educational measures. Considering the persistently high neonatal mortality rates in low- and middle-income nations, recognizing maternal NDS awareness becomes crucial for promoting early medical attention and reducing neonatal health risks. Existing research highlights the role of maternal knowledge in shaping neonatal well-being; however, gaps in knowledge remain prevalent, especially among first-time mothers. Using a cross-sectional approach, data were gathered through structured questionnaires, revealing significant relationships among maternal NDS awareness, sociodemographic aspects, prenatal care, and educational interventions. It is noteworthy that first-time mothers demonstrated lower NDS knowledge than mothers with multiple childbirth experiences, while those with higher education displayed greater awareness The effects of educational interventions were diverse, and antenatal visits were linked to enhanced knowledge. This study highlights the significance of focused treatments that target knowledge deficiencies, which can empower women and contribute to the reduction of infant health problems and mortality. encouraging further exploration of effective strategies to augment maternal knowledge and proactive healthcare-seeking behaviors.

Cette étude explore l'évaluation des connaissances concernant les signes de danger néonatals (NDS) chez les primipares au Pakistan lors de leur sortie des établissements de santé. L'enquête visait à établir des liens entre leur compréhension du NDS et des facteurs tels que le contexte sociodémographique, les contrôles prénatals et les mesures éducatives. Compte tenu des taux de mortalité néonatale constamment élevés dans les pays à revenu faible ou intermédiaire, il devient crucial de reconnaître la sensibilisation maternelle aux NDS pour promouvoir des soins médicaux précoces et réduire les risques pour la santé néonatale. Les recherches existantes mettent en évidence le rôle des connaissances maternelles dans la formation du bien-être néonatal ; cependant, des lacunes dans les connaissances demeurent répandues, en particulier parmi les primo-mères. En utilisant une approche transversale, les données ont été recueillies au moyen de questionnaires structurés, révélant des relations significatives entre la sensibilisation maternelle au NDS, les aspects sociodémographiques, les soins prénatals et les interventions éducatives. Il convient de noter que les mères primipares ont démontré des connaissances NDS inférieures à celles des mères ayant eu plusieurs accouchements, tandis que celles ayant fait des études supérieures ont montré une plus grande conscience. Les effets des interventions éducatives étaient diversifiés et les visites prénatales étaient liées à une amélioration des connaissances. Cette étude met en évidence l'importance des traitements ciblés ciblant les déficits de connaissances, qui peuvent autonomiser les femmes et contribuer à la réduction des problèmes de santé et de la mortalité infantiles. encourager une exploration plus approfondie de stratégies efficaces pour accroître les connaissances maternelles et les comportements proactifs de recherche de soins de santé.

Evaluación de las conductas de lactancia materna y las prácticas de alimentación complementaria de las madres turcas y las madres refugiadas sirias / Evaluation of breastfeeding behaviors and complementary feeding practices of Turkish and Syrian refugee mothers

Objetivos: el objetivo de este estudio fue comparar la lactancia y los factores relacionados (edad, nivel educativo, edad al momento del primer embarazo, etc.) y las prácticas de alimentación complementaria de las madres refugiadas sirias y las madres turcas. Materiales y métodos: este estudio descriptivo y comparativo analizó las características nutricionales de los bebés de 9 a 60 meses de edad cuyas madres fueran turcas o refugiadas sirias que asistieron al Hospital Público de Kiziltepe entre enero y julio de 2022. Resultados: se incluyó a 204 madres (126 turcas y 78 sirias). La edad promedio de las madres turcas era 27,60 ± 5,17 años y la de las refugiadas sirias, 28,91 ± 5,62 años, sin una diferencia significativa entre ambos grupos (p: 0,091). La lactancia materna posparto fue del 91,3 % y la duración de la lactancia fue de 12 meses (0-24) en las ciudadanas turcas, mientras que, en las refugiadas sirias, fue del 84,6 % y 9 meses (0-24), respectivamente (consumo de leche materna, p: 0,144; tiempo de consumo, p: 0,161; sin diferencias estadísticas). El 23,8 % de las ciudadanas turcas y el 5,1 % de las refugiadas sirias recibieron capacitación sobre la lactancia, con una diferencia significativa entre ambos grupos (p: 0,001). Conclusión: en los grupos de refugiadas, las prácticas de nutrición infantil y materna se ven alteradas. En colaboración con las organizaciones locales e internacionales y los organismos estatales que ayudan a los grupos de refugiados se podrían mejorar las prácticas de nutrición maternoinfantil y reducir las brechas.

Objectives: The purpose of this study was to compare breastfeeding and related factors (age, level of education, age at first pregnancy, etc.), and complementary feeding practices between Syrian refugee and native Turkish mothers. Material and methods: This descriptive-comparative study examined the nutritional characteristics of infants aged 9 to 60 months whose mothers were Turkish or Syrian refugees who attended Kiziltepe State Hospital between January 2022 and July 2022. Results: 204 mothers (126 Turkish and 78 Syrian) who had a child aged 9-60 months were included. The average age of the mothers was 27.60 ± 5.17 years for Turkish citizens and 28.91 ± 5.62 for Syrian refugees, without significant difference between the two groups (p: 0.091). Postpartum breastfeeding was 91.3% and breastfeeding duration was 12 (0-24) months in Turkish citizens; in Syrian refugees, breastfeeding was 84.6% and average breastfeeding time was 9 (0- 24) months (respectively, breast milk intake p: 0.144, uptake time p: 0.161; no statistical difference). Breastfeeding training was received by 23.8% of Turkish citizens and 5.1% of Syrian refugees; there was a significant difference between the two groups (p: 0.001). Conclusion: In refugee groups, infant and maternal nutrition practices are disrupted. Working in conjunction with local and international organizations and state agencies that give help to refugee groups, the appropriate interventions, initiatives, supports, and awareness-raising activities would strive to improve practices in mother and baby nutrition and narrow gaps.

8-Year Follow-up of a Maternal Education Trial in a Low-Resource Setting.

OBJECTIVES: Nutrition and stimulation interventions promote early childhood development, but little is known about their long-term benefits in low- and middle-income countries. We conducted a follow-up study of a cluster-randomized maternal education trial performed in children aged 6 to 8 months to assess the sustainability of developmental benefits after 8 years. METHODS: The education intervention lasted 6 months and consisted of nutrition, hygiene, sanitation, and child stimulation aspects. We assessed child processing and cognitive abilities using the Kaufman Assessment Battery for Children Second Edition (KABC-II) and attention and inhibitory control using the Test of Variables of Attention after 8 years. The original trial included 511 mother-child pairs (intervention, n = 263; control, n = 248), whereas in the current study, 361 (71%; intervention, n = 185; control, n = 176) pairs were available for analyses. RESULTS: The intervention group scored higher than the controls (all P < .001) on all 5 KABC-II subscales and on the KABC-II global score (mean difference: 14; 95% confidence interval, 12-16; P < .001). For all 5 Test of Variables of Attention variables, the intervention group scored higher than the controls on both the visual and auditory tasks (all P < .05). Because the intervention was delivered as a package, a limitation is that we cannot pinpoint the individual contribution of each component (nutrition, hygiene, and stimulation) to the developmental benefits. CONCLUSIONS: The intervention group consistently scored markedly higher on both neuropsychological tests. Thus, even 8 years after the original maternal education intervention, the developmental benefits that we observed at child age of 1, 2, and 3 years, were sustained.

Benefits and Challenges of Implementing an Adaptation of Family Integrated Care in a Ugandan Setting.

BACKGROUND: Family Integrated Care (FICare) integrates parents as partners in neonatal intensive care unit care. Our team adapted and implemented this approach in a Ugandan unit for hospitalized neonates. PURPOSE: This qualitative descriptive study examined the perceptions of mothers and healthcare professionals (HCPs) of the benefits and challenges of this new approach to care. METHODS: Fifty-one mothers of hospitalized neonates born weighing greater than 2000 g participated in the program. They were taught to assess neonate danger signs, feeding, and weight. After discharge, a subsample (n = 15) participated in focus groups to explore benefits and challenges of their participation in care. Interviews with 8 HCPs were also conducted for the same purpose. Transcripts from focus groups and interviews were analyzed using inductive content analysis to describe the benefits and challenges from the perspectives of mothers and HCPs. RESULTS: For mothers a benefit was decreased stress. Both mothers and HCPs reported that the knowledge and skills mothers acquired were a benefit as was their ability to apply these to the care of their neonate. Improved relations between mothers and HCPs were described, characterized by greater exchange of information and HCPs' attentiveness to mothers' assessments. Mothers felt ready for discharge and used their knowledge at home. HCPs noted a decrease in their workload. Challenges included the need for mothers to overcome fears about performing the tasks, their own well-being and literacy skills, and access to equipment. IMPLICATIONS FOR PRACTICE: Mothers' participation in their neonates' care can have benefits for them and their neonate.

Care groups in an integrated nutrition education intervention improved infant growth among South Sudanese refugees in Uganda's West Nile post-emergency settlements: A cluster randomized trial.

OBJECTIVE: This study examined the effects of a peer-led integrated nutrition education intervention with maternal social support using Care Groups on infant growth among South Sudanese refugees in Uganda. METHODS: A community-based cluster-randomized trial (RCT) was conducted among 390 pregnant women (third trimester). Two intervention study arms were Mothers-only(n = 131) and Parents-combined (n = 142) with a Control (n = 117). WHO infant growth standards defined length-for-age z-scores (LAZ) for stunting, weight-for-age z-scores (WAZ) for underweight and weight-for-length z-scores (WLZ) for wasting. The Medical Outcomes Study (MOS) social support index was a proxy measure for social support. A split-plot ANOVA tested the interaction effects of social support, intervention, and time on infant growth after adjusting for covariates. Further, pairwise comparisons explained mean differences in infant growth among the study arms. RESULTS: The mean infant birth weight was 3.1 ± 0.5 kg. Over the study period, infant stunting was most prevalent in the Control (≥ 14%) compared to Mothers-only (< 9.5%) and Parents-combined (< 7.4%) arms. There were significant interaction effects of the Care Group intervention and social support by time on infant mean LAZ (F (6, 560) = 28.91, p < 0.001), WAZ (F (5.8, 539.4) = 12.70, p = < 0.001) and WLZ (F (5.3, 492.5) = 3.38, p = 0.004). Simple main effects by the end of the study showed that the intervention improved infant mean LAZ (Mothers-only vs. Control (mean difference, MD) = 2.05, p < 0.001; Parents-combined vs. Control, MD = 2.00, p < 0.001) and WAZ (Mothers-only vs. Control, MD = 1.27, p < 0.001; Parents-combined vs. Control, MD = 1.28, p < 0.001). CONCLUSION: Maternal social support with an integrated nutrition education intervention significantly improved infant stunting and underweight. Nutrition-sensitive approaches focused on reducing child undernutrition among post-emergency refugees may benefit from using Care Groups in programs. TRIAL REGISTRATION: Clinicaltrials.gov, NCT05584969.

Minimum acceptable diet and associated factors among children aged 6-23 months in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: To ensure a child's full growth, health, and development during infancy and the early years, adequate nutrition is crucial. A crucial window of opportunity for ensuring children's proper growth and development through adequate eating exists during the first two years of life. According to the evidence of the efficacy of interventions, achieving universal coverage of optimal breastfeeding could prevent 13% of deaths in children under the age of 5 worldwide, and using complementary feeding methods appropriately would lead to an additional 6% decrease in under-five mortality. METHODS: From several electronic databases, all published, unpublished, and gray literature was extracted and exported into EndNote version X20. For further analysis of the review, the retrieved data from the excel sheet were imported into the statistical software program Stata version. Metanalysis was used to determine the prevalence of MAD, and a random effects model was used to estimate the pooled prevalence of MAD. The DerSimonian-Laird Random effects model (REM) was used to combine the determinant factors from all qualifying papers for the meta-analysis, and the heterogeneity was independently assessed using a χ2 test, Q statistics, and matching I2 statistics. To retrieve the extent of publication bias, funnel plots were scattered and tested for asymmetry and, additionally, Egger's test was computed with the user-written "meta bias" command in Stata (version 11) software. To end, sensitivity analyses with trim and fill were performed. RESULTS: The pooled estimate of the overall prevalence of minimum acceptable diet in 16 studies in Ethiopia was 22% with (95% CI: 16, 28%) with a random effect model. However, eight papers were filled during trim and fill in order to counteract the small study effect. The overall filled pooled estimate was 7.9% with (95%CI: 11, 14.8%). Maternal education (primary and secondary) is 1.714 (95% CI 1.244,2.363) and 2.150(95% CI: 1.449,3.190), respectively, Ages of children with range of 12-17 months (2.158 (95% CI 1. 9,3.006) and 18-23 months 2.948(95% CI: 1.675,5.190)), Nutrition information ((1.883 (95% CI 1.169,3.032)) media exposure (1.778(95% CI: 1.396,2.265), and maternal knowledge (2.449 (95% CI 1.232, 5.027) were significantly associated with MAD. CONCLUSION: The pooled estimate of the overall prevalence of minimum acceptable diet in 16 studies in Ethiopia were low. Maternal education (primary and secondary), ages of child with range of 12-17 month and 18-23 months, mothers having nutrition information, mothers who have media exposure,and mothers having good knowledge were significantly associated with Minimum acceptable diet. The government, NGO, and other stakeholders should focus on improving Minimum acceptable diet among 6 to 23 months of children through promoting with mass media, focuses on nutrition council during critical contact point in health facility, and doing capacity building for the mothers/caregivers.

Measurement of cognition and profiling early learning environments in India, Indonesia and Senegal: a UKRI GCRF Action Against Stunting Hub protocol paper.

INTRODUCTION: Childhood stunting is associated with poorer child health, growth and development including diminished cognitive abilities. Mapping out the links between child stunting and Early Childhood Education and Development is critical to increasing understanding of the causes and effects of childhood stunting, and for programme and policy development. The aim of this study is to investigate and compare the development and educational environments across India, Indonesia and Senegal, and to identify the multifactorial drivers and impacts of childhood stunting to inform a new typology. METHODS AND ANALYSIS: This current study is part of an interdisciplinary observational research study, where women are recruited during pregnancy and mother-infant pairs followed prospectively, up to 24 months after birth. Eight measures will be used to profile children's early development and learning environments in two sample cohorts: (A) children aged 12 and 24 months born to the women recruited during pregnancy (ie, 500 pregnant mothers per country) and (B) a preschool case-control cohort of siblings from the main cohort aged between 3:6 and 5:6 years of age where anthropomorphic measures will be collected to assess degrees of stunting. Profiling of the development and learning environments in the countries will include both parent/caregiver self-reported and local staff (enumerators) direct assessments of children and settings. ETHICS AND DISSEMINATION: This study was approved by the institutional ethics committees of all partner institutions. In India, Indian Council of Medical Research-National Institute of Nutrition, Hyderabad; In Indonesia, Ethics Committee of the Faculty of Medicine, University of Indonesia; and in Senegal, National Ethics Committee for Scientific Research in Senegal.The findings of the study will be disseminated in national and international meetings, seminars, conferences and peer-reviewed journals.

Prevalence, trend, and inequality of prolonged exclusive breastfeeding among children aged 6-23 months old in India from 1992-2021: A cross-sectional study of nationally representative, individual-level data.

Background: Prolonged exclusive breastfeeding (PEB) for children older than six months old is a threat to appropriate complementary feeding practices. This study aims to examine the trend of PEB among children aged 6-23 months in India. Methods: We adopted five waves of National Family Health Survey (NFHS) data between 1992-93 and 2019-21. PEB was defined as children aged six months and above currently consuming breastmilk as the only source of energy, protein and micronutrients. We generated descriptive statistics and a series of multivariable logistic regressions to estimate the prevalence and trend in the PEB rate. Moreover, we assessed how child age and socioeconomic factors (i.e. child gender and age, place of residence, household wealth, and maternal education) were related with PEB using mutually and single-adjusted model. Results: There were 184 891 Indian children aged 6-23 months old included in this study with 48.0% being female. We found that the proportion of PEB increased from 4.3% in 1992 to 7.7% in 2021, of which the rate for children aged six-eight months rose from 14.0 to 20.1%. Our results showed that children who were from poorer households or with lower-educated mothers were more likely to experience prolonged exclusive breastfed. Take the year of 2019-21 as an example, compared to the households of the richest quintile, children from households of the poorer quintile were significantly more likely to experience PEB, with odds ratio (OR) of 1.33 (95% confidence interval (CI) = 1.09-1.61). Moreover, children with illiterate mothers had 21% higher odds of having prolonged exclusively breastfeeding (OR = 1.21; 95% CI = 1.01-1.44) compared with children with mothers who have college and above education. Conclusions: PEB among children over six months old is prevalent in India, particularly among children from disadvantaged households. Poverty reduction and maternal education are of great potential importance for policymakers to promote appropriate complementary feeding practice.

Mother's milk-mother's gift: Mobile-based training to increase self-efficacy of nursing women during postpartum and puerperium: A quasi-experimental study.

BACKGROUND: The World Health Organization recommends exclusive breastfeeding for 6 months followed by continued breastfeeding with complementary food up to 2 years of age or beyond. This study aimed to investigate the effect of mobile -based education on the self-efficacy of lactating women in the postpartum period. METHODS: A quasi-experimental study was carried out in 2018 in Shirvan, Iran among 69 postpartum women. Participants were assigned to intervention (n = 33) and control (n = 36) groups on the first day after delivery by random allocation. Intervention group received the mobile-based training for 4 weeks in the form of text messages, photos, video clips, and audio files. The control group received routine hospital care and training. Data were collected on demographic characteristics, delivery information, and the breastfeeding self-efficacy. Self-efficacy was measured in two groups at three time points; the first day after delivery, 4 weeks after delivery and 8 weeks after delivery. FINDINGS: The mean and standard deviation of breastfeeding self-efficacy score was higher in the intervention than control group 4 weeks (155.30 ± 10.93 vs 132.52 ± 19.70, P < 0.001) and 8 weeks after delivery (160.18 ± 11.33 vs 132.30 ± 24.09, P < 0.001). Compared to the control group, the rate of exclusive breastfeeding in the intervention group was significantly higher 4 and 8 weeks after the delivery (Pall < 0.05). DISCUSSION: The findings from this study showed a substantial increase in breastfeeding self-efficacy and exclusive breastfeeding in the group who received training through mobile-based education compared to the group that received routine care. APPLICATION TO PRACTICE: Mobile-based breastfeeding education might be a promising strategy to increase breastfeeding self-efficacy. It is suggested that midwives include the design of mobile-based educational programs as part of their educational strategies and use the advantages of this educational method during pregnancy and after childbirth. TRAIL REGISTRATION: This article has been registered in Iran's Clinical Trial Center with the code: 2 N20171024036972 IRCT.

The effects of video-assisted breastfeeding education given to primiparous pregnant women on breastfeeding self-efficacy: randomized control study.

BACKGROUND: Breastfeeding is vitally important for the health of the mother, baby, family and society. Especially the perception of breastfeeding self-efficacy of primiparous pregnant women is an important factor in breastfeeding. This study was conducted to determine the effects of online video-supported breastfeeding education on breastfeeding self-efficacy in primiparous pregnant women. METHODS: This randomized controlled study was conducted with primiparous pregnant women admitted to a university hospital in northern Turkey. The study involved 80 pregnant women, with 40 assigned to the experimental group and 40 to the control group. Participants in the intervention group received online video-assisted education, which covered the first meeting of the mother and baby as well as the initial breastfeeding session. The data for the breastfeeding self-efficacy scale were gathered at the onset of the study and three weeks later. In data analysis, categorical variables were assessed using the chi-square test, continuous variables and intergroup comparisons were conducted through the independent sample t-test, and intragroup comparisons were performed using the paired sample t-test. RESULTS: While the baseline breastfeeding self-efficacy levels of the primiparous pregnant women were similar between the groups, statistically significant differences were observed both within (p = 0.000) and between (p = 0.000) groups in the breastfeeding self-efficacy scores of pregnant women in the intervention group after the education intervention. CONCLUSION: Breastfeeding self-efficacy levels in the education group showed a statistically significant increase compared to both the pre-education and control groups. This highlights the importance of nurses providing support to primiparous pregnant women through video-assisted education during pregnancy to enhance breastfeeding self-efficacy. TRIAL REGISTRATION: ClinicalTrials.gov: NCT06121973 date of first registration (27/10/2023), retrospectively registered (08/11/2023).

The effectiveness of sexual health and development education given to children with intellectual disabilities: A randomized controlled study.

PURPOSE: The purpose of this study is to determine the effectiveness of an educational program implemented to support the sexual health and development of children with intellectual disabilities, using the Mastery Learning Model, on their knowledge of sexual health and development, as well as on their mothers' awareness of their children's sexual development. METHOD: This study was conducted as a randomized controlled trial with 48 children who have intellectual disabilities, divided into two groups: an education group (n = 24) and a control group (n = 24). The program implemented was a sexual health and development education program based on the Mastery Learning Model. The data collection tools used were 'The Sexual Development Characteristics of Children with Adolescent Intellectual Disability Scale' for mothers and 'The Sexual Development Knowledge Assessment Scale for Children with Intellectual Disabilities' for children. RESULTS: Following the educational program, the children in the education group demonstrated an increase in knowledge regarding their sexual development and health. Additionally, the mothers in the education group showed an increased awareness of their children's sexual health and development. One month after implementing the education program, which utilized mastery learning, the children in the education group exhibited a greater level of knowledge compared to the control group. CONCLUSION: This study utilized the Mastery Learning Model to achieve effective and comprehensive sexual health and development education for children with intellectual disabilities. PRACTICE IMPLICATIONS: Pediatric and school nurses are recommended to use the Mastery Learning Model for sexual health education in clinics and school health practices.

The effect of online breastfeeding education on breastfeeding motivation: A randomized controlled study.

PURPOSE: The aim of this study was to examine the effect of online breastfeeding education on breastfeeding motivation. DESIGN AND METHODS: The study had a single blind randomized, controlled, experimental design. The women in the online education group were primipara and in their postpartum 4-8 weeks and fulfilled inclusion criteria for the study. The study population comprised of the women presenting to the pregnancy outpatient clinic or giving birth in the gynecological and obstetrics clinic of a university hospital hospital in the West of Turkey and hearing about the Online Breastfeeding Education through social media. The sample size was calculated through a similar study. Data were collected between February 2022-November 2022. Simple random sampling was used and the study sample comprised of 50 women, of whom 25 were in the online breastfeeding education group and 25 were in the control group. Online breastfeeding education was given in groups of three or two, depending on availability, via the video communication platform (Zoom Video Communications). The control group received routine care. Data analysis was made with descriptive statistics, Wilcoxon rank sum test and Mann Whitney U test. RESULTS: Integrative motivation (U = 284, p < .05) and intrinsic motivation-identified regulation (U = 196, p < .05) significantly increased compared to the control group. CONCLUSION: Online breastfeeding education offered in the postpartum period can help to increase breastfeeding rates. PRACTICE IMPLICATIONS: It is recommended that nurses monitor breastfeeding status in the postpartum period and motivate mothers with online breastfeeding training in cases where access is not available. TRIAL REGISTRATION: Registered 12 February 2022 on www. CLINICALTRIALS: gov (NCT05262231).

Effectiveness of a positive deviance approach to improve appropriate feeding and nutritional status in South West Region, Ethiopia: A study protocol for a cluster randomized control trial.

BACKGROUND: Non-optimal infant and young child feeding practices (IYCFP) are linked to malnutrition and infant mortality in poor countries, notably in Ethiopia. The majority of growth stalls occur within the first two years of life; hence, there is a need to discover interventions that enhance appropriate IYCFP for improving nutritional outcomes during this critical period. Using the experience of mothers who have come up with solutions to their IYCFP problems to educate others, is a potential pathway to initiate and sustain behavioral changes in resource-limited areas. However, such interventions are not widely implemented in Ethiopia. OBJECTIVE: This study aims to assess the effectiveness of a positive deviance approach (PDA) to improve appropriate feeding and nutritional status in South West region, Ethiopia. METHODS: A cluster randomized controlled trial will be conducted to compare the effect of positive deviant intervention versus routine health education. The intervention will be provided by positive deviant mothers based on uncommon practices that potentially benefit IYCFP will be identified. Training of the trainers manual on counselling and supporting non-positive deviant mothers based on the uncommon practices identified and WHO IYCFP guidelines will be provided for facilitating change. Culturally appropriate and scientifically acceptable operational packages of information will be developed. A total of 516 mothers will be recruited from 36 zones. The intervention arm will receive 12 demonstration sessions in groups and every 15th day home visit by positive deviant mothers. Data will be entered into epi data version 3.1 and analyzed using STATA version 16.0. All analyses will be done as intention-to-treat. We will fit the mixed effects linear regression model for continuous outcomes and mixed effects linear probability model for the binary outcomes in the study zone as a random intercept to estimate study arm difference (intervention vs. routine health education) adjusted for the baseline values of the outcome and additional relevant covariates. DISCUSSION: We expect that the trial will generate findings informing IYCFP and nutritional policies and practices in Ethiopia. TRIAL REGISTRATION: This trial was registered at ClinicalTrials.gov as PACTR202108880303760, 30/8/2021.

Magnitude and determinant of healthcare-seeking behavior for childhood acute respiratory tract infections in Ethiopia: a cross-sectional study.

BACKGROUND: Acute respiratory infections (ARIs) remain a major public health concern which become the leading cause of mortality and morbidity in children under the age of five. A large percentage of childhood deaths and complications can be avoided by seeking proper medical care. Therefore, this study aimed to assess the magnitude, and individual and community-level determinants of mothers' healthcare-seeking behavior for their children under the age of five who had ARI symptoms in Ethiopia. METHOD: A secondary data analysis was conducted using the 2016 Ethiopian Demographic and Health Surveys(EDHS) with a total weighted sample of 643 under-five children who had ARI symptoms within two weeks of the survey. Due to the hierarchical nature of the EDHS data, a multi-level logistic regression model was used to identify the individual and community-level factors influencing mothers' health care-seeking behavior for their children with ARI symptoms. In the multivariable multilevel analysis, those variables with a p-value < 0.05 were considered to be significant predictors of the outcome variable. RESULTS: Healthcare-seeking behavior among mothers or caregivers for children with symptoms of ARIs was 32.61% (95% CI: 29.08-36.33%) in Ethiopia. The ICC in the null model indicated that about 55% of the total variability of treatment-seeking behavior was due to differences between clusters. Child aged > 24 months [AOR = 0.35; 0.19-0.63], having primary education [AOR = 3.25; 1.27-8.32], being media exposed [AOR = 2.49; 1.15, 5.38], female household head[AOR = 3.90; 1.35, 11.24], and delivery at health institution[AOR = 2.24; 1.00, 5.01] were significant predictors of health care seeking behavior of mother for their children with ARI symptoms. CONCLUSION: There is poor treatment-seeking behavior for children with symptoms of ARI in Ethiopia with significant community level variations. The multilevel logistic regression analysis showed that improving mothers' education, women's empowerment, facilitating institutional delivery and media accessibility are critical to promoting health-seeking behaviors among mothers or caregivers of under-five children with ARI symptoms. Hence, concerned bodies should design targeted interventions that increase mothers' or caregivers' treatment-seeking behavior for childhood ARI to reduce child morbidity and mortality.

A cluster randomised controlled trial of an early childhood parenting programme delivered through early childhood education centres in rural Zimbabwe.

BACKGROUND: Early childhood is a critical period for child development. Effective approaches to support families in low-resource settings in the use of responsive and stimulating parenting are needed. AIM: The aim of this study was to examine the effects of the Reach Up early childhood parenting programme on children's development, parenting attitudes and practices, when delivered through early childhood development (ECD) centres in Zimbabwe. METHODS: A cluster randomised controlled trial was conducted in Sanyati, a rural district in Zimbabwe. Twenty-four of 51 available centres were randomised to intervention (n = 12) or control (n = 12) groups. Sixteen mothers with a child aged 12-30 months were recruited from each centre's catchment area (n = 189 intervention; n = 193 control). The intervention comprised two home visits per month delivered by centre teaching assistants over a period of 27 months. Primary outcomes were child Developmental Quotient (DQ), Language, Eye and Hand coordination, Performance and Practical Reasoning subscale scores assessed at follow-up. Secondary outcomes were mothers' attitudes about child development, parenting practices and maternal depressive symptoms all measured at baseline and follow-up. Intention to treat analyses was conducted using mixed-effects regression models with the standard error adjusted for cluster and inverse proportionality weights to adjust for attrition. Significance was set at P < 0.05. RESULTS: A total of 285 (74.6%) of 382 children enrolled were tested, with 97 children lost to follow-up. The intervention improved the children's DQ by 3.55 points (95% CI 0.82 to 6.28), Eye and Hand by 3.58 (95% CI 0.59 to 6.56) and Practical Reasoning by 4.19 (95% CI 0.96 to 7.42). No significant improvements to Performance or Language scores, parenting attitudes, parenting practices and depressive symptoms were identified. CONCLUSIONS: A home visiting intervention delivered by ECD teaching assistants promoted children's development. This suggests that outreach from preschools may be an effective platform for delivery of parenting interventions.

Evaluation of breastfeeding behaviors and complementary feeding practices of Turkish and Syrian refugee mothers. / Evaluación de las conductas de lactancia materna y las prácticas de alimentación complementaria de las madres turcas y las madres refugiadas sirias.

Objectives: The purpose of this study was to compare breastfeeding and related factors (age, level of education, age at first pregnancy, etc.), and complementary feeding practices between Syrian refugee and native Turkish mothers. Material and methods: This descriptive-comparative study examined the nutritional characteristics of infants aged 9 to 60 months whose mothers were Turkish or Syrian refugees who attended Kiziltepe State Hospital between January 2022 and July 2022. Results: 204 mothers (126 Turkish and 78 Syrian) who had a child aged 9-60 months were included. The average age of the mothers was 27.60 ± 5.17 years for Turkish citizens and 28.91 ± 5.62 for Syrian refugees, without significant difference between the two groups (p: 0.091). Postpartum breastfeeding was 91.3% and breastfeeding duration was 12 (0-24) months in Turkish citizens; in Syrian refugees, breastfeeding was 84.6% and average breastfeeding time was 9 (0- 24) months (respectively, breast milk intake p: 0.144, uptake time p: 0.161; no statistical difference). Breastfeeding training was received by 23.8% of Turkish citizens and 5.1% of Syrian refugees; there was a significant difference between the two groups (p: 0.001). Conclusion: In refugee groups, infant and maternal nutrition practices are disrupted. Working in conjunction with local and international organizations and state agencies that give help to refugee groups, the appropriate interventions, initiatives, supports, and awareness-raising activities would strive to improve practices in mother and baby nutrition and narrow gaps.

Objetivos: el objetivo de este estudio fue comparar la lactancia y los factores relacionados (edad, nivel educativo, edad al momento del primer embarazo, etc.) y las prácticas de alimentación complementaria de las madres refugiadas sirias y las madres turcas. Materiales y métodos: este estudio descriptivo y comparativo analizó las características nutricionales de los bebés de 9 a 60 meses de edad cuyas madres fueran turcas o refugiadas sirias que asistieron al Hospital Público de Kiziltepe entre enero y julio de 2022. Resultados: se incluyó a 204 madres (126 turcas y 78 sirias). La edad promedio de las madres turcas era 27,60 ± 5,17 años y la de las refugiadas sirias, 28,91 ± 5,62 años, sin una diferencia significativa entre ambos grupos (p: 0,091). La lactancia materna posparto fue del 91,3 % y la duración de la lactancia fue de 12 meses (0-24) en las ciudadanas turcas, mientras que, en las refugiadas sirias, fue del 84,6 % y 9 meses (0-24), respectivamente (consumo de leche materna, p: 0,144; tiempo de consumo, p: 0,161; sin diferencias estadísticas). El 23,8 % de las ciudadanas turcas y el 5,1 % de las refugiadas sirias recibieron capacitación sobre la lactancia, con una diferencia significativa entre ambos grupos (p: 0,001). Conclusión: en los grupos de refugiadas, las prácticas de nutrición infantil y materna se ven alteradas. En colaboración con las organizaciones locales e internacionales y los organismos estatales que ayudan a los grupos de refugiados se podrían mejorar las prácticas de nutrición maternoinfantil y reducir las brechas.

Introduction of Breast Milk Substitutes During the First 3 Days of Life: Results of the Mexican National Survey of Demographic Dynamics, 2018.

Background: The introduction of foods or fluids other than breast milk in the first few days after birth interferes with the establishment of breastfeeding. This study aimed to investigate the association of formula introduction during the first 3 days of life with maternal sociodemographic characteristics, hospital practices, and breastfeeding duration. Materials and Methods: Information from the National Survey of Demographic Dynamics, 2018, which includes 17,686 mother-baby pairs was analyzed. Mother-baby pairs were classified into categories according to breastfeeding duration: <5 months and ≥5 months. Statistical methods and a machine learning algorithm (Bayesian network, BN) were used to analyze the data. Results: In general, 3,720 (21%) mothers reported introducing formula during the first 3 days of life. A lower education level, lower sociodemographic stratum, living in a rural area, and considering oneself indigenous were factors associated with not introducing formula during the first 3 days of life. A total of 5,168 (29.2%) mother-baby pairs practiced breastfeeding for <5 months, and 12,518 (70.8%) for ≥5 months. Almost twice as many mothers who practiced breastfeeding for <5 months introduced formula during the first 3 days of life (31.7%) compared with those who practiced breastfeeding for ≥5 months (16.6%). The BN model can sufficiently predict cases with a breastfeeding duration ≥5 months (precision-recall curve area = 0.792). Discussion: Introducing formula during the first 3 days of life was associated with a shorter breastfeeding duration. BN analysis showed a probabilistic dependency between the type of delivery and variables associated with the establishment of breastfeeding.

Study Protocol for a Stepped-Wedge Cluster (Nested) Randomized Controlled Trial of Antenatal Colostrum Expression (ACE) Instruction in First-Time Mothers: The ACE Study.

BACKGROUND: Although many mothers initiate breastfeeding, supplementation with human-milk substitutes (formula) during the birth hospitalization is common and has been associated with early breastfeeding cessation. Colostrum hand expressed in the last few weeks before birth, known as antenatal colostrum expression (ACE), can be used instead of human-milk substitutes. However, evidence is lacking on the efficacy of ACE on breastfeeding outcomes and in non-diabetic mothers. METHODS AND PLANNED ANALYSIS: This multicenter stepped-wedge cluster (nested) randomized controlled trial aims to recruit 945 nulliparous pregnant individuals. The trial is conducted in two phases. During Phase 1, control group participants are under standard care. During Phase 2, participants are randomized to ACE instruction via a pre-recorded online video or a one-on-one session with a midwife. Adjusted logistic regression analysis will be used to examine the relationship between ACE instruction and breastfeeding outcomes. RESEARCH AIMS AND QUESTIONS: Primary aim: (1) Does advising pregnant individuals to practice ACE and providing instruction improve exclusive breastfeeding rates at 4 months postpartum? Secondary research questions: (2) Do individuals who practice ACE have higher rates of exclusive breastfeeding during the initial hospital stay after birth? (3) Is teaching ACE via an online video non-inferior to one-on-one instruction from a midwife? (4) Does expressing colostrum in pregnancy influence time to secretory activation, or (5) result in any differences in the composition of postnatal colostrum? DISCUSSION: Trial findings have important implications for maternity practice, with the online video providing an easily accessible opportunity for ACE education as part of standard antenatal care.

Effectiveness and cost-effectiveness of Assets-based feeding help Before and After birth (ABA-feed) for improving breastfeeding initiation and continuation: protocol for a multicentre randomised controlled trial (Version 3.0).

INTRODUCTION: Breastfeeding has health benefits for infants and mothers, yet the UK has low rates with marked social inequalities. The Assets-based feeding help Before and After birth (ABA) feasibility study demonstrated the acceptability of a proactive, assets-based, woman-centred peer support intervention, inclusive of all feeding types, to mothers, peer supporters and maternity services. The ABA-feed study aims to assess the clinical and cost-effectiveness of the ABA-feed intervention compared with usual care in first-time mothers in a full trial. METHODS AND ANALYSIS: A multicentre randomised controlled trial with economic evaluation to explore clinical and cost-effectiveness, and embedded process evaluation to explore differences in implementation between sites. We aim to recruit 2730 primiparous women, regardless of feeding intention. Women will be recruited at 17 sites from antenatal clinics and various remote methods including social media and invitations from midwives and health visitors. Women will be randomised at a ratio of 1.43:1 to receive either ABA-feed intervention or usual care. A train the trainer model will be used to train local Infant Feeding Coordinators to train existing peer supporters to become 'infant feeding helpers' in the ABA-feed intervention. Infant feeding outcomes will be collected at 3 days, and 8, 16 and 24 weeks postbirth. The primary outcome will be any breastfeeding at 8 weeks postbirth. Secondary outcomes will include breastfeeding initiation, any and exclusive breastfeeding, formula feeding practices, anxiety, social support and healthcare utilisation. All analyses will be based on the intention-to-treat principle. ETHICS AND DISSEMINATION: The study protocol has been approved by the East of Scotland Research Ethics Committee. Trial results will be available through open-access publication in a peer-reviewed journal and presented at relevant meetings and conferences. TRIAL REGISTRATION NUMBER: ISRCTN17395671.