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To develop a method to assess the cost of extending the duration of maternity leave for formally-employed women at the national level and apply it in Brazil, Ghana and Mexico.We adapted a World Bank costing method into a five-step method to estimate the costs of extending the length of maternity leave mandates. Our method used the unit cost of maternity leave based on working women's weekly wages; the number of additional weeks of maternity leave to be analysed for a given year; and the weighted population of women of reproductive and legal working age in a given country in that year. We weighted the population by the probability of having a baby that year among women in formal employment, according to individual characteristics. We applied nationally representative cross-sectional data from fertility, employment and population surveys to estimate the costs of maternity leave for mothers employed in the formal sector in Brazil, Ghana and Mexico for periods from 12 weeks up to 26 weeks, the WHO target for exclusive breastfeeding.We estimated that 640 742 women in Brazil, 33 869 in Ghana and 288 655 in Mexico would require formal maternity leave annually. The median weekly cost of extending maternity leave for formally working women was purchasing power parity international dollars (PPP$) 195.07 per woman in Brazil, PPP$ 109.68 in Ghana and PPP$ 168.83 in Mexico.Our costing method could facilitate evidence-based policy decisions across countries to improve maternity protection benefits and support breastfeeding.Développer une méthode permettant de calculer le coût d'une prolongation du congé de maternité pour les femmes officiellement employées au niveau national et l'appliquer au Brésil, au Ghana et au Mexique.Nous avons adapté une méthode de calcul des coûts empruntée à la Banque mondiale et l'avons divisée en cinq étapes afin d'estimer le coût d'un allongement de la durée du congé de maternité. Notre méthode a utilisé le prix unitaire d'un congé de maternité en s'appuyant sur le revenu hebdomadaire moyen des femmes; le nombre de semaines de congé supplémentaires à analyser pour une année donnée; et la population pondérée de femmes en âge de travailler et de procréer dans un pays donné durant cette année. Nous avons pondéré la population en fonction de la probabilité d'avoir un enfant cette année-là chez les femmes occupant un emploi officiel, selon des caractéristiques individuelles. Nous avons eu recours à des données transversales représentatives à l'échelle nationale issues d'enquêtes sur la fertilité, l'emploi et la population afin de déterminer le coût du congé de maternité des mères travaillant dans le secteur officiel au Brésil, au Ghana et au Mexique. Et ce, sur des périodes comprises entre 12 et 26 semaines, qui correspondent à la durée d'allaitement exclusif recommandée par l'OMS.Nous estimons que chaque année, 640 742 femmes au Brésil, 33 869 femmes au Ghana et 288 655 au Mexique auraient besoin d'un congé de maternité officiel. Le coût hebdomadaire moyen d'un allongement du congé de maternité pour les femmes officiellement employées, exprimé en dollars internationaux à parité de pouvoir d'achat ($PPA), est de 195,07 $PPA par femme au Brésil, 109,68 $PPA au Ghana et 168,83 $PPA au Mexique.Notre méthode de calcul des coûts pourrait faciliter les décisions politiques fondées sur des données probantes dans les différents pays, afin d'améliorer les avantages liés à la protection de la maternité et de favoriser l'allaitement.Elaborar un método para evaluar el costo que supone ampliar la duración de la licencia de maternidad de las mujeres empleadas oficialmente a nivel nacional con el fin de aplicarlo en Brasil, Ghana y México.Se adaptó un método de cálculo de costos del Banco Mundial a un método de cinco pasos para estimar los costos relacionados con la ampliación de la duración de los mandatos de licencia de maternidad. El método utilizó el costo unitario de la licencia de maternidad basado en los salarios semanales de las trabajadoras; el número de semanas adicionales de licencia de maternidad que se debían analizar para un año determinado; y la población ponderada de mujeres en edad de procrear y de trabajar legalmente en un país determinado en ese año. Se ponderó la población por la probabilidad de tener un hijo ese año entre las mujeres con empleo formal, según las características individuales. Además, se aplicaron datos transversales representativos a nivel nacional que se obtuvieron de las encuestas de fertilidad, empleo y población para estimar los costos de la licencia de maternidad de las madres empleadas en el sector formal de Brasil, Ghana y México por periodos de 12 a 26 semanas, que es el objetivo de la OMS para la lactancia materna exclusiva.Se estimó que 640 742 mujeres en Brasil, 33 869 en Ghana y 288 655 en México requerirían anualmente una licencia de maternidad formal. El costo semanal medio de la ampliación de la licencia de maternidad para las mujeres que trabajan oficialmente fue de 195,07 dólares internacionales de paridad del poder adquisitivo ($PPA) por mujer en Brasil, 109,68 $PPA en Ghana y 168,83 $PPA en México.Este método de cálculo de costos podría facilitar la toma de decisiones sobre política basadas en pruebas para mejorar las prestaciones de protección de la maternidad y apoyar la lactancia materna en todos los países.الغرض وضع طريقة لتقييم تكلفة تمديد مدة إجازة الأمومة للنساء العاملات بشكل رسمي على المستوى الوطني، وتطبيقها في البرازيل وغانا والمكسيك. الطريقة قمنا بتطويع طريقة حساب التكاليف الخاصة بالبنك الدولي في طريقة من خمس خطوات لتقدير تكاليف تمديد مدة إجازات الأمومة. اعتمدت طريقتنا على تكلفة وحدة إجازة الأمومة على أساس الأجر الأسبوعي للسيدة العاملة؛ وعدد الأسابيع الإضافية لإجازة الأمومة المطلوب تحليلها لسنة ما؛ والعدد المرجح للسيدات في سن العمل الإنجابي والقانوني في بلد ما في تلك السنة. قمنا بتقييم السكان من خلال احتمال إنجاب طفل في تلك السنة بين السيدات في الوظائف الرسمية، وفقًا للخصائص الفردية. قمنا بتطبيق بيانات مستعرضة تمثيلية على المستوى الوطني من مسوح الخصوبة والتوظيف والسكان، وذلك لتقدير تكاليف إجازة الأمومة للأمهات العاملات في القطاع الرسمي في كل من البرازيل وغانا والمكسيك، لفترات من 12 أسبوعاً إلى 26 أسبوعاً، وهو ما يمثل هدف منظمة الصحة العالمية (WHO) للرضاعة الطبيعية الحصرية. النتائج قمنا بتقدير أن 640742 سيدة في البرازيل، و33869 سيدة في غانا، و288655 سيدة في المكسيك، سوف يطلبون إجازة أمومة رسمية سنوياً. كان متوسط ​​التكلفة الأسبوعية لتمديد إجازة الأمومة للسيدات العاملات بشكل رسمي، بالدولار الدولي وفقاً لتعادل القوى الشرائية ($PPP)، هو 195.07 $PPP لكل امرأة في البرازيل، و109.68 $PPP في غانا، و168.83 $PPP في المكسيك. الاستنتاج يمكن أن تسهل طريقة التكلفة لدينا من اتخاذ قرارات للسياسات المستندة على الأدلة عبر الدول، لتحسين.旨在从国家层面制定一种方法来评估延长有正式工作的女性的产假期限所产生的成本，并将该方法在巴西、加纳和墨西哥实施。.我们将世界银行的成本计算方法调整为五步法，用以估算延长产假期限的成本。我们的方法采用根据就业女性的每周工资计算得到的单位产假成本；在某年中需分析的额外产假周数；以及某国当年处于育龄和法定工作年龄妇女的加权人口。根据个体特征，我们依据有正式工作的女性当年生育婴儿的机率对人口进行了加权。我们从生育、就业和人口调查中选取具有全国代表性的横断面数据，估计巴西、加纳和墨西哥有正式工作的母亲产假期限从 12 周到 26 周（世卫组织纯母乳喂养的目标）所产生的成本。.我们估计巴西、加纳和墨西哥每年需要正式产假的女性分别为 640,742 人、33,869 人和 288,655 人。巴西、加纳和墨西哥延长每位有正式工作女性的产假所产生的每周成本中位数分别为购买力平价国际美元 (PPP$) 195.07、PPP$ 109.68 和 PPP$ 168.83。.我们的成本计算方法可以促进各国落实以证据为基础的政策决定，改善生育保障福利并支持母乳喂养。.Разработка метода для оценки затрат на национальном уровне на увеличение продолжительности отпуска по беременности и родам для официально работающих женщин и его применение в Бразилии, Гане и Мексике.Авторы адаптировали метод оценки Всемирного банка и превратили его в пятиступенчатую методику для оценки затрат, связанных с увеличением продолжительности отпуска по беременности и родам. В данной методике использовалась удельная стоимость отпуска по беременности и родам, основанная на сумме еженедельной заработной платы работающих женщин, количество дополнительных недель отпуска по беременности и родам анализировалось для конкретного года, а также рассчитывался взвешенный показатель женского населения репродуктивного возраста в группе разрешенного законом возраста для трудоустройства для данного года. Авторы взвесили численность населения по вероятности рождения ребенка в данном году среди официально трудоустроенных женщин в соответствии с индивидуальными характеристиками. Для оценки стоимости отпуска по беременности и родам для официально трудоустроенных матерей в Бразилии, Гане и Мексике на период от 12 до 26 недель (целевой показатель ВОЗ для исключительно грудного вскармливания) применялись репрезентативные в национальном масштабе перекрестные данные, полученные в ходе опросов, связанных с фертильностью, занятостью и численностью населения.По оценкам авторов, примерно 640 742 женщины в Бразилии, 33 869 женщин в Гане и 288 655 женщин в Мексике ежегодно нуждаются в официальном отпуске по беременности и родам. Средняя недельная стоимость продления отпуска по беременности и родам для официально трудоустроенных женщин в пересчете на международный доллар паритетной покупательной способности (ППС$) составила 195,07 на одну женщину в Бразилии, 109,68 в Гане и 168,83 в Мексике.Предложенный метод расчета затрат может способствовать принятию обоснованных политических решений в разных странах в целях повышения эффективности охраны материнства и поддержки грудного вскармливания.

Immune-related adverse events, particularly severe toxicities such as myocarditis, are major challenges to immune checkpoint inhibitor (ICI) utility in anti-cancer therapy1. The pathogenesis of ICI-myocarditis is poorly understood. Pdcd1-/-Ctla4+/- mice recapitulate clinicopathologic features of ICI-myocarditis, including myocardial T cell infiltration2. Single cell RNA/T cell receptor (TCR) sequencing on the cardiac immune infiltrate of Pdcd1-/-Ctla4+/- mice identified activated, clonal CD8+ T cells as the dominant cell population. Treatment with anti-CD8, but not anti-CD4, depleting antibodies rescued survival of Pdcd1-/-Ctla4+/- mice. Adoptive transfer of immune cells from mice with myocarditis induced fatal myocarditis in recipients which required CD8+ T cells. Alpha-myosin, a cardiac specific protein absent from the thymus3,4, was identified as the cognate antigen source for three MHC-I restricted TCRs derived from mice with fulminant myocarditis. Peripheral blood T cells from two patients with ICI-myocarditis were expanded by alpha-myosin peptides, and these alpha-myosin expanded T cells shared TCR clonotypes with diseased heart and skeletal muscles, indicating that alpha-myosin may be a clinically important autoantigen in ICI-myocarditis. These studies underscore the critical role for cytotoxic CD8+ T cells, are the first to identify a candidate autoantigen in ICI-myocarditis and yield new insights into ICI toxicity pathogenesis.

Immune-related adverse events, particularly severe toxicities such as myocarditis, are major challenges to the utility of immune checkpoint inhibitors (ICIs) in anticancer therapy1. The pathogenesis of ICI-associated myocarditis (ICI-MC) is poorly understood. Pdcd1–/–Ctla4+/– mice recapitulate clinicopathological features of ICI-MC, including myocardial T cell infiltration2. Here, using single-cell RNA and T cell receptor (TCR) sequencing of cardiac immune infiltrates from Pdcd1–/–Ctla4+/– mice, we identify clonal effector CD8+ T cells as the dominant cell population. Treatment with anti-CD8-depleting, but not anti-CD4-depleting, antibodies improved the survival of Pdcd1–/–Ctla4+/– mice. Adoptive transfer of immune cells from mice with myocarditis induced fatal myocarditis in recipients, which required CD8+ T cells. The cardiac-specific protein α-myosin, which is absent from the thymus3,4, was identified as the cognate antigen source for three major histocompatibility complex class I-restricted TCRs derived from mice with fulminant myocarditis. Peripheral blood T cells from three patients with ICI-MC were expanded by α-myosin peptides. Moreover, these α-myosin-expanded T cells shared TCR clonotypes with diseased heart and skeletal muscle, which indicates that α-myosin may be a clinically important autoantigen in ICI-MC. These studies underscore the crucial role for cytotoxic CD8+ T cells, identify a candidate autoantigen in ICI-MC and yield new insights into the pathogenesis of ICI toxicity.

In low‐ and middle‐income countries, almost three‐fourths of women in the labour force lack maternity protection. In the Philippines, current laws do not guarantee paid maternity leave to workers in the informal economy. A non‐contributory maternity cash transfer to informal sector workers could be used to promote social equity and economic productivity and could provide health benefits by helping mothers meet their breastfeeding goals. The objective of the study is to provide a realistic cost estimate and to assess the financial feasibility of implementing a publicly financed, non‐contributory maternity cash transfer programme to the informal sector in the Philippines. Using a costing framework developed in Mexico, the study estimated the annual cost of a maternity cash transfer programme. The methodology estimated the unit cost of the programme, the incremental coverage of maternity leave and expected number of enrollees. Different unit and incremental costs assumptions were used to provide a range of scenarios. Administrative costs for running the programme were included in the analysis. The annual financing need of implementing maternity cash transfer programme in the Philippines ranges from a minimum scenario of USD42 million (14‐week maternity cash transfer) to a more ideal scenario of USD309 million (26‐week maternity cash transfer). The latter is financially feasible as it is equivalent to less than 0.1% of the country's gross domestic product substantially lower than the share cost of not breastfeeding (0.7%). The annual cost of the programme is only 10% of the total cost of the largest conditional cash transfer programme.

Background Maternity leave policies are designed to protect gender equality and the health of mothers in the workforce and their children. However, maternity leave schemes are often linked to jobs in the formal sector economy. In low- and middle-income countries a large share of women work in the informal sector, and are not eligible to such benefit. This is worrisome from a social justice and a policy perspective and suggests the need for intervening. Costing the implementation of potential interventions is needed for facilitating informed decisions by policy makers. Methods We developed and applied a costing methodology to assess the cost of a maternity leave cash transfer to be operated in the informal sector of the economy in Brazil and Ghana, two countries with very different employment structures and socioeconomic contexts. We conducted sensitivity analysis by modeling different numbers of weeks covered. Results In Brazil, the cost of the maternity cash transfer would be between 0.004% and 0.02% of the GDP, while in Ghana it would range between 0.076% and 0.28% of the GDP. The relative cost of rolling out a maternity intervention in Brazil is between 2.2 to 3.2 times the cost in Ghana depending on the benchmark used to assess the welfare measure. The differences in costs between countries was related to differences in labor market structure as well as demographic characteristics. Conclusions Findings show how a standard methodology that relies on routinely available information is feasible and could assist policymakers in estimating the costs of supporting a maternity cash transfer for women employed in the informal sector, such intervention is expected to contribute to social justice, gender equity, and health trajectories.

To increase awareness of the current challenges facing the marine environment, the Future of Our Seas (FOOS) project brought together the expertise of scientists, public engagement experts and creatives to train and support a group of marine scientists in effective science communication and innovative public engagement. This case study aims to inspire scientists and artists to use the FOOS approach in training, activity design and development support (hereafter called the ‘FOOS programme’) to collaboratively deliver novel and creative engagement activities. The authors reflect on the experiences of the marine scientists: (1) attending the FOOS communication and engagement training; (2) creating and delivering public engagement activities; (3) understanding our audience; and (4) collaborating with artists. The authors also share what the artists and audiences learned from participating in the FOOS public engagement activities. These different perspectives provide new insights for the field with respect to designing collaborative training which maximizes the impact of the training on participants, creative collaborators and the public. Long-term benefits of taking part in the FOOS programme, such as initiating future collaborative engagement activities and positively impacting the scientists’ research processes, are also highlighted.

Background The economic cost of not breastfeeding in Indonesia is estimated at US$1.5–9.4 billion annually, the highest in South East Asia. Half of the 33.6 million working women of reproductive age (WRA) in Indonesia (15–49 years) are informal employees, meaning they are working as casual workers or they are self-employed (small scale business) and assisted by unpaid/family worker(s). No specific maternity protection entitlements are currently available for WRA working informally in Indonesia. This study aims to estimate the financing need of providing maternity leave cash transfer (MCT) for WRA working in the informal sector in Indonesia. Method The costing methodology used is the adapted version of the World Bank methodology by Vilar-Compte et al, following pre-set steps to estimate costs using national secondary data. We used the 2018 Indonesian National Socio-Economic Survey to estimate the number of women working informally who gave birth within the last year. The population covered, potential cash transfer’s unitary cost, the incremental coverage of the policy in terms of time and coverage, and the administrative costs were used to estimate the cost of MCT for the informal sector. Result At 100% coverage for 13 weeks of leave, the yearly financing need of MCT ranged from US$175million (US$152/woman) to US$669million (US$583/woman). The share of the yearly financing need did not exceed 0.5% of Indonesian Gross Domestic Product (GDP). Conclusions The yearly financing need of providing MCT for eligible WRA working in the informal sector is economically attractive as it amounts to less than 0.5% of GDP nominal of Indonesia. While such a program would be perceived as a marked increase from current public health spending at the onset, such an investment could substantially contribute to the success of breastfeeding and substantial corresponding public health savings given that more than half of working Indonesian WRA are employed in the informal sector. Such policies should be further explored while taking into consideration realistic budget constraints and implementation capacity.

BackgroundThe economic cost of not breastfeeding in Indonesia is estimated at US$1.5–9.4 billion annually, the highest in South East Asia. Half of the 33.6 million working women of reproductive age (WRA) in Indonesia (15-49 years) are informal employees, meaning they are working as casual workers or they are self-employed (small scale business) and assisted by unpaid/family worker(s). No specific maternity protection entitlements are currently available for WRA working informally in Indonesia. This study aims to estimate the cost of providing maternity leave cash transfer (MCT) for WRA working in the informal sector in Indonesia.MethodThe costing methodology used is the adapted version of the World Bank methodology by Vilar-Compte et al (2019), following pre-set steps to estimate costs using national secondary data. We used the 2018 Indonesian National Socio-Economic Survey to estimate the number of women working informally who gave birth within the last year. The population covered, potential cash transfer’s unitary cost, the incremental coverage of the policy in terms of time and coverage, and the administrative costs were used to estimate the cost of MCT for the informal sector. ResultAt 100% coverage for 13 weeks of leave, the annual cost of MCT ranged from US$175million (US$152/woman) to US$669million (US$583/woman). The share of the annual costs did not exceed 0.5% of Indonesian Gross Domestic Product (GDP).ConclusionThe yearly cost of providing MCT for eligible WRA working in the informal sector is economically attractive as it amounts to less than 0.5% of GDP nominal of Indonesia. While such a program would be perceived as a marked increase from current public health spending at the onset, such an investment could substantially contribute to the success of breastfeeding and substantial corresponding public health savings given that more than half of working Indonesian WRA are employed in the informal sector. Such policies should be further explored while taking into consideration realistic budget constraints and implementation capacity.

Although targeting health behaviour change through social media campaigns has gained traction in recent years, few studies have focused on breastfeeding social media campaigns. Within the context of rising social media utilization and recent declines in exclusive breastfeeding practices in Ghana, we implemented Breastfeed4Ghana, a Facebook‐ and Twitter‐based breastfeeding social media campaign. This study determined feasibility of implementing Breastfeed4Ghana and evaluated its impact on breastfeeding knowledge in Ghana. Key performance indicators of the campaign were monitored on social media platforms, Facebook and Twitter. An online cross‐sectional survey conducted across three time points (n = 451) assessed breastfeeding knowledge, campaign exposure, and understanding and acceptability of Breastfeed4Ghana among Ghanaian adults. Modified Poisson models were used to assess the relationship between campaign exposure and breastfeeding knowledge, adjusting for survey time point, sex, and parenthood status. The campaign acquired 4,832 followers. Based on follower demographics collected from Facebook and Twitter analytics, the target population was successfully reached. Campaign exposure among survey participants was 42.3% and 48.7% at midline and endline, respectively. Campaign acceptability was high (>90%), and >44% of those exposed to the campaign also shared the campaign with others. However, 61.0% of those exposed did not know or could not remember the purpose of the campaign. Campaign exposure was not associated with higher breastfeeding knowledge (APR [95% confidence interval] = 0.96 [0.73, 1.26]). Breastfeed4Ghana was highly feasible. However, campaign understanding yielded mixed findings and may explain the limited impact on breastfeeding knowledge.

Background The economic cost of not breastfeeding in Indonesia is estimated at US$1.5–9.4 billion annually (Walters et al, 2016; Siregar et al, 2018; Walters et al, 2019), the highest in South East Asia. Half of the 33.6 million working women of reproductive age (WRA) in Indonesia are informal employees, and less than 50% exclusive breastfeed. No maternity protection entitlements are currently available for WRA working informally in Indonesia. This study aims to estimate the cost of providing maternity leave cash transfer (MCT) for WRA working in the informal sector in Indonesia.Method The costing methodology used is the adapted version of the World Bank methodology by Vilar-Compte et al (2019), following pre-set steps to estimate costs using national secondary data. We used the 2018 Indonesian National Socio-Economic Survey to estimate the number of women working informally who gave birth within the last year. The population covered, potential cash transfer’s unitary cost, the incremental coverage of the policy in terms of time and coverage, and the administrative costs were used to estimate the cost of MCT for the informal sector. Result At 100% coverage for 13 weeks of leave, the annual cost of MCT ranged from US$175million (US$152/woman) to US$669million (US$583/woman). The share of the annual costs did not exceed 0.5% of Indonesian Gross Domestic Product (GDP).Conclusion The yearly cost of providing MCT for eligible WRA working in the informal sector is significantly lower than the current annual cost of not breastfeeding in Indonesia, as computed in previous work (Walters et al, 2016; Siregar et al, 2018; Walters et al, 2019). While such a program would be perceived as a marked increase from current public health spending at the onset, such an investment could substantially contribute to the success of breastfeeding and substantial corresponding public health savings given that more than half of working Indonesian WRA are employed in the informal sector. Such policies should be further explored while taking into consideration realistic budget constraints and implementation capacity.

Despite the well-established evidence that breastfeeding improves maternal and child health outcomes, global rates of exclusive breastfeeding remain low. Cost estimates can inform stakeholders about the financial resources needed to scale up interventions to ultimately improve breastfeeding outcomes in low-, middle- and high-income countries. To inform the development of comprehensive costing frameworks, this systematic review aimed to (1) identify costing studies for implementing or scaling-up breastfeeding interventions, (2) assess the quality of identified costing studies and (3) examine the availability of cost data to identify gaps that need to be addressed through future research. Peer-reviewed and grey literature were systematically searched using a combination of index terms and relevant text words related to cost and the following breastfeeding interventions: breastfeeding counselling, maternity leave, the World Health Organization International Code of Marketing of Breastmilk Substitutes, the Baby-Friendly Hospital Initiative, media promotion, workplace support and pro-breastfeeding social policies. Data were extracted after having established inter-rater reliability among the first two authors. The quality of studies was assessed using an eight-item checklist for key costing study attributes. Forty-five studies met the inclusion criteria, with the majority including costs for breastfeeding counselling and paid maternity leave. Most cost analyses included key costing study attributes; however, major weaknesses among the studies were the lack of clarity on costing perspectives and not accounting for the uncertainty of reported cost estimates. Costing methodologies varied substantially, standardized costing frameworks are needed for reliably estimating the costs of implementing and scaling-up breastfeeding interventions at local-, national- or global-levels.

Approximately 34% of residents from New Haven’s six lowest-income neighborhoods are food insecure, significantly higher than the rest of Connecticut and country (both approximately 12%). To underst...

OBJECTIVES: The United Nations Children Fund (UNICEF) Community based Infant and Young Child Feeding (IYCF) counselling package currently lacks comprehensive responsive feeding curriculum, thus limiting dissemination of these messages within IYCF counselling. Thus, project objectives were to: a) develop counselling cards based on recent evidence-based responsive feeding guidelines and b) test their feasibility in Ghana. METHODS: Five counselling cards were developed addressing the responsive feeding topics of: enjoying eating with family; hunger/satiety cues; introducing new foods; food texture as a function of child development; soothing a child. The UNICEF image bank was used to develop counselling cards with images compatible with the UNICEF Community based IYCF counselling package. Two peri-urban focus groups (FG) were conducted with Ghanaian mothers (N = 7) and fathers (N = 6) of children

BACKGROUND Social media utilization is on the rise globally, and the potential of social media for health behavior campaigns is widely recognized. However, as the landscape of social media evolves, so do techniques used to optimize campaign dissemination. OBJECTIVE The primary aim of this study was to evaluate the impact of 4 material dissemination paths for a breastfeeding social media marketing campaign in Ghana on exposure and engagement with campaign material. METHODS Campaign materials (n=60) were posted to a Facebook and Twitter campaign page over 12 weeks (ie, baseline). The top 40 performing materials were randomized to 1 of 4 redissemination arms (control simply posted on each platform, key influencers, random influencers, and paid advertisements). Key performance indicator data (ie, exposure and engagement) were extracted from both Facebook and Twitter 2 days after the material was posted. A difference-in-difference model was used to examine the impact of the dissemination paths on performance. RESULTS At baseline, campaign materials received an average (SD) exposure of 1178 (670) on Facebook and 1071 (905) on Twitter (n=60). On Facebook, materials posted with paid advertisements had significantly higher exposure and engagement compared with the control arm (P CONCLUSIONS Paid advertisements are an effective mechanism to increase exposure and engagement of campaign posts on Facebook, which was achieved at a low cost.

Background: Investing in maternity protection for working women is an important social equity mechanism. Addressing the maternity leave needs of women employed in the informal sector economy should be a priority as more than half of women in Latin America, South Asia, and sub-Saharan Africa are employed in this sector. Objective: To develop a costing methodology framework to assess the financial feasibility, at the national level, of implementing a maternity cash transfer for informally employed women. Methods: A World Bank costing methodology was adapted for estimating the financial need to establish a maternity cash transfer benefit. The methodology estimates the cash transfer’s unitary cost, the incremental coverage of the policy in terms of time, the weighted population to be covered, and the administrative costs. The 6-step methodology uses employment and sociodemographic data that are available in many countries through employment and demographic surveys and the population census. The methodology was tested with data for Mexico assuming different cash transfer unitary costs and the benefit’s time coverage. Results: The methodological framework estimated that the annual financial needs of setting up a maternity cash transfer for informally working women in Mexico ranges between US$87 million and US$280 million. Conclusions: A pragmatic methodology for assessing the costs of maternity cash transfer for informally employed women was developed. In the case of Mexico, the maternity cash transfer for women in the informal sector is financially feasible.

Background The UNICEF Community-based Infant and Young Child Feeding Counseling Package (C-IYCFCP) currently has limited responsive feeding (RF) content, thus limiting dissemination of RF messages within infant and young child feeding (IYCF) counseling. Objectives This project 1) developed counseling cards based on existing evidence-based RF guidelines and 2) tested their feasibility in Ghana. Methods Five RF counseling cards were developed focusing on eating with family; introducing new foods; hunger/satiety cues; food texture; and calming a child. Four focus group discussions (FGDs) were conducted with adult mothers and fathers of children younger than 3 y of age to assess the cultural appropriateness of the cards and accompanying key messages. The feasibility of including cards as part of IYCF counseling was tested via 1) systematic observation of 8 group education sessions utilizing the cards with the same target audience and 2) in-depth interviews with health care providers involved in IYCF training and/or counseling. Results FGD findings guided changes to all cards to ensure comprehension and cultural appropriateness. The group education sessions suggested that the counseling cards provided important RF messages that are specific, clear, and feasible to implement. Health care providers strongly endorsed the need for and utility of the RF counseling cards and felt they were feasible and important to integrate into the C-IYCFCP currently being used to deliver IYCF training and counseling in Ghana. Conclusions The counseling cards have a strong potential to add key RF dimensions to IYCF training and counseling in Ghana., We developed and tested responsive feeding counseling cards that can substantially strengthen UNICEF's Community-based Infant and Young Child Feeding Counseling Package in Ghana.

Breastfeed4Ghana was a social media-based campaign implemented to address identified gaps in the protection, promotion, and support of breastfeeding in Ghana. This paper describes the process of campaign materials development and testing to ensure their cultural and content appropriateness. The 60 campaign materials, each consisting of an image and text message, underwent a process of creation, testing, revision, and finalization. Existing research evidence and infant and young child feeding communication tools that were culturally relevant for Ghana were used to develop the materials. All materials were tested and finalized through an iterative process that incorporated input from six focus group discussions (FGDs) with mothers, and content and technical experts. The materials were revised to ensure scientific accuracy, understandability, and cultural appropriateness of the messages, as well as alignment of the messages with the images. Finalized materials were reviewed and approved by the Ghana Food and Drugs Authority. Analysis for this paper involved summarizing and categorizing the types and sources of input as well as the research team’s responses to the input received. The 60 campaign materials received a total of 132 inputs. Most inputs came from FGDs (78.4%); and most inputs were on the campaign material images. The evidence-informed process of materials creation, use of multiple input sources, and a broad-based iterative process allowed the creation of 60 evidence-based and culturally appropriate materials for a breastfeeding social media campaign in Ghana. This paper could serve as a guide for other social media campaign efforts looking to develop culturally appropriate materials.

Becoming Breastfeeding Friendly (BBF) is an initiative designed to help countries assess their readiness to scale-up breastfeeding programs and develop key recommendations to strengthen their breastfeeding environment. In 2016, Ghana was one of two countries to first pilot BBF. In applying BBF, a committee of 15 Ghanaian nutrition, health, and breastfeeding experts implemented the BBF toolbox over 8 months. Following implementation, semistructured interviews were conducted with 12 committee members (CMs) to (a) identify facilitators and barriers to implement BBF and (b) determine factors needed to strengthen the breastfeeding environment in Ghana. Using a grounded theory approach, five domains were identified. First, a dynamic committee of key stakeholders drove the implementation of BBF. Second, CMs faced some logistical and methodological challenges, including difficulty accessing data and the need for strong in-country technical support for adhering to the BBF process. Third, CMs felt well positioned to facilitate and lead the dissemination and implementation of recommendations. Fourth, accountability would be essential to properly translate recommendations. Fifth, to move recommendations to action, advocacy would be a required first step, and BBF was proposed to facilitate this step. BBF provided an in-depth analysis of Ghana's current breastfeeding environment to help Ghana strengthen its breastfeeding governance, policies, and programs while informing CMs' government and non-governmental organizations' breastfeeding efforts.

Breastfeeding is one of the most feasible and cost-effective maternal-child health interventions. Currently, global investments needed to achieve the WHO global nutrition target for exclusive breastfeeding (EBF) do not meet the recommended standards for economic investment and implementation of policies supporting mothers to breastfeed. Estimating implementation costs of high-quality, high-impact programs based on each country's enabling environment and specific context is essential for developing and prioritizing recommendations that can drive the successful scaling-up of breastfeeding programs globally. We provide a detailed comparison (strengths, limitations, and gaps) of the 2 most recent global cost analysis frameworks used to estimate financial needs for scaling-up breastfeeding interventions from World Breastfeeding Costing Initiative (WBCi) and the World Bank. Our comparison found that the World Bank presents the more advanced costing methodology for scaling-up breastfeeding programs. However, there is a need to adapt and improve this costing framework to guide individual countries based on key contextual factors that consider the complexity of health systems.

Food and nutrition insecurity becomes increasingly worse in areas affected by armed conflict. Children affected by conflict, or in war-torn settings, face a disproportionate burden of malnutrition and poor health outcomes. As noted by humanitarian response reviews, there is a need for a stronger evidence-based response to humanitarian crises. To achieve this, we systematically searched and evaluated existing nutrition interventions carried out in conflict settings that assessed their impact on children's nutrition status. To evaluate the impact of nutrition interventions on children's nutrition and growth status, we identified published literature through EMBASE, PubMed, and Global Health by using a combination of relevant text words and Medical Subject Heading terms. Studies for this review must have included children (aged ≤18 y), been conducted in conflict or postconflict settings, and assessed a nutrition intervention that measured ≥1 outcome for nutrition status (i.e., stunting, wasting, or underweight). Eleven studies met the inclusion and exclusion criteria for this review. Five different nutrition interventions were identified and showed modest results in decreasing the prevalence of stunting, wasting, underweight, reduction in severe or moderate acute malnutrition or both, mortality, anemia, and diarrhea. Overall, nutrition interventions in conflict settings were associated with improved children's nutrition or growth status. Emergency nutrition programs should continue to follow recent recommendations to expand coverage and access (beyond refugee camps to rural areas) and ensure that aid and nutrition interventions are distributed equitably in all conflict-affected populations.

Discusses a survey conducted in 1974 to determine students' perceptions of themselves and their academic environments, with the purpose of refuting 'deficit' theories of low performance of blacks in schools, arguing that the school system is encouraging black students to develop unrealistic academic self concepts, which act as barriers to reaching their future goals. (Author/JM)

Introduction to the 3rd Biennial Conference of the Society for Implementation Research Collaboration: advancing efficient methodologies through team science and community partnerships

INTRODUCTION/BACKGROUND One of the most frequently used statements regarding race issues in America is that of W.E.B. Du Bois (1903), who observed that the most pressing problem facing America in the twentieth century is that of the color line. This quote is so often repeated because the problem of how we perceive, define and negotiate race remains. The color line continues to affect African American families in every aspect of their day-to-day quest to live, work and play. Why is it that in 1998, over two centuries after slavery and almost a century after Du Bois, people of African descent still feel like outcasts in America? The following discussion focuses on this question, offering a theoretical framework which contributes to our better understanding this problem. It also describes the unique stress of African Americans who experience the dilemma of"being Black in White America." The argument is made for the inclusion of this unique stress in both the theory and research on African Americans. Harvard psychiatrist Dr. Chester Pierce describes the environment in which African Americans live as a mundane extreme environment: an environment where racism and subtle oppression are ubiquitous, constant, continuing and mundane. African Americans must daily suffer the annoying "micro-aggressions" such environments breed (Pierce, 1970, 1974), for instance, being ignored for service, assumed to be guilty of anything negative, treated as inferior, stared at because of color, ridiculed because of hair texture, or singled out for being different. We label the stress of living in such an environment as mundane extreme environmental stress (M.E.E.S.): mundane, because this stress is so common, a part of the day-to-day experience of all Blacks that it is almost taken for granted; extreme, because it has a harsh impact on the psyche and world view of Blacks (e.g., self-perception, behavior, interactions); environmental, because it is environmentally induced and fostered; stress, because the ultimate impact on African Americans and their families is indeed stressful, detracting and energy-consuming. History reveals the atrocities and inhumane treatment of slavery and the subsequent devastation of institutional, scientific (Hilliard, 1974, 1985), and personal racism, leading to continued inequities between African Americans and other Americans (Garwood, 1992). The foundation of mundane extreme environmental stress is rooted in this past and present. Many historians, anthropologists, sociologists and psychologists have written profound and descriptive accounts of the "peculiar institution" and aftermath (America, 1990; Genovese, 1979; Drake, 1945; Stamp, 1956; Woodson, 1933). Understanding the environment in which African Americans must raise their children is critical to understanding the M.E.E.S. with which every African American must contend. RACISM: THE FOUNDATION FOR M.E.E.S. The history of the treatment, perceptions and images of African Americans has led to the incubation and full development of the M.E.E.S. factor in each and every aspect of life for Black America. Jewell Handy Gresham ( 1989) provides a succinct link between early accounts of how African Americans were viewed by the "powers that be" and those that are perpetrated today. The author was struck by the consistency of the message portraying African Americans as pathological and further how data were (and still are) manipulatedand in some cases fabricated-to fuel the fires of racism. Dr. Gresham points out the following: In 1844 Secretary of State John Calhoun stated in a letter that where Blacks and Whites existed in the same society, slavery was the natural result. Wherever the state changed that providential relationship, the Blacks invariably degenerated "into vice and pauperism accompanied by bodily and mental afflictions incident thereto deafness, blindness, insanity and idiocy." In slave states, in contrast, the Black improved greatly "in number, comfort, intelligence and morals. …

(1976). High School Students’ Perceptions of Social Studies. The Social Studies: Vol. 67, No. 2, pp. 51-57.

Many Black families have chosen alternative lifestyles to accommodate the realities in their lives. The diversity in their lifestyles has often been viewed as “deviance” or “pathological” by White-oriented social science professionals. Black families, however, encounter the pressures any American family may face, and in addition they live under the continuous and varying stress of racially motivated oppression and inequalities that affect many aspects of their lives. The alternative lifestyles many Black American families have developed help to illuminate how Black families cope with the dual stresses of race and life events. This article describes the impact of stress in the lives of two of the variant alternative family forms found in Black families—a single parent family and an extended family. The two families are part of a comprehensive longitudinal study of Black families and their children, the Toddler and Infant Experiences Study (TIES). In addition to documentation of family stress, the data are examined within a conceptual framework that recognizes the dual stress factors of race and life events.

(1975). Racism without Racists: Institutional Racism in Urban Schools. The Black Scholar: Vol. 7, The Crisis of the Cities, pp. 10-19.