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Colostrum has important anti-infective properties. It may also somehow promote the development of the child's immunological system. Discarding colostrum, as practised in some cultures, could thus have adverse health consequences beyond the neonatal period. To test this hypothesis, the age at breast feeding start of 734 healthy newborns in urban Guinea-Bissau was ascertained. The children were then prospectively followed up to 3 years of age. Eighty nine deaths occurred during the study. The probability of death in the age interval 28 days to 3 years was about 20%. The child's age at breast feeding start had no statistical impact on postneonatal growth or survival. As a single measure, early breast feeding start is not likely to make much difference for the long term growth or survival of children living under material poverty conditions. [ABSTRACT FROM AUTHOR]

Gunnlaugsson G (Centre of Maternal and Child Health, Bissau, Guinea-Bissau), da Silva M C and Smedman L. Determinants of delayed initiation of breastfeeding: A community and hospital study from Guinea-Bissau. 1992; 21: 935–940. A prospective study on the timing of breastfeeding start in Bissau was undertaken in a periurban community (n = 734), and at the Central Hospital (n = 414). Only single, full-term, healthy children born by the vaginal route were included, the purpose being to characterize mothers who delay breastfeeding start for reasons not related to disease. Multivariate failure-time analysis (Cox' regression) was used to relate the child's age at breastfeeding start to a set of independent variables. In the community, those tending to delay breastfeeding start were mothers from the largest ethnic group in the country, mothers who had given birth at times other than the evening hours (6–12 pm) and mothers who had not attended antenatal clinics. At the hospital, delayed initiation was found among young mothers and mothers from one sparsely represented ethnic group. The most important determinant of delayed breastfeeding start was negative cultural ideas about colostrum. [ABSTRACT FROM PUBLISHER]

Before 2001, the World Health Organization (WHO) recommended that infants be exclusively breastfed for 4-6 mo with the introduction of complementary foods (any fluid or food other than breast milk) thereafter. In 2001, after a systematic review and expert consultation, this advice was changed, and exclusive breastfeeding is now recommended for the first 6 mo of life. The systematic review commissioned by the WHO compared infant and maternal outcomes for exclusive breastfeeding for 3-4 mo versus 6 mo. That review concluded that infants exclusively breastfed for 6 mo experienced less morbidity from gastrointestinal infection and showed no deficits in growth but that large randomized trials are required to rule out small adverse effects on growth and the development of iron deficiency in susceptible infants. Others have raised concerns that the evidence is insufficient to confidently recommend exclusive breastfeeding for 6 mo for infants in developed countries, that breast milk may not meet the full energy requirements of the average infant at 6 mo of age, and that estimates of the proportion of exclusively breastfed infants at risk of specific nutritional deficiencies are not available. Additionally, virtually no data are available to form evidence-based recommendations for the introduction of solids in formula-fed infants. Given increasing evidence that early nutrition and growth have effects on both short- and longer-term health, it is vital that this issue be investigated in high-quality randomized studies. Meanwhile, the consequences of the WHO recommendation should be monitored in different settings to assess compliance and record and act on adverse events. The policy should then be reviewed in the context of new data to formulate evidence-based recommendations. Copyright © 2007 American Society for Nutrition [ABSTRACT FROM AUTHOR]

Children on farms face high risks of work- and non-work-related fatalities, with tractors being a significant contributor. This study examines children's involvement in fatal tractor-related accidents within agriculture in Iceland from 1918 to 2024, explores adult reflections on childhood tractor-driving experiences, and analyses Members of Parliament's arguments against setting a minimum age for off-road tractor driving. The data are based on parliamentary debates on tractor-related legislation, fatal tractor-related accidents documented in newspaper archives and supplementary sources, and narrative interviews with former summer children who stayed at farms during their childhoods. Over half of the 81 registered accidents involved children-primarily boys-with 75% occurring between 1958 and 1988, when no minimum age for off-road tractor driving existed. The fatality incidence rate for children was more than four times higher than for adults. Arguments against minimum age requirements for off-road driving included the need for child labour, children's superior driving skills, and the denial that children were more often victims than adults. Since 1988, no child has died while driving a tractor. A human-centred approach focusing on the working conditions, driver capacity, and adherence to safety procedures and legal frameworks is needed to prevent future accidents.

Seasonal variation in photoperiod may affect psychosocial and physical well-being in healthy persons. We tested this hypothesis in healthy pre-menopausal women, without a history of mood disorders, living year-round in Reykjavik, Iceland (64.1°N). Participants reported daily self-assessments of well-being throughout a complete ovulatory menstrual cycle in summer and/or winter (70% participated in both seasons). Scores for mood, cognitive acuity, social support, physical health and a composite of these four indicators were each significantly higher in summer than in winter (linear mixed effects models: p < .001 for each model); tiredness did not differ by season. The effect of season was not significantly changed by inclusion of body mass index and/or age as covariates. Some prior studies have been hampered by sparse time sampling, inattention to covariates and/or relying on recalled data. This is to our knowledge the first investigation to test the study hypothesis with daily real-time data spanning complete ovulatory menstrual cycles in each of two seasons. This dense sampling has revealed modest seasonal variation in well-being in healthy women. Daylength (sunlight exposure) is likely a major, but not necessarily sole, factor in these seasonal differences in well-being; temperature is likely less important given Iceland's relatively moderate (for its high latitude) seasonal temperature swings., (© 2024 The Authors. International Journal of Psychology published by John Wiley & Sons Ltd on behalf of International Union of Psychological Science.)

Introduction: Barriers to family planning for potential clients have been explored in the literature, but rarely from the perspective of the women themselves in a low-income setting. This research aimed to understand clients' perspectives on being turned away from receiving a method of family planning at a facility on the day it was sought., Methods: Three focus group discussions were held in two districts of Malawi in 2019 with clients who had been turned away approximately three to six months prior., Results: The reasons for turnaway participants mentioned fell into eight categories: no proof of not being pregnant, method and/or supply stock-outs, arriving late, provider unavailable, provider refusal, needing to wait longer after delivery of a child, financial constraints, and medical reasons. Participants were often turned away more than once before finally being able to initiate a method, in some cases returning to the same facility and in others finding it through community health workers, traditional healers, or private facilities. Clients often resorted to sleeping apart from their husbands until they could initiate a method and reported stress and worry resulting from being turned away., Conclusions: Clients are turned away without a method of FP on the day they seek one for multiple reasons, nearly all of which are preventable. Many examples given by the participants showed a lack of knowledge and respect for clients on the part of the providers. Changing attitudes and behaviour, however, may be difficult and will require additional steps. Increasing the availability and use of pregnancy tests, having a more reliable supply of methods and materials, increasing the number of providers-including those trained well in all methods-and providing daily FP services would all help reduce turnaway. Improved access to family planning will help counties achieve their Sustainable Development Goals., Competing Interests: Declaration of Competing Interest The authors report no conflicts of interest., (Copyright © 2023. Published by Elsevier Ltd.)

The COVID-19 pandemic underscores the importance of a child rights-based approach to policymaking and crisis management. Anchored in the United Nations Convention on the Rights of the Child, the 3P framework-provision, protection, and participation-forms the foundation for health professionals advocating for children's rights. Expanding it with two additional domains-preparation and power-into a 5P framework has the potential to enhance child rights-based policies in times of crisis and future pandemics. The study aimed to (1) gather perspectives from child health-and-rights specialists on how children's rights were highlighted during the early phase of the pandemic in their respective settings; and (2) evaluate the usefulness of the 5P framework in assessing children's visibility and rights. A qualitative survey was distributed among child health-and-rights professionals; a total of 68 responses were analysed in Atlas.ti 9 from a multi-disciplinary group of policymakers and front-line professionals in eight world regions. As framed by the 5Ps, children's rights were generally not safeguarded in the initial pandemic response and negatively impacted children's health and wellbeing. Further, children lacked meaningful opportunities to raise their concerns to policymakers. The 5P framework holds the potential to shape an ethical child rights-based decision-making framework for future crises, both nationally and globally.

Background: Neither the global population nor individual countries have reached the World Health Organization (WHO) target of ≥50% of infants exclusively breastfed (EBF) until 6 mo. This may partly be because of the perceptions of insufficient milk and energy supply to meet rapid growth and development needs., Objectives: In a longitudinal observational study, we aimed to determine whether breastmilk energy content is sufficient to support growth during EBF until 6 mo., Methods: A sample of 27 EBF infants was dosed with doubly labeled water (DLW) at 5.6 mo to measure body composition, breastmilk intake, energy intake, and the metabolizable energy (ME) content of their mother's breastmilk over the following week. Z-scores were calculated for anthropometry using WHO reference data and for fat-free mass (FFM) and fat mass (FM) using United Kingdom reference data., Results: Anthropometric z-scores from birth indicated normal weight and length growth patterns. At ∼6 mo, the mean ± standard deviation (SD) FFM z-score was 0.22 ± 1.07, and the FM z-score was 0.78 ± 0.70, significantly >0. In the 22 infants with acceptable data, the mean ± SD measured intake of breastmilk was 983 ± 170 g/d and of energy, 318 ± 60 kJ/kg/d, equivalent to 75.9 ± 14.3 kcal/kg/d. The mean ME content of breastmilk was 2.61 kJ/g [standard error (SE) 0.1], equivalent to 0.62 kcal/g (SE 0.02). Mothers were positive toward breastfeeding, on paid maternity leave (planned mean 10 mo), and many (56%) had received specialized breastfeeding support., Conclusions: The evidence from this study confirms that when mothers are motivated and supported without economic restraints, breastmilk intake and the energy supplied by breastmilk to EBF infants at 6 mo of age is sufficient to support normal growth patterns. There was no evidence of constraint on FFM, and other studies show that high FM in EBF infants is likely to be transient. These data further support the recommendation for EBF ≤6 mo of age for body composition. This trial was registered at clinicaltrials.gov as NCT02586571., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

The COVID-19 pandemic affected the lives of children in a myriad of ways across the world. It exposed and aggravated existing inequalities between children within countries and across continents and hampered education. In Guinea-Bissau, school closure was one of the first restrictions implemented to confront the emerging pandemic. The aim was to describe and analyse the experiences of adolescents of school closures in the capital Bissau, their concerns about their future and manifestations of inequality. Data were collected by semi-structured, open-ended interviews with 30 adolescents aged 15-17 years three months into the pandemic during an enforced state of emergency. A thematic analysis identified five themes: appreciation of education, feeling left behind, being stuck in confinement, suggestions for support, and a disrupted future. The results highlight global rather than local inequalities in the demographic, manifested by a lack of targeted educational support for public and private school students; they knew about such efforts elsewhere. The school-attending participants suggested ways to mitigate disruptions in their education, while those out of school aiming to return saw their possibilities fading away. They appreciated education for personal and national benefits, and participants worried about the long-term effects of the pandemic. The study highlighted education loss for all and disrupted future expectations.

Women who are obese before pregnancy have a higher risk of caesarean section than normal weight women. We investigated the combined effect of pre-pregnancy weight and gestational weight gain on pre-labour and intrapartum caesarean section risk. We collected data on 22,763 singleton, term, live deliveries in 2003-2014 from the Icelandic Maternal and Child Health Study (ICE-MCH), based on Icelandic registries. These were the Icelandic Medical Birth Registry and the Saga Maternal and Child Health Database. Pre-pregnancy body mass index was categorised into underweight, normal weight, overweight and obese. Gestational weight gain was classified according to the Institute of Medicine´s recommendation into below, within and above the recommended range. Logistic regression models, adjusted for maternal and gestational characteristics, were used to calculate adjusted odds ratios (AOR) and 95% confidence intervals (CI) for the risk of caesarean section. Obese women had a higher risk of pre-labour (AOR 1.56, 95% CI 1.34-1.81) and intrapartum caesarean section (AOR 1.92, 95% CI 1.70-2.17) than normal weight women in all categories of gestational weight gain. Gestational weight gain above the recommended range, compared to within the range, increased the risk of intrapartum caesarean section among normal weight (AOR 1.46, 95% CI 1.23-1.73) and overweight women (AOR 1.291, 95% CI 1.04-1.60). Gestational weight gain below the recommended range, compared to within the range, increased the risk of pre-labour caesarean section (AOR 1.64, 95% CI 1.20-2.25), but only among overweight women. Women who are obese before pregnancy have a high risk of caesarean section regardless of gestational weight gain. However, women who are normal weight or overweight before pregnancy and gain weight above the recommended range during pregnancy may also have an increased risk of caesarean section., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: Geir Gunnlaugsson was the Chief Medical Officer for Iceland from 2010 to 2014. This does not alter our adherence to PLOS ONE policies on sharing data and materials. Other authors declare no conflict of interest., (Copyright: © 2023 Eloranta et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Nonalcoholic fatty liver (NAFL) and its sequelae are growing health problems. We performed a genome-wide association study of NAFL, cirrhosis and hepatocellular carcinoma, and integrated the findings with expression and proteomic data. For NAFL, we utilized 9,491 clinical cases and proton density fat fraction extracted from 36,116 liver magnetic resonance images. We identified 18 sequence variants associated with NAFL and 4 with cirrhosis, and found rare, protective, predicted loss-of-function variants in MTARC1 and GPAM, underscoring them as potential drug targets. We leveraged messenger RNA expression, splicing and predicted coding effects to identify 16 putative causal genes, of which many are implicated in lipid metabolism. We analyzed levels of 4,907 plasma proteins in 35,559 Icelanders and 1,459 proteins in 47,151 UK Biobank participants, identifying multiple proteins involved in disease pathogenesis. We show that proteomics can discriminate between NAFL and cirrhosis. The present study provides insights into the development of noninvasive evaluation of NAFL and new therapeutic options., (© 2022. The Author(s).)

Aim: Critically review research methods used to elicit children and young people's views and experiences in the first year of COVID-19, using an ethical and child rights lens., Methods: A systematic search of peer-reviewed literature on children and young people's perspectives and experiences of COVID-19. LEGEND (Let Evidence Guide Every New Decision) tools were applied to assess the quality of included studies. The critical review methodology addressed four ethical parameters: (1) Duty of care; (2) Children and young people's consent; (3) Communication of findings; and (4) Reflexivity., Results: Two phases of searches identified 8131 studies; 27 studies were included for final analysis, representing 43,877 children and young people's views. Most studies were from high-income countries. Three major themes emerged: (a) Whose voices are heard; (b) How are children and young people heard; and (c) How do researchers engage in reflexivity and ethical practice? Online surveys of children and young people from middle-class backgrounds dominated the research during COVID-19. Three studies actively involved children and young people in the research process; two documented a rights-based framework. There was limited attention paid to some ethical issues, particularly the lack of inclusion of children and young people in research processes., Conclusion: There are equity gaps in accessing the experiences of children and young people from disadvantaged settings. Most children and young people were not involved in shaping research methods by soliciting their voices., (© 2022 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)

Background: Routine childhood vaccination coverage rates fell in many countries during the COVID-19 pandemic, but the impact of inequity on coverage is unknown., Methods: We synthesised evidence on inequities in routine childhood vaccination coverage (PROSPERO, CRD 42021257431). Studies reporting empirical data on routine vaccination coverage in children 0-18 years old during the COVID-19 pandemic by equity stratifiers were systematically reviewed. Nine electronic databases were searched between 1 January 2020 and 18 January 2022. The risk of bias was assessed using the Newcastle-Ottawa Quality Assessment Tool for Cohort Studies. Overall, 91 of 1453 studies were selected for full paper review, and thirteen met the inclusion criteria., Results: The narrative synthesis found moderate evidence for inequity in reducing the vaccination coverage of children during COVID-19 lockdowns and moderately strong evidence for an increase in inequity compared with pre-pandemic months (before March 2020). Two studies reported higher rates of inequity among children aged less than one year, and one showed higher inequity rates in middle- compared with high-income countries., Conclusions: Evidence from a limited number of studies shows the effect of the pandemic on vaccine coverage inequity. Research from more countries is required to assess the global effect on inequity in coverage.

Family planning (FP) has been a development priority since the mid-1990s, yet barriers to access persist globally, including women being turned away from facilities without a method. This study aimed to assess the extent of, and reasons for, FP turnaway in three districts of Malawi. In 2019, data collectors screened women exiting 30 health facilities and surveyed those who had been denied a method. Follow-up surveys were conducted via telephone with turned away clients at six and 12 weeks postvisit. Of the 2,246 women who were screened, 562 were new or restarting users. Of these, 15% (83/562) reported having been turned away from the health facility without an FP method. Women cited 14 different reasons for turnaway; the top three were unavailability of method (34%), unavailability of a provider (17%), or a requirement to return on the scheduled FP day (15%). The multiple reasons cited for leaving the health facility without an FP method indicate that reducing turnaway will not be achieved easily. The top reasons for turnaway are related to health systems or management issues within health facilities. Facilities need additional support for staffing, training on long-acting and permanent methods, and a consistent supply of methods., (© 2022 The Authors. Studies in Family Planning published by Wiley Periodicals LLC on behalf of Population Council.)

Background: Worldwide, governments have implemented restrictions on movement and gatherings to contain the COVID-19 pandemic. In the spirit of the Convention on the Rights of the Child, children have a right to express their opinion on matters of concern to them. The study aimed to describe and analyse how adolescents in the capital Bissau understood the unfolding COVID-19 pandemic and their lived experiences during the first 3 months of the pandemic., Methods: Collaborators identified participants in five urban areas in Bissau in June 2020. Semistructured, open-ended interviews were conducted with 30 adolescents aged 15-17 years, attending private and public schools or out-of-school. The interviews were conducted in Kriol, recorded, transcribed, translated and analysed., Results: All the participants were heavily affected by the confinement measures during a state of emergency. Almost all believed in the realness of coronavirus while there were some doubts about its arrival in the country. The consequences were staying at home, enforced with increased police violence. At the same time, other violence on the streets or between neighbours had decreased. A few participants said they liked staying at home because they appreciated spending more time with their families. Most participants claimed that they and their family members tried to follow preventive measures. Almost all participants voiced concerns about the worsening financial situation at home, leading to food scarcity. Nearly all the adolescents were tired of the lockdown and worried about the pandemic's implications on their future opportunities., Conclusions: Study participants, here adolescents in Bissau, have a clear notion of their existence and the current situation's potential negative impact on their future. Their voices need to be heard and acted on, which may soften the lockdown's negative impact on adolescents in Guinea-Bissau, as elsewhere., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Family planning (FP) has been a global health priority for decades, yet barriers persist, including women being turned away from facilities without receiving services. This study assessed the provider role and perspective in client turnaway in three districts of Malawi. In 2019, data collectors surveyed 57 FP providers from 30 health facilities. All reported being comfortable providing FP to married women with children and married adolescents under 18 years old with children, whereas 12% of the providers expressed discomfort providing such services to married adolescents under 18 without children. Sixty percent of the providers required clients desiring FP and wishing to initiate oral contraceptives or injectables to be currently menstruating. Data collectors later conducted in-depth interviews (IDIs) with 8 of the 57 providers about client turnaway. During IDIs, providers' most frequently mentioned reasons for turnaway was client pregnancy or suspicion of pregnancy. Providers expressed fears that initiating FP with a pregnant woman could cause community mistrust in the efficacy of modern contraception. Provider support for FP waned for nulliparous clients, regardless of age or marital status. To improve FP services in Malawi, providers need continuous education on all available methods of FP, a reduction in stockouts and programs to further sensitize the community to how contraception works. Understanding how Malawi has helped providers overcome social and cultural norms regarding provision of FP to adolescents might help other countries to make improvements.

Objectives: To demonstrate the challenges of interpreting cross-country comparisons of paediatric asthma hospital admission rates as an indicator of primary care quality., Methods: We used hospital administrative data from >10 million children aged 6-15 years, resident in Austria, England, Finland, Iceland, Ontario (Canada), Sweden or Victoria (Australia) between 2008 and 2015. Asthma hospital admission and emergency department (ED) attendance rates were compared between countries using Poisson regression models, adjusted for age and sex., Results: Hospital admission rates for asthma per 1000 child-years varied eight-fold across jurisdictions. Admission rates were 3.5 times higher when admissions with asthma recorded as any diagnosis were considered, compared with admissions with asthma as the primary diagnosis. Iceland had the lowest asthma admission rates; however, when ED attendance rates were considered, Sweden had the lowest rate of asthma hospital contacts., Conclusions: The large variations in childhood hospital admission rates for asthma based on the whole child population reflect differing definitions, admission thresholds and underlying disease prevalence rather than primary care quality. Asthma hospital admissions among children diagnosed with asthma is a more meaningful indicator for inter-country comparisons of primary care quality.

Background: In the context of containment measures against the COVID-19 pandemic, the aims were to examine the impact of lockdown and school closures on childs' and adolescents' health and well-being and social inequalities in health., Methods: Literature review by searching five databases until November 2020. We included quantitative peer-reviewed studies reporting health and well-being outcomes in children (0-18 years) related to closure measures' impact due to COVID-19. A pair of authors assessed the risk of bias of included studies. A descriptive and narrative synthesis was carried out., Findings: Twenty-two studies, including high-income, middle-income and low-income countries, fulfilled our search criteria and were judged not to have an increased risk of bias. Studies from Australia, Spain and China showed an increase in depressive symptoms and decrease in life satisfaction. A decrease in physical activity and increase in unhealthy food consumption were shown in studies from two countries. There was a decrease in the number of visits to the emergency department in four countries, an increase in child mortality in Cameroon and a decrease by over 50% of immunisations administered in Pakistan. A significant drop of 39% in child protection medical examination referrals during 2020 compared with the previous years was found in the UK, a decrease in allegations of child abuse and neglect by almost one-third due to school closures in Florida, and an increase in the number of children with physical child abuse trauma was found in one centre in the USA., Interpretation: From available reports, pandemic school closure and lockdown have adverse effects on child health and well-being in the short and probably long term. We urge governments to take the negative public health consequences into account before adopting restrictive measures in childhood., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Digital technology plays an important role in achieving many of the Sustainable Development Goals. However, access is uneven, with 80% of those in high-income countries being online compared to 20% of those in the 47 least developed countries. This study aimed to describe and analyse adolescents' access to and usage of digital technology in Guinea-Bissau and its implications. In June 2017, a survey with a locally adapted Planet Youth questionnaire was implemented in the capital, Bissau, whereby classes in 16 secondary schools were surveyed on a variety of issues. In total, 2039 randomly selected students participated; the survey included ten questions specifically on the access to and use of digital technology. Half of the respondents had access to desktop/laptops, and one-third used mobile internet daily; about two-thirds had an experience of social media. Explanatory variables included educational institution, parental education, economic situation, and gender. Furthermore, students' experience of social media was significantly linked to bullying, anxiety, depression, smoking and alcohol consumption. Many adolescents in Bissau have no experience of using digital technology, including for schoolwork. Access improvements are necessary so that young Bissau-Guineans are not to be left behind in developing their capabilities and can benefit from proficiency in the use of digital technologies. At the same time, potential harmful usage of the media requires the implementation of preventive measures.

Iodine is an essential nutrient for growth and development during infancy. Data on iodine status of exclusively (EBF) and partially breastfed (PBF) infants as well as breast milk iodine concentration (BMIC) are scarce. We aimed to assess (a) infant iodine nutrition at the age of 5.5 months by measuring urinary iodine concentration (UIC) in EBF (n = 32) and PBF (n = 28) infants and (b) mothers' breast milk iodine concentration (n = 57). Sixty mother-infant pairs from three primary health care centres in Reykjavik and vicinities provided urine and breast milk samples for iodine analysis and information on mothers' habitual diet. The mother-infant pairs were participants of the IceAge2 study, which focuses on factors contributing to infant growth and development, including body composition and breast-milk energy content. The median (25th-75th percentiles) UIC was 152 (79-239) μg/L, with no significant difference between EBF and PBF infants. The estimated median iodine intake ranged from 52 to 86 μg/day, based on urinary data (assuming an average urine volume of 300-500 ml/day and UIC from the present study). The median (25th-75th percentiles) BMIC was 84 (48-114) μg/L. It is difficult to conclude whether iodine status is adequate in the present study, as no ranges for median UIC reflecting optimal iodine nutrition exist for infants. However, the results add important information to the relatively sparse literature on UIC, BMIC, and iodine intake of breastfed infants., (© 2020 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.)

Background: To analyse the impact of austerity measures taken by European governments as a response to the 2008 economic and financial crisis on social determinants on child health (SDCH), and child health outcomes (CHO)., Methods: A systematic literature review was carried out in Medline (Ovid), Embase, Web of Science, PsycInfo, and Sociological abstracts in the last 5 years from European countries. Studies aimed at analysing the Great Recession, governments' responses to the crisis, and its impact on SDCH were included. A narrative synthesis of the results was carried out. The risk of bias was assessed using the STROBE and EPICURE tools., Results: Fourteen studies were included, most of them with a low to intermediate risk of bias (average score 72.1%). Government responses to the crisis varied, although there was general agreement that Greece, Spain, Ireland and the United Kingdom applied higher levels of austerity. High austerity periods, compared to pre-austerity periods were associated with increased material deprivation, child poverty rates, and low birth weight. Increasing child poverty subsequent to austerity measures was associated with deterioration of child health. High austerity was also related to poorer access and quality of services provided to disabled children. An annual reduction of 1% on public health expenditure was associated to 0.5% reduction on Measles-Mumps-Rubella vaccination coverage in Italy., Conclusions: Countries that applied high level of austerity showed worse trends on SDCH and CHO, demonstrating the importance that economic policy may have for equity in child health and development. European governments must act urgently and reverse these austerity policy measures that are detrimental to family benefits and child protection.

Background: The Ebola epidemic in West Africa caused global fear and stirred up worldwide preparedness activities in countries sharing borders with those affected, and in geographically far-away countries such as Iceland., Objective: To describe and analyse Ebola preparedness activities within the Icelandic healthcare system, and to explore the perspectives and experiences of managers and frontline health workers., Methods: A qualitative case study, based on semi-structured interviews with 21 staff members in the national Ebola Treatment Team, Emergency Room at Landspitali University Hospital, and managers of the response team., Results: Contextual factors such as culture and demography influenced preparedness, and contributed to the positive state of mind of participants, and ingenuity in using available resources for preparedness. While participants believed they were ready to take on the task of Ebola, they also had doubts about the chances of Ebola ever reaching Iceland. Yet, factors such as fear of Ebola and the perceived stigma associated with caring for a potentially infected Ebola patient, influenced the preparation process and resulted in plans for specific precautions by staff to secure the safety of their families. There were also concerns about the teamwork and lack of commitment by some during training. Being a 'tiny' nation was seen as both an asset and a weakness in the preparation process. Honest information sharing and scenario-based training contributed to increased confidence amongst participants in the response plans., Conclusions: Communication and training were important for preparedness of health staff in Iceland, in order to receive, admit, and treat a patient suspected of having Ebola, while doubts prevailed on staff capacity to properly do so. For optimal preparedness, likely scenarios for future global security health threats need to be repeatedly enacted, and areas plagued by poverty and fragile healthcare systems require global support.

Objective: To assess whether the level of austerity implemented by national governments was associated with adverse trends in perinatal outcomes and the social determinants of children's health (SDCH) in rich countries DESIGN: Longitudinal ecological study of country-level time trends in perinatal outcomes and SDCH and from 2005 to 2015., Setting and Participants: 16 European countries using available data from the International Monetary Fund, the Organisation for Economic Co-operation and Development and Eurostat., Main Outcome Measures: Trends in perinatal outcomes (low birth weight (LBW); infant mortality) and the SDCH: child poverty rates; severe material deprivation in families with primary education; preschool investment in three time periods: 2005-2007, 2008-2010 and 2012-2015. Outcomes were compared according to the cyclically adjusted primary balance (CAPB, differences between 2013 and 2009) as a measure of austerity, stratified in tertiles. Generalised estimating equation models of repeated measures were used to assess time trend differences in three periods., Results: Countries with higher levels of austerity had worse outcomes, mainly at the last study period. Material deprivation increased during the period 2012-2015 in those countries with higher CAPB (interaction CAPB-period 2012-2015, B: 5.62: p<0.001), as did LBW (interaction CAPB-period 2012-2015, B: 0.25; p=0.004)., Conclusions: Countries that implemented more severe austerity measures have experienced increasing LBW, and for families with primary education also increasing material deprivation, worsening the negative impact of economic crisis. Reversing austerity policies that impact children is likely to improve child health outcomes., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY. Published by BMJ.)