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Importance: More than 2 million families face eviction annually, a number likely to increase due to the coronavirus disease 2019 pandemic. The association of eviction with newborns' health remains to be examined., Objective: To determine the association of eviction actions during pregnancy with birth outcomes., Design: This case-control study compared birth outcomes of infants whose mothers were evicted during gestation with those whose mothers were evicted at other times. Participants included infants born to mothers who were evicted in Georgia from January 1, 2000, to December 31, 2016. Data were analyzed from March 1 to October 4, 2020., Exposures: Eviction actions occurring during gestation., Main Outcomes and Measures: Five metrics of neonatal health included birth weight (in grams), gestational age (in weeks), and dichotomized outcomes for low birth weight (LBW) (<2500 g), prematurity (gestational age <37.0 weeks), and infant death., Results: A total of 88 862 births to 45 122 mothers (mean [SD] age, 26.26 [5.76] years) who experienced 99 517 evictions were identified during the study period, including 10 135 births to women who had an eviction action during pregnancy and 78 727 births to mothers who had experienced an eviction action when not pregnant. Compared with mothers who experienced eviction actions at other times, eviction during pregnancy was associated with lower infant birth weight (difference, -26.88 [95% CI, -39.53 to 14.24] g) and gestational age (difference, -0.09 [95% CI, -0.16 to -0.03] weeks), increased rates of LBW (0.88 [95% CI, 0.23-1.54] percentage points) and prematurity (1.14 [95% CI, 0.21-2.06] percentage points), and a nonsignificant increase in mortality (1.85 [95% CI, -0.19 to 3.89] per 1000 births). The association of eviction with birth weight was strongest in the second and third trimesters of pregnancy, with birth weight reductions of 34.74 (95% CI, -57.51 to -11.97) and 35.80 (95% CI, -52.91 to -18.69) g, respectively., Conclusions and Relevance: These findings suggest that eviction actions during pregnancy are associated with adverse birth outcomes, which have been shown to have lifelong and multigenerational consequences. Ensuring housing, social, and medical assistance to pregnant women at risk for eviction may improve infant health.

Background: Breastfeeding has positive impacts on the health, environment, and economic wealth of families and countries. The World Health Organization (WHO) launched the Baby Friendly Hospital Initiative (BFHI) in 1991 as a global program to incentivize maternity services to implement the Ten Steps to Successful Breastfeeding (Ten Steps). These were developed to ensure that maternity services remove barriers for mothers and families to successfully initiate breastfeeding and to continue breastfeeding through referral to community support after hospital discharge. While more than three in four births in Australia take place in public hospitals, in 2020 only 26% of Australian hospitals were BFHI-accredited. So what is the social return to investing in BFHI accreditation in Australia, and does it incentivize BFHI accreditation? This study aimed to examine the social value of maintaining the BFHI accreditation in one public maternity unit in Australia using the Social Return on Investment (SROI) framework. This novel method was developed in 2000 and measures social, environmental and economic outcomes of change using monetary values., Method: The study was non-experimental and was conducted in the maternity unit of Calvary Public Hospital, Canberra, an Australian BFHI-accredited public hospital with around 1000 births annually. This facility provided an opportunity to illustrate costs for maintaining BFHI accreditation in a relatively affluent urban population. Stakeholders considered within scope of the study were the mother-baby dyad and the maternity facility. We interviewed the hospital's Director of Maternity Services and the Clinical Midwifery Educator, guided by a structured questionnaire, which examined the cost (financial, time and other resources) and benefits of each of the Ten Steps. Analysis was informed by the Social Return on Investment (SROI) framework, which consists of mapping the stakeholders, identifying and valuing outcomes, establishing impact, calculating the ratio and conducting sensitivity analysis. This information was supplemented with micro costing studies from the literature that measure the benefits of the BFHI., Results: The social return from the BFHI in this facility was calculated to be AU$ 1,375,050. The total investment required was AU$ 24,433 per year. Therefore, the SROI ratio was approximately AU$ 55:1 (sensitivity analysis: AU$ 16-112), which meant that every AU$1 invested in maintaining BFHI accreditation by this maternal and newborn care facility generated approximately AU$55 of benefit., Conclusions: Scaled up nationally, the BFHI could provide important benefits to the Australian health system and national economy. In this public hospital, the BFHI produced social value greater than the cost of investment, providing new evidence of its effectiveness and economic gains as a public health intervention. Our findings using a novel tool to calculate the social rate of return, indicate that the BHFI accreditation is an investment in the health and wellbeing of families, communities and the Australian economy, as well as in health equity.

Background: The risk of entry to state care during infancy is increasing, both here in England and abroad, with most entering within a week of birth ('newborns'). However, little is known about these infants or of their pathways through care over early childhood., Objective: To characterize infant entries to care in England., Participants and Setting: All children in England who first entered care during infancy, between April 2006 and March 2014 (n = 42,000)., Methods: We compared sociodemographic and care characteristics for infants entering care over the study period by age at first entry (newborn: <1wks, older infant 1-51wks). Among those who entered before April 2010, we further characterized care over follow-up (i.e. 4 years from first entry) and employed latent class analysis to uncover any common pathways through care., Results: Almost 40 % of infants first entered care as a newborn. Most infants first entered care under s 20 arrangements (i.e. out-of-court, 60 % of newborns vs 47 % of older infants). Among infants entering before April 2010, most were adopted over follow-up (60 % vs 37 %), though many were restored to parental care (20 % vs 32 %) or exited care to live with extended family (13 % vs 19 %). One in six infants (17.7 %) had particularly unstable care trajectories over early childhood, typified by three or more placements or failed reunification., Conclusions: Evidence-based strengthening of pre-birth social work support is needed to improve preventive interventions before birth, to more effectively target infant placement into care. Linkages between child protection records and information on parents are needed to inform preventive strategies., (Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objective: To assess factors impacting child-welfare involvement and child abuse and neglect outcomes among prenatally substance-exposed infants., Study Design: This was a retrospective review of case registry data regarding substance-exposed infants tracked statewide in Delaware from 2014 to 2018. Differences in maternal, infant, and substance exposure factors by level of child-welfare involvement (screened-in vs screened-out case status) and child abuse and neglect outcomes were examined. Screened-in status was defined as case acceptance for investigation, family assessment, or treatment referral. Using logistic regression, associations between factors and screened-in status and between factors and child abuse and neglect outcomes were assessed. Cases involving child abuse and neglect were analyzed qualitatively., Results: Among 1222 substance-exposed infants, 70% were screened-in by child welfare for ongoing involvement; 28 (2.3%) of substance-exposed infants were identified as child abuse and neglect victims sustaining serious physical or fatal injury before 1 year of age. Most substance-exposed infants remained with caregivers; few entered foster care. Polysubstance exposure and maternal mental health condition were factors associated with screened-in status. Neither substance exposure type nor maternal mental health condition reliably predicted future child abuse and neglect., Conclusions: Substance-exposed infants had a significant risk for child abuse and neglect. Although maternal and substance exposure factors were associated with screened-in case status, they unreliably predicted future risk of child abuse and neglect., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective . To examine characteristics of the infant and mother associated with rapid infant weight gain (RIWG). Methods . Electronic health records (N = 4626) of term infants born were reviewed. Multivariable logistic regression examined the presence of RIWG (vs not) using participant characteristics in the whole sample and in stratified groups. Results . The prevalence of RIWG was 18.7%. Predictors of RIWG were infant male sex, younger infant gestational age, firstborn (vs later born) status, maternal Black or Other (Asian, American Indian, etc), non-Hispanic race/ethnicity (vs White non-Hispanic), Medicaid (vs non-Medicaid insurance), and maternal cigarette smoking status (vs never smoker). The regression model explained between 7.0% and 11.4% of the variance in RIWG. There were few differences in predictors of RIWG in stratified samples. Conclusions . Early childhood obesity intervention efforts may target the modifiable risk factors for RIWG starting prenatally.

According to the Centers for Disease Control and Prevention, the rate of breastfeeding in the United States has increased 34% between 2005 and 2015. Women who breastfeed can require treatment of various common illnesses. When caring for women who are breastfeeding, health care providers may unnecessarily discourage them from breastfeeding during treatment. Choosing the appropriate medications for these individuals is critical to ensure the woman is effectively treated, infant exposure to medication is minimized, and the breastfeeding relationship is preserved. This article provides an overview of essential principles for prescribing medications for women who are lactating. Recommendations for the management of common illnesses seen in the outpatient setting are suggested and resources that can help guide therapeutic decision making are offered., (© 2019 by the American College of Nurse-Midwives.)

Because of the many known maternal and neonatal health benefits of breastfeeding, there have been significant efforts to encourage exclusive breastfeeding, and many hospitals follow the guidelines of the Baby-Friendly Hospital Initiative. However, even with the right support, many women are unable to exclusively breastfeed, which may make them feel anxious and/or depressed. Psychological pressure to exclusively breastfeed has the potential to contribute to postpartum depression symptoms in new mothers who are unable to achieve their breastfeeding intentions. In this commentary, we focus on the well-being of the mother-infant dyad and argue for further research on maternal stress related to breastfeeding difficulties or pressure and the need to physically and psychologically assess and support women who are unable to breastfeed successfully or exclusively., (Copyright © 2019 AWHONN. Published by Elsevier Inc. All rights reserved.)

Introduction: There are at least 22 Arab league states and sections in Northern Africa, southwestern Asia, and Europe that incorporate the vast Middle Eastern culture. The purpose of this study was to identify the cultural variations in newborn care practices, self-management of common illnesses, and their potential impact on infant welfare., Method: A qualitative design using a focus group approach with 37 Arab mothers in Jordan was used., Results: Findings revealed strong similarities in terms of beliefs, care practices, and the experience of intergenerational conflict in establishing and maintaining traditional practices among mothers. Potentially harmful practices included restrictive swaddling, rubbing a newborn's body with salt, and encouraging the ingestion of herbs in newborns., Discussion: It is important for nurses and midwives to be aware of traditional practices, cultural beliefs, and the implications for infant welfare if they are to effectively engage with families to promote the well-being of the newborn.

Purpose: Breastfeeding rates continue to decrease in Lebanon. Studies addressing the relationship between breastfeeding duration and health outcomes in Middle Eastern countries are scarce. This study is the first in Lebanon to have investigated the determinants of both exclusive and mixed breastfeeding durations and the relationship with health in infants and toddlers., Design and Methods: Our sample of 1051 toddlers is nationwide and representative of all toddlers enrolled in daycare centers, and aged between 12 and 36 months., Results: Median of exclusive breastfeeding duration was 15 days and mean age of formula introduction was 2.03 (±3.22) months. Exclusive breastfeeding was initiated at a mean age of 10.56 (±27.12) hours and half of the toddlers (51.6%) were exposed to formula milk since day one following birth. Determinants of both exclusive and total breastfeeding durations were related to several parents' socio-demographic and behavioral factors. A longer duration of exclusive breastfeeding was associated with a lower frequency of pediatrician visits, antibiotic prescriptions, absence from daycare, and a lower risk of otitis, colic and UTI occurrence, after adjusting for cofounders. Similarly, a longer duration of total breastfeeding was associated with less antibiotic prescriptions and a lower risk of otitis., Conclusions: Our study highlights the health benefits of extending exclusive breastfeeding duration. It is urgent to address alarmingly low breastfeeding rates in Lebanon. Policy implementation and enforcement along with raising awareness and creating a supportive environment for breastfeeding mothers should involve the various stakeholders in order to succeed in increasing breastfeeding rates and duration., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objective: To identify the socioeconomic gradients in the measures of development and well-being of children under three years of age in Fortaleza, Northeastern Brazil., Methods: We compiled information using a socioeconomic survey instrument, collecting anthropometric measurements, observing the home environment, and applying the Denver Test II to 2,755 children aged between zero and 28 months who are potential beneficiaries of the Cresça com Seu Filho program in Fortaleza. These children were randomly selected from a universe identified from the administrative record of the Cadastro Único of the Ministry of Social Development of Brazil. For the analysis, we reported descriptive statistics, Pearson correlations, and mean differences., Results: Rates of chronic malnutrition and overweight were 7.0%. The results of the Denver II test indicated that personal social (23%) and language (20%) are the domains in which children have the highest developmental delay, when compared with the international reference sample. Parental practices measured by two sub-scales of the Home Observation of the Environment Inventory were poor, with only 14.0% of families having two or more books in the home and 35.0% of the households reporting having spanked their child in the past three days., Conclusions: We identified clear socioeconomic gradients in the anthropometric indicators, parenting practices, and the Denver Test II (especially in the language domain). Children from poorer households, as well as children of mothers with lower education levels, perform poorly on most measures.

Background: In India, the neonatal mortality rate is nearly double the Sustainable Development Goal target with more than half of neonatal deaths occurring in only four states, one of which is Bihar. Evaluations of immediate neonatal care and neonatal resuscitation skills in Bihar have demonstrated a need for significant improvement. However, barriers to evidence based practices in clinical care remain incompletely characterized., Methods: To better understand such barriers, semi-structured interviews were conducted with 18 nurses who participated as mentors in the AMANAT maternal and child health quality improvement project, implemented by CARE India and the Government of Bihar. Nurse-mentors worked in primary health centers throughout Bihar facilitating PRONTO International emergency obstetric and neonatal simulations for nurse-mentees in addition to providing direct supervision of clinical care. Interviews focused on mentors' perceptions of barriers to evidence based practices in immediate neonatal care and neonatal resuscitation faced by mentees employed at Bihar's rural primary health centers. Data was analyzed using the thematic content approach., Results: Mentors identified numerous interacting logistical, cultural, and structural barriers to care. Logistical barriers included poor facility layout, supply issues, human resource shortages, and problems with the local referral system. Cultural barriers included norms such as male infant preference, traditional clinical practices, hierarchy in the labor room, and interpersonal relations amongst staff as well as with patients' relatives. Poverty was described as an overarching structural barrier., Conclusion: Interacting logistical, cultural and structural barriers affect all aspects of immediate neonatal care and resuscitation in Bihar. These barriers must be addressed in any intervention focused on improving providers' clinical skills. Strategic local partnerships are vital to addressing such barriers and to contextualizing skills-based trainings developed in Western contexts to achieve the desired impact of reducing neonatal mortality.

Background: Australia experiences high breastfeeding initiation but low duration rates. UNICEF introduced the global breastfeeding strategy, the Baby-Friendly Hospital Initiative, to Australia in 1992, transferring governance to the Australian College of Midwives (ACM) in 1995. In 2017 23% of facilities were registered as 'baby-friendly' accredited., Aim: To examine the introduction and dissemination of the Baby-friendly Hospital Initiative into the Australian national setting., Methods: An instrumental case study was conducted containing two components: analysis of historical documents pertaining to the Initiative and participant's interviews, reported here. A purposive sampling strategy identified 14 participants from UNICEF, ACM, maternity and community health services, the Australian government and volunteer organisations who took part in in-depth interviews. Thematic analysis explored participants' perceptions of factors influencing the uptake and future of the since renamed Baby Friendly Health Initiative (BFHI) and accreditation programme, BFHI Australia. Two broad categories, enablers and barriers, guided the interviews and analysis., Findings: Participants revealed a positive perception of the BFHI whilst identifying that its interpretation and expansion in Australia had been negatively influenced by intangible government support and suboptimal capacity building. BFHI's advocacy agenda competed with BFHI Australia's need for financial viability. Widespread stakeholder collaboration and tangible political endorsement was seen as a way to move the strategy forward., Conclusion: Dissemination of BFHI Australia is hampered by multi-level systems issues. Prioritisation, stakeholder collaboration and adequate resourcing of the BFHI is required to create a supportive and enabling environment for Australian women to determine and practice their preferred infant feeding method., (Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

Background: As the global under-five mortality rate declines, an increasing percentage is attributable to early neonatal mortality. A quarter of early neonatal deaths are due to perinatal asphyxia. However, neonatal resuscitation (NR) simulation training in low-resource settings, where the majority of neonatal deaths occur, has achieved variable success. In Bihar, India, the poorest region in South Asia, there is tremendous need for a new approach to reducing neonatal morality., Methods: This analysis aims to assess the impact of a novel in-situ simulation training program, developed by PRONTO International and implemented in collaboration with CARE India, on NR skills of nurses in Bihar. Skills were evaluated by clinical complexity of the simulated scenario, which ranged from level 1, requiring NR without a maternal complication, to level 3, requiring simultaneous management of neonatal and maternal complications. A total of 658 nurses at 80 facilities received training 1 week per month for 8 months. Simulations were video-recorded and coded for pre-defined clinical skills using Studiocode™., Results: A total of 298 NR simulations were analyzed. As simulation complexity increased, the percentage of simulations in which nurses completed key steps of NR did not change, even with only 1-2 providers in the simulation. This suggests that with PRONTO training, nurses were able to maintain key skills despite higher clinical demands. As simulation complexity increased from level 1 to 3, time to completion of key NR steps decreased non-significantly. Median time to infant drying decreased by 7.5 s (p = 0.12), time to placing the infant on the warmer decreased by 21.7 s (p = 0.27), and time to the initiation of positive pressure ventilation decreased by 20.8 s (p = 0.12). Nevertheless, there remains a need for improvement in absolute time elapsed between delivery and completion of key NR tasks., Conclusions: PRONTO simulation training enabled nurses in Bihar to maintain core NR skills in simulation despite demands for higher-level triage and management. Although further evaluation of the PRONTO methodology is necessary to understand the full scope of its impact, this analysis highlights the importance of conducting and evaluating simulation training in low-resource settings based on simultaneous care of the mother-infant dyad.

Background: As mobile phone access continues to expand globally, opportunities exist to leverage these technologies to support demand for immunisation services and improve vaccine coverage. We aimed to assess whether short message service (SMS) reminders and monetary incentives can improve immunisation uptake in Kenya., Methods: In this cluster-randomised controlled trial, villages were randomly and evenly allocated to four groups: control, SMS only, SMS plus a 75 Kenya Shilling (KES) incentive, and SMS plus 200 KES (85 KES = USD$1). Caregivers were eligible if they had a child younger than 5 weeks who had not yet received a first dose of pentavalent vaccine. Participants in the intervention groups received SMS reminders before scheduled pentavalent and measles immunisation visits. Participants in incentive groups, additionally, received money if their child was timely immunised (immunisation within 2 weeks of the due date). Caregivers and interviewers were not masked. The proportion of fully immunised children (receiving BCG, three doses of polio vaccine, three doses of pentavalent vaccine, and measles vaccine) by 12 months of age constituted the primary outcome and was analysed with log-binomial regression and General Estimating Equations to account for correlation within clusters. This trial is registered with ClinicalTrials.gov, number NCT01878435., Findings: Between Oct 14, 2013, and Oct 17, 2014, we enrolled 2018 caregivers and their infants from 152 villages into the following four groups: control (n=489), SMS only (n=476), SMS plus 75 KES (n=562), and SMS plus 200 KES (n=491). Overall, 1375 (86%) of 1600 children who were successfully followed up achieved the primary outcome, full immunisation by 12 months of age (296 [82%] of 360 control participants, 332 [86%] of 388 SMS only participants, 383 [86%] of 446 SMS plus 75 KES participants, and 364 [90%] of 406 SMS plus 200 KES participants). Children in the SMS plus 200 KES group were significantly more likely to achieve full immunisation at 12 months of age (relative risk 1·09, 95% CI 1·02-1·16, p=0·014) than children in the control group., Interpretation: In a setting with high baseline immunisation coverage levels, SMS reminders coupled with incentives significantly improved immunisation coverage and timeliness. Given that global immunisation coverage levels have stagnated around 85%, the use of incentives might be one option to reach the remaining 15%., Funding: Bill & Melinda Gates Foundation., (Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license. Published by Elsevier Ltd.. All rights reserved.)

Background: Despite the recent international focus on maternal and child nutrition, little attention is paid to nutrition capacity development. Although infant feeding counselling by health workers increases caregivers' knowledge, and improves breastfeeding, complementary feeding, and children's linear growth, most of the counselling in sub-Saharan Africa is primarily conducted by nurses or volunteers, and little is done to develop capacity for nutrition at the professional, organizational, or systemic levels. The Cameroon Baptist Convention Health Services Nutrition Improvement Program (NIP) has integrated a cadre of nutrition counselors into prevention of mother-to-child transmission of HIV programs, infant welfare clinics, and antenatal clinics to improve infant and young child feeding practices (IYCF). The study objective was to evaluate the effects of NIP's infant feeding counselors on exclusive breastfeeding (EBF), complementary feeding (CF), and children's linear growth., Methods: A cross-sectional evaluation design was used. Using systematic random sampling, caregivers were recruited from NIP sites (n = 359) and non-NIP sites (n = 415) from Infant Welfare Clinics (IWCs) in the Northwest (NWR) and Southwest Regions (SWR) of Cameroon between October 2014 and April 2015. Differences in EBF and CF practices and children's linear growth between NIP and non-NIP sites were determined using chi-square and multiple logistic regression., Results: After adjusting for differences in religion, occupation, and number of months planning to breastfeed, children were almost seven times (Odds Ratio [OR]: 6.9; 95% Confidence Interval [CI]: 2.30, 21.09; β = 1.94) more likely to be exclusively breastfed at NIP sites compared to non-NIP sites. After adjusting for differences in occupation, religion, number of months planning to breastfeed, rural environment, economic status, attending other Infant Welfare Clinics, and non-biological caregiver, children were five times more likely to be stunted at non-NIP sites compared to NIP sites., Conclusion: Training a cadre of nutrition counselors is one approach towards increasing nutrition human resources to implement nutrition interventions to improve maternal and child nutrition. In this research project, the study design did not allow for conclusive results, but rather suggest IYCF counseling provided by nutrition counselors was effective in increasing EBF and reduced the risk of stunting in children 6-8 months.

In 2009 the first national and international guideline providing direction for breastfeeding women on drinking alcohol was included in the National Health and Medical Research Council Australian guidelines to reduce health risks from drinking alcohol. In the absence of an accompanying education campaign for the guidelines, the Australian Breastfeeding Association was able to fill this gap and work in partnership with a breastfeeding researcher to develop an education resource for Australian women that was also a national and international first. This commentary outlines the journey of the research that informed the development of the resource and the integral involvement of the Australian Breastfeeding Association throughout.

Objective: To assess the availability and utilization of emergency obstetric and neonatal care (EmONC) in Guinea given the high maternal and neonatal mortality rates., Methods: We used the Guinea 2012 needs assessment data collected via a national cross-sectional census of health facilities conducted from September to October 2012. All public, private, and faith-based health facilities that performed at least one delivery during the period of the study were included., Results: A total of 502 health facilities were visited, of which 81 were hospitals. Only 15 facilities were classified as fully functioning EmONC facilities, all of which were reference hospitals. None of the first level health facilities were fully functioning EmONC facilities. The ratio of availability of EmONC was one fully functioning EmONC facility for 745 415 inhabitants. The institutional delivery rate was 32.3% and the proportion of all births in EmONC facilities was 7.1%. Met need for EmONC was 12.2%. Among 201 maternal deaths in EmONC facilities, 69 were due to indirect causes. The intrapartum and very early neonatal death rate was 39 deaths per 1000 live births., Conclusion: The study showed low availability of EmONC services and underutilization of the available services. Further investigation is needed to evaluate the effect of the current policy of user fees exemption for deliveries and prenatal care in Guinea., (Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.)

Objective: To describe prenatal care in Angolan women delivered at a large tertiary care unit, and to explore the association between prenatal care and selected perinatal outcomes., Methods: We conducted a cross-sectional study between December 2012 and February 2013, involving 995 women aged 13-46years, delivered at Lucrécia Paím Maternity, Luanda. Trained interviewers collected information on timing, frequency, place, and satisfaction with prenatal care; sociodemographic and clinical characteristics; birth weight; and gestational age. Logistic regression models were fitted, and odds ratios with 95% confidence intervals (OR, 95%CI) estimated., Results: Quantitatively inadequate prenatal care (<4 visits) was more common in younger, less educated, poorer women, followed in public institutions, and those who felt more dissatisfied with care. More visits, both in primiparas and multiparas, were independently associated with more cesarean deliveries. After adjustment, having fewer than four visits was significantly associated with low birth weight (OR 2.00; 95% CI, 1.15-3.50) and preterm delivery (OR 2.74; 95% CI, 1.69-4.44 for 2-4 visits); similar associations were found regarding late entrance into care., Conclusion: Early entrance into prenatal care and the recommended number of visits are major determinants of mode of delivery and pregnancy outcomes, constituting targets to improve perinatal health., (Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.)

Objective: To describe the various local initiatives to access emergency obstetric and neonatal care in Burkina Faso., Methods: An existing framework was used to review the three processes for local initiatives: emergence, formulation, and implementation. Multiple case studies were conducted, followed by literature review and semi-structured interviews with key informants., Results: Sixteen districts had implemented local initiatives, including cost sharing, free care for women and children, and free care for delivery and cesareans. Most districts (n=10) had implemented the cost-sharing intervention. These initiatives were initiated by local actors as well as nongovernmental organizations. The profile of those involved led to different ways of handling the emergence and formulation processes. At implementation, these initiatives faced many issues including late payment of contributions, low involvement of local governments, and equity in participation., Conclusion: There are some issues in the implementation and sustainability of the local initiatives. Although many initiatives exist, these are unable to fully address the financial barriers to care. However, these initiatives highlight context-based financial barriers that must be taken into account to accelerate universal access to health care., (Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.)

Objective: To analyze and compare the availability, utilization, and quality of services for maternal and neonatal health in 2010 and 2014 in Burkina Faso., Methods: A cross-sectional study of emergency obstetric and neonatal care services (EmONC) in all public and private health facilities in Burkina Faso in 2010 and a sample of 812 health facilities in 2014. The generic tools developed by the Averting Maternal Death and Disability (AMDD) program were used as the basic tools for evaluation., Results: In 2010, 25 health facilities were considered as EmONC health facilities and there were 23 in 2014. In 2010 and 2014, the proportion of births in EmONC health facilities was low (4.5%). The cesarean delivery rate also remained very low, at 0.9% in 2010 and 1.13% in 2014. The proportion of obstetric complications supported in health facilities was 12.3% in 2010 and 17.1% in 2014. The direct complication case fatality rate in EmONC health facilities was 1.6% in 2010 and 1.3% in 2014., Conclusion: The two surveys did not show a significant improvement in the availability, utilization, and quality of maternal and neonatal healthcare services between 2010 and 2014., (Copyright © 2016. Published by Elsevier Ireland Ltd.)

Objective: To assess the availability, utilization, and quality of emergency obstetric and neonatal care (EmONC) in Togo., Methods: A cross-sectional study of EmONC services in all public and private health facilities in the territory of Togo conducted from July to December, 2012. The generic tools developed by the Averting Maternal Death and Disability program were used as the basic tools for this evaluation., Results: The survey involved 1019 health facilities including 864 potential EmONC facilities that constituted the final sample. The results showed that there was low availability of functional EmONC health facilities (8 basic EmONC and 24 comprehensive EmONC) with a large urban/rural variation. Among the 24 current CEmONC, 22 were in urban areas and half were from the private sector. The national ratio of availability was 3 EmONC health facilities per 500 000 inhabitants. Nationally, the cesarean delivery rate was 3.5%. The lethality rate of direct obstetric causes was estimated at 1.3%., Conclusion: Needs assessment for EmONC showed low availability of EmONC services and underutilization of the available services., (Copyright © 2016. Published by Elsevier Ireland Ltd.)

Although the etiology of the disease has not yet been fully clarified in the 21st century, clinical significance of the disease is huge because it is frequent in the neonatal period compared with other diseases. Today, owing to advanced diagnostic possibilities, hypertrophic pyloric stenosis is easily distinguished from other differential diagnoses that are manifested by vomiting as the main symptom. At Department of Pediatric Surgery, Zagreb Children’s Hospital, efforts have been invested to successfully manage this and a number of other conditions that affect newborns. We retrospectively analyzed data on 40 hospitalized children retrieved from the hospital information system for the 2010-2015 period and present them as a basis for the respective algorithms and future research. Reviewing a range of parameters, we have come to some concrete conclusions. On average, the disease started manifesting on 28th day after birth; 63% of the children developed metabolic alkalosis. Thickness of the muscle wall verified by ultrasound ranged from 3.1 mm to 7 mm. Surgery was performed seven days after hospitalization and correction of metabolic condition. The average duration of surgery was 48 minutes. The mean length of hospital stay was 11.64 days, of which 2 days in the intensive care unit. Complications occurred in two patients.

Background: Though the World Health Organization (WHO) recommended Infant and Young Child Feeding (IYCF) indicators have been in use, little is known about their association with child nutritional status. The objective of this study was to explore the relationship between IYCF indicators (timing of complementary feeding, minimum dietary diversity, minimum meal frequency and minimum acceptable diet) and child growth indicators., Methods: A community-based cross-sectional survey was carried out in November 2013. The study population comprised mothers/primary caregivers and their children selected using a two-stage cluster sampling procedure., Results: Of the 1984 children aged 6-23 months; 58.2 % met the minimum meal frequency, 34.8 % received minimum dietary diversity (≥4 food groups), 27.8 % had received minimum acceptable diet and only 15.7 % received appropriate complementary feeding. With respect to nutritional status, 20.5 %, 11.5 % and 21.1 % of the study population were stunted, wasted and underweight respectively. Multiple logistic regression analysis revealed that compared to children who were introduced to complementary feeding either late or early, children who started complementary feeding at six months of age were 25 % protected from chronic malnutrition (AOR = 0.75, CI = 0.50 - 0.95, P = 0.02). It was found that children whose mothers attended antenatal care (ANC) at least 4 times were 34 % protected [AOR 0.66; 95 % CI (0.50 - 0.88)] against stunted growth compared to children born to mothers who attended ANC less than 4 times. Children from households with high household wealth index were 51 % protected [AOR 0.49; 95 % CI (0.26 - 0.94)] against chronic malnutrition compared to children from households with low household wealth index. After adjusting for potential confounders, there was a significant positive association between appropriate complementary feeding index and mean WLZ (β = 0.10, p = 0.005) but was not associated with mean LAZ., Conclusions: The WHO IYCF indicators better explain weight-for-length Z-scores than length-for-age Z-scores of young children in rural Northern Ghana. Furthermore, a composite indicator comprising timely introduction of solid, semi-solid or soft foods at 6 months, minimum meal frequency, and minimum dietary diversity better explains weight-for-length Z-scores than each of the single indicators.

Screening programs for asymptomatic newborns (newborn screening - NBS) have increasingly been implemented in many westernized countries since the end of the 20th century (Wilson et al., 2010). The major goal of these programs is to unselectively screen all newborns for a well defined group of severe, rare, clearly identifiable and actionable conditions. These conditions should be diagnosed and treated in a timely fashion to ensure short and long term health of the newborn as an infant and an adult. As such, NBS programs are one of the pivotal public health achievements of the past decade (Centers for Disease Control and Prevention, 2011) that have led to the saving of lives and improving quality of life as well as posing less financial burden on the health care system. Technically the currently practiced screening process is performed 48 hours after birth, using a minute amount of blood collected on a dried blood spot card, which is subsequently subjected to biochemical analysis predominantly using mass spectrometry assays.

This report describes information sources accessed by pregnant women around antenatal and early infant diet. Australian women in their first pregnancy (n = 277) responded to questionnaires online and on paper between June 2010 and March 2011 as part of the Feeding Queensland Babies Study. Antenatal information sources are reported for maternal diet, breastfeeding and formula-feeding. Pregnant women sought and encountered information for their own and their infants' diet from many sources. Health care professionals provided antenatal dietary information for 80% of respondents and infant feeding advice for 69%. Relatives or friends were the respondents' largest reported information source for infant feeding, reported by 78%. Information on artificial baby milk was accessed on television by 77% and on the internet by 52% of respondents. Health care professionals should proactively support clients' informational needs and address encountered nutrition misinformation. Further research is necessary to establish the nature and accuracy of dietary information in the mass media.

Objective: To compare self-reported safe sleep data from a community social service agency and primary care centers., Design, Settings, and Participants: Cross-sectional Pregnancy Risk Assessment Monitoring System (PRAMS)-based survey data from a community social service agency and survey data from primary care centers were compared using descriptive statistics. There were 166 community survey respondents, average age of 25 years (SD = 5.4 years), and 79 primary care center respondents, average age of 24 years (SD = 5.4 years). Two binary logistic regressions were performed to examine the association between demographic differences and safe sleep position/bed sharing., Results: Safe sleep position responses did not differ significantly between the community-based (n = 126, 85%) and primary care center-based (n = 62, 79%) samples, χ(2)(1) = 0.79, P = .372. Reported bed sharing was significantly higher in the community sample (n = 54, 36%) than the health care center sample (n = 4, 5%), Fisher's exact test, P< .001. Black race was determined to be significantly associated with increased unsafe sleep positioning (OR = 2.86, P = .022). The community center cohort was the only significant predictor of bed sharing (OR = 25.40, P = .002)., Conclusion: Differences in reported safe sleep environments may be due to knowledge variances of safe sleep guidelines, or clinic-based respondents may have been more likely to provide socially desirable responses. The comparison data further highlight the need for continued targeted effort to improve safe sleep behaviors to improve infant health outcomes., (© The Author(s) 2015.)

Maltreatment that begins during infancy is likely to be chronic in duration and developmentally consequential if the appropriate intervention is not delivered. Repeated reports of maltreatment may signal unmet service needs. This study prospectively followed infants who remained at home following an initial report of maltreatment to determine the rate of re-reporting within 5 years. Birth records for all children born in California in 2006 were linked to statewide child protection records through 2012; 5.2% (n = 29,135) of children were reported for abuse or neglect prior to age 1. Following an initial report, 81.9% of infants remained in the home, the majority (60.7%) of whom were re-reported within 5 years. The highest rate of re-reporting was observed among infants whose initial allegation was substantiated and who had a case opened for family maintenance services (69.1%). Infants whose initial allegation was not investigated had re-reporting rates that were equal to or higher than other infants remaining in the home without services. Findings highlight that most families with infants reported for maltreatment are not formally served through the child protection system. High rates of re-reporting underscore the challenge of delivering services that remedy conditions necessitating child protection follow-up and call attention to the importance of accessing data from community service providers., (© The Author(s) 2014.)

Background: Pregnancy and childbirth still involve risk for pregnant women and their babies and health in the perinatal period remains an important public health priority. This study addresses the question of perinatal health in Umbria region., Methods: Data were obtained from the administrative source of the regional Standard Certificate of Live Births in Umbria in 2012. We used population data, which merges data from each mother and her baby for a total of 7964 records. To describe perinatal health we considered pathological pregnancy, fetal growth defect, birth weight, gestational age, Apgar scores at 5 minutes and stillbirth such as indicators of Maternal and Neonatal Health in according with population characteristics and risk factors (maternal age, parity, mothers' educational level and mothers' country of birth)., Results: In Umbria, in 2012 we have: - 29 stillbirths corresponding to a rate of stillbirths of 3.52 ‰ (stillbirths per 1000 births) - a perinatal mortality rate ( stillbirths and deaths in the first week of life) of 4.9 per 1000 live births and stillbirths - an Infant mortality rate (within the first year of life) of 2.5 per 1000 live births The 1.4 % of infants underwent neonatal resuscitation. This percentage detects an indicative Apgar score of important neonatal suffering (0-3) in the 1% of neonates. The frequency of infants with birth weight less than 2500 grams (LBW) was 6.4 %, with higher values ​​in females (7.3%) than males (2.7%). The frequency of infants with birth weight less than 1500 grams is 0.8%. The preterm birth (<37 weeks of gestation) rate is 6.3% of the total: 5.6% are pregnancies among the 32 and 36 weeks of gestation and 0.7% are pregnancies under the 32nd week of gestation. The pathological pregnancies are 7.9% and the Fetal Growth Restriction (FGR) is 2.7%. The health perinatal indicators considered were different in different population subgroups. The most representative population was Italian women (76.8%), with maternal age between 25-34 years (56.4%), primiparous (61.9%) and mothers with medium education levels (48.1%)., Conclusions: Results highlight the existence of differences in perinatal health. Worse maternal condition and neonatal status were observed especially for less advantaged social classes (i.e., foreign or poorly educated). Such inequalities should be examined in all areas of public policy and public services, to ensure equal opportunity for all.

Background: Poor maternal and child health indicators have been reported in Nigeria since the 1990s. Many interventions have been instituted to reverse the trend and ensure that Nigeria is on track to achieve the Millennium Development Goals. This systematic review aims at describing and indirectly measuring the effect of the Maternal, Newborn, and Child Health (MNCH) interventions implemented in Nigeria from 1990 to 2014., Methods: PubMed and ISI Web of Knowledge were searched from 1990 to April 2014 whereas POPLINE® was searched until 16 February 2015 to identify reports of interventions targeting Maternal, Newborn, and Child Health in Nigeria. Narrative and graphical synthesis was done by integrating the results of extracted studies with trends of maternal mortality ratio (MMR) and under five mortality (U5MR) derived from a joint point regression analysis using Nigeria Demographic and Health Survey data (1990-2013). This was supplemented by document analysis of policies, guidelines and strategies of the Federal Ministry of Health developed for Nigeria during the same period., Results: We identified 66 eligible studies from 2,662 studies. Three interventions were deployed nationwide and the remainder at the regional level. Multiple study designs were employed in the enrolled studies: pre- and post-intervention or quasi-experimental (n = 40; 61%); clinical trials (n = 6;9%); cohort study or longitudinal evaluation (n = 3;5%); process/output/outcome evaluation (n = 17;26%). The national MMR shows a consistent reduction (Annual Percentage Change (APC) = -3.10%, 95% CI: -5.20 to -1.00 %) with marked decrease in the slope observed in the period with a cluster of published studies (2004-2014). Fifteen intervention studies specifically targeting under-five children were published during the 24 years of observation. A statistically insignificant downward trend in the U5MR was observed (APC = -1.25%, 95% CI: -4.70 to 2.40%) coinciding with publication of most of the studies and development of MNCH policies., Conclusions: The development of MNCH policies, implementation and publication of interventions corresponds with the downward trend of maternal and child mortality in Nigeria. This systematic review has also shown that more MNCH intervention research and publications of findings is required to generate local and relevant evidence.

The purpose of this study was to review the evidence on the effect of initiation of breastfeeding early after birth and of exclusive breastfeeding during the first month in reducing neonatal mortality and morbidity. We searched Cochrane and PubMed databases for all available papers addressing our review questions and identified eleven papers. Data were extracted using a standard abstraction form. Evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation system. Meta-analysis was done using STATA 11.0. Early initiation of breastfeeding was associated with a reduced risk of neonatal mortality. Initiating breastfeeding after the first hour doubled the risk of neonatal mortality. Exclusively breastfed neonates had a lower risk of mortality and infection-related deaths in the first month than partially breastfed neonates. Exclusively breastfed neonates also had a significantly lower risk of sepsis, diarrhea and respiratory infections compared with those partially breastfed. The pooled evidence indicates that substantial benefits in reducing neonatal mortality and morbidity can be achieved with effective promotion of early initiation of breastfeeding and exclusive breastfeeding during the first month of life.

Objective: This study examined whether adopting a standardized prenatal substance use protocol (protocol) in a hospital labor and delivery unit reduced racial disparities in reporting to child protective services (CPS) related to maternal drug use during pregnancy., Study Design: This study used an interrupted time series design with a non-equivalent control. One hospital adopted a protocol and another hospital group serving a similar geographic population did not change protocols. Data on CPS reporting disparities from these hospitals over 3.5 years were analyzed using segmented regression., Result: In the hospital that adopted the protocol, almost five times more black than white newborns were reported during the study period. Adopting the protocol was not associated with reduced disparities., Conclusion: Adopting a protocol cannot be assumed to reduce CPS reporting disparities. Efforts to encourage hospitals to adopt protocols as a strategy to reduce disparities may be misguided. Other strategies to reduce disparities are needed.