Case Report: Through the Tennessee Initiative for Perinatal Quality Care (www.tipqc.org), four pilot prenatal (Family Medicine and OB-GYN) practices representing academic and private groups from across the state established primary improvement teams including relevant stakeholders. An online toolkit of evidence-based practices and published tools from the AAP, ACOG, ABM, and elsewhere was developed by an interdisciplinary team and provided to pilot practices. The toolkit included a menu of “potentially better practices” (PBPs) that could be implemented individually, or as a bundle. Success of this project relied on use of rapid Plan-Do-Study-Act (PDSA) cycles. Pilot practices were educated on basic QI procedures, data collection, toolkit content, etc. and shared experiences through monthly webinars called “Huddles”. Regional trainings were also provided at various intervals by the TIPQC staff. Before implementation of a PBP, each practice collected their baseline breastfeeding rate at the 4-8 week postpartum visit. Practices used a web-based, HIPAA-compliant data-entry system through REDCap. The project was reviewed and approved by the Institutional Review Boards (IRBs) of participating pilots, and funded under an agreement with the state of Tennessee. PBPs implemented by the pilot practices included: - Providing resident and provider education - Distributing written literature on breastfeeding benefits and advice - Providing written breastfeeding prescriptions - Having patients view educational breastfeeding videos - Creating a breastfeeding-friendly office environment Baseline pilot data revealed that at presentation for the first postpartum visit, 28.1%, 23%, and 49% of mothers were exclusively feeding breastmilk, feeding a mix of breastmilk and formula, and exclusively feeding formula, respectively (n=196). Baseline data was successfully collected, and early data following the first PDSA has been collected across the four pilot participants. For participating practices, this is the first time they have systematically looked at their 6-week breastfeeding rates. Open communication and brainstorming across the various practices has been very helpful. A numbers of challenges have been cited, including time constraints related to large volumes of patients and inability to extract data electronically, coordination of efforts among large numbers of providers and staff who may be unfamiliar with breastfeeding, and a need for more family, hospital, and community provider support for breastfeeding. Discussion: This quality improvement prenatal breastfeeding promotion pilot project provides insight into the process of team building and use of thin data sets to drive practice level improvement, and lays the groundwork for statewide spread, where challenges encountered in the pilot centers can be addressed. Participants are now looking at the reliability of their implementation, and determining whether their initial selections from the menu/toolkit were effective.

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Thesis M. Med.(Family Medicine))University of Limpopo (Medunsa Campus), 2010. / The experience of child birth occurs in all cultures and is important for the continuation of a community. Beliefs related to pregnancy and child birth though usually harmless may at times be detrimental to the health and well being of women that may practice them. The adherence to such beliefs depends on the socio cultural background of individuals and the importance they place on their cultural practices. Aim and objectives The study aimed to explore the health beliefs regarding pregnancy and childbirth of women attending the antenatal clinic at Chawama Health Center in Lusaka Zambia. The main study objectives were to determine the demographic characteristics of the women and ascertain their beliefs regarding diet, behaviour and belief in the use of herbs during pregnancy, delivery and the post natal period. Methods A descriptive, cross-sectional survey was conducted. A 32 item questionnaire was administered to 294 women over a four week period by two research assistants, after obtaining informed consent. Results Results indicate that traditional beliefs were wide spread among the participants though few significant associations were demonstrated. Dietary beliefs that what is eaten could ix affect the progress of labor or the unborn child’s appearance or behaviour were popular. Negative behaviour such as quarrelling or infidelity was believed could lead to difficult labour or adverse outcomes. Herbs were generally believed to be useful for certain indications such as to assist labour or for ‘cleansing’ after miscarriage. Conclusion Health beliefs regarding pregnancy and child birth are an integral part of the community and to be discussed in order to have some influence on them. Continued dialogue is recommended though current clinic health education sessions and qualitative studies to explore other beliefs and myths that are arising out of new health concerns such as HIV.

<p><strong>ABSTRACT</strong></p><p>Parental support is needed because it promotes a positive development in children, because parents ask for it and because it has positive effects on the public economy. Those responsible in Sweden for Child health care have shown an increased interest in supporting parenthood.</p><p><em>Aim:</em> The overall purpose of this study was to investigate what kind of support parents today desire from child health care. An additional purpose was to investigate if they feel their needs and wishes are met.</p><p><em>Method:</em> The study has a descriptive and qualitative design. The selection was eight parents of children under eighteen months of age: four mothers and four fathers. None of the participants were couples. Data collection was performed with semi structured interviews. Collected data were analyzed according to qualitative content analyses.</p><p><em>Results: </em>Two themes appeared: desired support –<em> </em>the child in focus and organisation – no place for fathers. Seven categories emerged: expectations before the child was born – the health of the child in focus and someone to call, expectations today – the health of the child and support in parenthood, seeking support from others than the Child health care, accessibility is important, continuity creates safety, the purpose of parent education group satisfactory & home visits – from ambivalent to positive experience. The study shows that the informants wants that Child health care focuses on the growth and development of the child, supports parents in their new role as parents and is accessible if the parents have questions. The informants were to great extent content with the support from the child health centre.</p><p><em>Conclusion:</em> According to parents wishes Child health care should focus on the child and it’s health along with strengthening the parents in their new role. The accessibility must improve to make the child health care centre a place even for fathers.</p><p><strong>Key words</strong></p><p>Child health centre, parents, support, desire, expectations.</p>

The purpose of this study was to describe the lived experience of hope for mothers of premature infants in the Neonatal Intensive Care Unit (NICU). This study was grounded in the existential-phenomenologic philosophy of Merleau-Ponty. A purposive sample of six mothers of infants born between 23 ½ and 31 weeks gestation were interviewed by the researcher 10 months to 2 ½ years after birth. Mothers were asked to think back to when their infant was in the NICU and tell about a specific time when they were aware of hope. Interviews were transcribed verbatim and analyzed following a hermeneutic process developed by Thomas & Pollio (2002). Data analysis revealed consistent themes across participants. The contextual ground was the World of the NICU—a world in which uncertainty, powerlessness, and the marking of time from admission until discharge were set against the backdrop of an unfamiliar environment perceived as negative by mothers. In this context hope emerged from within the mother-infant relationship. Three themes were figural in the mothers’ experience of hope: 1) hope and the infant, 2) hope and others, and 3) hope and the mother. Mothers took their cues to have hope directly from their infant(s). Discouraging or encouraging events dictated the extent to which mothers felt hopeful. Others had a powerful influence, either supporting or threatening mothers’ fragile hope. Sub-themes in hope and the mother were: 1) lack of knowledge/uncertainty, 2) lack of control/powerlessness, and 3) feeling like a mother. Noteworthy findings included the delayed onset of an awareness of hope—often several weeks after birth. Mothers focused solely on their infants; others became figural as they affected hope within the mother/infant dyad. They appreciated nurses who went the extra mile to encourage hope. The negative attitude or biting words of a single nurse quickly destroyed hope. Mothers rarely mentioned fathers, which suggests their lesser role in supporting hope. Mothers used the internet to reach out to others as there was limited opportunity for parent-to-parent interaction. They felt constrained to interact with other families by the emphasis on privacy related to HIPAA rules.

Résumé L’anémie est un problème de santé publique très répandu, avec des conséquences majeures sur la santé humaine et le développement économique et social. Elle affecte avec prédilection les jeunes enfants et les femmes enceintes. Ce travail avait pour objectifs d’analyser la situation de l’anémie chez les enfants âgés de 6-23 mois du district rural de Kongoussi (Burkina Faso), et de tester l’efficacité de stratégies intégrées de lutte. Il a consisté en deux enquêtes transversales et deux études d’intervention en population, menées entre janvier 2004 et juin 2006. La prévalence (IC à 95%) de l’anémie était de 98,8% (97,6 ; 99,9) parmi ces enfants, et la prévalence (IC à 95%) de l’anémie sévère de 29,5% (23,9 ; 35,0). Parmi les enfants présentant une anémie, 65,1% avaient une anémie hypochrome. Les enfants ne présentant pas de retard de croissance avaient un taux moyen (ES) d’hémoglobine plus élevé que les enfants présentant un retard de croissance : 81,1 (2,6) contre 77,2 (2,8) g/L, (p=0,026). La prévalence (IC à 95%) du retard de croissance était de 35,8% (29,4 ; 41,1). Le retard de croissance était associé aux pratiques d’alimentation de complément chez les enfants âgés de 12-23 mois. L’indice z-score de la taille pour l’âge était en moyenne (DS) de -1,33 (0,63), -1,61 (0,30), et -2,11 (0,32) chez les enfants pour lesquels étaient utilisées des céréales fortifiées, chez les enfants pour lesquels étaient utilisées des céréales non fortifiées, et chez les enfants qui ne recevaient pas d’aliments de complément, respectivement (p=0,018). L’infection à Plasmodium falciparum était présente chez 52,6% des enfants, 25,6% étant non fébrile et 27,0% fébrile. En comparaison aux enfants non infectés, les enfants ayant une infection fébrile, mais aussi ceux ayant une infection non fébrile avaient un taux d’hémoglobine plus faible, les différences (ES) étant de 7,86 (1,75) g/L avec p<0,001 et de 3,52 (1,74) g/L avec p=0,044, respectivement. Dans un contexte de prise en charge préventive et curative du paludisme et des géohelminthases, la supplémentation en fer pendant 6 mois a conduit à une augmentation moyenne (DS) du taux d’hémoglobine de 16,3 (13,6) g/L (p<0,001), alors que cette augmentation a été de 22,8 (14,6) g/L (p<0,001) pour la supplémentation en micronutriments multiples, soit une différence (IC à 95%) de 6,5 (2,0 ; 11,1) avec p=0,003. La supplémentation en fer conduisait à une réduction de la prévalence de l’anémie de 40,6%, alors que cette réduction était de 62,0% avec la supplémentation en micronutriments multiples, soit un ratio ajusté de prévalences de guérison [PRR (IC à 95%)] de 1,62 (1,22 ; 2,15), p<0,001. Une farine améliorée à été produite à partir d’ingrédients disponibles localement ; elle se composait de petit mil (51,7%), haricots (8,8%), arachide (7,8%), malt de sorgho rouge (9,0%), soumbala (9,3%), sucre (12,7%), et de sel iodé (0,8%). La bouillie améliorée préparée avec cette farine avec une consistance de 120 mm/30 s (distance d’écoulement dans un consistomètre de Bostwick) avait une densité énergétique de 103 kcal/100 g, une teneur en fer de 2,6 mg/100 kcal, et une teneur en zinc de 1,2 mg/100 kcal. La production de la farine et la préparation de la bouillie étaient reproductibles par les ménagères. La consommation de bouillie à chaque session était en moyenne de 29 ou 28 g/kg de poids corporel/repas, correspondant à 108 ou 105% de la consommation souhaitée, alors que la présence au centre de nutrition ouvert dans le village n’était que de 68 ou 58%, dans le groupe consommant la bouillie sans supplément de micronutriments et le groupe consommant la bouillie avec un supplément de micronutriment multiples, respectivement. Dans un contexte de prise en charge préventive et curative du paludisme et des geohelminthases la consommation de la bouillie améliorée sans supplément de micronutriments conduisait à une augmentation du taux d’hémoglobine de 14,8 (11,8) g/L (p<0,001), et la consommation de la bouillie améliorée avec des suppléments de micronutriments multiples entraînait une augmentation de 17,3 (15,8) g/L (p<0,001), soit une différence (IC à 95%) de 3,5 (-1,0 ; 8,1) g/L (p=0,13). La prévalence de l’anémie en fin d’intervention était de 67,9% et de 55,6% dans les groupes BA et BAM, respectivement (p=0,13) Ces résultats soulignent la nécessité de mesures permettant de réduire rapidement la prévalence de l’anémie chez les enfants âgés de 6-23 mois de ce district. La stratégie de supplémentation en micronutriments multiples combinée à la prise en charge préventive et curative du paludisme et des géohelminthiases est la stratégie à préférer. La supplémentation en micronutriments multiples pourrait être relayée progressivement par la stratégie basée sur une alimentation de complément améliorée au niveau des ménages, toujours dans un contexte de prise en charge préventive et curative du paludisme et des géohelminthases. Intégrés dans la routine des ménages et soutenus par une formation et une éducation nutritionnelles, les procédés de production de farine puis de bouillie améliorée devraient avoir une plus grande portée sur la prévention de l’anémie à moyen et long termes. Summary Anaemia is a widespread public health problem with major consequences for human health as well as social and economic development. Pregnant women and young children are the most affected. This work aimed at 1) analysing the anaemia situation among children aged 6-23 months of the rural district of Kongoussi (Burkina Faso), and 2) assessing the efficacy of integrated strategies. Two cross-sectional and two randomised, population-based studies were conducted over the January 2004-June 2006 period. The prevalence (95% CI) of anaemia was 98.8% (97.6 ; 99.9); that of severe anaemia was 29.5 (23.9 ; 35.0). Hypochromia was retrieved in 65.1% of anaemic children. Mean (SE) haemoglobin concentration was higher in non-stunted children [81.1 (2.6) g/L] than in their stunted counterparts [77.2 (2.8) g/L], p=0.026. The prevalence (95% CI) of stunting was 35.8% (29.4 ; 41.1). After adjustment for children, mothers and household characteristics, and for current and past breastfeeding patterns, the height-for-age z-score (HAZ) remained associated with the mode of complementary feeding among children aged 12-23 months. The adjusted mean HAZ (SE) was –1.33 (0.63), -1.61 (0.30), and –2.11 (0.32) among children consuming fortified cereals, unfortified cereals, or no complementary food, respectively (p=0.018) Plasmodium falciparum infection was noted in 52.6% of children with 25.6% being afebrile and 27.0% being febrile. Compared to uninfected children, children with febrile infection and those with afebrile infection had lower haemoglobin concentration, the differences (ES) being 7.86 (1.75) g/L (p<0.001) and 3.52 (1.74) g/L (p=0.044), respectively. Combined with malaria and geohelminths preventive and curative care, daily iron supplementation for 6 months led to a mean increase (SD) of haemoglobin concentration of 16.3 (13.6) g/L (p<0.001), whereas the increase was 22.8 (14.6) g/L (p<0.001) with daily multiple micronutrients supplementation. The difference (95% CI) of haemoglobin concentration at the end of intervention was of 6.5 (2.0 ; 11.1), p=0.003. Iron supplementation reduced the prevalence of anaemia by 40.6%, while the reduction was of 62.0% with the multiple micronutrients supplementation. The prevalence rate ratio [PRR (95% CI)] of children who were cured from anaemia at the end of intervention was 1.62 (1.22 ; 2.15), p<0.001. A new, local-ingredient-based flour was developed to prepare an improved mush for children. It was composed of pearl millet (51.7%), beans (8.8%), peanuts (7.8%), malted red sorghum (9.0%), soumbala (9.3%), sugar (12.7%) and iodized salt (0.8%). When this improved mush was prepared with a consistency of 120 mm/30 s (Bostwick flow distance), its volumetric mass, energy density, iron content and zinc content are 103 g/100 ml, 103 kcal/100 g, 2.6 mg/100 kcal, and 1.2 mg/100 kcal respectively. The flour production and mush preparation were reproducible by rural housewives. The average mush consumption was 29 and 28 g/kg body weight/meal, corresponding to 108 and 105% of the desired consumption, whereas the child’s presence at the nutrition centre that was opened in his village was 68 and 58%, in the group consuming the mush without micronutrient supplement (MG) and that consuming the mush with a multiple micronutrients supplement (MMG). Mean (SD) haemoglobin concentration increased of [14.8 (11.8) g/L, p<0.001] in the MG and [17.3 (15.8) g/L, p<0.001] in the MMG. The between group difference (95% CI) of 3.5 (-1.0 ; 8.1) g/L in mean (SD) endpoint haemoglobin concentration was not significant (p=0.13). The prevalence of anemia at the end of intervention was 67.9% and 55.6% in the MG and MMG, respectively (p=0.13) These results underline the need of urgent actions to rapidly reduce the prevalence of anemia. The multiple micronutrients supplementation combined with malaria and geohelminths preventive and curative care is the strategy to prefer. However, this strategy could be progressively replaced by that including complementary feeding improvement. To increase the mush consumption and better meet the needs of young children, flour and mush production must enter the routines of individual households. If this integration is to succeed, it should be supported by a large-scale program of training and nutrition education.

ABSTRACT Parental support is needed because it promotes a positive development in children, because parents ask for it and because it has positive effects on the public economy. Those responsible in Sweden for Child health care have shown an increased interest in supporting parenthood. Aim: The overall purpose of this study was to investigate what kind of support parents today desire from child health care. An additional purpose was to investigate if they feel their needs and wishes are met. Method: The study has a descriptive and qualitative design. The selection was eight parents of children under eighteen months of age: four mothers and four fathers. None of the participants were couples. Data collection was performed with semi structured interviews. Collected data were analyzed according to qualitative content analyses. Results: Two themes appeared: desired support – the child in focus and organisation – no place for fathers. Seven categories emerged: expectations before the child was born – the health of the child in focus and someone to call, expectations today – the health of the child and support in parenthood, seeking support from others than the Child health care, accessibility is important, continuity creates safety, the purpose of parent education group satisfactory &amp; home visits – from ambivalent to positive experience. The study shows that the informants wants that Child health care focuses on the growth and development of the child, supports parents in their new role as parents and is accessible if the parents have questions. The informants were to great extent content with the support from the child health centre. Conclusion: According to parents wishes Child health care should focus on the child and it’s health along with strengthening the parents in their new role. The accessibility must improve to make the child health care centre a place even for fathers. Key words Child health centre, parents, support, desire, expectations.

Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 7 uppsatser.

Thesis (Ph. D.)--University of Washington, 2003. / Vita. Includes bibliographical references (leaves 127-134).