Child Health Clinics Research Articles

Prenatal and postnatal exposure to NO2 and rapid infant weight gain - A population-based cohort study.

Childhood overweight and obesity is a global public health problem. Rapid infant weight gain is predictive of childhood overweight. Studies found that exposure to ambient air pollution is associated with childhood overweight, and have linked prenatal exposure to air pollution with rapid infant weight gain. To examine the association between prenatal and postnatal ambient NO2 exposure, a traffic-related marker, with rapid weight gain in infants. We carried out a population-based historical cohort study using data from the Israeli national network of maternal and child health clinics. The study included 474,136 infants born at term with birthweight ≥2500 g in 2011-2019 in central Israel. Weekly averages of NO2 concentration throughout pregnancy (prenatal) and the first 4 weeks of life (postnatal) were assessed using an optimized dispersion model and were linked to geocoded home addresses. We modelled weight gain velocity throughout infancy using the SuperImposition by Translation and Rotation (SITAR) method, a mixed-effects nonlinear model specialized for modelling growth curves, and defined rapid weight gain as the highest velocity tertile. Distributed-lag models were used to assess critical periods of risk and to measure relative risks for rapid weight gain. Adjustments were made for socioeconomic status, population group, subdistrict, month and year of birth, and the alternate exposure period - prenatal or postnatal. The cumulative adjusted relative risk for rapid weight gain of NO2 exposure was 1.02 (95% confidence intereval [CI] 1.00, 1.04) for exposure throughout pregnancy and 1.02 (95% CI 1.01, 1.04) for exposure during the first four postnatal weeks per NO2 interquartile range increase (7.3 ppb). An examination of weekly associations revealed that the critical period of risk for the prenatal exposure was from mid-pregnancy to birth. Prenatal and postnatal exposures to higher concentrations of traffic-related air pollution are each independently associated with rapid infant weight gain, a risk factor for childhood overweight and obesity.

Integrating PrEP in maternal and child health clinics in Kenya: analysis of a service availability and readiness assessment (SARA) survey.

Risk of HIV acquisition is high during pregnancy and postpartum, and pre-exposure prophylaxis (PrEP) is recommended for peripartum populations. Integrating PrEP into maternal and child health (MCH) clinics is feasible and acceptable. Understanding clinics' service availability and readiness is essential for effective scale up. The PrEP in Pregnancy, Accelerating Reach and Efficiency study (PrEPARE; NCT04712994) engaged PrEP-experienced facilities previously linked to a programmatic or research study in Western Kenya to document available services and commodities via a modified service availability and readiness assessment (SARA) survey with 20 PrEP tracer items covering: staffing/guidelines, services/equipment, and medicines/commodities. Facilities' prior study engagement occurred between 2017 and 2019; SARA survey data was collected between April 2020 and June 2021. Descriptive statistics were stratified by prior study engagement. ANOVA tests assessed associations between facility characteristics and gaps. Fisher's tests assessed differences in commodity availability and stockouts. Of the 55 facilities surveyed, 60% had received PrEP training in the last two years, 95% offered PrEP integrated into MCH, and 64% and 78% had both auditory and visual privacy in PrEP and HIV testing service (HTS) delivery spaces, respectively. Supervision frequency was heterogeneous, but 82% had received a supervision visit within 3 months. Availability of commodities was variable and the most commonly unavailable commodities were PrEP in MCH (71% available) and risk assessment screening tool (RAST) and PrEP cards (60% and 75% available, respectively). The number of service and commodity gaps per facility ranged from zero to eight (median: 3; IQR: 2, 5). The most frequent gaps were: PrEP training and risk assessment cards (40% each), lack of privacy in PrEP (36%) and HIV testing services (31%) spaces, PrEP pills in MCH (29%), and PrEP cards (25%). There were no differences in mean number of gaps by county, previous study engagement, or public vs. private status. Level 4 facilities had fewer gaps (mean 2.2) than level 2, 3, and 5 facilities (mean 5.7, 4.5, and 5.3 respectively; p < 0.001). PrEP service availability and readiness was generally high across MCH facilities. However, there is a need for increased frequency of provider training and supportive supervision focused on fidelity. To address key commodity stockouts such as PrEP pills, implementation of electronic logistics management information systems may be needed. Targeting these gaps is essential to effectively scale up integrated PrEP delivery, especially among facilities with limited infrastructure.

Parents’ expectations regarding media use among children up to 6 years of age

AimTo describe parents’ expectations concerning information sources and counseling related to media use by children up to six years of age. DesignQualitative descriptive design. MethodsData were collected by interviewing the parents (n=20) between January and March 2020. A qualitative content analysis was used. ResultsThree main themes emerged: family media use, parents’ expectations of information and counseling sources, and parents’ expectations of the content of information and counseling. Parents reported that their children’s screen time varied from one to 2 ​h per weekday. Child health clinics and Early Parenthood Education and Care Centers were the most used information and counseling sources related to children’s media use. Parents expected conversations, brochures, and advice for appropriate websites at child health clinics and parents’ evenings. They considered it important to have trustworthy websites where they could search for reliable, current, and empirical information related to children’s media use. Parents expected that the information provided would include children’s media-use recommendations, information regarding the advantages and disadvantages of children’s media use, parents’ responsibility in children’s media use, and parent-child media co-use.

Child Health Essential Skills Stations (CHESS): Development, Implementation, and Evaluation of an Undergraduate Child Health Clinical Skills Course

Background: Teaching undergraduate medical students clinical skills in a child health setting is a particular challenge for clinical educators. Students spend less time with pediatric patients and have fewer opportunities to practice clinical skills. The coronavirus (COVID-19) pandemic further reduced students’ opportunities to observe and practice skills in the workplace. This has necessitated a greater shift towards teaching skills in a "skills lab" setting, which allows for simulated practice in a safe environment. This study reports the design, implementation, and evaluation of a standardized course that utilizes the "skills lab" to train undergraduate medical students in five clinical skills important to child health. Objectives: This study aimed to implement and evaluate a standardized undergraduate clinical skills course for child health and improve students' confidence in performing child health clinical skills. Methods: Evaluations were carried out over approximately one academic year, with a total of 174 participants from a single medical school in the United Kingdom. Qualitative and quantitative data were collected, examining students' self-reported confidence (pre- and post-course) along with free-text course evaluations. A paired t-test was used to calculate the mean difference in students' pre- and post-course confidence scores. Qualitative evaluations were analyzed for themes using framework analysis. Results: The students had greater confidence in all measured learning outcomes following the course. Qualitative data, examined using framework analysis, suggested that the course was valued by students, who felt it was relevant to their future practice. Numerous written comments suggested particular content and teaching methods that were strengths of the course, including practical elements, small group teaching, and feedback from tutors. Conclusions: Implementing a child health clinical skills course in a skills lab setting is feasible and valued by students. The course increased the self-reported confidence of the studied cohort and might therefore support them in practicing these skills with actual patients. Further studies are required to determine whether these effects demonstrate longevity and whether they translate to increased competence in performing the taught skills.

Changing praxis from within - an in-depth qualitative exploration of how home visits affected statutory service at a Child Health Clinic

PurposeThis study aims to define critical domains of salutogenic home visits conducted by public health nurses, and how thevisits can supplement a universal Child Health Clinic. Design and methodA qualitative grounded theory study was conducted among three public health nurses in Stovner district, Oslo, Norway. The nurses were followed for 26 months offering home visits to all first-time parents. Data from focus group discussions, monthly reflection notes and bi-weekly meeting minutes were analysed using qualitative content analysis. ResultsThree critical themes emerged: building trust, prenatal visits and maintaining a salutogenic, strength-based approach. Extended public health nurse autonomy facilitated tailored support based on individual family needs. This promoted proportionate universalism to naturally be the gradient of the home visit intensity and kept actions at a universal level. ConclusionsThe key component of family access and utilizing support was building and maintaining trust. Conducting prenatal visits was an important part of the nurse-family relationship, positively affecting later Child Health Clinic follow-up and continued care. Practice implicationsCritical domains and benefits of practicing home visits emerged in this study and disclosed important aspects necessary for family access and utilizing support. By changing the point of entry from postnatal to prenatal, public health nurses-family relationship gets an important head start, positively affecting later follow-up and continued care. A tailored support to new families without using a predefined agenda and a salutogenic, strength-based philosophy can fit the public health nurses' professional beliefs and extend their autonomy.

Knowledge, attitude and practice towards pelvic floor muscle training among childbearing women

This study aims to identify knowledge, attitude, and practice of pelvic floor muscle training (PFMT) and to identify the prevalence of urinary incontinence. The method used was a cross-sectional study. Self-administered knowledge, attitude, and practice questionnaires were distributed among childbearing women attending Maternal & Child Health Clinics in the East Coast region of Malaysia. The findings revealed that most respondents (N = 896) had good or moderate knowledge (80.1%) and attitudes (77.3%) regarding PFMT but most of them (87.2%) still lacked practice. However, there was no association between urinary incontinence and PFMT practice. On the contrary, married women showed a higher risk of urinary incontinence. The practice of pelvic floor muscle training should be recommended and emphasized to childbearing women by healthcare professionals.

Factors associated with inadequate urinary iodine concentration among pregnant women in Mbeya region Tanzania.

Background: Insufficient and excessive iodine intake during pregnancy can lead to serious health problems. In Tanzania, information available on iodine status during pregnancy is minimal. The aim of this study was to assess the iodine status and its association with socio-demographic factors in pregnant women in the Mbeya region, Tanzania. Method: A cross sectional survey involving 420 pregnant women (n=420) registered in Reproductive and Child Health Clinics was conducted. Data were collected via interviews and laboratory analysis of urinary iodine concentration (UIC). Results: Median UIC was 279.4μg/L (+/-26.1) to 1915μg/L. Insufficient iodine intake (UIC below 150μg/L) was observed in 17.14% of participants, sufficient intake in 24.29% and 58.57% had intakes above the recommended level (&gt;250μg/L). Pregnant women who consume fish had an increased risk of insufficient iodine [Adjusted OR7= 2.60 (95%CI 1.31-5.15)] while the risk was lower for those who attended primary education compared to non-formal education [Adjusted OR= 0.29 (95%CI 0.08-0.99)]. Pregnant women resident in Mbarali district aged between 35-49 years were associated with an increased risk of UIC above recommended level [Adjusted OR=4.09 (95%CI 1.85-9.010] and [Adjusted OR=2.51 (95%CI 0.99-6.330] respectively . Conclusion: This study demonstrated a significant relationship between geographical factors (residence in the Mbarali district) and excess median urine iodine concentration, in addition, this study also found an association between consumption of freshwater fish and insufficient mean urine iodine concentration as indicated by the World Health Organization recommendation. Therefore, educational programs on iodine intake are needed as attending primary education was found to be a protective factor for insufficient median urine iodine concentration.

The effects of revised peer-counselor support on the PMTCT cascade of care: results from a cluster-randomized trial in Kenya (the EMMA study)

BackgroundThis study evaluated the effect of revisions to existing peer-counselor services, called Mentor Mothers (MM), at maternal and child health clinics on medication adherence for women living with HIV (WLWH) in Kenya and on early infant HIV testing.MethodsThe Enhanced Mentor Mother Program study was a 12-site, two-arm cluster-randomized trial enrolling pregnant WLWH from March 2017 to June 2018 (with data collection through September 2020). Six clinics were randomized to continued MM-supported standard care (SC). Six clinics were randomized to the intervention arm (INT = SC plus revised MM services to include more one-on-one interactions). Primary outcomes for mothers were defined as: (PO1) the proportion of days covered (PDC) with antiretroviral therapy (ART) ≥ 0.90 during the last 24-weeks of pregnancy; and (PO2) ≥ 0.90 PDC during the first 24-weeks postpartum. Secondary outcomes were infant HIV testing according to national guidelines (at 6, 24, and 48 weeks). Crude and adjusted risk differences between study arms are reported.ResultsWe enrolled 363 pregnant WLHV. After excluding known transfers and subjects with incomplete data extraction, data were analyzed for 309 WLWH (151 SC, 158 INT). A small share achieved high PDC during the prenatal and postnatal periods (0.33 SC/0.24 INT achieved PO1; 0.30 SC/0.31 INT achieved PO2; crude or adjusted risk differences were not statistically significant). In addition, ~ 75% in both study arms completed viral load testing during year two after enrollment, with > 90% suppressed in both arms. For infants, ≥ 90% in both arms had at least one HIV test through study follow up (76 weeks) but testing on schedule according to PMTCT guidelines was uncommon.ConclusionsWhile national guidelines in Kenya recommended that all HIV-infected pregnant women take a daily antiretroviral regimen for life following a HIV diagnosis, results presented here indicate that a minor share achieved high medication coverage during the prenatal and postnatal periods analyzed. In addition, adjustments to Mentor-Mother services showed no improvement in study outcomes. The lack of effect for this behavioral intervention is relatively consistent with the existing literature to improve mother-infant outcomes along the PMTCT care cascade.Clinical Trial NumberNCT02848235. Date of first trial registration 28/07/2016.

Knowledge, Attitude and Practices regarding Exclusive Breastfeeding Among Mothers Attending Maternal Child Health Clinic at Kitagata Hospital, Sheema District, Uganda

Knowledge, Attitude and Practices regarding Exclusive Breastfeeding Among Mothers Attending Maternal Child Health Clinic at Kitagata Hospital, Sheema District, Uganda

Knowledge, Attitude and Practices regarding Exclusive Breastfeeding Among Mothers Attending Maternal Child Health Clinic at Kitagata Hospital, Sheema District, Uganda

Knowledge, Attitude and Practices regarding Exclusive Breastfeeding Among Mothers Attending Maternal Child Health Clinic at Kitagata Hospital, Sheema District, Uganda

Understanding factors influencing home pregnancy test use among women in western Kenya: A qualitative analysis.

There are limited data on home pregnancy test use among women in low-and-middle-income countries. A prior survey found that only 20% of women in western Kenya used a home pregnancy test to confirm their pregnancies before going to antenatal care. This qualitative study aims to understand why women do not use home pregnancy tests in early pregnancy. From April 2021 to July 2021, we interviewed women from four antenatal care clinics in Homa Bay and Siaya counties. We recruited women previously enrolled in the PrEP Implementation for Mothers in Antenatal care (PrIMA) study, a cluster-randomized trial that evaluated the best approaches to implementing PrEP in maternal and child health clinics in Western Kenya (NCT03070600). Interviews were conducted via phone, audio recorded, translated, and transcribed verbatim. We coded and analyzed the transcripts to capture factors influencing women's capability, opportunity, and motivation to use home pregnancy tests. We conducted 48 semistructured interviews with women aged 21-42 years. Twenty-seven women did not use a home pregnancy test in their most recent pregnancy. Seventeen of these women reported not using a home pregnancy test before. Lack of knowledge, mistrust in the accuracy of tests, preferring to rely on signs and symptoms of pregnancy or get a test from the health facility, cost, and accessibility were key barriers to home pregnancy test use. Improving the uptake of home pregnancy testing during early pregnancy will require efforts to enhance community knowledge of test use and associated benefits and reduce cost burdens by making tests more affordable and accessible.

Health-related quality of life measured by SF-36 among postdelivery mothers attending maternal and child health clinic in Eastern Nepal: a cross-sectional study.

This was a cross-sectional study using nonprobability sampling conducted at a Maternal and Child Health (MCH) Clinic in Nepal. The study participants were 129 women postdelivery to 12 months who visited the MCH Clinic from 2 September 2018 to 28 September 2018. Outcome measures were sociodemographic, clinical indicators, obstetric indicators, and their relation with the overall HRQoL score of postdelivery mothers using the Short Form Health Survey (SF-36) Version 1. Of 129 respondents, 68.22% were in the 21-30 age group, 36.43% were upper caste, 88.37% were Hindu, 87.60% were literate, 81.39% were homemakers, 53.49% with income less than 12 months, 88.37% had family support, and 50.39% with vaginal deliveries. HRQoL was significantly more in employed women (P=0.037), those with family support (P=0.003), and those who had a cesarean section (P=0.02) and wanted pregnancy (P=0.040). HRQoL in women postdelivery can be influenced by employment status, family support, type of delivery, and desirability of pregnancy.

PENGETAHUAN IBU TENTANG PEMBERIAN PARACETAMOL PASCA IMUNISASI DASAR DI UNIT BALAI KESEHATAN IBU DAN ANAK (BKIA) RUMAH SAKIT UMUM IMELDA PEKERJA INDONESIA MEDAN

Immunizations must be given to children from birth so that their bodies are protected from dangerous diseases. Complete basic immunizations that have fever side effects are DPT and measles immunizations, while BCG, polio and hepatitis B immunizations cause pain around the injection and redness. Antipyretics are used to treat high fever and seizures due to fever after immunization. This study aims to determine the level of experince of mothers about giving paracetamol after basic immunization to children at the mother and child health clinic (MCH) RSU Imelda Pekerja Indonesia Medan. The sample used in this study was 30 people. This research is a quantitative descriptive study with a time series approach. The results of this study indicate that the characteristics of the mother's greatest level of work are housewives (66.7%) and the highest level of education of mothers is high school (53.3%). The mother's level of experince about giving paracetamol after immunization showed that the mother had a good level of experince (70%). In addition, the type of immunization that was given the most to children was BCG immunization (40%), where the age of the most immunized children was 2 months (20%). In addition, each child who was given paracetamol after BCG immunization was 4 children (13.3%). The average age of mothers who bring their children immunized is 24-26 years old (16.7%).

Implementation of evidence-based multiple focus integrated intensified TB screening to end TB (EXIT-TB) package in East Africa: a qualitative study

IntroductionTuberculosis (TB) remains a major cause of morbidity and mortality, especially in sub-Saharan Africa. We qualitatively evaluated the implementation of an Evidence-Based Multiple Focus Integrated Intensified TB Screening package (EXIT-TB) in the East African region, aimed at increasing TB case detection and number of patients receiving care.ObjectiveWe present the accounts of participants from Tanzania, Kenya, Uganda, and Ethiopia regarding the implementation of EXIT-TB, and suggestions for scaling up.MethodsA qualitative descriptive design was used to gather insights from purposefully selected healthcare workers, community health workers, and other stakeholders. A total of 27, 13, 14, and 19 in-depth interviews were conducted in Tanzania, Kenya, Uganda, and Ethiopia respectively. Data were transcribed and translated simultaneously and then thematically analysed.ResultsThe EXIT-TB project was described to contribute to increased TB case detection, improved detection of Multidrug-resistant TB patients, reduced delays and waiting time for diagnosis, raised the index of TB suspicion, and improved decision-making among HCWs. The attributes of TB case detection were: (i) free X-ray screening services; (ii) integrating TB case-finding activities in other clinics such as Reproductive and Child Health clinics (RCH), and diabetic clinics; (iii), engagement of CHWs, policymakers, and ministry level program managers; (iv) enhanced community awareness and linkage of clients; (v) cooperation between HCWs and CHWs, (vi) improved screening infrastructure, (vii) the adoption of the new simplified screening criteria and (viii) training of implementers. The supply-side challenges encountered ranged from disorganized care, limited space, the COVID-19 pandemic, inadequate human resources, inadequate knowledge and expertise, stock out of supplies, delayed maintenance of equipment, to absence of X-ray and GeneXpert machines in some facilities. The demand side challenges ranged from delayed care seeking, inadequate awareness, negative beliefs, fears towards screening, to financial challenges. Suggestions for scaling up ranged from improving service delivery, access to diagnostic equipment and supplies, and infrastructure, to addressing client fears and stigma.ConclusionThe EXIT-TB package appears to have contributed towards increasing TB case detection and reducing delays in TB treatment in the study settings. Addressing the challenges identified is needed to maximize the impact of the EXIT-TB intervention.

Utilization of Antenatal Services among Postnatal Mothers.

Antenatal care is medical supervision and care given to pregnant women to ensure, support and maintain maternal and fetal well-being throughout the pregnancy. Therefore, this study was done to find out the utilization of antenatal services among postnatal mothers. The descriptive cross sectional study design was used to identify the utilization of antenatal services among postnatal mothers who came in Maternal and Child Health Clinic for the immunization of baby. Total 367 postnatal mothers within one year of childbirth were recruited by simple random sampling technique, and data was collected with face-to-face interview by using semi structured interview schedule. Analysis was done by using descriptive and inferential statistics. All postnatal mothers consumed iron and folic acid during pregnancy, 96.2% consumed until the childbirth, 94.0% got freely, 97.0% taken anti helminths drug, 98.1% did urine test, 98.1% did blood test, 97.8% got ultrasound service, and 96.5% received Td vaccine. Likewise, higher proportion had checked weight 98.6% and lower proportion had checked height 86.9%. Similarly, majority 90.2% received counselling on danger signs and only 26.2% received the counselling on preparation of items safe delivery and care of newborns. There is significant association of antenatal care service utilization with postnatal mothers' educational level and her husband's occupation (P<0.05 level). Although most of the postnatal mothers utilized antenatal care services, some aspect of antenatal education and counselling need to be improved such as preparation of item for delivery and new born care, finance, and blood donors.

Prevalence and Factors Associated with Mental Distress among Caregivers of Children with Mental Illness Attending Child and Adolescent Clinic at Muhimbili National Hospital, Dar Es Salaam

Background: Caregivers play an exceptionally important role in the lives of those they provide care for as well as to the healthcare system. The burden of caring for children with mental illness (CWMI) often falls on their caregivers, especially the mothers. Caregivers of CWMI experience significant challenges and are at an increased risk of experiencing mental distress than the general population. Resilience, emotion regulation, and social support are identified as protective factors against mental distress among caregivers. Objective: To determine the prevalence and factors associated with mental distress among caregivers of CWMI attending the child and adolescent mental health clinic at Muhimbili National Hospital (MNH) in Tanzania. Methodology: Hospital-based descriptive cross-sectional study was conducted at MNH Dar es Salaam, Tanzania. A purposive and convenient sample of 120 caregivers of CWMI attending the child and adolescent mental health clinic at MNH were recruited in the study. Interviewer-administered paperless questionnaire consisting of a socio-demographic questionnaire, self-reporting questionnaire (SRQ), 10-item Connor- Davidson Resilience Scale (CD-RISC), Emotion Regulation Questionnaire (ERQ), and Multidimensional Scale of Perceived Social Support (MSPSS) were used to collect data. Data were analyzed using SPSS version 28.0.1.1, where descriptive, bivariate and multivariate analyses were conducted. Results: Among the 120 caregivers studied, 97 (80.8%) were female, and 43 (35.8%) were aged between 35 – 44 years. Among the 120 participants 27 (22.5%) had mental distress, 35 (29.2%) had low resilience, 22 (81.7%) had low cognitive reappraisal, 27 (47.5%) had high expressive suppression, and 5% (6) had low perceived social support. All variables with a p-value of &lt; 0.20 in the bivariate analysis were entered into the multivariate analysis model, where the independent risk of mental distress was four times higher amongst those living out of ..........

Self-Reported Parental Healthy Dietary Behavior Relates to Views on Child Feeding and Health and Diet Quality.

The aim of this cross-sectional study was to investigate whether parental views on child feeding and its impact on health differ between those parents whose self-perception was that they followed a healthy diet to those who do not. Furthermore, differences in the child's diet quality and weight were compared between the groups. Parents of 2-6-year-old children (n = 738), recruited from child health clinics throughout Finland, answered semi-structured questionnaires on their views on child feeding and health as well as their child's diet quality. Participants were divided into two groups based on their self-perceived report of following a healthy diet: health-conscious (HC, n = 396) and non-health-conscious (non-HC, n = 342) parents. HC parents considered health, eating behavior, and nutrient-related factors more often when feeding their child than non-HC parents (<0.001 < p < 0.03). Moreover, they more commonly considered diet to have an important impact on their child's long-term health than the non-HC parents (<0.001 < p < 0.05). Children of HC parents were more likely to have a good diet quality (p = 0.01) and lower BMI-SDS values (p = 0.015) than those of non-HC parents. Parental health consciousness was linked with better diet quality and healthier weight in their children. This information may be useful in the regular clinical monitoring of children's health.

A Text Messaging-Based Support Intervention to Enhance Pre-exposure Prophylaxis for HIV Prevention Adherence During Pregnancy and Breastfeeding: Protocol for a Randomized Controlled Trial.

Cisgender women in Kenya are at elevated risk of HIV acquisition during pregnancy and post partum. Acute HIV infection during pregnancy and breastfeeding accounts for approximately one-third of all vertical HIV transmissions. The World Health Organization recommends offering oral tenofovir-based pre-exposure prophylaxis (PrEP) to pregnant and postpartum women who are HIV negative but at substantial and ongoing risk for HIV acquisition. PrEP delivery for pregnant and postpartum women is expanding within routine maternal child health clinics in Kenya. However, approximately half of pregnant women discontinue PrEP within 30 days of initiation. Therefore, it is crucial to develop PrEP adherence strategies that enhance support for adherence when peripartum events and health issues pose challenges to sustaining PrEP adherence. We are conducting a randomized controlled trial to determine the effect of a bidirectional communication platform named Mobile Solutions for Women's and Children's Health (mWACh), which utilizes two-way SMS text messaging between patients and remote nurses to support PrEP adherence and address maternal health concerns in real time during the peripartum period. The mWACh-PrEP study is a randomized trial designed to support PrEP adherence during the peripartum period by comparing mWACh-PrEP to the standard of care (ie, in-clinic adherence counseling) among women who are HIV negative and initiating PrEP. Purposive sampling was used to select 5 facilities offering PrEP in antenatal clinics in Kisumu and Siaya Counties, and block randomization will be used to divide participants into groups. Participants in the intervention arm will receive a customized messaging curriculum via SMS text messages targeted toward their particular perinatal stage. The primary outcome, PrEP adherence at 6 months post partum, will be evaluated using a log-binomial regression model, adjusting for imbalanced baseline characteristics. Based on a previous study of directly observed dosing conditions, we will use a hair tenofovir concentration cutoff of 0.038 ng/mg (corresponding to 7 doses/week) as the primary adherence outcome measured at 6 months post partum (binary outcome). Qualitative interviews and cost-effective analyses will be conducted to understand the feasibility, acceptability, and economic impact of the intervention. Enrollment began in March 2022 and is projected to continue until July 2023, with follow-up through March 2024. The study results are expected to be reported in 2025. This trial will provide insights into using mobile health to enhance PrEP adherence among pregnant and postpartum mothers. Additionally, the findings will have implications for the use of mobile health technology to improve adherence to other daily medications during the peripartum period. ClinicalTrials.gov NCT04472884; https://clinicaltrials.gov/ct2/show/NCT04472884. DERR1-10.2196/41170.

Wezesha Watoto: Implementation of Clinic-Based Developmental Screening in Kenya

Background: The importance of child developmental screening is gaining increased traction within low-resourced settings, but little is known about the implementation of screening programs within clinical systems. This study aimed to evaluate the acceptability, feasibility, fidelity, and sustainability of integrating a child developmental screening tool in a maternal and child health (MCH) clinic in western Kenya.&#x0D; Methods: This implementation study takes place within infrastructure of Academic Model Providing Access to Healthcare (AMPATH). Developmental screening was integrated into MCH care in September 2021 and is ongoing for children ages 18-36 months with perinatal HIV exposure. Feasibility, sustainability, and fidelity are measured with weekly time-motion analysis of clinic flow and daily clinic record review. Acceptability, feasibility, and sustainability were evaluated using semi-structured interviews of caregivers and clinic staff, completed at baseline and 6 months post-implementation. Mixed methods data were analyzed using descriptive statistics, thematic coding, and triangulation.&#x0D; Results: Since onset, 187 children were screened (69.8% of eligible children), with rate of screening consistent over time. Average time to complete screening is 5.4 minutes and decreasing over time. Perceived time of screening was inflated at baseline (≈16min) and 6 months (≈20min). Facilitators to screening included staff teamwork and caregiver cooperation. Lack of time and child’s mood were barriers. Caregivers appreciated others’ concern for their child’s development and noted ease in answering questions. Staff’s remarks were congruent, while emphasizing the need for motivating incentives for children and staff. At 6 months, staff noted screening had become routine. They desired feedback on performance and provided ideas for improvement. Caregivers frequently asked about availability of assistance if potential delays are identified during screening.&#x0D; Conclusion: The integration of developmental screening is aided by positive perceptions from both clinic staff and caregivers. Regular retraining, staff feedback, and referral resources may optimize integration. Research evaluating cost effectiveness is needed.

Breastfeeding practices among mothers attending a tertiary care hospital in Kashmir

Background: According to world health organization (WHO), exclusive breastfeeding (EBF) for the first 6 months of life is vital for optimal growth and development of a child. During this period, other liquids or breastfeeding substitutes should not be given to infants except for medicine or oral rehydration solution. Methods: This cross-sectional study was conducted in the child health clinic of the department of community medicine, SKIMS. The study participants were mothers accompanying their infants coming for immunisation at the child health centre. A semi-structured, questionnaire was used to interview the mothers regarding breast feeding practices of their infants. The data was entered in Microsoft excel 2010 and analysed using SPSS Version 20. Results: The prevalence of EBF was 38.7%. Mixed feeding was received by 54% and 7.3% were formula-fed. Variables that were significantly associated with EBF include residence and mother’s education. Infants from rural area were more likely to be exclusively breastfed compared to those from urban area (OR=0.365; 95% CI=0.166-0.802; p=0.012). Mothers with up to 9 years of formal education were more likely to exclusively breastfed their children than those with more than 9 years of formal education (OR=0.300;95% CI=0.121-0.744, p=0.009). Conclusions: To ensure that the rate of EBF among the mothers is increased, all the stakeholders (spouse, family and government) as well as the people at work place must play their part to the best extent.