United Nations International Children Research Articles

Perspectives about the baby friendly hospital/health initiative in Australia: an online survey

BackgroundEvidence supports the health and economic benefits of breastfeeding, and the positive impact of the Baby Friendly Health Initiative (BFHI) on increasing breastfeeding rates and improving breastfeeding outcomes. The BFHI is a World Health Organization and United Nations International Children’s Emergency Fund initiative to promote, support and maintain breastfeeding. The BFHI was updated in 2018 and includes the Ten Steps to Successful Breastfeeding (the Ten Steps 2018) and the International Code of Marketing of Breast-milk Substitutes (the WHO Code). Despite policy and guideline support for breastfeeding and the BFHI, there are currently only 70 accredited hospitals, healthcare centres and regional clusters in Australia, accounting for 23% of maternity facilities. This research aimed to explore health professionals and other stakeholders’ perspectives on the uptake and implementation of the BFHI in Australia from an organisational change perspective.MethodsAn online survey administered via relevant Australian-based professional associations was fully or partially completed by 332 participants who support mothers and newborns in their roles. Descriptive statistics and content analysis were used to analyse quantitative and qualitative data.ResultsThe majority of participants supported legislating the WHO Code, closely monitoring BFHI compliance, ensuring sufficient knowledge about breastfeeding and the BFHI among staff, improving care within maternity facilities, continuous support of mothers’ post-discharge, and improving social media support of breastfeeding. It was also perceived that an interdisciplinary team approach and multidisciplinary involvement were important requirements for successfully implementing the BFHI. There was no consensus among participants that Australian health policies support breastfeeding and the implementation of the BFHI.ConclusionsThis study emphasised the significance of legislation around the Code, executive and leadership support and culture, and providing adequate resources concerning uptake and implementation of the BFHI. Considering that uptake of the BFHI has been limited and no formal government support has been provided to further develop the BFHI and support the Code in Australia, findings of this research may help with potential future actions to facilitate the BFHI uptake and Code implementation.

Syrian Refugee Children And Mental Health Trauma

In 2015, the United Nations International Children’s Emergency Fund (UNICEF) named Syria as the most dangerous place on earth to be a child (UNICEF, 2). Since the onset of civil war in 2011, nearly 4.8 million Syrians are refugees outside of Syria and approximately 6 million are internally displaced (United Nations Office for the Coordination of Humanitarian Affairs, 2016). While some refugees have successfully resettled in North American and European nations, many remain in limbo in refugee camps. What is most staggering about the population of affected persons is that nearly half, approximately 6 million, are children (UNICEF, 2016). Nearly all of these children have been subjected to trauma that has manifested in a variety of ways. They have often been subjected to or witnessed violence and have experienced the loss of one or more of their caregivers. Refugees face difficulty accessing psychological and health services and are met with the stigma surrounding mental health in countries including Lebanon and Turkey, regions that many refugee children have fled to. In the absence of these supports, the mental trauma a child is experience can impact learning and development and have disastrous impacts on their future.

Mapping evidence on malnutrition screening tools for children under 5 years in sub-Saharan Africa: a scoping review protocol

BackgroundIn sub-Saharan Africa (SSA), malnutrition remains a major public health challenge, particularly among children under 5 years of age. Despite nutritional screening tools being developed and available to detect early malnutrition in under five-year-old children, malnutrition continues to be a health concern. However, the level of evidence on nutritional screening tools for predicting early malnutrition at the community level in a high disease burden setting is unclear. The objective of this scoping review is to systematically map the evidence on malnutrition screening tools for children under 5 years in sub-Saharan Africa (SSA) and to identify knowledge gaps.MethodsThe proposed study will be guided by an improved Arksey and O’Malley’s framework, Levac et al. 2010 recommendations, and the 2015 Joanna Briggs Institute guidelines. We will conduct a systematic search of relevant imperial sources of evidence from the following databases: CINAHL with full text, Academic search complete via EBSCOhost, Google Scholar, Science Direct, and PubMed. We will search for grey literature from the following humanitarian and aid organization websites: World Health Organization (WHO), The United Nations International Children’s Emergency Fund (UNICEF), and governmental departments. Following the database searches and title screening, eligible sources of evidence will be exported to an EndNote X9 reference library. Thereafter, duplicate articles will be removed in preparation for abstract and full article screenings. Data from the included sources of evidence will be extracted, and the emerging themes will be analyzed. The relationship between the emerging themes and the research questions will be critically examined. The quality of the included sources of evidence will be determined by using the Mixed Method Appraisal Tool (MMAT) version 2018. The search results will be presented in adapted Preferred Reporting Items for Systematic Reviews and Meta-Analysis: Extension for Scoping Reviews chart (PRISMA-ScR).DiscussionWe anticipate finding relevant literature on malnutrition screening tools for children under 5 years in SSA. This study is likely to reveal research gaps, which could guide future research on malnutrition screening tools.

Deadly Wells in Bangladesh

This case allows instructors to lay out the challenges of providing universal access to safe drinking water in some developing and emerging countries—one of the current UN development goals. The challenge across developing countries is to find long-lasting and sustainable solutions, and to realize that present answers to the challenge may be a far cry from these criteria. The discussion aims to address the complex and multifaceted nature of water supply in developing countries, and to emphasize that many of the assumptions made in advanced economies may not apply. The aim is to search for the best (long-lasting and sustainable) solutions, admitting there is no silver bullet, even though some alternatives are clearly better than others. Excerpt UVA-GEM-0158 Oct. 1, 2019 Deadly Wells in Bangladesh In the early 1980s, K.C. Saha from the Calcutta School of Tropical Medicine in India successfully related skin lesions in the Indian state of West Bengal to arsenic in groundwater. In 1992, researchers under the direction of Dipankar Chakraborti from the School of Environmental Studies at Jadavpur University came across an unusual female patient while they were active in the arsenic-affected village of Gobindapur in West Bengal. She was the only one in her West Bengali family with lesions, but she had migrated from Bangladesh after her marriage. It turned out that many of her Bangladeshi relatives had similar lesions, and she had noticed lesions in residents of neighboring Bangladesh villages as well. Soon suspicions were confirmed of arsenic contamination in Bangladesh. In 1994, the World Health Organization (WHO) and the United Nations International Children's Emergency Fund (UNICEF) were notified but slow to take action, as were Bangladeshi institutions. Reportedly in 1993, Bangladesh's Department of Public Health Engineering (DPHE) had already confirmed arsenic contamination in tube wells, which were PVC pipes with a cast-iron hand pump on top. The country and the international health community awoke to the reality and magnitude of the challenge in 1998, when an international conference was convened in Bangladesh's capital, Dhaka. In 2000, the Bulletin of the World Health Organization described Bangladesh's predicament in the strongest possible terms, which would resonate for many years to come: Bangladesh is grappling with the largest mass poisoning of a population in history because groundwater used for drinking has been contaminated with naturally occurring inorganic arsenic. It is estimated that of the 125million inhabitants of Bangladesh, between 35million and 77million are at risk of drinking contaminated water. The scale of this environmental disaster is greater than any seen before; it is beyond the accidents at Bhopal, India, in 1984, and Chernobyl, Ukraine, in 1986. . . .

Supporting Refugee Distance Education: A Review of the Literature

ABSTRACTThe sudden influx of refugees into countries around the world has caused a complicated, multi-faceted, international refugee crisis. Refugees, whether in camps or urban areas, face a myriad of problems and obstacles, yet one of the most critical issues young refugees face is the lack of educational opportunities and/or resources. United Nations International Children’s Emergency Fund warns that this lack of education could potentially create a “lost generation” which may lead to serious implications, not only for these young refugees but also to surrounding, nearby societies. This paper seeks to understand if and how Information and Communication Technology (ICTs) have been reported in the literature as being used in different contexts to connect young refugees with high quality educational opportunities, and whether the urban or camp contexts impact these opportunities. The results of this review of the literature indicate that a number of different ICTs have successfully been used in a variety of different educational settings and for a variety of purposes. Additionally, where a refugee lives could impact the accessibility and nature of the ICT tools available to provide an education.

BABY FRIENDLY HOSPITAL INITIATIVE: 25 YEARS OF EXPERIENCE IN BRAZIL.

ABSTRACTObjective: To describe the experience of the 25-year-old trajectory of the Baby Friendly Hospital Initiative (BFHI) in Brazil. The first unit was implemented in 1992.Methods: Information and data were collected from publications on the World Health Organization (WHO), the United Nations International Children’s Emergency Fund (UNICEF) and the Ministry of Health websites and in national and international journals, about the period 1990-2017. The descriptors used were: “iniciativa hospital amigo da criança”, “hospital amigo da criança”, “baby friendly initiative hospital”, “aleitamento materno” and “breastfeeding”. The number of hospitals in the 25 years, the course of the BFHI and its repercussions on breastfeeding in Brazil were evaluated.Results: The BFHI is an intervention strategy in hospital care at birth focused on the implementation of practices that promote exclusive breastfeeding from the first hours of life and with the support, among other measures of positive impact on breastfeeding, of the International Code of Marketing of Breastmilk Substitutes. Currently, the initiative has been revised, updated and expanded to integrate care for newborns in neonatal units and care for women since prenatal care. It can be concluded that, during these 25 years, the quantity of hospitals varied greatly, with numbers still below the capacity of hospital beds. BFHI shows higher rates of breastfeeding than non-accredited hospitals. However, the number of hospitals are still few when compared to other countries.Conclusions: The BFHI has contributed to breastfeeding in Brazil in recent decades. Greater support for public policies is needed to expand the number of accredited institutions in the country.

Vaccination coverage in Qatar: Benchmarking with global figures.

Introduction: Vaccination is considered one of the most successful and cost-effective public health interventions of the 20th century. In 2017, Qatar's Expanded Program of Immunization (EPI) provided vaccination services against a comprehensive list of 15 vaccine-preventable diseases. Objectives: To assess the performance of Qatar's national immunization system, identify possible gaps by determining the national vaccination coverage rates, and benchmark these rates against regional and global figures. Methods: The data utilized herein were retrieved from the vaccination coverage estimates generated by the World Health Organization and United Nations International Children's Emergency Fund. Relevant local, regional, and global vaccination coverage figures were manually extracted and then analyzed for six vaccines (DTP3, Pol3, MCV2, HepB, PCV3, and RotaC) in 2017. Percentages and proportions were compared using the Chi-squared test. Results: Vaccination coverage levels in Qatar have surpassed the optimal level of 90% for all vaccines. Compared with international figures, the national coverage exceeds the relevant benchmarks. For DTP3 and Pol3, Qatar achieved 97% coverage compared with 99% coverage in Jordan and 85% coverage globally. For MCV2, Qatar achieved 93% coverage compared with 99% coverage in Jordan and 67% coverage globally. For RotaC, Qatar achieved 97% coverage compared with 96% coverage in Jordan and 28% coverage globally. For HepB, Qatar achieved 97% coverage compared with 43% coverage globally. Conclusions: Compared with the international benchmarks of major vaccines, the vaccination coverage rates in Qatar are high. However, challenges for maintaining high coverage, such as cultural and language barriers, should be addressed.

Estimation of iodine content of commercially available consumable salts in and around Madhuranthagam, Tamil Nadu, South India

Iodine is an essential micronutrient in the thyroid hormone synthesis, hence inadequate or excess iodine may result in thyroid dysfunction. Hence the dietary iodine intake has to be monitored regularly for the recommended levels. With other confounding factors in dietary source, salt fortification with iodine was implemented by World Health Organisation (WHO) and United Nations International Children’s Emergency Fund (UNICEF) in 1993. Inspite of Universal Salt Iodization (USI), Hypothyroidism is believed to be a common health issue in India and Worldwide. Hence this study was done on a small scale primarily by estimating the salt iodine content of commercially available consumable salts. Salt packets were collected from the retail shops in and around Madhuranthagam. The iodine content in the salt samples was estimated and expressed in parts per mllion (p.p.m) based on the Titration method recommended by WHO. The results were analysed by the number of samples (in percentage) with adequate, less and excess iodine content as per the WHO recommendation. Keywords: Consumable salt iodine, Iodine status, Thyroid dysfunction, Hypothyroidism, Universal salt iodization (USI).

Breastfeeding Promotion and Baby-Friendly Health Facilities in Turkey: A Systematic Approach to Scale up the Program

Objectives: In Turkey, Breastfeeding Promotion and Baby-Friendly Health Facilities Program (BFHF) was launched in 1991 with the collaboration of the Ministry of Health (MoH) and United Nations International Children’s Emergency Fund (UNICEF). Since 2002, the program has been extended from hospitals to the primary health care services and the community level. This paper aims to present the current status of BFHF and development of new strategies to revitalize the program and thus, to contribute to the progress. Materials and Methods: All information about health facilities and provinces was collected from the database of the Child and Adolescent Health Department. Discussions about Initiative with stakeholder institutions and baby-friendly advocates took place in the National Breastfeeding Committee Meeting and in Annual Breastfeeding Symposium. Then a SWOT (strengths, weaknesses, opportunities, threats) analysis of the Program was performed by the working group. Using this analysis results, new strategies and course of action were identified. Results: The current number of baby-friendly hospitals has reached a total of 1051(69.42% of all hospitals). Of those, 46 were maternity hospitals, which were 93.50% approved as baby-friendly at the end of 2017. Between 2008 and 2017, 120 (%11.42) of those pre-certified hospitals were reassessed. Between 2002 and 2013, all 81 provinces have been designated Baby-Friendly Provinces. Since 2008, 61 of the 81 provinces have been designated Golden Baby-Friendly Provinces and 95% of Family Medicine Units have been certified as baby-friendly. According to the SWOT analysis result, the main strength of the program was strong recognition and support of the BFHF by the government. The difficulties in maintaining of baby-friendly standards in health facilities and inadequate reassessment of pre-certified facilities were determined as the main weaknesses of the BFHF by the working group. Conclusion: To protect, promote and support breastfeeding effectively and to reach the national and global breastfeeding goals, interventions should be planned in a combination of settings by concurrently involving health policies, health systems, home, family and the community.

Effect of books and toys on early childhood development in poor rural areas of China

Objective: To explore the effect of books and toys on early childhood development in poor rural areas of China. Methods: The baseline survey data of the Integrated Early Childhood Development (IECD) conducted in 2013, which was supported by the United Nations International Children's Emergency Fund (UNICEF) China Office, were analyzed retrospectively in this study. The survey was conducted in 6 counties in 2 provinces of China (Shanxi and Guizhou), and all 6 neighboring counties were located in extremely poor areas. The socio-demographic characteristics and caring behaviors of the caregivers (the lack of children's books and toys) were assessed by UNICEF's Multiple Indicator Cluster Surveys-5 and caregivers' depression was assessed by the Zung Self-rating Depression Scale. A total of 2 701 children were enrolled, of these, 1 151(42.62%) were girls, the age (18±10) months and 1 263 (46.76%) children were from Shanxi Province, the remaining 1 438 (53.24%) children were from Guizhou Province. The early childhood developmental status was evaluated by Ages and Stages Questionnaires (ASQ). Log-binomial model was used to analyze the association between early childhood development and the lack of children's books and toys. Furthermore, sensitivity analyses (data stratification) were made to explore the effect of books and toys on early childhood development under different caregiving conditions with different caregivers who were depressive or non-depressive. Results: Among the 2 701 participants, 1 537 (56.90%) children lacked of books, 1 148 (42.50%) children lacked of toys, the suspected development delay (SDD) prevalences of overall ASQ, communication (CM), gross motor (GM), fine motor (FM), cognitivity (CG) and personal-social (PS) domains were 33.02% (892/2 701), 15.51% (419/2 701), 13.25% (358/2 701), 15.66% (423/2 701), 14.96% (404/2 701) and 11.81% (319/2 701). Under adjustment of the potential confounders, the Log-binomial regression showed that children who lacked books had significantly higher risk of SDD in overall ASQ (prevalence ratio (PR)=1.27, 95%CI: 1.11-1.45) and CM (PR=1.64, 95%CI: 1.31-2.07) than those who had sufficient books. Compared with children who had sufficient toys, those who lacked the toys also had the increased risk of SDD in overall ASQ (PR=1.34, 95%CI: 1.19-1.50), CM (PR=1.44, 95%CI: 1.18-1.76), GM (PR=1.54, 95%CI: 1.24-1.91), FM (PR=1.86, 95%CI: 1.52-2.27), CG (PR=1.80, 95%CI: 1.47-2.20) and PS (PR=1.88, 95%CI: 1.49-2.39). Sensitivity analysis revealed that the lack of books increased the risk of SDD in overall ASQ of the caregivers' non-depression group (PR=1.35, 95%CI: 1.08-1.71) and depression group (PR=1.17, 95%CI: 1.01-1.38), and the lack of toys increased the risk of SDD in overall ASQ of the caregivers' depression group (PR=1.54, 95%CI: 1.32-1.79). Conclusion: Lack of childrens' books and shortage of toys were independent risk factors for early childhood development in poor rural areas of China and both of them increased the risk of SDD significantly.

Reproductive and Sexual Health Consequences of Child Marriage: A Review of literature

Background & aim: marriage, which defined as a formal marriage or informal union before the age of 18 years, occurs widely throughout the world. marriage directly impacts girls’ education, and sexual as well as psychological well-being. In this regard, the current review was conducted to examine the and sexual health consequences of child marriage. Methods: This review was conducted by searching the scientific databases including PubMed and Google Scholar as well as websites of various international organizations active in health issues between 1946 and 2018. Key words for searching included Child marriage , marriage ,sexual health, reproductive health, and maternal mortality . Published articles and also publications of International Planned Parenthood Federation (IPPF), United Nations International Children's Emergency Fund (UNICEF), World Health Organization (WHO) and Center for Reproductive Rights (CRR) were reviewed. Results: marriage as a result of poverty has many adverse consequences on and sexual health of girls. These include death during childbirth, physical and sexual violence, isolation, depression, cervical cancer and risk of sexually transmitted diseases (STD). Teen pregnant women are at high risk of preterm birth as well as neonatal death more than other women. Conclusion: Girls' marriage at an early age can increase the risk of sexual and complications. Therefore, training programs should be implemented to increase the awareness of society, parents, and religious leaders, to empower girls in this regard.

Prevalence and Socio-economic Impacts of Malnutrition Among Children in Uganda.

Malnutrition is one of the common problems that afflict the poor in low- and middle-income countries like Uganda. The rate of decline of malnutrition in the country has been very slow for the last 15 years. This problem is of utmost concern in this era of Sustainable Development Goals (SDGs) in which achieving the goals is imperative. The aim of our study was to review literature on the prevalence and socio-economic impacts of malnutrition among children under 5 in Uganda and provide recommendations to address identified gaps. This review assesses available evidences, including journal articles, country reports, the World Health Organization (WHO) reports, the United Nations International Children’s Emergency Funds (UNICEF) reports, and other reports on issues pertaining to malnutrition among children in Uganda. Malnutrition, poverty, and chronic diseases are interconnected in such a way that each of the factors influences the presence and permanence of the other, resulting in a synergistic impact. The prevalence of acute and severe malnutrition among children under 5 is above the World Health Assembly target to reduce and maintain the prevalence under 5% by 2025. There are also limited studies on etiology of anemia as regards its prevalence in Uganda. The study presents a better understanding of the social and economic impact of child malnutrition on the families and the country’s development. The study also strongly suggests that, for Uganda to achieve sustainable development goal 2, financial investments by the government are necessary to address nutrition in the early stages of an individual’s life.

Первые десятилетия сотрудничества для развития. Участники, достижения и трудности

Первые десятилетия сотрудничества для развития. Участники, достижения и трудности

Diagnosing the double burden of malnutrition using estimated deviation values in low- and lower-middle-income countries.

ObjectiveTo examine the possibility of diagnosing the double burden of malnutrition using estimated deviation values in low- and lower-middle-income countries.MethodsA modified version of the Japanese Diagnostic Tool was used. Data on 194 countries were analyzed, including data from the United Nations International Children’s Fund, World Health Organization and World Bank. After conducting a Box–Cox transformation, deviation values were calculated. The degree to which the values deviated relative to a deviation cutoff value of 50 was assessed. Focusing on countries with low- and middle-income economic levels, we examined the utility of this tool to show characteristic nutritional problems in each country.ResultsThe deviation values had normal, distorted, bimodal, or trimodal distributions. In the lower-middle-income countries, almost all countries had values ranging from 40 to 60 for education and water environments (urban and rural), and the differences were minimal. However, different causes of noncommunicable disease-related deaths were considered, and the primary cause appeared to be related to lifestyle factors, particularly alcohol consumption and tobacco smoking. In comparison, the deviation values related to death among low-income countries also appeared to be related to differences in education and sanitation in urban and rural areas.ConclusionThe study results can help to determine the status of nutritional inequalities and plan country-specific strategies to reduce the double burden of malnutrition.

Geographical Variations in Maternal Mortality Due to Obstetric Haemorrhage and Its Association with Potential Risk Factors in Central and Western China: A Bayesian Spatiotemporal Analysis

Background: China planned to achieve its fifth Millennium Development Goals by 2015, including reducing maternal mortality. The leading cause of maternal mortality in the country is obstetric haemorrhage. However, there is limited evidence on the burden of maternal mortality due to obstetric haemorrhage. It is also unclear which ecological-level risk factor is associated with maternal mortality due to obstetric haemorrhage. Methods: The data on maternal mortality due to obstetric haemorrhage were collected from the China Maternal Mortality Surveys conducted in 1832 counties of mainland China over the 2010-2013 period. The Bayesian spatiotemporal regression and the Geodetector model were used to examine the spatiotemporal distribution of the maternal mortality ratio (MMR) due to obstetric haemorrhage, as well as its association with per capita income, the proportion of pregnant women who received antenatal care at least five times, the hospital delivery rate, and the distance from the nearest blood station (DBS). Findings: The overall MMR due to obstetric haemorrhage decreased in China, but the trends largely varied by region. There were 568 hotspot counties, located mostly in China's western regions. Western China had the highest MMR due to obstetric haemorrhage. The proportion of pregnant women who had five or more maternal checkups and the DBS were the major risk factors for maternal mortality due to obstetric haemorrhage. The MMR increased from 1.92 to 2.51 to 7.06, with an increase in the DBS from 100 km, respectively. Interpretation: The findings provide information for accurate spatial targets and public health policies to reduce maternal deaths at both country and regional levels. Funding Statement: The case study was supported by the MOST (2012CB955503), the NSFC (41271404 and 41421001), the China Medical Board (grant number 11-065), and the United Nations International Children's Emergency Fund (2016EJH011). The data were collected by Sichuan University and processed by the Institute of Geographic Sciences and Natural Resources Research. Declaration of Interests: The authors declare they have no actual or potential competing financial interests.

Community-based care of children affected by AIDS in Swaziland: a gender-aware analysis.

Care of children affected by AIDS in Swaziland is predominately provided by families, with support from 'community-based responses'. This approach is consistent with United Nations International Children's Fund's (UNICEF) framework for the protection, care and support of children affected by AIDS. However, the framework relies heavily on voluntary caregiving which is highly gendered. It pays limited attention to caregivers' well-being or sustainable community development which enables more effective caregiving. As a result, the framework is incompatible with the social justice principles of primary health care, and the sustainable development goals (SDGs).AimOur aim was to examine the effects and gender dimensions of providing voluntary, community-based, care-related labour for children affected by AIDS. We conducted multiple-methods research involving an ethnography and participatory health research, in a rural Swazi community. We analysed data related to community-based responses using an abductive, mixed-methods technique, informed by the capabilities approach to human development and a gender analysis framework.FindingsTwo community-based responses, 'neighbourhood care points' (facilities that provide children meals) and the 'lihlombe lekukhalela' (child protector) program were being implemented. The unpaid women workers at neighbourhood care points reported working in challenging conditions (eg, lacking labour-saving technologies), insufficient and diminishing material support (eg, no food), and receiving limited support from the broader community. Child protectors indicated their effectiveness was limited by lack of social power, relative to the perpetrators of child abuse. The results indicate that support for community-based responses will be enhanced by acknowledging and addressing the highly gendered nature of care-related labour and social power, and that increasing access to material resources including food, caregiver stipends and labour-saving technologies, is essential. These strategies will simultaneously contribute to the social and economic development of communities central to primary health care, and achieving the poverty, hunger, gender and work-related SDGs.

Malnutrition in India: status and government initiatives.

Malnutrition, according to the World Health Organization (WHO), refers to deficiencies, excesses, or imbalances in a person's intake of energy and/or nutrients. It is well-known that maternal, infant, and child nutrition play significant roles in the proper growth and development, including future socio-economic status of the child. Reports of National Health & Family Survey, United Nations International Children's Emergency Fund, and WHO have highlighted that rates of malnutrition among adolescent girls, pregnant and lactating women, and children are alarmingly high in India. Factors responsible for malnutrition in the country include mother's nutritional status, lactation behaviour, women's education, and sanitation. These affect children in several ways including stunting, childhood illness, and retarded growth. Although India has nominally reduced malnutrition over the last decade, and several government programs are in place, there remains a need for effective use of knowledge gained through studies to address undernutrition, especially because it impedes the socio-economic development of the country. Thesefindings mayprovide useful lessons for other developing countriesthat are working towards reducing child malnutrition in their settings.

Determinants of immunization status among 12- to 23-month-old children in Indonesia (2008\u20132013): a multilevel analysis

BackgroundImmunization is one of the most cost-effective public health interventions to prevent children from contracting vaccine-preventable diseases. Indonesia launched the Expanded Program for Immunization (EPI) in 1977. However, immunization coverage remains far below the United Nations International Children’s Emergency Fund (UNICEF) and World Health Organization (WHO) target of 80%. This study aims to investigate the determinants of complete immunization status among children aged 12–23 months in Indonesia.MethodsWe used three waves of the Indonesian National Socioeconomic Survey (2008, 2011, and 2013) and national village censuses from the same years. Multilevel logistic regression was used to conduct the analysis.ResultsThe number of immunized children increased from 47.48% in 2008 to 61.83% in 2013. The presence of health professionals, having an older mother, and having more educated mothers were associated with a higher probability of a child’s receiving full immunization. Increasing the numbers of hospitals, village health posts, and health workers was positively associated with children receiving full immunization. The MOR (median odds ratio) showed that children’s likelihood of receiving complete immunization varied significantly among districts.ConclusionsBoth household- and district-level determinants were found to be associated with childhood immunization status. Policy makers may take these determinants into account to increase immunization coverage in Indonesia.

The Baby Friendly Hospital Initiative and the ten steps for successful breastfeeding. a critical review of the literature.

There is no doubt regarding the multiple benefits of breastfeeding for infants and society in general. Therefore, the World Health Organization (WHO) in a conjoint effort with United Nations International Children's Emergency Fund (UNICEF) developed the "Ten Steps to Successful Breastfeeding" in 1992, which became the backbone of the Baby Friendly Hospital Initiative (BFHI). Following this development, many hospitals and countries intensified their position towards creating a "breastfeeding oriented" practice. Over the past two decades, the interest increased in the BFHI and the Ten Steps. However, alongside the implementation of the initiative, extensive research continues to evaluate the benefits and dangers of the suggested practices. Hence, it is our intention to make a critical evaluation of the current BFHI and the Ten Steps recommendations in consideration of the importance of providing an evidence-based breastfeeding supported environment for our mothers and infants.

Experiences, beliefs and attitude on donation of human milk in women of Arauco province

Breastfeeding is the natural process in which an infant is fed with breast milk. In hu mans, it is a biocultural process, subject to modifications based on social, economic and cultural influences. In this context, The United Nations International Children's Fund (UNICEF) considers that "breastfeeding is key for survival". To interpret the perception about experiences, beliefs, and attitudes towards the donation of breast milk in adult women from the "Dr. Rafael Avaria Va lenzuela Hospital" in the commune of Curanilahue, Biobío Region, Chile. Qualitative study with a phenomenological approach. The convenience sample was made up of 15 women who participated in a semi-structured interview. A content analysis was applied to the ob tained results using informant triangulation. Women presented knowledge of the act of donating breast milk, emphasizing an altruistic paradigm. They associated this act with generosity, especially for babies who do not have access to breast milk directly from their mothers. There is a smaller group that has participated in cross-nursing in a family setting, having the certainty of who is giving and who is receiving the milk. The cross-nursing is an approved practice among the interviewed women, who consider it an altruistic act. However, its practice is based on reasons of trust and closeness.