Well-baby Clinics Research Articles

Prevalence and Determinants of Diarrhoea Disease amongst Under-Five Children Attending Immunization Clinic in a Secondary Health Facility in Benin City

Introduction: Diarrhoea is a major public health challenge in low and middle-income countries. It is the second leading cause of mortality in children under the age of five. It is also recognized that exposure to diarrhoea pathogens in developing countries is associated with such factors as quality and quantity of water, availability of toilet facilities, housing conditions, level of education, household economic status, place of residence, feeding practices, and the general sanitary conditions (personal or domestic hygiene) around the house. These factors are still prevalent in many Nigerian communities. This study therefore sought to determine the prevalence of diarrhoea and risk factors among under-five children seen at immunisation clinic of a secondary hospital in Nigeria. Methodology: This was a cross-sectional study of 210 mothers attending well-baby clinic of a multi-specialist secondary health facility in Benin-City, South-South, Nigeria. Information relating to socio-demographics and occurrence of diarrhoea in their wards was obtained using ore-tested questionnaire. Data obtained were tabulated and analyzed using IBM SPSS version 21. Chi-square was used to determine the relationship between qualitative variables the statistical significance was set at P<0.05. Result: Prevalence of diarrhoea was 38.6% with a mean number of episodes per year of 2.14. Prevalence of dysentery was 4.3%. There was significant association between age, nutritional status, source of water and the occurrence of diarrhoea (P values of 0.04, 0.038 & 0.02 respectively). Conclusion: This study shows a high prevalence of diarrhoea amongst under-5 children in our environment.

Challenges and barriers to immunization during COVID-19: An experience of parents/caregivers from a well-baby clinic of a tertiary care hospital of Eastern India

BackgroundImmunization in children is one of the best methods of preventing vaccine preventable diseases.With the onset of the COVID-19 pandemic,there have been disruptions in vaccine supply,its uptake and perception towards routine immunization, globally and in India. This study was planned to identify the challenges faced by the parents, the perceived barriers towards childhood immunization and perception regarding vaccination during the ongoing pandemic. MethodsA cross-sectional study was carried out in the well-baby clinic, providing immunization services. The informants were parents/caregivers of under-five children accompanying their children to the well-baby clinic within the study period. Data was collected using a semi-structured interviewer administered questionnaire and analysed using Epi-info software and p value less than 0.05 was considered to be statistically significant. ResultsDelay in immunization was noted in 62% of the children. The challenges stated by respondents for delay in immunization during this pandemic mostly were “fear about getting infected” (30%) and “someone instructed them not to take the child to the hospital if not ill” (13%). The most common perceived barriers were ‘no vaccination sites were open’ or ‘did not know where the baby can be vaccinated’. ‘Child should receive all vaccines’(99%) and ‘safety is more important than vaccination’ (83%)was the perception of respondents about immunization during the pandemic. ConclusionThough the respondents were aware of the need for timely vaccinations of their children, still a substantial delay was seen among majority of them due to fear of getting infected and unavailability of vaccines.

Successful breastfeeding following a level II NICU stay in Qatar – a longitudinal study

BackgroundExclusive breastfeeding is an essential need for mothers and newborn babies, but cultural practices and employment demands significantly influence feeding practices. The association between neonatal intensive care unit (NICU) admission and breastfeeding outcomes are variable. Data for Qatar and Middle East, in particular, are limited. Hence, this study aims to estimate the rate of breastfeeding at the time of NICU discharge and the rate of successful breastfeeding after NICU discharge in Qatar during well-baby follow-ups.MethodsThis quantitative longitudinal study was conducted over 18 months from January 2019 and included neonates born in Al Wakra Hospital admitted to the NICU. Demographic data, feeding during NICU stay and at discharge were obtained from lactation charts. Data regarding feeding practices after discharge were obtained through a questionnaire administered at 4 weeks and 8 weeks in well-baby clinics. Descriptive statistics and logistic regression analyses were performed to determine the rates of breastfeeding and the association between the various factors.ResultsOf the 678 participants screened, 364 were eligible for analysis. The rates of exclusive breastfeeding were 20% (73/364), 54% (197/364) and 42% (153/364) at discharge, 4 weeks and 8 weeks, respectively. Any breastfeeding was 64% (233/364), 40% (146/364) and 43% (157/364) at discharge, 4 weeks and 8 weeks, respectively. Logistic regression analysis showed that neonates who had NICU stays longer than 4 days had a higher rate of exclusive breastfeeding at discharge (adjusted odds ratio 3.000; 95% CI 1.25, 7.198) but had a reduced rate of breastfeeding and higher rate of formula feeding during follow-ups. Although breastfeeding rates were better in preterm infants at NICU discharge, regression analysis showed that none of the other factors, including gestation and maternal education had a significant association with the rate of exclusive breastfeeding at the time of discharge or during follow-ups.ConclusionsThe overall breastfeeding rates from this level II NICU in Qatar are better than previously available data. Studies with extended follow-up and assessment of intervention methods should be planned to improve and sustain the practice of exclusive breastfeeding.

Oral Health Coaches at Well-Baby Clinics to Promote Oral Health in Preschool Children From the First Erupted Tooth: Protocol for a Multisite, Pragmatic Randomized Controlled Trial.

BackgroundEarly childhood caries is considered one of the most prevalent diseases in childhood, affecting almost half of preschool-age children globally. In the Netherlands, approximately one-third of children aged 5 years already have dental caries, and dental care providers experience problems reaching out to these children.ObjectiveWithin the proposed trial, we aim to test the hypothesis that, compared to children who receive usual care, children who receive the Toddler Oral Health Intervention as add-on care will have a reduced cumulative caries incidence and caries incidence density at the age of 48 months.MethodsThis pragmatic, 2-arm, individually randomized controlled trial is being conducted in the Netherlands and has been approved by the Medical Ethics Research Board of University Medical Center Utrecht. Parents with children aged 6 to 12 months attending 1 of the 9 selected well-baby clinics are invited to participate. Only healthy children (ie, not requiring any form of specialized health care) with parents that have sufficient command of the Dutch language and have no plans to move outside the well-baby clinic region are eligible. Both groups receive conventional oral health education in well-baby clinics during regular well-baby clinic visits between the ages of 6 to 48 months. After concealed random allocation of interventions, the intervention group also receives the Toddler Oral Health Intervention from an oral health coach. The Toddler Oral Health Intervention combines behavioral interventions of proven effectiveness in caries prevention. Data are collected at baseline, at 24 months, and at 48 months. The primary study endpoint is cumulative caries incidence for children aged 48 months, and will be analyzed according to the intention-to-treat principle. For children aged 48 months, the balance between costs and effects of the Toddler Oral Health Intervention will be evaluated, and for children aged 24 months, the effects of the Toddler Oral Health Intervention on behavioral determinants, alongside cumulative caries incidence, will be compared.ResultsThe first parent-child dyads were enrolled in June 2017, and recruitment was finished in June 2019. We enrolled 402 parent-child dyads.ConclusionsAll follow-up interventions and data collection will be completed by the end of 2022, and the trial results are expected soon thereafter. Results will be shared at international conferences and via peer-reviewed publication.Trial RegistrationNetherlands Trial Register NL8737; https://trialsearch.who.int/Trial2.aspx?TrialID=NL8737International Registered Report Identifier (IRRID)DERR1-10.2196/39683

Factors contributing to home births among postpartum women in Manzini, Swaziland

Background/Aims Home births carry risks, especially in underdeveloped areas, including labour and childbirth complications and maternal and perinatal morbidity and mortality. Intrapartum care offered in healthcare facilities has fewer risks, as they employ skilled birth attendants and medical equipment. However, widespread provision of intrapartum care remains challenging in Swaziland. The incidence of avoidable intrapartum maternal and perinatal challenges could be reduced if more women gave birth accompanied by skilled birth attendants. The aim of this study was to explore and describe the factors associated with home birth in Swaziland, despite the practice being discouraged. Methods A qualitative design using convenient sampling was used. A total of 13 postpartum women took part in the study, who gave birth at home and brought their newborn babies to a well-baby clinic for immunisation 3 days after birth. Individual in-depth interviews were conducted and the data were subjected to thematic analysis. One theme was identified with associated subthemes. Results Personal factors formed the main theme describing the reasons for home birth. The subthemes were ignorance, silent labour, financial problems and access to a traditional birth attendant. Conclusions Enhanced health education during antenatal care on labour signs as well as reduced or abolished hospital fees for pregnant women and improved availability of ambulance services may help address women's reasons for choosing home birth. Encouraging women to give birth with a skilled birth attendant is important to reduce maternal and neonatal morbidity and mortality.

ASSESSING NURSE’S ATTITUDES AND PRACTICE AFTER PARTICIPATING IN A VACCINATION TRAINING PROGRAM: A QUANTITATIVE STUDY

Background: Primary healthcare nurses are pivotal to the successful uptake of immunization worldwide. Central to this, is the attitude and practice nurses may have toward vaccines during administration. It is postulated that altering knowledge towards immunization may impact both attitude and practice towards successful immunization uptake. The aim of this research was to assess nurses’ knowledge, attitude and practice after the delivery of a three-day continuing professional development program regarding administration, safe handling and delivery of vaccines. Method: This research consisted of a quantitative cross-sectional study, utilizing a self-administered survey. The survey contained questions related to immunization knowledge, attitude, and practice. Before and after attendance of an immunization program for continuing professional development, the survey was administered to nurses working in well-baby clinics, communicable diseases clinics, travel clinics and school nurses. Specific areas identified gaps in knowledge, attitude, and practice among participating nurses. Results: Results from our study suggest that attitudes and practices of participants identified a significant difference after receiving an immunization educational program that focused on administration and delivery of immunization skills. Conclusion: Continuous professional development activities such as this have shown a marked increase in the attitude and practices of nurses making it tantamount to the success of vaccine uptake. Implications for Practice: Nurses are poised to be frontline advocates for the uptake of immunization; therefore education and training needs to be provided in order for them to understand and further affect change. Keywords: Vaccine, Immunization, Knowledge, Attitude, Practice

Prenatal and perinatal risk factors of food allergy in Taiwanese young children

BackgroundIn recent decades, the prevalence of food allergy (FA) in children has increased in Western countries; however, there have been only limited studies on FA, especially among young children, in Asian countries, including Taiwan. In this study, we identified prenatal and perinatal risk factors associated with FA in young children in Taiwan. MethodsFor this prospective birth cohort study, we adopted the Southern Taiwan Allergy Research Alliance (STARA)-FA questionnaire to collect data related to prenatal and perinatal risk factors and self-reported allergic symptoms in children aged 1–3 years in the well-baby clinics of 4 medical centers located in 3 cities, Chia-Yi, Tainan, and Kaohsiung, Taiwan. The STARA-FA questionnaire consisted of 99 questions to investigate the association of prenatal and perinatal risk factors with FA. ResultsWe recruited 903 young children aged 1–3 years in Taiwan. Among those, 95 (14.7%) children had allergic reactions to foods. The most common food allergens were eggs (26/95, 27.3%), milk (22/95, 23.2%), fruits (13/95, 13.7%), and seafood (12/95, 12.6%). We also found that there were 134 (14.8%) children with eczema, 86 (9.5%) with wheezing, and 240 (26.6%) with rhinitis. Children with a personal history of eczema (adjusted odds ratio [AOR], 2.48; 95% confidence interval [CI], 1.38–4.45) and a family allergy history (AOR, 2.06; 95% CI, 1.18–3.57) had a significantly increased risk of FA. Maternal peanut consumption during pregnancy was associated with a decreased risk of FA in children (AOR, 0.57; 95% CI, 0.33–0.98). ConclusionsIn this study, the prevalence of FA in a cohort of Taiwanese young children was 14.7%. Risk factors associated with FA were a personal eczema history and a family allergy history, which might serve as predictive or prevention factors for the development of FA in young children in Taiwan.

Trends in Weight Gain Among Breastfed Infants Versus Bottle-Fed Infants at a Tertiary Care Hospital in Karachi, Pakistan

BackgroundInfants need to be exclusively breastfed up to six months of age, and breastfeeding should be continued up to two years of age along with complementary food. In Pakistan, the majority of newborns are not exclusively breastfed. This study was done to compare weight gain between breastfed infants and non-breastfed infants at a tertiary care hospital in Karachi, Pakistan.MethodologyThis observational cohort study was conducted at the well-baby clinic and vaccination center of the National Institute of Child Health, Karachi, Pakistan, from January 2021 to December 2021. A total of 360 normal term babies (180 in each group) with age below 11 months on either exclusively breastfeeding or other milk feed were included. Data were collected by the duty senior staff nurse of the well-baby clinic and monitored on daily basis by the researchers. The sociodemographic characteristics of mothers of breastfed and non-breastfed babies and birth weight, length, and BMI Z scores of babies in both groups were compared.ResultsIn a total of 360 babies, there were 192 (53.3%) boys and 168 (46.7%) girls. Overall, the mean maternal age was calculated to be 28.1±6.2 years, ranging between 18 and 37 years. The employment status of mothers (p=0.0117) and monthly income of parents (p=0.0388) were significantly different between groups. The mean weight gain in the exclusively breastfeeding group was 4.0±0.5 kg between the first and fifth visit (final visit) in comparison with 4.5±0.5 kg in the non-breastfeeding group (p<0.0001).ConclusionNon-breastfed babies gained significantly more weight in comparison with exclusively breastfed babies. More multicenter trials involving a large proportion of populations are needed to further verify the findings of the present study.

Sleep problems reduced from 6 to 24 months of age with no evidence of links between disturbed sleep and later developmental problems.

AimSleep is essential for infant development. We assessed the prevalence of sleep problems in infants at 6, 12 and 24 months, investigated the relationship between infants’ sleep problems and development, and determined to what extent sleep problems at 6 months were related to changes in the developmental course.MethodsInfant sleep problems were measured by a parent‐reported sleep questionnaire. The Ages and Stages Questionnaires were used to measure developmental skills in a sample of 1555 infants recruited from 9 well‐baby clinics in Norway. ASQ scores were compared between infants with and without sleep problems by using two‐sample t‐tests. The relationship between infant sleep problems at 6 months and changes in Ages and Stages Questionnaires scores over time was investigated using linear mixed‐effects models.ResultsThe prevalence of infant sleep problems were 14.6% at 6 months, 7.4% at 12 months and 3.3% at 24 months. There was no clear evidence of differences in ASQ or ASQ:SE scores by sleep problems from 6 to 24 months, but communication and problem‐solving scores for infants with sleep problems increased faster.ConclusionPrevalence of sleep problems decreased with age. There was no clear evidence of early sleep disturbance and later development problems.

Clinical Audit on Well Baby Services at Primary Health Care Corporation, Qatar

Background: Regular well-baby visits during the first three years of childhood are critical to identify health, behavioral and development problems that could have long-lasting effects into adulthood. WHO stresses the importance of child health, and states that ensuring the healthy growth and development of children should be the prime concern. Aim: To ensure that well-baby services provide clinical care according to children’s age as per well-baby service protocol within primary health care centers, to find gaps if any and to generate an action plan for further improvement. Methodology: A retrospective chart review (baseline audit) was conducted on 245 health records of children who attended well-baby clinic for three months (March 01, 2018 to May 31, 2018). Further to the implementation of the action plan, a re-audit with retrospective chart review of 477 health records for three months (June 01, 2019 to August 31, 2019) was conducted to evaluate the improvements in the practice. Results: Performance for criterion on relevant clinical history taking (feeding and bowel history) has slightly increased from the baseline for each of the following age groups: from 71% to 82% at 4 months, 77% to 80% at 18 months and, 76% to 81% at 30 months, however, a declination was shown at 2 months 88% to 80%. Assessment of developmental milestones at 2, 18 and 30 months of age increased by 5% (76% to 81%), 13% (70% to 83%) and 19% (50% to 69%) respectively and, at 4 months performance remained the same at 69%. Examination of congenital hip dislocation/abduction has demonstrated a significant improvement where its performance increased by 79% (8% to 87%) at 2 months, and 82% (2% to 84%) at 4 months of age. On the other hand, at ages 18 &amp; 30 months which were not measured in the baseline audit in the re-audit, it was 68% and 45% respectively. Screening for vision at 2 months of age has increased by 13% (78% to 91%), but, there was a slight drop of 10% in the screening of hearing from 86% to 76% at 2 months. Screening of autism spectrum disorder using a tool in children 18 and 30 months of age dropped from 86% to 83% and from 86% to 75% respectively. Conversely, request laboratory investigation to rule out anemia has increased by 46% (47% to 93%) at 18 months and 61% (23% to 84%) at 30 months. Conclusions: Impactful audits with actionable recommendations make real difference in practice and compliance. In conclusion, action plans implemented further to the baseline audit are effective in increasing the compliance in most of the areas. Key Words: Well-baby services audit, primary health care, Qatar

Predictors of maternal self-efficacy and the mediating role of postpartum fatigue for Jewish and Arab women in Northern Israel

ObjectiveThe study aims to investigate positive and negative social interactions as predictors of maternal self-efficacy and to examine the mediating role of postpartum fatigue. DesignParticipants included 450 Arab and Jewish mothers of healthy one-month-old infants who visited 14 well-baby care clinics located in northern Israel. The study used a prospective longitudinal cohort design. Participants completed the first questionnaire and agreed to a follow-up phone interview three months later. Both ethnic groups had a response rate of 90% for the follow-up interview. The questionnaire included six scales that measured socioeconomic status and demographics, obstetric characteristics, social networks and support, negative social interactions, fatigue and maternal self-efficacy (MSE). The phone interview was a shorter version of the written questionnaire focusing on MSE and fatigue. Maternal self-efficacy four month after birth was examined with social support, negative interactions and fatigue, using multiple linear regressions within each ethnic group. FindingsIn both groups, negative social interactions decreased perceptions of maternal self-efficacy. Women who reported higher social support after birth experienced a greater sense of maternal self-efficacy four months after birth, though the association was stronger among Jewish women. Post-partum fatigue affects Arab and Jewish mothers differently. Among Arab mothers, fatigue at one month mediates MSE as well as the relationship between social support and negative interactions at four months. Among Jewish mothers, these factors are directly related to MSE, with no mediation effect. Implications for practiceThe correlations found between social interactions, fatigue and maternal self-efficacy can be useful in providing appropriate care that includes information and parental support. Health professionals working with postpartum women must assess degree of postpartum fatigue and negative postpartum social interactions as well as social support during the postpartum period.

The Ability of Saudi Parents' To Detect Early Language Delay in Their Children: A Study in Primary Health Care Centers, King Abdulaziz Medical City, Riyadh, Saudi Arabia.

PurposeOur study aims to assess parents’ ability to detect early language delay in their children in association with related demographic and environmental factors to help in predicting its risk.MethodsA cross-sectional study was conducted at three main primary health care centers at National Guard Health Affairs, Riyadh, Saudi Arabia. Participating parents were asked if they think their children have language delay and if they were able to detect it early. Then, validated age-appropriate screening tools were administered to assess the child’s language development. The parents' answers regarding their child’s language development were then compared to the screening tool assessment results.ParticipantsA total of 250 parents attending a well-baby clinic for their children’s routine vaccinations participated in the study after informed consent was obtained.ResultsLanguage delay was more prominent in the one-year-old age group (26.7%). In addition, children who were not breastfed were significantly more likely to have language delays (P-value 0.014). The parents’ ability to detect language delay varied among the different age groups. Fifty-seven point one percent (57.1%) of children aged two years old and 61.5% of children aged five years old who were found to have language delay were not noticed by their parents (P-value 0.03, 0.02).ConclusionParents showed a lack of ability to detect language delay early. Increasing their awareness of the typical language development milestones and the importance of early intervention is very important to minimize the consequences of late intervention.

Relationships between Thai fathers’ self-efficacy to support breastfeeding and exclusive breastfeeding duration

ObjectiveTo determine associations between Thai fathers’ self-efficacy to support exclusive breastfeeding and exclusive breastfeeding duration. DesignA descriptive quantitative design was used. Participants and SettingsThe study sample consisted of 205 father-mother couples (410 participants) with an infant who was 6 months old. Data were conducted from well-baby clinics of two hospitals in Thailand’s Chiang Mai province from January to March 2020. MeasurementEach participant completed a sociodemographic questionnaire and Breastfeeding Self-Efficacy Scale (Short-Form). Father participants also completed the Father’s Attitude toward Exclusive Breastfeeding questionnaire. FindingsBivariate correlation analyses of survey data showed that paternal and maternal breastfeeding self-efficacy scores were positively associated with longer duration of exclusive breastfeeding (ρ=0.19 and ρ=0.54, respectively). Paternal self-efficacy scores were also positively correlated with maternal self-efficacy scores (ρ=0.30, p=.01). However, the results of Tobit regression analyses indicated that paternal self-efficacy scores did not moderate the relationship between maternal self-efficacy scores and exclusive breastfeeding duration. Only maternal self-efficacy scores were significantly associated with duration of exclusive breastfeeding (B=.16, p<.01). Key conclusionsThis is the first Thai study to assess the relationship between fathers’ breastfeeding support self-efficacy and exclusive breastfeeding duration. The results increase our understanding of paternal factors that impact exclusive breastfeeding duration. Although paternal self-efficacy did not moderate the effects of maternal self-efficacy on exclusive breastfeeding duration in this study, paternal self-efficacy positively related to maternal self-efficacy and breastfeeding duration. Implication for practicePaternal breastfeeding support self-efficacy should be promoted in co-parenting breastfeeding interventions both antenatal care clinics and postpartum units to promote exclusive breastfeeding and increase Thailand’s overall exclusive breastfeeding rate.

Practice in child restraint system use among attendees of Well-baby clinics in Jeddah, Saudi Arabia.

Background:The systematic use of child restraint system (CRS) while driving has been promoted by the WHO to improve road safety.Objectives:To assess the levels of practice in CRS use for children aged ≤5 years among mothers attending the Well-baby clinics and to explore the associated factors and attitudes.Methods and Material:A cross-sectional study was conducted among mothers visiting the Well-baby clinics at five primary health care centers in Jeddah, Saudi Arabia, using a multistage stratified-cluster sampling. Practice in CRS was assessed by interviewing the participants regarding the availability of a CRS in their car, usage frequency for a child <5 years, and alternative child-sitting methods. Sociodemographic data, further road safety parameters, and attitudes were analyzed as independent factors of adequate practice using multivariate logistic regression.Results:Of the 192 included mothers, eight (4.2%) had a history of accident while driving with a child. Majority of the participants (62.5%) declared not having their cars equipped with a CRS and used inappropriate car-sitting methods. Of the 37.5% who had CRS in their cars, 27.1% declared using it always or frequently. Adequate practice in CRS was independently associated with mother’s age (OR = 0.91, P = 0.09), low (OR = 0.10, P = 0.001) and moderate family income (OR = 0.23, P = 0.012), and the belief that CRS is not essential while driving with children (0.32, P = 0.023).Conclusions:There is inadequate practice in child road safety among families attending the Well-baby clinics in Western Saudi Arabia, which is associated with several misconceptions and negative attitudes towards the utility of CRS.

Touch Screen Device Usage and its Effect on Sleep among Young Children: Do Parents Delude Younger Generation Deliberately? Time to Ruminate and Impede this Technological Harm.

The American Academy of Pediatrics had recommended that children younger than 2 years should avoid digital media. However, in the Indian context, it was less explored. The study aimed to determine the relationship between touch screen device (TSD) usage and sleep of infants, toddlers. Using a cross-sectional design, 76 parents of infants and toddlers attending well-baby clinic of a tertiary care hospital in Eastern India were approached, and 57 parents who fulfilled the eligibility criteria were selected using a nonprobability convenient sampling technique. Data were collected using a pretested validated tool including TSD usage pattern, the brief infant sleep questionnaire. Descriptive statistics and Pearson correlation were used to analyze the data. The mean age of TSD usage was 15.6 ± 5.8 months with a mean duration of 65 ± 9.6 min/day. Mothers (51%) reported circumstances to offer TSD was feeding the child. There was a significant negative relationship between night sleep and TSD usage among children (r = -0.35, P < 0.01). TSD usage time significantly affects the nighttime duration of sleep of infants and toddlers. Parents to be educated on proper usage and ill effects of TSD to prevent sleep issues.

Infant care practices among mothers attending well-baby clinics at primary health care centers in Unaizah city.

Infant care, crucial for the well-being of infants, is an inherent human practice. Although there are important implications of infant care practices on infant health, there is a dearth of comprehensive studies covering all important aspects of infant care in an individual study. To determine practices regarding infant feeding, infant sleep, use of pacifiers, and immunization, and to explore the association of these practices with mother's demographic data. A cross-sectional study was conducted using a self-administrated questionnaire distributed among mothers attending well-baby clinics in Primary Health Care Centers (PHCCs), Unaizah city, Qassim region, Saudi Arabia. By using the two-stage cluster sampling method, 50 women participated from each of the four selected PHCCs, leading to a total of 200 participants. The survey was conducted from December 2020 to February 2021. Data were analyzed using SPSS software. A total of 124 (62%) respondents were between the ages of 26 and 35 years, 64% had a bachelor's degree, and 69.5% were housewives. Breastfeeding was practiced by 88% of women, 48% began infant weaning at 6 months of age, and 49% put their infant to sleep on their back. Up-to-date vaccination was reported for 188 (94%) infants. Infant pacifier use was reported by 58% of the respondents, and 82.5% of the participants had been offered formula milk for the newborn at the hospital. Vaginal delivery, absence of complications during pregnancy or labor, presence of a housemaid, and family income of more than 10,000 Saudi Riyals were significantly associated with better infant care practices. The study participants have good practices for certain infant care aspects such as immunization; however, improvement is needed for other practices, including weaning at the proper age, infant sleep position, and the use of pacifiers. Administrative measures are required to monitor the use of formula milk at hospitals and to enhance health education for mothers.

Mothers' feeding practices among infants (4-12 months) and associated factors: a cross-sectional study in Saudi Arabia.

A global target of increasing exclusive breast-feeding (EBF) to at least 50% by the year 2025 was set by the WHO for infants under 6 months. The lowest prevalence in the world was found in the Eastern Mediterranean region in 2010-18 and little is known about the status of mothers' feeding practices in Saudi Arabia. The present study aimed to assess mothers' actual feeding and weaning practices used with their infants by the mothers' different age groups. The present study was conducted among 247 mothers of infants aged 4-12 months who were attending public well-baby clinics. Quantitative data were obtained by nutritionists using an electronic semi-structured questionnaire about mothers' feeding practices. Only 5·3% of mothers engaged in EBF, 44·9% breast-fed their infants after an hour of birth, while 92·7% of infants had ever been breast-fed. The average intent/plan to continue breast-feeding was 4·9(±3·1) months. Younger mothers introduced weaning food around 4 weeks earlier than older mothers (mean differences were -0·4, 95% CI -0·71, -0·13; P = 0·031). A total of 64·3% of infants received complementary feeding before completing 17 weeks. Maternal age group and delivery mode were the only factors associated with the early introduction of complementary feeding. A total of 69·2% of the mothers believed that 'it is a good time' and 61·1% felt that 'infants are hungry and need other sources of food'. Online sources and family advice were the top sources of information on mothers' feeding practices. Provision of professional advice about EBF and optimal weaning practices are significant areas for improvement in terms of compliance with recommended infant feeding practices.

The Burden of Disease and Risk Factors of Iron Deficiency Anemia in Preschool Children Attending the Well-Baby Clinic in the National Guard Primary Health Care Centers in the Western Region of Saudi Arabia

Aims: To estimate the burden and risk factor of Iron Deficiency Anemia (IDA) in preschool children attending well-baby clinics in primary health care centers of the National Guard in Jeddah.&#x0D; Study Design: Cross Sectional study design&#x0D; Place and Duration of Study: This study was carried out in the primary health care centers of the National Guard Hospital in Jeddah, Saudi Arabia, which are the specialized polyclinic namely Iskan clinic district and Bahra Clinic. The study was started on 26 September, 2018 to January 2020.&#x0D; Methodology: A cross-sectional study included all preschool children aged 2-5 years attending well-baby clinics. Data were collected by distributing a self-developed and validated questionnaire to parents or guardians in waiting areas outside the well-baby clinics.&#x0D; Results: A total of 286 participants met the inclusion criteria. Anemia was found in 9.8% children. The prevalence of IDA among the participants was only 6.3%, but it was the most common compared to other types of anemia. The only findings that were found statistically significant with anemia were family history (P = 0.001) and use of supplement (P = 0.000).&#x0D; Conclusion: IDA is still the most prevalent type of anemia; however, it was found in only 6.3% participants. The only statistically significant factors associated with anemia were positive family history and supplement intake.

Covid-19 and Routine Vaccination Programme: Did it Affect Badly?

Background: The impact of COVID-19 on general health care delivery systems has been huge including the immunization services. Several measures were taken by most of the government all over the world to prevent the spread of infection such as lockdown, wearing masks, social distancing, etc. People have suffered a lot during the pandemic, not only due to the burden of the disease but have also faced difficulties in other domains of life. One of the important concerns is the interruption of routine immunization services. The consequences of interrupted immunization services may be life-threatening, as chances of outbreaks of vaccine-preventable diseases (VPD) in susceptible children could be high.&#x0D; Aim: To find out delay in routine immunization services during covid-19 and also to determine the factors associated with delay in immunization.&#x0D; Materials and Methods: This study was a cross-sectional hospital-based observational study at Career Institute Of Medical Sciences And Hospital, Lucknow, India. We collected the vaccination record after lockdown from Well-Baby Clinic and telephonically from the parents, starting from 1st June 2020 till 31st December 2020. We checked the records of vaccination of infants to find out delay in the vaccinations, as per the National Immunization Schedule. The records of a total of 265 infants were enrolled. Out of which, 33 did not fit the inclusion criteria and therefore were excluded from this study.&#x0D; Results: Findings of our study pointed that there was significant delay in routine immunization among infants. The factors responsible for delay in different vaccination observed in this study were, Phobia of COVID-19- 20%, lockdown- 22%, interruption of routine health services-15%, social myths-8%, poor transport facility- 10%, illness of child- 8%, did not notice- 3% and multiple factors- 13%.&#x0D; Conclusion: COVID -19 pandemic has affected the routine immunization services that results in delay of different vaccines at different ages which may lead to outbreak of vaccine preventable diseases, so it is need of the hour to intervene at the earliest to prevent such outbreaks among children.

A mixed method inquiry of early complementary feeding of infants in the Dominican Republic

Exclusive breastfeeding (EBF) is infrequent and decreasing over time in the Dominican Republic. This study aimed to identify patterns of, and women's rationale for, early complementary feeding. Mothers of children under 12 months of age living in a low-resource peri-urban community had three opportunities to contribute: (i) responding to feeding questions embedded in a standardized questionnaire used at a well-baby clinic (n = 101), (ii) participating in focus groups (n = 31), and (iii) engaging in home-based, semi-structured individual interviews (n = 25). Quantitative questionnaire data were analyzed to identify feeding practices as a function of child age. Textual data from the individual interviews and focus groups were systematically reviewed and coded to identify key constructs through a qualitative descriptive approach. The majority (>86%) of mothers reported breastfeeding at all monthly age bands up to six months. However, EBF was rare, with more than half reporting use of other milks and other foods by the infants' second and fifth month, respectively. Overarching themes to explain early complementary feeding from the qualitative data can be broadly captured by the complementary perceptions that there are problems with relying on breastfeeding alone and that there are benefits to early complementary feeding in the early months of an infant's life. EBF was experienced as (A) insufficient, (B) not always available, (C) sometimes not safe, (D) having potentially negative effects on the mother, and (E) bringing challenges. Complementary feeding was identified as helpful in addressing each of these concerns. Although mothers typically endorsed breastmilk as the preferable and best option for infant feeding, this did not translate into EBF and was not presented as contradictory to the use and perceived benefits of early complementary feeds.