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BackgroundUNICEF advocates for children’s rights by ensuring their basic needs are met and their potential maximized. Reducing child mortality and improving health are central to this mission, particularly through breastfeeding and complementary feeding. This study aims to analyse these practices in Belize using data from three past Multi Indicator Cluster Studies (MICS) and conducted a research study that explores barriers and factors influencing breastfeeding, including the Baby-Friendly Hospital Initiative, with a focus on maternal mental health. The study examines breastfeeding within the first hour after birth, exclusive breastfeeding for the first six months (EBF), and continued breastfeeding for up to two years and beyond.MethodsA mixed-methods design was used, combining quantitative MICS data (2006, 2011, 2015-16), desk reviews, and qualitative data collected in Belize in August-September 2022, to assess the context and psychosocial factors, including maternal mental health, that influence breastfeeding and complementary feeding practices among caregivers. Data collection involved 45 face-to-face interviews mainly with female caretakers of children under two, Key Informant Interviews, and Focus Group Discussions with caretakers and healthcare staff. Maternal mental health was assessed using the Self-Reporting Questionnaire (SRQ-20).ResultsThe findings indicate that two out of three children were not exclusively breastfed for the first six months. Among the 45 interviewed caretakers, 93% reported overall breastfeeding (exclusive, non-exclusive, or complementary), 82% practiced EBF during the first six months, and 78% breastfed within one hour after birth. While general breastfeeding was common, EBF showed increasing trends, and early initiation was less frequent. Half of the woman interviewed were at risk of common mental health disorders. There was no significant direct association between mental health and breastfeeding. Correlation analysis showed that mothers with poorer mental health had more children, less education, lower socioeconomic status, and greater awareness of breastfeeding barriers.ConclusionsWhile breastfeeding rates in Belize are improving, psychosocial vulnerabilities persist. Indirect links between maternal mental health and structural disadvantage, as well as the identified barriers to breastfeeding highlight the need for integrated, equity-focused public health interventions to enhance breastfeeding outcomes and address broader child nutrition challenges.

Abstract Background: Hygiene and Infant and Young Child Feeding (IYCF) practices are critical determinants of maternal and child health, especially in humanitarian settings. The FDMN makeshift settlements in Cox’s Bazar, Bangladesh, are home to a large population of pregnant and lactating women (PLWs) who face heightened risks due to poor living conditions, limited access to healthcare, and food insecurity. Objective: This study aimed to assess hygiene behaviors and IYCF practices among PLWs in the Kutupalong makeshift settlements and examine the associations of these practices with key socio-demographic characteristics. Methods: A community-based cross-sectional study was conducted among 415 PLWs aged 18–35 years, selected using systematic random sampling from four randomly chosen camps. Data were collected through face-to-face interviews using a structured questionnaire between March and April 2023. Descriptive statistics and chi-square tests were performed using SPSS version 26 to assess associations between socio-demographic variables and key outcomes. Results: Among the respondents, 75.08% of mothers provided colostrum to their newborns, and 91.08% practiced handwashing after defecation. However, only 39.73% initiated complementary feeding at the recommended six months, and just 40.48% of children consumed at least five food groups in the last 24 hours. Handwashing before food preparation was reported by 54.83%. Significant associations were found between maternal age, education, and family structure with both hygiene and IYCF practices (p < 0.05). Conclusion: The study highlights the influence of maternal socio-demographic factors on health behaviors and underscores the need for targeted education and behavior change interventions. Improving hygiene infrastructure and IYCF counseling can significantly contribute to better maternal and child health outcomes in humanitarian contexts like the Rohingya makeshift settlements.

Abstract Background:Uganda is consistently one of the highest burden countries for mother-to-child transmission of HIV (MTCT). This study assessed Uganda’s progress toward elimination of MTCT and factors associated with MTCT. Methods:Mother-infant pairs (MIP) were recruited at immunization clinics at randomly sampled public and private health facilities in Uganda during 2017-2019. Using a multistage sampling method, a national representative sample of MIP aged 4-12 weeks were recruited and followed longitudinally for 18 months or until the infant acquired HIV. Early MTCT was defined as an infant with confirmed HIV infection at enrollment and was calculated using logistic regression to estimate adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) for associated factors. Poisson regression was used to estimate incidence rate and incidence rate ratio (IRR) for infants acquiring HIV at any time during the study after enrollment (late MTCT) and associated factors. Results:Early MTCT was 2.2% (95% CI: 1.3–3.6) and late MTCT rate was 5.2 per 1000 person-years (95% CI: 2.5-10.9). In the adjusted model, only detectable maternal HIV viral load (≥1,000 copies/mL) was significantly associated with early MTCT (aOR: 6.8, 95% CI: 2.3-19.9). Similarly, ever having a detectable viral load (at any visit) was significantly associated with late MTCT (IRR: 6.2, 95% CI: 1.2-31.7). Conclusion:Uganda’s program has made large strides to eliminate MTCT. Identifying and addressing elevated maternal HIV viral load, especially during pregnancy and the early breastfeeding period could further reduce the number of new childhood infections in Uganda.

<title>Resumen</title> <p>El estudio de los trastornos mentales en personas con discapacidad intelectual y del desarrollo está cada vez más presente en la investigación, pues afecta directamente a su calidad de vida. El objetivo principal de esta investigación fue describir la presencia de síntomas psicopatológicos en una muestra de personas con discapacidad intelectual y del desarrollo, y analizar las diferencias según el tipo de alojamiento y tratamiento farmacológico. Los participantes fueron 57 personas adultas con discapacidad intelectual leve y moderada seleccionadas de manera intencional. Se recogieron datos sociodemográficos y de salud, y se administraron los Inventarios PAS-ADD, y Mini PAS-ADD. Se encontró que el 5% de los participantes presentaban síntomas psicopatológicos. La sintomatología depresiva fue la más descrita. También se encontraron diferencias en la presencia de síntomas según el tipo de alojamiento, pero no se encontraron diferencias según si tenían o no pautado tratamiento farmacológico. Se considera necesario analizar la presencia de trastornos mentales en personas con discapacidad intelectual y del desarrollo y su relación con factores sociales y de salud, ya que repercuten directamente sobre la eficacia de las intervenciones y los apoyos, y con ello sobre su calidad de vida.</p>

Additionally, icddr, b extends its thanks to the Governments of Bangladesh and Canada for their core/unrestricted support. " The original article has been corrected.

Abstract Background One crucial obstacle to attaining universal immunization coverage in Sub-Saharan Africa is the paucity of timely and high-quality data. This challenge, in part, stems from the fact that many frontline immunization staff in this part of the world are commonly overburdened with multiple data-related responsibilities that often compete with their clinical tasks, which in turn could affect their data collection practices. This study assessed the data management practices of immunization staff and unveiled potential barriers impacting immunization data quality in Cameroon. Methods A descriptive cross-sectional study was conducted involving health districts and health facilities in all 10 regions in Cameroon selected by a multi-stage sampling scheme. Structured questionnaires and observation checklists were used to collect data from Expanded Program of Immunization (EPI) staff, and data were analyzed using STATA VERSION 13.0 (StataCorp LP. 2015. College Station, TX). Results A total of 265 facilities in 68 health districts were assessed. There was limited availability of some data recording tools like vaccination cards (43%), maintenance registers (8%), and stock cards (57%) in most health facilities. Core data collection tools were incompletely filled in a significant proportion of facilities (37% for registers and 81% for tally sheets). Almost every health facility (89%) did not adhere to the recommendation of filling tally sheets during vaccination; the filling was instead done either before (51% of facilities) or after (25% of facilities) vaccinating several children. Moreso, about 8% of facilities did not collect data on vaccine administration. About a third of facilities did not collect data on stock levels (35%), vaccine storage temperatures (21%), and vaccine wastage (39%). Conclusion Our finding unveils important gaps in data collection practices at the facility level that could adversely affect Cameroon's immunization data quality. It highlights the urgent need for systematic capacity building of frontline immunization staff on data management capacity, standardizing data management processes, and building systems that ensure constant availability of data recording tools at the facility level.

IntroductionUganda has high maternal, neonatal, and under-five mortality rates. This study documents stakeholder perspectives on best practices in a maternal and newborn health (MNH) quality-improvement programme implemented in the West Nile region of Uganda to improve delivery and utilisation of MNH services.MethodsThis exploratory cross-sectional qualitative study, conducted at the end of 2021, captured the perspectives of stakeholders representing the different levels of the healthcare system. Data were collected in four districts through: interviews with key informants working at all levels of the health system; focus group discussions with parents and caretakers and with community health workers; and interviews with individual community members whose lives had been impacted by the MNH programme. The initial content analysis was followed by a deductive synthesis pitched according to the different levels of the health system and the health-systems building blocks.ResultsThe findings are summarised according to the health-systems building blocks and an account is given of three of the interventions most valued by participants: (1) data use for evidence-based decision making (with regard to human resources, essential reproductive health commodities, and financing); (2) establishment of special newborn care units and high-dependency maternity units at district hospitals and training of the health workforce (also with reference to other infrastructural improvements such as the provision of water, sanitation and hygiene facilities at health facilities); and (3) community referral of pregnant women through a commercial motorcycle voucher referral system.ConclusionThe MNH programme in the West Nile region adopted a holistic and system-wide approach to addressing the key bottlenecks in the planning, delivery, and monitoring of quality MNH services. There was general stakeholder appreciation across the board that the interventions had the potential to improve quality of care and newborn and maternal health outcomes. However, as the funding was largely donor-driven, questions about government ownership and sustainability in the context of limited resources remain.

This study characterized undernutrition among children (0-24 months) by age groups specified for Infant and Young Child-feeding (IYCF) and determined the association between child malnutrition and IYCF. This cross-sectional survey recruited mother-children dyads (N = 1443). WHO standards were used to assess nutritional status and IYCF indicators. Multivariate analyses were performed to assess the association between IYCF and nutritional indicators. Stunting, underweight, wasting, overweight, and obesity were prevalent in 33.1%, 26%, 20.2%, 4.6%, and 2.9% of the children, respectively. Age-wise distribution of undernutrition identified severity of stunting and underweight at 10-24 months (median < -1.6 SD; < -1.2 SD; 25th percentile at -2.6 & -2.2 SD respectively) and wasting highest at 0-6 months (25th percentile close to -2SD). Boys manifested higher stunting (lower value -5.2 SD) and were more wasted (lower value -4.7 SD). IYCF prevalence recorded early initiation at 45.2%, exclusive breastfeeding at 23.1%, and prelacteal and bottle-feeding at 37.5 and 22.5% respectively. Child minimum diet diversity (MDD) ≥4 was not achieved by 84%. Minimum meal frequency and minimum acceptable diet were achieved by 75% and 14% respectively. Bottle-feeding increased the odds of wasting [AOR: 1.501 (95% CI: 1.062-2.121)], severe stunting [AOR: 1.595 (95% CI: 1.079-2.358)] and underweight [AOR: 1.519 (95% CI 1.102-2.094)]. Wasting according to BAZ scores was associated with delayed initiation of breastfeeding [AOR: 1.387 (95% CI: 1.018-1.889)] and bottle feeding [AOR: 1.538 (95% CI: 1.087-2.175)]. Delayed introduction of complementary feeding increased the odds of severe stunting [AOR: 2.189 (95% CI: 1.090-4.399)]. Formula feeding increased the odds of underweight [AOR: 1.738 (95% CI: 1.046-2.888)] and obesity [AOR: 4.664 (95% CI: 1.351-16.10)]. Prelacteal feeding increased the odds of severe forms of stunting and underweight by 56% and 79% respectively, and overweight by 96%. Setting and age-specific interventions to improve age-appropriate child-feeding practices are vital to address the double burden of malnutrition in the critical age group.

IntroductionFacility interventions to improve quality of care around childbirth are known but need to be packaged, tested and institutionalised within health systems to impact on maternal and newborn outcomes.MethodsWe conducted cross-sectional assessments at baseline (2016) and after 18 months of provider-led implementation of UNICEF/WHO’s Every Mother Every Newborn Quality Improvement (EMEN-QI) standards (preceding the WHO Standards for improving quality of maternal and newborn care in health facilities). 19 hospitals and health centres (2.8M catchment population) in Bangladesh, Ghana and Tanzania were involved and 24 from adjoining districts served for ‘comparison’. We interviewed 43 facility managers and 818 providers, observed 1516 client–provider interactions, reviewed 12 020 records and exit-interviewed 1826 newly delivered women. We computed a 39-criteria institutionalisation score combining clinical, patient rights and cross-cutting domains from EMEN-QI and used routine/District Health Information System V.2 data to assess the impact on perinatal and maternal mortality.ResultsEMEN-QI standards institutionalisation score increased from 61% to 80% during EMEN-QI implementation, exceeding 75% target. All mortality indicators showed a downward trajectory though not all reached statistical significance. Newborn case-fatality rate fell significantly by 25% in Bangladesh (RR=0·75 (95% CI=0·59 to 0·96), p=0·017) and 85% in Tanzania (RR=0.15 (95% CI=0.08 to 0.29), p<0.001), but not in Ghana. Similarly, stillbirth (RR=0.64 (95% CI=0.45 to 0.92), p<0.01) and perinatal mortality in Tanzania reduced significantly (RR=0.59 (95% CI=0.40 to 0.87), p=0.007). Institutional maternal mortality ratios generally reduced but were only significant in Ghana: 362/100 000 to 207/100 000 livebirths (RR=0.57 (95% CI=0.33 to 0.99), p=0.046). Routine mortality data from comparison facilities were limited and scarce. Systematic death audits and clinical mentorship drove these achievements but challenges still remain around human resource management and equipment maintenance systems.ConclusionInstitutionalisation of the UNICEF/WHO EMEN-QI standards as a package is feasible within existing health systems and may reduce mortality around childbirth. Critical gaps around sustainability must be fundamental considerations for scale-up.