Effectiveness of breastfeeding for pain relief in infants during vaccination at Bharatpur

Background: Vaccination is an integral part of childhood development since it protects children from a variety of diseases. It is, however, the most common cause of pain in children. Breastfeeding is effective tool for reducing pain in infants during vaccinations. The objective of the study was to determine the effectiveness of breastfeeding for pain relief in infants during vaccination.Methods: A true experimental pretest and posttest design was conducted at Maternal and Child Health Clinic at Bharatpur, Nepal among 140 infants receiving pentavalent vaccines (Diphtheria, Pertussis, Tetanus, Hepatitis B and Hemophilus influenzae B). A structured interview schedule was used to collect socio-demographic information of mothers and infants. Bio physiologic method was used to determine biological and physical status of the infants. Modified behavioral pain scale was used to measure the level of pain in infants in both the control and experimental groups.Results: The study revealed that the total modified behavioral pain scale (mean ±SD after vaccination was 8.74±0.53 in control and 8.23±1.07 in experimental respectively. The study showed that breastfeeding had significantly lowered pain level (p<0.001) and lessened duration of cry (p=0.002) in infants in experimental group than in control group after vaccination. However, related to injectable vaccination, the study showed that breastfeeding did not significantly stabilized heart rate in infants in both the groups (p=0.122).Conclusions: The study concluded that the infants who were breastfed experienced less pain than those who were not breastfed during vaccination.

136 Characterizing the medical and social complexity of Inuit children, youth, and their families from Nunavut who access care at an urban tertiary level paediatric hospital – A retrospective chart review of an Inuit child health clinic

Primary Subject area Social Paediatrics Background The Inuit Child Health Clinic is a consulting general pediatric outpatient clinic at an urban tertiary level paediatric designed to improve integration and coordination of care for Inuit children, youth, and their families from Nunavut. Characterizing medical and social complexity for this patient population will help to address existing gaps in health and social care, as well as contribute to the development of a culturally safe and sensitive determinants of health screening tool. Objectives To study and characterize the complexities that families cared for by the Inuit Child Health Clinic experience in navigating the health and community environments to identify gaps that exist within their care and understand how we can better support their unique needs. We define medical complexity similarly, referenced in existing literature as multi-system or multi-service involvement or prolonged stay in the city of the urban tertiary level paediatric hospital to access medical care. Design/Methods A retrospective chart review of patients (children and youth between the ages of 0-18 years old) and their caregivers that attended an outpatient general paediatric medicine clinic visit appointment with the Inuit Child Health Clinic between September 30, 2016, and September 30, 2019. A review of 59 patient charts were completed by 2 independent reviewers each for demographic information, medical complexity variables, and social complexity variables. This research has been approved by a local Research Ethics Board as well as the Nunavut Research Institute. Results There are high levels of medical and social complexity as evident through the high average number of healthcare services accessed, number of comorbidities, and number of admissions to hospital. We also found considerable inconsistencies with respect to documentation by providers on the social determinants of health of patients. Note: In collaboration with the Inuuqatigiit Centre for Inuit Children Youth and Families, Qikiqtani Inuit Association (QIA), Nunavut Tunngavik Incorporated (NTI), and the Department of Health in Nunavut, the results and knowledge will be shared and mobilized to reflect a narrative that is community-driven and comments on any possible gaps in social determinants of health screening in clinical settings. Furthermore, in collaboration with the Qaujigiartiit Health Research Centre, this work will inform and support the broader program evaluation of the Inuit Child Health Clinic to meet the needs of patients, families, caregivers, and healthcare professionals. Conclusion A multidisciplinary team approach that focuses on integrative care may be an effective and efficient means to promote communication and collaboration between multiple service providers that are often involved in providing care to this population that is put at-risk due to systemic health and social inequities. Improving social history taking and integrating more formal screening for social determinants of health within the Inuit Child Health Clinic practice should be considered.

Drug usage pattern and potential teratogenesity risk among pregnant women attending maternal and child health clinic of Mettu Karl Referral Hospital, South Western, Ethiopia: a cross sectional study, 2021

Introduction: Physiological alterations during pregnancy as well as the bio- conversion of compounds can significantly influence the teratogenic effects of drugs and chemicals by affecting absorption, body distribution, the active form(s), and excretion of the compound. Certain medications may cause harm to the foetus due to their potential teratogenic effects and the physiological adjustments occurring in the mother during pregnancy. Prescription of drug used by pregnant women should be viewed as one of a public health issue. This study aware health care workers on harmful drugs prescription to pregnant women and helps in understanding the type of medication used during pregnancy and safety of drugs used during pregnancy, thereupon this study was ascertain drug usage pattern and potential teratogenicity risk among pregnant women attending maternal and child health clinic of Mettu Karl Referral Hospital. Methods: A hospital-based cross-sectional study design was carried out from April 13/2021 to June 15/2021. Data was collected through employing semi-structured questioner, and then the collected data was cleared, coded and analyzed by statistical packages for social sciences 25.0 version statistical software. Descriptive statistics were used to describe the data. P value <0.05 was considered as a cut point for statistical significance in the final model. Results: A total of 156 participants were interviewed of whom, 81(51.9%) pregnant women were age between 20-35 years old and a majority 113(72.4%) of them were married. Among medical condition majority 40(25.6%) of the participants had peptic ulcer disease and 26(16.7%) urinary tract infections followed by 20(12.8%) acute illness and 12(7.7%) hyperemesis. Among the total drug prescribed for pregnant women 30(19.2%) FDA category C was the common followed by 29 (186%) FDA category B and 26(16.7%) FDA category D. Only 10(6.4%) of prescribed drug were FDA category X. Pregnant women whose age >35 years (AOR=4.05, 95%CI:1.274-1.903; p=0.001), urban residents (AOR=2.72, 95%CI:2.524-3.927; p=0.035), and pregnant women during second trimester (AOR=1.79, 95%CI:3.926-9.406; p=0.013) were significantly associated with MCH follow up. Conclusion and recommendation: From the drug prescribed, majority of pregnant women were taken antibiotics followed by 18(11.5%) NSAID, iron sulfate, and proton pump inhibitors. Among the dosage form, above half of the participants were taken the tablet dosage form followed by capsule and gels dosage form. Health care workers should have to brought good care for pregnant women, since they perhaps vulnerable to drug teratogenesity

Knowledge, Practices and Factors Affecting Exclusive Breastfeeding among Lactating Mothers with Babies aged 6 months to 1 year attending Magomeni Reproductive and Child Health Clinic, Kinondoni, Dar es Salaam: Descriptive Cross Sectional Study

Background: Exclusive Breastfeeding defined as the infant has to receive only breast milk from his/her mother with the exception of other kinds of food for six months. Exclusive Breastfeeding helps to prevent diseases to infants and it reduces risk of ovarian cancer to mother.Methodology: Descriptive cross sectional study was conducted among 124 lactating mothers with infants aged 6 months to one year attending Magomeni RCH Clinic in Kinondoni, Dar es Salaam. Simple random sampling procedure was used to obtain 124 lactating mothers. Data was collected from mothers who agreed to participate and signed the consent form by the use of close ended Swahili version questionnaire on assessing knowledge, practices and factors affecting Exclusive Breastfeeding among Lactating Mothers with Babies aged 6 months to 1 year attending Magomeni Reproductive and Child Health Clinic in Kinondoni district, Dar es Salaam.Result: About 74 (59.7%) respondents had high knowledge on EBF and 92 (74.2%) respondents initiated breastfeeding within one hour after delivery while 77 (62.1%) practiced exclusive breastfeeding. Findings show that 64(51.6%) respondents denied that exclusive breastfeeding causes loss of shape of their breasts while 48 (38.7%) respondents accepted that exclusive breastfeeding causes loss of shape of their breasts. Only 12 (9.7%) respondents didn’t know if EBF causes loss of breasts shape or not. Moreover, 19 (15.3%) respondents had physical difficulties/problems like cracking of nipples, inadequate milk, while 105(84.7%) didn’t get any physical difficult. Therefore there is significant association between mothers belief of losing shapes of their breasts and EBF (p=0.05). Physical difficulties/problems to lactating mothers study is significantly associated with EBF (p = 0.000).Conclusion: The overall knowledge among the lactating mothers with babies aged six months to one year was high and had good exclusive breast feeding practice. Although majority of the respondents are knowledgeable about EBF, the results show a gap between knowledge and actual practice within six months which is a recommended duration for Exclusive Breast feeding.

Knowledge, Practices and Factors Affecting Exclusive Breastfeeding among Lactating Mothers with Babies aged 6 months to 1 year attending Magomeni Reproductive and Child Health Clinic, Kinondoni, Dar es Salaam: Descriptive Cross Sectional Study

Background: Exclusive Breastfeeding defined as the infant has to receive only breast milk from his/her mother with the exception of other kinds of food for six months. Exclusive Breastfeeding helps to prevent diseases to infants and it reduces risk of ovarian cancer to mother. Methodology: Descriptive cross sectional study was conducted among 124 lactating mothers with infants aged 6 months to one year attending Magomeni RCH Clinic in Kinondoni, Dar es Salaam. Simple random sampling procedure was used to obtain 124 lactating mothers. Data was collected from mothers who agreed to participate and signed the consent form by the use of close ended Swahili version questionnaire on assessing knowledge, practices and factors affecting Exclusive Breastfeeding among Lactating Mothers with Babies aged 6 months to 1 year attending Magomeni Reproductive and Child Health Clinic in Kinondoni district, Dar es Salaam.Result: About 74 (59.7%) respondents had high knowledge on EBF and 92 (74.2%) respondents initiated breastfeeding within one hour after delivery while 77 (62.1%) practiced exclusive breastfeeding. Findings show that 64(51.6%) respondents denied that exclusive breastfeeding causes loss of shape of their breasts while 48 (38.7%) respondents accepted that exclusive breastfeeding causes loss of shape of their breasts. Only 12 (9.7%) respondents didn’t know if EBF causes loss of breasts shape or not. Moreover, 19 (15.3%) respondents had physical difficulties/problems like cracking of nipples, inadequate milk, while 105(84.7%) didn’t get any physical difficult. Therefore there is significant association between mothers belief of losing shapes of their breasts and EBF (p=0.05). Physical difficulties/problems to lactating mothers study is significantly associated with EBF (p = 0.000).Conclusion: The overall knowledge among the lactating mothers with babies aged six months to one year was high and had good exclusive breast feeding practice. Although majority of the respondents are knowledgeable about EBF, the results show a gap between knowledge and actual practice within six months which is a recommended duration for Exclusive Breast feeding.

Co-producing a social determinants of health questionnaire for an urban population in community child health

We used quality improvement (QI) and co-production methodologies to explore how child health professionals can be helped to open up conversations about poverty and other social issues in a London community child health clinic between July and October 2019.

Dental caries in three-year-old preschool children in Lima, Peru assessed according to the CAST instrument.

The aim of this study was to determine the caries situation of three-year-old preschool children residing in low socioeconomic status districts in Lima, Peru. The study is a crosssectional analysis of the caries situation of suburban areas of Lima. A stratified sampling procedure by geographical distribution, considering healthcare centers with a motherand- child health clinic and surrounding preschools as factors, identified 45 randomly selected preschools, of which 17 accepted to participate. Children from 3-year-old classrooms were examined by two independent calibrated dentists using the Caries Assessment Spectrum and Treatment (CAST) instrument at their premises using artificial light, sterile examination mirrors and gauze for drying each tooth before evaluation. ANOVA and the Tamhane method were used to analyze the data. 308 children, mean age 3.4 years (min: 3 years; max: 3 years, 7 months), were examined. The sample prevalence of enamel and dentine carious lesions (CAST code 3-7) was 91.2% while the prevalence of dentine carious lesions (CAST code 4-7) was 58.8%. The mean number of teeth with cavities that had reached the pulp and those that had an abscess or fistula were 2.0% and 0.5% respectively. The majority of enamel and dentine carious lesions were observed in molars. The CAST severity score was 7.0. Mean examination time was 57 seconds. The burden of dental caries of the children at this young age was high.

Exploring Strategies to Improve Adherence to Immunization Schedule: A Study among Children Attending Maternal and Child Health Clinic at Kenyatta National Hospital, Nairobi, Kenya

Background. Globally, immunization is among the major contributors to public health, preventing 20% of childhood mortality annually. The highest fatality rates from vaccine preventable diseases are usually among children under five. Despite immunization guidelines put in place by the World Health Organization, globally, 1.5 million children die annually related to inadequate vaccination coverage. Existing literature indicate that there is an increase in nonadherence to immunization schedule in developing countries, and therefore, there is an increased demand to improve adherence to immunization schedule. Objective. To explore strategies that will improve adherence to immunization schedule among children under 24 months attending the Maternal and Child Health clinic at Kenyatta National Hospital. Methods. A cross-sectional mixed method study involving caregivers (n=214) of well babies attending the Maternal and Child Health clinic. Data was collected using semistructured questionnaires, focus group discussions, and key informant interviews and analyzed using SPSS V.20. Results. There was a significant relationship between the level of education and marital status of the caregivers and adherence to immunization schedule. Barriers found that is related to adherence to immunization schedule included far distance from health facility, baby’s sickness, and vaccine stock-outs while employment of a caregiver was a constrainer factor. Conclusion. The enabling factors to current strategies of improving adherence to immunization schedule were having more health facilities near residential areas, using text messages reminders a day before the clinic date to remind caregivers of the due date for the clinic, and constant availability of vaccines. The health system strategies that would improve adherence to immunization schedules were more flexible clinic hours, availability of vaccines on daily basis, phone call reminders by health care providers, and increasing awareness on the importance of both vaccinations and adherence to immunization schedule.