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. Aim: To find out delay in routine immunization services during covid-19 and also to determine the factors associated with delay in immunization. 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. 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%. 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.

Factors Associated with the Maintenance of Breastfeeding at One Year among Women in Chiang Mai, Thailand

This study aimed to investigate factors associated with breastfeeding for at least one year among women in Chiang Mai, Thailand. We conducted a cross-sectional study of 451 mothers with children aged between 12 and 24 months who visited the well-baby clinic among women who visited the well-baby clinic in secondary and tertiary hospitals. The data collected included maternal sociodemographic information, employment status, reasons contributing to continued breastfeeding, primary sources of information, and influential people affecting continued breastfeeding. Multivariable logistic regression analysis was used to investigate the relationship between explanatory variables and continued breastfeeding at one year. Reporting “easier to bond with baby” as a reason to continue breastfeeding (AOR 3.118, 95% CI: 2.022, 4.809) and multiparous status (AOR 1.588, 95% CI: 1.042, 2.420) were positive predictors of mothers who had breastfeeding at least one year postpartum while mothers with undergraduate education level (AOR 0.635, 95% CI: 0.404, 0.997) were more likely to discontinue breastfeeding. Our study highlighted that working mothers have lower odds of continued breastfeeding than stay-at-home mothers (SAHMs), which was found for work with day shifts (AOR 0.437, 95% CI: 0.261, 0.731), work with rotational shifts (AOR 0.481, 95% CI: 0.247, 0.934), and work from home jobs with a flexible schedule (AOR 0.439, 95% CI: 0.229, 0.838). These findings showed that both employment outside home and work from home were strong risk factors for discontinuing breastfeeding before 12 months. We suggest that a breastfeeding-friendly workplace policy is essential to enhance the continuance of breastfeeding. Additionally, working at home requires more research to explore breastfeeding barriers and establish more support strategies.

Awareness, Attitude and Use of Chlorhexidine Gel for Cord Care in a Well-Baby Clinic in Port Harcourt, Nigeria

Introduction: Neonatal mortality rate in Nigeria is high and sepsis is a significant contributor. The World Health Organization recommends the use of 7.1% chlorhexidine gel for cord care to prevent neonatal sepsis and mortality. Aim: The study aimed to assess the awareness, attitude and use of chlorhexidine gel for cord care among mothers in Port Harcourt. Methods: A cross sectional study was carried out in the well-baby clinic in Rivers State University Teaching Hospital for 3 months. A research proforma with questions to assess awareness, attitude and use of chlorhexidine gel for cord care practices among the participants was used to collect data and analyzed with SPSS version 23. A score of 70% or more was taken as benchmark for good awareness, attitude and use. Result: A total of 199 mothers participated in the study, 126(63.3%) had heard of chlorhexidine gel, mostly from antenatal clinics. Thirty (23.8%) knew that it prevents neonatal infections, 74(58.7%) perceived it was effective, but only 19(9.6%) used it. About a third of the mothers had good awareness and attitude towards the use of chlorhexidine gel but only 18(9%) used it correctly. Mothers with tertiary level of education significantly had good attitude towards its use and poor knowledge correlated significantly with poor use, P < 0.05. Conclusion: The level of awareness, attitude and use of CHX in cord care practices in Port Harcourt is poor. There is an urgent need to educate mothers on the proper use and benefits of chlorhexidine gel in cord care practices. Key words: Chlorhexidine gel, Cord Care, Awareness, Attitude, Use, Port Harcourt.

Effect of Cough Trick Technique on Vaccination Prick Pain among Preschool Children

Aims: To determine the effectiveness of the Cough trick technique on vaccination prick pain among preschool children. Study Design: Quantitative approach with true experimental research design. Place and Duration of Study: Pranav baby clinic, Chennai, from May 2021 to June 2021. Methodology: True experimental post-test only research design was adopted to conduct the study with a samples of 40 children. Children were randomly allocated into the experimental group (n=20) and the control group (n=20). Demographic variables were collected from mothers of preschoolers using a structured questionnaire. The cough trick technique was administered to the experimental group during intramuscular vaccination whereas the control group received the regular technique of the intramuscular vaccination. The post-test level of pain was assessed by FLACC scale for both the group. The data were tabulated and analyzed by descriptive and inferential statistics using SPSS statistical package. Results: The result of the study shows that in the experimental group, 14(70%) had mild pain and 6(20%) had no vaccination prick pain whereas in the control group, 14(70%) had severe pain and 6(20%) had moderate vaccination prick pain. Independent‘t’ test reveals that there is a significant difference in the level of pain after administration of the cough trick technique between the experimental and control at the level of P<0.05. Conclusion: The finding of the present study concludes that cough trick technique is an effective and easy method to minimize and reduce the pain during intramuscular vaccination. It is a simple distraction technique that can be effective in helping children cope with the pain of immunization.

Is parental satisfaction important in a public hospital NICU

Background: NICU in public hospitals in developing countries face immense challenges in the form of overcrowding, less manpower and lack of equipment. Patient care is the prime responsibility of the health care workers. Parental satisfaction although an important part of health care is not given its due importance. There are very few studies analysing parental satisfaction of NICU babies in the developing countries including India. The objective of this cross-sectional study was to 1. Assess satisfaction regarding medical treatment 2. To assess satisfaction regarding General environment. Take suggestions regarding improvement in services.Methods: A total of four hundred and fifty-nine parents were interviewed. They were parents of babies admitted in NICU, those coming for follow up in the well-baby clinic. Parents of babies who died or left against medical advice were interviewed at the time of leaving the hospital or telephonically later. Results were analysed statistically using the student chi square test.Results: 92.6% of the respondents were satisfied with the medical services and 96.6% were satisfied with the general environment. Reasons for lack of satisfaction were analysed. Nuclear families, urban background, adverse outcome of the baby were the Key factors. Parents gave pertinent suggestions like improvement in cleanliness, more beds, increase in medical staff, better availability of medicines and blood products.Conclusions: There is need to develop standardised protocols to analyse parental satisfaction. This will lead to better understanding of parental expectations and help to improve patient care.

Factors Predicting Six Months Breastfeeding among Thai Adolescent Mothers*

Background: This predictive correlation research aimed to study variables that predict six months of breastfeeding among Thai adolescent mothers. Methods: The participants were 253 Thai adolescent mothers and attending the Department of Well-baby Clinic at hospitals of Bangkok Metropolitan Administration. Data were collected by using questionnaires comprising the following areas: personal characteristics and intention to be pregnant, perceived benefits of breastfeeding, perceived barriers to breastfeeding and breastfeeding self–efficacy, family support, perception of performance from nurses, digital literacy, and the infant feeding form passing checking of the validity of contents and computing Cronbach’s Alpha Coefficient. Data were analyzed by using frequency, percentage, mean, standard deviation, and logistic regression.Results: The findings revealed that digital literacy [Exp (B) = 1.248, 95%CI = 1.120-1.392], self– efficacy [Exp (B) = 1.066, 95%CI = 1.018-1.116] and intention to pregnancy [Exp (B) = 1.139, 95%CI = 1.009-1.284] could explain 37.5% (R2 = 0.375, p<0.05) of the variance in the six months exclusive breastfeeding among Thai adolescent mothers. Conclusions: The result of this study may help health care providers in developing some activities and strategies to improve digital literacy skills. They should enhance self-efficacy for breastfeeding practice among adolescent mothers by providing knowledge and practice of breastfeeding at the antenatal clinic. Moreover, a predictive study on factors related to six months of breastfeeding among Thai adolescent mothers may be done in the future. This can be achieved by realigning breastfeeding policy directives as well as traditional family practices, community collaboration in conjunction with the hospital to promote breastfeeding beyond six months of infants’ age, school, and establishment.

The Prevalence and Risk Factors of Iron Deficiency Anemia in Thai Infants by Complete Blood Count at 9-Month-Old

Background: Infants are the most at risk from iron deficiency (ID) and iron deficiency anemia (IDA), but the prevalence of the latter in this group is unclear. Estimation as to the prevalence of IDA using Hb of less than 11 g/dL may have been exaggerated due to thalassemia and hemoglobinopathies. On the other hand, iron studies are costly and not routinely available in low resource settings. In the present research, the authors estimated the prevalence of IDA in 9-month-old infants at the authors’ well-baby clinic by improving the post-iron-treatment criteria of Hb and defined the risk factors of IDA in infants. Objective: To estimate the prevalence of IDA in 9-month-old infants at the well-baby clinic and to define the risk factors of IDA. Materials and Methods: A retrospective cohort study of 391 children who had complete blood count (CBC) screening at 9-month-old at the well-baby clinic. Anemia was defined according to the WHO criteria (hemoglobin of 11 g/dL or less for children aged six months to five years). IDA was defined as an increase of at least Hb 1 g/dL after receiving iron treatment for one to two months. Mean levels of hematological parameters were compared between groups using independent samples t-test. The characteristics with potential risk factors for IDA were compared with iron non-responder and normal group. Multivariable adjusted odd ratios and 95% confidence intervals (CIs) of IDA were calculated using multinomial logistic regression with control for risk factors. Results: One hundred fourteen children (29.1%) were anemic. There was no difference between anemic and non-anemic children in baseline characteristics. Seventy children in the anemic group were diagnosed with IDA. The prevalence of IDA in the present study was 17.9%. The IDA group showed significant improvement in Hb, Hct, MCV, MCH after receiving iron treatment, but there were no significant changes in the iron non-responder group. The risk factor for IDA was exclusive breastfeeding for at least six months (odds ratio 3.14, 95% CI 1.67 to 5.90, p<0.001). Conclusion: The prevalence of IDA and anemia in the present study was 17.9% and 29.1%, respectively. The risk factor for IDA was exclusive breastfeeding for at least six months. Keywords: Anemia, Iron deficiency anemia, Prevalence of anemia in infants, Complete blood count screening, Thai infants

Screen Dependency Disorders in children under two years of age: A Parent Report Measure

Screen dependency disorder is a growing concern. The rising trend in use of digital devices among young children being less researched, the study was done to find out the prevalence and pattern of total and device-specific screen viewing (SV), in a well baby clinic among children less than two years of age, Data was collected through in-person interviews from mothers of the children. Increasing child age and type of family were found to be significantly associated with higher prevalence of SV. Smart phones had similar usage rates at par with TVs; reiterating the fact that mobile devices have become widely available in the entire population, being second source of SV. Parental knowledge and parental practices were also found to influence the SV and screen-time in children. Modifiable factors like parental knowledge on SV, parental SV practices can help in designing health promotion strategies and recommendations on SV