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Interventions to support breastfeeding for infants under six months with growth falteringBackground: Infants with growth faltering often require tailored interventions to support their breastfeeding. We systematically synthesised and examined evidence from qualitative studies on stakeholder perspectives about feasibility of breastfeeding interventions for infants aged <6months with growth faltering. Methods: We conducted a comprehensive search of six electronic databases in addition to manual searches to identify qualitative studies published during January 2000-June 2024 on interventions to support breastfeeding for infants aged <6m with growth faltering. Identified articles were screened in two stages against an inclusion criteria with titles and abstract screened first followed by full-text screening. Included studies were quality appraised using the Critical Appraisal Skills Programme checklist. The primary outcome was intervention feasibility. Results: Thirty studies, conducted in 15 countries were included. Interventions included pumping with machine, manual expression, cup/spoon/bottle supplementation, and minimal enteral feeding. Key factors that were seen to influence feasibility across interventions were: 1. Health service factors including availability of equipment, professional support, communication between healthcare professionals and mothers/parents, and consensus on interventions among healthcare professionals; 2. Mother and infant related factors including mothers’ motivation, preparedness and family support. Overall stakeholder perspectives reflected a dominance of health service factors across all interventions, acting as either a barrier or facilitator for uptake. Conclusions: Pumping breast milk with machine and manual expression were the most commonly reported interventions. There is a need to address health-service related barriers, both at policy and practice levels, to ensure feasibility of interventions to support breastfeeding for infants aged <6m with growth faltering. Key messages: • Pumping breast milk with machine and manual expression were the most commonly reported interventions to support breast feeding for infants aged <6 months with growth faltering. • Health service factors are key to ensure feasibility of interventions support breast feeding for infants aged <6 months with growth faltering.
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Perspectives on prenatal care among mothers in an ethnically diverse neighbourhoodBackground: Timely initiation of prenatal care is critical to maximising positive maternal and infant health outcomes. Women from ethnic minority backgrounds in high income countries are likely to initiate prenatal care later than the recommended 10 weeks. We explored experiences and perspectives of prenatal care among mothers in an ethnically diverse area in the United Kingdom. Methods: We conducted in-depth qualitative semi-structured interviews with 20 expectant and recent mothers who started prenatal care after 10 weeks in an ethnically diverse area. Mothers were recruited using purposive and snowball sampling, through local networks and online advertisements. Interviews were conducted in-person, over the phone or online based on participants’ preferences. Data were analysed using a thematic framework guided by Levesque Conceptual Framework. Results: Three key themes emerged: 1.experiences of and perceptions about prenatal care appointments; 2.factors hindering timely initiation of prenatal care; and 3.strategies to enhance prenatal care uptake. Women felt dissatisfied with limited engagement during appointments and suggested that seeing the same professional could improve trust and confidence. Delays were linked to low awareness and insufficient information on scheduling, as well as employment and childcare constraints. Participants recommended simplified health information about care pathways, appointment reminders, and multilingual resources to improve access. Conclusions: Key barriers in prenatal care highlight the need for targeted co-produced interventions, including provision of simplified health information and culturally inclusive resources to enhance timely uptake among women in ethnically diverse areas in high income countries. Key messages: • Women in ethnically diverse area perceived several barriers for timely prenatal care initiation. • Key barriers in prenatal care highlight the need for targeted coproduced interventions, to support mothers in ethnically diverse areas to start prenatal care on time.
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Defensive Dentistry: Perceptions and Experiences Among General Dental Practitioners in Primary Care.Introduction: Although the term ‘defensive dentistry' is documented, with a range of opinions around practising dentists, little is understood about the perception and the lived experiences of general dental practitioners (GDPs) about practising in a defensive way. Aim To explore how defensive dentistry is understood and experienced by GDPs working in primary care. Methodology An interpretive mixed-methods approach was adopted using an online questionnaire followed by semi-structured interviews. In total, 25 participants completed the questionnaire and six follow-up interviews were completed. Results Three main themes were identified: the sense of fear; practising the ‘act of avoidance' with certain patients and/or procedures; and the overall impact on the profession. Conclusion GDPs unanimously identified the negative aspects of defensive practice as actions carried out for self-protection rather than the interests of patients. The reasoning for such practices included fear of litigation and/or investigation by the General Dental Council, heightening in recent years due to increased public awareness of litigation, and loss of public trust. Participants reported stress, low morale and deskilling as outcomes for practising defensively.
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Stakeholder perspectives on equity, acceptability and feasibility of the duration and type of supplemental milk for infants under six months with growth faltering: a qualitative evidence synthesisReview objectives What are the perspectives of stakeholders on equity, acceptability and feasibility with respect to the most effective supplemental milk, and for how long should these should be given infants <6 months with growth faltering. Searches We will conduct comprehensive searches on the following electronic databases for potential studies: CINAHL Complete (EBSCO), MEDLINE (EBSCO), EMBASE (Ovid), APA PsycINFO (EBSCO), Web of Science (Clarivate Analytics) and Scopus(Ovid). We will limit the search to peer-reviewed published qualitative or mixed-methods (where the qualitative element of the study is included in the findings) studies published in the English language between January 2000 – June 2022. Study design We will include primary studies that used qualitative study designs such as ethnography, phenomenology, case studies, grounded theory studies and qualitative process evaluations. We will include studies that used both qualitative methods for data collection (e.g. focus group discussions, individual interviews, observation, diaries, document analysis, and open-ended survey questions) and data analysis (e.g. thematic analysis, framework analysis, grounded theory). We will include mixed methods studies where it is possible to extract the qualitative data that were collected and analysed. We will exclude studies that collected data using qualitative methods but did not undertake qualitative analysis (e.g. open-ended survey questions where the response data are analysed using descriptive statistics only). We will exclude studies that did not report an intervention to manage difficulties with breast feeding. We will exclude studies reporting quantitative data only, and grey literature, discussion articles, conference abstracts.
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Parenting ‘mixed’ children: negotiating difference and belonging in mixed race, ethnicity and faith familiesInsights into parenting ‘mixed’ children More and more is known about the ‘mixed’ population of Britain – those brought up in families with different racial, ethnic and faith backgrounds. But less is known about their parents. Who are they and what are their experiences of bringing up their children? This report aims to provide insights about parenting mixed children to inform debates about family life and professional strategies for support. Focusing on mothers and fathers living together, it: • Investigates how parents from different racial, ethnic and/or faith backgrounds give their children a sense of belonging and identity. • Examines parents’ approaches to cultural difference and how they pass on aspects of belonging and heritage across generations. • Explores the opportunities, constraints, challenges and tensions in negotiating a sense of identity and heritage between parents.
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Late antenatal care initiation and neonatal outcomes in an ethnically diverse maternal cohortBackground Ethnic minority status and maternal socio-economic deprivation are linked to delayed access to health care during pregnancy. The link between late antenatal care initiation and neonatal outcomes in settings with high ethnic diversity and social disadvantage is seldom explored. This study examined associations between late antenatal care initiation (first antenatal appointment >12 weeks gestation) and neonatal outcomes of preterm birth (<37 weeks gestation) and low birth weight (<2500 g) in an ethnically diverse socially disadvantaged maternal cohort. Methods A retrospective cross sectional study using routinely collected anonymous data of singleton births between April 2007 - March 2016 from a large UK National Health Service maternity unit in an ethnically diverse, socially disadvantaged area. Univariate and multivariate logistic regression models were used to examine the associations between late antenatal care initiation and prevalence of preterm birth and low birth weight. Results Of the 46,307 singleton births recorded, more than one third (34.8%) were to mothers from Black African, Black Caribbean, Indian, Pakistani, and Bangladeshi mothers. Gestational week at first antenatal appointment was available for 99.31% births among which 79.2% had their first appointment at ≤ 12 weeks, 12% at 13-20 weeks, and 8.8% at > 20 weeks. Mothers who booked at 13+ weeks were significantly more likely to have a preterm and/or low birth weight baby. Compared to mothers who booked at ≤ 12 weeks, those booking at > 20 weeks were 4.08 times (95% CI: 3.29,5.07) as likely to have an extremely preterm baby (<28 weeks of gestation) and 3.12 (CI 2.66, 3.67) times as likely to have a baby born with extremely low birthweight (<1500g). Conclusions Mothers in ethnically diverse socially deprived areas who started antenatal care late were at increased risk of adverse neonatal outcomes. Targeted intervention programmes and services are needed to support these mothers. Key messages * Mothers who start antenatal care late are more likely to have a preterm and/or low birth weight baby in ethnically diverse socially disadvantaged areas. * There is a need for targeted programmes and services to support mothers in ethnically diverse socially disadvantaged areas to start antenatal care on time.
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Spatial analysis of the association between area deprivation and neonatal outcomes in an ethnically diverse maternal cohort in England: a retrospective cross-sectional studyBackground Maternal socioeconomic disadvantage and ethnic minority status are linked to increased risk of adverse neonatal outcomes. Neighbourhoods are structural and contextual conditions in which babies are born, but associations between area deprivation and neonatal outcomes in ethnically diverse areas are seldom examined. We examined spatial variations in neonatal outcomes using area deprivation at small-area levels in an ethnically diverse maternal cohort in the east of England. Methods This was a retrospective cross-sectional study using routinely collected anonymous data of singleton births between April 1, 2015, and Feb 28, 2022, in a UK National Health Service maternity unit. Primary outcomes were low birthweight (ie, under 2500g) and preterm birth (ie, before 37 weeks of gestation). We did geospatial analyses of maternal residence postcode areas to understand associations between primary outcomes and area deprivation based on 2019 Indices of Multiple Deprivation using generalised linear regression, optimised hotspot, and spatial autocorrelation (Global Moran's I) in ArcGIS Pro 3.0.2. Findings Of 36 359 singleton births, 12 491 (34·4%) were to mothers from Black Caribbean, Black African, Indian, Pakistani, or Bangladeshi backgrounds. The prevalence of low birthweight (3319 [9·1%] of 36 359) and preterm birth (3147 [8·7%] of 36 359) was higher than the national average (6·8% and 7·4%, respectively). Low birthweight varied across Indices of Multiple Deprivation deciles, from 4 (3·9%) of 103 in the least deprived areas to 48 (10·5%) of 456 in the most deprived areas, with significant clustering in the most deprived areas (Moran's I 0·061; p<0·0001). Mean birthweight differed by 228g between the least (3402g) and most (3174g) deprived areas. An inverse linear association between birthweight and area deprivation was evident (R2 0·18). Preterm birth varied from 7 (6·8%) of 103 in the least deprived areas to 45 (9·9%) of 456 in the most deprived areas, but showed no significant association with area deprivation (R2 0·06). Interpretation Neonates born to mothers in the most deprived areas of ethnically diverse neighbourhoods are more likely to have adverse outcomes, particularly low birthweight, highlighting the need for targeted primary and secondary interventions. Spatial analysis of routine data can be used to examine health inequalities at the small-area level to inform spatially targeted resources. Funding Wellbeing of Women, in partnership with the Burdett Trust for Nursing (grant reference RG2245). Contributors SP conceptualised and designed the study, coordinated and supervised data extraction and analysis, interpreted the findings, and drafted the abstract. CP contributed to literature review, data analysis and interpretation, and drafting the abstract. EA led the data analysis and contributed to the interpretation of the findings and drafting of the abstract. P-CT and TP contributed to the literature review, data analysis, and interpretation. All authors read and approved the final abstract. Declaration of interests We declare no competing interests.
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Systematic review of the effectiveness of interventions aimed at improving male involvement in family planning in sub-Saharan AfricaReview objectives What is the effectiveness of interventions aimed at improving male involvement in family planning in sub-Saharan Africa? Searches Search for relevant studies in academic databases such as PubMed, CINAHL, Google Scholar, Scopus, Frontiers, and Discovery (the database of the University of Bedfordshire library). The search strategy will include only terms relating to or describing the intervention. The terms will be combined with the PubMed filter for various interventions. The search terms will be adapted for use with other bibliographic databases in combination with database-specific filters for intervention studies, where these are available. The search will be restricted to studies published in English Language only. Studies published between January 2013 and the date the searches are run will be sought. The searches will be re-run just before the final analyses and further studies retrieved for inclusion. Study design There are no restrictions to the types of study to be included.
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Effectiveness of postnatal maternal or caregiver interventions on outcomes among infants under six months with growth faltering* Commissioned report submitted to the World Health Organisation. Reports 57-60 has been used to inform WHO Guideline on the prevention and management of wasting and nutritional oedema (acute malnutrition): Management section | Global Nutrition Cluster: Technical Alliance
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A systematic review to collect and synthesise evidence for community-led child and maternal health programmes in the UKReview objectives Review questions: 1. What are the experiences of service users that participate in community-led child and maternal interventions/programmes 2. What is the evidence of the effectiveness of these interventions/programmes Using the SPIDER tool Sample: Conception to three years of age, pregnant women, and families with children aged up to three years. The phenomenon of Interest: The study will assemble knowledge and synthesise evidence in the area of community-led maternal and child health programmes in the UK Design: Published literature of any research design, grey literature Evaluation: Experiences, the effectiveness of community-led child and maternal health programmes in the UK Research Type: Qualitative, Quantitative, and Mixed methods
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Equity, acceptability and feasibility of interventions to manage difficulties with breastfeeding for infants under six months with growth faltering: a qualitative evidence synthesisReview objectives What are the perspectives of stakeholders on equity, acceptability and feasibility of interventions with a focus on restoring or improving the volume and quality of breastmilk and breastfeeding when breastfeeding practices are sub-optimal or prematurely stopped for infants <6 months with growth faltering? Searches We will conduct comprehensive searches on the following electronic databases for potential studies: CINAHL Complete (EBSCO), MEDLINE (EBSCO), EMBASE (Ovid), APA PsycINFO (EBSCO), Web of Science (Clarivate Analytics) and Scopus(Ovid). We will limit the search to peer-reviewed published qualitative or mixed-methods (where the qualitative element of the study is included in the findings) studies published in the English language between January 2000 – June 2022. Additionally, we will review the reference lists of relevant systematic reviews and will conduct a search on Google Scholar. An English language restriction and a methodological filter for type of study will be included in the search strategy. Study design We will include primary studies that used qualitative study designs such as ethnography, phenomenology, case studies, grounded theory studies and qualitative process evaluations. We will include studies that used both qualitative methods for data collection (e.g. focus group discussions, individual interviews, observation, diaries, document analysis, and open-ended survey questions) and data analysis (e.g. thematic analysis, framework analysis, grounded theory). We will include mixed methods studies where it is possible to extract the qualitative data that were collected and analysed. We will exclude studies that collected data using qualitative methods but did not undertake qualitative analysis (e.g. open-ended survey questions where the response data are analysed using descriptive statistics only). We will exclude studies that did not report an intervention to manage difficulties with breast feeding. We will exclude studies reporting quantitative data only, and grey literature, discussion articles, conference abstracts.
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Effectiveness of interventions to manage difficulties with breastfeeding for mothers of infants under six months with growth faltering for improving breastfeeding practices and increasing breastmilk intake: a systematic review updateReview objectives In mothers/caregivers of infants <6 months with growth faltering who are experiencing difficulties with breastmilk intake, which interventions to manage difficulties with breastfeeding can improve breastfeeding practices and increase breastmilk intake? Searches Searches will be conducted in three databases: PubMed, CINAHL, and Cochrane Library. We will limit the search to human studies only and studies published in the English language between December 2018 and December 2021. Study design Inclusion: we will include experimental studies (randomised and non-randomised controlled trials) Exclusion: opinions/commentary, reviews, observational studies, qualitative studies, protocols
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Prevalence of Human Immunodeficiency Virus infection among pregnant women in Nigeria: a systematic review [Prospero]Review objectives What is the prevalence of HIV infection among pregnant women in Nigeria? Searches Relevant healthcare databases such as PubMed (MEDLINE), CINAHL, PsycINFO, Global Health, E-journals, Academic Search Elite, and AMED (Allied and Complementary Medicine Database) were searched in addition to author institutional libraries and online resources such as Google Scholar. Google Scholar search showed the first 1000 yielded articles. A combination of text words were used for the search covering the target population and outcome elements such as: - (Human immunodeficiency virus OR HIV OR AIDS) AND (prevalence OR incidence OR epidemiology OR frequency OR occurrence) AND (pregnancy OR pregnant OR prenatal OR antenatal OR perinatal OR maternal) AND Nigeria. Following the rigorous databases searches, literature that scaled through the screening process were subjected to reference list checking to ensure there is no omission of any relevant article. Studies published in English language between 2008 and 2018 were included. Study design Published quantitative primary and secondary studies on the prevalence of HIV infection among pregnant women carried out in Nigeria.
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Student perspectives on co-creation of learning resources and its benefits on learner developmentPartnership between students and academics in designing learning experiences is shown to have a range of beneficial outcomes. This paper explores student perspectives about the desirability feasibility and the benefits of co- creation on learner development based on the findings from a mixed methods research study situated within an on-going project to develop and evaluate student co-created learning resources. Forty five students from health science disciplines completed a brief online survey consisting of 13 items relating to three domains about the desirability feasibility and the benefits of co-c creation with response options on a five point scale ranging from strongly disagree to strongly agree. Additionally qualitative interviews were conducted with five students who took part in a co-creation project to develop an online learning resource. The findings indicate high levels of agreement from students about the desirability feasibility and the benefits of co-creation on learner development.