bluuebunny/crossref_metadata_2025 huggingface dataset:
Improving prevention in primary care: results of a review of reviews and a case study
Authors: Clet E , Leblanc P , Cohidon C , Alla F
Published: October 2023

Background

For many reasons, such as the ageing of the population and the increase in chronic diseases, the organization of primary care (PC) systems is undergoing a major transformation in many European countries. Prevention policies are becoming more and more important but are still struggling to be implemented in the field. This study therefore aims to identify and analyse the obstacles and levers to the integration of prevention into PC.

Methods

This study mobilized: i) A systematic review of reviews of the literature who was conducted on PubMed, Web of Science, Embase and the Cochrane Database, ii) a case study who focused on three different cases of coordinated PC practice structures in France called communauté professionnelle territoriale de santé (CPTS). A qualitative method was used: 18 semi-structured interviews were conducted with health professionals, institutions and partners.

Results

In the review, among the 420 records identified, 35 reviews were included. This review identified many barriers (e.g. time and training) and levers (e.g. guidelines and motivation of the professionals) to the integration of prevention into PC. They were classified into 8 thematic categories according to their potential field of action. The case study complements the findings of the literature in the light of the French context. Specific obstacles and levers in the French context and in CPTS organizations were identified. For example, the construction of a network of professionals, the integration of PC into the health care system, its context and links with other policies (education, housing, transport, employment, etc.) were identified as major levers.

Conclusions

This study highlights: 1) the need to consider all the factors that can influence the integration of prevention in PC in order to meet the challenge of the preventive shift faced by our health systems 2) the specific conditions linked to the coordinated practice by PC professionals, using the French example.

Key messages

• The practice of prevention in PC is very complex, depending on many factors.

• It must be organized and integrated into the health system and local policies.
Factors associated with hospital service access during COVID-19: A longitudinal study in Uganda
Authors: Komasawa M , Aung M N , Ssekitoleko R , Saito K , Shirayama Y , Makimoto S , Yuasa M
Published: October 2023

Background

A global review summarized that the failure of healthcare systems and the capability of pandemic responses affected adverse health outcomes more than restricted movement policies. Studies on sub-Saharan Africa reported that lockdowns directly impeded access to necessary health services. We examined the factors associated with the accessibility of hospital services in Uganda.

Methods

We performed a multiple linear regression analysis. The outcome variable is the number of monthly outpatients (NMPs) at eight services (obstetrics, maternal care, family planning, malaria testing, HIV testing, antiretroviral therapy, diabetes, and child immunization) in four regional referral hospitals (Kabale, Lira, Soroti, and Naguru), comprising 32 services. Explanatory variables included the stringency index (SI) and vaccination policy (VP) from the Oxford COVID-19 government response tracker, and COVID-19 confirmed cases (CC). The data covered the period from January 2019 to December 2021. Statistical significance was set at 0.05.

Results

The SI showed a significantly negative association with NMPs (16/32 services, 50.0%) in four hospitals. The CC also showed similar trends (8/32 services) in three hospitals. In contrast, VP was positively associated with NMPs (8/32 services). Of the eight services, both malaria and HIV testing were negatively associated with SI in all hospitals. Naguru hospital in the capital city, where health facilities were sufficient, was the least affected by SI (2/8 services) while Kabale and Lira hospitals in local cities were negatively impacted regarding SI (5/8 services).

Conclusions

This study showed that the restrictive measures to control COVID-19 transmission had the greatest impact on the disruption of hospital service access, more than the COVID-19 infection itself. Innovative service delivery systems for all necessary populations should be developed during mobility restrictions in health-resource-limited settings for future health crises.

Key messages

• Stringency, public health and social measures, showed the strongest association with the disruption of hospital service access in Uganda, particular in areas with insufficient health facilities.

• Innovative service delivery systems for all necessary populations should be developed in health-resource-limited settings for future health crises.
Electronic file data analysis to improve health services and impact health policies. A pilot study
Authors: Tsilakis D , Parissis I , Polyzogopoulou E , Barbouni A , Lagiou A
Published: October 2023

Background

An important issue faced by Emergency Departments (ED) worldwide is “overcrowding”, whereby demand for health services exceeds available resources and may lead to increased morbidity and mortality. One cause of overcrowding is patients’ visits characterized as “avoidable” or “inappropriate”. Our study aims to estimate their prevalence in a Cardiology ED of a tertiary hospital.

Methods

This is a cross-sectional study, utilizing electronic files of patients attending a Cardiology ED during 2021. Using predefined criteria including tests, treatments, referral to/by other specialties/healthcare facilities and final admission, visits are categorized as either “inappropriate” or not. Our pilot results include all patients attending Cardiology ED on two separate days, one weekday and one weekend, in two different seasons, to account for respective variations.

Results

55 patients (28 females) were studied with a mean age of 53.3 years, of whom 16 (29.1%) were transported by ambulance and 9 (16.4%) were finally admitted. Main analysis showed that 4/55 (7.3%) visits were “inappropriate”, however, in 13/51 (25.5%) of the “appropriate” visits, the sole criterion was D-dimers testing. A prespecified sensitivity analysis including them in the “inappropriate” group, increased the prevalence of “inappropriate” visits to 30.9% (17/55).

Conclusions

Our results show that a considerable proportion of visits in a Cardiology ED may be “inappropriate”, and thus could be more suitable for primary care management. If confirmed by our full study results, this could trigger a health policy reform, aiming to increase the role of primary care thus reducing ED “overcrowding”.

Key messages

• To our knowledge, this is the first study evaluating “inappropriate” Emergency Department visits, focused solely on a Cardiology ED.

• The considerable proportion of patients who could be managed in primary care, paves the way for novel healthcare policies to reform ED services in Greece.
Evaluation of lifestyle change in patients with cardiovascular event in an Italian regional hospital
Authors: Parente F , Panatto D , Dattoli V , Formoso M , Polo A , Milazzo M , Guida P , Icardi G
Published: October 2023

Background

Lifestyle change is one of the tertiary measures undertaken to prevent a new Cardiovascular Event (CVE). In order to evaluate critical issues and undertake actions aimed at improving preventive strategies, we carried out a cross-sectional survey to assess post-CVE lifestyle in patients aged 18-79 years affected by CVE in the 5 years prior to their current admission to Miulli Hospital (Acquaviva delle Fonti, Italy) (702 beds, 64 wards).

Methods

Consecutive patients were enrolled (10/20/22-4/4/23). Data were collected by means of an anonymous questionnaire based on literature.

Patients were matched, according to gender, age and level of education, with two control groups: one constituted by healthy controls (ratio 1:10) and the other by CVE patients (ratio 1:2) involved in the European Health Interview Survey (EHIS).

Results

Forty-two subjects (a number suitable for statistical analysis) were enrolled (73.8% male). They ate fruit and vegetables at least once/day, with an increase from the pre-CVE period (fruit: 61.9% vs 69%; vegetables: 59.5% vs 66.7%) to levels similar to healthy subjects (fruit: 71.7%; vegetables: 66%). Comparison with the CVE EHIS group revealed lower fruit consumption (69% vs 78.6%) but higher vegetable consumption (66.7% vs 52.4%). The proportion of those who did not use alcohol increased after CVE (64.3% vs 69%) to higher levels than in the control groups (healthy subjects: 56.9%; CVE EHIS group: 61.9%). Fish consumption increased from 1-3 times/week (45.2% vs 38.1%) to 4-6 times/week (23.8% vs 33.3%). Red meat consumption decreased from 4-6 times/week (33.3% vs 14.3%) to 1-3 times/week (50% vs 64.3%). A reduction in smoking followed CVE similarly to the EHIS population (90.5% VS 84.5%). No improvement in physical activity was recorded.

Conclusions

The activities of tertiary prevention undertaken yielded a lifestyle improvement in post-CVE patients, who adopted similar habits to those of healthy subjects.

Key messages

• In post-CVE patients, preventive measures can be enhanced through medical counseling at the time of discharge.

• Lifestyle surveillance in post-CVE patients should be strengthened.
Improving healthcare professionals’ interactions with patients to tackle antimicrobial resistance
Authors: Ayorinde A , Ghosh I , Shaikh J , Adetunji V , Brown A , Jordan M , Gilham E , Todkill D , Ashiru-Oredope D
Published: October 2023

Background

Antimicrobial resistance (AMR) is one of the most important public health threats. It is important for healthcare professionals (HCPs) who prescribe, dispense, administer and/or monitor antimicrobials to mitigate inappropriate antimicrobial use. This review identified existing interventions which aim to improve HCPs’ interaction with patients and examined factors that enables or hinders appropriate behaviours.

Methods

We searched MEDLINE, EMBASE, Science Citation Index, Social Sciences Citation Index, Google Scholar, internet and conducted forward and backward citation searching from eligible studies. We included studies of any design, published in English language from year 2010 to 2023. We applied narrative synthesis and used the COM-B (Capability, Opportunity, Motivation - Behaviour) as a theoretical framework for barriers and facilitators at HCP and patient levels.

Results

We included 59 studies of diverse designs examining a range of interventions from 16 countries. Many interventions involved multiple components beyond HCPs’ interaction with patients, e.g., Treat Antibiotics Responsibly, Guidance, Education and Tools (TARGET). Patient interaction components mostly involved use of posters, leaflets, videos, interactive decision support tools and C reactive protein point-of-care testing. The interventions were often found to be useful. Barriers and facilitators identified related to capability (e.g., knowledge/understanding about AMR, diagnostic uncertainties, awareness of interventions, forgetfulness); opportunity (e.g., time constraint, intervention accessibility) and motivation (e.g., patient's desire for antibiotics, fear of litigation).

Conclusions

There are many useful interventions to improve HCPs and patients’ interactions for appropriate behaviours in antibiotic use. The barriers and facilitators identified in this review should be considered by intervention designers/adopters and policy makers to improve implementation and effectiveness.

Key messages

• Factors hindering appropriate antimicrobial use are complex.

• This review can inform the development and implementation of strategies to improve healthcare professional’ interaction with the users.
Medical students’ vaccine hesitancy, knowledge and attitudes: A cross-sectional study
Authors: Giustolisi F , Modica Fiascaro A , Palella M , Oliveri Conti G , Ferrante M , Fiore M
Published: October 2023

Background

Despite physicians being in a unique position to address concerns about vaccine hesitancy (VH), there are hesitant and concerned physicians about vaccination safety and utility. This study aimed to investigate medical students’ knowledge, VH and their association: besides students’ attitudes towards vaccines.

Methods

VH, knowledge, and attitudes towards vaccines were collected using an anonymous self-administered questionnaire. Cronbach's alpha of questionnaire domains was 0.70, 0.80 and 0.78 for VH, knowledge and attitudes, respectively. The opinion answers were added to calculate vaccine Hesitancy Index (HI < 18=low, 19-22=medium, >23=high).

Results

Although the frequency of hesitant students decreased from the first to the fifth year, unfortunately a percentage of future doctors with a non-negligible HI level persisted (medium HI level: 31.3%, high HI level 14.9%). We found a negative association between the percentage of students aware of recommended vaccines for healthcare professionals (chickenpox 74.5%vs 57.5%, p = 0.00; measles, mumps, and rubella 92.8%vs83.5%, p = 0.03; meningococcus 79.7%vs 67.7%, p = 0.00) and HI (low vs high). Furthermore, we found a positive association between the frequency of students who had not been vaccinated (varicella 2.3%vs3.9%, p = 0.00) or who did not know if they were (varicella 8.2%vs22.8%, p = 0.00; Hepatitis B 11.4%vs20.5%, p = 0.02; Tdap 4.6%vs15.0%, p = 0.00) and HI (low vs high). Overall, the reason for not getting vaccinated given by most students was ‘I didn't have time’ (flu: 60.8%vs66.9%) showing a positive association with HI. Conversely, a negative association was found with the reason ‘The vaccine is not free’ (flu 71.4%vs0.0%) that is higher HI corresponded to less vaccine knowledge.

Conclusions

Actions are needed in the future on the education of medical students as well as on the role they perceive themselves to have in responding to patient hesitation, and on their level of confidence in doing so.

Key messages

• Physicians are in the best position to understand hesitance patients, to respond to their worries and concern, and to find ways of explaining to them the benefit of vaccination.

• Widespread and interdisciplinary training on vaccine hesitancy, risk communication, infodemiology and community engagement are needed.
Segmentation analyses as an effective tool to improve tobacco prevention and cessation
Authors: Wieber F W , Müller S , Ackermann K , Furchheim P , Zysset A , Meyer M , Dratva J
Published: October 2023

Background

Defining and understanding target groups is a key for successful tobacco prevention and cessation programs. While most campaigns and interventions only take basic demographic and socioeconomic characteristics of the target groups into account, additional knowledge about behavioral or psychographic characteristics (e.g., motives) is needed. Therefore, we developed and tested profiles of adolescents and adults.

Methods

A systematic literature review revealed 219 articles with criteria that relate to (not) smoking. These criteria were consolidated in 8 expert interviews, 8 qualitative group discussions and 47 interviews with children and adolescents and in 53 interviews with actual and past adult smokers and included in a questionnaire that 2'732 adolescents and 2'899 adults (representative sample) filled in.

Results

Segmentation analyses revealed five adolescent and four adult profiles that show systematic pattern regarding demographics, socioeconomics, social resources/independence, hobbies, psychological well-being/stress, and smoking behavior /intention to quit. Segments were replicated with data from a national tobacco cessation program. Segment-specific messages were derived and experimentally tested.

Conclusions

The successfully developed target group profiles are available as a tool for tobacco prevention experts to improve current and future tobacco prevention and cessation activities.

Key messages

• Defining and understanding target groups is a key for successful tobacco prevention and cessation programs.

• The successfully developed target group profiles are available as a tool for tobacco prevention experts to improve current and future tobacco prevention and cessation activities.
Health Literacy Interventions in cancer care: A review of systematic reviews
Authors: Jeitani C , Van den Broucke S , Leemans C
Published: October 2023

Background

Health literacy (HL), refers to the cognitive and social qualities that influence an individual's motivation and capacity to acquire, comprehend, and apply information to improve their own health. Therefore, interventions targeting HL may allow a better understanding of the illness leading to better-adapted behaviors. Interventions targeting HL in an illness such as cancer may be essential due to the high disease burden, the availability of cancer screening programs, the complexity of multimodal therapy, and the emphasis on cancer clinical trials. This study will review systematic reviews that look into different HL interventions in oncology and hematology targeting patients, health care professionals, and/or organizational HL. The objective of this study is to highlight the already studied factors and their effectiveness, in addition to highlighting the missing factors in light of recent findings on different concepts within HL.

Methods

A literature search was performed using terms such as Cancer AND health literacy AND Interventions AND patients or medical staff, or medical organizations in five different multidisciplinary databases. Reviews that constituted studies that targeted interventions in the oncology population and explicitly mentioned HL as a factor or an outcome were included.

Results

A hundred and thirteen studies were retrieved. Seven studies fit the criteria and were therefore included. The ongoing study's preliminary results show no intervention studies targeting organizational HL. Most reviews included interventions at the patient level. The effectiveness of the interventions varied among studies. Most HL interventions targeted patient communication skills training.

Conclusions

Most of the interventions to date target HL through patient education and communication making it difficult to apply HL in the entirety of its definition, clinically.

Key messages

• Interventions considered as Health Literacy interventions often target solely patient education.

• A call for better use of the term Health Literacy is needed in order to address the different aspects of englobed by HL through its definition and its application.
2.Q. Workshop: Difficult to reach – populations: How to recruit for qualitative and/or quantitative studies?
Authors:   Organised by: University of Bergen (Norway),   Chair persons: Claire Collins (Ireland)
Published: October 2023

Background

Migrants are often described as a difficult-to-reach group for research and become underrepresented or their representation is biased in most research projects. Researchers face challenges related to language barriers, intercultural communication, participant health literacy level, time, participant expectations, differences in education levels, cultural heritage, and values. Other challenges may be related to techniques (sending follow-up emails, phone calls, or face-to-face contact with participants). Improving the recruitment of a representative sample of participants is critical for conducting qualitative and quantitative research that includes the diverse populations we live in. Over the last five years, our research group conducted two large projects among Syrian refugees, including surveys, interviews, and interventions: the CHART project (Changing Health and health care needs Along the Syrian Refugees’ Trajectories to Norway) and the Integration for Health project. Both projects encountered challenges in recruitment but managed to recruit as intended. Based on our positive experiences conducting these studies, this workshop aims to share lessons learned to overcome recruitment challenges during the recruitment and data collection phases and to learn from other researchers with positive experiences.

Aim

To gain knowledge and improve skills in recruiting and addressing participants described as hard to reach in research and to reflect upon the best ways of accessing hard-to-reach populations.

Timetable

• Who are the hard-to-reach populations in public health and why? Esperanza Diaz - 10 min

• Moderated conversation by Claire Collins. Presenters: Ayan Sheikh-Mohamed, Wegdan Hassan, and Khadra Yasien Ahmed, who present challenges from their studies- what we have done well and what not -20 minutes.

• Work in groups: further sharing of experiences with participants and lessons to carry home - 20 minutes.

Key messages

• This workshop will increase awareness, knowledge, and skills in how to understand your target population.

• Build trust and share various tools for recruiting hard-to-reach populations to increase the success of public health research.

Speakers/Panelists

Wegdan Hasha

University of Bergen, Bergen, Norway

Khadra Yasien Ahmed

Department of Global Public Health and Primary Care, University of Bergen, Norway

Ayan Bashir Sheikh-Mohamed

Department of Global Public Health and Primary Care, University of Bergen, Norway

Esperanza Diaz

Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
Defining doctoral training competencies
Authors: OLeary N , Clarke M
Published: October 2023

Background

Structured Population Health, Policy and Health Services Research Education (SPHeRE) is a national doctoral training programme for scholars undertaking research in population health, policy, and health services research (PHPHSR) research in Ireland. The programme has a formative impact on the future of PHPHSR. To ensure graduates are equipped to meet the needs of 21st century public health research, we undertook a review of two interconnected areas, the research priorities and training curriculum underpinning the programme.

Objectives

Our overall aim is to provide exemplary PHPHSR training, enabling graduates address current and future PHPHSR needs via cutting edge research. To achieve this, we set the following objectives:

1. Identify key PHPHSR priorities for stakeholders including researchers, funders and public health agencies

2. Update the curriculum to reflect research priorities and evolving needs for PHPHSR graduates

Results

To achieve both objectives we used parallel complimentary methods. We began by reviewing literature for research prioritisation and curriculum review. Both processes were undertaken as team endeavors and are in the process of being written up as scoping reviews. As such we are also contributing to the knowledge base in the area of PHPHSR doctoral training, while also updating our own programme. Key findings included the need for continuous stakeholder engagement in setting research priorities, to ensure focus of training is orientated towards emerging needs. In terms of curriculum the need for competency focused curriculums emerged clearly. For example, leadership skills are increasingly required. While traditionally seen as incidental, these now need to be integrated within the curriculum. To achieve this we are consulting with stakeholders using a range of participatory methods such as World Café.

Conclusions

Literature review and stakeholder engagement are key components of evidence-based doctoral training programmes.

Key messages

• PHPHSR Doctoral training is a rapidly evolving area.

• Comprehensive research prioritisation and curriculum review are required ensure doctoral training remains fit for purpose.
How do hospitals deal with nursing shortages? Insights from the northern German-Dutch border region
Authors: Schnack H , Tuinman A , Brouwer S , Finnema E , Ansmann L
Published: October 2023

Background

In many countries, hospitals are confronted with nursing shortages. So are hospitals in Germany and the Netherlands as neighboring countries with dire consequences for the hospital. Simultaneously, competition for nurses is high, and hospitals are looking for innovative measures to deal with nursing shortages. This study examines how nursing shortages affect hospitals in the Northern German-Dutch border region and what strategies they use to attract and retain nurses.

Methods

A sequential mixed-methods study with n = 55 key informants (e.g., nursing directors or human resources managers) from hospitals in the northern German-Dutch border region was conducted. Data was collected by questionnaire followed by qualitative interviews from April to August 2023. The survey data was analyzed descriptively and the interview data via content analysis. To integrate the qualitative and quantitative results, joint displays were used. The quantitative and preliminary qualitative results will be presented at the conference.

Preliminary results

First descriptive results indicate that nursing shortages are associated with an increase in overtime, a rise in sick leave and a worsening of the working climate. Preliminary data suggests that recruiting via personal contacts and via social media is seen as an effective recruitment measure to tackle nurse shortages. However, cross-border recruitment of Dutch or German nurses is hardly used by the hospitals. To retain nurses, the interviewed key informants pointed out the importance of flexible working hours, professional development, and a good working climate.

Conclusions

As nurse shortages affect nurses and patient care in hospitals likewise, hospitals are forced to invest in positive and healthy workplaces to attract and retain nurses. The study therefore supports hospitals in the northern German-Dutch border region in sharing best practices and is a starting point to encourage hospitals in exchanging ideas across the border.

Key messages

• Cross-border comparison of nurse shortages shows that Dutch and German hospitals face similar challenges.

• Potential for addressing the nursing shortage arises from cross-border recruitment of German or Dutch nurses.
Zero projects: compliance and evaluation of direct observation checklist as surveillance method
Authors: Erro-Iturri B , Loroño-Ortiz G , Jiménez-Onsurbe M , Carbajal-Domínguez S , Gonzalez de Viñaspre-Remirez I , De Luz-Sanchez Y , Hernandez-Gonzalez A , Barberena-Iriarte C , Rico-Pisuerga M A , Páramo-Andrés S
Published: October 2023

Background

The multimodal projects: “Zero Urinary Tract Infection” (Z-UTI), “Zero Resistance” (Z-R), “Zero Pneumonia” (Z-P) and “Zero Bacteraemia” (Z-B) consist in implementing a bundle of evidence-based recommendations to prevent healthcare-associated infections (HAIs) and acquisition of multidrug-resistant bacteria (MDR-B) during patient's intensive care unit stay. They have been instituted in our tertiary hospital for several years and in order to assess compliance, we perform surveillance based on direct observation checklist. The aim was to examine compliance of recommendations and to evaluate direct observation as surveillance method.

Methods

Descriptive analysis of audits performed between 2020-2022. Compliance was estimated as the average of “yes”-marked percentage. Recommendations with “yes”-marked below 50% were excluded. Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis of direct observation checklist was conducted.

Results

Regarding Z-R (n = 129 observations) compliance was 86.5%.”Giving information about isolation to family” was excluded registering 55.4% “not seen”-marked. In Z-P (n = 262 obs.) compliance was 82.3%. “Hand hygiene and sterile technique for bronchial secretions aspiration” was excluded registering 48.2% “not seen”-marked. As for Z-UTI (n = 607 obs.) compliance was 92,5% (excluded: 4 standards with 78.2% “not seen”-marked). In Z-B (n = 988 obs.) compliance was 78.5% (excluded: 4 standards with 80.6% “not seen”-marked; 1 standard with 49.5% “not appropriate”-marked). Surveillance of projects by direct observation allows in-the-moment feedback but some recommendations could be checked as “not seen” due to observation's schedule. Lack of time and people involved could threaten surveillance. However, HAIs and MDR-B are a major public health problem to deal with.

Conclusions

Study demonstrates good compliance of recommendations, existing standards with high “not seen” percentages. SWOT analysis gives guidance on doing effective surveillance.

Key messages

• Due to increasing concern of MDR-B acquisition and HAIs, is crucial to develop projects including evidence-based recommendations to prevent this major public health problem.

• Once we develop a strategy we must become able to monitor it and moreover, evaluate how we are doing surveillance in order to improve and make changes if necessary.
Factors associated with utilization of focused antenatal care (FANC) services in Nigeria: 2013 -2018
Authors: Haruna-Ogun O
Published: October 2023

Background

The global burden of maternal mortality is high, hence measures such as focused antenatal care (FANC) has been put in place to reduce pregnancy-related deaths. However, attendance of FANC is low in many sub-Saharan African countries, including Nigeria. Many women in Nigeria fail to attend the minimal number of contacts with health professionals. However, the factors associated with utilization of FANC services are yet to be clearly understood. Thus, the objective of this study was to examine trends in the use of FANC services and the factors associated with its use among women in Nigeria.

Data and Methods

The 2013 and 2018 dataset of the Nigerian Demographic and Health Survey was analysed in this study. Univariate, bivariate, and multivariate analysis were conducted.

Results

The study found that between 2013 and 2018, the number of women receiving FANC increased by more than 5%, from 51.5% to 56.8%. Furthermore, the results showed that, in both surveys, attainment of post-primary level of education, residing in urban areas, living in a wealthy household, and residing in the Southern region of the country were significantly associated with utilization of FANC. However, household wealth and women's level of education were the greatest predictors of FANC utilization in both surveys.

Conclusions

Policy intervention aimed at addressing women with low antenatal care attendance is critical in improving maternal health in Nigeria. It is also important for government at all levels to implement policies that ameliorate the economic conditions of women, promote education of girls and women, improve healthcare delivery in rural settings, improve the number of antenatal care facilities and ensure equitable distribution of FANC facilities and providers across the various regions and places of residence in the country.

Key messages

• Focused antenatal care has the potential of improving pregnancy-related outcome because it enables health professionals to detect and manage abnormalities. However, attendance is low in Nigeria.

• Using a nationally representative dataset, the study explored the factors associated with focused antenatal care. The result showed that socio-economic characteristics are crucial to use or non-use.
The impact of the international code of marketing of breast-milk substitutes in Ghana and Tanzania
Authors: Lima Constantino J , Biesma R , Pichler S , Kramer L
Published: October 2023

Background

Measures that promote and protect breastfeeding have a major impact on child survival rates, as it was estimated that increasing breastfeeding rates can reduce child mortality by 13% in Africa. The International Code of Marketing of Breast-Milk Substitutes is an important measure to protect and promote breastfeeding and the safe use of commercial milk formulas. Ghana and Tanzania adopted measures that are substantially aligned with the Code into national legislation in 2000 and 1994, respectively.

Methods

In this study, we estimate the effects of the Code implementation through national laws on child mortality in Ghana and Tanzania by using the synthetic control group method and performing placebo tests to assess statistical inference. The main outcome is the effect of the national laws on overall child mortality and secondary outcomes are the effect of the laws on child mortality by lower respiratory infections and diarrhea in both countries.

Results

Two-sided inference tests showed a statistically significant treatment effect for deaths by lower respiratory infections in Ghana (p = 0.0476; LTE = - 0.8423) and one-sided inference tests showed statistically significant treatment effects for deaths by lower respiratory infections in Ghana (p = 0.0476; LTE = -0.8423) and Tanzania (p = 0.0476; LTE = - 5.1627), and for diarrhea in Tanzania (p = 0.0476; LTE = - 8.1694). To corroborate our results, we also performed the analysis for two major causes of child mortality that are not affected by the intervention, namely congenital diseases and birth asphyxia and trauma birth, for which we did not find significant treatment effects.

Conclusions

The results demonstrate that the Code had a potentially beneficial impact on child mortality in Ghana and Tanzania and corroborate previous research that the Code is a necessary but insufficient step to alone improve child health outcomes.

Key messages

• The results show that the implementation of the Code had a potentially beneficial impact on child mortality in Ghana and Tanzania.

• Policymakers should consider implementing or strengthening the Code within countries in order to improve child and health outcomes.
Early menarche and overweight: evidence from the Italian Health Behaviour School-aged Children Study
Authors: Marconi D , Lipari D , Nardone P , Ciardullo S , Pierannunzio D , Vieno A , Dalmasso P , Lazzeri G
Published: October 2023

Background

Globally, the prevalence of obesity has increased in the last years and tends to be higher in richer countries. Overweight (including obesity) interests all the ages, including childhood and adolescence. Our study aimed to investigate the correlation between body mass index (BMI) and age at menarche.

Methods

We used a unique standardized national dataset on adolescent girls (21 regions) participating in the Italian Health Behaviour in School-aged Children Study (HBSC). HBSC is a European surveillance supported by WHO, conducted every 4 years. Two independent nationally representative survey datasets: one on 15-year-olds (n = 6907 year 2017/2018) and one on 11-year-olds (n = 9506 year 2013/2014) were analysed. The survey instrument was the self-report questionnaire. Median age at menarche and 95% confidence intervals (CIs) were estimated by means of Kaplan-Meier analysis. Hierarchical models were used to assess the relationship between BMI and age at menarche (months). “Region-level obesity” was measured as the prevalence of overweight/obesity (%) in each region. We evaluated the relationship with socioeconomic status (SES) through the Family Affluence Scale.

Results

Region-level median age at menarche ranged between 12 years/5 months and 13 years/4 months. Region-level prevalence of overweight among 15-year-old girls ranged between 6% and 24%. Age at menarche was inversely associated with individual BMI (unstandardized regression coefficient beta= -0.81; 95% CI, -0.92 to -0.70). Individual and class-level measures of BMI accounted for 215.2% of the region-level variance in age at menarche. The coefficient of Family Affluence differed significantly 0.25 (0.09 to 0.41).

Conclusions

Our results show that being overweighted in pre-adolescence is associated with the early puberty.

Strong social inequalities were observed, with adolescents from lower SES are likely to be overweight or obese In line with all the other European countries.

Key messages

• Weight status can influence menarche.

• Policies to reduce socioeconomic inequalities are needed to prevent health problems.
School and child participation rates in COSI-Ireland, pre- and post-COVID-19 pandemic
Authors: Kilduff O , Lee C , Slattery J , Hunt E , Douglass A , O'Brien S , Murrin C M , Kelleher C C
Published: October 2023

Background

The Childhood Obesity Surveillance Initiative (COSI) is a World Health Organisation (WHO) project established in 2008 to routinely measure trends in overweight and obesity among primary school children in over 40 European countries. This study compares school and child participation rates for COSI-Ireland Round 6 (R6), conducted October 2022 - March 2023, to Round 5 (R5), conducted in 2018, pre-COVID-19.

Methods

Sentinel schools (n = 187) invited to partake in all previous Irish COSI rounds were again invited by letter and follow-up telephone calls to participate in R6. These schools remain a representative sample of all primary schools in Ireland, including DEIS (Delivering Equality of Opportunity in Schools) schools. Consent was obtained at three levels: school, parent, and child. Parents of children in one randomly selected class of 1st, 2nd, 5th, and 6th classes of each consenting school were invited to participate by letter. Verbal assent was obtained from each child with parental consent before being measured.

Results

School participation in R6 decreased slightly compared to R5; 65% (n = 121/187) and 73% (n = 135/185), respectively. In total, 79% (n = 33/42) of DEIS schools consented to partake in R6, substantially higher than non-DEIS school participation of 61% (n = 88/145). The R6 DEIS school response rate was also similar to R5 (81%; n = 21/26), despite an increase in the number of DEIS schools following reclassification in 2022. The examination rate of the total cohort in R6 was 55.5% (n = 5,180/9,337), in line with R5 (57.6%). The number of children examined was similar across classes, with slightly more girls (54%) than boys (46%).

Conclusions

Despite the challenges posed by COVID-19 in conducting this research, COSI-Ireland R6 school participation was well preserved, notably in DEIS schools, demonstrating their commitment to equity in obesity trends. Child examination rates were also remarkably well-maintained relative to the preceding pre-pandemic round.

Key messages

• COSI-Ireland R6 findings will allow for continued monitoring of obesity in primary school children and inter-European country comparison.

• COSI-Ireland R6 findings will inform programme planning and evaluation to address childhood overweight and obesity.
Wishes and obstacles to having children – Results from the nationwide Healthy Finland survey
Authors: Lehtoranta L , Klemetti R , Majlander S , Heino A , Gissler M , Lundqvist A
Published: October 2023

Background

Fertility rates have been declining globally since 2010, also in the Nordics. In Finland this decline has been steep and the country has now hit lowest fertility level ever. Changes in fertility rates often occur with economic status and life expectancy improvements in a population. In Finland, delaying childbearing is a major cause for declining fertility rates. The aim of this study was to examine how ethical, economic and societal factors affect having children.

Methods

In total 65,986 randomly selected adults living in Finland were invited to answer the Healthy Finland questionnaire-based survey in 2022-2023. Subjects (n = 28,480, participation rate 32.3 %, males 42.1 % and females 57.9 %) aged 20 to 54 years were asked questions on childlessness and infertility.

Results

17.6% of subjects reported not wanting more or any children while 9.3% wanted to have (more) children. 14.7% reported never wanting to having nor wanting to have children. 4.2% reported having had an experience of infertility and 3.1% reported receiving fertility treatments. Currently 0.5 % were expecting a baby and 1.5% actively trying for a baby. In the sample population, most common reasons for not having children were economic situation (6.2%), never wanting to have children (6.1%), relationship situation (5.9%), and work or studies (5.6%). Other reasons included capability issues (4.3%), ecological or environmental reasons (4.1%), other miscellaneous reasons (4.0%), and loneliness or lack of social network (3.9%), lack of societal support (3.2%), and own, spousal or family illnesses (2.9%).

Conclusions

While childlessness may be a temporary state in many people's lives, close to every seventh person chooses it permanently. Several external reasons affect voluntary childlessness ranging from ethical to practical. Further data is needed to evaluate the societal and economic obstacles to make childlessness a truly voluntary choice.

Key messages

• The Healthy Finland population survey provides information on the major causes of voluntary childlessness, including economic reasons and never wanting to have children.

• In this population, every seventh person did not have nor ever want to have children.
Exploring facilitators for breastfeeding among Irish mothers: a systematic literature review
Authors: Kasra L , Nazaruk D
Published: October 2023

Background

Irish women have one of the lowest rates of breastfeeding in Europe. This review aimed to identify the reported barriers, benefits, and opportunities to increase breastfeeding rates among Irish women.

Methods

The current study implemented a systematic search strategy by using PRISMA guidelines. The research databases PubMed, Mendeley, Web of Science, and Google Scholar were utilized. A deductive thematic analysis of the articles was performed.

Results

Of the 776 identified articles, 20 were included in this literature review. Some of the identified perceived barriers to breastfeeding were: i) Lack of support from healthcare professionals (ii) Negative cultural attitude/social stigma (iii) Embarrassment (iv) Lack of breastfeeding knowledge/advice (v) Lack of public spaces for breastfeeding vi) Low socioeconomic status (vii) Early return to work postpartum viii) Lack of public/work spaces to pump ix) Hospital environment and resources. The identified opportunities were: (i) Policy changes for breastfeeding (ii) Changing social norms for breastfeeding (iii) Breastfeeding education for adolescents and the general public (iv) Social Marketing Campaign. Discussion: This review reveals that efforts toward shifting cultural perceptions through social marketing strategies and public education campaigns might be needed to address the individual barriers to breastfeeding. In addition, many identified barriers could be eliminated by policy implementation that supports breastfeeding. Lastly, health professionals could use current results to guide their practice and provide care more effectively.

Conclusions

This review suggests that the problem of low breastfeeding rates in Ireland is caused by the interplay of multiple factors on various levels of the socioecological model. Therefore to increase breastfeeding rates among the target population, a multifactorial approach is needed. Future programs, interventions, and efforts should consider that.

Key messages

• The efforts toward shifting cultural perceptions through social marketing strategies, public education campaigns, and policy implementation might be needed to increase breastfeeding in Ireland.

• To increase breastfeeding rates among the target population, a multifactorial approach is needed.
Impact of COVID-19 pandemic on healthy of children and families in Italy. Qualitative EPaS-ISS study
Authors: Cattaneo C , Tambascia G , Palermo V , Di Nolfi A , Luzi I , Gentile A E , Zambri F , Ciardullo S , Giusti A ,   Project Research Group EPaS-ISS
Published: October 2023

Background

This study is the qualitative component of a national research carried out in collaboration with the WHO/Europe Childhood Obesity Surveillance Initiative. The aim was to explore the COVID-19 pandemic effects on health behaviours, needs, and psychosocial resources of children and their family in Italy.

Methods

According to the convergent parallel mixed-method, this qualitative study was carried out simultaneously with the quantitative one. Purposeful sampling was used to recruit parents, teachers, key respondents and children. The data were collected by online focus groups (FG) except the FG with children. FGs transcriptions were analysed through a categorical approach using NVivo.

Results

Six FGs were conducted between April-May 2022 (65 adults; 14 children). Participants highlight how the pandemic had consequences at multiple levels: individual, family, community and social.

At the individual level, data showed how thinning out interpersonal relationships and emotional experiences affected children's psychosocial well-being and learning. As for nutrition, it was observed that food was used as both an emotional comfort (e.g. snack consumption) and an opportunity for family aggregation. The ban on going out and social distancing penalized movement and sport. The lack of physical activity and changes in daily routines also affected sleeping. The screen exposure increased due to distance learning and video calls; parents reported excessive use of video games and a difficulty in limiting screen time. The impact of the closures on foreign children and from deprived backgrounds, including school dropouts, was also an issue. Creative play, care of plants and animals, and activities with the family were some of the resources emerging.

Conclusions

Qualitative perspective enriches research on changes in children and families’ habits during the pandemic, showing needs and difficulties and suggesting some necessary actions for the health and education systems.

Key messages

• The COVID-19 pandemic had an impact on children that might persist beyond the pandemic period.

• Health and education policies must offer a compensatory response to the children and families’ needs.
Strengths, weaknesses, opportunities and threats of a community-based egg program in rural Honduras
Authors: Kasra L , Nazaruk D , Ramos G , Manship L , Palacios A M
Published: October 2023

Background

Young children living in poor rural areas in Honduras are susceptible to suffering from undernutrition. About 1 in every 4 children under age 5 have stunting. Stunting during early childhood has negative consequences on an individual's life that can have short-term and lasting effects. This study's purpose was to explore the perceptions of the mothers of children that participate in a community-based nutrition-agriculture program that offers 1 egg daily to all children ages 6 to 24 months in 13 communities.

Methods

Using community-engaged methods, we implemented a SWOT analysis to identify strengths, weaknesses, opportunities, and threats using a semi-structured guide to conduct in-depth interviews in n = 14 participating mothers in the Hens Hatching Hope project (ClinicalTrials.gov Identifier: NCT04721197). Interviews were performed by a local community health worker in Spanish, translated to English, and analyzed via content analysis by a researcher. Main themes were identified and synthesized.

Results

Some of the identified strengths were the “improved community access to eggs” and “financial assistance that offset burdening household expenses”. For weaknesses “expansion of program age eligibility to accommodate multi-child households” and “no control over parent's use of eggs”. For opportunities “Implementation of external community resources” and “improve water and sanitation initiatives”, for threats “changes in political climate” and “frail farm infrastructure”.

Conclusions

Perception of the program is positive among all mother participants. This analysis identified multiple strengths and opportunities to 1) improve the program locally, and 2) expand the program's scope and reach. Further, this analysis identified weaknesses and potential threats that will serve to modify and improve the delivery and uptake of the intervention.

Key messages

• Explore program strengths, weaknesses, opportunities, and threats perceived by particpating mothers of a community-based nutrition agriculture program that provides 1 egg a day to their child's diet.

• The swot analysis of participating mothers’ interviews serves in the developing contingency plans to continue the Hens Hatching Hope program.