@article {10842, title = {Report on an international workshop on kangaroo mother care: lessons learned and a vision for the future.}, journal = {BMC Pregnancy Childbirth}, volume = {18}, year = {2018}, month = {2018 May 16}, pages = {170}, abstract = {

BACKGROUND: Globally, complications of prematurity are the leading cause of death in children under five. Preterm infants who survive their first month of life are at greater risk for various diseases and impairments in infancy, childhood and later life, representing a heavy social and economic burden for families, communities and health and social systems. Kangaroo mother care (KMC) is recommended as a beneficial and effective intervention for improving short- and long-term preterm birth outcomes in low- and high-income settings. Nevertheless, KMC is not as widely used as it should be. The International Network on KMC runs biennial workshops and congresses to help improve the coverage and quality of KMC worldwide. This paper reports the results of the two-day workshop held in November 2016, where 92 participants from 33 countries shared experiences in a series of round tables, group work sessions and plenaries.

FINDINGS: Barriers to and enablers of KMC are discussed with regard to parents, health workers and the health system. Key factors for effective implementation and uptake relate to appropriate training for health staff, adherence to protocols and the creation of a welcoming environment for families. Recommendations for planning for national programmes are made according to a six-stage change model. Resources and the cost of making progress are discussed in terms of investment, maintenance, and acceleration and scaling-up costs. KMC training requirements are presented according to three levels of care. To ensure quality KMC, key requisites are proposed for the different KMC components and for sensitive communication with caregivers. The group attending to the monitoring and evaluation of KMC at a national and subnational level highlight the lack of standard indicator definitions. Key priorities for investment include health services research, harmonisation of indicators, development of a costing tool, programming and scaling up, and the follow-up of preterm infants.

CONCLUSION: It is hoped that this report will help to further scale-up and sustain KMC through a systematic approach that includes raising commitment, identifying key strategies to address the main barriers and using existing facilitators, ensuring training and quality, agreeing on indicators for monitoring and evaluation, and advancing implementation research.

}, keywords = {Education, Education, Nonprofessional, Female, Government Programs, Health Plan Implementation, Humans, Infant, Infant Mortality, Infant, Newborn, Infant, Premature, Infant, Premature, Diseases, International Cooperation, Kangaroo-Mother Care Method, Male}, issn = {1471-2393}, doi = {10.1186/s12884-018-1819-9}, author = {Cattaneo, Adriano and Amani, Adidja and Charpak, Nathalie and De Leon-Mendoza, Socorro and Moxon, Sarah and Nimbalkar, Somashekhar and Tamburlini, Giorgio and Villegas, Julieta and Bergh, Anne-Marie} } @article {10475, title = {Introduction of Complementary Foods in a Cohort of Infants in Northeast Italy: Do Parents Comply with WHO Recommendations?}, journal = {Nutrients}, volume = {9}, year = {2017}, month = {2017 Jan 04}, abstract = {

Timing and type of complementary food in infancy affect nutritional status and health later in life. The objective of this paper was to assess complementary feeding practices, looking at timing, type, and compliance with World Health Organization (WHO) recommendations. Data were obtained from a birth cohort of 400 infants, enrolled in Trieste (Italy) between July 2007 and July 2008 and followed up for three years, using a "food introduction timing table". Five WHO recommendations standards were used to assess parental compliance and associated factors. Thirty seven percent of mothers returned the completed "timing table" up until the child was three years of age. Eighty six percent of infants were already receiving complementary foods at six months. The first food type to be introduced was fresh fruit (170 days from birth, median). Overall, infants shared a very similar diet, which was different from the family diet and characterized by delayed introduction of certain food types. Five percent of parents complied with either all five or only one of the WHO recommendations, 34\% with three, and 35\% with four. The parents{\textquoteright} partial compliance with WHO recommendations is probably due to conflicting information received from different sources. This advocates for national evidence-based guidelines, supported and promoted by health professionals.

}, keywords = {Adult, Cohort Studies, Dairy Products, Diet, Edible Grain, Female, Follow-Up Studies, Fruit, Humans, Infant, Infant Nutritional Physiological Phenomena, Italy, Logistic Models, Male, Mothers, Patient Compliance, Recommended Dietary Allowances, Socioeconomic Factors, Vegetables, World Health Organization}, issn = {2072-6643}, doi = {10.3390/nu9010034}, author = {Carletti, Claudia and Pani, Paola and Monasta, Lorenzo and Knowles, Alessandra and Cattaneo, Adriano} } @article {8354, title = {Effectiveness of the Baby Friendly Community Initiative in Italy: a non-randomised controlled study.}, journal = {BMJ Open}, volume = {6}, year = {2016}, month = {2016}, pages = {e010232}, abstract = {

OBJECTIVE: To assess the effectiveness of the Baby Friendly Community Initiative (BFCI) on exclusive breast feeding at 6 months.

DESIGN: Controlled, non-randomised trial.

SETTING: 18 Local Health Authorities in 9 regions of Italy.

PARTICIPANTS: 5094 mother/infant dyads in 3 cohorts were followed up to 12 months after birth in 3 rounds of data collection: at baseline, after implementation of the intervention in the early intervention group and after implementation in the late intervention group. 689 (14\%) dyads did not complete the study.

INTERVENTION: Implementation of the 7 steps of the BFCI.

MAIN OUTCOME MEASURES: The rate of exclusive breast feeding at 6 months was the primary outcome; breast feeding at discharge, 3 and 12 months was also measured.

RESULTS: The crude rates of exclusive breast feeding at discharge, 3 and 6 months, and of any breast feeding at 6 and 12 months increased at each round of data collection after baseline in the early and late intervention groups. At the end of the project, 10\% of infants were exclusively breast fed at 6 months and 38\% were continuing to breast feed at 12 months. However, the comparison by adjusted rates and logistic regression failed to show statistically significant differences between groups and rounds of data collection in the intention-to-treat analysis, as well as when compliance with the intervention and training coverage was taken into account.

CONCLUSIONS: The study failed to demonstrate an effect of the BFCI on the rates of breast feeding. This may be due, among other factors, to the time needed to observe an effect on breast feeding following this complex intervention.

}, issn = {2044-6055}, doi = {10.1136/bmjopen-2015-010232}, author = {Cattaneo, Adriano and Bettinelli, Maria Enrica and Chapin, Elise and Macaluso, Anna and C{\'o}rdova do Esp{\'\i}rito Santo, L{\'\i}lian and Murante, Anna Maria and Montico, Marcella} } @article {3640, title = {Advertisements of follow-on formula and their perception by pregnant women and mothers in Italy.}, journal = {Arch Dis Child}, volume = {100}, year = {2015}, month = {2015 Apr}, pages = {323-8}, abstract = {

OBJECTIVE: To assess how follow-on formula milks for infants aged 6-12 months are presented to and understood by mothers.

DESIGN: A quantitative and qualitative cross-sectional study including (1) an analysis of advertisements in three magazines for parents; (2) in-depth semistructured qualitative interviews to pregnant women on their perception of two advertisements for follow-on formula and (3) self-administered questionnaires for mothers to explore their exposure to and perception of formula advertisements.

PARTICIPANTS: Eighty pregnant women 32-36 weeks of gestation with no previous children and 562 mothers of children <3 years old.

SETTING: Maternal and child health centres in eight cities of Italy.

RESULTS: Advertisements of formula (n=89) represented about 7\% of all advertisements in the three magazines, the majority (58\%) being for follow-on formula. Advertisements were parent-oriented, aimed at helping parents solve health problems of their babies or at eliciting good feelings, or both. The qualitative interviews to pregnant women showed inability to define the advertised products at first glance due to the ambiguity of the numeral 2 and the presumed age of the portrayed baby; this inability did not disappear after carefully viewing the advertisements and reading the text. When asked in the self-administered questionnaires whether they had ever come across advertisements of infant formula, 81\% of mothers reported that they had, despite the legal inexistence of such advertisements, and 65\% thought that it was for a product to be used from birth.

CONCLUSIONS: Advertisements of follow-on formula are perceived by pregnant women and mothers as promoting infant formula.

}, keywords = {Adult, Advertising as Topic, Attitude to Health, Cross-Sectional Studies, Female, Humans, Infant, Infant Formula, Italy, Mothers, Perception, Periodicals as Topic, Pregnancy, Pregnant Women, Reading, Surveys and Questionnaires, Young Adult}, issn = {1468-2044}, doi = {10.1136/archdischild-2014-306996}, author = {Cattaneo, Adriano and Pani, Paola and Carletti, Claudia and Guidetti, Margherita and Mutti, Valentina and Guidetti, Cecilia and Knowles, Alessandra} } @article {1839, title = {Academy of breastfeeding medicine founder{\textquoteright}s lecture 2011: inequalities and inequities in breastfeeding: an international perspective.}, journal = {Breastfeed Med}, volume = {7}, year = {2012}, month = {2012 Feb}, pages = {3-9}, abstract = {

Breastfeeding is the biological norm for infant feeding but is also a social construct. As such, its rates and practices are determined by the same social determinants that shape health inequalities and inequities. In the past 30 years, several reports have drawn attention to the changing pattern of breastfeeding inequalities across countries and population groups. Breastfeeding rates tend to fall and rise following a similar pattern everywhere, although at different times and speed. The role of women within families and societies, the routines of maternity hospitals and other healthcare services, and the pressure exerted by the baby food industry are among the factors that influence the time and speed of changes in breastfeeding rates and practices across countries and population groups. Inequities (i.e., inequalities considered unfair and avoidable by reasonable action) can be redressed by interventions for the protection, promotion, and support of breastfeeding. Evidence-based and quality-implemented support and promotion activities, if applied without an equity lens, may increase inequities. Activities for the protection of breastfeeding (e.g., implementation and enforcement of the International Code of Marketing of Breastmilk Substitutes; legislations, regulations, and policies to remove obstacles and barriers to good-quality breastfeeding support and to protect women and mothers in the workforce; elimination of obstacles and barriers to breastfeeding anywhere, anyhow, and anytime mothers want) apply to all women and are less dependent on take up by the target population. If well designed and enforced, protective interventions contribute to reducing inequalities and inequities and to delivering promotion and support activities more effectively.

}, keywords = {Breast Feeding, Cross-Cultural Comparison, Female, Health Policy, Health Promotion, Healthcare Disparities, Humans, Infant Food, Infant, Newborn, Internationality, Maternal Health Services, Mothers, Pregnancy, Socioeconomic Factors}, issn = {1556-8342}, doi = {10.1089/bfm.2012.9999}, author = {Cattaneo, Adriano} } @article {1968, title = {Establishing the Baby-Friendly Community Initiative in Italy: development, strategy, and implementation.}, journal = {J Hum Lact}, volume = {28}, year = {2012}, month = {2012 Aug}, pages = {297-303}, abstract = {

BACKGROUND: The Baby-Friendly Hospital Initiative (BFHI), developed by the World Health Organization and the United Nations Children{\textquoteright}s Fund (UNICEF) to promote breastfeeding in maternity facilities worldwide, has had a global impact on breastfeeding outcomes, but other interventions are needed both before and after hospital discharge to meet the recommended targets at 6 months. The Baby-Friendly Community Initiative (BFCI), a multifaceted program for community-based breastfeeding promotion that is complementary to the BFHI, addresses this challenge.

OBJECTIVE: To describe the development, strategy, and implementation of the BFCI in Italy.

METHODS: In 2006, UNICEF Italy created a working group to develop the BFCI for the Italian health system. A review of the different BFCI models worldwide was conducted. A preliminary adaptation of tools to Italian community health care settings was developed in 2007, when the Italian BFCI Seven Steps were published. Two years later, UNICEF Italy launched the Standards for Best Practice for both hospitals and communities, based on 2009 BFHI and UNICEF UK BFCI materials.

OUTCOMES: The main outcome was to promote this process in Italian regional health systems and develop tools to assess compliance with the BFCI criteria. There is now one fully accredited Baby-Friendly Community in Italy, and 17 other communities are working on the various stages.

CONCLUSIONS: The BFCI, a complex program that involves participation, training, audits, a continuous flow of feedback, and provision of resources for health workers and families, is now a reality in Italy.

}, keywords = {Breast Feeding, Continuity of Patient Care, Delivery Rooms, Female, Health Policy, Humans, Infant, Infant Care, Infant Welfare, Infant, Newborn, Italy, Maternal Health Services, Organizational Policy, Outcome and Process Assessment (Health Care), Practice Guidelines as Topic, Pregnancy, Program Development, Program Evaluation, United Nations, World Health Organization}, issn = {1552-5732}, doi = {10.1177/0890334412447994}, author = {Bettinelli, Maria Enrica and Chapin, Elise M and Cattaneo, Adriano} } @article {1773, title = {Breastfeeding to 24 months of age in the northeast of Italy: a cohort study.}, journal = {Breastfeed Med}, volume = {6}, year = {2011}, month = {2011 Aug}, pages = {177-82}, abstract = {

AIM: This study assessed the prevalence and duration of breastfeeding up to 24 months and the associated socioeconomic determinants in a birth cohort of children.

METHODS: Four hundred infants born in a hospital in the north east of Italy were enrolled at birth and followed up for 36 months. Data on infant feeding were gathered through a feeding diary compiled at fixed intervals. Data were also gathered on type of delivery and weight, length, and health status at birth, as well as on selected socioeconomic indicators of the mothers. A multivariate logistic regression analysis was used to determine any association that exclusivity and duration of breastfeeding may have with selected socioeconomic variables and with health conditions of the infants at birth.

RESULTS: Ninety-eight percent of mothers initiated breastfeeding, 69\% of them exclusively. This rate, however, had declined to 6\% by 6 months. There was a remarkable endurance of breastfeeding at 24 months (12\%). The variables significantly associated with exclusive breastfeeding at 3 months and any form of breastfeeding at 12 months are mother{\textquoteright}s age (p=0.007 at 3 months, p=0.026 at 12 months) and postdischarge hospital admission (p=0.029 at 3 months).

CONCLUSIONS: In this population, breastfeeding rates are higher than previously reported, but lower than recommended, especially as far as exclusivity is concerned. Full implementation of the World Health Organization-UNICEF Baby Friendly Initiatives in hospitals and communities is needed to improve them further. Monitoring systems should include the collection of data on breastfeeding beyond 12 months of age.

}, keywords = {Adult, Age Factors, Birth Weight, Breast Feeding, Cohort Studies, Family Characteristics, Female, Gestational Age, Guideline Adherence, Health Promotion, Humans, Infant, Infant, Newborn, Italy, Neonatal Screening, Prevalence, Socioeconomic Factors, Time Factors}, issn = {1556-8342}, doi = {10.1089/bfm.2011.0019}, author = {Carletti, Claudia and Pani, Paola and Knowles, Alessandra and Monasta, Lorenzo and Montico, Marcella and Cattaneo, Adriano} } @article {1858, title = {ESPGHAN{\textquoteright}s 2008 recommendation for early introduction of complementary foods: how good is the evidence?}, journal = {Matern Child Nutr}, volume = {7}, year = {2011}, month = {2011 Oct}, pages = {335-43}, abstract = {

Since 2002, the World Health Organization and many governments and professional associations have recommended exclusive breastfeeding for 6 months followed by complementary feeding (giving solid foods alongside breast milk) as optimal infant feeding practice. Several articles have been published challenging this recommendation. Arguably, the most influential has been the 2008 commentary of the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Committee on Nutrition, which recommended that complementary foods should be introduced to all infants between 17 and 26 weeks. We challenge the validity of ESPGHAN{\textquoteright}s position, questioning the adequacy of the literature search, the interpretation and evidence used to reach their conclusions and the balance of an approach that focuses on disease prevention, with scant consideration of growth and neuromotor development. We contend that ESPGHAN{\textquoteright}s position should be understood as an expert opinion that may be influenced by conflicts of interest. In our view, the ESPGHAN position paper is not evidence based and does not justify a change of the current public health recommendation for 6 months of exclusive breastfeeding. At an individual level, health professionals should understand that developmental readiness for starting solid foods has an age range like other developmental milestones; that fewer infants will probably be ready to start complementary feeding before, rather than after, 6 months; and that their role is to equip parents with the confidence and skills to recognise the signs of developmental readiness. This empowerment process for infants and parents should be preferred over the prescriptive ESPGHAN approach.

}, keywords = {Breast Feeding, Evidence-Based Practice, Humans, Infant, Infant Food, Infant Nutritional Physiological Phenomena, Milk, Human, Nutritional Status, Public Health, Reproducibility of Results, World Health Organization}, issn = {1740-8709}, doi = {10.1111/j.1740-8709.2011.00363.x}, author = {Cattaneo, Adriano and Williams, Carol and Pall{\'a}s-Alonso, Carmen Rosa and Hern{\'a}ndez-Aguilar, Maria Teresa and Lasarte-Velillas, Juan Jos{\'e} and Landa-Rivera, Leonardo and Rouw, Elien and Pina, M{\'o}nica and Volta, Alessandro and Oudesluys-Murphy, Anne Marie} } @article {1598, title = {Progress towards the achievement of MDG4 in the Commonwealth of Independent States: uncertain data, clear priorities.}, journal = {Health Res Policy Syst}, volume = {8}, year = {2010}, month = {2010}, pages = {5}, abstract = {

Data on under five mortality in the twelve countries of the Commonwealth of Independent States show important fluctuations over time due to variations in quality of data, definitions of neonatal deaths and methods of mortality estimation. Despite the uncertainties regarding mortality trends, the analysis of health and social information from different sources offers clues to identify priority areas and key strategic directions for accelerating the achievement of the 4th Millennium Development Goal. Neonatal deaths represent from 40\% to over 50\% of under five deaths in all these countries. Maternal mortality was above 50 per 100,000 in 2005, despite the good coverage with antenatal care and births assisted by skilled birth attendants. The scanty information on quality of perinatal care indicates widespread substandard care at all levels. Stunting in children under five is above 10\% in ten out of twelve countries and coexists with emerging overweight. Exclusivity and duration of breastfeeding fall short of what is recommended. There are important inequalities in child and maternal mortality, malnutrition and access and use of health services within countries. Taken as a whole, the available information clearly indicates that priority should be given to improvement of the health of women in reproductive age and of the quality of perinatal care, including the establishment of reliable data collection systems. To achieve this, action will need to focus on strengthening the capacity of the health system to improve the technical content of service provision, and on improving access and appropriate use of services by the most disadvantaged groups. The involvement of other sectors will be necessary to improve reproductive health and nutrition at community level and to tackle inequity. Comparisons between countries with similar socioeconomic background but different health policies seem to indicate that gradual progression towards universal coverage with essential health care through a national health insurance system is associated with larger reduction of child mortality than troubled transition towards a privatized and unregulated health system.

}, issn = {1478-4505}, doi = {10.1186/1478-4505-8-5}, author = {Cattaneo, Adriano and Gafurov, Ilkhom and Bomestar, Tamara and Bacci, Marianna and Kumar, Sanjiv and Popovic, Dragoslav and Tamburlini, Giorgio} } @article {1708, title = {Rotavirus vaccine efficacy in African and Asian countries.}, journal = {Lancet}, volume = {376}, year = {2010}, month = {2010 Dec 4}, pages = {1897; author reply 1898}, keywords = {Africa, Child, Dysentery, Gastroenteritis, Humans, Rotavirus Infections, Rotavirus Vaccines, Treatment Outcome}, issn = {1474-547X}, doi = {10.1016/S0140-6736(10)62207-6}, author = {Tamburlini, Giorgio and Cattaneo, Adriano and Monasta, Lorenzo} } @article {1707, title = {Toward a consensus on guiding principles for health systems strengthening.}, journal = {PLoS Med}, volume = {7}, year = {2010}, month = {2010}, pages = {e1000385}, keywords = {Global Health, Humans, Public Health}, issn = {1549-1676}, doi = {10.1371/journal.pmed.1000385}, author = {Swanson, Robert C and Bongiovanni, Annette and Bradley, Elizabeth and Murugan, Varnee and Sundewall, Jesper and Betigeri, Arvind and Nyonator, Frank and Cattaneo, Adriano and Harless, Brandi and Ostrovsky, Andrey and Labont{\'e}, Ronald} }