@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 {10522, title = {Improving the quality of hospital care for children by supportive supervision: a cluster randomized trial, Kyrgyzstan.}, journal = {Bull World Health Organ}, volume = {95}, year = {2017}, month = {2017 Jun 01}, pages = {397-407}, abstract = {

OBJECTIVE: To determine whether periodic supportive supervision after a training course improved the quality of paediatric hospital care in Kyrgyzstan, where inappropriate care was common but in-hospital postnatal mortality was low.

METHODS: In a cluster, randomized, parallel-group trial, 10 public hospitals were allocated to a 4-day World Health Organization (WHO) course on hospital care for children followed by periodic supportive supervision by paediatricians for 1~year, while 10 hospitals had no intervention. We assessed prospectively 10 key indicators of inappropriate paediatric case management, as indicated by WHO guidelines. The primary indicator was the combination of the three indicators: unnecessary hospitalization, increased iatrogenic risk and unnecessary painful procedures. An independent team evaluated the overall quality of care.

FINDINGS: We prospectively reviewed the medical records of 4626 hospitalized children aged 2 to 60~months. In the intervention hospitals, the mean proportion of the primary indicator decreased from 46.9\% (95\% confidence interval, CI: 24.2 to 68.9) at baseline to 6.8\% (95\% CI: 1.1 to 12.1) at 1~year, but was unchanged in the control group (45.5\%, 95\% CI: 25.2 to 67.9, to 64.7\%, 95\% CI: 43.3 to 86.1). At 1~year, the risk ratio for the primary indicator in the intervention versus the control group was 0.09 (95\% CI: 0.06 to 0.13). The proportions of the other nine indicators also decreased in the intervention group ( < 0.0001 for all). Overall quality of care improved significantly in intervention hospitals.

CONCLUSION: Periodic supportive supervision for 1~year after a training course improved both adherence to WHO guidelines on hospital care for children and the overall quality of paediatric care.

}, keywords = {Child, Child Care, Cluster Analysis, Hospitalization, Hospitals, Public, Humans, Kyrgyzstan, Medical Audit, Pediatricians, Professional Role, Prospective Studies, Quality Improvement}, issn = {1564-0604}, doi = {10.2471/BLT.16.176982}, author = {Lazzerini, Marzia and Shukurova, Venera and Davletbaeva, Marina and Monolbaev, Kubanychbek and Kulichenko, Tatiana and Akoev, Yuri and Bakradze, Maya and Margieva, Tea and Mityushino, Ilya and Namazova-Baranova, Leyla and Boronbayeva, Elnura and Kuttumuratova, Aigul and Weber, Martin Willy and Tamburlini, Giorgio} } @article {3595, title = {Promoting effective child development practices in the first year of life: does timing make a difference?}, journal = {BMC Pediatr}, volume = {14}, year = {2014}, month = {2014}, pages = {222}, abstract = {

BACKGROUND: There is an increasing need for parenting programs aimed at promoting parent-child interaction. A variety of interventions have been proposed. The use of audiovisual materials for parents has been shown to be effective but limited information is available on the optimal timing for its use, particularly for new parents during the first year of life of their children. The aim of this study is to compare the effectiveness of a video administered at two different times to first-time parents in modifying parental knowledge, attitudes and intentions with regards to effective care practices.

METHODS: Open randomized controlled trial carried out in a referral mother and child hospital. Eligible parents were randomly assigned to receive a video at one month (early intervention) or at seven months (late intervention) of age of their child. The video addressed four specific activities related to early child development: reading aloud to the baby, early exposure to music, promotion of early socialization for parents and for children. The primary outcome was the proportion of parents who declared that their knowledge, attitudes and intentions changed after having seen the video at one or seven months of age of the child.

RESULTS: One hundred and five families were randomly allocated either to the early (53) or to the late (52) intervention group. For 99 families (52 in the early and 47 in the late group) a complete outcome evaluation was available. Parents included in the early administration group more frequently reported modifications in their knowledge of the suggested practices while parents in the late group more frequently reported a change in their attitudes. This finding was consistent across all four practices. The video was found to influence parental intentions in the great majority of interviewed parents with no significant difference between groups (82.7\% and 87.2\% in the early and late intervention group, respectively).

CONCLUSIONS: Audiovisual materials can be an effective complementary tool in programs aimed at supporting parents, particularly those dealing with their first baby. The results provide some useful insights into the differential benefits of using audiovisual aids at different times during the first year of life of the baby.

TRIAL REGISTRATION: ClinicalTrials.gov NCT02120430.

}, issn = {1471-2431}, doi = {10.1186/1471-2431-14-222}, author = {Roia, Anna and Paviotti, Elena and Ferluga, Valentina and Montico, Marcella and Monasta, Lorenzo and Ronfani, Luca and Tamburlini, Giorgio} } @article {1879, title = {Burden of disease caused by otitis media: systematic review and global estimates.}, journal = {PLoS One}, volume = {7}, year = {2012}, month = {2012}, pages = {e36226}, abstract = {

BACKGROUND: Otitis media (OM) is a leading cause of health care visits and drugs prescription. Its complications and sequelae are important causes of preventable hearing loss, particularly in developing countries. Within the Global Burden of Diseases, Injuries, and Risk Factors Study, for the year 2005 we estimated the incidence of acute OM, chronic suppurative OM, and related hearing loss and mortality for all ages and the 21 WHO regional areas.

METHODS: We identified risk factors, complications and sequelae of OM. We carried out an extensive literature review (Medline, Embase, Lilacs and Wholis) which lead to the selection of 114 papers comprising relevant data. Data were available from 15 of the 21 WHO regions. To estimate incidence and prevalence for all countries we adopted a two stage approach based on risk factors formulas and regression modelling.

RESULTS: Acute OM incidence rate is 10.85\% i.e. 709 million cases each year with 51\% of these occurring in under-fives. Chronic suppurative OM incidence rate is 4.76 {\textperthousand} i.e. 31 million cases, with 22.6\% of cases occurring annually in under-fives. OM-related hearing impairment has a prevalence of 30.82 per ten-thousand. Each year 21 thousand people die due to complications of OM.

CONCLUSIONS: Our study is the first attempt to systematically review the available information and provide global estimates for OM and related conditions. The overall burden deriving from AOM, CSOM and their sequelae is considerable, particularly in the first five years of life and in the poorest countries. The findings call for incorporating OM-focused action within preventive and case management strategies, with emphasis on the more affected.

}, keywords = {Cost of Illness, Hearing Loss, Humans, Internationality, Otitis Media}, issn = {1932-6203}, doi = {10.1371/journal.pone.0036226}, author = {Monasta, Lorenzo and Ronfani, Luca and Marchetti, Federico and Montico, Marcella and Vecchi Brumatti, Liza and Bavcar, Alessandro and Grasso, Domenico and Barbiero, Chiara and Tamburlini, Giorgio} } @article {1828, title = {Quality of maternal and neonatal care in Albania, Turkmenistan and Kazakhstan: a systematic, standard-based, participatory assessment.}, journal = {PLoS One}, volume = {6}, year = {2011}, month = {2011}, pages = {e28763}, abstract = {

BACKGROUND: Progress in maternal and neonatal mortality has been slow in many countries despite increasing access to institutional births, suggesting deficiencies in the quality of care. We carried out a systematic assessment of the quality of maternal and newborn care in three CEE/CIS countries, using an innovative approach to identify priority issues and promote action.

METHODS: A standard-based tool, covering over 400 items grouped in 13 main areas ranging from support services to case management, was used to assess a sample of ten maternity hospitals in Albania, Kazakhstan and Turkmenistan. Sources of information were visit to services, medical records, observation of cases, and interviews with staff and mothers. A score (range 0 to 3) was attributed to each item and area of care. The assessment was carried out by a multidisciplinary team of international and national professionals. Local managers and staff provided the necessary information and were involved in discussing the findings and the priority actions.

RESULTS: Quality of care was found to be substandard in all 13 areas. The lowest scores (between one and two) were obtained by: management of normal labour, delivery, obstetric complications and sick babies; infection prevention; use of guidelines and audits; monitoring and follow-up. Neonatal care as a whole scored better than obstetric care. Interviewed mothers identified lack of information, insufficient support during labour and lack of companionship as main issues. Actions to improve quality of care were identified at facility as well as at central level and framed according to main health system functions.

CONCLUSIONS: Quality of care is a key issue to improve maternal and neonatal outcomes, particularly in countries such as CEE/CIS where access to institutional births is nearly universal. Approaches that involve health professionals and managers in comprehensive, action-oriented assessments of quality of care are promising and should be further supported.

}, keywords = {Albania, Child Health Services, Female, Humans, Infant, Newborn, Kazakhstan, Maternal Health Services, Pregnancy, Quality of Health Care, Turkmenistan}, issn = {1932-6203}, doi = {10.1371/journal.pone.0028763}, author = {Tamburlini, Giorgio and Siupsinskas, Gelmius and Bacci, Alberta} } @article {1849, title = {Setting research priorities to reduce global mortality from childhood pneumonia by 2015.}, journal = {PLoS Med}, volume = {8}, year = {2011}, month = {2011 Sep}, pages = {e1001099}, keywords = {Biomedical Research, Child, Preschool, Humans, Infant, Infant, Newborn, Pneumonia}, issn = {1549-1676}, doi = {10.1371/journal.pmed.1001099}, author = {Rudan, Igor and El Arifeen, Shams and Bhutta, Zulfiqar A and Black, Robert E and Brooks, Abdullah and Chan, Kit Yee and Chopra, Mickey and Duke, Trevor and Marsh, David and Pio, Antonio and Simoes, Eric A F and Tamburlini, Giorgio and Theodoratou, Evropi and Weber, Martin W and Whitney, Cynthia G and Campbell, Harry and Qazi, Shamim A} } @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} }