[ effect of pacifier use on breast-feeding duration]

Use of pacifiers by young infants has been recognized as one of the factors that interfere with the establishment of successful breast-feeding. Our aim was to find out if pacifier-use results in early termination of breast-feeding. A historical cohort study was done on mother-infant pairs visiting health centers for check-ups, routine vaccinations or common childhood ailments during the year 1385-1386. All subjects satisfying the enrollment criteria, and available to the study team, were interviewed by trained personnel and relevant information documented on predesigned questionnaires. Duration of breast-feeding was compared between pacifier-users and non-users. Four-hundred and fifty infants were enrolled; after exclusion of babies with confounding factors, data of 307 infants was analyzed. Two-hundred thirty-nine mothers had continued predominant breast-feeding for 3 months and 218 mothers had done so for at least 6 months. Breast-feeding was discontinued in 59 infants before 6 months. 24.75% of infants were regular pacifier users, 80% of these had started pacifiers during the first few days of life. The rate of termination of breast-feeding at 3 months in pacifier-users was 28.9% as compared to 5.7% in non-users, [P=0.000]. At 6 months the rates in pacifier-uses and non-users were 46.1% vs. 10.4%, respectively, [P=0.000]. Our findings show that while over-all breast-feeding rates in 6 month-old infants are high at 71%, pacifier use in infants is associated with early termination of breast-feeding

Injection practices in children: knowledge and perception of healthcare workers

Injections are one of the most common health care procedures. Each year some 16 thousand million injections are administered in developing and transitional countries. Due to unsafe injection practices 26 million years of life are lost each year. To define the knowledge of health care providers about safe injection practice in children according to WHO standards. We prepared a cross sectional study and included health care personnel in two university affiliated medical centers. Data about the knowledge of safe injection practices, as recommended by the World Health Organization, was collected using a previously designed questionnaire. Statistical analysis was performed by using SPSS 13.0. 150 personnel answered the questions. Percentage of incorrect answers were as follows: use of gloves 92%, need to disinfect single dose vials 80%, disinfecting site of muscular injections 86.7%, safe needle disposal 70.7%, recapping the needle 56%, and the optimal site for intramuscular injections in young children 12.7%. 72.7% were not familiar with auto-disable syringes. There was no significant difference in the belief that injection is better than oral medication between doctors and nurses [p > 0.05]. Almost 80% of doctors and more than 50% of nurses believed that parents preferred injection prescriptions for their children. Our findings revealed a serious lack of knowledge about safe injection practices among health care providers albeit doctors or nurses. We recommend that instructions about safe injection practices should be included in the medical and nursing curriculum. Moreover, improving communication skills between health care providers and their patients would prevent the misuse of all drugs including injections

[Prescribing practices in childhood gastro-enteritis and its comparison with WHO guidelines]

Dehydration resulting from acute diarrhea kills 1.5 million children each year. Rational management is based on oral re-hydration as recommended by the World Health Organization. This study was conducted to define the rationality of prescriptions written for acute watery diarrhea in children. A cross-sectional study was done on children who had been treated for acute gastroenteritis during the two weeks prior to their visit to the clinics of two teaching hospitals. Information obtained through interviewing the caretakers and scrutinizing the prescriptions, was documented. Prescribing practices of general practitioners and pediatricians were compared in three settings; private offices, hospital outpatients, and general polyclinics. 273 prescriptions were analyzed. An average of 4.1+/-2.3 drugs had been prescribed on each visit. At least one antibiotic was included in more than 76% of prescriptions. 60% of children were not given ORS. An injection was written in 51% of prescriptions and anti-emetics in 61%. There was no significant difference between general practitioners and pediatricians in the number of drugs per prescription. 75.7% of pediatricians and 78.5% of GPs had prescribed at least one antibiotic [p=0.58]. In teaching hospitals the average number of drugs prescribed for each visit was 3.1, in polyclinics, 3.2 and in private offices 3.6 [p=0.03]. Unjustified use of medicines and sub-optimal management of acute gastroenteritis were identified in more than 70% of prescriptions. Further studies and effective training programs are urgently needed to reverse current irrational treatment practices