Breastfeeding Interpersonal Communication, Mobile Phone Support, and Mass Media Messaging Increase Exclusive Breastfeeding at 6 and 24 Weeks Among Clients of Private Health Facilities in Lagos, Nigeria.

BACKGROUND: Although most health facilities in urban Nigeria are privately owned, interventions to promote optimal breastfeeding practices in private facilities have not previously been implemented. OBJECTIVES: We tested the impact of a breastfeeding promotion intervention on early initiation of breastfeeding and exclusive breastfeeding among clients of private facilities in Lagos, Nigeria. METHODS: The intervention included training for health-care providers on the Baby-Friendly Hospital Initiative and breastfeeding counseling skills, provision of interpersonal communication and support to women at facilities and on WhatsApp, distribution of behavior change communication materials, and mobile phone and mass media messaging. We used logistic regression models adjusted for clustering to measure intervention impact in a cohort of women (n = 1200) at 10 intervention and 10 comparison facilities interviewed during their third trimester and at 6 and 24 weeks postpartum. RESULTS: The intervention significantly increased the percentage of infants who were exclusively breastfed at 6 weeks (83% intervention; 76% comparison; P = 0.02) and 24 weeks (66% intervention; 52% comparison; P < 0.001), but had no impact on early initiation of breastfeeding (35% intervention; 33% comparison; P = 0.65). Among infants who were exclusively breastfed at 6 weeks, the odds of continued exclusive breastfeeding at 24 weeks were higher in the intervention arm than in the comparison arm (OR, 1.6; 95% CI: 1.2-2.1). Infants had increased odds of being exclusively breastfed at 6 weeks if their mothers discussed breastfeeding with a private health provider (OR, 2.3; 95% CI: 1.5-3.4), received text or WhatsApp messages about breastfeeding (OR, 1.7; 95% CI: 1.0-2.7), or heard breastfeeding radio spots (OR, 4.2; 95% CI: 1.2-14.7). Infants had increased odds of exclusive breastfeeding at 24 weeks if their mothers participated in a WhatsApp breastfeeding support group (OR, 1.5; 95% CI: 1.0-2.2). CONCLUSIONS: A breastfeeding intervention in private health facilities in Lagos increased exclusive breastfeeding. Implementation of breastfeeding interventions in private facilities could extend the reach of breastfeeding promotion programs in urban Nigeria. This trial was registered at clinicaltrials.gov as NCT04835051.

Complementary Feeding Social and Behavior Change Communication for Fathers and Mothers Improves Children's Consumption of Fish and Eggs and Minimum Meal Frequency in Kaduna State, Nigeria.

Background: Fathers are key influencers of complementary feeding practices, but few studies in low- and middle-income countries have measured the effects of complementary feeding social and behavior change communication (SBCC) targeted at both fathers and mothers. Objectives: The aims of this study were to measure the effects of an SBCC intervention on children's dietary diversity (primary outcome) and other complementary feeding indicators, fathers' and mothers' complementary feeding knowledge, and fathers' support for complementary feeding (secondary outcomes). Methods: The 12-mo intervention in Kaduna State, Nigeria, engaged parents through community meetings, religious services, home visits from community health extension workers (CHEWs), mobile phone messages (fathers only), and mass media. Cross-sectional population-based surveys of cohabiting fathers and mothers with a child aged 6-23 mo were conducted, and regression models were used to compare results at baseline (n = 497) and endline (n = 495). Results: Children's minimum dietary diversity did not change from baseline to endline (62% to 65%, P = 0.441). Children's consumption of fish (36% to 44%, P = 0.012) and eggs (8% to 20%, P = 0.004) and minimum meal frequency (58% to 73%, P < 0.001) increased. Fathers' and mothers' knowledge of the timing of introduction of different foods and meal frequency improved. Fathers' support for child feeding by providing money for food increased (79% to 90%, P < 0.001). Fathers' and mothers' reported intervention exposure was low (11-26% across types of SBCC). Child feeding outcomes were not associated with fathers' exposure. Children's odds of both fish and egg consumption increased significantly with mothers' exposure to community meetings, religious services, home visits, and television spots, and children's odds of minimum meal frequency increased significantly with mothers' exposure to home visits. Conclusions: A multipronged SBCC intervention improved complementary feeding practices, fathers' and mothers' knowledge of complementary feeding, and fathers' support for complementary feeding, despite low levels of reported exposure, which may have been influenced by coronavirus disease 2019 (COVID-19) disruptions. This trial was registered at ClinicalTrials.gov as NCT04835662.

Comparing the Learning Effectiveness of Three Virtual Simulation Tools With Nursing Students During the Coronavirus Disease (COVID-19) Pandemic.

Background: We explored the learning effectiveness of three virtual simulation tools used in the Coronavirus Disease pandemic environment. Sample: Study participants consisted of students from two nursing classes, a junior and a senior class. Method: A mixed-methods approach compared three tools' performance across five learning domains. Descriptive statistics and analysis of variance compared mean ratings for learning domains. Open-ended questions were included for qualitative evaluation. Results: Thirty-six respondents rated the Resource Simulation Center (RSC), based on the observation of videos of students undergoing simulation exercises, as superior to the other two. There were no differences between the other two tools. Qualitative findings echoed preference by students for "RSC". Conclusion: "RSC" was preferred over a commercial product based on computer generated graphics, and a free-online product based on clinical scenarios acted out in short videos. Differences in debriefing practices may have influenced the results, thereby emphasizing the role of debriefing with virtual simulation tools.

Cyber-safety and COVID-19 in the early years: A research agenda

Young children aged birth to 5?years are known users of the internet, both unsupervised and in collaboration with adults. Adults also use the internet to share details of children?s lives with others, via sharenting and educational apps. During COVID-19 internet use by children and families rose significantly during periods of enforced stay-home. Internet use by children, and by adults on behalf exposes children to conduct, contact and content risks online. These risks mean that cyber-safety in the early years is increasingly necessary, especially concerning increased internet usage during COVID-19. While cyber-safety is well developed for primary and secondary-school aged children this is not the case for young children, their families and educators. This paper proposes a research agenda for cyber-safety in the early years, using critical constructivism and internet studies to define the internet as a non-unitary technology. Three main objects of study concerning cyber-safety in the early years, including the reference to COVID-19 are identified for targeted research, including: technologies, context and policy.