Breastfeeding in emergencies with assessment of recent humanitarian crises and the Covid-19 pandemic.

The world is becoming a place where the number of emergencies and humanitarian crises is increasing rapidly due to economic inequality and the gap between developed and underdeveloped countries, as well as climate changes leading to disruption of the natural balance and development of natural disasters. The most vulnerable groups of the population including women and children always are affected by disasters. The younger the child, the more vulnerable he/she is, especially if not naturally fed or having a mother or parents. Various humanitarian organizations have been involved in a number of crises, with the World Health Organization and UNICEF and other United Nations-related organizations leading the way. In the care of mothers, infants and young children, most important is to ensure appropriate nutrition because otherwise it can result in life-threatening health conditions. The lack of protection, support and promotion of natural nutrition (breastfeeding) and its disruption and undermining by uncritical and uncontrolled donations and distribution of infant formula are the biggest challenge due to the lack of information of mothers, those who provide support in emergencies from both governmental and non-governmental sector, without cross-sectoral cooperation, thus causing uncoordinated and sometimes harmful interventions. Therefore, it is recommended that governments issue guidelines on infant and young child nutrition prior to the occurrence of an emergency, and crisis management regulations in which the issue of infant and young child nutrition will be given due consideration.Copyright © 2020 Croatian Paediatric Society. All rights reserved.

SARS-CoV-2 in Pregnancy, Birth and Puerperium. Guideline of the DGGG and DGPM (S2k-Level, AWMF Registry Number 015/092, March 2022)

Objective This S2k guideline of the German Society for Gynecology and Obstetrics (DGGG) and the German Society of Perinatal Medicine (DGPM) contains consensus-based recommendations for the care and treatment of pregnant women, parturient women, women who have recently given birth, and breastfeeding women with SARS-CoV-2 infection and their newborn infants. The aim of the guideline is to provide recommendations for action in the time of the COVID-19 pandemic for professionals caring for the above-listed groups of people. Methods The PICO format was used to develop specific questions. A systematic targeted search of the literature was carried out using PubMed, and previously formulated statements and recommendations issued by the DGGG and the DGPM were used to summarize the evidence. This guideline also drew on research data from the CRONOS registry. As the data basis was insufficient for a purely evidence-based guideline, the guideline was compiled using an S2k-level consensus-based process. After summarizing and presenting the available data, the guideline authors drafted recommendations in response to the formulated PICO questions, which were then discussed and voted on. Recommendations Recommendations on hygiene measures, prevention measures and care during pregnancy, delivery, the puerperium and while breastfeeding were prepared. They also included aspects relating to the monitoring of mother and child during and after infection with COVID-19, indications for thrombosis prophylaxis, caring for women with COVID-19 while they are giving birth, the presence of birth companions, postnatal care, and testing and monitoring the neonate during rooming-in or on the pediatric ward.Copyright © 2023. Thieme. All rights reserved.

Nutrition Strategies Pre-infection, during, and Post-infection with Coronavirus Disease

Coronavirus disease is a serious viral infection that is characterized by severe inflammation and lymphopenia. The virus attacks many organs causing acute respiratory distress and malfunctioning of the organs leading to death. Through strengthening of the innate immune system, a balanced diet plays a critical role in defense against bacterial and viral diseases. A healthy diet before, during and after an infection can lessen the severity of the symptoms and speed up the recovery of damaged cells. Due to the Mediterranean diet's high concentration of bioactive polyphenols, which have antioxidant, anti-inflammatory, and antithrombic properties, numerous studies have suggested that it is a preventative dietary strategy against many diseases including coronavirus disease. Nutrition and herbal plants play a key role to enhance the immunity of people to protect and fight against coronavirus. Diet rich in antioxidants and phytochemicals represents perfect barrier to the virus through elevation of the innate immunity of the body. In addition, gut microbiota including prebiotics, probiotics, and synbiotics were found to enhance immunity to reduce the symptoms of the disease during infection. Protein-rich foods and honey bee products reported significant role during and post-coronavirus infection. This review presents updated information from original pre-clinical and clinical researches, and review articles as well to expose the nutritive strategies including breastfeeding benefits to infants pre-infection, during, and post-infection with coronavirus.Copyright © 2023, Scientific Foundation SPIROSKI. All rights reserved.

Benefits of Breastfeeding on Child and Postpartum Psychological Health of the Mother

Ab s t r ac t Aim: The aim of this study was to summarize different types of benefits that have been observed in the baby's development and the mother's psychological health during the postpartum period. Background(s): Breastfeeding is a natural process that plays a vital role in the physical as well as mental health of the mother and child. Breast milk is rich in contents such as proteins, fats, and vitamins, which are responsible for building the immune system of the baby. Lactation helps in decreasing the prevalence of infant mortality rate. It enhances the development of the physical health of the children. Breastfeeding protects the mother from many systemic conditions like endometrial cancer, ovarian cancer, breast cancer, etc. It has been observed that with an increase in healthy breastfeeding practices, there is a decline in the cases of maternal mental health issues reported mainly in the postpartum period. Review result: The authors have explained various types of advantages of breastfeeding on the child's and mother's health, their mechanism of action, effects on the baby, and mother-child relationship. Conclusion(s): The mother's mental health plays a crucial role in a healthy infant, and breastfeeding is key to it. The role of breastfeeding is therefore considered a boon for the mother because if there is a decrease in health issues in the child, the mother's mental condition improves automatically. Therefore, breastfeeding should be promoted at the national level. Clinical significance: Breastfeeding not only helps in reducing maternal stress and postpartum depression but also improves the physical health of the child and mother during the postpartum period. The clinicians should teach mothers about the importance and also the correct positions of breastfeeding. "Breastfeeding week" is celebrated every year from August 1 to August 7, as implemented by the Indian government.Copyright © The Author(s). 2023 Open Access.

Implementation and recommendation of postpartum visit methods during COVID-19 pandemic: a qualitative study from Indonesia

Background. The Maternal Mortality Rate (MMR) in Indonesia is still a health problem that must be solved. In 2018 and 2019, the postpartum period still dominates maternal mortality in Surabaya. The postpartum visit method is one of the essential things that can affect postpartum services, so it is necessary to evaluate the implementation of the postpartum visit method and recommend visiting methods to improve maternal health. Objective.The study explores the implementation and recommendation of postpartum visit methods during the COVID-19 Pandemic. Materials and Methods. It used a qualitative research type by assessing the interview and observation dept. The instruments used are questionnaires and observation sheets. Researchers conducted interviews with 14 mothers who had completed the postpartum period, five midwives, a stakeholder in the health office and two experts in the field of maternal health. The data is processed using organizing, reduction, coding, description, linking between themes, and data interpretation. Results. Offline visits to health facilities still dominate the implementation of the postpartum visit method. The recommended postpartum visit method combines visits to health facilities, home visits, and telehealth. Besides that, it is necessary to consider maternal postpartum services up to 3 months after delivery, especially for postpartum mothers who have problems. Conclusion. The postpartum visit method during the COVID-19 pandemic, has not run optimally because there are restrictions on offline visits. However, it has not been supported by online monitoring or home visits.Copyright © the Author(s), 2023.

COVID-19 VACCINE SAFETY DURING PREGNANCY AND BREASTFEEDING IN WOMEN WITH AUTOIMMUNE DISEASES: RESULTS FROM THE COVAD STUDY

Background:COVID-19 vaccine hesitancy among pregnant and breastfeeding women with autoimmune diseases (AID) is often attributed to the fear of adverse events (AE) and disease flares (DF). No data are available regarding COVID-19 vaccine safety in this population.Objectives:We aimed at describing delayed-onset (>7 days) vaccine-related AE (minor and major), DF, and related AID treatment modifications from the COVID-19 Vaccination in Autoimmune Diseases (COVAD) study.Methods:Among complete responses from 9201 participants as of June 21, 2022, 6787 (73.8%) were women. Six subgroups were identified upon diagnosis of AID vs healthy controls (HC) and their pregnancy/breastfeeding status at the time of any dose of vaccine (Figure 1).Figure 1.Flowchart of the study. AID: autoimmune diseases;HC: healthy controls;rAID: rheumatic AID;nrAID: non-rheumatic AID.[Figure omitted. See PDF]ResultsForty pregnant and 52 breastfeeding AID patients were identified and their vaccination rates (at least one dose) was 100% and 96.2%, respectively (Table 1). Overall AE, minor AE, and major AE were reported significantly more frequently by pregnant than non-pregnant patients (45% vs. 26%, p=0.01;40% vs. 25.9%, p=0.03;17.5% vs. 4.6%, p<0.01), but no difference was found in comparison with pregnant HC. No difference was observed between breastfeeding patients and HC. Post-vaccination DF were reported by 17.5% of pregnant and 20% of breastfeeding patients, and by 18% of age- and disease-matched control patients (n=2315). All DF in pregnant/breastfeeding patients were managed with glucocorticoids and a fifth of them required initiation or change in immunosuppressive treatment.Table 1.Characteristics of female subjects according to groups. Percentages in parenthesis. *Pregnancy/breastfeeding status at the time of the survey and/or at the time of at least one dose of COVID-19 vaccine. Chi squared test: ~ p=0.01;° p=0.03;§ p<0.01.Total Women (n=6787)Group A Non-pregnant, non-breastfeeding with AID (n=4862)Group B Pregnant with AID* (n=40)Group C Breastfeeding with AID* (n=52)Group D Non-pregnant, non-breastfeeding HC (n=1749)Group E Pregnant HC* (n=31)Group F Breastfeeding HC* (n=53)Age (median, IQR)47, 35-5850, 38-6134, 31-35.2533, 30-3539, 29-4934, 30-36.533, 30-36Caucasian3225 (47.5)2634 (54.1)12 (30)22 (42.3)538 (30.8)7 (22.6)12 (22.6)No comorbidities3027 (44.6)1815 (37.3)19 (47.5)36 (69.2)1102 (63)17 (54.8)38 (71.7)Number of vaccinated women, n (%)6632 (97.7)4753 (97.8)40 (100)50 (96.2)1710 (97.8)30 (96.8)49 (92.5)≥3 doses4850 (71.5%)3583 (73.7%)26 (65%)33 (63.5%)1155 (66%)23 (74.2%)30 (56.6%)No AE4950 (74.6)3517 (74)~22 (55)~36 (72)1312 (76.7)22 (73.3)36 (73.5)Injection site (arm) pain and soreness630 (9.5)471 (9.9)7 (17.5)7 (14)138 (8.1)2 (6.7)5 (10.2)Minor AE1614 (24.3)1232 (25.9)°16 (40)°12 (24)338 (19.8)7 (23.3)10 (20.4)Major AE285 (4.3)196 (4.6)§7 (17.5)§1 (2)77 (4.5)1 (3.3)3 (6.1)Hospitalization74 (1.1)51 (1.1)2 (5)0 (0)20 (1.2)0 (0)1 (2)ConclusionThis study provides the first insights into the safety of COVID-19 vaccination during the antenatal period in women with AID. While AEs were more commonly reported by pregnant patients with AID, these were no higher than among pregnant healthy controls without AID. These observations are reassuring, likely to strengthen physician-patient communication and overcome hesitancy as the benefits for the mother and fetus by passive immunization are likely to overweigh the potential risks of AE and DF.Reference[1]Fazal ZZ, et al;COVAD Study Group. COVAD survey 2 long-term outcomes: unmet need and protocol. Rheumatol Int 2022;42:2151-2158.AcknowledgementsThe authors are grateful to all respondents, to all patients support groups, and to all COVAD Study Group collaborators from 106 Countries.Disclosure of InterestsNone Declared.

Vaccination against COVID-19.

Vaccination is essential to manage the COVID-19 pandemic. Vaccination significantly protects against severe COVID-19, hospitalization and death;it also protects against symptomatic infection and reduces the risk of transmission to other people. Protection against the new SARS-CoV-2 variants may be lower, but protection against severe course and death remains high. Two mRNA vaccines (BNT162b2 and mRNA-1273) and two vector vaccines (AZD1222 and Ad26.COV2.S) are currently available in the Czech Republic. Vaccination of persons over 60 years of age and immunocompromised persons, who are demonstrably at the highest risk of a serious course of the disease, is of the utmost importance. In order to achieve adequate vaccination coverage, it is necessary to motivate other groups of people to be vaccinated, including children over 12 years of age and young adults. Vaccination is also recommended in preg-nant women in the 2nd and 3rd trimesters and in breastfeeding women. For selected groups of vaccines, a third dose of vaccination is recommended (additional third dose 4 weeks after the second dose or a booster dose 8 to 12 months after the second dose). The side effects are usually mild, with serious complications (including anaphylaxis, thrombocytopenia with thrombosis syndrome, myocardi-tis, Guillain-Barre syndrome and capillary leak syndrome) being rare.Copyright © 2021, Trios spol. s.r.o.. All rights reserved.

Impact of COVID-19 Lockdown on Anthropometric Body Measurements and Nutritional Behaviors in a Colombian Cohort Receiving Online Nutritional Advice

Objective: In this study, we aimed to retrospectively assess the change in weight before and after the COVID-19 mandatory lockdown in Colombia among adults who received nutritional and healthy lifestyle recommendations at weight loss and wellness clinics by telehealth. The primary objective was to describe and compare the mean weight reduction measured at the baseline and by the end of the lockdown. Secondary objectives include describing and comparing body fat percentage, muscle mass percentage, and BMI measured at the baseline and by the end of the lockdown. Method(s): One hundred and seventy-two middle-aged (18-68 years old) women and men received online nutritional and healthy lifestyle advice during the COVID-19 lockdown in Colombia. Weight, fat (%), muscle mass (%), and BMI were assessed before and after the lockdown. We included baseline measurements taken before the lockdown from March 1st to June 20th, 2020, and post-lockdown measurements from August 31st to October 20th, 2020. Exclusion criteria included pregnancy or breastfeeding women, acutely decompensated diabetes, hypertension, CKD, Hypothyroidism or taking any of the obesity treatment medications approved in Colombia, including liraglutide, semaglutide or orlistat. A retrospective analysis was completed to compare the change in mean body anthropometrics. Shapiro Wilk test was used to assess for normality. Paired T Test and Wilcoxon sign test were used to compare the distribution of body anthropometrics before and after the lockdown. IRB approval was obtained before exporting and analyzing the collection of data. Result(s): Out of 205 subjects and after a review of exclusion criteria, 172 subjects were included in the data analysis. 90.1% (155) were women. 52.3% (135) had overweight or obesity. After the COVID-19 lockdown, the mean weight loss reduction was 8.79 kg (SD +/- 5.45, p<0.0001), corresponding to an 11.4% weight loss reduction. The mean fat mass percentage loss was 2.89 % (SD +/- 2.64, p<0.0001), and the mean BMI presented a reduction of 3.16 (SD +/- 1.96, p <0.0001). The mean muscle percentage loss was 0.10% (SD +/- 2.67, p 0.482). Discussion/Conclusion: Subjects receiving telehealth nutritional advice in Colombia during the COVID-19 lockdown had significant clinical and statistical weight, BMI, and fat loss reduction. Muscle mass was preserved;however, this mean change was not statistically significant. Physical inactivity during the lockdown period was a potential contributor to a nonsignificant mean muscle mass change. The subjects in this study were highly motivated to virtually attend weight loss and wellness clinics and to improve body anthropometrics by optimizing lifestyle changes. Telehealth weight loss strategies should always be considered when in-person patient interaction is not available.Copyright © 2023

Study of Anxiety, stress and Depression Associated with Breastfeeding in COVID-positive Mothers of block Hazratbal, Kashmir

Background: Coronavirus disease-2019 (COVID-19) has rapidly disseminated worldwide, with a wide variety of clinical manifestations ranging from mild respiratory symptoms to severe pneumonia. Since then, there have been over 62300396 cases of COVID-19 infections worldwide, with 6550033 deaths. Coronavirus disease has presented the world to uncertainty and clinical dilemma with developing and constantly changing management guidelines and protocols. In the backdrop of this pandemic, it thus becomes crucial to study the effects of the infection on pregnancy, childbirth, and the postpartum period. In this study, we analyzed experiences of breastfeeding mothers during the COVID-19 pandemic, specifically concerning how COVID-positive status affected their infant's feeding decisions. Objective(s): To study anxiety, fear and depression associated with breastfeeding in coronavirus disease (COVID)-positive mothers. Method(s): The following DASS scale was used to measure depression anxiety, and stress of coronavirus disease-2019 (COVID-19) among postpartum women along with a self-made breastfeeding questionnaire to assess the association with breastfeeding. Result(s): Among the total of 77 respondents, 13% showed symptoms of depression, 16% anxiety and 9% stress. The breastfeeding questionnaire suggested that most women are afraid of transmitting the infection to their newborns and they lack the knowledge about the importance of breast milk in warding off other infections. Also, women found it difficult to take care of their newborns on their own. Conclusion(s): With this study, we could determine the effects of this pandemic on anxiety depression, and stress levels of COVID infection in postpartum women. It clearly showed that being COVID positive created, affected, and exacerbated mental health issues for mothers. So, there is an urgent need to provide emotional and psychosocial support to this group of the population during the crisis. Otherwise, the adverse outcome is possible involving both mother and newborn.

Dancing with your baby: The experiences of the breastfeeding mother-infant dyad discovered through the artistry of symbolic dance

Dancing With Your Baby: The Experiences of the Breastfeeding Mother-Infant Dyad Discovered Through the Artistry of Symbolic Dance is a study that explored the experiences of the breastfeeding mother-infant dyad through the dance/movement therapy techniques mirroring, leading and following, image making, and symbolic dance.An art-based research study with the inquiries of the breastfeeding mother-infant dyad in mind, was designed with a phenomenological approach that included autobiographical narratives and embodied lived emotions and reflection, which allowed for the integration of dance and movement within the arts-based research realm. Interviews were conducted with each participant to provide an in-depth comprehension of their breastfeeding and postpartum experiences. The participants attended three open group discussions where they expressed their breastfeeding struggles and accomplishments, bonding with their child, and motherhood. Participants were asked to create gestural descriptors that described their breastfeeding experience, and through the image making process, participants choreographed a symbolic dance which was captured on film. Journal entries included written testimonial and self-portraits created through photography and visual art. Eight themes emerged from this study: loneliness, pain, tired, importance of nurturing their infant, guilt, grief, joy, and closure. The researcher's embodied empathetic reflection to the mother-infant movement sequences were also captured on film and is accompanied with a voice over that addressed the participants feelings and thoughts, and the overarching themes.This study was conducted during the COVID-19 pandemic and provided participants insight in finding resilience during breastfeeding and nurturing their infants during stressful times through therapeutic movement, kinesthetic empathy, and artistic dance. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Evaluation of Knowledge, Attitude, Practice and Hospital Experience Regarding COVID-19 among Pregnant and Postpartum Mothers at a Tertiary Care Hospital in Kashmir: A Cross-sectional Study

Background: Coronavirus disease (COVID-19) is an infectious disease caused by the SARS-CoV-2 virus. The virus can spread from an infected person when they cough, sneeze, speak, or breathe through mouth or nose. Majority of the people who get infected with the virus will experience mild to moderate illness. However, some will become severely ill and require medical attention. Pregnancy is associated with increased risk for severe COVID-19. Few studies have examined knowledge, attitudes, and practices (KAP) during the pandemic especially the high-risk groups like pregnancy and post-partum period. Aim(s): To analyze the knowledge, attitude, practice and hospital experience regarding COVID-19 among pregnant and post-partum mothers at a tertiary care hospital in Kashmir. Method(s): A cross-sectional study was conducted among 403 research participants from a tertiary care hospital of Kashmir in year 2020-2021 using a semi-structured questionnaire. The confidentiality and anonymity of respondents was maintained. The data was entered in Microsoft Excel and analysed using Statistical Package for Social Sciences version 25. The findings were presented as percentages (95% confidence intervals;CI), median, means and Standard deviation. Result(s): A total of 403 post-partum women participated in the study. Almost all the participants had heard about COVID-19 (96.6%). A majority of them were aware about how COVID-19 gets transmitted and its preventive measures. Most of the participants (62%) knew that COVID-19 has effects on pregnancy. Almost all of participants (97%) wore mask during hospital stay. All of the women washed their hands with soap water or alcohol based sanitizer. A fewer of the mothers (20%) wore mask while breastfeeding their baby. The results of binary logistic regression analysis found associations between knowledge and marital status (OR = 4.983, 95% CI 1.894-13.107). Correlation analysis found a weak positive correlation between knowledge and practice scores (r = 0.210, p-value = 0.01). Conclusion(s): As the COVID-19 cases are still increasing globally, participants overall had high KAP scores. This study can guide public health strategies regarding pregnant women and COVID-19. We recommend that interventions to improve and attitude and practice scores.

Frequency and Duration of Severe Acute Respiratory Syndrome Coronavirus-2 (Sars-Cov-2) in Feces of Breastfeeding Mothers with and without Confirmed Covid-19

Purpose of Study: Health policy regarding possible mother-to-child transmission of SARS-CoV-2 via breastfeeding was highly debated during the first months of the COVID-19 pandemic. However, subsequent research revealed that mother-to-infant transmission of SARS-COV-2 through breastmilk is highly unlikely, and the World Health Organization continues to recommend breastfeeding for all mothers, including those with confirmed COVID-19. Another mode of viral transmission and diagnostic testing that garnered scientific interest is the fecal route.The purpose of this study was to determine the detection rate of SARS-CoV-2 RNA in fecal samples collected from breastfeeding mothers with and without confirmed COVID-19. Methods Used: From April 2020 to March 2021, fecal samples were collected repeatedly over an 8-wk period from 28 nursing mothers with confirmed COVID-19 (162 total fecal samples) and from 24 healthy nursing mothers with no known exposure to COVID-19 (93 total fecal samples). For mothers enrolled within 7 d of a positive COVID-19 test, up to 7 repeated samples were collected: 3 in the first wk and 1 each at wk 2, 3, 4, and 8. For self-reported healthy mothers, up to 4 samples were collected: d 1, d 7, wk 3, and wk 8. RNA was isolated, and the presence of SARS-CoV-2 RNA was determined using RT-qPCR following a modified version of the CDC's SARS-CoV-2 assay. Summary of Results: Among COVID-19-positive mothers, 7/28 (25%) had SARS-CoV-2 in at least one fecal sample. Among these mothers, mean duration of presence of SARS-CoV-2 in feces was 1.6 +/- 1.4 wk. One mother had SARS-CoV-2 in feces in five samples (d 1, d 3, d 7, wk 2, wk 4), while two mothers only had SARS-CoV-2 in a single fecal sample. Among healthy breastfeeding mothers without known COVID-19 exposures, 1/24 (4.2%) had SARS-CoV-2 in a single sample (d 7). Conclusion(s): We detected SARS-CoV-2 in feces of 25% of breastfeeding mothers with COVID-19 and 4.2% of breastfeeding mothers who self-reported no known COVID-19 sickness or exposures. Our data reveal that only 5/28 (17.9%) of d 1 fecal samples collected from mothers with COVID-19 had detectable SARS-CoV-2. (Table Presented).

SARS-CoV-2 SEROPREVALENCE AND RISKS FACTORS IN AFRICAN WLHIV ON ART AND THEIR INFANTS

Background: SARS-CoV-2 seroprevalence data in women living with HIV (WLHIV), their infants and associated risk factors in this subpopulation remain limited. We retrospectively measured SARS-CoV-2 seroprevalence from 09/2019- 12/2021 among WLHIV and their children in the PROMOTE observational cohort in Uganda, Malawi, and Zimbabwe prior to widespread SARS-CoV-2 vaccination in those countries. Method(s): Sociodemographic, clinical data and blood were collected q6 months. Plasma stored during 3 waves of the COVID-19 pandemic in East/ Southern Africa were tested for SARS-CoV-2 specific IgG antibodies (Ab) using serological assays that detect adaptive immune responses to SARS-CoV-2 spike protein. Modified-Poisson regression models were used to calculate prevalence rate ratios (PRR) and 95% confidence intervals (CI) to identify sociodemographic and clinical risk factors. Result(s): Plasma samples from 979 PROMOTE mothers and 1332 children were analysed. We found no significant differences in baseline characteristics between participants testing positive (+) and negative (-) for SARS-CoV-2 Ab. Overall maternal SARS-CoV-2 seroprevalence was 57.6% (95%CI: 54.5-60.7) and 39.3% (95%CI: 36.7-41.9) for infants. The earliest + result was detected from a sample collected on 09/2019, in Malawi. Factors significantly associated with SARS-CoV-2 seropositivity were country of origin (reference Uganda, aPRR 1.45, 95%CI: 1.24-1.69) and non-breastfeeding mother (aPRR=1.22, 95%CI: 1.02-1.48). Children above 5 years had a 10% increased risk of SARS-CoV-2 seropositivity (aPRR=1.10, 95%CI: 0.90-1.34) when compared to younger children. We found no statistically significant association with sanitation, household density, distance to clinic, maternal employment, ART regimen or viral load. Mother/infant SARS-CoV-2 serostatuses were discordant in 373/865 (43.1%) families tested: mothers+/children- in 51.2%;mothers-/children+ in 12%;child+/sibling+ concordance was 21.4%. Conclusion(s): These SARS-CoV-2 seroprevalence data indicate that by late 2021, about half of mothers and about a third of children in a cohort of HIV-affected families in eastern/southern Africa had been infected with SARS-CoV-2. Breastfeeding was protective for mothers, likely because of the need to stay home for young children. Discordant results between children within same families underscores the need to further understand transmission dynamics within households.

Attitude towards covid-19 vaccines and vaccine hesitancy in antenal and breast-feeding women in tribal and urban communities of Kashmir-A cross-sectional study

Background: The World Health Organization indicated vaccine hesitancy as one of the top 10 threats to global health. The success of a vaccine depends not only on its efficacy but also on its acceptance. Pregnant women are at high risk of severe illness, intensive care unit admission (3 times more likely), and invasive ventilation (1.5 times more likely) when compared with non-pregnant women of the same age. Objective(s): * To study attitude towards covid 19 vaccines in antenatal and breastfeeding women * Proportion of vaccine hesitancy among antenatal and breastfeeding women in tribal and urban communities of Kashmir. Material(s) and Method(s): * Study design: Cross-sectional study * Study period: August 2021 to December 2021 * Study population: Antenatal and breast-feeding women in tribal and urban communities of block Hazratbal, Kashmir. * Sample size: A total of 414 participants were recruited for the study. * Sampling technique: snowball sampling. * Study tool: VAX (vaccine attitude scale) scale was used to asses attitude of study participants towards vaccine. * Information about socio demographic variables and reasons for vaccine hesitancy was also obtained. Result(s): 1) Among the reasons assessed for uncertainty or unwillingness to vaccinate (n = 350) 65% of woman were worried about possible side effects both for themselves and for fetus/infant. 2) In Response to VAX (Vaccine attitude scale) scale n = 414 % of women had high level of negative attitude towards protection after getting vaccinated and 79.9% of women had high level of negative attitude towards safety of covid-19 vaccination. Conclusion(s): The dissemination of professional and reliable information regarding the safety and efficacy of COVID-19 vaccine uptake by qualified health care personnel can significantly increase the level of trust and public awareness regarding the safety and efficacy of COVID-19 vaccine uptake in pregnancy and while breastfeeding.

Successful matched unrelated donor hematopoietic stem cell transplantation for infantile Wolman disease

Introduction: Wolman disease is a rare genetic disorder with an autosomal recessive inheritance. A mutation in the LIPA gene causes lysosomal acid lipase (LAL) deficiency results in lipid storage and adrenal insufficiency. Death in early infancy is due to liver failure. Patients and methods: We describe the clinical course of a three-month-old infant diagnosed with Wolman disease. A rapid mutational analysis confirmed a LIPA gene defect. Results: He underwent matched unrelated donor peripheral blood stem cell hematopoietic stem cell transplantation (HSCT) at 3 months of age, with a treosulfan-based conditioning, which resulted in engraftment with donor-derived hematopoietic cells. He required supportive care for sinusoidal obstruction syndrome and mucositis. He was administered low dose prednisolone for grade I skin graft versus host disease, and a complete donor chimerism was documented on several occasions. At one year post HSCT, his growth and development were optimal, and there was no hepatosplenomegaly. He is maintained on glucocorticoid and mineralocorticoid supplements for primary hypoaldosteronism. Conclusion: The case emphasizes the timely diagnosis and the potential for successful treatment of Wolman disease by HSCT. © 2022 Pediatric Hematology Oncology Chapter of Indian Academy of Pediatrics

Milk donation and pandemic: human milk as a global good

The human milk donation has been an undervalued and very biasedly examined subject until relatively recently, in comparison with other types of human donation (organs, tissues, fluids), not being recognized its dimension of bodily altruistic and philanthropic act in the same way as other (mildly) analogous realities, as well as in its approach from the perspective of feminist and gender studies. On the other hand, although the COVID-19 pandemic and the various lockdown processes have had an onerous impact on human breastfeeding in general, we find data on the global increase in breastfeeding donation as a specific altruistic gesture during the pandemic in Spain and, even, on the decisions in the most complicated moments of the state of alarm about donating one's own milk in the tragedy of perinatal death. These altruistic donations contribute to carrying out the fulfillment of what has already been declared a human right and one of the social investments with the most advantageous cost-benefit index. The recognized, intensified and amplified need for milk banks in a pandemic brings to the fore in a specific way the condition of human milk as capital physiological resource, and, ultimately, as a global good. This article is dedicated to delving into a critical hermeneutics of milk donation in light of the pandemic and as an opportunity to rethink the studies of recent decades in this regard.

Resident Perceptions and Confidence Regarding Pediatric Preventive Care

Purpose of Study: Residents have experienced changes in educational structure, format, content, and patient experience due to the COVID-19 pandemic. Resident physicians across the country have reported changes in workload including a decrease in well child checks and immunizations resulting in limited clinical exposure. This study aimed to assess the confidence of first year pediatric residents (interns) in conducting routine preventive screening for children and to identify potential gaps in knowledge among this cohort. Methods Used: We conducted a cross-sectional observation study that included 13 categorical first year pediatric residents. A voluntary, anonymous online survey was administered in September 2022. The survey assessed confidence levels, and perceived comfort regarding common preventive pediatric encounters and screening tools. The survey included 7-questions based on the 4th Edition Bright Future's Guidelines and respondents rated their answers on a 5-point Likert scale. The surveys were distributed anonymously via e-mail using Survey Monkey, a web-based software platform that provided an intuitive interface for validated data capture. Participants were given 2 weeks to complete the survey and reminders were sent via email. Summary of Results: Eight of 13 interns participated for a response rate of 62%. Sixty-three percent of the residents had completed a subinternship in pediatrics. Of our respondents, 75% reported feeling "not at all confident" in executing well child check-ups for children <12months old and 63% reported feeling "very confident" in examining children> 13months old. Regarding the ability to perform a genitourinary examination in children >12years of age, 63% of respondents stated that they were "slightly" or "not at all confident". We asked interns to rate their confidence in providing anticipatory guidance to their patients. Interns perceived being somewhat confident regarding guidance about safe sex, tobacco use, and healthy lifestyles but less confident regarding newborn care, breast feeding and infant nutrition. Nearly 40% reported comfort in recommending and advising parents about the risks and benefits of age appropriate immunizations. We asked residents to report their ability in administering and interpreting screening tools (ASQ, MCAT, EPDS). Interns reported that were able to interpret results but lacked confidence in providing guidance. Conclusion(s): Our study identifies opportunities to bridge experiential knowledge gaps and confidence among pediatric interns who may have had limited clinical exposure to pediatrics following the COVID-19 pandemic. Graduate medical education programs should consider developing tailored educational interventions specifically geared for identified learning gaps to mitigate the challenges posed by the pandemic.