Access to Workplace Supports is Positively Associated with Exclusive Breastfeeding among Formally Employed Mothers in Kenya.

BACKGROUND: Mothers in low-income settings who work in agricultural employment are challenged to meet breastfeeding (BF) recommendations. Recent legislation in Kenya mandates maternity leave and workplace supports, yet the relation of these benefits with BF practices is poorly understood. OBJECTIVES: We evaluated the associations with workplace-provided BF supports and BF practices among formally employed mothers in Kenya. The availability of supports was hypothesized to be associated with a higher prevalence and greater odds of exclusive breastfeeding (EBF). METHODS: We conducted repeated cross-sectional surveys among formally employed mothers at 1-4 d and 6, 14, and 36 wk (to estimate 24 wk) postpartum in Naivasha, Kenya. We used logistic regression adjusted for maternal age, education, physical burden of work, HIV status, and income to evaluate associations between workplace supports and EBF practices. RESULTS: Among formally employed mothers (n = 564), those who used onsite workplace childcare were more likely to practice EBF than those who used community- or home-based childcare at both 6 wk (95.7% compared with 82.4%, P = 0.030) and 14 wk (60.6% compared with 22.2%, P < 0.001; adjusted OR: 5.11; 95% CI: 2.3, 11.7). Likewise, at 14 wk among mothers who currently used daycare centers, a higher proportion of mothers who visited daycare centers at or near workplaces practiced EBF (70.0%) than of those not visiting daycare centers (34.7%, P = 0.005). EBF prevalence was higher among mothers with access to workplace private lactation spaces than among mothers without such spaces (84.6% compared with 55.6%, P = 0.037), and among mothers who lived in workplace housing than those without onsite housing (adjusted OR: 2.06, 95% CI: 1.25, 3.41). CONCLUSIONS: Formally employed mothers in Kenya who have access to and use workplace-provided BF supports were more likely to practice EBF than mothers who lacked these supports. As the Kenya Health Act is implemented, lactation rooms, onsite housing and daycare, and transportation to visit children can all support BF and EBF among employed mothers.

Formal maternal employment is associated with lower odds of exclusive breastfeeding by 14 weeks postpartum: a cross-sectional survey in Naivasha, Kenya.

BACKGROUND: In many low- and middle-income countries, improvements in exclusive breastfeeding (EBF) have stalled, delaying reductions in child mortality. Maternal employment is a potential barrier to EBF. OBJECTIVES: We evaluated associations between maternal employment and breastfeeding (BF) status. We compared formally and non-formally employed mothers in Naivasha, Kenya, where commercial floriculture and hospitality industries employ many women. METHODS: We conducted a cross-sectional survey among mothers (n = 1186) from September 2018 to October 2019 at 4 postpartum time points: at hospital discharge (n = 296) and at 6 wk (n = 298), 14 wk (n = 295), and 36 wk (to estimate BF at 24 wk; n = 297) postpartum. Mothers reported their BF status and reasons for EBF cessation. We used multivariable logistic regression models to test the association between formal maternal employment and 3 outcomes: early BF initiation (within 1 h of birth), EBF at each time point, and continued BF at 9 mo. Models were informed by a directed acyclic graph: a causal diagram used to characterize the relationship among variables that influence the independent (employment) and dependent (BF status) variables. RESULTS: EBF did not differ by employment status at hospital discharge or at 6 wk postpartum. However, formally employed mothers were less likely than those not formally employed to report EBF at 14 wk (59.0% compared with 95.4%, respectively; AOR: 0.19; 95% CI: 0.10, 0.34) and at 24 wk (19.0% compared with 49.6%, respectively; AOR: 0.25; 95% CI: 0.14, 0.44). The prevalence of continued BF at 36 wk did not differ by group (98.1% for formally employed compared with 98.5% for non-formally employed women; AOR: 0.80; 95% CI: 0.10, 6.08). The primary reasons reported for early EBF cessation were returning to work (46.5%), introducing other foods based on the child's age (33.5%), or perceived milk insufficiency (13.7%). CONCLUSIONS: As more women engage in formal employment in low- and middle-income countries, additional supports to help prolong the period of EBF may be beneficial for formally employed mothers and their children.

Failure of Syndrome-Based Diarrhea Management Guidelines to Detect Shigella Infections in Kenyan Children.

BACKGROUND: Shigella is a leading cause of childhood diarrhea mortality in sub-Saharan Africa. Current World Health Organization guidelines recommend antibiotics for children in non cholera-endemic areas only in the presence of dysentery, a proxy for suspected Shigella infection. METHODS: To assess the sensitivity and specificity of the syndromic diagnosis of Shigella-associated diarrhea, we enrolled children aged 6 months to 5 years presenting to 1 of 3 Western Kenya hospitals between November 2011 and July 2014 with acute diarrhea. Stool samples were tested using standard methods for bacterial culture and multiplex polymerase chain reaction for pathogenic Escherichia coli. Stepwise multivariable logit models identified factors to increase the sensitivity of syndromic diagnosis. RESULTS: Among 1360 enrolled children, median age was 21 months (interquartile range, 11-37), 3.4% were infected with human immunodeficiency virus, and 16.5% were stunted (height-for-age z-score less than -2). Shigella was identified in 63 children (4.6%), with the most common species being Shigella sonnei (53.8%) and Shigella flexneri (40.4%). Dysentery correctly classified 7 of 63 Shigella cases (sensitivity, 11.1%). Seventy-eight of 1297 children without Shigella had dysentery (specificity, 94.0%). The combination of fecal mucous, age over 23 months, and absence of excessive vomiting identified more children with Shigella-infection (sensitivity, 39.7%) but also indicated antibiotics in more children without microbiologically confirmed Shigella (specificity, 82.7%). CONCLUSIONS: Reliance on dysentery as a proxy for Shigella results in the majority of Shigella-infected children not being identified for antibiotics. Field-ready rapid diagnostics or updated evidence-based algorithms are urgently needed to identify children with diarrhea most likely to benefit from antibiotic therapy.

Safe storage of handguns. What do the police recommend?

OBJECTIVE: To ascertain the specific suggestions that local police departments in the United States give to parents who ask for advice about methods to safely store handguns. METHODS: A cross-sectional, semistructured telephone survey was administered to a sample of 102 police departments in the United States in cities with populations of 10,000 or more, selected within blocks of cities of similar population size. An investigator, posing as a parent of 3-year-old and 10-year-old children, called departments seeking specific advice on how to safely store a handgun acquired for protection. RESULTS: Usable responses were generated for 93 (91%) of the departments sampled. Only 3 departments (3.2%) refused to give advice over the telephone. The most commonly suggested storage methods were trigger locks (55 departments [59%]), portable lockboxes for handguns (48 [52%]), and the separation of guns from ammunition (30 [32%]). Seven percent of departments suggested removing the gun from the household. Over half of those suggesting trigger locks and lockboxes considered these devices safe (35 [64%] for trigger locks and 27 [56%] for lockboxes) and yet rapidly accessible to an adult (36 [65%] for trigger locks and 36 [75%] for lockboxes). Responding police officers most commonly reported using the following storage methods at home: no storage method (31 [38%]), portable lockboxes (23 [28%]), out-of-reach location (11 [13%]), separation of gun and ammunition (10 [12%]), and trigger locks (5 [6%]). CONCLUSIONS: Trigger locks are frequently recommended but infrequently used by police themselves at home. Portable lockboxes are frequently recommended as well as used by police.

Legal implications of genetics and crime research.

Two controversial topics dominate discussions of the legal implications of genetics and crime research; (1) the viability and politics of such research, which has sparked fervent debate in the USA; and (2) the current status of new or atypical criminal law defences, which would include a genetic-defect defence to criminal behaviour. This chapter begins by examining the scientifically discredited XYY chromosome syndrome defence, the major genetic-defect defence that defendants have attempted, albeit unsuccessfully. It then focuses on attorneys' efforts to test for evidence of genetic abnormality in the recent and highly publicized case involving convicted murderer Stephen Mobley, whose family history reveals four generations of violent, aggressive and behaviourally disordered men and women. Mobley is currently appealing his death sentence before the Georgia Supreme Court on the basis that the trial court denied his request both to have genetic testing performed and to have such testing allowed as evidence into court. This chapter concludes by emphasizing that the question is not whether genetic evidence will ever be admitted into court, but when and under what kinds of circumstances. No doubt, genetic evidence, and comparable kinds of biological evidence, will have a major impact on juries when such evidence is more fully accepted by the legal and scientific communities.

Admissions for injury at a rural hospital in Ghana: implications for prevention in the developing world.

OBJECTIVES: Strategies for injury prevention have been extensively studied in developed nations but not in the developing world. This study sought to determine which mechanisms of injury were common in a rural developing area and which were important contributors to mortality and disability. METHODS: All 614 patients admitted for injuries to a rural African hospital between 1987 and 1991 were analyzed retrospectively for mechanism of injury and outcome, as assessed by mortality and long-term functional status. RESULTS: The leading mechanisms of injury were transport related (29%) and burns (16%). Burns accounted for 61% of injuries in children under 5 years. Mortality was 7.3% in the series, with 24% of deaths owing to transport injuries. Disability developed in 103 (22%) of the 462 survivors available for assessment, with most disability resulting from transport injuries (26% of all disabilities), burns (13%), and agricultural injuries (14%). CONCLUSIONS: Among injured patients who presented for treatment in this rural developing area, the largest burden of mortality and disability was from burns and transport-related injuries. Population-based studies are needed to substantiate whether these should be priorities for injury prevention efforts.

Aggressive fluid resuscitation and broad spectrum antibiotics decrease mortality from typhoid ileal perforation.

One of the most severe complications of typhoid enteritis is perforation of ileal ulcerations. The typically high mortality rates from these perforations are in part due to extremely limited supportive care in hospitals in typhoid endemic areas. In the setting of a rural African hospital, this study demonstrated a decrease in overall mortality rate from 40% with one layer closure and chloramphenicol alone to 19% with two-layer closure and chloramphenicol, gentamicin and metronidazole. This was primarily due to a decrease in late (> 24 h) mortality. There was also a decrease in overall mortality rate from 43% with < 10 ml/kg of intraoperative fluid administration to 14% with > 10 ml/kg. This was primarily due to a decrease in early (< 24 h) mortality. Even within the constraints of the rural developing world, more aggressive initial fluid resuscitation can decrease early mortality, while broader spectrum antibiotics and two-layer closure can decrease late mortality from typhoid ileal perforation.

Maternal knowledge, attitude and practices regarding childhood acute respiratory infections in Kumasi, Ghana.

Acute respiratory infections (ARI) are a major cause of paediatric mortality and morbidity, particularly when associated with delays in treatment. A study of mothers' knowledge, attitudes and practices regarding ARI in their children aged less than 5 years was conducted in an urban Ghanaian population. One hundred and forty-three women traders were interviewed in open air markers in Kumasi, Ghana. Based on Western standards, there was a poor maternal understanding of the aetiology of ARI. A variety of herbal and home care therapies, including some which have potentially harmful effects, were routinely employed for the prophylaxis and treatment of ARI. For example, castor oil and enemas (25.9%) were reported as agents to prevent ARI, and antibiotics were prescribed by the parents in 39.9% for treating coughs. While the mothers exhibited an understanding of symptoms which differentiate between mild and severe ARI, a substantial number indicated that they would delay accessing a health care facility in the presence of the following symptoms which signify severe respiratory distress: dyspnoea (11.2%); tachypnoea (18.9%); chest retraction (21.7%); cough, fever and anorexia (30.0%); and cough, fever and lethargy (57.3%). These findings support the need for an ARI health education programme in Ghana.

PIP: At the two largest open air markets in Kumasi, Ghana, interviews were conducted with 143 women who had at least one child aged less than five years. Researchers wanted to examine their knowledge, attitude, and practices concerning acute respiratory infection (ARI) in children. The women tended to be married, Christian, from the Ashanti tribe, aged 20-29 years, and to have 2-3 living children. 73.4% had a child or children who had suffered from cough and fever within the last six months. 73.4% named exposure to cold as a direct cause of cough. Many women incorrectly blamed worm infestation for causing cough and fever (21%) and constipation for causing cough (25.9%). None mentioned pathogens as a cause of cough and fever. None said that good ventilation and avoidance of overcrowding prevent cough and fever. The more serious the symptoms, the more likely the mothers were to seek treatment at a health care facility (e.g., cough only, 0.7%; cough and fever, 6.3%; cough, fever, and anorexia, 30%; and cough, fever, and lethargy, 57.3%). Common home care practices for treating a runny nose included ephedrine or other types of nasal drops, herbal medicines, antipyretics, and antibiotics. 39.9% would use antibiotics to treat coughs. Honey and cough syrup were often used to treat cough and fever. Some herbal and home care therapies had potentially harmful effects. For example, 25.9% said that they used castor oil and enemas to prevent ARI. The women had an acceptable knowledge score on severity of symptoms (mode = 15/20; range = 11-18). These findings indicate a need for a health education program targeting mothers of children aged less than five years.

Trauma outcomes in the rural developing world: comparison with an urban level I trauma center.

Trauma is well known as a major cause of death and disability in the developed world, but has been inadequately studied in developing nations. We reviewed 539 trauma patients admitted from 1987 through 1991 to a rural African hospital, the Holy Family Hospital (HFH) in Berekum, Ghana, and compared these results with 14,270 patients admitted during the same period to a level I trauma center, the Harborview Medical Center (HMC) in Seattle, Washington. At HFH, 59% of patients were seen > 24 hours after injury, compared with 4% of HMC patients (p < 0.001). Only 25% of HFH patients received prehospital care, compared with 82% of HMC patients (p < 0.001). Mean ISS was higher at HMC (10.0 +/- 6.3) than a HFH (6.7 +/- 6.5) (p < 0.001), but trauma mortality rates were identical (6%) at both institutions. Neurologic injuries were the leading cause of death at both HFH (62%) and HMC (54%). There was no significant difference between institutions in mortality for patients with ISS 1-8 (HMC: 0.7% n = 6390; HFH: 0.3%, n = 342). There was a marked decrease in mortality for patients with ISS 9-24 at HMC (3%, n = 3709) compared with HFH (10%, n = 146) (p < 0.001). There was a less pronounced decrease in mortality for patients with ISS > 24 at HMC (41%, n = 1520) compared with HFH (73%, n = 26) (p < 0.01). The type and the severity of injuries causing fatalities in this developing nation suggest that no inexpensive hospital-based changes would improve outcomes.(ABSTRACT TRUNCATED AT 250 WORDS)

Paediatric trauma in the rural developing world: low cost measures to improve outcome.

We reviewed 181 injured children admitted to a rural African hospital from 1987 to 1990 to ascertain factors influencing survival and functional outcome. Burns were the most common (39 per cent), occurred in the youngest patients, and were due to domestic scalding in 54 per cent of cases. Of the patients, 65 per cent presented more than 24 h after injury and 81 per cent presented without any previous treatment. Major disability occurred in 14 per cent of survivors and was associated with Injury Severity Score (ISS), extremity injury, and delayed presentation. Mortality was associated with the ISS. The mean ISS was 6.3. An ISS of 20-25 was associated with 75 per cent mortality. Trauma caused 8 per cent of hospital deaths in the 5-19 years age group. To reduce the mortality and disability from paediatric trauma in the rural developing world, we recommend: (i) prevention strategies targeting domestic burns in younger children, (ii) increased attention to care of extremity injuries and burns, and (iii) increased use of non-medical health care providers in more remote areas.

Birth stress and lateral preferences.

Conflicting evidence exists concerning the possible role of birth stress in the etiology of left-sided lateral preferences. In order to clarify this issue, associations among lateral preferences of hand, eye, and foot and eight indices of prenatal and perinatal stress were examined in the present study on a sample of 987 boys and girls who participated in the Philadelphia Collaborative Perinatal Project. Controls were instituted for some of the methodological and measurement problems encountered in past birth stress and laterality research. Results showed that subjects with different lateral preferences did not differ significantly in their distributions of all but one birth stress items. Hence, there was no substantial evidence for a link between birth stress and left-sided preferences. Alternative hypotheses for the etiology of left-sidedness should therefore be explored.

Birth order and lateral preferences.

Associations between birth order and lateral preferences of hand, eye and foot were examined in a sample of 6436 black seven year old boys and girls whose mothers participated in the Collaborative Perinatal Project (CPP) in Philadelphia. Overall, most of the subjects (87%) showed right hand preference, and the majority of subjects showed right eye (55%) and foot (63%) preferences. Analysis of cross preferences indicated some tendency for a consistent right side orientation. However, patterns of lateral preferences were similar for both boys and girls across seven birth order groups. The data were interpreted as showing that birth order and lateral preferences are not interrelated.

Affinity chromatographic purification of antibody subsets depends on the mode of cross-linking of antigen to the affinity matrix.

Affinity columns for the separation of rabbit antibodies (Abs) to the purified nicotinic acetylcholine receptor (AcChR) from Torpedo californica electroplax were constructed in two ways: (1) by direct cross-linking of purified AcChR to cyanogen bromide activated Sepharose 4B, and (2) by first cross-linking a purified curarimimetic neurotoxin to cyanogen bromide activated Sepharose 4B, subsequently saturating with AcChR, and finally cross-linking the toxin to noncovalently bound receptors with bisimidate cross-linkers such as dimethyl suberimidate (DMS). Ab(AcChR) from pooled rabbit antisera were chromatographed in near stoichiometric proportions to the AcChR bound to the column to allow equilibrium selection of antibodies directed against sites which were not sterically hindered. The concept that columns of the second type subfractionate Ab(AcChR) was tested by analyzing Ab(AcChR) from column fractions with an ELISA and radioimmunoassay (RIA) procedure. The ELISA was constructed to that the exposed face of the AcChR was the same as that expected for columns of the second type, i.e. for the internal or cytoplasmic face. Enhanced ratios of ELISA to RIA measures of Ab(AcChR) reflected substantial purification of cytoplasmic face antibodies in DMS-cross linked columns. Total Ab(AcChR) was measured by RIA. Both types of columns gave substantial purification of tightly bound antibodies, i.e. those which were eluted with 3M potassium thiocyanate. Thirty-fifty percent of the IgG eluted was found in these fractions, which contained 2-6% of the total eluted protein. Approximately half of the total IgG present in these fractions represented specific IgG against AcChR. Both types of columns could be reutilized giving similar results; however, their efficiency was diminished.

Neuropsychological and early environmental correlates of sex differences in crime.

Results of recent research suggest that longitudinal influences on sex differences in verbal and spatial abilities, and delinquent behavior, may be similar. The present study examined biological, environmental, and psychological variables collected from birth through age 17 on a sample of subjects who participated in the Philadelphia Collaborative Perinatal Project (CPP). Findings supported in part past research suggesting that environmental relationships with intellectual ability and delinquency are strongest for males, whereas biological relationships are somewhat more important for females. Socioeconomic factors were among the strongest predictors of delinquency for both sexes, however. In turn, biological and environmental influences on verbal and spatial abilities and their relationships with later achievement were different between the sexes. Results are discussed in terms of possible sex differences in the development of the left and right cerebral hemispheres, as well as in the vulnerability to environmental influences.

Lateral preferences of hand, eye and foot: relation to cerebral dominance.

Patterns of lateral preferences of hand, eye and foot were analyzed on 7364 children, differing in race (black and white) and sex. Right hand and foot preferences were found in over 80%, and right eye preferences were found in over 50% of the subjects. No sex or race differences appeared in left-right preferences. However, significantly more females than males, and more blacks than whites, showed variable foot preference. Further analyses of cross preferences indicated that about 40% of the subjects showed consistent lateral preferences of hand, eye, and foot (about 37% right, and about 3% left), whereas the other 60% were divided among ten groups of different preference combinations. The three lateral measures were correlated to differing degrees. The data were interpreted as showing the effects of cerebral dominance on lateral preferences of hand, eye and foot. The effects seemed to be considerably stronger for hand and foot than for eye preferences. Due to a lack of supporting data, interpretation of race differences in variable foot preference must be considered tentative.

Early cognitive functioning: sex and race differences.

Six scales of early cognitive functioning were administered at three times (eight months, four and seven years) to 3013 black and white, male and female children. Hypotheses addressed the nature and extent of longitudinal sex differences in cognitive abilities among racial groups varying in physical maturation. Controlling for selected socioeconomic influences, a slight sex by race interaction was found at four and seven years. Generally, white females scored somewhat lower on cognitive tests than white males, whereas black females scored equivalently or somewhat higher than black males. Test score differences among the four sex and race groups were more apparent in seven-year spatial abilities relative to verbal abilities. Findings are discussed in terms of possible maturational and environmental influences on cognitive abilities among different sex and race groups.