ABSTRACT
BACKGROUND: Postnatal depression adversely affects many mothers and infants with good evidence that caregiving difficulties associated with depressive symptoms play a key role in later adverse childhood outcomes. In many countries, there is only limited support available for women who experience symptoms of depression during the postnatal period, particularly those experiencing subthreshold symptom levels. Furthermore, mental health services and community family health services in many countries tend to focus primarily on providing help for depressive symptoms or maternal caregiving, respectively, despite these problems commonly being comorbid. Group-based nurse-led interventions delivered over the Web through mobile phone "apps" have the potential to be a cost-effective method of providing a large number of mothers with easy access to integrated support for both maternal depressive symptoms and caregiving difficulties. OBJECTIVE: This paper describes the protocol for a pragmatic randomized controlled trial of a 4-month group-based nurse-led intervention delivered over the Web when infants were 2-6 months. The primary aims of the trial are to determine whether the intervention (1) reduces levels of maternal depressive symptoms and (2) improves the quality of maternal caregiving when infants are 8-12 months of age. METHODS: The trial aimed to recruit and randomize 160 mothers of infants aged 2-8 weeks to either the intervention (eMums plus) or standard care. Assessments were completed when infants were aged 1-2 (preintervention), 8, and 12 months. The primary outcomes were the level of maternal depressive symptoms and the quality of maternal caregiving assessed when infants were aged 12 months. The intervention provided specific support for problems with mood and problems with caregiving. The intervention was delivered by community health nurses as a part of routine service delivery to mothers via a mobile phone app. RESULTS: Participant recruitment was carried out from March to July 2017. Follow-up data collection was completed in mid-2018. Data analysis has commenced. CONCLUSIONS: In the past, many mothers participated in nurse-led face-to-face groups postnatally. However, mothers' groups held in clinics can be difficult for busy mothers to attend. The eMums intervention was delivered over the Web by nurses, allowing easy access by mothers early in an infant's life. The intervention was evaluated while delivered as part of the routine service practice by community child health nurses. The advantage of evaluating the effectiveness of the intervention in the routine service practice is that if it is found to be effective, it can be more easily adopted by the service provider than if it had been assessed in an efficacy trial. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/11549.
ABSTRACT
RESUMO Objetivou-se, neste estudo, identificar a prevalência da amamentação na primeira hora de vida e seus resultados para a manutenção do aleitamento materno. Trata-se de uma pesquisa descritiva desenvolvida em uma instituição hospitalar com Iniciativa Hospital Amigo da Criança da Tríplice Fronteira, realizada no segundo e terceiro trimestres de 2015. A coleta dos dados envolveu observação da primeira mamada e após 18 horas de nascimento; e contato telefônico após 90 dias. Os dados foram analisados pela estatística simples. Observaramse 88 binômios, dos quais 79,5% mamaram na primeira hora de vida. O parto normal foi um fator protetor para a amamentação na primeira hora e boa sucção. No alojamento conjunto, os binômios que iniciaram a mamada na primeira hora demonstraram melhor adaptação da sucção, porém não melhor resposta do recém-nascido. Após 90 dias do nascimento, a maioria das crianças estava sendo amamentada, mas também recebiam leite artificial. Aponta-se para a necessidade de sensibilizar gestores e profissionais de saúde para promover a prática do aleitamento materno na primeira hora de vida como uma prioridade de cuidado.
RESUMEN El objetivo de este estudio fue identificar la prevalencia de la lactancia en la primera hora de vida y sus resultados para el mantenimiento de la lactancia materna. Investigación descriptiva desarrollada en una institución hospitalaria con Iniciativa Hospital Amigo del Niño de la triple frontera, en el segundo y tercer trimestre de 2015. La recolección de los datos involucró observación de la primera mamada y tras 18 horas de nacimiento; y contacto telefónico tras 90 días. Los datos fueron analizados por la estadística simple. Se observaron 88 binomios, siendo que, 79,5% mamaron en la primera hora de vida. El parto normal fue un factor protector para la lactancia en la primera hora y buena succión. En el alojamiento conjunto, los binomios que iniciaron la mamada en la primera hora demostraron mejor adaptación de la succión, pero sin una mejor respuesta del recién nacido. Después de 90 días del nacimiento, la mayoría de los niños estaba siendo amamantada, aunque, también recibía leche artificial. Se apunta a la necesidad de sensibilizar a gestores y profesionales de salud para promover la práctica de la lactancia materna en la primera hora de vida como una prioridad de cuidado.
ABSTRACT The objective of this study was to identify the prevalence of breastfeeding in the first hour of life and its outcomes to breastfeeding continuation. This is a descriptive research developed at a hospital institution with the Child-Friendly Hospital Initiativein the triple frontier, during the second and third quarter of 2015. Data collection involved observation of the first breastfeeding and breastfeeding 18 hours after birth, and a phone call after 90 days. Data were analyzed through simple statistics. A total of 88 binomials were assessed, with 79.5% being breastfed in the first hour of life. Normal delivery was a protective factor to breastfeeding in the first hour of life and to good suction. As for rooming-in, those binomials that started being breastfed in the first hour showed better suction adaptation, but not better response from the newborn. After 90 days of birth, most children were being breastfed but were receiving artificial milk too. It is worth highlighting the need to make health managers and professionals sensitive to promoting breastfeeding practice in the first hour of life as a healthcare priority.
