Breastfeeding Positioning and Attachment among Postnatal Mothers: A Mixed Methods Study in a Tertiary Care Hospital in Puducherry, South India.

Introduction: Proper positioning and attachment play a key role in exclusive breastfeeding. Whereas incorrect breastfeeding techniques lead to poor milk transfer and early discontinuation of breastfeeding. Objectives: 1. To assess the breastfeeding techniques among postnatal mothers and to identify the factors associated with improper positioning and poor attachment. 2. To prioritize the action points to improve the poor breastfeeding practices according to the viewpoint of the staff nurses. Materials and Methods: A hospital-based mixed-methods study was carried out in Puducherry for 6 months. In quantitative phase, 99 postnatal mothers were interviewed consecutively and breastfeeding techniques were observed based on Baby Friendly Hospital Initiative and Integrated Management of Neonatal and Childhood Illness guidelines. In qualitative phase, 45 staff nurses ranked the action points to improve the poor breastfeeding practices. Bivariate and multivariate analyses were employed. Mean rank and Kendalls' Concordance Coefficient were calculated for the ranked data. Results: About 28.3% and 27.3% of mothers demonstrated improper positioning and poor attachment, respectively. Young mothers, housewives, <10 days old infants, and failure to receive breastfeeding counseling were associated with poor breastfeeding techniques. Poster displays, healthcare workers' training, targeted counseling, and assistance were the priority action points suggested by the staff nurses. Conclusion: Maternal age, maternal occupation, infants' age, and breastfeeding counseling influenced breastfeeding techniques. The prioritized action points need to be implemented to achieve the level of Baby Friendly Hospital.

Children 'At Risk' of Developing Specific Learning Disability in Primary Schools.

OBJECTIVES: To study the proportion of children of age 5 to 7 y at risk of specific learning disability (SLD) and to analyse the socio-demographic risk factors. METHODS: A school based cross-sectional study was conducted in six schools in Puducherry. Four hundred eighty students were enrolled and study was conducted in a triphasic approach. Phase I- Screening by teachers using SLD-SQ (Specific Leaning Disability - Screening Questionnaire); Phase II- Vision, hearing, and Intelligence Quotient (IQ) assessment were done in students screened positive with SLD-SQ and those with vision or hearing impairment and subnormal intelligence were excluded; Phase III- Remaining children were subjected to NIMHANS SLD index (Level I profile). RESULTS: Of the 480 enrolled students 109 were screened positive with SLD-SQ. Twelve students were excluded in Phase II. Remaining 97 evaluated were evaluated with NIMHANS SLD index and 36 (7.5%) were screened positive. Boys (9.6%) were significantly more affected than girls (4.9%). Similarly, risk was significantly higher in students of government schools (12.1%) than private schools (2.2%). Ignoring punctuation and capitals was the commonest problem in SLD-SQ whereas, dysgraphia was most common in NIMHANS index. CONCLUSIONS: The present study shows though SLD is highly prevalent and remains undiagnosed due to lack of awareness among teachers and parents. Since early intervention leads to better outcomes, Universal screening should be made mandatory and remedial teaching centres made available, accessible and economical.

Incontinentia pigmenti: a rare genodermatosis in a male child.

Incontinentia pigmenti is rare X-linked dominant disorder. There is no consistent expression of Incontinetia pigmenti in female child, but in male child, they always lead to death in utero. Vesicular, verrucous, hyperpigmented, and atrophic stages are the four stages of Incontinetia Pigmenti and it is uncommon for all stages to be seen in a same case. It is a rare genodermatosis, with only very few cases of male child with Incontinentia pigmenti have been reported. Thus, we report this case due to its extreme rarity and the child showed all the first 3 stages on followup.

Antenatal counseling on breastfeeding -- is it adequate? A descriptive study from Pondicherry, India.

BACKGROUND: Antenatal counseling on breastfeeding and postnatal lactation support are likely to improve rates of exclusive breastfeeding. This descriptive study was undertaken to assess whether antenatal visits were utilized for promotion of exclusive breastfeeding in addition to the routine obstetric services. METHODS: This descriptive study was conducted at a tertiary hospital in Pondicherry, India. Every third primigravida mother admitted in the maternity ward from June to December 2005 was recruited. Among these 144 primigravida mothers, 108 who had a minimum of three antenatal visits ("booked") were included in the study. These 108 mothers were administered a pre-tested semi-structured questionnaire on breastfeeding in the local language, Tamil, within 24 hours of giving birth. Appropriate flash cards with pictures were also used while administering the questionnaire. The awareness among mothers (both "counseled" and "not counseled") regarding health information pertaining to breastfeeding was assessed. RESULTS: Of the booked mothers, 21% (n = 23) had received some antenatal counseling about breastfeeding while 79% (n = 85) had not received any such counseling. Four percent had undergone breast examination during antenatal visits. Awareness related to breastfeeding among mothers in the "counseled" group was better than those in the "not counseled" group. Even in the "counseled" group, awareness among mothers with regard to correct breastfeeding technique and concept of continuing breastfeeding during illness in the baby was no different from those in the "not counseled" group. CONCLUSION: Existing antenatal counseling on breastfeeding is inadequate in the population studied and needs to be strengthened. Informing all pregnant women about the benefits and management of breastfeeding should be a priority during antenatal visits.