Testing communication models for relactation in an Egyptian setting.

BACKGROUND: Early discontinuation of breastfeeding exposes babies to severe and fatal illnesses. The aim of this study was to identify the barriers to relactation among Egyptian women who had stopped breastfeeding and to test different interventions to support the mothers to relactate. SUBJECTS AND METHODS: We conducted a prospective longitudinal cohort study of 200 mothers from Alexandria with babies less than 3 months of age who were not breastfeeding. They were exposed to three different types of educational models (problem solving, coaching, and cautioning) and followed up by phone calls over a period of 6 weeks. RESULTS: Compliance with the protocol for relactation varied according to the educational model used. Only 10% succeeded in relactating. The most effective educational strategy was the problem solving (45%) and the coaching (50%). The least effective was the cautioning approach (5%). Determinants of relactation included mother's education level (100%), cup feeding with no nipples or soothers (70%), and the husband's involvement (70%). CONCLUSIONS: We conclude that the choice of appropriate educational models is key to encouraging mothers to return to breastfeeding. This study strongly supports Step Ten of the Baby Friendly Hospital Initiative.

Evaluating the indoor and outdoor environment: using a simple method.

Housing is the conjunction of the dwelling, the home, the immediate environment and the community. Between 1960 and 1980, the urban population in developing countries more than doubled and is expected to reach 56% of the total population by the year 2025. In many cities, the development of squatter settlements and shanty towns had grown rapidly causing the destruction of green areas. The number of people living in urban slums and shanty towns is an indicator of conditions in the cities and the United Nations had estimated that about one-third of urban dwellers in developing countries live in such settlements. Poverty is highly prevalent among the residents of these areas. Outdoor environmental degradation, together with the social degradation affects the health of the urban population especially the poor causing a burden of ill-health, disability, poor indoor housing, and high maternal and infant mortality. The aim of the present study is to evaluate the indoor and outdoor environment using a simple method and to assess its reliability and validity. The scoring system, which was developed for the assessment of the indoor and outdoor environmental levels included 36 items (18 for the indoor and 18 for the outdoor) using a questionnaire. Results revealed that the proposed scoring system was able to reveal significance difference between served (water, electricity, and sewerage system were available) and unserved areas when using t-test, z-test, and chi-square testing. The proposed scoring system was reliable and valid especially in indoor assessment. Outdoor scores might need more modifications to improve its reliability.

Identification of causes of neonatal mortality using the ICD-10 classification: a study in neonatal intensive care units in Alexandria Governorate (MOHP).

In most developing countries, neonatal care has remained static or neglected for decades where neonatal mortality was 38/1000 live births compared to 6/1000 in developed countries. According to the World Health Organization (who) neonatal causes of death were infections (34%), asphyxia (28%), problems linked with preterm birth (23%) and congenital anomalies (10%). In Alexandria govemorate (A.R.E.) causes of death of,admitted neonates in neonatal intensive care units (NICU) were not recorded. The aim of the present study is to identify causes of neonatal deaths based on the International classification of diseases-10 (ICD-10) among admitted neonates in the NICU in MOHP hospitals in Alexandria so as to set preventive strategies to decrease the neonatal mortality. A descriptive cross-sectional study was conducted on 2424 neonates admitted through one year (April 2001-March 2002) in eight hospitals of MOHP. Certain modifications in the routinely collected monthly reports were necessary and a new computer program was developed in the Alexandria information center. Results revealed that hyaline membrane disease was the 1st cause of neonatal deaths (16.5%) followed by causes related to prematurity (15.8%). It was also the 1st causes of death of preterm neonates (27.5%). Birth asphyxia and congenital anomalies were the 1st and 2nd causes of death among full term neonates (21.7% each). Single dose of corticosteroid injection could be recommended for mothers expected to have a premature labor to decrease the incidence of hyaline membrane disease among preterm neonates.