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Iellamo A, Wong CM, Bilukha O, Smith JP, Ververs M, Gribble K, Walczak B, Wesolowska A, Al Samman S, O’Brien M, Brown AN, Stillman T, Thomas B. "I could not find the strength to resist the pressure of the medical staff, to refuse to give commercial milk formula": a qualitative study on effects of the war on Ukrainian women's infant feeding. Front Nutr 2024; 11:1225940. [PMID: 38826579 PMCID: PMC11140133 DOI: 10.3389/fnut.2024.1225940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 04/24/2024] [Indexed: 06/04/2024] Open
Abstract
Introduction During emergencies, breastfeeding protects infants by providing essential nutrients, food security, comfort, and protection and is a priority lifesaving intervention. On February 24, 2022, the war in Ukraine escalated, creating a humanitarian catastrophe. The war has resulted in death, injuries, and mass internal displacement of over 5 million people. A further 8.2 million people have taken refuge in neighboring countries, including Poland. Among those impacted are infants and young children and their mothers. We conducted a study to explore the infant feeding challenges and needs of Ukrainian women affected by the war. Methods We conducted a qualitative descriptive study involving in-depth interviews (IDIs) with 75 war-affected Ukrainian mothers who had at least one infant aged less than 12 months at the time of the interview. Eligible mothers were either (1) living as Ukrainian refugees in Poland, having crossed the border from Ukraine on or after February 24, 2022, when the war started (n = 30) or (2) living in Ukraine as internally displaced persons or as residents in the community (n = 45). All interviews were audio-recorded (either transcribed or had responses summarized as expanded notes) and analyzed using qualitative thematic analysis using a two-step rapid analysis process. Results Participants in Ukraine who wanted to initiate breastfeeding right after birth faced opposition from healthcare workers at maternity hospitals. Ukrainian refugees who gave birth in Poland faced language barriers when seeking breastfeeding support. Half of the participants in Ukraine received commercial milk formula (CMF) donations even if they said they did not need them. Most respondents stated that breastfeeding information and support were urgently needed. Conclusion Our data suggests that healthcare workers in Ukrainian maternity hospitals require additional training and motivation on delivering breastfeeding support. In addition, lactation consultants in maternity ward are needed in Ukraine, and interpretation support is needed for refugees to overcome language barriers. There is a need to control the indiscriminate donations of commercial milk formula and to ensure that complementary foods and commercial milk formula are available to those that need it. This study confirms the need for actions to ensure infant and young child feeding (IYCF) support is provided during emergencies.
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Affiliation(s)
| | | | - Oleg Bilukha
- Global Public Health Emergency Branch, Global Health Center, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Julie P. Smith
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, NSW, Australia
| | - Mija Ververs
- Global Public Health Emergency Branch, Global Health Center, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Karleen Gribble
- School of Nursing and Midwifery, Western Sydney University, Parramatta, NSW, Australia
| | - Bartłomiej Walczak
- Institute of Applied Social Sciences, University of Warsaw, Warsaw, Poland
| | - Aleksandra Wesolowska
- Laboratory of Human Milk and Lactation Research, Department of Medical Biology, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
- Human Milk Bank Foundation, Warsaw, Poland
| | - Sura Al Samman
- Jordan Community Health and Nutrition Behavior Change Project, FHI 360 WAMERO, Amman, Jordan
| | - Michael O’Brien
- Crisis Response Unit, FHI 360, Washington, DC, United States
| | - Annette N. Brown
- Strategy and Innovation with Evidence Unit, FHI 360, Washington, DC, United States
| | | | - Blythe Thomas
- 1000 Days Initiative, FHI Solutions, Washington, DC, United States
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Mattar L, Hassan H, Kalash N, Malli D, Diab-El-Harake M, Nassour S, Jomaa L. Assessing the nutritional content and adequacy of food parcels among vulnerable Lebanese during a double crisis: COVID-19 pandemic and an economic meltdown. Public Health Nutr 2023; 26:1271-1283. [PMID: 36779273 PMCID: PMC10346028 DOI: 10.1017/s1368980023000241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 11/29/2022] [Accepted: 01/18/2023] [Indexed: 02/14/2023]
Abstract
OBJECTIVES This study aimed to explore the nutritional content and quality of food parcels distributed in Lebanon and assess their adherence to dietary guidelines during the COVID-19 pandemic and an unprecedented economic crisis. DESIGN Cross-sectional study (June-July 2020); phone survey (thirty items). SETTING Lebanon. PARTICIPANTS Food parcel providers (FPP; n 72) involved in food parcel distribution (FPD), mainly to Lebanese households. RESULTS FPP included international non-governmental organizations (INGO) (n 3), local non-governmental organizations (n 45) and personal initiatives (n 24). Overall, low adherence to the World Food Programme (WFP) food parcel guidelines were observed among FPP for specific food items, including vegetables, fish, legumes and cereals, whereas salt content significantly surpassed the guidelines (all P-values <0·001). On average, a food parcel provided 608·4 ± 55 kcal/d/person. The greatest contributors to total energy intake (TE) in the food parcel were carbohydrates (46·4 %) and fats (46·8 %), while protein contributed to 7 %TE. In addition, %TE from fats and sugars significantly surpassed the dietary reference intakes (DRI) for a single person per d (134-234 % and 185 % of DRI, respectively, P-values <0·001). Only 10-15 % of daily needs for key micronutrients, including Fe, Zn, thiamin, riboflavin and dietary folate, were met through the food parcels. Adequate food safety and hygiene practices were reported among FPP, yet dramatic changes in food costs due to overlapping crises affected the quality and quantity of food in parcels. CONCLUSIONS Findings highlight the need to improve the nutritional content of food parcels and adherence to dietary guidelines to alleviate food and nutrition insecurity while preventing diet-related diseases among vulnerable beneficiaries in Lebanon.
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Affiliation(s)
- Lama Mattar
- Nutrition Program, Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, Beirut, Lebanon
| | - Hussein Hassan
- Nutrition Program, Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, Beirut, Lebanon
| | - Nour Kalash
- Nutrition Program, Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, Beirut, Lebanon
| | - Dana Malli
- Nutrition Program, Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, Beirut, Lebanon
| | - Marwa Diab-El-Harake
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Sahar Nassour
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Lamis Jomaa
- Department of Human Sciences, College of Health and Sciences, North Carolina Central University, Durham, NC, USA
- Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
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3
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AlArab N, Nabulsi D, El Arnaout N, Dimassi H, Harb R, Lahoud J, Nahouli L, Abou Koura A, El Saddik G, Saleh S. Reproductive health of Syrian refugee women in Lebanon: a descriptive analysis of the Sijilli electronic health records database. BMC Womens Health 2023; 23:81. [PMID: 36823589 PMCID: PMC9951425 DOI: 10.1186/s12905-023-02231-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/16/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND The Syrian conflict has been responsible for the highest exodus of refugees, with Lebanon hosting the greatest number of refugees per capita, which placed a significant strain on an already overburdened healthcare system. Women are the most vulnerable group in times of conflict and displacement, with sexual and reproductive health and rights often neglected. This study focuses on the obstetric characteristics and pregnancy outcomes of Syrian Refugee (SR) women in Lebanon, in Comparison to their pre-displacement data. METHODS This study is a secondary analysis of de-identified data from the Sijilli database. The data reported and analyzed were the refugees' socio-demographics, obstetric history, pregnancy outcomes, experienced maternal and neonatal complications, breastfeeding history and duration, and contraception use and types. Data were reported in both frequencies and means/medians. Chi-square test, t-test, and ANOVA tests were used to compare pregnancies in Syria to those that happened in Lebanon. RESULTS A total of 1065 female records were included in this study, with 634 ever-pregnant women and the total number of pregnancies being 3272. SR women were shown to get pregnant in Lebanon at a younger age compared to cases in Syria. The number of gravidities is equal in women who got pregnant in Syria and those who moved later to Lebanon. The mean spacing between pregnancies has decreased comparing SR women who got pregnant in Syria only versus those who got pregnant in Lebanon only. Among the mixed group, the mean spacing between pregnancies as well as the prevalence of spontaneous abortions significantly increased after displacing to Lebanon. C-section rate was higher among SR women after moving to Lebanon. Also, maternal complications and not breastfeeding have increased after moving to Lebanon. A prior pregnancy was significantly associated with higher contraception use rate. The most common methods of contraception were oral contraceptive pills and intra-uterine devices. CONCLUSION The C-section deliveries, spontaneous abortions and maternal complications have all increased among SR women after being displaced to Lebanon. While the age at first pregnancy, mean spacing between their pregnancies and breastfeeding rates have decreased after moving to Lebanon. SR women are less likely to use contraceptives after their displacement. It is necessary to address access to reproductive healthcare and antenatal care delivery among displaced refugee women living in informal tented settlements.
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Affiliation(s)
- Natally AlArab
- grid.22903.3a0000 0004 1936 9801Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Dana Nabulsi
- grid.22903.3a0000 0004 1936 9801Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Nour El Arnaout
- grid.22903.3a0000 0004 1936 9801Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Hani Dimassi
- grid.411323.60000 0001 2324 5973School of Pharmacy, Lebanese American University, Beirut, Lebanon
| | - Ranime Harb
- grid.411323.60000 0001 2324 5973School of Pharmacy, Lebanese American University, Beirut, Lebanon
| | - Julien Lahoud
- grid.22903.3a0000 0004 1936 9801Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Lara Nahouli
- grid.411654.30000 0004 0581 3406Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Abdulghani Abou Koura
- grid.411654.30000 0004 0581 3406Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ghaidaa El Saddik
- grid.18112.3b0000 0000 9884 2169Beirut Arab University, Beirut, Lebanon
| | - Shadi Saleh
- Global Health Institute, American University of Beirut, Beirut, Lebanon. .,Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Riad El Solh, Beirut, 1107 2020, Lebanon.
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Abou-Rizk J, Jeremias T, Nasreddine L, Jomaa L, Hwalla N, Frank J, Scherbaum V. Infant Feeding Practices, Nutrition, and Associated Health Factors during the First Six Months of Life among Syrian Refugees in Greater Beirut, Lebanon: A Mixed Methods Study. Nutrients 2022; 14:nu14214459. [PMID: 36364722 PMCID: PMC9654662 DOI: 10.3390/nu14214459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/14/2022] [Accepted: 10/19/2022] [Indexed: 01/25/2023] Open
Abstract
The objective was to describe infant feeding practices, nutrition and related health aspects of infants under six months among Syrian refugees in Greater Beirut, Lebanon. A cross-sectional study was conducted among Syrian refugee mothers with infants under six months in July-October 2018 (N = 114). Additionally, eleven focus group discussions were conducted to explore supportive factors and barriers associated with early breastfeeding practices. The prevalence of pre-lacteal feeding was high (62.5%), whereas early initiation of breastfeeding was low (31%), and exclusive breastfeeding very low (24.6%). One-fifth of the infants were anemic (20.5%) and 9.6% were wasted. A significantly higher proportion of non-exclusively breastfed infants had a fever and took medicines than those who were exclusively breastfed. Supporting factors of adequate infant feeding practices comprised knowledge on maternal nutrition and exclusive breastfeeding, along with receiving support from healthcare professionals and family members. Identified barriers included preterm delivery, pre-lacteal feeding, an at-risk waist circumference and moderate to severe depression among mothers, bottle feeding, early introduction of food, maternal health reasons, breastmilk substitutes' distribution, and misinformation offered by mothers-in-law. To address sub-optimal feeding practices documented among Syrian refugees, awareness on proper breastfeeding practices, maternal nutrition, and psychosocial support should be provided to mothers and family members alike.
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Affiliation(s)
- Joana Abou-Rizk
- Institute of Nutritional Sciences, Faculty of Natural Sciences, University of Hohenheim, 70599 Stuttgart, Germany
- Correspondence: or
| | - Theresa Jeremias
- Institute of Nutritional Sciences, Faculty of Natural Sciences, University of Hohenheim, 70599 Stuttgart, Germany
| | - Lara Nasreddine
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut 11-0236, Lebanon
| | - Lamis Jomaa
- Department of Human Sciences, College of Health and Sciences, North Carolina Central University, Durham, NC 27707, USA or
- Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut 11-0236, Lebanon
| | - Nahla Hwalla
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut 11-0236, Lebanon
| | - Jan Frank
- Institute of Nutritional Sciences, Faculty of Natural Sciences, University of Hohenheim, 70599 Stuttgart, Germany
| | - Veronika Scherbaum
- Institute of Nutritional Sciences, Faculty of Natural Sciences, University of Hohenheim, 70599 Stuttgart, Germany
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5
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Giusti A, Marchetti F, Zambri F, Pro E, Brillo E, Colaceci S. Breastfeeding and humanitarian emergencies: the experiences of pregnant and lactating women during the earthquake in Abruzzo, Italy. Int Breastfeed J 2022; 17:45. [PMID: 35706034 PMCID: PMC9199337 DOI: 10.1186/s13006-022-00483-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 05/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background Emergencies have a great impact on infant and young child feeding. Despite the evidence, the recommended feeding practices are often not implemented in the emergency response, undermining infant and maternal health. The aim of this study was to explore the experiences of pregnant and lactating women during the earthquake emergency that occurred in L’Aquila on 6 April 2009. Methods The study design was qualitative descriptive. Data were collected by individual semi-structured interviews, investigating the mother’s experiences of pregnancy, childbirth, breastfeeding, infant formula or complementary feeding during the emergency and the post emergency phase. Data analysis was categorical and was performed by using N-Vivo software. Results Six women who were pregnant at the time of the earthquake were interviewed in January 2010. In addition to the essential needs of pregnant and lactating women, such as those related to the emergency shelters conditions, the main findings emerged from this study were: the reconfiguration of relationships and the central role of partners and family support; the need of spaces for sharing experiences and practices with other mothers; the lack of breastfeeding support after the hospital discharge; the inappropriate donations and distribution of Breast Milk Substitutes. Conclusions During and after L’Aquila earthquake, several aspects of infant and young child feeding did not comply with standard practices and recommendations. The response system appeared not always able to address the specific needs of pregnant and lactating women. It is urgent to develop management plans, policies and procedures and provide communication, sensitization, and training on infant and young child feeding at all levels and sectors of the emergency response.
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Affiliation(s)
- Angela Giusti
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | - Francesca Marchetti
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy. .,National Institute of Health, Viale Regina Elena, 229, 00161, Rome, Italy.
| | - Francesca Zambri
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | - Elide Pro
- Italian Red Cross, Milan, Italy.,Department of Obstetrics and Gynecology, Fabrizio Spaziani Hospital, Frosinone, Italy
| | - Eleonora Brillo
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy.,Center for Research in Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy
| | - Sofia Colaceci
- Saint Camillus International University of Health and Medical Sciences (UniCamillus), Rome, Italy
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6
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Abimibayo Adeoya A, Sasaki H, Fuda M, Okamoto T, Egawa S. Child Nutrition in Disaster: A Scoping Review. TOHOKU J EXP MED 2022; 256:103-118. [DOI: 10.1620/tjem.256.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Akindele Abimibayo Adeoya
- International Cooperation for Disaster Medicine Laboratory, International Research Institute of Disaster Science (IRIDeS), Tohoku University
| | - Hiroyuki Sasaki
- International Cooperation for Disaster Medicine Laboratory, International Research Institute of Disaster Science (IRIDeS), Tohoku University
| | - Mikiko Fuda
- Nutrition Support Center, Tohoku University Hospital
| | - Tomoko Okamoto
- Department of Nutrition, Sapporo University of Health Sciences
| | - Shinichi Egawa
- International Cooperation for Disaster Medicine Laboratory, International Research Institute of Disaster Science (IRIDeS), Tohoku University
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7
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Aros-Vera F, Chertok IRA, Melnikov S. Emergency and disaster response strategies to support mother-infant dyads during COVID-19. INTERNATIONAL JOURNAL OF DISASTER RISK REDUCTION : IJDRR 2021; 65:102532. [PMID: 34458086 PMCID: PMC8386097 DOI: 10.1016/j.ijdrr.2021.102532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 07/05/2021] [Accepted: 08/21/2021] [Indexed: 06/06/2023]
Abstract
The COVID-19 pandemic has produced an unprecedented global health crisis. Vulnerable populations, such as breastfeeding mother-infant dyads, are in a particularly delicate situation. Before, during, and after birth mothers and their infants could be exposed to the virus. Due to fear of infection transmission, there has been an increase in separation of COVID-positive mothers and their infants and a decline in breastfeeding, despite research supporting the provision of mother's milk for her infant. During this crisis, evidence-based education counseling and resources can support healthful infant feeding which is necessary for short- and long-term infant growth and development. Using a framework of disaster preparedness and response, we delineate operational guidelines and policy recommendations to support maternal-infant dyads during the COVID pandemic outbreak. Key recommendations include promotion of breastfeeding and milk expression, avoiding the use of formula, engaging healthcare providers in supporting lactation, and incorporating evidence-based breastfeeding and lactation protocols and practices in disaster preparedness and disaster response plans.
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Affiliation(s)
- Felipe Aros-Vera
- Department of Industrial and Systems Engineering, Ohio University, 1 Ohio University, Athens, OH, 45701, USA
| | - Ilana R Azulay Chertok
- Associate Director of Nursing Research and Scholarship, Ohio University, 1 Ohio University, Athens, OH, 45701, USA
| | - Semyon Melnikov
- Department of Nursing, Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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8
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Janet S, Russell N, Morton N, Martinez D, Tamannai M, Lafferty N, Roggeveen H, Ogundipe OF, Carreras I, Gao A, Didier E, Petrucci R. MSF Paediatric Days: a step forward in operationalising 'Humanitarian Paediatrics'. BMJ Paediatr Open 2021; 5:e001156. [PMID: 34632107 PMCID: PMC8477328 DOI: 10.1136/bmjpo-2021-001156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/30/2021] [Indexed: 11/03/2022] Open
Abstract
Around the world, one in four children live in a country affected by conflict, political insecurity and disaster. Healthcare in humanitarian and fragile settings is challenging and complex to provide, particularly for children. Furthermore, there is a distinct lack of medical literature from humanitarian settings to guide best practice in such specific and resource-limited contexts. In light of these challenges, Médecins Sans Frontières (MSF), an international medical humanitarian organisation, created the MSF Paediatric Days with the aim of uniting field staff, policymakers and academia to exchange ideas, align efforts, inspire and share frontline research and experiences to advance humanitarian paediatric and neonatal care. This 2-day event takes place regularly since 2016. The fourth edition of the MSF Paediatric Days in April 2021 covered five main topics: essential newborn care, community-based models of care, paediatric tuberculosis, antimicrobial resistance in neonatal and paediatric care and the collateral damage of COVID-19 on child health. In addition, eight virtual stands from internal MSF initiatives and external MSF collaborating partners were available, and 49 poster communications and five inspiring short talks referred to as 'PAEDTalks' were presented. In conclusion, the MSF Paediatric Days serves as a unique forum to advance knowledge on humanitarian paediatrics and creates opportunities for individual and collective learning, as well as networking spaces for interaction and exchange of ideas.
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Affiliation(s)
- Sophie Janet
- Medical Department, Médecins Sans Frontières, Barcelona, Spain
| | - Neal Russell
- Medical Department, Médecins Sans Frontières, Amsterdam, The Netherlands
| | - Nikola Morton
- Medical Department, Médecins Sans Frontières, Paris, France
| | - Daniel Martinez
- Medical Department, Médecins Sans Frontières, Geneva, Switzerland
| | - Mona Tamannai
- Medical Department, Médecins Sans Frontières, Barcelona, Spain
| | - Nadia Lafferty
- Medical Department, Médecins Sans Frontières, Barcelona, Spain
| | - Harriet Roggeveen
- Medical Department, Médecins Sans Frontières, Amsterdam, The Netherlands
| | | | | | - Anja Gao
- Medical Department, Médecins Sans Frontières, Paris, France
| | - Elise Didier
- Medical Department, Médecins Sans Frontières, Brussels, Belgium
| | - Roberta Petrucci
- Medical Department, Médecins Sans Frontières, Geneva, Switzerland
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9
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Revising "Nutritional Reference Values for Feeding at Evacuation Shelters" According to Nutrition Assistance by Public Health Dietitians Based on Past Major Natural Disasters in Japan: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910063. [PMID: 34639364 PMCID: PMC8508193 DOI: 10.3390/ijerph181910063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/20/2021] [Accepted: 09/20/2021] [Indexed: 11/18/2022]
Abstract
It is important to provide nutritionally adequate food in shelters to maintain the health of evacuees. Since the Great East Japan Earthquake in 2011, Japan’s Ministry of Health, Labour and Welfare has released the “Nutritional Reference Values for Evacuation Shelters” (Reference Values) after every major natural disaster. There is clear evidence, however, that the Reference Values have only been used infrequently. This study aims to revise these guidelines to include the actual situation in the affected areas and the feasibility of the endeavor. This qualitative study uses group interviews with local government dietitians to propose revisions to Japan’s Reference Values. These revisions include the following: issuing Reference Values within 1 week of a disaster, showing one type of values for meal planning for each age group, showing the minimum values of vitamins, upgrading salt to basic components, creating three phases of nutrition (Day 1, Days 1–3, and After Day 4), stipulating food amounts rather than nutrient values, and creating a manual. Local government officials could use the Reference Values as guidelines for choosing food reserves, and dietitians could use them while formulating supplementary nutrition strategies for a model menu in preparation for disasters.
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10
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Hwang CH, Iellamo A, Ververs M. Barriers and challenges of infant feeding in disasters in middle- and high-income countries. Int Breastfeed J 2021; 16:62. [PMID: 34425848 PMCID: PMC8383418 DOI: 10.1186/s13006-021-00398-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 06/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Global evidence from the past 35 years confirmed the protective effect of breastfeeding and supported the guidance to protect, promote, and support breastfeeding practices, particularly in natural disaster and conflict settings. This study aimed to summarize the difficulties faced by disaster responders and mothers for optimal infant feeding during disasters in middle and high-income countries. METHODS A scoping literature review was conducted by searching databases for peer-reviewed literature and grey literature published between January 2010 and December 2018 that focused on infant feeding in the aftermath of disasters. Only disasters that occurred in middle or high-income countries as defined by the World Bank for the 2018 fiscal year were included. RESULTS The study found that a major challenge faced by organizations establishing infant feeding in emergencies (IFE) programs is the violation of The International Code of Marketing of Breastmilk Substitutes by other aid organizations and governments, such as acceptance of donated infant formula and untargeted distribution of formula. Additionally, many disaster responders were unfamiliar with IFE protocols. Mothers faced other barriers to breastfeed their infants during disasters. They often lacked privacy or spaces conducive to breastfeeding. Limited fluid and energy intake, stress, and exhaustion also deterred mothers from breastfeeding. Many challenges for responders and barriers mothers face for optimal infant feeding practices persist despite existing guidelines. CONCLUSIONS The findings of this study reveal the lack of IFE preparedness and response capacity in middle and high-income countries, and the need for governments and aid organizations to adapt guidelines and establish policies and programs to support infant feeding in emergencies.
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Affiliation(s)
- Cindy H Hwang
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Mija Ververs
- Johns Hopkins Bloomberg School of Public Health, Center for Humanitarian Health, Baltimore, MD, USA.
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11
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Bellizzi S, Farina G, Fiamma M, Pichierri G, Salaris P, Napodano CMP. The multi-agency partnership roadmap for newborns in humanitarian settings: Timely and crucial during the COVID-19 pandemic. J Glob Health 2021; 11:03015. [PMID: 33643625 PMCID: PMC7898555 DOI: 10.7189/jogh.11.03015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Saverio Bellizzi
- Medical Epidemiologist, Independent Consultant, Geneva, Switzerland
| | | | | | - Giuseppe Pichierri
- Kingston Hospital NHS Foundation Trust, Microbiology Unit, Kingston Upon Thames, UK
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12
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Barriers and enablers of breast-feeding protection and support after the 2017 earthquakes in Mexico. Public Health Nutr 2020; 24:2286-2296. [PMID: 32753080 DOI: 10.1017/s1368980020002359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To study the barriers and enablers of breast-feeding protection and support after the 2017 earthquakes in Mexico. DESIGN A qualitative study using a phenomenological approach to analyse data collected from in-depth interviews, virtual ethnography and documentary analysis of newspapers. SETTING Data were collected after the September 2017 earthquakes in Mexico (from 8 September 2017 to 15 May 2018). PARTICIPANTS The participants included key informants (n 13) from different sectors. Postings retrieved from forty-two Facebook and forty-seven Twitter accounts and a WhatsApp group informed the virtual ethnography analysis. Newspaper material covering the 2017 earthquakes in Mexico (seven newspapers) was retrieved for the documentary analysis. RESULTS Interviews with key informants revealed a lack of knowledge, unclear institutional protocols during emergencies and lack of enforcement of existing international frameworks. The virtual ethnography uncovered a strong call for donations in the immediate aftermath of the earthquakes, and generalized donations of formula revealed a tense relationship between actions taken by breast-feeding experts and the negative reactions from the government and citizens. This analysis highlights the relevance of pre-existing networks of experts in protecting and supporting breast-feeding. From the newspaper documentary analysis, similar themes emerged. CONCLUSIONS This study identified key barriers and enablers in the protection and support of breast-feeding during the 2017 earthquakes in Mexico. Relevant actors should embrace the lessons highlighted in this study because countries such as Mexico are likely to experience other emergencies in the near future.
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Durrance-Bagale A, Salman OM, Omar M, Alhaffar M, Ferdaus M, Newaz S, Krishnan S, Howard N. Lessons from humanitarian clusters to strengthen health system responses to mass displacement in low and middle-income countries: A scoping review. J Migr Health 2020; 1-2:100028. [PMID: 33458716 PMCID: PMC7790453 DOI: 10.1016/j.jmh.2020.100028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/03/2020] [Accepted: 12/03/2020] [Indexed: 11/17/2022] Open
Abstract
Potential scope for health-system learning from cluster responses to mass displacement. Non-health clusters can contribute to health improvements during mass displacement. Cluster approaches are often siloed with insufficient cross-cluster learning. Equitable power dynamics between displaced people, humanitarian actors, and governments are still needed.
The humanitarian cluster approach was established in 2005 but clarity on how lessons from humanitarian clusters can inform and strengthen health system responses to mass displacement in low and middle-income countries (LMIC) is lacking. We conducted a scoping review to examine the extent and nature of existing research and identify relevant lessons. We used Arksey and O'Malley's scoping framework with Levac's 2010 revisions and Khalil's 2016 refinements, focussing on identifying lessons from discrete humanitarian clusters that could strengthen health system responses to mass population displacement. We summarised thematically by cluster. Of 186 sources included, 56% were peer-reviewed research articles. Most related to health (37%), protection (18%), or nutrition (13%) clusters. Key lessons for health system responses included the necessity of empowering women; ensuring communities are engaged in decision-making processes (e.g. planning and construction of camps and housing) to strengthen trust and bonds between and within communities; and involving potential end-users in technological innovations development (e.g. geographical information systems) to ensure relevance and applicability. Our review provided evidence that non-health clusters can contribute to improving health outcomes using focussed interventions for implementation by government or humanitarian partners to inform LMIC health system responses to mass displacement.
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Affiliation(s)
- Anna Durrance-Bagale
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom
| | - Omar Mukhtar Salman
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom
| | - Maryam Omar
- Bart's Health NHS Trust, The Royal London Hospital, Whitechapel Road, London E1 1BB, United Kingdom
| | - Mervat Alhaffar
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom
| | - Muhammad Ferdaus
- BRAC University, UB04 - 66 Bir Uttam AK Khandakar Road, Dhaka 1212, Bangladesh
| | - Sanjida Newaz
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, 750 Bannatyne Ave, Winnipeg MB R3E 0W2, Canada
| | - Sneha Krishnan
- Environment, Technology and Community Health (ETCH) Consultancy Services, Mumbai, India
| | - Natasha Howard
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom.,National University of Singapore, Saw Swee Hock School of Public Health, 12 Science Drive 2, 117549, Singapore
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Azad F, Rifat MA, Manir MZ, Biva NA. Breastfeeding support through wet nursing during nutritional emergency: A cross sectional study from Rohingya refugee camps in Bangladesh. PLoS One 2019; 14:e0222980. [PMID: 31577816 PMCID: PMC6774527 DOI: 10.1371/journal.pone.0222980] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 09/11/2019] [Indexed: 11/28/2022] Open
Abstract
Background/Objectives This study examined the best practices with regard to infant and young child feeding in emergency (IYCF-E) program. This was done by observing a breastfeeding support scenario through wet nursing in Rohingya refugee camps in Cox’s Bazar, Bangladesh. Methods Information on demographics, IYCF-E knowledge, wet nursing support, type of constraints faced, and possible ways to overcome such constraints was collected through face-to-face interviews with 24 conveniently selected wet nurses. Linear regression was used to analyze the associations. Results Mean age of wet nurses was 21.6 years; 16.67% had adequate knowledge about IYCF-E; and 29.17% had prior knowledge about wet nursing. Mean age of supported infants was 1.29 months, and 58.33% had a familial relationship with the wet nurses. Duration of breastfeeding support was significantly associated with the wet nurse’s age, age of the wet nurses’ youngest children, familial relationship with infants, knowledge about IYCF-E, and follow-ups from community nutrition workers (Ps <0.05). The status of facing problems (58.33%) was negatively correlated with duration of wet nursing, although this association was not statistically significant. The most extensively reported problems were as follows: misunderstandings with the infant’s family (85.71%), family workload and time limitations (21.43%), household distance (42.86%), and family members’ poor compliance (21.43%). Counseling from community nutrition workers (64.29%) and mediation by community leaders (57.14%) played key roles in mitigating such problems. Self-satisfaction (37.50%), counseling (62.50%), and religious inspiration (58.33%) were key motivators behind dedicated breastfeeding support. Conclusion Wet nursing in the Rohingya refugee camps in Cox’s Bazaar, Bangladesh, was associated with several factors involving both supply and demand. The present findings may help design better IYCF-E programs in similar context.
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Affiliation(s)
- Faria Azad
- Programme Assistant, World Food Programme of the United Nations, Cox’s Bazar, Chittagong, Bangladesh
| | - M. A. Rifat
- Consultant, United Nations Children’s Fund, Cox’s Bazar, Chittagong, Bangladesh
- * E-mail:
| | | | - Nushrat Alam Biva
- Institute of Nutrition and Food Science, University of Dhaka, Dhaka, Bangladesh
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Shaker‐Berbari L, Ghattas H, Symon AG, Anderson AS. Infant and young child feeding in emergencies: Organisational policies and activities during the refugee crisis in Lebanon. MATERNAL & CHILD NUTRITION 2018; 14:e12576. [PMID: 29316209 PMCID: PMC6055656 DOI: 10.1111/mcn.12576] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 11/09/2017] [Accepted: 11/13/2017] [Indexed: 11/29/2022]
Abstract
Appropriate infant and young child feeding (IYCF) is key to reducing mortality amongst children aged under 2. Facilitating adherence to recommended IYCF practices during emergencies includes having relevant policies to support breastfeeding and complementary feeding as well as regulating the distribution of breast milk substitutes. In the current crisis, more than 1.2 million Syrian refugees are in Lebanon and it is timely to examine organisational IYCF policies and programmes. One hundred and thirty-five non-governmental organisations providing humanitarian aid in Lebanon were invited to participate in an online survey about organisational policies and programmatic activities on IYCF. Responses were obtained from 54 organisations: 29 International Non-Governmental Organisations (INGOs) and 25 Local Non-Governmental Organisations (LNGOs). In total, 8 (15%) reported having a written policy on IYCF, but only 1 policy (in draft format) was available for inspection. Twelve (8 INGOs and 4 LNGOs) indicated endorsing an external IYCF policy, but only 6 listed a valid policy. Four organisations (3 INGOs and 1 LNGO) had programme objectives that indicate protection, promotion, and support of IYCF. Three LNGOs reported receiving infant formula donations and 5 organisations (2 INGOs and 3 LNGOs) indicated distributing infant formula; 2 (1 INGO and 1 LNGO) did so in accordance with international and national policies. Few organisations violated IYCF guidance but organisational policies and activities on IYCF are not well established. In order to improve response in the current refugee crisis in Lebanon, there is a need to ensure policies are in place and implemented so that interventions support, promote, and protect IYCF.
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Affiliation(s)
| | - Hala Ghattas
- Faculty of Heath SciencesAmerican University of BeirutBeirutLebanon
| | - Andrew G. Symon
- School of Nursing and Health SciencesUniversity of DundeeDundeeScotlandUK
| | - Annie S. Anderson
- Centre for Public Health Nutrition ResearchUniversity of DundeeDundeeUK
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