Complementary feeding indicators from the World Health Organization and the Ministry of Health: agreement analysis and comparison of estimated prevalence in a cohort of children in southwestern Bahia, Brazil, 2018

OBJECTIVE

To assess the agreement between complementary feeding indicators established by the World Health Organization (WHO) and the Ministry of Health (MOH) and to compare the prevalence of these indicators in the first year of a child's life.

METHODS

: This was a cross-sectional study in a cohort of 286 children from Vitória da Conquista, state of Bahia, Brazil; agreement between indicators and comparison between prevalences were analyzed using the Kappa coefficient and McNemar's test; the prevalence of the indicators "introduction of complementary feeding" (ICF), "minimum dietary diversity" (MDD), "minimum meal frequency" (MMF) and "minimum acceptable diet" (MAD) were calculated.

RESULTS

: Three indicators showed poor agreement, with only one demonstrating moderate agreement; prevalence of WHO indicators was higher than that of the MOH (ICF, 94.3% vs. 20.7%; MDD, 75.2% vs. 50.7%; MMF, 97.2% vs. 44.8%; MAD, 96.8% vs. 26.9%).

CONCLUSION

The majority of indicators showed poor agreement and the prevalence of WHO indicators exceeded that of the Ministry of Health.

Contesting Legitimacy of Global Governance Institutions: The Case of the World Health Organization During the Coronavirus Pandemic

This article examines the (de)legitimation of a global governance institution (GGI) in the throes of a full-blown legitimacy crisis: the World Health Organization (WHO) during the coronavirus pandemic. Substantively, it fleshes out systematically the discursive (de)legitimating practices of six (types of) actors: the Trump administration, US allies, US quality press, global health-scientific community, the WHO, and the Chinese government. To that end, it synthesizes elements from the rich literature on legitimacy and elaborates a conceptual apparatus bolstered by operational sources of legitimacy. Empirically, it is grounded in a qualitative content analysis of a purpose-built data corpus of 458 texts that contain justifications for (de)legitimation. In so doing, this study not only presents a holistic and yet granular view of discursive (de)legitimation by some pivotal actors surrounding the WHO and its pandemic response, but offers general insights on legitimacy and (de)legitimation of GGIs during times of crisis.

Attention to childbirth and delivery in a university hospital: comparison of practices developed after Network Stork

OBJECTIVE

to compare, after four years of the implementation of the Stork Network, the obstetric practices developed in a university hospital according to the classification of the World Health Organization.

METHOD

cross-sectional study carried out in the year of adherence to the Stork Network (377 women) and replicated four years later (586 women). Data were obtained through medical records and a structured questionnaire. The Chi-square test was used in the analysis.

RESULTS

four years after the implementation of the Stork Network, in Category A practices (demonstrably useful practices/good practices), there was increased frequency of companions, non-pharmacological methods, skin-to-skin contact and breastfeeding stimulation, and decreased freedom of position/movement. In Category B (harmful practices), there was reduction of trichotomy and increased venoclysis. In Category C (practices with no sufficient evidence), there was increase of Kristeller's maneuver. In Category D (improperly used practices), the percentage of digital examinations above the recommended level increased, as well as of analgesics and analgesia, and there was decrease of episiotomy.

CONCLUSION

these findings indicate the maintenance of a technocratic and interventionist assistance and address the need for changes in the obstetric care model. A globally consolidated path is the incorporation of midwife nurses into childbirth for the appropriate use of technologies and the reduction of unnecessary interventions.