Mobile health interventions for improving maternal and child health outcomes in South Africa:a systematic review

Background:Maternal and child health(MCH)remains a significant public health concern globally despite previous efforts made to improve MCH services.Initiatives such as antenatal care,postnatal care services exclusive breastfeeding,child vaccination and supplements have been rolled out to improve MCH outcomes.However,inadequate maternal healthcare,socioeconomic factors,obstetric haemorrhaging,complications of hypertension during pregnancy,lack of maternal information,poor universal health coverage and uptake of MCH services exacerbate maternal mortality and child mortality rates,especially in resource-constrained areas in many sub-Saharan African countries including South Africa.Objective:This study aimed to review mobile health(mHealth)interventions deployed to improve maternal and child health outcomes.Methods:The study adopted the Preferred Reporting Items for Systematic Reviews and Meta-Analyses model to search and retrieve relevant literature from reputable,prominent electronic databases(Google Scholar,Scopus,PubMed,Embase,CINAHL,Web of Science,etc.).A total of 26 papers were selected and analyzed.Results:The findings revealed several mHealth interventions such as MomConnect,Mobile Alliance for Maternal Action,NurseConnect,ChildConnect,CommCare,Road to Health Application and Philani Mobile Video Intervention for Exclusive Breastfeeding have been utilized by healthcare workers and women to improve access to MCH services.However,inadequate digital infrastructure,digital divide,resistance to change,inadequate funding,language barriers,short message service and data costs,lack of digital skills and support,compatibility,scalability and interoperability issues,legislative and policy compliance,lack of mHealth awareness,data security and privacy concerns hinder uptake and utilisation of mHealth interventions.There is a need to scale up and sustain mHealth interventions and update existing regulatory framework,policies and strategies.Conclusion:mHealth interventions offer unprecedented opportunities to improve access to maternal information and substantially improve maternal and child health services.Stakeholder engagement and the development of sustainable funding strategies are important for successfully implementing and scaling mHealth projects while addressing existing and emerging key issues.

Impact of Antimicrobial Stewardship Programs on Antibiotic Use and Drug Resistance:Analysis of Data from Maternal and Child Health Care Hospitals in Hubei Province,China

ObjectiveTo evaluate the impact of Antimicrobial Stewardship Programs(ASPs)on antibiotic use and drug resistance.MethodsThis was a retrospective,multicenter,management intervention study.The data from 85 maternity hospitals(maternal and child health care hospitals)in Hubei province from 2012 to 2019 were collected.The indicators related to antimicrobial drug use included the utilization rate of different grades of antimicrobial drugs,the intensity of antimicrobial agent use,the rational use of prophylactic antimicrobial agents before class I surgical incision,and pathogenic detection and consultation rates before antimicrobial drug use.ResultsSince the implementation,the purchase of antimicrobial agents in hospitals has been maintained within the prescribed range,and the defined daily dose system(DDDs)of antimicrobial agents has been reduced,prophylactic use and accurate treatment of antimicrobial agents related to class I surgical incision have been more reasonable.With the implementation of ASPs,the detection rate of imipenem-resistant Acinetobacter baumannii,cefotaxime-resistant Escherichia coli,and methicillin-resistant Staphylococcus aureus has been decreased in China from national bacterial resistance surveillance data.ConclusionASPs have positive effects on antibiotic use and drug resistance in 85 maternity hospitals(maternal and child health care hospitals).

Restraint Usage Characteristics and Other Factors Associated with Safety of Children Involved in Motor Vehicle Crashes

Involvement in road traffic crashes as vehicle occupants is a leading cause of death and serious injury among children. The objective of this study was to investigate crash severity factors and child safety restraint use characteristics in order to identify effective countermeasures to increase children＇s highway safety. Characteristics and percentages of restraint use among child passengers aged 4-13 years were examined using highway crash data from Kansas. The association between restraint use, injury severity and characteristics of children involved in crashes were investigated using OR （odds ratios） and a logistic regression model, which was used to identify risk factors. Results showed that children, who were unrestrained, were seated in the front seat, traveling with drunk drivers and on rural roads, and traveling during nighttime was more vulnerable to severe injury in the case of motor vehicle crashes. The most frequent contributing causes related to crashes involving children included driver＇s inattention while driving, failure to yield right-of-way, driving too fast, wet roads and animals in the road. Based on identified critical factors, general countermeasure ideas to improve children＇s traffic safety were suggested, including age-appropriate and size-appropriate seat belt restraints and having children seated in the rear seat. Parents and children must gain better education regarding these safety measures in order to increase child safety on the road.

Determining Optimal Strategies to Reduce Maternal and Child Mortality in Rural Areas in Western China: an Assessment Using the Lives Saved Tool

China, as a whole, is about to meet the Millennium Development Goals for reducing the maternal mortality ratio (MMR) and infant mortality rate (IMR), but the disparities between rural area and urban area still exists. This study estimated the potential effectiveness of expanding coverage with high impact interventions using the Lives Saved Tool (LiST). It was found that gestational hypertension, antepartum and postpartum hemorrhage, preterm birth, neonatal asphyxia, and neonatal childhood pneumonia and diarrhea are still the major killers of mothers and children in rural area in China. It was estimated that 30% of deaths among 0-59 month old children and 25% of maternal deaths in 2008 could be prevented in 2015 if primary health care intervention coverage expanded to a feasible level. The LiST death cause framework, compared to data from the Maternal and Child Mortality Surveillance System, represents 60%-80% of neonatal deaths, 40%-50% of deaths in 1-59 month old children and 40%-60% of maternal deaths in rural areas of western China.

Marked Improvement in China's Maternal and Child Health

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The Potential Role of a Health and Demographic Surveillance System in Rural Northern Nigeria to Reduce Maternal and Child Deaths

There exist a huge gap between generation of evidence-based research findings and its use to inform policies in most developing countries. Further, it is evident that most developing countries are lagging behind in formulating appropriate policies aimed at improving people’s lives due to lack of evidence-based research findings. We describe the potential of a Health and Demographic Surveillance System (HDSS) in informing appropriate health interventions towards reducing the high maternal and child deaths in rural communities of north western Nigeria through the Verbal Autopsy (VA) data collection. VA data collection involves the use of VA questionnaires—set of open ended and closed ended questions adapted from the World Health Organization (WHO) module— administered to the caregivers, parents or family members of a deceased person to elicit information on signs and symptoms and their durations, and other pertinent information about the deceased in the period before death. VA interviews were conducted by trained VA enumerators on all 2100 deaths reported during the update round 4 of routine data collection (July-December, 2012) and returned forms were checked for consistencies and completeness by a trained research officer. The forms were later coded by trained medical doctors for possible cause of death using the WHO International Classification of Diseases (ICD 10) codes. Fifty cases of neonatal deaths, 1650 cases of infant and child deaths, and 400 cases of adult deaths were reported during the update round 4 data collection. Neonatal sepsis was reported as the leading cause of neonatal deaths (58%) while malaria and intestinal infectious diseases were reported as the leading cause of infant and child deaths and adult deaths respectively (45% and 17%, respectively). The study provides documented evidence of high neonatal deaths due to neonatal sepsis in an area with low hygiene and high home delivery rates. The findings from the VA data collection at Nahuche HDSS inform the intervention study on home distribution of chlorhexidine to pregnant women. The findings from this study call on government and other stakeholders to strengthen research capacity to generate timely data and findings returned to policy makers within the shortest period of time for decision making.

Barriers to Optimal Maternal and Child Feeding Practices in Pastoralist Areas of Somali Region, Eastern Ethiopia: A Qualitative Study

Maternal and child nutrition is critical for child health and survival. Appropriate feeding practices are of fundamental importance for health, nutrition, survival and development of infants and children. In pastoral areas of Ethiopia, barriers related to culture, knowledge, social norms, beliefs, behaviors, decision making in the household and burden of other responsibilities contribute to nutritional status of women and children to deteriorate. Policies and strategies are recommending assessment of barriers for designing programs and interventions to improve maternal and child nutrition practices. This study is aimed to assess barriers of optimal maternal and child feeding practices in Pastoralist areas of Somali region, Eastern Ethiopia. A qualitative community based research method was used involving 17 focus group discussions and 20 in-depth interviews with mothers, grandmothers, health professionals and religious leaders from three districts. Data from FGDs and interviews were transcribed and coded. The agreed upon codes were synthesized and grouped into exhaustive categories. The categories were then merged into themes representing the most common barriers on maternal and child feeding practice that emerged from the FGDs and interviews. We found that traditional beliefs, myths, culture custodian influence, low accessibility and availability of nutritional foods, pattern and burden of other responsibilities, poor knowledge and health seeking behavior, perceived milk insufficiency as main barriers for optimal maternal and child feeding practices. Barriers on optimal maternal and child feeding are very common in the study areas. More work needs to be done to strengthen community-based nutrition with strong social behavioral change communication with emphasis on age-specific counselling on maternal and child nutrition at health facilities, during antenatal and early postnatal visits in the study areas through different media channels, particularly, Somali Region TV and FMs to promote optimal nutrition in the region.

An Exploration of the Relationship between Maternal and Child Factors Contributing to Child Abuse

Background: There are many reports in the mass media and scientific literature about child abuse caused by parents. Medical practitioners also are concerned about child abuse and need to grapple with the prevention and early detection of child abuse when working in medical facilities. Aim: The aim of this descriptive study was to explore the relationship between maternal and child factors contributing to child abuse. Methods: A sample of 50 multiparas (mothers with more than 1 child) in a 48-bed postpartum hospital unit in Okinawa prefecture were asked to fill out an anonymous questionnaire regarding the relationship between mothers and their first child in September, 2007. The questionnaire contained 30 items of physical punishment that are quoted from “The Handbook of Correspondence to Child Abuse” (Ministry of Health, Labor and welfare in Japan), 24 items relating to maternal factors and 22 items to child factors, plus items related to mothers’ satisfaction with the health guidance given in the hospital. Data were analyzed using JMP (ver. 14.2;SAS Institute Inc., Cary, NC, U.S.). The significance level was set at 0.05. Results: Forty-one (82%) questionnaires were analyzed. Of the 41 valid responses, 19 mothers reported abusing their children. Child factors contributing to the abuse included the first child’s regression to infantile behavior, bullying younger brothers or sisters and being rough and violent to their friends. The significant maternal factor leading to abuse was the belief that mothers were irritated by their child. Conclusion: A first child’s developmental difficulties had a significant relationship with the harsh punishment by their mothers. The mothers need to understand their child’s developmental behavior and provide a favorable environment for nurturing young children.

Patient Safety,Adverse Healthcare Events and Near-Misses in Obstetric Care—A Systematic Literature Review

Systematic development of a patient safety culture is necessary because lack of quality care leads to human suffering. The aim of this review was to identify evidence of obstetric adverse events (AEs) and near-misses in the context of patient safety. We conducted a search of the published literature from Europe, Australia and the USA in the following databases: Cinahl, Cochrane, Maternity and Infant Care, Ovid, Pro-quest and PubMed, guided by PRISMA procedures. A total of 427 studies were screened, 15 full papers retrieved and nine studies included in the final thematic analysis. The selected papers address a broad spectrum of adverse patient safety events in obstetric care. The themes that emerged were: type of AEs, near-misses and their consequences, strategies to support and improve Patient Safety (PS) and domains related to the WHO Patient Safety competence outcomes. The findings of the first theme were grouped into the following categories: healthcare professionals’ perspectives on ethical conflicts, attributing blame and responsibility, and patients’ perspectives on lack of trust and involvement, as well as medication errors. The second theme, strategies to support interventions to improve PS, was based on two sub-themes: communicating effectively and gaining competence by learning from adverse events, while the third theme was domains related to the WHO Patient Safety competence outcomes. In conclusion, few studies have examined strategies for managing AEs despite the existence of programmes that target the implementation of changes, such as improved teamwork training. In addition to exploring strategies to make safety a priority for patients and healthcare professionals, it is of the utmost importance to improve communication with patients and between professionals in order to maintain and enhance safety. Efforts by organizations and individuals to continuously develop knowledge about the risk of AEs and the use of best practice guidelines are also essential.

Evidence of Linkages between Patient Safety and Person-Centred Care in the Maternity and Obstetric Context—An Integrative Review

The aim was to evaluate the current state of knowledge pertaining to patient safety and its link to person-centred care. The international relevance of patient safety has expanded, as have the models of person-centred care. Inspired by this new trend, we collated and summarized the literature for evidence of the two topics. The study was guided by Russell, Whittemore and Knafl’s integrative review framework. An electronic database search was conducted for relevant articles from 2005 to 2016. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The structure and process of the evaluation of the evidence are described and the findings interpreted by means of a thematic synthesis. One theme emerged: trustful, safe communication in the relationship between the patient, family members and healthcare professionals and two domains;safety culture and multidisciplinary capacity building. The dominant dimension in the safety culture domain is respectful communication, which implies sharing experiences that lead to a sense of control during labour and birth and is related to the women’s feeling of personal capacity. The dominant dimensions in the multidisciplinary capacity building domain are collaborative teamwork, coordination and risk management, knowledge sharing and patient-centred communication. In conclusion, to enhance patient safety, it is necessary to develop patient-focused, evidence-based skills and guidelines as well as a supportive organization. Due to their interaction with patients, midwives’ communication competence on the part of midwives is essential for supporting the birth and fulfilling the women’s needs and expectations.

The Use and Misuse of Mobile Phones in the Maternity Ward—A Threat to Patient Safety?

An important task for the midwife is following up mother-child interaction to facilitate mother-infant attachment. The aim of this study was to explore midwives’ perceptions of parents’ use of mobile phones in the maternity ward. The research question was: Is the use of mobile phones in the maternity ward a threat to patient safety? Two focus group interviews exploring midwives’ perceptions (n = 10) of parent’ use of mobile phones during and after the birth were conducted in January 2016. Systematic text condensation was used to analyse the data, revealing three themes pertaining to safety concerns: Interrupted communication due to parents’ excessive use of mobile phones during labour and postnatally, Unsafe care caused by lack of attention to the newborn baby’s signals as a result of being disturbed by the mobile phone and Unsafe care because of parents interrupting their conversation with the midwife by answering the mobile, acting in a disrespectful manner and failing to pay attention. The midwives’ descriptions of parents’ use of mobile phones in the maternity ward included reflections on mobile phone usage as a permanent phenomenon. They were concerned that parents’ use of mobile phones in the maternity ward could negatively affect the attachment process and considered that it interrupted their work. In conclusion, there is a need for increased awareness of parents’ use of mobile phones in the maternity ward. Further research is required to gain greater insight into the consequences of mobile phone use in order to promote patient safety by ensuring effective communication between parents and midwives. In addition, research is needed to explore the safety discourse, clinical risks and/or health problems involved in the development of infant-parent attachment in newborn babies.

The direct and indirect impact of COVID-19 pandemic on maternal and child health services in Africa:a scoping review

Introduction:The novel coronavirus disease 2019(COVID-19)continues to disrupt the availability and utilization of routine and emergency health care services,with differing impacts in jurisdictions across the world.In this scoping review,we set out to synthesize documentation of the direct and indirect effect of the pandemic,and national responses to it,on maternal,newborn and child health(MNCH)in Africa.Methods:A scoping review was conducted to provide an overview of the most significant impacts identified up to March 15,2022.We searched MEDLINE,Embase,HealthSTAR,Web of Science,PubMed,and Scopus electronic databases.We included peer reviewed literature that discussed maternal and child health in Africa during the COVID-19 pandemic,published from January 2020 to March 2022,and written in English.Papers that did not focus on the African region or an African country were excluded.A data-charting form was developed by the two reviewers to determine which themes to extract,and narrative descriptions were written about the extracted thematic areas.Results:Four-hundred and seventy-eight articles were identified through our literature search and 27 were deemed appropriate for analysis.We identified three overarching themes:delayed or decreased care,disruption in service provision and utilization and mitigation strategies or recommendations.Our results show that minor consideration was given to preserving and promoting health service access and utilization for mothers and children,especially in historically underserved areas in Africa.Conclusions:Reviewed literature illuminates the need for continued prioritization of maternity services,immunization,and reproductive health services.This prioritization was not given the much-needed attention during the COVID-19 pandemic yet is necessary to shield the continent’s most vulnerable population segments from the shocks of current and future global health emergencies.

Comparative numerical study on the child head injury under different child safety seat angles

It has been shown that annually around 1250 children younger than 15 years old die in traffic accident.The number of children who also injured as a consequence of car accidents is noticeably higher.According to the ECE-R44 regulation the safety of children in the cars,the use of a child safety seat(CSS)is highly recommended.Using a CSS would dramatically diminish the injuries of traffic accidents.However,the posture,especially the angle,of a child when seating on a seat may also affect the amount of injury occurs during the accident.It has been revealed that during the accident only few children remained seated in the standard position,and most of them whether slouched or slanted and turned their head to the side-support of the CSS.Extreme positions,such as leaning forward,escaping from the harness or holding feet were also observed.This study aimed to perform a finite element(FE)study to figure out what angle of seating would result in the least amount of injury to the child head in a typical car crash under the speed of 47 km/h.To do that,a 1.5 years old child dummy(a dummy representing the anthropometry of a 1.5 years old child)has been accommodated on a seat under the angles of 15°,30°,and 45°.The results revealed.The resulted displacements in the head after the accident were also calculated at X,Y,and Z directions.The results in this regard indicated a higher displacement at X direction whereas the lowest one was seen at Y direction.The results have implications not only for understanding the amount of injury to the child head after the accident under different seating angles,but also for giving an insight to the CSS industries and families to choose the right seating posture for the child in the car to reduce the severity of injury.

Evidence on result-based financing in maternal and child health in low-and middle-income countries:a systematic review

Introduction:Result-Based Financing(RBF)is an umbrella term for financial mechanisms that link incentives to outputs or outcomes.International development agencies are promoting RBF as a viable financing approach for the realization of universal health coverage,with numerous pilot trials,particularly in low-and middle-income countries(LMICs).There is limited synthesized evidence on the performance of these mechanisms and the reasons for the lack of RBF institutionalization.This study aims to review the evidence of RBF schemes that have been scaled or institutionalized at a national level,focusing on maternal,newborn,and child health(MNCH)programming in LMICs.Methods:A systematic literature review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)guidelines.The authors identified and reviewed country-level RBF evaluation reports for the period between January 2000 and June 2019.Data were extracted from both published and gray literature on RBF application in MNCH using a predesigned matrix.The matrix headers included country of application;program setting;coverage and duration;evaluation design and methods;outcome measures;and key findings.A content thematic analysis approach was used to synthesize the evidence and emerging issues.Results:The review identified 13 reports from 11 countries,predominantly from Sub-Saharan Africa.Performancebased financing was the most common form of RBF initiatives.The majority of evaluation designs were randomized trials.The evaluations focused on outputs,such as coverage and service utilization,rather than outcomes.RBF schemes in all 11 countries expanded their scope,either geographically or accordingly in terms of performance indicators.Furthermore,only three studies conducted a cost-effectiveness analysis,and only two included a discussion on RBF’s sustainability.Only three countries have institutionalized RBF into their national policy.On the basis of the experience of these three countries,the common enabling factors for institutionalization seem to be political will,domestic fund mobilization,and the incorporation of demand-side RBF tools.Conclusion:RBF evidence is still growing,partial,and inconclusive.This limited evidence may be one of the reasons why many countries are reluctant to institutionalize RBF.Additional research is needed,particularly regarding costeffectiveness,affordability,and sustainability of RBF programs.

Attitude toward Safety among Staffs in the Iranian Maternity Care Units of Public Hospitals with High Maternal Death Rate, 2015-2016

Background: Although extensive Mother-friendly Hospital initiatives have been improved the quality of maternity care in Iran, recent national reports have been indicated that obstetrics errors are still common. The current study aimed to assess safety attitude in the maternity care units of public hospitals in a region with high rate of maternal death in Iran. Materials and Methods: Data was collected from 314 midwives, specialist and also managers working in all public hospitals in 2016. The Cronbach’s alpha coefficient was used to analyze psychometric features of the Safety Attitudes Questionnaire (SAQ). Results: 86.2% of the participants (n = 314) completed the questionnaire. Results showed that lower scores in teamwork, safety climate and also job satisfaction subcomponents. The working conditions and stress recognition had the highest negative scores. There was a significant relationship between the following subcomponents and work load: teamwork (r = ﹣0.416, P-value = 0.05), stress recognition (r = 0.40, P-value = 0.05) and also working conditions (r = 0.421;P-value = 0.02). The score of midwives was significantly lower than specialists regarding job satisfaction (P-value = 0.014), working conditions (P-value = 0.02) and also the overall safety attitude score (P-value = 0.001). About 63% of respondents reported no error during the last year. The mean of error reporting during the last year significantly increased among specialists compared to midwives (P-value = 0.001). Conclusion: Maternity care units in the region with high maternal death have been faced with many intangible barriers related to safety attitude such as poor teamwork climate, working condition and also poor stress recognition. It is now needed to promote supportive environment for midwives and also strengthening staff cohesion through guiding the strategic direction of current maternity risk management system in creating open and just culture, improving leadership behaviors among senior managers and also addressing poor staffing levels.

Effect of Urbanization on Child Safety

Background: The world’s population living in urban areas has grown up from 14% to over 50%. This study was designed aiming to compare injuries related mortality and morbidity in Urban vs Rural settings among children in Iran. Methods: Data were gathered from a household survey. A t-test was used to analyze the relationship between outcomes. Achievements: Injury in all ages accounts for 17% of all deaths in Iran. 20% of death in children is due to injuries. Children in urban settings sustain injuries due to traffic accident, airway blockage and fall from height more than rural children. About 63.5% of morbidity related to injuries occurs in private homes or in residential areas e.g. yards and compounds. In these injuries, no significant statistically difference was found between rural vs. urban setting (p ≤ 0.05). Conclusion: Beside area level measures as an index for considering urbanization, other elements including quality of roads, distances from markets and so on should be considered as well. Safety for children is an important element to be provided prior to planning cities by urban developers. Expansion of the International Safe Community program is a potential solution.

Innovations in maternal and child health:case studies from Uganda

Background:Nearly 300 children and 20 mothers die from preventable causes daily,in Uganda.Communities often identify and introduce pragmatic and lasting solutions to such challenging health problems.However,little is known of these solutions beyond their immediate surroundings.If local and pragmatic innovations were scaled-up,they could contribute to better health outcomes for larger populations.In 2017 an open call was made for local examples of community-based solutions that contribute to improving maternal and child health in Uganda.In this article,we describe three top innovative community-based solutions and their contributions to maternal health.Main text:In this study,all innovations were implemented by non-government entities.Two case studies highlight the importance of bringing reproductive health and maternal delivery services closer to populations,through providing accessible shelters and maternity waiting homes in isolated areas.The third case study focuses on bringing obstetric imaging services to lower level rural health facilities,which usually do not provide this service,through task-shifting certain sonography services to midwives.Various health system and policy relevant lessons are highlighted.Conclusions:The described case studies show how delays in access to health care by pregnant women in rural communities can be systematically removed,to improve pregnancy and delivery outcomes.Emphasis should be put on identification,capacity building and research to support the scale up of these community-based health solutions.

Prevention of Maternal-to-Child Transmission of HIV: Knowledge, Attitude and Factors Influencing Active Participation among HIV-Positive Men in a Military Health Facility in Lagos, South Western Nigeria

Introduction: Traditionally, Prevention of Maternal-to-Child Transmission (PMTCT) of HIV involves women and excludes men despite their important roles. There is a need for more data on factors influencing male participation in PMTCT programs. Design: This was a cross-sectional, descriptive study of married HIV-positive men receiving care at the adult ART clinic, 68 Nigerian Army Reference Hospital Yaba. Data were collected from March 15 to April 30, 2018. Result: Out of the 366 respondents, 333 (91%) were aware that HIV can be transmitted from mother to child. However, only 43.2% correctly identified that it can be transmitted during pregnancy, while 30.2% stated during labour. Almost all of the respondents (96.4%) would also accept that their positive partners take antiretroviral treatment to protect her unborn baby, 86.9% would support non breastfeeding option after delivery, and 95.6% indicated readiness to buy formula milk for the baby. Similarly, majority believed that a pregnant woman can be tested for HIV without the permission of her partner (Mean = 1.47 ± 0.893), and that men should accompany their spouse to ANC/PMTCT clinics (Mean = 1.86 ± 0.921). Conclusion: This study revealed that despite low knowledge of PMTCT among men, there is a good level of attitude and involvement among them. We recommend further study to fully explore the impact of education on men’s participation.

School bus and children's traffic safety

Objective:There is no safer way to transport a child than a school bus.Fatal crashes involving occupants are extremely rare events in the US.In recent years,school bus transportation began to develop in China.We want to bring advanced experience on school bus safety in Western countries such as the US to developing countries. Methods:We searched the papers related to school bus safety from Medline,Chinese Scientific Journals Database and the Web of the National Highway Traffic Safety Administration(NHTSA). Results:There were only 9 papers related to school bus safety,which showed that higher levels of safety standards on school buses,school bus-related transportation and environmental laws and injury prevention were the primary reasons for the desired outcome.Few school bus is related to deaths and injuries in the developed countries. Conclusions:The developing countries should make strict environmental laws and standards on school bus safety to prevent children's injury and death.

A Case Study on the Impact of Mother-to-Mother Support Groups on Maternal, Infant and Young Child Nutrition and Care Practices in Habaswein and Wajir South Districts of North Eastern Kenya

Only about 25% of babies are exclusively breast fed until six months of age in developing countries though they are at a greater risk of infection and infant mortality. The Global Strategy for Maternal, Infant and Young Child Feeding (MI- YCF) Strategy developed by WHO/UNICEF in 2002 was to revitalize world attention to the impact of feeding practices on the nutritional status, growth, development, health and survival of infants and children. The data for this case study was collected through key informant interviews, observations and review of Save the Children nutrition programme reports and surveys. This information was then organized to produce a detailed description of the maternal, infant and young child nutrition programme in Habaswein and Wajir South districts or sub-counties. The maternal and infant young child nutrition (MIYCN) programme was launched in Habaswein and Wajir South districts in January 2012. The MIYCN programme followed recommendations of a Knowledge, Practice and Coverage (KPC) survey report in July 2012. To date, the programme has formed 48 Mother-to-mother Support Groups (MTMSGs), which are actively promoting the uptake of the recommended MIYCN practices in the community. MIYCN indicators have been markedly improved between July 2011 and February 2013 when surveys were conducted. The uptake of kitchen gardening has picked up significantly at Meri site and some mothers now have a changed attitude towards unskilled home deliveries and are conducting referrals for skilled births. The marked improvements in the performance of MIYCN indicators between July 2011 and February 2013 inWajir South and Habaswein districts can be partly attributed to the MIYCN programme established in January 2012. However, a randomized community trial is still required to provide conclusive results on the impact of care support groups on maternal, infant and young child feeding in this region.