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Background Responding to stagnating neonatal mortality rates in Ghana, a five-year collaboration called Making Every Baby Count Initiative (MEBCI) was undertaken to improve the quality of newborn care provided around the time of birth. A multi-pronged approach was used to build health worker (HW) capacity in resuscitation, essential newborn care, and infection prevention using a curriculum built on the American Academy of Pediatric’s (AAP) Helping Babies Breathe (HBB) and Essential Care for Every Baby (ECEB) modules with an added section on infection prevention (IP). Methods MEBCI used a training of trainer’s approach to train 3688 health workers from district-level facilities in four regions in Ghana between June 2015 and July 2017. Prior to training, HWs familiarized themselves with the learning materials. Concurrently, MEBCI worked to improve enabling environments that would sustain the increased capacity of trained health workers. Knowledge and skills gained were tested using AAP’s Knowledge checklist and validated single-scenario Objective Structured Clinical Examinations (OSCEs) tools. Findings: Majority of HWs trained were midwives (58.8%) and came from district-level hospitals (88.4%). Most HWs passed the HBB OSCE (99.9%, 3436/3440). Age of doctors was negatively associated with HBB scores (r = − 0.16, p = 0.0312). Similarly, older midwives had lower HBB scores (r = − 0.33, p value Initiating ventilation within the Golden Minute was challenging for HWs (78.5% passed) across all regions. Overall, the pass rate for ECEB OSCEs was 99.9% in all regions. Classify newborn for further care and communicate plan to family were frequent challenges observed in Volta Region (69.5% and 72.0% pass rate respectively). HWs less than 40 years of age performed significantly better than health workers older than 40 years (p = 0.023). Age of only paediatricians was positively associated with ECEB scores (r = 0.77, p r = − 0.08, p Conclusion MEBCI’s integrated HBB-ECEB-IP training resulted in significant mastery of the clinical knowledge and skills of HWs. Harmonization and standardization of the course delivery by trainers and having a core team to ensure training fidelity are essential to maintaining high quality while scaling a program nationally. Funding Children’s Investment Fund Foundation (CIFF).

Objective To validate a novel objective structured clinical examination (OSCE) tool for assessing neonatal care skills among delivery attendants trained as part of the Essential Care for Every Baby (ECEB) program and to assess ECEB training effectiveness. Methods Between August 1 and September 30, 2015, a cross-sectional study enrolled ECEB-trained healthcare providers who attended deliveries from the Brong Ahafo and Eastern regions of Ghana. Participants completed a previously developed 21-item OSCE tool that assessed neonatal-care competency. Participant performance was scored independently by regional trainers and national master trainers. The inter-rater scoring reliability was assessed using the Cohen kappa coefficient and performance was compared across participant characteristics. Results The study enrolled 57 trained delivery attendants from 12 district hospitals. Inter-rater agreement was perfect (kappa 1.00) or almost perfect (kappa 0.81–0.99) for nine OSCE items, substantial (kappa 0.61–0.80) or moderate (kappa 0.41–0.60) for 11 items, and fair (kappa 0.21–0.40) for one item. Differences in OSCE-item performance were recorded based on participants’ regions, facility type, age, and education level ( P Conclusions In a resource-limited setting, the OSCE tool demonstrated substantial reliability and ECEB-trained healthcare practitioners exhibited satisfactory performance. The OSCE tool could be useful in similar settings and could have potential for up-scaled use in assessing neonatal-management skills.

Background The Youth CAN (Change.Activity.Nutrition.) project engages and empowers adolescents to become agents of change for health within their community. Students become active researchers through youth-led participatory action research (YPAR), an innovative approach to youth-driven community assessment and project development. Objective To engage low-income, urban youth to identify an issue; connect with community stakeholders; and propose, develop, and implement a community-based project to promote healthy eating and active living. Study Design, Setting, Participants Two cohorts of high school students were recruited to conduct community assessments; cohort 1 (n = 20) consisted of students from a neighborhood high school and cohort 2 (n = 30) included participants in a summer leadership program at a local, non-profit organization. Measurable Outcome/Analysis Youth shared their experiences through multiple mediums of YPAR: PhotoVoice (photography), Spoken Word (poetry), and Street Art (graffiti-style artwork). Project themes were compiled and used to facilitate discussions between youth and community stakeholders using the World Cafe method. Perceived barriers and facilitators to healthy eating and active living were explored and discussion outputs were synthesized into common themes to determine potential community-based projects. Results Students’ projects were displayed in an exhibit to inspire dialogue for the World Cafe. PhotoVoice (n = 32), Spoken Word (n = 8), and Street Art (n = 10) projects portrayed the lived experiences of youth in their community. The World Cafe consisted of discussions driven by youth (n = 20) with input from community stakeholders (n = 20). Themes included addressing the current school lunch environment, implementing community gardens, and introducing composting at schools. Students are currently working with community stakeholders and researchers to design and implement a community project. Conclusions Youth empowerment is fundamental in building connections within the community and yielding community projects to promote health. Future research efforts should incorporate multiple applications of YPAR into nutrition education programs to engage a broader youth audience.

The regional Latin American and Caribbean (LAC) Neonatal Alliance and national neonatal alliances in Bolivia, El Salvador, and Peru were studied through in-depth interviews and a review of publications. Findings were analyzed to distill successful strategies, structures, and tools for improving neonatal health by working through alliances that can be replicated at the regional or national level. The studies found the following factors were the most critical for successful outcomes from alliance work: inclusion of the Ministry of Health as a leader or primary stakeholder; a committed, diverse, technically expert, and horizontal membership; the presence of champions for neonatal health at the national level; development of a shared work plan based on feasible objectives; the use of shared financing mechanisms; the use of informal and dynamic organizational structures; and a commitment to scientific evidence-based programming. The relationship between the regional and national alliances was found to be mutually beneficial.

Postpartum hemorrhage (PPH) is a leading cause of maternal death. Despite strong evidence showing the efficacy of routine oxytocin in preventing PPH, the proportion of women receiving it after delivery is still below 100%. The Uniject injection system prefilled with oxytocin (Uniject) has the potential advantage, due to its ease of use, to increase oxytocin utilization rates. We aimed to assess its cost-effectiveness in Latin America and the Caribbean (LAC). We used an epidemiological model to estimate: a) the impact of replacing oxytocin in ampoules with Uniject on the incidence of PPH, quality-adjusted life years (QALYs) and costs from a health care system perspective, and b) the minimum increment in oxytocin utilization rates required to make Uniject a cost-effective strategy. A consensus panel of LAC experts was convened to quantify the expected increase in oxytocin rates as a consequence of making Uniject available. Deterministic and probabilistic sensitivity analyses were performed. In the base case, the incremental cost of Uniject with respect to oxytocin in ampoules was estimated to be USD 1.00 (2013 US dollars). In the cost-effectiveness analysis, Uniject ranged from being cost-saving (in 8 out of 30 countries) to having an incremental cost-effectiveness ratio (ICER) of USD 8,990 per QALY gained. In most countries these ICERs were below one GDP per capita. The minimum required increment in oxytocin rates to make Uniject a cost-effective strategy ranged from 1.3% in Suriname to 16.2% in Haiti. Switching to Uniject could prevent more than 40,000 PPH events annually in LAC. Uniject was cost-saving or very cost-effective in almost all countries. Even if countries can achieve only small increases in oxytocin rates by incorporating Uniject, this strategy could be considered a highly efficient use of resources. These results were robust in the sensitivity analysis under a wide range of assumptions.

Attitudinal and behavioral differences have been reported between African American and white adolescents and adults regarding body image. The purpose of the study was to examine the relationships of body image perception and preference by race among a group of urban fourth graders. The study group consisted of 166 African American and 55 white students from eight urban public schools selected to represent the demographic profile of Baltimore, Maryland. Body image data were collected by questionnaire and employed Collins' pictorial body image scale (numbered 1-7 to correspond with increasing body size, with 4 being the healthy figure). Overweight was defined as ⩾ 85th percentile of body mass index (BMI=Weight (kg)/Height (m) 2 ). Statistical analyses were performed using SPSS version 8. When we did not divide the sample by gender, white students were more likely than African Americans (59% versus 37%) to choose a small Fig. (1-3) as ideal while African Americans were more likely (19% versus 4%) to choose a larger Fig. (5-7) as ideal. When the sample was limited to girls, the same pattern emerged; 68 % of whites versus 40 percent of African Americans chose an ideal figure of 1-3. For larger figures, 20 percent of African American girls versus 4 % of white girls selected these as ideal. It is noteworthy that in both cases, the African American children were more likely to choose the healthy figure (figure 4) as ideal. Further study is needed to shed light on what factors influence very young children's body size preference and how these selections can influence the epidemic of overweight/obesity as well as eating disorders among children.

Dietary intakes and body size that are qualitatively and quantitatively appropriate are essential for human health and well being. During childhood these requirements are even more crucial though researchers are reporting a greater number of children who are dieting to lose weight. The purpose of this study was to determine the relationships between body mass index (BMI=Weight (kg)THeight (m) 2 ), perception of body image, and dieting behavior among a group of urban fourth grade students. The study group consisted of 252 fourth grade students from eight urban public schools selected to represent the demographic profile of Baltimore, Maryland. Body image data were collected by questionnaire and employed Collins pictorial body image scale (numbered 1-7 to correspond with increasing body size). Overweight was defined as ≥85th percentile of BMI. Statistical analyses were performed using SPSS. The correlation of BMI with body image perception was 0.33 ( Spearman's rho). There was a statistically significant difference (p=0.000) in the way students saw themselves and their BMI measurements. Ten percent of the overweight subjects saw themselves as figure 1-3 and 42 percent rated their figure as 4. Therefore, almost half (49 percent) of urban 4th graders who were overweight chose a body image that did not represent their actual size. There was a statistically significant difference (p=0.000) in the perception of body image and the desire for change. A troubling 30 percent of the 4th graders indicated that they were currently dieting while 37 percent reported being on a diet to lose weight during the past year. These findings indicate a need in early childhood for guidance in the areas of nutrition and appropriate body size for health.