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To (i) describe the infant feeding practices of South African women living in Soweto and (ii) understand from the mothers’ perspective what influences feeding practices.
Semi-structured focus group discussions (FGD) and in-depth interviews (IDI) were conducted, and data were analysed using thematic analysis.
Soweto, South Africa.
Nineteen mothers were stratified into three FGD according to their baby’s age as follows: 0–6-month-olds, 7–14-month-olds and 15–24-month-olds. Four mothers from each FGD then attended an IDI.
Although mothers understood that breast-feeding was beneficial, they reported short durations of exclusive breast-feeding. The diversity and quality of weaning foods were low, and ‘junk’ food items were commonly given. Infants were fed using bottles or spoons and feeding commonly occurred separately to family meal times. Feeding practices were influenced by mothers’ beliefs that what babies eat is important for their health and that an unwillingness to eat is a sign of ill health. As such, mothers often force-fed their babies. In addition, mothers believed that feeding solid food to babies before 6 months of age was necessary. Family matriarchs were highly influential to mothers’ feeding practices; however, their advice often contradicted that of health professionals.
In South Africa, interventions aimed at establishing healthier appetites and eating behaviours in early life should focus on: (i) fostering maternal self-efficacy around exclusive breast-feeding; (ii) challenging mixed feeding practices and encouraging more responsive feeding approaches and (iii) engaging family members to promote supportive household and community structures around infant feeding.
Postpartum depression and anxiety are under-addressed public health problems with numerous treatment access barriers, including insufficiently available mental health specialist providers.
To examine the effectiveness of nurse-delivered telephone interpersonal psychotherapy (IPT) for postpartum depression. Trial registration ISRCTN88987377.
Postpartum women (n = 241) with major depression (on the Structured Clinical Interview for DSM-IV (SCID-I)) from 36 Canadian public health regions in rural and urban settings were randomly assigned to 12 weekly 60 min nurse-delivered telephone-IPT sessions or standard locally available care. The primary outcome was the proportion of women clinically depressed at 12 weeks post-randomisation, with masked intention-to-treat analysis. Secondary outcomes examined included comorbid anxiety, self-reported attachment and partner relationship quality.
At 12 weeks, 10.6% of women in the IPT group (11/104) and 35% in the control group (35/100) remained depressed (OR = 0.22, 95% CI 0.10–0.46), with the IPT group 4.5 times less likely to be clinically depressed (SCID); 21.2% in the IPT group and 51% in the control group had an Edinburgh Postnatal Depression Scale (EPDS) score >12 (OR = 0.26, 95% CI 0.14–0.48), and attachment avoidance decreased more in the IPT group than in the control group (P = 0.02). Significant differences favoured the IPT group for comorbid anxiety and partner relationship quality at all time points, with no differences in health service or antidepressant use. None of the IPT responders relapsed by 36 weeks. Between-group SCID differences were sustained at 24 weeks, but not at 36 weeks.
Nurse-delivered telephone IPT is an effective treatment for diverse urban and rural women with postpartum depression and anxiety that can improve treatment access disparities.
Induced abortion is an indicator of access to, and quality of reproductive healthcare, but rates are relatively unknown in women with schizophrenia.
We examined whether women with schizophrenia experience increased induced abortion compared with those without schizophrenia, and identified factors associated with induced abortion risk.
In a population-based, repeated cross-sectional study (2011–2013), we compared women with and without schizophrenia in Ontario, Canada on rates of induced abortions per 1000 women and per 1000 live births. We then followed a longitudinal cohort of women with schizophrenia aged 15–44 years (n = 11 149) from 2011, using modified Poisson regression to identify risk factors for induced abortion.
Women with schizophrenia had higher abortion rates than those without schizophrenia in all years (15.5–17.5 v. 12.8–13.6 per 1000 women; largest rate ratio, 1.33; 95% CI 1.16–1.54). They also had higher abortion ratios (592–736 v. 321–341 per 1000 live births; largest rate ratio, 2.25; 95% CI 1.96–2.59). Younger age (<25 years; adjusted relative risk (aRR), 1.84; 95% CI 1.39–2.44), multiparity (aRR 2.17, 95% CI 1.66–2.83), comorbid non-psychotic mental illness (aRR 2.15, 95% CI 1.34–3.46) and substance misuse disorders (aRR 1.85, 95% CI 1.47–2.34) were associated with increased abortion risk.
These results demonstrate vulnerability related to reproductive healthcare for women with schizophrenia. Evidence-based interventions to support optimal sexual health, particularly in young women, those with psychiatric and addiction comorbidity, and women who have already had a child, are warranted.
Maternal anxiety negatively influences child outcomes. Reliable estimates have not been established because of varying published prevalence rates.
To establish summary estimates for the prevalence of maternal anxiety in the antenatal and postnatal periods.
We searched multiple databases including MEDLINE, Embase, and PsycINFO to identify studies published up to January 2016 with data on the prevalence of antenatal or postnatal anxiety. Data were extracted from published reports and any missing information was requested from investigators. Estimates were pooled using random-effects meta-analyses.
We reviewed 23 468 abstracts, retrieved 783 articles and included 102 studies incorporating 221 974 women from 34 countries. The prevalence for self-reported anxiety symptoms was 18.2% (95% CI 13.6–22.8) in the first trimester, 19.1% (95% CI 15.9–22.4) in the second trimester and 24.6% (95% CI 21.2–28.0) in the third trimester. The overall prevalence for a clinical diagnosis of any anxiety disorder was 15.2% (95% CI 9.0–21.4) and 4.1% (95% CI 1.9–6.2) for a generalised anxiety disorder. Postnatally, the prevalence for anxiety symptoms overall at 1–24 weeks was 15.0% (95% CI 13.7–16.4). The prevalence for any anxiety disorder over the same period was 9.9% (95% CI 6.1–13.8), and 5.7% (95% CI 2.3–9.2) for a generalised anxiety disorder. Rates were higher in low- to middle-income countries.
Results suggest perinatal anxiety is highly prevalent and merits clinical attention. Research is warranted to develop evidence-based interventions.
Up to 13% of psychiatric patients are readmitted shortly after discharge. Interventions that ensure successful transitions to community care may play a key role in preventing early readmission.
To describe and evaluate interventions applied during the transition from in-patient to out-patient care in preventing early psychiatric readmission.
Systematic review of transitional interventions among adults admitted to hospital with mental illness where the study outcome was psychiatric readmission.
The review included 15 studies with 15 non-overlapping intervention components. Absolute risk reductions of 13.6 to 37.0% were observed in statistically significant studies. Effective intervention components were: pre- and post-discharge patient psychoeducation, structured needs assessments, medication reconciliation/education, transition managers and in-patient/out-patient provider communication. Key limitations were small sample size and risk of bias.
Many effective transitional intervention components are feasible and likely to be cost-effective. Future research can provide direction about the specific components necessary and/or sufficient for preventing early psychiatric readmission.
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