BackgroundSkin to skin contact (SSC) at birth is the standard of care for newborns without risk factors. However, implementation of SSC at birth has been far from optimal. A qualitative study was undertaken to determine the barriers, enablers and potential solutions to implementation of SSC at birth in healthy newborn infants in a level III neonatal-care facility in Bangalore, India.MethodsConsultants and residents/postgraduates (PG) from the departments of Obstetrics (n = 19) and Pediatrics (n = 14) and nurses (n = 8) in the labor room (LR) participated in the study. In depth interviews (IDI) and focus group discussions (FGD) were carried out with an interview guide and a moderators’ guide containing inbuilt probes. Subjects of FGD were homogenous. All IDI and FGD were audio-taped, transcribed and analyzed using N VIVO version 9 (using free and tree nodes). Two authors separately coded the transcripts. Major and minor themes were identified. Rigor was ensured by triangulation and theoretical saturation. Informed consent and ethical approval was obtained.ResultsAll subjects were aware of SSC at birth, some of its benefits and had practiced SSC. The major barriers identified were lack of personnel (nurses), time constraint, difficulty in deciding on eligibility for SSC, safety concerns, interference with clinical routines, and interdepartmental issues. Recall of an adverse event during SSC was also a major barrier. Furthermore, we found that most participants considered 1 h as impractical; and promoted 5–15 min SSC. Minor themes were gender bias of the newborn and cultural practices.The participants offered solutions such as assigning a helper exclusively for SSC, allowing a family member into the LR, continuing SSC after initial routines, antenatal counselling, constant reminders in the form of periodic sessions with audiovisual aids or posters in the obstetrics ward, training of new nurses and PG, and inclusion of SSC in medical and nursing curriculum.ConclusionsThe major barriers to SSC at birth are lack of personnel, time constraint and safety concerns. Training, designated health personnel for SSC and teamwork are the key interventions likely to improve SSC at birth.Electronic supplementary materialThe online version of this article (10.1186/s12887-018-1033-y) contains supplementary material, which is available to authorized users.

BackgroundThe latest outbreak of Ebola in West Africa overwhelmed the affected countries, with the impact on health extending far beyond Ebola–related deaths that have exceeded 11 000. The need to promptly mobilise resources to control emerging infections is widely recognized. Yet, data on research funding for emerging infections remains inadequately documented.MethodsWe defined research investment as all funding flows for Ebola and/or Marburg virus from 1997 to April 2015 whose primary purpose was to advance knowledge and new technologies to prevent or cure disease. We sourced data directly from funding organizations and estimated the investment in 2015 US dollars (US$).ResultsFunding for Ebola and Marburg virus research in 1997 to 2015 amounted to US$ 1.035 billion, including US$ 435.4 million (42.0%) awarded in 2014 and 2015. Public sources of funding invested US$ 758.8 million (73.1%), philanthropic sources US$ 65.1 million (6.3%), and joint public/private/philanthropic ventures accounted for US$ 213.8 million (20.6%). Prior to the Ebola outbreak in 2014, pre–clinical research dominated research with US$ 443.6 million (73.9%) investment. After the outbreak, however, investment for new product development increased 942.7–fold and that for clinical trials rose 23.5–fold. Investment in new tools to control Ebola and Marburg virus amounted to US$ 399.1 million, with 61.3% awarded for vaccine research, 29.2% for novel therapeutics research such as antivirals and convalescent blood products, and 9.5% for diagnostics research. Research funding and bibliometric output were moderately associated (Spearman’s ρ = 0.5232, P = 0.0259), however number of Ebola cases in previous outbreaks and research funding (ρ = 0.1706, P = 0.4985) and Ebola cases in previous outbreaks and research output (ρ = 0.3020, P = 0.0616) were poorly correlated.ConclusionSignificant public and philanthropic funds have been invested in Ebola and Marburg virus research in 2014 and 2015, following the outbreak in West Africa. Long term, strategic vision and leadership are needed to invest in infections with pandemic potential early, including innovative financing measures and open access investment data to promote the development of new therapies and technologies.

Compared to other Mexican states, Chiapas possessed the lowest rate of contraception use among women 15−49 years old (44.6%) in 2018. This convergent mixed-methods study assessed family planning use, perceptions, and decision-making processes among women and men in rural communities where Compañeros En Salud (CES) works in Chiapas, Mexico. We conducted surveys of reproductive-aged women and semi-structured interviews with reproductive-aged women, men, and physicians completing their social-service year in CES communities from 2016 to 2017. Of the 625 survey respondents, 368 (58.9%) reported using contraception. The most common methods were female sterilization (27.7%), bimonthly injection (10.9%), and the implant (10.9%). Interviews were completed with 27 women, 24 men, and 5 physicians and analyzed through an inductive approach. Common reasons for contraception use were preventing pregnancy, lack of resources for additional children, and birth spacing. Adverse effects, influence of male partners, and perceived lack of need emerged as reasons for non-use. Male partners often made the final decision about contraceptive use, while women often chose what method. Physicians reported adverse effects, misconceptions about methods, and lack of women’s autonomy as barriers to contraception use. Given misconceptions about contraception methods and the dominant role of men in contraception decision-making, our study illustrates the importance of effective counseling and equitable gender dynamics for family planning programming in rural Chiapas.

Background The Mexican Ministry of Health has advocated for increased skilled birth attendance in hospital facilities to decrease maternal and newborn morbidity and mortality. Partners In Health (PIH) works in a rural region of Mexico where the home birth rate is 60%. The primary purpose of this project is to improve the quality of care, including adherence to evidence-based practices and promotion of respectful practices during childbirth, in a rural hospital in Chiapas, Mexico. Additionally, we hope to strengthen the role of professional midwives and obstetric nurses as competent clinicians in managing women with low-risk pregnancies during childbirth.Methods PIH collaborated with Ariadne Labs to adapt and implement the WHO Safe Childbirth Checklist in a rural hospital in Ángel Albino Corzo, Chiapas. Four pause points (at admission, just before delivery, within 1h of birth, and before discharge) were adapted according to the local context. Additional items were added to capture respectful practices during childbirth. We provided coaching training to the professional midwife and perinatal and obstetric nurses to make optimal use of the checklist for ongoing quality improvement in a team-based environment. The checklist and coaching tools have been developed into a mobile application using CommCare for instant data capture and continuous monitoring and evaluation. We used a mixed-methods study to capture adherence to evidence-based practices and integrated these findings with patient and provider experiences during labour and delivery. We conducted post-discharge surveys and post-partum interviews to explore how patients perceive the care they received during childbirth.Findings By August, 2016, five obstetric nurses, one perinatal nurse, and one professional midwife were using the adapted Safe Childbirth Checklist in the study hospital. Data collection using CommCare began in September, 2016, and will continue until June, 2017. By March, 2017, we had captured data from about 350 birthing women using the WHO Safe Childbirth Checklist and 160 women who had completed the discharge survey. We have conducted interviews with 25 postpartum women and some of their birth companions. Data collection is ongoing but preliminary data from September to December, 2016, show that 64% (171/266) of women were asked at least two questions about their preferences in labour, 13% (28/216) of women received episiotomies without indication, 68% (147/216) initiated skin-to-skin within 1h of delivery, and 56% (122/216) of women initiated breastfeeding after delivery. Preliminary analysis of the discharge surveys reveal high satisfaction with the care women received at the hospital. Qualitative interviews indicate some variation in birth experiences.Interpretation There is some variation in adherence with evidence-based practices and perceptions of good quality of care at the rural hospital since implementing the adapted Safe Childbirth Checklist along with other PIH-driven community initiatives. While we do not have a baseline f...

Complex perinatal syndromes (CPS) affecting pregnancy and childhood, such as preterm birth, and intra- and extra-uterine growth restriction, have multiple, diverse contexts of complexity and interaction that determine the short- and long-term growth, health and development of all human beings. Early in life, genetically-guided somatic and cerebral development occurs alongside a psychism “in statu nascendi,” with the neural structures subjected to the effects of the intra- and extra-uterine environments in preparation for optimal postnatal functioning. Different trajectories of fetal cranial and abdominal growth have been identified before 25 weeks’ gestation, tracking differential growth and neurodevelopment at 2 years of age. Similarly, critical time-windows exist in the first 5–8 months of postnatal life because of interactions between the newborn and their environment, mother/care-givers and feeding practices. Understanding these complex relational processes requires abandoning classical, linear and mechanistic interpretations that are placed in rigid, artificial biological silos. Instead, we need to conduct longitudinal, interdisciplinary research and integrate the resulting new knowledge into clinical practice. An ecological-systemic approach is required to understand early human growth and development, based on a dynamic multidimensional process from the molecular or genomic level to the socio-economic-environmental context. For this, we need theoretical and methodological tools that permit a global understanding of CPS, delineating temporal trajectories and their conditioning factors, updated by the incorporation of new scientific discoveries. The potential to optimize human growth and development across chronological age and geographical locations – by implementing interventions or “treatments” during periods of greatest instability or vulnerability – should be recognized. Hence, it is imperative to take a holistic view of reproductive and perinatal issues, acknowledging at all levels the complexity and interactions of CPS and their sensitive periods, laying the foundations for further improvements in growth and development of populations, to maximize global human potential. We discuss here conceptual issues that should be considered for the development and implementation of such a strategy aimed at addressing the perinatal health problems of the new millenium.