RESUMEN
BACKGROUND: During humanitarian crises, women and children are particularly vulnerable to morbidity and mortality. To address this problem, integrated child health interventions that include support for the well-being of mothers must be adapted and assessed in humanitarian settings. Baby Friendly Spaces (BFS) is a holistic program that aims to improve the health and wellbeing of pregnant and lactating women and their children under two years of age by providing psychosocial support and enhancing positive infant and young child-care practices. Using a mixed-methods, pre-post design, this study explored ways to strengthen the implementation and acceptability of the BFS program, and assess outcomes associated with participation among South Sudanese mothers and their children living in the Nguenyyiel refugee camp in Gambella, Ethiopia. DISCUSSION: A stronger evidence-base for integrated maternal and child health interventions, like BFS, in humanitarian emergencies is needed, but effectively conducting this type of research in unstable settings means encountering and working through myriad challenges. In this paper we discuss lessons learned while implementing this study, including, challenges related to ongoing local political and tribal conflicts and extreme conditions; implementation of a new digital data monitoring system; staff capacity building and turnover; and measurement were encountered. Strategies to mitigate such challenges included hiring and training new staff members. Regular weekly skype calls were held between Action Against Hunger Paris headquarters, the Action Against Hunger team in Gambella and Johns Hopkins' academic partners to follow study implementation progress and troubleshoot any emerging issues. Staff capacity building strategies included holding brief and focused trainings continuously throughout the study for both new and current staff members. Lastly, we engaged local Nuer staff members to help ensure study measures and interview questions were understandable among study participants. CONCLUSIONS: Research focused on strengthening program implementation is critically important for improving maternal and child health in humanitarian emergencies. Research in such settings demands critical problem-solving skills, strong supervision systems, flexibility in timeline and logistics, and tailor-made training for program and research staff members and context- adapted strategies for retaining existing staff.
RESUMEN
Growth changes in the dentition and the facial skeleton of boys and girls with Class I malocclusion from 10 to 14 years of age are presented, and the changes are compared with those for children with Class II Division 1 malocclusion. Radiographs of 335 children with Class II Division 1 malocclusion and 273 Class I controls were assessed. Radiographs were converted to x and y coordinate data, and 52 commonly used linear, angular, and coordinate axis measurements were made. Both the Class II Division 1 and the control groups were subdivided into 6 samples according to sex and skeletal age (10, 12, and 14 years +/- 6 months; chronological age ranged from 8.5 to 15.5 years). The mean plots from the coordinate data for the Class I boys and girls at 14 years were superimposed over the mean plots for the 10-year-old groups, creating circumpubertal growth standards. The standards are supported by growth vector diagrams and other data and lead to the following conclusions: (1) boys and girls with Class I malocclusion differ distinctly from each other in the amount and the direction of circumpubertal growth; (2) radiographic composite standards are useful and accurate clinical tools to show mean dentofacial skeletal growth and change between 10 and 14 years of age; (3) compared with the controls, the maxillary dentition of girls with Class II Division 1 malocclusion grows more horizontally, the maxillary (but not the mandibular) incisors procline farther, and the mandible grows more horizontally; (4) compared with the controls, the midfacial convexity in Class II Division 1 boys is markedly increased, due to more horizontal growth at A-point and less horizontal growth at nasion and pogonion, and maxillary and mandibular anterior teeth are proclined farther; (5) angular measurements involving S, N, A-point, B-point, and Pog are useful only when the position of N is known; and (6) cranial base flexure bears no relationship to the development of Class II Division 1 malocclusion.