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1.  Mothers’ experiences of bottle-feeding: a systematic review of qualitative and quantitative studies 
Archives of disease in childhood  2009;94(8):596-601.
Most babies receive at least some formula milk. Variations in formula-feeding practices can have both short- and long-term health consequences. We systematically reviewed the literature on parents’ experiences of bottle-feeding to understand how formula-feeding decisions are made.
We systematically searched for and appraised relevant English-language papers identified by searching 12 electronic databases, reference lists and related articles and by contacting first authors of included papers. We analysed and synthesised the included studies using a combination of narrative and thematic approaches. Consensus on the final inclusion, interpretation and synthesis of studies was reached across the research team.
Six qualitative studies and 17 quantitative studies (involving 13,263 participants) were included. Despite wide differences in study design, context, focus and quality, several consistent themes emerged. Mothers who bottle-fed their babies experienced negative emotions such as guilt, anger, worry, uncertainty and a sense of failure. Mothers reported receiving little information on bottle-feeding and did not feel empowered to make decisions. Mistakes in preparation of bottle-feeds were common. No studies examined how mothers made decisions about the frequency or quantity of bottle-feeds.
Inadequate information and support for mothers who decide to bottle-feed may put the health of their babies at risk. While it is important to promote breastfeeding, it is also necessary to ensure that the needs of bottle-feeding mothers are met.
PMCID: PMC3697301  PMID: 19602520
Infant feeding; formula milk; experiences; qualitative methods; systematic review
2.  Infant feeding practice and childhood cognitive performance in South India 
Archives of disease in childhood  2009;95(5):347-354.
Several studies have suggested a beneficial effect of infant breast-feeding on childhood cognitive function. Our main objective was to examine whether duration of breast-feeding and age at introduction of complementary foods are related to cognitive performance in 9-10 year old school going children in South-India.
We examined 514 children from the Mysore Parthenon birth cohort for whom breast-feeding duration (6 categories from <3 to ≥18 months) and age at introduction of complementary foods (4 categories from <4 to ≥6 months) were collected at the 1st, 2nd and 3rd year annual follow-up visits. Their cognitive function was assessed at a mean age of 9.7 years using 3 core tests from the Kaufman Assessment Battery for children and additional tests measuring long-term retrieval/storage, attention and concentration, visuo-spatial and verbal abilities.
All the children were initially breast-fed. The mode for duration of breast-feeding was 12-17 months (45.7%) and for age at introduction of complementary foods 4 months (37.1%). There were no associations between longer duration of breast-feeding, or age of introduction of complementary foods, and cognitive function at 9-10 years, either unadjusted or after adjustment for age, sex, gestation, birth size, maternal age, parity, socio-economic status, parents’ attained schooling, and rural/urban residence.
Within this cohort, in which prolonged breast-feeding was the norm (90% breast-fed ≥6 months and 65% breast-fed for ≥12 months), there was no evidence suggesting a beneficial effect of longer duration of breast-feeding on later cognitive ability.
PMCID: PMC3428883  PMID: 19946010
Breast-feeding; Complementary foods; Children; Cognitive performance; India
3.  Quality indicators and quality assessment in child health 
Archives of disease in childhood  2009;94(6):458-463.
Quality indicators are systematically developed statements that can be used to assess the appropriateness of specific healthcare decisions, services and outcomes. In this review, we highlight the range and type of indicators that have been developed for children in the UK and US by prominent governmental agencies and private organizations. We also classify these indicators in an effort to identify areas of child health that may lack quality measurement activity. We review the current state of health information technology in both countries since these systems are vital to quality efforts. Finally, we propose several recommendations to advance the quality indicator development agenda for children. The convergence of quality measurement and indicator development, a growing scientific evidence base and integrated information systems in healthcare may lead to substantial improvements for child health in the 21st century.
PMCID: PMC2774840  PMID: 19307196
Quality; Quality indicators; General pediatrics; Health information technology
4.  Reporting of MMR evidence in professional publications: 1988–2007 
Archives of Disease in Childhood  2009;94(11):831-833.
To examine how journals and magazines disseminate research evidence and guidance on best practice to health professionals by aligning commentaries on measles, mumps, and rubella vaccine (MMR) evidence in journals with key events in the MMR controversy.
Content analysis.
Data sources:
Comment articles in six commonly read UK publications.
Main outcome measures:
Number of comment pieces by publication, year and article type; trends in the focus, tone and inclusion of recommendations on MMR.
860 articles met the inclusion criteria (BMJ n = 104, Community Practitioner n = 45, Health Visitor n = 24, Practice Nurse n = 61, Nursing Standard n = 61 and Pulse n = 565). Of these 860 comment pieces, 264 made some reference to evidence endorsing the safety of MMR. Around one in 10 were rated as negative (10.9%, n = 29) or neutral (11.3%, n = 30) in relation to MMR safety, and nearly a quarter (22.7%, n = 60) were rated as mixed. Following the publication of Wakefield et al’s 1998 paper there was a period of neutrality. In 2000, despite growing public concerns and widespread media coverage, fewer than 20 comment pieces were published. Less than a quarter of comment pieces (n = 196, 22.7%) included recommendations.
While a period of neutrality may reflect a professional response to uncertainty by holding back until consensus emerges, it may also represent a missed opportunity to promote evidence-based practice.
PMCID: PMC2776329  PMID: 19414434
5.  Successful paediatric HIV treatment in rural primary care in Africa 
Archives of Disease in Childhood  2009;95(6):414-421.
Clinical outcomes of HIV-infected children on antiretroviral treatment (ART) in a decentralised, nurse/counsellor-led programme.
Clinical cohort.
KwaZulu-Natal, South Africa.
HIV-infected children aged ≤15 years on ART, June 2004–2008.
Main outcome measures
Survival according to baseline characteristics including age, WHO clinical stage, haemoglobin and CD4%, was assessed in Kaplan–Meier analyses. Hazard ratios for mortality were estimated using Cox proportional hazards regression and changes in laboratory parameters and weight-for-age z scores after 6–12 months' treatment were calculated.
477 HIV-infected children began ART at a median age of 74 months (range 4–180), median CD4 count (CD4%) of 433 cells/mm3 (17%) and median HIV viral load of log 4.2 copies/ml; 105 (22%) were on treatment for tuberculosis and 317 (76.6%) were WHO stage 3/4. There were significant increases after ART initiation in CD4% (17% vs 22%; p<0.001), haemoglobin (9.9 vs 11.7 g/l; p≤0.001) and albumin (30 vs 36 g/l; p≤0.001). 32 (6.7%) children died over 732 child-years of follow-up (43.7 deaths/1000 child-years; 95% CI 32.7 to 58.2), 17 (53.1%) within 90 days of treatment initiation; median age of death was 84 (IQR 10–181) months. Children with baseline haemoglobin ≤8 g/l were more likely to die (adjusted HR 4.5; 95% CI 1.6 to 12.3), as were those aged <18 months compared with >60 months (adjusted HR 3.2; 95% CI 1.2 to 9.1).
Good clinical outcomes in HIV-infected children on ART are possible in a rural, decentralised service. Few young children are on ART, highlighting the urgent need to identify HIV-exposed infants.
PMCID: PMC3181433  PMID: 19880392

Results 1-5 (5)