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In 2021, 25 million children worldwide did not receive full basic childhood vaccinations, the highest figure in over a decade. There are large variations between countries in vaccination coverage. Globally, the lifetime prevalence of domestic violence among ever-partnered women is 30%. Exposure to domestic violence affects both maternal and child health. However, there is limited contemporary evidence on whether children born to women who are exposed to domestic violence are any more or less likely to be vaccinated. We conducted a cross-sectional study using data from the most recent Demographic and Health Surveys (DHS) from 7 West African countries (Benin, Gambia, Liberia, Mali, Nigeria, Senegal, Sierra Leone). We used multivariable logistic regression to examine the association between women's lifetime experience of any emotional, physical and/or sexual domestic violence and whether her most-recent born child aged 12-35 months old had received a full complement of basic childhood vaccinations (covering tuberculosis, diphtheria, tetanus, pertussis, polio and measles). Data from 9,104 mother-child pairs was analysed (range 480 from Senegal to 3,230 from Nigeria). Overall, 47% of children were fully vaccinated (range 31% in Nigeria to 81% in The Gambia). 41% of women reported any experience of domestic violence (range 20% in Senegal to 54% in Sierra Leone). After adjustment for a range of child, maternal, household and partner-level variables, children born to women who reported experience of domestic violence were no more or less likely to be fully vaccinated (adjusted odds ratio = 1.02, 95% confidence interval 0.90-1.17). There was some evidence that the association may vary by country; in Sierra Leone, children born to women who reported experience of domestic violence were significantly less likely to be fully vaccinated (adjusted odds ratio = 0.62, 95%CI 0.44-0.88). There was no significant association between a woman's exposure to domestic violence and whether her child was fully vaccinated. Further work is needed to understand the contextual factors which may explain potential variations between countries.

IntroductionPrevention of necrotising enterocolitis (NEC) is vital for improving neonatal outcomes. Feeding own mother’s milk helps prevent NEC. Rates of own mother’s milk feeding in the East Midlands are lower than the national average and the incidence of NEC is higher. The East Midlands Neonatal Operational Delivery Network (EMNODN) has created a care bundle to improve these in babies born at <32 weeks’ gestation, the group at the highest risk of NEC. The bundle was introduced in September 2022 and embedded by December 2022. We will evaluate its effectiveness and conduct a process evaluation to understand barriers and facilitators to implementation.Methods and analysisWe will conduct a retrospective cohort study (workstream 1) using data from the National Neonatal Research Database (NNRD). We will identify infants receiving any own mother’s milk on day 14 and at discharge, and cases of severe NEC. We will aggregate outcomes by birth month and use interrupted time series analysis to estimate an incidence rate ratio for changes after the care bundle was embedded, relative to pre-implementation. We will model data from all other NNRD units and assess whether there are any concurrent changes to exclude confounding due to other events.We will apply the RE-AIM framework (workstream 2), supplemented by the Consolidated Framework for Implementation Research and Framework for Implementation Fidelity, to conduct a mixed methods evaluation in EMNODN units. We will triangulate data from several sources, including questionnaires and semistructured interviews with parents and healthcare professionals, and data from patient records.Ethics and disseminationThe study has approval from the South East Scotland Research Ethics Committee 01 and the Health Research Authority and Health and Care Research Wales (IRAS 323099). Results will be disseminated via scientific journals and conferences, to neonatal service commissioners and through public-facing infographics.Trial registration number NCT05934123.

Preterm infants (i.e., those born before 37 completed weeks of pregnancy) often require additional care and are admitted to neonatal units soon after birth. Readiness for discharge home typically requires a level of physiological maturity such that an infant is able to: 1) breathe spontaneously without additional support; 2) maintain their own body temperature; 3) take all their nutritional requirements orally; 4) weighs ≥ 1700g and is gaining weight. Longer hospital stays than necessary can be detrimental to infants, stressful for families, and costly. Currently, little is known about whether, how long and why preterm infants stay in hospital beyond physiological readiness for discharge. We will conduct a retrospective cohort study using data from the National Neonatal Research Database on all infants born at < 37 weeks' gestational age (GA) admitted to neonatal units in England and Wales from 2016-2022. The day of life and postmenstrual age infants reach each physiological milestone, and the final barrier to discharge, will be identified. We will assess whether the final barrier differs by GA and between neonatal Operational Delivery Networks and summarise the number of days infants remain in hospital after surpassing all physiological milestones. We will explore the characteristics of infants, mothers and neonatal units associated with extended hospital stays beyond physiological readiness for discharge. The results of this study will allow identification of areas to target to help achieve a safe reduction in length of hospital stay and will support the development of evidence-based recommendations to guide optimal discharge practices. ClinicalTrials.gov NCT06284044.

To understand the psychosocial experience of infertility among women with polycystic ovarian syndrome in Oman. In this qualitative study, semi-structured interviews were conducted with 20 Omani women diagnosed with polycystic ovarian syndrome (PCOS) and infertility across two fertility clinics, in Muscat-Oman. Interviews were audio-recorded, transcribed analysed verbatim and qualitatively using the framework approach. Four main themes emerged from participants' interviews related to the cultural aspects around infertility, the impact of infertility on participants' emotions, the effects of infertility on couples' relationship and self-management strategies for dealing with infertility. Culturally, women are expected to conceive soon after marriage, and most participants were blamed for the delay rather than their husbands. Participants experienced psychosocial pressure to bear children, mainly from in laws, where some admitted that their husbands' family suggested they remarried for having children. The majority of women mentioned being emotionally supported by their partners; however marital tensions in the form of negative emotions and threats of divorce were apparent in couples that had been experiencing infertility for longer time. Women were emotionally feeling lonely, jealous and inferior to other women with children and concerned that they would not have children to look after them in older age. Although women who had experienced infertility for a greater duration seemed to become more resilient and cope better, other participants described how they were using different strategies to cope with infertility including taking up new activities; whereas others admitted moving out from their in laws' house or avoiding social gatherings where the topic of children was likely to come up. Omani women with PCOS and infertility experience significant psychosocial challenges given the high value placed on fertility within the culture as a result they seem to adapt a variety of coping strategies. Health care providers may consider offering emotional support during consultations.

People with mental health disorders are much more likely to smoke compared to those who do not. This study investigates recent trends in smoking behaviors among both these populations in England. We used survey responses from adults (aged 16 years and older) living in households in England who participated in the Health Survey for England from 1993 to 2011 (n = 11,300 per year on average). Linear regression was used to quantify annual changes over the time period in smoking prevalence, daily cigarette consumption, and desire to quit among respondents with and without 2 indicators of mental disorder (self-reported longstanding mental illness and recent use of psychoactive medication). Among survey respondents who did not report a longstanding mental illness, there were long-term declines in smoking prevalence (-0.48% per year, 95% confidence interval [CI] = -0.56 to -0.40) and daily cigarette consumption (-0.14% per year, 95% CI = -0.17 to -0.11). Similar declines were also seen among respondents not taking psychoactive medications. However, there were no long-term changes in smoking prevalence and cigarette consumption among respondents who reported these indicators of mental disorder, although smoking prevalence among those taking psychoactive medications may have declined during the later part of the study period. Smokers both with and without the 2 indicators of mental disorder showed similar levels of desire to quit smoking. Smoking is largely unchanged since 1993 among those with indicators of longstanding mental disorders or recent psychoactive medication usage, although declines have been observed among those without such indicators of mental disorder.

Importance During the coronavirus disease 2019 (COVID‐19) lockdown, changes in the visiting rules in neonatal units might have affected the initiation and continuation of breastfeeding. Objective To investigate the effects of the implementation of the COVID‐19 lockdown in the UK on mother's own milk (MOM) feeding in hospital and at the time of discharge in two UK neonatal units. Methods Retrospective cohort study using routinely recorded data from electronic patient records. Data were retrieved from two neonatal services in the UK East Midlands region. Adjusted logistic regression was used to compare the odds of MOM feeding before, and after the implementation of the UK lockdown. Results Among 2073 infants, after adjusting for maternal and infant characteristics and underlying trends over time, there were no differences in the odds of infants receiving any MOM during admission; any MOM at discharge or exclusive MOM at discharge before and after the imposition of the lockdown. Infants with birthweight <1000 g were three times less likely to receive any MOM at discharge compared to those with birthweight >2500 g (adjusted odds ratio [OR] 0.33, 95% confidence interval [CI]: 0.22–0.50). Younger mothers were less likely, and Black British mothers more likely, to be feeding MOM to their infants at discharge, while women in the least deprived Index of Multiple Deprivation (IMD) quintiles were 2–4 times more likely to do so, compared to those in the most deprived IMD quintile (adjusted OR 2.78, 95% CI: 1.97–3.90). Interpretation Despite the difficulties faced during COVID‐19 pandemic‐induced restrictions, infants in the participating neonatal units continued to receive MOM in similar proportions as before the pandemic. Despite visiting and other restrictions, the odds of an infant admitted to a neonatal unit receiving its own mother's milk were similar before, and after, the imposition of the UK national lockdown on March 23, 2020. It is likely that there were other important, but less measurable, impacts on parent and infant wellbeing in this period.

Background Smoking is a UK public health threat but GPs can be effective in helping patients to quit; consequently, the Quality and Outcomes Framework (QOF) incentivises the recording of smoking status and delivery of cessation advice in patients’ medical records. This study investigates the association between smoking-related QOF targets and such recording, and the factors which influence these clinical activities. Methods For 2000 to 2008, using medical records in The Health Improvement Network (THIN) database, the annual proportions of i) patients who had a record of smoking status made in the previous 27 months and ii) current smokers recorded as receiving cessation advice in the previous 15 months were calculated. Then, for all patients at selected points before and after the QOF’s implementation, data on gender, age, Townsend score, and smoking-related morbidity were extracted. Multivariate logistic regression was used to investigate individual-level characteristics associated with the recording of smoking status and cessation advice. Results Rapid increases in recording smoking status and advice occurred around the QOF’s introduction in April 2004. Subsequently, compliance to targets has been sustained, although rates of increase have slowed. By 2008 64.5% of patients aged 15+ had smoking status documented in the previous 27 months and 50.5% of current smokers had cessation advice recorded in the last 15 months. Adjusted odds ratios show that, both before and after the introduction of the QOF, those with chronic medical conditions, greater social deprivation and women were more likely to have a recent recording of smoking status or cessation advice. Since the QOF’s introduction, the strongest characteristic associated with recording activities was the presence of co-morbidity. An example of this was patients with COPD, who in 2008, were 15.38 (95% CI 13.70-17.27) times and 11.72 (95% CI 10.41-13.21) times more likely to have a record of smoking status and cessation advice, respectively. Conclusions Rates of recording smoking status and cessation advice plateaued after large increases during the QOF’s introduction; however, recording remains most strongly associated with the presence of chronic disease as specified by the QOF, and suggests that incentivised targets have a direct effect on clinical behaviour.

ObjectiveTo describe the diagnosis and treatment of patent ductus arteriosus (PDA) in infants born at <32 weeks’ gestational age (GA) in England and Wales between 2010 and 2017.Study designRetrospective cohort study using routinely recorded data from the National Neonatal Research Database of infants born at <32 weeks admitted to neonatal units in England and Wales from 2010 to 2017.ResultsAmong 58 108 infants born at <32 weeks’ GA, 28.3% (n=16 440) had a PDA diagnosed clinically or with echocardiographic confirmation. Of these, 34.8% (n=5721; 9.8% of total <32 weeks’ infants included) had PDA treatment including 7.6% (n=1255) with indomethacin, 23.5% (n=3857) with ibuprofen and 5.6% (n=916) with surgical closure. The highest incidence of PDA was among infants born at 24 and 25 weeks’ GA (70.2% and 70.8%, respectively), decreasing to 6.1% among infants born at 31 weeks’ GA. The percentage of infants with a PDA increased over the study period (25.5% in 2010 to 28.5% in 2017). The percentage of infants who received ibuprofen or indomethacin or had PDA surgery decreased from 41.3% in 2010 to 33.7% in 2017, with an increase in use of ibuprofen from 20.2% to 27.3% while use of indomethacin decreased from 20.0% to 8.8%. Surgical closure of PDA decreased from 9.1% to 3.0%. Indomethacin was used for median (IQR) 3 (2–5) days while ibuprofen was given for 3 (2-4) days, at a median of 8 and 10 days after birth, respectively; surgical treatment was used later at 33 (24–45) days after birth.ConclusionsIbuprofen is the preferred drug and surgical interventions are becoming less frequent for PDA closure among very preterm infants in England and Wales.Trial registration numberNCT03773289.

ObjectiveTo describe the use of probiotics among preterm infants in neonatal units and explore factors that influence exposure.DesignObservational study using prospectively recorded health data.SettingEngland and Wales.Patients48 048 infants born at <32 weeks gestational age (GA) and admitted to a neonatal unit between 1 January 2016 and 31 December 2022.Main outcome measuresMeasures of probiotic use (number and proportion of infants exposed to probiotics, postnatal age of first probiotic exposure and discontinuation).ResultsThe proportion of infants who received probiotics increased from 9% to 54% over the study period. Median GA of infants given probiotics was 29+3 weeks (IQR 27+3–30+6). Probiotics were started on median day 5 (IQR 2–8), earlier for those born at >28 weeks GA (median day 4, IQR 2–7), most frequently after enteral feeds (66% of exposed infants) and were usually discontinued between 32 and 36 weeks postmenstrual age (PMA) (47% at 32+0–33+6 weeks PMA, 33% at 34+0–35+6 weeks PMA). Among infants cared for in probiotic neonatal intensive care units (defined as units where 50% or more infants born <32 weeks gestation were exposed to probiotics), 23% were never given probiotics. Infants from whom probiotics were withheld had a lower gestational age, lower birth weight z score and higher illness severity score or were more mature.ConclusionsBy 2022, over half of infants born at <32 weeks GA were exposed to probiotics, but almost one quarter did not receive them despite being in a probiotic unit. Our findings help inform the interpretation of observational data and the design of future studies addressing the continued uncertainty around the safety and efficacy of probiotics.

Background There are well-established socio-economic differences in the prevalence of smoking in the UK, but conventional socio-economic measures may not capture the range and degree of these associations. We have used a commercial geodemographic profiling system, Mosaic, to explore associations with smoking prevalence in a large primary care dataset and to establish whether this tool provides new insights into socio-economic determinants of smoking. Methods We analysed anonymised data on over 2 million patients from The Health Improvement Network (THIN) database, linked via patients' postcodes to Mosaic classifications (11 groups and 61 types) and quintiles of Townsend Index of Multiple Deprivation. Patients' current smoking status was identified using Read Codes, and logistic regression was used to explore the associations between the available measures of socioeconomic status and smoking prevalence. Results As anticipated, smoking prevalence increased with increasing deprivation according to the Townsend Index (age and sex adjusted OR for highest vs lowest quintile 2.96, 95% CI 2.92-2.99). There were more marked differences in prevalence across Mosaic groups (OR for group G vs group A 4.41, 95% CI 4.33-4.49). Across the 61 Mosaic types, smoking prevalence varied from 8.6% to 42.7%. Mosaic types with high smoking prevalence were characterised by relative deprivation, but also more specifically by single-parent households living in public rented accommodation in areas with little community support, having no access to a car, few qualifications and high TV viewing behaviour. Conclusion Conventional socio-economic measures may underplay social disparities in smoking prevalence. Newer classification systems, such as Mosaic, encompass a wider range of demographic, lifestyle and behaviour data, and are valuable in identifying characteristics of groups of heavy smokers which might be used to tailor cessation interventions.