Frankie Fair - Academia.edu (original) (raw)

Papers by Frankie Fair

Maternal and Child Nutrition, Jun 1, 2021

Despite its reported benefits, breastfeeding rates are low globally, and support systems such as ... more Despite its reported benefits, breastfeeding rates are low globally, and support systems such as the Baby Friendly Initiative (BFI) have been established to support healthy infant feeding practices and infant bonding. Increasingly reviews are being undertaken to assess the overall impact of BFI accreditation. A systematic synthesis of current reviews has therefore been carried out to examine the state of literature on the effects of BFI accreditation. A systematic search of CINAHL, MEDLINE, Maternal and Infant Health, Scopus, the Cochrane Library and PROS-PERO was undertaken. Study selection, data extraction and critical appraisal of included reviews using the AMSTAR-2 tool were undertaken by two authors, with disagreements resolved through discussion with the third author. Due to heterogeneity, a narrative synthesis of findings was applied. Fourteen reviews met the inclusion criteria. Overall confidence in the results of the review was rated as high for three reviews, low for two reviews and critically low for nine reviews. Most evidence suggests some increase in breastfeeding initiation, exclusivity and duration of breastfeeding, and one main trial suggests decreased gastrointestinal infection and allergic dermatitis in infants. However, overall certainty in the evidence was rated as very low across all outcomes due to concerns over risk of bias within and heterogeneity between the original studies. More contemporary, good-quality randomised controlled trials or well-controlled prospective comparative cohorts are required to better evaluate the impact of full BFI accreditation, with particular attention paid to the context of the research and to long-term maternal and infant health outcomes.

medRxiv (Cold Spring Harbor Laboratory), Aug 24, 2022

doi: medRxiv preprint NOTE: This preprint reports new research that has not been certified by pee... more doi: medRxiv preprint NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice.

European journal of public health, Apr 17, 2018

European journal of public health, Sep 1, 2020

A total of 234 parturients were included. Referrals represented 15.1% of the obstetric activity i... more A total of 234 parturients were included. Referrals represented 15.1% of the obstetric activity in this facility. There were 26 reasons for referrals and the most common was Maternal care for pelvic organ abnormalities (19.7%) and premature rupture of membranes (12.8%). 34.4% of the referrals were unclassifiable according to ICD-10. Most of the indications for referrals (71.4%) did not conform to the list of referral indications of the NPP. Twenty-eight diagnoses were retained after referrals: the most common was Maternal care for pelvic organ abnormalities (15.8%). In 42% of women, reasons for referral did not match with diagnoses established at the time of the patients' admission to hospital. Conclusions: The referral system must be analyzed in order to ensure a maximum level of safety for the mother-child couple through the formalization of the protocols and the promotion of the role of peripheral maternity facilities, which are the structures of first recourse. Key messages: The current referral system in the region of Kasserine still faces several challenges that need to be addressed in order to make it more effective. Maternal referral systems are an effective measure to help to reduce preventable maternal deaths, they should be continuously assessed and revised.

Journal of Pregnancy, 2016

Introduction. Maternal obesity and excessive gestational weight gain are associated with multiple... more Introduction. Maternal obesity and excessive gestational weight gain are associated with multiple adverse outcomes. There is a lack of clarity on the specific components of effective interventions to support pregnant women with gestational weight management. Method. All 44 studies within a preexisting review of lifestyle interventions, with a potential to impact on maternal weight outcomes, were considered for content analysis. Interventions were classified using Behaviour Change Technique (BCT) taxonomy clusters to explore which categories of BCT were used in interventions and their effectiveness in managing gestational weight gain. Results. The most commonly used BCTs were within the categories of "feedback and monitoring," "shaping knowledge," "goals and planning," "repetition and substitution," "antecedents," and "comparison of behaviours." For diet and mixed interventions "feedback and monitoring," "shaping knowledge," and "goals and planning" appeared the most successful BCT categories. Conclusions. Poor reporting within studies in defining the BCTs used, in clarifying the differences in processes between intervention and control groups, and in differentiating between the intervention and research processes made BCT classification difficult. Future studies should elaborate more clearly on the behaviour change techniques used and report them accurately to allow a better understanding of the effective ingredients for lifestyle interventions during pregnancy.

British journal of midwifery, Dec 2, 2022

Background Women from migrant or minority ethnic backgrounds are particularly vulnerable to perin... more Background Women from migrant or minority ethnic backgrounds are particularly vulnerable to perinatal mental ill health. Peer support can be beneficial for those with perinatal mental ill health. This study's aim was to evaluate a training package combining perinatal mental health and the impact of migration to enable better support for women from ethnic minorities with perinatal mental ill health. Methods Peer supporters who undertook training completed a survey immediately afterwards and interviews were conducted 3 months later. A total of 10 peer supporters were trained. Results The participants all rated the training as ‘excellent’ or ‘very good’ and reported increased awareness of perinatal mental ill health, cultural issues and women's vulnerability. More complex scenarios were requested, given the multi-factorial nature of many women's needs. Conclusions The combined training provided participants from different backgrounds with opportunities to learn from one another. Further evaluation among participants new to peer supporting is required.

European journal of public health, Sep 1, 2020

In 2018, the study team conducted a self-administered survey among parents of children 0-6 years ... more In 2018, the study team conducted a self-administered survey among parents of children 0-6 years old living in Yerevan, the capital of Armenia. Using two stage cluster sampling, 33 kindergartens were chosen as clusters by simple random sampling and from each cluster 10 parents received a questionnaire. The study team applied a multivariable logistic regression model using the backward elimination approach to finalize the independent predictors of CSS-s use. Results: Overall, 263 parents returned completed questionnaires, of which 26.2% (69) were CSS users. The CSS non-users included those who did not have a CSS (163) or had a CSS but used it sometimes, seldom or never (31). The study results showed that the factors associated with the CSS-s use among Armenian parents in the adjusted analyses were age in children (OR = 0.61, p = 0.003), attitude score (OR = 1.53, p = 0.003), knowledge score (OR = 1.45, p = 0.011) regarding CSS-s, consistent driver's side seatbelt compliance (OR = 3.4, p = 0.005), and monthly expenditures (OR = 3.35, p = 0.024). Conclusions: This study was the first exploration of Armenian parents' practice of CSS-s. Our findings might serve as a starting point for further research on proper use of CSS among Armenian parents not only in Yerevan, but across all regions of the country. The revealed predictors of parental CSS-s use might be used for the development of fruitful interventions to enhance the practice of CSS-s in Armenia. Key messages: This was the first-time exploration of CSS-s practice and predictors of CSS-s use in Armenia, where there is no CSS law and parents play the sole role in child passenger safety. Educational interventions for children and their parents on the importance of age and size appropriate CSS-s usage will help increase CSS-s use among Armenian parents.

Reproductive Health, Apr 4, 2018

Background: The practice of antenatal breast expression (ABE) has been proposed as a strategy to ... more Background: The practice of antenatal breast expression (ABE) has been proposed as a strategy to promote successful breastfeeding. Although there has been some focus on the evaluation of the effects of ABE in promotion of breastfeeding, little or no evidence exists on women's experiences of ABE or opinions on ABE, particularly amongst overweight or obese women. Methods: This study aimed to explore women's knowledge, practices and opinions of ABE, and any differences within the overweight and obese subgroups. A cross-sectional survey was undertaken using an online questionnaire distributed by a maternity user group representative via social media. Quantitative data were analysed using Chi-square and Fisher's exact tests in SPSS. Simple thematic analysis was used for the qualitative data. Results: A total of 688 responses were analysed; the sample represented a group of breastfeeding mothers, of whom 64.5% had heard of ABE, 8.2% had been advised to do ABE, and 14.2% had undertaken ABE. Of the women who had been advised to do ABE, 67.9% had complied. Most participants (58.6%) were unsure if ABE was a good idea; however 80.9% would consider doing ABE if it was found to be helpful to prepare for breastfeeding. Women in the overweight or obese subgroups were significantly more likely to have heard of ABE (p < 0.001), and positive opinion of ABE also increased with higher BMI groups. The qualitative data demonstrated participants felt ABE may be beneficial when mother or baby have medical problems, and in preparation for breastfeeding, but highlighted their concerns that it may interfere with nature and be harmful, and that they wanted more information and knowledge about ABE. Conclusions: Amongst women who have breastfed, many have heard of ABE, compliance with advice to undertake ABE is relatively high, and ABE is considered an acceptable practice. Further investigation into the benefits and safety of ABE is warranted, to address the needs of childbearing women for evidence-based information about this practice. If the evidence base is established, overweight and obese pregnant women could be an important target group for this intervention.

The Cochrane library, Sep 17, 2019

BackgroundExclusive breastfeeding is recommended for all infants until six months of age due to t... more BackgroundExclusive breastfeeding is recommended for all infants until six months of age due to the many health benefits for both the mother and infant.Evidence suggests that mothers who are overweight (body mass index (BMI) 25.0 to 29.9 kg/m²) or obese (BMI ≥ 30.0 kg/m²) are less likely to initiate breastfeeding and to breastfeed for a shorter duration. Considering the rising prevalence of overweight and obesity globally and the known benefits of breastfeeding particularly in reducing the long‐term risks of obesity and diabetes for infants, establishing effective ways to support and promote breastfeeding in women who are overweight or obese is paramount in achieving the goal of healthier communities.ObjectivesTo assess the effectiveness of interventions to support the initiation or continuation of breastfeeding in women who are overweight or obese.Search methodsOn 23 January 2019 we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform (ICTRP) and reference lists of retrieved trials.Selection criteriaRandomised controlled trials (RCTs) and quasi‐RCTs that compared interventions to support the initiation and continuation of breastfeeding in women who are overweight or obese. Interventions included social support, education, physical support, or any combination of these. Interventions were compared either with each other or against a control group.Data collection and analysisWe assessed all potential trials identified from the search strategy. Two review authors extracted data from each included trial and assessed risk of bias. We resolved discrepancies through discussion with the third review author. We assessed the quality of the evidence using the GRADE approach.Main resultsWe found no trials comparing one type of support versus another. We included seven RCTs (including one cluster‐RCT) involving 831 women. The number of women in each trial ranged from 36 to 226. The trials were conducted in high‐income countries: USA (5 trials); Denmark (1 trial) and Australia (1 trial), between 2006 and 2015. Three trials only included women who were obese prior to pregnancy and four trials included both women who were overweight and women who were obese. We judged risk of bias in the included trials to be mixed; only one trial was judged to be low risk of bias for random sequence generation, allocation concealment and attrition bias.Physical breastfeeding support (manual or electric breast pump) versus usual care (no breast pump)Very low‐certainty evidence from one small trial (39 women) looking at a physical support intervention (manual or electric breast pump) versus usual care (no pump) means it is unclear whether physical support improves exclusive breastfeeding at four to six weeks (risk ratio (RR) 0.55, 95% confidence interval (CI) 0.20 to 1.51) or any breastfeeding at four to six weeks (RR 0.65, 95% CI 0.41 to 1.03). The trial did not report other important outcomes of interest in this review: non‐initiation of breastfeeding, exclusive or any breastfeeding at six months postpartum.Multiple methods of breastfeeding support versus usual careSix trials (involving 792 women) used multiple methods of support including education and social support through telephone or face‐to‐face contact. One of these trials also provided physical support through providing a breast pump and a baby sling and one trial provided a small gift to the women at each trial visit. Support in the trials was provided by a professional (four trials) or a peer (two trials). One trial provided group support, with the other five trials supporting women individually. One trial (174 women) did not report on any of our main outcomes of interest.We are unclear about the effects of the intervention because we identified very low‐certainty evidence for all of the important outcomes in this review: rate of non‐initiation of breastfeeding (average RR 1.03, 95% CI 0.07 to 16.11; 3 trials, 380 women); exclusive breastfeeding at four to six weeks (average RR 1.21, 95% CI 0.83 to 1.77; 4 trials, 445 women); any breastfeeding at four to six weeks (average RR 1.04, 95% CI 0.57 to 1.89; 2 trials, 103 women); rate of exclusive breastfeeding at six months postpartum (RR 7.23, 95% CI 0.38 to 137.08; 1 trial, 120 women); and any breastfeeding at six months postpartum (average RR 1.42, 95% CI 1.08 to 1.87; 2 trials, 223 women).The included trials under the above comparisons also reported on some of this review's secondary outcomes but very low‐certainty evidence means that we are unclear about the effects of the intervention on those outcomes.Authors' conclusionsThere is insufficient evidence to assess the effectiveness of physical interventions, or multiple methods of support (social, educational or physical) for supporting the initiation or continuation of breastfeeding in women who are overweight or obese. We found no RCTs comparing one type of support to another type of support. All of our GRADE assessments resulted in very low‐certainty evidence, with downgrading decisions based on limitations in trial design (e.g. risk of attrition bias), imprecision, inconsistency. The available trials were mostly of variable quality with small numbers of participants, confounded by poor adherence within both the intervention and control groups.Well designed, adequately powered research is needed to answer questions about the social, educational, physical support, or any combination of these interventions that could potentially help mothers who are overweight or obese to achieve optimal breastfeeding outcomes. We need trials that examine interventions designed specifically for women who are overweight or obese, delivered by people with training about how to overcome some of the challenges these women face when establishing and maintaining breastfeeding. Particular attention could be given to the assessment of antenatal interventions aimed at improving breastfeeding initiation in women with a raised BMI, and not just focusing on recruiting women who have an intention to breastfeed. Given that the majority of current trials were undertaken in the USA, further trials in a diverse range of countries and settings are required. Future trials need to give consideration to the theoretical basis of the intervention using established frameworks to enable replicability by others and to better determine the components of effective interventions.

BMC Women's Health, Nov 9, 2017

Background: Indonesia has a considerably high incidence of maternal and infant mortality. The cou... more Background: Indonesia has a considerably high incidence of maternal and infant mortality. The country has however been experiencing a social and economic transition, influencing its general population demographics and nutritional status including the state of health and nutrition of pregnant women. This study aimed to explore body mass index (BMI) and gestational weight gain (GWG), and their relationship with pregnancy outcomes in a sample of Indonesian pregnant women. Methods: This observational cohort study included a total of 607 pregnant women who were recruited in 2010 from maternity clinics in Western Sumatra, Indonesia. Multiple logistic and regression analyses were undertaken to compare pregnancy and birth outcomes for different BMI and GWG, using normal weight women and women with a recommended weight gain as the referent groups. Results: The prevalence of underweight (BMI < 18.5 kg/m 2) in pregnancy was high at 20.1%; while 21.7% of women were overweight (BMI: 23.0-27.4 kg/m 2) and 5.3% obese (BMI ≥ 27.5 kg/m 2) using the Asian BMI classifications. The incidence of overweight (BMI: 25.0-29.9 kg/m 2) and obese (BMI ≥ 30.0 kg/m 2) according to the international BMI classifications were 13.5% and 1.1% respectively. The majority of women gained inadequate weight in pregnancy compared to the Institute of Medicine (IOM) recommendations, especially those who had a normal BMI. Birthweight adjusted mean difference aMD (95% confidence interval) 205 (46,365) and the odds of macrosomia adjusted odds ratio aOR 13.46 (2.32-77.99) significantly increased in obese women compared to those with a normal BMI. Birthweight aMD-139 (−215, −64) significantly decreased in women with inadequate GWG compared to those with recommended GWG, while SGA aOR 5.44 (1.36, 21.77) and prematurity aOR 3.55 (1.23, 10.21) increased. Conclusions: Low nutritional status and inadequate GWG remain a cause for concern in these women. The higher odds of macrosomia with increasing maternal BMI and higher odds of prematurity and small for gestational age infants with inadequate weight gain also require attention. Research and practice recommendations: Urgent attention is required by researchers, policy makers and decisionmakers to facilitate development of culturally sensitive interventions to enhance nutritional status and health of mothers and babies, in an area known for its high incidence of maternal and neonatal mortality.

European journal of public health, Sep 1, 2020

European journal of public health, Oct 1, 2021

BMC Health Services Research, Jun 22, 2020

Background: Maternal overweight and obesity are associated with numerous adverse outcomes includi... more Background: Maternal overweight and obesity are associated with numerous adverse outcomes including higher rates of maternal and infant mortality and morbidity. Overweight and obesity before, during and after pregnancy are therefore a significant public health priority in England. This project explored and mapped healthy weight service availability at different stages of the childbearing cycle. Methods: A mixed methods approach included a questionnaire-based survey disseminated through Local Maternity Systems and semi-structured interviews or focus groups with providers and commissioners. Current maternal weight service provision was explored along with some of the barriers and facilitators for providing, delivering and accessing healthy weight services. Descriptive statistics were reported for quantitative data and content analysis was used for thematic reporting of qualitative data. Results: A total of 88 participants responded to the survey. All services were offered most frequently during pregnancy; with healthy eating and/or weight management services offered more often than physical activity services. Few services were targeted specifically at women with a raised body mass index. There was a high degree of inconsistency of service provision in different geographical areas. Several themes were identified from qualitative data including "equity and variation in service provision", "need for rigorous evaluation", "facilitators" to encourage better access or more effective service provision, including prioritisation, a change in focus and co-design of services, "barriers" encountered including financial and time obstacles, poor communication and insufficiently clear strategic national guidance and "the need for additional support". Conclusions: There is a need to reduce geographical variation in services and the potential health inequalities that this may cause. Improving services for women with a raised body mass index as well as services which encourage physical activity require additional emphasis. There is a need for more robust evaluation of services to ensure they are fit for purpose. An urgent need for clear national guidance so that healthcare providers can more effectively assist mothers achieve a healthy weight gain was identified. Commissioners should consider implementing strategies to reduce the barriers of access identified such as childcare, transport, location and making services free at the point of use.

British Journal of Midwifery

ObjectivesPoor pre-transport and intra-transport care are associated with early neonatal morbidit... more ObjectivesPoor pre-transport and intra-transport care are associated with early neonatal morbidity and mortality. The objective of this study is to produce a critical overview of research on neonatal transport practices, the use of any low-cost interventions, including Kangaroo mother care (KMC) employed in neonatal transport on the outcomes of neonates transported for specialized care in Sub-Saharan Africa, through a systematic review and narrative synthesis.Study designThe study design is a protocol for systematic reviewMethodsA comprehensive literature search will be conducted using the electronic databases of CINAHL, EMBASE, MEDLINE, Web of Science, as well as Google Scholar. A manual search will be carried out of the reference lists of eligible studies for relevant papers. The search strategy will include combining three key blocks of terms, namely: ‘neonates’, ‘transport’ and ‘Sub Saharan Africa,’ using database-specific subject headings and text words. Two independent reviewe...

PLOS ONE

Introduction Maternal weight management services have been recognised as a good opportunity to in... more Introduction Maternal weight management services have been recognised as a good opportunity to influence lifestyle and dietary behaviour of mothers and families. Exploring women’s views of maternal weight management services is paramount to understand what constitutes the most suitable service. This study therefore explored experiences among women with a raised body mass index (BMI) of maternal weight management service provision and the barriers and facilitators to weight management during pregnancy. Method Thirteen women with a BMI≥40kg/m² undertook semi-structured interviews around weight management experiences during pregnancy. Interviews were audio recorded and transcribed verbatim. Inductive thematic analysis was undertaken. Results Four themes emerged. 1). "Understanding where I am at" showed current readiness and motivation of women varied, from being avoidant to being motivated to make changes. 2). "Getting information" revealed inconsistent information ...

Obesity Reviews, 2021

SummaryWomen with overweight or obesity are twice as likely to gain excessive gestational weight ... more SummaryWomen with overweight or obesity are twice as likely to gain excessive gestational weight than women of normal weight. Identifying effective interventions to support this group achieve healthy gestational weight gain is important. An overview of systematic reviews regarding the effectiveness of lifestyle interventions on gestational weight gain in women with overweight or obesity was undertaken, including searching eight electronic databases. Quality of included reviews was assessed by two independent researchers. A narrative data synthesis was undertaken, with subgroup and sensitivity analyses by type of intervention and quality of the included reviews. A total of 15 systematic reviews were included within this meta‐review. A small reduction in gestational weight gain of between 0.3 and 2.4 kg was noted with lifestyle interventions compared with standard care. There was some evidence that dietary only or physical activity only interventions may reduce the odds of gestational...

BMC Pregnancy and Childbirth, 2021

Background The number of international migrants continues to increase worldwide. Depending on the... more Background The number of international migrants continues to increase worldwide. Depending on their country of origin and migration experience, migrants may be at greater risk of maternal and neonatal morbidity and mortality. Having compassionate and culturally competent healthcare providers is essential to optimise perinatal care. The “Operational Refugee and Migrant Maternal Approach” (ORAMMA) project developed cultural competence training for health professionals to aid with providing perinatal care for migrant women. This presents an evaluation of ORAMMA training and explores midwives’ experiences of the training and providing care within the ORAMMA project. Methods Cultural competence was assessed before and after midwives (n = 35) received ORAMMA compassionate and culturally sensitive maternity care training in three different European countries. Semi-structured interviews (n = 12) explored midwives’ experiences of the training and of caring for migrant women within the ORAMMA...

Maternal & Child Nutrition, 2021

Maternal and Child Nutrition, Jun 1, 2021

medRxiv (Cold Spring Harbor Laboratory), Aug 24, 2022

European journal of public health, Apr 17, 2018

European journal of public health, Sep 1, 2020

Journal of Pregnancy, 2016

British journal of midwifery, Dec 2, 2022

European journal of public health, Sep 1, 2020

Reproductive Health, Apr 4, 2018

The Cochrane library, Sep 17, 2019

BMC Women's Health, Nov 9, 2017

European journal of public health, Sep 1, 2020

European journal of public health, Oct 1, 2021

BMC Health Services Research, Jun 22, 2020

British Journal of Midwifery

PLOS ONE

Obesity Reviews, 2021

BMC Pregnancy and Childbirth, 2021

Maternal & Child Nutrition, 2021