Fathers have an important but often neglected role in the promotion of healthy breastfeeding practices in developing countries. A community-based education intervention was designed to mobilize fathers' support for early breastfeeding. This study aimed to evaluate an education intervention targeting fathers to increase the proportion of early breastfeeding initiation and to reduce prelacteal feeding. Quasi-experimental study design was used to compare intervention and control areas located in two non-adjacent rural districts that shared similar demographic and health service characteristics in northern Viet Nam. Fathers and expectant fathers with pregnant wives from 7 to 30 weeks gestational age were recruited. Fathers in the intervention area received breastfeeding education materials, counselling services at a commune health centre and household visits. They were also invited to participate in a breastfeeding promotion social event. After intervention, early breastfeeding initiation rate was 81.2% in the intervention area and 39.6% in the control area (P < 0.001). Babies in the intervention area were more likely to be breastfed within the first hour after birth [odds ratio (OR) 7.64, 95% confidence interval (CI) 4.81-12.12] and not to receive any prelacteal feeding (OR 4.43, 95% CI 2.88-6.82) compared with those in the control area. Fathers may positively influence the breastfeeding practices of mothers, and as a resource for early childcare, they can be mobilized in programmes aimed at improving the early initiation of breastfeeding.

Crude rates such as the crude death rate are functions of both the age-specific rates and the age composition of a population. However, differences in the age structure between two populations or two time periods can result in specious differences in the corresponding crude rates making direct comparisons between populations or across time inappropriate. Therefore, when comparing crude rates between populations, it is desirable to eliminate or minimize the influence of age composition. This task is accomplished by using a standard age structure yielding an age-standardized rate. This paper proposes an updated International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH) standard for use in low- and middle-income countries (LMICs) based on newly available data from the health and demographic surveillance system site members of the INDEPTH network located throughout Africa and southern Asia. The updated INDEPTH standard should better reflect the age structure of LMICs and result in more accurate health indicators and demographic rates. We demonstrate use of the new INDEPTH standard along with several existing ‘world’ standards and show how resulting age-standardized crude deaths rates differ when using the various standard age compositions.

We examined the extent to which fathers can be taught and encouraged to develop positive relationships with their children, especially in infancy, and the effects of this fathering intervention on infant development. A multifaceted relationally focused intervention was used to assist fathers in Vietnam to engage in responsive direct and indirect involvement with their infants and work together with the mother as part of a parenting team. Fathers and mothers from 13 communes in a rural and semiurban district were recruited to the intervention group. Intervention fathers received group and individual counseling before and after birth, an interactive print resource, community messages about fathering, and the opportunity to participate in a Fathers Club. Couples from 12 comparable communes in a noncontiguous district were recruited to the control group. Fathers and mothers completed questionnaires at the prebirth recruitment and at 1-, 4-, and 9-months postbirth. Intervention fathers demonstrated greater increase in knowledge and attitudes regarding father-infant relationships. Both fathers and mothers reported that fathers engaged in more affection, care-taking, and play in the early months of their infants' lives and fathers felt more attached to their infants right from birth. A developmental assessment at 9 months showed that intervention infants demonstrated higher levels of motor, language, and personal/social development. This study demonstrated that fathers can be taught to interact more sensitively, responsively, and effectively with their newborn infants. Their increased interaction and emotional attachment appears to lay the foundation for enhanced infant development. (PsycINFO Database Record

Background Socio-economic growth in many low and middle-income countries has resulted in more available, though not equitably accessible, healthcare. Such growth has also increased demands from citizens for their health systems to be more responsive to their needs. This paper shares a protocol for the RESPONSE study which aims to understand, co-produce, implement and evaluate context-sensitive interventions to improve health systems responsiveness to health needs of vulnerable groups in Ghana and Vietnam. Methods We will use a realist mixed-methods theory-driven case study design, combining quantitative (household survey, secondary analysis of facility data) and qualitative (in-depth interviews, focus groups, observations and document and literature review) methods. Data will be analysed retroductively. The study will comprise three Phases. In Phase 1, we will understand actors’ expectations of responsive health systems, identify key priorities for interventions, and using evidence from a realist synthesis we will develop an initial theory and generate a baseline data. In Phase 2, we will co-produce jointly with key actors, the context-sensitive interventions to improve health systems responsiveness. The interventions will seek to improve internal (i.e. intra-system) and external (i.e. people-systems) interactions through participatory workshops. In Phase 3, we will implement and evaluate the interventions by testing and refining our initial theory through comparing the intended design to the interventions’ actual performance. Discussion The study’s key outcomes will be: (1) improved health systems responsiveness, contributing to improved health services and ultimately health outcomes in Ghana and Vietnam and (2) an empirically-grounded and theoretically-informed model of complex contexts-mechanisms-outcomes relations, together with transferable best practices for scalability and generalisability. Decision-makers across different levels will be engaged throughout. Capacity strengthening will be underpinned by in-depth understanding of capacity needs and assets of each partner team, and will aim to strengthen individual, organisational and system level capacities.

A multifaceted, relationally focused intervention involving group and individual pre‐ and postnatal counseling, print resources, and community resources encouraged 390 fathers of newborn infants in Vietnam to responsively support mothers and work with them as a parenting team. Both partners completed questionnaires prebirth and 1‐, 4‐, and 9‐months postbirth on measures of breastfeeding support, exclusive breastfeeding duration, relationship quality, and infant development. Compared to 412 comparison group couples, intervention couples evidenced greater father support, especially in terms of helping and responsiveness to the mother's needs. This support predicted longer exclusive breastfeeding duration, improved relationship quality, and higher levels of infant development at 9 months. Sensitively working together with mothers as a coordinated team enhanced couple's relationship functioning and improved children's developmental outcomes.