PubMed Baby Friendly

Interdisciplinary Skills Review Program to Improve Team Responses During Postpartum Hemorrhage.

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Interdisciplinary Skills Review Program to Improve Team Responses During Postpartum Hemorrhage.

J Obstet Gynecol Neonatal Nurs. 2017 Oct 25;:

Authors: Bittle M, O'Rourke K, Srinivas SK

Abstract
OBJECTIVE: To develop an interdisciplinary, interactive, skills review program to improve team responses during a postpartum hemorrhage (PPH).
DESIGN: Online didactic modules in combination with an interdisciplinary skills program consisting of seven hemorrhage-related stations.
SETTING/LOCAL PROBLEM: The project was conducted in the Women's Health Department in a quaternary-care Magnet- and Baby Friendly-designated academic medical center in Philadelphia, Pennsylvania. Women cared for at this center have comorbidities that place them at greater risk for PPH. A need was identified to implement a multidisciplinary and comprehensive program to assess hemorrhage risk and appropriately recognize and intervene with all PPHs in this setting.
PARTICIPANTS: The 276 participants, including registered nurses, obstetric and family medicine attending physicians and residents, advanced practice nurses, and ancillary staff in the hospital's Women's Health Department, completed the initial obstetric hemorrhage program.
INTERVENTION/MEASUREMENTS: The program included online didactic modules, seven interdisciplinary skills stations led by trained nurses and providers, and an in situ simulation. Successful completion of the online modules was a prerequisite for participation in the skills stations. All participants completed a written program evaluation at the conclusion of the program.
RESULTS: Results of the postassessment survey indicated that participants rated the program 3.94 of 4.00 for overall effectiveness to improve interdisciplinary team responses to PPH. Comments were overwhelmingly positive, and participants expressed increased confidence and knowledge related to PPH after completion of the program.
CONCLUSION: An interdisciplinary program that included online didactic modules, interactive skills stations, and simulation improved team confidence and responses to PPH.

PMID: 29080398 [PubMed - as supplied by publisher]

Protocol for establishing an infant feeding database linkable with population-based administrative data: a prospective cohort study in Manitoba, Canada.

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Protocol for establishing an infant feeding database linkable with population-based administrative data: a prospective cohort study in Manitoba, Canada.

BMJ Open. 2017 Oct 22;7(10):e017981

Authors: Nickel NC, Warda L, Kummer L, Chateau J, Heaman M, Green C, Katz A, Paul J, Perchuk C, Girard D, Larocque L, Enns JE, Shaw S, Manitoba Infant Feeding Database Development Team

Abstract
INTRODUCTION: Breast feeding is associated with many health benefits for mothers and infants. But despite extensive public health efforts to promote breast feeding, many mothers do not achieve their own breastfeeding goals; and, inequities in breastfeeding rates persist between high and low-income mother-infant dyads. Developing targeted programme to support breastfeeding dyads and reduce inequities between mothers of different socioeconomic status are a priority for public health practitioners and health policy decision-makers; however, many jurisdictions lack the timely and comprehensive population-level data on infant-feeding practices required to monitor trends in breastfeeding initiation and duration. This protocol describes the establishment of a population-based infant-feeding database in the Canadian province of Manitoba, providing opportunities to develop and evaluate breastfeeding support programme.
METHODS AND ANALYSIS: Routinely collected administrative health data on mothers' infant-feeding practices will be captured during regular vaccination visits using the Teleform fax tool, which converts handwritten information to an electronic format. The infant-feeding data will be linked to the Manitoba Population Research Data Repository, a comprehensive collection of population-based information spanning health, education and social services domains. The linkage will allow us to answer research questions about infant-feeding practices and to evaluate how effective current initiatives promoting breast feeding are.
ETHICS AND DISSEMINATION: Approvals have been granted by the Health Research Ethics Board at the University of Manitoba. Our integrative knowledge translation approach will involve disseminating findings through government and community briefings, presenting at academic conferences and publishing in scientific journals.

PMID: 29061626 [PubMed - in process]

Impact of Human Immunodeficiency Virus Drug Resistance on Treatment of Human Immunodeficiency Virus Infection in Children in Low- and Middle-Income Countries.

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Impact of Human Immunodeficiency Virus Drug Resistance on Treatment of Human Immunodeficiency Virus Infection in Children in Low- and Middle-Income Countries.

J Infect Dis. 2017 Oct 17;:

Authors: Siberry GK, Amzel A, Ramos A, Rivadeneira ED

Abstract
Children living with human immunodeficiency virus (HIV) in low- and middle-income countries (LMICs) experience higher rates of virologic failure than adults. Human immunodeficiency virus drug resistance (HIVDR) plays a major role in pediatric HIV treatment failure because nonsuppressive maternal antiretroviral therapy (ART) during pregnancy and breastfeeding as well as infant antiretroviral prophylaxis lead to high rates of pretreatment drug resistance to regimens most commonly used in children living with HIV. Lack of availability of durable, potent drugs in child-friendly formulations in LMICs and adherence difficulties contribute to acquired drug resistance during treatment. Optimizing drugs available for treating children living with HIV in LMICs, providing robust adherence support, and ensuring virologic monitoring for children receiving ART are essential for reducing HIVDR and improving treatment outcomes for children living with HIV in LMICs.

PMID: 29045697 [PubMed - as supplied by publisher]

Donor Human Milk and Fortifier use in United States level 2, 3, and 4 Neonatal Care Hospitals.

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Donor Human Milk and Fortifier use in United States level 2, 3, and 4 Neonatal Care Hospitals.

J Pediatr Gastroenterol Nutr. 2017 Oct 17;:

Authors: Perrin MT

Abstract
OBJECTIVE: In 2011 the United States Surgeon General issued a call to action to "identify and address obstacles to greater availability of safe banked donor milk for fragile infants." The purpose of this study is to analyze patterns in donor human milk (DHM) and fortifier use in level 2, 3, and 4 neonatal facilities in 2015 and to identify factors associated with non-use.
METHODS: Data from the 2015 Maternity Practices in Infant Nutrition and Care survey, conducted by the Center for Disease Control and Prevention, was analyzed for questions about feeding practices within neonatal hospitals.
RESULTS: The percentage of neonatal facilities that reported using DHM in 2015 was 38.3%, up 74% from 2011. The majority of level 3 and level 4 facilities reported using DHM (65.7% and 73.3% respectively) and fortifiers (96.1% and 91.9% respectively). Within DHM-using facilities, a wide range of DHM feeding patterns were reported. The prevalence of DHM use was higher in facilities that had the highest rates of mother's own milk feedings (P < 0.001), in facilities that were participating in the Baby Friendly Hospital Initiative (P < 0.001), and in facilities that were in a state with an operating milk bank (P < 0.001).
CONCLUSIONS: DHM use continues to increase in advanced care neonatal settings, with significant difference based on acuity level, facility size, breastfeeding culture, and proximity to a milk bank. Geographic gaps in DHM use provide the opportunity for targeted efforts to improve access.

PMID: 29045350 [PubMed - as supplied by publisher]

Newborn Safety Bundle to Prevent Falls and Promote Safe Sleep.

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Newborn Safety Bundle to Prevent Falls and Promote Safe Sleep.

MCN Am J Matern Child Nurs. 2017 Oct 17;:

Authors: Lipke B, Gilbert G, Shimer H, Consenstein L, Aris C, Ponto L, Lafaver S, Kowal C

Abstract
PURPOSE: At our Baby-Friendly USA hospital, with at least 80% of mothers breastfeeding and rooming-in, it is not uncommon for mothers to fall asleep in their hospital bed while feeding. The aim of this study was to develop a newborn infant safety bundle and evaluate its efficacy in helping reduce unsafe sleep situations while simultaneously preventing newborn falls.
STUDY DESIGN AND METHOD: Data were collected in March 2015 using an infant at risk-to-fall instrument prior to nurses initiating the newborn infant safety bundle. The bundle included: (a) a parent safety agreement; (b) education, teach-back, and role modeling of safe sleep practices; and (c) implementation of a reporting and debriefing system for infant falls. All new mothers were eligible for inclusion. Data were collected over a random month every quarter for four quarters (through June 2016).
RESULTS: Fourteen percent (n = 23) of babies born at the hospital in March 2015 were found to be exposed to risk-to-fall situations; over half of their mothers were found asleep and still holding the baby. Following bundle implementation, identified unsafe sleep situations during June 2015 to June 2016 have trended down with no reports of an infant fall through May 2017.
CLINICAL IMPLICATIONS: Increasing parental awareness, understanding, and participation in safe sleep practice creates and maintains a safer infant environment in the hospital setting.

PMID: 29045245 [PubMed - as supplied by publisher]

Tools to improve planning, implementation, monitoring, and evaluation of complementary feeding programmes.

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Tools to improve planning, implementation, monitoring, and evaluation of complementary feeding programmes.

Matern Child Nutr. 2017 Oct;13 Suppl 2:

Authors: Untoro J, Childs R, Bose I, Winichagoon P, Rudert C, Hall A, de Pee S

Abstract
Adequate nutrient intake is a prerequisite for achieving good nutrition status. Suboptimal complementary feeding practices are a main risk factor for stunting. The need for systematic and user-friendly tools to guide the planning, implementation, monitoring, and evaluation of dietary interventions for children aged 6-23 months has been recognized. This paper describes five tools, namely, ProPAN, Optifood, Cost of the Diet, Fill the Nutrient Gap, and Monitoring Results for Equity System that can be used in different combinations to improve situation analysis, planning, implementation, monitoring, or evaluation approaches for complementary feeding in a particular context. ProPAN helps with development of strategies and activities designed to change the behaviours of the target population. Optifood provides guidance for developing food-based recommendations. The Cost of the Diet can provide insight on economic barriers to accessing a nutritious and balanced diet. The Fill the Nutrient Gap facilitates formulation of context-specific policies and programmatic approaches to improve nutrient intake, through a multistakeholder process that uses insights from linear programming and secondary data. The Monitoring Results for Equity System helps with analysis of gaps, constraints, and determinants of complementary feeding interventions and adoption of recommended practices especially in the most vulnerable and deprived populations. These tools, and support for their use, are readily available and can be used either alone and/or complementarily throughout the programme cycle to improve infant and young child-feeding programmes at subnational and national levels.

PMID: 29032631 [PubMed - in process]

Application of Kotter's Theory of Change to Achieve Baby-Friendly Designation.

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Application of Kotter's Theory of Change to Achieve Baby-Friendly Designation.

Nurs Womens Health. 2017 Oct - Nov;21(5):372-382

Authors: Henry LS, Christine Hansson M, Haughton VC, Waite AL, Bowers M, Siegrist V, Thompson EJ

Abstract
Creating an environment that optimally supports exclusive breastfeeding can require a cultural transformation. Our initial attempt at obtaining Baby-Friendly Hospital Initiative (BFHI) designation was unsuccessful when surveyors determined insufficient enculturation of BFHI practices. Using Kotter's theory of change, we overcame the barriers, enhanced our practices, and effectively transformed the culture, and our facility ultimately became the first maternity hospital in Pennsylvania to obtain BFHI designation. Nursing leadership was essential to this process. Our experience serves as a template for others seeking to achieve Healthy People 2020 goals related to breastfeeding.

PMID: 28987210 [PubMed - in process]

Contemporary issues in anaphylaxis and the evolution of epinephrine autoinjectors: What will the future bring?

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Contemporary issues in anaphylaxis and the evolution of epinephrine autoinjectors: What will the future bring?

Ann Allergy Asthma Immunol. 2017 Oct;119(4):333-338

Authors: Greenberger PA, Wallace DV, Lieberman PL, Gregory SM

Abstract
BACKGROUND: Food allergy and anaphylaxis appear to be increasing in the United States, especially in young children, and preparedness is paramount to successful emergency management in the community. Although the treatment of choice for anaphylaxis is epinephrine delivered by autoinjection, some devices are challenged by less user-friendly designs or pose the risk of injury, especially in young patients. Human factors engineering has played a larger role in the development of more recent epinephrine autoinjector technologies and will continue to play a role in the evolution and future design of epinephrine autoinjectors.
OBJECTIVE: To discuss contemporary issues related to the identification and management of anaphylaxis, current and future epinephrine autoinjector design, and unmet needs for the treatment of special populations, namely, young children weighing less than 15 kg.
METHODS: The literature was reviewed and select articles retrieved to support expert clinical opinions on the need for improved recognition of anaphylaxis, epinephrine autoinjector design, and unmet needs in special populations.
RESULTS: Anaphylaxis may be underrecognized and poorly defined in infant- and toddler-aged children, current devices may not be adequate to safely treat these patients (ie, inappropriate needle length), and health care professionals may not be aware of these issues.
CONCLUSION: As epinephrine autoinjector technology continues to evolve, device characteristics that promote safe, user-friendly experiences and give clinicians and their patients confidence to successfully treat anaphylaxis during an emergency, without injury, will be favored.

PMID: 28958374 [PubMed - indexed for MEDLINE]

One Step for a Hospital, Ten Steps for Women: African American Women's Experiences in a Newly Accredited Baby-Friendly Hospital.

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One Step for a Hospital, Ten Steps for Women: African American Women's Experiences in a Newly Accredited Baby-Friendly Hospital.

J Hum Lact. 2017 Sep 01;:890334417731077

Authors: Miller EM, Louis-Jacques AF, Deubel TF, Hernandez I

Abstract
BACKGROUND: Despite strides made by the Baby-Friendly Hospital Initiative to improve and normalize breastfeeding, considerable racial inequality persists in breastfeeding rates. Few studies have explored African American women's experience in a Baby-Friendly Hospital Initiative system to understand sources of this inequality. Research aim: This study aimed to explore African American women's experiences of the Ten Steps to Successful Breastfeeding at a women's center associated with a university-affiliated hospital that recently achieved Baby-Friendly status.
METHODS: Twenty African American women who had received perinatal care at the women's center and the hospital participated in qualitative interviews about their experiences. Data were organized using the framework method, a type of qualitative thematic analysis, and interpreted to find how African American women related to policies laid out by the Ten Steps to Successful Breastfeeding.
RESULTS: Three key themes emerged from the women's interviews: (a) An appreciation of long-term relationships with medical professionals is evident at the women's center; (b) considerable lactation problems exist postpartum, including lack of help from Baby-Friendly Hospital Initiative sources; and (c) mothers' beliefs about infant autonomy may be at odds with the Ten Steps to Successful Breastfeeding.
CONCLUSION: Hospitals with Baby-Friendly status should consider models of breastfeeding support that favor long-term healthcare relationships across the perinatal period and develop culturally sensitive approaches that support breastfeeding beliefs and behaviors found in the African American community.

PMID: 28938077 [PubMed - as supplied by publisher]

Health Facility Staff Training for Improving Breastfeeding Outcome: A Systematic Review for Step 2 of the Baby-Friendly Hospital Initiative.

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Health Facility Staff Training for Improving Breastfeeding Outcome: A Systematic Review for Step 2 of the Baby-Friendly Hospital Initiative.

Breastfeed Med. 2017 Sep 20;

Authors: Balogun OO, Dagvadorj A, Yourkavitch J, da Silva Lopes K, Suto M, Takemoto Y, Mori R, Rayco-Solon P, Ota E

Abstract
The Baby-Friendly Hospital Initiative (BFHI) implemented through the "Ten Steps to Successful Breastfeeding" has been widely promoted as an intervention that improves breastfeeding rates. Step 2 requires the training of all healthcare staff in skills that are necessary to implement the policy. This systematic review provides evidence about the effect of training healthcare staff in hospitals and birth centers on breastfeeding outcomes. Randomized controlled trials (RCT), quasi-RCT, and controlled before and after (CBA) studies comparing training of healthcare staff on breastfeeding and supportive feeding practices with no training were included in this review. We searched CENTRAL PubMed, EMBASE, CINAHL, Web of Science, and the British Nursing Index for studies. Studies were screened against predetermined criteria, and risk of bias of included studies was assessed using the Risk of Bias Assessment tool for Non-Randomized Studies for non-RCT studies and the Cochrane Handbook for Systematic Reviews of Interventions for RCT studies. Of the six studies included in this review, three were RCT whereas three were CBA studies. The studies were conducted in 5 countries and involved 390 healthcare staff. Provision of educational interventions aimed at increasing knowledge and practice of BFHI and support was found to improve health worker's knowledge, attitude, and compliance with the BFHI practices. In one study, the rate of exclusive breastfeeding increased at the intervention site but no differences were found for breastfeeding initiation rates. All included studies had methodological limitations, and study designs and methodologies lacked comparability.

PMID: 28930480 [PubMed - as supplied by publisher]

REACH: study protocol of a randomised trial of rehabilitation very early in congenital hemiplegia.

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REACH: study protocol of a randomised trial of rehabilitation very early in congenital hemiplegia.

BMJ Open. 2017 Sep 18;7(9):e017204

Authors: Boyd RN, Ziviani J, Sakzewski L, Novak I, Badawi N, Pannek K, Elliott C, Greaves S, Guzzetta A, Whittingham K, Valentine J, Morgan C, Wallen M, Eliasson AC, Findlay L, Ware R, Fiori S, Rose S

Abstract
OBJECTIVES: Congenital hemiplegia is the most common form of cerebral palsy (CP). Children with unilateral CP show signs of upper limb asymmetry by 8 months corrected age (ca) but are frequently not referred to therapy until after 12 months ca. This study compares the efficacy of infant-friendly modified constraint-induced movement therapy (Baby mCIMT) to infant friendly bimanual therapy (Baby BIM) on upper limb, cognitive and neuroplasticity outcomes in a multisite randomised comparison trial.
METHODS AND ANALYSIS: 150 infants (75 in each group), aged between 3 and 6 months ca, with asymmetric brain injury and clinical signs of upper extremity asymmetry will be recruited. Children will be randomised centrally to receive equal doses of either Baby mCIMT or Baby BIM. Baby mCIMT comprises restraint of the unimpaired hand using a simple restraint (eg, glove, sock), combined with intensive parent implemented practice focusing on active use of the impaired hand in a play-based context. In contrast, Baby BIM promotes active play requiring both hands in a play-based context. Both interventions will be delivered by parents at home with monthly home visits and interim telecommunication support by study therapists. Assessments will be conducted at study entry; at 6, 12 months ca immediately postintervention (primary outcome) and 24 months ca (retention). The primary outcome will be the Mini-Assisting Hand Assessment. Secondary outcomes include the Bayley Scale for Infant and Toddler Development (cognitive and motor domains) and the Hand Assessment of Infants. A subset of children will undertake MRI scans at 24 months ca to evaluate brain lesion severity and brain (re)organisation after intervention.
ETHICS AND DISSEMINATION: Full ethical approvals for this study have been obtained from the relevant sites. The findings will be disseminated in peer-reviewed publications.
TRIAL REGISTRATION NUMBER: Australian and New Zealand Clinical Trials Registry: ACTRN12615000180516, Pre results.

PMID: 28928195 [PubMed - in process]

National Trends in Pediatricians' Practices and Attitudes About Breastfeeding: 1995 to 2014.

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National Trends in Pediatricians' Practices and Attitudes About Breastfeeding: 1995 to 2014.

Pediatrics. 2017 Oct;140(4):

Authors: Feldman-Winter L, Szucs K, Milano A, Gottschlich E, Sisk B, Schanler RJ

Abstract
BACKGROUND AND OBJECTIVES: The American Academy of Pediatrics (AAP) has affirmed breastfeeding as the preferred method of infant feeding; however, there has been little systematic examination of how pediatricians' recommendations, affiliated hospitals' policies, counseling practices, and attitudes toward breastfeeding have shifted over the past 2 decades. These trends were examined from 1995 to 2014.
METHODS: Data are from the Periodic Survey (PS) of Fellows, a nationally representative survey of AAP members. PS #30 (1995; response rate = 72%; N = 832), PS #57 (2004; response rate = 55%; N = 675), and PS #89 (2014; response rate = 51%; N = 620) collected demographics, patient and practice characteristics, and detailed responses on pediatricians' recommendations, affiliated hospitals' policies, counseling practices, and attitudes toward breastfeeding. By using bivariate statistics and logistic regression models, the analysis investigated changes over time with predicted values (PVs).
RESULTS: From 1995 to 2014, more pediatricians reported their affiliated hospitals applied for "baby-friendly" designation (PV = 12% in 1995, PV = 56% in 2014; P < .05), and more reported that they recommend exclusive breastfeeding (65% to 76% [P < .05]). However, fewer respondents indicated that mothers can be successful breastfeeding (PV = 70% in 1995, PV = 57% in 2014; P < .05) and that the benefits outweigh the difficulties (PV = 70% in 1995, PV = 50% in 2014; P < .05). Younger pediatricians were less confident than older pediatricians in managing breastfeeding problems (P < .01).
CONCLUSIONS: Pediatricians' recommendations and practices became more closely aligned with AAP policy from 1995 to 2014; however, their attitudes about the likelihood of breastfeeding success have worsened. These 2 divergent trends indicate that even as breastfeeding rates continue to rise, continued efforts to enhance pediatricians' training and attitudes about breastfeeding are necessary.

PMID: 28924062 [PubMed - indexed for MEDLINE]

An instrumental case study examining the introduction and dissemination of the Baby Friendly Health Initiative in Australia: Participants' perspectives.

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An instrumental case study examining the introduction and dissemination of the Baby Friendly Health Initiative in Australia: Participants' perspectives.

Women Birth. 2017 Sep 08;:

Authors: Atchan M, Davis D, Foureur M

Abstract
BACKGROUND: Australia experiences high breastfeeding initiation but low duration rates. UNICEF introduced the global breastfeeding strategy, the Baby-Friendly Hospital Initiative, to Australia in 1992, transferring governance to the Australian College of Midwives (ACM) in 1995. In 2017 23% of facilities were registered as 'baby-friendly' accredited.
AIM: To examine the introduction and dissemination of the Baby-friendly Hospital Initiative into the Australian national setting.
METHODS: An instrumental case study was conducted containing two components: analysis of historical documents pertaining to the Initiative and participant's interviews, reported here. A purposive sampling strategy identified 14 participants from UNICEF, ACM, maternity and community health services, the Australian government and volunteer organisations who took part in in-depth interviews. Thematic analysis explored participants' perceptions of factors influencing the uptake and future of the since renamed Baby Friendly Health Initiative (BFHI) and accreditation programme, BFHI Australia. Two broad categories, enablers and barriers, guided the interviews and analysis.
FINDINGS: Participants revealed a positive perception of the BFHI whilst identifying that its interpretation and expansion in Australia had been negatively influenced by intangible government support and suboptimal capacity building. BFHI's advocacy agenda competed with BFHI Australia's need for financial viability. Widespread stakeholder collaboration and tangible political endorsement was seen as a way to move the strategy forward.
CONCLUSION: Dissemination of BFHI Australia is hampered by multi-level systems issues. Prioritisation, stakeholder collaboration and adequate resourcing of the BFHI is required to create a supportive and enabling environment for Australian women to determine and practice their preferred infant feeding method.

PMID: 28923268 [PubMed - as supplied by publisher]

Factors affecting utilization of youth friendly health services in Lagos State, Nigeria.

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Factors affecting utilization of youth friendly health services in Lagos State, Nigeria.

Int J Adolesc Med Health. 2017 Sep 15;:

Authors: Femi-Adebayo TT, Kuyinu Y, Adejumo OA, Goodman O

Abstract
Background Youth friendly health services (YFHS) are services that attract, respond to the needs of and retain young people for continuing care. This study was conducted to determine the factors affecting utilization of government (GYFF) and non-governmental youth friendly facilities (NGYFF) in Lagos state, Nigeria. Methods A descriptive cross-sectional study was conducted. A total of 543 adolescents aged 15-24 years, between August 1, 2014 and October 31, 2014 were consecutively recruited from 10 (five government and five non-governmental) youth friendly health facilities that had been in operation for at least 6 months prior to the study. Logistic regression was used to determine predictors of utilization of youth friendly health facilities. Results Overall, the mean age of respondents was 17.9 ± 2.8. However, the mean age of respondents at GYFF (18.5 ± 3.0) was significantly higher than those at NGYFF (17.1 ± 2.5) (p < 0.001). Of the 567 youths enrolled, 196 (34.6%) had good utilization of youth friendly facilities (YFF) (34% from the GYFF and 35.2% from the NGYFF). Marital status, school attendance, having a baby, satisfaction with visit, perception that information shared was kept confidential and accessibility of the youth friendly services were associated with utilization of YFF (p < 0.05). Confidentiality and access to facilities were predictors of utilization of YFF. Conclusion There is poor utilization of both government and non-governmental youth friendly services in Lagos, Nigeria. There is a need for both the government and private sector to harmonize resources aimed at encouraging utilization of YFF in Lagos, Nigeria.

PMID: 28915109 [PubMed - as supplied by publisher]

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