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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
The Breastfeeding Practices: The Positioning and Attachment Initiative Among the Mothers of Rural Nagpur
Correspondence Address :
Dr. Subhash B. Thakre,
Associate Professor, Department of Community Medicine,
Plot No. 9, Swami Swarupanand Society,
Narendra Nagar, Nagpur-15
Phone: 9822366532
E-mail:drsubhasht@rediffmail.com
Background:
The strategy of the Integrated Management of Neonatal and Childhood Illnesses (IMNCI) has recommended a systematic assessment of breastfeeding and it has emphasized on the counseling of the mother on the proper positioning and the attachment of the infant to the breast. Hence, the present, cross sectional study was undertaken to assess the correct breast positioning and attachment.
Materials and method:
Midwives (ANM) who were trained in IMNCI assessed the breastfeeding positioning and attachment by using the IMNCI guidelines during the study period at a rural hospital in Saoner, Nagpur District.
Results:
The assessment which pertained to the positioning and the attachment was done in 104 babies. A breast feeding problem was recognized in 43.27% babies of the subjects. Poor breast positioning (25% - 53.84%) and poor attachment (26% - 58.65%) were recognized before imparting the health education. A significant (P<0.05) improvement in the breast positioning and attachment was observed after the health education.
Conclusion:
Health education and supporting the mothers while they were breastfeeding were found to be useful tools in improving the positioning and the attachment of the baby to the breast.
Breast positioning, Breast attachment, Rural, IMNCI, Feeding problems
Introduction
Effective breastfeeding is a function of the proper positioning and attachment of the child to the breast (1). Breastfeeding is a natural act and it is also a learned behaviour. The mother and other caregivers require active support from the health care system (2). In India, the practice of breastfeeding is almost universal, but the initiation of breastfeeding is generally quite late and the colostrum is often discarded (3). The Breastfeeding Promotion Network of India (BPNI) was born to protect, promote and to support breastfeeding (4). The National Rural Health Mission (NRHM) intended to implement the Integrated Management of Neonatal and Childhood Illnesses (IMNCI) through the existing healthcare delivery system (5). The IMNCI strategy recommended a systematic assessment of breastfeeding and it emphasized on the counseling of the mother on the proper positioning and the attachment of the infant to the breast (1). Good positioning and attachment of the baby during breastfeeding facilitates milk production and milk release and it helps in preventing sore nipples, engorgement and mastitis (6). The information on the skills of lactating mothers with respect to the proper positioning and attachment of the infant during breastfeeding was lacking. Hence, the present, cross sectional study was undertaken to assess the correct breast positioning and attachment as per the IMNCI guidelines, as were practised by mothers in rural hospitals and to identify the babies with feeding problems.
The study area and the study subjects The present, cross-sectional study was undertaken at the Rural Health Training Centre, Saoner, which is a field practice area of the Government Medical College, Nagpur. This study was undertaken during October – December 2010. All the babies who were delivered at the health centre and their mothers were included in the study. Sample size estimation: The proportion of the infants with a straight neck or a slightly bend back was 71% and 89% before the health education was imparted and after health education was imparted respectively (7). With a power of 90% and an α error of 5%, the sample size which was required was 93 i.e. approximately 100. However, a consecutive sample size of all the 105 babies who were born during the study period was included in the study. One still born baby was excluded. Hence, 104 mothers and their babies were available for the final analysis. D ata collection Socio-demographic characteristics: The information on the socio-demographic characteristics of the mothers like their ages, education, economic status, parity, birth order, birth weight of their babies, etc were obtained. The confidentiality of the data and the privacy of the mothers were respected at all times. An informed consent was obtained from all the study participants. The institutional ethics committee gave their approval in carrying out the study. The assessment of the breastfeeding was done by using the IMNCI assessment form 1 for young infants, after explaining the details of the study to the mothers. The neonates were checked for feeding problems such as feeding less than eight times in the last 24 hours, giving any other food or drinks and low weight for age. The weights of the babies were taken and they were categorized as low birth weight (if their weight was < 2.5kg). The first (at 24 hours after birth) and the second (at the time of the discharge) assessment were done at the health centre. If the baby was not fed in the previous hour, the mother was asked to put her baby to the breast. If the baby was fed during the last one hour, then the mother was asked as to when the baby would feed again and the assessment was planed accordingly. Staff nurse/public health nurse/auxiliary nurse midwives observed the breastfeeding process for four minutes and they recorded the babies’ positioning and attachment to the breast as per the IMNCI guidelines. The poor positioning of the babies was recognized by signs like twisting or bending forward of the babie’s necks, the babie’s bodies being turned away from their mothers, the babie’s bodies being not close to their mothers or only the babie’s neck and head being supported. A baby was said to have a poor attachment when the chin was not touching the breast, when its mouth was not wide open, when its lower lip was not turned outward or when a little areola was visible above than below the mouth of the baby. The signs of good attachment and positioning were recorded as ‘Yes’ and the signs of poor attachment and positioning were recorded as ‘No’ in a data sheet. Irrespective of the good signs or the poor signs of the positioning or attachment, the mother was explained about the good positioning and attachment by using take action cards, which were specially designed for this study. In cases of poor attachment and positioning signs, the staff nurses/ ANMs helped the mothers to position and attach their babies better. Statisticatatisticatatistical analysis The data were analyzed by using the Epi_Info (version 6.04) software package. The continuous data were presented as mean values along with their Standard Deviations (SD). McNemar’s Chi-square test was applied to test the difference between two proportions. A result with a p value of less than 0.05 was considered as statistically significant.
The socio-demographic profiles of the mothers (n=104) who delivered at the Rural Health Centre, Saoner, is shown in [Table/Fig-1]. The mean (± SD) age of the mothers was 24.26 (±3.13), with an age range of 19-35 years. A majority of them were educated. Sixty (57.69%) of the mothers were form rural areas. A majority (81.73%) of the mothers were Hindus and 98.18% of them belonged to the reserved categories. (e.g. scheduled caste, scheduled tribes and other backward categories). Only 19.23% mothers were below the poverty line and 85.58% were primi or second para. (Table/Fig 1) presents the characteristics of the 104 babies. The mean (± SD) birth weight of the neonates was 2.71 (± 0.45) kg. The male: female sex ratio was 1:089. A majority (84.62%) of the newborns received breastfeeding within one hour of their birth. Forty five (43.27%) of the babies had at least one of the feeding problems like feeding < 8 times in 24 hours, taking any other food or drink and low birth weight. Colostrum was fed to a majority i.e. 96 (92.31%) of the babies and only 6.73% mothers fed other foods or drinks to their babies. The assessment which was related to the positioning of the babies during breastfeeding before and after the health education, is shown in (Table/Fig 2). After the health education, a significant number 94(90.38%) of the mothers were found to keep their babie’s necks and bodies straight (p=0.01), 74(71.15%) mothers kept their babies close to them (p=0.001), 73(70.19%) babie’s bodies were turned towards their mothers (p=0.01), and 44(42.31%) babie’s whole bodies were found to be supported with both the hands of their mothers (p=0.01). The assessment which pertained to the attachment of the babies which was done before and after the health education revealed that in a significant (p=0.01) number of babies 89(85.58%), the chin was touching the breast, in 64(61.54%) babies, the lower lip was turned outwards and in 90(86.54%) babies, the mouth was widely open.
Effective breastfeeding is crucial for getting all the benefits of breastfeeding (8). The various barriers such as the mother’s poor awareness about exclusive breast feeding, fear of inadequacy of the breast milk and poor support at the family level are known; (9) however, the information on the mother’s skills on the positioning and the attachment of the baby to the breast have not been well documented (10). A study which was done in the rural areas of north India reported that significantly more numbers of mothers of the babies with feeding problems had problems in the attachment of the baby to the breast as well as in the positioning of the infant to the breast (7). The present study attempted to assess the breast positioning and the attachment of the babies and the feeding problems in a sample of rural and urban mothers in Nagpur district. Our results indicated that about 43.26% of the babies had any of the feeding problems like feeding less than eight times in 24 hours, being given any other food or drinks or low weight for age, even though all the deliveries took place in the health unit. Only 6.7% of the infants were given food or drinks other than the mother’s milk in our study as compared to 26.3% in another study (7). In our study, the initiation of breastfeeding within one hour was 84.62%. In other parts of Maharashtra (11), the breastfeeding within one hour was reported to be 24.1%, whereas in this study it was 84.62%. The better practices which were adopted by the mothers with respect to the early initiation of feeding, the frequency of feeding and pre-lacteal feeding in the study area, may be attributed to the hospital deliveries. It may also be due to the awareness and the education of the pregnant mothers through the celebration of the village level monthly Bal Suraksha 3Diwas (BSD) and the Village Health,Nutrition Day (VHND) which are under the National Rural Health Mission (12),(13). After the delivery, there is an opportunity to educate and support the mothers about the correct positioning and the attachment of the infant to the breast, which is for effective breastfeeding. No significant difference was observed in the supporting of the baby by both the hands by the mother in the urban and rural combined sample. Other authors have also reported similar findings (7),(14). In the study area, both the rural as well as the urban women customarily wore sarees and blouses. To feed the babies, the mothers had to lift their blouses to their chests and they had to hold them with one of their hands. Many of the mothers held their breasts with one hand and so they found it very difficult to support their babies with both the hands. In such situations, recommending breastfeeding as per the IMNCI guidelines became a bit difficult. The pre-and post- comparisons showed no significant differences in the assessment visibility of the areola in the combined sample (rural+urban mothers). Law et al. demonstrated that a 4-hour workshop in a positioning and attachment health education programme by using a ‘hands-off’ approach, can increase the midwives’ knowledge on breastfeeding support, which is relevant for the immediate post-natal period. 10 Wallace and Kosmala-Anderson reported that only 54% of the midwives in England were competent in the positioning and attachment of their babies to their breasts (15). A hospital based study in Libya on the breast feeding practices- positioning and attachment also reported similar findings (16). Another study 7 also confirmed our findings that the IMNCI guidelines of breastfeeding- helped mothers in bringing the babies close to them and in turning towards them. The staff of the health care facilities should ensure the education of the mothers regarding the positioning and the attachment of their infants to their breasts before their discharge from the health care facilities.
Abbreviatiiations
AWW - Anganwadi Worker
ASHA - Accredited Social Health Activist.
ANM Auxiliary Nurse and Midwifery
IMNCI - Integrated Management of Neonatal
and Childhood Illness
NRHM - National Rural Health Mission
BPL - Below poverty line.
th
We would like to take this opportunity express our sincere gratitude to all those who have in some way contributed to bring this study in the final shape. In particular, we would like to thank all the study participant. We thank Dr. Arun Humane, Professor and Head, Department of Community Medicine, Government Medical College, Nagpur for constant encouragement and support to carry out this study.
ID: JCDR/2012/4704:2439
Date of Submission: Jun 14, 2012
Date of Peer Review: Jun 22, 2012
Date of Acceptance: Jun 30, 2012
Date of Publishing: Sep 30, 2012
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