When knowledge is not enough: barriers to recommended cassava processing in resource-constrained Kwango, Democratic Republic of Congo.

Background: Despite interventions to provide knowledge and improve bitter cassava processing in the Democratic Republic of Congo (DRC), cassava processing is sub-optimal. Consumption of insufficiently processed bitter cassava is associated with konzo, a neurological paralytic disease.

Objective: This study aimed to explore barriers to appropriate cassava processing carried out by women in one deep rural, economically deprived area of DRC.

Challenges of using e-health technologies to support clinical care in rural Africa: a longitudinal mixed methods study exploring primary health care nurses' experiences of using an electronic clinical decision support system (CDSS) in South Africa.

Background: Electronic decision-making support systems (CDSSs) can support clinicians to make evidence-based, rational clinical decisions about patient management and have been effectively implemented in high-income settings. Integrated Management of Childhood Illness (IMCI) uses clinical algorithms to provide guidelines for management of sick children in primary health care clinics and is widely implemented in low income countries. A CDSS based on IMCI (eIMCI) was developed in South Africa.

A qualitative study to explore dietary knowledge, beliefs, and practices among pregnant women in a rural health zone in the Democratic Republic of Congo.

Background: A nutritious and healthy diet during pregnancy is essential for the health of both mother and baby. Inadequate dietary intake during pregnancy contributes to maternal malnutrition and can have lifelong effects on the health of the child. Maternal malnutrition is common in many low-income countries, including the Democratic Republic of Congo (DRC).

Exploring women's exposure to marketing of commercial formula products: a qualitative marketing study from two sites in South Africa.

Background: Regulating the marketing of commercial formula products is a long-term commitment required to protect breastfeeding. Marketing strategies of formula manufacturers, retailers and distributors evolve at a rapid rate.

Objective: The aim of this research was to describe exposure of pregnant women and mothers of young children in South Africa to marketing of commercial formula products, compared to international recommendations and national legislation.

They push their products through me: health professionals' perspectives on and exposure to marketing of commercial milk formula in Cape Town and Johannesburg, South Africa - a qualitative study.

Objective: To understand the views of public and private sector health professionals on commercial milk formula, to describe their exposure to companies that market commercial milk formula within their workplaces and to describe their awareness of South African (SA) regulations.

Design: A qualitative study consisting of semistructured interviews.

Setting: The study was conducted in Cape Town and Johannesburg, SA.

An exploration of pregnant women and mothers' attitudes, perceptions and experiences of formula feeding and formula marketing, and the factors that influence decision-making about infant feeding in South Africa.

Background: Despite strong evidence showing the lifelong benefits of breastfeeding for mothers and children, global breastfeeding practices remain poor. The International Code of Marketing of Breastmilk Substitutes is an internationally agreed code of practice, adopted by the World Health Assembly in 1981, to regulate promotion of commercial formula, and is supported by legislation in many countries. However, marketing of formula remains widespread and contributes to mother's decisions to formula feed.

Does the unconditional cash transfer program in South Africa provide support for women after child birth? Barriers to accessing the child support grant among women in informal work in Durban, South Africa.

Background: The child support grant (CSG) is the largest unconditional cash transfer program in Africa and aims to alleviate poverty and improve child health and nutrition in low-income families in South Africa. Among informal working women, the CSG is an important source of income after childbirth when informal workers are unable to work, but reports suggest that women experience delays in accessing the CSG. We explore experiences and challenges of accessing the CSG among informal workers in Durban, South Africa.

Health workers' disrespectful and abusive behaviour towards women during labour and delivery: A qualitative study in Durban, South Africa.

Background: A high prevalence of disrespectful and abusive behaviour by health workers towards women during labour and delivery has been widely described in health facilities, particularly in Africa, and is a worldwide public health concern. Such behaviours are barriers to care-seeking, and are associated with adverse outcomes for mothers and newborns. This paper reports experiences of disrespectful care among informal working women in three public health facilities in Durban, South Africa.

Infant feeding, growth monitoring and the double burden of malnutrition among children aged 6 months and their mothers in KwaZulu-Natal, South Africa.

South Africa has a documented high prevalence of stunting and increasing obesity in children as well as obesity in adults. The double burden of malnutrition, which can be on an individual-, household- or population level, has implications for both health and the economic development of a community and country. This paper describes a large-scale survey (N = 774) of infant feeding, growth monitoring and anthropometry among mother and child pairs aged 6 months of age in KwaZulu-Natal (KZN), South Africa, conducted between January and August 2017.

'I am not only beneficial to the community but to the entire country, I am trained as a researcher now': Developing health research skills in low-income countries.

Partnerships between Higher Education Institutions in the global South and North have potential for building capacity in public health research in low-resource countries. We present experiences of partners involved in a North-South-South partnership between universities in Norway, the Democratic Republic of Congo (DRC) and South Africa. The partnership aimed to establish a postgraduate programme in nutritional epidemiology at the University of Kinshasa, DRC, and develop a cadre of researchers and academic leaders to provide locally generated health research to inform policy.

'I can no longer do my work like how I used to': a mixed methods longitudinal cohort study exploring how informal working mothers balance the requirements of livelihood and safe childcare in South Africa.

Background: Returning to work after childbirth is challenging for working mothers. Childcare quality may have lifelong effects on children's health, development and cognitive function. Over 60% of working women globally are informal workers without employment or maternity protection, but little is known about how these women care for their children.

A North-South-South partnership in higher education to develop health research capacity in the Democratic Republic of the Congo: the challenge of finding a common language.

Background: Globally, increasing numbers of higher education institutions (HEIs) in non-English-speaking countries have adopted English as a medium of instruction (EMI), because of the perception that this provides opportunities to attract high-calibre students and academic staff, and engage with the international research community. We report an evaluation of a North-South-South collaboration to develop health research capacity in the Democratic Republic of the Congo (DRC) by establishing a postgraduate programme in nutritional epidemiology at the Kinshasa School of Public Health (KSPH), where EMI was adopted. We report experiences and perceptions of stakeholders, facilitators and students about using EMI.

Establishing a postgraduate programme in nutritional epidemiology to strengthen resource capacity, academic leadership and research in the democratic republic of Congo.

Background: Low- and Middle-income countries (LMIC) face considerable health and nutrition challenges, many of which can be addressed through strong academic leadership and robust research translated into evidence-based practice. A North-South-South partnership between three universities was established to implement a master's programme in nutritional epidemiology at the Kinshasa School of Public Health (KSPH), Democratic Republic of Congo (DRC). The partnership aimed to develop academic leadership and research capacity in the field of nutrition in the DRC.

Addressing the interaction between food insecurity, depression risk and informal work: findings of a cross-sectional survey among informal women workers with young children in South Africa.

Background: There is a high burden of depression globally, including in South Africa. Maternal depression is associated with poverty, unstable income, food insecurity, and lack of partner support, and may lead to poor outcomes for mothers and children. In South Africa one-third of working women are in informal work, which is associated with socioeconomic vulnerability.

'I decided to go back to work so I can afford to buy her formula': a longitudinal mixed-methods study to explore how women in informal work balance the competing demands of infant feeding and working to provide for their family.

Background: In South Africa almost 2 million women work informally. Informal work is characterised by poor job security, low earnings, and unsafe working conditions, with high rates of poverty and food insecurity. The peripartum period is a vulnerable time for many working women.

Translating new evidence into clinical practice: a quasi-experimental controlled before-after study evaluating the effect of a novel outreach mentoring approach on knowledge, attitudes and confidence of health workers providing HIV and infant feeding counselling in South Africa.

Objectives: We report the effectiveness of a mentoring approach to improve health workers' (HWs') knowledge, attitudes and confidence with counselling on HIV and infant feeding.

Design: Quasi-experimental controlled before-after study.

Setting: Randomly selected primary healthcare clinics (n=24 intervention, n=12 comparison); two districts, South Africa.

Evaluation of the effectiveness of a quality improvement intervention to support integration of maternal, child and HIV care in primary health care facilities in South Africa.

Background: Despite policies and guidelines recommending integration of health services in South Africa, provision of maternal and child health services remains fragmented. This study evaluated a rapid, scaleable, quality improvement (QI) intervention to improve integration of maternal and child health and HIV services at a primary health level, in KwaZulu-Natal, South Africa.

Methods: A three-month intervention comprised of six QI mentoring visits, learning sessions with clinic staff to share learnings, and a self-administered checklist aimed to assist health workers monitor and implement an integrated package of health services for mothers and children.

An educational intervention to update health workers about HIV and infant feeding.

Clinical guidelines are used to translate research findings into evidence-based clinical practice but are frequently not comprehensively adopted by health workers (HWs). HIV and infant feeding guidelines were revised by the World Health Organization to align feeding advice for HIV-exposed and unexposed infants, and these were adopted in South Africa in 2017. We describe an innovative, team-based, mentoring programme developed to update HWs on these guidelines.

Communication between mothers and health workers is important for quality of newborn care: a qualitative study in neonatal units in district hospitals in South Africa.

Background: There is a high global burden of neonatal mortality, with many newborn babies dying of preventable and treatable conditions, particularly in low and middle-income countries. Improving quality of newborn care could save the lives of many thousands of babies. Quality of care (QoC) is a complex and multifaceted construct that is difficult to measure, but patients' experiences of care are an important component in any measurement of QoC.

A descriptive study to explore working conditions and childcare practices among informal women workers in KwaZulu-Natal, South Africa: identifying opportunities to support childcare for mothers in informal work.

Background: Although women working in the informal economy are a large and vulnerable group, little is known about infant feeding and childcare practices among these women. The aim of this study was to explore childcare practices among mothers in informal work.

Methods: A cross-sectional survey among mothers with children aged < 2 years working in the informal economy in an urban and a rural site in KwaZulu-Natal, South Africa.

Breastfeeding advice for reality: Women's perspectives on primary care support in South Africa.

Breastfeeding education and support are critical health worker skills. Confusion surrounding infant feeding advice linked to the HIV epidemic has reduced the confidence of health workers to support breastfeeding. High antiretroviral therapy coverage of breastfeeding women living with HIV, and an Infant Feeding policy supportive of breastfeeding, now provides an opportunity to improve breastfeeding practices.

Using an action learning methodology to develop skills of health managers: experiences from KwaZulu-Natal, South Africa.

Background: Strong management skills are key to improving performance of health systems. Action learning, a technique to develop management skills, has been used successfully with health managers but not usually among lower level managers or in low and middle-income countries (LMICs).

Methods: This study uses a qualitative approach to explore experiences, successes and challenges of using an action learning approach to improve skills of managers in neonatal units in KwaZulu-Natal (KZN), South Africa.

A qualitative study exploring infant feeding decision-making between birth and 6 months among HIV-positive mothers.

Despite efforts to support breastfeeding for HIV-positive mothers in South Africa, being HIV-positive remains a barrier to initiating and sustaining breastfeeding. The aim was to explore decision-making about infant feeding practices among HIV-positive mothers in a rural and urban settings in KwaZulu-Natal, South Africa. HIV-positive pregnant women were purposively sampled from one antenatal clinic in each setting.