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Moraes BA, Strada JKR, Gasparin VA, Espirito-Santo LCD, Gouveia HG, Gonçalves ADC. Breastfeeding in the first six months of life for babies seen by Lactation Consulting. Rev Lat Am Enfermagem 2021; 29:e3412. [PMID: 33852684 PMCID: PMC8040780 DOI: 10.1590/1518-8345.3538.3412] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 08/10/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to identify breastfeeding patterns, survival of exclusive breastfeeding and factors associated with its interruption, in the first six months of life of babies seen by Lactation Consulting. METHOD a prospective cohort, with 231 mother-babies in a Baby-Friendly Hospital. An initial questionnaire was applied after 24 hours of birth, after consulting, as well as a follow-up questionnaire, applied by telephone at 15, 30, 60, 120 and 180 days, with sociodemographic and obstetric variables, maternal habits, father's schooling, birth data and baby feeding. Survival Analysis was carried out. RESULTS at 180 days of age, exclusive breastfeeding was 12.7% and the probability was 19.6% in the analysis of the survival curve. The factors associated with its interruption were smoking during pregnancy (HR 1.66; CI 1.05 - 2.61), age ≥ 35 years old (HR 1.73; CI 1.03 - 2.90), difficulty in breastfeeding after hospital discharge (HR 2.09; CI 1.29 - 3.41), search for professional assistance (HR 2.45; CI 1.69 - 3.54) and use of a pacifier (HR 1.76; IC 1.21 - 2.58). CONCLUSION lactation consultancy contributed to the improvement of the exclusive breastfeeding rates, although there are opportunities for advances.
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Affiliation(s)
- Bruna Alibio Moraes
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil
| | | | - Vanessa Aparecida Gasparin
- Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil
- Universidade do Estado de Santa Catarina, Departamento de Enfermagem, Chapecó, SC, Brazil
| | | | - Helga Geremias Gouveia
- Universidade Federal do Rio Grande do Sul, Departamento de Enfermagem Materno Infantil, Porto Alegre, RS, Brazil
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Agampodi TC, Dharmasoma NK, Koralagedara IS, Dissanayaka T, Warnasekara J, Agampodi SB, Perez-Escamilla R. Barriers for early initiation and exclusive breastfeeding up to six months in predominantly rural Sri Lanka: a need to strengthen policy implementation. Int Breastfeed J 2021; 16:32. [PMID: 33832496 PMCID: PMC8034146 DOI: 10.1186/s13006-021-00378-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 03/17/2021] [Indexed: 11/10/2022] Open
Abstract
Background Sri Lanka was named as the first-ever ‘Green’ breastfeeding nation status by the World Breastfeeding Trends Initiative (WBTi) in January 2020. However, improvements are still needed. This study aims to identify barriers and facilitators for early initiation of breastfeeding and exclusive breastfeeding for 6 months in rural Sri Lanka. Methods We conducted in-depth interviews with 16 mothers with infants, who had been unable to practice early initiation of breastfeeding and/or exclusive breastfeeding (EBF), in six child-welfare clinics in Anuradhapura, Sri Lanka. Three focus group discussions were held with public health midwives (PHMs). Initial thematic analysis that built upon force field and social learning theories was performed. Results Main barriers for EBF were clustered at three time periods; during the first 2–3 days, 2–3 weeks, and 4–5 months postpartum. Early barriers included cesarean section pain, poor breast latch, maternal exhaustion, suboptimal maternity ward environment, and lack of support for breastfeeding. Around 2–3 weeks postpartum mothers introduced water or infant formula due to social norms and poor support. On-demand feeding was misunderstood. Around 4 and 5 months postpartum, EBF ended due to return to work. PHMs reported a heavy workload limiting their time to support breastfeeding. Conclusion EBF interruption was due to diverse individual- and environnmental- level barriers that varied across the first 6 months. To improve EBF, Sri Lanka should focus on strengthening policies for reducing the excessive rates of cesarean section, improving support in maternity ward facilities, fostering on-demand breastfeeding, enhancing support for working mothers and reducing the work load of PHMs. Supplementary Information The online version contains supplementary material available at 10.1186/s13006-021-00378-0.
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Affiliation(s)
- Thilini Chanchala Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka.
| | - Neerodha Kithmini Dharmasoma
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Iresha Sandamali Koralagedara
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Thushari Dissanayaka
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Janith Warnasekara
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Suneth Buddhika Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Rafael Perez-Escamilla
- Department of Social and Behavioral Science, Yale School of Public Health, New Haven, USA
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153
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Abstract
BACKGROUND There is great global variation in the sleeping arrangements for healthy newborn infants. Bed sharing is a type of sleeping practice in which the sleeping surface (e.g. bed, couch or armchair, or some other sleeping surface) is shared between the infant and another person. The possible physiological benefits include better oxygen and cardiopulmonary stability, fewer crying episodes, less risk of hypothermia, and a longer duration of breastfeeding. On the other hand, the most important harmful effect of bed sharing is that it may increase the risk of sudden infant death syndrome (SIDS). Studies have found conflicting evidence regarding the safety and efficacy of bed sharing during infancy. OBJECTIVES To evaluate the efficacy and safety of bed sharing, started during the neonatal period, on breastfeeding status (exclusive and total duration of breastfeeding), incidence of SIDS, rates of hypothermia, neonatal and infant mortality, and long-term neurodevelopmental outcomes. SEARCH METHODS We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL 2020, Issue 7) in the Cochrane Library; MEDLINE via PubMed (1966 to 23 July 2020), CINAHL (1982 to 23 July 2020), and LILACS (1980 to 23 July 2020). We also searched clinical trials databases, and the reference lists of retrieved articles, for randomised controlled trials (RCTs) and quasi-RCTS. SELECTION CRITERIA We planned to include RCTs or quasi-RCTs (including cluster-randomised trials) that included term neonates initiated on bed sharing within 24 hours of birth (and continuing to bed share with the mother in the first four weeks of life, followed by a variable time period thereafter), and compared them to a 'no bed sharing' group. DATA COLLECTION AND ANALYSIS We used standard methodological procedures as recommended by Cochrane. We planned to use the GRADE approach to assess the certainty of evidence. MAIN RESULTS Our search strategy yielded 6231 records. After removal of duplicate records, we screened 2745 records by title and abstract. We excluded 2739 records that did not match our inclusion criteria. We obtained six full-text studies for assessment. These six studies did not meet the eligibility criteria and were excluded. AUTHORS' CONCLUSIONS We did not find any studies that met our inclusion criteria. There is a need for RCTs on bed sharing in healthy term neonates that directly assess efficacy (i.e. studies in a controlled setting, like hospital) or effectiveness (i.e. studies conducted in community or home settings) and safety. Future studies should assess outcomes such as breastfeeding status and risk of SIDS. They should also include neonates from high-income countries and low- and middle-income countries, especially those countries where bed sharing is more prevalent because of cultural practices (e.g. Asian countries).
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Affiliation(s)
- Rashmi R Das
- Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | - Mari Jeeva Sankar
- Newborn Health Knowledge Centre, WHO Collaborating Centre for Training and Research in Newborn Care, Department of Pediatrics, All India Institute of Medical Sciences, Delhi, India
| | - Ramesh Agarwal
- Newborn Health Knowledge Centre, WHO Collaborating Centre for Training and Research in Newborn Care, Department of Pediatrics, All India Institute of Medical Sciences, Delhi, India
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Baker P, Santos T, Neves PA, Machado P, Smith J, Piwoz E, Barros AJD, Victora CG, McCoy D. First-food systems transformations and the ultra-processing of infant and young child diets: The determinants, dynamics and consequences of the global rise in commercial milk formula consumption. MATERNAL & CHILD NUTRITION 2021; 17:e13097. [PMID: 33145965 PMCID: PMC7988871 DOI: 10.1111/mcn.13097] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/25/2020] [Accepted: 09/27/2020] [Indexed: 12/12/2022]
Abstract
The inappropriate marketing and aggressive promotion of breastmilk substitutes (BMS) undermines breastfeeding and harms child and maternal health in all country contexts. Although a global milk formula 'sales boom' is reportedly underway, few studies have investigated its dynamics and determinants. This study takes two steps. First, it describes trends and patterns in global formula sales volumes (apparent consumption), by country income and region. Data are reported for 77 countries, for the years 2005-19, and for the standard (0-6 months), follow-up (7-12 m), toddler (13-36 m), and special (0-6 m) categories. Second, it draws from the literature to understand how transformations underway in first-food systems - those that provision foods for children aged 0-36 months - explain the global transition to higher formula diets. Total world formula sales grew by 115% between 2005 and 2019, from 3.5 to 7.4 kg/child, led by highly-populated middle-income countries. Growth was rapid in South East and East Asia, especially in China, which now accounts for one third of world sales. This transition is linked with factors that generate demand for BMS, including rising incomes, urbanisation, the changing nature of woman's work, social norms, media influences and medicalisation. It also reflects the globalization of the baby food industry and its supply chains, including the increasing intensity and sophistication of its marketing practices. Policy and regulatory frameworks designed to protect, promote and support breastfeeding are partially or completely inadequate in the majority of countries, hence supporting industry expansion over child nutrition. The results raise serious concern for global child and maternal health.
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Affiliation(s)
- Phillip Baker
- Institute for Physical Activity and NutritionDeakin UniversityGeelongVictoriaAustralia
- School of Exercise and Nutrition SciencesDeakin UniversityGeelongVictoriaAustralia
| | - Thiago Santos
- International Center for Equity in HealthFederal University of PelotasPelotasBrazil
| | - Paulo Augusto Neves
- International Center for Equity in HealthFederal University of PelotasPelotasBrazil
| | - Priscila Machado
- Institute for Physical Activity and NutritionDeakin UniversityGeelongVictoriaAustralia
| | - Julie Smith
- Research School of Population HealthAustralian National UniversityCanberraAustralian Capital TerritoryAustralia
| | - Ellen Piwoz
- Bill and Melinda Gates Foundation, SeattleWashingtonUSA
| | - Aluisio J. D. Barros
- International Center for Equity in HealthFederal University of PelotasPelotasBrazil
| | - Cesar G. Victora
- International Center for Equity in HealthFederal University of PelotasPelotasBrazil
| | - David McCoy
- Centre for Primary Care and Public HealthQueen Mary UniversityLondonUK
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155
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Black MM, Behrman JR, Daelmans B, Prado EL, Richter L, Tomlinson M, Trude ACB, Wertlieb D, Wuermli AJ, Yoshikawa H. The principles of Nurturing Care promote human capital and mitigate adversities from preconception through adolescence. BMJ Glob Health 2021; 6:e004436. [PMID: 33875519 PMCID: PMC8057542 DOI: 10.1136/bmjgh-2020-004436] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 03/17/2021] [Accepted: 03/27/2021] [Indexed: 01/31/2023] Open
Abstract
A comprehensive evidence-based framework is needed to guide policies and programmes that enable children and adolescents to accrue the human capital required to meet the Sustainable Development Goals (SDGs). This paper proposes a comprehensive, multisectoral, multilevel life-course conceptualisation of human capital development by building on the Nurturing Care Framework (NCF), originally developed for the foundational period of growth and development through the age 3 years. Nurturing care (NC) comprises stable environments that promote children's health and nutrition, protect from threats, and provide opportunities for learning and responsive, emotionally supportive and developmentally enriching relationships. NC is fostered by families, communities, services, national policies and beyond. The principles apply across the life course, endorse equity and human rights, and promote long-term human capital. This paper presents an evidence-based argument for the extension of the NCF from preconception through adolescence (0-20 years), organised into six developmental periods: preconception/prenatal, newborn/birth, infancy/toddlerhood, preschool, middle childhood and adolescence. The proposed framework advances human capital within each developmental period by promoting resilience and adaptive developmental trajectories while mitigating negative consequences of adversities.Attaining the SDGs depends on strengthening human capital formation, extending throughout childhood and adolescence and supported by NC. Embedded in enabling laws, policies and services, the dynamic NCF components can mitigate adversities, enhance resilience and promote the well-being of marginalised groups. The life-course extension of the NCF is strategically positioned to enhance human capital, to attain the SDGs and to ensure that children or adolescents are not left behind in reaching their developmental potential.
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Affiliation(s)
- Maureen M Black
- Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
- RTI International, Research Triangle Park, North Carolina, USA
| | - Jere R Behrman
- Department of Economics, University of Pennsylvania School of Arts and Sciences, Philadelphia, Pennsylvania, USA
- Population Studies Center, University of Pennsylvania School of Arts and Sciences, Philadelphia, Pennsylvania, USA
| | - Bernadette Daelmans
- Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | | | - Linda Richter
- Centre of Wxcellence in Human Development, University of the Witwatersrand, Johannesburg, Soutn Africa
| | - Mark Tomlinson
- Global Health, Stellenbosch University, Cape Town, South Africa
- School of Nursing and Midwifery, Queens University, Belfast, UK
| | - Angela C B Trude
- Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Donald Wertlieb
- Eliot-Pearson Department of Child Study and Human Development, Tufts University, Medford, Massachusetts, USA
| | - Alice J Wuermli
- Global TIES for Children, New York University, New York, New York, USA
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156
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Burnham L, Gambari A, Beliveau P, Ustianov J, Parker MG, Merewood A. Perspectives of Nurses in Mississippi on Implementation of the Baby-Friendly Hospital Initiative. J Obstet Gynecol Neonatal Nurs 2021; 50:392-401. [PMID: 33775640 DOI: 10.1016/j.jogn.2021.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To describe the experiences and perceptions of Mississippi maternity nurses in hospitals that gained Baby-Friendly designation, including perceived barriers and facilitators to implementation of the Baby-Friendly Hospital Initiative. DESIGN Descriptive qualitative study using thematic analysis of focus group data. SETTING Maternity care services of five Baby-Friendly-designated hospitals in Mississippi. PARTICIPANTS Twenty-two maternity nurses. METHODS We conducted 90-minute in-person focus groups in which participants described their hospitals' Baby-Friendly experiences. We analyzed focus group transcripts thematically to describe the facilitators and barriers to implementation of the Baby-Friendly initiative. RESULTS We identified five main themes: The Change Required for BFHI Was Hard, Nurses Felt Empowered by Taking Leadership Roles, Patient Education Was Pivotal to Practice Implementation, Nurses Felt Challenged by Unintended Consequences, and Attitudes Changed From Negative to Positive Over the Course of Adoption. CONCLUSION Participants from hospitals throughout Mississippi shared similar experiences and cited common facilitators and barriers to achieving Baby-Friendly designation. Participants described the overall process of Baby-Friendly designation as challenging but worthwhile because of the resulting improvements in maternity care, nurses' knowledge, and health outcomes for women and their newborns. Nurses at other hospitals that seek to obtain designation can learn from these experiences to make their own transitions easier.
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157
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Breast-feeding promotion in hospitals and prospective breast-feeding rates during the first year of life in two national surveys 1997-1998 and 2017-2019 in Germany. Public Health Nutr 2021; 24:2411-2423. [PMID: 33722333 DOI: 10.1017/s1368980021001099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The present study aimed to assess the current state of breast-feeding promotion in hospitals and the prevalence of breast-feeding during the first year of life in Germany and to compare the results with a study 20 years earlier. DESIGN In the studies on 'breast-feeding and infant nutrition in Germany' named 'SuSe', a cross-sectional survey in hospitals was combined with a subsequent prospective survey of breast-feeding and infant nutrition during the first year of life (0·5, 2, 4, 6 and 12 months after birth) in mother-infant pairs who were recruited in the hospitals. Written questionnaires and phone calls were used in SuSe I and web-based questionnaires in SuSe II. Breast-feeding promotion and prevalence were evaluated using recommendations from the WHO and the UNICEF. SETTING Two nationwide surveys SuSe I (1997-1998) and SuSe II (2017-2019). PARTICIPANTS In SuSe I, 177 hospitals and 1717 mother-infant pairs and in SuSe II 109 hospitals and 962 mother-infant pairs were included. RESULTS In SuSe II, hospitals implemented seven of the WHO 'Ten Steps to Successful Breastfeeding' to a greater extent than the hospitals in SuSe I. More mothers exclusively breastfed for 4 months (57 % v. 33 %) and continued breast-feeding until 6 (78 % v. 48 %) and 12 months (41 % v. 13 %). In both studies, exclusive breast-feeding decreased between 4 and 6 months of age due to the introduction of complementary feeding. CONCLUSIONS In Germany, breast-feeding habits have come closer to the recommendations over the last 20 years.
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158
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Birhan TY, Birhan NA, Alene M. Pooled Prevalence and Determinants of Prelacteal Feeding Practice in Eastern Africa Evidence from Demographic and Health Survey Data: A Multilevel Study. Risk Manag Healthc Policy 2021; 14:1085-1095. [PMID: 33758561 PMCID: PMC7979327 DOI: 10.2147/rmhp.s297564] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 02/25/2021] [Indexed: 12/20/2022] Open
Abstract
Background Despite the benefits of breast milk and colostrum for the health and survival of children, early prelacteal feeding is commonly practiced worldwide, particularly in low- and middle-income countries. The aim of this study was to evaluate the pooled prevalence and determinants of prelacteal feeding in Eastern Africa. Methods This study was carried out within 11 East African countries from 2010 to 2018, a pooled study of prelacteal feeding was performed. For assessing model fitness and contrast, intra-class correlation coefficient, median odds ratio, proportional change in variance, and deviance were used. In order to identify possible covariates associated with prelacteal feeding in the study area, the multilevel multivariable logistic regression model was adapted. Adjusted Odds Ratio was used with 95% confidence interval to declare major prelacteal factors. Results The pooled prevalence of prelacteal feeding in Eastern Africa was 12% (95% CI: 11.42–12.53%), with the highest prevalence of prelacteal feeding in the Comoros (39%) and the lowest in Malawi (3%). Multilevel multivariable logistic regression model; wealth index (AOR = 1.22; 95% CI 1.03–1.34), ANC visit (AOR = 1.42; 95% CI: 1.12–1.79), institutional delivery (AOR = 0.58; 95% CI: 0.58–0.64), small birth size (AOR = 1.14; 95% CI: 1.30–1.26), delivery type (AOR = 2.61; 95% CI: 2.30–2.96), and high community ANC visit (AOR = 0.90; 95% CI: 0.84–0.97) were significantly associated with prelacteal feeding in Eastern Africa. Conclusion In East Africa, the magnitude of prelacteal feeding was still high. The possible determinants of prelacteal feeding in Eastern Africa were wealth index, birth interval, delivery mode, place of delivery, ANC visit, and community ANC visit. Structural improvements are required for women with caesarean births to achieve optimal breastfeeding practice in Eastern Africa.
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Affiliation(s)
- Tilahun Yemanu Birhan
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Nigussie Adam Birhan
- Department of Statistics, College of Natural and Computational Science, Mekdela Amba University, Mekdela, Ethiopia
| | - Muluneh Alene
- Department of Public Health, Debre Markos University, Debre Markos, Ethiopia
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Segura-Pérez S, Hromi-Fiedler A, Adnew M, Nyhan K, Pérez-Escamilla R. Impact of breastfeeding interventions among United States minority women on breastfeeding outcomes: a systematic review. Int J Equity Health 2021; 20:72. [PMID: 33676506 PMCID: PMC7936442 DOI: 10.1186/s12939-021-01388-4] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/18/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND In the U.S., strong ethnic/racial, socioeconomic, demographic, and geographic breastfeeding (BF) inequities persist, and African American and Hispanic women are less likely to meet their breastfeeding goals compared to White women. This systematic review (SR) was designed to answer the question: What is the impact of breastfeeding interventions targeting ethnic/racial minority women in the U.S. on improving BF initiation, duration and exclusivity rates? METHODS The SR was conducted following the Institute of Medicine Guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. The study protocol was developed and registered a priori in PROSPERO (ID#CRD42020177764). The electronical databases searched was MEDLINE All (Ovid). Search strategies were led by the team's expert public health librarian using both controlled vocabulary and free text queries and were tested against a validated set of relevant papers included in existing reviews. The GRADE methodology was used to assess the quality of the studies. RESULTS We included 60 studies that had randomized (n = 25), observational (n = 24), quasi-experimental (n = 9), or cross-sectional (n = 2) designs. The studies focused on populations that were multi-ethnic/racial (n = 22), only Hispanic (n = 24), only Black (n = 13), and only American Indian (n = 1). The study interventions were classified following the socioecological model: macrosystem/policy level (n = 6); community level (n=51), which included healthcare organizations (n = 34), The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) (n = 9), and community organizations/public health institutions (n = 8); and interpersonal level (n = 3). CONCLUSIONS Policy and community level interventions delivered through WIC, healthcare facilities, and community agencies) are likely to improve BF outcomes among women of color. The combination of interventions at different levels of the socioecological model has not been studied among minority women in the U.S. Implementation science research is needed to learn how best to scale up and sustain effective BF interventions, taking into account the needs and wants of minority women. Thus, it is strongly recommended to conduct large scale implementation research studies addressesing how to strengthen the different health and social environments surrounding women of color in the U.S. to improving their BF outcomes.
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Affiliation(s)
| | | | - Misikir Adnew
- Yale School of Public Health, 135 College Street, New Haven, CT 06510 USA
| | - Kate Nyhan
- Harvey Cushing/John Hay Whitney Medical Library, Yale School of Public Health, New Haven, USA
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160
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Francis J, Mildon A, Stewart S, Underhill B, Ismail S, Di Ruggiero E, Tarasuk V, Sellen DW, O'Connor DL. Breastfeeding rates are high in a prenatal community support program targeting vulnerable women and offering enhanced postnatal lactation support: a prospective cohort study. Int J Equity Health 2021; 20:71. [PMID: 33658034 PMCID: PMC7931510 DOI: 10.1186/s12939-021-01386-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/13/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND In Canada, 91% of all mothers initiate breastfeeding, but 40-50% stop by 6 months and only 34% breastfeed exclusively for 6 months, with lower rates among socially and/or economically vulnerable women. The Canada Prenatal Nutrition Program (CPNP) aims to support breastfeeding among vulnerable women, but there is no formal framework or funding for sites to integrate proactive postnatal breastfeeding support. This research aimed to i) describe infant feeding practices among clients of one Toronto CPNP site using charitable funds to offer a lactation support program (in-home lactation consultant visits, breast pumps); ii) determine whether breastfeeding outcomes at 6 months differ based on maternal sociodemographics and food insecurity; and iii) assess utilization of the lactation support program. METHODS Infant feeding practices were collected prospectively at 2 weeks, 2, 4 and 6 months postpartum via telephone questionnaires (n = 199). Maternal sociodemographics were collected at 2 weeks and food insecurity data at 6 months postpartum. Program monitoring records were used to determine utilization of the lactation support program. RESULTS Ninety-one percent of participants were born outside of Canada; 55% had incomes below the Low-Income Cut-Off; and 55% reported food insecurity. All participants initiated breastfeeding, 84% continued for 6 months and 16% exclusively breastfed for 6 months. Among breastfed infants, ≥76% received vitamin D supplementation. Approximately 50% of infants were introduced to solids before 6 months. Only high school education or less and food insecurity were associated with lower breastfeeding rates. Overall, 75% of participants received at least one visit with a lactation consultant and 95% of these received a breast pump. CONCLUSIONS This study provides initial evidence that postnatal lactation support can be delivered within a CPNP site, with high uptake by clients. While all participants initiated breastfeeding and 84% continued for 6 months, adherence to the recommended 6 months of exclusive breastfeeding was low. Further research is needed to better understand the barriers to exclusive breastfeeding and how to support this practice among vulnerable women. Study registered at clinicaltrials.gov as NCT03400605 .
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Affiliation(s)
- Jane Francis
- Nutritional Sciences, University of Toronto, Toronto, ON, Canada
- Translational Medicine Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - Alison Mildon
- Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | - Stacia Stewart
- Health Promotion & Community Engagement, Parkdale Queen West Community Health Centre, Toronto, ON, Canada
| | - Bronwyn Underhill
- Health Promotion & Community Engagement, Parkdale Queen West Community Health Centre, Toronto, ON, Canada
| | - Samantha Ismail
- Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | - Erica Di Ruggiero
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Valerie Tarasuk
- Nutritional Sciences, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Joannah and Brian Lawson Centre for Child Nutrition, University of Toronto, Toronto, ON, Canada
| | - Daniel W Sellen
- Nutritional Sciences, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Joannah and Brian Lawson Centre for Child Nutrition, University of Toronto, Toronto, ON, Canada
- Anthropology, University of Toronto, Toronto, ON, Canada
| | - Deborah L O'Connor
- Nutritional Sciences, University of Toronto, Toronto, ON, Canada.
- Translational Medicine Program, The Hospital for Sick Children, Toronto, ON, Canada.
- Joannah and Brian Lawson Centre for Child Nutrition, University of Toronto, Toronto, ON, Canada.
- Pediatrics, Sinai Health, Toronto, ON, Canada.
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161
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Vanguri S, Rogers-McQuade H, Sriraman NK. ABM Clinical Protocol #14: Breastfeeding-Friendly Physician's Office-Optimizing Care for Infants and Children. Breastfeed Med 2021; 16:175-184. [PMID: 33599542 DOI: 10.1089/bfm.2021.29175.sjv] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A central goal of the Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.
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Affiliation(s)
- Swathi Vanguri
- Department of Obstetrics and Gynecology, Crozer-Keystone Health System, Upland, Pennsylvania, USA
| | | | - Natasha K Sriraman
- Department of Pediatrics, Eastern Virginia Medical School, Norfolk, Virginia, USA.,Division of General Academic Pediatrics, Children's Hospital of the King's Daughters, Norfolk, Virginia, USA.,Division of Community Health & Research, Eastern Virginia Medical School, Norfolk, Virginia, USA
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162
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Ward LP, Tonnis R, Otuneye AT, Clemens N, Akinbi H, Morrow AL. Impact of Institutional Breastfeeding Support in Very Low-Birth Weight Infants. Breastfeed Med 2021; 16:238-244. [PMID: 33211538 DOI: 10.1089/bfm.2020.0137] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background and Objectives: Feeding of human milk is associated with improved health outcomes in preterm infants. Mothers of preterm infants have difficulty establishing and maintaining an adequate milk supply. Our institution participated in Best Fed Beginnings (BFB), a national breastfeeding quality improvement collaborative, in 2012. Although most practice changes targeted healthy term infants, we hypothesized that mother's milk feeding (MMF) to preterm infants would also improve. Our objective was to compare MMF in very low-birth weight (VLBW) infants at discharge before and after our participation in BFB. Materials and Methods: We completed a retrospective chart review of VLBW infants born between January 2006 and June 2016. The primary outcome measure was the percentage of VLBW infants receiving MMF at hospital discharge. We used Fisher's exact test to determine the difference before and after 2012 and performed the Kruskal-Wallis test to determine changes in median time to pump initiation in mothers of VLBW infants. Multiple logistic regression was used to determine variables associated with the primary outcome. Results: A total of 1,077 VLBW infants were eligible. After launching BFB, MMF at discharge increased in VLBW infants, from 35.2% to 46.0%, p < 0.001. Median time to pump initiation decreased from 11 to 5 hours after 2012, p = 0.0001. Factors significantly associated with receiving MMF at discharge included birth post-BFB; private insurance; non-Black race; shorter length of stay; older maternal age; and mother's milk as first feeding. Conclusions: Hospital culture supportive of breastfeeding impacts not only healthy term infants but also VLBW infants. Earlier initiation of milk expression significantly improves provision of MMF to preterm infants at discharge.
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Affiliation(s)
- Laura P Ward
- Division of Neonatology, Cincinnati Children's Hospital Medical Center, Perinatal Institute, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Rachel Tonnis
- Pediatric Residency Program, UT Southwestern Medical Center, Dallas, Texas, USA
| | | | - Nancy Clemens
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Henry Akinbi
- Division of Neonatology, Cincinnati Children's Hospital Medical Center, Perinatal Institute, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Ardythe L Morrow
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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163
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Abstract
This review highlights clinical outcomes of human milk from infancy through adulthood. Human milk outcomes of both preterm and term infants, including critically ill term infants (such as infants with congenital heart disease and those requiring therapeutic hypothermia) are summarized. Several human milk diets are identified to reduce the risk of specific diseases. Emerging research of newly discovered components of human milk are also reviewed. Human milk has significant effects on the gut microbiome, somatic growth, and neurocognitive outcomes. Continued research promises to improve donor human milk and donor milk derived products to achieve better outcomes for infants who do not receive their own mother's milk. The promotion of human milk is well-founded on evidence from the previous half century.
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Affiliation(s)
- Katherine E Chetta
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Medical University of South Carolina, Shawn Jenkins Children's Hospital, 10 McClennan Banks Drive, MSC 915, Charleston, SC 29425, United States.
| | - Elizabeth V Schulz
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Uniformed Services University, United States
| | - Carol L Wagner
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Medical University of South Carolina, Shawn Jenkins Children's Hospital, 10 McClennan Banks Drive, MSC 915, Charleston, SC 29425, United States
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164
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Ruzafa‐Martinez M, Harillo‐Acevedo D, Ramos‐Morcillo AJ. Monitoring of the Implementation of a Breastfeeding Guideline for 6 Years: A Mixed‐Methods Study Using an Interrupted Time Series Approach. J Nurs Scholarsh 2021; 53:358-368. [DOI: 10.1111/jnu.12636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2020] [Indexed: 02/03/2023]
Affiliation(s)
- Maria Ruzafa‐Martinez
- Associate Professor Nursing Department Faculty of Nursing University of Murcia Murcia Spain
| | - David Harillo‐Acevedo
- Midwife, Hospital Rafael Méndez III Healthcare AreaMurcia Health Service Murcia Spain
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165
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Maastrup R, Rom AL, Walloee S, Sandfeld HB, Kronborg H. Improved exclusive breastfeeding rates in preterm infants after a neonatal nurse training program focusing on six breastfeeding-supportive clinical practices. PLoS One 2021; 16:e0245273. [PMID: 33534831 PMCID: PMC7857627 DOI: 10.1371/journal.pone.0245273] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 12/27/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Early breast milk expression, prolonged skin-to-skin contact, rooming-in, use of test-weighing and minimizing use of pacifiers are positively associated with exclusive breastfeeding of preterm infants, whereas use of nipple shields is negatively associated. AIM To test whether a training program for neonatal nurses with a focus on these six breastfeeding-supportive clinical practices affects the rate of preterm infants exclusively breastfed at discharge to home, the postmenstrual age at establishment of exclusive breastfeeding, and maternal self-reported use of the practice in the neonatal intensive care unit, the. METHODS A quasi-experimental multi-centre intervention study from 2016-2019 including a control group of 420 preterm mother-infant dyads, an intervention with a training program for neonatal nurses and implementation of weekly breastfeeding meetings for neonatal nurses, and an intervention group of 494 preterm mother-infant dyads. RESULTS Significantly more preterm infants in the intervention group were exclusively breastfed at discharge to home (66.6%) than in the control group (58.1%) p = 0.008. There was no significant difference in postmenstrual age at establishment of exclusive breastfeeding between control and intervention group (37.5 vs.37.8 weeks, p = 0.073). Compared to the control group the number of infants continuing daily skin-to-skin contact after incubator care increased (83.2% vs. 88.3%, p = 0.035), infants using a nipple shield decreased (61.8% vs. 54.2%, p = 0.029), and the number of mothers initiating breast milk expression before six hours post-partum increased (32.6% vs. 42.4%, p = 0.007). There was a significant correlation between percentage of neonatal nurses participating in the breastfeeding training program and changes in exclusive breastfeeding rates (Pearson Correlation 0.638, p = 0.047). CONCLUSION Exclusive breastfeeding rates in preterm infants and maternal self-reported use of breastfeeding-supportive practices increased by training neonatal nurses in the six clinical practices. It is important to include all nurses in the breastfeeding training program to ensure positive effect on exclusive breastfeeding rates.
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Affiliation(s)
- Ragnhild Maastrup
- Department of Neonatology, Knowledge Centre for Breastfeeding Infants with Special Needs, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Research Unit Women's and Children's Health, Juliane Marie Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ane L Rom
- Research Unit Women's and Children's Health, Juliane Marie Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Sisse Walloee
- Dept of Clinical Research, OPEN-Patient data Explorative Network, University of Southern Denmark, Odense, Denmark
| | | | - Hanne Kronborg
- Department of Public Health, Section for Nursing, Aarhus University, Aarhus, Denmark
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166
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Kimani-Murage EW, Kimiywe J, Mutoro AN, Wilunda C, Wekesah FM, Muriuki P, Mwangi BM, Samburu BM, Madise NJ, McGarvey ST, Griffiths PL. Effectiveness of the baby-friendly community initiative on exclusive breastfeeding in Kenya. MATERNAL AND CHILD NUTRITION 2021; 17:e13142. [PMID: 33528102 PMCID: PMC8189218 DOI: 10.1111/mcn.13142] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/17/2020] [Accepted: 01/05/2021] [Indexed: 12/01/2022]
Abstract
The baby-friendly hospital initiative (BFHI) promotes exclusive breastfeeding (EBF) in hospitals, but this is not accessible in rural settings where mothers give birth at home, hence the need for a community intervention. We tested the effectiveness of the baby-friendly community initiative (BFCI) on EBF in rural Kenya. This cluster randomized study was conducted in 13 community units in Koibatek sub-county. Pregnant women aged 15-49 years were recruited and followed up until their children were 6 months old. Mothers in the intervention group received standard maternal, infant and young child nutrition counselling, support from trained community health volunteers, health professionals and community and mother support groups, whereas those in the control group received standard counselling only. Data on breastfeeding practices were collected longitudinally. The probability of EBF up to 6 months of age and the restricted mean survival time difference were estimated. A total of 823 (intervention group n = 351) pregnant women were recruited. Compared with children in the control group, children in the intervention group were more likely to exclusively breastfeed for 6 months (79.2% vs. 54.5%; P < .05). Children in the intervention group were also exclusively breastfed for a longer time, mean difference (95% confidence interval [CI]) 0.62 months (0.38, 0.85; P < .001). The BFCI implemented within the existing health system and including community and mother support groups led to a significant increase in EBF in a rural Kenyan setting. This intervention has the potential to improve EBF rates in similar settings.
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Affiliation(s)
- Elizabeth W Kimani-Murage
- Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya.,International Health Institute, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary & Life of Public Health, Brown University, Providence, RI, USA
| | - Judith Kimiywe
- Department of Food, Nutrition and Dietetics, Kenyatta University, Nairobi, Kenya
| | - Antonina N Mutoro
- Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya.,Human Nutrition, University of Glasgow, Glasgow, UK
| | - Calistus Wilunda
- Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
| | | | - Peter Muriuki
- Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Bonaventure M Mwangi
- Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Betty Mogesi Samburu
- Formerly Division of Nutrition and Dietetics, Ministry of Health in Kenya, Nairobi, Kenya.,Nutrition Section, United Nations Children's Fund (UNICEF) Kenya Country office, Nairobi, Kenya
| | - Nyovani Janet Madise
- Research and Development Policy, African Institute for Development Policy, Lilongwe, Malawi
| | - Stephen T McGarvey
- International Health Institute, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary & Life of Public Health, Brown University, Providence, RI, USA
| | - Paula L Griffiths
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.,School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
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167
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Lisi C, De Freitas C, Barros H. Maternal Country of Birth and Exclusive Breastfeeding During the First In-Hospital Day in Portugal: The Influence of the Baby-Friendly Hospital Initiative. J Hum Lact 2021; 37:147-157. [PMID: 33377852 DOI: 10.1177/0890334420982248] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Early breastfeeding practices are important determinants of later breastfeeding behaviors and can be influenced by multiple factors. Despite the Baby-Friendly Hospital Initiative reported positive influence on breastfeeding initiation, its influence on the association between maternal country of birth and first day in-hospital breastfeeding has not been examined. RESEARCH AIMS To determine (1) if association between maternal country of birth and first day in-hospital exclusive breastfeeding exists in Portugal and (2) if any association is affected by giving birth in a Baby-Friendly Hospital. METHODS Data were drawn from baMBINO-a longitudinal, 2017-2019 nationwide study designed to assess the perinatal health and healthcare experiences of migrant and native Portuguese women. Data from participants (N = 5,340) were collected during their hospital stay from 32 maternity units. Missing data were handled through multiple imputation. After stratifying by Baby-Friendly Hospital Initiative accreditation, a multivariate logistic regression was performed. RESULTS First day in-hospital exclusive breastfeeding rates were high among both migrant and native participants (89.2% vs. 87.4%). Migrants were more likely to exclusively breastfeed when compared to natives (OR = 1.19, 95% CI [1.00, 1.41]). In non-Baby-Friendly Hospitals, a positive association was found between participants from Eastern European countries (aOR = 2.46, 95% CI [1.27, 4.78]) and first day in-hospital exclusive breastfeeding. In accredited hospitals, maternal country of birth did not influence exclusive breastfeeding during the first 24 hr. CONCLUSIONS The Baby-Friendly Hospital Initiative attenuates differences between migrant and native participants, promoting optimal breastfeeding practices among natives.
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Affiliation(s)
- Cosima Lisi
- 449819 EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Portugal.,Departamento de Ciências de Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Portugal
| | - Cláudia De Freitas
- 449819 EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Portugal.,Departamento de Ciências de Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Portugal.,Centre for Research and Studies in Sociology, University Institute of Lisbon (ISCTE-IUL), Portugal
| | - Henrique Barros
- 449819 EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Portugal.,Departamento de Ciências de Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Portugal
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168
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Byrom A, Thomson G, Dooris M, Dykes F. UNICEF UK Baby Friendly Initiative: Providing, receiving and leading infant feeding care in a hospital maternity setting-A critical ethnography. MATERNAL AND CHILD NUTRITION 2021; 17:e13114. [PMID: 33471431 PMCID: PMC7988865 DOI: 10.1111/mcn.13114] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/26/2020] [Accepted: 11/04/2020] [Indexed: 11/28/2022]
Abstract
Although breastfeeding is known to improve health, economic and environmental outcomes, breastfeeding initiation and continuation rates are low in the United Kingdom. The global WHO/UNICEF Baby Friendly Hospital Initiative (BFHI) aims to reverse declining rates of breastfeeding by shifting the culture of infant feeding care provision throughout hospital maternity settings. In the United Kingdom, the global BFHI has been adapted by UNICEF UK reflecting a paradigm shift towards the experiences of women and families using maternity services. This research used a critical ethnographic approach to explore the influence of the national UNICEF UK Baby Friendly Initiative (BFI) standards on the culture of one typical maternity service in England, over a period of 8 weeks, across four phases of data collection between 2011 and 2017. Twenty‐one staff and 26 service users were recruited and engaged in moderate‐level participant observation and/or guided interviews and conversations. Basic, organising and a final global theme emerged through thematic network analysis, describing the influence of the BFI on providing, receiving and leading infant feeding care in a hospital maternity setting. Using Antonovsky's sense of coherence construct, the findings discussed in this paper highlight how the BFI offers ‘informational’ (comprehensible), ‘practical’ (manageable) and ‘emotional’ (meaningful) support for both staff and service users, strengthened by effective, local leadership and a team approach. This is juxtaposed against the tensions and demands of the busy hospital maternity setting. It is recommended that ongoing infant feeding policy, practice and leadership balance relational and rational approaches for positive infant feeding care and experiences to flourish.
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Affiliation(s)
- Anna Byrom
- School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
| | - Gill Thomson
- Maternal and Infant Nutrition and Nurture Unit (MAINN), University of Central Lancashire, Preston, UK
| | - Mark Dooris
- School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
| | - Fiona Dykes
- Maternal and Infant Nutrition and Nurture Unit (MAINN), University of Central Lancashire, Preston, UK
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169
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Murad A, Renfrew MJ, Symon A, Whitford H. Understanding factors affecting breastfeeding practices in one city in the Kingdom of Saudi Arabia: an interpretative phenomenological study. Int Breastfeed J 2021; 16:9. [PMID: 33407636 PMCID: PMC7789192 DOI: 10.1186/s13006-020-00350-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 12/09/2020] [Indexed: 11/29/2022] Open
Abstract
Background Breastfeeding duration has declined in the Kingdom of Saudi Arabia (KSA) in recent decades, although accurate national data about different breastfeeding indicators by infant age are lacking. This qualitative study, the first in KSA, aimed to understand the factors affecting mothers’ decisions and experiences regarding any breastfeeding practices. Methods A qualitative phenomenological approach was used to investigate mothers’ experiences of breastfeeding. Non-probability convenience sampling and snowballing strategies were designed to recruit participants. Semi-structured interviews were conducted with 16 mothers, from two hospitals and three primary health clinics in Al-Madinah city, from December 2017 to March 2018. Interpretative phenomenological analysis was the analysis framework. Results Three themes were identified: 1) ‘Up against the system’: policies, staff and systems were the main barriers to exclusive breastfeeding; 2) ‘Social support and negativity’: family support in the first 40 postpartum days protected breastfeeding continuation and was highly appreciated, but negative comments limited breastfeeding practices thereafter; and 3) ‘Managing tensions’: mothers’ religious beliefs about breastfeeding boosted their decisions; however, the challenge of managing tensions influenced mothers to stop breastfeeding earlier than they wished. The study revealed that mothers had no doubts about wanting to breastfeed their babies; but continuation was adversely affected by unhelpful hospital policies and staff actions, the lack of ongoing social support, and by others people’s negativity, rather than by the mothers’ own views. Stopping breastfeeding earlier than planned was a complex decision for most mothers. However, mothers said that they intended to breastfeed their next baby successfully. Conclusions Healthcare professionals (maternity staff, paediatricians and pharmacists) need education and training to support exclusive breastfeeding effectively. Increasing the number of hospitals with Baby Friendly Hospital Initiative accreditation, which includes staff practice changes, is needed to protect and support exclusive breastfeeding. Ongoing professional and peer support, and improving conditions at workplaces and universities, are needed to help mothers to continue breastfeeding successfully. Effective, coordinated national policies can support mothers’ decisions in relation to breastfeeding. Such changes will reduce the tensions experienced by women and help them to achieve their breastfeeding goals and to breastfeed for longer.
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Affiliation(s)
- Amal Murad
- Maternity and Childhood Department, College of Nursing, Taibah University, Al-Madinah, Saudi Arabia.
| | - Mary J Renfrew
- Mother and Infant Research Unit (MIRU), School of Health Sciences, University of Dundee, Dundee, Scotland, UK
| | - Andrew Symon
- Mother and Infant Research Unit (MIRU), School of Health Sciences, University of Dundee, Dundee, Scotland, UK
| | - Heather Whitford
- Mother and Infant Research Unit (MIRU), School of Health Sciences, University of Dundee, Dundee, Scotland, UK
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170
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Walsh A, Pieterse P, McCormack Z, Chirwa E, Matthews A. Improving breastfeeding support through the implementation of the baby friendly hospital and community initiatives: a scoping review protocol. HRB Open Res 2021; 4:1. [PMID: 34095749 PMCID: PMC8142597 DOI: 10.12688/hrbopenres.13180.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2020] [Indexed: 12/02/2023] Open
Abstract
Background: Improved breastfeeding practices have the potential to save the lives of over 823,000 children under 5 years old globally every year. Exclusively breastfeeding infants for the first six months would lead to the largest infant mortality reduction. The Baby-Friendly Hospital Initiative (BFHI) is a global campaign by the World Health Organization and the United Nations Children's Fund (UNICEF), which promotes best practice to support breastfeeding in maternity services. The Baby-Friendly Community Initiative (BFCI) is an extension of the BHFI's 10 th step of the Ten Steps to Successful Breastfeeding and of the BFHI overall. Its focus is on community-based breastfeeding supports for women. There have been no known attempts to synthesise the overall body of evidence on the BFHI in recent years, and no synthesis of empirical research on the BFCI. This scoping review asks the question: what is known about the implementation of the BFHI and the BFCI globally? Methods and analysis: This scoping review will be conducted according to the Joanna Briggs Institute methodology for scoping reviews. Inclusion criteria will follow the Population, Concepts, Contexts approach. A data charting form will be developed and applied to all the included studies. Qualitative and quantitative descriptive analysis will be undertaken. In order to address equity of access to the BFHI/BFCI, the Levesque et al. (2013) access to health care framework will be used as a lens to analyse the charted data in relation to this aspect of the review. An already established group of stakeholders with experience of infant feeding policy and implementation in Malawi will be consulted, to obtain expert views on the findings of the scoping review. Conclusion: This review will establish gaps in current evidence which will inform areas for future research in relation to this global initiative.
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Affiliation(s)
- Aisling Walsh
- Department of Public Health and Epidemiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Pieternella Pieterse
- School of Nursing, Psychotherapy & Community Health, Dublin City University, Dublin, Ireland
| | - Zoe McCormack
- School of Nursing, Psychotherapy & Community Health, Dublin City University, Dublin, Ireland
| | - Ellen Chirwa
- Kamuzu College of Nursing, University of Malawi, Blantyre, Malawi
| | - Anne Matthews
- School of Nursing, Psychotherapy & Community Health, Dublin City University, Dublin, Ireland
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171
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Ongun H, Demir M. Family-centered lactation counseling and breastfeeding in preterm infants upon neonatal intensive care discharge. J Clin Neonatol 2021. [DOI: 10.4103/jcn.jcn_167_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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172
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Brown A, Shenker N. Experiences of breastfeeding during COVID-19: Lessons for future practical and emotional support. MATERNAL & CHILD NUTRITION 2021; 17:e13088. [PMID: 32969184 PMCID: PMC7537017 DOI: 10.1111/mcn.13088] [Citation(s) in RCA: 164] [Impact Index Per Article: 54.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/08/2020] [Accepted: 09/10/2020] [Indexed: 12/18/2022]
Abstract
The COVID-19 pandemic and subsequent lockdown and social distancing led to changes to breastfeeding support available to women in the United Kingdom. Face-to-face professional support was reduced, and face-to-face peer support was cancelled. Anecdotal media accounts highlighted practices separating some mothers and babies in hospitals, alongside inaccurate stories of the safety of breastfeeding circulating. Meanwhile, new families were confined to their homes, separated from families and support networks. Given that we know breastfeeding is best supported by practices that keep mother and baby together, high-quality professional and peer-to-peer support, and positive maternal well-being, it is important to understand the impact of the pandemic upon the ability to breastfeed. To explore this, we conducted an online survey with 1219 breastfeeding mothers in the United Kingdom with a baby 0-12 months old to understand the impact of the pandemic upon breastfeeding duration, experiences and support. The results highlighted two very different experiences: 41.8% of mothers felt that breastfeeding was protected due to lockdown, but 27.0% of mothers struggled to get support and had numerous barriers stemming from lockdown with some stopped breastfeeding before they were ready. Mothers with a lower education, with more challenging living circumstances and from Black and minority ethnic backgrounds were more likely to find the impact of lockdown challenging and stop breastfeeding. The findings are vital in understanding how we now support those women who may be grieving their loss of breastfeeding and are affected by their negative experiences and how we can learn from those with a positive experience to make sure all breastfeeding women are better supported if similar future events arise.
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Affiliation(s)
- Amy Brown
- Department of Public Health, Policy and Social SciencesSwansea UniversitySwanseaUK
- Centre for Lactation, Infant Feeding and TranslationSwansea UniversitySwanseaUK
| | - Natalie Shenker
- Department of Surgery and CancerImperial College LondonLondonUK
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173
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McDade TW, Koning SM. Early origins of socioeconomic inequalities in chronic inflammation: Evaluating the contributions of low birth weight and short breastfeeding. Soc Sci Med 2021; 269:113592. [PMID: 33360022 PMCID: PMC7780588 DOI: 10.1016/j.socscimed.2020.113592] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/27/2020] [Accepted: 12/04/2020] [Indexed: 12/28/2022]
Abstract
The United States is characterized by persistent and widening social inequities in a wide range of adult health outcomes. A life course approach challenges us to consider if, and how, these inequities trace back to early life conditions, and chronic inflammation represents a potentially important mechanism through which early environments may have lasting effects on health in adulthood. Low birth weight (LBW) and shorter durations of breastfeeding both predict increased inflammation in adulthood, which is associated with increased risk for cardiovascular disease, metabolic syndrome, and all-cause mortality. Using data from a large representative sample of young adults in the US (National Longitudinal Study of Adolescent to Adult Health (Add Health)), we document the socioeconomic status (SES) gradient in chronic inflammation, as indicated by concentrations of C-reactive protein (CRP). Using a nested set of structural equation models and marginal standardization techniques, we investigate the extent to which this gradient is explained by patterns of LBW and breastfeeding in infancy. Findings reveal a particularly important role for breastfeeding duration: Based on model predictive margins, increasing breastfeeding duration to three or more months corresponds to a flattening of the SES gradient by 80%, and 83% when LBW is eliminated. This study expands current understandings of the consequential role of developmental environments for population health and for addressing health inequities in future generations.
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Affiliation(s)
- Thomas W McDade
- Department of Anthropology, Northwestern University, Evanston, IL, 60208, USA; Institute for Policy Research, Northwestern University, Evanston, IL 60208, USA; Child and Brain Development Program, Canadian Institute for Advanced Research, Toronto, Ontario, M5G 1Z8, Canada.
| | - Stephanie M Koning
- Institute for Policy Research, Northwestern University, Evanston, IL 60208, USA
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174
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Schafer EJ, Livingston TA, Roig-Romero RM, Wachira M, Louis-Jacques AF, Marhefka SL. "Breast Is Best, But…" According to Childcare Administrators, Not Best for the Childcare Environment. Breastfeed Med 2021; 16:21-28. [PMID: 33085512 DOI: 10.1089/bfm.2020.0078] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Nearly 74% of U.S. mothers work full-time and employment is a cited reason for stopping breastfeeding. In the effort to increase breastfeeding duration, childcare providers could facilitate continuation of human milk feeding when mothers return to work. Yet, mothers report receiving little support when transitioning infants into childcare. Objective: Explore the themes of comfort with human milk and formula feeding among childcare administrators near Tampa, Florida. Material and Methods: Twenty-eight childcare administrators participated in semistructured interviews regarding policies and perceptions about infant feeding practices at their center. Using Applied Thematic Analysis, interview themes were identified. Results: Most administrators agreed "breastfeeding is best." However, they expressed discomfort with mothers breastfeeding at the center and perceived risk with handling and feeding human milk. These perceptions are illustrated through the theme "Formula feeding is normative" and four emergent subthemes: "Human milk is potentially harmful," "People are uncomfortable with breastfeeding in public," "I'm not the expert," and "'Breastfeeding is best', in theory." Conclusion: While breastfeeding may be best for health, from the childcare administrators' perspectives, it may not be best for the childcare environment. A cultural shift may be needed to change norms and perceptions in the childcare environment to support mothers in their effort to provide human milk. Perhaps it is time for a new message, such as "We can help you."
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Affiliation(s)
- Ellen J Schafer
- Department of Community and Environmental Health, Boise State University, Boise, Idaho, USA
| | - Taylor A Livingston
- Department of Anthropology, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
| | | | | | - Adetola F Louis-Jacques
- Department of Obstetrics and Gynecology, University of South Florida, University of South Florida College of Medicine, Tampa, Florida, USA
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175
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Chen LL, Gau ML, Kao CH, Pan WL. Baby-friendly hospital initiative accreditation in Taiwan: Challenges and assistance needs. Midwifery 2020; 94:102903. [PMID: 33340806 DOI: 10.1016/j.midw.2020.102903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/23/2020] [Accepted: 12/07/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Li-Li Chen
- PhD student, Department of Nursing, National Taipei University of Nursing and Health Sciences, 365, Ming-Te Road, Peitou, Taipei, Taiwan.
| | - Meei-Ling Gau
- Professor, Graduate Institute of Nurse-Midwifery, National Taipei University of Nursing and Health Sciences, 365, Ming-Te Road, Peitou, Taipei, Taiwan.
| | - Chien-Huei Kao
- Associate Professor, Department of Nurse-Midwifery and Women Health, National Taipei University of Nursing and Health Sciences, 365, Ming-Te Road, Peitou, Taipei, Taiwan.
| | - Wan-Lin Pan
- Assistant Professor, Department of Nursing, National Taipei University of Nursing and Health Sciences, 365, Ming-Te Road, Peitou, Taipei, Taiwan.
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176
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Gallegos D, Parkinson J, Duane S, Domegan C, Jansen E, Russell-Bennett R. Understanding breastfeeding behaviours: a cross-sectional analysis of associated factors in Ireland, the United Kingdom and Australia. Int Breastfeed J 2020; 15:103. [PMID: 33267900 PMCID: PMC7709394 DOI: 10.1186/s13006-020-00344-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 11/23/2020] [Indexed: 12/29/2022] Open
Abstract
Background Breastfeeding is a complex behaviour relying on a combination of individual mother and infant characteristics, health systems, and family, community and professional support. Optimal breastfeeding in high-income countries is particularly low. Despite having similar sociocultural backgrounds, breastfeeding rates between Ireland, the United Kingdom (UK) and Australia vary, thus there is a need to understand whether this is due to individual, sociocultural or policy differences. This research identifies the between-country differences in infant feeding mode and examines if country differences in feeding mode persist once known individual, behavioural and structural factors are considered using socioecological and person-context models. Methods Participants were adult women with at least one infant less than 6 months of age, who completed an online survey (n = 2047) that was distributed by social media in June 2016. Within-country differences in infant feeding mode (‘any breastfeeding’ vs. ‘no breastfeeding’) were examined first before hierarchical multivariable logistic regression was used to determine if country differences in feeding mode persisted after adjusting for known factors associated with breastfeeding. Results In this sample, ‘any breastfeeding’ rates were 89, 71 and 72% in Australia, Ireland and the United Kingdom respectively. Within-country differences were evident in Australia, Ireland and the UK. Four factors showed no association with infant feeding mode in Australia while they did in the other countries (maternal age, income, skin-to-skin contact, support from friends and family). Two factors were unique to Australia: the odds of being in the ‘no breastfeeding’ group increased when the baby was delivered via caesarean and when not enough breastfeeding information was available after birth. One determinant was unique to Ireland: the odds of being in the ‘no breastfeeding’ group increased when respondents indicated they were not religious; in the UK this occurred when respondents were living in a town/village. After adjusting for sets of known factors of infant feeding mode based on socioecological and person-context models, country differences remained in hierarchical regressions: the odds of not breastfeeding were higher in both Ireland (AOR 3.3, 95%CI 1.8,6.1) and the United Kingdom (AOR 2.7, 95%CI 1.5, 4.7) compared to Australia. Conclusions This study indicates that different levels in the socioecological system are related to infant feeding behaviours. An adequate inter-systems level response would consider the interactions within and between behavioural and structural mechanisms which support breastfeeding behaviour. Optimising infant feeding practices will require an integrated web of interventions that go beyond the individual and focus on addressing factors that will influence families within their communities as they move between systems. Supplementary Information The online version contains supplementary material available at 10.1186/s13006-020-00344-2.
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Affiliation(s)
- Danielle Gallegos
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Victoria Park Rd, Kelvin Grove, QLD, 4059, Australia. .,Woolworths Centre for Childhood Nutrition Research, Faculty of Health, Queensland University of Technology, Graham St, South Brisbane, QLD, 4101, Australia.
| | - Joy Parkinson
- Social Marketing @ Griffith, Griffith University, 170 Kessels Rd, Nathan, QLD, 4111, Australia
| | - Sinead Duane
- Applied Systems Thinking, Whitaker Institute, National University of Ireland, Galway, Ireland
| | - Christine Domegan
- Applied Systems Thinking, Whitaker Institute, National University of Ireland, Galway, Ireland
| | - Elena Jansen
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Victoria Park Rd, Kelvin Grove, QLD, 4059, Australia.,Division of Child & Adolescent Psychiatry, Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rebekah Russell-Bennett
- School of Advertising, Marketing and Public Relations, Queensland University of Technology, Gardens Point, Brisbane, 4000, Australia.,Centre for Behavioural Economics, Society and Technology, Queensland University of Technology, Gardens Point, Brisbane, 4000, Australia
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177
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Perrine CG, Chiang KV, Anstey EH, Grossniklaus DA, Boundy EO, Sauber-Schatz EK, Nelson JM. Implementation of Hospital Practices Supportive of Breastfeeding in the Context of COVID-19 - United States, July 15-August 20, 2020. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2020; 69:1767-1770. [PMID: 33237892 PMCID: PMC7727601 DOI: 10.15585/mmwr.mm6947a3] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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178
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Azad MB, Nickel NC, Bode L, Brockway M, Brown A, Chambers C, Goldhammer C, Hinde K, McGuire M, Munblit D, Patel AL, Pérez-Escamilla R, Rasmussen KM, Shenker N, Young BE, Zuccolo L. Breastfeeding and the origins of health: Interdisciplinary perspectives and priorities. MATERNAL AND CHILD NUTRITION 2020; 17:e13109. [PMID: 33210456 PMCID: PMC7988860 DOI: 10.1111/mcn.13109] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 10/17/2020] [Accepted: 10/20/2020] [Indexed: 12/18/2022]
Abstract
Breastfeeding and human milk (HM) are critically important to maternal, infant and population health. This paper summarizes the proceedings of a workshop that convened a multidisciplinary panel of researchers to identify key priorities and anticipated breakthroughs in breastfeeding and HM research, discuss perceived barriers and challenges to achieving these breakthroughs and propose a constructive action plan to maximize the impact of future research in this field. Priority research areas identified were as follows: (1) addressing low breastfeeding rates and inequities using mixed methods, community partnerships and implementation science approaches; (2) improving awareness of evidence-based benefits, challenges and complexities of breastfeeding and HM among health practitioners and the public; (3) identifying differential impacts of alternative modes of HM feeding including expressed/pumped milk, donor milk and shared milk; and (4) developing a mechanistic understanding of the health effects of breastfeeding and the contributors to HM composition and variability. Key barriers and challenges included (1) overcoming methodological limitations of epidemiological breastfeeding research and mechanistic HM research; (2) counteracting 'breastfeeding denialism' arising from negative personal breastfeeding experiences; (3) distinguishing and aligning research and advocacy efforts; and (4) managing real and perceived conflicts of interest. To advance research on breastfeeding and HM and maximize the reach and impact of this research, larger investments are needed, interdisciplinary collaboration is essential, and the scientific community must engage families and other stakeholders in research planning and knowledge translation.
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Affiliation(s)
- Meghan B Azad
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada.,Developmental Origins of Chronic Diseases in Children Network (DEVOTION), Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.,Manitoba Interdisciplinary Lactation Centre (MILC), Winnipeg, Manitoba, Canada.,Human Capital & Economic Opportunity Global Working Group, Center for the Economics of Human Development, University of Chicago, Chicago, Illinois, USA
| | - Nathan C Nickel
- Developmental Origins of Chronic Diseases in Children Network (DEVOTION), Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.,Manitoba Interdisciplinary Lactation Centre (MILC), Winnipeg, Manitoba, Canada.,Department of Community Health Sciences and Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lars Bode
- Department of Pediatrics and Larsson-Rosenquist Foundation Mother-Milk-Infant Center of Research Excellence, University of California San Diego, La Jolla, California, USA
| | - Meredith Brockway
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada.,Manitoba Interdisciplinary Lactation Centre (MILC), Winnipeg, Manitoba, Canada
| | - Amy Brown
- Department of Public Health, Policy and Social Sciences and Centre for Lactation, Infant Feeding and Translation, Swansea University, Swansea, UK
| | - Christina Chambers
- Mommy's Milk Human Milk Research Biorepository, Center for Better Beginnings, University of California San Diego, San Diego, California, USA
| | | | - Katie Hinde
- Center of Evolution and Medicine and School of Human Evolution and Social Change, Arizona State University, Tempe, Arizona, USA
| | - Michelle McGuire
- Margaret Ritchie School of Family and Consumer Sciences, University of Idaho, Moscow, Idaho, USA
| | - Daniel Munblit
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University, Moscow, Russia.,Inflammation, Repair and Development Section, National Heart and Lung Institute, Imperial College London, London, UK.,inVIVO Planetary Health, Worldwide Universities Network (WUN), West New York, New Jersey, USA
| | - Aloka L Patel
- Department of Pediatrics, Section of Neonatology, Rush University Children's Hospital, Chicago, Illinois, USA
| | - Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, Connecticut, USA
| | | | - Natalie Shenker
- Department of Surgery and Cancer, Imperial College London, London, UK.,Human Milk Foundation, Harpenden, UK
| | - Bridget E Young
- Division of Allergy and Immunology, Department of Pediatrics, School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
| | - Luisa Zuccolo
- MRC Integrative Epidemiology Unit and Department of Population Health Sciences, University of Bristol, Bristol, UK
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179
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Ali NB, Karim F, Billah SKM, Hoque DMDE, Khan ANS, Hasan MM, Simi SM, Arifeen SEL, Chowdhury MAK. Are childbirth location and mode of delivery associated with favorable early breastfeeding practices in hard to reach areas of Bangladesh? PLoS One 2020; 15:e0242135. [PMID: 33186387 PMCID: PMC7665793 DOI: 10.1371/journal.pone.0242135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 10/28/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Early initiation of breastfeeding within one hour of birth (EIBF) and no prelacteal feeding are WHO recommended practices for improving maternal and newborn health outcomes. Globally, EIBF can avert around 22% of newborn death. In recent years, Bangladesh has experienced increasing facility delivery coverage and cesarean section rates. However, the impact of these changes on early breastfeeding initiation in hard to reach areas (HtR) of the country is still poorly understood. Therefore, this study aimed to examine the independent associations between childbirth locations and mode of delivery with favorable early breastfeeding practices in four hard to reach areas of Bangladesh. METHOD We extracted data from a cross-sectional study conducted in four HtR areas of Bangladesh in 2017. A total of 2768 women, having birth outcomes in the past 12 months of the survey, were interviewed using structured questionnaires. EIBF and no prelacteal feeding were considered as favorable early breastfeeding practices. The categories of childbirth locations were defined by the place of birth (home vs. facility) and the delivery sector (public/NGO vs. private). The mode of delivery was categorized into vaginal delivery and cesarean section. Generalized linear models were used to test the independent associations while adjusting for potential confounders. RESULTS The prevalence of EIBF practices were 69.6%(95% CI:67.8-71.3); 72.2%(95% CI:67.8-71.3) among home births Vs 63.0%(95% CI:59.5%-66.4%) among facility births. Around 73.9% (95% CI:72.3-75.6) mother's in the study areas reported no-prelacteal feeding. Compared to home births, women delivering in the facilities had lower adjusted odds of EIBF (aOR = 0.51; 95%CI:0.35-0.75). Cesarean section was found to be negatively associated with EIBF (aOR = 0.20; 95%CI:0.12-0.35), after adjusting for potential confounders. We could not find any significant associations between the place of birth and mode of delivery with no prelacteal feeding. DISCUSSIONS This study found that facility births and cesarean deliveries were negatively associated with EIBF. Although the implementation of "Baby-Friendly Hospital Initiatives" could be a potential solution for improving EIBF and no prelacteal feeding practices, the challenges of reduced service availability and accessibility in HtR areas must be considered while devising effective intervention strategies. Future studies can explore potential interventions to promote early breastfeeding for facility births and cesarean deliveries in HtR areas.
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Affiliation(s)
- Nazia Binte Ali
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Farhana Karim
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - S. K. Masum Billah
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Abdullah Nurus Salam Khan
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States of America
| | - Mohammad Mehedi Hasan
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sonjida Mesket Simi
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shams E. L. Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohiuddin Ahsanul Kabir Chowdhury
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States of America
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180
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Zhang Y, Yang J, Li W, Wang N, Ye Y, Yan S, Wang S, Zeng T, Huang Z, Zhang F, Li Y, Yao S, Wang H, Rozelle S, Xu T, Jin X. Effects of baby-friendly practices on breastfeeding duration in China: a case-control study. Int Breastfeed J 2020; 15:92. [PMID: 33143740 PMCID: PMC7640486 DOI: 10.1186/s13006-020-00334-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 10/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Baby-Friendly Hospital Initiative is generally considered an effective way to promote breastfeeding. Although China has the largest number of baby-friendly hospitals in the world, research on baby-friendly practices in China is limited, and the rate of exclusive breastfeeding (EBF) at 6 months, 20.7%, compared to the 2025 global goal of 50% is low. It is, therefore, important to determine the factors that remain significant barriers to EBF in China. To explore how the key baby-friendly practices affect EBF duration in China, we used a case-control study to compare the effects of baby-friendly-related practices on both EBF and non-breastfeeding (NBF) mothers at 3 months and to investigate the effects of both single and comprehensive baby-friendly practices in promoting EBF duration at 3 months, which is one step toward EBF at 6 months. METHODS Participants were recruited from four maternal and child health hospitals in western (Chongqing), eastern (Qingdao), southern (Liuzhou), and central China (Maanshan). A total of 421 mothers (245 in the EBF group, 176 in the NBF group) of infants aged 3 months were surveyed through a self-reported questionnaire from April 2018 to March 2019. The experience of baby-friendly practices and breastfeeding during hospitalization were assessed with yes/no questions. Socio-demographic factors that influenced breastfeeding at 3 months were analyzed using bivariate and multivariate logistic regression analyses. RESULTS Of mothers in the EBF group, 65.57% reported engaging in at least seven baby-friendly practices compared to 47.72% of mothers in the NBF group. Significantly more mothers in the EBF group engaged in baby-friendly practices than in the NBF group. These practices included "breastfeeding within one hour after birth" (74.29% vs. 59.09%), "breastfeeding on demand" (86.48% vs. 75.00%), and "never use a pacifier" (46.53% vs. 31.25%). After adjusting for confounding variables, we found that the mothers who engaged in fewer than seven baby-friendly practices were about 1.7 times less likely to breastfeed than were those who engaged in seven or more baby-friendly practices (odds ratio [OR] 1.720, 95% confidence interval [CI] 1.106, 2.667). Further, the mothers who did not breastfeed on demand were as likely to not breastfeed up to 3 months (OR 2.263, 95% CI 1.265, 4.049), as were mothers who did not breastfeed during hospitalization (OR 4.379, 95% CI 1.815, 10.563). CONCLUSIONS These data from hospitals in China suggest that higher compliance with baby-friendly practices may have a positive impact on EBF at 3 months, particularly in terms of promoting the implementation of breastfeeding on demand and breastfeeding during hospitalization in China.
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Affiliation(s)
- Yue Zhang
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, 100081, China.
| | - Jinliuxing Yang
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, 100081, China
| | - Wenhao Li
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, 100191, China
| | - Nianrong Wang
- Chongqing Health Center for Women and Children, Chongqing, 400000, China
| | - Ya Ye
- Chongqing Health Center for Women and Children, Chongqing, 400000, China
| | - Shuangqin Yan
- Ma'anshan Maternal and Child Health Hospital, Ma'anshan, 243011, Anhui, China
| | - Sumei Wang
- Ma'anshan Maternal and Child Health Hospital, Ma'anshan, 243011, Anhui, China
| | - Ting Zeng
- Liuzhou Maternity and Child Healthcare Hospital, Liuzhou, 545001, Guangxi, China
| | - Zijuan Huang
- Liuzhou Maternity and Child Healthcare Hospital, Liuzhou, 545001, Guangxi, China
| | - Fenghua Zhang
- Qingdao Maternal and Children Healthcare Center, Qingdao, 26600, Shandong, China
| | - Yin Li
- Qingdao Maternal and Children Healthcare Center, Qingdao, 26600, Shandong, China
| | - Shiyi Yao
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, 100081, China
| | - Haijun Wang
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, 100191, China
| | - Scott Rozelle
- Freeman Spogli Institute for International Studies, Stanford University, Stanford, California, 94305, USA
| | - Tao Xu
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, 100081, China
| | - Xi Jin
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, 100081, China
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181
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Abstract
Objective: The WHO and UNICEF recommend home visits to improve health outcomes for mothers and newborns. We evaluated the effect of home visits by community volunteers during pregnancy and postpartum on breast-feeding practices, women’s knowledge about benefits, beliefs and myths of breast-feeding, obstetric and neonatal warning signs, preparation for childbirth and initial care for newborns, and diarrhoea and respiratory diseases in children. Design: Community quasi-experimental design. We estimated difference-in-difference models with fixed effects at the community level weighted by propensity score and investigated implementation barriers through focus groups and semi-structured interviews. Setting: Poor rural communities in Mexico; 48 intervention and 29 control. Participants: Baseline and follow-up information were reported from two independent cross-sectional samples of women with babies aged between 6 and 18 months (baseline: 292 control, 320 intervention; follow-up: 292 control, 294 intervention). Results: The intervention increased reports of exclusive breast-feeding in the first 6 months by 24·4 percentage points (pp) (95 % CI: 13·4, 35·4), mothers’ knowledge of obstetric warning signs by 23·4 pp (95 % CI: 9·2, 37·5) and neonatal warning signs by 26·2 pp (95 % CI: 15·2, 37·2) compared to the control group. A non-linear dose–response relation with the number of home visits was found. Diarrhoea and respiratory diseases among children decreased in the intervention v. control group but were not statistically significant. Conclusions: Home visits should be implemented as a complementary strategy to the provision of prenatal and postnatal care in rural communities due to their potential positive effects on the health of mothers and their children.
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182
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Monteiro JCDS, Guimarães CMDS, Melo LCDO, Bonelli MCP. Breastfeeding self-efficacy in adult women and its relationship with exclusive maternal breastfeeding. Rev Lat Am Enfermagem 2020; 28:e3364. [PMID: 33027402 PMCID: PMC7529446 DOI: 10.1590/1518-8345.3652.3364] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 05/05/2020] [Indexed: 11/27/2022] Open
Abstract
Objective: to analyze the relationship between maternal self-efficacy to breastfeed and
sociodemographic, obstetric, and neonatal variables; between the duration of
exclusive breastfeeding and sociodemographic variables; and between the
breastfeeding self-efficacy and the duration of exclusive breastfeeding at
the intervals of 30, 60, and 180 days postpartum. Method: a longitudinal and prospective study conducted with 224 women. A
sociodemographic questionnaire, the Breastfeeding Self-Efficacy Scale –
Short Form, and a questionnaire on breastfeeding and child feeding were used
for collecting the data. Fisher’s exact test and Pearson’s correlation
coefficient test were used for analysis. Results: there was no association between breastfeeding self-efficacy and the duration
of exclusive breastfeeding identified at 30, 60, and 180 days. Self-efficacy
was associated with the type of delivery and complications in the postpartum
period. There was also an association between religion and exclusive
breastfeeding 30 and 60 days postpartum, and assistance with baby care and
exclusive breastfeeding at 60 days. Conclusion: It was identified that the type of delivery, complications in the postpartum
period, religion, and assistance with baby care corroborate to increase
maternal confidence in the ability to breastfeed.
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183
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Determinants of breastfeeding practices in Myanmar: Results from the latest nationally representative survey. PLoS One 2020; 15:e0239515. [PMID: 32970726 PMCID: PMC7514058 DOI: 10.1371/journal.pone.0239515] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 09/08/2020] [Indexed: 11/19/2022] Open
Abstract
Optimal breastfeeding practices can ensure healthy growth and development of infants, which in the long term can impact the country's economic development. Nevertheless, Myanmar has yet to achieve the WHO's target of 70% for early initiation of breastfeeding, and the country's target of 90% for exclusive breastfeeding. The purpose of this study was to assess the associations between early initiation of breastfeeding and exclusive breastfeeding and bio-demographic, socio-economic and behavioral factors in Myanmar. Using the 2015-2016 Myanmar Demographic and Health Survey, the analysis of early initiation of breastfeeding was based on a sample of 1,506 under-2 children and the analysis of exclusive breastfeeding was based on a sample of 376 children aged 0-5 months. Multiple logistic modeling, with heteroskedasticity-adjusted standard errors, was used. The prevalence rates of early initiation of breastfeeding and exclusive breastfeeding in the study were 67.9% and 52.2% respectively. Having a vaginal delivery (AOR = 2.5; 95% CI = 1.7-3.7) and having frequent (≥ 4) antenatal visits (AOR = 2.4; 95% CI = 1.5-3.8) were associated with higher odds of early initiation of breastfeeding. Having a postnatal checkup (AOR = 0.5; 95% CI = 0.3-0.9) and having an infant that was perceived to be small at birth (AOR = 2.5; 95% CI = 1.1-5.7, for infants perceived to be large at birth) were significantly associated with decreased odds of exclusive breastfeeding. In order to promote optimal breastfeeding practices, this study suggested that delivery and quality of health services during pregnancy need to be strengthened in Myanmar.
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184
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Win T, Tun Sein T, Ikeda W, Morita A, Sokejima S. Does Father's Social Capital Matter to Child Undernutrition in Myanmar? Asia Pac J Public Health 2020; 32:418-425. [PMID: 32857618 DOI: 10.1177/1010539520951717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article examined the association between social capital of fathers and child undernutrition using a community-based survey in Myanmar in 2018. The anthropometric measurements of 1546 children aged 6 to 59 months and face-to-face interviews of 1546 respective biological fathers were performed. The three social capital indicators (institutional trust, social supports, and collective action) were included in 2-level logistic regression models for child wasting and child stunting. Social supports from fathers' social networks were protective measures for child wasting and child stunting at individual and community levels, respectively. The collective action of fathers was positively associated with child stunting at individual level. No association was found between institutional trust and both indicators of child undernutrition at all levels. The individual-level collective action on child stunting was conditional on the community-level social supports. Our findings suggest that existing nutritional strategies in Myanmar may be strengthened by targeting fathers to increase their support in child nutrition and by targeting the community to engage in the nutritional programs with their full support.
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Affiliation(s)
- Thida Win
- University of Medicine, Mandalay, Myanmar
| | | | | | | | - Shigeru Sokejima
- Mie University Hospital, Tsu, Mie, Japan.,Mie University, Tsu, Mie, Japan
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185
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Wasser HM, Thompson AL, Suchindran CM, Goldman BD, Hodges EA, Heinig MJ, Bentley ME. Home-based intervention for non-Hispanic black families finds no significant difference in infant size or growth: results from the Mothers & Others randomized controlled trial. BMC Pediatr 2020; 20:385. [PMID: 32811460 PMCID: PMC7433206 DOI: 10.1186/s12887-020-02273-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 08/04/2020] [Indexed: 01/30/2023] Open
Abstract
Background Non-Hispanic black (NHB) infants are twice as likely as non-Hispanic white infants to experience rapid weight gain in the first 6 months, yet few trials have targeted this population. The current study tests the efficacy of “Mothers & Others,” a home-based intervention for NHB women and their study partners versus an attention-control, on infant size and growth between birth and 15 months. Methods Mothers & Others was a two-group randomized controlled trial conducted between November 2013 and December 2017 with enrollment at 28-weeks pregnancy and follow-up at 3-, 6-, 9-, 12-, and 15-months postpartum. Eligible women self-identified as NHB, English-speaking, and 18–39 years. The obesity prevention group (OPG) received anticipatory guidance (AG) on responsive feeding and care practices and identified a study partner, who was encouraged to attend home visits. The injury prevention group (IPG) received AG on child safety and IPG partners only completed study assessments. The primary delivery channel for both groups was six home visits by a peer educator (PE). The planned primary outcome was mean weight-for-length z-score. Given significant differences between groups in length-for-age z-scores, infant weight-for-age z-score (WAZ) was used in the current study. A linear mixed model, using an Intent-To-Treat (ITT) data set, tested differences in WAZ trajectories between the two treatment groups. A non-ITT mixed model tested for differences by dose received. Results Approximately 1575 women were screened for eligibility and 430 were enrolled. Women were 25.7 ± 5.3 years, mostly single (72.3%), and receiving Medicaid (74.4%). OPG infants demonstrated lower WAZ than IPG infants at all time points, but differences were not statistically significant (WAZdiff = − 0.07, 95% CI − 0.40 to 0.25, p = 0.659). In non-ITT models, infants in the upper end of the WAZ distribution at birth demonstrated incremental reductions in WAZ for each home visit completed, but the overall test of the interaction was not significant (F2,170 = 1.41, p = 0.25). Conclusions Despite rich preliminary data and a strong conceptual model, Mothers & Others did not produce significant differences in infant growth. Results suggest a positive impact of peer support in both groups. Trial registration ClinicalTrials.gov, NCT01938118, 09/10/2013.
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Affiliation(s)
- Heather M Wasser
- Department of Nutrition, University of North Carolina, 135 Dauer Drive, CB# 7400, Chapel Hill, NC, 27599-7400, USA. .,University of North Carolina, Chapel Hill, NC, USA.
| | - Amanda L Thompson
- Department of Nutrition, University of North Carolina, 135 Dauer Drive, CB# 7400, Chapel Hill, NC, 27599-7400, USA.,University of North Carolina, Chapel Hill, NC, USA
| | | | | | | | | | - Margaret E Bentley
- Department of Nutrition, University of North Carolina, 135 Dauer Drive, CB# 7400, Chapel Hill, NC, 27599-7400, USA.,University of North Carolina, Chapel Hill, NC, USA
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186
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Silva MDB, Carvalhaes de Oliveira RDV, Braga JU, de Almeida JAG, Melo ECP. Breastfeeding patterns in cohort infants at a high-risk fetal, neonatal and child referral center in Brazil: a correspondence analysis. BMC Pediatr 2020; 20:372. [PMID: 32767990 PMCID: PMC7412808 DOI: 10.1186/s12887-020-02272-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 08/03/2020] [Indexed: 11/29/2022] Open
Abstract
Background To investigate the prevalence and patterns of breastfeeding at discharge and in the first six months of life in a high-risk fetal, neonatal and child referral center. Methods Prospective, longitudinal study that included the following three steps: hospital admission, first visit after hospital discharge and monthly telephone interview until the sixth month of life. The total number of losses was 75 mothers (7.5%). Exposure variables were sorted into four groups: factors related to the newborn, the mother, the health service and breastfeeding. The dependent variable is breastfeeding as per categories established by the WHO. All 1200 children born or transferred to the high-risk fetal, neonatal and child referral center, within a seven-day postpartum period, from March 2017 to April 2018, were considered eligible for the study, and only 1003 were included. The follow-up period ended in October 2018. For this paper, we performed an exploratory analysis at hospital discharge in three stages, as follows: (i) frequencies of baseline characteristics, stratified by risk for newborn; (ii) a multiple correspondence analysis (MCA); and (iii) clusters for variables related to hospital practice and exclusive breastfeeding (EBF). Results The prevalence of EBF at hospital discharge was 65.2% (62.1–68.2) and 20.6% (16.5–25.0) in the six months of life. Out of all at-risk newborns, 45.7% were in EBF at discharge. The total inertia corresponding to the two dimensions in the MCA explained for 75.4% of the total data variability, with the identification of four groups, confirmed by the cluster analysis. Discussion Our results suggest that robust breastfeeding hospital policies and practices influence the establishment and maintenance of breastfeeding in both healthy and at-risk infants. It is advisable to plan and implement additional strategies to ensure that vulnerable and healthy newborns receive optimal feeding. It is necessary to devote extra effort particularly to at-risk infants who are more vulnerable to negative outcomes. Conclusion At-risk newborns did not exclusively breastfeed to the same extent as healthy newborns at hospital discharge. A different approach is required for at-risk neonates, who are more physically challenged and more vulnerable to problems associated with initiation and maintenance of breastfeeding.
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Affiliation(s)
- Maíra Domingues Bernardes Silva
- Human Milk Bank in the Fernandes Figueira Nacional Institute for Women, Children and Adolescent Health (IFF), Oswaldo Cruz Foundation (FIOCRUZ), Av Rui Barbosa, 716, Flamengo, Rio de Janeiro, RJ, CEP: 22250-020, Brazil.
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187
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Pretorius CE, Asare H, Genuneit J, Kruger HS, Ricci C. Impact of breastfeeding on mortality in sub-Saharan Africa: a systematic review, meta-analysis, and cost-evaluation. Eur J Pediatr 2020; 179:1213-1225. [PMID: 32592027 DOI: 10.1007/s00431-020-03721-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 06/10/2020] [Accepted: 06/15/2020] [Indexed: 10/24/2022]
Abstract
Sub-Saharan Africa has lower breastfeeding rates compared to other low- and middle-income countries, and globally holds the highest under-five mortality rates. The aims of this study were to estimate mortality risk for inappropriate breastfeeding, prevalence of breastfeeding, population attributable fraction, and the economic impact of breastfeeding on child mortality, in sub-Saharan Africa. The systematic review included databases from Medline and CINAHL. Meta-analysis of mortality risk estimates was conducted using random effect methods. The prevalence of breastfeeding in Sub-Saharan African countries was determined using UNICEF's database. Population attributable fraction was derived from the prevalence and relative risk data. The cost attributable to child deaths in relation to inappropriate breastfeeding was calculated using the World Health Statistics data. The pooled relative mortality risk to any kind of infant feeding compared to exclusive and early breastfeeding initiation were 5.71 (95%CI: 2.14, 15.23) and 3.3 (95%CI: 2.49, 4.46), respectively. The overall exclusive and early initiation of breastfeeding prevalence were 35%(95%CI: 32%;37%) and 47%(95%CI: 44%;50%), respectively. The population attributable fraction for non-exclusive and late breastfeeding initiation breastfeeding were 75.7% and 55.3%, respectively. The non-health gross domestic product loss resulted in about 19.5 USB$.Conclusion: Public health interventions should prioritize appropriate breastfeeding practices to decrease the under-five mortality burden and its related costs in sub-Saharan Africa. What is Known: • Globally, sub-Saharan Africa holds the highest under five mortality rates and still has lower breastfeeding rates compared to other low- and middle-income countries. • There is a significant association between child mortality and inappropriate breastfeeding practices. What is New: • A five-fold and three-fold increased risks for under-five mortality were estimated with regard to non-exclusive breastfeeding and delayed breastfeeding initiation, respectively. • 55-75% of under-five deaths can be attributable to inappropriate breastfeeding practices and at least part of them could be potentially prevented with breastfeeding promotion interventions, saving a non-health gross domestic product loss of 19.5 USB$.
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Affiliation(s)
- Cianté E Pretorius
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa.
| | - Hannah Asare
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
| | - Jon Genuneit
- Pediatric Epidemiology, Department of Pediatrics, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Herculina S Kruger
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa.,Medical Research Council Hypertension and Cardiovascular Disease Research Unit, North-West University, Potchefstroom, South Africa
| | - Cristian Ricci
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa.,Pediatric Epidemiology, Department of Pediatrics, Medical Faculty, Leipzig University, Leipzig, Germany
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188
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Taha Z, Ali Hassan A, Wikkeling-Scott L, Eltoum R, Papandreou D. Assessment of Hospital Rooming-in Practice in Abu Dhabi, United Arab Emirates: A Cross-Sectional Multi-Center Study. Nutrients 2020; 12:nu12082318. [PMID: 32752235 PMCID: PMC7468932 DOI: 10.3390/nu12082318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/17/2020] [Accepted: 07/29/2020] [Indexed: 11/23/2022] Open
Abstract
The World Health Organization (WHO) recommends rooming-in to reduce infant mortality rates. Little research has been done to assess practices such as rooming-in and its relation to breastfeeding in the United Arab Emirates (UAE). The aim of this study was to examine the prevalence of rooming-in during hospital stay among mothers with infants six months old and below, in addition to other associated factors in Abu Dhabi, UAE. This study utilized a sub-sample extracted from a dataset based on a convenience sample of mothers who were recruited from governmental maternal and child health centers as well as from the community. The purpose of the original research was to evaluate infant and young children's feeding practices. A pre-tested questionnaire was used during interviews with mothers once ethical clearance was in place. Multivariable logistic regression was conducted to describe the results. The original sample included 1822 participants, of which 804 infants met the inclusion criteria. The mean age for mothers and infants was 30.3 years and 3.5 months, respectively. The rate of rooming-in during hospital stay was 97.5%. Multivariable logistic regression analysis indicated factors associated with not rooming-in were low maternal age (Adjusted Odds Ratios (AOR) = 1.15, 95% confidence interval (CI): 1.03, 1.30), low gestational age (GA) (AOR = 1.90, 95% CI: 1.52, 2.36), abnormal pre-pregnancy body mass index (BMI) (AOR = 3.77, 95 % CI: 1.22, 11.76), and delayed initiation of breastfeeding (AOR = 4.47, 95 % CI: 1.08, 18.48). In the context of the high rate of rooming-in revealed in this study, there should be a focus on those groups who do not room-in (i.e., younger women and those with babies of a younger gestational age). Rooming-in practice provides self-confidence in taking care of a baby, knowledge about breastfeeding, and stimulates early-phase lactation.
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Affiliation(s)
- Zainab Taha
- Department of Health Sciences, College of Natural and Health Sciences, Zayed University, Abu Dhabi P.O. Box 144534, UAE; (L.W.-S.); (D.P.)
- Correspondence: ; Tel.: +971-2-5993111; Fax: +971-2-4434847
| | | | - Ludmilla Wikkeling-Scott
- Department of Health Sciences, College of Natural and Health Sciences, Zayed University, Abu Dhabi P.O. Box 144534, UAE; (L.W.-S.); (D.P.)
| | - Ruba Eltoum
- Faculty of Medicine, Charles University, 500 03 Hradec Kralove, Czech Republic;
| | - Dimitrios Papandreou
- Department of Health Sciences, College of Natural and Health Sciences, Zayed University, Abu Dhabi P.O. Box 144534, UAE; (L.W.-S.); (D.P.)
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189
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Stamenkovic Z, Matejic B, Djikanovic B, Bjegovic-Mikanovic V. Surprising Differences in the Practice of Exclusive Breastfeeding in Non-Roma and Roma Population in Serbia. Front Public Health 2020; 8:277. [PMID: 32714892 PMCID: PMC7342049 DOI: 10.3389/fpubh.2020.00277] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 05/27/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Exclusive breastfeeding is essential for early childhood development, although the use of adaptive milk formulas instead of breastfeeding is widespread nowadays. This study aimed to examine the prevalence of exclusively breastfed infants under the age of 6 months in non-Roma and Roma population and factors associated with this practice. Materials and Methods: This study is a secondary analysis of the Serbian Multiple Indicator Cluster Survey investigating non-Roma and Roma infants under the age of 6 months. The study included mothers of 321 non-Roma and 164 Roma infants younger than 6 months. Univariate and multivariate logistic regression served to analyze factors associated with the practice of exclusive breastfeeding in both populations. Results: The prevalence of exclusive breastfeeding was almost the same among mothers in both non-Roma and Roma population (13.3 vs. 13%, p = 0.910). Exclusive breastfeeding was significantly more often (p < 0.001) among wealthier women, women whose newborns were over 2,500 g on birth, multipara, and women who had not established menstrual cycle among both populations. Living outside the capital significantly diminishes the chance for exclusively breastfed infants in the non-Roma community (Vojvodina: OR 0.16, CI 95% 0.03–0.92; eastern Serbia: OR 0.02, CI 95% 0.01–0.35) as well as living in the rural area (urban: OR 10.35, CI 95% 1.94–55.28). Unexpectedly, in the non-Roma population, not staying in the same room with the newborn in the maternity ward increases the chance for the baby to be exclusively breastfed (OR 7.19, CI 95% 1.80–28.68). The same pattern has been observed in Roma population. Non-Roma mothers multipara are more likely to exclusively breastfeed their children than primipara (OR 7.78, CI 95% 1.09–20.93), while among Roma mothers, the inverse association has been found although not significant (OR 0.42, CI 95% 0.14–1.23). Attending a childbirth preparation program more than 18 times increases the chances of infants being exclusively breastfed (OR 18.65, CI 95% 1.34–53.67). In the Roma population, there was no single woman that attended a childbirth preparation program. Conclusion: The pattern of exclusive breastfeeding significantly differs between non-Roma and Roma populations. Preventive work should have focus on strengthening support to mothers and medical staff in maternity wards.
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Affiliation(s)
- Zeljka Stamenkovic
- Institute of Social Medicine, Medical Faculty University of Belgrade, Belgrade, Serbia
| | - Bojana Matejic
- Institute of Social Medicine, Medical Faculty University of Belgrade, Belgrade, Serbia
| | - Bosiljka Djikanovic
- Institute of Social Medicine, Medical Faculty University of Belgrade, Belgrade, Serbia
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190
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Cost-effectiveness analysis of Baby-Friendly Hospital Initiative in promotion of breast-feeding and reduction of late neonatal infant mortality in Brazil. Public Health Nutr 2020; 24:2365-2375. [PMID: 32686631 DOI: 10.1017/s1368980020001871] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To analyse the cost-effectiveness of Baby-Friendly Hospital Initiative (BFHI) in promoting breast-feeding during the first hour of life (BFFHL) and reducing late neonatal mortality. DESIGN Cost-effectiveness economic assessment from the health system perspective, preceded by a prospective cohort of mother-baby followed from birth to 6 months of life. The direct costs associated with two health outcomes were analysed: intermediate end point (BFFHL) and final end point (reduction in late neonatal mortality). SETTING Study was carried out in six hospitals in the city of São Paulo (Brazil), three being Baby-Friendly Hospitals (BFH) and three non-BFH. PARTICIPANTS Mothers with 24 h postpartum, over 18 years old, single fetus and breast-feeding at the time of the interview were included. Poisson regressions adjusted for maternal age and level of education were estimated to identify factors related to BFFHL and late neonatal mortality. Sensitivity analysis was performed to ensure robustness of the economic assessment. RESULTS Cost-effectiveness analysis showed that BFHI was highly cost-effective in raising BFFHL by 32·0 % at lower cost in comparison with non-BFHI. In addition, BFHI was cost-effective in reducing late neonatal mortality rate by 13·0 % from all causes and by 13·1 % of infant mortality rate from infections. CONCLUSIONS The cost-effectiveness of the BFHI in promoting breast-feeding and reducing neonatal mortality rates justifies the investments required for its expansion within the Brazilian health system.
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191
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Sandhi A, Lee GT, Chipojola R, Huda MH, Kuo SY. The relationship between perceived milk supply and exclusive breastfeeding during the first six months postpartum: a cross-sectional study. Int Breastfeed J 2020; 15:65. [PMID: 32680551 PMCID: PMC7367342 DOI: 10.1186/s13006-020-00310-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 07/13/2020] [Indexed: 11/10/2022] Open
Abstract
Background Perceived milk supply is an important modifiable factor for optimal breastfeeding. However, little is known about maternal perception of milk supply or how it impacts breastfeeding practices. The aim of this study was to examine relationships of perceived milk supply, maternal breastfeeding self-efficacy, and skin-to-skin contact with early initiation and exclusive breastfeeding among mothers of infants less than 6 months of age in Indonesia. Methods This was a cross-sectional study conducted in Yogyakarta City, Indonesia between August and October 2015. Maternal perception of milk supply was assessed using the Hill and Humenick Lactation Scale. Data on breastfeeding practices, and maternal and infant factors were collected using a structured questionnaire. Multiple regression and multivariate logistic regression analyses were performed to obtain estimates of associations. Results Thirty four percent of mothers had initiated breastfeeding within an hour after birth, and 62.4% of mothers were exclusively breastfeeding. High levels of perceived breast milk supply were reported in mothers who practiced skin-to-skin contact or rooming-in with their infants, experienced positive infant sucking behavior, or had high breastfeeding self-efficacy (p < 0.05). Mothers with a higher level of perceived milk production (Odds Ratio [OR] 3.20; 95% Confidence Interval [CI] 1.76, 5.83) or practicing skin-to-skin contact (OR 2.36; 95% CI 1.13, 4.91) were more likely to exclusively breastfeed, while employed mothers were less likely to breastfeed their infants exclusively (OR 0.47; 95% CI 0.24, 0.93). Conclusions In this study, skin-to-skin contact and breastfeeding self-efficacy are important determinants of perceived milk supply. Higher perception of milk supply was positively linked with exclusive breastfeeding. Our study highlights the importance of the assessment for mother’s perception of milk supply, maternal breastfeeding self-efficacy, and skin-to-skin contact in achieving optimal breastfeeding outcomes.
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Affiliation(s)
- Ayyu Sandhi
- Department of Pediatric and Maternity Nursing, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada , Yogyakarta, Indonesia.,School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Gabrielle T Lee
- Applied Psychology, Faculty of Education, Western University, London, ON, Canada
| | - Roselyn Chipojola
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Mega Hasanul Huda
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Shu-Yu Kuo
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.
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192
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Crenshaw JT, Budin WD. Hospital Care Practices Associated With Exclusive Breastfeeding 3 and 6 Months After Discharge: A Multisite Study. J Perinat Educ 2020; 29:143-151. [PMID: 32760183 DOI: 10.1891/j-pe-d-19-00033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Maternity care practices influence breastfeeding outcomes long after women leave the birth setting. We conducted this study to describe, from mothers' perspective, maternity care practices associated with breastfeeding at 3 and 6 months. Mothers who recalled having skin-to-skin care (SSC) and rooming-in for 23 or more hours/day were more likely to report exclusive breastfeeding when surveyed at 3 months. Perception of not enough milk and difficulty latching explained more than 85% of supplementing and weaning at 3 months. Women also reported that returning to work influenced their decision to supplement or wean. Our multisite study supports implementing low cost and evidence-based interventions such as immediate and uninterrupted SSC and rooming in to improve breastfeeding exclusivity. Findings highlight the ongoing need to bridge the gap between hospital discharge and community breastfeeding support, including workplace accommodations.
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193
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Marshall NE, Lallande LF, Schedin PJ, Thornburg KL, Purnell JQ. Exclusive Breastfeeding Rates at 6 Weeks Postpartum as a Function of Preconception Body Mass Index Are Not Impacted by Postpartum Obstetrical Practices or Routines. Breastfeed Med 2020; 15:458-464. [PMID: 32412795 PMCID: PMC7374594 DOI: 10.1089/bfm.2020.0006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objective: Women with overweight/obesity have significantly lower rates of exclusive breastfeeding (EBF) at 6 weeks postpartum compared with women of normal weight. We sought to determine whether differences in Baby-Friendly Hospital Initiative (BFHI) adherence, obstetric practices, or social support explain these weight-related EBF disparities. Methods: One hundred forty-two healthy women who intended EBF (61 normal weight, 50 overweight, and 31 obese by preconception body mass index [BMI]) were enrolled in a cross-sectional study. Obstetric data were collected and participants completed modified Infant Feeding Practices Study II surveys at 6 weeks postpartum. Results: Women with obesity were significantly less likely to undergo spontaneous labor and more likely to receive synthetic oxytocin and epidural anesthesia compared with women with overweight or normal weight. Women who were overweight were less likely to report extended family support for breastfeeding compared with women with obesity or normal weight; however, BFHI components and composite BFHI score did not differ by maternal BMI. Furthermore, regardless of BMI, women with greater adherence to BFHI practices were more likely to be EBF at 6 weeks postpartum (p-value <0.001). Nonetheless, at 6 weeks postpartum, women with obesity were expressing milk more frequently and less likely to have met their own breastfeeding goals compared with women with overweight and normal weight. Conclusions: Differences in EBF rates by BMI were not explained by BFHI adherence or obstetric practices. These data suggest physiological differences, rather than intrapartum practices and support services, may explain differences in EBF rates by maternal overweight/obesity.
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Affiliation(s)
- Nicole E Marshall
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Developmental and Cancer Biology, Oregon Health & Science University, Portland, Oregon, USA
| | - Laura F Lallande
- Providence St. Vincent Medical Center, Oregon Health & Science University, Portland, Oregon, USA
| | - Pepper J Schedin
- Department of Cell, Developmental and Cancer Biology, Oregon Health & Science University, Portland, Oregon, USA.,Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Kent L Thornburg
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Jonathan Q Purnell
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA
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194
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McCoy MB, Heggie P. In-Hospital Formula Feeding and Breastfeeding Duration. Pediatrics 2020; 146:peds.2019-2946. [PMID: 32518168 DOI: 10.1542/peds.2019-2946] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/25/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND In-hospital formula feeding (IHFF) of breastfed infants is associated with shorter duration of breastfeeding. Despite evidence-based guidelines on when IHFF is appropriate, many infants are given formula unnecessarily during the postpartum hospital stay. To account for selection bias inherent in observational data, in this study, we estimate liberal and conservative bounds for the association between hospital formula feeding and duration of breastfeeding. METHODS Infants enrolled in the Minnesota Special Supplemental Nutrition Program for Women, Infants, and Children were selected. Breastfed infants given formula were matched with infants exclusively breastfed (n = 5310) by using propensity scoring methods to adjust for potential confounders. Cox regression of the matched sample was stratified on feeding status. A second, more conservative analysis (n = 4836) was adjusted for medical indications for supplementation. RESULTS Hazard ratios (HR) for weaning increased across time. In the first analysis, the HR across the first year was 6.1 (95% confidence interval [CI] 4.9-7.5), with HRs increasing with age (first month: HR = 4.1 [95% CI 3.5-4.7]; 1-6 months: HR = 8.2 [95% CI 5.6-12.1]; >6 months: HR = 14.6 [95% CI 8.9-24.0]). The second, more conservative analysis revealed that infants exposed to IHFF had 2.5 times the hazard of weaning compared with infants who were exclusively breastfed (HR = 2.5; 95% CI 1.9-3.4). CONCLUSIONS IHFF was associated with earlier weaning, with infants exposed to IHFF at 2.5 to 6 times higher risk in the first year than infants exclusively breastfed. Strategies to reduce IHFF include prenatal education, peer counseling, hospital staff and physician education, and skin-to-skin contact.
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Affiliation(s)
- Marcia Burton McCoy
- Special Supplemental Nutrition Program for Women, Infants, and Children, Division of Child and Family Health, Minnesota Department of Health, St Paul, Minnesota;
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195
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Zakarija-Grković I, Cattaneo A, Bettinelli ME, Pilato C, Vassallo C, Borg Buontempo M, Gray H, Meynell C, Wise P, Harutyunyan S, Rosin S, Hemmelmayr A, Šniukaitė-Adner D, Arendt M, Gupta A. Are our babies off to a healthy start? The state of implementation of the Global strategy for infant and young child feeding in Europe. Int Breastfeed J 2020; 15:51. [PMID: 32493416 PMCID: PMC7271477 DOI: 10.1186/s13006-020-00282-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 04/27/2020] [Indexed: 11/28/2022] Open
Abstract
Background To protect children’s right to optimal nutrition, WHO/UNICEF developed a Global Strategy for Infant and Young Child Feeding, endorsed by all 53 WHO/EURO Member States. The World Breastfeeding Trends Initiative (WBTi) is a tool for monitoring implementation of the Global Strategy. It comprises 15 indicators, ten referring to policies and programmes, and five to feeding practices. Each is scored on a scale of 10, giving a total score of 150 for Global Strategy implementation. To date, 18 WHO/EURO Member States – Armenia, Austria, Belgium, Bosnia and Herzegovina, Croatia, France, Georgia, Germany, Italy, Lithuania, North Macedonia, Malta, Moldova, Portugal, Spain, Turkey, Ukraine and United Kingdom – have conducted a WBTi assessment and produced a report. Methods Between June 2018 and May 2019, all 18 WBTi European reports were carefully read and analysed by a group of national WBTi coordinators. Descriptive data analysis, including inter-country comparisons, was conducted using frequencies and percentages. This paper summarises the findings. The full 88-page report will be published on the WBTi website. Results Three-quarters of 18 European countries have adequate maternity protection, and two-thirds have breastfeeding initiation rates of 50% or higher. However, ‘Preparedness and planning for appropriate and safe Infant and Young Child Feeding (IYCF) in emergencies’ is seriously neglected. Breastfeeding duration is far below WHO recommendations, with an average of 8.7 months. Only three European countries have a budget allocated for implementing IYCF policies and plans, and a third currently have no Baby-friendly designated maternity facilities. Bottle feeding is prevalent, despite its inherent risks, monitoring of IYCF practices is inadequate, with most countries not routinely collecting data, and violations of the International Code of Marketing of Breast-milk Substitutes are commonplace. Conclusions European governments are not doing enough to protect, promote and support sound infant and young child feeding practices. Political commitment at the highest level and adequate funding are required to ensure optimal IYCF for Europe’s babies. This report highlights worrying gaps, thereby providing governments, international organisations and other concerned parties with an opportunity to invest in priority areas and, by doing so, hopefully create a better future for our babies.
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Affiliation(s)
| | | | - Maria Enrica Bettinelli
- IBFAN Italia and University of Milan, School of Medicine, Via Festa del Perdono 7, 20122, Milan, Italy
| | | | - Charlene Vassallo
- Health Promotion and Disease Prevention Directorate, St Luke's Square, Guardamangia, PTA 1010, Pietà, Malta
| | - Mariella Borg Buontempo
- Health Promotion and Disease Prevention Directorate, St Luke's Square, Guardamangia, PTA 1010, Pietà, Malta
| | - Helen Gray
- Lactation Consultants of Great Britain, 6 Livingstone Terrace, Bath, BA2 3LE, UK
| | - Clare Meynell
- Lactation Consultants of Great Britain, 6 Livingstone Terrace, Bath, BA2 3LE, UK
| | | | - Susanna Harutyunyan
- Yerevan State Medical University after Mkhitar Heratsi, 2 Koruni str, 0025, Yerevan, Armenia
| | - Stefanie Rosin
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik für Neonatologie, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Andrea Hemmelmayr
- Austrian Alliance of Lactation Consultants, Ortsstraße 144/8/2, 2331, Vösendorf, Austria
| | - Daiva Šniukaitė-Adner
- Lithuanian Lactation and Breastfeeding Consultants Association, Pušų str.32, 08116, Vilnius, Lithuania
| | - Maryse Arendt
- IBFAN Luxembourg, 17 rue Charlemagne, 1328, Luxembourg, Luxembourg
| | - Arun Gupta
- Breastfeeding Promotion Network of India (BPNI), BP-33 Pitampura, Delhi, 110034, India
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196
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Haas MR, Landry A, Joshi N. Breast Practices: Strategies to Support Lactating Emergency Physicians. Ann Emerg Med 2020; 75:681-690. [DOI: 10.1016/j.annemergmed.2020.01.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 01/05/2020] [Accepted: 01/06/2020] [Indexed: 11/30/2022]
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197
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Mallick L, Benedict RK, Wang W. Facility readiness and counseling during antenatal care and the relationship with early breastfeeding in Haiti and Malawi. BMC Pregnancy Childbirth 2020; 20:325. [PMID: 32471370 PMCID: PMC7257126 DOI: 10.1186/s12884-020-02919-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 04/01/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early initiation of breastfeeding (within an hour of birth) has benefits for newborn health and survival. Optimal breastfeeding supports growth, health, and development. Health facilities provide essential pregnancy, maternal, and newborn care and offer support for early breastfeeding. We examined the relationship between the breastfeeding-related health service environment during antenatal care (ANC) and early initiation of breastfeeding. METHODS Using data from recent Service Provision Assessment (SPA) surveys in Haiti and Malawi, we defined three indicators of the health service environment: availability of facilities with ANC services reporting routine breastfeeding counseling; provider training on breastfeeding; and breastfeeding counseling during ANC. We linked SPA data geographically to Demographic and Health Surveys (DHS) data from Haiti and Malawi. Multilevel, multivariable logistic regressions examined associations between the health service environment and early initiation of breastfeeding, controlling for women's background characteristics, with separate analyses for urban and rural residence. RESULTS Over 95% of facilities in Haiti and Malawi reported routinely providing breastfeeding counseling during ANC. Only 40% of both urban and rural providers in Malawi and 29 and 26% of providers at urban and rural facilities in Haiti (respectively) received recent training in counseling on breastfeeding. Further, only 4-10% of clients received counseling. Breastfeeding counseling was generally more common among clients who attended ANC with a provider who had received recent training. After linking SPA and DHS data, our analysis showed that having more providers recently trained on breastfeeding was significantly associated with increased odds of early breastfeeding among women in urban areas of Haiti and Malawi. Additionally, women in urban areas of Malawi lived near facilities with more counseling during ANC were more likely to begin breastfeeding within an hour of birth compared with women in areas with less counseling. CONCLUSIONS Our study identified gaps in the health system's capacity to implement the recommended global guidelines in support of optimal breastfeeding practices. While breastfeeding counseling during ANC can promote early breastfeeding, counseling was not common. The study provides evidence that provider training could help improve counseling and support for early initiation of breastfeeding.
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Affiliation(s)
- Lindsay Mallick
- The DHS Program, Avenir Health, ICF, 530 Gaither Road, Suite 500, Rockville, MD, 20850, USA.
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Antoñanzas-Baztán E, Belintxon M, Marín-Fernández B, Redín-Areta MD, Mujika A, Pumar-Méndez MJ, Lopez-Dicastillo O. Six-month breastfeeding maintenance after a self-efficacy promoting programme: an exploratory trial. Scand J Caring Sci 2020; 35:548-558. [PMID: 32400032 DOI: 10.1111/scs.12870] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/25/2020] [Accepted: 04/20/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND Breastfeeding care plays a fundamental role in establishing breastfeeding and longer duration after discharge. Practices though vary among professionals involved and are often inconsistent with good practices recommended, being a threat to women's breastfeeding self-efficacy. Breastfeeding self-efficacy is considered a predictor for successful breastfeeding and a significant variable amenable to intervention for promoting lactation AIM: To evaluate the efficacy, feasibility and acceptability of a new breastfeeding self-efficacy promoting programme (SIALAC) on 6-month breastfeeding maintenance. METHODS In this exploratory multi-centre controlled trial, participants were allocated into control and intervention groups sequentially. Professionals in charge of the treatment groups were trained in between, with an especial focus on reducing practice variability. Control and intervention group women received usual care, and the intervention group received in addition SIALAC, a three-stage breastfeeding self-efficacy promoting programme. Primary outcome was breastfeeding maintenance up to 6 months analysed by Kaplan-Meier and Cox proportional hazard regression analysis. Student's t-test or chi-square tests were also used for continuous and categorical variables. Data on breastfeeding status and breastfeeding self-efficacy were collected at baseline, and 4, 8 and 24 weeks after birth. RESULTS From May 2014 through November 2015, participants were enrolled. The sample consisted of 112 women. No relevant socio-demographic or obstetric difference was found between groups. The intervention achieved a significant difference between groups in breastfeeding survival (X2 = 4.94, p = 0.026). Six-month breastfeeding maintenance was significantly higher in the intervention group (67% vs. 55%; X2 = 5.384, p = 0.020). Breastfeeding dropout in the control group was 3.3 (CI 1.1, 10.1) times higher than that of the intervention group at 6 months. Breastfeeding self-efficacy scores were higher in the intervention group although without significant statistical difference. The programme showed good acceptability. CONCLUSION Breastfeeding self-efficacy promoting programme SIALAC was beneficial in fostering 6-month breastfeeding survival. Full-scale trial should consider feasibility-related issues identified.
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Affiliation(s)
- Elena Antoñanzas-Baztán
- Complejo Hospitalario de Navarra, Pamplona, Spain.,Department of Health Sciences, Faculty of Health Sciences, Public University of Navarra, Pamplona, Spain.,ImPuLS Research Group, University of Navarra, Pamplona, Spain
| | - Maider Belintxon
- ImPuLS Research Group, University of Navarra, Pamplona, Spain.,Department of Community, Maternity and Pediatric Nursing, School of Nursing, University of Navarra, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Blanca Marín-Fernández
- Department of Health Sciences, Faculty of Health Sciences, Public University of Navarra, Pamplona, Spain
| | - Maria D Redín-Areta
- Department of Health Sciences, Faculty of Health Sciences, Public University of Navarra, Pamplona, Spain
| | - Agurtzane Mujika
- ImPuLS Research Group, University of Navarra, Pamplona, Spain.,Department of Community, Maternity and Pediatric Nursing, School of Nursing, University of Navarra, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Maria J Pumar-Méndez
- ImPuLS Research Group, University of Navarra, Pamplona, Spain.,Department of Community, Maternity and Pediatric Nursing, School of Nursing, University of Navarra, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Olga Lopez-Dicastillo
- ImPuLS Research Group, University of Navarra, Pamplona, Spain.,Department of Community, Maternity and Pediatric Nursing, School of Nursing, University of Navarra, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
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199
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Lok KYW, Chow CLY, Fan HSL, Chan VHS, Tarrant M. Exposure to baby-friendly hospital practices and mothers' achievement of their planned duration of breastfeeding. BMC Pregnancy Childbirth 2020; 20:261. [PMID: 32357927 PMCID: PMC7193339 DOI: 10.1186/s12884-020-02904-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 03/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Both breastfeeding intentions and exposure to baby-friendly hospital practices were found to be associated with a longer duration of breastfeeding. This study aims to examine the effect of exposure to baby-friendly hospital practices on mothers' achievement of their planned duration of breastfeeding. METHODS A total of 1011 mother-newborn pairs from the postnatal units of four public hospitals in Hong Kong were recruited. Sociodemographic data and breastfeeding intention data were collected via self-report questionnaires during the postnatal hospitalization and exposure to Baby-Friendly hospital practices were assessed through hospital records and maternal self-report. Breastfeeding status after hospital discharge was assessed through telephone follow-up for up to 12 months postnatal, or until participants were no longer breastfeeding. RESULTS Only 55% (n = 552) of study participants achieved their intended duration of breastfeeding. Participants with higher socioeconomic status, previous breastfeeding experience, and those who had lived in Hong Kong for less than 5 years, were more likely to achieve their planned duration of breastfeeding. Among baby-friendly hospital practices, feeding only breast milk during the hospitalization and providing information about breastfeeding support on discharge were associated with participants' achieving their individual breastfeeding intentions. After adjustment, when compared with women who experienced onebaby-friendly practice, participants who experienced six baby-friendly hospital practices were significantly more likely to achieve their planned duration of breastfeeding (adjusted odds ratio = 8.45, 95% confidence interval 3.03-23.6). CONCLUSIONS Nearly half of participants did not achieve their planned breastfeeding duration. Exposure to baby-friendly hospital practices, especially in-hospital exclusive breastfeeding and providing breastfeeding support information upon hospital discharge may help more mothers to achieve their individual breastfeeding goals.
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Affiliation(s)
- Kris Y W Lok
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 4/F, William MW Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong.
| | - Charlotte L Y Chow
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 4/F, William MW Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong
| | - Heidi S L Fan
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 4/F, William MW Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong
| | - Vincci H S Chan
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 4/F, William MW Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong
| | - Marie Tarrant
- School of Nursing, University of British Columbia, 1147 Research Road, ART 360B, Kelowna, BC, Canada
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Chipojola R, Lee GT, Chiu HY, Chang PC, Kuo SY. Determinants of breastfeeding practices among mothers in Malawi: a population-based survey. Int Health 2020; 12:132-141. [PMID: 31294780 PMCID: PMC7057137 DOI: 10.1093/inthealth/ihz034] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 03/05/2019] [Accepted: 04/12/2019] [Indexed: 11/22/2022] Open
Abstract
Background High rates of early initiation and exclusive breastfeeding have been reported in Malawi, yet the underlying factors are unknown. Our objective is to examine the determinants of breastfeeding practices for mothers of infants less than 24 months old in Malawi. Methods A cross-sectional study was conducted using nationally representative data from the 2010 Malawi Demographic and Health Survey. Multivariate logistic regression analysis was used. Results Of 7282 women, 95.4% initiated breastfeeding within 1 hour after birth; thereafter 71.3% of women practiced exclusive breastfeeding, 6.1% predominantly breastfed, and 1.9% chose bottle feeding exclusively. The odds of early initiation were higher among women with frequent antenatal care visits and multiparous mothers. Similarly, frequent antenatal care visits and hospital delivery were positive determinants for exclusive breastfeeding. Infants at 6 months of age were more likely to predominantly breastfeed than they were at 1 month. The odds of bottle feeding were higher among women who were educated, who delivered at a hospital. Conclusions Optimal breastfeeding practices are highly prevalent in Malawi. Health care practice emphasizing frequent antenatal care visits that provide breastfeeding education and breastfeeding support in hospital care after childbirth are important for sustaining breastfeeding.
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Affiliation(s)
- Roselyn Chipojola
- School of Nursing, College of Nursing, Taipei Medical University, 250 Wuxing Street, Taipei, TAIWAN
| | - Gabrielle T Lee
- Applied Psychology, Faculty of Education, Western University, 1137 Western Road London, Ontario, Canada
| | - Hsiao-Yean Chiu
- School of Nursing, College of Nursing, Taipei Medical University, 250 Wuxing Street, Taipei, TAIWAN
| | - Pi-Chen Chang
- School of Nursing, College of Nursing, Taipei Medical University, 250 Wuxing Street, Taipei, TAIWAN
| | - Shu-Yu Kuo
- School of Nursing, College of Nursing, Taipei Medical University, 250 Wuxing Street, Taipei, TAIWAN
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